Kidney Lymphoma and the Importance of Computed Tomography (CT)

By MC Raflesia

Kidney lymphoma is most frequently observed along with multisystemic, dispersed lymphoma or as tumor reappearance. Kidney lymphoma might be observed in immunocompromised patients or, hardly ever, as primary disease as well.
With the kidneys being the most usually involved organs, extranodal spread of lymphoma frequently influences the genitourinary system.
The lymphoma can obstruct urine from leaving the kidney. This could cause kidney failure, which could lead to low urine output, weariness, loss of appetite, nausea, or swelling in the hands or feet. The lymphoma could obstruct feces as well moving by means of the bowel. This bowel stumbling block could lead to nausea, vomiting, and serious abdominal pain.
Lymphoma of the kidneys is detected at the time of autopsy in nearly one half of cases. It is seldom suspected on conventional urologic surveys like intravenous urography.
In the nonattendance of right clinical treatment, since involvement of the kidneys typically points to dispersed disease the prognosis is poor. The disease can present with progressive kidney failure. Survival is really poor in principal kidney lymphoma: in less than 1 year 75% of patients die. By early detection of the disease and by doing systemic chemotherapy the prognosis could be recovered.
Kidney lymphoma displays no racial predilection. Kidney lymphoma shows no sex predilection. Nonetheless, it is allegedly perceived more frequently in male patients. Kidney lymphoma takes place in every age group. The disease typically influences adults; but, kidney lymphoma has been reported in childhood as well.
For the detection, diagnosis, staging, and monitoring of kidney lymphoma, contrast material-enhanced computed tomography (CT) remains the modality of option. In patients in whom intravenous administration of iodinated contrast material is contraindicated, magnetic resonance (MR) imaging is principally helpful. Ultrasonography (US) is less sensitive than CT and MR imaging for identifying kidney lymphoma, though really useful for diagnosing lymphoma in the testis or epididymis.
However, in patients with suspected kidney lymphoma, the most sensitive, efficient, and complete examination for evaluation of the kidneys is computed tomography (CT). Helical CT especially recovers detection and characterization of lymphomatous kidney involvement by optimizing contrast dynamics and data acquisition. It is the present modality of option for precise staging of lymphoma.
If you want to get some excellent resources on kidney, please visit my site on You and Your Kidney [http://allaboutkidney.blogspot.com/] or Kidney Lymphoma [http://allaboutkidney.blogspot.com/2008/06/kidney-lymphoma-and-importance-of.html]

What Does CT Software Do?

By Kathryn Dawson

Computed Tomography Scan, or a CT scan creates 3D images by processing many 2D X-ray images. This type of scan (or modality) is another method of scanning the body to help see problems, abnormalities and poor health for diagnosis and treatment. It is also sometimes known as a CAT scan. It is a simple and straightforward scan that is non-invasive and can therefore be delivered on an outpatient basis. In more detail, it involves the capturing of a series of X-ray views taken from many different angles within the body to produce many different images of the cross section of the bones and soft tissue in the body. It goes much further than an X-ray can by providing in-depth pictures of the organs, tissue, blood vessels and bones in the body. The 2D cross sectional images provided are then subjected to further processing by the software to provide clear 3D images for analysis. 

In a typical X-ray process, the body is subjected to a small dose of radiation, some of which gets absorbed by the body and then projected onto photographic film. In a CT scan however, many X-ray beams are exposed to the body, and X-ray detectors are used to measure the amount of radiation being absorbed. The person within the scanner will have the X-ray beam rotate around their body so it follows a spiral path. The multiple images taken of the body from this examination are then processed by specialist software to produce a 3D image of the body's interior. This image will then be processed by a radiologist and passed on to the relevant physician or group of physicians for further action and treatment of the patient. 

CT scans are often called upon for quick examination of a patient who has been in a serious accident where injuries could well be internal. Car accidents or other serious traumas for example can often result in internal bleeding or swelling in the brain that won't be immediately obvious and will need a CT scan to diagnose. It is possible for doctors to closely examine the brain using a computed topographical scan so any abnormalities or even very slight problems can be detected. Further to examining the brain, a CT scan is also ideal for revealing muscle and bone disorders including breaks and fractures, internal bleeding and other serious internal injuries, cancerous tumors, infections and blood clots as well as heart disease and other serious illnesses. CT scans can even be an assistance during surgeries, biopsies or radiation therapy treatment by working as a guide. 

The technology with regard to CT scans and software has progressed over the years and now this form of scanning is one of the most effective and efficient ways of examining the body from the inside, enabling doctors to see various cancers, abnormalities and internal health problems. Many serious illnesses and conditions do not have external symptoms for a long time, so CT scans enable them to be caught and treated much earlier than they otherwise would be. Medical imaging such as these types of scans make correct diagnosis easier for doctors too as the clear images provided leave little room for doubt when diagnosing an illness. 

CT software plays a crucial part in the field of medicine. Without being able to see the interior of the body a whole host of illnesses and problems would go undiagnosed. Doctors across many different fields use medical imaging solutions such as CT scans regularly and are often the basis of diagnosis of diagnosis of cancers and problems in the brain. A radiologist will initially process the information of a CT scan and will pass the information on to the physician treating the patient. In very interesting cases the data will be reviewed during a tumor board presentation for further action and treatment of the patient involved. There is more chance of successful treatment when an early diagnosis is made.

MRI Scans vs CT Scans

By Kathryn Dawson

There a few different methods of obtaining medical diagnostic images. Each method or type is known as a modality. In particular, MRI scans and CT scans bring a great deal to the field of medicine. Doctors use both modalities to help them provide accurate information about their patient in order to accurately diagnose what is wrong with them. There are differences between the two, with each providing its own advantages and disadvantages. This article acts as a guide to explaining the main differences between these two important and effective types of scan. Read on to find out more. 

The acronym CT, used with in the term CT scan, is an abbreviation of computed tomography. This modality uses x-rays which is a type of ionizing radiation to produce images of the body's interior. This makes it particularly good at investigating tissue that is more dense than the tissue that surrounds it. A good example of this is bone compared to muscle and the soft tissue and cells encasing it. In order to gain more clarity when using a CT scan, the medical personnel may administer what is known as a contrast agent. To get the most from this, the substance used may be more dense than the part of the body being investigated. This makes iodine or barium good substances to use. For example, for those of us who have had x-rays, the term barium meal may be familiar. 

The acronym MRI is an abbreviation of the term magnetic resonance imaging. Unlike CT and x-ray systems, MRI does not use ionizing radiation. Instead it uses radio waves sent through a magnetic field to acquire its images. This makes it ideal for investigating non-calcified tissue, i.e. other than bones and teeth. That is not to say it cannot be used for this purpose, it is just better suited for looking at softer tissue, organs and cells in the body. A contrast agent can also be used when carrying out an MRI scan: gadolinium or manganese are the most appropriate types as they have paramagnetic properties, and of course MRI makes use of magnetic fields. 

Although both CT and MRI scans produce two dimensional images of tissue and three dimensional reconstructions are created from this, MRI scans have greater image contrast capabilities. By varying an array of scanning parameters, different features of the body can be detected more easily. An MRI is generally considered to be more accurate when it comes to detecting tumors or problems in the brain, although a CT scan is better at detecting solid tumors in the abdomen or chest. 

A CT scan is cheaper than carrying out an MRI scan and is also more widely available so is usually the preferred route to take by doctors. An MRI scan tends to be used only when they have exhausted the other options and need further information still. A CT scan is also much quicker than an MRI scan. 

Both MRI scans and CT scans are important tools used by a doctor to facilitate accurate diagnoses of serious illnesses such as heart disease and cancer. When used in imaging in oncology, these modalities are particularly vital. By combining scanned images over time they allow information to be obtained such as how much the cancerous cells have spread and at what rate they are growing. This means patients can receive updates on whether their treatment is working and whether the cancer shrinking rather than growing in size. PET CT software in particular is vital for providing valuable oncological information such as this. Very different but equally as important as one another, CT scans, and MRI scans as well, play an important role in modern medicine.

Scientists work on mapping trajectory of bullet wounds - Labmate Online

Scientists at the Uniformed Services University in Bethesda, Maryland, are working on a way to use computed tomography (CT) scanning to determine the route taken by bullets through wounded soldiers and other individuals.

CT has already been demonstrated to be of value in tracking the routes of bullets in their victims, but the scientists say a cohesive approach to the process has not been developed as yet.

However, they now hope to devise a single means by which to map the course taken by the projectile after entering its victim, with advantages such as the ability to determine where the gunman was, if his position is not already known.

Lead author on the study Les R Folio says: "The information provided by multidetector CT has the potential to improve patient care and aid in both military and civilian forensic investigations."

The university specialises in providing training to nurses, physicians and educators working within the military sector on the unique issues faced in their roles.

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Health care fight isn`t over - Bismarck Tribune

  MIKE McCLEARY/Tribune Dr. Ted Fogarty, a radiologist at Medcenter One in Bismarck, looks for signs of a stroke while viewing multiple images of a computed tomography (CT) perfusion study of a patient's brain displayed on a computer screen. The colors in the brain scans show the blood flow in the brain. The use of the CT perfusion study is a helpful tool for physicians in the early diagnosis of a stroke. Preventative care is one of the components emphasized in the implementation of the new national healthcare system. 12-9-2010
Less than a year after it passed, the landmark changes to health care face a repeal by Republicans in the U.S. House. It took months of political maneuvering to even pass the Patient Protection and Affordable Care Act, and then in the fall health care reform helped cost some politicians their seats, including former North Dakota Rep. Earl Pomeroy.
“It pains me so much, all the heat the congressional delegation took for standing up for families like us,” said Brenda Neubauer, whose son had reached the lifetime benefits cap on one insurance plan and was nearing the benefits cap on a second insurance plan.
Her son, Jacob, 16, has hemophilia, a disorder in which his blood does not clot. She spent many years working with North Dakota’s congressional delegation to change the lifetime cap on health insurance. The new health care law finally resolved it.
The federal overhaul of health care is a politically divisive issue that will change options in the country. It will top the agenda of this congressional session and already its  being challenged in court because of the mandate that all Americans purchase insurance. Although the House has enough votes by Republicans to repeal it, the effort will likely fail in the Democrat-controlled Senate.
It will be phased in over the next five years, and parts of it will be challenged in Congress. Most of the changes from the health care reform bill go into effect in 2014, although some started last September.
“When the debate started about the health care system, it was about making it more affordable to Americans, not about expanding access,” North Dakota Insurance Commissioner Adam Hamm said. “The fundamental problem is not access. The fundamental problem is affordability.”
Instead, the bill will likely raise health care costs over time, unless portions of it are changed or repealed, Hamm said. One area where the costs likely will increase is insurance premiums. For instance, Aetna is reprogramming its plans so that it reflects its adoption of the dependent coverage to age 26. Previously, plans covered dependent children until age 22 or 24 if they were students.
The cost of an insurance plan depends on what is covered. Generally, the more covered services, the greater the cost of the plan.
“Insurance premiums will have the greatest impact,” said Brenda Nagel with Aetna. “Health care costs are still rising. No one, as a nation, has addressed health care costs.”
Large employers most likely already offer some of the coverage the law now requires. It is the smaller group plans and individual plan markets that will probably see greater increases because of the need to add coverage to their plans.
For example, Aetna, which has 500 employees in North Dakota, already covers preventive care for its employees. Preventive care includes exams and tests that can help detect potential health issues before they become more costly to treat. Other businesses may not offer this coverage, which is required under the new law.
More importantly, it will change how people get health insurance, and who gets covered; as well as mandate what course of treatment health care facilities provide and to use electronic medical records to exchange patient information.
One of the biggest changes is to health insurance. More people will qualify for Medicare, and people will be required to have health insurance, or face a fine. Tax credits also will be available to some people based on income to help defray the cost of insurance. it also eliminates pre-existing condition exemptions and lifetime caps on coverage, as well as covering dependent children up to age 26.
Businesses need to offer group plans to employees or provide a voucher for employees to buy health insurance elsewhere.
For healthcare providers in North Dakota, the bill is a blessing and a curse. It included a provision that increased Medicare reimbursement rates, but it also has provisions for technology and reporting that will cost the providers additional money in equipment and personnel.
The bill included the frontier states amendment, which raises the Medicare reimbursement rate to the national average for five states, including North Dakota. The change means an extra $65 million a year in Medicare funding for North Dakota, which receives about one-third to one-half less in Medicare reimbursement than what a hospital receives in an urban area.
“Our request all along was for fair reimbursement for Medicare,” said Medcenter One CEO Craig Lambrecht.
Health care facilities will need to adhere to stricter surveillance and auditing, as well as agree to a common course of treatment for certain chronic diseases.
The hospital is anticipating more people will seek health care because they have insurance, said Dr. Anthony Tello, corporate medical director at Medcenter One.
As it is, there are some uninsured people who do not seek health care. In the long run, the uninsured are likely to require more costly medical services because they did not see a doctor before something catastrophic happens. It also is likely to reduce the number of uninsured people who go to the emergency rooms. Instead, those people are likely to go to clinics, Tello said.
Additionally, hospitals will have to report how they manage common chronic medical conditions. People then will be able to search the information through a website.
Facilities also need to implement electronic medical records. For Medcenter One, this is already used in its clinics. It will need to be implemented in the hospital, Tello said.
The law also requires providers to adhere to a common course of treatment for diseases and illnesses. Through the quality control reports, the providers will show what evidenced-based treatment they provide.
Tello worries that increased use will require them to hire more physicians, which is already difficult to do in North Dakota, especially if they are specialists, he said. That is because wages tend to be lower than in more populated parts of the country, and the location does not attract as many job candidates.
There is some fear among North Dakota health care facilities that they will not be able to comply with the mandates and consequently close, said Jerry Jurena, the president of the North Dakota Hospital Association.
“It’s not a perfect bill,” Jurena said.
For the Neubauer family, though, it eases their concerns about how Jacob will continue treatment.
“We worked many, many years and made trips to Washington because it is important,” Neubauer said. “He will have to deal with it for the rest of his life.”
For now, he has the insurance to afford it.
(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@bismarcktribune.com.)
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Imaging With Ionizing Radiation Common in Children - Doctors Lounge

The use of diagnostic imaging procedures with ionizing radiation appears to be common among children, according to a study published online Jan. 3 in the Archives of Pediatrics & Adolescent Medicine.

WEDNESDAY, Jan. 5 (HealthDay News) -- The use of diagnostic imaging procedures with ionizing radiation appears to be common among children, according to a study published online Jan. 3 in the Archives of Pediatrics & Adolescent Medicine.

In a retrospective cohort study, Adam L. Dorfman, M.D., of the University of Michigan Medical School in Ann Arbor, and colleagues identified 355,088 individuals younger than 18 years of age who were continuously enrolled in UnitedHealthcare during Jan. 1, 2005, and Dec. 31, 2007.

The researchers found that 436,711 imaging procedures using ionizing radiation were performed in 150,930 individuals (42.5 percent). The highest rates of use of ionizing radiation occurred in children older than 10 years of age, with frequent use occurring in infants younger than 2 years. The investigators found that plain radiography accounted for 84.7 percent of imaging procedures, with computed tomography imaging accounting for 11.9 percent of all procedures. In addition, 7.9 percent of children received at least one computed tomography scan, and 3.5 percent underwent two or more scans.

"These results highlight the importance of generating data-based guidelines to aid clinicians in determining the appropriateness of performing imaging procedures in children," the authors write.

One author disclosed financial relationships with medical device and other companies; another author disclosed serving on the scientific advisory board for UnitedHealthcare.

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Digital X-rays: helping to educate younger patients - Dentistry IQ

By Parag R. Kachalia, DDS
© Dreamstime.com

    Children are notorious for their curiosity. They want to know the whys and the hows about everything. That enthusiasm for gathering information can be a great asset to their dental health. Dental radiography can help in this quest. My younger patients, as well as their parents, benefit from the visualization of my explanation that clear, detailed digital X-rays can provide.
One of the most compelling benefits of digital radiography, especially with my sensors (Gendex GXS-700™), is patient education. Kids are accustomed to computers and television. I can imagine that if I held up a small film X-ray, they would overlook the small details that affect my diagnosis. To a child caries on a traditional film may just look like a tiny dot. However, images displayed on my 20-inch monitor show teeth and their conditions maximized to its fullest. I review each image with the patient, or with the patient and parent, pointing out the areas of concern and possible treatment options. Inevitably, all ages are intrigued by the details, and also by the fact that they can actually understand the scope of the dental issues reflected by the X-rays. I can draw on the image to show anything from unerupted teeth and caries involvement to healthy views, to emphasize my diagnosis even more by comparison.

 Younger patients also appreciate that their experience in the dental radiography chair is more comfortable and shorter. My sensors have rounded corners and smooth edges, and they come in two sizes, one that is just right for my younger patients. The Size 1 “pedo” sensor was designed to be closest in size to the most widely used X-ray film for children. The sensor’s shape also facilitates quick movement around the mouth, shortening capture time. With the new sensors, gag reflex problems are far fewer. And, the immediacy of the images fascinates them and gets them more excited about dental visits.
Clear images, two sizes, and direct USB
When I need a consult quickly — in the case of a consultation with the child’s orthodontist (or other specialists for my adult patients) — my team can electronically and securely share the images, and we can discuss the case over the phone so we can get treatment started right away. The same is true for sending information to patients and insurance companies.
Children and adults need to understand what is happening, so they will want to follow through with proper dental treatment and care. When patients leave my office, they are not thinking about their treatment and asking why I suggested it; they are thinking about their future dental health and asking why not?
  Dr. Kachalia is an assistant professor at the University of the Pacific, School of Dentistry. He is the director of new technologies and is a faculty member within Pacific’s prestigious complex and esthetic rehabilitation program. He is a researcher, published author, and speaks internationally on restorative dentistry, CAD/CAM dentistry, and dental technologies. He maintains a private practice in San Ramon, Calif., with his wife, Dr. Charity Duncan-Kachalia, and is a member of the Pride Institute Technology Leadership Council.
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Optical Coherence Tomography (OCT) and Contact Lens Growth Drives Ophthalmic ... - PR Newswire (press release)

Surge in Cataract Surgeries Fuel Intraocular Lens (IOL) Market to Almost $1.4 Billion

VANCOUVER, Jan. 11 /PRNewswire/ - ccording to two new reports by iData Research (www.idataresearch.net), the leading global authority in medical device and pharmaceutical market research, growth in the use of optical coherence tomography (OCT) for the detection of ocular conditions will drive the U.S. diagnostic ophthalmic market to over $650 million by 2017. In addition, the U.S. contact lens market is expected to reach over $4.6 billion due to increased use of soft contact lenses and daily disposables by the aging baby-boomer generation. Companies such as Johnson & Johnson, CIBA Vision and CooperVision have emerged as the leading contact lens manufacturers in 2010.

"OCT sales slowed in 2009 due to the recession, however their use is growing in popularity among optometrists and ophthalmologists despite rising prices," says Dr. Douglas Fung, Analyst Manager at iData. "This growth is due to the technologies' superior resolution capabilities and ability to image the vascular structure under the retina. Physicians are expected to purchased second and third OCT units for their practices, leading to double-digit growth rates through 2013." 

iData's reports state that the non-mydriatic/mydriatic combination fundus camera segment was one of the fastest-growing in the diagnostic ophthalmic market, increasing at a CAGR of over 15% in 2010.

"Fundus cameras help to diagnose conditions such as diabetic eye disease, glaucoma and macular degeneration," says Dr. Fung. "The market is being driven by sales of combination devices from companies such as Topcon and Canon, which provide a cost-effective all-in-one solution."

iData's interventional ophthalmic report states moreover that the intraocular lens market is expected to reach almost $1.4 billion by 2017 due to advances in accommodative lenses that mimic the eye's natural ability to focus. Abbott's Synchrony® accommodative IOL is expected to gain FDA approval in 2011.

For more information on iData's 2 report series on the "U.S. Markets for Diagnostic & Interventional Ophthalmic Devices 2011", register free on iData's website at:

http://www.idataresearch.net/idata/registration.php

About iData Research

iData Research (www.idataresearch.net/idata/discoveridata.php) is an international market research and consulting group focused on providing market intelligence for medical device and pharmaceutical companies. iData covers research in: ophthalmics, diabetes, surgical equipment, and more.

SOURCE iData Research Inc.

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Russian syndrome of tomographic immunity - RusBusinessNews

What is most essential in quality medical care? Good personnel and equipment. The Sverdlovsk Region has no luck with either of these - high-caliber professionals are almost non-existent; as for equipment, the situation is quite opposite - it is plentiful, but it is idle and just gathers dust. The "RusBusinessNews" reporter made an attempt to find out what prevents the doctor from curing the patient.

In November 2010, in Makhnevo, a settlement in the Middle Urals, a 9-year-old boy died. When sliding downhill on the sledge he crashed into a tree, hit his head and sometime later died. The experts are sure that the child could be rescued. "This death could have been prevented", Maxim Starodubtsev, President of the Association of Regional Medical Insurers, states.

Makhnevo does not have any hospital. Local residents seek medical help in the first-aid station where general practitioners work. The only ambulance car is assigned to it. It took the ambulance two hours to get to the boy - when the call was received it was in Alapayevsk district center. It took another two hours to get to the district hospital; however, the hospital did not have the required equipment. They had to wait for a specialist accident-assistant squad from Ekaterinburg for about one hour. By that time the boy died. M. Starodubtsev says that such a situation is not singular - similar cases take place in the Middle Ural hinterland all the time. For example, early in 2010 the ambulance came too late to save two men in the Nizhneturinsk Region.

The Makhnevo tragedy can hypothetically be split into components. On the one hand, the ambulance failed to arrive on time. The blame lies with the territorial administration that did not provide financing to implement the program of government guarantees. During follow-up examinations, municipality executives tend to refer to lack of money, which made it impossible to optimize vehicle fleet and personnel; however, it does not release them from responsibility. The ambulance is on the balance sheet of municipalities, which are not able to support it; ii will be a long time before the ambulance is transferred to the financial system of compulsory health insurance.

On the other hand, there are claims to the general practitioner. The medical institute graduate who opted for general practice must be competent in all basic illnesses that may be encountered within the area he/she assigned to, including acute injuries. The doctor should have made every effort to diagnose the injury received by the child and to help him. He could even have called air ambulance from Ekaterinburg. "It is very important to conduct thorough and professional investigation. I am very afraid that this case can be put through red tape, because it may turn out as very indicative", Maxim Starodubtsev pointed out.

As for the equipment that was not available in the Alapayevsk hospital, it is rather exception to the rule. Most of the hospitals in the Sverdlovsk Region do not experience any shortage of equipment, sometimes having it in excess. However, the distribution of equipment among medical care institutions is inappropriate. Furthermore, part of the expensive equipment purchased through the Health National Project stands idle. There is no one who would operate it - either there are no payroll jobs, or specialists are not competent. M. Starodubtsev says that there are quite a few cases when the required spare part is missing and cannot be found or bought, and the expensive equipment has to "move" to the storage facility. There are situations when medical equipment is not used due to lack of funds for its installation or consumables.

As Alexei Kamenev, President of the First All-Russian Association of Private Medical Practitioners said, the Health National Project was brought to life in 2005. Essentially, the made decision was right and adequate: saturate hospitals and clinics with equipment and medications. However, it turned out wrong.

"The quantity of paid services increased, and availability of free medical care decreased. The saturation of health care institutions with equipment resulted in higher prices for medical services. Sometime ago American health care experts argued that the number of computer tomography scanners was not a problem: diagnostics will be better, but affordability of medical services will decrease. Therefore, cost effectiveness will be incommensurable. Today, we are facing the same situation", A. Kamenev remarks.

Analysts think that the main problem is not in availability or absence of equipment, but in the lack of well-developed strategy adopted by government authorities for development of the medical care system. This statement is convincingly illustrated by the incident that took place at the October meeting summoned by the Sverdlovsk Region's Health Ministry. The Minister Arkady Belyavsky criticized executives of municipal and regional health care departments for irresponsible approach to preparation of municipal requests for equipment. The requests served as the basis determining the relevant section of the regional program of health care modernization. It turned out that what medical institutions need first of all is a washing machine, cabinet oven, and refrigerator for a mortuary!

A. Belyavsky said angrily: "You will receive exactly what you have asked". The ministry, in its turn, decided that municipal hospitals needed much more: 5 magnetic resonance imaging devices, 6 angiography units, 18 apparatuses for computer tomography. The officials did not want to think what they are going to do with this sophisticated equipment without qualified specialists. Based on provisional estimates, during the next two years 18 billion rubles will be allocated for health care improvement in the Sverdlovsk Region. Out of them, 7.5 billion is planned to be spent on equipment.

"The situation with medical personnel is deteriorating steadily", Maxim Starodubtsev stated. The level and qualification of doctors are decreasing rapidly. Lack of proper supervision is one of the reasons. There is a growing number of doctors who become operators, and even there they are not able to work decently. The population that has been tired of low-quality medical care does not mind even such doctors, having only one request: they should perform their functions in dispatching centers more diligently. Here, we mean that they should ensure timely arrival of patients at higher level hospitals that still have skilled professionals. However, event such basic objectives are not fulfilled by dispatcher doctors.

The Middle Ural Ministry of Health admits that there is 50% personnel shortage. The Deputy Minister Dilyara Medvedskaya notes that the personnel shortage is one of the main problems in the Russian health care; the shortage of first-aid medical personnel, including specialists working in villages, is most pressing. Graduates of medical higher schools do not want to work in small settlements. In 2006, the ministry launched target programs attracting applicants from hinterland and paying for their studies from regional budget funds. The first graduates of the program will start working in municipal hospitals in three years. Let's hope that over this time the tomographs covered with dust will not fall apart in hospital warehouses.

Anna Khorkova

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Circ Feature: FFR-guided PCI is cost savings at one year

Fractional flow reserve (FFR)-guided PCI in patients with multivessel coronary disease is one of those rare situations in which a new technology not only improves outcomes but also saves resources, according to an economic evaluation of the FAME study published in the Dec. 14 issue of Circulation.

The FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study demonstrated significantly improved health outcomes at one year in patients randomized to multivessel PCI guided by FFR, compared with PCI guided by angiography alone. Prior to this study, the economic impact of routine measurement of FFR in this setting was not known.

“The trial design was a one-year analysis from the U.S. healthcare perspective,” William F. Fearon, MD, from the division of cardiovascular medicine at Stanford University Medical Center in Stanford, Calif., told Cardiovascular Business News. “Anytime a new medical technique or technology emerges, it must show that it has the capability of improving patient outcomes. However, given the current economic and healthcare environment, it also is beneficial to show its cost-effectiveness.”

In this study, 1,005 patients were randomly assigned to FFR-guided or angiography-guided PCI and followed up for one year. A prospective cost-utility analysis comparing costs and quality-adjusted life-years (QALYs) was performed with a time horizon of one year. Direct medical costs included those of the index procedure and hospitalization and costs for major adverse cardiac events during follow-up.

They found that the major adverse cardiac events at one year occurred in 13.2 percent of those in the FFR-guided arm and 18.3 percent of those in the angiography-guided arm. QALYs were slightly greater in the FFR-guided arm (0.853 vs. 0.838).

From an economic perspective, they found that the mean overall costs at one year were significantly less in the FFR-guided arm ($14,315 vs. $16,700). Bootstrap simulation indicated that the FFR-guided strategy was cost saving in 90.74 percent and cost effective at a threshold of $50,000 per QALYs in 99.96 percent.

The authors wrote that the “cost savings occur both at the index procedure, primarily owing to a decrease in drug-eluting stent use being a major cost driver, which more than offsets the increased cost of the pressure wire and adenosine, and during follow-up as a result of a decrease in re-hospitalization and fewer major adverse cardiac events.”

Fearon noted that procedural costs accounted for approximately 70 percent of the cost savings, and the follow-up event rates accounted for about 30 percent of the savings.

Overall, the researchers reported that about 90 percent of the total cost occurred at the index hospitalization. However, approximately 30 percent of the overall cost difference between the two strategies is generated during follow-up, indicating increasing cost savings even after the initial procedure.

While the authors mentioned, as a limitation, that the "durability of these findings need to be confirmed after longer follow-up," Fearon hypothesized that the longer-term findings, such as out of five years, may not prove "drastically different," as most of the events and costs occurred during the PCI procedure or soon after the PCI procedure for the FAME patients.

“We were pleased to find out that FFR-guided PCI is not only cost effective, but it also saves money for the U.S. healthcare system,” Fearon said.

Computed Tomographic Angiography in the Diagnosis of Coronary Artery Stenosis and for the Evaluation of Acute Chest Pain

COMPUTED TOMOGRAPHIC ANGIOGRAPHY IN THE DIAGNOSIS OF CORONARY ARTERY
STENOSIS AND FOR THE EVALUATION OF ACUTE CHEST PAIN
A Technology Assessment
INTRODUCTION
The California Technology Assessment Forum was requested to review the scientific evidence for the use of
cardiac computed tomographic angiography in the diagnosis of coronary artery stenosis and for the
evaluation of acute chest pain. This review was prompted by reports that there may be new information
about cardiac computed tomography published since this topic was evaluated by the Blue Cross Blue Shield
Association Technology Evaluation Center (BCBSA TEC) in August, 20061.
BACKGROUND
Coronary artery disease (CAD) is the number one cause of death in men and women. CAD is caused by atherosclerotic plaques developing in the coronary arteries. Many therapies have been shown to decrease CAD mortality, therefore early detection and treatment is critical.

The gold standard for defining coronary artery anatomy is angiography. During coronary angiography, a
catheter is introduced into the femoral, brachial or radial artery and is then passed up to the aorta. Iodinated
contrast dye is then directly injected into the coronary arteries, while digital X-ray images are taken.
Although the risks are generally considered low, there are some risks to the procedure. These include
bleeding and other complications at the catheter insertion site, catheter manipulation causing embolization
of plaque leading to stroke or myocardial infarction, dye related complications, including allergic reactions
and renal toxicity, and exposure to radiation, which may be associated with an increased risk of cancer2, 3.
Coronary artery computed tomography (CT) angiography (CTA) is a non-invasive technology that can
directly image coronary artery anatomy, while decreasing some of the risks associated with an invasive
procedure. It has been proposed as an alternative to coronary angiography. CTA requires the use of
contrast material (administered intravenously) and high speed high resolution CT machinery to take detailed
volumetric pictures of blood vessels.

There are several technical challenges involved in getting good images with CTA. First, the image must be
obtained in a short period of time to avoid blurring. Sometimes beta blockers are given before the
procedure to slow the heart down; therefore pictures can then be taken during diastole when motion is
reduced. Second, rapid scanning is best so that the images can be taken while the patient is holding his/her
breath. Third, thin sections enable higher quality images. Volumetric imaging is then performed and
enables multiple images to be reconstructed to fully demonstrate the coronary arteries.
Multidetector row CT (MDCT) scanning uses helical CT (rotating a tube around the patient to get continuous spiral images). They have multiple detectors – 4, 8, 16, 32, 40 or 64. Limitations of MDCT include: 1) it is harder to obtain good images with a fast heart rate, and 2) the distal portions of the coronary arteries are more difficult to see due to more motion artifact. Many of the earlier studies were done with 16 row MDCT, but MDCT with at least 32 rows is soon likely to become standard.

Important negative consequences of CTA are radiation exposure, which is significantly higher than
conventional angiography3, and nephrotoxicity from the dye. An additional potential complication is the
identification of incidental non-coronary lesions, which then require additional evaluation to determine their
significance.
Two potential uses of CTA are addressed in this report; 1) Use of CTA to diagnose coronary artery stenosis,
and 2) use of CTA in the evaluation of acute chest pain.
Use of CTA to diagnose coronary artery stenosis has the goal of determining whether or not patients have
significant stenoses of the coronary arteries, while avoiding an invasive procedure. CTA could be used as
an alternative to invasive angiography or as an additional noninvasive cardiac test that may be
complementary to other noninvasive tests routinely used (e.g. exercise stress tests). An important issue to
consider is whether or not it replaces other diagnostic tests or becomes an additional or additive test.
For patients with acute chest pain being evaluated in the emergency room, an important goal would be to exclude clinically significant CAD, so as to avoid unnecessary hospitalization. It would thus potentially be most useful in a low risk chest pain population.

Radiology: PEM complements MR, but gaps remain

A multicenter prospective study of positron emission mammography (PEM) and breast MR published in the January issue of Radiology found that PEM provided breast-level sensitivity comparable to breast MR, while MR delivered greater lesion-level sensitivity, in addition to reporting a multitude of other findings.

With previous data indicating that PEM may be more specific and possibly more accurate than MR, researchers designed the current study to detail the performance characteristics of PEM compared with MR, including the effect on surgical breast management, in ipsilateral breasts with cancer, wrote lead author Wendie A. Berg, MD, from the American College of Radiology Imaging Network in Lutherville, Md.

The researchers at six sites recruited 388 female candidates for breast-conserving surgery (median age, 58 years) with newly diagnosed invasive and/or intraductal breast cancer to undergo PEM and MR exams. Imaging results were independently reviewed by different investigators blinded to the results of the other exam. After all surgeries, Berg and colleagues documented and characterized mastectomies as appropriate or inappropriate, obtained data about modifications in surgical management based on imaging results and gauged the accuracy of estimates of disease extent by PEM and MR.

“PEM tended to better depict cancer when it was present, depicting 357 of the 386 foci versus 344 foci depicted with MR imaging. Biopsy sites were more readily identified with MR imaging,” wrote Berg. Eighty-two of the 388 breasts were found to have additional tumor foci, with 60 percent of these identified via MR, 51 percent identified via PEM and 27 percent identified with conventional imaging. “The addition of conventional imaging review to either MRI or PEM significantly improved the sensitivity of MR imaging or PEM alone. Integrating PEM and MR findings significantly improved the detection of additional cancer: to 61 of 82 breasts versus 49 of 82 breasts with MR imaging alone,” continued the investigators.

MR imaging characterized 61 of the 116 malignant lesions unknown at study entry as suspicious. PEM characterized 47 and conventional imaging 24 as suspicious. However, PEM delivered greater specificity than MR in the characterization of benign lesions, characterizing 151 of the 189 as negative compared to 124 of the 189 via MR. PEM was less likely than MR to prompt unnecessary biopsies.

PEM yielded a superior positive predictive value versus MR when it prompted biopsies at 66 percent versus 53 percent, respectively. The addition of PEM to MR significantly improved the detection of DCIS over MR alone from 39 percent to 57 percent, and the addition of PEM to MR also improved detection of invasive cancer over MR alone from 64 percent to 73 percent.

MR outperformed PEM among the 56 participants who required mastectomy based on the extent of disease. MR correctly identified 71 percent of the cases, whereas PEM correctly identified 36 percent. However, MR findings prompted five inappropriate mastectomies, and PEM prompted one.

Berg and colleagues reported that MR was more accurate than PEM in surgical planning, with MR accurate in 75 percent of breasts and PEM accurate in 67 percent.

Given the improved detection of additional malignancies with conventional image review, Berg wrote, “[o]ur results suggest that a coordinated review of all breast imaging studies at the time of PEM or MR image interpretation is important for improved diagnosis.”

The authors surmised, “PEM proved to be complementary to MR imaging for defining preoperative disease extent in the ipsilateral breast of women with newly diagnosed breast cancer … even the combination of PEM and MR imaging did not fully depict disease extent, particularly in cases with an extensive intraductal component, multifocal disease, or multicentric disease--that is, the very patient populations anticipated to benefit most from accurate preoperative assessment of disease extent.”

Everything You Always Wanted to Know About Mammograms but Were Afraid to Ask

Mammography is a specific type of imaging that uses a low dose x-ray system to examine the breast; a mammogram -- a mammography exam -- is an x-ray photograph of the breast. It's a safe and highly accurate technique that has been around for the past 30 years. It is used both as a screening tool to detect early breast cancer, abnormal growths or changes in the breast tissue in women experiencing no symptoms, and to diagnose breast disease in women experiencing symptoms such as pain, lumps, or discharge from the nipple. In a screening mammogram, the breast is x-rayed from top to bottom and from side to side while in a diagnostic mammogram a particular lump or area of abnormal tissue is focused on.

A mammogram is carried out during a regular physical exam or to investigate any physical changes in the breast. As well as being useful to look for lumps that are too small to be felt during a physical exam, a mammogram can help a physician decide if any lump or growth needs further investigation. Mammography is therefore extremely important in detecting the early stages of breast cancer because it can identify an abnormal growth before it can be felt during a breast examination. There is no doubt that mammography can play a huge part in breast cancer survival -- and research has clearly shown this to be the case.

Mammography is performed on an outpatient basis. Any woman undergoing a mammogram should inform her doctor if she is pregnant or believes she might be pregnant. No changes to diet are required in preparation for a mammogram, and any medication should be taken as usual. Products such as body cream, deodorant, lotion, or powder should not be worn under the arms or on the chest on the day of the mammogram as this might interfere with the x-ray. All clothing should be removed (a gown will be provided for the patient to wear), as should all jewelry. The technologist should be advised of any breast problems and any previous mammogram results should be handed to the radiologist at the time of the current mammogram.

Registered mammography technologists perform the test, most of whom are women. The x-ray images are interpreted by a doctor specializing in this field.

During the test a patient will be asked to stand in front of an x-ray machine, and a technician will position the breast in a mammography unit. The breast will be placed on a platform and compressed with a clear plastic paddle. Compressing the breast is necessary to even out the breast thickness so that all the breast tissue can be visualized. Spreading out the tissue ensures that no small abnormalities are obscured by overlying breast tissue. It also allows for a lower dose of radiation to be used given that a thinner amount of breast tissue is being imaged. The patient must remain very still during the imaging and may be asked to refrain from breathing for a few seconds while the x-ray photo is being taken. The patient may feel a little discomfort during this process but it should only last a few seconds. Once the images have been taken, the technician will ask the patient to wait until she has determined that the images are of sufficient quality to enable the radiologist to make a reading. Compression on the breast will probably cause discomfort but this is necessary in order to get a clear picture with as small a dose of radiation as possible. However, any pain felt should be reported to the technician. One way a woman can minimize the discomfort is to schedule her mammogram seven to 10 days after the start of her last period when there is the least chance of her breasts being tender. The breast will be x-rayed from a number of positions to get an adequate visualization of the breast tissue. During a routine mammogram, two images of each breast are taken which takes about 30 minutes. Additional images of the breasts or an ultrasound may be required after the images have been interpreted to enable a more precise diagnosis to be carried out: this is a routine measure.

After the test, it’s quite normal for a patient to feel tenderness or aching where the breasts were compressed during the screening. There may also be some very slight bruising. A mild painkiller such as aspirin or ibuprofen will help alleviate any discomfort; and normal activities can be resumed immediately after the mammogram.

The results of the mammogram will be sent to the patient’s physician (the patient will also receive the results from the mammography facility). All results are now required to be sent within 30 days of screening and contact will be made with the patient within five days if there’s a problem. However, no one should assume that their results were normal if they don’t hear anything -- they should contact their physician to get confirmation. There are some centers performing mammograms that are able to produce the results while a patient waits.

According to the American Cancer Society, out of every 1000 mammograms only one or two lead to a diagnosis of cancer. Approximately 10 percent of women require additional mammography, and only eight to 10 percent of those women need a biopsy of which 80 percent will not be cancer.

The risk of breast cancer increases with age, so for a woman over 40 it’s important to have a yearly mammogram. Any woman believing that she needs one should contact her physician.

Breast self-examination is still very important, as not all breast cancers are detected by a mammogram. And self-examination is especially important for younger women who have denser breast tissue. All women should perform breast self-examination once a month from age 20. Women should also have their breasts examined by their physician or physician's nurse every three years from age 20 and every year from age 40.

In the US, breast cancer is the most common cancer among women accounting for nearly one of every three cancers diagnosed. In 2001, it was estimated that 192,200 American women were diagnosed with breast cancer for the first time and 40,200 women died from the disease. The National Cancer Institute, the American Cancer Society, and the American College of Radiology all now recommend that women over the age of 40 have annual mammograms.

While breast cancer in men is uncommon, it does happen. Both men and women have breast tissue, although men have much less of it than women; most of the breast tissue in men is located behind the nipple. Breast cancer in men accounts for less than one percent of all breast cancers

Regular mammograms can help reduce a woman’s chance of developing breast cancer, and the higher risk of breast cancer a woman has, then the more important it is to have regular screenings. Once a woman reaches 40 her chances of developing breast cancer increase. Any woman who has a family history of breast or ovarian cancer or has received radiation treatment to her chest in the past is advised to start having annual mammograms from the age of 30. The National Cancer Institute advises those women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer to seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening. And anyone who is concerned about the frequency of their mammograms should discuss the issue with their physician.

The bottom line is that mammograms save lives. However, there are a few drawbacks: mammograms don’t detect all types of breast cancer -- they can miss 15-20 percent of breast cancers that are just not visible using this technique. It's also important to remember that mammograms can sometimes produce incorrect readings and result in unnecessary surgery.

Nevertheless, while mammograms can’t guarantee to prevent breast cancer, they can save lives by detecting abnormalities in the breast at a very early stage. Mammograms have been shown to reduce the risk of dying from breast cancer by 35% in women over the age of 50; and for women between 40 and 50 studies suggest mammograms may reduce the risk of dying from breast cancer by 25–35%. Detecting breast cancer in its early stages through mammography also increases a woman's chance of being able to keep her breasts.

Magnetic resonance imaging (MRI) tests are also used to detect breast cancer. However, while MRI tests are more thorough than mammograms they also detect more growths that look suspicious but which in fact turn out to be benign. MRI tests are also much more expensive than mammograms and may not be covered by insurance. Mammography screening remains the best technique to detect breast cancer early.

The cost of a screening mammogram is between $100 and $150. Most states have laws stating that health insurance companies must reimburse individuals all or part of the cost of a screening mammogram. All women aged 40 and over with Medicare can get a screening mammogram each year. Medicare will also pay for one baseline (a woman’s first screening) mammogram for women between the ages of 35 and 39.

Taking Care Of Women - Jamestown Post Journal

In an effort to get more women screened for their mammogram, the Western New York Affiliate of Susan G. Komen for the Cure awarded WCA Hospital a $47,329 grant to maximize mammography participation by reaching out to women who have canceled, missed or are overdue for their mammogram screening and links them to appropriate resources to get screened.

The adapted strategies of the program are taken from the National Cancer Institute's Research-tested Intervention Program, "Maximizing Mammography Participation.''

According to the American Cancer Society, breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer.

"The purpose of our breast health education and navigation program is to offer the best protection from breast cancer mortality for women in Southern Chautauqua County by maximizing screening mammogram participation," said Toni DeAngelo, WCA Hospital community health and wellness director and grant coordinator. "The program also educates women on the importance of good breast health practices that will decrease the risk of breast cancer through mammography screening."

Studies show that timely screening can prevent a substantial number of deaths from breast cancer. For a variety of reasons, many women do not schedule their mammogram as often as they should, according to Dorothy Carlson, trained program navigation telephone counselor, who reaches out to women and encourages them to get screened.

"The number of missed appointments can be quite high," she said. "We understand that women's lives are very busy and for whatever reason, they are unable to schedule or keep their appointment. Our intention is to reach out to women by giving them a gentle reminder about the importance of mammogram screening and help them access breast health services by linking them to appropriate resources to get screened."

The Komen grant also helps women overcome barriers to breast care that may keep them from getting their mammogram screening.

"If women need transportation, insurance, a physician order, or any other barrier to breast care, we help them overcome these barriers so they can access mammogram screenings without delay," Mrs. DeAngelo said.

For women who are unable to pay for a mammogram, WCA Hospital connects them to available programs that help defray medical costs.

"There has been a decline in women getting screened because they may be unemployed or uninsured," Mrs. DeAngelo said. "Fortunately, the Chautauqua County Cancer Services Program can help women get screened by providing low cost or no-cost mammograms if they meet eligibility requirements."

Designated a Breast Imaging Center of Excellence, the Center For Imaging & Medical Arts at WCA Hospital, provides same day mammogram results and has expanded its health and wellness program with the addition of a nurse specialist who is specially trained to coordinate the clinical, educational and supportive needs of consumers who are scheduled for breast health services at the Center For Imaging. The WCA Center For Imaging is open from 7 a.m. to 4:30 p.m. Monday through Friday and offers Saturday hours from 7 to 11:30 a.m.

Susan G. Komen for the Cure, headquartered in Dallas, Texas, is dedicated to education and research about causes, treatment, and the search for a cure for breast cancer. The Komen Western New York Affiliate is part of the 125-affiliate network of Susan G. Komen for the Cure, the world's largest and most progressive grassroots network fighting to end breast cancer forever.

For more information about the Maximizing Mammography Participation grant at WCA Hospital, contact Dorothy Carlson at 664-8619. Women, who are uninsured, may contact the Chautauqua County Partners for Prevention for a free mammogram screening at 800-506-9185.

Coronary Computed Tomography Angiography: General Considerations

Coronary computed tomography (CCTA) is currently considered to be a technique for high-resolution computed tomography (CT) imaging of the heart. It has become generally accepted that patients with negative CT cardiac results will not need to undergo cardiac catheterization. The radiation dose for the CCTA with modern techniques is much lower than even a few years ago and in some cases, even lower than for cardiac catheterization.

The 64-Slice CT scanner is considered to be the high-end CT system and is preferable for CCTA. However, even earlier generation CT systems are suitable for this task.

In some research studies, there has been an attempt to determine the most beneficial use of cardiac CT scanners, and the consensus appears to be that the high negative predictive value of the multislice CT scanner, used to filter out those patients who do not require further investigatory tests for coronary disease, is where it is currently used most effectively.

CCTA is a non-invasive test, requiring only a contrast injection and for some patients, beta blockers. Therefore the CT scan can be performed as an outpatient examination. The disadvantage of CCTA is that there is a limitation with respect to the image quality for patients with irregular or high heart rates. In such cases, patients may be medicated by beta blockers.
CCTA is also limited where there is extensive calcification, as the high contrast of the calcium leads to "blooming" artifact.

The implementation of X- ray tube current modulation resulted in a dramatic decrease in radiation. In addition, the use of CT scans with ECG -triggering of the radiation resulted in average doses around 3 MSV.

The cost of premium-class, 64-slice CT scanning can be $1.2 - $1.5 million. A dual-source, 64-slice CT scan system costs $1.9 - $2.5 million.
The running costs including: a service contract, three full- time staff members and contrast media are $700 - $850k. In terms of potential revenue, the CCTA exam costs about 10% to 12% of the cost of cardiac catheterization.

Technical Considerations

CCTA requires an accurate imaging of coronary arteries, which move with the cardiac and respiratory cycles. Therefore, high spatial resolution and high temporal resolution are essential.

High contrast-to-noise ratio is of primary importance. To achieve a good enough ratio, it is possible to either increase the X-ray tube output and use thicker slices, or to increase the contrast. The spatial resolution will be impaired by increasing the slice width and filtering the signals.

To eliminate cardiac motion artifact, high-rotation speed system is necessary. Current cardiac CT scanners have 3-3.3 R.P.M speed.

For higher temporal resolution, half the gantry rotation time is used for the reconstruction. To assure the best temporal resolution, it is important to acquire the image in the most stationary phase of the cardiac cycle. Therefore, ECG signal is used to enable the reconstruction of the CCTA image in the cardiac phase of least motion.

The typical scan length of a CCTA examination is about 14 CM. It is essential that the CT scan is completed well within a patient's breathhold, so as to avoid respiratory motion artifacts.

Imaging of the coronary arteries can be achieved on a CT scanner in a variety of different ways. Where the complete heart cycle is scanned, greatest flexibility is available in selecting the optimal phase for coronary artery image reconstruction. This approach enables the best functional analysis. However, the dose to the patient is high. Where only a selected part of the cardiac cycle is CT scanned, the radiation is only during a short interval. In this situation, the radiation is low. There is also the merging of the two approaches: all phases of the heart are CT scanned with reduced radiation, and only the stationary phase window is fully illuminated. Full image quality is obtained for the coronary artery image required phase, whereas the images for functional analysis have lower quality.

In general, the CCTA systems can be classified in 4 groups:

1. Axial scan, Prospective ECG Triggered: this is the most commonly used mode, due to the resultant lower dose. Modern systems typically require 3-4 rotations. It is suitable for patients with heart rates below 70 BMP.

2. Axial scan, Retrospective ECG Gated: in this mode, the axial scan is performed over the full cardiac cycle, over a number of gantry rotations (depending on the detector coverage) so the patient is exposed to high-dose rates.

3. Helical Scan, Retrospective ECG Gated: in this mode the radiation is continuous, while the heart is covered with a low-pitch helical scan. The involved radiation dose is high. This is the mode of choice for patients with high or unstable heart rates.

4. Helical scan, Prospective ECG Triggered: in this mode, the radiation is triggered by ECG, as it is with the axial triggered systems. Systems with dual source (two x-rays tubes and detectors which are positioned at 90 degrees each to other) can be operated at high pitch. A full scan can be performed in less than 0.5 seconds.

Low-pitch prospective systems are rare nowadays.

Performance of CCTA
CT scanning results in a plain-scan resolution of approximately 0.5 mm. With a typical reconstruction field of view of 25 cm, and a reconstruction matrix of 512×512, the pixel size is approximately 0.5 mm, which is a good match for the resolution.

The longitudinal axis resolution of modern, quality CT scanner systems approaches 0.5 mm.

Over 4,000 unreported x-rays at Tullamore hospital

A NATIONAL Radiology Survey has revealed that over 4,000 x-rays went unreported at the Midlands Regional Hospital, Tullamore between 2009 and 2010. 2,905 index fracture and orthopaedic studies x-rays were unreported in 2009 and 1,129 in 2010.
Dr Maurice Hayes was commissioned by the HSE to investigate the accumulation of unreported x-rays in Tallaght Hospital and concerned with establishing if this was an issue in other HSE funded hospitals, a National Radiology Survey was undertaken. Work on the survey, to identify any radiology backlogs and to report on their resolution, was carried out between March 10 and November 4 last.

Out of a total annual workload of more than 2.5 million examinations each year across all hospitals, the total number of investigations returned as unreported by a radiologist was 33,914. This represented less than 0.5% of all activity over the period (2008 – present).

Remedial actions were taken in all hospitals that reported non-compliance and there were no instances of adverse event (patient harm) reported to the HSE as a consequence of backlogs. This is in keeping with the initial assessment that the practices in place, while informal, were in practice appropriately identifying certain investigations as low risk and appropriate for reviewing by clinicians other than radiologists.

In one site an adverse event was reported relating to an instance of delayed cancer diagnosis due to an unreported x-ray. This had been noted prior to the national survey. This case has been investigated and fully communicated to the patient.

In a statement, the HSE said it is implementing the recommendations of Dr Maurice Hayes' report, adding, "These measures will drive improvements in the quality of service and will help to prevent the recurrence of further backlogs of unreported radiology.

"The lessons learned from the Hayes report and the national audit will contribute to improvements across the hospital system. The roll out of the National Integrated Medical Information System (NIMIS) will further strengthening radiology services, quality and processes within our health system."

Radiology Classes - The First Step Towards a Promising Career

By Lisa S Thomas

Are you interested in pursuing a career as a Radiologist? If yes, then you should start looking into different Radiology programs and Radiology Classes right away.

Here's a quick guide to introduce you to the different radiology courses which you are likely to study during your degree program.

Foundation Courses

Foundation courses are common in all the basic Radiology Classes that you are bound to take regardless of where you are studying. The two main foundation courses required to become a Radiology Technician include:

1. The Radiographic Fundamentals Course

The Radiographic Fundamental Course is simply an overview of the field of radiology and its importance in the health care industry. Some of the key elements of this course include learning about imaging methods and various safety measures while using the radiation equipment.

2. Anatomy and Physiology Course

This encompasses the significance of learning about the human body. If you want to be a good Radiology Technician, then a thorough understanding of subjects like the imaging procedure used for diagnosing sicknesses is vital. Moreover, in this course, you will also learn about the human body, the bones and muscles, the skin, the respiratory muscles and the skeletal system.

Apart from the basic foundation courses, you are also required to take some very important core courses. The skills, competence and techniques you learn from these classes will help you in building your confidence and aptitude. A few of these include:

Procedures in Radiology: This course will be constant throughout the entire training program; however, you will discover the subject more in depth with time. This class includes producing and evaluating radiographic images; plus, it also allows you to learn the essential patient positioning techniques during the diagnostic imaging procedure.
Radiologic Imaging: Radiologic Imaging teaches you different necessary techniques such as image exposure, digital radiography intensification, and tomography. It is extremely important to ace this course since it covers most of the practical aspects of your job. Moreover, during this class, you will also be taught to examine, conduct hypotheses and form conclusions based on the images taken.
Radiology Exposure and Protection: One of the main things that you need to learn in your Radiology Classes is the radiology exposure from CT Scanners, X-Ray Machines and MRI machines. Learning how to protect against each of these is also important as exposure to their rays can be hazardous to your health. Hence this class will focus solely on teaching you about the different elements of x-rays, the quality of radiographic images and the types of radiology equipment used.
So whether it's the foundation courses or the core ones, acing a Radiology Class requires a lot of hard work, patience and determination. So, Good Luck!

Lisa Thomas is your guide to medical careers.

Learn about Radiology Classes, job and salary. Search for health care schools near you and receive free information from Radiology Classes at http://www.medicalassistantvacancies.com.

A Doctor’s Mammogram Mission Turns Personal- New York Times

This year was different. After Dr. Weiss went home, she got a call from the doctor’s office.

“They said, ‘Can you come back, now?’ ” she recalled. “I said I’d prefer not to, and they said, ‘Are you sure?’ And I realized at that moment that it was more serious.”

Dr. Weiss, who soon learned that she had an invasive Stage 1 cancer in her left breast, is not just any physician. A radiation oncologist and a specialist in breast cancer, she founded a popular Web site, breastcancer.org, for women seeking comprehensive information about the disease, and she considers herself a woman with a mission. She sees patients three days a week, but she devotes four days a week to the site, which draws millions of visitors from 250 countries each year. She is writing her third book on breast cancer for a general audience.

A year ago, when a federal task force issued new guidelines relaxing the recommendations for mammography screening, Dr. Weiss was one of their fiercest critics. Mammograms aren’t perfect, she said at the time, but they save lives. Now she says one may have saved hers.

In the annals of medicine, Dr. Weiss’s story is just that: a story, an individual experience of the kind scientists dismiss as anecdotal, no reason to rethink policy. But it underscores the lingering, uncomfortable questions about when and how often to undergo breast cancer screening, and how to balance the benefits of early diagnosis with the harms of mammography — including false positive results that can lead to unnecessary biopsies and overtreatment.

The new guidelines call for postponing routine screening for women at average risk to age 50, from 40, and recommend scans every other year instead of every year.

If Dr. Weiss had followed them, she might have skipped this year’s scan, giving the tumor more time to grow undetected; and if she had not had a trail of scans from her 40s, doctors would not have been able to compare the images and notice the tumor’s subtle emergence. (In fact, her risk is above average, because of her dense breast tissue and a family history. But she noted, “Most women who get breast cancer don’t have a family history — that’s a huge myth.”)

Yet even at the American Cancer Society, which continues to advise women to start regular mammograms at 40, experts acknowledge the limitations of screening.

“Most people think mammography is much more beneficial than it actually is,” said Dr. Otis Brawley, the society’s chief medical officer. “Even if you take the most liberal, most pro-mammogram argument, we need something better.”

Dr. Brawley says that on balance, mammography saves lives. But he notes that it misses some cancers, and that radiation from the scans will actually cause some cancers to develop.

In addition, some women will be called back repeatedly for additional procedures, scans and biopsies that ultimately rule out cancer but can be painful and anxiety-provoking. Mammograms also find some cancers that grow very slowly but look the same as any other cancerous tumor, leading to aggressive but unnecessary treatment.

The United States Preventive Services Task Force found that while mammograms saved lives over all — reducing the breast cancer death rate by 15 percent — the benefits fell off rapidly for younger women, who also bore the greatest burden of the harms. While one cancer death is prevented for every 1,339 women in their 50s and every 377 women in their 60s who undergo screening, 1,904 women in their 40s would need to be screened for 10 years to prevent a single cancer death.

The panel also discouraged breast self-exams and even physicians’ breast exams.

But though the recommendations received saturation coverage in the news media last year, little attention was given a month later, when the panel modified its message. Concerned that it had been misunderstood, the panel took the extraordinary step of amending the standard language of its recommendations and removed the critical word “against” as applied to routine mammography of women in their 40s.

It let stand the language recommending that the decision to start screening every other year “should be an individual one” that “takes patient context into account, including the patient’s values regarding the specific benefits and harms.”

“No one had read that second sentence — no one got beyond the words ‘recommend against’ routine screening in women 40 to 49,” said Dr. Bruce Ned Calonge, chairman of the task force, in a recent interview. “We didn’t say, ‘Don’t screen.’ The intent of the task force was to promote shared decision-making between physicians and women in that age interval.”

There are already some indications that primary-care doctors are cutting back on mammography referrals. A recent report by the Centers for Disease Control and Prevention said a third of breast cancer cases were diagnosed at late stages, when treatment is more difficult.

The trend is disturbing to Dr. Weiss, who says she fears that radical changes in the way women live — earlier puberty, rising obesity and alcohol consumption, environmental pollution, long-term use of oral contraceptives, later childbearing and less breast-feeding — could lead to more breast cancer emerging at younger ages.

Her own surgery went well. She did not need radiation or chemotherapy, because the cancer had not spread. She began hormone therapy and was soon back to her crowded full-time schedule.

Dr. Weiss, who lives in Wynnewood, Pa., has made some lifestyle changes since her diagnosis — filtering her tap water, no longer cooking in plastic, and buying hormone-free meat and organic fruit. She lost 15 pounds and became a Zumba dance-exercise enthusiast. She eats lots of leafy green vegetables, has cut down on wine and always tries to get a good night’s sleep.

“I’m sharing my story in order to encourage women to step forward and get that mammogram,” she said. “I’m lucky to have caught this early, and I want to use my situation as an example of the value of early detection.

“The thing is: every woman is at risk. And every woman needs to do everything she can to protect herself.”

View the original article here

Research and Markets: Get a Generous Discount with This Essential Medical ... - TMCnet

Dublin, Jan 05, 2011 (M2 PRESSWIRE via COMTEX) -- Research and Markets (http://www.researchandmarkets.com/research/89efce/medical_imaging_bu) has announced the addition of the "Medical Imaging Bundle" report to their offering.

The Medical Imaging Bundle offers a 15% discount off the total transaction price for the following reports being purchased simultaneously: - Mammography World Markets - Medical Imaging Markets - Nuclear Cardiology Markets - Picture Archiving and Communications Systems (PACS) - Positron Emission Tomography (PET) Markets - Ultrasound Markets Mammography World Markets The womens mammography segment is poised for a major new phase of growth fueled by the availability of new technology coming out of the computer and digital areas and the higher interest of individual patients and general healthcare consumers to take charge of their own health status. Continuous improvements in technology are resulting in a growing number of new imaging diagnostic tests that combine high levels of accuracy with rapid, easy-to-use product formats. Digital mammography is driving more screening programs. The emphasis in this report is on those companies and products that are actively developing and marketing clinical laboratory instrumentation and reagents and supplies for performing diagnostic tests on conditions specifically related to womens health. This study concentrates on the mammography market segment in large worldwide markets such as the U.S., Japan and Europe. Certain areas that are not covered include what is generally characterized as digital imaging techniques instruments and reagents, PACS or other data storage methods, or other medical imaging technologies, although many of the instruments, reagents and techniques in the mammography market segment are intimately associated with these broader areas. Specialty areas in medical imaging are touched upon, since these segments are frequently a part of the overall analytical focus of companies marketing general mammography equipment. However, no effort is made to quantify the size of this broader market.

Medical Imaging Markets There will be a steady increase in demand for medical imaging services, along with pressures to improve the quality of healthcare delivered in the home and to lower its cost. The medical imaging segments are poised for a major new phase of growth fueled by the availability of new technology coming out of the computer and digital information technology segment, and the higher interest of individual older baby boom patients and general healthcare consumers to monitor health status. Continuous improvements in technology are resulting in a growing number of new imaging tests that combine high levels of accuracy with rapid, easy-to-use product formats. Digital mammography is driving more screening programs. The purpose of this report is to describe the specific market segment of the diagnostics market sector called medical imaging. This sector includes all of the generally-accepted imaging activities that are currently used today, including X-ray and radiography, mammography, magnetic resonance imaging (MRI), ultrasound, gamma camera market, computed tomography (CT) scans and positron emission tomography (PET) scans. It examines these clinical measurement devices and their reagents and supplies as used in hospitals, clinics and doctor's offices. It also includes associated market segments like picture archiving and communications system (PACS) markets, cardiology imaging markets, three-dimensional (3D) imaging markets and other emerging technologies.

Nuclear Cardiology Markets The purpose of this report is to analyze and describe the nuclear cardiology market segments in the U.S. and worldwide. It examines the measurement devices that are utilized by physicians to diagnose and monitor heart diseases. This study also discusses key products in nuclear cardiology and examines the trends that are stimulating this market. It includes a survey of all major companies actively engaged in marketing, manufacturing or developing nuclear cardiological instrumentation, with each company discussed in depth. The main objectives of this analysis are to: 1) identify viable technology drivers through a comprehensive look at platform technologies for nuclear cardiology testing; 2) obtain a complete understanding of the individual nuclear cardiology testing platforms from their basic principles to their clinical applications; 3) discover feasible market opportunities by identifying high-growth applications in different clinical diagnostic areas; 4) focus on global industry developments through an in-depth analysis of the major world markets for nuclear cardiology technology, including growth forecasts; and 5) present market figures related to the current value of nuclear cardiology, market projections, market share, key players, and sector growth rates.

Picture Archiving and Communications Systems (PACS) During the past 35 years, ultrasound and nuclear medicine were introduced into clinical medicine, computed tomography (CT) revolutionized diagnostic procedures and magnetic resonance imaging (MRI) emerged, bringing new diagnostic information at the cellular level. X-ray morphed from analog films to digital, and virtually all medical images became soft files on the electronic networks. As imaging departments in healthcare facilities have migrated from film to digital, the display and storage systems have had to migrate too. These new digital imaging storage and display systems are called picture archiving and communication systems (PACS). Most PACSs handle images from various medical imaging instruments, including ultrasound, MRI, positron emission tomography (PET), CT, endoscopy, mammograms, etc. The focus of this report is to analyze and describe the PACS market segments. PACS market penetration in the U.S. healthcare space has been significant, at almost 90%. A PACS network typically consists of a central server that stores a database containing the images connected to one or more clients via a local area network (LAN) or a wide area network (WAN) that provides or utilizes the images. More and more PACS utilize Internet-based technologies as their means of communication. This allows remote viewing and diagnosis with implications for both civilian and military healthcare facilities. Since radiology departments dominate the production of images, interconnections with radiology information systems (RIS) are also looked at in this study.

Positron Emission Tomography (PET) Markets The medical imaging segments are poised for a major new phase of growth fueled by the availability of new technology coming out of the computer and digital information technology segment. Continuous improvements in technology are resulting in a growing number of new imaging tests that combine high levels of accuracy with rapid, easy-to-use product formats. Part of that medical imaging improvement is coming from positron emission tomography (PET). PET is a scanning technique used in combination with small amounts of radio-labeled compounds to visualize the anatomy and function of the brain. The purpose of this report is to describe the specific market segment of the diagnostics medical imaging market called PET scanning. This sector includes all of the generally accepted imaging activities that are currently used in PET, including equipment for PET, PET/CT, SPECT and the use of radiopharmaceuticals for imaging. It examines these clinical measurement devices and their reagents and supplies as used in hospitals and clinics. It also reviews associated clinical market segments in which PET scanning has taken a prominent role including cancer treatment, cardiology and neurology imaging markets.

Ultrasound Markets During the past 35 years, ultrasound and nuclear medicine were introduced into clinical medicine, computed tomography (CT) revolutionized diagnostic procedures and magnetic resonance imaging (MRI) emerged, bringing new diagnostic information at the cellular level. X-ray morphed from analog films to digital, and virtually all medical images became soft files on the electronic superhighway. This report describes the increasingly diversified market segment of the diagnostics market sector called ultrasonography or, more commonly, ultrasound. This sector currently includes prenatal ultrasonography, cardiac and cardiology-imaging ultrasound, and increasingly portable or handheld ultrasound, which some believe may partly to fully replace the ubiquitous use of stethoscopes over time. Emerging market segments such as three-dimensional (3D) and now four-dimensional (4D) ultrasound are also examined.

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For mammography, a new kind of house call - DOTmed.com

This report originally appeared in the December 2010 issue of DOTmed Business News

Six years ago, Swedish Medical Center, a sprawling hospital complex seated in Seattle's now-trendy Capital Hill neighborhood, decided if women weren't coming to mammography, mammography would go to them. The hospital rolled out what it says is the world's first mobile digital mammography vehicle, which it uses in its outposts throughout Washington State.

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"Swedish thought [pairing] digital, which was the newest and best technique, and the underserved population, was a perfect marriage," said Darlene Fanus, supervisor of the mobile mammography program with the hospital.

The 48-foot-trailer, made by Medical Coaches of Oneonta, N.Y., travels to centers affiliated with Swedish around rural Washington, where it offers complete women's care for those who otherwise might not receive it: pelvic and clinical breast exams and a Pap smear. A second coach was added to the fleet in 2008.

"Frankly, when we go out to these areas, we're the only health care these women have," Fanus said. "There's lots of poverty, domestic violence, methamphetamine use. That's our shining star, taking care of those women."

Swedish's mobile mammography program is only one of dozens of similar programs nationwide. There's a veritable mobile mammography boom. Vans, trailers and coaches travel the nation's roads, from Don and Sybil Harrington Breast Center's $654,000 Mobile Mammography Coach cruising the byways of the Texas Panhandle to The McLeod Mobile Mammography Unit stopping by local doctors' offices and even an ACE Hardware Store near Myrtle Beach, S.C.

And it's not just the United States. This fall, Kuwait welcomed the country's first mobile digital mammography unit, expected to travel throughout the country's six governorates. "This project is just the beginning," said Dr. Abdulrahman Al-Awadhi, chairman of the Kuwait Society for Preventing Smoking and Cancer, which held an event to greet the device's arrival, according to Kuwait Times.

But while growing in popularity and sometimes a lifesaver, literally, to the many women it helps, mobile mammography is not always perceived as the best option for everyone. "For women in remote, rural areas, mobile mammography is the only option. However, we would hope that women in urban settings would make the effort to be screened at a comprehensive, stationary facility to better ensure continuity of care, year after year," said Addie Backlund, executive director of the American-Italian Cancer Foundation, which manages a mobile, no-cost breast cancer screening program for underserved women.

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The gift of technology, all year long - Dental Economics

Terry L. Myers, DDS, FAGD

For more on this topic, go to and search using the following key words: dental technology, digital imaging, digital radiography, digital X-rays, 3-D imaging, cone beam, technology, social media, e-mail, Dr. Terry L. Myers.

December is filled with holiday activities, some sentimental "Auld Lang Syne," and anticipation of new adventures. With the improving economy, hopefully the stores will be filled with shoppers looking for perfect gifts. During this season, don't forget to put your practice on your shopping list, and give yourself a "gift that keeps on giving." This phrase was originally used for a phonograph ad in the 1920s, but its spirit still has voice today – the gift of technology will continue to benefit your practice long after the holiday season.

My favorite technologies bring cheer to my office year-round.

Digital radiography has many attributes for the dentist, the patient, and the staff. Digital imaging, especially with my DEXIS® Platinum sensor, provides clear, crisp images that can show cracks, periapical radiolucencies, and even interproximal decay that has broken through the enamel to the dentin.

I can enlarge the image to fill my large computer monitor while maintaining resolution. For me, that's the gift of better treatment planning. There's no waiting for all of this either; digital images appear on the screen almost immediately.

My patients receive the gift of understanding that ultimately leads to their increased and continued dental health. With the clarity and size of the image, educating my patients is much easier, and I can draw or spotlight areas of interest. My sensor's rounded corners increase patient comfort, and that's a cause for celebration too.

My staff gladly accepts the gift of an easier workday. With the direct USB connection, they can easily transport the sensor between operatories and plug in without a docking station. The cable and shape of the digital sensor allows for quicker, easier movement around the mouth, reducing an FMX to a five-minute job.

Not cleaning up or changing the chemicals involved in traditional X-ray is not only a gift, it is a relief. Images can be integrated into a practice-management system, such as DENTRIX, so that all patient files, history, and images are organized and easily retrieved.

For expanding the scope of my practice, my medium-field-of-view GXCB-500 HD™ cone beam scanner gives me the gift of information that is unavailable in 2-D formats. This radiographic option is perfect for diagnosis and patient education for more complicated procedures, such as implants.

From the CBCT scan, I can determine the height and width of bone, position of the roots, and proximity of the teeth to the nerves and sinuses. Now, I can keep more patients in-house, whenever possible, and plan less-invasive procedures.

Intraoral cameras also help with case acceptance. These views provide a great perspective of deteriorating amalgams, possible crown opportunities, tooth fractures, periodontal problems, or even small cracks.Intraoral and extraoral pictures can be printed or e-mailed to patients so they don't forget why treatment is necessary.

As communicating with existing patients and reaching new ones becomes more tied to the Internet, visual technology, such as social networking and Web design, take center stage. Make an impact by emphasizing your technological capabilities on your Web site, Facebook page, or Twitter feed.

Reminders through cell phone texting or e-mails keep the younger generation on time for appointments, and birthday messages remind everyone that their teeth need a birthday checkup too.

I hope this year of columns has given you additional insights into incorporating innovative dental economics and growing a successful business, as well as providing the best care possible to patients. All of us at Keystone Dentistry wish you happiness, health, and technology that counts, all year long!

Dr. Terry L. Myers is a fellow in the Academy of General Dentistry and a member of the Academy of Cosmetic Dentistry and the Dental Sleep Disorder Society. He has a private practice in Belton, Mo. You may contact Dr. Myers at office@keystone-dentistry.com.Digital technology: an ongoing gift for you and your patients

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