"Radiology and the Family Physician" Featured at RSNA 2009
This new course co-presented by the RSNA Public Information Committee and the American Academy of Family Physicians will address:
- What radiologists can expect from family physicians
- What family physicians need from radiologists as the specialists in medical imaging
- The concept of the "Patient-centered Medical Home” (PCMH) model
- How radiologists and family physicians can improve communications and work more effectively to enhance patient care
- Opportunities for radiologists to improve and expand interactions with family physicians
Registration for "Radiology and the Family Physician" (RC 216) and all other RSNA 2009 courses is under way at RSNA.org/register.
Headlines
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
Leading the News
Medicare Plans to Cut Specialists' Payments
The Centers for Medicare & Medicaid Services (CMS) has proposed reducing payments to radiologists and other specialists in order to increase payments to primary care physicians. Under the proposal, radiologists would see payments for advanced imaging services, including MRI and CT, reduced by an estimated 20 percent. The proposal is open for public comment until August 31, and CMS is expected to make a final decision by November 1.
From "Medicare Plans to Cut Specialists' Payments"
Wall Street Journal (07/02/09) Zhang, Jane
Research
PET-CT Can Eliminate Unnecessary Surgery in Patients With Lung Cancer
Assessing the clinical impact of combined positron-emission tomography and computed tomography (PET-CT) on preoperative staging of non-small-cell lung cancer was the purpose of a new study conducted by researchers in Denmark. They report that although this method can eliminate unnecessary surgery, it makes little difference in saving the lives of lung cancer patients. The study involved 189 patients with newly diagnosed lung cancer, whose tumors were considered treatable with surgery based partly on a CT scan. Eighteen of the 91 people who received conventional assessment were deemed to have inoperable cancer, versus 38 of 98 patients evaluated via PET-CT. Seventy-three patients received surgery following conventional assessment, while 60 were operated on following PET-CT scanning. Surgery proved futile for 21 people evaluated with PET-CT, compared to 38 patients who did not undergo the combined scan.
From "Preoperative Staging of Lung Cancer With Combined PET-CT"
New England Journal of Medicine (07/02/09) Vol. 361, No. 1, P. 32; Fischer, Barbara; Lassen, Ulrik; Mortensen, Jann; et al.
Researchers Compare Outcomes for Patients Undergoing US-Guided Percutaneous Treatment With Those Who Do Not
Italian researchers set out to compare short- and long-term outcomes of patients with rotator cuff calcific tendonitis to whom ultrasonographically (US)-guided percutaneous treatment was and was not applied. The study involved 287 patients, 219 of whom were randomly assigned to receive US-guided percutaneous therapy, while 68 were in a control group that did not receive the treatment. Following the inducement of local anesthesia, two 16-gauge needles were inserted into the calcific deposit. One needle injected saline solution, while the other needle extracted the dissolved calcium. Follow-up was carried out after one month, three months, 12 months, five years, and 10 years. The researchers determined that patients who received the treatment exhibited a significant reduction in pain and improved mobility after a month, three months, and one year, compared to control group patients at one year. However, the nontreated group reported improvement similar to the treated group after five and 10 years. The research is published in the July issue of Radiology.
From "Rotator Cuff Calcific Tendonitis: Short-term and 10-Year Outcomes After Two-Needle US-Guided Percutaneous Treatment—Nonrandomized Controlled Trial"
Radiology (07/01/09) Vol. 252, No. 1, P. 157; Serafini, Giovanni; Sconfienza, Luca M.; Lacelli, Francesca; et al.
CBCT Tumor Localization Reduces Setup Margins in Conventionally Fractionated Radiotherapy for Lung Tumors
A group of researchers set out to determine whether a methodology in which cone-beam computed tomography (CBCT) is used to pinpoint tumors in conventionally fractionated radiotherapy for lung tumors can successfully reduce setup margins. The study involved 22 lung cancer patients treated with conventionally fractionated radiotherapy using daily image guidance with CBCT, 13 of whom had sufficient CBCT scans for analysis. The patients went through treatment simulation in the BodyFix immobilization system using four-dimensional CT to take respiratory motion into account. Daily alignment was first achieved according to skin tattoos, followed by CBCT. All of the CBCT scans were retrospectively registered to the planning CT scans through the use of automated soft-tissue and bony registration, and the subsequent couch shifts in three dimensions were recorded. The researchers concluded that the employment of daily CBCT soft-tissue registration to localize the tumor in conventionally fractionated radiotherapy reduced the required setup margin by up to roughly 1.5 centimeters, versus using no image guidance or image guidance using bony anatomy as a substitute for the target.
From "Tumor Localization Using Cone-beam CT Reduces Setup Margins in Conventionally Fractionated Radiotherapy for Lung Tumors"
International Journal of Radiation Oncology, Biology, Physics (07/09) Vol. 74, No. 4, P. 1100; Yeung, Anamaria R.; Li, Jonathan G.; Shi, Wenyin; et al.
Anterior Dynamic Ultrasound of Infant Hips Appears Dependent on Investigator
A group of researchers undertook a study to determine to what extent the variation of positive findings of anterior dynamic ultrasound of the infant hip depends on the investigator. They assessed information on all ultrasound investigations of infant hips at a county hospital between January 2004 and August 2007. The researchers calculated the proportion of findings for different observers, and they performed a multivariable logistic regression analysis to adjust the risk of treatment by investigating orthopedic surgeon and radiologist for each other along with calendar period and infant sex. The proportion of positive findings for infants treated varied by orthopedic surgeon from 4.2 percent to 53.9 percent, while the corresponding variation for radiologists ranged from 7.4 percent to 23.9 percent. "Although the true proportions of positive findings in our study are unknown, our findings are unlikely to be explained by selection bias or chance," the researchers conclude. "Thus, our study suggests that anterior dynamic ultrasound of the infant hip is highly dependent on the investigator and further studies of the implications of our results are warranted."
From "Anterior Dynamic Ultrasound of the Infant Hip: Evaluation of Investigator Dependence"
Acta Radiologica (06/09) Vol. 50, No. 6, P. 690; Kaijser, Magnus; Larsson, Jonas; Rosenberg, Lena; et al.
Technology
New MRI Technique Could Mean Fewer Breast Biopsies in High-risk Women
University of Wisconsin (UW)-Madison professor Wally Block and colleagues have developed a magnetic resonance imaging (MRI) data-acquisition method that can visually identify cancerous lesions based on characteristics about their shape. The breakthrough could mean that women with a high risk of breast cancer may have to submit to fewer biopsies. The technique allows an MRI machine to acquire data radially and achieve a high-resolution, three-dimensional image that can be turned, sliced, and viewed from many angles. Machines outfitted with the method also compile more information in less time. Furthermore, the technique facilitates the separate viewing of fat and water images. "Most of the time radiologists are concentrating on water images, but sometimes our fat images of the breast are also useful," notes Block. "The boundaries of a lesion often stand out very clearly when embedded in fat." The research was supported by funding from the Walter H. Coulter Translational Research Partnership in biomedical engineering at UW-Madison, along with grants and in-kind support from GE Healthcare. Block and colleagues have tested the technique on 20 patients at the University of Wisconsin Hospital and have shared it with University of Toronto colleagues for additional evaluation. The researchers also are working with fellow UW-Madison professor Scott Reeder on the refinement of methods to image both breasts at the same time.
From "New MRI Technique Could Mean Fewer Breast Biopsies in High-risk Women"
Science Daily (06/29/09)
Medical-Legal Issues
CMS Considers National Coverage Decision Changes for MRI
The Centers for Medicare & Medicaid Services (CMS) has received a request to revise the national coverage decision (NCD) for MRIs to include blood flow measurement. The requester for this change maintains that the noncoverage of blood flow measurement is contradictory to the national coverage of MRI under the NCD for magnetic resonance angiography. CMS also received a request to revise the reference to cardiac pacemakers in order to permit coverage of MRI when a Medicare beneficiary has a device that has been FDA approved for use in the MRI environment. The current NCD does not cover MRIs when the patient has any type of pacemaker or metallic clips on vascular aneurysms. Based on these requests, CMS has found that blanket noncoverage of MRI for blood flow determination is no longer supported by available evidence. CMS therefore has proposed that the phrase "blood flow measurement" be removed from the Nationally Noncovered Indications of the NCD Manual. With this change, local Medicare contractors will now have the choice whether or not to cover this use for MRIs. However, CMS has not proposed a change to the current provisions of the NCD Manual that contraindicate the use of MRIs in patients with implanted cardioverter-defibrillators or cardiac pacemakers as there are currently no such devices approved by the FDA for use in the MRI environment.
From "Proposed Decision Memo for Magnetic Resonance Imaging (MRI)"
CMS Press Release (06/30/09)
House Bill Would Close Stark In-Office Loophole
Radiology advocates have long been concerned about the so-called Stark law in-office loophole, believing that it is a way for physicians who are not radiologists to avoid the law's provisions barring physicians from referring patients to places they have a financial interest in. A measure in the Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, proposed by Rep. Jackie Speier (D-Calif.), would close the loophole by excluding some advanced diagnostic imaging services from the Stark laws' in-office ancillary services exception. MRI, CT, and PET would be among the modalities barred from in-office self-referral under the Speier bill, but X-ray, ultrasound, and fluoroscopy studies would not be barred, nor would imaging services for radiation therapy treatment planning, imaging services in conjunction with an interventional radiology procedure, or nuclear medicine exams other than PET. Peer-reviewed studies and Government Accountability Office reports have shown that imaging utilization is increased significantly when physicians refer patients to facilities they have a financial interest in.
From "House Bill Would Close Stark In-Office Loophole"
AuntMinnie.com (07/02/09) Yee, Kate Madden
CMS Pitches 90 Percent Use Rate in Proposed 2010 MPFS Rule
The Centers for Medicare and Medicaid Services (CMS) has proposed a 90 percent equivalent use rate in its proposed rule for the 2010 Medicare Physician Fee Schedule. CMS said the hike, from the current percentage of 50 percent, is necessary because actual usage of imaging gear is higher, according to a March 2009 study from the Medicare Payment Advisory Commission (MedPAC). Pam Kassing with the American College of Radiology said the 90 percent use rate "will have a huge impact on the technical component for higher modalities of imaging such as [computerized tomography, magnetic resonance, positron emission tomography], and possibly [intensity-modulated radiation therapy]." Reed Smith partner Tom Greeson noted that there are needless tests ordered and billed to Medicare but said that the CMS proposal is the wrong way to address this problem. He called the proposal "the easy way out" and said that "MedPAC made the recommendation, and everyone seized on it without trying to find a more credible approach to curtailing overuse, like appropriateness guidelines." Greeson pointed out that Congress is now focusing on healthcare reform, and if it requires a different utilization rate than the one CMS is proposing, then CMS will probably fall into line.
From "CMS Pitches 90 Percent Use Rate in Proposed 2010 MPFS Rule"
AuntMinnie.com (07/01/09) Yee, Kate Madden
Clinical Practice
X-Rays and CT Offer Predictive Power for Swine Flu Diagnosis
Radiological findings from x-ray and CT scans can be used to confirm the diagnosis of A/H1N1 flu in humans, according to Mexican Society of Radiology President Dr. Luis Felipe Alva Lopez. He has found that the most prominent CT and x-ray features of the disease include rapidly progressing basal and axial interstitial/alveolar consolidation and diffuse ground-glass opacities. Lopez, a thoracic radiologist who currently works as an advisor to Mexico's National Institute of Respiratory Disease, also maintains that these imaging patterns are similar to those observed in patients with SARS.
From "X-Rays and CT Offer Predictive Power for Swine Flu Diagnosis"
Diagnostic Imaging (06/30/09) Abella, H.A.
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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