There's just something energizing about attending a conference and having an opportunity to network with clinicians and chat with the readers of rt image. Last week's Leading Edge in Diagnostic Ultrasound 2010 gave the rt image staff a perfect opportunity to hit the road for a day and head down to Atlantic City's Borgata Hotel Casino and Spa. It was well worth the couple hour drive from our suburban Philadelphia headquarters to absorb the educational sessions and spend time in our exhibit hall booth meeting and greeting the approximately 1,200 attendees. With the casino serving as a backdrop, you had to pass by the glitz, bells, whistles, blinking lights and sensory overload from the slot machines and gaming tables on the way to the escalator that led to the conference. The headlines pretty much write themselves: "Leading Edge hits the Jackpot," "Full House at Annual Conference," "Ultrasound is on a Roll." You get the point. This annual educational conference, hosted by the Jefferson Ultrasound Institute, part of the Thomas Jefferson University and Hospitals in Philadelphia, delivered on its goal to provide overviews of hot topics and updates on major specialty areas. The program included sessions on women's imaging, musculoskeletal ultrasound, vascular ultrasound, and contrast agents. I even had a few moments to chat with program director Barry B. Goldberg, MD, a professor of radiology at Thomas Jefferson University Hospital, who put together an informative program and attracted speakers from his facility and a few from far flung locales such as California, Arizona and even London. David Cosgrove, MBBCh, piled up the frequent flyer mileage by hopping over the pond from the Hammersmith Hospital in London to present on contrast imaging. I logged most of my time in the educational sessions that touched on advances in obstetrics and gynecology ultrasound. And after listening to presentations by David Nyberg, MD, from The Fetal & Women's Center of Arizona in Scottsdale, and Ana Monteagudo, MD, from the New York University School of Medicine and Bellevue Hospital in New York, I was left with a new appreciation of the difficulties of diagnosing and assessing fetal abnormalities. For me, and undoubtedly for many of the other physicians, sonographers and vascular technologists who attended, it was time well spent. Look for more coverage of The Leading Edge in Diagnostic Ultrasound conference in the digital edition of our June 7 issue.

- Scott Huelskamp, Editor

Posted by: Kelly Olsen-Stanko

I'm a sucker for Apple products. Not for the obvious reasons -- I don't care about what color the iPod comes in, in fact I actually never had an iPod -- I just genuinely enjoy their simple user interfaces and operating systems, pristine graphics, and sleek designs. Don't forget about durability either, there's a 2006 hand-me-down Macbook being passed around in my family that's in perfect operating condition.

With the release of the iPad and the recent next-generation iPhone snafu, my Apple senses have been tingling overtime.

No, I don't have an iPad (...yet), but I do like to look at them, like this video showing the unique influence the device has over cats.

Earlier this week, radRounds posted a different kind of look at the iPad: an "under the hood" X-ray.

Isn't she lovely? Now, on to the iPad MRI...kidding!

X-ray art and industrial imaging are of course nothing new, but it's always neat to see the inner workings of particularly popular or common things, at least to me. But what about you, are inanimate object scans a tired subject in radiology now, or does curiosity come with every new device or object scanned?

And how about your devices, ever X-rayed your cell phone for fun? Drop a line and tell us your stories.

Posted by Kelly Olsen-Stanko

This week, landmark legislation for healthcare reform was signed into law. As the bill makes it's final pass though the House for approval today, much of America, including the radiology industry, is still in debate.

The reform bill addresses many healthcare issues of access and affordability. Some of the bill's most controversial and more popular elements include: extended insurance coverage for young adults until the age of 26 under their parents' plan; insurance companies are barred from denying coverage to children for pre-existing conditions; and an individual health mandate requiring proof of insurance by 2014.

The American Society for Radiation Oncology (ASTRO) is applauding these reform measures. In a press release from Tuesday, Tim R. Williams, MD, chairman of ASTRO, said: "We believe that the insurance reforms will aid in early cancer diagnosis and prevention. Maintaining access to coverage for patients and cancer survivors will ultimately save lives. We look forward to working with Congress and governmental agencies to develop comparative effectiveness programs to improve quality care for patients."

But in order to help fund coverage, prevention, and implement programs, taxes and fees are being placed on related services and industries. While teenage girls across the nation may be outraged over the 10 percent tax on tanning services, pharmaceutical and insurance companies making more than $5 million in sales per year must deal a heftier charge – an annual fee based on their market shares, which is expected to result in billions of dollars. Finally, the medical manufacturer's device tax is still causing waves. This 2.3 percent excise tax will be placed on all kinds of device manufacturers, including imaging and radiology equipment vendors, starting in January of 2013.

There have been many critics of the device tax who say that it will stifle innovation and small businesses by forcing them to cut their research and development funds and lay off employees. None have been more vocal about this than the Medical Device Manufacturer's Association.

On Sunday, MDMA released a statement expressing these exact concerns and offered their own suggestions. "If eliminating the tax is not possible," reads the release, "structuring it to provide relief for smaller companies is critical."

Earlier this year for my article on refurbished equipment, I spoke with MDMA's director of federal affairs, Thomas Novelli. He reiterated these same sentiments. You can read the rest of his comments and the article here.

So, what are your feelings? How do you think you will be impacted at work and how will these and other measures in the bill affect radiology, for better or worse?

By Kelly Olsen-Stanko

Last night I came across this image , which I thought was a picture. The library nerd in me was so excited, and I awed at the beauty of it.

Then I learned it wasn't a picture at all, but computer generated imagery (CGI) made completely from 3-D and architecture software. This image, conceived by Olivier Charles, Armel Neouze, and Jacques Gelez, won the Master Award for Interior Architecture in EXPOSÉ 7, a digital art book series. It depicts the creators' vision of the Stockholm Public Library.

So unfortunately for all of us, it doesn't exist. But this isn't the first time I've been duped by the Internet. A few months ago, I came across a product while looking to solve some space and laundry issues in my apartment. While I can't exactly recall (or find a picture) of the concept item, it was a washer and dryer set that was built into furniture. I was thrilled that I discovered something that fit my exact need and looked stylish. Only later did I find out that this, too, was just a concept piece and that every item on the site only existed virtually or as prototypes.

I know that similar steps are taken when designing and unveiling new radiology systems and equipment, especially since they're usually marketed before they've been FDA-cleared for commercial sale. So, are there any products you particularly like that have been at trade shows like RSNA this year, only to find out they're not for sale yet? Do you have ideas of your own for radiology that you wish would be become a reality?

Posted by: Bob Stott

Every fall, my dad gets the family together for one weekend camping trip – as he puts it, "a last chance to get away from everyone before we're trapped in with them for the winter." In years past, these trips to the great outdoors have meant primarily one thing: person-to-person communication.

Cell phones, BlackBerries, and PDAs had no service and no outlets to recharge them, televisions at best had one grainy basic cable channel, and the nearest (and most audible) radio station had a strictly 1960s classic rock format. In desperation, our younger generations were forced to return to the primal basics and, some perhaps for the first time, engage our parents and relatives in actual open, face-to-face communication. No texting. No constant e-mail updates. No escaping in online games.

However, even the expanse of the great outdoors doesn't seem to be much of a barrier against the flood of portable technology – at this year's camping trip, most of the younger children's cellular devices had direct satellite connections and batteries that could last for days, as they sat quietly, texting each other across the campfire.

And right there, it stares at me: the blinding contradiction. While we insist that our world is becoming increasingly complex, we have instead created a communications culture that has decreased the time available for us to sit and think, uninterrupted. We are ever primed to receive a quick message to which we are expected to give a rapid response – never mind the necessities of conversation, the back of forth of actual human communication with the underlying subtle messages, emotions, etc. I think my younger cousins may never know another way to think and interact.

For example, we can spend hours keeping up with our e-mails. A friend once told me, "I look at my watch to check the time. I look at my BlackBerry to check on my life." Its frightening to think about. People become alienated from their own physical experience and anxious about watching a virtual testament of their lives scrolling along faster than they can handle. Over time, I've watched 'screen addiction' – whether its a laptop, palmtop, cell phone or BlackBerry – consume people. We learn to see ourselves as one with our devices: always on, always uploading, always updating status, profile, life.

Many of today's kids get cell phones from their parents and more than likely I will follow suit when I have children (if I haven't implanted tracking devices in them by that point, of course). However, merely by extension of the device, kids are never quite alone, never having to count on themselves, or be wary of getting lost – not with a parent on speed dial. This is a comfortable element in a dangerous world, yet there is a price to pay in the development of autonomy.

There, at the campfire, it dawns on me how much many of these children can't be "alone" – cut off from their digital identity, tied up in e-mail, status updates, and social networking, I don't think many of them know how to act in a legitimate social encounter. How do you express an emotion verbally that usually only requires a symbol – one emoticon of the curt range of happy and sad faces – to say in a text message?

I think about their emotional development, these kids growing up with dolls in one hand and a cellular device in the other: when the breadth of human emotions is reduced to a shorthand of emoticon emotions, and reformatted for the small screen, how much is left out, presumably floating in cyberspace, in the process?

By Mark D. Marotta

Some time back, I wrote an article for rt image about the looming molybdenum-99 (Mo-99) supply situation. I've since posted a couple of blogs on this topic, which was also included as one of our "25 Most Influential in Radiology" for 2009.

As a quick refresher, Mo-99 is the precursor to technetium-99b, a radioisotope used in 80 percent of diagnostic and nuclear medicine procedures.

Around the time that my original article appeared in early June, there was a shutdown at the Chalk River reactor in Canada, one of a half-dozen facilities worldwide that produces Mo-99 for use in the U.S. Later in the summer, another reactor, in Petten, The Netherlands, went offline for routine maintenance, but it has since reopened.

The Society of Nuclear Medicine (SNM) in Reston, Va., has conducted a survey looking at how nuclear pharmacies have been affected by the Mo-99 supply shortage. Here is an SNM press release about the survey results.

According to the survey results, there were 97 respondents. Nearly 60 percent of pharmacies reported that they had been affected by the Mo-99 shortage; only 1.15 percent reported no effect. (The results released by the SNM do not explain why the numbers do not add up to 100 percent.)

In response to a question about whether they had alternate sources of Mo-99, a little over 29 percent said they did. Nearly 22 percent of those respondents indicated they went to a different manufacturer.

Another question asked respondents what percentage of prescriptions for Tc-99m radiopharmaceuticals they had been able to fill. Nearly 19 percent said 76 percent to 100 percent, and almost 21 percent indicated 52 percent to 75 percent. Among those unable to fill prescriptions for Tc-99m or Mo-99, 36.21 percent of respondents said they expected the interruption to last more than one month.

The survey also respondents to indicate all changes they had made because of the shortage. The list of answers included (but was not limited to): rescheduling patient orders (76.29 percent), order cancellation (64.95 percent), changes in the radiopharmaceutical used (82.47 percent), decrease in dosage (81.44 percent), and so forth. Among those indicating a change in the radiopharmaceutical used, 82.47 percent reported using thallium-201 instead of Tc-99m for cardiac imaging procedures.

According to the SNM's press release, its president,Michael M. Graham, MD, PhD, says even a day's delay of a scanning procedure can have a serious effect on care. Robert Atcher, PhD, MBA, who chairs the SNM's task force on domestic isotope availability, calls the situation "untenable."

Posted by: Stephanie Twining

It's finally out – rt image's choices for the top 25 Most Influential people, places, and things for 2009. It was several months in the making, but we couldn't be more excited about our final selections. The magazine is bursting with impressive minds, explosive technological advances, and life-saving innovations.

Undoubtedly, many of you are applauding our choices – because, let's face it, most of these people and technologies have seriously stellar resumes. But some of you might be wondering how we came to chose the 25 we did. Well, wonder no more.

As the introduction to the article says, we scoured the news and journal articles, looking for the brightest stars in the field. There, we found Joyce Keyak, PhD, associate professor in residence in the Department of Orthopaedic Surgery at the University of California, Irvine, who helped create a radioactive bone cement that could improve the treatment of vertebral metastases.

We also looked back on the previous year to see who and what was on our radar most often. With all the chatter the past few months about the moly-99 shortage, no one could deny the influence this issue has and will continue to have on nuclear medicine in the future. We also noticed more than a dozen articles from the past year dedicated to the "going green" movement – which is obviously no small interest in the industry.

And, of course, we consulted the experts (that's you, our readers). We asked for your nominations and took them to heart. One reader suggested we take a closer took at JUREI's "Teaching the Teachers" program, and we were moved by the noble and effective global initiative to increase access to ultrasound imaging in developing countries.

Once we had our choices, the editorial team put our heads together and hammered out the order from No. 1 to 25. And it was harder than you'd think. In fact, we found so many influential items that we just had to fit in, that we named them "Most Notables" – you can find them online here.

So there you have it. A little behind-the-scenes look at our process for choosing the 25 Most Influentials of 2009. Take a look at our "Ones to Watch" list here, because we'll have our eye on those in the coming year – and they might just nab a spot on next year's top 25.

We've extended the deadline for nominations for rt image's Most Valuable Product Awards to Monday, Aug. 31. Send us an e-mail at editorial@rt-image.com explaining what product or service you'd like to nominate for an MVP award and why.

Nominations should include the following information:
· Product name
· 150-word description of why it is being nominated
· Nominating radiology professional's name and credentials

We're accepting nominations for products in the following categories:
· Advanced Visualization
· CAD
· CR
· CT
· Data Storage and Management
· Display Systems/Monitors
· DR
· EMR
· Ergonomic Workstations
· Imaging Agents
· Mammography
· MRI
· Nuclear Medicine/Molecular Imaging
· PACS
· Patient Positioning
· Printers
· Radiation Therapy
· Refurbished Equipment Vendors
· RIS
· Speech Recognition/Transcription
· Staffing
· Teleradiology
· Ultrasound

Get your nominations in, and then pick up the Oct. 5 issue of rt image to see who won!

By Mark D. Marotta

In my last post, I went into some further detail about some of the information I had come across while researching my Aug. 3 article about MRI infection control.

My post focused on some of the numbers contained in the survey conducted by Peter Rothschild, MD, on infection control policies and practices at MRI facilities. As the post indicates, the report summarizing Rothschild's survey findings says that there is a "substantial difference" between responses from outpatient MRI centers and hospital-based facilities. Additionally, during my interview with Rothschild, he commented that mobile MRIs, which are especially common at smaller hospitals, don't have sinks on board.

Rothschild told me that, at outpatient centers, many of the people that run the magnets are registered technologists, but some are not. "The laws in almost every state in the country says anyone can run the magnet; you don't have to be certified," he said. Rothschild added that many states are now trying to change their laws to require some form of certification.

Rothschild's report about his survey results offers further detail on this point. According to the report, which came out in May, there has been a "legal loophole" about the requirements to become an MRI operator. "Since the MRI procedure does not involve the use of ionizing radiation, there are no federal requirements for any sort of training or certification to operate an MRI and currently only one state, West Virginia, requires an MRI operator to be licensed," the report says. Rothschild writes that this loophole places patients at risk, especially if they are more susceptible to antibiotic-resistant strains of staph infections.

His report goes on to say, "Due to overwhelming concern for patient safety related to untrained personnel operating sophisticated medical devices, several states have recently begun closing this loophole. New Mexico recently passed a law, scheduled to become effective July 1, 2009, to require MRI operators to be licensed by the state, as has been the case in West Virginia for several years. Due to these safety concerns, several other states are considering adopting similar regulations for MRI operators, although closing this loophole may take years."

In my next post, I plan to present information about another portion of Rothschild's report.

Posted by: Stephanie Twining

In 1820, Hans Christian Ørsted discovered that electric currents produce a magnetic field. Today, through the magic of Google, I discovered that it's Ørsted's birthday.

So, first things first, Happy 232nd Birthday, Hans Christian Ørsted! For those who aren't familiar, Ørsted's experiment was a pretty simple one. He created an electrical current by connecting wires to a battery. When the battery was switched on and off, he noticed the needle of a compass deflected from magnetic north. His current-carrying wires were formed into coils, which – in simple terms – are used to create the main magnetic field for most MRI systems. Pretty cool, Ørsted.

Ørsted's discovery was pretty amazing, and paved the way for MRI technology to radically improve healthcare (ok, maybe it didn't necessarily pave the way, but it at least set down a gravel path, which was later paved by other scientists). But even more amazing, is that Google has introduced Ørsted to millions of people today.

Head over to Google.com (after reading all the great content from the current MRI-centric issue of rt image, of course), and you'll see that the logo has been transformed into a doodle of Ørsted's experiment. This "Google Doodle" is one of hundreds that the search engine will create for various holidays or special events. Yesterday, for instance, the doodle was of the meteor shower.

So, thanks, Google. Thanks for educating me – and the masses – about our little-known friend, Ørsted. Thanks for forging into the future while still keeping history alive.