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Posts Tagged ‘Radiology’

A fresh study that is conducted at the Massachusetts General Hospital (MGH) by the medical research team shows a new direction to the improved usage of Computed Tomography (CT) scanning in the assessment of abdominal pain. Use of CT in  emergency care departments aid physicians diagnose swiftly.

The study was published in the February issue of the American Journal of Roentgenology. CT scans altered the treatment strategies for almost half of the patients, and considerably reduced possible hospital admissions for unnecessary tests and examinations that incur needless cost.

The report speaks about the importance of CT scanning in the emergency care departments, in terms of necessary policy significant factors! Researchers evaluated out on how the usage of Computed Tomography (CT) for patients with abdominal pain makes an impact on the thought pattern of physician, about the diagnosis they carry out, keeping up with confidence for a better treatment plan, and the team found out that it affected all in a balanced way! Medical diagnostic imaging has become popular in for to trim down healthcare costs, and research team believes that the usage of Computed Tomography (CT) in the emergency care departments can definitely enhance the competence in many medical conditions, but they lacked enough evidences to back up the declaration, and for the very reason the research team chose abdominal pain than any other symptoms/disorders, for the study, as the very disorder (abdominal pain) is common, and has no clearly defined clinical/medical guidelines obtainable for other common symptoms directing to CT, similar to headache!

In during 2006 and 2008 (utilizing the time period of about 15 months), the physicians that were in the MGH Emergency Department who ordered for CT scans for patients that came up with abdominal pain (not related to traumatic injury) were asked to find time with a questionnaire, for both before and after the scanning results! The questionnaire was comprised of questions related to physicians’ present diagnosis of the possible symptomatic cause, their confidence level in the diagnosis, and their anticipated treatment suggestions! The complete set of questionnaires are available (on the care provided to about 584 patients) for analysis!

On the surprising note, the CT scan results altered the analysis/diagnosis of about 49 percent of the patients, and the management plan/strategy for about 42 percent! Researchers found from the result that the number of patients (samples) that would probably have been kept for observation for additional diagnostic/analytical procedures, trimmed down to about 44 percent, and the total amount of mapped hospital submissions even got reduced by 20 percent, in a an astonishing way! They realized that the CT scanning vitally improved the confidence level of physicians in their diagnostic pattern, both when the scan altered, and when it did not alter the pre-scan analysis and judgment, but the development showed less in staff physicians/doctors in comparison to resident physicians! Researchers say, poor diagnostic certainty will always lead to poor choice/decision making for treatment planning, but on the other, improved confidence in the treatment/technique will always improve treatment planning, and even help in trimming down needless utilization of hospital/healthcare resources!

On the concluding note, the researchers green signaled CT scan as to be a vital tool for providing patients with relevant and apt care, on time! Though the research team did not include cost analysis in their study, but they were confident that their results suggesting CT scan will definitely trim down the usage of other diagnostic tests and procedures, as CT proved well in many instances for to lower down overall cost, showed instant diagnostic results, and demonstrated hugely saving on time needed for to move patients through emergency care departments!

A recent study report published in the journal of American College of Radiology states that the overpowering majority of Breast Cancer Surveillance Consortium that works together to progress breast cancer (Oncology) study and research executes magnetic resonance imaging (MRI) of human breast in the US, is up to equivalence level with other – European Society of Breast Imaging (proffer guiding principles for analytical interventional breast procedures), and American College of Radiology Imaging Network (National Cancer Institute cooperative group) technological standard and requisites.

The Breast Cancer Surveillance Consortium (BCSC) is a shared effort for to perk up breast cancer research and treatment.

Breast magnetic resonance imaging has been taken on by community practice medical facilities in occupational therapy, where most of the affected women (breast cancer) go through breast imaging (mammography) in the US. But on the other side, not much is recognized out of the scientific and technological quality of magnetic resonance imaging (MRI) carried out at these medical facilities.

The idea behind the research of the medical team was to study and weigh up MRI tools and acquirement methods at present utilized by a range of community practice medical facilities over different parts in the US. The team decided to make use of data available from the Breast Cancer Surveillance Consortium for to settle on its conformity with existing bare minimum standards specifically put down by American College of Radiology Imaging Network (ACRIN) and European Society of Breast Imaging (ESOBI).

Breast magnetic resonance imaging (MRI) carried out by BCSC medical facilities were recognized out in the process, and inquired up concerning breast magnetic resonance imaging tools/equipments and its critical technical parameters, and the end results were computed out and the proportion of medical facilities coping up with ACRIN and ESOBI medical standards were estimated at.

Researchers found at the end that out of 23 medical facilities carrying out breast magnetic resonance imaging (MRI), the final results were taken up from around 14 medical facilities that stuck on bare minimum standards for breast magnetic resonance imaging (MRI) equipment over community medical practice.

Medical equipments were found in conformity with advocated 1.5T MRI field strength, and all the scanners made use of breast coil, as proposed by ACRIN and the ESOBI. Moreover, the researchers feel the need of breast magnetic resonance imaging technique to be optimized for the effective usage, following up with critical technical parameters.

Besides, the research team sighed with relief (amongst most of the facilities that were being reviewed by) on realizing the fact that all (researched out facilities) met the terms and medical standards of ACRIN and ESOBI for breast magnetic resonance imaging equipment.

On the concluding note with a smile on our face, we remind you not to miss going through our other sections for more on radiology, nuclear medicine and medical research and development reports.

Researchers from Mount Sinai School of Medicine have created a method to visualize coronary artery plaques vulnerable to rupture using multi-color computed tomography (CT).

An innovative multicolor CT is a very helpful innovation that will bring in a better and earlier diagnosis of cardiovascular disease. The information are published in the September issue of Radiology.

Ruptures of atherosclerotic plaques are due to nearly 70 percent of heart attacks. High density lipoproteins (HDL), the “good” cholesterol, are drawn to plaques vulnerable to rupture and remove them from the arterial wall. The Mount Sinai team harnessed HDL by enveloping tiny gold particles within it and injected them into mice. By using a sophisticated multi-color CT scanner, the researchers were able to view the gold particles as the HDL was targeting macrophages. It also targetted cells that caused inflammation in the arterial wall, therefore highlighting the location of the vulnerable plaques.

“The use of multi-color CT and gold nanoparticles to visualize plaque will revolutionize cardiac imaging,” said the research team leader, Zahi A. Fayad, PhD, Professor of Radiology and Medicine and the Director of the Translational and Molecular Imaging Institute at Mount Sinai School of Medicine. “The acquisition of this technology and development of this method will help us improve cardiovascular disease diagnosis in our patients, furthering our commitment to translational research. We look forward to continuing our study of this technology in the clinical setting.”

Conventional CT detectors brings about a gray image of the artery being studied, and are impossible to present contrast to differentiate types and density of tissue. Additionally, spectral CT can simultaneously distinguish calcium deposits and contrast agents used such as iodine, which is often used to identify stenoses, or the narrowing of arteries, informing the severity of atherosclerosis and heart attack risk.

The first institution in the world to use this scanner, made by Phillips Medical Systems, in a pre-clinical setting is the Mount Sinai. “There is a significant unmet need for imaging technology that visualizes plaque vulnerable to rupture,” said the lead author of the work, David Cormode, PhD, Postdoctoral Fellow, Translational and Molecular Imaging Institute, Mount Sinai School of Medicine. “The fact that the multi-color CT technique shows the gold particles, iodine and calcifications, provides us with a more complete picture of the nature of the atherosclerotic arteries.”

Multi-color CT technology may also be handy in imaging other biological process and diseases, including cancer, kidney disease, and bowel diseases. The Mount Sinai team plans to continue studying the new scanner in additional animal studies and in humans.

“Mount Sinai has a decades-long history of making advances in cardiac imaging that have had a significant impact on the field and in patient care,” said Valentin Fuster, MD, PhD, Director of Mount Sinai Heart, the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, The Mount Sinai Medical Center. “As the first center in the world to pioneer this imaging method, we are leading the charge once more in improving diagnostic tools that lessen the potentially devastating impact of heart disease.”

A study finds that surgeons specially trained to perform breast cancer surgeries can interpret a mammogram as good as a trained breast radiologist and they provide an excellent alternative to meet the shortage of radiologists.

The findings of the study, titled ‘Surgeon-Read Screening Mammography: An Analysis of 10 020 Examinations,’ was presented at the 11th Annual Meeting of the American Society of Breast Surgeons.

The objective of the study was to determine whether the reading performance of breast surgeons can be compared to that of mammography radiologists.

The prospective research involved 13 622 mammograms read at a dedicated, surgeon-run breast health centre between January 2003 and June 2009.

Mammograms were conducted according to conventional mammography guidelines by certified technicians on state of the art film-screen and from July 2006 on full-field digital equipment.

All the mammograms were double read by two experienced breast surgeons and the findings were catagorised according to BIRADS.

The study concluded that the findings of the breast surgeons were equivalent to that in organized national screening programs run by specialized breast radiologists in Europe and Australia. With fewer recalls, a lower biopsy rate with a higher malignancy rate of biopsy and a high cancer detection rate, they were better than highly skilled radiologists in the United States.

This study provide a first benchmark for surgeon-read screening mammography.

“These findings suggest that the ability to precisely analyze breast images is enhanced by both ongoing experience and specialized training,” comments Justus Apffelstaedt, MD, FCS (SA), Associate Professor of Surgery and Head: Breast Clinic, University of Stellenbosch, chief author of the study, who practices at the South African site. He added that, ‘Breast surgeons review large numbers of breast images as part of their ongoing treatment planning and delivery.  Now, this study shows that with appropriate training, they prove to be highly accurate primary mammography interpreters.’

In the current scenario, when many doctors and patient advocacy groups are advocating low-dose computed tomography (CT) as a standard screening tool for the diagnosis of lung cancer, researchers have found out that these screening tests lead to higher false positive rates and thereby unnecessary anxiety and follow-up interventions.

Additionally, these tests can lead to potential hazards of radiation exposure and unnecessary health expenditure from the screening tests as well as from unnecessary interventions. Also an indolent lung cancer might not lead to the person’s death.

The ongoing National Lung Screening Trial aims to find out the actual effectiveness of lung cancer screening in saving patient’s lives when there is widespread promotion of lung cancer screening tests especially CT and x-rays among the public by doctors as well as companies.

The Lung Cancer Mortality Reduction Act of 2009 Senate bill states that “significant and rapid improvements in lung cancer mortality can be expected through greater use and access to lung cancer screening tests”.

The details of the research findings titled ‘Cumulative Incidence of False-Positive Test Results in Lung Cancer Screening’ are published in the April issue of the ‘Annals of Internal Medicine’. The lead author of the study is Jennifer Croswell, MD, MPH from the National Institutes of Health.

The researchers state in the journal that there is no ‘solid evidence’ yet about the advantages or disadvantages of screening but the knowledge is important as the people involved are healthy adults.

The study followed up 3318 persons, aged 55 to 74 years, from September 2000 to January 2001 who were randomly assigned to undergo CT or chest x-ray. They had a history of cigarette smoking 30 pack-years or more, and were current smokers or had quit in the past 10 years.

The screening tests were repeated after one year if the baseline examination was negative for lung cancer.

Patients who received one CT scan had a 21 percent risk of a false-positive result, compared with a 9 percent risk for those who had a chest X-ray. The risk was 33 percent for those who underwent two annual CT scans compared with a 15 percent in those who had two chest X-rays.

Seven percent of participants with a false-positive low-dose CT examination and 4% with a false-positive chest x-ray underwent an invasive follow-up procedure.

“The most important thing right now is to try to figure out if this lowers death rates,” Dr. Jennifer M. Croswell told Reuters Health. “Most professional medical societies do not recommend this (lung cancer screening) right now,” she said, “and the reason is because we don’t know if it works.”

Scientists plan to take-up their concerns, regarding radiation hazards from excessive radiology procedures, to the public on tuesday at a Food and Drug Administration (FDA) meeting, The New York Times reports.

The two-day public meeting (March 30th and 31st) is called by FDA to evaluate the issues regarding unnecessary radiation exposure from routine procedures and to discuss steps devicemakers can take to reduce patient exposure to radiation.

The report states that according to reports from FDA and interviews with the agency scientists, the FDA has ignored warnings from government experts regarding riskes from powerful Computed Tomography (CT) scans used for colo-rectal cancer screening.

Cancer risk from unnecessary radiology diagnostic procedures, doctors prescribing unneccesary scans, lack of standardization of CT scanners and other radiation emitting equipment are all much debated issues nowadays with regard to reducing radiation exposure. Use of CT scans for cancer screening in healthy adults is another hot topic.

The average life time dose of diagnostic radiation has increased around 7 times in the last thirty years. The increasing popularity of CT scans, driven by overzealous doctors and companies, is in particular a cumulative factor for this. The radiation emitted by a single whole body scan is equivalent to that emitted by about 500 conventional x-rays. Studies have showed that CT scans increase the cancer risk by about 0.05 percent.

New York Times reports that it is a very difficult position for the patients side because doctors, patient advocacy groups and manufacturers advocate these tests for their econimic interests; radiologists who own and use equipment favour the tests while patient groups are funded by manufacuters or physician groups.

Also the FDA, who has to sort out the issue, is also divided with internal dispute, the newspaper says. A group of agency scientists might testify that the FDA managers ignored their concerns thereby endangering the public.

A new study finds that women who does not undergo annual mammographic screening have higher rate of detection of breast cancer as palpable breast tumors, which are at an advanced stage when compared to cancers detected by mammography screening.

The study supports the benefits of yearly screening mammographyas well as clinical breast examination (CBE) and breast self-examinationat in early detection of breast cancer. Thus it contradicts the new U.S Preventative Services Task Force (USPSTF) recommendations – biennial mammography screening starting at 50yrs, discouraging teaching breast self examination and that current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE).

“Presentation as a palpable mass was more frequent in those women who had not had a mammogram in the prior 12 months. This finding is even more concerning when you consider the recent recommendations for decreasing the use of mammography because it would result in an even greater proportion of breast cancers being detected by palpation and therefore at more advanced stages.”said Judy Boughey, MD, FACS, assistant professor of surgery, Mayo Clinic, Rochester, MN, and a co-investigator of the study.

The study investigator is Dr. Amy C. Degnim, MD, FACS, associate professor of surgery, Mayo Clinic and the findings of the study are published in the March issue of the Journal of the American College of Surgeons.

University of Nebraska Medical Center (UNMC) lymphoma experts say that patients who are completely treated for lymphoma are recieving unnecessary Computed Tomography (CT) and Positron Emission Tomography (PET) examinations during their follow-up visits, often on the patient’s requests.

UNMC oncologist, Julie Vose, M.D., and co-author Malik Juweid, M.D. published their comments regarding this issue in a letter the editor in the March Edition of the ‘New England Journal Of Medicine’. They said that only a small percent of the Hodgkin’s lymphoma recurrences are diagnosed by PET/CT while majority is detected by the patient himself or during the doctor’s routine examination of the patient without imaging.

This leads to unnecessary radiation exposure and also unnecessary expediture. The radiation exposure has the risk of other cancers like lung and breast cancer.

During follow-up, physical examination, educating the patient about symtioms, routine blood tests and a yearly chest x-ray would be sufficient. Dr. Vose said that that the policy is not to do a scan unless there are symptoms or positive examination findings.

“In patients at low risk of recurrence, reducing the exposure to excessive radiation is an important goal,” she said.

The American College of Radiology (ACR) writes to Obama stating the benefits of CT colonography (CTC), also known as virtual colonoscopy, and his recent physical examination which included the test, as a rationale to require medicare coverage for the latest colorectal cancer screening technology.

Studies have shown that CTC is accurate as standard colonography and the benefits include low invasiveness, lack of sedation, lesser cost, much less procedure time and more importantly the patient can go back to work directly after the procedure which will attract more people to undergo the test and thus saves more lives.

Colorectal is the second leading cause of cancer deaths in the United States; and while Medicare denies CTC coverage, many private insurers like CIGNA, United Healthcare, and Anthem Blue Cross Blue Shield now cover screening as wellas diagnostic CT colonography. The congress needs to act to require Medicare coverage to CTC.

The American Cancer Society endorses CT colonography and added it to its list of recommended colorectal cancer screening exams and suggests that the exam be repeated every five years.

The results of a survey conducted by the the National Council on Aging (NCOA) says that many old age patients having an electronic implanted device  in them might be getting MRI because of lack of communication with the doctor and lack of knowledge about the effects of MRI ( Magnetis Resonance Imaging) on the device.

The survey focused on older adults and healthcare providers. Older people have higher number of implanted devices in them as well as they have greater need for imaging tests like MRI due to old age ailments.

The survey, results of which are discussed in the New England Journal Of Medicine’,  finds that

• about one third of patients and half of professionals does not recall informing the patient about medical imaging risks after implantation.
• about one third of patients with implantable devices underwent MRI examination despite the risks
• around one fourth of these patients who had MRI agree that they had developed problems with the functioning of the device later.
• Both patients as well as doctors agree that confusion exists regarding medical imaging protocols in patients with implants and education is necessary.

Education and awareness regarding medical imaging safety is necessary, especially regarding MRI because it can cause malfunction of devices like defibrilators, cardiac pacemakers etc. The doctors should weigh the need for the test with the risk of malfunction before deciding on the test and the patient should also be aware before giving consent.