Author Interviews, Brigham & Women's - Harvard, CT Scanning, JAMA, Stroke / 21.06.2016

MedicalResearch.com Interview with: Dr. Gregoire Boulouis MD MS Research Fellow at Massachusetts General Hospital / Harvard Med. School Boston, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Boulouis: Hemorrhagic Stroke or Intracerebral hemorrhage (ICH) still has a poor prognosis. A substantial proportion of patients will experience ongoing intracranial bleeding and their hematomas will grow in size in the first hours following presentation, a phenomenon called 'hemorrhage epxansion'. Patients with hemorrhage expansion have been shown to have significantly worse clinical outcome. If all baseline ICH characteristics (location, initial hemorrhage volume, ..) are non modifiable at the time of diagnosis, hemorrhage expansion, however, represents one of the few potential targets to improve outcome in ICH patients. An accurate selection of patients at high risk of expansion is needed to optimize patients' selection in expansion targetted trials and, eventually, to help stratifying the level of care at the acute phase. In this study, we investigated whether the presence of non-contrast Computed Tomography hypodensities within the baseline hematoma, a very easily and reliably assessed imaging marker, was associated with more hemorrhage expansion. A total of 1029 acute phase ICH patients were included ; approximately a third of them demonstrated CT hypodensities at baseline. In this population, CT hypodensities were independently associated with hemorrhage expansion with an odds ratio of 3.42 (95% CI 2.21-5.31) for expansion in fully adjusted multivariable model. (more…)
AHA Journals, Author Interviews, CT Scanning, Diabetes, Heart Disease / 17.06.2016

MedicalResearch.com Interview with: Prof. David A. Halon MB ChB, FACC, FESC Associate Professor of Clinical Medicine Technion, Israel Institute of Technology. Director, Interventional Cardiology Lady Davis Carmel Medical Center Haifa, Israel MedicalResearch.com: What is the background for this study? Prof. Halon: Type 2 diabetics are well known to have more cardiovascular events than non-diabetics but even among diabetics this risk is heterogeneous and some remain at very low risk. It remains uncertain if additional diagnostic modalities over and above clinical risk scores may be helpful in defining which diabetics are at high risk for an adverse event. We performed a study using cardiac CT angiography (CCTA) in 630 type 2 diabetics 55-74 years of age with no history of coronary artery disease to examine if CTA findings would have additional prognostic value over traditional risk scores for cardiovascular or microvascular based events over 7.5 years of follow-up. (more…)
Author Interviews, CT Scanning, JAMA, Lung Cancer, NIH / 16.05.2016

MedicalResearch.com Interview with: Hormuzd A. Katki, PhD Division of Cancer Epidemiology and Genetics National Cancer Institute National Institutes of Health Department of Health and Human Services, Bethesda, Maryland MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Katki: The National Lung Screening Trial (NLST) showed that 3 annual CT screens reduced lung cancer death by 20% in a subgroup of high-risk smokers.  However, selecting smokers for screening based on their individual lung cancer risk might improve the effectiveness and efficiency of screening.  We developed and validated new lung cancer risk tools, and used them to project the potential impact of different selection strategies for CT lung cancer screening. We found that risk-based selection might substantially increase the number of prevented lung cancer deaths versus current subgroup-based guidelines.  Risk-based screening might also improve the effectiveness of screening, as measured by reducing the number needed to screening to prevent 1 death.  Risk-based screening might also improve the efficiency of screening, as measured by reducing the number of false-positive CT screens per prevented death. (more…)
Author Interviews, CT Scanning, Heart Disease, Lifestyle & Health / 16.04.2016

MedicalResearch.com Interview with: Jacquelyn Kulinski, MD Assistant Professor Division of Cardiovascular Medicine Medical College of Wisconsin Milwaukee, WI 53226 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Kulinski: Sedentary behavior, or “sitting disease”, is increasingly recognized as a risk factor for cardiovascular disease, diabetes, cancer and early death.  Many of these associations appear to be independent of exercise activity. The mechanisms through which sedentary behavior influences cardiovascular risk are largely unknown.  Therefore, we investigated the association between accelerometer measured sedentary behavior and coronary artery calcium (CAC), a marker of subclinical heart disease, in over 2,000 participants using data from the Dallas Heart Study (DHS) population. We found a significant association between increasing sitting time and CAC in a population without prior history of cardiovascular disease.  This association was independent of measured exercise activity, traditional risk factors, and even socioeconomic factors.  Each hour of sedentary time was associated with a 16% increase in CAC burden.  Interestingly, the association between exercise and CAC was not significant in the fully-adjusted model.  (more…)
Author Interviews, Beth Israel Deaconess, CT Scanning, JAMA, Neurological Disorders, Stroke / 04.01.2016

MedicalResearch.com Interview with: Sandeep Kumar, MD Assistant Professor of Neurology Harvard Medical School Director, Inpatient Stroke Service Department of Neurology, Stroke Division Beth Israel Deaconess Medical Center Boston, MA 02215 Medical Research: What is the background for this study? What are the main findings? Dr. Kumar: Transient deficits that start suddenly and typically last for a few minutes to a few hours are the hallmark of a transient ischemic attack (TIA) or a minor ischemic stroke. In this single-center observational study, we have reported similar clinical presentation in some patients with intracerebral hemorrhage (ICH) that are difficult to distinguish from cerebral ischemia based only on clinical signs and symptoms. (more…)
Author Interviews, CT Scanning, JAMA, Lung Cancer / 02.01.2016

  MedicalResearch.com Interview with: Jan Marie Eberth, PhD Assistant Professor, Department of Epidemiology and Biostatistics Deputy Director, SC Rural Health Research Center Core Faculty, Statewide Cancer Prevention and Control Program Arnold School of Public Health University of South Carolina Columbia, SC 29208 Medical Research: What is the background for this study? Dr. Eberth: With the breakthrough findings of the National Lung Screening Trial released in 2011, professional organizations have largely embraced population-based screening guidelines for patients at high risk for lung cancer. The diffusion of screening into broad clinical practice has been slow to be adopted, given concerns about the efficacy of screening in community settings, lack of insurance reimbursement and unclear billing logistics, and difficulty weighing the pros of screening against the known cons (e.g., high rate of false positives). Medical Research: What are the main findings? Dr. Eberth: Provisions of the Patient Protection and Affordable Care Act mandate that US Preventive Services Task Force-recommended screening tests with an A or B rating receive full insurance coverage by private payers. The Centers for Medicare and Medicaid (CMS) soon thereafter approved full coverage for lung cancer screening in high-risk patients (i.e., those aged 55-77 years, asymptomatic for lung cancer, tobacco smoking history of 30+ pack-years, is a current smoker or has quit smoking within the past 15 years). Coding is rapidly evolving; as of November 2015, CMS released HCPCS codes G0296 (pre-screening counseling visit) and G0297 (screening visit). These codes will be accepted retroactively starting January 4, 2016 to the date of the final coverage determination (back to February 5, 2015). No coinsurance or deductibles shall be charged to the patient for either the pre-screening counseling visit, or the screening visit itself. Quality of screening  is an important, but understudied, area of research. Several publications have focused on aspects of quality programs, and how to achieve quality benchmarks, but data is still being collected to assess variation across programs. In the future, data from screening registries, such as the American College of Radiology Lung Cancer Screening Registry (LCSR), can be leveraged to examine these quality metrics and improve risk-prediction models for lung cancer. (more…)
Author Interviews, CT Scanning, Heart Disease / 24.12.2015

MedicalResearch.com Interview with: Dr. Joan Pinto-Sietsma MD PhD Department of Clinical Epidemiology, Biostatistics and Bioinformatics Academic Medical Center Amsterdam, The Netherlands.  Medical Research: What is the background for this study? What are the main findings? Response: A positive family history for premature coronary artery disease is an important risk factor for coronary artery disease. Therefore, it is frequently proposed to be included in current risk assessment tools and clinical practice guidelines. On the other hand, a positive family history for coronary artery disease only identifies families at risk, whereas it fails to identify which specific individual within a family is at particular risk. Therefore, its applicability in clinical practice is limited. The detection of subclinical atherosclerosis as assessed by assessing coronary artery calcification, with CT scanning, has emerged as prognostic evaluation of coronary artery disease. Prospective follow-up studies have shown that coronary artery calcification predicts cardiovascular events, independent of risk factors. Therefore, assessing coronary artery calcifications in families with premature coronary artery disease might help in determining which individuals within such families are at particular risk and therefore help decide regarding treatment. We analysed the association between a positive family history for premature coronary artery disease and coronary artery calcifications in 704 asymptomatic individuals. Furthermore, we assessed the predictive value of coronary artery calcifications in individuals with a positive family history for premature coronary artery disease in a sub analysis in 834 individuals of the St. Francis Heart Study, in which subjects were followed for about 3.5 years. We observed, that individuals of high risk families (a positive family history of premature coronary artery disease) had a 2 time higher risk to have a calcium score > the 80th percentile as compared to individuals with a negative family history of premature coronary artery disease. Besides, individuals from high risk families with a high calcium score (> the 80th percentile) had a 2 time higher risk to get a cardiovascular event in 3,5 years, whereas individuals of high risk families without coronary calcifications did not have an increased risk at all. (more…)
Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, CT Scanning, Gender Differences, Lung Cancer / 04.12.2015

MedicalResearch.com Interview with: Phillip Boiselle, M.D. Staff, Cardiothoracic Imaging Beth Israel Deaconess Medical Center Associate Dean for Academic and Clinical Affairs Professor of Radiology, Harvard Medical School Boston, Mass Medical Research: What is the background for this study? What are the main findings? Dr. Boiselle: Previous studies have shown that women have a greater mortality benefit from lung cancer screening then men, and that this test (CT screening) is more cost-effective for women than men. Our purpose was to determine whether the relative risk of lung cancer for women and men differed depending on the specific type of lung nodule that was discovered at screening. Such differences could potentially help to influence a more personalized approach to patient management in lung cancer screening. (more…)
Author Interviews, Cancer Research, CT Scanning, JAMA, Melanoma, Radiology, University of Michigan / 25.09.2015

MedicalResearch.com Interview with: Benjamin Y. Scheier, MD Division of Hematology/Oncology Department of Internal Medicine University of Michigan, Ann Arbor Medical Research: What is the background for this study? What are the main findings? Dr. Scheier: Existing data suggests that PET/CT has use in the detection of metastases from multiple primary tumor types. However, PET/CT lacks data supporting its use in staging asymptomatic patients with early-stage melanoma, may inconsistently impact treatment decisions, and carries a false-positive finding risk that may detract from its use. To evaluate an evolving practice, this study aims to assess the use of PET/CT in detecting occult metastases in SLN-positive melanoma prior to resection. In this retrospective evaluation of patients with melanoma and clinically silent regional lymph nodes treated at the University of Michigan, only 7% had PET/CT findings that ultimately identified metastatic melanoma and precluded LND. Of the 46 patients who underwent a preoperative PET/CT, 15 (33%) had intense uptake distant from the primary tumor and local lymph node basin. Nine of those 15 patients (60%) had abnormalities biopsied prior to LND. Three of the 9 biopsies yielded metastatic melanoma, a false-positive rate of 67% for PET/CT in identifying distant metastases in asymptomatic patients. (more…)
Author Interviews, Clots - Coagulation, CT Scanning, Emergency Care, Geriatrics / 24.09.2015

MedicalResearch.com Interview with: Dr Lim Beng Leong MBBS, MRCS (A&E), FAMS Jurong Health Services Emergency Department, Singapore  Medical Research: What is the background for this study? What are the main findings? Dr. Leong: It is common in the emergency department to see patients with warfarin who suffer a minor head injury (HI) with GCS >13. It is standard practice according to international guidelines to perform a plain CT scan of the head. What is contentious in the literature is the subsequent management of those patients with a normal initial CT scan. Practice is heterogeneous and includes a mandatory second CT scan at 24 hours mark or observation and repeat CT scan at the discretion of the attending doctor. We have found in our study that the "observe and repeat CT scan for symptomatic cases" approach only was safe as abnormal second CT scans were rare (1 in 295 cases). We traced the patients' course 2 weeks post discharge and none of the patients were re-admitted for reasons of delayed intra-cranial hemorrhage (ICH). However, the cohort of patients consist largely of geriatric patients with falls. More than 50% of these patients were hospitalized for more than 3 days; the longest of 2-3 weeks. They were likely to have various reasons that required longer hospitalizations apart from observation for delayed ICH, such as assessing for risk, etc. (more…)
Author Interviews, CT Scanning, Duke, Heart Disease, NEJM / 02.04.2015

Pamela S. Douglas, M.D. Duke University School of Medicine Duke University Medical Center Durham, NC 27715MedicalResearch.com Interview with: Pamela S. Douglas, M.D. Duke University School of Medicine Duke University Medical Center Durham, NC 27715 Medical Research: What is the background for this study? Dr. Douglas: The primary objective of the PROMISE study was to compare the health outcomes of people who went to the doctor with new symptoms such as shortness of breath and/or chest pain that were suggestive of coronary artery disease and that required additional evaluation. This was an important investigation because no large research trial has ever been conducted to help guide the care of such patients. Instead, the selection of tests for such patients—which constitutes at least 4 million patients in the United States each year—has been largely left up to physician and patient preference rather than proven results. Medical Research: What are the main findings? Dr. Douglas: 10,003 patients from 193 different medical facilities across the US and Canada agreed to be part of the PROMISE study and  were randomized to a functional stress test or an anatomic test Using CT angiography.  The study found that the clinical outcomes of participants with suspected coronary artery disease were excellent overall, and were similar in terms of death and major cardiac conditions regardless of whether patients had a functional stress test or a computed tomographic scan. However, the CT scan may be better at ruling out the need for subsequent tests and procedures in patients who are free of heart disease, and involved a lower radiation exposure relative to a stress nuclear study. We also found, in a separately reported study, that the costs of the two diagnostic strategies were similar. (more…)
Author Interviews, CT Scanning, Heart Disease / 16.03.2015

Prof. David Newby British Heart Foundation Professor of Cardiology University of Edinburgh Director of the Wellcome Trust Clinical Research FacilityMedicalResearch.com Interview with: Prof. David Newby British Heart Foundation Professor of Cardiology University of Edinburgh Director of the Wellcome Trust Clinical Research Facility MedicalResearch: What is the background for this study? What are the main findings? Dr. Newby: The diagnosis of angina (chest pain) due to coronary heart disease can be very challenging and we often get it wrong. We have a wide range of tests that can try and identify patients with angina due to coronary heart disease. However, even with these tests, we fail to identify 1 in 3 patients who go on to have heart attacks. So we need better tests. The study shows that if you add CTCA to a clinic consultation, you clarify the diagnosis in 1 in 4 patients, alter the investigations in 1 in 6 and change the subsequent treatments in 1 in 4. This did appear not only to increase the use of coronary revascularisation but also reduce the risk of subsequent heart attacks by 38-50%. (more…)
Author Interviews, CT Scanning, Lancet, Medical Imaging, MRI, Pediatrics, Stanford / 20.02.2014

Dr Heike Daldrup-Link Associate Professor of Radiology Stanford University School of Medicine, Palo AltoMedicalResearch.com: Interview with: Dr Heike Daldrup-Link Associate Professor of Radiology Stanford University School of Medicine, Palo Alto   MedicalResearch.com: What are the main findings of the study? Answer: We use magnetic resonance imaging, a technology based on magnetic fields rather than radiotracers or x-rays. The underlying technology is not new – it has been used for tumor staging for many years. This is an advantage as MR scanners are available in nearly every major Children’s Hospital where children with cancer are treated. What is new about our approach is that we combined anatomical and functional images, similar to current approaches that use radiotracers and CT (PET/CT):  We first acquired scans that showed the anatomy of the patient very well and we then acquired scans that depict tumors as bright spots with little or no background information. We did that by using an iron supplement as a contrast agent: The iron supplement can be detected by the MRI magnet and improved tumor detection and vessel delineation MR scans. We then fused the anatomical scans with the tumor scans. (more…)
Annals Internal Medicine, Author Interviews, CT Scanning, Lung Cancer / 31.12.2013

dr_harry_j_dekonigMedicalResearch.com Interview with: Harry J de Koning, MD PhD Professor of Public Health & Screening Evaluation Rotterdam, The Netherlands. MedicalResearch.com: What are the main findings of the study? Dr. de Koning: Annual CT screening for lung cancer has a favorable benefit-to-harm ratio for individuals ages 55 through 80 years with 30 or more pack-years’ exposure to smoking. It would lead to 50% (model ranges, 45% to 54) of cases of cancer being detected at an early stage (stage I/II), 575 screenings examinations per lung cancer death averted, a 14% (range, 8.2% to 23.5%) reduction in lung cancer mortality, 497 lung cancer deaths averted, and 5250 life-years gained per the 100 000-member (1950-) cohort. Harms would include 67 550 false-positive test results, 910 biopsies or surgeries for benign lesions, and 190 overdiagnosed cases of cancer (3.7% of all cases of lung cancer [model ranges, 1.4% to 8.3%]), again for a 100 000-member (1950-) cohort. (more…)
Author Interviews, Cancer Research, CT Scanning, Heart Disease, JACC, Lung Cancer, Medical Imaging / 08.07.2013

Dr. Pim A. de Jong, Department of Radiology University Medical Center Utrecht, Heidelberglaan 100, E.01.132, 3508GA Utrecht, the Netherlands. MedicalResearch.com: What are the main findings of the study? Dr. de Jong: The main findings of the study is that lung cancer screening CT scans can predict future cardiovascular events. MedicalResearch.com: Where any of the findings unexpected? Dr. de Jong: The unexpected aspect is that the CT scans were not-ECG gated, but even these non-gated scans were good enough to quantify arterial calcifications and predict risk. (more…)
Author Interviews, CT Scanning, Medical Imaging, Neurological Disorders / 04.07.2013

Dr. Juan Pablo Villablanca, MD Director, Neuroradiology Ronald Reagan UCLA Medical Center UCLA Medical Center, Santa MonicaMedicalResearch.com Interview with Dr. Juan Pablo Villablanca, MD Director, Neuroradiology Ronald Reagan UCLA Medical Center UCLA Medical Center, Santa Monica   The Natural History of Asymptomatic Unruptured Cerebral Aneurysms Evaluated Using CTA - Growth and Rupture Incidence and Correlation to Epidemiologic Risk Factors. MedicalResearch.com:  What are the main findings of the study?

Answer:   Our longitudinal study showed that growing aneurysms have a significantly higher risk of rupture than aneurysms that are stable in size over time. Due to this increased risk, we recommend that all aneurysms, regardless of size, should be followed regularly to look for growth. We have also found that larger aneurysm size, aneurysm growth and cigarette smoking may independently increase the risk of rupture. (more…)

Author Interviews, BMJ, Brigham & Women's - Harvard, Cancer Research, CT Scanning, Medical Imaging, Medical Research Centers / 27.05.2013

prof_john_d_mathewsJohn D. Mathews, MBBS, MD, PhD, DSc Hon, DMedSc Hon, Professor of epidemiology at the School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians MedicalResearch.com: What are the main findings of the study? Prof Mathews: We found that for persons having at least one CT scan before the age of 20 years, and followed for an average period of 10 years, the average risk of cancer was increased by 24% compared with unexposed persons matched for age, sex and year of birth. The cancer risk increased by 16% for each CT scan that preceded the cancer by more than one year. The proportional increase in risk was greater for persons exposed at younger ages. (more…)
Author Interviews, Cancer Research, CT Scanning, Medical Imaging / 07.05.2013

MedicalResearch.com eInterview with Dr. Waël C. Hanna University of Toronto departments of Thoracic Surgery and Diagnostic Radiology, MedicalResearch.com: What are the main findings of the study? Dr. Hanna: By using Minimal Dose CT Scan (MnDCT) for surveillance of patients after lung cancer resection, we can detect 94.2% of recurrent or new lung cancer in this patient population. When we use chest x-ray (CXR) to conduct surveillance on the same cohort of patients, we can only detect 21.1% of new or recurrent lung cancer cases. Therefore, while MnDCT scan subjects the patient to a similar effective dose of radiation as CXR (0.2 mSV vs. 0.16 mSv), it is a vastly superior test for follow-up of this high risk population. More importantly, when we use MnDCT for surveillance, we can detect new or recurrent lung cancer at the asymptomatic locoregional stage in 78% of patients, and there quarters of those patients are candidates for further treatment in the form of surgery or radiation. In the patients who were treated, median survival was 69 months after initial operation, versus 25 months in those who received no treatment. (more…)
Author Interviews, CT Scanning, Mayo Clinic, Medical Imaging, Orthopedics / 17.04.2013

MedicalResearch.com:  Katrina N. Glazebrook, MB, ChB Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 MedicalResearch.com:  Why did you do the study? Dr. Glazebrook: We felt CT was being underutilized for evaluation of knee injuries. The utility of CT has been well documented in the assessment of fractures, but little attention has been made on soft tissue evaluation. CT now has high spatial resolution with very thin reconstructions in any desirable plane, and we have previously noted that this allowed injured soft tissue structures such as cruciate ligaments to be well visualized [presented at Society of Skeletal Radiology meeting March 2013]. We had determined in that prior study that the best reconstruction plane to evaluate both normal and torn anterior cruciate ligaments was the oblique sagittal plane parallel to the lateral femoral condyle as routinely used in MRI imaging of the knee The soft tissue window, single energy bone removal and Dual energy bone removal were the best reconstructions to determine the presence or absence of ACL disruption The bone removal techniques removed the distracting bone so the soft tissue structures were more apparent. (more…)