Medicexchange.com News

Archive for September, 2010

The iStethescope Pro application has added yet another healthcare application to the iPhone, which as the name suggests can monitor heart beat like the stethescope. It allows you to listen to the heart beat using sensors of the smartphone and see the heart wave form in a graphical manner similar to that of an electrocardiogram.

The application was developed by University College London researcher, Peter Bentley and more than three million doctors have downloaded the application on their smartphones after the free version was introduced last week.

“Everybody is very excited about the potential of the adoption of mobile phone technology into the medical workplace, and rightly so,” said Bentley

Three-dimensional (3D) MRI is the latest and most useful technique for displaying fetal anatomy and diagnosing problems in the womb in a wide spectrum of clinical applications, according to an article of Jeffrey C. Hellinger, M.D., a pediatric imaging specialist at Stony Brook University Medical Center.

“Through enhanced visualization, 3D MRI improves one’s understanding and ability to display fetal anatomy. With a better understanding and display of anatomy, it enhances exam interpretation and communication,” said Dr. Hellinger, who details the uses and advantages of the technique in “Fetal MRI in the Third Dimension,” a review published in the July-August issue of Applied Radiology, the journal for radiologists, and available online.

Stuart E. Mirvis, M.D., Editor-in-Chief of Applied Radiology, comments on the piece of writing “Our cover story this month is quite likely the first article of its kind. It is an excellent review of 3D Fetal MRI techniques…The article does more than illustrate several flashy pictures that can be generated on 3D workstations and instead shows clinical radiologists, who may not be as familiar with this technology, that not only can it be done, but there are very beneficial emerging applications.”

3D sequences has many advantages for a pregnant mother says Dr. Hellinger. Since the fetus is moving frequently in the 20-24 week exam, 2D MRI necessitates obtaining multiple images in multiple planes. “That translates to a fairly long exam, an average of 30 minutes to 45 minutes. For any patient an MRI can be discomforting, let alone someone who is pregnant.”

With a 3D MRI, a practitioner can obtain volumetric, high resolution images that can be manipulated to view in any plane desired, obviating the need for redundant 2D images and potentially decreasing the overall exam time. “With the right image quality, that means less time in the magnet for the mom, improving workflow, and improving patient satisfaction,” he explained. Ultrasound and the newer 3D ultrasound remains the “principle obstetrical imaging modality. It is readily performed in outpatient and inpatient settings at minimal inconvenience to the mother, yielding reliable information for immediate clinical counseling and management,” Dr. Hellinger writes in the Applied Radiology article. However, Dr. Hellinger writes that MRI “offers superior spatial resolution and structural detail, affording comprehensive anatomical displays from single acquisitions.

“MRI is often requested to provide more definitive anatomical understanding and diagnosis for abnormalities identified on the screening ultrasound, as well as to assess for concomitant abnormalities. The literature has also advocated its use for anatomical screening in the setting of congenital heart disease and predisposed families.”

“Ultrasound serves as the standard test to evaluate non-cardiac fetal anatomy, and MRI imaging for fetal, placental, and uterine abnormalities can be useful in confirming or clarifying possible abnormalities that ultrasound detects. But because of our inability to control fetal movement in utero, the shorter time taken to get 3D MRI images of fetuses gives us a better chance of getting useful fetal images than standard 2D MRI,” says Paul, Ogburn, M.D., Director, Maternal-Fetal Medicine.

“Three-D imaging can act as an adjunct to add to our understanding of congenital heart defects and also of any other congenital abnormalities that may be present in the fetus,” says Laurie Panesar, M.D., Assistant Professor of Pediatrics in the Division of Pediatric Cardiology.

“By detecting these types of problems prenatally, we can better prepare for the baby’s birth and also better prepare the parents what to expect when their baby is born.” Thomas Biancaniello, M.D., Chief of Pediatric Cardiology, adds that 3D MRI is beneficial for imaging the fetus because “the diagnostician may have little control of the views obtained by fetal echocardiography because of the fetal position.

“3D MRI has been shown to be useful in infants, older children, and teenagers with congenital heart disease, as it allows visualization of structures that are out of the range of more conventional imaging,” he explains. According to Catherine Kier, M.D., Chief of Pediatric Pulmonology, Allergy and Immunology, and Director, Cystic Fibrosis Center, 3D MRI plays into the importance of early diagnosis, which is critical regarding long-term pediatric patient outcomes.

“Congenital pulmonary abnormalities like diaphragmatic hernia and cystic lung lesions can be diagnosed with state-of-the-art fetal imaging like 3D MRI. This in combination with subspecialty collaboration and comprehensive services will lead to excellent patient outcomes.”

Dr. Hellinger’s article contains striking fetal images taken with 3D MRI. He and co-author Monica Epelman, M.D., of the Department of Radiology at The Children’s Hospital of Pennsylvania, conclude the article on 3D fetal MRI stating, “Successful utilization requires optimized image quality and understanding of advanced visualization techniques. Continued evidence-based investigation is required to determine the impact of 3-dimensional fetal MRI on fetal diagnosis and management.”

Hormone replacement therapy after menopause may interfere with the accuracy of mammograms used to screen for breast cancer and the risk may be greater with hormones delivered by patch or injection compared with pills, found in a recent study.

According to an article in the journal Menopause, it is said that women on HRT at the time of the mammogram, had a false-positive, meaning they turned out not to have cancer on further testing. And they also contradict the theory that HRT patches and injections might be less likely to cause problems than pills. In addition, the study found that a newer type of hormone therapy used in some countries — a drug called tibolone, which has weak estrogen-like properties –

seemed to affect mammogram accuracy just as much as conventional HRT did. Researchers found that nearly 75% of Danish women who underwent screening mammography between 1993 and 2007, current hormone users were more likely to have a false-positive result than women who had never used HRT.

When the researchers looked at the various types of hormone therapy, they found that women using patches with combination estrogen-progesterone replacement, as well as those on injections of estrogen only, had about twice the false-positive risk of women using oral HRT. Most women on HRT, regardless of the type, did not have a false-positive.

“Data are needed from other studies before general advice can be given on what kind of hormone is the safest,” Dr. Sisse H. Njor, of the University of Copenhagen, declared to the Reuters Health in an email.

The problem with HRT appears is that it increases breast density. After menopause, women’s breast tissue generally becomes less dense and more fatty, but women on HRT tend to have breast density that is more similar to younger women. On mammograms, Njor explained, tumors appear as “bright” spots, whereas fat tissue appears dark. Dense breast tissue, on the other hand, also appears bright, which makes mammogram interpretation more difficult. The theory had been that HRT delivered by patch or injection might be less likely to cause problems than pills because those forms might have a less extensive effect on tissues throughout the body, including breast tissue.

“Our results did not support the hypothesis,” Njor said. Exactly why combination patches and estrogen injections were linked to an increased risk of false-positives is unclear. Differences in how the various forms of HRT affect women’s hormone fluctuations might play a role, the researchers speculate.

Because of the established link between HRT and reduced mammogram accuracy, experts generally say that doctors and women should be aware of the risk, but that should not stop women from having mammography screening.

Studies indicate that once a woman stops using HRT, the odds of having a false-positive mammogram go down, though it is not clear how long it typically takes for those odds to reach the level of women who have never used HRT, according to Njor.