Digital Radiography News

A new optical device has the ability to detect eye disease in the palm of a hand. The tool, which is about the size of a hand-held camcorder, scans a patient's entire retina in mere seconds and could significantly help primary care physicians in the early detection of a slew of retinal diseases including diabetic retinopathy, glaucoma, and macular degeneration. Researchers at the Massachusetts Institute of Technology (MIT) describe their new ophthalmic-screening instrument in a paper published in the open-access journal Biomedical Optics Express, published by The Optical Society (OSA). Albeit other research groups and companies have created hand-held devices using similar technology, the new design is the first to join state of the art technologies such as ultrahigh-speed 3-D imaging, a tiny micro-electro-mechanical systems (MEMS) mirror for scanning, and a method to correct for unintentional movement by the patient. These inventions, the authors note, should enable physicians to gather comprehensive data with just one measurement. Usually, to diagnose retinal diseases, an ophthalmologist or optometrist must inspect the patient in his or her office, normally with table-top instruments. However, few people visit these specialists on a constant basis. Therefore, in order to improve public access to eye care, the MIT research group, in cooperation with the University of Erlangen and Praevium/Thorlabs, has developed a portable device that can be transported and used outside a specialist's office. "Hand-held instruments can enable screening a wider population outside the traditional points of care. For instance, they can be used at a primary-care physician's office, a pediatrician's office or even in the developing world," said researcher James Fujimoto of MIT, an author on the Biomedical Optics Expresspaper. The device uses a procedure called optical coherence tomography (OCT), which the MIT group and collaborators helped forge in the early 1990s. The technology sends beams of infrared light into the eye and onto the retina. Echoes of this light return to the machine, which uses interferometry to measures changes in the time delay and scale of the returning light echoes, revealing the cross sectional tissue structure of the retina, similar to radar or ultrasound imaging. Tabletop OCT imagers have become a traditional form of care in ophthalmology, and current generation hand-held scanners are used for imaging infants and monitoring retinal surgery. The researchers were able to minimize what has been characteristically a large somewhat cumbersome device into a portable size by using a MEMS mirror to scan the OCT imaging beam. They tested two designs, one of which is similar to a handheld video camera with a flat-screen display. In their tests, the researchers discovered that their device could attain images comparable in quality to standard table-top OCT instruments used by ophthalmologists. To cope with the motion instability of a hand-held device, the instrument takes multiple 3-D images at high speeds, scanning a specific volume of the eye several times but with different scanning directions. By using multiple 3-D images of the same part of the retina, it is possible to correct for distortions due to motion of the operator's hand or the subject's own eye. According to Fujimoto, the next stage, is to assess the technology in a clinical environment. However, the device is still relatively expensive and will most likely be some time before this technology finds its way into doctors' offices or in the field, pressuring manufacturers to find a way to support or lower its cost. “Many people with eye diseases may not even be aware of them until irreversible vision loss occurs. Screening technology is important because many eye diseases should be detected and treated long before any visual symptoms arise. For example, in a 2003 Canadian study of nearly 25,000 people, almost 15 percent were found to have eye disease, even though they showed no visual symptoms and 66.8 percent of them had a best-corrected eyesight of 20/25 or better. Problems with undetected eye disease are exacerbated with the rise of obesity and undiagnosed diabetes. The Center for Disease Control and Prevention estimates that 11.3 percent of the U.S. population over the age of 20 has diabetes, even though many do not know it,” said Fujimoto. For the coming years, Fujimoto believes that hand-held OCT technology can be applied in many other medical specialties beyond ophthalmology, for instance in applications ranging from surgical guidance to military medicine. "The hand-held platform allows the diagnosis or screening to be performed in a much wider range of settings. Developing screening methods that are accessible to the larger population could significantly reduce unnecessary vision loss,” he ... Read more

Researchers from The University of Manchester, part of Manchester Cancer Research Centre believe they have found a new approach to make chemotherapy treatment more effective for pancreatic cancer patients. Pancreatic cancer is an aggressive cancer with poor diagnosis and limited treatment options and is extremely resistant to chemotherapy and radiotherapy.However, researchers believe they have discovered an effective means for selectively killing pancreatic cancer while conserving healthy cells which could make treatment more efficient. "Pancreatic cancer is one of the most aggressive and deadly cancers. Most patients develop symptoms after the tumor has spread to other organs. To make things worse, pancreatic cancer is highly resistant to chemotherapy and radiotherapy. Clearly a radical new approach to treatment is urgently required. We wanted to understand how the switch in energy supply in cancer cells might help them survive,” said Dr Jason Bruce, from the Physiological Systems and Disease Research Group, and lead researcher.   The research, which was published in The Journal of Biological Chemistry this month, found pancreatic cancer cells may have their own particular energy supply that sustains calcium levels and keeps cancer cells alive. Maintaining a low concentration of calcium within cells is pivotal to their survival and this is achieved by calcium pumps on the plasma membrane. This calcium pump, known as PMCA, is fuelled using ATP, the key energy agent for many cellular processes.   All cells produce energy from nutrients using two major biochemical energy sources, mitochondria and glycolysis. Mitochondria create around 90% of the cells' energy in normal healthy cells. However, in pancreatic cancer cells there is a significant shift towards glycolysis as the main energy source. It is believed that the calcium pump may have its own supply of glycolytic ATP, and it is this fuel supply that gives cancer cells a survival advantage over normal cells.   The researchers used cells retrieved from human tumors and examined the effect of blocking each of these two energy sources in turn.   Their study, funded by the Biotechnology and Biological Sciences Research Council (BBSRC), Central Manchester University Hospitals NHS Foundation Trust (CMFT)/National Institute of Health Research (NIHR) Manchester Biomedical Research Centre and AstraZeneca, reveals that blocking mitochondrial metabolism had no effect. However, when they blocked glycolysis, they noted a reduced supply of ATP which repressed the calcium pump, resulting in a toxic calcium overload, eventually leading to cell death.   "It looks like glycolysis is the key process in providing ATP fuel for the calcium pump in pancreatic cancer cells. Although an important strategy for cell survival, it may also be their major weakness. Designing drugs to cut off this supply to the calcium pumps might be an effective strategy for selectively killing cancer cells while sparing normal cells within the pancreas,” said Bruce.   "These findings will certainly of great interest to the pancreatic cancer research community and we'd be keen to see how this approach progresses. Finding weaknesses that can be exploited in this highly aggressive cancer is paramount, so we want to congratulate the Manchester team for their discovery,” noted CEO of the national charity, the Pancreatic Cancer Research Fund, Maggie ... Read more

A recent study published in BJU International, shows that radiation therapy (RT) used to treat uterine cancer may increase a patient's risk of developing bladder cancer. The findings point out the significance of observing patients for possible signs and symptoms of bladder cancer to guarantee early diagnosis and treatment. In the United States, uterine cancer is the fourth most common cancer in women, with a projected 49,560 women diagnosed in 2013. In addition to surgery, 38 percent of patients receive pelvic radiation therapy to decrease uterine cancer recurrence. Studies have revealed that women treated with radiation therapy for uterine cancer, like men who undergo radiation therapy for prostate cancer, have an increased risk of developing bladder cancer later in life. To inspect and examine the matter further, Guan Wu, MD, PhD, of the University of Rochester Medical Center, and his team analyzed the records of 56,681 patients diagnosed with uterine cancer as their first primary malignancy between 1980 and 2005. Their data was gathered from the Surveillance, Epidemiology and End-Results (SEER) database. With a median follow-up of 15 years, bladder cancer occurrence in uterine cancer patients treated with pelvic radiation therapy was twice as high as that noted in patients treated without radiation. Likewise, the death rate from bladder cancer was just about three times higher in patients treated with pelvic radiation than in those who did not undergo radiation treatment. It is usually thought that bladder cancers that develop following pelvic radiation tend to be aggressive, with high grades and stages, however this study found that the types, grades, and stages of bladder cancer that developed were similar in patients treated with and without radiation therapy. "Physicians who care for patients with a history of uterine cancer and pelvic radiation treatment should keep in mind the increased risk of bladder cancer. Proper clinical evaluation should be performed to avoid delayed diagnosis, which may improve the quality of care for this group of patients,” said ... Read more

Researchers from Curtin University have demonstrated natural radioactivity within DNA can change chemical compounds, leading to a new pathway for genetic mutation. The research, recently published in Biochimica et Biophysica Acta-General Subjects, observed and examined the natural radioactivity within human DNA on the atomic-scale, for the very first time. While radioactivity takes place naturally in our bodies as well as in every other living organism across the globe, it was never before conceived to have an effect on our DNA in such a direct way. Using high-performance computers, the research team from Curtin and Los Alamos National Laboratory were able to reveal that radioactivity could modify molecular structures which encode genetic information, producing new molecules that do not belong to the four-letter alphabet of DNA. “The new molecules may well generate mutations by confusing the replication mechanisms in DNA. This work takes an entirely new direction on research into natural radioactivity in biology and raises important questions about genetic mutation. We have discovered a subtle process that could easily be overlooked by the standard cell repair mechanisms in the body, potentially creating a new pathway for mutations to occur,” said Professor Nigel Marks from Curtin's Discipline of Physics and Astronomy and Curtin's Nanochemistry Research Institute. Marks notes how riveting and unexpected the work has been, as it was based off an Australian Research Council funded project on nuclear waste. "As part of the project between Curtin and Los Alamos we developed a suite of computational tools to examine deliberate radioactivity in crystalline solids, only to later realize that the same methods could be applied to natural radioactivity in molecules. This direction was an unplanned outcome of our research program, just the way blue skies research should be,” he said. The natural radioactivity in focus involved the decay of carbon atoms, Carbon-14, turning into nitrogen atoms, Nitrogen-14. "This was one of the most abundant forms of radioactive decay occurring in biological systems. Over a human lifetime, around 50 billion Carbon-14 decays occur within our DNA. While it is still not obvious how DNA replication is affected by the presence of chemical compounds that are different to the four-letter alphabet of DNA, it is quite remarkable to consider that Carbon-14 could be a source of genetic mutation that would be impossible to avoid due to the universal presence of radiocarbon in the environment,” said ... Read more

According to a report presented at the American Society for Cell Biology (ASCB) annual meeting in New Orleans, an experimental drug that singles out macrophages, a kind of immune cell,  in the microenvironment surrounding the fatal brain tumor glioblastoma multiforme decreased the cancer’s growth and prolonged survival of laboratory mice with the cancer. “The rates of apoptosis, or programmed cell death, were higher in the mice treated with the experimental agent than in the untreated animals that also had high-grade glioblastomas. As a result, the drug-treated laboratory mice survived many months longer than the untreated animals with the same cancer,” said Johanna Joyce, Ph.D., of the Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City. “The experimental drug blocks cell receptors for colony-stimulating factor-1 (CSF-1R), which is essential to the differentiation and survival of tumor-associated macrophages and microglia (TAMS), which are the brain's front-line immune defense cells. The microenvironment that surrounds brain tumors contains many macrophages with this receptor,” she added. Glioblastoma multiforme (GBM) is the most prevalent and the most fatal adult primary brain tumor, with a median survival rate of just 14 months from the time of diagnosis. Even with heavy handed treatment by surgery, radiation, and chemotherapy, most treatment plans targeting the glioma cells in GBM fail. Faced with this daunting task, Joyce and her research team at MSKCC searched for an alternative strategy and looked to the cancer's cellular neighbors, the non-tumor cells that are part of the glioma microenvironment. More specifically, they honed in on tumor-associated macrophages and TAMs. When Joyce's lab utilized an inhibitor of the CSF-1 receptor (CSF-1R) to target TAMs in a mouse model of GBM, the treated mice survived many months longer than the control group. Their established, high-grade gliomas degenerated in increase and growth, even though the glioma cells themselves were not the targets of the CSF-1R treatment. According to Joyce, with the TAMs blockaded by CSF-1 inhibitors, it was the tumor cells that demonstrated elevated signs of apoptosis. The TAMs were not even exhausted in the treated mice, despite the drug blockade of their growth factor. Instead the TAMs survived by responding to growth factors secreted by the gliomas, including GM-CSF and IFN-?. The MSKCC researchers also discovered that tumor spheres, recently secluded from glioma patients in the surgery department at MSKCC, responded to the drug when implanted in animals. The CSF-1R blockade slowed intracranial growth in the patient-derived glioma xenografts. According to the National Brain Tumor Society, because GBM is the most common glioma, its genome was the first to be sequenced for the Cancer Genome Atlas, which placed GBM into four genetic subtypes: proneural, neural, classical, and mesenchymal. The mice used in Joyce's lab experiments are modeled after the proneural GBM subtype. All forms of GBM have a 2- to 3-person for every 100,000 incidence rate in the U.S. and Europe. Due to its highly invasive phenotype, GBM is almost impossible to resect completely in surgery. Drug and radiation treatments are the traditional follow-ups. Joyce notes that these new results, which were first reported only a couple months ago in Nature Medicine, are promising for planned clinical trials of CSF-1R inhibitors in accordance with radiation therapy in glioma patients. "We are optimistic that CSF-1R inhibitors may provide a more effective therapy than current treatments for the disease management of glioma patients," said ... Read more

Researchers from Johns Hopkins University in Baltimore recently advised that 3D reconstructions of CT urography datasets are valuable materials that can help identify transitional cell carcinoma (TCC) in the upper urinary tracts that would otherwise go undetected by solely look at axial images. “The ureters can be problematic to evaluate on CT, partly because of difficulties in obtaining adequate ureteral distention and pacification. Proper diagnosis hinges not only on appropriate interpretation of the axial images but also on the utilization of a 3D technique (volume rendering or maximum intensity projection) as an ancillary tool,” wrote Siva P. Raman, MD, and colleagues in the December issue of the American Journal of Roentgenology. The authors noted that in addition to poor accession, the majority of ureteral TCCs are found in the distal third of the ureters, which is especially difficult to distend sufficiently. To alleviate some of these challenges, Raman and colleagues wrote that their department at Johns Hopkins assesses CT urography datasets twice. First after a preliminary survey of source axial images, an independent second reader performs a 3D evaluation using two interactively created reconstructions: maximum-intensity projection (MIP) images and volume-rendered (VR) images. For MIP, algorithms highlight and choose the highest-attenuation voxels along lines projected through the volumetric dataset. While regarded as a 3D technique, the MIP images are 2D representations of the source data, which can make determining a 3D relationship between structures difficult; however Raman and colleagues wrote that they found them to be quite helpful in assessing and studying the ureters. According to the authors, VR uses a more complex algorithm to categorize particluar tissue types in each voxel before assigning a color and transparency level based on the percentage of each tissue type, and then rendering software produces an image. This technique can create “virtual endoscopic” images of collecting systems and ureters. “At our institution, where two separate readers interpret the axial and 3D datasets, we have seen numerous TCCs initially missed, on a review of the axial images and multiplanar reformations but subsequently diagnosed on the 3D images,” wrote Raman and co-workers. Moreover, in addition to helping to detect elusive carcinomas, the authors took note of several other benefits to 3D imaging techniques in CT urography, including: Accentuating subtle narrowing – 3D reconstructions can make it easier to find subtle strictures or sites of narrowing by delineating both ureters in a single imaging plane. Accentuating subtle differences in wall thickness and urothelial enhancement – Subtle wall thickening in small portions of the ureteral circumference can be easy to miss when not using a 3D technique. Evaluating distal ureters – 3D reconstructions can be helpful in delineating true strictures or tumors in distal ureters.Identifying flat polyploid lesions – VR and MIP can help visualize lesions that would otherwise be difficult to identify on axial ... Read more

According to a recent study, beta-amyloid plaques are not only a trait of Alzheimer disease, but they are also found in up to 30% of patients who die with acute traumatic brain injury, in which they occur largely in gray matter. Following traumatic ... Read more

Nuclear medicine imaging is a technological advanced radiology scanning process that is pain-free and is utilized by radiologists, physicians and medical staff. This novel, highly sophisticated technological advancement enabels doctors and radiologists to better distinguish and diagnose medical conditions without have to revert to surgically opening up patients or trying to interpret potential medical conditions with traditional X-rays. Unlike other kinds of radiology, nuclear medicine imaging is a medical scanning machine developed to demonstrate how certain parts of the body are functioning as opposed to only reviewing bone, tissue, and organ physical images. Based on hundreds of comments from pleased patients, The Center for Diagnostic Imaging (CDI) is the first choice for pet scan in Miami when it comes to diagnosing or ruling out signs of potential diseases or medical conditions. Furthermore, CDI has announced new breakthrough achievements in providing better diagnosing and treating medical conditions through nuclear medicine imaging testing. CDI medical professionals can now get a closer look at a patient's organs, tissues and bones. This latest improvement can effectively recognize if certain body parts are functioning correctly and, if not, diagnose and determine apt treatment procedures as called for. Nuclear medicine imaging scanning can better diagnose a range of diseases including, but not limited to, heart disease, aneurysms, thyroid problems, irregular or inadequate blood flow. Most importantly, nuclear medicine imaging is proficient in spotting different kinds of cancers, which is crucial in terms of the type and level of treatment services the patient will need. In many cases, the sooner cancer is discovered within a patient, the odds of treating and curing it significantly increase. Another version of nuclear medicine imaging available at CDI is Positron Emission Tomography, also known as PET scans. In certain centers, nuclear medicine images integrate PET scans and magnetic resonance imaging (MRI) because together, both scanning processes can better pinpoint diseases or other medical conditions and provide radiologists with higher-definition images. Also, in addition to nuclear medicine imaging testing, CDI also provides: Full body computerized tomography scans (CT Scans) - uses a computer which takes data from several X-ray images of structures inside a patient's body and converts them into a 3-D image for a physician to review. Full body computed tomography angiography scans (CTA Scans) - utilizes special X-ray equipment designed to produces several images of specific internal body parts. Mostly used to examine blood vessels, however can also be used to examine internal organs and bones. Ultrasounds - medical scan which helps physicians diagnose and treat medical conditions. Ultrasounds capture the size, structure and shape of portions of the patient's body which cannot be seen using standard X-rays. It is the perfect medical technology for detecting potential complications in organs, tissues, and vessels. It is also the ideal machine in identifying tumors, gallstones, kidney stones, or liver disease. X-rays – CDI’s bone scan is highly recommended when identifying bone structure abnormalities or fractures. In addition to reviewing bone structure, CDI's professional staff can also use X-rays in detecting signs of lung disease, intestinal obstruction, gallstones, and kidney stones. Breast care - Part of CDI is the Comprehensive Breast Care Center. The Comprehensive Breast Care Center’s breast ultrasound is known as Miami’s first choice when it comes to early detection of breast cancer. The center offers the most advanced and latest 3D mammograms technology in diagnosing cancer cells ... Read more

According to Japanese researchers, recurring use of gadolinium-based contrast agents was linked to an increased MRI signal intensity in specific brain areas that could affect the interpretation of scans. Tomonori Kanda, MD, PhD, of Teikyo University School of Medicine in Tokyo, and co-workers reported that analysis of MRI scans in 381 patients alluded to a noteworthy association between the number of prior administration of gadolinium contrast agents and signal intensities in the dentate nucleus (regression coefficient 0.010, 95% CI 0.009-0.011, standardized regression coefficient 0.695) and globus pallidus (regression coefficient 0.004, 95% CI 0.002-0.006, standardized regression coefficient 0.288). These relationships were major regardless of whether patients had impaired kidney function, the researchers indicated online in Radiology. Kanda and colleagues determined that these effects of gadolinium contrast agents should be carefully considered when reading and interpreting scans. "Some differential diagnosis may be changed," they wrote. For instance, they pointed out that "T1 hyperintensity of the dentate nucleus seen in patients with multiple sclerosis [MS] may have more to do with the large cumulative gadolinium dose than the disease itself." Gadolinium contrast-enhanced MRI scans are also frequently performed in patients undergoing radiotherapy of the brain. The researchers noted that the device by which gadolinium may affect signal intensities in these specific brain areas is unfamiliar and could not be dealt with their data. The most obvious possibility is that it reflects deposition of gadolinium. "Further evaluation on the basis of autopsy specimens and/or animal experiments will be needed," Kanda and colleagues wrote. “If that should turn out to be the case, the possibility of misdiagnosis would not be the only potential adverse impact, wrote J. Keith Smith, MD, PhD, of the University of North Carolina in Chapel Hill. "The free metal ion of gadolinium is toxic, so if the gadolinium ion is disassociating from the larger MRI-contrast molecule, and accumulating in the brain, this could raise a concern for previously unknown health risk from gadolinium contrast administration," he said. However, neuroradiologist Jonathan Clemente, MD, at Carolinas Healthcare System's Neurosciences Institute in Charlotte, N.C., argued that misdiagnosis was not a probable outcome. “Brain lesions associated with MS and other diseases can be detected using other pulse sequences like FLAIR and Double Inversion Recovery. Such techniques can reveal active demyelination without need for contrast. The presence of high signal intensity in the globus pallidus and dentate nucleus does not compromise the interpretation of MRI scans in MS research or other patients," said Clemente. In response, Kanda and colleagues wrote that they had become interested in the issue after casually noticing that patients with a history of receiving gadolinium contrast were exhibiting high signal intensities in the two regions. They examined MRI scans taken in 381 consecutive patients in January and February 2011 (excluding two who did not undergo unenhanced T1-weighted imaging and one other who had received total parenteral nutrition with manganese). From these scans, they found 19 who had previously undergone six or more gadolinium-enhanced 1.5-T scans (excluding those receiving brain irradiation or those who had an existing brain tumor or abnormal liver function), and 16 who had at least six previous scans with no improvement. Patients in the first group had received up to 12 scans with gadolinium enhancement (mean 7.1). Signal intensity was measured as the ratio in the dentate nucleus relative to the pons, on one hand, and in the globus pallidus to the thalamus, on the other. For the group with extensive histories of gadolinium exposure, both ratios increased in most patients over time from their first such scan to the one performed in early 2011; in most of the group with no gadolinium exposure, the ratios either remained the same or decreased. Smith emphasized that the retrospective study did not prove that gadolinium exposure had harmed patients or even that it was necessarily responsible for the increased signal intensities; suggesting that “it could have resulted simply from increased severity of underlying disease, which one might expect to be correlated with repeated gadolinium exposure, and which was not addressed in the study.” Ultimately Smith concluded that larger trials would be required in order to verify that gadolinium exposure causes the increased signal ... Read more

Based on a study published in the American Journal of Roentgenolog, dynamic contrast-enhanced MRI (DCE-MRI) is valuable in not only quantifying the perfusion measurements of hepatocellular carcinoma (HCC) and liver parenchyma, but also evaluating perfusion changes following HCC chemoembolization Angiogenesis is mainly involved in the metastatic growth and progression of HCC, which is treated with transarterial chemoembolization (TACE) and total molecular targeted therapies. DCE-MRI, requiring IV injection of contrast agents, allows for the quantification of tissue and tumor’s vascular traits. This imaging modality can cover the whole liver with spatial and temporal resolution using a volumetric three-dimensional sequence, allowing evaluation and analyses of numerous lesions and regional differences in liver parenchyma. Insufficient research has been collected on DCE-MRI data assessing HCC lesions and cirrhosis. Bachir Taouli, MD, of New York’s Mount Sinai School of Medicine, and colleagues put together a study in which they reported their primary experience with DCE-MRI for perfusion quantification of HCC and the surrounding liver. For this study, 31 patients diagnosed with HCC, ages 41 to 83, received DCE-MRI. Points of interest included the abdominal aorta, the portal vein, liver parenchyma and HCC lesions. Perfusion parameters were arterial flow, portal venous flow, arterial fraction, distribution volume and mean transit time (MTT). Two observers in consensus analyzed the data attained from the DCE-MRIs of the study’s participants. Results pointed out that compared with liver parenchyma, HCC had a considerably higher arterial hepatic blood flow and arterial fraction, with a considerably lower distribution volume and portal venous hepatic blood flow. There was no difference found in MTT. Untreated HCCs had higher arterial fraction and lower portal venous hepatic blood flow value than chemoembolized HCCs. “These results suggest that DCE-MRI can be used as a noninvasive marker of HCC angiogenesis and may potentially be useful for characterizing cirrhotic nodules and for predicting and monitoring response to TACE and targeted antiangiogenic drugs currently in use in HCC,” wrote Taouli and ... Read more

Based on a study published in the December 2013 issue of Radiology, when comparing PET/CT, PET/MR imaging could provide more accurate diagnosis and staging of patients with cancer, as well as improve overall patient care. The introduction of joint, hybrid PET/MR scanners in 2011 allowed for the advantages of each imaging system to be positioned in one place. However, the scanner’s potential value and role in clinical practice are still being determined. “MR imaging has a superior soft-tissue contrast-to-noise ratio when compared to that of CT, which enables detailed evaluation of soft tissues with the abdomen, pelvis, and central nervous system. Moreover, MR imaging affords us the opportunity to evaluate tissue function with diffusion-weighted imaging, MR spectroscopy, and perfusion-weighted imaging. These MR features, combined with the metabolic information from PET, suggest the potential for PET/MR imaging to have an extensive effect on patient care,” wrote the study’s lead author, Onofrio A. Catalano, MD, of the SDN Istituto Ricerca Diagnostica Nucleare of Naples, Italy, and colleagues. The authors conducted a retrospective study to compare and contrast the relative clinical impact of PET/MR imaging to that of PET/CT performed on the same day in patients with cancer. The study’s population consisted of 134 patients with cancer with a non-central nervous system primary neoplasm. Participants received same-day fluorodeoxyglucose (FDG) PET/CT and FDG PET/MR imaging. The imaging studies were separately interpreted by teams of radiologists and nuclear medicine physicians. The referring physician then noted the differences between PET/CT and PET/MR observations as either discoveries that influenced clinical management or findings that had no affect on clinical management. Results pointed out that two of the 134 patients had findings that affected clinical management on PET/CT, but not on PET/MR. While, findings that affected clinical management noted on the PET/MR studies, but not noted on the PET/CT studies were found in 24 of the 134 patients. The inconsistencies between findings that affected clinical management detected with PET/MR imaging over those detected with PET/CT were statistically important. “In summary, in 17.9 percent of the patients with cancer in our selected population, PET/MR imaging furnished information, especially on staging of the liver, lymph nodes, and pelvis, that was unavailable with PET/CT and that affected clinical management,” the authors ... Read more

As 2013 comes to a close, expert radiologists provided their input on how to improve performance in the coming year. 1- Only use final reads: Radiology groups using nighttime coverage services or depending on the emergency physician to perform preliminary reads may be causing themselves extra work. “Lots of radiology groups use nighthawk type services to maintain control of night-time reads, having them do prelims. And they come in and do final reads in morning. That’s not a very efficient workflow,” said founder and principal consultant of Accountable Radiology Advisors in Ohio, Teri Yates. “Radiology groups fear that allowing the nighttime service to do final reads weakens their position and puts contracts at risk, which is a legitimate concern. But using preliminary reads from others increases communication problems if discrepancies are found by the radiologist providing the final read. In emergent cases, the patient may already have been treated and sent home. Sometimes that discrepancy doesn’t get effectively communicated, to the patient,” Yates added. 2- Employ voice recognition with self-editing: Voice recognition software enables a radiologist to get their thoughts down quickly. However, they also shouldn’t wait around for someone else to edit their work. “By self-editing it on the spot, you get the report out right away. When a group converts to voice recognition and 100 percent self-editing, turnaround time becomes very fast,” said Yates. With this method, radiologists can complete a read and report within 30 minutes, which means that the ordering physician, like an emergency physician, doesn’t feel the need to do a preliminary read. 3- Go for structured reporting: Automation and technology can enhance efficiency with structured reporting, and there’s less dictation required. Additionally, those who utilize it make fewer errors. “Think of it as a diagnostic check list. If reading a chest CT scan looking for a pulmonary embolus, you’re obligated to look at everything in the chest, not just for the embolus. With structured reporting, a template or checklist guides you through the reporting and dictation process. Templates can populate predetermined phrases and the structure makes sure the radiologist comments on each area, hopefully with consistent language. This is helpful to the referring physicians, because they’ll see the same system order every time,” said Yates. 4- Depend on automated communication of vital discoveries: “Following up with referring physicians about critical findings is a very time consuming process for radiologists. It can disrupt the reading workflow, and if the referring physician isn’t available, there needs to be a tracking system so it doesn’t get lost,” notes Yates. Multiple software solutions incorporate with dictation systems, or are individual systems. Paper logs used by some radiology practices are not proficient. Using software, a radiologist can launch the tool when needed to enter the finding on a work list, and this object must to be checked off before it’s removed from the electronic list. Some systems populate the referring physician’s contact information or tell the administrative aide to reach the doctor by phone. Some systems allow information to go by text or smartphone application. Once communication is made, the software system can put a statement on the radiology report, noting the time that results were communicated. 5- Implement rule-based scheduling: Radiology offices usually have various rules when scheduling an imaging exam. Examples might be that the office can’t do a diagnostic mammogram on a specific day because there’s no radiologist available to read it, or the imaging machine is reserved for research, so it’s unavailable at that time for a patient exam. “One of the biggest failures I see is when people make those rules and they’re not built into their scheduling system, and it’s dependent on someone remembering it. We push to make sure the system they use to schedule is as closely reflective of the rules of their department. This way there’s less error, and the patients are properly scheduled.” said Philadelphia healthcare consultant specializing in call center technology, Irene Vergules. “It can be as simple as making sure schedules are constantly maintained in the computer system. If you can’t do a contrast study in the evening, don’t let the system offer those time slots,” she said. 6- Utilize scheduling software to the fullest extent: Most offices don’t utilize scheduling system software to its full capabilities. “Push your system to the limits and figure out what else the system can do for you,” Vergules states. “That might be using modifiers to determine if a study should be longer or shorter. Learn what the system can do by contacting user groups or asking other organizations about their use of the same software. Ask those challenging questions,” she said. 7- Team up: Even if the organization is tiny, radiologists can share best practices, quality initiatives, and even gain financially by teaming up with like-minded groups. An example, Yates notes, is Strategic Radiology, a conglomerate of 17 large radiology practices that merged together partly for economic advantages as a group purchasing organization. “They said they can be more efficient and effective if they work together. The practices are independent, but share data, which helps them lower practice costs by seeing how similar organizations are run. Most radiology groups in county have 10 persons or less. An eight-person group has the same basic needs as a 100-person group. Due to small scale, individual practices may not be able to afford some of the resources of larger organizations, but by banding together they work together to meet some of those needs,” she said. 8- Make things easier for the patients: Especially when growing a practice, radiologists should ensure their hours of operation aren’t restrictive, so that patients can reach scheduling staff or get appointments at times convienient for them. “Some places close for lunch or open only 8 to 4. It’s hard for some people to call during those hours,” said Vergules. This involves knowing your community and your location limitations. “Depending on where you live, some people wouldn’t go there at night or on weekends,” she said, due to safety issues. For other facilities, nights and weekends are an effectiveuse of imaging time. When scheduling a study, be sure to make it as simple as possible for the scheduler and the patient by asking only the right screening ... Read more