Lung Cancers Detected On Screening CT Scans Have Better Survival

MedicalResearch.com Interview with:

Matthew B. Schabath PhD Department of Cancer Epidemiology H. Lee Moffitt Cancer Center and Research Institute Tampa, Florida

Dr. Matthew Schabath

Matthew B. Schabath PhD
Department of Cancer Epidemiology
H. Lee Moffitt Cancer Center and Research Institute
Tampa, Florida

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

Response: Our study is a post-hoc analysis of data from a large randomized clinical trial (RCT) called the National Lung Screening Trial (NLST). The NLST found that lung cancer screening with low-dose helical computed tomography (LDCT) significantly reduced lung cancer deaths by 20 percent compared to screening with standard chest radiography (i.e., X-Ray).

In our publication, we performed a very detailed analysis comparing outcomes of lung cancer patients screened by LDCT according to their initial (i.e., baseline), 12 month, and 24 month screening results. We found that patients who had a negative baseline screening but tested positive for lung cancer at the 12- or 24-month screen had lower survival and higher mortality rates than patients who had a positive initial screen that was a non-cancerous abnormality but developed lung cancer in subsequent screens.

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PET Scan Identifies Low Serotonin Functioning Linked To Suicidal Behavior

Maria A. Oquendo, M.D. Professor of Psychiatry Vice Chair for Education Columbia University Medical Center American Psychiatric Association, President International Academy of Suicide Research, President

Dr. Maria Oquendo

MedicalResearch.com Interview with:
Maria A. Oquendo, M.D.
Professor of Psychiatry
Vice Chair for Education
Columbia University Medical Center
American Psychiatric Association, President
International Academy of Suicide Research, President

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

Response: Our team has worked for years on identifying the biological underpinnings of both risk for suicidal behavior (SB) and for predicting the lethality or medical consequences of suicidal behavior. We have shown that if you compare those who are depressed and have had SB to those who are depressed but do not have suicidal behavior, you can see clear differences in the serotonin system using Positron Emission Tomography and a molecule tagged with radioactivity. We predicted that if you could see these differences cross-sectionally, then their presence might also predict suicidal behavior and its lethality in the future. Our study showed that those with higher serotonin 1a binding in the raphe nuclei, which likely indicates low serotonin functioning, made more medically damaging suicide attempts in the two years that followed. They also suffered from more pronounced suicidal ideation in the subsequent year.

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Study Calls For Curbing of Excessive Imaging after Thyroid Cancer Treatment

MedicalResearch.com Interview with:

Megan Haymart, M.D. Assistant Professor Institute for HealthCare Policy and Innovation University of Michigan

Dr. Megan Haymart

Megan Haymart, M.D.
Assistant Professor
Institute for HealthCare Policy and Innovation
University of Michigan

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

Response: Over the past three decades the incidence of thyroid cancer has risen. The majority of this rise in incidence is secondary to an increase in low-risk disease. In the setting of this rise in low-risk thyroid cancer, our team noted that over time there was a dramatic rise in imaging after initial treatment for thyroid cancer. We subsequently wanted to understand the implications of this increase in imaging. Does more imaging equal improved outcomes? In this study published in BMJ, we found that this marked rise in imaging after primary treatment of differentiated thyroid cancer was associated with increased treatment for recurrence but with the exception of radioiodine scans in presumed iodine-avid disease, no clear improvement in disease specific survival.

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Women Still Getting CA-125 and CT Testing After Ovarian Cancer, Despite Lack of Clear Benefit

MedicalResearch.com Interview with:

Katharine Mckinley Esselen, M.D. Instructor in Obstetrics, Gynecology and Reproductive Biology Beth Israel Deaconess Medical Center Brigham and Womens Hospital

Dr. Katharine M. Esselen

Katharine Mckinley Esselen, M.D.
Instructor in Obstetrics, Gynecology and Reproductive Biology
Beth Israel Deaconess Medical Center
Brigham and Womens Hospital

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

Response: There is no consensus on how to follow a patient in remission from ovarian cancer in order to detect recurrent disease. However, a 2009 randomized clinical trial demonstrated that using CA-125 blood tests for routine surveillance in ovarian cancer increases the use of chemotherapy and decreases patient’s quality of life without improving survival compared with clinical observation. Published guidelines categorize CA-125 tests as optional and discourage the use of radiographic imaging for routine surveillance. Thus, this study aims to examine the use of CA-125 tests and CT scans at 6 Cancer Centers and to estimate the economic impact of this surveillance testing for ovarian cancer.

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Analysis of Multiple MRI and PET Images Detects Earliest Signs of Alzheimer’s Disease

MedicalResearch.com Interview with:

Dr. Yasser Iturria Medina PhD Post-doctoral fellow Montreal Neurological Institute

Dr. Y. M. Medina

Dr. Yasser Iturria Medina PhD
Post-doctoral fellow
Montreal Neurological Institute

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

Response: We used over 200 peripheral molecular biomarkers, five different neuroimaging modalities and cognitive/clinical measurements to detect spatiotemporal abnormalities in subjects with dementia or with mild signs of cognitive deterioration. By means of a mathematical framework, we reordered all the biomarkers/descriptors considered, according to how much they change during the disease process. The results suggested that, contrary as suggested by more traditional clinical analyses, there are multiple early signs of neurodegeneration, at the molecular level and at the brain’s macroscopic and cognitive state. In particular, we observed notable early signs of generalized vascular dysregulation, which may be supporting the vascular hypothesis of Alzheimer’s disease. However, we still need to perform deeper analyzes, in order to clarify the complex causal mechanisms that trigger the disease.

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Supply of Technetium-99m For Cardiac Stress Testing Constricted By Regulations and Aging Reactors

MedicalResearch.com Interview with:

Venkatesh Locharla Murthy MD, PhD, FACC, FASNC Assistant Professor, Internal Medicine Frankel Cardiovascular Center University of Michigan

Dr. Venkatesh Murthy

Venkatesh Locharla Murthy MD,
PhD, FACC, FASNC

Assistant Professor, Internal Medicine
Frankel Cardiovascular Center
University of Michigan

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

Response: Technetium-99m, which is very commonly used for cardiac stress testing, has had multiple supply disruptions due to aging nuclear reactors where it is produced coupled with changing regulations to minimize the risk of nuclear proliferation. The most severe of these disruptions occurred over six months in 2010.

We asked whether this disruption lead to changes in patterns of care among Medicare beneficiaries. We found that during this time, use of technetium-99m in nuclear stress testing fell from 64% to 49%, reflecting a shift towards thallium-201, which has higher radiation exposure and lower diagnostic specificity. This was reflected in a 9% increase in the rate of cardiac catheterization after a nuclear stress test during the study period, implying nearly 6,000 additional, possibly unnecessary, catheterizations during that time.

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Breast Cancer Surgery Can Be Improved By Turning Patient Over For MRI

MedicalResearch.com Interview with:

Eva C. Gombos, MD Assistant Professor, Radiology Harvard Medical School Brigham and Women’s Hospital

Dr. Eva Gombos

Eva C. Gombos, MD
Assistant Professor, Radiology
Harvard Medical School
Brigham and Women’s Hospital

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

Response: Treatment of early stage breast cancer, breast-conserving therapy (BCT), which consists of lumpectomy followed by whole-breast irradiation, requires re-excision 20 %–40% of patients due to positive margins.

Breast MR is the imaging modality with the highest sensitivity to detect breast cancer. However, patients who undergo breast MR imaging have not experienced reduced re-excision or improved survival rates.

Our hypothesis is that supine (performed with patient lying on her back) MR imaging within the operating room can be used to plan the extent of resection, to detect residual tumor immediately after the first attempt at definitive surgery, and to provide feedback to the surgeon within the surgical suite. The aim of this study was to use intraoperative supine MR imaging to quantify breast tumor deformation and displacement secondary to the change in patient positioning from imaging (prone performed the patient lying on her stomach) to surgery (supine) and to evaluate the residual tumor immediately after BCT.
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PET-CT Scan Can Guide Treatment in Advanced Hodgkin’s Lymphoma

MedicalResearch.com Interview with:

Peter Johnson MA, MD, FRCP Professor of Medical Oncology Cancer Research UK Centre Southampton General Hospital Southampton

Prof. Peter Johnson

Peter Johnson MA, MD, FRCP
Professor of Medical Oncology
Cancer Research UK Centre
Southampton General Hospital
Southampton

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

Prof. Johnson: Based upon retrospective series looking at the ability of interim PET to predict the outcomes of treatment, we aimed to test the idea of modulating treatment in response to an early assessment of the response to ABVD: could we safely reduce the amount of treatment by omitting bleomycin in the group who had responded well? Although the risk of severe toxicity from bleomycin is generally low, for the small number of patients who experience it, it can be life-changing or even fatal. We also wanted to test whether it might be possible to reduce the use of consolidation radiotherapy by comparison to our previous trials, and this seems to have worked too: we used radiotherapy in less than 10% of patients in RATHL, as compared to around half in our previous trials. We have seen better survival figures than in our previous studies with less treatment overall, so it feels as though we are on the right track.

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MRI Imaging Links Saturated Fat In Breasts with Aggressive Breast Cancer

MedicalResearch.com Interview with:
Sungheon G. Kim, PhD
Associate Professor
Department of Radiology
NYU Langone and
Researcher at the Center for Advanced Imaging, Innovation, and Research

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

Dr. Kim: The role of fat in breast cancer development and growth has been studied extensively using body mass index (BMI), a measure of whole body fatness, and dietary fat intake in a number of epidemiological studies. However, there is a paucity of studies to assess the role of breast fat itself in breast cancer due to lack of a non-invasive and fast measurement method. Since breast fibroglandular cells are surrounded by breast fat cells, the characteristics of breast fat may have a stronger relationship with breast cancer development and growth than BMI and/or dietary fat. However, it is not trivial to study the role of breast fat, mainly due to the lack of a non-invasive and fast measurement method sensitive enough to important features of breast fat, such as types of fat.

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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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Overdiagnosis of Breast Cancer Through Mammograms Complicated by Lack of Understanding of Tumor Progression

MedicalResearch.com Interview with:
Ragnhild Falk PhD
Oslo Centre for Biostatistics and Epidemiology
Research Support Services
Oslo University Hospital and
Solveig Hofvind PhD
Department of Screening Cancer Registry of Norway
and Oslo and Akershus University College of Applied Sciences
Oslo, Norway

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

Response: The issue of overdiagnosis has been heavily debated, and a variety of results have been presented. However, the exact proportion of overdiagnosis is unknown as one do not know what would have happen in the absent of screening.

We have split the proportion of overdiagnosis into two parts based on the time at which the death occur; scenario 1 as the proportion of women diagnosed with a screen-detected breast cancer and who died within the lead-time period, and scenario 2 as women detected with slow growing tumors that never would have caused any harm during the women’s life if she had not attended screening.

In principle, all screening programs will detect breast cancer among women who die of other causes in the near future since there exist competing risk of death among women targeted by screening. Although the all-cause mortality rates are low, it is inevitable.

We wanted to focus on the first scenario and estimated the number of women diagnosed with screen detected breast cancer who died within the estimated lead-time period caused by screening. We estimated his proportion to be less than 4 percent of all screen-detected cases in the given England & Wales and the Norwegian setting.

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Most Patients Referred By Genetic Screening For Breast MRI Do Not Have Study Performed

MedicalResearch.com Interview with:

Stamatia Destounis, MD, FSBI, FACR Elizabeth Wende Breast Care, LLC, Clinical Professor of Imaging Sciences University of Rochester School of Medicine and Dentistry  Rochester NY 14620

Dr. Stamatia Destounis

Stamatia Destounis, MD, FSBI, FACR
Elizabeth Wende Breast Care, LLC,
Clinical Professor of Imaging Sciences
University of Rochester
School of Medicine and Dentistry
 Rochester NY 14620 

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

Dr. Destounis: Identification of women who have an increased risk of breast cancer is important, as they are often eligible for additional screening methods, such as breast MRI. One criterion for eligibility for screening breast MRI is >20% lifetime risk of breast cancer, as determined by risk assessment models through genetic counseling.

At my facility, we have incorporated a genetics program. Through the program we are flagging and identifying a large volume of patients who are potentially eligible for additional services. This study was conducted to determine the value of screening MRI in the patient subgroup who have undergone genetic counseling at my facility. In this group we found 50% of patients who were referred for counseling were also recommended to have screening MRI. However, only 21.3% of those recommended actually pursued the exam. Of those patients who did have a screening MRI, 4 were diagnosed with breast cancer, all of which were invasive and node negative. We ultimately had a 10% biopsy rate and 50% cancer detection rate in this subgroup.
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MRI-Guided Prostate Biopsies Have Potentially Higher Yield With Fewer Samples

MedicalResearch.com Interview with:

Dr. Nelly Tan MD David Geffen School of Medicine Department of Radiology UCLA

Dr. Nelly Tan

Dr. Nelly Tan MD
David Geffen School of Medicine
Department of Radiology
UCLA

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

Dr. Tan: Standard of care for prostate cancer diagnosis has been to perform ultrasound guided random (non-targeted) prostate biopsy (TRUS) which is neither sensitive or specific. The main limitation had been our inability to detect and localize prostate cancer through imaging.

Over the past 10 years, MRI has taken center stage for detection and localization of prostate cancer and has shown to improve prostate cancer diagnosis, risk stratification, and staging of the disease. Over the past few years, MRI guided biopsy techniques (in the form of Ultrasound-MRI (US-MRI) fusion and in-bore direct MRI guided biopsy) have been reported. We reported our performance of direct in-bore MRI guided biopsy at UCLA. Our study showed a prostate cancer diagnosis of 59% in all patients and 80% of patients with prostate cancer had clinically significant cancer.

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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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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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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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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

Lung Cancer: New Screening Guidelines and Reimbursement Protocols

 

Jan Marie Eberth

Dr. Eberth

MedicalResearch.com Interview with:
Jan Marie Eberth, PhD
Assistant Professor, Department of Epidemiology and Biostatistics
Deputy Director, SC Rural Health Research Center
Core Faculty, Statewide Cancer Prevention and Control Program
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208

Medical Research: What is the background for this study?

Dr. Eberth: With the breakthrough findings of the National Lung Screening Trial released in 2011, professional organizations have largely embraced population-based screening guidelines for patients at high risk for lung cancer. The diffusion of screening into broad clinical practice has been slow to be adopted, given concerns about the efficacy of screening in community settings, lack of insurance reimbursement and unclear billing logistics, and difficulty weighing the pros of screening against the known cons (e.g., high rate of false positives).

Medical Research: What are the main findings?

Dr. Eberth: Provisions of the Patient Protection and Affordable Care Act mandate that US Preventive Services Task Force-recommended screening tests with an A or B rating receive full insurance coverage by private payers. The Centers for Medicare and Medicaid (CMS) soon thereafter approved full coverage for lung cancer screening in high-risk patients (i.e., those aged 55-77 years, asymptomatic for lung cancer, tobacco smoking history of 30+ pack-years, is a current smoker or has quit smoking within the past 15 years).

Coding is rapidly evolving; as of November 2015, CMS released HCPCS codes G0296 (pre-screening counseling visit) and G0297 (screening visit). These codes will be accepted retroactively starting January 4, 2016 to the date of the final coverage determination (back to February 5, 2015). No coinsurance or deductibles shall be charged to the patient for either the pre-screening counseling visit, or the screening visit itself.

Quality of screening  is an important, but understudied, area of research. Several publications have focused on aspects of quality programs, and how to achieve quality benchmarks, but data is still being collected to assess variation across programs. In the future, data from screening registries, such as the American College of Radiology Lung Cancer Screening Registry (LCSR), can be leveraged to examine these quality metrics and improve risk-prediction models for lung cancer.

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Coronary Calcium Score Plus Family History Better Identifies Individuals at Risk of Heart Disease

MedicalResearch.com Interview with:
Dr. Joan Pinto-Sietsma MD PhD

Department of Clinical Epidemiology, Biostatistics and Bioinformatics
Academic Medical Center
Amsterdam, The Netherlands. 

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

Response: A positive family history for premature coronary artery disease is an important risk factor for coronary artery disease. Therefore, it is frequently proposed to be included in current risk assessment tools and clinical practice guidelines. On the other hand, a positive family history for coronary artery disease only identifies families at risk, whereas it fails to identify which specific individual within a family is at particular risk. Therefore, its applicability in clinical practice is limited.

The detection of subclinical atherosclerosis as assessed by assessing coronary artery calcification, with CT scanning, has emerged as prognostic evaluation of coronary artery disease. Prospective follow-up studies have shown that coronary artery calcification predicts cardiovascular events, independent of risk factors. Therefore, assessing coronary artery calcifications in families with premature coronary artery disease might help in determining which individuals within such families are at particular risk and therefore help decide regarding treatment.

We analysed the association between a positive family history for premature coronary artery disease and coronary artery calcifications in 704 asymptomatic individuals. Furthermore, we assessed the predictive value of coronary artery calcifications in individuals with a positive family history for premature coronary artery disease in a sub analysis in 834 individuals of the St. Francis Heart Study, in which subjects were followed for about 3.5 years.

We observed, that individuals of high risk families (a positive family history of premature coronary artery disease) had a 2 time higher risk to have a calcium score > the 80th percentile as compared to individuals with a negative family history of premature coronary artery disease. Besides, individuals from high risk families with a high calcium score (> the 80th percentile) had a 2 time higher risk to get a cardiovascular event in 3,5 years, whereas individuals of high risk families without coronary calcifications did not have an increased risk at all.

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Brains of Troubled Youth Demonstrate Key Grey Matter Changes

Stephane De Brito, PhD Birmingham Fellow School of Psychology Robert Aitken Building, Room 337a University of Birmingham UK

Dr. De Brito

MedicalResearch.com Interview with:
Stephane De Brito, PhD

Birmingham Fellow
School of Psychology
Robert Aitken Building, Room 337a
University of Birmingham  UK

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

Dr. De Brito: In the last decade, an increasing number of neuroimaging studies have used structural magnetic resonance imaging (sMRI) to examine the brains of youths who show behavioural problems that include antisocial and aggressive behaviour. Those studies have mostly relied on a method called voxel-based morphometry (or VBM), which is a whole-brain and automated technique that allows researchers to objectively assess the local composition of brain tissue, such as grey matter volume. The main problem is that the findings from those sMRI studies have been quite disparate and few have been replicated, partly due to differences in sample sizes and characteristics across studies. Therefore, we set out to carry out a meta-analysis of the available data to provide a clearer account of the literature on this topic. A particular strength of our meta-analysis is that we used the original brain imaging maps (also referred to as statistical parametric maps) from 11 of the 13 studies, which makes our analysis more accurate and reliable. The final sample comprised of 394 youths with behavioural problems and 350 typically developing youths, making it the largest study on this topic to date.

Our results showed that, compared to typically developing youths, those with behavioural problems show reduced grey matter volume in the amygdala, the insula, and the prefrontal cortex. These brain areas have been shown to be important for decision-making, empathic responses, processing facial expressions and emotion regulation; key cognitive and affective processes that are shown to be deficient in youths with behavioural problems.

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Ultra Long Distance Runners Regenerate Cartilage During Race

Uwe Schütz, M.D. Radiologist and specialist in orthopedics and trauma surgery Department of Diagnostic and Interventional Radiology University Hospital of Ulm Germany

Dr. Schütz

MedicalResearch.com Interview with:
Uwe Schütz, M.D.
Radiologist and specialist in orthopedics and trauma surgery
Department of Diagnostic and Interventional Radiology
University Hospital of Ulm
Germany

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

Dr. Schütz: In this study, which is a small part of the Trans Europe Foot Race (TEFR) TEFR-project, we investigated the question, what happens to the joints, in detail to the joint cartilage of the lower extremities, when running 4500 km without any day rest for nearly 10 weeks. Is there really a risk for developing an arthrosis when doing this, like some researches and many physicians postulate?

Well, what we find when accompanying 44 ultra-athletes with a modern 1.5Tesla MRI mounted on a custom made 38tonnes truck trailer day by day over 64 days on their way throughout whole Europe is, that the joint cartilage is initially altered by this running burden: It shows signals of cartilage matrix degradation beneath the first 1000 to 1500 km of running. But then the situation changes. When further running occurs, then the cartilage shows the ability to partially regenerate under ongoing running burden. This is a pretty new and astonishing finding, first time measured and observed in human joint in vivo. But knowledge of Scandinavian animal studies show the same behavior in dog cartilage.

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