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Article available online at:
http://www.rt-image.com/113009RSNAnews
News from RSNA 2009, Day 1
Headlines from the Chicago show
11.16.09
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This ultrasound image shows a solid mass (Fig. a). Elasticity software was applied and the area was noticeably larger (Fig. b). A biopsy proved this to be invasive cancer. When imaging cancer, the area is larger on the elastogram than on ultrasound. (RSNA)
An X-ray of a child who swallowed a stay-tab, with a stay-tab held next to the X-ray for comparison.
A large proportion of patients who undergo abdominal/pelvic CT receive unindicated and unnecessary additional image acquisition resulting in excess radiation exposure, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).
“It is the responsibility of all physicians who work with ionizing radiation to ensure that the dosage is as low as reasonably achievable without compromising the patient’s wellbeing,” says Kristie Guite, MD, radiology resident at the University of Wisconsin (UW) in Madison. “Our study found that this principle is not being followed in many practices.”
Because it provides valuable diagnostic information, CT use has risen rapidly. In recent years, a number of reports have highlighted the increasing radiation exposure to patients through the use of medical imaging, particularly CT. While these reports have often focused on general and screening uses, little attention has been paid to radiation from additional series, including routine non-contrast or delayed-phase CT, which may or may not be indicated by the patient’s condition, but are sometimes performed so that nothing is overlooked.
To determine the frequency of unindicated additional scanning and the resultant excess radiation exposure to patients, the researchers reviewed the appropriateness and radiation dose of abdomen and pelvis CT exams for 500 patients performed at outside institutions and submitted to UW – Madison for interpretation. The patients ranged in age from nine months to 91 years, with most between 30 and 50 years old.
There were a total of 978 series for the 500 patients. Using the American College of Radiology (ACR) Appropriateness Criteria®, 35.3 percent (345/978) of the CT series in 52.2 percent (261/500) of the patients were determined to be unindicated. The most common unnecessary exam was delayed-phase imaging, accounting for 268 (77.7 percent) of the 345 unnecessary series. In delayed-phase imaging, several images of the same region are obtained a short period of time after contrast injection to detect changes. Among the 500 patients, the mean excess radiation dose per patient from unnecessary scans was 11.3 millisieverts (mSv), equivalent to the dose received from 113 chest X-rays or three years of naturally occurring background radiation.
“We suspect that at many institutions there is a lack of focus on selecting CT protocols tailored specifically to answer the clinical question,” says coauthor J. Louis Hinshaw, MD, assistant professor of radiology at UW – Madison. “It is certainly easier to select an ‘every size fits all’ approach.”
The researchers also noted a possible connection in some cases between additional scanning and increased payment, such as performing both non-contrast and contrast-enhanced scans when only one series was indicated.
Efforts are ongoing to protect patients from unnecessary radiation exposure from medical imaging procedures, including the Image Gently initiative for safety in pediatric radiology and an American College of Radiology-RSNA task force for adult radiation protection. In addition to following strict appropriate imaging utilization standards, radiologists and medical physicists stress the importance of minimizing dose without sacrificing diagnostic ability. Advances in CT technology over recent years have markedly decreased dose while maintaining optimal image quality.
Guite advises patients not to be unduly alarmed when their physician orders a CT exam. “The use of CT has been a huge benefit to human health,” she says. “When used appropriately, the benefits of the diagnostic information obtained with CT far outweigh the potential risks.”
Hinshaw suggests that patients ask their physicians about the risks and benefits of the proposed exam and inquire at the CT facility as to the number of series that will be performed, and if a smaller number of series would be sufficient.
— RSNA
Elastography Reduces Unnecessary Breast Biopsies
Elastography is an effective, convenient technique that, when added to breast ultrasound, helps distinguish cancerous breast lesions from benign results, according to an ongoing study presented Nov. 30 at the annual meeting of the Radiological Society of North America (RSNA).
When mammography yields suspicious findings, physicians often use ultrasound to obtain additional information. However, ultrasound has the potential to result in more biopsies because of its relatively low specificity, or inability to accurately distinguish cancerous lesions from benign ones. Approximately 80 percent of breast lesions biopsied turn out to be benign, according to the American Cancer Society.
“There’s a lot of room to improve specificity with ultrasound, and elastography can help us do that,” says the study’s lead author, Stamatia V. Destounis, MD, a diagnostic radiologist at Elizabeth Wende Breast Care, a large, community-based breast imaging center in Rochester, N.Y. “It’s an easy way to eliminate needle biopsy for something that’s probably benign.”
Elastography improves ultrasound’s specificity by utilizing conventional ultrasound imaging to measure the compressibility and mechanical properties of a lesion. Since cancerous tumors tend to be stiffer than surrounding healthy tissue or cysts, a more compressible lesion on elastography is less likely to be malignant.
“You can perform elastography at the same time as handheld ultrasound and view the images on a split screen, with the 2-D ultrasound image on the left and the elastography image on the right,” Destounis says.
As part of the ongoing study, 179 patients underwent breast ultrasound and elastography. The research team obtained 184 elastograms and performed biopsies on all solid lesions. Of 134 biopsies, 56 revealed cancer. Elastography properly identified 98 percent of lesions that had malignant findings on biopsy, and 82 percent of lesions that turned out to be benign. Elastography was also more accurate than ultrasound in gauging the size of the lesions.
“Ultrasound can underestimate the true size of lesions, as it only sees the actual mass and not the surrounding changes the mass may cause,” Destounis says.
— RSNA
Beverage Can Stay-Tabs Pose Swallowing Risk
Three decades ago, a study revealed that beverage can pull-tabs were being swallowed by children, prompting a switch by U.S. manufacturers to stay-tabs. But a study presented at the annual meeting of the Radiological Society of North America (RSNA) found that the new tabs are still potentially unsafe.
“One of the driving factors leading the change in beverage can construction in the U.S. was to eliminate inadvertent swallowing of the pull-tab and potential related injury to the gastrointestinal tract,” says the study’s lead author, Lane F. Donnelly, MD, radiologist-in-chief and director of biodiagnostics at Cincinnati Children’s Hospital Medical Center. “Our findings raise the possibility that the redesign of beverage cans may not have reduced the number of ingestions.”
In 1975, amid already growing concerns that removable beverage can pull-tabs posed a litter problem, as well as a potential injury hazard if stepped on, a study in the Journal of the American Medical Association revealed two cases of accidental ingestion and one case of aspiration of pull-tabs that had been dropped back into the cans. As a result, U.S. beverage can manufacturers refitted cans with stay-tabs that remained attached to the can after opening. However, these tabs could still be removed with little effort.
Donnelly identified 19 cases of inadvertent stay-tab ingestion at Cincinnati Children’s Hospital Medical Center over a 16-year period from 1993 to 2009. The mean age of the children who had swallowed the tabs was 8.5. Only four of the children were younger than age 5. Most of the cases were teenagers. “It is unusual that the majority of cases occurred among teenagers, since foreign body ingestion typically occurs in infants and toddlers,” Donnelly says.
While most of the 19 cases in the study were resolved without surgery, ingestion of foreign bodies, particularly those with sharp edges, can lead to injury of the gastrointestinal tract. Some cases do require surgery.
Confounding the problem is that stay-tabs are difficult to see on X-rays. While 19 ingestions were witnessed or self-reported, only four (21 percent) of the 19 ingested stay-tabs were visible on X-rays. In each visible case, the tab was located in the stomach.
“Clinicians and radiologists should be aware that this does occur,” Donnelly says. “Not seeing the tab on the X-ray does not mean it was not swallowed.”
The findings of the study question the current construction of beverage cans in the U.S. and indicate that the tabs still pose a potential danger to children and adolescents.
“The identification of 19 ingested stay-tabs at a single children’s hospital suggests that such occurrences are not uncommon,” Donnelly says.
— RSNA
Siemens Introduces Minimally Invasive Procedure for Oncology
At the 95th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) in Chicago, Malvern, Pa.-based Siemens Healthcare has introduced its comprehensive portfolio for imaging in interventional oncology.
Using these minimally invasive procedures for cancer therapy, the interventional radiologist navigates catheters or needles in the millimeter range. To this end, systems and applications are required that supply high image quality for the detection of details in soft tissue. Siemens provides imaging systems and applications to support the physician throughout the entire workflow, from tumor evaluation and procedure planning to therapy and follow-up.
syngo® DynaCT enables the display of soft tissue, including tumors and the complex structures of the blood vessels supplying them during therapy. Thanks to short reconstruction times, abdominal images can be made available to the treating physician within 22 seconds.
Large-volume syngo DynaCT offers the interventional radiologist virtually unlimited freedom of movement in combination with the robotic-based angiography system Artis zeego®. The system's flat detector rotates twice 220 degrees around the patient allowing cross-sectional images covering 47 centimeters to be acquired. These images enable more comprehensive anatomic coverage than soft tissue images acquired with any other angiography system. The liver and lungs can be covered fully.
syngo Embolization Guidance enables advanced planning of the embolization of tumor-feeding blood vessels. Using this application, the vessel supplying the tumor can be marked, and the centerline of the vessel is automatically calculated. The centerline is then superimposed on the live fluoroscopic image, thus simplifying catheter guidance during tumor embolization considerably.
With syngo InSpace 3-D/3-D Fusion, previously acquired CT, MR, or PET/CT images can be fused with high-contrast 3-D angiography images or with syngo DynaCT datasets in order to present all relevant diagnostic and interventional data at a glance. The fused dataset can be overlaid on live fluoroscopic images in the interventional lab and provides additional information on the tumor during the procedure (e.g., regarding its activity).
If a tumor is to be treated with an ablative procedure, it is especially important to position the needles that release the energy to the tumor precisely. syngo iGuide helps to plan and position the needle. The iGuide Cappa navigation system supports the placement of radiofrequency and biopsy needles via electromagnetic navigation without requiring any radiation.
— Siemens Healthcare
Simulated Training for Ultrasound-Guided Procedures Improves Patient Safety
Using mannequins to teach doctors-in-training how to do ultrasound-guided procedures is an effective way to improve their skills without compromising patient care and safety, according to a new study from Henry Ford Hospital in Detroit presented at the Radiology Society of North America Annual Meeting in Chicago.
The study shows that this simulation-based training course can be a valuable tool to improve medical residents' knowledge, dexterity, and confidence for performing some of the more common ultrasound-guided procedures, including breast biopsies, liver biopsies, thyroid biopsies, and the removal of fluid in the body. A simulated model also allows for standardization of medical education.
For the study, researchers enrolled 29 radiology residents from all four levels of training. The residents were given written, video, and live interactive training from staff on the basics of ultrasound-guided procedures. Residents had six months to practice these skills at the Center for Simulation, Education and Research at Henry Ford Hospital. As part of the study, residents used phantom mannequins that contained both hypo- and hyperechoic nodules to simulate the ultrasound procedure. Written and practical examinations were given before and after training to assess for changes in competency and proficiency.
Study results show a significant improvement between the residents' pre- and post-test scores on both the written and practical exams. After training, residents also demonstrated improved dexterity in the technical aspects of ultrasound-guided procedures.
On the survey questionnaire, residents said that the course improved their knowledge level and technical ability for ultrasound-guided procedures. It also boosted their confidence for performing biopsies.
In all, the researchers say, this additional simulation training translates to improved patient care and safety, as well as patient satisfaction, decreased risk of complications, decreased procedural time, and the ability to improvise in difficult or unexpected situations.
As a result of these study findings, Henry Ford Hospital has expanded this course to include simulated training for CT-guided interventional procedures.
— Henry Ford Hospital
Toshiba Enters Ultra-Portable Ultrasound Market
Tustin, Calif.-based Toshiba America Medical Systems Inc. has introduced the new Viamo™ laptop ultrasound system, a work-in-progress that is being showcased at this year's RSNA annual meeting in Chicago.
The new Toshiba Viamo laptop ultrasound system offers:
- Best-in-class imaging capabilities in a laptop size, making it ideal for high-end radiology, vascular, emergency, bariatric, and OB/GYN exams, even at bedside. For example, Viamo is beneficial during liver transplants when medical personnel must image the anastomoses to assess blood flow through the vessels.
- Image quality and color flow comparable to those of larger, more expensive cart-based systems.
- Ease of use with a simple touch-screen interface that is programmable in panel or tablet modes.
- Ability to interchange Toshiba transducers while using the Viamo\'92s transportation pole, thus improving productivity and flexibility while saving healthcare costs by reducing the need to purchase multiple transducers. This feature improves productivity and saves money for current customers by using their existing Toshiba transducers on the Viamo. Additionally, new customers are able to use Viamo transducers with other Toshiba ultrasound systems they may purchase in the future.
NightHawk Radiology Launches Redesigned Quality Assurance Program
Scottsdale, Ariz.-based NightHawk Radiology Services has implemented a redesigned Quality Assurance (QA) program to foster better communication between its radiologists and customers.
NightHawk has provided an overview of the new QA program in several presentations at RSNA 2009 in Chicago.
The QA program is based on continuous feedback processes. Radiologists\'92 interpretations and reports are evaluated by customers and submitted to NightHawk for iterative review by internal and external physician review boards. A multitude of key metrics ensures accurate and fair quality measurements. The QA program utilizes a highly analytical, systematic, and disciplined approach to assign physicians a monthly Medical Quality Score comprising two key measurements: report accuracy and report quality.
A key tenet of the improved QA program is transparency. Customers have the opportunity to provide and receive feedback on all radiology reads provided by NightHawk physicians. Quality measurements and results will also be available to each customer by site on a monthly basis, tracking the overall performance and scores for NightHawk radiologists.
— NightHawk
Konica Minolta Introduces New Generation Xpress CR
Wayne, N.J.-based Konica Minolta Medical Imaging USA's Xpress CR 210, introduced at the Radiological Society of North America (RSNA) annual meeting in Chicago, offers a more compact, higher performance design that includes advanced C-plate technology for sharper, more efficient imaging process.
Based on the company's "Ultimate Resource Sharing" concept, the Xpress CR 210 also provides the flexibility to separate the location of consoles and readers for optimized productivity based on the number and type of examination, floor space, and work flow demands.
The new C-plate series has a columnar crystal phosphor layer that efficiently delivers excellent sharpness and granularity for high quality images. The Xpress CR supports a sampling pitch of 43.75µm for mammography, while the pediatric cassette, which supports 87.5µm read function, is optimized to meet requirements for reduced radiation dose, following the ALARA (As Low As Reasonably Achievable) principle and Image Gently campaign.
The Xpress CR 210 processes up to 100 plates per hour for maximum performance with a compact footprint. Users have the flexibility to select either the CS-3 console, which offers a customizable imaging platform able to meet the needs of demanding deployments, or the CS-2 control station, which incorporates automated processing functions, auto body part recognition, and learns user preferences for density and contrast adjustments.
— Konica Minolta Medical Imaging
Web-based EMR Tools Now Available in BRIT Systems' Roentgen Files
At the annual meeting of the Radiology Society of North America (RSNA), Dallas-based BRIT Systems has introduced new Web-based tools for Roentgen Files that expand workflow capabilities for radiology groups and departments that do not have an electronic medical record (EMR). BRIT has developed EMR-type tools as part of the company\'92s next-generation, browser-based Roentgen Works family of radiology information technology products, and in anticipation of increased EMR/EHR adoption resulting from the American Recovery and Reinvestment Act (ARRA) of 2009.
The new Roentgen RIS EMR tools include computerized physician order entry (CPOE), and creating and sharing Continuity of Care Records (CCRs). Also, Roentgen RIS now generates reports that are compatible with personal health records, such as Google Health.
The CPOE function in Roentgen RIS opens a Web portal for physicians to request procedures and view images and reports. Plus, radiologists and radiology departments will now have the ability to import, update, and export CCRs in accordance with the American Society of Test Methods Standard directly from Roentgen RIS. Imaging facilities and clinicians can enhance patient communication through portals that allow them to view schedules, exams, preparation information, images, and reports online. Soon, these capabilities will be extended to the patients, as well. As with the other Roentgen Works products, tasks are achieved with browser-based technology and do not require any downloading of applications.
— BRIT Systems
GE Healthcare Introduces Dose-Efficient Technology for Interventional Radiology
At this year's Radiology Society of America (RSNA) annual meeting, GE Healthcare presented the new Innova® dose-efficient X-ray technology powered by the GE AutoEx control system, which automatically and continuously adapts to help keep image quality and patient dose at optimum levels. The technology can reduce patient dose by as much as 40 percent without compromising image quality and is one of the first new-to-market product features validated under GE's healthymagination initiative dedicated to improving the quality, access, and cost of healthcare.
Imaging with Innova X-ray systems supports a variety of interventional procedures. As these procedures grow in complexity and length, minimizing exposure to radiation remains a priority. GE Healthcare offers the capability to potentially reduce dose by managing, customizing, and personalizing radiation dose for each individual patient and procedure.
High dose efficiency with Innova imaging allows clinicians to tailor each procedure, helping to optimize the dose for the patient's needs or the procedure's complexity without compromising image quality. Based on evidence supporting the potential for these products to improve the quality of patient care, the Innova family of products has been healthymagination validation by external independent experts from Oxford Analytica. GE launched healthymagination in May, which includes a $6 billion commitment from GE through 2015 to innovate smarter processes and technologies that help physicians and hospitals throughout the world provide a higher level of healthcare to more people – and save costs in the process.
Innova systems use a flat-panel detector that provides the industry's highest Detective Quantum Efficiency (DQE), a parameter internationally accepted as the best index of detector performance in the contrast- and dose-limited imaging done in actual clinical studies. High DQE enables better-quality images at the same dose, or the same-quality image at a lower dose.
In addition, AutoExposure Preference Settings let physicians personalize image quality and dose. InnovaSense™ patient contouring further extends dose efficiency, helping to minimize detector-to-patient distance for fast positioning, excellent image geometry, and less radiation exposure.
— GE Healthcare
