Knowledge of Risks From Imaging Radiation Has Room For Improvement

MedicalResearch.com Interview with:

David Leswick MD FRCPC Radiologist Saskatoon Health Region and the University of Saskatchewan

Dr. David Leswick

David Leswick MD FRCPC
Radiologist Saskatoon Health Region and the
University of Saskatchewan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this study is that the use of computed tomography (CT) is increasing, and there is a significant radiation dose imparted to the population through imaging. There have been multiple prior studies showing limited knowledge of both dose levels and its associated risk from medical imaging procedures, and we wanted to evaluate local knowledge in our Health Region. We surveyed a total of 308 health care providers, including 217 referring physicians, 32 radiologists and 59 technologists. Overall, most respondents were aware of the risk of malignancy from CT, with only 23% of physicians, 3% of radiologists, and 25% of technologists believing there was no increased risk of malignancy from a single CT scan. Underestimating radiation dose levels from a procedure is more concerning than overestimating as it may lead to minimization of the perceived risk. Although relatively few respondents (20%) selected the most appropriate dose estimate for an abdominal CT scan in chest x-ray equivalents, the majority (54%) correctly or overestimated dose, with better knowledge amongst radiologists and imaging technologists than referring physicians. In general, respondents were appropriately more concerned regarding radiation dose when imaging pregnant and pediatric patients as risks from radiation are higher in those groups of patients.

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“Bad Genes” plus “Bad Environment” Lead To Brain Abnormalities in Youth With Conduct Disorders

Dr-Luca-Passamonti.jpg

Dr. Luca Passamonti

MedicalResearch.com Interview with:
Dr. Luca Passamonti MD
Department of Clinical Neurosciences
University of Cambridge

MedicalResearch.com: What is the background for this study?

Dr. Passamonti: We wanted to study if the brain of young people with two different forms of conduct disorder (CD) (https://en.wikipedia.org/wiki/Conduct_disorder), a neuropsychiatric disease associated with severe and persistent antisocial behaviors (weapon use, aggression, fire-setting, stealing, fraudulent behavior), was different from that of young peers with no such abnormal behaviors.

There is already evidence that conduct disorder may have a biological basis (i.e., reduced levels of cortisol under stress) and brain alterations but a whole “map” of the brain in conduct disorder studying cortical thickness was never been done before.

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Computerized Triggers May Help Prevent Delays in X-Ray Reports

MedicalResearch.com Interview with:

Daniel R. Murphy, M.D., M.B.A. Assistant Professor - Interim Director of GIM at Baylor Clinic Department of Medicine Health Svc Research & General Internal Medicine Baylor College of Medicine Houston, TX

Dr. Daniel Murphy

Daniel R. Murphy, M.D., M.B.A.
Assistant Professor – Interim Director of GIM at Baylor Clinic
Department of Medicine
Health Svc Research & General Internal Medicine
Baylor College of Medicine
Houston, TX

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Murphy: Electronic health records (EHRs) have improved communication in health care, but they have not eliminated the problem of patients failing to receive appropriate and timely follow up after abnormal test results. For example, after a chest x-ray result where a radiologist identifies a potentially cancerous mass and suggests additional evaluation, about 8% of patients do not receive follow-up imaging or have a visit with an appropriate specialist within 30 days. Identifying patients experiencing a delay with traditional methods, like randomly reviewing charts, is not practical. Fortunately, EHRs collect large amounts of data each day that can be useful in automating the process of identifying such patients.

We evaluated whether an electronic “trigger” algorithm designed to detect delays in follow up of abnormal lung imaging tests could help medical facilities identify patients likely to have experienced a delay. Of 40,218 imaging tests performed, the trigger found 655 with a possible delay. Reviewing a subset of these records showed that 61% were truly delays in care that required action. We also found that the trigger had a sensitivity of 99%, indicating that it missed very few actual delays.

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Performance of Mammogram Readers Does Not Diminish With Time

MedicalResearch.com Interview with:

Dr Sian Taylor-Phillips PhD Assistant Professor of Screening and Test Evaluation Division of Health Sciences Warwick Medical School University of Warwick Coventry

Dr. Taylor-Phillips

Dr Sian Taylor-Phillips  PhD
Assistant Professor of Screening and Test Evaluation
Division of Health Sciences
Warwick Medical School
University of Warwick
Coventry

MedicalResearch.com: What is the background for this study?

Dr Taylor-Phillips : Psychologists have been investigating a phenomenon of a drop in performance with time on a task called ‘the vigilance decrement’ since World War 2. In those days radar operators searched for enemy aircraft and submarines (appearing as little dots of light on a radar screen). People thought that the ability to spot the dots might go down  after too much time spent on the task. Many psychology experiments have found a vigilance decrement, but most of this research has not been in a real world setting.

In this research we wanted to know whether there was a drop in performance with time on a task for breast screening readers looking at breast x-rays for signs of cancer. (Breast x-rays or mammograms show lots of overlapping tissue and cancers can be quite difficult to spot). This was a real-world randomised controlled study in UK clinical practice.

In the UK NHS Breast Screening Programme two readers examine each woman’s breast x-rays separately for signs of cancer. They look at batches of around 35 women’s x-rays. At the moment  both readers look at the x-rays in the same order as each another, so if they both experience a drop in performance, it will happen at the same time. We tested a really simple idea of reversing the batch order for one of the readers, so that if they have a low ebb of performance it happens when they are looking at different women’s breast x-rays.

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Fat/Bone Ratio Correlates Better with Obesity Risks than BMI

MedicalResearch.com Interview with:

Albert Roh MD Radiology Resident Maricopa Integrated Health System

Dr. Albert Roh

Albert Roh MD
Radiology Resident
Maricopa Integrated Health System

MedicalResearch.com: What is the background for this study?

Dr. Roh: Obesity is well documented to be associated with many medical conditions.  Currently, obesity is defined as body mass index (BMI) over 30 kg/m^2.  Although simple to calculate and relatively accurate, BMI has its limitations.  BMI does not factor in the subject’s body type or fat distribution pattern.  For example, a muscular subject and a fatty subject may both have BMI of 30 and be considered obese, although the muscular subject would not be predisposed to the comorbidities associated with obesity.  Similarly, two subjects may have the same BMI but have different fat distribution patterns: “apple” with fat distributed primarily on the chest/abdomen and “pear” with fat distributed on the hips.  The “apple” fat distribution correlates better with the comorbidities associated with obesity.

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Lack of Health Insurance Linked to Later-Stage Cancer Presentation

MedicalResearch.com Interview with:

Dr. Christine Fisher MD, MPH Department of Radiation Oncology University of Denver

Dr. Christine Fisher

Dr. Christine Fisher MD, MPH
Department of Radiation Oncology
University of Denver

MedicalResearch.com: What is the background for this study?

Dr. Fisher: Screenable cancers are treated by oncologists every day, including many in invasive, advanced, or metastatic settings.  We aimed to determine how health insurance status might play into this, with the hypothesis that better access to health care would lead to presentation of earlier cancers.  While this sounds intuitive, there is much debate over recent expansions in coverage through the Affordable Care Act and how this may impact health in our country.

MedicalResearch.com: What are the main findings?

Dr. Fisher: The findings confirm that those without health insurance present with more advanced disease in breast, cervix, colorectal, and prostate cancers, including tumor stage, grade and elevated tumor markers.  That is to say, all else being equal for risk of cancer, lack of health insurance was an independent risk factor for advanced presentation. 

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Cardiac Catheterization Laboratory Workers Face Occupational Health Risks From Chronic Radiation Exposure

MedicalResearch.com Interview with:
Dr. Maria Grazia Andreassi, PhD
Director, Genetics Research Unit,
CNR Institute of Clinical Physiology
Pisa, Italy

MedicalResearch.com: What is the background for this study?

Response: Over the last 20 years, advances in imaging technology have led to an explosive growth and performance of fluoroscopically-guided cardiovascular procedures, highly effective and often life-saving. However, these procedures requires substantial radiation exposure (e.g. the average effective radiation dose for a percutaneous coronary intervention or an ablation procedure is about 15 mSv, equal to 750 chest x-rays or ~6 years of background radiation) to patients and staff, especially interventional cardiologists and electrophysiologists.

In fact, interventional cardiologists and electrophysiologists needs to operate near the patient and the radiation source and accumulate significant lifetime radiation exposure over a long career. The potential hazards of cumulative radiation exposure are the risk of cataract development and cancer induction. Anyway, there is now growing evidence in scientific community of an excess risk for other non-cancer disease even at moderate and low dose levels of ionizing radiation exposure, especially cardiovascular disease and cognitive effects. However, the characterization of health risks of accumulated low-dose radiation is incomplete and largely lacking.

Therefore, the purpose of our study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure.

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Infertility and Fertility Treatments Linked To Greater Breast Density

MedicalResearch.com Interview with:

Frida Lundberg | PhD Student Dept. of Medical Epidemiology and Biostatistics Karolinska Institutet

Frida Lundberg

Frida Lundberg | PhD Student
Dept. of Medical Epidemiology and Biostatistics
Karolinska Institutet

Medical Research: What is the background for this study?

Response: Fertility treatments involve stimulation with potent hormonal drugs that increase the amount of the sex hormones estrogen and progesterone. These hormones have been linked to breast cancer risk. Further, as these treatments are relatively new, most women who have gone through them are still below the age at which breast cancer is usually diagnosed. Therefore we wanted to investigate if infertility and fertility treatments influences mammographic breast density, a strong marker for breast cancer risk that is also hormone-responsive.

Medical Research: What are the main findings?

Response: We found that women with a history of infertility had higher absolute dense volume than other women. Among the infertile women, those who had gone through controlled ovarian stimulation (COS) had the highest absolute dense volume. The results from our study indicate that infertile women, especially those who undergo COS, might represent a group with an increased risk of breast cancer. However, the observed difference in dense volume was relatively small and has only been linked to a modest increase in breast cancer risk in previous studies.  As the infertility type could influence what treatment the couples undergo, the association might also be due to the underlying infertility rather than the treatment per se.

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Clinical Findings and Brain Calcifications of Zika Babies Described

MedicalResearch.com Interview with:

Team of Doctors Brazil - Article BJM - Zika -  Ana van Der Linden, Alessandra Brainer, Maria de Fatima Aragao, Vanessa va Der Linden e Arthur Cesário.jpg

Team of Doctors:  Ana van Der Linden, Alessandra Brainer, Maria de Fatima Aragao, Vanessa va Der Linden e Arthur Cesário

Maria de Fatima Vasco Aragao MD, PhD
Radiologist and Neuroradiologist
Professor of Radiology, Mauricio de Nassau University, Recife, Brazil
Scientific Director of Multimagem Radiology Clinic, Recife – PE, Brazil
President of Pernambuco Radiology Society

MedicalResearch.com: What is the background for this study?

Response: The new Zika virus epidemic in Brazil was recognized as starting in the first half of 2015 and the microcephaly epidemic was detected in the second half of that same year.

This is a transmission electron micrograph (TEM) of Zika virus, which is a member of the family Flaviviridae. Virus particles are 40 nm in diameter, with an outer envelope, and an inner dense core.

This is a transmission electron micrograph (TEM) of Zika virus, which is a member of the family Flaviviridae. Virus particles are 40 nm in diameter, with an outer envelope, and an inner dense core.

MedicalResearch.com: What are the main findings?

  • Response:  In our study of the 23 mothers, only one did not report rash during pregnancy (rash is a sign that can happen in Zika virus infection). However, Zika virus infection can be asymptomatic in three of every four infected patients. All of the 23 babies had the same clinical and epidemiological characteristics and other congenital infection diseases had been excluded. Of these 23 babies, six were tested for IgM antibodies, specific to Zika virus and all six proved positive. So, by deduction, the other 17 babies on whom it was not possible to make the IgM test, were considered as also having presumed congenital infection related to the Zika virus, after other congenital infections being excluded.
  • All the babies showed malformations of cortical development and sulcation.  The most frequent cortical malformation were: Microcephaly with a simplified cortical gyral pattern and areas of thick cortex of polymicrogyria or pachygyria which were located predominantly in the frontal lobes.
  • Abnormalities of the corpus callósum (hypogenesis and hypoplasia) were common.
  • Decreased brain volume was a common finding. Ventriculomegaly was present in all the babies, with a predominant enlargement of the posterior portions of the lateral ventricles,
  • Delayed myelination were also common. The cisterna magna was enlarged in most of the cases, with or without cerebellar hypoplasia.
  • Some of the babies showed a symmetrical enlargement of the anterior subarachnoid space of the supratentorial compartment, associated with severe ventriculomegaly.

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Retrospective Study Compares Removal of Three Nonpermanent IVC Filter Types

MedicalResearch.com Interview with:

Eric T. Aaltonen MD, MPH Interventional Radiologist Assistant Professor, Department of Radiology Radiology  NYU Langone Medical Center

Dr. Eric Aaltonen

Eric T. Aaltonen MD, MPH
Interventional Radiologist
Assistant Professor, Department of Radiology
Radiology 
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Aaltonen: A few years ago we started placing Denali  inferior vena cava (IVC) filters and noticed that these filters tended to not tilt and were subsequently more straight forward to remove when patients returned for filter retrieval.  Subsequently, a retrospective study was performed comparing these Denali filters with ALN and Option filters that have also been placed and removed at our hospitals.  The results demonstrate that Option filters have an increased rate of tilt at retrieval and increased retrieval time compared to Denali filters.  No significant difference in tilt or retrieval time was found with ALN filters.  Additionally, the presence of tilt correlates with more equipment use and increased fluoroscopy time during retrieval.

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Very Low Dose CT Scans Successfully Detect Bone Fractures

MedicalResearch.com Interview with:

Sanjit Konda, MD Assistant professor of orthopaedic surgery NYU Langone Medical Center

Dr. Sanjit Konda

Sanjit Konda, MD
Assistant professor of Orthopaedic surgery
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Konda: We serendipitously found that we could identify periarticular fractures associated with deep knee wounds with the use of a CT-scan. We published a study in the Journal of Orthopaedic Trauma showing that a CT scan could identify a traumatic arthrotomy of a joint better than a saline load test, which at the time was considered the diagnostic gold standard. When we presented that work, we received criticism that we were subjecting patients to a high dose of radiation for a diagnostic test; however, our rationale at the time was that the saline load test was a painful, invasive procedure using a needle, and that we would trade a bit of radiation for lack of invasive procedure.

This got us thinking of ways we could decrease the amount of radiation in the CT yet maintain the same diagnostic accuracy of identifying penetrating joint injuries. Collaborating with Dr. Soterios Gyftopoulos, an assistant professor in the Department of Radiology at NYU Langone, we were able to successfully reduce the amount of radiation in these CT scans and still get good bony images. We then thought, if we can get a CT scan that shows us good bony detail and is safer, then why shouldn’t we be doing it on every joint fracture, not just these arthrotomy cases? We then applied this to our current research protocol, REDUCTION(Reduced Effective Dose Using Computed Tomography In Orthopaedic Injury) in which we reduced the average amount of radiation from 0.43 msV to 0.03 msV, or down to the average dose given in a routine chest X-ray. After running a comparison study with our ultra-low dose radiation protocol compared to conventional CT scans, we found we were able to obtain nearly the exact same types of images for various joint fractures and locations without sacrificing any diagnostic accuracy in most cases. We gave sets of these CT scans to orthopaedic surgeons to analyze, and found we achieved 98 percent sensitivity and 89 percent specificity with the ultra-low dose CT scans when occult fractures, or those that could not be seen on an X-ray, were removed from our analysis.

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New Combination Coronary Imaging Technique Identified Dangerous Plaques

MedicalResearch.com Interview with:

Guillermo J. Tearney, MD PhD Mike and Sue Hazard Family MGH Research Scholar Professor of Pathology, Harvard Medical School Wellman Center for Photomedicine Massachusetts General Hospital

Dr. Gary Tearney

Guillermo J. Tearney, MD PhD
Mike and Sue Hazard Family MGH Research Scholar
Professor of Pathology, Harvard Medical School
Wellman Center for Photomedicine
Massachusetts General Hospital

MedicalResearch.com: What is the background for this study?
Dr. Tearney: In this study, we investigated a new, advanced catheter-based imaging technology for identifying the coronary plaques that may potentially precipitate heart attack. The new technique combines intracoronary OCT, that provides images of tissue emicrostructure with near-infrared autofluorescence (NIRAF) that informs on the molecular/biological characteristics of plaque.

MedicalResearch.com: What are the main findings?

Dr. Tearney: Our main findings were that:
1) Intracoronary OCT-NIRAF is safe and feasible in patients
2) NIRAF was elevated focally in portions of the coronary artery that contained high risk OCT features, and
3) The findings are suggestive that NIRAF may be a new imaging feature that is indicative of inflammation in human coronary lesions in vivo.

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PET Scans May Be Overused To Detect Recurrent Lung Cancer

MedicalResearch.com Interview with:

Mark A. Healy, MD Department of Surgery Center for Healthcare Outcomes & Policy, University of Michigan Ann Arbor, MI

Dr. Mark Healy

Mark A. Healy, MD
Department of Surgery
Center for Healthcare Outcomes & Policy, University of Michigan
Ann Arbor, MI  

Medical Research: What is the background for this study? What are the main findings?

Dr. Healy: In our study, we found high overall use of PET as a primary study for recurrence detection in lung and esophageal cancers, with substantial hospital-based variation in the use of PET. Despite this, there was not a significant difference in survival for patients across high and low PET use hospitals.

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Meditation May Improve Experience with Imaging-Guided Needle Breast Biopsy

MedicalResearch.com Interview with:

Mary Scott Soo, M.D. FACR Associate professor of Radiology Duke Cancer Institute

Dr. Mary Scott Soo

Mary Scott Soo, M.D. FACR
Associate professor of Radiology
Duke Cancer Institute

Medical Research: What is the background for this study?

Dr. Soo: Imaging-guided needle breast biopsies for diagnosing suspicious breast lesions have been performed for many years and have definite advantages as a diagnostic tool over surgical biopsies. These biopsies are performed in outpatient settings, which decrease costs and reduce delays, and are highly accurate and less invasive than surgical procedures, requiring only local anesthesia. However, performing biopsies in this outpatient setting limits the use of intravenous sedation and pain medication that could address commonly experienced patient anxiety and occasional associated pain. Anxiety and pain can negatively impact the patient’s experience and could possibly affect the biopsy outcome due to patient movement, and could potentially even alter patients’ adherence to follow-up recommendations. Prior studies have explored methods to reduce anxiety, using interventions such as music, hypnosis and anxiolytics. Although hypnosis and anxiolytics are effective, these are a little more complicated to implement due to training costs for administering hypnotherapy, and costs, potential side effects, and need for an adult driver to take the patients home when anxiolytics are used. Other research has shown that meditation-based interventions can lead to positive psychological and physical outcomes, and may be helpful for decreasing anxiety, pain and fatigue.

Loving-kindness mediation is a type of mediation that focuses on relaxation and developing positive emotions, by silently repeating phrases encouraging compassion and goodwill towards oneself and others, while also reducing negative emotions. Previous studies have shown that even a 7-minute loving-kindness meditation can be effective for increasing positive emotions, so my co-authors Rebecca Shelby PhD, a clinical psychologist at Duke’s Pain Prevention and Treatment Research Program,clinical psychologist Anava Wrenn PhDwho has used loving-kindness meditation in a different practice setting, and breast imaging radiologist Jennifer Jarosz MD and I put together a team to study whether an audio-recorded, lovingkindness meditation could reduce anxiety, fatigue and pain during the imaging-guided breast biopsy time frame.  We consulted with Mary Brantley, MA, LMFT, who teaches loving-kindness meditation at Duke’s Integrative Medicine, to develop an audio-recorded loving-kindness mediation used specifically in the breast biopsy setting, and compared this to using music during biopsies or standard care (supportive dialogue) from the technologist and radiologist performing the biopsy.

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Only Small Increase in CT Screening for Lung Cancer Despite New Guidelines

MedicalResearch.com Interview with:

Phillip M. Boiselle, MD Professor of Radiology and Associate Dean for Academic and Clinical Affairs Harvard Medical School Beth Israel Deaconess Medical Center Boston, Massachusetts

Dr. Phillip Boiselle

Phillip M. Boiselle, MD
Professor of Radiology and Associate Dean for Academic and Clinical Affairs
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Medical Research: What is the background for this study?

Dr. Boiselle: We surveyed leading academic medical centers in 2013 and found considerable variability in their practice patterns as well as a relatively small number of patients being screened for lung cancer at these sites. Considering landmark developments since that time, including favorable policy and payment decisions by USPSTF  and CMS  and development of radiology-specific nodule guidelines by the American College of Radiology, we were curious to see whether there would be greater conformity of practice patterns and increased patient volumes in response to these developments.

Medical Research: What are the main findings?

Dr. Boiselle: First, our finding of greater conformity of lung cancer screening practices at present compared to 2013 confirmed our hypothesis that the development of radiology-specific guidelines by ACR would contribute to greater uniformity.

Second, we were surprised by the very modest level of increase in patient volumes for CT screening over time despite the favorable USPSTF and CMS decisions. We emphasize, however, that the timing of our survey occurred too early to determine the full impact of CMS coverage on patient volumes

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Is Low Dose Radiation Exposure Really Harmful?

MedicalResearch.com Interview with:
Jeffry A. Siegel, PhD
President & CEO, Nuclear Physics Enterprises, Marlton, NJ
Charles W. Pennington, MS, MBA
NAC International, Norcross, GA, Retired; Executive Nuclear Energy Consultant
Bill Sacks, PhD, MD
Emeritus Medical Officer, FDA Center for Devices and Radiological Health
Silver Spring, MD
James S. Welsh, MS, MD, FACRO
Department of Radiation Oncology
Stritch School of Medicine Loyola University Chicago, Maywood, IL

Medical Research: What is the background for this study? What are the main findings?

Response: The background is the falsity of the widespread claim that all ionizing (high energy) radiation is harmful regardless of how low the dose.  This claim is expressed in the official policies of almost all radiation regulatory agencies around the world, as well as in many scientific journal papers.  It has been responsible for a common fear of radiation (radiophobia) among the public and members of the medical profession, including even most radiologists and nuclear medicine physicians.

The radiophobia resulting from this false allegation has been instrumental in the forced evacuations of hundreds of thousands of people near nuclear energy plants at Chernobyl and Fukushima that have produced thousands of deaths from the evacuations themselves of sick and/or elderly people, from consequent suicides, alcoholism, heart attacks, and strokes, as well as other health destroying reactions to the loss of homes, possessions, jobs, and communities.

This erroneous belief has acted to prevent many people from getting needed CT scans and x-ray studies, and to prevent many parents from permitting their children to get such imaging studies, with consequences such as surgical explorations that might have been otherwise unnecessary and carry risks of injury and mortality, or such as the foregoing of treatment that would otherwise be health restoring.

This unfounded proclamation and its resultant radiophobia have acted as obstacles to the development of clean and sustainable nuclear energy, and have underlain widespread irresponsible propaganda by all sorts of would-be anti-nuclear gurus.  There are other harmful effects of this unwarranted contention, including severe limitations on funding for further research into the beneficial effects of low-dose radiation.

The main findings in this article are that the very scientists whose experimental work gave rise to this false claim in the 1940s – Hermann Muller and Curt Stern and their colleagues – in fact demonstrated the exact opposite, namely that below certain threshold radiation doses there were no harmful effects at all and possible beneficial effects.  Even more importantly, there were no scientists at the time who realized that Muller and Stern’s conclusions flew in the face of their actual experimental results.  Or at least there were none who were inclined to point out the falsity of Muller and Stern’s unwarranted conclusions, perhaps intimidated by Muller’s status as a Nobel Prize winner (1946, for his earlier work on radiation-caused mutations in fruit flies).

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Proposed Model Clarifies Ovarian Risk Assessment By Ultrasound

Dirk Timmerman, MD PhD Department of Development and Regeneration Department of Obstetrics and Gynecology University Hospitals Leuven Leuven, Belgium

Dr. Dirk Timmerman

More on Ovarian Cancer on MedicalResearch.com
MedicalResearch.com Interview with:
Dirk Timmerman, MD PhD

Department of Development and Regeneration
Department of Obstetrics and Gynecology
University Hospitals Leuven
Leuven, Belgium

Medical Research: What is the background for this study? What are the main findings?

Dr. Timmerman: Ovarian cancer is the most aggressive and lethal gynecological malignant neoplasm. The prognosis of ovarian cancer is poor, with only about 40% of patients still alive five years after being diagnosed. The preoperative characterization of an adnexal tumor is fundamental for selecting the optimal management strategy. An accurate differentiation between benign and malignant masses can lead to optimal referral of patients with malignant diseases to gynecological oncology centers for further diagnostics and treatment, which positively influences the prognosis. On the other hand, it may help in safely selecting patients with benign ovarian masses for minimally invasive or fertility sparing surgery, and in some cases maybe even conservative follow-up. The International Ovarian Tumor Analysis (IOTA) study is the largest diagnostic accuracy study of its kind. Transvaginal ultrasound is a cheap and very accessible imaging technique. Using ultrasound features, which are easy to assess by a trained examiner, we proposed a model to define the individual risk of malignancy for each patient presenting with an adnexal tumor. This could considerably impact on the morbidity and mortality associated with adnexal pathology.

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Heart Wall Thickness Linked To Ventricular Arrhythmias

More on Heart Disease on MedicalResearch.com

Yitschak (Yitsik) Biton, MD Postdoctoral Research Fellow University of Rochester Medical Center Saunders Research Building Heart Research Follow-Up Program Rochester, NY

Dr. Yitschak Biton

MedicalResearch.com Interview with:
Yitschak (Yitsik) Biton, MD
Postdoctoral Research Fellow
University of Rochester Medical Center
Saunders Research Building
Heart Research Follow-Up Program
Rochester, NY

Medical Research: What is the background for this study? What are the main findings?

Dr. Biton: Patients with heart failure and reduced ejection fraction have increased risk for sudden cardiac death due to ventricular arrhythmias. The causes of these arrhythmias are thought to be adverse left ventricular remodeling and scarring. Cardiac resynchronization therapy has been previously shown to reverse the adverse process of remodeling and induce reduction in cardiac chamber volumes. Relative wall thickness is a measure of the remodeling process, and it could be classified into normal, eccentric and concentric. In our study we showed that the degree relative wall thickness in patients with dilated cardiomyopathy and eccentric hypertrophy is inversely associated with the risk of ventricular arrhythmias. Furthermore we showed the CRT treated patients who had increase in relative wall thickness (became less eccentric) had lower risk for ventricular arrhythmias.

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CT Scans Reveal Black-White Differences in Cardiac Morphology

More on Heart Disease on MedicalResearch.com

MedicalResearch.com Interview with:
John Nance, MD
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science
Medical University of South Carolina
Charleston, South Carolina 

Medical Research: What is the background for this study? What are the main findings?

Dr. Nance: There are known ethnic and racial disparities in the burden, morbidity, and mortality of cardiovascular disease. The causes, of course, are multifactorial, and range from genetic differences to healthcare access issues. Our goal was to further explore these differences by utilize a dataset encompassing black and white patients who had undergone a coronary CT angiogram for the assessment of acute chest pain. We compared various measures of myocardial morphology and function, namely myocardial mass, interventricular septal wall thickness, left ventricular inner diameter in diastole and systole, and ejection fraction. We found that black patients had significantly higher myocardial mass than whites despite adjusting for age, gender, body mass index, and hypertension. Likewise, the septal wall was thicker in black patients. Interestingly, ejection fraction was slightly lower in black patients, but this finding was not statistically significant.  Continue reading

Screening and Treatment of DCIS Reduces Number of Invasive Breast Cancers

Prof Stephen Duffy BSc MSc CStat Professor Of Cancer Screening Wolfson Institute Of Preventive Medicine Queen Mary University of London

Prof. Stephen W. Duffy

MedicalResearch.com Interview with:
Prof Stephen Duffy BSc MSc CStat
Professor Of Cancer Screening
Wolfson Institute Of Preventive Medicine
Queen Mary University of London

Medical Research: What is the background for this study? What are the main findings?

Prof. Duffy: There is debate on the value of diagnosing and treating ductal carcinoma in situ (DCIS) of the breast, depending mainly on different theories about the risk of progression to invasive breast cancer if DCIS were untreated. No-one asserts that no DCIS is progressive and no-one asserts that all DCIS is progressive. There is, however, a range of opinions on the proportion of progressive disease.

We found that those mammography screening units in the UK with higher detection rates of DCIS had lower subsequent rates of invasive cancers in the three years after screening.

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Breast Radiologist Discusses Screening Mammography Public Education

Jiyon Lee, M.D. Assistant Professor of Radiology, NYU School of Medicine NYU Cancer Institute, Breast Imaging Center New York, New York 10016

Dr. Lee

MedicalResearch.com Interview with:
Jiyon Lee, M.D.
Assistant Professor of Radiology, NYU School of Medicine
NYU Cancer Institute, Breast Imaging Center
New York, New York 10016

Medical Research: What is the background for this study? What are the main findings?
Dr. Lee:   Even before the USPSTF changed their breast screening guidelines in 2009, I conducted community outreach to help educate others on my area of expertise, breast imaging and breast screening. I presented lay friendly, illustrated, and practical explanations in a structured talk, about the big picture and the salient details, in a way that I would want if I were not a breast radiologist. As is customary for such community outreach, we solicited feedback from attendees. It was gratifying to hear the positive responses. That they wished for such education for others served as a clarion call that is understandable. Education should be objective and noncoercive.  “Knowledge is power,” but only if complete and accurate.

Breast cancer is still a common disease, we are all at least at average risk, and screening is still standard of care.  Much of the debate surrounding screening mammography centers on the age of onset of screening and the optimal screening interval. The USPSTF states that shared-decision making between women and their providers may occur, especially for women in 40-49 year group.  But the TF does not stipulate when or how or by whom this talk will ensue, and notice that their guidelines refer to film mammography, and “biennial” mammography.

Since the time of this manuscript, the American Cancer Society issued new guidelines on 10/20/2015 that among its bullet points emphasized annual mammography for women 45-54 years and deemphasized clinical breast exam, while supporting option to start annually at age 40 with shared decision making to weigh what are referred to as “risks” and benefits. Although the fine print does reaffirm that annually starting at age 40 is the screening model that saves the most lives, the ACS is encouraging deliberate value judgment regarding “risks” and “harms.” Their fine print is also intimating that women 55 and over have nondense tissue and that their cancers are indolent. The ensued publicity and mixed messaging have caused another cycle of confusion regarding breast cancer screening. As the experts in this field of image-based screening, radiologists have opportunity to clarify and contextualize the issues and details of the screening discussion, and can do so with objectivity, respect for all sides of the debate, and compassion. All responsible ways to continually educate both women and all providers will enable both sides to engage in the discussion fairly. Because as we discourage paternalistic medicine and promote shared decision making, it’s not fair play if all responsible sides do not get fair say. Do realize that not all women see providers regularly, and depending on the medical subspeciality, not all providers are mentioning screening til women reach a certain age and may not relay importance of the physical exam components that complement imaging.

This article specifically highlights how such direct and interactive public education can effect potential benefit in two ways.

  • First, directly reduce one of the core criticisms about screening: the “anxiety” that women may experience, which is heavily weighed as a “harm” of screening.  Most women do not experience high anxiety, and are glad to have a test that may help them. And education can help demystify much of the process and protocol, and explain up to what may be that patient’s next test results if she engages in screening at all. No one can tell that.
  • Two, education can directly increase one of the necessary components of shared decision making that is presumed in implementing breast screening: informing women. The pre- and post-lecture questionnaire, along with fact-based quiz questions, provided insight and enabled learning opportunity for the audience that are not usual for community outreach.  Education that keeps on going—and is shareable!– after the lecture is done.

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Brains of Men and Women More Similar Than Different

Dr-Lise-EliotMedicalResearch.com Interview with:
Lise Eliot PhD

Associate Professor of Neuroscience
Chicago Medical School
Rosalind Franklin University
North Chicago, IL 60064   

Medical Research: What is the background for this study?

Dr. Eliot: The hippocampus participates in many behaviors that differ between men and women, such as episodic memory, emotion regulation, and spatial navigation.  Furthermore, the hippocampus is known to atrophy in diseases such as depression, anxiety disorders, and Alzheimer’s disease, all of which are more prevalent in women.  It is conceivable that a premorbid difference in hippocampal volume contributes to females’ greater vulnerability.  In the scientific literature, the hippocampus is often said to be proportionally larger in females than males.  We set out to test this by doing a systematic review of the literature for hippocampal volumes in matched samples of healthy males and females, measured using structural MRI data collected from over 6000 participants of all ages.

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Coronary Artery Calcium Score Improves Risk Prediction In Younger Adults

Dr. Andre R. M. Paixao MD Division of Cardiology Department of Internal Medicine Washington Hospital Center Washington, DC

Dr. Andre R. M. Paixao MD

MedicalResearch.com Interview with:
Dr. Andre R. M. Paixao MD
Division of Cardiology
Arkansas Heart Hospital
Little Rock, AR.

Medical Research: What is the background for this study?

Dr. Paixao: Coronary artery calcium (CAC) measured by computed tomography has emerged as a powerful predictor of coronary heart disease (CHD) but most of the evidence behind it comes from cohorts comprised of older individuals (mean age 62 years).Coronary artery calcium has a very strong association with age and young individuals tend to have a higher proportion of noncalcified plaque so validating the predictive value of CAC in a younger cohort is of extreme importance.  

Medical Research: What are the main findings?

Dr. Paixao: Using data from the Dallas Heart Study, a multi-ethnic cohort comprised of younger individuals (mean age 44 years), the addition of Coronary artery calcium to a traditional risk factor model significantly improved discrimination and risk classification (change in c-statistic = 0.03; NRI = 0.216, p = 0.012).

We also performed a meta-analysis of prior studies and observed that our findings are of similar magnitude to those reported in older individuals (NRI = 0.200).

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Non-Invasive MRI Demonstrates Reduced Brain Connectivity in Autism Spectrum Disorder

MedicalResearch.com Interview with:
Kay Jann, PhD, Department of Neurology

Danny JJ Wang, Prof., Department of Neurology
Laboratory of Functional MRI Technology
Ahmanson-Lovelace Brain Mapping Center
Department of Neurology
University of California Los Angeles
Los Angeles 

Medical Research: What is the background for this study? What are the main findings?

Response: The brain controls most of our behavior and thus changes in how brain areas function and communicate with each other can alter this behavior and lead to impairments associated with mental disorders. Higher cognitive functions are controlled by brain areas that form complex interconnected networks and alterations in these networks can lead to cognitive impairments. In autism, one such network is the so called default mode network. This network controls self-referential thoughts, reasoning past and future and is involved in understanding mental states of others (i.e. Theory of Mind).

Functional MRI based functional connectivity is a research tool to understand the interrelations between brain areas and how separate, distributed areas can be organized into brain networks that serve specific cognitive functions. In autism, local hyperconnectivity along with hypoconnectivity in long range connections between anterior and posterior cingulate cortices has been discussed to be one of the physiological underpinnings of the behavioral symptoms in social interaction and cognition observed in austism. It is hypothesized to be due to a developmental delay and disbalance of the balance between neuronal excitation/inhibition in brain areas that lead to oversynchronized strong short-range (local) networks while long-range connections that develop later in neurodevelopment are less well established.

In our study, we used a non-invasive MRI technique called arterial spin labeling (ASL) perfusion MRI for the first time in autism research. Similarly to Positron Emission Tomography (PET) this technique allows measuring cerebral blood flow (CBF), however without the need to inject radioactive tracers. ASL MRI uses magnetically labeled blood water as an endogenous tracer to quantify CBF. Accordingly, our approach enabled us to combine information about how brain areas are functionally connected, as well as their associated metabolic energy consumption in autism spectrum disorder. 

We found that in typically developing children, the known relation between how strongly an area is connected to other areas in a brain network, the more energy it requires holds. In children with autism spectrum disorder this relation, however, was disrupted in a major brain area (the dorsal anterior cingulate cortex) that is relevant to social interactions and in Theory of Mind. Both are cognitive processes that are to some extent impaired in persons with autism spectrum disorders.

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PET/CT May Yield False Positive Findings in Early Stage Melanoma

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.

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