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Leading the News
Research
Medical-Legal Issues
Clinical Practice
Industry News
From RSNA
October RSNA News Now Online
The full version of the October issue of RSNA News is now available online.
Highlights include:
MR Imaging Accurately Depicts Deep Endometriosis
Preoperative MR imaging may help radiologists diagnose deep endometriosis and more precisely characterize extent of disease, thereby aiding in treatment planning, according to a new study published in Radiology.
Radiology Architects Forecast the Facility of the Future
The ever-evolving world of healthcare virtually guarantees the radiology facility of tomorrow will look very different from the structures of today, according to noted radiology architects.
Technology to Help Radiologists "Feel" Images Is Among New Developments
A 3D mouse allowing radiologists to analyze images and "feel" resulting organs is among emerging technologies that also include an iPAD interface to make image annotations stored in a searchable repository.
PET Technique Could Aid in Targeted Breast Cancer Treatment
New research showing that PET scans in mice detect and monitor a protein often associated with aggressive breast cancer could facilitate the development of new, targeted therapies for breast, ovarian, prostate and lung cancers.
Special RSNA 2009 Meeting Preview Section
Along with gaining insight into cutting-edge discoveries, evolving techniques and strategies that can translate into better radiology both in the coming years and in current practice, RSNA 2009 attendees will get the latest information on high-profile issues including radiation dose and informatics.
Articles provided in PDF for easy printing.
RSNA 2009 Explores Breakthroughs in Science and Quality
Raise Your Quality Quotient at RSNA 2009
Gold Medalists
Honorary Members
Plenary Sessions
Sessions and Courses (includes associated sciences, education exhibits and scientific posters, refresher courses and informatics)
Technical Exhibits
Chicago Welcomes RSNA Attendees
Restaurant Listing
Leading the News
FDA Investigates Safety of CT Brain Perfusion Scans
The FDA has been notified of 206 radiation overexposures during perfusion CT imaging to aid in the diagnosis and treatment of stroke. Over an 18-month period, received radiation doses at the facility where these overexposures occurred were 3-4 Gy - approximately eight times the expected dose of 0.5 Gy. In some cases, excessive doses resulted in hair loss and erythema. Although these adverse events were contained to one facility, the FDA has raised concerns that they may reflect more widespread problems with CT quality assurance programs and may not be isolated to this particular facility or imaging procedure. Therefore, the FDA encourages every facility performing CT imaging to review its CT protocols and be aware of the dose indices normal displayed on the control panel. For each protocol selected, and before scanning the patient, the FDA asks that radiologists carefully monitor dose indices. In the meantime, the FDA is working with the parties involved in this particular case to gather more data about this situation and to understand its potential impact.
From "Safety Investigation of CT Brain Perfusion Scans: Initial Notification"
FDA.gov (10/08/09)
Research
Cancer Risk From Imaging-Generated Radiation Exposure Is Found to Be Dependent on Age, Sex
The risk of developing cancer due to radiation exposure from nuclear and CT scans is largely dependent on the age and sex of the recipient, according to a presentation by Stephen Balter, PhD, of the Columbia University Medical Center made at the recent Transcatheter Cardiovascular Therapeutics conference in San Francisco. Based on National Cancer Institute data, Balter and colleagues found that a 20-year-old female receiving an effective dose of 100 mSv had a 1.65 percent risk of developing radiation-induced cancer, compared to 1.42 percent for a patient without radiation exposure. In a 60-year-old male patient, the same amount of radiation yielded a similar risk to that of the 20-year-old female patient (0.49 percent). However, the male patient's risk for developing cancer absent the radiation exposure was 27.71 percent. "As the population gets older, the natural incidence of radiation goes up and the radiation risks go down, and so the relative importance of radiation goes down," Balter explained. Balter also highlighted several radiation reduction techniques for various modalities, including, fluoroscopy, CT, and nuclear scans.
From "Cancer Risk From Imaging-Generated Radiation Exposure Dependent on Age, Sex"
Cardiology Today (10/01/2009)
Degenerative Changes of the Cervical Spine After Whiplash Injury Observed on MRI Over Ten Years Is Not Associated With Clinical Symptoms
Researchers in Japan performed a prospective long-term follow-up study to evaluate relationships between magnetic resonance imaging (MRI) findings and changes in clinical symptoms, along with variables associated with the prognosis of symptoms. The study involved the participation of 133 patients with acute whiplash injury between 1993 and 1996 who received neurological examinations by spine surgeons and second MRI scans of the cervical spine. The MRI scans assessed a reduction in the signal intensity of the intervertebral disc, anterior compression of the dura and the spinal cord, posterior disc protrusion, disc space narrowing, and foraminal stenosis. The adjusted odds ratio was calculated to determine associations between the presence or absence of degenerative changes on MRI, accident details, and patients' symptoms. MRI was able to detect the progression of some degenerative changes in nearly 100 percent of the patients, while clinical symptoms diminished in more than 50 percent. No statistically significant relationships between MRI findings and changes in clinical symptoms were drawn. The researchers conclude that there was no association between progression of degenerative changes of the cervical spine on MRI and clinical symptoms during the 10-year follow-up period.
From "Longitudinal Magnetic Resonance Imaging Study on Whiplash Injury Patients: Minimum 10-Year Follow-up"
Journal of Orthopaedic Science (10/01/09) Vol. 14, No. 5, P. 602; Ichihara, Daisuke; Okada, Eijiro; Chiba, Kazuhiro; et al.
Mammograms Cut Risk of Breast Cancer Death
Researchers estimate that three-fourths of the women who die of breast cancer each year do not have regular mammograms. This estimate is based on a study of 6,997 women diagnosed with breast cancer in Massachusetts between 1990 and 1999. Of those women, 80 percent had at least two regular mammogram screenings. Over the next 13 years, there were 461 deaths from breast cancer; 345 (75 percent) were among women who did not receive regular mammograms and 116 (25 percent) were among women who were regularly screened. The findings were released at a news conference with the American Society of Clinical Oncology in advance of the 2009 Breast Cancer Symposium in San Francisco.
From "Mammograms Cut Risk of Breast Cancer Death"
WebMD (10/06/09) Laino, Charlene
FDG-PET and/or CT Indicated in the Staging of Patients With Melanoma With Palpable Lymph Node Metastases
FDG-PET and/or CT are necessary components in the staging of patients with melanoma with palpable lymph node metastases, a recent study found. For the purposes of the study, researchers tracked patients with palpable, proven lymph node metastases of melanoma between 2003 and 2007. FDG-PET and CT were used to detect the number and site of distant metastases. Such metastases were suspected in 32 percent of the patients following FDG-PET and 29 percent of the patients following CT. Treatment changed in 19 percent of the patients; in 79 percent as a result of both scans, 17 percent exclusively by FDG-PET, and in 4 percent exclusively by CT.
From "Prospective Comparison of Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography in Patients With Melanoma With Palpable Lymph..."
Journal of Clinical Oncology (10/09) Vol. 27, No. 28, P. 4774; Bastiaannet, Esther; Wobbes, Theo; Hoekstra, Otto S.; et al.
Medical-Legal Issues
CMS Releases Tracking Sheet for MRA
The Centers for Medicare & Medicaid Services (CMS) has issued a tracking sheet for magnetic resonance angiography (MRA) following its recent reconsideration of the national coverage decision (NCD) for MRI, removing the national noncoverage for MRI for blood flow determination. While reviewing the published scientific evidence of that NCD for MRI, CMS became aware of evidence that may support coverage of one or more currently noncovered indications for MRA. Therefore, CMS has decided to open the national coverage analysis (NCA) to review the evidence on current non-covered indications for MRA. The initial public comment period for this NCA will last until Nov. 6. CMS is requesting public comment on the health benefit outcomes of any current non-covered indications for MRA in the Medicare population.
From "NCA Tracking Sheet for Magnetic Resonance Angiography"
CMS Press Release (10/08/09)
OIG Plans to Review Medicare, Medicaid Auditing Programs
CMS is boosting its Medicare and Medicaid auditing activities, which has gained the attention of the U.S. Office of Inspector General (OIG). OIG next year plans to review the progress of many Medicare and Medicaid auditing programs, as well as CMS' oversight of several of the programs, according to its 2010 Work Plan. OIG will review Medicaid Integrity Program efforts "to determine whether states proactively manage overall program risks at the state agency, payment contractor, and provider levels" as well as how states prioritize actions to prevent improper payments; how providers and/or payment areas are identified for an audit; and whether improper payments are collected and properly reported to CMS.
From "OIG Plans to Review Medicare, Medicaid Auditing Programs"
HealthLeaders Media (10/07/09) Kraynak, Andrea
Clinical Practice
3.0-T Pelvic MRI Proves Accurate and Noninvasive for the Diagnosis and Mapping of Endometriosis Prior to Surgery
Pelvic MRI provides an accurate and noninvasive way to diagnose and map endometriosis preoperatively, according to a study published in the October 2009 issue of Radiology. Researchers performed 3.0 T pelvic MRI before surgery in 41 patients suspected of having endometriosis. They found that MRI had a sensitivity of 96.3 percent, a specificity of 100 percent, and an accuracy of 97.6 percent in diagnosing deep endometriosis. Imaging could also accurately depict all locations of the disease including uterosacral ligaments and the colon wall. Use of an intrarectal gel as contrast did not improve assessment of colon wall infiltration using high-spatial-resolution T2-weighted imaging.
From "Endometriosis: Contribution of 3.0-T Pelvic MR Imaging in Preoperative Assessment- Initial Results"
Radiology (10/01/09) Vol. 253, No. 1, P. 126; Hottat, Nathalie; Larrousse, Caroline; Anaf, Vincent; et al.
CBCT Found to Be an Adequate Technique for Postoperative Imaging of Patients With Bionic Ear Implants
Researchers in Italy performed a study to measure, in terms of radiation dosage, the possibility of substituting dental volumetric cone-beam computed tomography (CBCT) for multislice CT (MSCT) in patients with bionic ear implants. The study involved 100 patients with Vibrant SoundBridge implants on the round window who underwent follow-up, with 15 receiving MSCT and 85 receiving CBCT. The average tissue-absorbed doses were assessed during both scans, which were focused on the temporal bone with the smallest field of view and a low-dose protocol. Despite a qualitative inferiority compared to MSCT images, the CBCT images permitted assessment of the implants' position, and the effective dose of CBCT was almost three times lower than that of MSCT. This led to the conclusion that CBCT could be considered a suitable method for postoperative imaging and follow-up of patients with bionic ear implants thanks to its low radiation dose and adequate image quality.
From "Radiation Dose Saving Through the Use of Cone-Beam CT in Hearing-Impaired Patients"
La Radiologia Medica (09/30/09) Faccioli, N.; Barillari, M.; Guariglia, S.; et al.
Industry News
Growing Number of Hospitals and Imaging Centers Track Exposure to Radiation
A small number of U.S. medical facilities and outpatient imaging centers are automatically sending radiation data to patients' records whenever certain scans, such as computed tomography (CT), are performed. A 2007 Columbia University Medical Center report found that up to 2 percent of cancers in the United States could be related to radiation from CT imaging. Meanwhile, Emory University researchers recently disclosed that the number of CT scans conducted in the country increased from 3 million in 1980 to 62 million in 2006. Adding to the concern is an increase in the number of children receiving CT scans because young people are much more sensitive to radiation than adults and because early exposure increases the likelihood of high radiation accumulation over the course of one's lifetime. Experts say that it will probably be years before a substantial number of hospitals are automatically transmitting imaging test data to patients' records. In the meantime, concerned patients can keep track of the information by downloading a card off the Alliance for Radiation Safety in Pediatric Imaging's Web site and have physicians or technicians fill it out, according to Robert Zeman at George Washington University Hospital. James Jelinek at Washington Hospital Center recommends that consumers record and share their imaging test data with family members, so they can remind each other to take the record for both scheduled appointments and emergencies.
From "Adding Up the Radiation From Scans"
Washington Post (10/06/09) Kritz, Francesca Lunzer
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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