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Headlines
From RSNA
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
Industry News
From RSNA
Featured in RadioGraphics: Best
Cases from the AFIP
In a new case from the Armed Forces Institute of Pathology, learn more
about the clinical imaging and pathologic evaluation of urachal
carcinoma.
Ultrasound, CT and MR imaging, with their ability to display
cross-sectional images, are ideally suited for demonstrating urachal
anomalies. This article uses a case study of a 58-year-old male patient
to detail the imaging features and pathologic evaluation of urachal
carcinoma, as well as prognosis and treatment.
Read more about “Urachal Carcinoma,” by Ingrid M. Koster, M.D., and
colleagues, in RadioGraphics.
Leading the News
Battle Looms Over Funding Cuts for MRIs
Healthcare overhaul legislation that the U.S. Congress is considering
contains a provision to reduce Medicare payments to doctors offering
magnetic resonance imaging (MRI) scans and other imaging tests in their
offices, which has a coalition of physicians and medical imaging
equipment manufacturers up in arms. President Obama and some Democratic
lawmakers claim the cuts will help reduce overuse of such tests, while
critics retort that patients' access to such scans could be
significantly curtailed because the provision could force some doctors
out of the testing business. Opponents say paying doctors less for
performing in-office tests will make the practice unaffordable for
some, and the stoppage of such testing means that doctors would send
patients to hospitals that could require long waits or long trips.
"There are a lot of small towns [where doctors] are doing [computerized
tomography] and MRIs, and I don't think they're going to be able to
stay in business," warns Breast Center of Northwest Arkansas
radiologist Steven Harms. Physicians who carry out MRIs and other tests
in their offices have been investigated in recent years because of
financial links some have to the testing facilities, and two years ago
the Centers for Medicare & Medicaid Services said that this scheme
can encourage doctors to order unnecessary tests to raise profits.
Access to Medical Imaging Coalition lobbyist Tim Trysla stresses that
Capitol Hill and the Obama administration must study the effects of the
proposed legislation further. "When someone has delayed health care,
that is certainly not good," he notes.
From "Battle Looms Over Funding Cuts for MRIs"
USA Today (07/17/09) Fritze, John
Research
Coronary Artery Calcification Scans Can Raise
Cancer Risks
New research indicates that repeated coronary artery calcification
(CAC) scans could lead to cancer in those being diagnosed. The study
found that as many as 42 out of every 100,000 patients screened every
five years from ages 45 to 75 could develop radiation-induced cancer.
"These radiation risk estimates can be compared with potential benefits
from screening, when such estimates are available," wrote Dr. Kwang Pyo
Kim, now with the Department of Nuclear Engineering at Kyung Hee
University in Gyeonggi-do, South Korea, and colleagues. For the
purposes of the study, radiation doses delivered to adult patients were
calculated from available protocols using Monte Carlo radiation
transport. Radiation risk models, derived using data from Japanese
atomic bomb survivors and medically exposed cohorts, were then used to
estimate the excess lifetime risk of radiation-induced cancer.
From "Coronary Artery Calcification Screening: Estimated Radiation Dose
and Cancer Risk"
Archives of Internal Medicine (07/13/09) Vol. 169, No.
13, P. 1188; Kim, Kwang Pyo; Einstein, Andrew J.; de Gonzalez, Amy
Berrington
Gadofosveset-Enhanced MRA of the Pedal Vasculature
in Patients With Diabetes Mellitus Shown to Be Superior to DSA
The purpose of this study by researchers at Johannes Gutenberg
University in Mainz, Germany, was to compare gadofosveset-enhanced
magnetic resonance angiography (MRA) of the pedal vasculature with
selective intraarterial digital subtraction angiography (DSA). Eighteen
patients with peripheral arterial occlusive disease (PAOD) and type II
diabetes were prospectively examined. MR imaging consisted of dynamic
and of high-resolution steady-state imaging, and selective DSA was
performed within five days and served as standard of reference. Image
analysis was done by two observers. Gadofosveset-enhanced MRA of the
pedal vasculature proved to be superior to DSA, offering a long imaging
time window and allowing for better depiction of the pedal outflow.
Steady-state imaging delineated inflammatory complications associated
with the diabetic foot.
From "Gadofosveset-Enhanced MR Angiography of the Pedal Arteries in
Patients With Diabetes Mellitus and Comparison With Selective
Intraarterial DSA"
European Radiology (07/09/09) Röhrl, Boris; Kunz,
Rainer Peter; Oberholzer, Katja
Technology
Fist-Sized Tumor Removed From Brain With Help of
New 3-D Brain Mapping
A surgical team from the Brain Tumor Center at the University of
Cincinnati Neuroscience Institute successfully removed a fist-sized
tumor from a patient's brain using a new technology that combines four
different types of images into a three-dimensional brain map. "The
ability to completely map the brain and to understand—before we
operate—where the tumor lies in relation to important structures is a
milestone in our use of digital computer technology to heighten patient
safety during complex brain tumor surgery," said Mayfield Clinic
neurosurgeon John Tew, MD. The four scans were integrated and installed
into a surgical guidance computer, which revealed the growth's
relationship to all of the brain's functional centers, electrical
pathways, and blood vessels so that the surgeons could plot out a safe
route to the tumor. The fusion of three types of imaging—magnetic
resonance imaging, functional magnetic resonance imaging, and diffusion
tensor imaging—has been used by Brain Tumor Center specialists as a
guide to stereotactic surgery since early 2007. In the latest
development, specialists added the fusion of computed tomography
angiography, which provides a map of blood vessels.
From "Fist-Sized Tumor From Brain With Help of New 3-D Brain Mapping"
Science Daily (07/14/09)
New Tests Help Spot Early-Stage Alzheimer's
The findings of a five-year study of the brain changes that indicate
the advancement of Alzheimer's disease were presented at an Alzheimer's
Association conference in Vienna, Austria, and research has found that
new tests evaluating brain changes and body chemistry may show
potential as diagnostic tools for detecting the early onset of
Alzheimer's. "The idea is if there could be biological markers
identified that tracked what was going on in the brain, this would give
you a better idea of whether a drug was having a biological effect,"
said Neil Buckholtz of the U.S. National Institute on Aging's
Alzheimer's Disease Neuroimaging Initiative (ADNI) in a telephone
interview. Irish researchers discovered that magnetic resonance imaging
scans measuring brain volume in the left hippocampus and a combination
of memory tests accurately identified almost 95 percent of people who
had progressed from mild cognitive impairment to early Alzheimer's.
Meanwhile, U.S. researchers found that positron emission tomography
scans that measure glucose combined with low scores on memory tests
could yield a strong prediction of disease progression. Buckholtz
anticipates that the ADNI study will produce many more research
findings. "The idea is we are trying to define the best biomarkers or
combination of biomarkers that will allow us to assess progress," he
noted.
From "New Tests May Help Spot Early-Stage Alzheimer's"
Reuters (07/14/09) Steenhuysen, Julie
Fluorescent Probes Permit Monitoring of
Chemotherapy Effectiveness
Real-time monitoring of chemotherapy effectiveness against tumors may
be enabled by fluorescent probes that allow the apoptosis of tumor
cells to be observed, and Stanford University School of Medicine
researchers have worked out such a method. They established that
noninvasive imaging of the degree of apoptosis occurring in living
animals' tumors is possible, facilitating measurement of the efficacy
of apoptosis-inducing treatments. One technique for determining whether
the treatment is effective is to monitor enzymes called caspases, which
trigger a chain of molecular steps that govern apoptosis when activated
by biochemical cues from inside or outside the cell. The researchers
attached fluorescent "tags" to small molecules designed to adhere to
caspases when they are active, and the probes are stimulated by certain
wavelengths of light that travel through skin without being absorbed,
emitting their own light in response. A special detector is used to
image this light. An early test of the probe involved the
administration of an apoptosis-inducing drug called dexamethasone to
mice, and fluorescence was induced in the thymus as expected. Follow-up
experiments involved a new, monoclonal antibody that triggers caspases
and induces apoptosis, particularly in rapidly dividing cells such as
those found in tumors. Fluorescence was seen in the tumor cells
undergoing apoptosis, but not in the surrounding healthy tissue. The
activation of caspases is a very early apoptosis event, and its
monitoring could accelerate clinicians' ability to observe the
effectiveness of new anti-tumor drugs, says Stanford Cancer Center
professor Matthew Bogyo, PhD.
From "Noninvasive Optical Imaging of Apoptosis by Caspase-targeted
Activity-based Probes"
Nature Medicine (07/09) Edgington, Laura E.; Berger,
Alicia B.; Bogyo, Matthew; et al.
Medical-Legal Issues
House Bill Would Make Healthcare a Right
House Democratic leaders have tabled a plan that would for the first
time designate healthcare a right and a responsibility for all
Americans. Under the proposal, the federal government would be
responsible for ensuring that every person has access to an affordable
insurance plan, regardless of income or health. The measure calls for a
5.4 percent tax increase on individuals making more than $1 million a
year, with a gradual tax beginning at $280,000 for individuals.
Employers that fail to provide coverage would be hit with a penalty
equivalent to 8 percent of workers' wages, with an exemption for small
businesses. Individuals declining an offer of affordable coverage would
pay 2.5 percent of their incomes as a penalty, up to the average cost
of a health insurance plan. Though not officially released, total costs
for the plan are estimated at $1.5 trillion over 10 years.
From "House Bill Would Make Healthcare a Right"
Associated Press (07/15/09) Werner, Erica
Obama Eyes the Purse Strings for Medicare
The White House is seeking to wrest control over Medicare reimbursement
rates away from lawmakers, which could prove difficult given that
congressional authority has proven its merit in drawing votes for
lawmakers. The Obama administration has tabled two proposals aimed at
achieving its goal. One would empower MedPAC to determine cuts and
changes to Medicare, while the other would create a similar entity,
called the Independent Medicare Advisory Council, to make Medicare
recommendations to the president. Congress could vote to overturn
decisions but would no longer tailor Medicare spending to address local
concerns.
From "Obama Eyes the Purse Strings for Medicare"
Washington Post (07/16/09) Murray, Shailagh
Clinical Practice
About 45,000 Docs Qualify for Medicaid HIT Funding
The health information technology (HIT) funding in this years’ stimulus
package includes additional funding for physicians who treat a large
volume of Medicaid and poor patients. These physicians are eligible for
up to $63,750 in Medicaid stimulus money over the next six years to
install health information technology for electronic health records
(EHRs). A study by the George Washington Medical Center found that
about 45,000 physicians will qualify for the Medicaid stimulus funding
if they demonstrate meaningful use of HIT for a patient mix that
includes at least 30 percent Medicaid beneficiaries. Office-based
pediatricians who do not meet the 30 percent Medicaid volume threshold
but have at least 20 percent Medicaid patients will receive up to
$42,500. Physicians who practice at federally qualified health centers
or rural health centers can qualify if 30 percent of their patient base
is characterized as "needy," including those covered by Medicaid, those
who receive uncompensated care, and patients who are charged
income-related sliding scale fees. The study estimated that nearly all
(99 percent) health center physicians meeting a predominant practice
standard will qualify for the Medicaid HIT incentives.
From "About 45,000 Docs Qualify for Medicaid HIT Funding"
HealthLeaders Media (07/08/09) Commins, John
Industry News
U.S. Is Poised to Enter Medical Isotope Market
An official from the U.S. National Nuclear Security Administration
(NNSA) says the shutdown of Canada's National Research Universal
Reactor, which supplies approximately 60 percent of the U.S. demand for
medical isotopes, has created a "supply crisis," prompting the U.S.
government to consider investing in medical isotope production. Parrish
Staples, director of the U.S. Office of European and African Threat
Reduction, says it would cost the U.S. government $120 million to set
up a process for domestic production of molybdenum-99 using
low-enriched uranium. The NNSA is now investigating possible
technologies that would provide the United States with a secure,
reliable source of isotopes without using any weapons-grade uranium. A
House appropriations committee reportedly has approved $12 million to
conduct the study.
From "U.S. Is Poised to Enter Medical Isotope Market"
Toronto Star (Canada) (07/10/09) Smith, Joanna
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
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