January issue of RSNA News Now Available
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The January issue of RSNA News is now available at RSNAnews.org
Highlights include:
Backlash Continues Against Breast Cancer Screening Guidelines
CT Reveals Pulmonary Embolism in Severely Ill Swine Flu Patients
International Panel Assesses Hybrid Imaging
Communication Key in Avoiding Malpractice Minefields
Headlines
Leading the News
Research
Technology
Clinical Practice
Industry News
Leading the News
Brain Scans Pinpoint PTSD in War Veterans
Post-traumatic stress disorder (PTSD) can be difficult to diagnose, as it is a collection of psychological symptoms often caused by other conditions or injuries. However, University of Minnesota Prof. Apostolos Georgopoulos and colleagues were recently able to use magnetoencephalography (MEG) to detect clusters of abnormal brain signals in areas of the brain involved in memory. In the study, MEG was able to correctly classify all but one of 18 patients with PTSD who were not receiving medications for their disease. Georgopoulos hopes these findings could indicate that MEG or PET may have the potential to assess and monitor disease progression and the effects of therapy.
From "The Synchronous Neural Interactions Test as a Functional Neuromarker for Post-Traumatic Stress Disorder (PTSD): A Robust Classification Method…"
Journal of Neural Engineering (01/20/10) Georgopoulos, A.P.; Tan, H. R. M.; Lewis, S. M.; et al.
Research
Studies Show That Follow-Up Colonoscopy Often Misused
Two new studies indicate that follow-up colonoscopy is both overused and underused. Patients at a high risk for colorectal cancer often do not receive timely "surveillance" colonoscopy, and there is also an over-utilization among low-risk patients who are unlikely to develop colon cancer. "This misuse wastes health care resources and risks development of cancers in high-risk patients that might have been preventable," says Dr. Robert Schoen, from the University of Pittsburgh School of Medicine, who served as a senior investigator in both studies. Schoen says the researchers want people to be screened for colorectal cancer with colonoscopy, but the problem is repeated colonoscopies. Colonoscopy can search the entire length of the colon for any growths that can become cancerous, and it is considered the most sensitive way to screen for colon cancer. In a National Cancer Institute-sponsored cancer screen trial, researchers found "substantial overuse" of surveillance colonoscopy among people at low risk for colorectal cancer, and "significant underuse" among people at high risk. Specifically, among 1,029 patients with no precancerous colorectal growths during an initial exam, 58 percent underwent a follow-up exam an average of every 3.9 years, though the recommendation would be to receive an exam every five to 10 years. The researchers were unable to identify medical reasons for the premature follow up exams. Additionally, the researchers found that within five years of the initial colonoscopy, only 58.4 percent of patients with advanced precancerous growths had a follow-up colonoscopy, despite the recommendation that they have a exam every three years. Dr. John Allen of the University of Minnesota School of Medicine in Minneapolis, in a written commentary, urges a dramatic change in how medicine is practiced and paid for. For example, Allen suggests throwing out fee-for-service payments procedure, which encourages overuse, and replacing it with payments based on quality care and outcomes. Allen says there are examples of regional organizations that have successfully implement such systems, including Intermountain Healthcare, Geisinger Health Systems, Mayo Clinic, and Kaiser Permanente.
From "Follow-Up Colonoscopy Often Misused: Studies"
Reuters Health (01/19/10) Lowe, Rachael Myers
CT Shows Percent Emphysema Airflow Obstruction Linearly Related to Impaired Left Ventricular Filling
In a population-based study, a 10-point increase in percent emphysema on CT scans and more severe airflow obstruction appear to be linearly related to impaired left ventricular filling, reduced stroke volume, and lower cardiac output without changes in the ejection fraction. The study measured left ventricular structure and function using MRI in 2,816 patients between the ages of 45 and 84 years. Percent emphysema was defined as the percentage of voxels below -910 Hounsfield units in the lung windows on cardiac CT. Spirometry was performed according to American Thoracic Society Guidelines and generalized additive models were used to test for threshold effects.
From "Percent Emphysema, Airflow Obstruction, and Impaired Left Ventricular Filling"
New England Journal of Medicine (01/21/10) Vol. 362, No. 3, P. 217; Barr, R. Graham; Bluemke, David A.; Ahmed, Firas S.; et al.
Technology
Digital Mammography Helps Lower Radiation Dose
Researchers report that digital mammography delivers significantly less radiation than conventional mammography and that the reduction in radiation exposure may be greater for women with larger and denser breasts. The researchers analyzed data from 5,102 women who received both digital and standard film mammography. The study showed that the average breast radiation dose per view was 22 percent lower for digital mammography. A study published in 2005 showed that digital mammography detected up to 28 percent more cancers than film mammography in women under age 50, in women who were pre- or peri-menopausal, and women with dense breasts. Currently, more than 60 percent of breast imaging facilities in the United States offer digital mammography.
From "Comparison of Acquisition Parameters and Breast Dose in Digital Mammography and Screen-Film Mammography..."
American Journal of Roentgenology (02/10) Vol. 194, No. 2, P. 362; Hendrick, R. Edward; Pisano, Etta D.; Averbukh, Alice; et al.
Handheld SD-OCT Imaging Device Diagnoses Neonates With Progressive ROP Earlier, More Accurately
Researchers using a handheld spectral domain optical coherence tomography (SD-OCT) imaging device have obtained high-resolution scans of premature infants with progressive retinopathy of prematurity (ROP). They reported that the new handheld devices eliminated many of the technical challenges involved in imaging the retina of infants and can enable shallow detachments and presumed retinoschisis to be diagnosed earlier and more accurately. The SD-OCT system contains a moveable imaging hand piece that is connected via a flexible fiber-optic cable to a cart holding the SD-OCT system. This handheld system makes it possible to bring the advanced imaging capability into a neonatal intensive care unit.
From "Retinoschisis Detected With Handheld Spectral-Domain Optical Coherence Tomography in Neonates With Advanced Retinopathy of Prematurity"
Archives of Ophthalmology (01/10) Vol. 128, No. 1, P. 57; Muni, Rajeev H.; Kohly, Radha P.; Charonis, Alexander C.; et al.
Clinical Practice
Radiology Reports Should Have Few Disclaimers, Study Suggests
Those writing radiology reports should seek to avoid disclaimer comments and hedging because, although disclaimers can provide important feedback as to the accuracy of the radiology images, overuse of such terms can undermine the report's validity. These recommendations are based on a retrospective analysis of 624 ultrasound reports generated by radiologists and sonographers. The reports were assessed for the presence of any disclaimers or caveats regarding the quality of the images. The analysis found that 57.1 percent of sonographer ultrasound reports contained a disclaimer related to image quality, compared to just 9.9 percent of radiologist scans. Overall, radiologists performed significantly better in providing a clear negative or positive diagnosis to the clinical question on the request form, when compared to sonographers.
From "Caveat Reporting in Ultrasound Interpretation of Surgical Pathology: A Comparison of Sonographer Versus Radiologist"
Journal of Evaluation in Clinical Practice (01/14/10) Garcea, Giuseppe; Mahmoud, Asif; Ong, Seok Ling; et al.
Popular Handheld Devices Show Promise in the Field of Emergency Radiology
Mobile devices like personal digital assistants (PDAs) and the iPod Touch are commonly used by doctors, but a new study shows that they may be particularly useful for emergency radiologists, who may soon be able to use them for teleconsultation and emergency procedures. A total of 46 percent of attending physicians and trainees and 45 percent of radiologists use PDAs, according to the study. In the study, researchers compared the diagnostic efficacy of a PDA and iPod Touch against secondary-class monitors for two image types, wrist radiographs and images from a CT of the brain. A total of 168 readings were gathered. The researchers found that in the PDA brain CT study, the scores of PDA readings were significantly higher than those of monitor readings when all observers' readings are taken into account. No statistically significant differences between handheld device and monitor findings were found for the PDA wrist images or in the iPod Touch devices studies, although some comparisons did approach significance.
From "Diagnostic Efficacy of Handheld Devices for Emergency Radiologic Consultation"
American Journal of Roentgenology (02/10) Vol. 194, No. 2, P. 469; Toomey, Rachel J.; Ryan, John T.; McEntee, Mark F.; et al.
Radiology E-Ordering Makes Meaningful Use List, but Problems Remain
The Centers for Medicaid and Medicare Services' (CMS) recently proposed regulations on "meaningful use" and electronic health record (EHR) certification create both opportunities and challenges for the radiology industry. Fortunately, the proposed regulations now recognize and support the use of computerized radiology order entry and acknowledge the availability of computerized decision support tools, which makes the industry more efficient and transparent. Unfortunately, despite the growing importance of medical imaging in diagnosing and treating the most serious health issues, like cancer and heart disease, specialty EHR's like those in radiology information systems are still not recognized by the CMS. Furthermore, many of the meaningful use criteria are irrelevant to the practice of radiology. To promote this issue and ensure medical imaging is featured in a national discussion the industry will have to address the issue of quality and promote the use of tools that provide transparency. The e-Ordering Coalition and its Provider Roundtable are working with the ACR and other radiology organizations to address such issues, and are preparing a response during the HHS and CMS open comment period.
From "Radiology E-Ordering Makes Meaningful Use List, but Problems Remain"
Diagnostic Imaging (01/19/10) Koenig, Nancy
Radiologists 'Rehearsing' Positive Findings Influences Mammogram Accuracy
Searching mammograms for cancerous lesions prior to starting work each day may influence the likelihood that radiologists will detect positive findings. Cognitive psychologists at the Visual Attention Lab at Brigham and Women's Hospital asked 12 individuals to perform a simulated airport screening task. Subjects were asked to find the weapons present in hundreds of images that resembled airport x-ray screenings. The researchers discovered that when the prevalence of the weapons in images increased from approximately 50 percent of slides to 98 percent of slides, subjects got better at catching contraband. However, the rate of false positives also increased from 15 percent to 58 percent. Based on these findings, lead study author Dr. Jeremy Wolfe says it might be possible to create exercises that could alter the prevalence rates, thus aiding radiologists in cancer detection. However, he cautions such exercises also could increase the rate of false positives. In order to test this theory, Wolfe and colleagues are slipping digital images into radiologist workflows to determine if their ability to spot lesions is effected by how commonly seen they are.
From "Varying Target Prevalence Reveals Two Dissociable Decision Criteria in Visual Search"
Current Biology (01/10) Wolfe, Jeremy M.; Van Wert, Michael J.
Industry News
Blue Cross Seeks Tighter Review of Scans
Starting in March, Blue Cross Blue Shield of Nebraska will more closely scrutinize certain diagnostic scans, and doctors ordering nonemergency, outpatient MRIs, CT scans, and two other kinds of diagnostic imaging must first contact a firm for review. Blue Cross is now one of a growing number of insurance companies and states seeking tighter review of expensive diagnostic tests. Such reviews are intended to contain costs and ensure scans are necessary, though some are concerned that they are a step toward rationing care. Nebraska's Medicaid program requires prior approval for high-cost outpatient imaging, and Iowa's Medicaid program will have similar requirements starting in March. Blue Cross Blue Shield of Iowa and South Dakota have contracted with the Chicago-based firm American Imaging Management (AIM) since 2005 for prior review of diagnostic imaging, and Blue Cross Blue Shield of Nebraska has followed suit. Blue Cross Blue Shield of Nebraska vice president Lee Handke says the use of high-tech medical imaging has grown significantly over the past 10 years, and insurers are concerned about overuse. Additionally, there is growing concern that repeated imaging, particularly with CT scans, can potentially expose patients to too much radiation. Handke says Blue Cross in Nebraska will not reject a doctor's order, even if the firm believes it is unnecessary. The process may compel physicians to think harder about whether a scan is truly necessary and to discuss scan guidelines with an AIM professional.
From "Medical Scans to Get a Closer Look"
Omaha World-Herald (NE) (01/19/10) Ruggles, Rick
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