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Leading the News
Studies Link CT Scans to Cancer
The risk of cancer associated with popular CT scans appears to be greater than previously believed, according to two new studies published Dec. 14 in the Archives of Internal Medicine. The findings support caution against the overuse of CT scans and other medical technologies that use radiation. Overuse of CT scans and variations in doses of radiation caused by different machines and different operators are exposing patients to high radiation doses that will lead to tens of thousands of new cases of cancer and as many as 15,000 deaths for each year that the scanners are used, according to the studies. One study, sponsored by the U.S. National Institutes of Health and the National Cancer Institute, estimates that approximately 29,000 future cancers could be related to CT scans performed in the United States in 2007 alone, based on the 2006 Biological Effects of Ionizing Radiation VII risk models. "This study is being taken very seriously by radiologists," says Dr. Alec Megibow, a professor of radiology at NYU Langone Medical Center. He cautions that careless use of scanners can lead to high doses of radiation, but asserts that, with proper use, "the benefits of a CT scan far outweigh the risks." In the other study, researchers from UC San Francisco found that the same imaging procedure performed at different institutions - or even on different machines at the same hospital - can yield a 13-fold difference in radiation dose, potentially exposing some patients to inordinately high risk.
From "Overuse of CT Scans Will Lead to New Cancer Deaths, a Study Shows"
Los Angeles Times (12/15/09) Maugh II, Thomas H.
FDA Probes Radiation at Hospitals
Federal health regulators are investigating reports of dangerous radiation levels at two more California hospitals, following earlier unsafe medical scans at a Los Angeles facility. The Food and Drug Administration is probing the use of CT scans at Glendale Adventist Medical Center and Providence St. Joseph Medical Center in Burbank, Calif. The brain scans are used to diagnose strokes. FDA officials say they are investigating at least 10 reports of excessive radiation at Glendale Adventist and an unspecified number of problems at St. Joseph. The FDA began looking into problems with CT scanning in October after patients at Cedars-Sinai Medical Center in Los Angeles reported losing hair or skin redness. The hospital in November said 260 patients were exposed to excess radiation, up from prior reports of 206. FDA officials say it is unclear whether the dangerous exposures are being caused by human error or a problem with CT equipment. Cedars-Sinai and Glendale Adventist both use scanners from General Electric. FDA officials say they have received reports of problems at other hospitals using different brands of scanners. GE spokesman Arevind Gopalratnam says "there were no malfunctions or defects in any of the GE Healthcare equipment involved,'' adding that GE is cooperating with the FDA's investigation.
From "FDA Probes Radiation at Hospitals"
Associated Press (12/08/09)
FDA Makes Interim Recommendations to Address Concern of Excess Radiation Exposure During CT Perfusion Imaging
The FDA has provided imaging facilities and radiologists with interim recommendations to prevent excess radiation during CT perfusion imaging. These notifications are part of an ongoing investigation by the FDA into cases where patients were accidentally exposed to excess radiation during scans at Cedars-Sinai Medical Center in Los Angeles and other medical facilities. According to the recommendations, facilities should assess whether patients who underwent CT perfusion scans may have received excess radiation, and they should review their radiation dosing protocols for all CT perfusion studies. Facilities are then advised to implement quality control procedures designed to ensure dosing protocols are followed for every scan. The recommendations also suggest that radiologists check display panels on all CT scanners prior to performing a study and that they adjust the dose of radiation so it is appropriate for each study when performing more than one scan on the same patient. Additionally, the recommendations ask manufacturers to review user training protocol and put in place stricter surveillance measures to detect problems quickly.
From "FDA Makes Interim Recommendations to Address Concern of Excess Radiation Exposure During CT Perfusion Imaging"
FDA.gov (12/07/09)
Research
EEG-fMRI Improves Standard Evaluations of Patients With Nonlesional FLE
EEG-fMRI may help to determine the epileptic focus in patients with nonlesional frontal lobe epilepsy (FLE). A group of researchers at the Montreal Neurological Institute assessed nine nonlesional FLE patients who were studied with EEG-fMRI using a 3T scanner. The researchers compared spike-related blood oxygen level dependent (BOLD) signal changes to the topography of the spikes and to any available PET and SPECT results. They found concordance between spike localization and positive BOLD response in eight patients, while PET and SPECT investigations corresponded with BOLD signal changes in six of seven investigations. In two instances, reviewing the structural MRI guided by EEG-fMRI data resulted in considering a suspicious deep sulcus.
From "Adding to Standard Evaluations of Patients With Nonlesional Frontal Lobe Epilepsy"
Neurology (12/08/2009) Vol. 73, No. 23, P. 2023; Moeller, F.; Tyvaert, L.; Nguyen, D.K.; et al.
Dimpling and Other Specific CT Criteria Aid Radiologist Performance in Differentiating Polypoid Early From Advanced Gastric Cancer
Researchers from the Seoul National University Hospital conducted a new study attempting to retrospectively determine whether there are specific CT features that can be used to differentiate polypoid advanced gastric cancer (PAGC) from advanced gastric cancer (PAGC) and to assess the performance of radiologists using specific CT findings for differentiation. This study was based on a review of the CT scans of 46 patients - 27 with PEGC and 19 with PAGC. In the study, two radiologists retrospectively reviewed the images for the presence and depth of dimpling at the tumor base, the presence of vessel invagination at the dimpling site, thickening of the low-attenuating outer layer, perigastric infiltration, and transmural full-thickness enhancement of the lesion. The presence of severe dimpling greater than 3.5 mm at the base of the tumor had the highest odds ratio for differentiating early from advanced gastric cancer, followed by vessel invagination, the presence of dimpling, perigastric infiltration, and transmural full-thickness enhancement. Multivariate analysis showed that the presence of dimpling greater than 3.5 mm was the only independent variable that differentiated polypoid advanced gastric cancer from polypoid early gastric cancer. Subsequent differentiation of advanced from early gastric cancer with the described CT findings was very good, yielding areas under the receiver operating characteristic analysis curves of 0.827 and 0.811 for the two observers. The study concludes that ancillary CT findings, including dimpling greater than 3.5 mm, are helpful for radiologists in differentiating PAGC from PEGC, and contribute to good individual accuracy for differentiation.
From "Radiologist Performance in Differentiating Polypoid Early From Advanced Gastric Cancer Using Specific CT Criteria: Emphasis on Dimpling Sign"
American Journal of Roentgenology (12/01/2009) Vol. 193, P. 1546; Lee, Eun Sun; Kim, Se Hyung; Lee, Jae Young; et al.
VLCBV Predicts HT Better Than DWI or Apparent Diffusion Coefficient Volume
Very Low Cerebral Blood Volume (VLCBV) has been found to predict hemorrhagic transformation (HT) after thrombolysis better than did diffusion weighted imaging or apparent diffusion coefficient volume. These findings are based on a 91-patient study in which HT occurred in 44 patients. Parenchymal hematoma occurred in 13 patients, four of whom were symptomatic. In addition to accurately predicting HT, VLCBV was found to show a significantly higher median volume in cases with PH.
From "Regional Very Low Cerebral Blood Volume Predicts Hemorrhagic Transformation Better Than Diffusion-Weighted Imaging Volume and Thresholded Apparent …"
Stroke (12/09) Campbell, Bruce C.V.; Christensen, Soren; Butcher, Kenneth; et al.
Technology
New Imaging Technique Reveals Different Heart Motions by Age, Gender
A new study published in the American Heart Association's journal Circulation: Cardiovascular Imaging reports that scientists have discovered important, fundamental differences in heart motion by age and gender, using noninvasive imaging techniques. The study is the first to provide gender- and age-specific data on the motions of the normal heart, based on a regional analysis of myocardial velocities covering all 16 segments of the left ventricle. The results, obtained with magnetic resonance imaging (MRI) tissue phase mapping, are the most precise measurements ever obtained of the left ventricle's complex motions as it contracts and relaxes with each heartbeat. University Hospital Freiburg senior cardiology consultant Daniela Foll, the lead author of the study, says, "This information could change the diagnosis and assessment of heart disease from its earliest stages." A healthy heart performs a complex wringing motion with each beat, and the base of the left ventricle changes its direction of rotation up to six times per beat. Foll says as heart problems develop, various regions of the left ventricle change the speed at which they move during each beat. "MRI enables a complete analysis of muscle motion within the entire left ventricle," says Foll. "Knowledge of the exact distribution and timing of the velocities within the ventricle is essential for the exact understanding of the muscle performance in heart disease." If trials confirm the findings of the study, MRI tissue phase mapping could be used as a complementary system to electrocardiograms currently used to diagnose heart disease. The study found, contrary to earlier studies, that apex rotation speed decreases with aging. In young subjects, women had higher up-and-down motion velocities along the long-axis of the ventricle than men; but in older subjects these motion speed differences were reversed, meaning the MRI images identified a greater decline in women in muscle shortening and expansion from the ventricle's base to its top during contraction and relaxation.
From "New Imaging Technique Reveals Different Heart Motions by Age, Gender"
ScienceDaily (12/10/09)
Clinical Practice
On-Call Radiology Residents Accurately Interpret Off-Hours Neuro CT Exams
On-call radiology residents commonly provide accurate preliminary interpretation of emergency neuroradiology CT scans during off hours, according to results of a recent study performed at a level I trauma center. For the study, researchers reviewed a quality assurance database of neuroradiology CT examinations to compare preliminary interpretations by on-call residents with final analyses by attending neuroradiologists during a 12-month period. They found that out of 6,852 cases reviewed, there were 252 with disagreements; of those, 226 were confirmed as resident errors, 171 of which were considered significant. Among those 171 cases, 105 had no change in clinical management while 55 required some change.
From "Accuracy of Preliminary Interpretation of Neurologic CT Examinations by On-Call Radiology Residents and Assessment of Patient Outcomes at Level I…"
JACR (12/09) Vol. 6, No. 12, P. 864; Miyakoshi, Asako; Nguyen, Quynh T.; Cohen, Wendy A.; et al.
FDA Panel Suggests Bayer, GE, MRI Drugs Be Restricted
An FDA advisory panel has recommended that gadodiamide (Omniscan) and gadopentetate dimeglumine (Magnevist) be contraindicated for use in patients with severe renal problems because they put patients at greater risk for nephrogenic systemic fibrosis (NSF) than other drugs. This change was made after the FDA and European regulators received reports of patients with severe renal disease who developed NSF after using gadolinium contrast agents. Gadodiamide and gadopentetate dimeglumine are two of seven contrast agents considered for contraindication by the panel. Based on current data, the panel determined that these two medications were associated with the highest risk of NSF.
From "FDA Panel Suggests Bayer, GE, MRI Drugs Be Restricted"
CNN Money (12/08/09)
Fellowships in Breast Imaging Improve Cancer Detection, Increase False Positives
Fellowship training in breast imaging may lead to improved cancer detection, according to a study published in the December issue of Radiology. However, the study also found that this practice may lead to higher false positive rates. Researchers, led by Dr. Joann G. Elmore of the University of Washington, surveyed radiologists who interpreted mammograms in seven U.S. regions. From this survey they created an evaluation of which radiologist characteristics were associated with recall rate, false-positive rate, sensitivity, and positive predictive value of recall. Radiologists participating in the study had a median recall rate of 9.3 percent and an average false positive rate between 6.3 percent and 13.2 percent. In adjusted regression models, female radiologists and fellowship-trained radiologists had significantly higher recall and false positive rates. Fellowship training also was the only characteristic significantly associated with improved sensitivity and the overall accuracy parameter.
From "Variability in Interpretive Performance at Screening Mammography and Radiologists' Characteristics Associated With Accuracy"
Radiology (12/01/09) Elmore, Joanne G.; Jackson, Sara L.; Abraham, Linn; et al.
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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