Applications Being Accepted for International Young Academics
The RSNA Introduction to Research for International Young Academics program encourages young radiologists from countries outside the U.S. and Canada to pursue careers in academic radiology. The program consists of a special seminar held during the RSNA annual meeting.
The nomination deadline is April 15. Eligible candidates are residents and fellows currently in radiology training programs or radiologists not more than two years out of training who are beginning or considering an academic career. Nominations must be made by the candidate’s department chairperson or training director. Fluency in English is required. Nomination forms can be found online.
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Leading the News
Women Not Following Through With Recommended Breast Screening MRI
A study published in Academic Radiology focused on a sample of 64,659 women which found that while 1,246 of them were at high enough breast cancer risk to recommend additional screening with magnetic resonance imaging (MRI), just 173 of these women returned to the clinic within 12 months for the screening. In 2007, the American Cancer Society recommended that women at elevated lifetime risk for breast cancer be screened with MRI in addition to annual mammograms, yet few clinics put the recommendation into practice. One clinic that has, however, is the Denver-based Invision Sally Jobe Breast Centers, which assisted in the university's research. Clinicians at the clinic used the National Cancer Institute's Gail Model to identify a patient's lifetime risk for breast cancer. For women with a higher than 20 percent lifetime risk, the clinic included in the mammography results that were sent to women's primary care physicians a note detailing the elevated risk and suggesting that the doctor refer high-risk women for the recommended MRI. "Did women never hear the recommendation from their physician?" asks Colorado School of Public Health professor Deborah Glueck. "Did they choose not to follow through? Did they go elsewhere for an MRI? We don't know." Glueck says the most critical issue is whether the advantages of MRI screening for women with elevated breast cancer risk compensate for its high monetary, medical, and psychological expenses. "For this to be true, first MRI has to catch breast cancer sooner than traditional mammography, it has to catch cancers that would otherwise kill, it has to catch cancers for which early treatment is more effective than later treatment, and the medical and psychological negatives in the process of screening and follow-up care—for example the potential for increased biopsies—have to be lower than the medical positives," Glueck notes.
From "Women Not Following Through With Recommended Breast Screening MRI"
Medical Xpress (01/31/12)
Read more in RSNA News: New research showing that timeliness of follow-up after abnormal mammograms varies widely among facilities suggests the potential for improvement and underscores the need for U.S.-published guidelines for institutions to follow, say experts. Coming in the April issue of RSNA News, available online April 2.
Research
CT Guidance Helps Brain Hemorrhage Outcomes
A new computed tomography (CT)-guided method involving direct application of drugs to patients' brain clots via a catheter is improving the survival rate and surgical treatability of intracerebral hemorrhage, according to a study detailed at the International Stroke Conference. The researchers estimated that roughly 50 percent of people who suffer from intracerebral hemorrhage die from it, and most patients only get supportive care in an intensive care unit. The risks associated with craniotomy surgery are why it is undertaken in only about 10 percent of patients. The procedure described by the researchers involves making a dime-sized hole in the skull and inserting a catheter through the hole and directly into the clot. Small doses of clot-dissolving tissue plasminogen activator are then dripped through the catheter over several days. The study involved 93 patients who were randomly assigned to receive either the new therapy or traditional supportive treatment in which clots are left to dissolve on their own. The outcomes indicate that patients treated with the new CT-guided procedure had their clots shrink by about 20 percent per day, compared to 5 percent of patients who received standard supportive therapy. Lead study author Daniel Hanley says the new method also dissolved the clots without the potentially harmful side effects associated with craniotomy. He notes that the treatment does not require special gear and seems to shield the brain better than craniotomy.
From "CT Guidance Helps Brain Hemorrhage Outcomes"
AuntMinnie.com (02/02/12)
Contrast Face-Off Reveals Little Difference in Renal Function
The effects of IV iohexol and iopamidol on renal function in outpatients undergoing computed tomography (CT) were compared through the performance of a prospective, double-blind, randomized clinical trial of 389 adults with low risk for contrast-induced nephropathy. Serum creatinine (SCr) concentration was quantified at baseline and two and three days following contrast administration, while a noninferiority analysis was planned to compare the average maximum SCr change from baseline between subject groups. Contrast-induced nephropathy rates for both contrast agents were compared as a secondary end point. Iohexol was administered to 190 patients while iopamidol was administered to 199 patients. The average change in SCr from baseline using the maximum second-day or third-day measurement was 0.07 plus or minus 0.12 mg/dL for the iohexol sample and 0.05 plus or minus 0.12 mg/dL for the iopamidol sample. The difference between contrast agents with respect to the average change in SCr from baseline was -0.02 plus or minus 0.12 mg/dL, and contrast-induced nephropathy rates were not statistically different going by any definition. A minuscule difference in increase in average SCr from baseline made the outcomes unable to exhibit absolute noninferiority of iohexol versus iopamidol, but this difference is likely of minimal or no clinical value in outpatients undergoing CT with low risk for contrast-induced nephropathy.
From "Comparative Investigation of IV Iohexol and Iopamidol: Effect on Renal Function in Low-Risk Outpatients Undergoing CT"
American Journal of Roentgenology (02/12) Vol. 198, No. 2, P. 392 Dillman, Jonathan R.; al-Hawary, Mahmoud; Ellis, James H.; et al.
PET After Radiation Therapy Predicts NSCLC Survival
A study investigated potential associations between maximum standardized uptake value (SUVmax) on 18F-FDG positron emission tomography (PET) before and after radiation therapy (RT) and survival outcomes for patients with locally advanced non-small cell lung cancer (NSCLC). The researchers determined that the post-RT SUVmax in both the primary tumor (PT) and the lymph nodes (LNs) was a predictor of survival, with overall survival (OS) and disease-free survival (DFS) being poorer the higher the residual SUVmax after RT was. The study involved 49 patients with stage III non-small cell lung cancer who had undergone 18F-FDG PET at the M.D. Anderson Cancer Center both before and up to 3.5 months after undergoing radiochemotherapy. Univariate and multivariate analyses demonstrated that having a high post-RT SUVmax corresponded with a higher risk of death. Furthermore, following definitive RT, the greater the decrease in SUVmax in the lesion that had the highest SUVmax at diagnosis, the longer the OS, local–regional control, and distant metastasis-free survival. The information collected through the assessment should help identify patients at high risk of recurrence and for whom additional treatments can be designed appropriately.
From "Large Decreases in Standardized Uptake Values After Definitive Radiation Are Associated With Better Survival of Patients With NSCLC"
Journal of Nuclear Medicine (02/12) Vol. 53, No. 2, P. 225 Guerra, Jose L. Lopez; Gladish, Gregory; Komaki, Ritsuko; et al.
Technology
New MRI Technique Helps Diagnose Gliomas
The presence of mutations in isocitrate dehydrogenases 1 and 2 (IDH1 and IDH2) has been demonstrated in most World Health Organization grade 2 and grade 3 gliomas in adults, and these mutations are associated with the accumulation of 2-hydroxyglutarate (2HG) in the tumor. Researchers assessed noninvasive detection of 2HG via proton magnetic resonance spectroscopy (MRS). The researchers devised and optimized the pulse sequence with numerical and phantom analyses for 2HG detection, and they calculated the 2HG concentrations using spectral fitting in the tumors of 30 subjects. Identification of 2HG corresponded with mutations in IDH1 or IDH2 and with higher levels of D-2HG by mass spectrometry of the resected tumors. Noninvasive detection of 2HG may have value as a diagnostic and prognostic biomarker.
From "2-Hydroxyglutarate Detection by Magnetic Resonance Spectroscopy in IDH-Mutated Patients With Gliomas"
Nature Medicine (01/12) Choi, Changho; Ganji, Sandeep K.; DeBerardinis, Ralph J.; et al.
Medical-Legal Issues
180 Lawmakers Join Fight to Stop Medicare Cut to Radiologists
The American College of Radiology says it has recruited 180 co-sponsors for a congressional bill that would stop a Medicare cut to radiologists. The Diagnostic Imaging Services Access Protection Act, H.R. 3269, would stop the Centers for Medicare & Medicaid Services (CMS) from implementing a 25 percent cut to doctors who perform multiple advanced imaging scans on the same patient in one day. CMS is reducing the professional component of Medicare reimbursement for doctors who perform multiple MRI, CT, or ultrasound scans on a patient in the same day. The cut of 25 percent is lower than the 50 percent cut originally proposed by CMS. The bill would halt those cuts through this year and would postpone reductions until 2013, and the cuts would only then go into effect if a study proved doctors gained efficiencies by doing multiple scans that would justify the cuts.
From "ACR Touts 180 Co-Sponsors for Radiology Bill"
Dotmed (01/30/11) Nafziger, Brendon
Number of Physicians Employed by Hospitals Snowballing
The latest survey numbers from the American Hospital Association point to a 34 percent increase in physicians employed by hospitals between 2000 and 2010, while the American Medical Association and the American Osteopathic Association report a mere 17 percent increase in the number of allopathic and osteopathic doctors in patient care and other healthcare roles. Among the factors boosting hospitals' incentives for hiring more physicians is the passage of healthcare reforms two years ago favoring the formation of accountable care organizations; the provision of bonuses for more efficient, higher-quality care; and the establishment of bundled payments that hospitals and physicians share for inpatient care. Many physicians also are migrating to hospitals to relieve themselves of various burdens associated with independent practice, including long hours, at-risk revenue streams, and government pressure to adopt costly electronic health record systems.
From "Number of Physicians Employed by Hospitals Snowballing"
Medscape (01/24/12) Lowes, Robert
Clinical Practice
How to Brand Your Radiology Practice
The importance of branding is often overlooked in the medical field. Many medical professionals do not try to sell themselves, instead relying on their skill and rapport. However, in an increasingly competitive environment, branding a practice can be very useful. A few simple strategies can create an effective and unique brand for a radiology practice. In many specialties, branding involves primarily patients, but in radiology, it may involve referring providers and offices in addition to patients. First, they should be appreciative of business. When speaking with providers or offices, they should be sure to let them know who is calling and from where. They should thank practices and offices that make referrals, and when on location, they should give technical staff their business card and ask them to give one to each patient to let them know who their radiologist was during that visit. Doing so will create a connection and show they are willing to extend the relationship beyond the brief encounter. They also should thank patients for their time and their choice, and when a patient checks in is the perfect time for support staff to fill out a thank you card that can be mailed later.
From "How to Brand Your Radiology Practice"
Diagnostic Imaging (01/30/11) Woodcock, Richard
MSK Ultrasound Volume Increase Higher Among Non-Radiologists
Musculoskeletal (MSK) ultrasound volume increased between 2000 and 2009, more so among non-radiologists than among radiologists, research shows. Researchers obtained data from the CMS Physician/Supplier Procedure Summary Master Files from 2000 to 2009, specifically records for procedures for extremity non-vascular ultrasound. Analysis results showed that musculoskeletal ultrasound volume increased from 56,254 procedures in 2000 to 233,964 in 2009. The volume increase among non-radiologists, and more specifically podiatrists, was much greater than the volume increase among radiologists. "In a health care climate in which increased utilization deserves further scrutiny, this study has demonstrated significant utilization increases by specialties that are not traditional imaging providers and may be in a position to self-refer," said lead author Dr. Richard E. Sharpe, writing in the February issue of the Journal of the American College of Radiology.
From "MSK Ultrasound Volume Increase Higher Among Non-Radiologists"
EurekAlert (02/01/12)
Rads Must Be Prepared to Disclose Errors to Patients
An editorial in the February issue of Radiology authored by Stephen D. Brown at Children's Hospital Boston and colleagues indicates that radiologists should prepare for situations which require disclosing harmful radiologic errors to patients. Among the reasons cited by the authors for having open radiologist-patient communication where unexpected errors are concerned is the advance of technology to the point where patients can get fast and direct access to radiologic reports and the establishment of more guidelines covering disclosure of medical errors in recent years. Brown and colleagues also wrote that a clear approach for reporting radiologic errors demonstrates an organization's commitment to patient-centered care. "A culture that supports disclosure of error and open communication between doctors and their patients also supports a culture of patient safety, through increased acknowledgment and ownership of errors made," they pointed out. Among the obstacles to disclosure in radiology is a medical culture that makes most doctors hesitant to admit errors to patients for legal and other reasons. Furthermore, diagnostic imaging is not 100 percent precise even when performed and interpreted in accordance with guidelines, which makes it difficult to characterize an error when dealing with a study with less than perfect sensitivity or specificity. The authors offer some strategies for improving radiologic error disclosure, such as setting radiology-specific guidelines for reportage of negative events; adapting the disclosure process for the novel context of radiology, and mirroring the severity or complexity of the adverse event; and establishing training programs for radiologists so that they can cultivate the communication skills needed to effectively disclose errors.
From "Rads Must Be Prepared to Disclose Errors to Patients"
CMIO.net (01/30/12)
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