Still Time to Submit Quality Improvement Storyboard Abstracts for RSNA 2009
RSNA is accepting abstracts describing quality assessment and improvement in radiology for possible display in the Quality Storyboard section of the Lakeside Learning Center at RSNA 2009.
The deadline is midnight CDT on June 15.
Abstracts should describe quality initiatives undertaken to improve care or services to patients. Authors of chosen projects must be available to speak in person with meeting attendees about their projects for at least one 30-minute session during the annual meeting.
For more information, go to RSNA.org/quality/storyboards.
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Leading the News
Study Finds Pediatric Cancer Survivors Are Not Getting Needed Tests
A new study finds that adult survivors of childhood cancers who are most in need of tests to watch for subsequent malignancies are less likely to follow screening recommendations than the general public or even their healthy siblings. Less than 50 percent of the cancer survivors in the study received mammograms, colonoscopies, or skin cancer screenings as frequently as recommended, and study leader Dr. Paul Nathan with the Hospital for Sick Children in Toronto says that "many survivors do not know the specific treatments they had," let alone what follow-up tests should be performed. Radiation and other cancer treatment methods increase the risk of a recurrence, as do genetic factors that led to the disease in the first place. Researchers employed government-sponsored studies to compare screening behaviors among 8,318 cancer survivors in the United States and Canada, over 2,660 of their siblings, and 8,318 healthy people from the general populace. Of the cancer survivors who were at increased risk of recurrence because of childhood radiation treatments, fewer than 12 percent were receiving colonoscopies every five years, which is recommended. Just 46 percent had had a mammogram within the previous two years, and only 27 percent were screened for skin cancer. "Many cancer survivors have had enough of doctors and hospitals and may purposely avoid certain types of screening that might give them bad news," says Dr. Philip Rosoff, who runs a follow-up clinic for cancer survivors at Duke University. Other survivors are having cancer scans discouraged or refused by doctors who feel the patients are overreacting.
From "Study: Cancer Survivors Not Getting Needed Tests"
Associated Press (06/01/09) Marchione, Marilynn
Research
Distended Rectum on Planning CT Indicates Increased Biochemical Failure in Patients With Prostate Cancer
The appearance of a distended rectum on the planning computed tomogram for image-guided conformal arc radiotherapy has a negative prognostic impact, according to a recent study led by researchers from the University Hospital Brussels Department of Radiotherapy in Brussels, Belgium. Benedikt Engels, MD, and colleagues came to this conclusion following an analysis of the outcomes of 238 patients with prostate cancer. In 213 of these patients, daily co-registration of X-rays and digitally reconstructed radiographs were used in patient positioning for radiotherapy, while the remaining 25 patients underwent positioning based on direct prostate visualization with implanted markers. The researchers found that the five-year freedom from biochemical failure (FFBF) was 88.4 percent. Variables related to worse FFBF included original risk group, dose level, average rectal cross-sectional area determined on the planning computed tomogram, and the use of implanted markers instead of bony structures for patient positioning. However, the researchers also concluded that the margins around the clinical target volume were inadequate in cases in which markers were used.
From "Conformal Arc Radiotherapy for Prostate Cancer: Increased Biochemical Failure in Patients With Distended Rectum on the Planning Computed Tomogram…"
International Journal of Radiation Oncology, Biology, Physics (06/09) Vol. 74, No. 2, P. 388; Engels, Benedikt; Soete, Guy; Verellen, D.
Short-term Hormone Therapy Suspension Does Not Significantly Impact Mammography Recall
A group of researchers held a three-group randomized, controlled trial to test whether one to two months of hormone therapy suspension before screening mammography decreases additional mammography recall in women aged 45 to 80. Their research was primarily funded by the U.S. Department of Defense and the National Cancer Institute. The experiment involved 1,704 female subjects who used hormone therapy at their most recent screening mammography, were due for screening mammography, and were still using hormone therapy. The primary outcome was mammography recall, while the secondary outcome was change in mammographic breast density between the index and study mammograms. Sixty-one of 542 women in the no-suspension group, 50 of 478 women in the one-month suspension group, and 44 of 451 women in the two-month suspension group experienced recall. There was no identification of subgroups in which brief suspension of hormone therapy resulted in decreased mammography recall, while decreases in percentage of breast density with suspension were orderly and statistically significant. Women in the suspension groups exhibited more pronounced menopause symptoms. The researchers conclude that brief hormone therapy suspension was affiliated with small changes in breast density and had no impact on recall rates. There is no evidence favoring short-term hormone therapy suspension before mammography.
From "Short-term Hormone Therapy Suspension and Mammography Recall"
Annals of Internal Medicine (06/02/09) Vol. 150, No. 11, P. 752; Buist, Diana S. M.; Anderson, Melissa L.; Reed, Susan D.; et al.
BOLD MRI Improves Measurement of Cancer Therapy Success
Researchers at the University of Texas Southwestern Medical Center have developed an MRI test that involves breathing oxygen that could help determine the best way to treat some oncology patients. "The patient simply inhales pure oxygen, which then circulates through the bloodstream, including to the tumors," says radiology professor Dr. Ralph Mason, senior author of the research, which will be published in a future edition of Magnetic Resonance in Medicine. "Using MRI, we can then go in and estimate how much oxygen a particular tumor is taking up, providing us some insight into how the tumor is behaving and what sort of treatment might be effective." This technique, dubbed BOLD (blood oxygen level dependent) MRI, was found to perform as well as the more invasive standard procedure FREDOM MRI, which requires injecting a reporter molecule into the tumor. "The BOLD technique appears to indicate accurately the oxygen levels in tumors," says Mason. "Because BOLD is immediately applicable to patients, this holds promise as a new method for predicting response to therapy."
From "Oxygen Plus MRI Might Help Determine Cancer Therapy Success"
ScienceDaily (06/03/09)
Technology
Conficker Worm Highlights PACS Cybersecurity Issues
Healthcare imaging has become increasingly reliant on digital PACS technology. However useful they are, PACS networks also create vulnerabilities that can increase the risk of medical imaging equipment and archiving malfunctions. These vulnerabilities were recently brought to light by the discovery that the Conficker computer virus had infected the PACS networks of more than 300 U.S. healthcare facilities. Initial reports indicated that the infected computers were MRI workstations, but subsequent testing found that the infected computers were operating on PACS networks. Although most of these computers have been "dewormed," there are at least 50 that have not been, according to security experts. Protecting PACS networks from viruses like the Conficker worm can be a difficult process, but it is an important one. Patches cannot automatically be installed onto most medical devices without testing and validation. When new patches are released, they must be tested on diagnostic imaging and other kinds of equipment to ensure they do not interfere with a device's safety and effectiveness. In addition to patch-installation, radiologists should encourage security systems for all PACS computers that use scheduled "intrusion-detection" checks to identify any points of vulnerability on the network. After being properly protected, every computer in the system needs to be checked for viruses because one computer can infect all others in the network.
From "Conficker Worm Highlights PACS Cybersecurity Issues"
AuntMinnie.com (06/02/09) Keen, Cynthia E.
Medical-Legal Issues
CMS Reconsidering the Use of F-18 PET Scans to Identify Bone Metastasis of Cancer
The Centers for Medicare and Medicaid Services (CMS) has released for comment a National Coverage Assessment (NCA) Tracking Sheet for F-18 PET scans to identify bone metastasis of cancer. The current National Coverage Determination (NCD) does not cover sodium fluoride PET scans, including F-18. The comment period for this NCA will run from June 4, 2009, to July 4, 2009. A new decision memo on the subject is scheduled to be released by December 4, 2009.
From "NCA Tracking Sheet for Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer"
CMS Press Release (06/04/09)
Feds Target Radiology Imaging Payment Cuts
Efforts to cut healthcare costs in the United States have taken aim at physician radiology services, whose annual costs to Medicare more than doubled to $14 billion between 2000 and 2006. A General Accounting Office report to Congress last year said, "Spending on advanced imaging, such as CT scans, MRIs, and nuclear medicine, rose substantially faster than other imaging services, such as ultrasound, X-ray, and other standard imaging." Meanwhile, a report in March from the Medicare Payment Advisory Commission (MedPAC) said, "The rapid volume growth of costly imaging services may be driven, at least in part, by prices that are too high." The Senate Finance Committee and others at the federal level are looking at two main ways to cut costs: prior authorization, particularly for advanced imaging, and restructuring of the payment formula to lower the value of equipment in the payment equation so provider reimbursement would be much lower. The pre-approval idea has been strongly opposed by the Access to Medical Imaging Coalition as well as the Medical Imaging and Technology Alliance (MITA). "Based on insufficient data and analysis, the MedPAC report makes recommendations that will lead to dramatic Medicare cuts for imaging and have dire consequences for the diagnosis, treatment, and care of patients," says Ilyse Schuman, managing director of MITA.
From "Feds Target Radiology Imaging Payment Cuts"
Health Leaders Magazine Online (05/09) Clark, Cheryl
Clinical Practice
Radiologists Must Improve Knowledge Regarding the Management of Severe Contrast Material-Induced Allergic Reactions
Radiologists do not have sufficient knowledge of epinephrine for the management of severe contrast material-induced reactions, according to a recent study published in the June issue of Radiology. The 253 radiologists participating in the study were given a scenario where a patient had a severe allergic reaction to contrast material. The radiologists were first asked their initial medication of choice, then questioned specifically on the use of epinephrine. Of the radiologists participating in the study, 91 percent said epinephrine was the most important initial medication to treat the reaction. While no radiologist gave the ideal response, 41 percent provided an administration route, concentration, and dose that was deemed acceptable. However, 17 percent of radiologists provided an overdose and only 11 percent knew what concentration of epinephrine was available in their drug kit and/or crash cart and what equipment would be required to administer it to a patient.
From "Survey of Radiologists' Knowledge Regarding the Management of Severe Contrast Material-Induced Allergic Reactions"
Radiology (06/01/09) Vol. 251, No. 3, P. 691; Lightfoot, Christopher B.; Abraham, Roshan Joseph; Mammen, Thomas
Patients With IBD Are Exposed to Potentially Serious Excesses of Ionizing Radiation
Digestive Disease Week 2009 (DDW) included several studies underlining the progress researchers have made in understanding the development and treatment of inflammatory bowel disease (IBD). One study looked at the possible connection between radiation exposure in medical imaging and the development of IBD, Crohn's disease, and ulcerative colitis. "We know that CT scans are excellent diagnostic tests, however they do have the potential risk of exposure to ionizing radiation. Physicians need to test, explore and learn about new and better diagnostic modalities, such as intestinal ultrasound, that could eventually replace CT scan," says Karen Kroeker, MD, lead researcher on the study. "In addition, physicians need to be aware of how many CT scans their patients have been exposed to so that they can determine the risk of additional CT scans."
From "Patients With IBD Are Exposed to Potentially Serious Excesses of Ionizing Radiation"
EurekAlert (06/01/09)
Industry News
Radiation Staffing Holds Steady
The 2009 American Society of Radiologic Technologists (ASRT) Radiation Therapy Staffing survey has found that despite the economic downturn, the hiring of full-time radiation therapists has remained relatively steady. Facilities that had a 2009 budget for radiation therapists reported employing an average of 4.9 full-time therapists. That figure represents only a slight decline from the 2007 average of 5.2 full-time therapists. The survey also found that the vacancy rate for radiation therapists increased from 5.4 percent in 2007 to 7.6 percent in 2009. Specific vacancy rates included 8.2 percent for medical dosimetrists, 12.1 percent for medical physicists, 9.2 percent for radiation oncologists, and 7.1 percent for radiology nurses.
From "Radiation Staffing Stable, With More Positions Opening"
HealthImaging.com (05/28/2009)
RSNA Weekly is a briefing of the latest radiology-related news selected from hundreds of sources by the editors of Information, Inc. While care is taken to use good sources, inaccuracies in source material are not the responsibility of RSNA or Information, Inc.
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