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Leading the News
DTI Helps Identify Link Between Concussions and Brain Tissue Injury
A strong connection between concussions and brain injury has been drawn by researchers at Yeshiva University's Albert Einstein College of Medicine. The present concussion diagnosis methodology cannot reveal who will recover quickly and who will experience the most severe impairment of executive function from head injuries. The study suggests that diffusion tensor imaging (DTI) could offer a more objective way to diagnose concussions, ascertain whether brain injury has actually taken place following trauma, and possibly anticipate the lasting loss of executive function. DTI measures the diffusion of water in the brain's white matter to detect subtle changes. The research involved 20 people known to have received concussions and a control group of 20 healthy subjects. Magnetic resonance (MR) and computed tomography (CT) scanning was performed on both groups, along with a series of neuropsychological tests to evaluate executive function. Brain imaging and testing was performed on all concussion patients within two weeks of their injuries. Reviewers who assessed the MR and CT images of patients and controls uncovered no abnormalities in either group, but the neuropsychological results indicated that the people who suffered concussions performed substantially worse on executive function tests than the controls. Abnormal brain regions were detected in 15 of the concussion patients through DTI, which found no abnormalities in the controls. In addition, the presence of major areas of structural damage in concussion patients anticipated low scores on their executive function tests. "By detecting brain injury early with DTI and then initiating cognitive rehabilitation therapies for those patients, we may be able to limit the effects of concussions," concluded Einstein researcher Michael L. Lipton, MD, PhD. The research is published in the September 2009 issue of Radiology.
From "Diffusion-Tensor Imaging Implicates Prefrontal Axonal Injury in Executive Function Impairment Following Very Mild Traumatic Brain Injury"
Radiology (09/01/08) Vol. 252, No. 3, P. 816; Lipton, Michael L.; Gulko, Edwin; Zimmerman, Molly E.; et al.
Research
Pulmonary CTA Can Identify Conditions Other Than Pulmonary Embolism
Pediatric pulmonary computed tomography angiography (CTA) can identify alternative conditions to pulmonary embolism (PE), and a group of researchers conducted a study to evaluate the frequency and types of alternative diagnoses identified in children with clinically suspected but excluded PE. A pair of radiologists reviewed the pulmonary CTA studies for all consecutive pediatric patients with clinically suspected PE who had pulmonary CTA from July 2004 to March 2008. The radiologists performed a systematic review of 96 diagnostic-quality pulmonary CTA studies without proof of PE from 89 patients, seeking a possible alternative diagnosis in the lungs, mediastinum, central airways, cardiovascular system, pleura, and skeleton. Of the 89 patients that lacked CTA evidence of PE, 28 were male and 61 female. The average age of patients was 13.4 years, plus or minus 4.7 years. Forty-one percent of the 96 pulmonary CTA studies without evidence of PE exhibited normal results, while 59 percent had alternative diagnoses, including pneumonia, atelectasis, and malignant disease. Each pulmonary CTA study without evidence of PE exhibited congenital heart disease, pulmonary hypertension, and pericardial effusion, while one each exhibited pulmonary nodules, rib fractures, right atrial thrombus, and fat embolism. Seventeen patients were identified as having pleural effusions associated with coexisting abnormalities, including eight with pneumonia, eight with atelectasis, and one with rib fractures. The researchers concluded that pneumonia and atelectasis were the two most common alternative diagnoses.
From "Beyond the Pulmonary Arteries: Alternative Diagnoses in Children With MDCT Pulmonary Angiography Negative for Pulmonary Embolism"
American Journal of Roentgenology (09/01/2009) Vol. 193, No. 3, P. 888; Lee, Edward Y.; Kritsaneepaiboon, Supika; Zurakowski, David; et al.
Researchers Compare Use of Sonography and Scintigraphy in the Evaluation of Gallbladder Function
In a recent study, scintigraphy was found to estimate a lower ejection fraction (EF) as well as a wider EF variability than sonography in the evaluation of gallbladder function. The study also found that scintigraphy could not be performed in 5 percent of the participants because of nonfilling of the gallbladder. Additionally, the use of sonography to estimate gallbladder EF was less time-consuming and less costly. With these techniques, the range of normal gallbladder EFs should be adjusted for the technique used. These conclusions were reached following a study of 20 healthy volunteers who were evaluated with sonography and scintigraphy to estimate gallbladder EF simultaneously.
From "Comparison of Sonography and Scintigraphy in the Evaluation of Gallbladder Functional Studies With Cholecystokinin"
Journal of Ultrasound in Medicine (09/01/09) Vol. 28, No. 9, P. 1143; Barr, Richard G.; Kido, Taka; Grajo, Joseph R.
DCE MRI Finds Correlation Between Pancreatic Microcirculation and Type 2 Diabetes
Dynamic contrast material-enhanced (DCE) MRI is able to effectively image endothelial permeability and decreased plasma volume in the pancreas in patients with coronary artery disease (CAD) with type 2 diabetes. Researchers using DCE MRI also found that patients suffering from diabetes for more than 10 years showed further increase of endothelial permeability. DCE MRI was used with a two-dimensional T1-weighted fast low-angle shot sequence in oblique axial planes to assess pancreatic microcirculation in patients with and without type 2 diabetes. Microcirculatory quantitative parameters— including volume transfer constant, extravascular extracellular space volume per unit volume of tissue, and plasma volume per unit volume of tissue—were compared by using independent-sample t tests. The research is published in the September 2009 issue of Radiology.
From "Correlation Between Pancreatic Microcirculation and Type 2 Diabetes in Patients With Coronary Artery Disease"
Radiology (09/01/09) Vol. 252, No. 3, P. 704; Yu, Chih-Wei; Shih, Tiffany Ting-Fang; Hsu, Chao-Yu; et al.
Researchers Establish DVH Parameters for Predicting Local Control in MRI-Guided Cervical Cancer Brachytherapy
A group of researchers set out to explore the value of dose-volume histogram (DVH) parameters for predicting local control in magnetic resonance image-guided brachytherapy (IGBT) for cervical cancer patients. Some 141 patients with cervical cancer were treated with 45-50 Gy external beam radiotherapy combined with four times 7 Gy IGBT with or without cisplatin. Gross tumor volume (GTV), high-risk clinical target volume (HRCTV), and intermediate-risk clinical target volume were contoured, and DVH parameters were evaluated. Doses were then converted to the equivalent dose in 2 Gy through the application of the linear quadratic model, and groups were defined for patients with or without local recurrence (LR) in the true pelvis for tumor size at diagnosis or greater than 5 centimeters and for tumor size response at IGBT of 2 centimeters to 5 centimeters or greater than 5 centimeters. The researchers recorded 18 LRs, and the most critical DVH parameters correlated with LR were the D90 and D100 for HRCTV. They observed a rise in local control in IGBT in cervical cancer patients with the dose delivered, which can be expressed by the D90 and D100 for HRCTV. Local control rates greater than 95 percent can be reached if the D90 for HRCTV is 87 Gy or higher.
From "Dose-Volume Histogram Parameters and Local Tumor Control in Magnetic Resonance Image-Guided Cervical Cancer Brachytherapy"
International Journal of Radiation Oncology, Biology, Physics (09/09) Vol. 75, No. 1, P. 56; Dimopoulos, Johannes C.A.; Lang, Stefan; Kirisits, Christian; et al.
Technology
Modified Virus Makes Cancer Cells Fluoresce to Improve Tumor Detection
Okayama University scientists have developed a modified cold virus, called OBP-401, that can enter all cells and replicate only in those that have activated telomerase, an enzyme expressed in cancer cells. The researchers have modified the virus to carry green fluorescent protein (GFP), allowing researchers to image cancer cells. In a recent study published in the Proceedings of the National Academy of Sciences, Robert Hoffman - a surgeon at the University of California, San Diego - and colleagues used the virus to image tumors that were scattered throughout the bodies of mice. They were then able to perform surgery on the tumors by exposing them to light of the proper wavelength and viewing them through a filter designed to detect GFP. The team was not yet able to reach single-cell precision, but they were able to see and remove small cancerous areas that would otherwise have remained unnoticed.
From "A Beacon to Guide Cancer Surgery"
MIT Technology Review (08/28/09) Humphries, Courtney
Graphics Chips Speed Up Medical Imaging
Graphics processing units (GPUs) sold by Advanced Micro Devices (AMD) and Nvidia are finding increasing use in medical imaging, where they can accelerate the processing of data and furnish results faster. TechniScan software engineer Jim Hardwick says an Nvidia graphics chip could produce a three-dimensional (3D) image of a breast scanned by an ultrasound imaging device his company is developing in about half the time that a traditional microprocessor would take. He notes that it is critical that physicians and patients get the results of imaging scans as expediently as possible. "They want to be able to look at the image and talk before [the patient] leaves the office," Hardwick says. The cores on GPUs far outnumber those on central processing units (CPUs), offering parallel data stream processing and faster computing speed. University of Pittsburgh researchers determined in a 2008 study that an Nvidia GPU generated much faster computerized-tomography images of lung cancer than was possible with a CPU, leading the scientists to conclude that "the benefit of using GPUs' processing power can be widely appreciated in medical image devices and diagnosis." The speed of Nvidia's GPUs is appealing to health professionals, who have come to depend on medical-imaging equipment to supply increasingly detailed pictures of diseases and other maladies. Experts say that machines that furnish 3D views are particularly useful because they sometimes allow doctors to detect ailments that do not register on other machines, but such equipment demands formidable data processing power. Lynda Domogalla of Barco says her company sells a 3D-capable machine that uses AMD GPUs to radiologists. She notes that intensive image processing is beyond the capacity of CPUs, but with GPUs "it's on a screen very quickly so the radiologist doesn't spend time waiting for the display." AMD's Patti Harrell speculates that within a decade, "you're going to find [GPUs] in virtually all of the medium and large-scale scanning and screening types of devices."
From "Graphics Chips Speed Up Medical Imaging"
San Jose Mercury News (CA) (08/31/09) Johnson, Steve
Medical-Legal Issues
Studies Show Cost Advantages of Retail Clinics
A pair of studies appearing in the September issue of Annals of Internal Medicine show that clinics in drug stores provide care for minor ailments on par with, or better than, other medical facilities at significantly lower costs. For the studies, researchers analyzed data on 2,100 patients treated for middle ear infections, sore throats, and urinary tract infections at retail clinics in Minnesota, where retail clinics are well-established. The average cost for treatment at clinics was $110 while the average cost was $156 at an urgent care facility, $166 at a doctor's office, and $570 at an emergency department.
Approximately 980 retail clinics existed in the United States as of August 2008, a tenfold increase since 2006. But retail clinics exist in only 33 states, and in those that have them, 88.4 percent are in urban areas. Just 10.6 percent of the U.S. population lives within a five-minute drive of a clinic and 28.7 percent lives 10 minutes away.
From "Drive-Thru Medical: Retail Health Clinics' Good Marks"
Time (09/01/09) Kluger, Jeffrey
Clinical Practice
EMRs Integrated With e-Scans and Radiology Reports Prove to Be a Money-Saver
Health reform proponents who say that electronic medical records (EMRs) can save health providers money have seen their argument bolstered by HealthPartners, which has realized $430,000 in savings over the past year by including electronic X-rays, magnetic resonance imaging, computerized tomography scans, and radiology reports in patients' e-records. About 25 percent of that amount was saved by eliminating the need to transcribe radiologist reports, while the rest of the savings stemmed from no longer needing to pay for film storage. "The benefits of being paperless include increased efficiency because images can be available quickly at multiple locations and they cannot be lost," said Kim LaReau with HealthPartners' Regions Hospital in St. Paul, Minnesota. The e-records have been available to Regions physicians, along with HealthPartners' 25 medical clinics around the Twin Cities. HealthPartners intends to expand the system to its facilities in central Minnesota and Wisconsin in 2010. Increasing numbers of health providers around the United States are employing such systems for radiology records, including Park Nicollet Health Services of St. Louis and the Mayo Clinic.
From "HealthPartners Saves Money With E-records"
Minneapolis-St. Paul Business Journal (08/28/09) Newmarker, Chris
LUNA Not Found to Improve Outcomes for Women With Chronic Pelvic Pain
Researchers have found that laparoscopic uterosacral nerve ablation (LUNA) does not improve pain outcomes for women with chronic pelvic pain when compared to laparoscopy without pelvic denervation. This conclusion was based on a controlled trial of 487 women with chronic pelvic pain lasting longer than six months. Women were assigned to undergo either LUNA or traditional laparoscopy. Median follow up time was 69 months. At that time, LUNA was not found to improve severe pain, dysmenorrhea, dyspareunia, or quality of life compared to laparoscopy.
From "Laparoscopic Uterosacral Nerve Ablation for Alleviating Chronic Pelvic Pain"
Journal of the American Medical Association (09/02/09) Vol. 302, No. 9, P. 955; Daniels, Jane; Gray, Richard; Hills, Robert K.; et al.
Radiologists Offer Reasons for Increasing and Unnecessary Use of Imaging Services
In an effort to determine the reasons behind the increasing utilization of imaging, researchers at the University of Oslo in Norway surveyed 374 radiologists. Participants were asked to rate potential causes of increased investigation volume as well as unnecessary investigations. The five highest reasons given for increasing use of radiology investigations were new radiological technology, higher patient demand for imaging, clinicians' intolerance for uncertainty, expanded clinical indications, and availability. "Over-investigation" and "insufficient referral information" were cited as the most frequent causes of unnecessary imaging.
From "What Causes Increasing and Unnecessary Use of Radiological Investigations? A Survey of Radiologists' Perceptions"
BMC Health Services Research (09/09) Vol. 9, No. 155, Lysdahl, Kristin B.; Hofmann, Bjorn M.
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