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Headlines
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
Leading the News
MRI Depicts Risk Factors for Fast Cartilage Loss
The Multicenter Osteoarthritis (MOST) study, led by researchers from
the Boston University Medical Center Department of Radiology, has
identified several risk factors that indicate an increased risk of fast
cartilage loss. These risk factors include high body mass index,
meniscal damage, synovitis or effusion, and any severe baseline
MR-depicted lesions. Researchers were able to identify these risk
factors after obtaining MR images on 347 knees that had baseline
cartilage damage less than or equal to 2.5 based on the Whole-Organ
Magnetic Resonance Image Score (WORMS) system. Fast cartilage loss was
defined as a WORMS of at least five in any subregion at 30-month
follow-up. Of the knees examined, 25.9 percent exhibited cartilage loss
and 5.8 percent showed fast cartilage loss. The study was published in
Radiology Online before print on July 27, 2009.
From "Tibiofemoral Joint Osteoarthritis: Risk Factors for MR-Depicted
Fast Cartilage Loss Over a 30-Month Period in the Multicenter
Osteoarthritis Studies"
Radiology Online (07/27/09)
Research
Whole-Body MR Neurography Permits Imaging
Acquisition When Patient Is Breathing Freely
Whole-body magnetic resonance (MR) neurography is an MR-based approach
that can selectively visualize the peripheral nervous system over long
trajectories in one examination. The applied whole-body MR neurography
method is based on the concept of diffusion-weighted whole-body imaging
with background body signal suppression. The technique permits image
acquisition while the patient is freely breathing. This permits
thin-slice acquisitions and multiple-slice excitations for
three-dimensional reformatting and display. Researchers report that
whole-body MR neurography was performed on a healthy 23-year-old male
volunteer and a 73-year-old man with clinicopathological findings that
supported the diagnosis of chronic inflammatory demyelinating
polyneuropathy (CIDP), using a 1.5-T system. Normal-sized brachial and
lumbosacral plexi were imaged, while other peripheral nerves were
barely visible in the healthy 23-year-old volunteer. However, in the
73-year-old CIDP patient, whole-body MR neurography revealed
symmetrical, widespread thickening of peripheral nerves throughout the
body.
From "Whole-Body Magnetic Resonance Neurography"
New England Journal of Medicine (07/30/09) Vol. 361,
No. 5, P. 538; Yamashita, Tomohiro; Kwee, Thomas C.; Takahara, Taro; et
al.
Technology
AI Helps Diagnose Metastatic Cancer
University of Chicago researchers have developed a computer program
that employs artificial intelligence to analyze ultrasound images in
order to help doctors diagnose metastatic cancer earlier. The team is
disclosing the results of a preliminary pilot study that
retrospectively reanalyzed the ultrasounds of 50 women with suspected
breast cancer who all had apparently normal lymph nodes, suggesting
that their cancers were not metastatic. All of the patients had their
cancers and axillary lymph nodes removed, and tissue biopsies indicated
that the cancer of 20 patients had metastasized. The goal of the pilot
study was to ascertain whether the computer program would have
accurately spotted the metastatic cases based on analysis of the
ultrasounds. "We discovered that a computer analysis of breast
ultrasound could potentially predict with promising accuracy which
patients had metastasis and which did not," says University of Chicago
professor Karen Drukker. The researchers are planning an observer study
wherein several radiologists will use the program to determine if it
augments their ability to diagnose metastasis. The first preclinical
results obtained using the program was scheduled to be discussed by the
researchers at the American Association of Physicists in Medicine
meeting, held July 26-30, 2009, in Anaheim, California.
From "Artificial Intelligence Used to Diagnose Metastatic Cancer"
Science Daily (07/28/09)
Hybrid Linac-MRI System Unveiled
Researchers at the University of Alberta's Cross Cancer Institute are
developing a new technology that combines medical linear accelerators
(linacs) and magnetic resonance imagers (MRIs) to improve cancer
therapies by facilitating real-time monitoring of moving tumors in
people's lungs and other soft tissues such as the liver or prostate
while radiation treatment is ongoing. Meanwhile, Stanford University
scientists are working out the specifications for how a hybrid
linac-MRI system can be used. Both groups were scheduled to detail
their findings at the 51st meeting of the American Association of
Physicists in Medicine, held July 26-30, 2009, in Anaheim, California.
Image-guided radiation treatment (IGRT) has emerged in recent years as
a method for following moving tumors. It typically involves the
implantation of markers to localize the tumors or x-rays to produce
computed tomography images of the patient before therapy to determine
the growth's position on that day and adjust the patient's position to
ensure that the tumor—and only the tumor—receives the prescribed
radiation dose. Stanford University scientist Amit Sawant says that
existing IGRT techniques, though effective, do not provide true
image-based guidance of the entire volume of the tumor. Linacs generate
powerful x-rays that kill cancer cells, while MRIs offer superior
distinction between cancerous and non-cancerous tissues, and so an
integration of the two systems is desirable, if the interoperability
challenge can be solved. Linac systems emit radio waves that interfere
with MRI hardware, while MRIs use strong magnets that can disrupt linac
systems. The Cross Cancer Institute's B. Gino Fallone and colleagues
have constructed a prototype linac-MRI system using a design that
insulates the magnetic fields and radio waves. Fallone expects a
working, clinically ready model to be available in about five years.
From "Hybrid Linac-MRI System Described at Medical Physics Meeting in
Anaheim"
EurekAlert (07/21/09)
Medical-Legal Issues
Health Co-ops Pushed as an Alternative to Federal
Insurance
A bipartisan group of senators is endorsing insurance cooperatives,
which would offer a system of health providers or contract out for
members' medical services, as an alternative to the proposed public
health plan, which has garnered stiff opposition. This system of
co-ops, which would be controlled by consumers rather than the
government or companies that have to answer to their shareholders,
would receive seed money from the federal government but would
eventually be expected to be self-sufficient through premiums charged
to customers. Several insurance cooperatives exist nationwide in
various forms, including the United Agricultural Benefit Trust in
California, a state-licensed association of growers, which has been
offering health insurance to its members and their employees for more
than 25 years. The trust negotiates rates with a network of doctors and
hospitals and maintains reserves to cover the costs of claims from its
customers as commercial insurers do but is owned by its members, who
serve on its governing board, and does not need to turn a profit,
leaving more money to cover members.
From "The Centrist Alternative on Healthcare: Cooperatives"
Los Angeles Times (07/29/09) Levey, Noam N.; Hook, Janet
FDA Panel Requests Further Data for Imaging Drug
An FDA advisory panel has recommended against approval of binodenoson
(CorVue) because it found that the drug's manufacturer, King
Pharmaceuticals, did not provide sufficient data to show that the drug
was as effective as adenosine, which is already approved for marketing
in the United States. Panel members said more data was needed, though
binodenoson did appear to be a safer alternative. The two drugs were
compared in tests to diagnose heart disease, widening the blood vessels
so doctors can better see inside the heart when running imaging tests.
King was urged to perform additional studies to demonstrate the
efficacy of binodenoson, with the deadline for FDA approval currently
set for Oct. 18, 2009.
From "U.S. FDA Panel Rejects King Imaging Drug Data"
Reuters (07/28/09) Richwine, Lisa
U.S. House Panel Limits Comparative Medical Studies
The U.S. House of Representatives Energy and Commerce Committee voted
on July 30 to prohibit the federal government from "denying or
rationing" medical care based on studies comparing medical drugs and
devices. The panel passed the Republican-sponsored amendment, despite
objections from Democrats. It is a victory for drug and medical device
makers, which argue that such comparison studies could favor cheaper
treatments. The current House bill sets up a federal center for
comparative effectiveness research. The medical product industry
asserts that comparative effectiveness research will favor older,
cheaper therapies and that the results could be used to deny insurance
coverage. The Senate is expected to include comparative effectiveness
language in its healthcare reform bill. Senate Finance Committee
Chairman Max Baucus (D-Mont.) backs establishment of a nonprofit
corporation for the research, but it would be barred from issuing
practice guidelines or coverage recommendations for insurers.
From "U.S. House Panel Limits Comparative Medical Studies"
Reuters (07/30/09) Dixon, Kim
Report Indicates Providers Would Face Lower
Payments Under Healthcare Reform
Healthcare providers would receive less pay under the proposed
America's Affordable Health Choices Act than they are paid by private
insurers, according to a new analysis by the UnitedHealth Group
subsidiary Lewin Group. Under the legislation, hospitals that accept
Medicare and a new public insurance option would receive 32 percent
less in reimbursement than they receive in private insurance payments
pay for the same care, while physicians would be reimbursed 14 percent
less under the public plan option or Medicare than from private
insurance. However, about 32.6 million formerly uninsured people would
gain health coverage under the bill, and consumers would spend between
20 percent to 25 percent less in premiums under a public plan than
under private insurance.
From "Under Reform, Providers Would Face Lower Payments, Report Says"
Modern Healthcare (07/27/09) Vesely, Rebecca
Clinical Practice
Study Examines Discrepancy Rates of On-Call
Radiology Residents' Interpretations of CTA Studies
Researchers at the University of Vermont School of Medicine attempted
to ascertain the discrepancy rates of radiology residents'
interpretations of emergent CT angiography (CTA) studies of the neck
and circle of Willis and to evaluate any negative clinical outcomes.
The researchers retrospectively reviewed 538 CTA studies that were
ordered after hours and given preliminary readings by residents from
Jan. 1, 2006, through Dec. 31, 2007. Discrepancies between the
residents' interpretations and the final reports of neuroradiology
attending physicians were categorized as either false-negatives or
false-positives, and discrepancies that could impact patient care or
clinical care were deemed major. The general discrepancy rates for neck
CTA and circle of Willis CTA were 13.5 percent and 13.6 percent,
respectively. The misinterpretation rate of first-year residents was
19.5 percent, which was statistically significant versus more
senior-level residents. Fifty-seven false-negative interpretations were
recorded, with stenosis greater than 50 percent and aneurysm being the
most common misses. The most frequent false-positive was overcalling a
potential intracranial aneurysm, while no adverse clinical outcomes
were identified. At 13.6 percent, the discrepancy rate between
interpretations by on-call radiology residents and attending physicians
of neuroradiology CTA studies was higher than anticipated, with a
statistically significant greater miss rate among the most junior
residents. The researchers note that the miss rate could be alleviated
by recent changes with respect to the radiology residents' overnight
call.
From "Discrepancy Rates of On-Call Radiology Residents' Interpretations
of CT Angiography Studies of the Neck and Circle of Willis"
American Journal of Roentgenology (08/01/2009) Vol.
193, No. 2, P. 527; Meyer, Russell E.; Nickerson, Joshua P.; Burbank,
Heather N.; et al.
Researchers Find CT Is Not Useful for Young
Children in the ED With Normal Neurological Examination and History
Researchers have determined that computed tomography (CT) is of little
use to young children presenting to the emergency department (ED) with
headache but normal neurological examination findings and nonworrying
history, as the technique rarely leads to diagnosis or contributes to
immediate management. They studied the records of 364 kids aged two to
five years between July 1, 2003, and June 30, 2006, in a large urban ED
for headache assessment. Seventy-two percent of 306 children with
secondary headaches identified from initial history and physical
examination were thought to be suffering from acute febrile ailments
and viral respiratory tract syndromes. CT scans were carried out in 16
of the 58 kids with no evident central nervous system disorder or
systemic illness diagnosed at presentation, and the scans did not
facilitate diagnosis or management in 15 of the patients. The study
authors write that "a family history often is contributory and should
be part of the evaluation of young children with headache in the ED."
The researchers also caution that the risk of exposure to radiation
from CT scanning is highest in the youngest age group. "Studies such as
this one can contribute to recognition of medical interventions for
which indications need rethinking," they conclude.
From "Headache in Young Children in the Emergency Department: Use of
Computed Tomography"
Pediatrics (07/09) Vol. 124, No. 1, P. e12; Lateef,
Tarannum M.; Grewal, Mandeep; McClintock, William; et al.
RSNA Weekly is a briefing
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