Digital Radiography News

A trial study conducted by the National Lung Screening Trial (NLST) showed that around 18% of lung cancers detected by low-dose CT screening were slow-growing tumors that would not have had any consequence on patients during their lifetime. Edward F. Patz Jr., MD, of Duke University Medical Center, and co-workers discovered that the trial revealed a mortality advantage to screening, but for every one lung cancer death prevented for every 320 patients with screening in the trial, 1.38 cases of overdiagnosis would be anticipated. "These overdiagnosis cases represent an important potential harm of screening because they incur additional cost, anxiety, and morbidity associated with cancer treatment," they wrote in the online journal, JAMA Internal Medicine. Patz and his peers recommended that physicians make it a point to include the risk of overdiagnosis when describing the risks of low-dose CT screening for lung cancer to patients. “While the findings may help shape patient expectations, they wouldn't likely shift the risk-benefit ratio much for individual patient. Nor is the recent U.S. Preventive Services Task Force recommendation to screen high-risk patients annually likely to be affected,” Patz explained. "I don't think this will shift recommendations at all. It's just part of this entire puzzle we're trying to piece together, how we can best offer a mass screening program as public policy,” he added. In response, the American College of Radiology (ACR) agreed with the study, releasing a statement calling the overdiagnosis rate "modest" and appropriate with the estimated rate with other forms of cancer screening. “Lung cancer screening using low-dose CT is the only test ever shown to reduce mortality in high-risk smokers, the leading cause of cancer death in the U.S. It does so cost effectively compared to other screening tests. Overdiagnosis is an expected part of any screening program and does not alter these facts,”the statement read. Preparations for the lung cancer screening programs throughout the country should go on as the medical community continues to concentrate on the issue of overdiagnosis, the ACR suggested. The organization said it plans to move on with its efforts to support those programs, which include establishing suitable criteria and making a structured reporting and data collecting system to standardize methods. Most programs seem to be following the NLST or altered versions of its criteria. The trial randomized 53,454 men and women ages 55 to 74 with at least a 30 pack-year history of smoking to screening using low-dose CT or chest radiography. During the average 6.4 years of follow-up, CT-based screening picked up 1,089 lung cancers as opposed to 969 in the chest x-ray arm. “Since the actual cancer rate was likely the same between the two well-matched groups, those extra cancers detected could have represented overdiagnosis, “the researchers explained. The surplus cancer rates were 18.5% when deliberated as a possibility that the CT-detected cancer wouldn't have become clinically apparent during the screening period if CT wouldn't have been done and 11% when calculated more from a public health viewpoint as the portion of all lung cancer cases diagnosed in the study that wouldn't have been diagnosed then without CT screening. The overdiagnosis rate was 31% when compared with no screening. The likelihood that a tumor represented an overdiagnosis as opposed to a chest x-ray screening was also higher at 22.5% for non-small cell lung cancer and at 78.9% for bronchoalveolar lung cancer. "These data raise the question as to the necessity and type of therapy required if a diagnosis of minimally invasive adenocarcinoma is established and challenge the diagnostic community to develop a classification scheme that could accurately phenotype all lung tumors," Patz's group wrote. “The 4 to 5 years of follow-up after screening may not have been long enough to account for the lead time of all low-dose CT-detected cancers, particularly because tumor growth rates are quite variable and do not consistently follow classical expected exponential growth curves," the researchers cautioned. “Because CT screening found smaller, earlier stage tumors than chest x-ray, that arm would likely have had additional cancer rate "catch up" over time, so the overdiagnosis estimates provide an upper bound on the true overdiagnosis rate associated with low-dose CT screening relative to chest radiology screening," they explained. Patz ultimately recommended that the key to decreasing the danger of overdiagnosis will be to identify biomarkers to mark and single out the idle lung ... Read more

The National Institute of Standards and Technology (NIST) has produced model modification tools for an experimental medical imaging method that provides new advantages in diagnosing and monitoring of certain cancers and potentially other medical conditions. NIST designed, built, and tested two model phantoms for calibrating ultralow-field (ULF) magnetic resonance imaging (MRI) systems. Phantoms are frequent and widely applied tools for quality control in medical imaging. They are usually objects with simple shapes, but very well-defined responses to a particular kind of imaging scanner. As their name suggests, phantoms are stand-ins for the body, and are utilized to help optimize MRI machines to deliver the best possible medical images for a given type of tissue. The NIST preliminary models are the first standard calibration tools for ULF-MRI, providing a quantitative way to evaluate performance, authenticate the technique, and directly compare different experimental and clinical MRI scanners. "Tissues that may look the same in clinical MRI can look very different in ULF-MRI, which provides new contrast mechanisms. Our hope is that we can move this technique along to attract more interest from [industry] vendors,” said NIST physicist, Michael Boss. MRI noninvasively acquires images of soft tissues predicated on measurements of how hydrogen nuclei, in the water that makes up much of the body, react to magnetic fields. ULF-MRI improves tissue contrast in particular types of MRI scans. Prostate tumors, for instance, can be quite hard to see with standard MRI, but apprear visibly clear under ULF-MRI. ULF-MRI has also been used experimentally to image the brain, and tested in at least one nonmedical application, inspection of liquids at airports. ULF-MRI also provides practical usages: The instruments are simpler in design, lighter in weight, and less costly than conventional MRI scanners. That's because ULF-MRI functions at a much lower magnetic field strength, measured in microteslas, thousands of times lower than standard MRI, which functions at up to 3 teslas and calls for huge magnets. The low magnetic field strength means ULF-MRI requires the most sensitive magnetometers available: SQUIDs (superconducting quantum interference devices). This is fitting because it makes ULF-MRI appropriate for joining with other SQUID-based imaging techniques such as magnetoencephalography. NIST staff previously designed phantoms for standard MRI systems and also have broad experience both making and using SQUIDs. NIST's new ULF-MRI phantoms are short plastic cylinders, shaped like hockey pucks but slightly smaller, containing six or 10 plastic jars filled with different salt solutions that become magnetized in a magnetic field. Each phantom measures a different facet of scanner performance such as spatial resolution. NIST researchers tested the new phantoms on both a standard MRI system at the University of Colorado Health Sciences Center (Denver, Colo.) and an experimental ULF-MRI scanner at the University of California (UC) at Berkeley, where the method was first presented about a decade ago. Tests results indicate the prototype phantoms are well-suited to ULF-MRI applications and allow direct comparison of ULF and clinical MRI system performance. NIST researchers now plan to integrate design improvements predicated on lessons learned from the prototypes, with the goal of enhancing phantom stability and providing traceability to standard measurement units. NIST and UC Berkeley researchers also plan to collaborate to further develop ULF-MRI technology for detection of prostate and breast ... Read more

According to a new study researchers, for the very first time, have discovered that blood vessels in face transplant beneficiaries rearrange themselves, leading to an understanding of the biologic changes that occur following full face transplantation. Results of the study were presented at the annual meeting of the Radiological Society of North America (RSNA). Face transplantation is a new phenomenon in reconstructive surgery for patients who have lost some or their entire face byway of injury or disease. The first full face transplantation in the United States was performed at Brigham and Women's Hospital in Boston in 2011. As a result, hospital specialists carried out full face transplantations on three additional patients. In terms of how the procedure is performed, surgeons attach the patient's major arteries and veins to those from a donor face, or facial allograft, to guarantee healthy circulation in the transplanted tissue. Because the technology is quite new, very little is known about the vascular changes that help blood penetrate, or perfuse, into the transplanted tissue. The development of new blood vessel networks in transplanted tissue is vital to the success of face transplant surgery. "All three patients included in this study at Brigham and Women's maintain excellent perfusion, or blood flow, the key element of viability of the facial tissues and the restoration of form and function to those individuals who otherwise had no face. We assumed that the arterial blood supply and venous blood return was simply from the connections of the arteries and the veins at the time of the surgery,” said director of the hospital's Applied Imaging Science Laboratory, and the study’s co-author, Frank J. Rybicki, M.D., Ph.D., FAHA, FACR. To learn more, Dr. Rybicki and Dr. Kanako K. Kumamaru, M.D., Ph.D., research fellow at Brigham and Women's Applied Imaging Science Laboratory, used 320-detector row dynamic computed tomography angiography (CTA) to examine the facial allografts of the three patients one year following their successful transplantation. The CTA technology provides imaging over 16 centimeters of coverage, allowing the researchers to observe collateralization, a course in which the body stimulates existing blood vessels to extend, widen, and establish new connections. Collateralization is often a product of anastomoses, or branches formed between neighboring blood vessels. "The key finding of this study is that, after full face transplantation, there is a consistent, extensive vascular reorganization that works in concert with the larger vessels that are connected at the time of surgery," said Kumamaru. Results revealed that the new blood vessel networks move posteriorly, or toward the ears and even farther behind the head, in addition to the large arteries and veins that move anteriorly in the face, or close to the jaw. "We have found that since the vessels more commonly associated with the back of the head are critical to maintain the perfusion via vascular reorganization, it is essential to visualize these vessels and determine that they are normal pre-operatively. Patients under consideration for face transplantation have universally had some catastrophic defect or injury,” said Kumamaru. The authors realize that the findings could help improve surgical planning and evaluation of possible complications in face transplant patients. For example, prior literature suggests the joining of several arteries and veins to ensure sufficient blood flow in the facial allograft. However, performing these numerous connections causes longer operation time as opposed to a single anastomosis. "Our findings support the simplified anastomosis for full face transplant procedure that, in turn, can potentially shorten the operative time and reduce procedure-associated complications," said ... Read more

  A study was recently presented at the annual meeting of the Radiological Society of North America (RSNA) that observed the use of radioimmunotherapy (RIT) to eradicate residual human immunodeficiency virus (HIV)-infected cells in the blood samples of patients treated with antiretroviral therapy, presenting a promising approach for curing HIV infection. Highly active antiretroviral therapy (HAART) has altered the stance for patients infected with HIV by suppressing the duplication of the virus in the body. However, despite the success of HAART in successfully decreasing the heavy load of HIV, scientists believe reservoirs of latently infected cells persist in the body, canceling out the possibility of a permanent remedy. "In an HIV patient on HAART, drugs suppress viral replication, which means they keep the number of viral particles in a patient's bloodstream very low. However, HAART cannot kill the HIV-infected cells. Any strategy for curing HIV infection must include a method to eliminate viral-infected cells,” said professor of radiology, microbiology and immunology at Albert Einstein College of Medicine in the Bronx, N.Y. and the study’s lead author, Ekaterina Dadachova, Ph.D. For the study, Dadachova and a team of researchers provided RIT to blood samples from 15 HIV patients treated with HAART at the Einstein-Montefiore Center for AIDS Research. As a matter of fact, from a historical point of view, RIT has been utilized to treat cancer, as it employs monoclonal antibodies, which are cloned cells that are enlisted by the immune system to identify and liquidate antigens. Antigens are foreign objects like bacteria and viruses that provoke an immune response in the body. The antibod   y, designed to recognize and bind to a specific cell antigen, is paired with a radioactive isotope. When injected into the patient's bloodstream, the laboratory-developed antibody travels to the target cell where the radiation is then delivered. “In RIT, the antibodies bind to the infected cells and kill them by radiation. When HAART and RIT are used together, they kill the virus and the infected cells, respectively,” said Dadachova. For this study, Dadachova and her research team matched the monoclonal antibody (mAb2556) designed to target a protein exhibited on the surface of HIV-infected cells with the radionuclide Bismuth-213. The researchers discovered that RIT was able to kill HIV-infected lymphocytes previously treated with HAART, significantly lessening the HIV infection in the blood samples to undetectable levels. "The elimination of HIV-infected cells with RIT was profound and specific. The radionuclide we used delivered radiation only to HIV-infected cells without damaging nearby cells,” noted Dadachova. A crucial part of the study tested the ability of the radiolabeled antibody to reach HIV-infected cells in the brain and central nervous system. Using an in vitro human blood brain barrier model, the researchers showed that radiolabeled mAb2556 could make it passed the blood brain barrier and destroy HIV-infected cells without any explicit damage to the barrier itself. "Antiretroviral treatment only partially penetrates the blood brain barrier, which means that even if a patient is free of HIV systemically, the virus is still able to rage on in the brain, causing cognitive disorders and mental decline. Our study showed that RIT is able to kill HIV-infected cells both systemically and within the central nervous system,” said Dadachova. Dadachova notes that the next step for the RIT treatment will be performing clinical trials in HIV ... Read more

A new study shows that treating patients with tereotactic body radiation for suspected, but not biopsied, lung cancers seems to enabel suitable local control of the disease with low toxicity. "We achieved crude local control of lung cancer in 97.1% of our patients," said assistant professor of radiation oncology at the Loyola University Chicago Stritch School of Medicine, in his oral presentation, Matthew Harkenrider. "The estimated 2-year regional control is 80%; distant control is 85%, and overall survival is 85% in 16.7 months of median follow-up," Harkenrider said at the annual meeting of the Radiological Society of North America (RSNA). The RSNA meeting is the largest medical meeting in the U.S., with an expected attendance of more than 50,000 doctors, radiologists and allied healthcare professionals that enage in all the latest medical imaging developments and innovations worldwide. "About 15% of non-small-cell lung cancer is localized to the lung at diagnosis and can be controlled by sublobar dissection. However, when sublobar dissection can't be performed without wedge dissection or segmentectomy, the local control is inferior to lobectomy. Lung cancer patients also have chronic obstructive lung disease, vascular disease and other comorbidities that preclude surgical management. In these cases, stereotactic body radiation therapy has been used as the preferred treatment management for these patients. Some patients have radiological evidence of tumors but cannot tolerate the biopsy procedure; others have undergone unsuccessful biopsy. The goal of the study was to investigate outcomes among this population,” explained Harkenrider. The study was conducted at the University of Virginia and at the University of Louisville where it restrospectively analyzed patients treated with stereotactic body radiation therapy without a biopsy. Not one of the patients had nodal disease and there was no indication of metastases at baseline. However, they did have radiographic imaging that was constant with lung cancer. The researchers registered 34 patients, 17 from each of the participating institutions. They receivedpretreatment imaging with CT and PET/CT scans; and were then treated with a standard radiation dose of 50 Gy, in a median of 5 fractions. All patients underwent additional CT scans 6 to 8 weeks following the preliminary stereotactic body radiation procedure, and then every 3 to 6 months afterward. Average age of the patients in the study was 76 years; the patients had an Eastern Cooperative Oncology Group Performance Status of 0-1; most patients expressed a sullied lung performance. Nineteen of the 34 patients did not have a biopsy because of their chronic obstructive lung disease or pneumothorax; while another eight patients had cardiac disease that ruled out the stress of performing a biopsy, noted Harkenrider. He also mentioed that acute toxicity of the radiation therapy was well-tolerated by the study patients. No grade 3 or greater toxicities were noted; three late grade 3 dyspneas were treated. "We had only one local failure in these patients. The majority of the patients had stable lesions on follow-up.” "This concern of whether we are really treating cancer can always occur when there is no biopsy. But we have imaging follow-ups in these patients. We see these lesions enlarge. We feel quite comfortable in treating these cases. We are actually treating more and more of those tumors in these cases,” said session moderator Zhongxing Liao, MD, of the University of Texas MD Anderson Cancer Center in Houston. “The concern over whether patients actually do have cancer "also depends upon what area of the country you are treating patients. In the South, where most of these patients lived, there is endemic granulomatous lung disease," which can mimic lung cancer nodules on scans. However, he noted, this study's results are in line with findings in areas where there are populations without the concern for granulomatous lung disease,” Harkenrider said in response. "To our knowledge, this is the first U.S. series to solely report outcomes for these patients. Standard of care for medically inoperable, early stage lung cancer patients remains to obtain pathologic diagnosis prior to treatment," he ... Read more

Based on a new study, levels of the serum biomarker S100B, in accordance with S100B antibody levels, can be used to precisely detect brain metastases in patients with lung cancer. “The use of S100B as a biomarker for brain metastases might decrease the cost of imaging in this patient population. However, our numbers are low,” said Dr. Humberto Choi, MD, from the Department of Pulmonary, Allergy and Critical Care Medicine at the Cleveland Clinic. Choi presented results from the longitudinal prospective study at CHEST 2013. S100B is a protein found in the brain, muscle, and fat. It is synthesized by astrocytes in the brain and released into the bloodstream when the blood–brain barrier is disturbed. Due to the growth of metastatic lesions in the brain violates the integrity of the blood–brain barrier, researchers suggest that serum levels of S100B could be a possible biomarker of brain metastases. Furthermore, prior studies have demonstrated that autoantibodies are produced after lengthy exposure to S100B. This discovery led Choi and peers to assume that S100B antibody levels might be useful to identify long-term and sustained blood–brain barrier damage connected with cerebrovascular damage from the blood–brain barrier disruption that is attributable of brain metastasis. The study included 111 adults seen at the Cleveland Clinic from 2010 to 2012 with a new or untreated diagnosis of lung cancer at any stage. Patients with and without neurologic symptoms were also part of the study. The researchers found that serum levels of S100B were highly sensitive for identifying lung cancer patients with brain metastases. When they merged the levels of S100B with levels of the antibody to S100B, they were able to increase specificity without loss of sensitivity. When they included clinical information, such as staging before brain imaging, they were able to increase accuracy. The biomarker assay had 100% sensitivity and 43.3% specificity in the 33 patients who were initially identified as having stage I or II brain metastasis. On the basis of these results, 39.3% of these patients would not need brain imaging for staging. Choi's team hypothesized the study data to the population in the United States as a whole to illustrate the potential cost savings of a S100B biomarker assay. They estimated that in 2013 there would be 228,000 cases of lung cancer, 34,200 (15%) of which would likely be localized disease. The biomarker assay would, theoretically, make it possible to abandon imaging in more than 13,000 patients in the localized disease group. Assuming a cost of $3300 per MRI, this would equate into a savings of $44,015,400. "It was a very good presentation. It looks like the numbers were pretty good to exclude metastases at the early stages,” said Michael A. Jantz, MD, FCCP, from the University of Florida Health in Gainesville. The audience’s responses to the study was also positive, with one audience member calling the S100B biomarker assay "an alternative way to stage ... Read more

Based on a new study set to be presented at the annual meeting of the Radiological Society of North America (RSNA), premature births seem to trigger developmental processes in the white matter of the brain that could potentially put children at higher risk of problems later in life. Preterm infants, usually those born 23 to 36 weeks follwoing conception, compared to the standard 37- to 42-week gestation, are faced with an increased risk of behavioral problems, ranging from impulsiveness and distractibility to more serious conditions like autism and attention deficit hyperactivity disorder (ADHD). "In the United States, we have approximately 500,000 preterm births a year. About 60,000 of these babies are at high risk for significant long-term problems, which means that this is a significant problem with enormous costs,” said director of the New Imaging Technology Lab at Children's Hospital Los Angeles and associate professor of research radiology at the University of Southern California in Los Angeles, Stefan Blüml, Ph.D. Blüml and peers have been examning preterm infants in a concerted effort to learn how premature birth could offset changes in brain structure that could be linked to clinical problems that arise later in life. Most of the styudy’s focus has been on the brain's white matter, which broadcasts signals and allows communication between different regions of the brain. While some white matter damage is readily apparent on structural magnetic resonance imaging (MRI), Blüml's team has been using magnetic resonance spectroscopy (MRS) to observe differences on a microscopic level. For this study, the researchers compared the concentrations of specific chemicals connected to mature white matter and gray matter in 51 full-term and 30 preterm infants. The study group had normal structural MRI findings, but MRS results revealed major differences in the biochemical maturation of white matter between the term and preterm infants, pointing to a disturbance in the timing and synchronization of white and gray matter maturation. Gray matter is the part of the brain that processes and sends out signals. "The road map of brain development is disturbed in these premature kids. White matter development had an early start and was 'out of sync' with gray matter development,” said Blüml. According to Blüml, this false start of white matter development is spurred by events at birth. "This timeline of events might be disturbed in premature kids because there are significant physiological switches at birth, as well as stimulatory events, that happen irrespective of gestational maturity of the newborn. The most apparent change is the amount of oxygen that is carried by the blood,” he said. “The amount of oxygen delivered to the fetus's developing brain in utero is quite low, and our brains have evolved to optimize development in that low oxygen environment. However, when infants are born, they are quickly exposed to a much more oxygen-rich environment. This change may be something premature brains are not ready for,” he added. While this change may lead to irregularities in white matter development, Blüml cited that the newborn brain has an incredible ability to adapt or even "re-wire" itself, a notion known as plasticity. Plasticity not only eanbels the brain to govern and acquire new skills over the course of development, like learning to walk and read, but could also make the brains of preterm infants and young children more responsive to therapeutic interventions, particularly if any abnormalities are identified early. "Our research points to the need to better understand the impact of prematurity on the timing of critical maturational processes and to develop therapies aimed at regulating brain development," said ... Read more

Nasopharyngeal carcinoma (NPC) affects cells lining the nasopharynx. The bulk of NPC cases can be cured by radiation therapy (RT), however, 20% are resistant to radiation treatment. In the issue of the Journal of Clinical Investigation, Yu-Sun Chang and colleagues at Chang Gung University aimed to find a way to forecast which individual cases of NPC would be sensitive to radiation therapy. In their research titled, “Leukemia inhibitory factor promotes nasopharyngeal carcinoma progression and radioresistance,” the authors compared the levels of various serum factors between NPC patients that responded to radiation therapy and patients that were resistant to therapy.  Patients who did not respond to radiation therapy had higher serum levels of the IL-6 family cytokine leukemia inhibitory factor (LIF), and that LIF levels were predictive of NPC patient response to radiation therapy. The researchers further showed that LIF itself triggers NPC. In an accompanying commentary, Micah Luftig from the Duke University School of Medicine discusses the implications of LIF as a predictor of NPC resistance to radiation ... Read more

According to an international team of researchers, the resistance of some cancers to the cell-killing effects of radiation therapy (RT) could be a result of the irregularities in the mitochondria, the cellular structures responsible for generating energy. The team’s findings were published in the journal, Developmental Cell. Associate professor of biochemistry and molecular genetics at the University of Illinois at Chicago, Maxim Frolov and peers explored the effects of a metamorphosis in a gene called E2F, which controls other genes responsible for instigating programmed cell death, a normal function in most cells. Cells undergo programmed cell death, or apoptosis, when they are no longer required, as a normal process of aging, or in response to environmental factors like radiation that damage cellular DNA. When Frolov and colleagues subjected fruit flies carrying a mutant E2F gene to radiation, genes that initiate apoptosis were activated, but the flies did not die. "Something else was preventing the flies from dying, even though the genes needed to undergo cell death were turned on," said Frolov. A more in-depth look within the cells of the flies showed that their mitochondria were distorted and generated less energy than normal mitochondria. Flies with the most severely misshapen mitochondria were the most resistant to radiation-induced cell death. The observation in fruit flies suggested a previously unknown role for the E2F transcription factor, the protein encoded by E2F that regulates expression of other genes, in mitochondrial function. "It seems their mitochondria were also affected by the E2F mutation and were not functioning at full strength. You need properly functioning mitochondria to carry out programmed cell death,” said Frolov. Observing human cells, the researchers found the same effects: those that lacked the E2F gene were resistant to the effects of radiation. Frolov noted that the similarity in the findings demonstrates that basic cellular functions do not change much across the vast evolutionary distance between fruit flies and humans. "This result highlights a remarkable degree of conservation between fruit flies and humans and illustrates the advantages of using model organisms in cancer research," said Frolov, whose laboratory is part of the UIC Cancer Center. Frolov and his colleagues believe that dysfunctional mitochondria might trigger the differences in how patients respond to radiation therapy. Prior studies have suggested that the inability of some patients' mitochondria to support apoptosis might be the cause for differences in their response to chemotherapy for acute myelogenous leukemia. "If we could develop a small-molecule drug that could enhance mitochondrial function in these patients, we may be able to improve the effectiveness of radiation therapy," he ... Read more

In a joint effort, National Decision Support Company, Montage Healthcare Solutions and Nuance Communications are looking to provide the new Imaging 3.0™ tools to radiologists at the earliest convenience. The new imaging tool has been described to completely reinvent how radiology will be practiced. Sensing a need for higher integration in the health care industry and the means to make it happen, the American College of Radiology (ACR) is leading the Imaging 3.0™ initiative to make a big splash in the field of radiology. Imaging 3.0™ is a set of technology and data management tools that enable radiologists to deliver quality patient care in a developing health care delivery system and under revised payment models. The technology’s infrastructure takes into consideration and supports new workflows that serve to improve and advance care integration and data capture, allowing radiologists to exhibit their involvement to value-based care. "The disconnect between the ordering of a study and the resulting outcome has made it difficult to document the value of these exams. Connecting the order and result are the ideal touch points within healthcare to integrate an Imaging 3.0™ workflow. Having a platform to measure and track this value is the glue that ties this process together, and collaboration between vendors and the ACR are key to making this happen,” said CIO of ACR, Mike Tilkin.  ACR Select, from National Decision Support Company (NDSC), is the first step in radiology's new roadmap under Imaging 3.0™.  The fully integrated software offers ACR Appropriateness Criteria-based decision support tools to the ordering physician to guide them to the best imaging procedure for their patient. "In addition to offering expert-derived advice, ACR Select empowers the radiologist as an active participant in the care process and results in better outcomes and utilization. Standardization in processes that are well documented to improve care have been elusive because physicians have resisted the perceived automation of decision making as usurping the art of medicine.  ACR Select offers a basis in the evidence-based standards of care supported by the ACR's Appropriateness Criteria and the access point between the referring physician and the radiologist when cases are not clear-cut and require additional consultation.  And, ACR Select records this interaction and variations from the care standard to inform and develop the future evidence base from the clinical process,” said NDSC founder and CEO, Mike Mardini. A key element of the Imaging 3.0™ message is guaranteeing the right test at the right time, and also providing a data-rich report that is effectively interpreted.  Nuance's PowerScribe 360 platform is the most widely used radiology reporting platform within the market. "Our platform enables radiologists to create actionable, structured reports in an accurate, efficient manner including critical results notifications and logging. A succinct, actionable radiology report is the most tangible value the radiologist delivers in the care process,” said senior vice president of marketing and product strategy, Nuance, Peter Durlach. "By providing feedback on the order in the form of a structured report, our content just keeps getting better and better. Actionable reports are also a way to ensure that radiologist recommendations are documented and followed, thereby helping to drive better patient care and ensure radiology's role in the care continuum,” added Mardini. The new Imaging 3.0™ tools will be on full display at the annual Radiological Society of North America conference, December 1-5, 2013 in Chicago, ... Read more

Convergent Imaging Solutions, a leader in workflow-optimized image fusion software, announced the release of UniSyn Image Fusion 3.1, an update to its widely used medical imaging software suite. Providing wider viewing capabilities, UniSyn 3.1 features study comparison as a fully integrated component and allows up to four PET/CT or PET/MR datasets to be compared at the same time. The new release will also feature tools for automatically registering and saving standalone CT and MR series with present PET/CT studies. "Quantified tracking of disease is an important part of the evaluation and treatment of cancer patients. Version 3.1 has significant improvements in study comparison and lesion quantification capability, in particular, using RECIST and PERCIST criteria. Combined with our intuitive and powerful user interface, and convenient deployment model, we are able to provide an industry leading solution for radiologists and oncologists,” said founder and CEO of Convergent Imaging Solutions, Mathew A. Thomas. The new features will also be available to customers of Intelerad Medical Systems™, a Convergent partner who has integrated UniSyn as an Image Fusion module within its industry-leading distributed radiology solution. "By leveraging UniSyn, Intelerad is able to provide an Image Fusion module built directly into IntelePACS. This provides clinicians in hospitals and specialty centers with the ability to compare patient PET/CT, SPECT/CT and PET/MR studies from any location and share results from one streamlined workflow,” said Chief Engineering Officer, Intelerad , Rick Rubin. Furthermore, UniSyn 3.1 features a VPN free deployment model, that enables its users to download and install anywhere inside or outside the facility, and recover and view images from any internet accessible computer, without the trouble of setting up dedicated Virtual Private Networks. Other features added to UniSyn include: Simultaneous pan, zoom and stack and automatic registration of prior studies. Save and restore of SUV and other volumetric and linear measurements. Application of prior maximum SUV measurements to current study. Auto-segmentation of PET and CT images for rapid determination of lesion ... Read more

Dayton Children’s Hospital has become one of the dozens of hospitals and imaging centers across the nation in applying new scanning technology that significantly reduces doses of potentially cancer-causing radiation. Radiation exposure stemming from computed tomography (CT) procedures is a major concern in both adults and children. However, radiation in children and infants present various and arduous challenges due to their developing bodies which are more sensitive to the effects of radiation. According to  the National Cancer Institute the risk for developing a radiation-linked cancer can be much higher for a child than for an adult; with an estimation of as many as 9 million CT scans are conducted yearly on children in the United States. While according to hospital officials, around 3,500 CT scans are performed annually at Dayton Children’s Hospital. "As pediatric radiologists, we are very aware that radiation exposure has small risks, and that these risks are greatest in children because of their growing cells, small size, and longer life expectancy. Anything we can do to reduce radiation exposure in medical imaging is important, especially in small children,” said director of medical imaging at Dayton Children's, Dr. Elizabeth Ey. In efforts to reduce radiation doses the hospital has acquired new imaging software called AIDR 3D, which is said to reduce radiation exposure from CT scans as up to 80 percent and still delivering a detailed image. he radiation dose reduction is greatest when imaging the neck, chest, and abdomen, officials reported. "There is a limit to how low a radiation dose can be used and still get a diagnostic image. If the dose is too low, there won't be enough information to make a clear image. The new CT upgrade allows a lower dose than what we have been using thanks to more sophisticated software that can create as clear an image as before with less information and hence less radiation,” said Ey. “But even with low-dose technology, CT scans should be performed only when necessary to keep radiation doses as low as possible and avoid repeated exposure ,” explained pediatric radiologist at Cincinnati Children's Hospital Medical Center and chair of The Alliance for Radiation Safety in Pediatric Imaging,  Dr. Marilyn Goske. “CT scans do save lives, but we want to use them wisely," she added. In order to raise awareness on the issue, the alliance launched an "image gently" campaign in 2007, encouraging doctors and hospitals to commit to lowering radiation doses from imaging scans. More than 22,000 individual doctors and an unidentified number of hospitals have signed onto the pledge, including Dayton Children's. "What that tells us is that the message is starting to get out there and actually changing patients' care," said Goske. Dayton Children's also just added two new pulsed fluoroscopy radiology units, which are known to be more sensitive and can take up less than half the radiation to generate a clear image. Fluoroscopy is a method of "real time' X-ray" that allows radiologists to see movement, rather than one still image, according to a news release. Fluoroscopy is regularly used to view movement during swallowing, to assess for suitable drainage of urine from the bladder, and to assess the position and bowel movement. "We constantly seek to learn new and better ways to image children, keeping their health and welfare above all else. We consider each child and their condition individually in order to perform the most appropriate imaging study,” said ... Read more