She had a doctor’s order. She had insurance coverage. She’d had a breast ultrasound. She had a family history of breast cancer and a personal history of breast lumps. She’d had a benign breast lump removed the previous year, after an ultrasound and a mammogram.

But she was 26. Both facilities, she said, told her she was too young for a mammogram.

Katie Schaber responded by e-mailing WKMG-TV Local 6 news in Orlando. The station contacted Libby’s Legacy Breast Cancer Foundation of Orlando, which in turn contacted the Women’s Center for Radiology in Orlando.

In January, Schaber got her 3-D mammogram, which did find an anomaly in her left breast. A follow-up MRI at the Women’s Center found no problem. The center advised Schaber to have another follow-up in six months and a mammogram every year.

Julie Miller, MD, a diagnostic radiologist at the Women’s Center, told Local 6 she has seen girls as young as 17 with breast cancer. Dr. Miller added:

If the patient is young, you would start with an ultrasound to minimize radiation. But you certainly wouldn’t stop at that point just because of her age.

Schaber had gone to Sand Lake Imaging of Orlando in December, armed with her doctor’s prescription for an ultrasound and a mammogram. The clinic did the ultrasound but then declined to do the mammogram.

On her blog, Schaber wrote, “A doctor reviewed my ultrasound and said that, since I was so young and since he didn’t think the scan showed anything too serious, he wouldn’t do a mammogram.”

Sand Lake Imaging said federal law prohibited it from discussing the case.

Next, Schaber tried Florida Hospital Celebration Health of Celebration. Again, she said, she was told the hospital would do an ultrasound but not a mammogram.

Jennifer Roberts, media relations manager for the hospital, told Local 6:

We must abide by our accredited appropriateness criteria approved by the American College of Radiology for diagnostic mammography and breast ultrasound. These criteria recommend that women 29 and under receive an ultrasound and/or provide adequate health history, including previous exams, prior to performing a diagnostic mammogram.

Schaber, a reference librarian at Full Sail University in Winter Park, Florida, has detailed the story on a deeply personal (and award-winning) blog called from IF to when. It focuses on her diagnosis of infertility and its effects on her and her husband’s lives.

Regarding the mammogram issue, she told Local 6, “It seems a little odd to me that I have to keep fighting for something that so many women find uncomfortable. But I think that it is important.”

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Bad news for those who hoped soy isoflavone supplements might protect against breast cancer. See our Facebook page for details.

Related seminar: Breast Imaging and Intervention: A Comprehensive Review (discount and free shipping)

The CyberKnife normally targets tumors. It uses real-time imaging and a robotic arm to deliver precisely targeted, highly concentrated beams of radiation.

In this study, the researchers aimed at the trigeminal nerve, a three-branched nerve that carries sensations from the face to the brain. Trigeminal neuralgia, which causes electric shock–like facial pain and spasms, affects up to five in 100,000 people. The condition generally strikes in middle age. Pain episodes are usually brief, but they can be so severe that they can trigger depression.

Standard treatments include drugs and surgery. Radiation therapy has been tried, according to the study authors, but it has left up to half of patients with facial numbness.

A team of radiologists, radiation oncologists, and a neurosurgeon at Winthrop-University Hospital in Mineola, New York (on Long Island), tried the CyberKnife on 17 patients whose trigeminal neuralgia hadn’t responded to medication or previous surgery. The doctors used the beam to irradiate a 6-millimeter section of the trigeminal nerve.

Follow-up data were available for 16 of the patients. Of those, 14 experienced either partial or complete pain relief. Eleven reported freedom from all pain at some point following the surgery, and seven of those remained pain-free through their last follow-up visit, which took place an average of five months after surgery.

More research on larger patient cohorts is obviously needed. But, the study concludes:

Non-isocentric radiosurgery can be used as an alternative to more invasive treatments and warrants further follow-up and investigation.

Neuralgia symptoms did recur in four patients, at about three, eight, nine, and 18 months after surgery. Only two patients reported side effects: a “feathery dysesthesia” (pain resulting from a normal stimulus) and a mild loss of sensation in the surgical area.

Related seminar: Neuro & Musculoskeletal Imaging

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

We reported on the launching of this study in 2010. It built on research done in the 1970s and 1980s by Mostafa Fahim, PhD, of the University of Missouri in Columbia.

The North Carolina researchers found that ultrasound applied to the testes of rats did indeed reduce sperm counts below what’s considered the threshold of fertility for humans. The most effective regimen, they discovered, involved two 15-minute treatments two days apart, with the testes heated to 37°C (98.6°F).

The study was published online Monday in the open-access journal Reproductive Biology and Endocrinology. The research team also has a Web site about the project.

There are a few questions. As principal investigator James Tsuruta, PhD, said:

Further studies are required to determine how long the contraceptive effect lasts and if it is safe to use multiple times.

Dr. Tsuruta was quoted in a news release from BioMed Central, which publishes Reproductive Biology and Endocrinology.

A very comprehensive news release from the Male Contraceptive Information Project discusses the new research and the contradictory history of ultrasound contraception research (as well as the experiences of a couple of do-it-yourself researchers). It is well known that heat can reduce sperm production, but Dr. Tsuruta said heat apparently isn’t the only mechanism by which ultrasound works:

There is something special about heating with ultrasound. It caused 10 times lower sperm counts than just applying heat.

Many questions remain: How long does the contraceptive effect last? Is it reversible? Will it work the same way on humans? Would men really come back for two clinical visits in two days? Would men be enthusiastic about direct application of ultrasound to the testes in the first place? What are the long-term effects on sperm production?

“I am convinced that any procedure which leads to subfertility in males is likely to have effects on embryo development,” said Brian Setchell, PhD, of the University of Adelaide in Australia, an expert in animal reproduction. “The effects are not only after heat. Sperm from obese males produce embryos that develop more slowly, and there is evidence for diabetes, various toxins, and therapeutic agents having the same effects in males.”

Depending on the availability of research funding, which seems to be scarce in this field, we may learn the answers to these questions. Stay tuned.

Related seminar: Abdominal & Pelvic Imaging: CT/MR/US

Dense breast tissue may mask tumors on a mammogram and is a risk factor for breast cancer.

Senator Karen Mayne, D-West Valley City, is sponsoring the legislation. According to the Deseret News newspaper of Salt Lake City, she told the Utah Senate Health and Human Services Committee last week:

Today I bring you a bill of love. I don’t want my sisterhood to have any more tragedy, loss of life, loss of income.

The committee unanimously voted to send the legislation to the Senate floor, though one committee member said he had reservations. “I have a general concern in incorporating suggestions into our code,” said Senator Mark Madsen, R-Lehi. He said he also didn’t like legislating the practice of medicine, though he didn’t object to the notification recommendation itself.

The Utah Medical Association supported the amended legislation, said Michelle McOmber, executive vice president:

Part of the reason why we didn’t want a mandate was because health care changes so quickly. We feel good with the amendment.

Mayne said she would have preferred the original bill’s mandate. “We need something that has some teeth,” she said.

McOmber said women can already learn about their breast density from their primary-care physician, who receives a detailed mammogram report from the radiologist. But Senator Luz Robles, D-Salt Lake City, said that wasn’t enough. Women shouldn’t have to ask for that information, she said.

“It’s not because we don’t want to know,” she said. “You expect to get information that is relevant to your health.”

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Happy Monday. To make your Monday even happier, or at least a little more interesting, check out our Facebook page.

Related seminar: Breast & Women’s Imaging Seminar

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

Terahertz waves, also known by the much cooler-sounding name “T-rays,” are in the far-infrared part of the spectrum—some say between the microwave and infrared zones. Their wavelengths are hundreds of times longer than those of the rays in the visible light spectrum. Their most common use right now is in airport security scanners.

T-rays have great potential for medical imaging applications. They don’t penetrate deeply into the body. But each type of molecule has its own unique signature in the T-ray range. So T-rays can distinguish between, for example, normal cells and cancerous cells. They can also detect such phenomena as increased blood flow around tumors.

Researchers have just announced a breakthrough that focuses T-rays into a much stronger directional beam than had been possible, and at room temperature. For details, see a study published online this month in Nature Photonics. Previously, T-ray generators had to operate at very low temperatures, which is expensive.

Stefan Maier, PhD, a coauthor of the study, sees vast potential:

T-rays promise to revolutionize medical scanning to make it faster and more convenient, potentially relieving patients from the inconvenience of complicated diagnostic procedures and the stress of waiting for accurate results.

The idea is to use T-rays in a portable sensing, computing, and data communications device, like the tricorder of Star Trek fame. Dr. Maier was quoted in a news release from Imperial College London, where he is a physics professor.

T-rays’ possibilities intrigue others as well. Rensselaer Polytechnic Institute of Troy, New York, has created a Center for Terahertz Research that encompasses four separate laboratories. According to its Web site:

Perhaps the greatest potential for this research lies in biomedical imaging and genetic diagnostics. T-rays offer hope for improved detection of breast cancer through sharper imaging and molecular fingerprinting.

However, there may be a complication. T-rays are not ionizing, and they don’t break chemical bonds. But some studies have reported genetic damage, possibly through interference with DNA. Other studies have found no such effects.

We’ll definitely be hearing more about T-rays. Stay tuned.

Related seminar: Radiology Review

That could be very useful because the earlier the intervention, the better the prognosis in treating developmental dyslexia.

Senior investigator Nadine Gaab, PhD, of the hospital’s Labs of Cognitive Neuroscience said dyslexia usually isn’t diagnosed until the child is in third grade, although the various available neuropsychological interventions are more effective when begun earlier. The delay in diagnosis, she said, can lead to frustration for both the child, who struggles with reading, and the parents:

Families often know that their child has dyslexia as early as kindergarten, but they can’t get interventions at their schools. If we can show that we can identify these kids early, schools may be encouraged to develop programs.

Dr.Gaab was quoted in a hospital news release. The research is detailed in a study published online this week in Proceedings of the National Academy of Science.

The researchers used functional MRI to scan the brains of preschool-age children—average age: 5½—as the kids performed tasks requiring them to decide whether two words started with the same sound. (For this and other brain research, the researchers have developed an elaborate protocol to get children to hold still in the MRI machine by turning the procedure into a game.)

Children with a family history of developmental dyslexia showed the same brain activity as that exhibited by older children and adults with dyslexia. Children in the control group did not.

Nora Maria Raschle, PhD, also of The Labs of Cognitive Neuroscience, is the study’s lead author. She said the research could make a real difference in the lives of children with dyslexia by allowing them to get early treatment:

We hope that identifying children at risk for dyslexia around preschool or even earlier may help reduce the negative social and psychological consequences these kids often face.

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For another novel use of MRI—examining the feet of sprinters to find out what makes them so fast—see our Facebook page.

Related seminar: Pediatric Radiology—Clinical and Radiology Perspectives

“Currently no standard approach to the evaluation of peripheral neuropathy exists,” said Brian Callaghan, MD, assistant professor of neurology at the University of Michigan Medical School. “We need more research to determine an optimal approach. We do a lot of tests that cost a lot of money, and there’s no agreement on what we’re doing.”

Dr. Callaghan led the research. He was quoted in a University of Michigan Health System news release.

The study was published Monday in Archives of Internal Medicine. It examined the use of 15 “relevant” tests in diagnosing the disorder. The closest thing to a standard approach right now is an MRI of the brain or spine, which was used for 23.2 percent of the patients studied.

Unfortunately, the researchers think that’s a bad idea. They’d prefer a glucose tolerance test, which was used for only 1 percent of the patients. Here’s how the study puts it:

Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield magnetic resonance imaging, whereas few receive low-cost, high-yield glucose tolerance tests.

The most common cause of the nerve dysfunction that characterizes peripheral neuropathy is diabetes. Hence the efficacy of a glucose tolerance test.

Of course, there can be a lot of other causes too, some of which MRI does detect well. However, expect health care’s cost-cutting forces to target its use, at least as a first option. As Dr. Callaghan put it: “Our findings, that MRIs were frequently ordered by physicians but a lower-cost glucose tolerance test was rarely ordered, show that there is substantial opportunity to improve efficiency in the evaluation of peripheral neuropathy.”

Related seminar: Diagnostic Imaging Review: For Residents, Fellows and Radiologists

Mary Hamer, MD, of Lake City, Florida, has been financially supporting van der Sloot, who pleaded guilty on January 11 to killing Stephany Flores, a 21-year-old student he had met in a casino in Lima, Peru. A Peruvian court sentenced him to 28 years in prison.

van der Sloot, 24, has also been suspected in the 2005 death in Aruba of Natalee Holloway of Mountain Brook, Alabama, a Birmingham suburb. On January 12, an Alabama judge officially declared her dead. U.S. authorities are attempting to extradite van der Sloot so he can face fraud and extortion charges associated with the Holloway case.

Dr. Hamer said van der Sloot’s lawyer, Jose Jimenez, deceived her into sending the $75,000 as bail money. Peruvian law does not allow bail in murder cases. Jimenez said it was a miscommunication based on a mistranslation of “parole” as “bail.” He said he has returned the money, minus fees. Dr. Hamer said that she hadn’t received it and that she was near bankruptcy. She told RadarOnline:

I have sent Jimenez about $100,000 in legal fees, bail money, and other expenses. I’ve sent them because he has asked me to pay his legal fees.

van der Sloot is asking for more. The Daily Beast reported that on the day he was sentenced, he wrote Dr. Hamer a series of letters asking her to continue supporting him. He said he needed $69,000, plus $1,000 to buy a new phone.

“You will always be in my heart, but this, what you are doing to me now I do not comprehend,” he wrote. “Why do you want to hurt me?”

Before the sentencing, Dr. Hamer attempted to persuade Peruvian authorities to release van der Sloot to her custody, saying she would rehabilitate him. In an e-mail on January 11, she wrote what she called “My humble request for clemency and mercy for the honest and sincere confession of Joran van der Sloot. In 2022, Mr. van der Sloot will present his thesis of peace to the Peruvian people and the world.”

While she was complaining about Jimenez, he was also complaining about her:

She proclaims his innocence through incoherent arguments and has discredited me in the process.

That seems to sum things up nicely.

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Can the cognitive impairments of brain radiation be reversed by oxygen starvation? See our Facebook page.

Related seminar: Neuroradiology Review