RSNA Tools Organize MOC Efforts
RSNA offers various products and online tools to help you organize, obtain, record and store your CME and MOC-related activities. These resources are available through the RSNA Education Portal at RSNA.org/education/moc.
- My Professional Learning Map—Create a practice profile, enter CME requirements, calculate a history and analysis to plan for future activities and create personalized action plans.
- MOC File—Store documents pertaining to a user's personalized MOC plan.
- RSNA Credit Repository—Verify and print RSNA-awarded AMA PRA Category 1 Credits™ and enter self-claimed Category 2 Credit for self-directed learning.
- Quality Web page—Discover information and resources relevant to quality in radiology and MOC practice quality improvement (PQI) projects.
- MOC Brochure Series—Read up on everything from basic MOC guidelines to quality principles.
For more information on how RSNA can assist with maintenance of certification, call 1-800-381-6660 x3733.
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From RSNA
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
From RSNA
June RSNA News Now Online
The full version of the June issue of RSNA News is now available online.
Highlights include:
Medical Isotope Shortage Threatens Patient Care
A combination of factors must be addressed in order to solve an ongoing, worldwide medical isotope shortage, according to nuclear medicine physicians and radiation oncologists who are being forced to delay or cancel elective—and occasionally even emergency—procedures.
Ozone Gas Used to Relieve Lower Back Pain
A minimally invasive technique that uses oxygen and ozone to alleviate lower back pain associated with herniated disks is proving to be a cost-effective treatment, according to researchers who conducted a metaanalysis on the technique.
Patient Portals Move Toward Widespread Use
Duke University Medical Center is among the early adopters of a transformative new technology—the patient portal—that is becoming more prevalent as patient demand for health information increases and more hospitals adopt electronic health records.
Technique "Lights Up" Iron in Brains of Patients with Parkinson Disease
A new imaging technique that highlights the altered distribution of metal ions in the brains of patients with Parkinson disease could give researchers a better understanding of where the iron is distributed and how its chemical makeup is altered over time.
R&E Silver Anniversary Campaign Calls on Radiologists to Continue Legacy
The RSNA Research & Education Foundation Silver Anniversary Campaign may be nearing its finish, but the Foundation is just getting started when it comes to supporting radiology breakthroughs, said R&E leaders.
Leading the News
Radiation Dose Reduction Program Improves Risk/Benefit Profile of CCTA
Researchers sought to determine whether a collaborative radiation dose–reduction program was associated with reduced radiation dose in patients undergoing cardiac computed tomography angiography (CCTA). A total of 4,995 sequential patients undergoing CCTA for suspected coronary artery disease were involved in the study, including 4,862 patients who had complete radiation data for analysis. A best-practice CCTA scan model was used, including minimized scan range, heart rate reduction, electrocardiographic-gated tube current modulation, and decreased tube voltage in suitable patients. Primary outcomes included dose-length product and effective radiation dose from all phases of the CCTA scan, and secondary outcomes were image quality and frequency of diagnostic-quality scans. The research demonstrated that consistent application of currently available dose-reduction techniques was linked with a significant reduction in estimated radiation doses without impairment of image quality.
From "Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose-reduction Techniques"
Journal of the American Medical Association (06/10/09) Vol. 301, No. 22, P. 2340; Raff, Gilbert L.; Chinnaiyan, Kavitha M.; Share, David A.
Research
DWI Has Potential as a Tool for Radiation Therapy Planning
The value of diffusion-weighted imaging (DWI) for dominant intraprostatic lesion assessment was evaluated by a team of researchers using a sample of 23 patients with early prostate cancer. Forty-three lesions were identified in the patients via pathologic study, and the half-dozen independent observers correctly identified 11 to 22 of 43 lesions on T2-weighted imaging (T2WI) alone and 20 to 31 lesions on T2WI plus DWI. On T2WI alone, positive predictive values were 42 percent to 73 percent, while combined T2WI and DWI yielded positive predictive values of 58 percent to 80 percent. Detection was higher on T2WI plus DWI than on T2WI alone for all observers. It is the researchers' conclusion that DWI has potential as a tool for radiation therapy planning because when combined with T2WI it improves the localization of prostate cancer.
From "Usefulness of Diffusion-Weighted Imaging in the Localization of Prostate Cancer"
International Journal of Radiation Oncology, Biology, Physics (06/09) Vol. 74, No. 2, P. 399; Kajihara, Hiroo; Hayashida, Yoshiko; Murakami, Ryuji; et al.
Radiologists Use 3D CT Stress-Test to Determine Consistent Patterns of Range of Motion in the Ankle Joint
Measuring the range of motion of the ankle joint can assist in accurately diagnosing ankle laxity. A computed tomography-based stress-test (3D CT stress-test) was used to determine the three-dimensional position and orientation of tibial, calcaneal, and talar bones in this study by researchers from the University of Amsterdam, whose goal was to establish a quantitative database of the normal ranges of motion of the talocrural and subtalar joints. Comparison of the ranges of motion of pathologic ankle joints with healthy subjects showed an increased inversion and axial rotation in the talocrural joint instead of in the suspected subtalar joint. The researchers thus concluded that the proposed diagnostic technique and the acquired database of helical parameters of ankle joint ranges of motion are suitable to apply in clinical cases.
From "Determination of Consistent Patterns of Range of Motion in the Ankle Joint With a Computed Tomography Stress-Test"
Clinical Biomechanics (07/09) Vol. 24, No. 6, P. 517; Tuijthof, Gabriëlle Josephine Maria; Zengerink, Maartje; Beimers, Lijkele
Study Tests the Reliability of Radiographic Measurements in Patients With Hallux Valgus Before and After Proximal Crescentic Osteotomy
Researchers in Osaka Medical College's Department of Orthopedic Surgery conducted a study of the reliability of radiographic measurements that are made prior to and following a proximal crescentic osteotomy of the first metatarsal in order to explore the intraobserver and interobserver reliability of different techniques to measure the angles. They chose 20 preoperative and 20 postoperative dorsoplantar weight-bearing radiographs for patients who had undergone a proximal crescentic osteotomy of the first metatarsal, and three foot and ankle surgeons used five different methods to measure the hallux valgus angle and the intermetatarsal angle. The most reliable technique was determined via calculation of the intraobserver and interobserver correlation coefficients and agreement. The researchers report that a method whereby the longitudinal axis of the first metatarsal was defined using a line linking the centers of the first metatarsal head and the proximal articular surface of the first metatarsal produced the highest intraobserver and interobserver correlation coefficients for the preoperative hallux valgus and intermetatarsal angles and the postoperative hallux valgus angle. The researchers conclude that this technique yields the best intraobserver and interobserver reliability for the measurement of the hallux valgus and intermetatarsal angles, and can thus be recommended for assessing radiographs before and after a proximal crescentic osteotomy performed for the treatment of hallux valgus.
From "Radiographic Measurements in Patients With Hallux Valgus Before and After Proximal Crescentic Osteotomy"
Journal of Bone and Joint Surgery (06/01/2009) Vol. 91, No. 6, P. 1369; Shima, Hiroaki; Okuda, Ryuzo; Yasuda, Toshito; et al.
Technology
Advanced Image Analysis Can Provide Better Risk Assessment in Hardening of the Arteries
More reliable and precise evaluations of atherosclerosis can be achieved via new dynamic programming-based methods for ultrasound images developed by Peter Holdfeldt. Ultrasound images can help determine a patient's risk for atherosclerosis by measuring the thickness of the walls in the carotid artery, while ultrasound also can be utilized to study whether the composition of various types of plaque can predict the risk of cardiovascular diseases. "Measurements of the thickness of the walls of the carotid require the detection of boundaries between different layers of tissue in the blood vessel," says Holdfeldt. "Previously dynamic programming has been used to automatically detect boundaries in still images. But the new method uses dynamic programming for detection in image sequences of one and the same blood vessel instead." Holdfeldt's method begins with the determination of several alternative locations of the boundary in each image, and then one of the alternatives is chosen from each image. "This has proven to provide more correct detections of boundaries than what you can get from a program that detects boundaries on the basis of a single image," notes Holdfeldt. In addition, he has devised a technique for automatically classifying atherosclerotic plaque with more objective and quantifiable analysis. Holdfeldt's research is part of a collaborative effort between Sweden's Chalmers University of Technology and the Wallenberg Laboratory for Cardiovascular Research at Sahlgrenska University Hospital in Gothenburg.
From "Advanced Image Analysis Can Provide Better Risk Assessment in Hardening of the Arteries"
Science Daily (06/05/09)
Researchers Investigate Ultrasound Improvements
Researchers at Stanford University's acoustics group are dedicated to improving ultrasound imaging, and they speculate that the transducer, which converts electrical impulses to sound waves and vice versa, could be augmented with microelectronics tools. Researchers have been searching for reliable ways to arrange many individual transducers into compact arrays, and the simplest solution is to lay a series of transducers out on a line. "While a one-dimensional transducer array can be steered and focused within a single plane to make a two-dimensional image, a 2-D array can be steered and focused throughout a volume to make a three-dimensional image--and this can be done in real time," the researchers note. Building 2-D arrays of ultrasonic transducers using traditional transducers is very hard, but techniques that are now routinely employed to produce various kinds of microelectromechanical systems offer the precise fabrication needed to manufacture the arrays in the form of a silicon ultrasound transducer. Such transducers boast greater bandwidth than piezoelectrics, and they can emit and detect the many different frequencies that are contained in a short ultrasonic pulse, which makes for better resolution. The researchers use photolithography and other fabrication methods of the semiconductor industry to manufacture transducer arrays with even the most complex geometries very precisely and affordably. The transducer is assembled by connecting many small units in parallel, and each unit features a thin membrane, separated from an underlying substrate by a minuscule gap. Silicon-fabricated transducers can be easily connected to the front-end electronics of an ultrasound imager, and the researchers predict that "it won't be long before this new breed of transducers arrives at hospitals all over the world."
From "Next-Gen Ultrasound"
IEEE Spectrum (05/09) Vol. 46, No. 5, P. 44; Khuri-Yakub, Butrus; Oralkan, Omer; Kupnik, Mario
Medical-Legal Issues
Hospital Groups Push Back Against Cuts
Hospitals and other medical-industry groups are pushing back against President Barack Obama's proposal to cut $313 billion over a decade in government health spending as the White House intensifies its effort to overhaul the nation's health system. The White House on June 13 outlined the spending cuts to healthcare providers paid through Medicare and Medicaid, bringing total cost savings and tax increases identified by the Obama administration to help pay for the plan to nearly $950 billion. The Access to Medical Imaging Coalition, which represents makers of medical-imaging equipment, says the administration's proposed cuts "will impair access to diagnostic imaging services and result in patients' delaying or forgoing life-and-cost saving imaging procedures."
From "Hospital Industry Bristles at Cuts"
Wall Street Journal (06/15/09) P. A3; Adamy, Janet; Rockoff, Jonathan
House Healthcare Reform Plan Would Ditch SGR
A House proposal calls for replacing the sustainable grow rate (SGR) used to calculate Medicare payments, although it fails to provide an alternative. If no action is taken this year on SGR, physicians would face a 21 percent reimbursement cut in 2010 and an additional 6 percent yearly decrease for several years afterwards. The House measure would also increase Medicare reimbursement for primary care physicians.
From "House Healthcare Reform Plan Would Ditch SGR"
MedPage Today (06/09/09) Walker, Emily P.
Senate Democrats Unveil Healthcare Bill
Top Democrats in the U.S. Senate have unveiled their vision to reform U.S. healthcare. The proposal would require individuals to buy insurance, provide subsidies to help make coverage affordable, establish a new government plan to help provide medical coverage for the uninsured, and prohibit insurers from denying coverage or charging more due to medical history. "Our goal is to strengthen what works and fix what doesn't," said Sen. Edward Kennedy (D-Mass.), chairman of the Senate Health, Education, Labor and Pensions Committee, in a statement that accompanied the measure's unveiling.
From "Senate Democrats Unveil Healthcare Bill"
Reuters (06/09/09) Smith, Donna
Clinical Practice
Radiologists Offer Ideas to Optimize Healthcare Improvements
Healthcare reform initiatives could benefit significantly from examples of optimal and suboptimal use of information seen in radiology, write James R. Duncan, MD, PhD, and Ronald G. Evens, MD, of the Mallinckrodt Institute of Radiology at the Washington University School of Medicine in St. Louis, Mo. The researchers maintain that radiology provides an excellent model of how information may be optimally gathered, processed, and used to make medical decisions. In radiographic studies, images are obtained, then combined with other diagnostic information to help physicians make an accurate diagnosis. When initial imaging procedures are unable to provide radiologists with enough information to make a concrete diagnosis, they have the option of performing additional studies. When making the decision to perform these procedures, radiologists must weigh the benefits that may be gained from repeated studies, or imaging using a higher resolution or a different modality, against the risks of certain procedures, such as increased radiation exposure. According to Duncan and Evens, the solution to this dilemma is to design a system that uses very specific algorithms to ensure data collection stops when sufficient information has been acquired to make an informed diagnosis. Based on this example, they argue that the adoption of electronic medical records and other healthcare advances should be accompanied by an effort to create systems that can properly analyze the large amounts of data inherent to such a system.
From "Using Information to Optimize Medical Outcomes"
Journal of the American Medical Association (06/10/09) Vol. 301, No. 22, P. 2383; Duncan, James R.; Evens, Ronald G.
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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