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. 30 – Dec. 5 at McCormick Place in Chicago.

rt image was there to collect all of the headlines and provide you with the latest news. Still craving more excitement? Click here to check out our exclusive Webcasts from the conference.


All news stories and images are courtesy of RSNA.


Treatment Offers Better Outcome to Women with Breast Implants

A study shows that women with early-stage breast cancer who have undergone breast augmentation may be treated successfully with a partial-breast radiation treatment called brachytherapy. Patients treated with brachytherapy have better cosmetic outcomes and avoid the risk of the implant hardening, compared to patients who undergo whole-breast radiation therapy.

“We are seeing an increasing number of breast cancer patients with augmentation,” says Robert R. Kuske Jr., MD, clinical professor at the University of Arizona Health Sciences Center in Phoenix, and radiation oncologist at Arizona Oncology Services in Scottsdale. “By nature, these women are concerned about their appearance, and we need to have options for them.”

According to the American Society of Plastic Surgeons, breast augmentation is the most popular cosmetic surgery in the United States, with 347,500 procedures performed in 2007, representing a 64-percent increase since 2000. Approximately one in eight women who undergo breast augmentation will develop breast cancer at some point in their lives.

The most common breast cancer treatment for patients with breast implants is skin-sparing mastectomy and implant exchange. Whole-breast radiation therapy after lumpectomy is an option, but carries a substantial risk during the healing process of scar tissue wrapping around the implant, causing it to become rock-hard and extremely painful.

This condition, known as capsular contracture, also distorts the appearance of the breast. Kuske set out to determine if partial-breast radiation with brachytherapy might offer a better outcome for women with implants wishing to avoid mastectomy. Breast brachytherapy is a radiation treatment that can be given in higher doses to a small, targeted area of the breast after lumpectomy.

Radioactive “seeds” are guided into place through small plastic tubes, or catheters, with the aid of imaging and a computer. The seeds emit high doses of radiation in short bursts. Scar tissue is minimal, the implant remains unaffected, and treatment time is shortened from 6.5 weeks with whole-breast radiation therapy, to five days with brachytherapy.

For the study, 65 women who were diagnosed with small, early-stage malignant tumors were treated with brachytherapy after a lumpectomy. The women received two doses per day, separated by six hours, over a five-day period.

Follow-up was six months to five years. None of the patients experienced tumor recurrence during the follow-up period. Cosmetic outcome was determined to be good-to-excellent in 100 percent of patients, with 95 percent judged excellent. Implant hardening was not observed in any of the patients.

“Compared to traditional treatments, brachytherapy offers an excellent alternative for these women,” Kuske says. “It offers very high rates of tumor control with fewer side effects, and is easier on their lifestyle.”



Exercise Helps Prevent Age-Related Brain Changes

Older adults who exercise regularly show increased cerebral bloodflow and a greater number of small blood vessels in the brain, according to new research. The study, conducted at the University of North Carolina (UNC)-Chapel Hill, is the first to compare brain scans of older adults who exercise to brain scans of those who do not.

 “Our results show that exercise may reduce age-related changes in brain vasculature and bloodflow,” says presenter Feraz Rahman, MS, currently a medical student at Jefferson Medical College in Philadelphia. “Other studies have shown that exercise prevents cognitive decline in the elderly. The blood vessel and flow differences may be one reason.”

The researchers recruited 12 healthy adults, ranging from ages 60 to 76. Six of the adults had participated in aerobic exercise for three or more hours per week over the last 10 years, and six exercised less than one hour per week.

All of the volunteers underwent MRI to determine cerebral bloodflow, and MR angiography to depict blood vessels in the brain. Using a novel method of 3-D computer reconstruction developed in their lab, the researchers were able to make 3-D models of the blood vessels and examine them for shape and size.

They then compared the blood vessel characteristics and how they related to bloodflow in both the active and inactive groups. The results showed that the inactive group exhibited fewer small blood vessels in the brain, along with more unpredictable bloodflow through the brain.

“The active adults had more small blood vessels and improved cerebral bloodflow,” says the study’s senior author, J. Keith Smith, MD, PhD, associate professor of radiology at UNC School of Medicine. “These findings further point out the importance of regular exercise to healthy aging.”



Brain Waves Show Sound-Processing Abnormalities in Autistic Children

Abnormalities in auditory and language processing may be evaluated in children with autism spectrum disorder by using magnetoencephalography (MEG). “Using MEG, we can record the tiny magnetic fields associated with electrical brain activity,” says Timothy Roberts, PhD, vice chair of research in the radiology department at the Children’s Hospital of Philadelphia.

“Recorded brain waves change with every sensation, thought, and activity. It’s like watching a movie of the brain in real time.” Typically used for epilepsy evaluation, MEG can also be used to identify timing abnormalities in the brains of patients with autism.

“We found that signatures of autism are revealed in the timing of brain activity,” Roberts says. “We see a fraction of a second delay in autistic patients.” Autism is a complex developmental disability that affects approximately one in every 150 American children, mostly boys, according to the Autism Society of America, in Bethesda, Md.

Autism inhibits the brain functions that govern the development of social and communication skills. For a MEG exam, a helmet that houses magnetic detectors and looks similar to an old-fashioned hair dryer is lowered over the patient’s head, while the patient remains in a seated position. The helmet analyzes electrical currents from the brain.

For the study, 64 patients, ranging from ages 6 to 15, with a diagnosis of autism spectrum disorder, were evaluated with MEG. Audio stimulation was introduced to the children in the form of beeps, tones in pairs, vowels or sentences. Sounds were presented at different frequencies and tone pairs in rapid succession, including unusual streams of incongruous tones and vowels.

The results were analyzed and compared with the results from a control group of age-matched nonautistic children. The findings showed that, in the children with autism, there was a fraction of a second delay in the brain’s response while processing the rapid succession sounds and the unusual streams, giving researchers an insight into the dysfunction of the auditory processing system in autistic children.

“This delay in processing certain types and streams of sound may underpin the subsequent language processing and communication impairment seen in autistic children,” Roberts says.
He predicts that the signatures of autism found in brain activity will become biomarkers to improve classification of the disorder, and aid in treatment and therapy planning.

“We hope that in the future, these signatures will also be revealed in the infant brain to help diagnose autism and allow earlier intervention,” Roberts says.



New Treatment Eliminates Pain from Plantar Fasciitis

A study shows that combining an ultrasound-guided technique with steroid injection is 95-percent effective at relieving the common and painful foot problem called plantar fasciitis.

“There is no widely accepted therapy or standard of care for patients when first-line treatments fail to relieve the pain of plantar fasciitis,” says the study’s lead author, Luca M. Sconfienza, MD, from Italy’s University of Genoa. “Our new technique is an effective, one-time outpatient procedure.”

Plantar fasciitis, the most common cause of heel pain, is an inflammation of the connective tissue called the plantar fascia that runs along the bottom of the foot, from the heel to the ball of the foot. The condition accounts for 11 percent to 15 percent of all foot symptoms requiring professional care, and affects 1 million people annually in the United States.

Conservative treatments, which may take up to a year to be effective, include rest, exercises to stretch the fascia, night splints, and arch supports. When the condition does not respond to conservative treatments, patients may opt for shockwave therapy, in which soundwaves are directed at the area of heel pain to stimulate healing.

Shockwave therapy is painful, requires multiple treatments, and is not always effective. Complications may include bruising, swelling, pain, numbness or tingling, and rupture of the plantar fascia. In the most severe cases of plantar fasciitis, patients may undergo invasive surgery to detach the fascia from the heel bone.

For this study, Sconfienza and colleagues used a new ultrasound-guided technique, along with steroid injection, on 44 patients with plantar fasciitis that was unresponsive to conservative treatments. After injection of a small amount of anesthesia, the anesthetic needle is used to repeatedly puncture the site where the patient feels the pain.

This technique, known as dry-needling,  creates a small amount of local bleeding that helps to heal the fasciitis. Lastly, a steroid is injected around the fascia to eliminate the inflammation and pain. The technique is performed with ultrasound guidance to improve accuracy and to avoid injecting the steroids directly into the plantar fascia, which could result in rupture.

 After the 15-minute procedure, symptoms disappeared for 42 of the study’s 44 patients (95 percent) within three weeks. “This therapy is quicker, easier, less painful, and less expensive than shockwave therapy,” Sconfienza says.

“In cases of mild plantar fasciitis, patients should first try noninvasive solutions before any other treatments. But when pain becomes annoying and affects the activities of daily living, dry-needling with steroid injection is a viable option.”



MRI Shows New Types of Injuries in Young Gymnasts

Research shows that adolescent gymnasts are developing a wide variety of arm, wrist, and hand injuries that are beyond the scope of previously described gymnastic-related trauma.

“The broad constellation of recent injuries is unusual and might point to something new going on in gymnastics training that is affecting young athletes in different ways,” says the study’s lead author, Jerry Dwek, MD, an assistant clinical professor of radiology at the University of California, San Diego (USCD), and a partner of San Diego Imaging at Rady Children’s Hospital and Health Center.

Previous studies have reported on numerous injuries to the growing portion of adolescent gymnasts’ bones. However, this study uncovered some injuries to the bones in the wrists and knuckles that have not been previously described. In addition, the researchers note that these gymnasts had necrosis, or “early death,” of the bones of their knuckles.

“These young athletes are putting an enormous amount of stress on their joints and possibly ruining them for the future,” Dwek says. The radius is the bone in the forearm that takes the most stress during gymnastics. Due to damage to the radial growth plates, the bone does not grow in proportion to the rest of the skeleton and may be deformed.

Consequently, it is not unusual for gymnasts to have a longer ulna than radius. Some former gymnasts must undergo surgery to shorten the ulna and regain the proper fit of the wrist bones into the forearm. Dwek and coauthor Christine Chung, MD, a member of the radiology faculty at UCSD, used MRI to study overuse injuries seen in the skeletally immature wrists and hands of gymnasts.

The researchers studied wrist and hand images of 125 patients, ages 12 to 16, including 12 gymnasts with chronic wrist or hand pain. “We were surprised to be looking at injuries every step down the hand – all the way from the radius to the small bones in the wrist and on to the ends of the finger bones at the knuckles,” Dwek says.

“These types of injuries are likely to develop into early osteoarthritis.”He suggests that additional study is needed to understand how gymnastic stresses are causing these injuries. “It is possible that by changing the way that practice routines are performed, we might be able to limit the stress on the joints and on delicate growing bones,” Dwek says.



Gary J. Becker, MD, Named RSNA President

Gary J. Becker, MD, has been named president of the RSNA Board of Directors.  A professor in vascular and interventional radiology at the University of Arizona College of Medicine in Tuscon, Becker has served as executive director of the American Board of Radiology (ABR) since January.

He was elected to the ABR Board of Trustees in 2000. From 2006 to 2007, Becker served as its associate executive director for diagnostic radiology and subspecialties. As RSNA president, Becker hopes to continue his efforts to ensure the Society’s role as a leader in supporting new imaging technologies.

“RSNA will play a crucial role in advancing the science of quantitative imaging,” he says. “It is RSNA’s duty to educate its members and the medical community at large in how to best use important new technologies, informatics, and quantitative methods to benefit patients.”

Becker earned his medical degree in 1977 from the Indiana University (IU) School of Medicine in Indianapolis. He also completed an internship in internal medicine and his residency there. Soon after, Becker was appointed assistant professor, associate professor, and, ultimately, professor and chief of the vascular section in the radiology department at IU.

In 1990, Becker accepted a position as director of interventional radiology at the Baptist Cardiac & Vascular Institute of Miami, where, in 1998, he became assistant medical director, as well as medical director of research and outcomes.

In June 2004, Becker went on to become the branch chief of image-guided intervention in the Cancer Imaging Program of the National Cancer Institute (NCI). He remained with NCI for the next year-and-a-half, before finding a new home in Arizona. Becker has served on the editorial boards of many medical publications and has contributed as a manuscript reviewer for many more.

He was the founding editor of the Journal of Vascular & Interventional Radiology and was its editor in chief from 1990 to 1995. He has also been an active member of approximately two dozen professional medical organizations. He is a fellow of the American College of Radiology, as well as the Society of Interventional Radiology, who awarded him a gold medal in 2008.

Becker’s leadership at RSNA began with an appointment to the Refresher Course Committee, followed by the Society’s Public Information Advisory Board and Planning Committee for the Office of Research Development. He served on various research development committees and, from 1994 to 1998, was on the RSNA Research & Education Foundation’s Distinguished Roster of Grant Reviewers.

At RSNA annual meetings over the years, Becker was a speaker for two Opening Sessions, served on the panel of an Image Interpretation Session, and, in 2000, delivered the Annual Oration in Diagnostic Radiology. He was elected to the Board of Directors in 2001 and served as chairman of the Board in 2007 and president-elect in 2008.



Hedvig Hricak, MD, phd, Drhc, Becomes RSNA President-Elect

Hedvig Hricak, MD, PhD, Drhc, has been named president-elect of the RSNA Board of Directors. Hricak, who chairs the radiology department at Memorial Sloan-Kettering Cancer Center in New York City, is currently a professor of radiology at Weill Medical College of Cornell University, as well as an attending radiologist at Memorial Hospital in New York City.

As RSNA president-elect, Hricak vows to continue advancing radiology’s role in improving patient care in the United States and abroad. “RSNA maintains preeminence in the field of radiology because of its dedicated leadership, talented volunteers, and partners. We will continue to work to improve patient care through global initiatives in research, education, and communication,” she says.

Born in Zagreb, Croatia, Hricak earned her medical degree in 1970 from the University of Zagreb. She completed her internship and began her residency at Hospital M. Stojanovic, also in Zagreb, and came to the United States in 1972.

In 1977, Hricak completed her radiology residency at St. Joseph Mercy Hospital in Pontiac, Mich., followed by a fellowship in CT and ultrasound at Henry Ford Hospital in Detroit, where she subsequently became a senior staff member. Hricak received her PhD (DrMedSc) from the Karolinska Institute in Stockholm, Sweden in 1992.

In 2005, she received an honorary doctorate (Drhc) from the Ludwig Maximilian University of Munich. Hricak began her academic appointments in 1979 at the University of Michigan in Ann Arbor.

From 1982 to 2000, she was at the University of California, San Francisco, where she became a professor of radiology, urology, radiation oncology, obstetrics, gynecology, and reproductive sciences, as well as chief of the uroradiology section, and subsequently the abdominal imaging section.

Hricak has edited or co-edited 26 books and monographs, and authored or co-authored 127 monographs and book chapters and 463 original research reports, reviews, and editorials. She is an associate editor and editorial board member of multiple premier medical journals.

In addition, Hricak was an associate editor of Radiology from 1985 to 1993 and a consultant to the editor of Radiology from 1993 to 1997. At present, she is the principal investigator of two National Cancer Institute (NCI) grants and one NCI contract, three Department of Defense grants, and a number of private foundation grants.

Hricak is a member of both the Institute of Medicine of the National Academies and the Nuclear and Radiation Studies Board of the National Academy of Sciences. She is a fellow of the American College of Radiology, the International Society for Magnetic Resonance in Medicine (ISMRM), and the Society of Uroradiology.

Hricak has served as president of the Society for Advancement of Women’s Imaging (1997 to 1999), the California Academy of Medicine (1999), the Society of Uroradiology (2000 to 2003), and the New York Roentgen Society (2004 to 2005). She serves on the executive committee of the Academy of Radiology Research and on the advisory boards of numerous local, national, and international foundations.

In the course of her career, Hricak has received many awards, including the Marie Sklodowska-Curie Award from the American Association for Women Radiologists, the Beclere medal of the International Society of Radiology, the gold medals of the ISMRM and the Association of University Radiologists, and a Moroccan Merit Medal.

She is an honorary fellow of the Royal College of Radiologists and an honorary member of the British Institute of Radiology, the Croatian Academy of Science and Art, the German Radiological Society, the Austrian Roentgen Society, the Journées Françaises de Radiologie, and the Swedish Society of Medical Radiology.

A member of the RSNA Board of Directors since 2002, Hricak has been the liaison of publications and communications. Prior to her appointment to the Board, she was chair of RSNA’s Public Information Advisors Board and was a member of other RSNA public information committees. Hricak will serve as president of RSNA in 2010.



RSNA Announces Honored Lectures and Annual Oration Topics

The RSNA annually invites three eminent researchers to deliver honored lectures during the RSNA Scientific Assembly and Annual Meeting. This year’s presenters were Michael J. Welch, PhD, of St. Louis; Elizabeth G. McFarland, MD, of Chesterfield, Mo.; and Minesh P. Mehta, of Madison, Wis.


Eugene P. Pendergrass New Horizons Lecture

Nanoparticles hold great potential not only as diagnostic agents, but also as therapeutic agents, according to the RSNA 2008 New Horizons lecturer. “

The promise of nanoparticles results from their unique size and the ability to attach or encapsulate many different detection, targeting or therapeutic groups to the particles,” says Michael J. Welch, PhD, professor of radiology, chemistry, and molecular biology and pharmacology at the Mallinckrodt Institute of Radiology at Washington University in St. Louis. He also teaches biomedical engineering at the university.

Welch adds that radionuclides for PET and SPECT imaging can be attached to nanoparticles, as can probes for optical imaging and gadolinium or other metals used as MR contrast agents. The subject of Welch’s topic in his New Horizons Lecture was “Nanotechnology in the Future of Imaging: Prospects and Pitfalls.”

Currently, Welch is the principal investigator of the PET component of Washington University’s small animal imaging resource, one of the five original small animal imaging programs funded by the National Cancer Institute (NCI). He is also principal investigator of the NCI-supported radionuclide resource and co-principal investigator of integrated nanosystems for diagnosis and therapy, supported by the National Heart, Lung and Blood Institute.

Welch’s investigation into the rapid synthesis of positron-labeled organic chemicals is recognized as essential to the development of PET in the early 1970s. His contributions earned him the Society of Nuclear Medicine’s Benedict Cassen Award in 2004.

Since 1979, Welch has been the primary investigator of the study “Cyclotron-Produced Isotopes in Biology and Medicine,” supported by the National Institutes of Health. It is the longest continuously renewed research grant at Washington University, now approaching 50 years of progress.


Annual Oration in Diagnostic Radiology

In the decade-and-a-half since CT colonography, or virtual colonoscopy, was introduced, tremendous technological gains and validation trials of diagnostic performance have pushed the technique to new levels of potential.

“Although CT colonography can provide a time-efficient, noninvasive structural examination of the whole colon, the many achievements gained are countered by significant challenges to overcome,” says Elizabeth G. McFarland, MD, radiologist with Diagnostic Imaging Associates at St. Luke’s Hospital in Chesterfield, Mo.

Her presentation at the Annual Oration in Diagnostic Radiology was titled “CT Colonography: Achievements and Challenges.”

McFarland notes how, in the first decade of CT colonography development, she was among the researchers able to attain NCI or corporate funding to pursue optimization of 3-D endoscopic views and CT techniques, and conduct validation trials of enriched cohorts of patients for detection of colorectal polyps.

Novel work in 3-D imagery, computer-aided diagnosis, preparation-free patient protocols, and larger validation trials in screening cohorts followed.

Currently serving as medical director and director of CT colonography at St. Luke’s Center for Diagnostic Imaging, McFarland is also an adjunct professor in 3-D imaging and radiology in the Mallinckrodt Institute of Radiology at Washington University, where she previously spent 10 years as an associate professor.

McFarland is chair of the American College of Radiology (ACR) colon cancer committee and has served on the board of directors for the Association of University Radiologists and on interdisciplinary panels for the American Gastroenterology Association, American Medical Association, and ACR. McFarland also led recent efforts to establish colorectal screening guidelines for the American Cancer Society.


Annual Oration in Radiation Oncology

The origins of radiotherapy are in diagnostic radiology, and, while the two fields diverged over the last 30 years, advanced molecular imaging is now driving the need to re-integrate the two fields into a common strategy for improved patient outcome, according to the presenter of the RSNA 2008 Annual Oration in Radiation Oncology.

“Advances in molecular medicine and diagnostic radiology will be central to moving the field of radiation oncology to the ultimate goal of personalized medicine or theragnostic radiation oncology,” says Minesh P. Mehta, MD, professor of neurological surgery at the University of Wisconsin (UW) at Madison.

Mehta addressed this topic during his presentation “Alchemy, Early Detection, Precision Guidance and Radiotherapy,” at this year’s Annual Oration in Radiation. Earning international recognition for his investigation of innovative therapies for brain tumors, Mehta has explored techniques with radiosurgery, fractionated stereotactic radiotherapy, intensity-modulated radiation therapy, and image-guided radiation therapy.

He has also studied promising methods to overcome therapeutic resistance, such as using targeted agents in conjunction with radiotherapy. Through clinical patient care programs at UW, Mehta has chaired major international phase-three randomized studies.

Mehta is Eric Wolfe Professor of Human Oncology at UW. He serves at five of the university’s specialized cancer clinics and maintains staff appointments at nearly a dozen hospitals in Wisconsin and Illinois.



RSNA Awards Gold Medals

The  RSNA has conferred its highest honor, the Gold Medal, upon Peggy J. Fritzsche, MD, of Redlands, Calif.; Anthony V. Proto, MD, FACR, of Richmond, Va.; and Lee F. Rogers, MD, of Tucson, Ariz.

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.


Peggy J. Fritzsche, MD

At a very early age, Peggy J. Fritzsche, MD, decided to pursue a career in medicine. Her passion and commitment in medicine led her to a successful career of radiologic innovation and improving patient care.

RSNA President Theresa C. McLoud, MD, says she has always admired Fritzsche as a strong leader and tireless worker. “She has emphasized the commitment that radiology as a specialty must make to improving communications with our patients and referring clinicians.”

An RSNA member since 1978, Fritzsche joined the RSNA Board of Directors in 1995. In 2003, she became the Society’s second woman president. Fritzsche served as chair of the RSNA Research & Education Foundation Board of Trustees from 2005 to 2006 and has continued to serve on the Individual Giving Committee.

She is a past-president of the American Association for Women Radiologists and is an honorary member of the European Society of Radiology, as well as a corresponding honorary member of the Swiss Radiological Society.

“I found it a privilege to participate in RSNA from the beginning, but to be rewarded with the Gold Medal is pure joy,” Fritzsche says. “It is an honor to be recognized for the innovation, vision, whatever it is that I have been able to contribute to further the cause of radiology, and RSNA.”

Fritzsche received her medical degree from Loma Linda University in Loma Linda, Calif. Fritzsche completed her residency at White Memorial Medical Center in Los Angeles. Since 1986, she has been at Loma Linda University, where she is currently a professor of radiology. From 1991 to 2004, Fritzsche served as medical director of the Riverside MRI Center in Riverside, Calif.

There, she ran a successful private practice by introducing advanced MRI techniques, making patient comfort her priority. Fritzsche’s prototype office design, which allowed mid-field, open MRI to be available at the same location as high-field MRI to accommodate large and claustrophobic patients, became a model for MR practice in the 1990s.

During her time on the RSNA Board of Directors, Fritzsche helped launch the public information Web site, RadiologyInfo.org, jointly sponsored by RSNA and the American College of Radiology, and chaired the committee responsible for RSNA’s three-year radiology exhibit at Disney’s Epcot in Orlando, Fla.


Anthony V. Proto, MD, FACR

As the sixth editor of RSNA’s scientific medical journal, Radiology, Anthony V. Proto, MD, FACR, demonstrated qualities of consistency, accuracy, and intellectual integrity. “During his tenure as editor of Radiology, he brought the journal to new heights through his visionary leadership, dynamism, and dedication to the task at hand,” says RSNA President Theresa C. McLoud, MD.

“Being honored with the RSNA Gold Medal is an event that will never fade from my memory, an event I will always cherish,” says Proto. An RSNA member since 1973, Proto served as editor of Radiology from 1997 to 2007.

He has also been awarded honorary membership to the Rocky Mountain Radiological Society, Philadelphia Roentgen Ray Society, Canadian Association of Radiologists, Italian Society of Medical Radiology, and the Chicago Radiological Society. In addition, he has been a trustee and an assistant executive director of the American Board of Radiology.

He has published 288 articles, editorials, book chapters, and abstracts, as well as presented many lectures on both the national and international stages. Proto’s tenure as editor of Radiology was marked by major transformations that he brought to the publication.

He reformed the authorship criteria by modeling them on recommendations of the International Committee of Medical Journal Editors. He also streamlined the peer-review process and shifted to an online submissions and review system. Proto received his medical degree in 1971 from Yale Medical School in New Haven, Conn.

He completed a surgical department internship and radiology residency at the State University of New York Upstate Medical Center in Syracuse. It was there that he became chief resident in diagnostic radiology in 1974 and finished a fellowship in thoracic radiology in 1975. The following year, Proto transferred to San Antonio for military duty, where, as a major, he served as training officer in the U.S. Air Force.

At the Wilford Hall USAF Medical Center at San Antonio’s Lackland Air Force Base, Proto became the chief of diagnostic and chest radiology. He is currently a tenured professor in the radiology department at the Medical College of Virginia at Virginia Commonwealth University in Richmond.


Lee F. Rogers, MD

With an expertise in skeletal trauma imaging in adults and children and a passion for advocating responsible practice of radiology, Lee F. Rogers, MD, has earned the respect and admiration of many colleagues. RSNA President Theresa C. McLoud, MD, views Rogers as a mentor who has made a significant impact on her and others in the radiology field.

“Dr. Rogers is truly a renaissance man in radiology. He has served in numerous capacities. To his friends and professional colleagues, he is perhaps most admired for his unfailing good humor, collegiality, and high sense of professionalism,” she says. Rogers has been an active member of RSNA since 1966 and was first vice president of RSNA in 1991.

He has served as president of the American College of Radiology and has been active in numerous radiological organizations, such as the American Board of Radiology, Chicago Radiological Society, Association of University Radiologists, and the Society of Chairs of Academic Radiology Departments.

Other achievements include honorary memberships in a number of radiological societies, as well as RSNA Gold Medal awards. Rogers has published a two-volume text called Radiology of Skeletal Trauma, which is considered a “must read” among medical scholars around the world.
His career started in 1959 with a medical degree from Northwestern University Medical School in Chicago.

After enlisting in the U.S. Army Medical Corps, Rogers completed an internship at Walter Reed Army Medical Center in Washington, D.C., and a residency at Fitzsimons General Hospital in Denver. From 1963 to 1967, Rogers served at the 2nd General Hospital in Landstuhl, Germany, and the Brooke General Hospital in San Antonio.

He also entered the private practice of radiology at Baptist Memorial Hospital in San Antonio. In 1968, Rogers began his academic career at the Houston-based University of Texas (UT) Medical School, becoming an associate professor of radiology in 1971.

The following year, he accepted a position at UT Health Sciences Center and was appointed director of the residency-training program. Rogers returned to Northwestern University Medical School in 1974 as a professor and chair of the radiology department, where he remained for 21 years.

In 1995, he became an I. Meschan Distinguished Professor of Radiology at Wake Forest University School of Medicine in Winston-Salem, N.C., and served as editor in chief of the American Journal of Roentgenology until 2004. Rogers currently works as a clinical professor of radiology at the University of Arizona Health Sciences Center in Tucson.



RSNA Awards Honorary Memberships

The RSNA has awarded honorary membership to three individuals who have distinguished themselves as outstanding contributors to the field of radiology and its allied sciences. The recipients are Jian-Ping Dai, MD, from Beijing; Maximilian F. Reiser, MD, from Munich, Germany; and Gustav K. von Schulthess, MD, PhD, from Zurich, Switzerland.


Jian-Ping Dai, MD

Jian-Ping Dai, MD, is regarded by fellow radiologists as a major influence in the development and advancement of radiology practice in China. “Dr. Dai’s strong and thoughtful leadership of Chinese radiology has placed imaging in the forefront of medical specialties throughout the global community,” says RSNA President Theresa C. McLoud, MD.

Dai says he accepts this honor on behalf of all the radiologists in China. “Thirty years ago, the Chinese people resolutely embarked on the historic journey of reform and an opening up to the international community,” he says.

“This new policy afforded me the opportunity to travel abroad and start my ‘personal learning in the global community’ and to work with international colleagues toward universal standards of quality care for our patients.”

Dai has been an RSNA member since 1991 and is active in many organizations within China. He served as president of the Chinese Society of Radiology and as chief editor of the Chinese Journal of Radiology from 1996 to 2005.

In 1987, Dai established the Chinese Society of Neuroradiology. He currently serves as vice president of the Chinese Medical Association, Chinese Hospital Association, Chinese Doctor Association, and China Association of Medical Equipment.

In addition to being active in many radiology organizations, Dai was vice minister of the Games Services Department for the Beijing Organizing Committee of the 2008 Olympic Games. Dai received his medical training and completed his radiology residency at Beijing Xuanwu Hospital.

He completed his fellowship in the neuroradiology division of the Department of Radiology at Massachusetts General Hospital, in Boston. Upon returning to China, Dai worked with C.C. Wang, MD, to create China’s first full-time neuroimaging center and introduced neurointerventional therapy to the country.

Currently, Dai is a professor of neuroradiology in the Beijing Neurosurgical Institute of Beijing Tiantan Hospital at the Capital University of Medical Services. He also serves as the president of Beijing Tiantan Hospital, as well as the principal advisor for radiology to the Chinese Ministry of Health.


Maximilian F. Reiser, MD

Maximilian F. Reiser, MD, has made his mark among fellow radiologists by becoming a leader in European radiology and an internationally recognized scholar on the clinical applications of CT and MR in the body. “Those of you who know or have worked with Dr. Reiser recognize his energy, strong work ethic and dedication to scholarship and excellence,” says McLoud.

An RSNA member since 1990, Reiser has been a member of the RSNA Public Information Advisors Network and, at RSNA 2007, served on the panel for the Sunday Image Interpretation Session and moderated a special focus session on radiation dosage.

 “RSNA, both the organization and the scientific and educational meeting, are exemplary and outstanding. Receiving honorary membership from the distinguished society is more than I would ever have dreamed,” Reiser says.

After receiving his medical degree from Ludwig Maximilian University in Munich, Reiser went on to complete a residency at the Technical University of Munich.

Academic appointments include professor and chair of radiology at the University of Bonn, chair of the academic promotion committee of the Munich University medical faculty, and chair of both the vascular and breast center of Munich University Hospitals.

He is currently a professor and chair of the Department of Clinical Radiology at Ludwig Maximilian University of Munich and was recently elected dean of the Munich University medical faculty.
Reiser supervised the European Congress of Radiology (ECR) as it moved forward in creating a new program designed to encourage more interdisciplinary exchange.

Under his guidance, ECR was able to draw more than 17,000 attendees from more than 90 countries and now is the second largest radiologic congress worldwide. Reiser has been a part of the ECR Board of Directors since 2000 and is currently the second vice president of the European Society of Radiology.

In addition to the RSNA honorary membership, Reiser has received the Holthusen Ring of the German Radiological Society and honorary membership in the Austrian Radiological Society, Hellenic Radiological Society, Korean Radiological Society, and U.K. Royal College of Radiology.

He is also a member of the Leopoldina, the German National Academy of Sciences. Reiser has authored or co-authored more than 700 peer-reviewed research manuscripts and reviews, as well as five textbooks.


Gustav K. von Schulthess, MD, PhD

Gustav K. von Schulthess, MD, PhD, is internationally known as a radiology pioneer, leader, and visionary. His accomplishments mirror his dedication and passion to the field. “Dr. von Schulthess’ leadership serves as an example of his endless enthusiasm, vigor, and dedication to education,” says McLoud.

Additionally, McLoud says, “All of these attributes are combined with his charm, enthusiasm, and depth of knowledge.” An RSNA member since 1985, von Schulthess was the president of the European Society of Magnetic Resonance in Medicine and Biology and received an honorary membership in 1996.

He served as president of the Swiss Society of Nuclear Medicine from 1996 to 1999 and received an honorary degree in medicine from the University of Copenhagen in 2007. “My education and affiliations have been at the crossroads of Europe and North America,” von Schulthess says. “I am grateful to have imbibed the American spirit, and I am proud that RSNA honors my ‘go-between’ role in this way.”

During his graduate education, von Schulthess pursued both medicine and physics, enrolling in the Division in Health Sciences and Technology program through Boston-based Harvard Medical School and Massachusetts Institute of Technology (MIT), in Cambridge.

In 1980, he graduated with a physics doctorate from MIT and a medical degree from Harvard. Upon returning to Switzerland, von Schulthess trained in internal medicine at University Hospital Zurich before pursing a residency in nuclear medicine.

He served as a junior staff member at University Hospital Zurich, a research fellow at the University of California, San Francisco, and the director of body MRI at University Hospital Zurich, where he was named acting director of the Division of Nuclear Medicine in the Department of Medical Radiology.

von Schulthess is currently the director of the Division of Nuclear Medicine and the co-director of the MR Centre at University Hospital Zurich, Switzerland. He is also a professor of nuclear medicine at the University of Zurich and is the co-founder and chief scientific advisor of Timaq, a company providing expertise for the pharmaceutical industry and contract research organizations in clinical trials.

von Schulthess is most commonly known internationally as the co-director of the International Diagnostic Course in Davos, Switzerland, which draws more than 1,000 participants and more than 40 top-ranking radiology and nuclear medicine professors.



CT Colonography Offers One-Stop Screening for Cancer and Osteoporosis

New research reveals that CT colonography, also known as virtual colonoscopy, has the potential to screen for two diseases at once – colorectal cancer and osteoporosis, both of which commonly affect adults over age 50.

“With CT colonography, in addition to screening for colorectal cancer, we were able to identify patients with osteoporosis,” says lead author Rizwan Aslam, MBChB, assistant clinical professor of radiology at the University of California, San Francisco.

CT colonography, an imaging study performed to detect pre-cancerous polyps in the large intestine, begins with an abdominal CT scan, which creates cross-sectional images of all structures in the abdomen, including the spine. Computer software then arranges the CT images to create an interior or “fly-through” view of the colon.

Using the same CT images, another software application can create 3-D images of the spine, allowing bone mineral density to be measured. Low bone mineral density is usually associated with osteoporosis, a disease in which bones become fragile and more likely to break. Most physicians recommend that adults undergo CT colonography or conventional colonoscopy every seven to 10 years, beginning at age 50.

In the study conducted at the San Francisco Veterans Administration Hospital, the researchers evaluated the results of 35 patients who underwent CT colonography and bone mineral density testing with dual-energy X-ray absorptiometry (DEXA), a standard bone density screening tool.

Patients included 30 males and five females, ranging from ages 54 to 79. The results of the study showed excellent agreement between the DEXA bone mineral density scores and the data generated through the CT colonography study. “The bone density measurements obtained from CT colonography were comparable to the DEXA results,” Aslam says. “Both tests identified osteoporotic bones.”

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, 10 million Americans over age 50 have osteoporosis. Approximately 34 million Americans are at risk due to low bone mass. Detecting osteoporosis early provides for early intervention and treatment.

“CT colonography isn’t a replacement for DEXA testing, but it could be a way to screen more people for osteoporosis,” says Aslam. “When an individual undergoes CT colonography, we can also obtain a bone density measurement with no additional radiation and at minimal cost.”



Patient Photos Spur Radiologist Empathy and Eye for Detail

Including a patient’s photo with imaging exam results may enable a more meticulous reading from the radiologist interpreting the images, as well as a more personal and empathetic approach. “Our study emphasizes approaching the patient as a human being and not as an anonymous case study,” says lead author Yehonatan N. Turner, MD, radiology resident at Shaare Zedek Medical Center in Jerusalem.

Many radiologists have limited contact with patients. A referring physician will order imaging exams, such as MRI or CT, and the radiologist interprets the results, never having met the patient. Technological advances have further distanced the radiologist from interaction with the patient.

With the advent of teleradiology, radiologists are now able to view images from remote locations via the Internet or satellite. “We feel it is important to counteract the anonymity that is common in radiologic exams, especially with the growth of teleradiology,” Turner says.

The researchers set out to determine if the addition of a patient’s photograph to the file would affect how radiologists interpreted the results. For the study, 318 patients referred for CT agreed to be photographed prior to the exam. The images of the patients were added to their files in the hospital’s PACS, a network for storage and retrieval of medical images.

The photograph appeared automatically when a patient’s file was opened. After interpreting the results of the exams, 15 radiologists were given questionnaires to gather data about their experience. All 15 radiologists admitted feeling more empathy toward the patients after viewing their photos.

In addition, the photographs revealed medical information, such as suffering or physical signs of disease. More importantly, the results showed that radiologists provided a more meticulous reading of medical image results when a photo of the patient accompanied the file.

Incidental findings are unexpected abnormalities found on an image that may have health implications beyond the scope of the original exam. In order to assess the effect of the photographs on interpretation, 81 examinations with incidental findings were shown in a blinded fashion to the same radiologists three months later, but without the photos.

Approximately 80 percent of the radiologic incidental findings reported originally were not reported when the photograph was omitted from the file. The radiologists involved in the study commented that, while the addition of the photo did not lengthen the time spent reading, it was a factor in how meticulously they interpreted the images.

All 15 radiologists agreed that the inclusion of a photograph in a patient’s file should be adopted into routine practice. The photos can also be included in long-distance teleradiology practices. “The photos were very helpful both in terms of improving diagnosis and the physicians’ own feelings as caregivers,” Turner says. “Down the road, we would like to see photos added to all radiology case files.”



New Imaging Technology Targets Hard-to-Detect Breast Cancers

A study has found that breast-specific gamma imaging (BSGI) is effective in the detection of cancers not found on mammograms or by clinical exam.

“BSGI can identify the most difficult to detect breast cancer – invasive lobular carcinoma,” says lead author Rachel F. Brem, MD, professor of radiology and director of the Breast Imaging and Interventional Center at the George Washington University Medical Center in Washington, D.C.

She continues, “It also can help us detect additional lesions of all types of breast cancer in women whose mammograms show only one suspicious lesion.”

Breast cancer affects more women than any other non-skin cancer and, according to the American Cancer Society, accounts for more than 40,000 deaths annually in the United States. Most experts agree that the best way to decrease breast cancer mortality is through early detection using mammography and clinical breast exam.

However, some cancers are difficult to detect with mammography and clinical exam, particularly in the earliest stage when treatment is most effective. While mammography findings are characterized by the difference in appearance between normal and suspicious breast tissue, BSGI findings are based on how cancerous cells function.

“It is this physiological approach to breast cancer diagnosis that allows for improved cancer detection,” Brem says. BSGI is an emerging molecular imaging technology using a high-resolution gamma camera that allows for imaging with very mild compression of the breast, along with an injection of a low-dose nuclear material called a radiotracer, which is absorbed by the cells.

Because cancerous cells have a higher rate of metabolic activity, the tracer is taken up by these cells at a higher level than in normal cells. Brem and colleagues reviewed the records of 159 women who had at least one suspicious or cancerous lesion found by mammography or physical exam and had undergone BSGI to determine if additional lesions were present.

BSGI results showed an additional suspicious lesion missed by mammography and physical exam in 46 (29 percent) of the women. In 14 (36 percent) of the 39 women who underwent biopsy, the newly discovered lesions were cancerous. “The data suggest that BSGI allows for the diagnosis of more and earlier breast cancers,” Brem says.

She points out that BSGI is not meant to replace mammography, but to be used as an adjunct to mammography. “It is an excellent tool for locating difficult-to-detect cancers and for screening high-risk women who have normal mammograms and physical examination,” Brem adds.



Stress Disorders Affect Memory Processing

Researchers using functional MRI (fMRI) have determined that the circuitry in the area of the brain responsible for suppressing memory is dysfunctional in patients suffering from stress-related psychiatric disorders.

“For patients with major depression and other stress-related disorders, traumatic memories are a source of anxiety,” says Nivedita Agarwal, MD, radiology resident at the University of Udine in Italy, where the study is being conducted, and research fellow at the Brain Imaging Center of McLean Hospital in Belmont, Mass., and the psychiatry department at Harvard Medical School in Boston.

Agarwal continues, “Because traumatic memories are not adequately suppressed by the brain, they continue to interfere with the patient’s life.” Agarwal and colleagues used brain fMRI to explore alterations in the neural circuitry that links the prefrontal cortex to the hippocampus, while study participants performed a memory task.

Participants included 11 patients with major depression, 13 with generalized anxiety disorder, nine with panic attack disorders, five with borderline personality disorder, and 21 healthy individuals.

All patients reported suffering varying degrees of stressful traumatic events, such as sexual or physical abuse, difficult relationships or “mobbing” – a type of bullying or harassment – at some point in their lives. After reviewing a list of neutral word pairs, each participant underwent fMRI.

During imaging, they were presented with one of the words and asked to either recall or to suppress the memory of its associated word. The fMRI images revealed that the prefrontal cortex, which controls the suppression and retrieval of memories processed by the hippocampus, showed abnormal activation in the patients with stress-related disorders compared to the healthy controls.

During the memory suppression phase of the test, patients with stress-related disorders showed greater activation in the hippocampus, suggesting that insufficient activation of the prefrontal cortex could be the basis for inadequate suppression of unwanted traumatic memories stored in the hippocampus.

“These data suggest that the mechanism for memory suppression is dysfunctional in patients with stress-related disorders primarily because of an alteration of the prefrontal cortex,” Agarwal says. “These patients often complain of poor memory, which might in part be attributed to this altered circuitry.”

According to Agarwal, fMRI is an important tool in understanding the neurobiological basis of psychiatric disorders and in identifying imaging markers to psychiatric disease, helping clinicians target specific parts of the brain for treatment.



Radiologists Diagnose Teens’ Self-Embedding Disorder

Minimally invasive, image-guided treatment is a safe and precise method for removal of self-inflicted foreign objects from the body, according to the first report on “self-embedding disorder,” or self-injury and self-inflicted foreign body insertion in adolescents.

“Radiologists are in a unique position to be the first to detect self-embedding disorder, make the appropriate diagnosis, and mobilize the healthcare system for early and effective intervention and treatment,” says the study’s principal investigator, William E. Shiels II, DO, chief of the radiology department at Nationwide Children’s Hospital in Columbus, Ohio.

Self-injury, or self-harm, refers to a variety of behaviors in which a person intentionally inflicts harm to his or her body without suicidal intent. It is a disturbing trend among adolescents, particularly girls, in the United States.

Prevalence is unknown because many cases go unreported, but recent studies have reported that 13 percent to 24 percent of high school students in the U.S. and Canada have practiced deliberate self-injury at least once.

More common forms of self-injury include cutting of the skin, burning, bruising, hair-pulling, breaking bones or swallowing toxic substances. In cases of self-embedding disorder, objects are used to puncture the skin or are embedded into the wound after cutting.

Shiels and colleagues studied 19 episodes of self-embedding injury in 10 adolescent girls, ranging from ages 15 to 18. Using ultrasound and/or fluoroscopic guidance, interventional pediatric radiologists removed 52 embedded foreign objects from nine of the patients.

The embedded objects included metal needles, metal staples, metal paperclips, glass, wood, plastic, graphite (pencil lead), crayon, and stone. The objects were embedded during injuries to the arms, ankles, feet, hands, and neck. One patient had self-embedded 11 objects, including an unfolded metal paperclip more than 6 inches in length.

Ultrasound guidance allowed the researchers to detect the presence and location of wood, crayons, and plastic objects not detectable on X-ray examinations. Removal was performed through small incisions in the skin that left little or no scarring and was successful in all cases, without fragmentation or complications.



Robotic Technology Improves Stroke Rehabilitation

Research scientists using a novel, hand-operated robotic device and functional MRI (fMRI) have found that chronic stroke patients can be rehabilitated. This is the first study using fMRI to map the brain in order to track stroke rehabilitation.

“We have shown that the brain has the ability to regain function through rehabilitative exercises following a stroke,” says A. Aria Tzika, PhD, director of the NMR Surgical Laboratory at Boston-based Massachusetts General Hospital (MGH) and Shriners Burn Institute and assistant professor in the surgery department at Harvard Medical School in Boston.

She is an affiliated member of the Athinoula A. Martinos Center for Biomedical Imaging in the Department of Radiology at MGH, where the research is ongoing. “We have learned that the brain is malleable, even six months or more after a stroke, which is a longer period of time than previously thought,” Tzika says.

According to the Centers for Disease Control and Prevention, stroke is the third leading cause of death in the United States, and a principal cause of severe long-term disability. Approximately 700,000 strokes occur annually in the United States, and 80 percent to 90 percent of stroke survivors have motor weakness.

Previously, it was believed that there was only a short window of three to six months following a stroke when rehabilitation could make an improvement. “Our research is important because 65 percent of people who have a stroke affecting hand use are still unable to incorporate the affected hand into their daily activities after six months,” Tzika says.

To determine if stroke rehabilitation after six months was possible, the researchers studied five right-hand dominant patients who had strokes at least six months prior that affected the left side of the brain and, consequently, use of the right hand.

For the study, the patients squeezed a special MR-compatible robotic device for an hour a day, three days per week, for four weeks. fMRI exams were performed before, during, upon completion of training, and after a nontraining period to assess permanence of rehabilitation.

fMRI measures the tiny changes in blood oxygenation level that occur when a part of the brain is active. The results showed that rehabilitation using hand training significantly increased activation in the cortex, which is the area in the brain that corresponds with hand use.

Furthermore, the increased cortical activation persisted in the stroke patients who had exercised during the training period but then stopped for several months. “These findings should give hope to people who have had strokes, their families, and the rehabilitative specialists who treat them,” Tzika says.



Portable CT Increases Chance of Stroke Survival and Recovery

A study conducted at North Shore Medical Center (NSMC)-Salem Hospital in Salem, Mass., has found that the availability of a portable eight-slice CT scanner in an emergency room can significantly increase the number of stroke victims who receive a potentially life-saving treatment.

“The hospital’s acquisition of a portable CT scanner facilitated more rapid assessment of acute stroke patients and is anticipated to increase the number of patients to whom thrombolytic therapy can be administered,” says the study’s lead author, David B. Weinreb, MD, now a resident physician in the radiology department at Hospital of Saint Raphael in New Haven, Conn.

According to the National Institute of Neurological Disorders and Stroke (NINDS), stroke is the third leading cause of death in the United States, and more than 700,000 cases of stroke are diagnosed annually. The most common kind of stroke, ischemic stroke, occurs when a blood clot blocks a blood vessel in the brain.

Such strokes can be treated with thrombolytic therapy, using a drug called tPA that dissolves the blockage. However, the window of opportunity to safely administer the medication is generally considered to be just three hours. Also, it is important to determine that there is no bleeding in the brain before administering tPA.

One out of six strokes is caused by bleeding rather than clotting. “tPA is usually the only shot we have at clot-induced ischemic strokes,” Weinreb says. “But it needs to be administered in a closely monitored situation, because the drug can have extremely adverse effects in those patients whose strokes are instead due to bleeds.”

Before a patient receives tPA, a head CT must be performed to ensure there is no bleeding in the brain. NINDS recommends that patients who arrive in the ER with signs of acute stroke undergo CT imaging within 25 minutes. For the study, Weinreb and colleagues began using a portable CT scanner to assess stroke patients in the ER of NSMC-Salem Hospital.

During the month prior to the acquisition of the portable scanner, and for a four-month period following its installation, researchers measured how much time elapsed between a physician order for a head CT and performance of the scan.

The availability of the CT scanner in the hospital’s ER reduced the time between the order and exam from 34 minutes to 15 minutes, a reduction of 54 percent. Based on simulation modeling, the researchers estimated that this improvement would increase by 86 percent the number of stroke patients able to be treated with thrombolytic therapy within the three-hour window.

According to Weinreb, most stroke patients are taken to relatively small community hospitals where access to CT scanning may be limited. When a CT scanner is available, it is not always in proximity to the ER, making transportation of critically ill patients to the radiology department both difficult and time-consuming.

“A portable eight-slice CT can be easily added and used to accurately identify a head bleed in a stroke or trauma patient,” Weinreb says. “This new technology is able to solve a very important problem for a community hospital, where the majority of stroke victims are being treated.”



New Mammography Technology Effective in Detecting Breast Cancer


A study has found that positron emission mammography (PEM), a new technique for imaging the breast, is not affected by either breast density or a woman’s hormonal status, two factors that limit the effectiveness of standard mammography and MRI at detecting cancer.

“The ability of PEM to detect cancer does not appear to be adversely affected by breast density, hormone replacement therapy or menopausal status,” says lead researcher Kathy Schilling, MD, director of breast imaging and intervention at the Center for Breast Care at Boca Raton Community Hospital in Florida.

Furthermore, she says, “The sensitivity of PEM is equal to or better than breast MRI, and PEM has fewer false-positive results.” The ability of X-ray mammography, a standard screening tool for breast cancer, to detect lesions is reduced when performed on dense breasts, where tissue is less fatty and more glandular.

Breast MRI is effective at detecting cancer in dense breasts and is increasingly being used to screen women at high risk for breast cancer. However, MRI has a high incidence of false-positive test results that indicate cancer is present when it is not.

Researchers believe these false positives are due in part to hormonal changes that occur during a woman’s menstrual cycle. “Unless the MRI is performed on day seven through 14 of a woman’s cycle, reading MRI images is extremely difficult,” Schilling says.

She continues, “This is a significant problem with breast MRI.” Because hormones do not have the same effect on PEM results, Schilling believes the imaging technique could play a significant role both in preoperatively evaluating breast cancer patients and in screening high-risk patients.

In the study, 208 patients with breast cancer underwent PEM, an application of high-resolution breast PET, in which a small amount of radioactive material is injected into the body to measure metabolic activity and determine the presence of disease.

The researchers used a PET unit specially developed for the breast and small body parts to perform the PEM exam. Of 189 malignant lesions imaged, PEM detected 176, for an overall sensitivity rate of 93 percent. Fifteen percent were ductal carcinoma in situ, a noninvasive cancer confined to the ducts of the breast; 85 percent were invasive cancer.

PEM successfully detected cancer in 100 percent of fatty breasts, 93 percent of dense breasts, 85 percent of extremely dense breasts, 93 percent of women both with and without a history of hormone replacement therapy, 90 percent of pre-menopausal women, and 94 percent of post-menopausal women.

According to Schilling, PEM is well-tolerated by patients, who sit upright during the exam and are not alone or closely confined as they would be during an MRI exam. While breast MRI exams produce more than 2,000 images to be interpreted, PEM produces just 48 images that can be correlated with a woman’s mammogram.

“PEM is easier to use, easier to interpret, and easier on the patients than MRI,” Schilling says. “It is also ideal for those patients whose MRI is difficult to interpret due to hormonal influences, women with implants, patients with metal in their bodies, or patients who suffer from claustrophobia. It is exciting that we now have a functional imaging approach with high sensitivity that compliments our current anatomic imaging modalities.”