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Research
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Leading the News
Chest CT Can Aid in Early Swine Flu Diagnosis
A recent review indicates that chest CT may be able to aid in the early detection of H1N1 influenza. The review included 222 patients with novel H1N1 infections observed from May 2009 to July 2009, 66 of whom underwent chest radiographs. Researchers evaluated initial radiographs for pattern, distribution, and extent of abnormality. Chest CT scans were also reviewed for the same findings and for pulmonary embolism (PE) when performed using IV contrast medium. Of all participating patients, 42 percent had an abnormal radiograph. The predominant radiographic finding was patchy consolidation, primarily in the lower and central lung zones. All patients who had to be admitted to an ICU for treatment had abnormal initial radiographs. Additionally, PE was detected in 36 percent of patients who underwent CT. Based on these results, the researchers concluded that patients with severe H1N1 who progress to bilateral extensive air-space disease, as shown on radiographs, are at high risk for PE, which can be detected using CT.
From "Chest Radiographic and CT Findings in Novel Swine-Origin Influenza A (H1N1) Virus (S-OIV) Infection"
American Journal of Roentgenology (12/01/2009) Agarwal, Prachi P.; Cinti, Sandro; Kazerooni, Ella A.; et al.
Research
Use of New Gadolinium Agents, Policies Prevents NSF
Switching from gadodiamide to gadobenate dimeglumine and gadopentetate dimeglumine contrast agents, combined with restrictive gadolinium-based contrast agent (GBCA) policies, may reduce the risk of nephrogenic systemic fibrosis (NSF), according to a review of tertiary care centers at two U.S. universities. The records of NSF patients were identified between January 2000 and December 2006 for the purposes of the study at center A and between October 2003 and February 2007 at center B. These time periods were prior to the adoption of the new GBCA policies and contrast agents. NSF cases were also tracked at both centers post-adoption from June 2007 to June 2008. The number of patients who underwent gadolinium-enhanced MRI at each center was also tracked as well as the patients at risk for NSF at center A and patients undergoing dialysis at center B. Respective total benchmark incidence of NSF at both centers was 37 out of 65,240. At-risk incidence at center A and dialysis incidence of NSF at center B was 28 of 925 and 9 of 312, respectively, in the pre-adoption period. Post-adoption, there were no incidences of NSF. The study was published at Radiology Online on October 7.
From "Nephrogenic Systemic Fibrosis: Change in Incidence Following a Switch in Gadolinium Agents and Adoption of a Gadolinium Policy"
Radiology Online (10/07/09) Altun, Ersan; Martin, Diego R.; Wertman, Rebecca; et al.
CBCT Identifies Interfraction and Intrafraction Tumor Motion in Lung SBRT
Only small intrafractional and interfractional changes in tumor motion amplitude (TMA) occur during lung stereotactic body radiation therapy (SBRT), according to a study of 18 patients with SBRT. For the purposes of the study, researchers used cone beam CT (CBCT) to perform tumor localization. CBCT was subsequently repeated to ensure geometric accuracy. Additional CBCT images were acquired at the midpoint and endpoint of each SBRT fraction. Respiration-correlated CBCT reconstructions then allowed the researchers to conduct a retrospective assessment of inter- and intrafractional changes in TMA. By doing so, the researchers also found that abdominal compression does cause larger variations in the time spent on the treatment couch as well as on both inter- and intrafractional TMA values.
From "Quantifying Interfraction and Intrafraction Tumor Motion in Lung Stereotactic Body Radiotherapy Using Respiration-Correlated Cone Beam CT"
International Journal of Radiation Oncology, Biology, Physics (11/09) Vol. 75, No. 3, P. 688; Bissonnette, Jean-Pierre; Franks, Kevin N.; Purdie, Thomas G.; et al.
Adoption of 64-Slice CT for Imaging Coronary Arteries May Be Premature
Hospitals are rapidly acquiring advanced imaging modalities, particularly 64-slice CT, for imaging coronary arteries, according to a newly published study. The researchers propose that this technology is most likely to be adopted by hospitals that treat cardiac patients, operate in competitive markets, are reimbursed for CT coronary imaging, and have favorable operating margins. Based on these findings, combined with the relative lack of evidence demonstrating the clinical usefulness of 64-slice CT for imaging coronary arteries, the researchers suggest that adoption by some cardiac-oriented hospitals may be premature.
From "Adoption and Spread of New Imaging Technology: A Case Study"
Health Affairs (Quarter 4, 2009) Ladapo, Joseph A.; Horwitz, Jill R.; Weinstein, Milton C.; et al.
Technology
Hyper-SAGE Boosts Remote MRI Sensitivity
Hyperpolarized xenon signal amplification by gas extraction (Hyper-SAGE) is a new magnetic resonance imaging (MRI) and nuclear magnetic resonance (NMR) method that could potentially spot extremely low concentrations of clinical targets, such as cancerous growths. "By detecting the MRI signal of dissolved hyperpolarized xenon after the xenon has been extracted back into the gas phase, we can boost the signal's strength up to 10,000 times," says Alexander Pines, a chemist at the University of California, Berkeley. The technique uses xenon gas that has been struck with laser light to hyperpolarize the spins of its atomic nuclei so that their orientation is identical. Xin Zhou, a member of Pines' research team, says that "Hyper-SAGE is a totally novel way to amplify a solvated xenon MRI/NMR signal in that instead of a chemical process, which is what previous signal enhancement techniques relied upon, it is a physical process. Because gas can be physically compressed, the density of information-carrying polarized gas in our detection chamber can be much greater than the density of an information-carrying solution. This means we can detect MRI signals from concentrations of molecules many thousands of times smaller than can be detected with conventional MRI." Zhou reports that gaseous xenon's long relaxation time means that the signal is of sufficient length for the researchers to glean all of the encoded information, which subsequently enables them to identify cancer-related proteins and other specific targets at micromolar or parts per million concentrations. "Also, Hyper-SAGE utilizes remote detection, meaning the signal encoding and detection processes are physically separated and carried out independently," Zhou says.
From "Hyperpolarized Xenon NMR and MRI Signal Amplification by Gas Extraction"
Proceedings of the National Academy of Sciences (10/06/09) Vol. 106, No. 40, P. 16903; Zhou, Xin; Graziani, Dominic; Pines, Alexander
Medical-Legal Issues
FDA Issues Draft Guidance for MQSA Updates
The FDA recently released draft guidance designed to provide recommendations to mammography facilities and their personnel under the Mammography Quality and Standards Act (MQSA). This guidance provides updates on the FDA's thinking regarding the MQSA in 16 areas of concern. These areas include contact information for accreditation bodies and certification agencies, Additional Mammography Reviews, previously approved alternative standards, Medicare and Medicaid reimbursement, mechanisms to inform patients of mammography results, and labeling for mammographic images. Other areas of concern include the personnel six-month expiration period, air kerma measuring instrument calibration, medical physicist involvement in cassette replacement, Full Field Digital Mammography (FFDM) and the use of single-use cushion pads, quality control testing for computer controlled compression devices, mammography equipment evaluation of laser printers, quality control testing of monitors and laser printers, mammography equipment evaluations of FFDM units, and evaluations of off-site laser printers. Comments for the guidance are being accepted by the FDA until Jan. 7, 2010.
From "Draft Guidance for Industry and FDA Staff; the Mammography Quality Standards Act Final Relations"
Federal Register (10/09/09) Vol. 74, No. 195, P. 52242
Clinical Practice
FDG-PET Found Effective in Diagnosing Osteomyelitis in Diabetic Foot
Researchers in this study assessed the diagnostic performance of [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) to diagnose osteomyelitis in the diabetic foot and compared it with that of magnetic resonance imaging (MRI) and plain film radiography (PFR). For the study, patients who met the prespecified criteria for complicated diabetic foot underwent FDG-PET, MRI, and PFR of the feet. Each imaging study was interpreted in a blinded fashion for the presence of osteomyelitis or other abnormalities. The gold standard for diagnosis in each patient was based on surgical, microbiological, and clinical follow-up results. The researchers found that FDG-PET is a highly specific imaging modality for the diagnosis of osteomyelitis in diabetic foot and should therefore be considered a useful complimentary imaging modality with MRI. When MRI is contraindicated, the high sensitivity and specificity of FDG-PET justifies its use after a negative or inconclusive PFR to aid an accurate diagnosis.
From "Diagnostic Performance of FDG-PET, MRI, and Plain Film Radiography (PFR) for the Diagnosis of Osteomyelitis in the Diabetic Foot"
Molecular Imaging and Biology (10/09/09) Nawaz, Asad; Torigian, Drew A.; Siegelman, Evan S.; et al.
Researchers Recommend Study of Outcomes in Surgeries Following Lower Back MRI
MRI is a technology frequently used to evaluate lower back pain despite some clinical evidence that questions its usefulness for this purpose, according to a newly-published study. Researchers from Stanford University analyzed the relationship between MRI supply and care and fee-for-service Medicare patients with lower back pain. The researchers found that increases in MRI supply are related to higher use of both lower back MRI and surgery. In light of these findings, they recommend that radiologists encourage careful attention to assessing the outcomes of surgeries following lower back MRI.
From "Magnetic Resonance Imaging and Low Back Pain Care for Medicare Patients"
Health Affairs (Quarter 4, 2009) Baras, Jacqueline; Baker, Laurence C.
Industry News
Radiation Overdoses Point Up Dangers of CT Scans
Americans receive more diagnostic radiation than ever, but two cases in California are highlighting the risks that powerful CT scans pose when used incorrectly. In early October, Cedars-Sinai Medical Center announced that it had mistakenly administered up to eight times the normal radiation dose to 206 possible stroke victims during a procedure intended to provide a clearer image of the brain over a course of 18 months. The overdoses involved CT brain perfusion scans, which are used in certain urgent situations, like a possible stroke, to identify the extent of possible blood flow problems in the brain. State and federal health officials are investigating the cause of the overdoses. Cedars-Sinai blamed its own flawed procedures for the overdoses, but said the manufacturer could help prevent errors by improving its internal settings and installing more safeguards. In the second case, at Mad River Community Hospital, in Arcata, Calif., a two-and-a-half year-old boy complaining of neck pain after falling off his bed has resulted in the revocation of a X-ray technician's state license for subjecting the child to more than an hour of CT scans, which normally takes only takes two or three minutes. The X-ray technician activated the CT scan 151 times on the same area, according to state investigators; a normal test involves about 25 images. The tests were stopped only after the child's father began to worry it was taking too long. The images were unclear, so another technician re-did the procedure in under two minutes using the same equipment. Bruce Fleck, Mad River Community Hospital's radiology manager at the time of the incident, says the overdose was a "rogue act of insanity." The Mad River case is particularly troubling because children are more susceptible to the long-term effects of radiation, including cancer. So far, the child has not shown any ill effects, but because the effects of radiation can take years to develop, the prognosis is uncertain. The family's lawyer says his radiation expert predicts the child will develop cataracts in three to five years.
From "Radiation Overdoses Point Up Dangers of CT Scans"
New York Times (10/15/09) Bogdanich, Walt
House Approves FDA Budget Boost
The U.S. House of Representatives has approved a bill that would increase the budget for the FDA's Center for Devices and Radiological Health (CDRH) by $34 million in 2010. The 12.1 percent increase raised the budget to $315 million, up from $281 million for fiscal 2009. While that increase is down from the $350 million budget approved by the House in July, it is congruent with the Obama administration's requests.
From "House Approves FDA Budget Boost"
Mass Device (10/09/2009)
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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