RSNA 2009 Quality Storyboards Available Online
Find inspiration for quality improvement projects at your institution with selected RSNA 2009 Quality Storyboards available online.
Offered for the first time, Quality Storyboards include projects evaluating personalized dose reduction techniques, reducing the need for sedation in pediatric imaging and systemic defenses against wrong patient, wrong procedure and wrong site incidents.
More than two dozen Quality Storyboards were presented at RSNA 2009.
Headlines
Leading the News
Research
Technology
Clinical Practice
Industry News
Leading the News
New Source of an Isotope in Medicine Is Found
On the verge of a worsening shortage of technetium 99, a radioactive isotope used in millions of medical procedures, a new source has become available through a nuclear reactor in Poland. The isotope is used to measure blood flow in the heart and help diagnose bone and breast cancers. Almost two-thirds of the world's supply comes from two reactors, one in Ontario that has been closed for repairs for nine months and not expected to open until April, and one in the Netherlands that will close for six months starting mid-February. Radiologists report that the shortage would force them to treat their patients using inferior materials and methods that became obsolete 20 years ago. However, Covidien, a St. Louis-based company that purifies material created in the reactor and packages the material in a usable form for radiologists, has reached a contract with the operators of the Maria reactor, near Warsaw, one of the world's most powerful research reactors. The Maria reactor will fill only a small portion of the shortage created by the reactor shutdowns, but University of Iowa professor of Radiology Dr. Michael M. Graham, a member of the board of the Society of Nuclear Medicine, says the new arrangement could be the difference between limping along and shutting down completely. The United States is also looking for domestic sources of the isotope. General Electric has a plan to make technetium 99 using neutrons from power reactors owned by utilities. This would be a revolutionary technique because those reactors are usually sealed up and run for months at a time while the medical isotope must be recovered within a few hours of its creation or else it decays.
From "New Source of an Isotope in Medicine Is Found"
New York Times (02/16/10) Wald, Matthew L.
Research
rCBV Maps Can Improve Accuracy of Tumor Biopsies
Relative cerebral blood volume (rCBV) maps in patients with brain tumors provide unique information that is analogous to FDG-PET. There is a greater overlap between rCBV and FDG-PET compared with Gd-enhancement. rCBV maps can therefore approximate tumor grade and predict survival. These results came from 21 patients with glial tumors who underwent FDG-PET and MR imaging, including rCBV and Gd-enhancement. Regions of interest were drawn around the increased FDG uptake, decreased signal intensity on rCBV maps, and Gd-enhancement.
From "Glial Tumor Grading and Outcome Prediction Using Dynamic Spin-Echo MR Susceptibility Mapping Compared With Conventional Contrast-Enhanced MR"
American Journal of Neuroradiology (02/10) Holodny, A.I.; Makeyev, S.; Beattie, B.J.; et al.
CT Identifies Different Types of Pectus Deformities
Researchers set out to evaluate via computed tomography (CT) studies the features of anterior chest wall development that can be associated with different types of pectus deformities. From 71 patients with pectus deformities and chest coronal CT scans, 48, with a mean age of 15.8 years, were selected and divided into five groups, according to clinical type of deformity and image quality. A similar CT study was carried out in a control group of 14 patients that lacked an underlying pectus deformity. Tomographic studies were undertaken on a 64-section CT scanner, with parameters varying based on the subject's body mass index. A half-dozen features of the sternum and costal cartilages in the groups were assessed via coronal reconstructions, while analysis also covered a sternal index and the sternocostal angles. The researchers concluded that the features examined and the index supply measurable and applicable information for the reading of anterior chest wall tomography, with potential ramifications for prognosis and treatment of different kinds of pectus deformities.
From "Pectus Deformities: Tomographic Analysis and Clinical Correlation"
Skeletal Radiology (02/10) Haje, Sydney Abrao; Haje, Davi de Podesta; Neto, Moacir Silva; et al.
Coronal and Sagittal CT Reformation Detect Subtle Pathology in Acute Head Trauma
Coronal and sagittal CT head reformations improve diagnostic confidence and interobserver agreement over axial images alone for visualization of normal structures and in the diagnosis of acute abnormality in patients with acute head trauma, according to a recent study. Researchers performed multidetector 16-section CT on these patients. They detected CT imaging abnormalities in 55 out of 200 patients scanned for head trauma. Acute traumatic intracranial abnormality was detected on axial scans in 45 patients. Subtle findings were confirmed on coronal and sagittal CT head reformations in 10 cases, all of which were undetected on axial CT.
From "Subtle Pathology Detection With Multidetector Row Coronal and Sagittal CT Reformations in Acute Head Trauma"
Emergency Radiology (03/10) Zacharia, Thomas T.; Nguyen, Dan T. D.
Technology
Fluorescent Probes Light Up Cancerous Tumors
A team of researchers led by Howard Hughes Medical Institute investigator Roger Tsien, PhD, has created fluorescent biological probes that can adhere to and illuminate cancerous tissue in mice. Tsien and colleagues employed synthetic molecules called activatable cell penetrating peptides (ACPPs) and microscopic nanoparticles to devise probes carrying fluorescent and magnetic tags. The tags make tumors visible to magnetic resonance imaging (MRI) and cause the cancerous tissue to "glow" on the operating table. The researchers demonstrated in a series of studies that if tumors had metastasized to surrounding tissue, the ACPP-nanoparticle probes allowed them to see areas of tumors that would not be visible under normal circumstances. "The development of biological probes that can guide surgeons, rather than depending only on feel and normal 'white light' to see, can provide tools to navigate the body on a molecular level," noted researcher and University of California, San Diego School of Medicine professor Quyen Nguyen, MD, PhD. The researchers measured tumor DNA with the polymerase chain reaction method and determined that, on average, 90 percent fewer cancer cells remained following surgery to remove tumors in mice using the ACPP-nanoparticle probes compared to surgery without them. The researchers said that just a single injection of the probe was necessary so that MRI could be used to analyze the entire mouse model for tumors before and after surgery.
From "Activatable Cell Penetrating Peptides Linked to Nanoparticles as Dual Probes for In Vivo Fluorescence and MR Imaging of Proteases"
Proceedings of the National Academy of Sciences (02/15/10) Olson, Emilia S.; Jiang, Tao; Aguilera, Todd A.; et al.
FDA Memo Hints at Curbs to Approval Process for Medical Devices
An internal FDA memo intimates that the agency may tighten or remove several routes for the rapid approval of medical devices amid worries of industry overuse. According to the memo, officials question the growing use of private firms that are hired by device manufacturers to pre-review products; if the third party passes the device, then the FDA may approve it without much further consideration. The document says the "real value to industry may be that this is perceived as a way to 'sneak things in.'" The FDA initiated a review of device approvals following Wall Street Journal stories about the Menaflex knee implant, which was approved in late 2008 using the fast-track 510(k) process despite the objections of more than six FDA scientists and managers; the 510(k) process is designed for products that bear a similarity to earlier or predicate devices. Device company executives and industry analysts are anticipating tighter regulations this year, while the industry is against the FDA constructing excessive obstacles to innovative products. The FDA questions in its memo the degree of leverage it possesses under existing statutes to demand more information from companies that employ the 510(k) process. Agency officials note that one option is to jettison the special 510(k) program, in which device manufacturers can get approval decisions within 30 days by claiming that their new product conforms to an earlier one they make except for a particular alteration. It is the FDA's contention that FDA reviewers often cannot check the truthfulness of summaries made by firms in real time.
From "FDA Memo Hints at Curbs to Approval Process for Medical Devices"
Wall Street Journal (02/17/10) Mundy, Alicia; Favole, Jared A.
PSF-based 3D PET Reconstruction Reduces Noise in Image Roughness
There is a linear correlation between background variability and ensemble noise for all combinations of reconstruction methods and parameters of point spread function (PSF)-based 3D PET reconstructions, according to a new study. These observations are based on the systematic evaluation of noise and signal properties in different combinations of these methods and parameters. Specifically, two fully 3D PET reconstruction algorithms were evaluated - ISEM with exact scanner line of response modeled and OSEM with line of response and a measured point spread function incorporated. Researchers found that, at matched iterations, the addition of PSF leads to images with less noise defined as image roughness (reduced by 35 percent for unfiltered data) and as the standard deviation image, while it has no effect on background variability or ensemble noise. In terms of signal to noise performance, PSF-based reconstruction has a 7 percent improvement in contrast recovery at matched ensemble noise levels and 20 percent improvement of quantitation SNR in unfiltered data.
From "Noise and Signal Properties in PSF-Based Fully 3D PET Image Reconstruction"
Physics in Medicine and Biology (02/10) Tong, S.; Alessio, A. M.; Kinahan, P. E.
Clinical Practice
Radiologists Identify Chest CT Features of Community-Acquired Respiratory Viral Infections in Adult Inpatients With Lower Respiratory Tract Infections
CT scans of inpatients with community-acquired viral infections most commonly show either a consolidation and ground-glass opacities or bronchial wall thickening and tree-in-bud opacities. For this reason, it is important for radiologists interpreting CTs with multifocal consolidations and/or multifocal ground-glass opacities to consider viral pneumonia when these findings are observed. They should also recommend appropriate diagnostic testing when clinically warranted. These recommendations are based on a retrospective analysis of chest CTs performed on 42 patients with viral respiratory tract infections. Reviewers were blinded to virus type and patient information.
From "Chest CT Features of Community-Acquired Respiratory Viral Infections in Adult Inpatients With Lower Respiratory Tract Infections"
Journal of Thoracic Imaging (02/10) Vol. 25, No. 1, P. 68; Shiley, Kevin T.; Van Deerlin, Vivianna M.; Miller Jr., Wallace T.
CAD Helps Radiologists to Assess Likelihood of Malignancy of Lung Nodules
Researchers have found that computer-aided diagnosis (CAD) has the potential to increase radiologists' accuracy in assessing the likelihood of malignancy of lung nodules on CT imaging. The researchers evaluated a total of 256 lung nodules, 124 of which were malignant and 132 that were benign. An automated CAD system was developed to characterize and provide malignancy ratings for lung nodules on CT volumetric images. Six radiologists were chosen as independent readers. The observer ratings were analyzed using the Dorfman-Berbaum-Metz multireader, multicase method. All six radiologists demonstrated improved performance with CAD.
From "Computer-Aided Diagnosis of Lung Nodules on CT Scans: ROC Study of Its Effect on Radiologists' Performance"
Academic Radiology (03/10) Vol. 17, No. 3, P. 323; Way, Ted; Chan, Heang-Ping; Hadjiiski, Lubomir ; et al.
Industry News
Study Shows That Use of MRIs, Other Medical Scans in ER Quadruple
A new report from the Centers for Disease Control and Prevention (CDC) found that the use of magnetic resonance imaging (MRI) and other high-tech diagnostic imaging in emergency rooms (ERs) has increased fourfold since the mid 1990s. In 2007, MRI, computed tomography (CT), or positron emission tomography scans were ordered or performed in 14 percent of ER visits, while the frequency of such scans at doctor offices and outpatient clinics rose to about 3 percent, representing an approximately 300 percent increase. Health officials and others are concerned about the cost and safety of such a high volume of scanning, with University of California, San Francisco cardiologist Rita Redberg noting that it is difficult to determine whether the increased use is excessive without solid guidelines as to when imaging is a medical necessity. The CDC report's authors point out that scanning machine technology has improved significantly since the 1990s, visualizing bodily problems with much greater clarity. There also has been substantial growth in the number of scanners, with CT machines increasing 20 percent in three years to over 10,100 in 2006; the number of MRI machines doubled to about 8,000 between 1995 and 2006. Redberg says there is no clear indication in studies as yet that scans are reducing mortality rates.
From "CDC: MRIs, Other Medical Scans in ER Quadruple"
Associated Press (02/17/10) Stobbe, Mike
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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