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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 juvenile ossifying fibroma (JOF).
JOF is a rare benign fibro-osseous tumor that typically arises from the facial bones of young patients. Despite its slow growth, JOF may behave in a locally aggressive manner and invade adjacent anatomic structures.
In this AFIP case, authors Heun J. Chang, M.D., and colleagues discuss how the clinical and imaging characteristics of JOF may not be easily recognized and detail the features—on radiographs, CT and MR—that should suggest JOF.
Read more about “Juvenile Ossifying Fibroma of the Calvaria” in RadioGraphics.
Leading the News
New Imaging Devices at NIHCC Automatically Record Radiation Exposure
Radiology and Imaging Sciences at the National Institutes of Health Clinical Center (NIHCC) has acquired equipment designed to record radiation dose exposure in a patient's hospital-based electronic medical record. Electronic radiology information systems in hospitals often do not collect or report radiation exposures from CT and PET scanners. However, NIHCC hopes to encourage the adoption of such systems. NIHCC believes the adoption of these systems is of particular importance because, as Dr. Ronald Neumann, chief of nuclear medicine and deputy associate director for imaging sciences at the Clinical Center points out, "The National Council on Radiation Protection and Measurements reported recently that Americans received seven times more radiation exposure from medical tests in 2006 than was the case in the 1980s. CT and cardiac nuclear medicine studies accounted for much of this increased medical radiation exposure." If NIHCC's efforts are successful, radiation dosage could become a standard element of a universal medical record used to assess radiation risk from life-long medical testing. Additionally, NIHCC will require that newly purchased equipment allow patients to record their radiation dose exposure on their personal health record. In order to aid these efforts, NIHCC's imaging program will work with vendors that supply Clinical Center imaging equipment to develop software tools to extract the examination type, date, and radiation dose exposure from CD-ROMs currently used to provide patients with copies of their diagnostic imaging studies. This information can then be uploaded to a personal health record.
From "New Diagnostic Imaging Devices at the NIH Clinical Center to Automatically Record Radiation Exposure"
NIH News Release (08/17/09)
Research
Total Body or Abdominal Irradiation Increases Risk of Diabetes in Childhood Cancer Survivors
The use of total body or abdominal irradiation in childhood cancer survivors increases the risk of diabetes, scientists suggest. This risk appears to be unrelated to body-mass index (BMI) or physical inactivity. Researchers analyzed data on 8,599 patients from the Childhood Cancer Survivor Study, which involved long-term survivors diagnosed between 1970 and 1986. Data also included 2,936 randomly selected siblings of the survivors. The mean age for survivors was 31.5 years, and 33.4 years for the siblings. After adjustment for factors such as BMI, age, sex, and insurance, survivors were found to be 1.8 times more likely than siblings to report diabetes. Adjusted models showed an increased risk of diabetes associated with total body irradiation, abdominal irradiation, and younger age at diagnosis.
From "Diabetes Mellitus in Long-Term Survivors of Childhood Cancer"
Archives of Internal Medicine (08/10/09) Vol. 169, No. 15, P. 1381; Meacham, Lillian R.; Sklar, Charles A.; Li, Suwen; et al.
Fatigue Related to Radiotherapy May Be Caused by Inflammation
Patients who experience fatigue during radiotherapy for breast and prostate cancer may be reacting to the activation of the proinflammatory cytokine network, reports the American Association for Cancer Research. The conclusion - reached by Julie Bower, PhD, an associate professor in the Department of Psychology and Psychiatry at the University of California, Los Angeles, and colleagues - is based on an observational study of 28 patients with breast cancer and 20 patients with prostate cancer, all early-stage. Dr. Stephen Hahn, chair of the Department of Radiation Oncology at the University of Pennsylvania, said that the study represents an important step towards understanding the biological basis for fatigue.
From "Fatigue Related to Radiotherapy May Be Caused by Inflammation"
American Association for Cancer Research (08/18/09)
ASIR Allows Radiologists to Lower Radiation Dose From CT Scans
Researchers have developed a new technique, called adaptive statistical iterative reconstruction (ASIR), that may enable radiologists to reduce patient radiation dose from CT scans by up to 65 percent. The ASIR technique allows radiologists to adjust images to improve quality, sharpening it and reducing the amount of radiation needed to produce a clear image. CT scans using the new ASIR method and the standard dose method were performed on 12 patients. The researchers observed "nearly identical image quality using the reduced dose CT method with ASIR compared to the standard dose CT method without ASIR."
From "Iterative Reconstruction Technique for Reducing Body Radiation Dose at CT: Feasibility Study"
American Journal of Roentgenology (09/01/2009) Vol. 193, No. 3, P. 764; Hara, Amy K.; Paden, Robert G.; Silva, Alvin C.; et al.
RFA Provides Treatment Alternative for Local Tumor Control in Renal Cell Carcinoma Patients
Radiofrequency ablation (RFA) provides a treatment alternative for local tumor control in patients with multiple, small metastatic pulmonary lesions from renal cell carcinoma, provided they are unsuitable for pulmonary resection. This conclusion was based on a nine-patient study in which the participants were treated with percutaneous RFA under fluoro-CT guidance. CT scans were performed at 1 month after the procedure and at 3-monthly intervals. No patient died within 30 days of the procedure. Five of the 12 RFA sessions resulted in a pneumothorax and three required insertion of a Pleurocath. One patient had a bronchopulmonary fistula with an associated small pleural effusion and one patient had pneumonia. Of the 25 ablations performed, 56 percent of the lesions decreased in size, one was stable in size, and 36 percent increased in size.
From "Use of Percutaneous Radiofrequency Ablation in Pulmonary Metastases From Renal Cell Carcinoma"
Annals of Surgical Oncology (08/09) Huo, Andrew Shu Yan; Morris, David Lawson; King, Julie; et al.
Technology
PET/CT Staging More Effective for Lung Cancer in Most Cases
A group of researchers set out to determine whether whole-body positron emission tomography and computed tomography (PET-CT) combined with cranial imaging correctly upstages cancer in more preoperative patients with early-stage non-small cell lung cancer (NSCLC) than does conventional staging and cranial imaging. The clinical trial involved eight hospitals and five PET-CT facilities in academic institutions. Qualifying patients were over 18, had histologic or cytologic proof of stage I, II, or IIIA NSCLC according to radiography and thoracic CT, and had a resectable tumor. PET-CT was applied to 170 patients while 167 received conventional staging, or abdominal CT and bone scans. Cancer was correctly upstaged in 23 of 167 PET-CT recipients and 11 of 162 conventional staging recipients, thus obviating surgery. Disease was incorrectly upstaged in 8 PET-CT recipients and one conventional staging recipient and incorrectly understaged in 25 PET-CT and 48 conventional staging patients. Fifty-two PET-CT recipients and 57 conventional staging recipients had passed away by the third year of the study. The researchers concluded that more patients with mediastinal and extrathoracic disease are identified with PET-CT and cranial imaging - and are thus spared stage-inappropriate surgery - than with conventional staging, although the procedure also incorrectly upstaged disease in more patients.
From "Positron Emission Tomography in Staging Early Lung Cancer"
Annals of Internal Medicine (08/18/09) Vol. 151, No. 4, P. 221; Maziak, Donna E.; Darling, Gail E.; Inculet, Richard I.; et al.
Medical-Legal Issues
Medicare Demonstrations Show Paying for Quality Health Care Pays Off
The Centers for Medicare & Medicaid Services (CMS) has announced results for a pair of quality demonstration projects for physicians and one for hospitals, as well as the start of three more value-based purchasing projects. The demonstrations continue to provide strong evidence that offering financial incentives for improving or delivering high quality care boosts quality and can reduce the growth in Medicare expenditures. The CMS said that all 10 doctor groups participating in the Physician Group Practice Demonstration accomplished benchmark performance on at least 28 of the 32 measures in its third year. Over 560 of 610 participating small and solo physician practices are earning rewards for performance on 26 quality measures under the new health information technology-based Medicare Care Management Performance Demonstration, which tracks the quality of preventive care and care given to patients with chronic illnesses. Meanwhile, the Hospital Quality Incentive Demonstration exhibits continued quality improvement among participating facilities. The CMS will make $12 million in bonus payments to 225 hospital providers as part of a continuing value-based purchasing study that has resulted in improved care across 30 standardized clinical practices. The CMS announced that 14 hospitals in total would partner with physicians in two separate gainsharing demonstrations and that approximately 200 nursing homes in three states would participate in a value-based purchasing initiative.
From "Medicare Demonstrations Show Paying for Quality Health Care Pays Off"
Centers for Medicare & Medicaid Services (08/17/09)
Clinical Practice
Digital Mammography Finds More Breast Cancers
The switch from film mammography to digital mammography has led to an increase in breast cancer detection rates, report Drs. Fred S. Vernacchia of the San Luis Diagnostic Center in San Luis Obispo, Calif., and Zachary G. Pena, of California State University, who note that up to 70 percent of screening facilities in the United States are still using film-screen mammography. Vernacchia and Pena analyzed data on 4,838 mammography screenings done in the year before they converted to digital mammography and on more than 21,500 screenings done over the next three years. They found that the number of cancers detected increased from between 4.1 to 4.5 cancers per 1,000 women imaged prior to the switch to 7.9 cancers per 1,000 women the year after introduction.
From "Digital Mammography: Its Impact on Recall Rates and Cancer Detection Rates in a Small Community-Based Radiology Practice"
American Journal of Roentgenology (08/01/2009) Vol. 193, No. 2, P. 582; Vernacchia, Fred S.; Pena, Zachary G.
FSE-Cube Is Effective in 3T MR Knee Imaging
Fast spin-echo sequence (FSE)-Cube is just as effective as traditional MRI protocol for imaging cartilage lesions, cruciate ligament tears, collateral ligament tears, meniscal tears, and bone marrow edema within the knee joint at 3T, according to a study published in the August 2009 issue of Radiology. The study included FSE-Cube and routine 3T MRI protocol performed on 100 symptomatic patients who subsequently underwent arthroscopic knee surgery. Two musculoskeletal radiologists independently reviewed all MRI studies. During the first review, routine MRI protocol was used to detect lesions and tears. The second review used FSE-Cube with multiplanar reformations.
From "Knee Joint: Comprehensive Assessment With 3D Isotropic Resolution Fast Spin-Echo MR Imaging"
Radiology (08/01/09) Vol. 252, No. 2, P. 486; Kijowski, Richard; Davis, Kirkland W.; Woods, Michael A.; et al.
Industry News
Medical Imaging Is Under the Gun in Health-Reform Push
Proposed by the White House and being pushed in the U.S. Congress are health-reform proposals that could seriously impact business for medical imaging equipment manufacturers by reducing Medicare payments to doctors and limiting the number of scans carried out. A June 2008 report from the Government Accountability Office (GAO) estimated that Medicare spending for physician imaging services more than doubled to $13.8 billion between 2000 and 2006. Health-reform bills in the House of Representatives would increase the assumed rate at which computed tomography scanners, magnetic resonance imaging scanners, and similar machines are used from 50 percent to 75 percent. Critics say Medicare would pay less per scan when factoring in the higher utilization rate. The House plan also urges a reduction in government payments for additional scans performed on nearby body parts. The major imaging-machine makers have argued that such moves would have negative consequences for patients and rural hospitals, and that rapid growth for medical scanning was already curtailed by prior rules passed by Congress through the Deficit Reduction Act of 2005. In rural facilities, imaging machines are likely to be used less frequently than in urban hospitals. A September 2008 GAO report found that Medicare expenses for physician imaging services declined 12.7 percent between 2006 and 2007, but utilization rates still went up, contradicting industry and physician suggestions that patient access would be reduced by lowering fees. GAO stated in the study that the Centers for Medicare & Medicaid Services "remains concerned about the high volume of imaging services and their value to beneficiaries."
From "Medical Imaging Under the Gun in Health-Reform Push"
Dow Jones Newswires (08/14/09) Kamp, Jon
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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