Author Interviews, Education, Heart Disease, Lifestyle & Health, Radiology / 16.06.2015

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. (more…)
Author Interviews, Heart Disease, NIH, Radiology / 03.06.2015

David A. Bluemke, MD, PhD, MsB, FAHA, FACR Director Radiology and Imaging Sciences Senior Investigator, National Institute of Biomedical Imaging and Bioengineering Adjunct Investigator, NLBI, NIDDKMedicalResearch.com Interview with: David A. Bluemke, MD, PhD, MsB, FAHA, FACR Director Radiology and Imaging Sciences Senior Investigator, National Institute of Biomedical Imaging and Bioengineering Adjunct 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. (more…)
Author Interviews, Medical Imaging, Outcomes & Safety, Pulmonary Disease, Radiology / 29.05.2015

Evgeniya Sokolovskaya, DO, MD Monmouth Medical Center Long Branch, NJ 07740.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. (more…)
Author Interviews, Prostate Cancer, Radiology / 06.05.2015

Matthias Eiber, MD Department of Nuclear Medicine Munich, GermanMedicalResearch.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. (more…)
AHRQ, Author Interviews, Cost of Health Care, JAMA, Medical Imaging, Pain Research / 17.03.2015

Jeffrey (Jerry) G. Jarvik MD MPH Professor, Radiology, Neurological Surgery and Health Services Adjunct Professor, Pharmacy and Orthopedics & Sports Medicine Director, Comparative Effectiveness, Cost and Outcomes Research Center University of Washington Seattle, WA 98104-2499MedicalResearch.com Interview with: Jeffrey (Jerry) G. Jarvik MD MPH Professor, Radiology, Neurological Surgery and Health Services Adjunct Professor, Pharmacy and Orthopedics & Sports Medicine Director, Comparative Effectiveness, Cost and Outcomes Research Center University of Washington Seattle, WA Medical Research: What is the background for this study? Dr. Jarvik:  When I arrived at the Univ of WA over 20 years ago, my mentor, Rick Deyo, had just finished leading a project that was responsible for developing one of the first set of guidelines for the diagnosis and treatment of acute low back pain. These guidelines, published in a booklet by AHRQ (then called AHCPR), recommended that patients with acute low back pain not undergo imaging for 4-6 weeks unless a red flag was present. One of the exceptions was that patients older than 50 could get imaged immediately, the rationale being that older adults had a higher prevalence of potentially serious conditions such as cancer, infections, etc, that would justify the early imaging. As a practicing neuroradiologist, it was clear that a potential problem with this strategy is that the prevalence of age-related changes, which may or may not be related to back pain, also increases with age. So earlier imaging of older adults would almost certainly reveal findings, and these could easily start a series of unfortunate events leading to potentially poor outcomes and more healthcare resource use. Thus this policy of early imaging of older adults didn’t entirely make sense. About 5 years ago, these guidelines hit home when I developed acute low back pain and since I was over 50 (barely) my doctor recommended that I get an imaging study. Being a knowledgeable patient and having a reasonable doctor, we mutually agreed not to get the study. I improved but that wasn’t the end of it. When we had the chance to apply for one of the CHOICE ARRA awards funded by AHRQ, we made answering this question of early imaging in older adults one of our primary goals. (more…)
Author Interviews, Cost of Health Care, JAMA, Medical Imaging, NYU / 12.03.2015

Danil Makarov, MD Lead Investigator Assistant Professor, Departments of Urology, Population Health and Health Policy Member, Laura and Isaac Perlmutter Cancer Center NYU Langone Medical Center, New York, NYMedicalResearch.com Interview with: Danil Makarov, MD Lead Investigator Assistant Professor, Departments of Urology, Population Health and Health Policy Member, Laura and Isaac Perlmutter Cancer Center NYU Langone Medical Center, New York, NY Medical Research: What is the background for this study? Dr. Makarov: The background for this study is that regional variation in patterns of care and healthcare spending is widely known.  The drivers of this regional variation, though, are poorly understood.  Certain policy groups like the IOM have suggested that policy efforts be focused on individual providers and patients. Programs such as Choosing Wisely, which encourage a dialogue between physicians and patients, are a great example of such efforts.  However, some of our prior research suggests that regional variation is not random and that there might be are regional-level factors which drive variation. To test out our hypothesis, we wanted to see whether inappropriate imaging for two unrelated cancers was associated at a regional level (it should not be). Medical Research: What are the main findings? Dr. Makarov: We found that, at a regional level, inappropriate breast cancer imaging was associated with inappropriate prostate cancer imaging. (more…)
Author Interviews, Primary Care, Radiology / 27.01.2015

Christine Hughes Hadley Hart Group, Chicago, IllinoisMedicalResearch.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. (more…)
Author Interviews, Baylor College of Medicine Houston, Radiology / 13.01.2015

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. (more…)
Author Interviews, Emergency Care, Radiology / 24.12.2014

Ania Z. Kielar, MD, FRCPC Department of Radiology at the University of Ottawa The Ottawa Hospital, Ottawa, Ontario,CanadaMedicalResearch.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. (more…)
Orthopedics, Radiology / 04.12.2014

Frank W. Roemer, MD Associate Professor of Radiology Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine Boston MA 02118MedicalResearch.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. (more…)
Author Interviews, Macular Degeneration, Radiology, Stanford / 10.11.2014

Daniel L. Rubin, MD, MS Assistant Professor of Radiology and Medicine (Biomedical Informatics) Department of Radiology | Stanford University Stanford, CA 94305-5488MedicalResearch.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. (more…)
Author Interviews, Duke, Radiology, Thyroid Disease / 03.11.2014

Dr. Jenny Hoang MBBS (Hons) Associate Professor of Radiology and Radiation Oncology Duke University Medical CenterMedicalResearch.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…)