Don't Miss U.K. Presents at
RSNA 2009
Featured at this year's annual meeting in the “Presents” series is the
United Kingdom. “U.K. Presents” will feature the best in radiologic
research from that region, including emergency radiology,
high-resolution CT of the lung and MR fluoroscopy.
The "Presents" series of Integrated Science and Practice sessions
highlighting international advances featured Italy in 2007 and Japan in
2008. Watch for Argentina and China in 2010 and India and Germany in
2011.
Registration and course enrollment for RSNA 2009 are under way at RSNA2009.rsna.org.
Headlines
Leading the News
Research
Technology
Medical-Legal Issues
Leading the News
House Tables Self-Referral Ban in Reform Bill
A self-referral amendment was excluded from the America's Affordable
Health Choices Act of 2009 when it was marked up by the U.S. House
Energy and Commerce Committee on July 31. In July, Rep. Jackie Speier
(D-Calif.) introduced the Integrity in Medicare Advanced Diagnostic
Imaging Act of 2009, which sought to revise Title XVIII of the Social
Security Act to ban "certain advanced diagnostic imaging services" from
the in-office ancillary services exception to the Stark Law's ban on
physician self-referral. Since then, the American College of Radiology
(ACR) and other radiology proponents have been pushing for the
inclusion of Speier's bill into the healthcare reform legislation.
Reps. Bruce Braley (D-Iowa) and Anthony Weiner (D-N.Y.) intended to
offer an amendment on physician self-referral to address the in-office
ancillary services exemption. But the amendment was not presented
during the mark-up, and there is uncertainty as to whether the
amendment will be offered when the committee reconvenes in September.
The ACR will keep working with congressional staff during the current
recess to clarify the issue.
From "House Tables Self-Referral Ban in Reform Bill"
Health Imaging & IT (08/03/09)
Research
New Study Questions Benefits of Popular Spinal
Procedure
A low-risk procedure for repairing fractured bones in the spine known
as vertebroplasty has surged in popularity in the last decade, to an
estimated 100,000 operations last year in the United States. However,
two studies examining the effect of the procedure found no detectable
benefit when compared with a placebo group of patients who received a
sham procedure that only mimicked the real thing. The results are
likely to stir further debate regarding claims that unnecessary or
relatively ineffective medical procedures are contributing to soaring
healthcare costs. Vertebroplasty is usually performed by radiologists,
who inject bone cement directly into a fractured vertebra to shore it
up. The procedure, which is covered by Medicare, ranges in cost from
$2,000 to $5,000. The results, published in the New England Journal of
Medicine, also will focus more attention on comparative-effectiveness
research. Some members of the Society of Interventional Radiology,
which recommends the procedure, disagreed with the study's conclusion.
Dr. Allan Brook, the director of interventional neuroradiology at
Montefiore Medical Center in New York City, contends that patients in
the studies may not have been the ones who could benefit most from the
surgery - those with the most pain. He notes that most patients who
were offered the chance to participate declined to enroll, which he
says suggests that they didn't want to take the chance of being
assigned to the “control” group that received the fake surgery.
From "Benefit of Popular Spinal Surgery is Questioned"
Wall Street Journal (08/06/09) Pereira, Joseph
Radiologists Detect Association Between Mucoid PA
and Bronchiectasis in Children With CF
To determine the severity of bronchiectasis of children with cystic
fibrosis, researchers performed thin-section chest CTs on patients with
cystic fibrosis who were between the ages of 6.6 years and 17.6 years.
Thin-section CT scores were determined objectively on coded images by
multiple raters in a standardized fashion. Microbiologic data were
obtained by means of culture of respiratory secretions by using methods
for differentiation of Pseudomonas aeruginosa (PA) as either nonmucoid
or mucoid. Eighty-three percent of patients showed bronchiectasis of
varying severity. Of 12 potential risk factors, only respiratory
infection with mucoid PA correlated significantly with bronchiectasis.
The research is published in the August issue of Radiology.
From "Association Between Mucoid Pseudomonas Infection and
Bronchiectasis in Children With Cystic Fibrosis"
Radiology (08/01/09) Vol. 252, No. 2, P. 534; Farrell,
Phillip M.; Collins, Jannette; Broderick, Lynn S.; et al.
Researchers Use CT to Assess Hepatic Microvascular
Changes in Liver Cirrhosis
Chinese researchers sought to evaluate the hepatic microvascular
parameters in patients with liver cirrhosis via perfusion computed
tomography (CT) by studying 39 patients with cirrhosis and 29 patients
who were free of liver disease. Twenty-two of the patients afflicted
with cirrhosis had compensated cirrhosis, while 17 had decompensated
cirrhosis. CT cine-scans were acquired over 50 s starting with the
injection of 50 mL of contrast agent, while the Perfusion 3 software
was used to obtain hepatic microvascular parameters, mean transit time
(MTT), and permeability surface area product (PS). The researchers
uncovered statistically significant differences of PS and MTT between
control subjects, patients with compensated cirrhosis, and those with
decompensated cirrhosis. These findings led to the conclusion that
perfusion CT can be used to quantitatively assess the hepatic
microvascular changes in liver cirrhosis patients.
From "Assessment of the Hepatic Microvascular Changes in Liver
Cirrhosis by Perfusion Computed Tomography"
World Journal of Gastroenterology (07/09) Chen,
Mai-Lin; Zeng, Qing-Yu; Huo, Jian-Wei; et al.
MRI Helps Physicians Diagnose, Stage, and Treat
Diabetes
A new study from Massachusetts General Hospital and Harvard Medical
School shows that MRI may help physicians diagnose, stage, and treat
diabetes. Noninvasive imaging can help evaluate beta cell mass, which
is significantly reduced in type 2 diabetes and nearly gone in type 1.
MRI can also detect inflammation of the pancreas and vascular changes
associated with diabetes. Detecting the number of functional beta cells
left could allow physicians to determine the most appropriate
treatments.
From "MRI in Diabetes: First Results"
American Journal of Roentgenology (08/01/2009)
Medarova, Zdravka; Moore, Anna
PET Scans Track Early-Stage Neuroblastoma
A new study finds that for some pediatric patients with early-stage
neuroblastoma, PET scanning is an essential tool for imaging the extent
of the disease. Six percent to 10 percent of childhood cancers in the
United States and 15 percent of cancer deaths in children are
attributed to neuroblastoma, and the National Cancer Institute
estimates that about 650 new neuroblastoma cases are reported each
year. The chief functional imaging agent used to evaluate the disease
in recent years has been 123I-metaiodobenzylguanidine (123I-MIBG), and
although 18F-FDG PET imaging of neuroblastoma is on the increase, the
researchers say there are lingering questions in terms of when and in
which patients 18F-FDG PET is most effective. "Functional imaging plays
an important role in assessing neuroblastoma, from initially diagnosing
and staging the disease to determining whether patients are responding
to treatment or whether the disease has recurred," says Cincinnati
Children's Hospital Medical Center professor Susan E. Sharp, MD. "Our
study found that while 123I-MIBG remains the front-line imaging tool
for neuroblastoma, 18F-FDG PET imaging can benefit some patients,
especially those with early-stage disease." According to the findings,
18F-FDG PET may also be helpful in imaging neuroblastoma tumors that do
not readily absorb 123I-MIBG. The researchers conclude that 123I-MIBG
is superior in assessing stage 4 neuroblastoma, as it can detect and
follow the response to treatment of tumors in the bone or bone marrow
with greater accuracy.
From "123I-MIBG Scintigraphy and 18F-FDG PET in Neuroblastoma"
Journal of Nuclear Medicine (08/09) Vol. 50, No. 8, P.
1237; Sharp, Susan E.; Shulkin, Barry L.; Gelfand, Michael J.; et al.
Technology
Researchers Forecast Cancer Recurrence Using New
Computer Model
A computer model that predicts the recurrence of cancer in a patient
according to how the tumor changes size following the first rounds of
radiation therapy has been developed by researchers at Ohio State
University. The scientists, led by Jian Z. Wang of Ohio State's James
Cancer Hospital and Solove Research Institute, studied 80 female
cervical cancer patients diagnosed with tumors of varying size, and
each patient was treated with radiation. After a few weeks of the
treatment, a magnetic resonance imaging (MRI) scanner was used to
measure the size of the contracting mass. Scientists were able to
calculate the percentage of cancerous cells that survived each daily
dose of radiation and how much time it took each patient's body to
clear away and flush out those dead cells by fitting a mathematical
model to the data obtained via the MRI scans. These numbers could be
used to anticipate whether or not a patient's cancer would recur years
after her treatments. If each daily radiation treatment destroyed at
least 70 percent of a tumor, a woman had a 30 percent better chance of
non-recurrence than someone with a more resistant growth. Likewise,
women whose bodies took longer than 22 days to flush out dead cancer
cells after each treatment were almost twice as likely to experience an
eventual recurrence. Wang suggested that treatment could be improved by
grouping patients according to whether their tumors are radioresistant
or radiosensitive. The researchers will present their findings at the
51st Annual Meeting of the American Association of Physicists in
Medicine in Anaheim, California.
From "Forecasting Cancer Recurrence With New Computer Model"
ScienceDaily (08/04/09)
Breast CT Scanner Could Improve Cancer Screen
Comfort
Breast cancer could be treated with CT scans, according to University
of California Davis researcher John Boone at the recent American
Association of Physicists in Medicine meeting. Boone said the
technology offers as much safety for patients as conventional
mammograms, along with superior tumor detection capability and greater
comfort. The scanning procedure involves a patient lying on her stomach
face down while the breast drops through a hole in the table, and the
scanner spins around the breast. Boone noted that additional work must
be carried out to spot microcalcifications. He plans to use the breast
CT scanner to direct interventional breast cancer treatment procedures
such as a robotic biopsy, cryoablation, and radiofrequency ablation.
Boone is hopeful that the scanner could be especially helpful in the
third procedure, whereby the tumor is killed through the application of
heat, to spare some women from lumpectomy and follow-up radiation
treatment. At the same conference, professor Michael O'Connor of the
Mayo Clinic discussed molecular breast imaging (MBI) via gamma cameras,
which was determined in a study to detect a larger number of cancers
than mammography scans. In the MBI procedure, patients intravenously
receive a small amount of radioisotopes that collect in breast tumors.
From "Breast CT Scanner Could Improve Cancer Screen Comfort"
U.S. News & World Report (08/02/09) Doheny, Kathleen
Researchers Develop Enhanced Radiopharmaceuticals
for Imaging Bone Cancer
Enhanced radiopharmaceutical agents to spot and treat bone cancer have
been developed by Philip Blower and colleagues from King's College
London and Barts and The London School of Medicine. The researchers
created a dual function molecule containing a bisphosphonate to target
bones and a radio-labeled portion to image in only two steps. Treating
bone cancer involves the injection of 99m-technetium or 188/186-rhenium
bisphosphonates. The bisphosphonates collect in the bone and treat the
area, while radio-labeled metals help with single photon emission
computed tomography imaging. Blower says that technetium
bisphosphonates' constitution as compound mixtures complicates
establishing each component's role, while the easy degradation of
rhenium complexes by enzymes leads to reduced bone uptake and higher
radiation doses in soft tissue. "Our motivation was to reduce these
effects so that doctors are more likely to prescribe this form of
treatment," Blower says. "We would like ultimately to be able to give
doses that are high enough not just to relieve pain but to treat the
cancer and extend life expectancy." The bisphosphonates both chelate
the metal and bind to bone in current treatments, and Blower segregated
the bisphosphonate and metal with a spacer, which bound tightly to the
metal so that the bisphosphonate was free to target bone. "From a
chemical perspective [the molecules are] far superior to the agents we
have already because we have a single compound and not a mixture of
really unknown compounds, and once we know what the chemistry is, it is
under our control and we can optimize it and make it do what we want to
do by changing the structure," notes Blower.
From "Image Is Everything"
Chemical Science (08/03/2009) Coates, Ian
Medical-Legal Issues
Federal Legislation Proposes $163 Million for
Domestic Mo-99 Production
Bipartisan legislation introduced by U.S. Rep. Edward J. Markey
(D-Mass.) would allocate $163 million over five years to reestablish
molybdenum-99 (Mo-99) manufacturing capabilities in the United States
and eliminate the export of highly enriched uranium for medical isotope
production. The country has depended on foreign sources for Mo-99 since
the closure of the last domestic supplier 20 years ago. About 16
million nuclear imaging procedures performed annually in the United
States use technetium-99m, a medical isotope derived from Mo-99;
however, Mo-99's 66-hour half-life makes stockpiling impossible. U.S.
nuclear imaging providers rely on two aging nuclear reactors - one in
Ontario and one in the Netherlands - for about 80 percent of their
Mo-99 supply, but the reactors have both shut down to address safety or
maintenance issues. Markey stated in a release that "we cannot afford
to have American patients held hostage to old and faulty nuclear
reactors in other countries." Society of Nuclear Medicine President
Michael Graham said in an interview that a federal infusion of money to
build domestic Mo-99 production capacity "would be a first and major
step" toward solving the shortage of medical isotopes. Operators of the
University of Missouri Research Reactor announced plans last year to
tweak their facility to generate sufficient Mo-99 to meet about 50
percent of U.S. demand. Another provision of Markey's legislation would
seal a loophole in U.S. nuclear nonproliferation law that permits the
export of atomic bomb-grade highly enriched uranium for medical isotope
production, by blocking the export of such material in seven to 10
years.
From "Federal Legislation Proposes $163 Million for Domestic Mo-99
Production"
Diagnostic Imaging (07/28/09) Brice, James
RSNA Weekly is a briefing
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