See Physics Teaching Modules at RSNA 2009
Residents looking to improve their basic science education, as well as seasoned practitioners looking for a refresher, will want to check out new, Web-based physics teaching modules at the RSNA Education Store at RSNA 2009.
Developed by RSNA and the American Association of Physicists in Medicine, the modules focus on the basic science underlying such areas as radiography, fluoroscopy, CT and ultrasound.
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Featured in RadioGraphics: From the Archives of the AFIP
In a RadioGraphics CME article from the archives of the Armed Forces Institute of Pathology, learn more about the radiologic-pathologic correlation of pigmented lesions of the central nervous system.
Pigmented lesions of the central nervous system (CNS) are a diverse group of entities that run the gamut from benign to malignant. These lesions may be well circumscribed or diffuse, and their imaging appearances are influenced by the degree of melanin content as well as the presence or absence of hemorrhage. Pigmented lesions of the CNS are uncommon, and knowledge of their imaging characteristics and pathologic features is essential for their identification.
In the review article, Alice Boyd Smith, Lt. Col., USAF MC, Elisabeth J. Rushing, COL, MC, USA and James G. Smirniotopoulos, M.D., address these issues concerning pigmented lesions of the CNS:
- Clinical and pathologic features
- Imaging characteristics
- Differential diagnosis
Read more about Pigmented Lesions of the Central Nervous System: Radiologic-Pathologic Correlation in RadioGraphics.
Leading the News
Researchers Question Use of Breast and Prostate Cancer Screenings
Breast and prostate cancer screenings have been taking place for 20 years. In that time, the percentage of early stage cancers has increased; however, the incidence of regional cancers has not decreased at a commensurate rate. Researchers believe that this is because screening may be increasing the burden of low-risk cancers without significantly reducing the burden of more aggressively growing cancers, which would explain why cancer mortality rates have not decreased. In an effort to increase the effectiveness of cancer screening, researchers have made several recommendations. First, they suggest that scientific discovery efforts improve their focus on developing and validating biomarkers that differentiate between significant and minimal risk cancers. They also recommend that the risks of screening and biopsy be disclosed to patients before screening, and, at the time of cancer detection, healthcare professionals disclose the risks and benefits of treatments for specific biological subtypes. The development of decision-support tools for both patient and clinicians could aid in these processes. Finally, researchers suggest that screening practices in high-risk patients be combined with proper prevention methods. For breast cancer, the focus should be on prevention efforts for women for whom the risk and benefits of intervention have been shown to be highest.
From "Rethinking Screening for Breast Cancer and Prostate Cancer"
Journal of the American Medical Association (10/21/09) Vol. 302, No. 15, P. 1685; Esserman, Laura; Shieh, Yiwey; Thompson, Ian
Research
FDG PET Proves Useful for Monitoring Tuberculosis Response to Treatment
FDG PET may be effective for monitoring the response of patients with tuberculosis to antimycobacterial treatment, according to a study presented at the 2009 meeting of the European Association of Nuclear Medicine in Barcelona. The study, presented by Dr. Mehmet A. Ozguven of the Gulhane Military Medical Academy and colleagues, included 17 patients with tuberculosis who underwent high-resolution CT and FDG PET. All patients also underwent an FDG PET scan before taking a six month triple antimycobacterial treatment regimen. Seven patients then underwent PET scanning in the first month of treatment, and three patients had PET exams in the sixth month of treatment.
From "EANM: FDG PET Useful for Pulmonary Tuberculosis Response Monitoring"
Health Imaging & IT (10/16/09)
CD47 Suppression Protects Normal Tissue from Radiation, Delays Tumor Growth
Researchers have identified a biochemical signaling pathway that can protect normal tissues from standard and high doses of radiation while delaying tumor growth. In experiments on mice, the researchers found that by systemically administering an antisense CD47 morpholino (injected with human tumors), they could block a molecule called thrombodspondin-1 (TSP1) from binding with its CD47 cell receptor and protect normal tissues from damage by ionizing radiation. The authors implanted syngenic B16 melanoma tumors into the thighs of mice, treated them with the CD47-targeting morpholino, and followed the tumor growth rates after irradiation. Treatment with the morpholino alone slightly delayed tumor growth, while treatment with irradiation alone resulted in the expected growth delay. Treatment of tumor-bearing limbs with the CD47 morpholino followed by irradiation delayed tumor regrowth by 89 percent relative to irradiation alone.
From "Radioprotection in Normal Tissue and Delayed Tumor Growth by Blockade of CD47 Signaling"
Science Translational Medicine (10/21/09) Vol. 1, No. 3, P. 3ra7; Maxhimer, Justin B.; Soto-Pantoja, David R.; Ridnour, Lisa A.; et al.
fMRI Shows That the Internet Is Altering Our Brains
University of California, Los Angeles (UCLA) researchers conducted a study that shows the Internet is changing how our brains operate. The study shows that adults with little Internet experience show changes in their brain activity after a single week of Internet use, suggesting that Internet training can stimulate neural activation patterns and could potentially enhance brain function and cognition in older adults. "We found that for older people with minimal experience, performing Internet searches for even a relatively short period of time can change brain activity patterns and enhance function," says study author and UCLA Semel Institute for Neuroscience and Human Behavior professor of psychiatry Gary Small. The UCLA team worked with 24 neurologically normal volunteers between the ages of 55 and 78 years. Before the study, half of the participants used the Internet daily, while the other half had very little experience. Participants performed Web searches while undergoing functional magnetic resonance imaging (fMRI) scans, which track brain activity by measuring the level of blood flow in the brain during cognitive tasks. Following the initial brain scan, subjects went home and performed Internet searches for one hour a day on seven days over a two-week period. The practice searches involved using the Web to answer questions on numerous topics by exploring different Web sites and reading information. Participants then underwent another brain scan while performing the same Internet simulation but with different topics. The first scans of subjects with little Internet experience showed brain activity in the regions that control language, reading memory, and visual abilities, while the second scans showed activation of the same areas but also activity in the middle frontal gyrus and inferior frontal gyrus, which are areas that are known to be important in working memory and decision-making. "The results suggest that searching online may be a simple form of brain exercise that might be employed to enhance cognition in older adults," says the study's first author and UCLA research Teena D. Moody.
From "UCLA Study: The Internet Is Altering Our Brains"
Fox News (10/19/09)
Medical-Legal Issues
FDA Issues Draft Guidance for CAD Devices
The FDA has issued draft guidance regarding premarket notification [510(k)] submissions for computer-assisted detection (CAD) devices applied to radiology images and device data. All recommendations made in the draft document were made during the Radiology Advisory Public Panel, which was held from March 4-5, 2008. These recommendations include guidelines for describing the CAD device in a premarket submission as well as for clinical and stand-alone performance assessments of CAD devices, user training, and device labeling. All comments on this draft guidance must be submitted within 90 days of its posting.
From "Draft Guidance for Industry and FDA Staff: Computer-Assisted Detection Devices Applied to Radiology Images and Radiology Device Data"
FDA.gov (10/21/09)
Imaging Advocates Pull Off Major Healthcare Reform Coup
The Senate Finance Committee made a last-minute addition to the Senate version of the healthcare reform bill that would link physician reimbursement to the use of appropriateness criteria for ordering imaging studies. The provision will likely be debated by the full Senate with the rest of the America's Healthy Future Act of 2009. The act asks for $10 billion in appropriations to fund the CMS Innovation Center, which would develop new solutions for physician reimbursement. Among many models required for testing, the bill would permit higher payments for physicians who refer patients to advanced imaging services in accordance with certain appropriateness criteria. Another provision in the bill would raise the assumed utilization rate in Medicare's payment rate formula for imaging equipment that costs more than $1 million to 65 percent in a 45-hour work week. The current utilization rate is 50 percent; and although imaging advocates do not support any change, the Senate's proposed utilization rate is significantly lower than the 95 percent proposed by the White House, the 90 percent rate recommended by the Medicare Payment Advisory Committee, and the 75 percent asked for in the House version of the healthcare reform bill. The Senate bill sets the rate assumption from 2010 to 2014 with an expected $3 billion in savings. If those savings are not achieved in that time period, the Department of Health and Human Services reserves the right to raise the rate as high as 75 percent.
From "Imaging Advocates Pull Off Major Healthcare Reform Coup"
Diagnostic Imaging (10/19/09) Abella, H.A.
Medicare Pricing Gets New Look; RUC Process Revisited
As the Centers for Medicare & Medicaid Services (CMS) prepares for its latest five-year review of possibly mis-valued services in the physician fee schedule, the Medicare Payment Advisory Commission (MedPAC) is once again raising its 2006 recommendation that the Health and Human Services secretary establish a separate expert panel to advise on potentially overvalued or undervalued services. "With the next five-year review about to start, perhaps these recommendations bear revisiting," said Kevin Hayes, a principal policy analyst with the commission, which recommended three years ago to have experts in clinical and healthcare economics sit on the proposed separate panel. Generally, CMS accepts most recommendations from its existing AMA/Specialty Society Relative Value Scale Update Committee, or RUC, which is made up of practicing physicians from various specialties. Hayes said, however, that there are some questions about things like the physician work portion of particular value units. Some published research, for example, has found that physicians spend 13.5 minutes on average in a typical colonoscopy, but the fee schedule estimates 30 minutes. "The overall policy question is whether the [relative value units] are accurate and equitable," Hayes said. "The question is particularly relevant to physician services because of the critical role physicians play in the health care system. More broadly, research from CMS suggests that overestimates of physician time may be a problem that applies to a number of services, and not just limited to an isolated procedure such as a colonoscopy." Meanwhile, some members of MedPAC have asked whether there could be an easier method for services whose payment rates are found to be outside a reasonable range. "If it's a question of outliers, then that's something CMS could handle with a reasonable addition of resources," said commission member Bruce Stuart, who serves as executive director of the Peter Lamy Center for Drug Therapy and Aging at the University of Maryland. "Is there some mechanism by which we could prioritize payment issues, focus on those, then pass it off to CMS?"
From "Medicare Pricing Gets New Look; RUC Process Revisited"
American Medical News (10/19/09) Silva, Chris
Clinical Practice
Radiologists Develop Scale to Help Clinicians Predict Disease Severity in Infants With NEC
Radiologists have developed a scale to assist clinicians in determining the severity of disease and the need for surgery in infants with necrotizing enterocolitis (NEC). The scale, known as the Duke Abdominal Assessment Scale (DAAS), was assessed in a case-control study of 43 infants. The study found that DAAS may enable earlier detection of patients at risk for developing NEC by creating "a clear, concise radiology report that provides the clinician with a consistent measure of concern by the radiologists," said study author Dr. Caroline L. Hollingsworth.
From "Radiographic Predictors of Disease Severity in Neonates and Infants With Necrotizing Enterocolitis"
American Journal of Roentgenology (11/01/2009) Vol. 193, No. 5, P. 1408; Coursey, Courtney A.; Hollingsworth, Caroline L.; Wriston, Cooper; et al.
Industry News
Cancer Society, in Shift, Has Concerns on Screenings
The American Cancer Society has backtracked on its long tradition of advocating most cancer screenings by developing a message that the benefits of spotting many cancers, particularly prostrate and breast, have been exaggerated. The message stresses that screening for breast and prostate cancer and certain other cancers can be accompanied by a risk of over-treating many small, non-deadly cancers while overlooking lethal cancers. American Cancer Society chief medical officer Otis Brawley says the society's reevaluation of its message about the potential advantages and risks of cancer screening was partly impelled by an analysis published in the Journal of the American Medical Association on Oct. 21. The study estimates a 40 percent rise in breast cancer diagnoses and a near doubling of early stage cancers, yet only a 10 percent slippage in cancers that have spread beyond the breast to the lymph nodes or elsewhere. Similar findings were found for prostate cancer diagnoses. The analysis discovered that both types of screening are detecting cancers that do not have to be found because they would never metastasize and kill the host or even be noticed if left alone. Simultaneously, both screening tests are having little impact on the number of deadly cancers. The researchers do not support the complete elimination of all cancer screening, but rather that patients making a decision about these tests should understand what is known about the risks and the benefits. "I am concerned that the complex view of a changing landscape will be distilled by the public into yet another 'screening does not work' headline," says Colin Begg of the Memorial Sloan-Kettering Cancer Center. "The fact that population screening is no panacea does not mean that it is useless."
From "Cancer Society, in Shift, Has Concerns on Screenings"
New York Times (10/21/09) Kolata, Gina
Philip Morris May Have to Fund Scans for Smokers
In a move that may open up new avenues for tobacco liability suits, the highest court in Massachusetts ruled that Philip Morris USA may be required to pay for diagnostic chest exams to give smokers an early warning for lung cancer. "We must adapt to the growing recognition that exposure to toxic substances and radiation may cause substantial injury, which should be compensable, even if the full effects are not immediately apparent," wrote Justice Francis X. Spina for the Supreme Judicial Court (SJC). The state court's interpretation of Massachusetts law had been requested by a federal district judge regarding a lawsuit filed by two Massachusetts smokers, who are seeking class-action certification. If the jury rules in favor of the plaintiffs in that case, Philip Morris could have to pay for a low-dose computed tomography scan for each patient. Though lawyers and the court said the state decision was narrowly drawn and only affects the pending federal suit now, Edward L. Sweda Jr. of the Tobacco Products Liability Project at Northeastern University said tobacco companies could face a "new category, a new track of litigation that they haven't had to deal with." Philip Morris is calling for the case to be rejected from federal court, saying that other state and federal courts have rejected the legal reasoning the SJC adopted.
From "Philip Morris May Have to Fund Tests for Smokers"
Boston Globe (10/20/09) Ellement, John R.
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