Shop Chicago and Win during RSNA 2009
Extending a Windy City welcome, many Chicago retailers are offering an exclusive 10.25 percent “no sales tax” discount to RSNA 2009 attendees, valid Saturday, November 28 through Sunday, December 6.
In addition, attendees, presenters and family members can enter an online sweepstakes for a chance to win a $500 gift certificate valid at Michigan Avenue shops including Water Tower Place, The 900 Shops and Shops at North Bridge.
A list of retailers offering “no sales discounts” and a downloadable coupon—as well as a chance to enter the sweepstakes—are available through the Chicago Convention & Tourism Bureau at ChooseChicago.com/ShopChicago.
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Congratulations to Our Free Hotel and Registration Winner
RSNA congratulates Tummas í Garði of the Faroe Islands, winner of the RSNA 2009 free registration and hotel promotion!
Leading the News
CMS Revises NCD for Magnetic Resonance Imaging
The Centers for Medicare & Medicaid Services (CMS) has granted a request to remove the national noncoverage of blood flow measurement from the MRI national coverage decision (NCD). The NCD for MRI will now permit local Medicare contractors to use their discretion to determine when coverage of MRI for blood flow measurement is appropriate. CMS made this decision after determining that the blanket noncoverage of MRI for blood flow measurement is no longer supported by existing clinical evidence. CMS also granted a request to permit coverage of MRI when a beneficiary has an implanted device that has been designed for testing in the MRI environment, based on evidence that MRI improves health outcomes in beneficiaries who have implanted cardioverter-defibrillators or pacemakers that are FDA-approved for such use.
From "Decision Memo for Magnetic Resonance Imaging"
CMS Press Release (09/29/09)
Research
Dual-Source CT Offers Comparable Accuracy and Radiation Dose for Detecting Significant Stenoses as 64-Section CT Coronary Angiography
Higher temporal resolution, as offered by dual-source CT coronary angiography, provides improved accuracy and specificity for the diagnosis of significant stenoses on a per-segment level in patients with heart rates of 65 beats per minute or less when compared to 64-section coronary angiography. Dual-source CT also accomplishes this goal at a similar radiation dose while providing a comparable diagnostic accuracy to 64-section coronary angiography on a patient-based level. These conclusions are based on a study that included 200 patients with heart rates of 65 beats/minute or less. Of those participants, 100 underwent dual-source and 100 underwent 64-seciton CT coronary angiography. Two blinded observers then independently assessed image quality of all coronary segments by using a four-point scale and searched for stenoses greater than 50 percent in each segment. The study is published in the October 2009 issue of Radiology.
From "Dual-Source Versus 64-Section CT Coronary Angiography at Lower Heart Rates: Comparison of Accuracy and Radiation Dose"
Radiology (10/01/09) Vol. 253, No. 1, P. 56; Baumuller, Stephan; Leschka, Sebastian; Desbiolles, Lotus; et al.
Study Finds That Adverse Reactions From Contrast Agents Rarely Occur
A recent review of 456,930 administered doses of iodinated and gadolinium-based contrast agents identified 522 cases of adverse events. According to Mayo Clinic researchers, who conducted the review, the majority of those adverse events were mild, including nausea and vomiting and mild rash. Only 16 cases necessitated transfer for further observation and treatment. Based on these findings, the researchers concluded that both iodinated and gadolinium contrast agents are associated with a very low rate of adverse events, the majority of which are mild and can be managed in the radiology department.
From "Frequency and Severity of Adverse Effects of Iodinated and Gadolinium Contrast Materials: Retrospective Review of 456,930 Doses"
American Journal of Roentgenology (10/01/2009) Vol. 193, No. 4, P. 1124; Hunt, Christopher H.; Hartman, Robert P.; Hesley, Gina K.
Calcium Scans Provide Effective Screening Tool for Heart Disease
Coronary artery calcium (CAC) scans can be performed without leading to excessive additional testing and costs, according to the multi-center Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research (EISNER) study. CAC scans have been found to be more effective than standard cholesterol and blood pressure measurements for detecting patients at risk for heart disease. Currently, these scans are not covered by most private insurance carriers due to concerns that detection of low levels of heart disease will result in unnecessary further testing. The EISNER study, however, found there was a strong relationship between coronary calcium scores and subsequent cardiac events. The 1,361-patient study also found a significant difference in the number, type, and frequency of medical tests and costs given a subject's CAC score. Additional stress testing was infrequent and related costs were low among subjects with low CAC scores. Both rose progressively as the CAC score increased, particularly in patients at highest risk.
From "Induced Cardiovascular Procedural Costs and Resource Consumption Patterns After Coronary Artery Calcium Screening"
Journal of the American College of Cardiology (09/29/2009) Vol. 54, No. 14, P. 1258; Shaw, Leslee J.; Min, James K.; Budoff, Matthew; et al.
Few Side Effects Found From Radiation Treatment Given After Prostate Cancer Surgery
A new study has found few adverse events in prostate cancer patients treated with radiotherapy after surgery to remove the prostate. Men participating in this study received radiotherapy after a prostate-specific antigen (PSA) test following surgery indicated cancer recurrence. The study, which spanned 20 years, was designed to specifically document any adverse events that might be associated with salvage radiotherapy following surgery. It included 308 patients with a median follow-up period of 60 months after salvage external beam radiotherapy. Of those patients, only one experienced a severe adverse event. None of the adverse events observed were fatal, and all were treated. Urinary leakage, which was reported as a common concern among patients, was not a common adverse event.
From "Late Toxicity After Postprostatectomy Salvage Radiation Therapy"
Radiotherapy & Oncology (09/09) Peterson, Jennifer L.; Buskirk, Steven J.; Heckman, Michael G.
Medical-Legal Issues
Senators Protest CMS Funding Cut for Radiation Oncology
Sens. Richard Burr (R-N.C.) and Blanche Lincoln (D-Ark.) recently wrote a letter to Health and Human Services Secretary Kathleen Sebelius in which they argued that Medicare funding cuts designed to lower usage rates for diagnostic imaging should not include reimbursement reductions related to radiation therapy. The letter was also signed by 32 other senators. Currently, the 2010 Physician Fee Schedule Proposed rule for Medicare includes a 19 percent decrease in reimbursement for radiation oncology, which the letter argues could actually add up to reductions of as must as 44 percent for certain radiation therapy treatments.
From "Senators Protest CMS Funding Cut for Radiation Oncology"
Fierce Healthcare (09/25/2009)
Clinical Practice
Pericardial Effusion Treatment Method Spares Patients Surgery and Offers Patients Big Cost Savings
Researchers have concluded that CT-guided tube pericardiostomy is just as effective as invasive surgery for the treatment of pericardial effusion. The study included 39 CT-guided tube pericardiostomy procedures that were all performed successfully. The researchers found that not only was this method safer for patients, it also produced significant cost savings when compared to traditional surgical treatment.
From "CT-Guided Tube Pericardiostomy: A Safe and Effective Technique in the Management of Postsurgical Pericardial Effusion"
American Journal of Roentgenology (10/01/2009) Vol. 193, No. 4, P. W314; Palmer, Suzanne L.; Kelly, Peter D.; Schenkel, Felicia A.; et al.
Clinical Information Impacts Diagnostic Performance in Breast Sonography
Researchers at Korea's Yonsei University Health System set out to evaluate whether the clinical information (CI) of patients impacts the degree of suspicion for malignancy by radiologists conducting breast sonography. Their study involved 150 breast lesions in 144 patients who underwent breast sonography and sonographically guided core needle biopsy. Malignancy was diagnosed for 78 lesions, while 72 were non-malignant. The sonograms of all lesions were reviewed by a trio of radiologists twice at eight-week intervals, first without any CI for the patients and then with CI, such as patient age, palpability, and personal history of risk factors for breast cancer. The final evaluation was categorized by the radiologists following the American College of Radiology Breast Imaging Reporting and Data System. The researchers compared diagnostic performance such as sensitivity and specificity and the level of suspicion for malignancy between the image reviews with and without CI. Sensitivity was augmented in all three reviews and specificity was lowered in the second review, while suspicion of malignancy increased significantly. The researchers conclude that the suspicion for malignancy on sonography and the sensitivity of sonographic interpretation increases with CI about a patient's breast cancer history and clinical presentation with a palpable mass.
From "Effect of Clinical Information on Diagnostic Performance in Breast Sonography"
Journal of Ultrasound in Medicine (10/01/09) Vol. 28, No. 10, P. 1349; Baek, Song-Ee; Kim, Min Jung; Kim, Eun-Kyung; et al.
Electronic Alerts About Abnormal Imaging Test Results Do Not Always Result in Timely Follow-up
Abnormal results on outpatient imaging tests do not always receive timely follow-up, even when clinicians receive and read results using electronic medical records (EMRs). Researchers used tracking software to determine whether EMR alerts concerning abnormal diagnostic results were read within two weeks and used medical records to establish if appropriate follow up measures were taken. Of the 123,638 imaging tests performed during the study period, 1,196 generated alters to the ordering clinician. Of those alerts, 18.1 percent were not acknowledged. Alerts were more likely to be unacknowledged if the ordering clinician was a trainee or if an alert was sent to more than one clinician. Timely follow-up of abnormal results did not occur following 7.7 percent of all alerts, including 7.3 percent of alerts that were acknowledged and 9.7 percent of alerts that were not. Follow-up was less likely to occur when more than one clinician received the alert, but more likely to occur when a radiologist also communicated concerns about the results verbally, either by phone or in person.
From "Timely Follow-up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting"
Archives of Internal Medicine (09/28/09) Singh, Hardeep; Thomas, Eric J.; Mani, Shrinidi; et al.
Researchers Develop Low-dose PET/CT Protocols
Researchers have developed low-dose PET/CT protocols for 11 patient weight categories. These categories were used to develop protocols for whole-body F-FDG imaging of patients in PET mode with a weight-based injected activity and acquisition times and for CT attenuation correction and localization with a weight-based tube current ranging from 10 to 40 mAs. Using these protocols, researchers were able to offer an initial set of acquisition parameters for pediatric PET/CT. They also found that the use of multiple weight categories allows for the continued refinement of dose-reduction parameters to minimize dose while maintaining image quality across the range of pediatric patient sizes.
From "Weight-Based, Low-Dose Pediatric Whole-Body PET/CT Protocols"
Journal of Nuclear Medicine (10/09) Vol. 50, No. 10, P. 1570; Alessio, Adam M.; Kinahan, Paul E.; Manchanda, Vivek
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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