November issue of RSNA News Now Available
Dont's Miss the Latest News
The November issue of RSNA News is now available at RSNAnews.org
Highlights include:
Simulation Faces Technological, Regulatory Obstacles on Way to Mainstream
Debate Sparked Over Risks of CT-based CAC Screening
Radiology Salaries Inch Up Slightly
Obesity and Heart Disease Link Spur Structured Reporting Ideas
Headlines
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
Industry News
Leading the News
USPSTF Raises Recommended Mammography Screening Age to 50
The United States Preventive Services Task Force (USPSTF) has changed its recommendation on mammography screening, advising women to start at age 50 rather than 40. Since 2002, USPSTF had recommended screening mammography every one to two years for women ages 40 and older. The group's new guidelines, which are different from those of some professional and advocacy organizations, are published online in The Annals of Internal Medicine. They are likely to touch off more discussion over the benefits of screening for breast cancer. The National Cancer Institute says that it is re-evaluating its guidelines in light of the task force’s report. However, the American Cancer Society and the American College of Radiology both say they are staying with their guidelines advising annual mammograms starting at age 40. The cancer society, in a statement by Dr. Otis Brawley, its chief medical officer, agrees that mammography had risks as well as benefits but, he says, the society’s experts have looked at “virtually all” the task force and additional data and concluded that the benefits of annual mammograms starting at age 40 outweigh the risks. Other advocacy groups, like the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network, welcome the new guidelines. Researchers based the new recommendations on analysis of the efficacy of five breast screening modalities in reducing breast cancer mortality: film mammography; clinical breast examination; breast self-examination; digital mammography; and breast MRI. In announcing the change, USPSTF acknowledged that "there is convincing evidence that screening with film mammography reduces breast cancer mortality," but that the evidence is strongest for women ages 50 to 74 than for women ages 40 to 49. The strongest evidence is for women ages 60 to 69. The agency found no evidence of a benefit to screening for women older than 75 and no evidence to support clinical breast examination beyond mammography. The new recommendations do not apply to a small group of women with unusual risk factors for breast cancer.
From "In Reversal, Panel Urges Mammograms at 50, Not 40"
New York Times (11/17/09) P. A1; Kolata, Gina
Research
Research Finds Optical Biopsy for Breast Cancer Increasingly Accurate
University of Florida researcher Dr. Huabei Jiang has developed a new technology, known as phase-contrast diffuse optical tomography, that could provide a less-invasive alternative to traditional breast biopsies. The experimental device uses lasers to create an image of the interior of a patient's breast, which can be used to determine whether or not any lesions display characteristic signs of cancer that normally could only be detected by biopsy, such as cellular size and density. Over the past 10 years, Jiang and his colleagues have tested the device on approximately 200 patients. In those patients, Jiang's imaging device identified biopsy-confirmed malignancies nearly 75 percent of the time. Jiang reports that he has now improved that accuracy rate to 91 percent in a study involving 144 women.
From "Optical Biopsy for Breast Cancer Increasingly Accurate, Research Finds"
ScienceDaily (11/08/09)
PET Imaging Response Found to Be a Prognostic Factor After Thoracic Radiation Therapy for Lung Cancer
A study conducted by researchers at Thomas Jefferson University Hospital shows that a rapid drop in metabolic activity on a PET scan following radiation therapy for non-small cell lung cancer is correlated with good local tumor control. The researchers, who presented the study at the 51st ASTRO Annual Meeting, also found that the higher the metabolic activity and tumor size on a PET scan before treatment, the greater the chances of the patient dying from lung cancer. "PET scanning is an emerging tool of molecular imaging in lung cancer, in contrast to CT scans and MRI scans which are anatomic imaging," said Thomas Jefferson University Jefferson Medical College associate professor of radiation oncology Maria Werner-Wasik. "It has become an important tool in the evaluation of lung cancer staging and evaluation of treatment response." The researchers conducted a retrospective analysis of 50 patients with lung cancer who received PET imaging before and after radiation therapy, and they analyzed the prognostic factors for tumor local failure. Metabolic activity was measured using the maximum Standardized Uptake Value (mSUV), and tumor size, or the Metabolic Tumor Volume, was also measured. The risk of local failure dropped incrementally for each unit decline in mSUV by the first post-therapy scan. When compared to the pre-therapy PET scan, the mSUV of the primary tumor declined by 72 percent in the first post-therapy scan, 76 percent in the second scan, and 77 percent in the third scan. Nineteen patients achieved a metabolic complete response, with a median time of 10.6 months, and eight patients suffered local failure. Being female, having stage IV disease, or having a large tumor size were factors significantly associated with increased local failure.
From "PET Imaging Response a Prognostic Factor After Thoracic Radiation Therapy for Lung Cancer"
ScienceDaily (11/06/09)
Brain Scans Show PTSD Not Just Mental
Medical scans are helping to identify how veterans' brains change from post-traumatic stress disorder (PTSD) and concussion-like brain injuries, which could one day allow for far easier diagnosis for patients. While this research may be enormously helpful in the future, it is already having a major impact by verifying that problems often thought to be "just in your head" actually have physical signs, and scientists are learning where and how to identify those signs. Dr. Jasmeet Pannu Hayes from Boston University, who is helping to lead the research at the Veterans Affairs' National Center for PTSD, says just showing a real physical cause helps prove it is a real disorder and encourages people to seek care. Up to one in five U.S. veterans in Iraq and Afghanistan is believed to have symptoms of PTSD, and an equal number are believed to have suffered traumatic brain injuries (TBI), which often do not involve open wounds but rather hidden damage caused by an explosion's pressure wave. The TBIs are similar to a concussion, but because symptoms are not always immediately apparent, soldiers can be exposed multiple times. While studying a Marine who was on explosive ordnance disposal and believed to have been exposed to 50 to 60 explosions, Hayes tracked how water flows through tiny, celery stalk-like nerve fibers in the Marine's brain and found otherwise undetectable evidence that those fibers were damaged, explaining his memory problems and confusion. Hayes used a noninvasive technique called "diffusion tensor imaging" that simply adds a little time to a standard MRI scan. It is possible to determine if an area of the brain has been damaged by measuring the direction and speed of the water molecules in the nerve fibers. Hayes also performed MRI scans while patients with PTSD tried to suppress their negative memories or followed PTSD therapy and changed how they viewed their trauma. The study showed that the fear-processing region of the brain was less active when people followed PTSD therapy.
From "Scanning Invisible Damage of PTSD, Brain Blasts"
Associated Press (11/10/09) Neergaard, Lauran
Technology
German Science Council Funds Installation of Whole-body MRI-PET Hybrid System
The German Science Council will supply 6.56 million euros to fund the installation of a prototype whole-body magnetic resonance imaging-positron emission tomography (MRI-PET) system in the center of excellence for imaging procedures at the radiology clinic in Eberhard-Karls University. "We believe the MRI-PET hybrid technology to be of particular value to onco-diagnostics and to stroke and cardiac diagnostics," says professor Claus D. Claussen, the medical director of the university hospital's radiology clinic. "In Tubingen, we have already taken the first steps towards this technology. The first combined equipment, which was developed by professor [Bernd J.] Pichler and team, is a 7-tesla MRI-PET scanner for small animals. Since it met with huge interest from research labs, it is now being marketed by a tomography manufacturer for research purposes. The demand, particularly in the pharmaceutical industry, is high because such a scanner allows for non-invasive examinations, for example of mice in bio-medical basic research. Such an MRI-PET scanner is ideally suited to document the course of a disease and therapy success." Claussen notes that his team has been testing a 3-tesla prototype MRI-PET hybrid system from Siemens for brain diagnostics since early last year, and they hope to uncover new findings about diseases such as Parkinson's, epilepsy, or Alzheimer's. "A combination of MRI and PET is the ideal synthesis of functional and morphological imaging," says Claussen. "A further advantage: It is a hybrid system, which enables simultaneous image acquisition rather [than] post-acquisition fusion of images, as is the case with PET-CT. This not only reduces examination times but also offers parallel documentation of interacting functional processes, thus providing much more precise information."
From "The First Whole-Body MRI-PET System"
European Hospital Online (11/13/09)
Medical-Legal Issues
CMS Issues Decision Memo for FDG PET for Cervical Cancer
The Centers for Medicare & Medicaid Services (CMS) has concluded that there is sufficient clinical evidence to support the use of FDG PET imaging for cervical cancer staging of beneficiaries diagnosed with cervical cancer. Therefore, CMS will cover one FDG PET for staging for beneficiaries who have biopsy proven cervical cancer when the beneficiary's treating physician determines that FDG PET is necessary to determine the location and/or extent of the tumor for several therapeutic purposes related to the treatment strategy. These purposes include determining whether the beneficiary is an appropriate candidate for invasive diagnostic or therapeutic procedures, the optimal anatomic location for an invasive procedure, and the anatomic extent of tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor.
From "Decision Memo for Positron Emission Tomography (FDG) for Cervical Cancer"
CMS Press Release (11/10/09)
CMS Issues NCA Tracking Sheet for Multiple PET Scans for Initial Treatment Strategy in Solid Tumors and Myeloma
The Centers for Medicare & Medicaid Services (CMS) has issued a national coverage assessment (NCA) tracking sheet for PET used to guide initial antitumor treatment strategy for beneficiaries who have solid tumors and myeloma that are biopsy proven or strongly suspected of being cancer based on other diagnostic testing. The current national coverage decision for PET only covers one scan for guiding initial antitumor treatment, but requestors have asked CMS to conduct an NCA to determine if clinical evidence supports coverage for more than one scan. The public comment period on this NCA tracking sheet will last until Dec. 9, 2009, and CMS is expected to issue a decision memo on the subject by May 5, 2010.
From "NCA Tracking Sheet for Positron Emission Tomography for Initial Treatment Strategy in Solid Tumors and Myeloma"
CMS Press Release (11/09/09)
Clinical Practice
Some Radiologists Say They Would Not Disclose Harmful Mammography Errors to Patients
Approximately one out of 10 radiologists report that they would not inform patients if an interpretation error led to a delayed cancer diagnosis, according to a study published in the November 2009 issue of Radiology. Researchers surveyed 364 radiologists at seven clinics participating in the Breast Cancer Surveillance Consortium. The participating radiologists were asked to review a hypothetical case in which mammograms had been read in the wrong order, causing a suspicious shadow to appear to be disappearing rather than growing. Approximately 9 percent of radiologists said they would definitely not tell the patient about the error, with approximately 51 percent saying they would only mention it if asked by the patient. Around 40 percent said they were likely or certain to disclose the mistake no matter what.
From "Disclosing Harmful Mammography Errors to Patients"
Radiology (11/01/09) Vol. 253, No. 2, P. 443; Gallagher, Thomas H.; Cook, Andrea J.; Brenner, R. James; et al.
Industry News
Cedars-Sinai Finds More Patients Exposed to Excess Radiation
Cedars-Sinai Medical Center officials disclosed on Nov. 9 that 260 patients had been exposed to high doses of radiation during computed tomography (CT) brain scans over 18 months, up from the hospital's original count of 206 in September. A review by the hospital also revealed that about a fifth of the patients received exposure directly to the lenses of their eyes, which raises their risk for cataracts, according to hospital representative Simi Singer. Officials said that the unintentional overdoses started in February 2008 following the reconfiguration of a scanner, and the error only affected patients undergoing CT brain perfusion scans. The error was not discovered until August 2009. A letter was sent to patients in which Cedars-Sinai's chief operating officer and chief medical officers apologized for the overdoses and said that the hospital will cover the cost of any associated medical care. Officials said Cedars-Sinai has set up a chain of authority for making scanner reconfigurations to guarantee that they do not result in radiation overdoses. CT technologists also will receive additional training.
From "Cedars-Sinai Finds More Patients Exposed to Excess Radiation"
Los Angeles Times (11/09/09) Santa Cruz, Nicole
Dr. Elias Zerhouni Picks the 7 Most Powerful People in Medicine
Dr. Elias Zerhouni, who served as director of NIH from 2002 to 2008 and is currently a professor of radiology and biomedical engineering at Johns Hopkins University, recently identified some of the most influential individuals in healthcare. First on Zerhouni's list is current NIH director Dr. Francis S. Collins, followed by National Institute of Allergy & Infectious Diseases Director Dr. Anthony S. Fauci and China Minister of Health Dr. Chen Zhu. Also on the list are Dr. David L. Baltimore, the chairman of the American Association for the Advancement of Science, Dr. Harold E Varmus, the president of the Memorial Sloan-Kettering Cancer Center, and Dr. Tadataka Yamada and William Gates III, who head the Global Health Program and the Bill and Melinda Gates Foundation, respectively. Rounding out Zerhouni's picks are Drs. James Thompson and Shinya Yamanaka of the University of Wisconsin and Kyoto University for creating stem cells without the use of embryos.
From "Dr. Elias Zerhouni Picks the 7 Most Powerful People in Medicine"
Forbes (11/12/09) Herper, Matthew
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