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Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
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Leading the News
Mammograms and Politics: Task Force Stirs Up a Tempest
A federal committee of medical experts has recommended that women younger than 50 years not get routine mammograms, arguing that it is not worth subjecting some patients to needless biopsies, radiation, and stress. It also is the recommendation of the U.S. Preventive Services Task Force that women not be taught to perform regular self-exams. On Nov. 17, Rep. Frank Pallone Jr. (D-N.J.) said his House health subcommittee will hold hearings on the mammogram issue in December, while other Democratic and Republican legislators implied that the task force had been influenced by insurance companies that will save more money if fewer mammograms are carried out. "We can't allow the insurance industry to continue to drive health-care decisions," argued Rep. Debbie Wasserman Schultz (D-Fla.), who said earlier this year that she had been treated for breast cancer. The American Cancer Society and the Access to Medical Imaging Coalition also had harsh words to say about the panel's recommendations. The former promised to continue recommending regular mammograms for women over the age of 40, and the latter cautioned that the panel's findings threaten to "turn back the clock on the war on breast cancer."
From "Mammograms and Politics: Task Force Stirs Up a Tempest"
Washington Post (11/18/09) P. A1; Eggen, Dan; Stein, Rob
Research
Researchers Analyze Structural Brain Changes in Alzheimer's Disease Using New Technique
Researchers have developed a fast and accurate method for quantifying subtle sub-regional brain volume loss using MRI. When applied to the newly completed dataset of the multi-institution Alzheimer's Disease Neuroimaging Initiative, scientists were able to demonstrate that such sub-regional brain volume measurements outperform available existing measures for tracking severity of Alzheimer's diseases, including widely used cognitive testing and measures of global brain-volume loss. The new methods described in the study require at least two brain scans to be performed on the same MRI scanner over a period of months. The new research shows that changes in the brain's memory regions, in particular the entorhinal cortex, offer sensitive measures of the early stages of the disease. The researchers tracked nearly 300 patients with mild cognitive impairment, 169 healthy controls, and 129 subjects with Alzheimer's disease. They then measured the rates of sub-regional cerebral volume changes for each group. Power calculations were performed to identify regions that would provide the most sensitive outcome measures in clinical trials of disease-modifying agents.
From "Analyzing Structural Brain Changes in Alzheimer's Disease"
ScienceDaily (11/16/09)
Even Ancient Egyptians Suffered Hardening of the Arteries, CT Scans Show
CT scans of Egyptian mummies have revealed evidence of atherosclerosis, which has been largely believed to be a disease caused by modern lifestyles. "Atherosclerosis is ubiquitous among modern-day humans and, despite differences in ancient and modern lifestyles, we found that it was rather common in ancient Egyptians of high socioeconomic status," says UC Irvine cardiologist Gregory Thomas, a co-author on the study. "The findings suggest that we may have to look beyond modern risk factors to fully understand the disease." UC San Diego School of Medicine cardiologist Michael I. Miyamoto says atherosclerosis may simply be a part of being human. The researchers, including cardiologists and Egyptologists, scanned a series of 20 mummies in the Egyptian Museum, using a Siemens machine permanently installed at the museum. Out of the 16 mummies who had identifiable arteries or hearts, nine had calcification that could clearly be seen in the arteries, or where the arteries would have been. The disease was clearly age-related, with seven of the eight who were over 45 years at their death having calcification, while only two that were younger had signs of the disease. The findings of the study are not necessarily surprising, as the upper-class Egyptians ate a diet high in meat from cattle, ducks, and geese, all of which are high in fat. Additionally, a common method of preservation was salt, which also contributes to heart disease.
From "Even Ancient Egyptians Suffered Hardening of the Arteries, CT Scans Show"
Los Angeles Times (11/17/09) Maugh, Thomas H.
Technology
Researchers Receive $1.6 Million NIH Grant to Develop Advanced Medical Imaging Tools
Prism Clinical Imaging and investigators from The Medical College of Wisconsin have received a $1.6 million grant from the National Institutes of Health (NIH) to develop and clinically validate advanced medical imaging software capable of assisting in the diagnosis and treatment of brain cancer patients. "This project will allow us to refine and validate new methods for mapping brain function with MRI and for displaying the results in an intuitive format that greatly simplifies interpretation by the physician," says Medical College professor of radiology and Prism co-founder Edgar De Yoe, a principal investigator on the three-year grant. Prism has already developed software that gives physicians anatomical, functional, and physiological image sequences in a single integrated view called a "stack." The company has also developed a new display, called a Functional Field Map, that instantly shows what the brain images mean for the patient's vision and movement abilities, allowing surgeons to identify and avoid areas in the brain that may be essential for movement, vision, and other functions. Previous studies have shown the advantages of the functional field map for clinical use, but further validating its potential in a controlled patient study will serve as a powerful tool for diagnosis, treatment planning, and follow-up assessments for almost any brain pathology, particularly cancer. The grant will fund advanced development of this imaging technology in a program intended to promote commercial application of promising healthcare technologies. The grant involves researchers at Cleveland Clinic and Radiology Associates of Sacramento and was made possible through funding from the Small Business Technology Transfer program at the NIH, which is intended to stimulate partnerships between innovative small business concerns and nonprofit research institutions through federally funded research and development. "This NIH program is crucial for translating new technologies from laboratory curiosities into practical products that can be used routinely by doctors. It also is a real shot in the arm for small high-tech companies, especially in the current economic environment," says De Yoe.
From "Prism and Medical College of Wisconsin Investigators Receive $1.6 Million NIH Grant to Develop Advanced Medical Imaging Tools"
Newswise (11/13/09)
Small Nanoparticles Bring Big Improvement to Medical Imaging
When observing the complex processes of a living cell, it can be quite easy to miss important events, particularly if the observation is intended to monitor changes that take place over long periods and requires high-spatial-resolution imaging. However, new research by the National Institute of Standards and Technology (NIST) and the National Institute of Allergy and Infectious Diseases (NIAID) makes it possible to scrutinize activities that take place over hours, or even days, inside cells, which could potentially help solve many of the mysteries associated with molecular-scale events. The researchers have discovered a method for using nanoparticles to illuminate the cellular interior to reveal these lengthy processes. One type of nanoparticle, called a quantum dot, glows when exposed to light and can be coated in organic materials specially tailored to be attracted to specific proteins within the part of a cell that a scientist wants to examine. "Quantum dots last longer than many organic dyes and fluorescent proteins that we previously used to illuminate the interiors of cells," says NIST biophysicist Jeeseong Hwang. "They also have the advantage of monitoring changes in cellular processes while most high-resolution techniques like electron microscopy only provide images of cellular processes frozen at one moment. Using quantum dots, we can now elucidate cellular processes involving the dynamic motions of proteins." The researchers focused primarily on characterizing quantum dot properties and how they differed from other imaging techniques. In one study, the researchers designed quantum dots to target a protein in human red blood cells that help cells squeeze through capillaries and narrow spaces by clustering. However, the network protein is changed by the malaria parasite, so by visualizing the clustering of the protein, the researchers hoped to learn something about the progress of a malaria infection. The researchers also found that when quantum dots attach themselves to other nanomaterials, the dots' optical properties change at the nanoscale environment, creating a wider possible use for quantum dots.
From "Small Nanoparticles Bring Big Improvement to Medical Imaging"
NIST Tech Beat (11/17/09)
Medical-Legal Issues
Insurers Unlikely to Alter Policies in the Debate Over Mammograms
Health insurers, including the Medicare program, say they are unlikely to change coverage of mammograms following new guidelines recently issued by the United States Preventive Services Task Force regarding the tests. The insurers say that they base their coverage decisions on a variety of research and guidelines from numerous groups, many of which continue to recommend more frequent screenings, including the American Cancer Society. Insurers say they are likely to cover any screening recommended by a doctor in consultation with a patient, particularly if there is a genetic predisposition or a family history of the disease. "As one of the nation’s leaders in providing mammography screenings, we believe that focusing on prevention and early detection is critical in improving women’s health and saving lives," Kaiser Permanente announced in a statement. "We do not currently plan on making any changes to our coverage or treatment practices." However, even under the former guidelines, many women have apparently not had the screening, often because they lack insurance.
From "Insurers Unlikely to Alter Policies in the Debate Over Mammograms"
New York Times (11/18/09) Singer, Natasha; Abelson, Reed
U.S. FDA Sees Varying Risk From MRI Agents
An FDA staff review has found that some contrast agents used with MRI appear to carry a higher risk of nephrogenic systemic fibrosis (NSF). The reviewers found that the highest risk of NSF appeared to be associated with gadodiamide, while the lowest risk was associated with gadoteridol and gadobenate dimeglumine. However, reviewers also concluded that the extent of the risk from any of the agents was unknown. In light of these findings, the data will now be sent to an outside panel for further study.
From "U.S. FDA Sees Varying Risk From MRI Agents"
Reuters (11/17/09) Richwine, Lisa
FDA Issues Nationwide Recall of ViperSheath Sheath Introducer
The FDA has issued a notification for cardiological and interventional radiological healthcare professionals regarding a recall of all lots of the ViperSheath Sheath Introducer due to reports that the sheath may stretch or fracture during use. Such a device fracture could lead to adverse events, including unplanned open surgery to remove the retained segments of the device or to control bleeding. Because the device is coil reinforced, any separation of the cannula has the potential to expose portions of the coil, creating the potential for vessel dissection or perforation.
From "Cardiovascular Systems ViperSheath Sheath Introducer - Recall"
Medwatch (11/17/2009)
Clinical Practice
Radiologists' Requests for Follow-Up Exams Doubled in the Past Decade
Between 1995 and 2008, the number of recommendations for additional imaging (RAIs) increased from 6 percent to 12 percent, according to a study published in the November 2009 issue of Radiology. This increase was detected by researchers using an algorithm to analyze nearly 6 million radiological exams conducted. The region of the body most likely to trigger an RAI was the chest, especially the breast, and examinations with positive findings had approximately five times the odds of seeking a follow up as ones with negative findings. Outpatients and those coming from the emergency room were also more likely to receive follow-up imaging. Additionally, the study found that for every decade of experience a radiologist had, he or she was approximately 15 percent less likely to order an additional exam.
From "Recommendations for Additional Imaging in Radiology Reports: Multifactorial Analysis of 5.9 Million Examinations"
Radiology (11/01/09) Vol. 253, No. 2, P. 453; Sistrom, Christopher L.; Dreyer, Keith J.; Dang, Pragya P.; et al.
Some Specialists Will See Extra Cuts in Medicare Pay
The Centers for Medicare & Medicaid Services' (CMS) decision to adopt significant changes to the practice-expense portion of the relative value unit system in the 2010 physician fee schedule entails especially large reductions for specialty practices involving heavy use of computed tomography (CT) and magnetic resonance imaging (MRI). The amount of time Medicare assumes that advanced diagnostic imaging gear is being utilized during physician office hours will increase from 50 percent to 90 percent over the next four years, lowering the program's coverage. Radiologists will consequently face an average 5 percent reduction in Medicare payments in 2010 and more cuts over the subsequent three years. That would be in the wake of a 23 percent reduction in medical imaging rates from the Deficit Reduction Act of 2005. Physicians warn the cuts could harm patients by increasing wait times for imaging exams. The cuts could be particularly detrimental to freestanding imaging facilities in rural regions and could lead to the closure of some centers. The Access to Medical Imaging Coalition released a statement on Nov. 3 warning that payment revisions could translate into massive reductions for certain non-hospital services, including a nearly 50 percent pay cut for pelvic CT scans, 46 percent for MRI scans of the spine or chest, and 27 percent for cardiovascular-related services. Tim Trysla, the imaging coalition's executive director, says surveys show offices use imaging equipment far less than the agency estimates.
From "Some Specialists Will See Extra Cuts in Medicare Pay"
American Medical News (11/16/09) Silva, Chris
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