Michael Bailey, PhD, one of the project leaders, summed up the research this way:

We have a diagnostic ultrasound machine that has enhanced capability to image kidney stones in the body. We also have a capability that uses ultrasound waves coming right through the skin to push small stones or pieces of stones toward the exit of the kidney so they will naturally pass, avoiding surgery.

Dr. Bailey is a co-investigator with the Smart Medical Systems and Technology Team at the National Space Biomedical Research Institute (NSBRI) in Houston. He is also a researcher at the Applied Physics Laboratory at the University of Washington (APL-UW) in Seattle. He was quoted in an NSBRI news release.

Astronauts are particularly susceptible to kidney stones because it’s difficult to keep them hydrated. Also, bones demineralize in reduced gravity, leading to elevated levels of salt in urine, which is a kidney stone risk factor.

Dr. Bailey and Lawrence Crum, PhD, principal investigator for the Smart Medical Systems and Technology Team and also an APL-UW researcher, have tinkered with an ultrasound machine to create a combined B-mode and Doppler mode. In Doppler mode, for reasons that are not yet understood, a kidney stone can appear brightly colored and twinkling. So, said Dr. Bailey:

We present the stone in a way that looks like it is twinkling in an image in which the anatomy is black and white, with one brightly colored stone or multiple colored stones.

The stone can then be targeted with a focused ultrasound wave to push it toward the ureter. The stone moves about a centimeter per second.

This technology obviously can be used on the ground as well. Dr. Bailey said the focused wave could clean up stone fragments that typically remain after kidney stone surgery.

“Space has demanded medical care technology that is versatile, low-cost, and has restricted size,” said Dr. Crum. “All of these required specifications for use in a space environment are now almost demanded by the general public.”

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A radiologic technologist asks a friend to be a guinea pig for a test of new MRI software. The test saves the friend’s life. Read about it on our Facebook page.

Related seminar: Imaging Advances: Abdominal, Thoracic, Skeletal

So says a study by researchers at Henry Ford Hospital in Detroit. They presented it this week at The Triological Society’s annual Combined Sections Meeting in Miami Beach, Florida.

The study retrospectively reviewed the cases of 1,681 patients with dizziness or vertigo who visited a Detroit metropolitan emergency department during the period of January 2008 through January 2011. Of those, 810 received a CT scan of the brain and head, at a total cost over the three years of $988,200. Only 0.74 percent of the scans found anything that required intervention, such as intracranial bleeding or stroke.

Study author Syed F. Ahsan, MD, said:

It is our hope that our investigation into our own practices will shed light on avenues to run leaner practices within our institution, as well as serve as a model for other health systems.

Dr. Ahsan is a neuro-otologist at Henry Ford Hospital, so it seems obvious which “Detroit metropolitan emergency department” the researchers might have studied. He was quoted in a hospital news release.

The problem with CT use in those circumstances is that while intracranial bleeding or stroke may cause dizziness, lots of other causes are more likely. The news release cites dehydration, anemia, drop in blood pressure when standing (orthostatic hypotension), inner-ear problems, and vestibular neuritis.

Dr. Ahsan also noted that previous studies have shown that CT scans don’t do a very good job of detecting stroke or intracranial bleeding in an emergency department setting anyway.

“When a patient comes into the emergency department experiencing dizziness,” he said, “a physician’s first line of defense is often to order a CT scan to rule out more serious medical conditions. But in our experience it is extremely rare that brain and head imaging yields significant results.”

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Two Florida bills would force imaging clinics and other medical offices to post their prices; see our Facebook post.

Related seminar: Emergency Radiology

The reality: The applications (and sometimes the hardware) to do all of the above either don’t exist or aren’t easily compatible with current electronic medical records software. Wireless coverage at many medical facilities is incomplete, forcing medical personnel to repeatedly log back in as they move through the building. An iPad doesn’t even fit in the pocket of a standard lab coat.

A new Kaiser Health News/NPR report explores those and other obstacles that are keeping tablet computers and other portable devices from fulfilling their potential in clinical settings.

Some doctors don’t think the devices have all that much potential to begin with. Joshua Lee, MD, medical director of information services for UC San Diego Medical Center, said he worries about patient privacy and asked:

Are you ever more than four feet away from a computer in the hospital? Nope. So how is the tablet useful?

On the other hand, Kate Franko, a physician assistant at UC San Diego, said her iPad was a tremendously useful tool. She even employs some of the many available medical apps to check for drug interactions and translate her medical questions into the languages of non–English-speaking patients.

However, she admitted that the technology can occasionally be a little too cool. “Sometimes there are moments when you want to check your e-mail and possibly update your Facebook,” she said, “and it does take willpower to not be distracted and to focus on patient care.”

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Check today’s Facebook post for end-of-the-year CME savings.

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Breast-cancer researcher Mina Bissell, PhD, explained:

Our data show that at lower doses of ionizing radiation, DNA repair mechanisms work better than at higher doses. This nonlinear DNA damage response casts doubt on the general assumption that any amount of ionizing radiation is harmful and additive.

Dr. Bissell, who holds the title of distinguished scientist at the Berkeley Lab’s Life Sciences Division, was quoted in a lab news release. The findings have particular significance for those who undergo such low-dose medical imaging procedures as mammograms.

The lab revealed the results of its research in a freely available study published online Monday in Proceedings of the National Academy of Sciences.

The decreased risk at low doses derives not from the amount of damage caused by the radiation but rather from how the body fixes the damage. The researchers found that after low doses of radiation, the body repairs double-strand DNA breaks (meaning the double helix is completely severed) on site. It’s a relatively simple procedure with relatively little chance of error.

But as doses increase, creating more double-strand breaks, the broken strands congregate at “radiation-induced foci” (RIF), which are aggregations of repair proteins. With lots of repairs going on at once, the opportunities for mistakes increase.

“We hypothesize that, contrary to what has long been thought, double-strand breaks are not static entities but will rapidly cluster into preferred regions of the nucleus we call DNA repair centers as radiation exposure increases,” said Sylvain Costes, PhD, a biophysicist who led the study.

“As a result of this clustering,” Dr. Costes said, “a single RIF may reflect a center where multiple double-strand breaks are rejoined. Such multiple repair activity increases the risks of broken DNA strands being incorrectly rejoined, and that can lead to cancer.”

The researchers are looking into whether their results, achieved with a single human breast cell line, will hold up with different lines and different breast cells. Stay tuned.

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MRI powers a tiny wireless camera that navigates the digestive system. Science fiction? Find out on our Facebook page.

Related seminar: ALARA — CT (As Low As Reasonably Achievable)

That may seem obvious, but a new study that came to that conclusion had a reason for exploring the question. The same researchers had found in an earlier study that “doctor’s choice” was not the best strategy for moderate- to high-risk patients, at least from a cost-benefit point of view.

Instead, the earlier study concluded that mandating a cardiac magnetic resonance (CMR) stress test in an observation unit rather than inpatient care was more cost effective.

Chadwick D. Miller, MD, of the department of emergency medicine at Wake Forest School of Medicine in Winston-Salem, North Carolina, led the researchers for both studies. The new study, published online last week in Circulation: Cardiovascular Imaging, looked at 120 patients at a single ED who presented with acute chest pain or other symptoms of acute coronary syndromes.

All received observation-unit care. Half got stress CMR imaging regardless. For the other half, the researchers left the selection of test up to the physician. In the doctor’s-choice group, 62 percent received a stress echo test, 32 percent CMR, 3 percent cardiac catheterization, 2 percent nuclear tests, and 2 percent coronary CT.

Length of stay and outcomes turned out to be similar for both groups. In each group, nontherapeutic catheterization was very low and the appropriateness of admission decisions was high.

But giving doctors options significantly reduced costs. The median cost was $2,050 for the CMR group, $1,686 for the “choice” group. Mean costs were $2,586 and $2,005, respectively.

The study drew the following conclusion:

In these lower risk patients, it appears the physician’s ability to tailor testing to the individual patient, while considering institutional imaging strengths, may be a key to enhanced healthcare efficiency.

So it’s better to let highly trained, highly skilled physicians implement that training and those skills. Imagine that.

Related seminar: Emergency Radiology (brand new)

B.C. Wang, PhD, studies molecules. (He’s Ramsey-Georgia Research Alliance Eminent Scholar in Structural Biology at the University of Georgia in Athens). X-ray crystallography—bombarding molecules’ crystalline forms with X-rays—reveals the position of chemical bonds and other important properties.

However, large molecules, which are especially important in drug development, don’t handle X-rays as well as small molecules do. In a University of Georgia news release, Dr. Wang explained:

A macromolecular crystal can only withstand a certain amount of X-ray dose before it is destroyed as a result of radiation damage. Obtaining accurate and complete diffraction data sets of these crystals is very important.

So Dr. Wang and his team tried doing several low-power scans of the same crystals (specifically, bovine insulin crystals) instead of a single higher-power scan. The weaker scans delivered the same total radiation dose as the single higher-power scan would have. They also produced much better data than the single scan. For details, see the study, published online this month (open access) in the journal Foundations of Crystallography.

Adapting this technique to human imaging could produce better-quality scans while reducing radiation exposure, though Dr. Wang cautions that such applications will not be ready for clinical use anytime soon.

Of course, there will be problems to overcome. For one thing, bovine insulin molecules are generally better at holding still than people are. And Dr. Wang’s team uses X-ray data in a different form from the familiar human X-ray image. But, obviously, such multislice technologies as CT have overcome similar issues.

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Follow us on Twitter, and we’ll feed you a handful of carefully chosen radiology-related morsels each week that we think you’ll find interesting, or at least amusing.

Related seminar: ALARA-CT (As Low As Reasonably Achievable) (free shipping ends tomorrow!)

Researchers (led by scientists from Dana-Farber Cancer Institute and Children’s Hospital Boston, both in Boston and both affiliated with Harvard University) have achieved remarkable success with mice. A month after radiation exposures that almost always prove fatal within that time period, 80 percent of mice given the two-drug regimen were alive and apparently healthy.

Radiologists, among others, might have use for a drug therapy that’s effective even when begun as late as a day after radiation exposure, said Eve Guinan, MD, of Dana-Farber:

There is great interest in creating systems for dealing with the short- and long-term health risks of a significant release of radiation, whether from an accident at a nuclear power plant, an act of terrorism, or even a small-scale incident in which a CT machine malfunctions.

Dr. Guinan, the study’s lead author, was quoted in a news release from Dana-Farber, where she is associate director of the Center for Clinical and Translational Research. The study was published this week in Science Translational Medicine.

The researchers gave the mice a fluoroquinolone antiobiotic similar to the human antibiotic ciprofloxacin (best known under the brand name Cipro) and rBPI21, a synthetic version of the natural human infection-fighting protein BPI.

The ability to generate new blood cells, which can shut down after radiation exposure, rebounded much more quickly and vigorously in the mice given both drugs.

Radiation can also cause leakage of bacteria and toxins into the bloodstream from the digestive tract or skin while preventing the formation of white blood cells, which the body normally uses to fight such infections. The white blood cells release BPI, which binds to endotoxins on the surface of the bacteria.

So the antibiotic kills the invading bacteria, and the rBPI21 binds to and helps eliminate the endotoxins. Both agents have a good safety record with humans and can be stored for long periods of time. Said senior author Ofer Levy, MD, PhD:

Both fluoroquinolone antibiotics and rBPI21 have been shown to be quite safe in humans. Their combined effectiveness in our study involving mice is an indication that they may be equally beneficial to people.

Dr. Levy is an associate physician and an assistant professor of pediatrics at Children’s Hospital Boston.

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We hope that our American readers had a happy Thanksgiving, that everyone is having a happy Friday, and that our new Facebook post will make your day more interesting.

Related seminar: ALARA-CT (As Low As Reasonably Achievable)

It comes from the Medical Imaging & Technology Alliance (MITA), a trade group for makers of medical imaging equipment. So perhaps it’s not so surprising.

MITA said in a Wednesday news release that, according to its own analysis of Medicare data, spending on imaging for each Medicare beneficiary has decreased 13.2 percent since 2006. In addition, the release said, imaging utilization per beneficiary decreased by 3 percent in 2010. Spending for Medicare services other than imaging has increased by 20 percent since 2006, and overall utilization increased by 2 percent in 2010, MITA said.

David Fisher, MITA’s executive director, said the reduction in imaging spending and use may be harming Medicare patients:

It is unsettling to see these accelerating declines in Medicare beneficiaries’ use of medical imaging services during a time of tremendous advances in imaging and radiation therapy technologies, which have become increasingly integral to medical best practices and early disease detection. This disconnect raises serious concerns about whether or not patients are receiving the care they need.

Somehow, we can’t see the congressional “super committee” bursting out of its phone booth, or its locked meeting room, or wherever it’s been thrashing out deficit-reduction proposals, and saying, “Sure, cut spending on Social Security, the military, our salaries, and everything else, but we really need to increase Medicare spending on imaging.”

Still, as MITA points out, imaging reimbursements have been cut seven times in six years, with payments for such services as bone density screenings, arm and leg artery X-rays, and brain MRI reduced by more than 60 percent. And further cuts have been proposed. Are Medicare patients in fact now getting second-rate care … well, maybe that’s too strong; let’s say suboptimal care in terms of imaging?

MITA also quotes John A. Patti, MD, chair of the American College of Radiology Board of Chancellors, as saying, “Current evidence, including this analysis, debunks the myth that imaging is significantly overused and somehow responsible for escalating health-care costs.”

Dr. Patti adds:

According to these data, the goal of bending the cost curve has indeed been achieved for medical imaging. Any further reductions would represent socially irresponsible policy.

Of course, the fact that a piece of legislation might be socially irresponsible has never stopped Congress before.

Related seminar: Radiology Review Course

So concludes a preliminary study published online Thursday in Annals of Emergency Medicine. The researchers discovered that patients with TBI had significantly higher blood levels of glial fibrillary acidic protein (GFAP) than those without.

In a statement, Linda Papa, MDCM, said:

This test has the potential for determining injury severity soon after injury, helping emergency physicians make decisions about performing CT scans, seeking neurological consultations, and transferring patients to other facilities.

Dr. Papa, of the department of emergency medicine at Orlando Regional Medical Center in Orlando, Florida, was the study’s lead author. She was quoted by HealthImaging.

The researchers obtained blood samples from 307 adult patients. Of the patients, 108 had TBI, with Glasgow Coma Scale (GCS) scores between 9 and 15, and loss of consciousness, amnesia, or disorientation. The other 199 were control subjects who were either uninjured or had injuries other than TBI. Blood samples were obtained within four hours of injury.

GFAP breakdown product (GFAP-BDP) was found in the blood of the TBI victims. According to the study’s background information, the product is released from injured glia cells.

“GFAP-BDP is detectable in serum within an hour of injury and is associated with measures of injury severity, including the GCS score, CT lesions and neurosurgical intervention,” the study concludes.

The authors said that the study is preliminary and that further research is necessary before a GFAP blood test could be recommended for clinical use. Dr. Papa said it had greater specificity than other blood tests studied for TBI. However, she said, it won’t totally replace imaging:

It is not a substitute for all CT scans, but it could possibly rule out patients who do not need them, as well as ensure that patients at risk get CT scans they need.

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On this Veterans Day, we salute with gratitude those who have have served in the armed forces. We deeply appreciate their sacrifice. It’s also Friday, which means we have a new Facebook post.

Related seminar: Neuro & Musculoskeletal Imaging

Interestingly, the study found that electronic health information exchange (HIE) use increased some types of imaging, notably chest X-rays.

Mark Frisse, MD, professor of biomedical informatics at Vanderbilt University Medical Center in Nashville, led the study. A Vanderbilt news release quoted him as saying:

This is the first study to show that, on a citywide basis, investments in technology can save medical costs by improving care. We took the ‘Tennessee simple’ approach and built a low-cost system that said, ‘Folks, if you do it simply and build it up, doing the right thing can save you money.’

ED physicians used the system, accessed through a secure Web portal, only when they thought it might be useful—which turned out to be 6.8 percent of the time.

Eleven EDs had full electronic access. The 12th did not until the very end of the study period. That hospital, which was the busiest (20 percent of total regional ED visits), relied on printed-out summaries and could inquire for more complete data. The study calls this the “mixed-access group.”

The 13-month study compared nine outcomes: ED-originated hospital admissions, admissions for observation, lab tests, head and body CT scans, ankle and chest X-rays, outpatient surgery, and echocardiograms. Each HIE-use patient was matched with a similar patient for whom doctors did not use the HIE.

Decreased admissions for the HIE-access cases over the 13 months saved $2,059,588, according to the study. CT scans also decreased, but not uniformly. At full-access EDs, head CTs and chest X-rays increased while body CTs and lab tests stayed flat. At the mixed-access hospital, head and body CTs and lab tests decreased while chest X-rays stayed flat.

The study (which is open-access) doesn’t comment on those differences except to say: “We speculate that the small but significant increase in chest X-ray use in inner-city ED within the direct access group is an example of differences in provider motivation.” Knowing the patient population each hospital serves would probably be enlightening, but the study does not identify the hospitals.

Patients could opt out of HIE participation, but only 1 percent to 3 percent did. Dr. Frisse said the system safeguards patient privacy. “It makes available only the information you choose, and it can only be used when you are needing care,” he said. “It is far more secure and useful than paper.”

He is definitely an enthusiast:

Our people believe that the savings from this study are less than 2 percent of the overall savings these technologies can afford if every physician’s office is connected. And we are absolutely convinced and committed to extending this approach to every health care setting.

Related seminar: National Diagnostic Imaging Symposium™