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Headlines
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
Leading the News
Medical Imaging Increases U.S. Life Expectancy
A recent study has found that advanced imaging procedures may increase life expectancy. The study, led by Columbia University Prof. Frank Lichtenberg, was designed to determine the impact of a number of different variables on U.S. life expectancy between 1994 and 2004. In their analysis of advanced imaging usage, Lichtenberg and colleagues found that states that experienced larger increases in utilization of advanced medical imaging had an average increased life expectancy rate of between 0.62 years and 0.71 years. They also discovered that these states did not experience a larger increase in per capita medical expenditures. This finding contradicts assumptions that advanced imaging usage has contributed to rising overall U.S. healthcare spending. Lichtenberg concluded that although newer diagnostic imaging procedures are more expensive, they may contribute to savings by reducing "the need for costly additional medical treatment."
From "Medical Imaging Increases U.S. Life Expectancy"
HealthImaging.com (06/18/2009)
Research
Researchers Unable to Establish Concrete Benefits of Pretreatment MRI for Breast Cancer Patients
Researchers report on how pretreatment magnetic resonance imaging (MRI) may or may not benefit breast cancer patients in terms of short-term surgical outcomes, including time to surgery, mastectomy rate, and margin status. Pretreatment MRIs were administered to 130 of 577 patients at a multidisciplinary breast cancer clinic from July 2004 to December 2006, and MRI use increased from 2004 compared to 2005 and 2006. Patients who received MRIs were younger, but its use was not connected with preoperative chemotherapy, family history of breast or ovarian cancer, presentation, or tumor features. A 22.4-day delay in pretreatment assessment was associated with MRI, while breast conserving therapy (BCT) was tried in 320 of 419 patients with complete surgical data. The odds ratio for mastectomy, controlling for T size and stage, was 1.80 following MRI compared to no MRI, while patients having MRIs did not have fewer positive margins at lumpectomy or conversions from BCT to mastectomy. The researchers do not associate MRI with improved margin status or BCT attempts, but they do associate it with a treatment delay and higher mastectomy rate. This leads to the conclusion that the routine use of MRI to select patients or BCT performance is not supported without evidence of improved oncologic outcomes.
From "Association of Routine Pretreatment Magnetic Resonance Imaging With Time to Surgery, Mastectomy Rate, and Margin Status"
Journal of the American College of Surgeons (06/09) Bleicher, Richard J.; Ciocca, Robin M.; Egleston, Brian L.; et al.
Frameless Image-Guided Intracranial Stereotactic Radiosurgery Provides Comparable Outcomes for Patients With Brain Metastases
A group of researchers report on the clinical outcomes of patients with brain metastases who underwent frameless image-guided radiosurgery, following preclinical investigations verifying the accuracy of target localization by the method. Fifty-three patients underwent frameless stereotactic radiosurgery using a linear accelerator outfitted with on-board image guidance for the treatment of 158 brain metastases between 2005 and 2006. The radiation doses were delivered in a single fraction, and patients underwent follow-up magnetic resonance imaging scans at two- to three-month intervals. The general survival rate was 70 percent at six months, 44 percent at 12 months, 29 percent at 18 months, and 16 percent at 24 months. Local control was achieved in 90 percent of 168 treated lesions at six months, 80 percent at one year, 78 percent at 18 months, and 78 percent at 24 months. There was no indication of imaging changes on post-stereotactic radiosurgery scans to imply mistargeting of a radiation isocenter. The researchers conclude that the clinical outcomes following frameless stereotactic radiosurgery were comparable to those after frame-based radiosurgery methods. They expect frameless radiosurgery to become a common technique for intracranial radiosurgery in view of its benefits in terms of patient comfort, ability to use fractionated treatment regimens, and convenience in scheduling of staff and equipment resources.
From "Frameless Image-Guided Intracranial Stereotactic Radiosurgery: Clinical Outcomes for Brain Metastases"
International Journal of Radiation Oncology, Biology, Physics (07/09) Vol. 74, No. 3, P. 702; Breneman, John C.; Steinmetz, Ryan; Smith, Aaron; et al.
Technology
Automated MRI Methodology Predicts Progression from MCI to Alzheimer's
An automated magnetic resonance imaging (MRI) methodology that measures the brain's memory centers and compares them to anticipated size can effectively predict the progression from mild cognitive impairment (MCI) to Alzheimer's disease, according to researchers at the University of California, San Diego School of Medicine. "Use of this procedure is like bringing the experience of an expert neuro-radiologist to any clinic that has the right software," says UC San Diego professor James Brewer, MD. "These fully automated and rapid methods of measuring medial temporal lobe volumes may help clinicians predict cognitive decline in their patients, and have the potential to influence how neurology is practiced." Michael Rafii, MD, with the UC San Diego Medical Center's Memory Disorders Clinic says that for over 12 months, clinic researchers have been employing a fully computerized procedure that takes images from the MRI scanner and converts them into quantitative values. The researchers analyzed the volumetric measures of 269 MCI patients over a period of six months; and baseline volume measurements of the hippocampus, amygdala, and temporal horn were assessed as predictors of cognitive change as gauged by two commonly used tools for screening cognitive function and dementia. "These values objectively measure the hippocampus and amygdala, and early data confirm previous findings that these brain areas may atrophy early in Alzheimer's disease and can offer a clinical marker for change," notes Rafii. Many MCI patients do not progress to Alzheimer's and thus do not need therapies to slow down or prevent neurodegeneration. This fact justifies the need for objective measures to distinguish between MCI patients who will and will not clinically decline.
From "High-throughput, Fully Automated Volumetry for Prediction of MMSE and CDR Decline in Mild Cognitive Impairment"
Alzheimer Disease and Associated Disorders (Quarter 2, 2009) Vol. 23, No. 2, P. 139; Kovacevic, Sanja; Rafii, Michael S.; Brewer, James B.
MET-PET Improves Radiation Therapy Planning
Japanese researchers have concluded that 11C-methionine positron emission tomography (MET-PET) has promise for precisely delineating target volumes in radiotherapy planning for brain metastases. The researchers looked at MRI gross target volume (GTV-MRI) -- defined as the contrast-enhanced area on gadolinium-enhanced T1-weighted MRI -- and at the MET-PET GTV, defined as the area of an accumulation of MET-PET apparently higher than that of normal tissue on MET-PET images. "For GTV-MRI volumes of =0.5 mL, the sensitivity of tumor detection by MET-PET was 43%. For GTV-MRI volume of >0.5 mL, GTV-PET volumes were larger than GTV-MRI volumes and a significant correlation was found between these variables by linear regression," the researchers concluded. "For all tumor sizes and tumor characteristics, a 2-mm margin outside the GTV-MRI significantly improved the coverage of the GTV-PET."
From "Target Definition by C11-Methionine-PET for the Radiotherapy of Brain Metastases"
International Journal of Radiation Oncology, Biology, Physics (07/09) Vol. 74, No. 3, P. 714; Matsuo, Masayuki; Miwa, Kazuhiro; Shinoda, Jun; et al.
Researchers Conclude MR Imaging-guided Percutaneous Sclerotherapy Successful in Pilot Study
A group of researchers employed a clinical 1.5-T magnetic resonance (MR) unit to assess the feasibility of MR imaging-guided percutaneous sclerotherapy of venous malformations (VMs). The study involved MR imaging-guided percutaneous sclerotherapy procedures carried out in 10 patients with a VM in the foot and/or ankle, calf, thigh and/or knee, and elbow. MR imaging was employed for needle insertion guidance and real-time monitoring of the injection process by using three-dimensional fast spoiled gradient-echo MR sequences and meglumine gadoterate/ethanol solutions as the sclerosing agent. The technical success was systematically assessed, along with safety and therapeutic outcomes, during a 12-month follow-up period. Technically successful MR imaging-guided percutaneous sclerotherapy was recorded in all 10 patients, and the procedure was determined to be relatively safe with a good therapeutic outcome after 12 months.
From "MR Imaging-guided Percutaneous Sclerotherapy of Peripheral Venous Malformations With a Clinical 1.5-T Unit: A Pilot Study"
Journal of Vascular and Interventional Radiology (07/09) Vol. 20, No. 7, P. 879; Andreisek, Gustav; Nanz, Daniel; Weishaupt, Dominik; et al.
Medical-Legal Issues
Stakeholders Urge Legislators to Increase Medical Device Oversight
A recent hearing of a House Energy and Commerce Committee subcommittee raised concerns over the ability of current FDA procedures to ensure the safety of medical devices. Committee chair Rep. Frank Pallone (D-N.J.) said that the committee was attempting to determine if medical device safety could be improved by legislative action or increased FDA oversight. Marcia Cross, healthcare director for the Government Accountability Office, testified at the hearing that various shortcomings "raise concerns" about the FDA's pre-approval device reviews and postmarket surveillance processes "that are necessary for ensuring the safety and effectiveness of medical devices." Dr. William Maisel, head of the Medical Devices Safety Institute, testified that recent recalls of some medical devices raised questions about the efficacy of the FDA's ability to identify device safety problems. According to Maisel, the FDA needs to improve its scientific evaluations of devices. Although no FDA officials testified at the hearing, FDA Commissioner Margaret Hamburg recently announced that she plans to closely investigate the FDA's use of abbreviated approval processes for medical devices and determine if more thorough reviews are necessary.
From "Tougher Medical Device Oversight Urged"
MSNBC (06/18/09)
Clinical Practice
Survey of Independent Imaging Centers Reveals That Diagnostic Radiology Networks Play a Critical Role in Channeling Patients
A survey by Lead Generation Solutions of 140 independent imaging centers across the United States reveals that diagnostic radiology specialty networks play a vital role in channeling people to imaging centers for both workers' compensation and health insurance patients. The survey, commissioned by One Call Medical, found that specialty networks are responsible for directing 44 percent of workers' compensation patients seen by the imaging centers and 18 percent of patients with health insurance. "The survey reveals a new and important trend—that diagnostic radiology specialty networks are now referring a significant and growing portion of the patients who require advanced radiology services,” says Don Duford, president and COO of One Call Medical. "Our providers also receive significant value in terms of a higher volume of referrals, and prompt payment."
From "Survey of Independent Imaging Centers Reveals That Diagnostic Radiology Networks Play a Critical Role in Channeling Patients"
Business Wire (06/22/09)
Negative 64-MDCT Coronary Angiography Reduces Length of Stay and Hospital Charges for Low-risk Patients With Chest Pain in the Emergency Department
Researchers at the University of Washington School of Medicine, looking to cut down on hospital charges and length of stay in low-risk patients with chest pain, investigated whether using 64-MDCT coronary angiography early in the workup could help achieve lower charges and shorter stays. The study included 50 patients with negative CT findings, and the researchers analyzed charges and stay lengths using actual patient data for all patients in the standard-of-care workup and for two earlier discharge scenarios based on negative cardiac CT results. The study showed that "for standard of care and the two CT-based earlier discharge analyses, the mean lengths of stay were 25.4, 14.3, and 5.0 hours; mean charges were $7,597, $6,153, and $4,251," with significantly lower lengths of stay and charges for the two CT-based analyses. The researchers concluded that discharging low-risk patients with chest pain from the emergency department based on negative cardiac CT, enzyme tests, and ECG may significantly cut down on both length of stay and hospital charges compared with the standard of care.
From "Low-risk Patients With Chest Pain in the Emergency Department: Negative 64-MDCT Coronary Angiography May Reduce Length of Stay and Hospital Charges"
American Journal of Roentgenology (07/01/2009) Vol. 193, No. 1, P. 150; May, Janet M.; Shuman, William P.; Strote, Jared N.; et al.
X-ray Contrast Media Increases Rate of Long-Term AEs in Patients With Kidney Damage
Researchers have performed a study concluding that the use of x-ray contrast media in patients with kidney damage can increase the rates of long-term adverse events (AEs) such as stroke, heart attack, and death. Such rates vary among different contrast agents. Ninety-two of 294 patients who received contrast media during x-ray coronary angiography studies experienced AEs following the exams, and patients with indications of contrast-induced nephropathy (CIN) exhibited higher AE rates than those without CIN. In addition, lower rates of CIN and AEs were noted in patients receiving iopamidol, a low-osmolar agent, compared to those who received iodixanol, an iso-osmolar agent. The researchers point out that commonly used methods to detect CIN actually measure kidney function rather than kidney damage.
From "Contrast-induced Nephropathy and Long-term Adverse Events: Cause and Effect"
Clinical Journal of the American Society of Nephrology (06/25/2009) Solomon, Richard J.; Mehran, Roxana; Natarajan, Madhu K.; et al.
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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