MedicalResearch.com Interview with:
Alison L. Chetlen, D.O.
Associate Professor, Department of Radiology
Penn State Milton S. Hershey Medical Center
Hershey, PA 17033
Medical Research: What is the background for this study?
Dr. Chetlen: Breast cancer risk assessment provides a means of identifying women who are at risk for development of this disease. Identifying individuals at high risk for breast cancer allows for genetic testing, supplemental breast cancer screening, possibly prophylactic surgery or chemoprevention in hopes of decreasing mortality from breast cancer. Despite the advantages of cancer genetic risk assessment and testing, most individuals in the general population who would benefit from such services currently do not receive them.
Medical Research: What are the main findings?
Dr. Chetlen: After implementation of a specific high-risk recommendation within our standardized mammography report along with a letter written in “lay” language informing patients of their high-risk status, the number of referrals to our high-risk clinic increased only modestly. Despite these specific recommendations to both physicians and patients, over 85% of high risk patients did not consult a high-risk provider regarding their elevated lifetime risk of breast cancer.
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MedicalResearch.com Interview with:
Ms. Rikke Elmose Mols
Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark.
MedicalResearch.com: What is the background for this study? What are the main findings?Response: Current ESC guidelines for patients with chest pain and low to intermediate pre-test probability of coronary artery disease (CAD) recommend control and modification of risk factors. However, patients with an elevated cardiovascular risk profile are frequently inadequately motivated for lifestyle changes and medicine adherence from knowledge about risk factors and information about risk reduction alone. Coronary artery calcification (CAC) is a marker of coronary atherosclerosis. The degree of coronary artery calcification may be assessed by the Agatston score (AS) derived by non-enhanced cardiac computed tomography, whereas non-invasive CT imaging of the coronary arteries require contrast-enhancement (coronary computed tomography angiography [CTA]). The presence of CAC is associated with an elevated probability of obstructive coronary artery disease (CAD) and an unfavorable clinical outcome. In symptomatic patients, demonstration of non-obstructive CAD identified by coronary CTA is associated with risk modifying behavior and intensified prophylactic medical treatment in observational studies. Among asymptomatic individuals, those with the highest Agatston score levels seem to be motivated for the adoption of risk modifying behaviour and visualization of CAC may stimulate adherence to lipid-lowering therapy and aspirin and a healthier lifestyle. The aim of the present prospective, randomized controlled study was to test the effect of adding visualization of coronary artery calcification to the standard information about risk and lifestyle modification on cholesterol levels and other risk markers in patients with a new diagnosis of non-obstructive CAD.
Visualization of coronary artery calcification and brief recommendations about risk modification (ESC guidelines) after coronary CTA in symptomatic patients with hyperlipidemia and non-obstructive CAD may have a favorable influence on plasma total-cholesterol concentration, adherence to statin therapy and risk behavior. Further investigations are needed.
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MedicalResearch.com Interview with:
David A. Bluemke, MD, PhD, MsB, FAHA, FACR
Director Radiology and Imaging Sciences
Senior Investigator,
National Institute of Biomedical Imaging and BioengineeringAdjunct Investigator, NLBI, NIDDK
Medical Research: What is the background for this study? What are the main findings?Dr. Bluemke: Most knowledge about the extent of coronary disease is from high risk patients who have coronary angiograms. Yet most individuals are symptomatic and have lower cardiovascular risk, and would not undergo a coronary angiogram.
Coronary CT angiography can be used to evaluate the extent of plaque in low or moderate risk individuals. The most concerning type of plaque is "soft plaque", which can increase or rupture over time.
Using coronary CT, all coronary plaque throughout the entire heart was measured. Importantly, the amount of soft plaque was uniquely associated with risk factors such as LDL, diabetes, and hypertension.
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MedicalResearch.com Interview with:
Evgeniya Sokolovskaya, DO, MD
Monmouth Medical Center
Long Branch, NJ 07740.
Medical Research: What is the background for this study? What are the main findings?
Dr. Sokolovskaya: As the utilization of diagnostic imaging has continued to increase in recent years, the workload of radiologists has correspondingly risen. Radiologists are under pressure to increase productivity by increasing workload volume. Previous studies have shown that increasing the number of reporting exams per day can affect the accuracy of radiologic interpretations, increase an error rate and degrade radiologists’ performance in the detection of pathology as viewing time per study decreases. The purpose of this pilot study was to determine if faster reporting speed when reading CT imaging studies of the Abdomen and Pelvis, results in higher number of misses and interpretation errors. The results of our study showed that the number of major misses and interpretation errors significantly increased at the faster reporting speed.
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MedicalResearch.com Interview with:
Jalal B. Andre, MD
Director of Neurological MRI
Harborview Medical Center
Assistant Professor of Radiology
University of Washington
Seattle, WA 98195-7115
Medical Research: What is the background for this study? What are the main findings?Dr. Andre: Patient motion during clinical magnetic resonance (MR) examinations occurs frequently, can result in artifacts that degrade image quality, and has the potential to mask underlying pathology and affect patient care. Surprisingly, the frequency of motion artifacts in clinical MR examinations has been poorly documented in the literature, as has been the cost associated with obtaining such exams, specifically those that do not meet diagnostic criteria. To better quantify these observations, we performed a retrospective study evaluating the prevalence of motion artifacts during a randomly selected week of clinical MR examinations.
We devised a graded 5-tier scale to quantify patient motion, which incorporated the potential for clinical impact Using this scale, two neuroradiologists performed a consensus evaluation at a picture archiving and communication system station of 192 MR examinations performed during a single calendar week. This evaluation revealed that significant motion artifact (defined as artifact that could impact image interpretation and potentially change diagnosis) was present in 7.5% of outpatient and nearly 30% of inpatient and/or emergency department MR examinations, and that repeated sequences (subcomponents of an MR examination) were present in nearly 20% of completed MR examinations. In addition, we found that the specific imaged body part was less predictive of subsequent patient motion than was patient disposition (if they were imaged as a hospital inpatient and/or emergency department patient). Using a base-case cost estimate derived from fiscal year 2012 outpatient Medicare reimbursement rates and institutional cost estimates, our analysis suggested that a potential cost of $592 per hour could be lost in hospital revenue secondary to patient motion. Extrapolated over a calendar year, the cost of patient motion (as potential forgone institutional revenue) approached $115,000 per scanner per year. (more…)
MedicalResearch.com Interview with:
Dott. Michelangelo Sartori
U.O. di Angiologia e Malattie della Coagulazione
Azienda Ospedaliera di Bologna
Policlinico Sant'Orsola Malpighi
Bologna
Medical Research: What is the background for this study? What are the main findings?Response: The safety of withholding anticoagulation only on the basis of ultrasound imaging has not been evaluated in patients with suspected (Upper Extremity Deep Vein Thromobsis) UEDVT. The purpose of this management study was to evaluate the failure rate of ultrasound testing for UEDVT diagnosis in outpatients. Our data show that, similarly to the lower extremity, a negative complete ultrasound assessment of the upper extremity can safely exclude DVT. We found a 3-month VTE rate of 0.6% after a negative ultrasound and such figure is not different from the 3-month VTE incidence in management studies for lower limb DVT. Thus anticoagulant therapy can be withheld for clinically suspected UEDVT after negative ultrasound examination without further testing in the ambulatory office setting.(more…)
MedicalResearch.com Interview with:
Matthias Eiber, MD
Department of Nuclear Medicine
Munich, Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Eiber: The background of the study is the investigation of a novel 68Ga-PSMA ligand using PET/CT in the workup of patients with recurrent prostate cancer after radical prostatectomy. Hereby, we found substantial higher detection rate compared to other methods. In total 222 (89.5%) patients showed pathological findings in 68Ga-PSMA-ligand PET/CT. Stratified by PSA-level the detection rates were 96.8%,93.0%,72.7% and 57.9% of ≥2,1-<2, 0.5-<1 and 0.2-<0.5ng/mL, respectively.
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MedicalResearch.com Interview with:
Prof. Dr. Nikolaus Becker
Epidemiologisches Krebsregister Baden-Württemberg
Deutsches Krebsforschungszentrum
Heidelberg Germany
Medical Research: What is the background for this study? What are the main findings?
Prof. Becker: Lung cancer is the leading cause of cancer death in our Western countries as well as worldwide. One reason is that it is clinically diagnosed mostly in an advanced stage with a poor five-year survival of less than 10%. Diagnosed at an early stage, more than 70% would survive 5 years. For low dose-multislice CT (MSCT) indications exist that it is able to detect lung cancers early. As every newly upcoming screening tool, it has to be carefully analyzed whether it is really able to decrease the mortality from lung cancers and at which costs in terms of undesired side effects such as false-positive findings and overdiagnosis. Our results indicate that spontaneous MSCT screening with changing doctors might be ineffective due to many false-positive alarms; if screening then within an organizational framework.
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MedicalResearch.com Interview with:
Paul F. Pinsky, PhDMPH
Acting Chief Early Detection Research Group
National Cancer Institute
Bethesda, MD, 20892
Medical Research: What is the background for this study? What are the main findings?
Response: The National Lung Screening Trial (NLST) reported, in 2011, a 20% reduction in lung cancer mortality with low-dose CT screening. However, there was a high false positive rate, around 25% in the first two screening rounds, and somewhat lower in the final round. In order to reduce the high false positive rate, and also to standardize the reported system for low-dose CT screening, analogous to the use of BIRADS for mammography screening, the American College of Radiology (ACR) developed the Lung-RADS classification system. It was released in May, 2014. Although it was developed based on published summary data from several studies, including the NLST, it was never applied to a large group of screened subjects on an individual basis. Therefore, we retrospectively applied Lung-RADS to previously collected, detailed screening data from the National Lung Screening Trial .
The major findings were that the false positive rate decreased very substantially using Lung-RADS instead of the original National Lung Screening Trial criteria. At the baseline screen, it decreased by 50% and at subsequent screens it decreased by 75%. There was also, however, a modest decrease in the sensitivity rate, from 93% to 85% at baseline and from 93% to 79% at subsequent screens.
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MedicalResearch.com Interview with:
Mohummad Minhaj Siddiqui, MD
Assistant Professor of Surgery - Urology
Director of Urologic Robotic Surgery
University of Maryland School of Medicine and
Peter A. Pinto, M.DHead, Prostate Cancer Section Director, Fellowship Program
Urologic Oncology Branch National Cancer Institute National Institutes of Health Bethesda, Maryland Medical Research: What is the background for this study? What are the main findings?
Response: For men suspected of having prostate cancer due to an elevated PSA or abnormal digital rectal exam, the next step in their diagnostic workup has traditionally been a standard 12-core biopsy to evenly sample the entire gland. Unlike most other cancers, prostate cancer is one of the few solid tumors left which is diagnosed by randomly sampling the gland with the hope of biopsying the tumor, if it is present. This paradigm has been largely due to the fact that imaging to date has been limited in its ability to identify prostate cancer. Recent advancements in multiparametric MRI of the prostate however has significantly improved clinician's ability to identify regions in the prostate suspicious for cancer. This has led to the emergence of MR/Ultrasound fusion technology which allows for targeted biopsy of the prostate into regions suspicious for cancer.
Although conceptually, it makes sense that a targeted biopsy has the potential to perform better than the standard random sampling of the prostate in the diagnosis of prostate cancer, studies were needed to understand if this is true, and if so, if the improvement was substantial enough to justify the extra expense and effort needed to obtain a MRI guided biopsy. This study performed at the National Cancer Institute's Clinical Center sought to address this clinical question of interest. From 2007-2014, a total of 1003 men suspected to have prostate cancer underwent an MRI of the prostate. If an area of suspicion was seen in the prostate, these men underwent both the targeted biopsy of the suspicious region in the prostate as well as the standard 12-core needle biopsy during the same session. The results from the targeted biopsy were compared to the results of the standard biopsy.
The key findings in this study was that targeted biopsy improved the rate at which high-risk clinically significant cancer was diagnosed by 30%. Of interest, the study also found that low-risk, clinically insignificant disease (the type of prostate cancer that is unlikely to cause any harm to the patient over the course of his natural life) was decreased in diagnosis by 17%. Decrease of diagnosis of such disease has the potential benefit that it could lead to less over-treatment of cancer that never needed to be treated. In a subset of 170 men that ultimately underwent surgery to remove the prostate to treat their cancer, we were further able to examine how well the prostate biopsy reflected the actual cancer burden in the whole gland. It is well known that standard biopsy can actually underestimate the total cancer grade in the whole prostate in upwards of 30-40% of cases. We found that the targeted biopsy was significantly better at predicting whether the patient had intermediate to high-risk cancer compared to standard biopsy. Through further analysis using a statistical method called decision curve analysis, we further found that for men who wish to undergo surgery for intermediate to high-risk cancer, but wish to go on active surveillance for low-risk cancer, targeted biopsy led to better decision making compared to standard biopsy, or even the two techniques combined.
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MedicalResearch.com Interview with:
Gabriel S. Dichter, PhD
Associate Professor
UNC Departments of Psychiatry and Psychology
Carolina Institute for Developmental DisabilitiesMedical Research: What is the background for this study? What are the main findings?
Dr. Dichter: The background for this study is that although most brain imaging research in autism spectrum disorders has focused on understanding the brain basis of social communication impairments, we know that autism symptoms are pervasive and may include difficulties with irritability, anxiety, mood, and even in some instances aggression or self injurious behaviors. Additionally, these types of associated features are among the first that prompt parents to bring their child to a pediatrician for an evaluation for a neurodevelopmental disorder, and so we know these symptoms can be deeply troubling to parents. All of these associated symptoms of autism suggest difficulty with regulating emotional responses, and so our team set out to investigate the brain basis of these difficulties. We taught participants with and without autism simple strategies to change their emotion responses and then scanned them using functional MRI to measure brain activity when they actively tried to change their emotional responses to pictures of faces. Our central finding was that although they reported they were able to change their emotional responses, brain imaging findings told us something quite different. The dorsolateral prefrontal cortex, a part of the brain that controls emotional responses, was underactive in the participants with autism. Consequently, they were less able to modulate parts of the brain’s limbic system that produces strong emotional responses. In other words, they had difficulty “turning on the brakes” to control emotional responses. Finally, the differences we observed in their brain activity predicted the severity of their overall autism symptoms, suggestion a direct linkage between emotion regulation impairments and autism severity. (more…)
MedicalResearch.com Interview with:
Christine Hughes
Hadley Hart Group, Chicago, Illinois
Medical Research: What is the background for this study?
Response: Value in healthcare is a popular topic today. Yet no clear value measures have been developed which could be used in policy decisions on reimbursement for diagnostic imaging procedures. Within the imaging sector it is a given that imaging has value. However efforts to articulate that value to payers and policy makers and others outside the sector have come up short. We did conduct qualitative research with radiologists but during this process of mapping a value chain it became clear that those M.D.s who use the data that radiology provides to make decisions on patient care could better speak to imaging’s value. And primary care because of the gatekeeper status for all types of care seemed appropriate.
Medical Research: What are the main findings?
Response: Primary care physicians highly value access to advanced imaging: 88% of the PCPs indicated that advanced imaging increases their diagnostic confidence; 90% believe imaging provides data not otherwise available; 88% reported access to imaging permits better clinical decision making; 88% reported increases confidence in treatment choices , and 86% say it shortens time to definitive diagnosis. Most Primary care physicians ( 85%) believe that patient care would be negatively impacted without access to advanced imaging.
One very interesting finding is in differences in attitudes and valuations in younger vs. older physicians towards advanced imaging modalities. For the purposes of this part of the analysis we divided the survey respondents into those in practice 1-20 years and those practicing radiology more than 21 years. Presumably those practicing less 21 years trained with ready access to advanced imaging versus those who presumably having practiced without ready access to the advanced imaging modalities of MRI, CT and PET. Respondents who have practiced without ready access attach higher value to the ability to shorten the time to definitive diagnosis, ability to replace invasive procedures, make better clinical decisions, and believe the quality of patient care would be negatively impacted without access to advanced imaging. The younger physicians attach more value to the practice efficiency issues such as enabling the Primary care physician to see more patients, or patient centric issues like the ability to communicate on a visual level with the patient.
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MedicalResearch.com Interview with:
Aymer Al-Mutairi, MD
Primary Care Research fellow
Dept. Family and Community Medicine
Baylor College of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Al-Mutairi: Previous studies indicate that 8% of abnormal imaging results did not receive follow-up actions by referring providers within 4 weeks. In addition, abnormal imaging results often state recommendations for further testing and radiology reports occasionally contain language that conveys doubt regarding the results.
We hypothesized that recommendations for further imaging, and expressions of doubt or uncertainty in the radiology report, are more likely to be associated with lack of timely follow-up. We found that patients with abnormal imaging results where radiologists recommended further imaging were less likely to be followed-up by a treating clinician within 4 weeks compared with patients without such recommendations. Expression of “doubt” in the radiology reports did not affect follow-up actions.
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MedicalResearch.com Interview with:
Ulas Sunar, Ph.D.
Research Assistant Prof.
Dept of Biomedical Engineering
SUNY-University at Buffalo
Medical Research: What is the background for this device? What are the main implications?Dr. Sunar: Most of ovarian cancer cases are not diagnosed until after the disease has spread in the abdominal cavity. A major challenge is to detect and remove dozens or hundreds of metastatic tumor nodules within the abdominal cavity. Fluorescence endoscopy can utilize the high sensitivity and specificity of fluorescence contrast and high resolution of endoscopic imaging.
We are developing a clinically-relevant, fiber-based endoscopy system that allows both accurate fluorescence imaging and for projecting adaptive-shaped light for light-induced chemodrug delivery. The system can provide high contrast for improved demarcation and trigger drug release to destroy micrometastases. The system utilizes a highly sensitive camera and structured light illumination scheme with a projector for accurate fluorescence imaging of drug distribution, as well as allows light-triggered drug release and adaptive light delivery for optimized treatment of micrometastases. We expect that our novel illumination and drug release strategy will permit lower doxorubicin doses to be administered while simultaneously achieving more specific drug delivery in order to destroy the micrometastases and improve survival rates.
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MedicalResearch.com Interview with:
Ania Z. Kielar, MD, FRCPC
Department of Radiology at the University of Ottawa
The Ottawa Hospital, Ottawa, Ontario,Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Kielar: One of the goals of imaging is to provide homogeneous and consistent, high-quality care for patients using available equipment. In our hospital system, we had two separate hospitals that merged to form one teaching centre over 15 years ago. Most processes and protocols are same between the two hospital sites as a result of having the same administration and the same University affiliation. Also, the same residents and staff rotate through the emergency departments and radiology departments at both hospitals. One variable that persists is the location of the CT scanner. At one center a space was created to place a CT scanner in the Emergency Department. At the other site, the CT scanner is in the radiology department. For non-trauma cases, we wanted to see if the difference in distance of the scanner with respect to the emergency department location, has a role in the time required to obtain CT scan from the time it is requested ,as well as the time to final patient disposition. We defined final patient disposition to include admission, subspecialty consultation or discharge home.
Medical Research: What are the main findings?Dr. Kielar: We found that there was a statistically significant difference in the time between requested CT and time to completion of the CT between the two hospital sites. It was faster when the CT scanner was located in the emergency department. This was in the range of 16 minutes ,which is longer than simply the time required to walk over (and back) to the the CT scanner from the emergency department.
We also found a statistically significant difference in the time of the final patient disposition. Of note, there was no statistically significant difference noted in the time to obtain a CT scan as well as the preliminary radiology interpretation for patients with hyperacute conditions such as suspected abdominal aortic aneurysm rupture, regardless of the location of the CT scanner with respect to the ED.
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MedicalResearch.com Interview with: Brian L. Sprague, PhDOffice of Health Promotion Research,
University of Vermont, Burlington, VT
MedicalResearch: What is the background for this study? Dr. Sprague: Mammographic breast density refers to the appearance of breast tissue on a mammogram. High breast density means that there is a greater amount of glandular tissue and connective tissue, which appears white on a mammogram. It is more difficult to detect breast cancer on a mammogram when there is greater breast density. It has also been shown that women with dense breasts are at a higher risk of developing breast cancer. Because of these two factors, women with dense breasts have a greater chance of developing breast cancer after a normal screening mammogram than women whose breasts are not dense. Many states have now passed laws that require mammography facilities to inform women with dense breasts so that they are aware of this. Similar legislation is now under consideration at the national level. More than 40% of women undergoing mammography screening have dense breasts.
Researchers are trying to determine whether supplemental breast cancer screening with other tools would improve outcomes for women with dense breasts. One possible approach is to use ultrasound imaging to screen for breast cancer in women with dense breasts after they have had a normal mammogram. We wanted to estimate the benefits, harms, and cost-effectiveness of this approach compared to mammography screening only. No randomized trials or observational studies have assessed long term outcomes after ultrasound screening for women with dense breasts, but we have short term data on how often cancer is diagnosed by ultrasound screening and how often false positive exams occur. We used computer simulation modeling to estimate long term outcomes by combining the currently available data on mammography and ultrasound screening with the best available data on breast cancer risk and survival.
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MedicalResearch.com Interview with:
Frank W. Roemer, MD
Associate Professor of Radiology
Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine
and Associate Professor of Radiology, University of Erlangen-Nuremberg, Germany
Medical Research: What is the background for this study? What are the main findings?Dr. Roemer: Meniscal surgery is one of the most common orthopedic procedures performed in order to alleviate pain and improve joint function. However, increasing evidence is emerging that suggests that meniscal resection is detrimental for knee joint preservation including accelerated rates of OA and joint deterioration defined as cartilage loss. Our study focuses on disease onset and shows that structural damage due to surgery might also be observed in these early stages of disease. In light of this the indications for performing meniscal surgery might need to be defined more stringently as is the case today in order to preserve joint structure in the long term.
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MedicalResearch.com Interview with
Frank J. Rybicki, MD PhD
Director, Applied Imaging Science Laboratory
Director, Cardiac CT and Vascular CT / MRI
Brigham and Women's Hospital
Associate Professor, Harvard Medical School
Boston, MA
Medical Research:What is the background for this study? What are the main findings?Dr. Rybicki: Face transplantation restores form and function to patients with catastrophic facial injuries. To date, surgical planning a vascular anastamoses have been well described. While all 7 patients at BWH have had 3d printed models from their CT scans, to date the findings and impact of 3D printing has not been described. Also, the role of printing the soft tissues of the face has not been described.
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MedicalResearch.com Interview with:
Dr. Jennifer Marin MD MSc
Director of Emergency Ultrasound
Division of Pediatric Emergency Medicine
Assistant Professor of Pediatrics and Emergency Medicine
University of Pittsburgh School of Medicine
Medical Research:What is the background for this study? What are the main findings?
Dr. Marin: Overuse of diagnostic imaging in the emergency department has become a focus of concern from policy makers, patients, and physicians. There are evidence-based clinical decision rules and policy recommendations published in order to optimize the use of such imaging. However, physicians don't necessarily use these tools in their decision-making. Head computed tomography (CT) imaging for patients with minor head trauma is a common CT performed in the emergency setting. Our study sought to evaluate how often physicians adhered to the American College of Emergency Physicians (ACEP) Clinical Policy on Neuroimaging. The policy outlines which patients warrant a CT in the setting of minor head trauma based on certain factors, such as age, mechanism of injury, and signs and symptoms of head trauma. What we found is that when the policy recommends that a head CT be performed, it is obtained more than 90% of the time. However, when a head CT is not recommended, it is actually obtained in nearly half of those patients. We hope this will draw attention to decision rules and clinical policies, such as that from ACEP, and remind physicians that using these tools can assist in appropriate imaging practices.
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MedicalResearch.com Interview with:Daniel L. Rubin, MD, MS
Assistant Professor of Radiology and Medicine (Biomedical Informatics)
Department of Radiology | Stanford University
Stanford, CA 94305-5488
Medical Research: What is the background for this study? What are the main findings?Dr. Rubin: Age-Related Macular Degeneration is the leading cause of blindness and central vision loss among adults older than 65. An estimated 10-15 million people in the United States suffer from the disease, in which the macula — the area of the retina responsible for vision — shows signs of degeneration. While about one of every five people with AMD develop the so-called “wet” form of the disease that can cause devastating blindness. In wet AMD, abnormal blood vessels accumulate underneath the macula and leak blood and fluid. When that happens, irreversible damage to the macula can quickly ensue if not treated quickly. Until now, there has been no effective way to tell which individuals with AMD are likely to convert to the wet stage. Current treatments are costly and invasive — they typically involve injections of medicines directly into the eyeball — making the notion of treating people with early or intermediate stages of Age-Related Macular Degeneration a non-starter. In our study, we report on a computerized method that analyzes images of the retina obtained with a test called spectral domain optical coherence tomography (SD-OCT), and our method can predict, with high accuracy, whether a patient with mild or intermediate Age-Related Macular Degeneration will progress to the wet stage. Our method generates a risk score, a value that predicts a patient’s likelihood of progressing to the wet stage within one year, three years or five years. The likelihood of progression within one year is most relevant, because it can be used to guide a recommendation as to how soon to schedule the patient’s next office visit. In our study, we analyzed data from 2,146 scans of 330 eyes in 244 patients seen at Stanford Health Care over a five-year period. Patients were followed for as long as four years, and predictions of the model were compared with actual instances of conversion to wet AMD. The model accurately predicted every occurrence of conversion to the wet stage of AMD within a year. In approximately 40% of the cases when the model predicted conversion to wet AMD within a year, the prediction was not borne out, however. We are currently refining the model to reduce the frequency of these false positives.
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MedicalResearch.com Interview with:
Dr. Jenny Hoang MBBS (Hons)
Associate Professor of Radiology and Radiation Oncology
Duke University Medical Center
Medical Research: What is the background for this study? What are the main findings?Dr. Hoang: The incidental thyroid nodule (ITN) is a very common finding on imaging studies of the neck, chest and cervical spine. The workup of incidental thyroid nodules has led to increased costs from additional procedures and in some cases to increased risk to the patient. Physicians are concerned about the risk of malignancy and a delayed cancer diagnosis, but the majority of incidental thyroid nodules are benign and small incidental thyroid malignancies typically have indolent behavior.
The American College of Radiology (ACR) formed the Incidental Thyroid Findings Committee to derive a practical approach to managing ITNs on CT, MRI, nuclear medicine, and ultrasound studies. This white paper describes consensus recommendations representing the Committee’s review of the literature and their practice experience. (more…)
MedicalResearch.com Interview with:Sven Haller, M.D.
University of Geneva in Geneva, Switzerland.
Medical Research: What are the main findings of the study?Dr. Haller:The main finding is that some elderly individuals with intact cognitive function at baseline already have visible alterations of the brain perfusion measured in Arterial Spin Labeling(ASL) MRI, which is similar to patients with mild cognitive impairment (MCI). This elderly individual may initially maintain intact cognitive functions due to the activation of their cognitive reserve, yet eventually the cognitive reserve is exhausted and those individuals develop subtle cognitive decline at follow-up 18 months later.
Consequently, Arterial Spin Labeling MRI may predict the very earliest form of cognitive decline.
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MedicalResearch.com Interview with: Rebecca Smith-Bindman, MD
Professor in the Departments of Radiology;
Epidemiology and Biostatistics; and Obstetrics, Gynecology and Reproductive Medicine UCSF San Francisco Calif.
Medical Research: What are the main findings of the study?Dr. Smith-Bindman: New technology is rapidly developed in medicine, and its important to understand how that technology should be used to improve patient health outcomes. Sometimes the technology is far better than existing technology and it should replace the earlier technology, and sometimes it is not and therefore should not be used. In this clinical scenario – I e. patients who present to an emergency department with abdomen or back pain thought to possibly reflect kidney stones, ultrasound is a simpler, less expensive , and more readily available test in the emergency department setting and therefore if it is equal to CT with respect to patient outcomes, it should be used as the first test in these patients. Currently, CT is the test widely used for patients with suspected kidney stones.
We assessed a large number of patients with suspected kidney stones seen at one of 15 large academic emergency medicine departments across the country. Patients were assigned to point of care ultrasound performed by an ED physician, radiology ultrasound or radiology CT. We assessed a broad range of patient centered outcomes and found each of the three tests we studied were equivalent in terms of these outcomes including complications related to missed diagnoses, related serious adverse events, time spent in the emergency department and repeated ED visits and hospitalizations. However, the exposure to ionizing radiation was around half as high in patients who underwent ultrasound as their first test, and thus ultrasound should be used as the first imaging test in patients with suspected nephrolithiasis.
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MedicalResearch.com Interview with: Ankur Pandya, PhD
Assistant Professor of Healthcare Policy and Research
Departments of Healthcare Policy and Research
Weill Cornell Medical College
New York, NY 10065.
Medical Research: What are the main findings of the study?Dr. Pandya: Asymptomatic carotid stenosis is a highly prevalent condition that can lead to ischemic stroke, which is a leading cause of death and healthcare costs in the U.S. Revascularization procedures are often performed on asymptomatic carotid stenosis patients, but experts have questioned whether the stroke prevention benefits outweigh the risks and costs of revascularization in these patients. Imaging-based stroke risk assessment has traditionally focused on the degree of artery narrowing, but there has been growing interest in using cerebrovascular reserve (CVR) assessment to stratify these patients into those that are more likely to have a stroke, and thus better candidates for revascularization, and those that would be better off with less invasive management strategies (such as medical therapy). We therefore developed a simulation model to evaluate whether the CVR-based decision rule could be used efficiently select the right patients for revascularization. We found that the CVR-based strategy represented the best value for money compared to immediate revascularizations or medical therapy-based treatment for all patients.
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MedicalResearch.com Interview with:Dr. Maarten de Rooij MD, PhD Candidate
Department of Radiology
Radboud University Nijmegen Medical Centre
Nijmegen, Gelderland 6525 GA, The Netherlands
MedicalResearch.com: What are the main findings of the study?Dr. de Rooij : Prostate cancer is the most common cancer in men and the second leading cause of cancer related death. The current diagnosis is based on ‘random or blind’ systematic transrectal ultrasound guided prostate biopsies in men with an elevated PSA. This can lead to over-diagnosis and over-treatment of prostate cancer, but can also miss important tumors. The role of multiparametric MRI (mpMRI) to improve the diagnosis of prostate cancer is evolving. In this meta-analysis we determined the diagnostic accuracy of mpMRI for the detection of prostate cancer. Our analysis included 7 studies using mpMRI which showed high overall specificity (0.88; 95% CI 0.82-0.92), with variable but high negative predictive values (0.65 - 0.95) and sensitivities (0.74; 95% CI 0.66-0.81).
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MedicalResearch.com Interview Invitation with:Dr. Brian C. Callaghan MD
Department of Neurology
University of Michigan Health System, Ann Arbor
MedicalResearch.com: What are the main findings of the study?Dr. Callaghan: The main findings are that we order headache neuroimaging (MRIs and CTs) frequently, this accounts for approximately $1 billion dollars annually, and the number of tests ordered is only increasing with time.
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MedicalResearch.com Interview with:Prof. Dr. Philip Van Damme, MD, PhD
Neuromuscular Reference Center, Neurology Department, University Hospitals Leuven
Vesalius Research Center, VIB, Leuven
Leuven Institute of Neurodegenerative Disorders (LIND)
KU Leuven, Belgium
MedicalResearch.com: What are the main findings of the study?Prof: Van Damme: Earlier FDG-PET studies carried out in the 80’ties already pointed out that patients with ALS had decrease glucose uptake in the brain that is more extended than the motor cortex, at least at the group level. Of course, this imaging technique has been improved since then.
We prospectively assessed the diagnostic and prognostic value of FDG-PET in patients that were referred to us because a diagnosis of ALS was suspected.
The most important finding of our study probably is that FDG-PET shows perirolandic and variable frontotemporal hypometabolism in most patients with ALS at the first presentation in our clinic. It suggests that FDG-PET is a very sensitive marker of cerebral involvement in ALS, which has a high sensitivity at the single patient level.
In addition our study revealed that the co-occurrence of extensive prefrontal or anterior temporal hypometabolism was present in about 10% of patients and had a negative effect on survival after disease onset.
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MedicalResearch.com Interview with:Michael Mastanduno
Thayer School of Engineering, Dartmouth College
14 Engineering Dr.
Hanover, NH 03755
MedicalResearch.com: What are the main findings of the study?Answer:The study was able to illustrate the design and clinical testing of an MRI breast coil for combined MRI and Near Infrared Spectroscopy. The coil was tested on 8 healthy volunteers spanning all bra cup sizes and mammographic density categories. In the past, MRI/NIRS imaging was only possible in C and D cup sized breasts. The system also will give researchers the ability to target lesions in hard-to-reach areas close to the chest wall. With the successful completion of this study, simultaneous MRI/NIRS is possible in all breast sizes, tissue compositions, and lesion locations.
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MedicalResearch.com Interview with:Dr. Vitria Adisetiyo, Ph.D.
Postdoctoral Research Fellow
Medical University of South Carolina
Center for Biomedical Imaging Charleston, SC 29425
MedicalResearch.com: What are the main findings of the study?Dr. Adisetiyo: Using a non-invasive MRI method called magnetic field correlation imaging, we detected significantly reduced striatal and thalamic brain iron in medication-naive children and adolescents with ADHD compared to age-, gender- and IQ-matched typically developing controls. ADHD patients who had a history of psychostimulant medication treatment (e.g. Ritalin, Aderrall) had brain iron levels comparable to controls, suggesting brain iron may normalize with psychostimulants. Blood iron measures did not differ between patients and controls.
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MedicalResearch.com Interview with:Nicholas M Perry MD
London Breast Institute
MedicalResearch.com: What are the main findings of your study?Dr. Perry: The main findings from the study were that automated density readings outperformed radiologists, and that women under the age of 50 had a more significant risk of breast cancer from higher breast density.
Also, and quite surprising was the appearance of a completely different age- density pattern in women with breast cancer. Whereas the women in the study without cancer showed a normal and steady decline in breast density with age, those with cancer showed a completely different curvi-linear pattern, which was evident in women as young as 30.
The message is that breast density remains an important factor for both the current breast screening methodologies, and for future research into investigation and management.
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MedicalResearch.com Interview with:
Alison L. Chetlen, D.O.
Associate Professor, Department of Radiology
Penn State Milton S. Hershey Medical Center
Hershey, PA 17033
Medical Research: What is the background for this study?
Dr. Chetlen: Breast cancer risk assessment provides a means of identifying women who are at risk for development of this disease. Identifying individuals at high risk for breast cancer allows for genetic testing, supplemental breast cancer screening, possibly prophylactic surgery or chemoprevention in hopes of decreasing mortality from breast cancer. Despite the advantages of cancer genetic risk assessment and testing, most individuals in the general population who would benefit from such services currently do not receive them.
Medical Research: What are the main findings?
Dr. Chetlen: After implementation of a specific high-risk recommendation within our standardized mammography report along with a letter written in “lay” language informing patients of their high-risk status, the number of referrals to our high-risk clinic increased only modestly. Despite these specific recommendations to both physicians and patients, over 85% of high risk patients did not consult a high-risk provider regarding their elevated lifetime risk of breast cancer.
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