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.