Nominate Your Resident or Fellow for a Roentgen Research Award
The RSNA Research & Education Foundation seeks nominations for the Roentgen Resident/Fellow Research award, designed to recognize and encourage outstanding residents and fellows in radiologic research.
Nominees are considered for their:
- Presentations of scientific papers at regional or national meetings
- Publication of scientific papers in peer-reviewed journals
- Receipt of a research grant or contributions to the success of a research program within the department
- Other research activities
The nomination deadline is April 1. For more information, including the nomination form and a listing of past recipients, click here.
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Featured in RadioGraphics: Best Cases from the AFIP
In a new case from the Armed Forces Institute of Pathology, learn more about the clinical imaging and pathologic evaluation of villous duodenal adenomas.
Authors Vitaly Izgur, M.D., Chandra Dass, M.D. and Charalambos C. Solomides, M.D., note that adenomas account for about one-half of all benign duodenal neoplasms. Villous adenomas, they add, are a subtype of adenomatous polyps with high potential for malignant transformation.
The authors note that the CT appearance of villous duodenal adenomas is nonspecific, typically having variegated attenuation and variable enhancement patterns, although large tumors may have a characteristic surface gyral pattern. CT is useful for determining the extraluminal extent of invasive tumors and assessing regional lymphadenopathy for surgical planning, according to the authors.
Read more about villous duodenal adenomas in RadioGraphics.
Leading the News
FDA Unveils Initiative to Reduce Unnecessary Radiation Exposure From Medical Imaging
The U.S. Food and Drug Administration has announced an initiative to reduce unnecessary radiation exposure from computed tomography (CT), nuclear medicine studies, and fluoroscopy. The three procedures are the biggest contributors to total radiation exposure for the U.S. population and use significantly higher radiation doses than other radiographic procedures. While CT, nuclear medicine, and fluoroscopic imaging have resulted in early diagnosis of diseases, improved treatment planning, and led to image-guided therapies that will help save lives--and the FDA supports a strong dialogue between patients and physicians about the necessity and risk of these procedures--they also expose patients to ionizing radiation, which can increase a person's lifetime cancer risk. Additionally, accidental exposure to high amounts of radiation can cause injuries, including skin burns, hair loss, and cataracts. FDA Center for Devices and Radiological Health Director Jeffrey Shuren says the amount of medical imaging radiation Americans are exposed to has increased dramatically over the past 20 years, and the purpose of the new initiative is to support the benefits of medical imaging while minimizing the risks. The FDA is advocating the adoption of two principles of radiation protection: appropriate justification of the radiation procedure and optimizing the radiation dose for each procedure. Shuren says by working together, the FDA and other organizations hope to help patients receive the right exam, at the right time, with the correct radiation dose. The FDA plans to issue targeted requirements for manufacturers of CT and fluoroscopic devices to incorporate important safeguards into the design of their machines and to develop safer technologies and provide appropriate training for practitioners.
From "FDA Unveils Initiative to Reduce Unnecessary Radiation Exposure From Medical Imaging"
U.S. Food and Drug Administration (02/09/2010) Long, Peper
Research
Guidelines Recommend Which Kids With Head Injuries Need CT Scans
Whenever a child is admitted to an emergency room with a minor head injury, it can be difficult to determine if the child needs a CT scan. A research team from 10 pediatric hospitals in Canada has developed a set of guidelines to help physicians determine whether a child should be scanned. The researchers studied 4,000 children under 16 years who were admitted to a hospital with minor head trauma. Subjects included those who had lost consciousness for a short time, had some memory loss, or had periods of vomiting, but not those who lost consciousness and needed obvious emergency medical intervention or had obviously minor injuries. The researchers determined that CT scans were highly recommended for young patients in four categories at high risk of needing an operation to remove a blood clot or needing to be put on ventilation in an intensive care unit. The guidelines for patients needing scans include those with skull fractures that are open to the outside air; those with worsening headaches; those with extreme irritability, including high-pitched crying and very unusual behavior; and those who did not have a top score on a specific neurological test. The researchers also identified three medium-risk factors that could increase the need for a scan, including a four- to five-centimeter soft bulge on the top of the skull; signs of a fracture at the base of the skull, such as bleeding behind the ears, raccoon eyes, or spinal fluid from the ears or nose; or a "dangerous mechanism" of injury, like falling down more than five stairs, farther than three feet, or from a bike without a helmet. The guidelines are not being applied to emergency rooms yet, however, as it will take another six months to a year for a complete validation study.
From "A Clinical Decision Rule for the Use of Computed Tomography in Children With Minor Head Injury"
Canadian Medical Association Journal (02/08/2010) Osmond, Martin H.; Klassen, Terry P.; Wells, George A.; et al.
Shorter Radiation Course Matches Standard for Breast Cancer
Researchers have found that accelerated, hypofractionated whole-breast irradiation is not inferior to standard radiation treatment in women who have undergone breast-conserving surgery for invasive breast cancer with clear surgical margins and negative axillary nodes. These conclusions were based on a study in which women with invasive breast cancer who had undergone breast-conserving surgery and in whom resection margins were clear and axillary lymph nodes were negative were assigned to receive either a hypofractionated three-week schedule of whole-breast irradiation or a five-week schedule. The risk of local recurrence at 10 years was 6.7 percent among the 612 women assigned to standard irradiation as compared with 6.2 percent among the 622 women assigned to the hypofractionated regimen.
From "Long-Term Results of Hypofractionated Radiation Therapy for Breast Cancer"
New England Journal of Medicine (02/11/10) Vol. 362, No. 6, P. 513; Whelan, Timothy J.; Pingol, Jean-Philippe; Levine, Mark N.; et al.
Calcium Scoring Misses 20 Percent of CAD Cases
The absence of coronary artery calcium does not rule out coronary artery disease (CAD) in symptomatic patients, according to a new study. Researchers report that in a multicenter clinical trial, 19 percent of patients with a coronary calcium score of zero had stenosis of at least 50 percent in one or more coronary artery segments and 20 percent of vessels that were seen to be totally occluded on revascularization had no calcium on scans. "The absence of coronary calcification should not be used as a gatekeeper and should not prevent a symptomatic patient from undergoing angiography," the researchers write. American Heart Association/American College of Cardiology guidelines currently suggest that excluding measurable coronary calcium could serve as an effective filter for sending patients on for invasive testing or for admitting them.
From "The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization..."
Journal of the American College of Cardiology (02/16/2010) Vol. 55, No. 7, P. 627; Gottlieb, Ilan ; Miller, Julie M. ; Arbab-Zadeh, Armin
Researchers Define Range of Initial and Follow-Up CT Findings of H1N1 in Immunocompromised Patients
A group of researchers attempted to define the range of initial and follow-up computed tomography (CT) findings of novel influenza A (H1N1) infection in eight immunocompromised patients scanned between May 2009 and August 2009. Twenty CTs were evaluated for the presence, severity, and distribution of ground glass opacity, consolidation, interlobular septal thickening, mosaic perfusion, airway wall thickening, airway dilatation, nodules, cysts, pleural effusion, pericardial effusion, lymphadenopathy, and air trapping. Airway thickening/dilatation, peribronchial ground glass opacity, centrilobular nodules, and tree-in-bud opacities were the most common conclusions, while peripheral consolidation involving the lower lobes also was a commonly encountered finding. Findings often involved all lobes and had a close relationship with either large or small airways. Two patients demonstrated atypical CT findings, including focal lobar consolidation and spotty lower lobe consolidation with soft tissue centrilobular nodules. The majority of the survivors exhibited near complete resolution of findings within 35 days. A common pattern in CT scans in H1N1-infected immunocompromised patients is a strong airway predominance of findings or peripheral areas of consolidation associated with the lower lobes. A subgroup of patients with H1N1 will present findings atypical of viral infection.
From "Thoracic CT Findings of Novel Influenza A (H1N1) Infection in Immunocompromised Patients"
Emergency Radiology (01/10) Elicker, Brent M.; Schwartz, Brian S.; Liu, Catherine; et al.
3D Reconstruction of CT Data Is Useful in Surgical Planning for Head and Neck Cancer
University of Chicago researchers compared four distinct three-dimensional (3D) reconstruction techniques of spiral computed tomography (CT) data for head and neck cancer to determine the most appropriate method for staging of lymph nodes and viewing of spatial relationships between the tumor, fascial spaces, adjacent soft tissues, and other structures. A series of 10 patients was assessed, and five of those 10 had squamous cell carcinoma, while two had lymphoma, one had thyroid cancer, one had Kikuchi's disease or necrotizing lymphadenitis, and one had esthesioneuroblastoma. Among the different methods of 3D reconstruction utilized were shaded surface display (SSD), multiplanar reconstructions (MPR), maximum intensity projection (MIP), 3D volume rendering (VR), and combined techniques. The 3D VR method exhibited potential advantages over other techniques, while the MIP method helped in the analysis of the patency of vessels and to exclude thrombus, compression, or displacement by tumor. Combined methodologies such as SSD and MPR accurately reconstructed the levels of lymph nodes and the association between the tumor projection of interest and various anatomic structures. The researchers concluded that 3D reconstruction of CT data is of great help in the localization and staging of neck tumors and in surgical planning and radiation treatment.
From "Use of Three-Dimensional Spiral Computed Tomography Imaging for Staging and Surgical Planning of Head and Neck Cancer"
Journal of Digital Imaging (01/10) Franca, Christiane; Levin-Plotnik, Daphne; Sehgal, Vivek; et al.
Technology
FDA Issues Guidance to Help Streamline Medical Device Clinical Trials
The FDA recently issued guidance on Bayesian statistical methods in the design and analysis of medical device clinical trials in an effort to create less costly and more efficient studies. The guidance also presents strategies for using Bayesian methods in postmarket studies. The full guidance can be found at
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/
GuidanceDocuments/ucm071121.pdf.
From "FDA Issues Guidance to Help Streamline Medical Device Clinical Trials"
FDA.gov (02/05/10)
Medical-Legal Issues
Bill's Goal Is Coverage of Breast Cancer Tests
Maryland House Del. Donna Stifler has tabled a measure that would require insurers to follow the American Cancer Society's (ACS) 2010 breast cancer guidelines for mammogram breast cancer screenings. The bill was drafted in reaction to a report in November by the U.S. Preventive Services Task Force, which said women only need mammograms every two years starting at age 50. The 2010 ACS guidelines call for women in their 20s and 30s to receive mammograms every three years that would be covered by their insurance, nonprofit health service plan, or health maintenance organization. Women in their 40s and beyond should receive annual mammograms covered by insurance. "It's a what-if bill, it's a preventative bill so that regardless of who runs the [ACS] or who wants to change their mind, it won't matter for women in Maryland," said Stifler, who is worried that ACS might someday change its guidelines or a federal law might be created to alter insurance coverage requirements to match the U.S. Preventive Services Task Force recommendations.
From "Bill's Goal Is Coverage of Breast Cancer Tests"
Baltimore Sun (02/09/10) Leven, Rachel
Congress Sets Hearing to Review Medical Radiation
The U.S. House of Representatives has scheduled hearings on medical radiation in response to a series of adverse incidents. Invited to testify at the hearings are representatives from the American Association of Physicists in Medicine, the American College of Radiology, the American Society for Radiation Oncology, the Medical Imaging and Technology Alliance, and the American Society of Radiologic Technologists. Recent months have seen increased scrutiny of medical radiation from both diagnostic and therapeutic sources. In January, the New York Times ran a series of articles concentrating on errors in radiation therapy procedures, and in 2009 the U.S. Food and Drug Administration published advisories about patient overdoses at Cedars-Sinai Medical Center in Los Angeles. Several studies published last year also have reported on the increase in radiation exposure from medical sources that Americans have received.
From "Congress Sets Hearing to Review Medical Radiation"
AuntMinnie.com (02/08/10) Keen, Cynthia E.
UnitedHealthcare Announces Policy Changes for Radiology Notification Program
Network physicians, including UnitedHealth premium quality and cost efficiency designated physicians, will be required to complete prior notification for advanced imaging services under policy revisions to UnitedHealthcare's Radiology Notification & Authorization Program. The program will mandate notification for claims from all ordering physicians beginning on the Feb. 15 date of service, although notification will not be mandatory for any advanced diagnostic imaging services that occur in an emergency room, observation unit, or during an inpatient stay, says UnitedHealthcare. Furthermore, notification will not be obligatory for any service dates before the Feb. 15 deadline. A physician's UnitedHealth Premium quality and cost efficiency designation will not be affected by the program amendments, according to the payor.
From "UnitedHealthcare Announces Policy Changes for Radiology Notification Program"
HealthImaging.com (02/10/2010)
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