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Headlines
From RSNA
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
From RSNA
July RSNA News Now
Online
The full version of the July issue of RSNA News is now
available online.
Highlights include:
Crime Scene Compound Shines Light on Immune
Inflammation
Researchers are examining potential uses for luminol—a compound used at
crime scenes to make blood glow—in detecting immune inflammation and
say the compound could eventually make its way to clinical application.
Brain Imaging Discoveries Translated into Practice at
New Center
With a goal of moving medical discoveries to clinical delivery, the new
Center for Brain Imaging Science at The Johns Hopkins Institute aims to
channel imaging expertise in the understanding and use of imaging
techniques for neuroscience.
Teleradiology Ushers in New Subspecialized Era
With nighttime teleradiology use a reality for half of the hospitals in
the U.S., radiologists' fears of commoditization are giving way to hope
for more streamlined subspecialty reading.
Malpractice Fears in Mammography Overestimated
Although experts agree that litigation appears to be a deterrent to
mammography, new research found that radiologists in breast imaging
substantially overestimate their actual risk of malpractice lawsuits.
RSNA Grant Recipient Pioneers Research in Breast
Tomosynthesis
Clinicians and radiologists may one day have an important
weapon—tomosynthesis imaging biomarkers—in accurately identifying women
at high risk for breast cancer thanks to pioneering research by RSNA
Research & Education Foundation grant recipient Despina Kontos,
Ph.D.
Leading the News
MRI Accurately Depicts Deep Endometriosis
MRI is effective in the diagnosis of deep endometriosis and also helps
surgeons better detect uterine tissue that needs to be removed,
according to a study by researchers at Erasme Hospital, Université
Libre de Bruxelles, in Brussels, Belgium. The researchers were able to
detect 26 out of 27 cases of deep endometriosis using MRI, with the
location of deep lesions accurately indicated on the images. MRI was
also able to distinguish between all cases of superficial and deep
endometriosis and differentiate between affected colon wall layers in
32 percent of study participants who had endometriosis in that area of
their body. The study was published in Radiology Online before print on
July 7, 2009.
From "Endometriosis: Contribution of 3.0-T Pelvic MR Imaging in
Preoperative Assessment- Initial Results"
Radiology Online (07/07/09) Hottat, Nathalie;
Larrousse, Caroline; Anaf, Vincent
Research
PET Quantifies Changes in HER2 Expression in Breast
Cancer Xenografts
18F-Labeled Affibody molecules can be used to successfully image HER2
proteins in vivo by PET and monitor the effectiveness of treatments
designed to target HER2, according to a recent study conducted by
researchers at the National Institutes of Health. The imaging technique
developed in the study represents a breakthrough in measuring HER2
expression. The conventional method requires biopsies of tumors that
have been removed from the body. However, these samples may not
represent the overall characteristics of the tumor and may not
accurately estimate HER2 expression. In the study, researchers attached
the radioactive nuclide fluorine-18 to a HER2-binding variant of the
Affibody molecule. PET scans were then used to detect the Affibody
molecule, allowing researchers to visualize breast cancer tumors with
HER2 protein in mice. The researchers implanted human breast cancer
cells - expressing either very high or high levels of HER2 - under the
skin of mice to show that this method of imaging can be used to monitor
changes in HER2 expression after treatment. Researchers then
intravenously injected the HER2-targeting Affibody compound and
performed PET imaging three to five weeks after tumors had formed. Four
doses of the drug 17-DMAG, which decreases HER2 expression, were
administered at 12-hour intervals. PET scans were performed before the
treatment and after each dose. These scans were able to show that HER2
expression was reduced by 71 percent in mice bearing tumors with very
high levels of HER2 protein and by 33 percent in mice bearing tumors
with high levels of the protein, compared to the levels measured before
treatment and to tumors that did not receive the treatment.
From "Changes in HER2 Expression in Breast Cancer Xenografts After
Therapy Can Be Quantified Using PET and 18F-Labeled Affibody Molecules"
Journal of Nuclear Medicine (07/09) Kramer-Marek,
Gabriela; Kiesewetter, Dale O.; Capala, Jacek
Obese Individuals Require Higher Effective
Radiation Dose
Researchers conducted a study to assess the increase in effective
radiation dose from diagnostic x-rays for overweight and obese adult
patients, versus the effective dose for lean reference phantoms. They
used computer simulations that delivered x-ray beams at various
strength levels to phantom patients representing five distinct fat
tissue levels, and different body areas were x-rayed to determine the
most effective entry points for rendering high-quality images. The
dosage levels, body position options, and body mass distribution
numbers were compared with the radiation dose the computer software
indicated that each phantom patient would have had to absorb to produce
the desired image. The researchers discovered that directing an x-ray
to the thickest part of a patient's fat enabled delivery of a lower
radiation dose than would be required if a different area were
targeted. However, the dosage required to get an effective x-ray from
the abdominal region of a moderately overweight person was up to 10
times greater than for a lean patient, while the dosage was up to 40
times greater for a more severely overweight or obese patient. The
research is published in the July issue of Radiology.
From "Increased Radiation Dose to Overweight and Obese Patients from
Radiographic Examinations"
Radiology (07/01/09) Vol. 252, No. 1, P. 128; Yanch,
Jacquelyn C.; Behrman, Richard H.; Hendricks, Michael J.; et al.
Researchers Develop New Paradigm for
Visually-guided Balloon Catheter Ablation of AF
Dr. Vivek Y. Reddy of the Mount Sinai School of Medicine and colleagues
recently developed a novel paradigm for atrial fibrillation (AF)
ablation. Under their paradigm, catheter ablation of the left atrial
pulmonary vein (PV) junction was directly visualized in both short-term
and long-term preclinical and clinical testing. During these tests, a
balloon-based endoscopic ablation system was advanced to each PV ostium
in order to guide lasers to the target left atrial PV junction. In the
short-term preclinical phase of testing, Reddy and colleagues were able
to successfully isolate 88 percent of targeted PVs. In long-term
experiments, 90 percent of targeted veins remained permanently
isolated. In the clinical phase of testing, 91 percent of PVs were
successfully isolated. After a single procedure, the 12-month drug-free
rate of freedom from atrial fibrillation was 60 percent.
From "Visually-Guided Balloon Catheter Ablation of Atrial Fibrillation"
Circulation (07/07/09) Vol. 120, No. 1, P. 12; Reddy,
Vivek Y.; Neuzil, Petr; Themistoclakis, Sakis
Technology
Remote Ultrasound Scans Aid Diagnosis of
Underserved Patients
A new remote ultrasound scan system being developed within the ARTIS
project has been devised by Philippe Arbeille, a professor at Trousseau
University Hospital in France. The technique spares patients living in
remote areas the burden of traveling great distances to receive scans
only to find nothing seriously wrong with them. Arbeille conducts the
scan from his Tours office and communicates with a second hospital
using a satellite link, controlling an ARTIS robot carrying an
ultrasound scanner on the patient's side with a joystick. The robot
scanner allows patients in rural hospitals to be scanned, and it also
is helpful for patients in Amazonia or Africa who lack access to
medical investigation. The ARTIS system also could find use in
difficult-to-reach workplaces such as ships or oil rigs. ARTIS is
supported by the European Space Agency, because the same technology
could be employed in manned spaceflights and space exploration.
From "Remote-Controlled Scans"
EuroNews (07/07/09)
Medical-Legal Issues
Court Rejects Physician Challenge to Change in
Self-Referral Rule
The U.S. District Court for the District of Columbia has rejected a
challenge brought by a group of physicians and physician-owned entities
to a recent change in the federal self-referral rules, ruling that it
did not have the authority to rule on the action because Medicare rules
require parties first to pursue an administrative appeal. The Stark law
generally prohibits physicians from referring patients to entities in
which they have a financial stake. CMS rules currently interpret an
entity to include only the party that directly bills Medicare for
designated health services. However, as of Oct. 1, CMS will expand the
definition to include those providing the services billed to Medicare.
From "Court Rejects Physician Challenge to Change in Self-Referral
Rule"
American Medical News (07/06/09) Sorrel, Amy Lynn
Pick to Lead Health Agency Draws Praise and Some
Concern
President Obama has nominated Dr. Francis S. Collins, former head of
the Human Genome Project, to head the National Institutes of Health
(NIH). As the new NIH director, Collins will oversee the distribution
of the approximately $37 billion in research grants and $4 billion in
research programs NIH is scheduled to allocate over the next 14 months.
Dr. Collins' nomination is expected to quickly be confirmed. However,
some critics have voiced concerns over his nomination, saying he raised
expectations unrealistically high for the Human Genome Project, leading
to huge amounts of money and attention being spent on the effort, which
could have been re-directed toward other research efforts.
From "Pick to Lead Health Agency Draws Praise and Some Concern"
New York Times (07/09/09) Harris, Gardiner
Clinical Practice
Peer Review Offers Potential Solutions for
Healthcare Reform
A recent review, published online by RadioGraphics on June 29, assesses
different methods of peer review in order to best determine diagnostic
accuracy. Specifically, the review, led by Dr. Shmuel Mahgerefteh of
the Hadassah Hebrew University Medical Center Department of Radiology
in Jerusalem, Israel, details the strengths and weaknesses of
determining diagnostic accuracy using interpretive agreement or
disagreement during ad blinded double reading as well as
workstation-integrated evaluations. Mahgerefteh and colleagues offer
these methods of peer review as possible benchmarks for practice-based
evaluation of physician performance in an effort to better meet
increasing regulatory requirements.
From "Peer Review in Diagnostic Radiology: Current State and a Vision
for the Future"
RadioGraphics (06/09) Mahgerefteh, Shmuel; Kruskal,
Jonathan B.; Yam, Chun S.
Hand-carried Ultrasonography Accurately Measures
IVC Collapsibility
IVC-collapsibility index measurements can be effectively taken using
intensivist-performed bedside ultrasonography (INBU). These
measurements can then provide a useful, noninvasive volume status
assessment in surgical intensive care unit (SICU) patients. Researchers
reached these conclusions following a study that included 83 patients
with CVP catheter monitoring devices who also underwent INBU IVC
evaluations that lasted between three and 10 minutes. By doing so,
researchers also found that IVC-CI, as measured by INBU, appears to
best correlate with CVP in collapsibility ranges less than 0.20 mmHg
and more than 0.60 mmHg.
From "Intensivist Use of Hand-carried Ultrasonography to Measure IVC
Collapsibility in Estimating Intravascular Volume Status: Correlations
With CVP"
Journal of the American College of Surgeons (07/09)
Vol. 209, No. 1, P. 55; Stawicki, S. Peter; Braslow, Benjamin M.;
Panebianco, Nova L.
CT Dilations of the Abdominal Aorta Often Excluded
From EMR
A group of researchers set out to study the frequency with which
computed tomography (CT)-documented dilations of the abdominal aorta
are accompanied by indications in the electronic medical record (EMR)
that the abnormality was identified by a clinician. The study involved
a review of 4,112 patients' CT scans in which 440 aortic dilations were
recognized. Ninety-one of those dilations were new findings, and
clinical teams were directly informed by radiologists about five new
dilations. Clinical teams failed to record in the EMR identification of
53 of 91 dilations within three months of the scan, and 9 percent of
these dilations were 5.5 centimeters or larger. The average time to
recognition of aneurysm in the EMR was 237 days, and no EMR
documentation existed for 16 dilations during a mean follow-up of 3.2
years. There was no evidence to indicate that any of the aneurysms
ruptured or that patient fatalities resulted from the delayed
follow-up. The researchers determined that some aneurysms may have been
recognized by clinicians, but were not documented in the EMR. The
conclusion of the study is that there must be better strategies to
guarantee documentation of follow-up of tests.
From "Failure to Recognize Newly Identified Aortic Dilations in a
Health Care System With an Advanced Electronic Medical Record"
Annals of Internal Medicine (07/07/09) Vol. 151, No. 1,
P. 21; Gordon, Jennifer R.S.; Wahls, Terry; Carlos, Ruth C.; 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.
Abstract News © Copyright 2009 INFORMATION, INC.
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