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From RSNA
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
From RSNA
September RSNA News Now Online
The full version of the September issue of RSNA News is now available online.
Highlights include:
PET/CT Predicts Early Response to Chemotherapy
Patients with soft-tissue sarcomas might not have to wait as long to see whether the first round of chemotherapy has proven effective thanks to new research showing that PET/CT can be used as early as one week after a single treatment cycle to determine whether the drugs are killing the cancer.
EHRs Help Track Cumulative Radiation Dose
Despite growing concern over CT-related radiation exposure, measuring risks of cumulative exposure from CT imaging is not a standard part of routine practice for most ordering physicians-something that could change with more widespread use of electronic health records (EHRs).
RSNA 2009 Spotlights Integrated Healthcare Technology
RSNA has taken on a principal role in setting universal operability standards for medical imaging just as the government launches its $20 billion initiative to expand health information technology (HIT) and achieve a nationwide electronic health record (EHR).
Radiologists Must Take Care of Their Vision, Study Shows
New research from the University of Maryland School of Medicine is raising awareness about the visual accuracy of radiologists as well as questions about the need to create vision requirements within the specialty.
Novel Myocardial Tagging Technique Stems from RSNA Grant
Cardiac imaging took a major step forward when Elliot R. McVeigh, M.D., Ph.D., used a $90,000 RSNA GE Medical Systems/RSNA Research Scholar Grant that enabled a groundbreaking, two-year study of myocardial tissue tagging - the first noninvasive method of measuring strain in the myocardium.
Leading the News
PET Identifies Differences in Brain Chemistry of People With ADHD
Researchers have identified new differences in the brain chemistry of people with attention deficit hyperactivity disorder (ADHD), finding that ADHD patients lack key proteins that allow them to experience a sense of reward and motivation. The researchers compared brain scans of 53 adult ADHD patients who had never received treatment with those from 44 people who did not have the condition. They used positron emission tomography (PET) to focus on how the participants' brains handled the chemical dopamine, a key regulator of mood, specifically focusing on dopamine receptors and transporters, without which dopamine cannot function effectively to influence mood. ADHD patients had lower levels of both proteins in both the nucleus accumbens and midbrain. Patients with more pronounced ADHD symptoms had the lowest levels of the proteins in these areas of the brain.
From "Evaluating Dopamine Reward Pathway in ADHD"
Journal of the American Medical Association (09/09/09) Vol. 302, No. 10, P. 1084; Volkow, Nora D.; Wang, Gene-Jack; Kollins, Scott H.; et al.
Research
Study Supports Protocol for Cardiac CT
A recent study found that adenosine stress CT may be as effective as single-photon CT (SPECT) in detecting stress-induced myocardial perfusion. Researchers analyzed data from 34 patients who underwent invasive angiography and a nuclear stress test. On a per-vessel basis, the researchers found that CT perfusion had a sensitivity of 79 percent and a specificity of 80 percent for detecting stenosis of at least 50 percent on invasive angiography, compared to 67 percent and 83 percent, respectively, for SPECT. CT angiography during adenosine also had a per-vessel sensitivity of 96 percent and a specificity of 73 percent for detecting stenosis of at least 70 percent.
From "Adenosine-Induced Stress Myocardial Perfusion Imaging Using Dual-Source Cardiac Computed Tomography"
Journal of the American College of Cardiology (09/15/2009) Vol. 54, No. 12, P. 1072; Blankstein, Ron; Shturman, Leon D.; Rogers, Ian S; et al.
PET/CT Scans Help Detect Recurring Prostate Cancer Earlier
Recurring prostate cancer could be detected sooner with positron emission tomography (PET)/computer tomography (CT) scanning that uses the imaging agent choline than with conventional scanning in certain patients who have undergone radical prostatectomy, according to a new study. As many as 30 percent of patients who have had their prostates surgically removed have suffered a recurrence of prostate cancer within five years. If the presence of prostate-specific antigen (PSA) is detected after radical prostatectomy, then imaging methods are used to ascertain whether and precisely where the cancer has returned. The study looked at PET/CT scans with choline, which has demonstrated greater accuracy in spotting recurrent prostate cancer than CT, magnetic resonance imaging, and bone scintigraphy. The study focused on 190 patients who had undergone radical prostatectomy and exhibited biochemical relapse in follow-up examinations. Not only did the research reveal that whole body PET/CT imaging with choline is substantially better than conventional imaging techniques in detecting prostate cancer in patients with biochemical relapse after radical prostatectomy, but it discovered a strong association between PET/CT detection of recurrent cancer, PSA levels, and PSA kinetics. The results suggest that only patients with a strong likelihood of having a positive scan based on PSA levels and kinetics should undergo choline PET/CT scans.
From "Influence of Trigger PSA and PSA Kinetics on 11C-Choline PET/CT Detection Rate in Patients With Biochemical Relapse After Radical Prostatectomy"
Journal of Nuclear Medicine (09/09) Vol. 50, No. 9, P. 1394; Castellucci, Paolo; Fuccio, Chiara; Nanni, Cristina; et al.
Ultrasonography Helps Predict Breast Cancer Recurrences and Metastasis
Lymph node ultrasonography (US) can detect disease recurrence and help predict the development of distant metastases in women who have had surgery for breast cancer, according to a study published in the September 2009 issue of Radiology. Researchers performed lymph node US on 1,817 women who had undergone breast surgery. Following at least 12 months of follow-up, the researchers found that 39 of the patients had lymph node recurrence (LNR), of whom 11 had ipsilateral LNR only. For detecting LNR, ultrasonography had a sensitivity of 76.9 percent, specificity of 98.7 percent, and accuracy of 98.2 percent, as well as a positive predictive value of 55.6 percent and a negative predictive value of 99.5 percent. Distant metastases were also found to occur more in patients with ipsilateral LNR than in those without.
From "US Surveillance of Regional Lymph Node Recurrence After Breast Cancer Surgery"
Radiology (09/01/09) Vol. 252, No. 3, P. 673; Moon, Hee Jung; Kim, Min Jung; Kim, Eun-Kyung; et al.
Technology
Does Proton Therapy Have a Future as a Mainstream Treatment for Cancer?
In certain U.S. cities, cancer patients are being treated with proton therapy, a relatively new form of radiation treatment. Proton therapy involves targeting positively charged beams more precisely at tumors and largely sparing healthy tissues from side effects. Although the treatment has considerable potential, Kevin Camphausen with the National Cancer Institute's (NCI) Radiation Oncology Branch cautions, "I don't think its use should become widespread until we can validate where it's needed, and where it has the greatest potential benefit for patients." Norman Coleman with NCI's Radiation Research Program agrees that "when you have something that is so precise with such sharp edges, you need to make sure that it's also accurate. This requires being certain that the target is hit as planned on the computer, including accounting for the uncertainties in diagnostic imaging, reproducibility in patient setup, and internal organ motion." Experts at NCI and around the country note that there are few published randomized control trials (RCTs) to demonstrate that proton therapy's performance trumps that of standard radiation treatment in terms of improving patients' quality of life or increasing survivability. Nancy Mendenhall with the University of Florida Proton Therapy Institute says that proton therapy is accessible to fewer than 1 percent of patients in the country. There currently are seven proton therapy centers in the United States, and others are either being planned or constructed. Mendenhall is convinced that, at the moment, it should be enough to compare outcomes of proton therapy with previously published studies of x-ray therapy, at least until there has been deeper investigation into the treatment capabilities of proton therapy, more treatment slots have been made available, and confidence in the technology and tools that are used to evaluate outcomes for the comparison group has increased. The position of those at NCI is that, while this technology is very promising, the gold standard for research is still an RCT. “We would encourage patients who are looking into proton therapy for their particular disease to seek out an NCI-sponsored clinical trial at one of the facilities that provides the treatment,” says Dr. Bhadrasain Vikram, chief of the Clinical Radiation Oncology Branch at NCI.
From "Proton Therapy for Cancer: A New Technology Brief"
National Cancer Institute Bulletin (09/08/09) Vol. 6, No. 17, P. 8; del Pino, Brittany Moya
Imaging Technology Advances Early Treatment of Psychotic Disorders
Researchers scanned the brains of 18 patients at high risk for psychosis, using a novel high-resolution application of fMRI technology. Using this technique, the researchers found that 70 percent of patients who went on to develop disorders such as schizophrenia had very high activity in a region of the hippocampus known as the CA1 subfield. Researchers are hopeful that, following the results of this study, this technology could be used to improve diagnosis of psychotic disorders in early stages.
From "Differential Targeting of the CA1 Subfield of the Hippocampal Formation by Schizophrenia and Related Psychotic Disorders"
Archives of General Psychiatry (09/09) Vol. 66, No. 9, P. 938; Schobel, Scott A.; Lewandowski, Nicole M.; Corcoran, Cheryl M.; et al.
Medical-Legal Issues
Radiologists Say Yea to Universal Healthcare Access, Nay to Public Option
A recent survey conducted by Diagnostic Imaging revealed that 49.5 percent of surveyed radiologists think it is very important that healthcare reform should guarantee access to U.S. citizens, while 30.2 percent said it was somewhat important. The survey had 220 total respondents, approximately 180 of whom were involved in diagnostic radiology, interventional radiology, and nuclear medicine. Nearly 70 percent of respondents agreed that medical imaging has been targeted for reform-related cost reductions; and 62.6 percent either strongly agreed or somewhat agreed that inappropriate imaging practices could be reduced through some form of prior authorization, such as radiology benefit management or automated order-entry. Nearly 70 percent said that they expected radiologist incomes to decrease in the next five years under healthcare reform, while 32 percent anticipated that healthcare reform would increase demand for imaging services somewhat and 40 percent said demand would decrease somewhat. Finally, 20.2 percent strongly agreed that a government-run alternative is a necessary part of any healthcare reform, compared to 41.3 percent who strongly disagreed.
From "Radiologists Say Yea to Universal Healthcare Access, Nay to Public Option"
Diagnostic Imaging (09/07/09) Hayes, John C.
Clinical Practice
MR-Assisted Guidance Used in Retrograde Drilling of Talar Osteochondral Lesions
Researchers performed and assessed a MR-assisted navigation method for minimally invasive retrograde drilling of talar osteochondral lesions. They found that a single imaging plane is sufficient for navigation during intervention. To accomplish this objective, a passive MRI navigation device was used to evaluate 16 cadaveric ankle joints. Use of interactive MR-assisted navigation in combination with a passive aiming device allowed precise and rapid retrograde drilling of talar osteochondral lesions. The research is published in the September 2009 issue of Radiology.
From "Osteochondral Lesions of the Talus: Retrograde Drilling With High-Field-Strength MR Guidance"
Radiology (09/01/09) Vol. 252, No. 3, P. 857; Seebauer, Christian J.; Bail, Hermann J.; Wichlas, Florian; et al.
Quality Control Is Important in Digital PACS Environment
Proper quality control procedures are essential in the digital PACS environment, say Mary-Theresa Shore, director of clinical operations at Massachusetts General Hospital (MGH) in Boston and Kathy Tabor McEwan, executive director of Boca Raton Community Hospital. The two women recently identified several typical problems in digital imaging departments that can be easily fixed by quality control measures. Some of these problems are connected with actual exam procedures, including exam completion, patient misidentification, incorrect image labeling, improper exam technique or protocol, and improper positioning. Others are problems of data integrity, such as unverified exams, mis-scheduled exams, mis-identified exams, mis-labeled exams, merged exams, and canceled exams. No matter what the nature of these problems, they can all easily lead to PACS errors that must be corrected so they do not affect image quality or radiologists' ability to correctly interpret exams and match them to the appropriate patient. In order to reduce the amount of time spent correcting PACS errors, MGH conducted a quality control pilot study in emergency radiology over six months that included CT, MRI, ultrasound, and general radiology. As part of the study, MGH created an "image integrity" card that all radiologists were asked to complete and attach to each study. The card included information on study modality, accession number, and whether there was a problem with positioning, protocol, techniques, demographics, or labeling. The project also tracked data integrity and had the PACS team report problems to the emergency room operations manager. These steps allowed MGH to identify errors and conduct appropriate retraining exercises. According to Shore, the pilot led to a 67 percent reduction in hours of rework, a 73 percent reduction in imaging integrity errors, and a 76 percent decrease in data integrity errors.
From "Quality Control in the Digital Environment: Not a Luxury, a Necessity"
AuntMinnie.com (09/07/09) Yee, Kate Madden
SPECT/CT Helps Clinicians Detect Arthritic Joints
A group of researchers report in the September issue of the British edition of the Journal of Bone and Joint Surgery that the combination of single photon-emission computed tomography (SPECT) and computed tomography (CT) can help radiologists and orthopedic surgeons identify multiple arthritic joints in the feet and ankles and localize degenerative joint disease. The study proved their hypothesis that SPECT-CT boosts intra- and inter-observer reliability. The researchers assessed 20 consecutive patients with pain of uncertain origin in the foot and ankle by radiography and SPECT-CT, as well as by separate bone scanning and CT. A quintet of observers determined whether arthritis was present or absent, and the images were evaluated twice at a six-week interval. The researchers discovered outstanding mean intra-observer reliability for SPECT-CT that was substantially higher than that for combined CT and bone scanning. Inter-observer agreement also was significantly higher for SPECT-CT, particularly in the evaluation of the naviculocuneiform and tarsometatarsal joints. "SPECT-CT imaging appears to overcome lack of experience by displaying active joint degeneration in a nonambiguous way," noted the researchers. They also wrote that with SPECT-CT, consensus among the observers was "perfect in all the anatomical areas of the foot and ankle and in selective areas with CT, bone scanning and CT, and bone scanning."
From "SPECT-CT Imaging in Degenerative Joint Disease of the Foot and Ankle"
Journal of Bone and Joint Surgery (09/01/2009) Vol. 91B, No. 9, P. 1191; Pagenstert, G.I.; Barg, A.; Leumann, A.G.; et al.
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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