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Archive for May, 2011

Echocardiography is useful for ventricular size and function, in patients with surmised pulmonary hypertension, but clinicians should not depend upon Doppler echocardiography solely, for authoritative diagnosing, or for prime conclusions.

Doppler echocardiogram overvalued/underrated pulmonary artery systolic pressure, considerably, in most of the cases.

 

The study was conducted by Allan S. Brett, MD, and is published in Journal Watch General Medicine May 24, 2011. (Courtesy: General Medicine Journal Watch)

Doppler Echocardiography (DE) is a diagnostic procedure that utilizes ultrasound to analyze the heart. Doppler echocardiography is frequently used by medical practitioners to analyze pulmonary hypertension, of increased pressure in the pulmonary arteries.

Medical research has depicted that pulmonary artery pressure echocardiogram can be imprecise.

In most of the cases, Doppler Echocardiogram overvalued/underrated pulmonary artery systolic pressure, considerably. (Vide: Cardiology)

Researchers considered the medical research study again of about 160 patients with assumed pulmonary hypertension that had experienced Doppler Echocardiography and pulmonary artery catheterization in 30 days.

The measurement of pulmonary artery systolic pressure varied of DE, from that of pulmonary artery catheterization by an extent 10 mm Hg in half of the cases.

Amongst these, about 41% were overestimations, and 59% were underestimations.

In various patients, disagreements amongst Doppler Echocardiography and pulmonary artery catheterization measurements outperformed 40 mm Hg – some were overvalues, and others were undervalues.

In another group of people, of about 23 patients that experienced Doppler Echocardiography on pulmonary artery catheterization, the consequences were alike to that in the successive group of people.

Even as two measurement techniques show numerical correlation in a large group of people, measurements from those techniques can dissent considerably in individual patients.

That differentiation is vital for measurement of pulmonary artery pressure through Doppler Echocardiography against pulmonary artery catheterization (Refer: Pulmonology).

Conclusion: Echocardiography allows for helpful information, including appraisals of ventricular size and function, in patients with surmised pulmonary hypertension, but clinicians should not depend upon Doppler Echocardiography solely, for authoritative diagnosing, or for prime conclusions.

FDA approved first Mobile Radiology App for iPhone®/iPad®, for clinicians and radiologists in remote locations.

Mobile MIM is effective for results of MRI, CT, and PET on mobile devices for diagnosis.

• It is applicable for other modalities as well, viz. fluoroscopy, angiography, ultrasound etc.
• Due to small size, it is not application friendly to Radiographs, for to attain resolution/contrast required to view an X-Ray.
• The portable device extends forth multi touch user interface with medical grade displays.

*(News Courtesy: RSNA)*

It took about 2 years for Food and Drug Administration (FDA) to approve mobile diagnostic radiology application for iPhone®/iPad®, for radiologists, away from clinical workstations.

Mobile radiology app facilitates radiology images taken in care units to be compacted for ensured network transfer, to be sent through portable wireless devices. Though individual facilities have built up similar application for their utility, FDA has not yet sanctioned those, aimed for primary diagnosing, rather secondary viewing. The commendation of Mobile MIM from FDA has opened new avenues to similar devices from other companies, in the market.

FDA examined Mobile MIM’s operation on various devices, measured resolution, luminance noise versus international guidelines and standards. FDA ascertained that Mobile MIM allows for enough resolution quality to be utilized for medical diagnostics, when a full workstation is unavailable.

Though the application will be useful for remote reference/consultation, the technology will be particularly good for getting at subspecialty expertise, not other than available. The resident can confer with radiology on call professional, at any location.

But, some problems could not be kept off with of Mobile MIM, as for physicians that make remote diagnosis from a state in which they are not licensed to – it can bring up grave legal issues.

Tumor tracking method can trim down amount of radiation dosage administered to circumventing healthy tissues, while maximizing radiation that the tumor receives.

The active tracking and dynamic delivery technique envisages tumor position. Tumor-tracking lessens irradiation by 20-30% for normal lung.

The medical research was conducted by Ivan Buzurovic, Ph.D., medical physics resident and researcher, and Yan Yu, Ph.D., director of medical physics, in the Department of Radiation Oncology at TJU (Courtesy: RSNA)

The real-time tumor motion and tracking method brings down the amount of radiation administered to circumventing health tissues, and maximizes the dose that the tumor receives.

Researchers wanted to ordinate control of the couch and the linear accelerator, to have through beam’s eye view, the appearance of tumor to be stationary.

Models of the robotic system through programmed algorithms were capable of to incessantly track down tumor, on radiation dose, facilitating exact radiation dosage administration to moving target, and cutting down dosage to surrounding vital organs/tissues. (Vide: Oncology)

The tumor tracking technique was modeled for two couches – HexaPOD™ and the ELEKTA Precise Table.

The latent time of linear accelerator and couch particularly range from 200 milliseconds to one-third of a second. The programmed algorithm anticipates where the tumor to be inclined with the latent time. The efficaciousness of the intended technique was examined by across-the-board model.

The method demonstrated well, to bring down damage to vital organs (spinal cord), on lung tumor scenario. Research team evaluated about 15 patients that had tumor motion from 1.5-2.5 cm, and observed that the spinal cord experienced from 0.5 to 11 Gy less, when the tumor-tracking method was utilized.

Researchers believe that this method in a great possibility will enhance radiation dosage distribution of the tumor volume, to improve treatment of patients, by lowering down radiation to vital organs and healthy tissues, to keep away from toxic effects of radiation (Radiology).

The technology, at present is accessible for confining the radiation beam to agitate when the tumor comes into a determined window, and put off when the tumor subsists at the other end, where this technique keeps up the intervention for the similar dosage.

The delivery is to be made swiftly prior any moment or rapid shifts in the patient (through body movement, or when they cough etc.). As the radiation is particularly focused to the region of the tumor, and not more to circumventing healthy organs/tissues, the method could possibly enhance the dose administered onto. At this juncture, possible dose enhancement is theoretic, and researchers are studying more on that.

They are looking up for tumor-control possibilities and likelihood of normal tissue complication.

Bruce G. Haffty, M.D., co-chair of the RSNA Oncologic Imaging and Therapies opined that the system should be able to respond, and adjust on its own. But, never the less, he firmly hopes that the medical research has driven radiation oncology a new direction, as it will help them for real-time tumor tracking, for altering radiation dosage administration.

Though more research is required, the method could become regular in coming future, concludes Dr. Haffty, where he urged for establishing the conception, as well.

Halving the radiation dosage in cardiac perfusion scan is practicable. New image processing software facilitates for vital radiation dose reduction.

 

These are the findings according to a study was conducted to examine if radiation dosage could be trimmed down, without affecting resolution of medical images. The research was lead by Professor Nili Zafrir, Director of Nuclear Cardiology, Rabin Medical Center in Petah Tikva, Israel.

The results of the study were put forward at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) in Amsterdam, which is one of the world’s key scientific events in cardiac computed tomography imaging and nuclear cardiology.

 

Of diverse imaging modalities for perfusion scanning – SPECT scans facilitate for non invasive assessment of myocardial blood flow, for detecting coronary artery syndrome.

Cardiac imaging (Cardiology) is generally carried out twice to assess cardiac muscle blood flow on stress and rest conditions, where blood flow is visualized on scan through radioisotope tracers passed by coronary arteries, which is administered in the middle muscular layer of the heart wall (myocardium), where the diagnostic images are established on gamma rays emitted by the tracer substance. The healthy myocardial tissues assimilate radioactive isotopes, but in case of lessened blood flow to cardiac muscles, perfusion defects can be observed. This refers to myocardial ischemia when there is poor balance amongst demand and supply of myocardial oxygen, exists.

Nili Zafrir said, the application of myocardial perfusion imaging is bounded, as due to high radiation dosage in the isotope tracer that the patients are instilled in. Though the radiation dosage is in the satisfactory range, but the level of radiation exposure and cancer risks associated with it is still a prime concern.

With conventional diagnostic imaging techniques, the patient is exposed every time to radiation dosage in the range of 8 and 25 mSv.

The study equated results from two different protocols – half dose injection and conventional full dose injection of isotope tracer. About 109 patients were picked for the study in varied groups that was examined with rest-and-stress, stress-and-rest, and stress-only imaging.

Based on weight of patients, full dose protocol was enforced in with radiation dosage in the range of 12 and 32 mCi. For half dosage protocols, the range was within 5 and 17 mSCi, where these were changed over to effective dose in mSv.

The image processing software that was constructed to trim down the time to acquire diagnostic images made the study easy for Nili Zafrir. The objective of the study was to utilize image processing software, to evaluate the feasibleness of cutting down radioisotope tracer in lieu of abridging accomplishment time.

Consequences of the study demonstrated that about 94% of the medical images from half-dose protocol had highest level of diagnostic precision and image quality when radiation dose of the perfusion fractioned.

Study author even accounts that about 35% of the patients in the half-dose protocol had only stress imaging, where they were exposed to an average of about 1.9 mSv. The overall effective dosage for stress imaging probe was 7.19 mSv in the half dose protocol, in comparison to conventional dose protocol that had 14.4 mSv.

Conclusion: Myocardial perfusion imaging is practicable with vital radiation dosage reduction. Half dose protocol trimmed down radiation exposure to 1.9 mSv in majority of patients, below than that of range in conventional perfusion imaging. Imaging quality of new processing software showed same image quality, as that of conventional protocol – the clinical results were equivalent to that identified by full dose imaging.

Clinical examination/observation of children with blunt head trauma is essential prior making a decision on CAT scans, to bring down unneeded computerized tomography scanning.

 

The medical research study is available in the Official Journal of the American Academy of Pediatrics, published online on May 9, 2011.

 

The study was led by Lise E. Nigrovic and research associates from the Traumatic Brain Injury Group for the Pediatric Emergency Care Applied Research Network (PECARN).

The clinical research objective of the team was to observe the tendency of children with blunt head trauma/traumatic brain injury (TBI) that are being observed in emergency room prior making a decision on computerized tomography scan. The team evaluated the affect of clinical planning/strategies on CAT scans, and its outcomes.

Researchers carried out sub-analysis of potential multicenter study/observation of children that had blunt head trauma. Clinical case report was accomplished, stating if children were observed prior making a conclusion for computed tomography scanning.

The team outlined clinically significant traumatic brain injury as an intracranial injury – ensuing in death, surgical intervention, rapid intubation for more than 2 days, and/or hospital admission for any long period of time.

For to equate computerized tomography rates among children that were observed, and others that were not, prior making a decision on computed tomography scans – the team utilized an extrapolated estimation equation model, to ascertain characteristics of patients and hospital clustering.

Results of about 40,000 children inscribed in the study. Clinicians found that out of 95% cases of patients, about 14% children were observed prior making a conclusion for computerized tomography scan.

The usage rate of CAT scans was lower in children that were observed (31.1%) than others that were not observed (35.0%), though the rate of clinically significant traumatic brain injury was identical. After adjustment for patient characteristics and hospital clustering, the divergence in the computerized tomography scan usage rate remained substantial.

Conclusion: Clinical observation is related with abridged usage of CAT scans among children with traumatic brain injury (TBI), and it is an effectual strategy to trim down unnecessary computerized tomography scan.

As per medical research study put forward at the Cancer Imaging and Radiation Therapy Symposium in Atlanta:

In comparison to lone CT scan, the aggregation of Computerized Tomography Scan (CT) with 18F-FDG PET (Fluorodeoxyglucose Positron Emission Tomography) images ensued into more outlined tumors, and likely dissimilar cancer therapy options, in head and neck cancer patients.

The research was led by Homan Dehnad, MD, Utrecht University Medical Center in Utrecht, Netherlands.

The conference was supported by Radiological Society of North America (RSNA) and the American Society for Radiation Oncology (ASTRO).

Medical researchers attempted to ascertain the implication of combination of CT and FDG-PET for deciding tumor delineation and therapy for head and neck cancer patients.

CT scan is standard method for determination of tumor delineation prior adjudicating head and neck cancer treatment, normally through intensity modulated radiation treatment. FDG PET utilizes radioactive products, in combination with sugar, and can generate more outlined tumors.

For the trial study, about 327 patients were treated with Intensity-Modulated Radiation Therapy (IMRT) for head neck cancer.

On grounds of the aggregated approach of CT scan and FDG PET, researchers detected shift in the characterization of the tumor in a patient, out of 3 patients. This resulted into change and adjustment of treatment for 10% of patients, and 33% of patients, respectively.

In about 17% of the patients, the primary tumor was not seeable on CAT scans alone, for the most part due to dental implants.

Researchers anticipated for enhanced delineation of the tumor, though they never looked forward to it to have drastic influence on cancer treatment options for the patients. They urged for requirement of multi-imaged facilities for every committed institute that dealt with head and neck cancer (Oncology).

Conclusion: The combination FDG PET CT scan is significant for tumor characterization in primary radiotherapy for head and neck cancer.

As per the study put forward at the Cancer Imaging and Radiation Therapy Symposium in Atlanta:

• Annual mammograms furnish similar consequences post breast conserving therapy for cancer patients, at lower health care cost
• Researchers tried to ascertain the clinical relevance and usefulness of follow up mammogram after Breast Conserving Therapy (BCT), when the patient is treated already with treated with a lumpectomy and radiation for stage breast cancer.

The conference was supported by Radiological Society of North America (RSNA) and the American Society for Radiation Oncology (ASTRO).

Annual mammograms are often carried on after BCT. Some of radiologists urge for interval mammogram (follow-up) after 6 months, after primary post-treatment mammogram, which is about 5 months after the culmination of radiotherapy, on the average, to ascertain constancy, to check out for cancer recurrence (Oncology).

For the trial study, about 88 of 467 BCT patients from Abington Memorial Hospital, Abington, PA had an interval mammogram (IM). This contributed to 4 biopsies that did not generate any recurrent or new cancer cases. The patients proceeded further for their annual mammograms after interval mammogram.

Medical researchers ascertained that ruling out IM would bring down higher healthcare costs, with no vital impact on patient outcomes.

Though an IM after BCT is normal, but physicians are required to reconsider their suggestion for an IM, to relieve patients with lower healthcare costs and unneeded biopsies.

Conclusion: Interval Mammograms after Breast Conserving Therapy is not recommended for patients, to save them money and unneeded biopsies.

The study was put forward at the Cancer Imaging and Radiation Therapy Symposium in Atlanta:

• A pelvic MRI scan with IV contrast and rectal balloon can discover prostate cancer reoccurrence at extremely lower PSA levels (Prostate-Specific Antigen)
• It extends forth possibility for higher treatment dose & cancer cure rate

The medical research was led by Seungtaek Choi, MD Anderson Cancer Center in Houston.

The conference was supported by Radiological Society of North America (RSNA) and the American Society for Radiation Oncology (ASTRO).

In Prostate cancer patients (Oncology) with constantly elevated PSA levels after prostatectomy – pelvic MRI scan with IV contrast media and rectal balloon is effective for local recurrence at lower Prostate-Specific Antigen levels.

Medical researchers, MD Anderson Cancer Center in Houston – assessed about 389 post prostatectomy patients that were given treatment from January 2004-October 2010, with about 143 patients received pelvic MRI for determination of cancer cells, for its presence. All but 35 patients had suspicious MRI findings, advocating local recurrence. 26 patients were examined (biopsy), of which 23 with symptoms of cancer.

After suspicious MRI finding, almost one third of patients with recurrence (post biopsy) showed PSA level less than 1 ng/mL; many had PSA levels lower as 0.3 ng/mL

To recognize out probable recurrence and location of recurrence in prostate cancer patients with high PSA – scan of the surgical bed carried out after a prostatectomy and before salvage treatment.

Medical researchers were not surprised, when high levels of cancer recurrence was picked by MRI in comparison to conventional CAT scans, as MRI scanning is better capable to distinguish out soft tissues. Though, determination of recurrent disease through MRI scan at low PSA levels did astonish them.

Seungtaek Choi considers this as good, for prognosis of response to salvage radiation therapy. Radiation oncologists can treat the regions of recurrent cancer to a higher dose radiation, otherwise and with ablative therapy (hormone) to cure cancer, progressively.

Conclusion: Dynamic contrast enhanced MRI (endorectal MRI) is effective in assessment of patients with increasing, or relentlessly elevated PSA levels after radical prostatectomy.

New U.S. Preventive Services Task Force (USPSTF) cancer screening guidelines potentially bear on endurance in younger patients.

• USPSTF urged against annual mammograms for 40 year old women, if not the patients had genetic disorder, or familiar risk of radiation.
• Full field digital mammography (FFDM) is beneficial over film radiography for younger patients with dense breast mass.

The medical research was conducted by: Paul Dale, M.D., Chief of Surgical Oncology and his colleagues (Nicole Shen, Linda Sue Hammonds, and Dick Madsen) of Ellis Fischel Cancer Center, University of Missouri-School of Medicine, Columbia, MO.

The medical research was put forward at the annual association meeting of American Society of Breast Surgeons.

Mammography for breast cancer proves good to women within the age group of 40-49 years. Leaving out people of this age group from annual mammogram under the reviewed guidelines for mammography – US Preventative Service Task Force (USPSTF), would in harmful way affect endurance.

A 10-year retrospective study carried on at the University of Missouri in Columbia, MO ascertains mammography that discovered out smaller breast tumors with less lymph node metastasis than other recognized through clinical breast screening of women in this age group.

Breast cancer has an improved medical prognosis when cared for prior breast tumors become conspicuous and classifiable through a doctor, or through self breast examination.

The breast cancer research study even ascertained that breast tumors recognized out through mammography in general had ameliorated consequences after discourse than that detected through clinical examinations.

Though the consequences of the medical research were not storming, on grounds of the know-know that Paul Dale has, the confined amount of research analyzing how the new rules of thumb by USPSTF might bear on breast cancer mortality rate was unanticipated.

In spite of substantial protests to new guidelines, few medical researchers have in distinction from others considered at mammography and its long-run affect on cancer (Oncology) outcomes in younger women.

The medical cancer research team of Dr. Dale evaluated data of patients for cancer treatment at tertiary hospital (referral center) in between 1998 and 2008.

About 1581 women were analyzed by – of which 20% were in the age group of 40 and 49, respectively.

Approximately 47% of the patients were analyzed through mammography; 53% were through clinical examinations, and other cancer screening methods.

In case of mammogram, the average size of tumor in the breast was 20 mm in diameter, though in other cancer screening the tumors were 30 mm in diameter.

The research team marks the divergence in tumor size, where the study likewise ascertained that the frequency of lymph node involvement in the clinically distinguished group was all but two times that of patients recognized out through mammogram.

Researchers reckoned the stats of five year disease free survival rate through relative survival methodological analysis, to be 94% for group on mammogram findings, and about 78% for other that did not go through mammogram. The lymph node negativity and tumor size were importantly related to increased survival rates.

The study discovered out that about 20% of women analyzed with breast cancer were under 50 years of age, and all but half of their tumors were identified out through mammography.

Dr. Dale marks that, with respect to latest advancements in directed treatment of early cancer, as per new guidelines – younger cancer patients would miss out chemotherapy, and have vital adverse cancer survival rates, when miss cancer screening, for early detection of tumor.

Conclusion: Mammographic screening in women aged 40-49 discovered out smaller tumors with less lymph node metastasis. Annual mammographic screening is urged for women of 40-49 years for cancer survival rate.