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Archive for April, 2011

 

MRI scanning enhances health outcomes for Medicare beneficiaries with implanted pacemakers, when the pacemakers are utilized agreeing with FDA approved labeling for use in an MRI environment, adjudicates – Centers for Medicare & Medicaid Services (U.S. Department of Health & Human Services),

CMS suggested that the usage of MRI is sensible and essential under Social Security Act §1862.

 

The following information is available from news center of American College of Radiology.

It anticipated for the change of language in section 220.2.C.1 of the Medicare National Coverage Determinations Manual, to get rid of the reason for Medicare coverage of MRI in beneficiary with imbedded pacemakers, when it is used in accordance to FDA approved labeling for use in an MRI environment.

Other contraindications, for the procedure that may be present in any given beneficiary would persist, in patients with pacemakers.

American College of Radiology (ACR) and North American Society for Cardiovascular Imaging (NASCI) commented on it saying that their societies harmonize with it, if clinically suggested under the advocated course of action of the manufacturing business that MRI is done only by individuals, at site with know-how and hands-on expertise on radiology and cardiology practice. They even remarked on the monitoring and precautionary measure, authenticated in the operating instructions of FDA approved device, to be bound to.

They contradicted Coverage with Evidence Development (CED). It was remarked that patients with FDA approved devices should have similar admittance to medically essential MRIs, as patients with no implanted medical devices.

NASCI & ACR even requested for the contraindication in section 220.2.C.1 to be substituted with the accompanying statement:

“The MRI examination is not covered when the following patient-specific contraindications are present: It is not covered for patients with pacemakers that have not been approved by the FDA for use in the MRI environment.”

Courtesy:
1)    http://www.acr.org/PR/NASCI-ACR-Comments.aspx
2)    http://www.acr.org/HomePageCategories/News/ACRNewsCenter/CMS-Concludes-MRI-Improves-Health-Outcomes-for-Patients-With-Pacemakers.aspx

PET scan demonstrated well, in comparison to TTE/TEE and multislice CT for infectious endocarditis.

• Infectious Endocarditis can be analyzed, once the accretion of FDG is observed on a PET scan in suspected region.
• PET scan discovered out FDG accumulation in region of prosthetic blood vessel of the right ventricular outflow tract.

The medical research was conducted by Tsuneaki Kenzaka, MD, Miho Shimoshikiryo, MD, Akihito Kitao, MD, Kazuomi Kario, MD, and Masayoshi Hashimoto, MD. The clinical trial is available in the Journal of Nuclear Cardiology.

The analysis of infectious endocarditis is characteristically based on clinical presentation, blood cultures and echocardiogram findings. Echocardiography is fundamental in the analysis/management of patients with infectious endocarditis.

Medical researches elaborated a medical case of infectious endocarditis, which could not be analyzed through Transthoracic Echocardiography (TTE) and Transesophageal Echocardiogram (TEE). The 35-year-old patient who had been suffering from high fever for more than 2 weeks had a significant medical history of tetralogy of fallot. On examination, no abnormal findings were observed in the blood and urine tests, except for increased white blood cells.

CAT scans with contrast medium and otherwise of the chest, abdomen and head did not divulge cause for the febricity. His medical history and current illness pointed out to infectious endocarditis. Due to artifact, the pulmonary valves could not be envisioned by. Streptococcus Viridans was recognized out in blood cultures, and valve repair was adjudicated for infectious endocarditis.

64-slice CTA was carried out to identify out infectious focal areas, researchers found low-density region in the valves, but could not differentiate it out from fuzzy artifact image in the simulated blood vessel site of the right ventricular outflow tract (RVOT).

PET scan then was adjudicated as a substitute for the procedure. The scan was acquired after instilling the patient with 18F-FDG (4 MBq/kg). Positron emission tomography apparently divulged out the localized accretion of FDG in the contrived blood vessel site of the RVOT. The second scan was carried out after treatment phase of six weeks. It did not show any accretion of FDG in the fraction of the artificial blood vessel.

Except for heparin administration, the second PET scan was administered as per the standard protocol. The patient recuperated with the treatment schedule, as the accumulation vanished after the treatment.

Conclusion: PET scan is effective in treating grave medical cases of infective endocarditis.

Mayo Clinic and Gamma Medica, Inc. have developed lower dose MBI system – which supports a 4 mCi MBI scan.

• MBI is being conceived to circumvent digital mammography, MRI, ultrasound etc.
• It showed 91% sensitivity (in combination with mammography), and 93% specificity over mammography in 1,000 patients.

In a recent Breast Imaging Meeting by Society of Nuclear Medicine conducted in Bethesda, Maryland from April 21-22, 2011 – Mayo Clinic (Rochester, MN) put forward highly awaited preliminary results of the clinical research studies, of about 2,400 patients on low dose Molecular Breast Imaging (MBI) cancer trial/screening in women with dense breasts.

The cancer clinical trial was funded by Susan G. Komen Foundation.

Women with dense breast that posed for digital mammogram between June 2010 and January 2011 were inscribed for this clinical study.

Research was conducted by Michael O’Connor, PhD – Medical Physicist, Carrie Hruska, PhD – Associate Consultant in Medical Physics, and Deborah J. Rhodes, MD – Lead clinical investigator.

Partakers experienced both molecular breast imaging (MBI) and mammogram. MBI was executed with 296 MBq (8mCi) injection of Tc-99m Sestamibi and dual head czt detectors, and developed in active frame to allow for genesis of 148 MBq (4 mCi) eq images.

MBI’s and mammograms were interpreted separately, where MBI’s were allotted an assessment score of 1-5 over BIRADS (Breast Imaging Reporting and Data System). The assessment scores of 3-5 on molecular breast imaging were conceived positive and contributed to diagnostic work-up.

About 440 women that were examined up to now, 6 patients were determined out with cancers. In line to Mammography – which did not find out any, MBI discovered out cancer in about 5 of 6 patients. The unexpended cancer was noticed on prophylactic mastectomy (7 mm invasive carcinoma).

MBI discovered out 2 cases of DCIS (Ductal Carcinoma In Situ) – 6 and 15 mm, tubular cancer (7mm), and invasive lobular carcinoma (36mm) that were hidden by Mammography.

About 79 women were called back for symptomatic valuation of the conclusion; almost 35 – due to predominant MBI alone; 40 because of incidental mammogram, and 4 due to both the examinations. Around 18 women had passed through diagnostic test/biopsy, where 16 women were cued by MBI, with positive predictive value (PPV) of 25%, while only 2 were being cued by Mammography with PPV of 0%. All the detected cancer cases were even seeable on the 148 MBq (4 mCi) equivalent images.

Though the study is on, but conclusion from this clinical research show out the significance of low-dose MBI, which can be a vital choice to mammography screening in women with dense breast. Medical researchers said, the re-examination after a year for this group, and advance study of incidental screening MBI is required to demonstrate out for sensitivity specificity.

Perfusion CT scan can demonstratively assess lung cancer angiogenesis, and show out vascularity and alterations, followed up with treatment.

The medical research was led by Francesco Fraioli, MD, and his associates, from Departments of Radiological Sciences, and Medical Oncology, University of Rome. (Courtesy: http://radiology.rsna.org/content/259/2/574.abstract)

 

Researchers wanted to determine if perfusion CT imaging done with next generation CT scanner is able for assessment of the effects of chemotherapy in combination with Antiangiogenic therapy, on patients with whole tumor mass with lung Adenocarcinoma, which originates in glandular epithelium.  The restoration of health is ascertained by blood vessel growth.

It was required to determine if CT variations associate with therapeutic response, as evaluated per RECIST criteria (Response Evaluation Criteria in Solid Tumors).

About 45 patients with unresectable glandular carcinoma, which were unable to be removed by surgery, followed out on perfusion CT scan, ahead and in about 40-90 days after chemotherapy and antiangiogenic treatment.

Followed up on RECIST criteria – blood volume/flow, time to peak, and permeability were calculated and measured through site-independent, blinded study. Pearson coefficient was utilized for correlation analysis to evaluate baseline CT numbers.

The baseline and reviewed perfusion parametric quantities of neoplastic lesions were examined on the whole for statistically substantial deviations through repeated measures analysis of covariance, and were also equated on grounds of response therapy, evaluated as per RECIST guidelines.

Pearson correlation coefficient demonstrated out substantial correlation amongst baseline value of blood volume and flow (ρ = 0.48; P = .001), time to peak and permeability (ρ = 0.31; P = .04), time to peak and blood flow (ρ = −0.66; P < .001), time to peak and blood volume (ρ = −0.39; P = .007). Blood volume, flow and permeability values were comparatively higher in responding patient than other.

Substantial deviation was there on reexamination for blood flow (P = .0001), volume (P = .02) and permeability (P = .0001). The time to peak was higher in non-responding patients (P = .012).

The research results reason out the significance of perfusion CT imaging for assessment of angiogenesis in lung cancer.

In the new KLAS report, “Ambulatory RIS/PACS: Integrating Provider Needs“, KLAS addressed the opinions/concerns of above 500 provider facilities about their RIS and PACS vendors.

• The research was conducted by Monique Rasband, KLAS Research Director and author of the report (Courtesy: http://www.klasresearch.com/News/PressRoom/2011/Ambulatory_RIS_PACS)
• Ambulatory PACS and RIS vendors were assessed in a single KLAS report. Full report “Ambulatory RIS/PACS: Integrating Provider Needs” on RIS/PACS vendors is available for healthcare providers/vendors at the following domain: www.KLASresearch.com/report

The conclusions from the blend of RIS and PACS in a common report statement extend forward complete expression at both the marketplace, which shows how suppliers shop for solutions. Suppliers expect for vendors that put forward smooth incorporation along with functionality, in between PACS and RIS. For the consolidation, some suppliers are ready to forfeit practicality.

Consolidation implies augmented supplier agreement/approval, with respect to amalgamated RIS/PACS marketplaces, opined research director, KLAS.

Some exclusion is there to the convention. Single-side sellers that extend forth only one side of RIS or PACS, e.g. MedInformatix & Intelerad fared remarkably in the marketplace, correspondingly. Since, single-side vendors are not required to concentrate on incorporation of RIS and PACS solutions, they can work on in the practicality to serve the purpose well.

Providers were found contented with sellers that offered single-database RIS/PACS. Sellers like DR Systems, CoActiv, and Infinitt put forward the fringe benefits of firm integration, inclusive of easy sustenance, coherent feel and look of RIS and PACS, and in various cases, brought down cost.

PACS vendor CoActiv scored top in the report – though was not graded, as it was not a regional solution. The top ranked system was Intelerad IntelPACS, while Infinitt ascended than previous year, and stood at 2nd position in the ambulatory PACS marketplace.

Vendors that offered PACS/RIS on set-apart database had more problems with the integration. Providers are displeased about the level of integration that GE and Agfa have yet to attain by.

GE is most susceptible RIS vendor, while Agfa is most susceptible PACS vendor. Apart than their effort to integrate PACS and RIS, their services are even not at the best, opines Rasband.

Fuji performed well and impressed the providers in both PACS and RIS marketplaces, correspondingly. It is uncommon, but Fuji took 2nd position in RIS, while 3rd position in PACS.

The consolidated market and poor vendor performance made most of the providers change over to other vendors, in the marketplace. While, on the other – some providers are in a state of inaction with no progress/change, because of ambiguity in the marketplace.

In time to come, providers are alarmed of coming across fresh developments from their vendors. Providers look forward to new modules, e.g. mammography viewing etc. They call on for web-based functionality, along with tested and timely upgrades, spoke up Rasband.

About 21 vendors are completely graded in “Ambulatory RIS/PACS: Integrating Provider Needs”, viz. Agfa, Aspyra, Avreo, Carestream, CoActiv, DR Systems, eRAD, FUJIFILM, GE Healthcare, Infinitt, Intelerad, McKesson, Merge (AMICAS), MedInformatix, NovaRad, Philips, RamSoft, ScImage, Sage, Sectra, Viztek. Early data vendors include: BRIT Systems, Digisonics, Epic, InStar, Siemens, and Swearingen.

According to a latest medical research at the Brigham and Women’s Hospital in Boston,

• Importing radiology imaging results of patients on CD can trim down needless medical imaging procedures.
• Repeat radiology exams escalate healthcare cost. The diagnostic imaging tests may bring out patients to x ray ionizing radiation and they may have contrast medium side effects through intravenous contrast materials.
• Imported image CDs brought down about 16-17% image rate/CT scans in every-day practice in hospitals.

The medical research was led by Aaron Sodickson, M.D., Ph.D., and the finding by them at Brigham and Women’s Hospital in Boston is available in the July issue of Radiology. (Courtesy: http://www.rsna.org/media/pressreleases/pr_target.cfm?ID=543)

Implementation of system to upload CD images of emergency care departments to PACS system of other receiving healthcare institutions brought down the imaging exam rate by about 17%, concurrently.

The lack of medical data/digital repository, and large scale distributed systems make it unfeasible for image transfer electronically amongst hospitals. CD images with medical diagnostic imaging results are vital clinical information of patients.

The imported CD images in PACS enable the images to be resourcefully evaluated by health team members, at distant locations.

If the receiving emergency medicine department has no import facility, when image import is failed, for the reason that the CD is dented, misplaced or with non- standard image formats, then repeat imaging is frequently carried out.

We know that considerable amount of imaging carried out on emergency room patient is recapitulated at the receiving medical institution. It soars up healthcare cost, retard patient care, and frequently exposes patients to ionizing radiation and other contrast medium side effects.

Brigham and Women’s Hospital, in year 2008 enforced a system to import CD images from other institutions into their PACS, on 24 hour basis.

Receiving physicians had to submit CD import order through electronic order system of radiology order entry. The CD is then passed on to emergency radiology department in hospital, where the CD contents are imported into PACS through picture import software.

Medical researchers evaluated medical records of about 1,487 successive patients that were moved to the Brigham and Women’s Hospital emergency department in year 2009, between February and August.  The imported CD contained medical images took on somewhere else. The CD import to PACS was tried out for all the patients, and the success percentage was about 78%. Inappropriate image formats, and CD failure ensured in about 326 ineffective CD imports.

Patients with successful CD imports had about 16-17% decreased rate of imaging/CT scans.

Researchers say the implementation of CD import measures has given them an effective way to take care of patients, in a better way.

Generalization of the outcome to about 2.2 million patient transfers amongst emergency departments, every year, in America – the predictable annual reduction in CT usage due to thriving CD import to PACS would be on the order of 484,000 CT scans.

The implementation of Electronic Medical Records, image repository and file transfer network can ensure the diagnostic imaging results are available to all healthcare departments, for better patient care and treatment. But till that point in time, it is feasible for CD image import to PACS format, to keep the patients away from needless examinations.

PET is an ideal tool for measurement of coronary endothelial dysfunction. Therefore, a finding of endothelial dysfunction may guide interventions for preventing the development of future cardiovascular events.

These findings are mentioned in a recent article available online in the Journal of Nuclear Cardiology. The lead authors of the article titled, ‘Assessment of coronary endothelial function using PET‘, are Keiichiro Yoshinaga MD, PhD, FACC, Osamu Manabe MD, PhD and Nagara Tamaki MD, PhD

Coronary endothelial dysfunction is the most basic irregularity in the evolution of coronary artery diseases. The most common cause is atherosclerosis. It is also seen in septic shock, high blood pressure/hypertension, diabetes etc.

Various coronary risk factors unfavorably affect endothelial cells. Endothelial function testing/detection can provide timely medical interventions to put off cardiovascular disorders, in future.

Myocardial perfusion imaging (coronary perfusion) is a feasible option. The measurement of myocardial blood flow through PET scans facilitate for assessment of endothelial function.

PET imaging/myocardial blood flow with sympathetic stress levels have been put on various patients with coronary risk factors. It was found useful in assessment of risk of coronary heart disease.

The authors opine that endothelial evaluation using PET can be used to study the pathophysiology of cardiovascular disease as well as in evaluation of the treatment. This can help in the development and testing of new treatment approaches for cardiac disease.

The authors recommend further development of this method as a research tool in cardiac disease management.

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Whole body PET MRI might substitute integrated PET CT scanning, as MR outmatches CT, for complementary examination in PET indication. The subject is discussed in a recent editorial published in the ‘European Journal of Nuclear Medicine and Molecular Imaging’, titled ‘Whole-body hybrid PET/MRI: ready for clinical use?‘

Combined PET/CT facilitates precise tumor staging, and evaluates radiation oncology response to the therapy and is superior in comparison to stand-alone PET or CT. The advance PET technology (PET/CT) alleviates for PET imaging of the trunk/body (head to mid-thigh) with isotropic resolution in 10 min and lesser than that.

The incorporation of high-end Multidetector CT (in dual modality) provides for contrast-enhanced CT evaluations. It augments the clinical significance of incorporated PET/CT imaging protocols.

MR imaging studies aid for soft tissue analysis/cephalometric analysis, cancer detection, tissue characterization, functional imaging etc. Patients often undergo MRI scans, other than a PET/CT study, for detection and staging of cancers. This is done for soft tissue analysis/morphological information, when stand-alone computed tomography is unable to provide information with.

Combined PET/MR examinations may potentially become significant than PET/CT imaging. MR outmatches CT, for complementary examination in PET indications. It is now proposed that whole body MR imaging might substitute PET/CT.

MRI machines detect area of restricted diffusion (diffusion weighted MRI). It provides information about injuries to parts of the nervous system, with high sensitivity. The feasibility of PET/MRI is more to be seen.

MRI Scan Brain

MRI scan can easily foretell patients with Mild Cognitive Impairment (MCI) that have more probability of progression to Alzheimer disease, say medical researchers.

The study was led by Linda K. McEvoy and colleagues from the Department of Radiology, University of California. The study is available online and will be in print in the June issue of Radiology.

The development rate of Alzheimer disease to Adults with mild cognitive impairment is about 15-20%, per year. Timely prediction for development of Alzheimer’s disease ascertains the patients get optimal health care and concern.

MCI/Dementia is the mental impairment of organic/functional origin. It affects behavior/conduct, memory, language, judgment and thinking etc. Alzheimer’s disease is a progressive form of presenile dementia, is akin to senile dementia, of the aged. Some people with MCI remain firm and unwavering, though others steadily decline, and some swiftly get worse.

“Being able to better predict which individuals with MCI are at greatest risk for developing Alzheimer’s would provide critical information if disease-modifying therapies become available,” said the study’s lead author, Linda K. McEvoy, Ph.D.

The ability to predict individuals with MCI at greater risk of progression to Alzheimer’s disease (AD) would be helpful for alternatives therapies. Medical researchers studied MRI tests from the Alzheimer’s disease Neuroimaging initiative, which was a sponsored study conducted in between year 2005 and 2010 with MCI and premature AD patients to identity biomarkers of the disease.

The study was inclusive of baseline MRI tests for primary point measurement, and secondary MRI scans were carried out a year afterward on about 317 affected patients with MCI, 164 premature AD, and about 203 healthy/fit individuals. The average/mean age of the partakers for the research study was 75 years. Researchers gauged the thickness of cerebral mantle, through MRI, and ascertained the form of thinning, to work out a risk score, to characterize brain atrophy, as MRI is highly responsive to it. The pattern of cortical thinning related to AD points out to the patients that have more likelihood of progression to this disorder.

By primary MRI, it had been calculated that the patients with MCI had a one-year possibility of translation to Alzheimer’s disease, from 3-40%. In comparison to clinical diagnosis for AD, the primary MRI offered for substantiated proof/information, risk estimation for the disorder. Through the combined outcomes of primary and secondary MRI scans performed, the medical researchers gauged the rate of change in brain atrophy. The risk of disease progression for MCI patients ranged from 3-69% on MRI exams, as brisk cortex thinning contemplates for degenerative disorder.

Though no treatment options are available currently, to prevent/slow the neurodegeneration related with Alzheimer’s disease, patients with high risk would desire to enroll in clinical study for disease modifying therapy (Medicare). The research team believes the premature detection will ascertain – the patients receive optimum health care, and allow for the families more time for plan/preparation.

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Study shows that there is an increased rate of CT scans done on children in the hospital emergency departments over the last 15 yrs.

The study available online will be in the June print edition of the ‘Radiology’ journal.

Researchers feel, need of healthcare staff (medical professionals) collaboration is vital, to ascertain pediatric CT is properly ordered, executed and translated out. Helical CT scanning is a vital diagnostic tool for brisk diagnostic evaluation of children in the hospital emergency rooms.

Minified scan times are particularly helpful in to trim down the need for sedation/drugging in pediatric cases. High dose radiation related with CT scan (ionizing radiations), in comparison to other diagnostic imaging exams is a grave concern. Body organs and parts of children are more sensitive to radiation, than grownups/adults with longer life expectancy, in which cancer may shape in.

To analyze CT utilization trends in children, the medical research team gone through National Hospital Ambulatory Medical Care study data available from 1995 to 2008. They found – pediatric emergency room visits (inclusive of CT examinations) shot up five-times across the study duration, with a compound rate (annual growth) of 14.3%, respectively. Diagnostic imaging for abdominal pain soared up (21%, in comparison to 15% in year 1995) the most than head injuries and other conditions (headache etc.) through CT technology.

In 1995, abdominal CT used to take long, with poor resolution, but by 2008 through helical scanning, the technology gained momentum through abdomen CAT scan (helical CT scan). Though high radiation dose is an issue, but this technology is broadly available, and fast on process. Abdominal CT radiation dose is equal to seven times that of head CT, which indicates about increased radiation treatment for children in hospital emergency rooms (from 1995-2008) than the increased rate (percentage) of visits, in which CT was carried out.

Researchers corroborate that, the execution of CT in children asks for expert supervision, concerned with choice of CT scan parameters (size-based) and sedation techniques. It is significant for to always adapt/modify CT methods, as per body size of the pediatric patient.

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