News from RSNA

Now that the exhibit hall has cleared, it’s the perfect time to reflect on some of the lessons learned at this year’s Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), held Nov. 25-30 at McCormick Place in Chicago. rt image was there to collect all of the headlines and provide you with the latest news*.

*All news stories and images are courtesy of RSNA.

McLoud Named RSNA President

Theresa C. McLoud, MD, was named president of the Radiological Society of North America (RSNA) board of directors at the society’s annual meeting in Chicago.

McLoud, a pioneer in thoracic radiology, has led the way for innovations in improving radiologic education worldwide and is currently the associate radiologist-in-chief and director of education for the department of radiology at Massachusetts General Hospital in Boston. She is also a professor of radiology at Harvard Medical School in Boston.

As RSNA president, McLoud plans to continue focusing on the needs of the international radiology arena and quality improvement initiatives as they pertain to adult education and the pre-eminence of the RSNA annual meeting.

“RSNA is continually expanding and improving its benefits and educational offerings to the global radiology community,” McLoud says. “I look forward to the continued collaboration of steadfast volunteers, stellar subspecialty organizations and dedicated staff to progress even further in our mission to provide the best in education, science and research.”

As a world-renowned expert in thoracic imaging, McLoud has conducted more than 150 postgraduate courses and has published more than 200 scientific papers, reviews and book chapters. In 1998, she published Thoracic Radiology: The Requisites, a popular, comprehensive and invaluable introductory text for residents beginning in thoracic imaging and preparing for the boards.

McLoud is a champion of occupational safety and combating global disease, having served seven years on the Mine Health Research Advisory Committee of the National Institute for Occupational Safety and Health.

She was awarded the Gold Medal of the American Roentgen Ray Society (ARRS) in 2004 and received the Marie Curie Award, the highest honor granted by the American Association for Women Radiologists, in 2003. She is past-president of the Fleischner Society, Society of Thoracic Radiology and ARRS.


DTI Shows Gray Matter Increase in Brains of Autistic Children

Using a novel imaging technique to study autistic children, researchers have found increased gray matter in the brain areas that govern social processing and learning by observation. The study was conducted at the Fay J. Lindner Center for Autism, North Shore-Long Island Jewish Health System in Bethpage, N.Y.

“Our findings suggest that the inability of autistic children to relate to people and life situations in an ordinary way may be the result of an abnormally functioning mirror neuron system,” says lead author Manzar Ashtari, PhD, from the Children’s Hospital of Philadelphia in Pennsylvania.

Mirror neurons are brain cells that are active both when an individual is performing an action and experiencing an emotion or sensation, and when that individual witnesses the same actions, emotions and sensations in others.

First observed in the macaque monkey, researchers have found evidence of a similar system in humans that facilitates such functions as learning by seeing as well as doing, along with empathizing and understanding the intentions of others. Ashtari’s study found the autistic children had increased gray matter in brain regions of the parietal lobes implicated in the mirror neuron system.

The study included 13 male patients diagnosed with high-functioning autism or Asperger syndrome and an IQ greater than 70 and 12 healthy control adolescents. Average age of the participants was about 11 years. Each of the patients underwent diffusion tensor imaging (DTI), a technique that tracks the movement of water molecules in the brain.

DTI is traditionally used to study the brain’s white matter, as well as the brain fibers. However, Ashtari’s team applied it to the assessment of gray matter by employing apparent diffusion coefficient based morphometry (ABM), a new method that highlights brain regions with potential gray matter volume changes. By adding ABM to DTI, the researchers can detect subtle regional or localized changes in the gray matter.

In addition to the gray matter abnormalities linked to the mirror neuron system, the results of this study revealed that the amount of gray matter in the left parietal area correlated with higher IQs in the control group, but not in the autistic children.

“In the normal brain, larger amounts of gray matter are associated with higher IQs,” Ashtari says. “But in the autistic brain, increased gray matter does not correspond to IQ, because this gray matter is not functioning properly.”


Minimally Invasive Treatment Reduces Tendonitis Shoulder Pain

Radiologists are using a new minimally invasive procedure to treat tendonitis in the shoulder. Ultrasound-guided, non-surgical therapy significantly reduces pain from calcific tendonitis of the rotator cuff and restores mobility.

“This is a quick, successful and inexpensive therapy for tendon calcifications,” says Luca M. Sconfienza, MD, from the department of radiology at A.O. Ospedale Santa Corona in Pietra Ligure and the department of experimental medicine at the University of Genova in Italy. “It provides significant and long-lasting reduction of symptoms.”

Calcific tendonitis is a condition that causes the formation of small calcium deposits within the tendons of the rotator cuff in the shoulder. It is most common in adults 30 to 40 years old. In most cases, the deposits become painful and can restrict mobility of the shoulder.

In minor cases, physical therapy or anti-inflammatory medications may be sufficient to address the problem until the calcifications break apart spontaneously. In severe cases, patients may require shockwave treatment or open surgery to remove the calcium.

Ultrasound-guided percutaneous (through the skin) therapy represents an effective and inexpensive alternative to surgery that is less stressful for the patient. For the 10-minute procedure, the shoulder is anesthetized and, with ultrasound guidance, a radiologist injects a saline solution into the rotator cuff to wash the area and break up the calcium. A second needle is used to aspirate, or withdraw, the calcium residue. Recovery time is about an hour. Calcifications that are completely treated do not ever return.

“Calcifications can break up on their own. Unfortunately, this can take from a few months to several years,” Sconfienza says. “This means the pain could persist for years before its spontaneous resolution.”

In addition, when untreated calcifications break up, the calcium is not extracted but spreads along the tendon and lodges in the subacromial bursa, a fluid sac that helps lubricate the tendon. Calcium buildup in the tendon and bursa can cause bursitis, a painful condition with a long recovery time and a high grade of disability.

The results of the study showed that in 71.7 percent of the patients, the calcification was fully aspirated in one treatment with a considerable reduction in pain and significant improvement to mobility of the affected limb.

In 23.6 percent of patients, a second procedure was performed because of the presence of more than one calcification. In 3.8 percent of patients, the calcification had dissolved or moved before treatment could take place. In 0.9 percent of patients, no resolution of symptoms occurred because of the presence of a tendon tear.


RSNA Awards Gold Medals to Bryan, Hendee, Thrall

The RSNA conferred its highest honor, the Gold Medal, upon R. Nick Bryan, MD, PhD, of Philadelphia; William R. Hendee, PhD, of Whitefish Bay, Wis.; and James H. Thrall, MD, of Boston.

In a tradition that originated in 1919, Gold Medals are presented each year to individuals who have rendered exemplary service to the science of radiology and who have received unanimous approval by the RSNA Board of Directors.

With a long-standing interest in neuroradiology sparked during a neurosurgery internship, R. Nick Bryan is a visionary leader, inventor and educator.

An RSNA member since 1979, Bryan became president of RSNA in 2002. He has also served as president of the American Society of Neuroradiology and American Society of Head & Neck Radiology.

As RSNA board chairman, he promoted development of new education grant programs for the RSNA Research & Education (R&E) Foundation. In 2005, as chairman of the R&E board of trustees, he challenged radiologists to raise $15 million by 2009.

William R. Hendee is a prolific scientist, as a well as a champion of healthcare safety and collaboration between academia and industry.

Hendee has served as president of the MCW Research Foundation, and has also been president of the American Association of Physicists in Medicine, Society of Nuclear Medicine, American Institute of Medical and Biological Engineering, and American Board of Radiology.

Prior to joining MCW, Hendee was vice president for science and technology at the American Medical Association (AMA) in Chicago and executive secretary of the AMA Council on Scientific Affairs.

An RSNA member since 1976, he has worked with numerous society committees and served on the board of trustees of the RSNA Research & Education Foundation for five years.

James H. Thrall doesn’t spend much time looking back at the myriad accolades and honors he has earned during almost 40 years in radiology. The key to Thrall’s success has been his ability to look forward.

Thrall currently serves on the board of councilors of the Society of Chiefs of Academic Radiology Departments and is a past-president of the American Roentgen Ray Society. In addition, he is vice chair of the board of chancellors and chair of the Commission on Molecular Imaging for the American College of Radiology.

Radiologist-in-chief at Massachusetts General Hospital, Thrall also serves as the Juan M. Taveras professor of radiology at Harvard Medical School in Boston. He chairs the executive committee of the Harvard departments of radiology and is a member of the RSNA Research & Education Foundation board of trustees.

An RSNA member since 1983, Thrall recently contributed to “The Blueprint for Imaging in Biomedical Research,” a vision of how imaging can accelerate and enhance biomedical research, published in the July 2007 issue of Radiology.


CTA Highly Accurate, Multicenter Trials Show

CT angiography is as accurate as an invasive angiogram in detecting coronary artery disease, according to the findings of the first two prospective multicenter 64-slice scanner trials.

“These two trials with comparable results clearly set the stage for the widespread adoption of and reimbursement for coronary artery CT examinations,” says Gerald D. Dodd III, MD, chair of the department of radiology at the University of Texas Health Science Center in San Antonio.

For the Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography (CORE-64) Trial, researchers at nine international centers studied 291 patients who were scheduled to undergo invasive coronary angiography for suspected or unknown coronary artery disease.

The study found that 64-slice multidetector CT angiography was highly accurate in detecting blockages of greater than 50 percent, with a sensitivity of 85 percent and a specificity of 90 percent. The noninvasive exam was equal in accuracy to invasive angiography in its ability to identify patients to be referred for angioplasty or bypass surgery.

“Reliable assessment of the presence of coronary blockages and accurate prediction of coronary revascularizations are feasible with 64-slice CT coronary angiography,” says presenter Marc Dewey, MD, radiologist at Humboldt University Berlin, Charité, Germany. “Patients with low to intermediate risk of having coronary blockages are most likely to benefit from coronary CT angiography, since in those patients the necessity of invasive angiography is greatly reduced.”

“The Assessment by Coronary Computed Tomographic Angiography of Individuals UndeRgoing InvAsive Coronary Angiography (ACCURACY) Trial” compared 64-row coronary CT angiography (CCTA) to quantitative coronary angiography (QCA). The results demonstrated that CCTA is highly accurate in detecting coronary blockages in chest pain patients referred for invasive coronary angiography and is also an effective noninvasive method to exclude obstructive coronary blockages.

Sixteen institutions performed CCTA on 232 patients with typical or atypical chest pain prior to invasive coronary angiography. Findings were then compared to those of QCA, the reference standard used to quantify the results of the invasive coronary angiography.

A total of 82 blockages greater than 50 percent in 49 patients and 31 blockages greater than 70 percent were detected in 28 patients by QCA. Per-patient sensitivity and specificity of CCTA were 93 percent and 82 percent, respectively, for blockages greater than 50 percent, and 91 percent and 84 percent for blockages greater than 70 percent. In addition, negative predictive value was 97 to 99 percent.
    

PET/CT Brings Hope to Breast Cancer Patients

Researchers are improving the chances of women faced with an aggressive and difficult to diagnose form of breast cancer. Inflammatory breast cancer spreads quickly and can be lethal in six to nine months. But, by using fluorodeoxyglucose PET combined with CT (FDG-PET/CT), radiologists and physicists are able to spot the spread of cancer earlier.

“PET/CT is useful in staging inflammatory breast cancer because it provides information on both the primary disease site, as well as disease involvement throughout the rest of the body,” says Selin Carkaci, MD, assistant professor of diagnostic radiology at the University of Texas M. D. Anderson Cancer Center (UTMDACC) in Houston. “In addition, PET/CT is also a practical tool for therapeutic planning.”

Inflammatory breast cancer is a rare, but extremely aggressive, form of breast cancer that doesn’t present like other forms of breast cancer. It accounts for 1 percent to 5 percent of all breast cancer cases in the United States. The disease tends to be diagnosed in women at a younger age and is characterized by redness, swelling or warmth in the breast. These symptoms occur within a three-month period.

Often there is no palpable lump, and by the time it is diagnosed, the cancer has already metastasized, or spread, reducing the chances for survival. According to the American Cancer Society, the five-year survival rate for patients with inflammatory breast cancer is only 25 percent to 50 percent.

With FDG-PET/CT, researchers are able to accurately determine the location of metastases early in the disease process, when appropriate treatment can be administered.

“Breast cancer is not a local problem,” says co-author Homer A. Macapinlac, MD, chair and professor of nuclear medicine at UTMDACC. “It is a systemic disease.”

The study included 41 women, mean age 50 years, who were newly diagnosed with inflammatory breast cancer. Each patient underwent a whole-body FDG-PET/CT exam.

FDG-PET/CT depicted metastases in 20 patients (49 percent). These findings were confirmed by biopsy and supplementary imaging. FDG-PET/CT produced only two false positive results, identifying those areas as cancerous when, in fact, no disease was present, resulting in a 95 percent accuracy rate. The PET/CT scans were also able to identify instances of cancer involvement in the patients’ lymph nodes with 98 percent accuracy.


‘Stereo’ Mammography May Reduce Recall Screenings

Stereoscopic digital mammography, a new diagnostic technique capable of producing 3-D, in-depth views of breast tissue, could significantly reduce the number of women who are recalled for additional tests following routine screening mammography. The clinical trial was conducted at Emory University Breast Clinic in Atlanta.

“Standard mammography is one of the most difficult radiographic exams to interpret,” says David J. Getty, PhD, division scientist at BBN Technologies of Cambridge, Mass. “In a two-dimensional image of the breast, subtle lesions may be masked by underlying or overlying normal tissue and thus be missed, and normal tissue scattered at different depths can align to mimic a lesion, leading to false-positive detections.”

Stereoscopic digital mammography consists of two digital X-ray images of the breast acquired from two different points of view separated by about eight degrees. When the images are viewed on a stereo display workstation, the radiologist is able to see the internal structure of the breast in three dimensions.

In the ongoing clinical trial, researchers use a full-field digital mammography unit modified to take stereo pairs of images. The workstation enables the mammographer to fuse the stereo image pair and to view the breast in depth.

“Stereo viewing is the only way to see the structure within the breast volume in true depth,” says Getty, who has been working on the development of the technology over the past 12 years.

As of July 2007, 1,093 patients at elevated risk for developing breast cancer were enrolled in the trial. Each patient received a full-field, standard digital mammography screening examination and a full-field, stereoscopic digital exam, which were then read independently by different radiologists.

A total of 259 suspicious findings were detected by the combined mammography procedures and were referred for additional diagnostic testing, including biopsy when indicated. Of those, 109 were determined to be true lesions. Standard mammography missed 40 of the 109 lesions while the stereoscopic exam failed to detect 24.

“Our early results suggest that stereo digital mammography could contribute to the earlier detection of cancer,” Getty says. “A small percentage of the additional lesions missed by standard mammography but detected by stereoscopic mammography will turn out to be cancerous.”

Of the 259 findings, 150 were false positives, meaning further testing revealed that no abnormality was present. Standard mammography yielded 103 false positives; stereo mammography yielded 53.

“In our study, stereo digital mammography reduced false positives by 49 percent,” says Getty. “This could have a significant impact by cutting in half the number of women who are needlessly recalled for additional diagnostic work-ups, resulting in a large savings in cost and patient anxiety.”


Injury Report Shows All-Terrain Vehicles Not Child’s Play

All-terrain vehicles (ATVs) pose a serious risk of injury and even death, according to the largest study ever conducted of ATV injuries in children.

“Our experience shows that children’s use of ATVs is dangerous and should be restricted,” says Chetan C. Shah, MD, radiology fellow at the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital in Little Rock.

ATVs – motorized vehicles with large, low-pressure tires, designed for off-highway use – can weigh up to 600 pounds and travel up to 75 miles per hour. While the American Academy of Pediatrics recommends that children under the age of 16 be prohibited from operating ATVs, no laws are in place in most states. ATV accidents are seldom reported because the vehicles are unlicensed and typically operated off-road or on private land.

According to the Consumer Product Safety Commission (CPSC), ATV-related injuries in children under the age of 16 more than doubled from 1995 to 2005, with 40,400 children treated in hospital emergency rooms nationwide in 2005. This figure represents nearly one-third of all ATV-related injuries treated that year. Child fatalities resulting from ATV accidents have also nearly doubled since 1995 with 120 reported deaths in 2005.

The study included 500 consecutive children admitted to Arkansas Children’s Hospital following ATV accidents. The children ranged in age from 6 months to 19 years (mean age, 11.5 years old) and included 345 boys and 155 girls.

Head injuries included 85 skull fractures, 66 cases of hemorrhage and 59 brain injuries. Spinal injuries included 21 spine fractures and five spinal cord injuries. Lung injuries were present in 36 children. Injuries to the spleen, liver, kidneys or pancreas were found in 70 children. Extremity fractures occurred in 208 children with broken legs being the most common.

There were 12 amputations, including nine partial foot amputations, one upper limb amputation and one below-knee amputation. There were six fatalities and several cases of long-term disabilities. The fatalities represent only the children who died at the hospital, not those who died at the accident site.

“The youngest patient in our series was a 6-month-old infant who was riding with his mother. His thigh bone was fractured,” Shah says. “Other patients included a 2-year-old who was driving a ‘child-size’ ATV and had traumatic amputation of four toes, and another 2-year-old driver who was found unconscious beside a flipped ATV. She had a severe brain hemorrhage that left her with permanent disability,” he says.


New Automated System IDs Victims of Mass Disasters in Minutes

A new, high-tech identification system developed in Japan will improve accuracy and significantly reduce the time it takes to identify victims of mass disasters.

“Families waiting to hear news regarding loved ones experience trauma while waiting for the identification process to resolve,” says Eiko Kosuge, DDS, dentist, radiologist and lecturer at the department of oral and maxillofacial radiology at Kanagawa Dental College in Japan. “With this new system, we can drastically cut the time and improve the accuracy of this process to help alleviate some of the emotional stress that occurs in the case of a mass disaster.”

Currently, all cases of dental identification in the wake of a mass disaster have to be handled one by one by forensic experts. After a mass disaster, such as an earthquake, tsunami, plane crash or act of terrorism, forensic experts must compare each victim’s records with scores of dental records to try to make a proper identification. This can be very time-consuming, taking weeks or months, and mistakes do occur.

To address this problem, Kosuge and colleagues developed a novel, automated dental X-ray matching system that can not only reduce the task of forensic experts, but also improve the accuracy of identification. According to Kosuge, the system can reduce the amount of work required for identification by up to 95 percent and produce matches at an average rate of less than four seconds each.

The system uses a highly accurate image-matching technique called Phase-Only Correlation (POC). The technique is used to align images and measure their similarity. With POC, the system registers images, corrects distortion and calculates a matching score.

For the study, the researchers used POC to analyze dental records of 60 patients before and after dental treatment. The total number of pairs was 3,600. The system produced three candidates to match each patient’s X-ray. Computation time averaged 3.6 seconds per pair.

The recognition rate was 87 percent for the first candidate, increased to 98 percent for the second candidate and to 100 percent for the third. These top three candidates were then evaluated by forensic experts for the final matching decision, thus cutting the workload of the experts by 95 percent.

“In the case of a mass disaster, the public will never know that this system was used,” Kosuge says. “What they will know is that instead of waiting a month for their loved ones to be returned, they will wait only days.”