Placenta praevia is when the placenta inserts wholly or in part into the lower uterine segment. A placenta extending within 2 cm of the internal cervical os in the late third trimester of pregnancy will likely necessitate caesarean section delivery.  amatically...

Spigelian hernia (SH) is an uncommon type of abdominal wall defect that is located on the semilunar line. Its content may vary and its severity is mostly due to small bowel (SB) complications. During the last 10 years, the use of computed tomography (CT) has increased dramatically...

Chronic pancreatitis (CP) is an inflammatory disease characterized by progressive and irreversible structural damage to the pancreas, resulting in permanent impairment of both exocrine and endocrine functions. The diagnosis of CP is usually based on findings of imaging studies such as ultrasonography...

A review of some recently published papers linking use of PACS with improvements in care and productivity.

The morbidity and socioeconomic cost of fractures (broken bones) is considerable. Whilst most fractures unite, between 5% and 10% of long bone fractures are associated with delayed or non-union, resulting in significant morbidity, loss of independence and loss of productivity . The length of time...

Erectile dysfunction has been successfully treated with penile prosthesis implantation for over 50 years . In 1980, the Jonas prosthesis utilized embedded silver wires in a silicone sheath to improve malleability of the penis . More recently, both American Medical Systems (AMS, Minneapolis, MN, USA)...

Shoulder pain and instability can originate from a number of conditions including rotator cuff abnormalities and glenoid labral tears, including superior labral anterior-to-posterior (SLAP) lesions [, ]. Clinical history and physical examination are used as part of the decision-making...

With the advent of hybrid PET/CT driven by oncology imaging, there are a growing number of centres using cardiac PET with Rb. This short-lived radioisotope (half-life 76.4 s) represents an attractive alternative to clinical imaging, as there is no need for a cyclotron...

Although radiological examinations play an important role in daily medical practice in the hospital setting, patients are not adequately informed about the radiation dose they are exposed to when undergoing a radiological examination. Lee et al found that nearly all patients...

Osteosarcoma is the most common malignant bone tumor in adolescents and young adults. The long-term survival of osteosarcoma patients has been significantly improved by combining neo-adjuvant chemotherapy and surgical resection . The goal of preoperative chemotherapy is to treat the micrometastatic...

The term haemangioma is used, somewhat confusingly, to describe various lesions in adults and children . Inexact terminology has in the past led to confusion about imaging findings and treatment algorithms. The term infantile haemangioendothelioma was widely used in the past, sometimes...

Abstract

Objective To analyze the correlation therapeutic effects of first sufficiency ¹³¹I therapy in Graves’ disease patients and improve its one-time curative ratio.

Magnetic resonance imaging (MRI) is commonly used to diagnose meniscal pathology. Some studies have found that MRI is not superior to physical examination in the diagnosis of meniscal tears [7, 14, 17], whereas others have demonstrated its value as an accurate and noninvasive diagnostic...

Selective cervical nerve root block is widely performed to diagnose the spinal level of cervical radiculopathy and relieve radicular pain, headache, shoulder stiffness, or extremity pain [1–3]. Various complications associated with cervical nerve root block have been reported [4,5]. Intravascular...

We present a round-up of recently published research on MR-HIFU as a non-invasive treatment for uterine fibroids.

In this 3.5 minute video interview Prof Michael Knopp discusses the 7T revolution and how as technologies advance in the science of 7T, the vision for taking advanced capabilities and applying them to clinical applications is evolving.

In this 4.5-minute video interview conducted at the 2011 meeting of the American College of Cardiology (ACC), Dr. Eric Silfen explains that there is an important new initiative to provide continuity of care after hospital discharge. The initiative, which is being promoted by the ACC and others, has been given the formal acronym of H2H, which stands for hospital to home care.

In this 3.5 minute video interview Prof Michael Knopp discusses the 7T revolution and how as technologies advance in the science of 7T, the vision for taking advanced capabilities and applying them to clinical applications is evolving.

Previous study findings have indicated that MR thermometry on the heart is feasible with ECG and respiratory triggering, but has a limited temporal resolution that makes it difficult to assess the precise thermal dose being delivered. In an effort to overcome this limitation, researchers from centers in Bordeaux, France, investigated a method of monitoring the temperature evolution in the heart at each cardiac cycle.

They combined cardiac triggering and dynamic navigator-based slice tracking with image registration and compensation of susceptibility changes with respiration, and tested this during RF ablation on a sheep heart in vivo. MR-guided RF-heating was performed on the left ventricle of the heart, and real-time MR thermometry was performed during the procedure by acquiring 400 dynamic images.

In a new study presented at the ACC conference, researchers from the Harbor UCLA Medical Center in Torrance, California, investigated the use of 64-slice multidetector CCTA to detect the presence of infarction, comparing it with nuclear myocardial perfusion imaging (MPI).

GetInsideHealth covers the 19th annual meeting of The International Society for Magnetic Resonance in Medicine in Montreal May 7-13, bringing you on-site reviews, interviews, video, and poster presentations.

Previous research has suggested that up to 50% of patients with paroxysmal AF receiving pharmacologic therapy will progress to persistent AF. Risk factors for progression include age, hypertension, a prior transient ischemic event, chronic obstructive pulmonary disease, and heart failure (as indicated by the HATCH score).

In a new study, specialists from the University of Michigan, in Ann Arbor, investigated the effect of RFA on the progression of paroxysmal AF in 504 patients (mean age 58 years). Just over one-third of the patients (38%) had a repeat RFA procedure.

FDG-PET has been validated as a measure of carotid inflammation, but relatively little is understood about whether FDG uptake can also be used to evaluate inflammatory activity in atherosclerotic segments of the aorta. Although atherosclerotic inflammation is known to occur predominantly within lipid-rich plaques in the lesser curvature of the ascending aorta, providing an opportunity for FDG PET studies to quantify disease activity in these areas, it was unclear whether potential obstacles, such as peri-aorta fat, might limit accuracy or reproducibility.

The researchers, from centers in Boston and New York, performed both MRI and FDG-PET in 15 subjects with atherosclerosis (the mean age of the subjects was 65 years). FDG update was measured within the aortic wall at 30-degree intervals on axial images. Lipid-rich plaques were defined as wall regions that were hyper-intense on both T1 and TOF [time of flight] MRI, and peri-aortic fat was also identified on MRI.

Researchers from NHS Tayside in Dundee, UK, studied use of a digital dosimeter worn on top of the lead apron, providing live information on exposure during fluoroscopy. They compared fluoroscopy usage in the 6 months before the introduction and implementation of the dosimeter, and in the 6 months afterwards.

A total of 208 pacemaker implantation procedures were performed in the study period. The mean X-ray screening time was reduced significantly with use of the dosimeter, from 3.7 min to 3.0 min. Similarly, the dose area product (DAP) for each procedure was reduced from a mean of 247 microGray/cm2 to 185 microGray/cm².

The group of researchers from the University of Munich in Germany, led by Dr. Martin Hadamitzky, assessed the value of CCTA data in addition to clinical risk predictors and CASC in the prediction of severe cardiac events.

A group of researchers from the University of Ottawa Heart Institute, Ottawa, Canada, have compared the accuracy of 2 different algorithms to predict mortality risk in octogenarian patients undergoing aortic valve replacement (AVR) or AVR plus coronary artery bypass grafting (CABG). 

A total of 394 patients (mean age 83 years, 53% male) undergoing AVR or AVR/CABG were included in the study. Expected hospital mortality was predicted using 2 risk-prediction algorithms: the STS predictive risk of mortality algorithm, and the LES algorithm. Patients were classified as low-, medium-, or high-risk, according to the criteria of the different algorithms, and were followed up for a mean of 4.7 years. Observed/expected (O/E) mortality ratios were calculated.

The coronary atherosclerotic plaque burden is known to be associated with the risk of contrary events, but it has been unclear whether non-invasive methods such as multidetector CT can effectively detect subtle changes in plaque burden over time.

To investigate, researchers from centers in Brazil and the USA compared quantitative plaque volume measurements obtained by 64-slice multidetector CT (MDCT) with those obtained by virtual histology intravascular ultrasound (VH). A total of 20 patients referred for percutaneous coronary intervention underwent MDCT before the procedure and VH during it, and both tests were repeated after a mean period of 9.3 months.

The specialists from the University of Toyama, Japan, conducted a study in 26 patients with acute coronary syndrome in order to investigate the relationship of macrophage accumulation and intraplaque hemorrhage to vulnerable plaque morphology. According to the senior author of the study, Dr. Takao Sato, previous work with virtual histology intravascular ultrasound (VH-IVUS), using spectral analysis of radiofrequency ultrasound backscatter signals "has been used to identify components of atherosclerotic plaque."

Specialists from centers in Adelaide, Australia, evaluated 362 consecutive patients referred to a tertiary cardiology center for stress perfusion CMR. Almost one-third of the patients had a history of previous myocardial infarction or percutaneous coronary intervention (PCI). Perfusion imaging was performed at stress (with adenosine 140 mcg/kg/min) and at rest on a 1.5T machine, and late enhancement was assessed with dual pass gadolinium at a total dose.

In this audio interview conducted exclusively for GetInsideHealth in March 2011, Professor Pierre Jaïs provides expert insights into recent developments in catheter ablation for atrial fibrillation (AF).

Listen to Dr Nick Perry of the London Breast Institute report on 11 years of experience with digital mammography in this audio interview conducted exclusively for GetInsideHealth on 23 March 2011.

An important challenge in cardiac CT is to minimize the radiation dose while maintaining and optimizing image quality. How this can be achieved is discussed in a new GetInsideHealth audio interview conducted with Dr Gilbert Raff, medical director of the Ministrelli Center for Advanced Cardiovascular Imaging at the William Beaumont Hospital in Royal Oak, Michigan, USA.

Abstract

Introduction Positron emission tomography (PET) is a state‐of‐the‐art functional imaging technique used in the accurate detection of cancer. The main problem with the tumours present in the lungs is that they are non‐stationary during each respiratory cycle. Tumours in the lungs can get displaced up to 2.5 cm during respiration. Accurate detection of the tumour enables avoiding the addition of extra margin around the tumour that is usually used during radiotherapy treatment planning.

Abstract

Purpose   Although a site common for pathology and of great importance to the neurosurgeon, the three-dimensional (3D) morphometry of the anterior communicating artery (ACoA) has had incomplete descriptions in the literature.

Abstract

Objectives This study aimed to evaluate an atraumatic prototype electrode carrier for cochlear implantation, the FLEX^{EAS 20} electrode. This electrode is designed to preserve hearing and to achieve a 360-degree insertion.

Abstract

Purpose   To describe the morphologic evolution of lung tumors treated with radiofrequency ablation (RFA) by way of computed tomography (CT) images and to investigate patterns of incomplete RFA at the site of ablation.

Abstract

Objectives   In this retrospective study the success and complication rates after radiologically guided port catheter implantation were evaluated.

Abstract

Uterine leiomyomata, or fibroids, although benign, cause debilitating symptoms in many women. Symptoms are often nonspecific and may be the presenting complaint in a number of other conditions. Furthermore, because the presence of fibroids may be coincident with other symptomatic conditions that result in similar complaints, there may be diagnostic difficulty and consequent difficulty in planning therapeutic strategy.

Abstract

Objectives   To evaluate whether a pharmacokinetic analysis is useful for both predicting and monitoring the response to chemoradiotherapy (CRT) in oral cancer.

Introduction

Quality-improvement practices and research are important in radiology for multiple reasons [1-9]. For all of us involved in medical imaging, regardless of the type of practice, part of our vision and mission is improving the health of all patients through imaging delivery. While certainly this involves direct patient care, improving the practice of medical imaging delivery as well as sharing clinical experiences can expand our vision and our mission beyond the immediate patients we are serving. In addition, patients as well as regulatory bodies are increasingly demanding that physicians practice quality improvement through mechanisms such as the maintenance of certification [10] and the potential maintenance of licensure. It can also be argued that participation in quality-improvement and research activities can increase work satisfaction and engagement of radiologists. Finally, active quality-improvement and research programs are essential for radiology to preserve its leadership role in medical imaging [1-6]. At our institution, we have put in place a Quality Improvement in Research and Imaging (QuIRI) program. The purpose of this manuscript is to describe the QuIRI process and how it has positively affected our research and quality-improvement program.

Abstract

Objective Cerebrovascular disease is 1 of the possible mechanisms of the previously reported relationship between Mediterranean-type diet (MeDi) and Alzheimer's disease (AD). We sought to investigate the association between MeDi and MRI infarcts.

Is "a small revolution in screening for colon cancer" underway, as some specialists recently concluded? To mark National Colorectal Cancer Awareness Month in the USA, we look at the latest published clinical data on colorectal cancer screening.

In a review paper published at the end of 2010, specialists from the Unit Of Medical Oncology at the Ospedali Riuniti di Bergamo, Italy, wrote that "a small revolution in screening for colon cancer is in the making".

In recent months several important new papers have been published relating to the diagnosis and management of ductal carcinoma in situ (DCIS) – the pathology that accounts for about one in five of all screen-detected breast cancers. Here we present a round-up of some of the main findings and the implications for clinical practice and future research.

In this first part of a 2-part interview, Professor Peter-Paul Verbeek of the University of Twente, in Enschede, The Netherlands, talks to GetInsideHealth.com about the concept of ambient intelligence and discusses its many potential applications within society. Prof. Verbeek is professor of philosophy of technology at the University of Twente’s Department of Philosophy, and has written frequently on ambient intelligence and persuasive technology.

What is ambient intelligence and why is it potentially so important?
Prof. Verbeek: “Ambient intelligence is what we call ‘smart environment’. By combining ubiquitous computing and intelligent user interfaces, environments come about that can intelligently respond to people’s behavior. This is a very interesting new configuration of humans and technologies. Whereas the usual configuration is ‘use’ – human beings making use of technological artifacts – ambient intelligence evokes a configuration of ‘immersion’. Human beings are immersed in environments that actively engage with their activities and experiences.”

Two important papers on telemonitoring in patients with chronic heart failure (CHF) have been published in the past few months, providing new information on the potential application and benefits of such projects.

First, specialists from centers in Germany summarized the experiences and findings from seven different CHF telemonitoring projects in the country. These primarily regional projects, some of which remain ongoing, involve a total of 7,720 patients with CHF. The patient breakdown by disease severity (according to the New York Heart Association staging system) is 14.5% at stage I, 51.1% at stage II, 26.3% at stage III, and 6.6% at stage IV, and the typical variables being monitored include heart rate, ECG, blood pressure and/or body weight.

Should low-dose helical CT now be the method of choice for lung cancer screening? In November 2010 the USA’s National Cancer Institute (NCI) released early findings from the National Lung Screening Trial (NLST) showing that screening with low-dose helical CT was associated with a significant mortality benefit compared with chest X-ray screening, in older current and former heavy smokers. Overall, there were 20% fewer lung cancer deaths in the population screened using CT than in the population screened using X-ray.

The first real-time 3D (RT3D) echocardiographic methodology was introduced in the early 1990s and circumvented the need for 3D image reconstruction from a series of 2D slices.²
During the last decades, among the many technological and software improvements in the acquisition of 3D images, the latest generation of scanners involves the use of more than 3,000 scanning elements, compared with 256 in the earlier versions. This allows for the production of pyramidal 3D datasets, permitting the real-time visualization of heart chambers and valve structures.¹

In this second part of a 2-part interview, Professor Peter-Paul Verbeek of the University of Twente, in Enschede, The Netherlands, talks to GetInsideHealth.com about the potential applications of ambient intelligence (introduced and discussed in general terms in part 1 of the interview) in healthcare.

Prof. Verbeek is professor of philosophy of technology at the University of Twente’s Department of Philosophy, and has written frequently on ambient intelligence and persuasive technology.

An imaging specialist discusses cardiac CT, including new clinical guidance and future applications of the technique. In this exclusive audio interview for GetInsideHealth, conducted in January 2011, Dr Morten Bøttcher of Aarhus University Hospital, Denmark, discusses the use of cardiac CT in daily clinical practice. The interview includes discussion of the updated “Appropriate Use Criteria” for cardiac CT published in October 2010 by a consortium of professional societies. Originally published in 2006, the updated guidance increases the number of appropriate uses, taking into account the expanding evidence base.

Abstract

Purpose To evaluate the ability of diffusion tensor imaging (DTI) to predict the transrectal ultrasound (TRUS) biopsy outcomes in persons who have no history of previous TRUS biopsy and present with elevated prostate-specific antigen (PSA) levels.

Abstract

Objective   To asses the features and explore the clinical relevance of popliteal lymph nodes (PLNs) detected on MRI examination for different pathologies of the knee.

The goal of the Alliance for Radiation Safety in Pediatric Radiology’s Image Gently campaign is to promote radiation protection for children undergoing imaging examinations that use ionizing radiation. The campaign creates awareness, develops educational content toward this goal, and more recently has advocated for change in equipment design to better meet the needs of pediatric patients. A previous meeting sponsored by the Alliance, the Image Gently CT Vendor Summit in 2008, urged manufacturers to standardize the CT dose display and nomenclature across vendors and promoted the adoption of a more accurate dose display or patient dose index to account for the wide range of size variability among pediatric patients. The campaign held a second meeting, the Image Gently Pediatric Digital Radiography Summit, building on the work of Drs. Charles E. Willis and Thomas L. Slovis, co-chairs of the 2004 conference, the ALARA Concept in Pediatric CR and DR: Dose Reduction in Pediatric Exams [1].

Abstract

Objectives/hypothesis Although precise localization of obstruction sites in the upper airway during sleep is essential in subjects with obstructive sleep apnea syndrome (OSAS), no gold standard diagnostic method has been established. This study aimed to evaluate the dynamic collapse inside the upper airway by using cine magnetic resonance imaging (MRI), also called sleep MRI.

Abstract

Purpose To investigate differences in perfusion profiles between degenerative endplate marrow changes and normal vertebral marrow in relation to spinal level, age, and sex with dynamic contrast-enhanced magnetic resonance imaging (DCE MRI).

Abstract

Introduction The purpose is to evaluate ¹⁸F-fluorodeoxy glucose-positron emission tomography (PET)/computed tomography (CT) for the detection of cervical carcinoma of the International Federation of Gynecology and Obstetrics stages Ib and IIa.

Abstract

Background   The purpose of this study is to analyze the diagnostic accuracy of MSCT in the identification of para-aortic lymph node metastases from gastric cancer.

Is the demand for catheter ablation for atrial fibrillation (AF) likely soon to exceed supply? In the past few months, several papers have been published that point to significant benefits from use of the technique and an increasing demand. At the same time there are suggestions from surveying physicians that this increasing demand for catheter ablation for AF is not being matched by an increase in the provision of electrophysiology services.

What has the recently published research shown? In one study published last year in the journal Heart, specialists investigated the long-term efficacy of catheter ablation for AF in a total of 285 patients who underwent 530 procedures (an average of 1.9 per patient – 1.7 for paroxysmal AF and 2.0 for persistent AF). The patients were followed up for an average of 2.7 years (range 0.2 to 7.4 years) after the last procedure.

Purpose To determine whether single time-point single-photon emission computed tomography—computed tomography (SPECT/CT) somatostatin receptor imaging can replace traditional dual time-point planar and SPECT somatostatin receptor scintigraphy for evaluation of neuroendocrine tumors.

Objectives Oxygen (O₂) is a cornerstone in the treatment of critically ill patients, and the guidelines prescribe 10–15 l of O₂/min even to those who are initially normoxic. Studies using indirect or invasive methods suggest, however, that supplemental O₂ may have negative cardiovascular effects. The aim of this study was to test the hypothesis, using noninvasive cardiac magnetic resonance imaging, that inhaled supplemental O₂ decreases cardiac output (CO) and coronary blood flow in healthy individuals.

Background The diagnosis of patients with acute dyspnoea is challenging, as clinical history and physical examination are often nondiagnostic and inaccurate. Consequently, clinicians often rely on the results of chest radiography (CXR) to determine the initial intervention and guide further treatment.

Increasing knowledge, interest, and visibility in the field of sports medicine has equipped clinicians in the field with a novel array of diagnostic and therapeutic options but has also provided a higher level of complexity in patient care. True understanding of the vast spectrum of radiographic technology available to the sports clinician has become more critical than ever.

Abstract

Objectives The purpose of this study was to determine if visualization of discrete sacral foramina on bone scintigraphy can be used as an adjunct criterion supportive of a superscan diagnosis.

Objective This study aimed to correlate magnetic resonance (MR) findings and discography with pain response at provocative discography in patients with low back pain.

Purpose   Imaging with positron emission tomography (PET) using 18F-2-fluoro-2-deoxy-D-glucose (FDG) plays an increasingly important role for response assessment in oncology. Several methods for quantifying FDG PET results exist. The goal of this study was to analyse and compare various semi-quantitative measures for response assessment with full kinetic analysis, specifically in assessment of novel therapies.

In a new review paper – available as a free PDF download with this article – specialists have made recommendations on how to minimize the radiation dose in multidetector computed tomography coronary angiography (CTCA) while maintaining image quality.

The specialists, from the Department of Medical Imaging’s Division of Cardiothoracic Imaging at Toronto General Hospital, Ontario, Canada, offer their recommendations in three categories: patient preparation, inside the CT suite, and after image acquisition.

Email-based telemedicine reviewed
Researchers at the Centre for Online Health, at the University of Queensland, Australia, have summarized the evidence relating to email-based telemedicine in a newly published review paper. Their findings, based on an analysis of 185 published papers, include the observation that email-based telemedicine has a wide range of potential applications, in primary consultation, second-opinion consultation, telediagnosis (including applications in image-based specialties such as dermatology, pathology, wound care, and ophthalmology, where digital images can be attached to emails), and administration (such as referrals). They highlight the need in certain instances for tailored email software, rather than ordinary email, to support telemedicine services (Caffery LJ, Smith AC. Stud Health Technol Inform. 2010;161:20-34).

In this audio interview conducted exclusively for GetInsideHealth on 20 December 2010, Dr Alan Groves discusses the cardiovascular causes of neurological disorders observed in preterm neonates, and how imaging techniques such as echocardiography and MRI are helping to advance our understanding.

Dr Groves discusses:
The role of circulatory factors in the pathophysiology of brain injury resulting in poor long-term outcomes in preterm infants.
The indicators/variables that specialists are monitoring in order to assess circulatory adequacy in neonatal units.
The insights being provided by cardiac MRI in preterm neonates.

Two important papers on telemonitoring in patients with chronic heart failure (CHF) have been published in the past few months, providing new information on the potential application and benefits of such projects.

First, specialists from centers in Germany summarized the experiences and findings from seven different CHF telemonitoring projects in the country. These primarily regional projects, some of which remain ongoing, involve a total of 7,720 patients with CHF. The patient breakdown by disease severity (according to the New York Heart Association staging system) is 14.5% at stage I, 51.1% at stage II, 26.3% at stage III, and 6.6% at stage IV, and the typical variables being monitored include heart rate, ECG, blood pressure and/or body weight.

In this first part of a 2-part interview, Professor Peter-Paul Verbeek of the University of Twente, in Enschede, The Netherlands, talks to GetInsideHealth.com about the concept of ambient intelligence and discusses its many potential applications within society. Prof. Verbeek is professor of philosophy of technology at the University of Twente’s Department of Philosophy, and has written frequently on ambient intelligence and persuasive technology.

What is ambient intelligence and why is it potentially so important?
Prof. Verbeek: “Ambient intelligence is what we call ‘smart environment’. By combining ubiquitous computing and intelligent user interfaces, environments come about that can intelligently respond to people’s behavior. This is a very interesting new configuration of humans and technologies. Whereas the usual configuration is ‘use’ – human beings making use of technological artifacts – ambient intelligence evokes a configuration of ‘immersion’. Human beings are immersed in environments that actively engage with their activities and experiences.”

In October 2010 the University of Wisconsin Hospital and Clinics, in Madison, USA, announced the introduction of a new method for identifying patients. The SAFE system uses near-infrared radiation to scan and record the pattern of venous blood flow in the palm – a pattern that is unique to each person.

When registering on the system, patients place their hand on a SAFE scanner for less than a minute during which the pattern of blood flow in the palm is recorded. The scan is stored as digital numerical information, and not as an actual image. At subsequent visits patients provide their date of birth and have their palm scanned. Their identification is then confirmed in seconds, and the correct electronic medical record can be accessed.

Hospital-acquired infections – with pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and Clostridium difficile – are well established as a leading cause of morbidity and mortality in many countries.

A recently published review paper (available free as a download with this article, see the details below) noted that hospital-acquired infection is one of the most common adverse events associated with healthcare in the USA, with approximately 2 million cases occurring every year. It has been estimated that these infections add US$ 17-20 billion to the annual costs of healthcare in the country. The WHO, meanwhile, has reported an overall prevalence rate of 8.7% in industrialized and developed nations.¹

The European Resuscitation Council (ERC) held its 10th scientific congress in Porto, Portugal, from 2-4 December, and GetInsideHealth.com was there. Here we present coverage of five sessions from the conference, covering topics ranging from including CPR in school curricula to emergency service planning for major sporting events such as the Olympic Games.

GetInsideHealth.com brings you a brief round-up of newly published research, and other healthcare news:

Assessing the use of radiotherapy for prostate cancer
Is radiotherapy for prostate cancer under- or over-used, compared with the level suggested by published evidence? Some answers have been provided by an analysis of the medical records of almost 130,000 patients with prostate cancer in Ontario, Canada and in the USA. Specialists used a criterion-based benchmark approach to estimate the need for radiotherapy (both external beam radiation and brachytherapy) and compared it with actual rates for Ontario and the USA. They found that the estimated and actual rates were similar for the USA.  In Ontario, however, there was a suggestion that radiotherapy was underutilized: the observed initial rate of radiotherapy was 28%, significantly lower than the predicted rate of 37.2%. (Kerba M,  et al. Clinical Oncol. 2010;22:801-9).

Wrist device aids telemonitoring in the elderly
Gerbovics [Austria] reported on the development and testing of a wrist-wearable prototype telemonitoring device, named the Health Data Hub. The device is intended for elderly people, and monitors the heart rate using pulse oximetry. Measurements are transmitted to a monitoring station, along with data on the context of the measurements (such as altimeter data indciating whether or not the patients is walking up stairs) in order to improve interpretation. An automatic alarm message is initiated if data indicate a worsening health status – this message can be sent to a dedicated monitoring center or to relatives. It is intended that the device will eventually also include temperature sensors, gyro sensors and acceleration sensors, and will use a touch display to request contextual information (such as whether the person is taking a walk, or making an unscheduled visit to their doctor). Tests are ongoing on the latest version of the device. Security and privacy still need to be addressed in order to guarantee the safe exchange of medical data.

What are the obstacles to implementing new information systems?
Advances in information technology have opened up the possibility of better healthcare at the primary, secondary, and tertiary level. However, obstacles may impede the implementation of potentially successful strategies in eHealth, unless they are identified and actively managed during early phases of implementation. Ryan [Australia] reported on the findings of an anonymous voluntary survey of 100 patients and 100 staff at a metropolitan tertiary center about the implementation of eHealth applications.

Opening address: telehealth “a global force in healthcare”
The Most Reverend Desmond Tutu [S. Africa], in his capacity as ambassador for eHealth for the International Society for Telemedicine and eHealth, opened this year’s conference remotely through a video message. He said the theme of the conference – “Telehealth for every nation, community and home” – highlighted the hope that telehealth would become “a global and a local force in healthcare, a worldwide unifying and enabling technology” with information and communications technologies being foremost in surmounting the challenges  associated with differing levels of healthcare access around the world.

The latest developments in telemedicine were discussed at the Global Telehealth 2010 conference held from 10-12 November in Fremantle, near Perth in Western Australia. This was the 15th international conference of the International Society for Telemedicine and eHealth, and also the first national conference of the Australasian Telehealth Society, which formed in 2008.

Dr. Carrascosa explains that physicians are often uncertain about what test to perform next in patients with normal perfusion studies who continue to report symptoms. Based on results of her study, CT angiography was found to be a valuable tool.

In this study, 47 women with a mean age of 58 years were evaluated with dual energy X-ray absorptiometry (DEXA) and CT screening. DEXA served as the reference standard for comparing QCT and a single trabecular measure of CT attenuation at L1 with CT colonography (CTC).

In this study, 304 patients undergoing screening mammography also underwent automated 3D US examination. The conventional mammography images were assessed by one independent examiner and the 3D images were assessed by two additional independent examiners. Conventional mammography was employed as the reference standard in order to calculate the sensitivity and specificity of the automated 3D technique.

The imaging study was conducted in 27 consecutive patients who were undergoing  TAVI due to severe aortic valve stenosis. Imaging studies were conducted with ECG-gated MDCT before and after Dyna-CT.

Dr. Moulik explains that current picture archiving and communications systems (PACS) already provide 3D images but in a limited form without stereoscopic viewing that provides visual depth. In addition to stereoscopic views, Dr. Moulik has been pursuing strategies to actually isolate organs within the image in order to move them independent of surrounding anatomy.

Specialists at Henry Ford Hospital, West Bloomfield, Michigan, suggest that RFA could become the primary treatment for small, functional adrenal neoplasms in the future, based on the results of their study, which they presented at the RSNA conference.

The study enrolled 13 consecutive patients with symptomatic functional adrenal tumors (diameter < 3.2 cm), who were treated with RFA over 7 years. Cross-sectional imaging, clinical symptoms, and adrenal biochemical markers were available for patients who met inclusion criteria. 10 patients (77%) had aldosteronoma and one patient each had a cortisol-secreting tumor, testosterone-secreting tumor, or pheochromocytoma.

Dr. Capunay started his presentation by pointing out that, “previous studies in patients with suspected CAD and normal functional studies showed that CTCA can recognize a wide range of anatomic observations.”

Dr. Capunay and colleagues used CTCA to evaluate the presence and severity of coronary stenosis in 36 patients with normal cardiac functional studies (CFS). All patients were referred for exclusion of CAD. 

Alexander Fingerle, MD, Klinikum rechts der Isar, Munich, Germany, and colleagues conducted a prospective study involving 40 patients with suspected pulmonary embolism. The scientists used iodine distribution maps acquired with a dual-layer, dual-energy MDCT to detect pulmonary embolism in the entire chest, including the lung periphery.

To investigate whether CT can provide similar information to MR regarding pericardial thickness and delayed enhancement, specialists at the Mayo Clinic in Rochester, Minnesota, searched hospital records for MR examinations of the heart or chest with an indication including “pericardium”, “pericardial”, “pericarditis”, or “constrictive” over a period of 5 years. Results were cross-referenced to identify patients who had undergone pericardiectomy and also had a preoperative CT scan of the chest for any indication.

Dr. Schwab explains that several other methods, such as assessment of chromosomal damage, have been used to evaluate the damaging effects of very high doses of radiation, but these are not sensitive enough as surrogates for measuring potentially damaging effects from low doses of radiation, such as those used in diagnostic studies.

The study was done by John Nance, MD, and colleagues at the Medical University of South Carolina, Charleston, South Carolina, who used cCTA to evaluate patients with acute chest pain and then correlated the findings with clinical outcomes.

Dr. Nance’s team enrolled 286 consecutive patients (33% male, mean age 55±11 years) who presented with acute chest pain and underwent contrast-enhanced cCTA for the assessment of atherosclerotic lesions.

In the study, specialists at Chulalongkorn University, Bangkok, Thailand, compared multi-isocenter IMRT and 3D conventional radiation in terms of target coverage, homogeneity and normal organs avoidance in patients undergoing CSI.

A total of 13 patients were treated with CSI using both 3D conventional and multi-isocenter IMRT. Planning target volume (PTV brain, PTV spinal sac) and organs-at-risk (OARs: heart, lungs, liver and both kidneys) were contoured.

“Left ventricular diastolic dysfunction has prognostic implications for various cardiac diseases, such as ischemic heart disease, heart failure, cardiomyopathy, and atrial fibrillation,” said Zhaoying Wen, MD, Beijing Anzhen Hospital, Beijing, China, who presented the study. “But it is invasive to measure left ventricular diastolic function using a catheter,” he added. “However, left atrial size and function has been proposed to reflect left ventricular diastolic function sensitively, and this can be assessed using MDCT,” Dr. Wen explained.

In their study, Dr. Wen and colleagues enrolled 73 patients who had been referred to CT coronary angiography. All patients were examined by MDCT and real-time 3D echocardiography (RT-3DE) on the same day.

“This work is quite a novel approach in that success of screening is usually measured in terms of reduction in mortality from breast cancer,” said Nicholas Perry, MD, of The London Breast Institute, London, UK. “We are not aware of any other studies in this age group comparing success in terms of breast preservation,” he added.

In their study, Dr. Perry and colleagues compared mastectomy rates following breast cancer diagnosis at a UK center in women aged 40-50 with a prior mammogram within the previous year to those with longer interval or no previous mammography.

Multi-phasic CT examinations of the liver can be used to detect malignant liver lesions; however, they can deliver doses of radiation that may increase a patient’s lifetime cancer risk.

To investigate whether it is possible to reduce the level of exposure while maintaining diagnostic accuracy, specialists at Royal Brisbane & Women's Hospital, Moorooka, Australia, performed a study using a CT liver lesion phantom consisting of a soft-tissue-equivalent disk with spherical lesions (9.5mm and 4.8mm diameter, each with a density 10 HU below background).

Prof. Ratib explains that this hybrid technology is being pursued by several device manufacturers and has significant advantages when it is important to combine information from MRI and PET to understand pathology in greater detail. Prof. Ratib presented his results with the hybrid device during several presentations at the 2010 RSNA.

Specialists at the Department of Radiology, Seoul National University Hospital, Seoul, Korea, have been able to identify key lesion characteristics revealed by CT examination that can enable clinicians to predict very accurately whether PSNs would be transient or persistent on follow-up CTs.

“Part-solid nodules have been reported to indicate a high probability of early lung cancer in many previous studies,” said Yong Sub Song, MD, who presented the research. “However, we observed that a substantial proportion of PSNs detected at screening CT could be transient because of inflammation or hemorrhage,” Dr. Song noted.

“PTLD is a rare, but serious and potentially lethal complication of solid organ transplantation,” said Homeira Zahiri, MD, University of Nebraska Medical Center, Omaha, Nebraska, who presented the study. “FDG-PET has proven useful for staging high and intermediate-grade lymphoma. However, the accuracy of FDG-PET for staging PTLD is unknown,” she added.

To investigate the usefulness of FDG-PET in the early detection, staging, and treatment of PTLD after solid organ transplantation, Dr. Zahiri’s team performed a study involving 16 transplant recipients with histologically confirmed PTLD.

Dr. Rajiah explains that although the diagnosis of constrictive pericarditis is straightforward when the symptoms are characteristic and consistent with echocardiography, the majority of patients either have atypical signs or imaging that is not definitive. This can lead to an expensive use of multiple imaging modalities and a delay in diagnosis and treatment.

Prof. Daly explains that the concept of iterative reconstruction was first introduced at the very introduction of CT scanning, but computers were not sufficiently powerful at that point to generate quality images. That has changed.

Dr. Talanow explains that the dramatic increase in the use of imaging technologies that expose patients to radiation is now considered a small but measurable cause of cancers. While imaging is a critical tool, awareness of the dangers is appropriate for prudent use.

“RFA is a safe and effective nonsurgical treatment for symptomatic benign thyroid nodules,” said Jung-Yin Huh, MD, Gangnam CHA General Hospital, Seoul, Korea, who presented the results.

Dr. Huh’s team evaluated the efficacy of single- vs. dual-session RFA treatment in patients with BTN in a prospective randomized trial. 30 outpatients were randomly assigned to one session of RFA (RFA-1, n=15) or two sessions of RFA (RFA-2, n=15) and were subsequently followed for a period of at least 6 months.

RFA was performed under continuous ultrasound- (US) guidance with an 18-gauge internally cooled electrode. Dependent variables included nodule volume, cosmetic score and symptom score.

The study was performed by specialists at Hull Royal Infirmary, in Hull, UK, to explore the factors influencing the experience of patients undergoing interventional radiological procedures.  

The researchers sent out questionnaires to 315 patients undergoing interventional vascular procedures prior to treatment, immediately following treatment, as well as 4 weeks and 3 months after the procedure.

The questionnaires were aimed at surveying the patients’ understanding of the procedure, their level of anxiety, and the amount of pain they were experiencing. The latter was assessed using a visual analog scoring system (VAS). The short form 36 (SF 36) health survey questionnaire was used to evaluate quality of life changes associated with the procedure.

The use of CT perfusion has been proposed for pancreatic lesion characterization; however, differences in scan standardization and analysis make it difficult to compare the numerical data obtained.

In an attempt to overcome these difficulties, scientists at the University of Verona, Italy, evaluated the use of time-density curves obtained from MDCT perfusion scans of the pancreas for the characterization of normal parenchyma, adenocarcinoma, chronic pancreatitis and endocrine tumors.

Lead investigator Antonella Filippone, MD, and colleagues used diffusion-weighted imaging (DWI) to assess response to CRT in patients with LARC. A total of 28 patients underwent magnetic resonance imaging (MRI) prior to and 8 weeks after treatment, including T2-weighted and an echo-planar DWI-sequence with 6 b-values (0 to 1000 mm2/sec), from which the apparent diffusion coefficient (ADC) was calculated.

“Multiple sclerosis is a demyelinating disease, the hallmark of which are the lesions that can be seen on conventional MRI scans,” said Fernanda Rueda Lopes, MD, who presented the research. “These lesions are usually classified as acute, subacute, or chronic, and they can also be in a process of de-myelination or re-myelination,” Dr. Lopes explained. “If a tool could be developed to identify and map these lesions, clinicians would be able to tell if a treatment is working or not,” she added.

The study was conducted by researchers at Stanford University, Stanford, California, and involved a review of Medicare claims submitted between 1998 and 2005 for over 10 million people, focusing on the well-characterized patient group of older adults, who are most frequently imaged. The data were analyzed in two temporally differentiated cohorts: 1998-2001 (N = 5,267,230) and 2002-2005 (N = 5,555,345).

The study, conducted by specialists at the Medical University of South Carolina, Charleston, South Carolina, evaluated the feasibility of adenosine-stress myocardial perfusion imaging, using 128-slice dual-source CT, for the qualitative and quantitative assessment of myocardial blood flow (MBF) compared to stress perfusion and viability MRI.

The researchers enrolled 20 patients (14 male, 6 female; mean age 60±11 years) who underwent a standardized cardiac CT protocol consisting of prospectively ECG-triggered coronary CT angiography, dynamic adenosine-stress myocardial perfusion imaging using a “shuttle” mode, and delayed enhancement acquisitions.

Dr. Michel and colleagues evaluated the accuracy of 4,879,715 preliminary radiological studies that were interpreted between 1/1/2007 and 12/31/2009. “Our study is the largest retrospective analysis of the accuracy of interpretation in a teleradiology practice,” Dr. Michel noted.

The study by Dr. Callstrom and colleagues enrolled 62 adult patients with painful bone metastases who had either failed or were poor candidates for conventional radiation treatment or chemotherapy. All patients were treated with CT-guided cryoablation using one or more cryoprobes under general anesthesia or conscious sedation. Osteolytic metastases involving or abutting bone were treated.

“Until now, trans-thoracic echocardiography has been the most widely used method for the diagnosis of AMIS,” Dr. Joe noted. However, the diagnostic accuracy of TTE is not very high, and it has limited value for detailed morphological assessment,” he added.

In an effort to help reduce similar errors in the future, Dr. Mansfield's team reviewed 656 radiological exams with delayed diagnoses that were collected from July 2002 to January 2010 at BAMC. Each case was reviewed by two radiologists and the diagnostic errors were classified based on the type of error.

Smallpox, measles, and typhoid are no longer the threat they once were. But according to a Philips-sponsored report by Marsh, the insurance broker and risk advisor, even in the twenty-first century other infectious diseases continue to emerge at a rapid pace—and frequently with significant human and financial costs.