"Radiology and the Family Physician" Featured at RSNA 2009
This new course co-presented by the RSNA Public Information Committee and the American
Academy of Family Physicians will address:
- What radiologists can expect
from family physicians
- What family physicians need from radiologists as the
specialists in medical imaging
- The concept of the "Patient-centered Medical
Home” (PCMH) model
- How radiologists and family physicians can improve
communications and work more effectively to enhance patient care
- Opportunities
for radiologists to improve and expand interactions with family
physicians
Register for "Radiology and the Family Physician" (RC 216) and all
other RSNA 2009 courses at RSNA.org/register.
Headlines
From RSNA
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
Industry News
From RSNA
Featured in RadioGraphics: Best Cases from the
AFIP
In new cases from the Armed Forces Institute of Pathology, learn more about the clinical
imaging and pathologic evaluation of cerebral toxoplasmosis and multiple
gastric carcinoids.
In patients with cerebral toxoplasmosis, the most
common presenting symptom is headache, often accompanied by altered mental status, fever,
seizures, cranial nerve abnormalities, visual field defects and sensory disturbances.
Common focal neurologic signs include motor weakness and speech disturbances.
In
an AFIP case involving a 35-year-old man diagnosed with human immunodeficiency virus
(HIV) infection, author Gregory Tse Lee, M.D., and colleagues discuss how cerebral
toxoplasmosis usually appears on unenhanced and contrast-enhanced CT images and
T1-weighted MR images. The authors also note that hallium single-photon emission CT
(SPECT) and PET can help distinguish toxoplasmosis and other infections from CNS lymphoma
and discuss the implications of clinical improvement preceding radiologic
improvement.
Gastric carcinoid tumors are rare, constituting less than 1
percent of gastric neoplasms and approximately 8.7 percent of gastrointestinal
carcinoids. Gastric carcinoids can be divided into three subtypes based on pathogenesis
and histologic characteristics.
In an AFIP case involving a morbidly obese
31-year-old woman, author Edward C. Hwang, M.D., M.B.A., and colleagues discuss the
appearance of the three subtypes on contrast-enhanced CT, as well as the differential
diagnosis of multiple gastric carcinoid tumors. Treatments are also
addressed.
Read more about Cerebral
Toxoplasmosis and Multiple Gastric Carcinoids in RadioGraphics.
Leading the News
Prospective ECG Gating Significantly Reduces Radiation Dose Delivered During
CT
Radiologists have learned that they can substantially reduce the radiation dose
patients receive during thoracic computed tomography (CT) angiography through prospective
electrocardiogram (ECG) gating. The researchers conducted a study comparing the use of
retrospective ECG gating to prospective ECG gating during CT angiography through analysis
of 80 patients, half of whom underwent the former procedure and the other half the
latter. While image quality was consistent between the two methods, retrospective gating
required a radiation dose that was three times the dose needed for prospective gating.
One of the radiologists said that prospective ECG gating during CT angiography "is a
technically robust, noninvasive imaging technique for the evaluation of vascular disease.
It is safer than conventional angiography and the patient benefits from having it done
intravenously rather than through the arteries."
From "Prospective and Retrospective ECG Gating for Thoracic CT Angiography: A
Comparative Study"
American Journal of Roentgenology (10/01/2009) Vol. 193, No. 4, P. 955; Wu, Wenhui;
Budovec, Joseph; Foley, W. Dennis; et al.
Research
Medicare Patients With Head and Neck Cancer Have High Radiation Therapy Dropout
Rates
Nearly half of Medicare patients in the United States interrupt or do not complete
their prescribed radiation therapy treatments for head and neck cancer, according to new
research. Researchers analyzed the medical records of 5,086 Medicare patients diagnosed
with head and neck cancers. For the purposes of the study, a complete course of
radiotherapy was defined as at least 25 patients who had prior surgery and at least 30
treatments for those who did not. The researchers found that in their overall study
population, 40 percent of the patients were unable to complete treatment or experienced
interruptions in therapy. Patients who underwent surgery first had a completion rate of
70.4 percent compared to 50 percent for those who did not undergo surgery.
From "Completion of Radiotherapy for Local and Regional Head and Neck Cancer in
Medicare"
Archives of Otolaryngology Head and Neck Surgery (09/09) Vol. 135, No. 9, P. 860;
Fesinmeyer, Megan Dann; Mehta, Vivek; Tock, Lauri; et al.
Imaging Data Reveal a Higher Pediatric Stroke Incidence Than Prior U.S.
Estimates
When combined with diagnostic codes on medical charts, imaging studies show that
the rate of stroke in infants and children is two to four times higher than commonly
thought. University of California San Francisco researchers analyzed the records of 2.3
million children. Researchers searched for stroke cases using the International
Classification of Diseases, 9th Division (ICD-9) codes and keywords suggesting stroke on
radiology reports from CT, MRI, and angiograms. Using the combined methods, they
confirmed 205 cases of ischemic stroke of ischemic stroke, yielding an incidence of 2.4
strokes per 100,000 person-years. Original estimates, based only on ICD-9 searches,
found between 0.54 and 1.2 strokes per 100,000 U.S. children per year. The team also
compared sensitivity of search measures, finding that the radiology search had an 83
percent sensitivity, while the ICD-9 code search had a 39 percent sensitivity.
From "Imaging Data Reveal a Higher Pediatric Stroke Incidence Than Prior U.S.
Estimates"
Stroke (09/09) Agrawal, Nidhi; Johnston, S. Claiborne; Wu, Yvonne W.; et al.
Researchers Compare the Efficacy of US and DMSA Scans in Predicting
Vesicoureteral Reflux in Children
Researchers recently compared dimercaptosuccinic acid (DMSA) scans and ultrasound
(US) with voiding cystourethrography (VCUG) or the prediction of vesicoureteral reflux
(VUR) in children under two years of age. The study including 220 children with their
first febrile urinary tract infection VUR was detected in 30.4 percent of patients. The
detection rate of VUR by US was 41.7 percent and 86 percent in low and high-grade patient
groups, respectively. When combined with DMSA, US detection of high-grade VUR was raised
to 95.3 percent while detection of low-grade VUR was raised to 62.5 percent.
From "The Efficacy of Ultrasound and Dimercaptosuccinic Acid Scan in Predicting
Vesicoureteral Reflux in Children"
UroToday (09/22/2009) Lee, H. Y.; Hyun, Soh B.; Hee, Hong C.; et al.
Technology
Study on Myeloma Diagnosis Techniques Favors Newer Imaging Methods
A study evaluating myeloma diagnosis methods established a preference for new
imaging techniques over traditional X-rays. Among the methods examined were magnetic
resonance imaging (MRI), radiography, and fluorodeoxyglucose positron emission tomography
(FDG-PET) with computed tomography (CT). One study co-author said that with improved
diagnosis techniques, "you can prevent fractures, pain, spinal cord lesions." The
researchers noted that while multiple myeloma is typically diagnosed based on a bone
marrow biopsy, eight out of 10 patients also exhibit bone lesions, whose detection can be
crucial to diagnosis and therapy. X-rays can frequently overlook lesions, especially in
the early stages of myeloma. Also, X-rays cannot supply data on the activity of cancer
in the bones, and they provide no indication of how long cancer has been present.
FDG-PET/CT was determined to be the most effective of the imaging techniques the
researchers studied, although such scans do not always spot lesions that are less than
0.5 inch in diameter. The researchers recommended MRI scanning for closer analysis of
bone marrow, as it facilitates bone content visualization.
From "Role of Radiography, MRI and FDG-PET/CT in Diagnosing, Staging and
Therapeutical Evaluation of Patients With Multiple Myeloma"
Annals of Hematology (09/09) Lutje, Susanne; de Rooy, Jacky W.J.; Croockewit, Sandra;
et al.
Medical-Legal Issues
FDA: Institute of Medicine to Study Premarket Clearance Process for Medical
Devices
The U.S. Food and Drug Administration (FDA) has commissioned the Institute of
Medicine (IOM) to study the premarket notification program used to review and approve
certain medical devices marketed in the United States. Specifically, the IOM will study
the 510(k) process for medical devices. At the same time, the FDA's Center for Devices
and Radiological Health (CDRH) will commission its own internal working group designed to
evaluate and improve the consistency of FDA decision-making in the 510(k) process. As
part of the IOM's study, a committee will be convened to determine whether the 510(k)
process properly protects patients and promotes innovation in support of public health.
If the answer to that question is no, the IOM will recommend legislative, regulatory, and
administrative changes that could be helpful to achieve the goals of the 510(k) process.
As part of the review, the IOM will hold two public workshops during the next nine
months, and it is scheduled to publish a final report in March 2011. The IOM review is
one of several priorities established for the CDRH. Other priorities include creating an
internal task force on the use of science in regulatory decision-making; developing an
effective compliance strategy; integrating premarket and postmarket information;
increasing transparency; and establishing clear procedures when a difference of opinion
arises during the review process.
From "FDA: Institute of Medicine to Study Premarket Clearance Process for Medical
Devices"
FDA.gov (09/23/09)
Self-Referral Foes Fail to Add Amendment to Healthcare Reform Bill
Congressional proponents of a measure that would have prevented physician
self-referral for imaging tests reportedly have withdrawn a bid to add the amendment to a
healthcare reform bill under consideration by the U.S. House of Representatives. The
purpose of the revision was to close a loophole in the Stark law that currently allows
physician referral to entities in which they have a financial stake. The bill's
sponsors, Reps. Anthony Weiner (D-N.Y.) and Bruce Braley (D-Iowa), withdrew the bill
after speaking to Rep. Henry Waxman (D-Calif.), chairman of the House Energy and Commerce
Committee. Waxman reportedly expressed a desire not to bring the amendment to a vote at
this time but agreed to work with the representatives throughout the legislative process
to try to address the issue of self-referral.
From "Self-Referral Foes Fail to Add Amendment to Healthcare Reform Bill"
AuntMinnie.com (09/24/09) Yee, Kate Madden
Clinical Practice
Clinical Indication and Patient Age Predict Likelihood of Malignancy in
Suspicious Breast MRI Lesions
A clinical history of known cancer and a patient age over 50 significantly
increase the risk of malignancy in suspicious MRI-detected breast lesions, according to a
recent review of a breast MRI database. Specifically, the study found that the
likelihood of malignancy for suspicious lesions found on MRI examinations performed for a
patient with a history of known cancer was 42 percent, compared to 22 percent for lesions
identified on examinations conducted for high-risk screening. Forty-four percent of
suspicious lesions in patients aged 50 and older were found to be malignant, compared to
30 percent in patients under the age of 50.
From "Clinical Indication and Patient Age Predict Likelihood of Malignancy in
Suspicious Breast MRI Lesions"
Academic Radiology (10/09) Vol. 16, No. 10, P. 1281; Gutierrez, Robert L.; DeMartini,
Wendy B.; Eby, Peter; et al.
Ultrasound Predicts Metastases, Survival of Patients With Melanoma
Ultrasound-based patterns can accurately diagnose the presence and stage of
metastases in patients with melanoma, according to a study led by Dr. Christiane Voit,
chief of the Skin Cancer Center's diagnostic unit at the Charité Medical
University of Berlin. The study, presented on September 23 at the 2009 European Cancer
Organization meeting, enrolled 850 melanoma patients. The investigators tested several
different ultrasound patterns and found that, of the patterns, peripheral perfusion and
balloon-shaped lymph nodes provided consistent signs, respectively, of early and
late-stage metastatic disease. Researchers also found that these signs could identify
the tumor burden before surgical biopsy in up to 90 percent of cases.
From "Ultrasound Predicts Metastases, Survival of Patients With Melanoma"
Diagnostic Imaging (09/23/09) Abella, H. A.
Industry News
Medical Imaging a Growth Industry, but Some Say Unneeded Scans Increase
Expenses
The medical imaging business is robust in places such as Texas and is making $100
billion a year nationally. But critics say that doctors are driving up costs by ordering
unnecessary scans, while the rising number of imaging machines has entailed significant
increases in use and higher costs for American consumers and taxpayers. The Dallas-Fort
Worth region surpassed the national rate for computed tomography (CT) and magnetic
resonance imaging scans for Medicare patients in 2005, and a report from America's Health
Insurance Plans warns that up to 50 percent of all high-tech scans for a number of
conditions might not lead to improved patient diagnosis or treatment "and may be
considered redundant or unnecessary." Studies also have indicated that excessive CT
imaging could raise patients' risk of developing cancer by subjecting them to unhealthy
doses of radiation. Health care specialists say that some physicians order scans of
insignificant medical value to shield themselves against potential malpractice claims.
Others might do so for financial reasons, referring patients for scans to be done on
their own machines. Among the factors industry observers say underlie the soaring use of
medical imaging are an aging population, the use of new technologies with old
technologies rather than the replacement of the latter by the former, and Americans'
appetite for new medical technology. Scanning machines have branched out of hospitals
and into private practices as they became faster, smaller, and less expensive, and
Medicare has rewarded doctors and independent practices in the past with higher
compensation per scan than hospital-based outpatient scanners.
From "Medical Imaging a Growth Industry, but Some Say Unneeded Scans Increase
Expenses"
Dallas Morning News (TX) (09/22/09) McNeill, Ryan
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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