Researchers at Ohio University in Athens, Ohio, scanned high-resolution casts of the skull and the neck bones of an allosaurus. They used a Toshiba Aquilion 64 machine at O’Bleness Memorial Hospital in Athens.

The scanning kicked off the process of figuring out how the giant, long-extinct predator would have moved its head and eaten its prey. Engineers fed data from the scans into a computer model. They added other information, including clues from the bones about muscle attachments and knowledge of the anatomical structure of such modern-day dinosaur relatives as birds and crocodilians. Mechanical engineer John Cotton, PhD, explained:

The engineering approach combines all the biological data—things like where the muscle forces attach and where the joints stop motion—into a single model. We can then simulate the physics and predict what allosaurus was actually capable of doing.

Dr. Cotton is an assistant professor of mechanical engineering at Russ College of Engineering and Technology. He was quoted in an Ohio University news release.

The researchers’ computer model reconstructed neck and jaw muscles, sinuses, the windpipe, and other soft tissues. You can see a cool animated version here. The open-access online journal Palaeontologia Electronica published an article about the research this week.

Eric Snively, PhD, a paleontologist and lead author of the article, previously studied the most famous predatory dinosaur, tyrannosaurus. He and his fellow researchers determined that tyrannosaurus fed by grabbing a mouthful of flesh and shaking its head from side to side to tear off a piece, like modern crocodiles.

But differing muscle attachment points gave allosaurus different feeding behavior, Dr. Snively said. “Allosaurus was uniquely equipped to drive its head down into prey, hold it there, and then pull the head straight up and back with the neck and body, tearing flesh from the carcass … kind of like how a power shovel or backhoe rips into the ground.”

A 28-foot, three-ton dinosaur with big, sharp teeth digging into its prey like a backhoe—now there’s an image. Yikes. Still, it’s fascinating that, as a Web site for the researchers’ lab puts it, “This approach combining detailed soft-tissue reconstruction with sophisticated engineering-based modeling opens a new window to the past.”

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British scientists also use CT scans to study dinosaurs—in their case, to analyze brain growth patterns. For details, see our Facebook page.

Related seminar: Imaging Advances: Abdominal, Thoracic, Skeletal

The litigation pits Bruce Simon, president of beef products marketer and shipper Omaha Steaks, against Mary Kay Drake, MD, an assistant professor of radiology at the Nebraska Medical Center in Omaha.

Joseph Daly, an attorney representing Dr. Drake, told the Omaha World-Herald that he was disappointed with the Supreme Court’s ruling:

The jury found in our favor that there was no negligence. It’s our position that Dr. Drake did not do anything that was negligent.

The case goes back to 2007, when Simon sought treatment for an arthritic hip. Kevin Garvin, MD, an orthopedic surgeon at the medical center, ordered imaging-guided injections into the hip joint. The first injection, in 2007, went fine. The second, in May 2008, didn’t.

According to court records, a first-year radiologist balked at using a 2.5-inch needle. (A 3.5-inch needle had been used the first time.) Dr. Drake, director of the radiology residency program, told the resident to use the shorter needle anyway. In two tries, it didn’t reach the hip joint. Using a different needle that was at least 7 inches long, Dr. Drake completed the injection herself, on her second try. Altogether, the procedure took 25 minutes from the time the injection site was sterilized.

Several days later, Simon was diagnosed with a staph infection in his hip. He underwent two hospitalizations, three months of treatment to control the infection, surgery to replace the hip joint, and a year in rehabilitation. He sued Dr. Drake, alleging malpractice.

Dr. Drake responded that she had followed the standard of care and that Simon had signed a consent form acknowledging the risk of infection.

The initial trial judge ruled that Dr. Garvin could not testify as a standard-of-care expert. But under questioning by Dr. Drake’s attorney, he did—saying that the shorter needle was acceptable and that he knew of no research that found multiple needle punctures correlating with higher rates of infection.

Simon’s attorney objected. The trial judge agreed that Dr. Garvin was unqualified to give the testimony but ruled it “harmless error” and did not instruct the jury to disregard the testimony. The jury returned a unanimous verdict for Dr. Drake. Simon appealed, saying Dr. Garvin’s testimony had prejudiced the jury. An appeals court upheld the verdict.

But the Supreme Court didn’t. “Compared with the testimony of a hired expert,” wrote Justice William Connolly, “a juror was likely to give great weight to Garvin’s opinion because he was Simon’s treating physician and testifying as an expert against his own patient.”

Up next: a do-over of the first trial.

Related seminar: Abdominal & Pelvic Imaging: CT/MR/US (just released last week; order by July 15 and save $200)

In 2009, the task force changed its recommendations on breast cancer screening, suggesting that women should begin routine mammography at age 50 instead of 40. Women in their 40s, the task force said, should consult their doctors about whether mammography is appropriate for their particular circumstances.

Other organizations and individuals in the breast cancer field disagreed, many of them vehemently. The cancer society continued recommending that mammograms start at 40.

A new Johns Hopkins study, published online last week in the Journal of General Internal Medicine, finds that the task force’s switch had little effect. Nationwide data from Behavioral Risk Factor Surveillance System surveys indicated that in 2006 and 2008, 53 percent of women in their 40s reported having a mammogram in the previous year. In 2010, after the task force’s new recommendations had been published. the percentage was 52—hardly a significant difference.

Lauren D. Block, MD, lead author of the study, said, “Patients—and likely their providers—appear hesitant to change their behavior, even in light of evidence that routine screening in younger women carries substantial risk of false positives and unnecessary further imaging and biopsies.”

Dr. Block continued:

Women have been bombarded with the message ‘mammograms save lives,’ so they want them no matter what.

Dr. Block is a clinical fellow in general internal medicine at the Johns Hopkins University School of Medicine in Baltimore. She was quoted in a Johns Hopkins news release.

Research published online last month in Cancer told the same story, actually finding a slight (although not statistically significant) increase in mammogram rates for women in their 40s.

Public and private insurance plans generally continue to cover routine mammograms for women in their 40s, which probably contributes to the continued high rate of screening, Dr. Block said. Many of her own 40-something patients, she said, want screening no matter what the pros and cons may be.

“Breast cancer gets so much attention in the media and in society in general, despite cardiovascular disease being by far the number one killer in women,” she said. “Everyone wants to feel as though they are preventing breast cancer. You hear one anecdotal story about someone in their 40s who found breast cancer during a mammogram and did really well with treatment, and that’s enough to fly in the face of any other facts that are out there.

“Women want the test.”

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The former chief executive officer of the Tuesday Morning store chain has filed a discrimination lawsuit saying that her firing was related to her being diagnosed with breast cancer. For details, see our Facebook page.

Related seminar: New Horizons in Breast Imaging

The internist skipped the additional testing and instead told the patient he had a brain tumor and would live maybe six months.

The patient did not have brain cancer. He had actually suffered several small strokes. Earlier this month, more than four years after the “six months to live” diagnosis, U.S. District Court Judge Donald Molloy awarded the patient $59,820 for the grief and stress that the mistaken diagnosis had caused him and his family. The judge wrote:

It is difficult to put a price tag on the anguish of a man wrongly convinced of his impending death. Mr. Templin lived for 148 days … under the mistaken impression that he was dying of metastatic brain cancer.

The Independent Record newspaper of Helena, Montana, chronicles the story this way: The patient, Mark Templin, arrived on January 28, 2009, at the VA Medical Center in Fort Harrison, Montana, complaining of chest pain. Doctors inserted a stent. A week later, Templin developed problems with memory, vision, and speech, and was having headaches.

An ophthalmologist suspected a stroke and recommended the CT scan. Despite the radiologist’s call for further testing, internist Patrick Morrow, MD, gave Templin and his family the diagnosis of brain cancer, the judge ruled. Dr. Morrow testified that he had actually said his “greatest fear” was cancer and had recommended an MRI, but the judge found no medical records to back those claims.

Templin quit his job, sold his truck, and entered hospice care. Then he started feeling better. A new CT scan showed evidence of several small strokes, and an MRI in December 2009 confirmed that his symptoms resulted from stroke, not brain cancer.

The judge ordered the VA to pay $500 a day for the initial period of severe mental and emotional distress from February 4, 2009, to April 15, 2009, and $300 a day for a period of less-severe distress from April 15 until the new diagnosis. He also told the VA to repay Templin for the costs of a “last” birthday celebration and a prearranged funeral service.

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MRI might be an acceptable alternative to conventional autopsy, especially for fetuses, newborns, and infants, a new study finds. For details, see our Facebook page.

Related seminar: UCSF Neuro and Musculoskeletal Imaging

The study of 816,000 mammograms compared the performance of CR, digital direct radiography, and X-ray film. The mammograms, carried out on 688,000 women ages 50 through 74, were done in 2008 and 2009 in the Canadian province of Ontario.

The cancer detection rates were similar for DR (4.9 cancers per 1,000 mammograms) and film (4.8), but significantly lower for CR (3.4).

That led Ontario Health Minister Deb Matthews, PhD, to order that CR machines in the province be scrapped. She told the Globe and Mail of Toronto:

We are moving very quickly to replace the mammogram technology that isn’t providing as high a quality as it could be.

Of Ontario’s 316 mammography machines, 76 use CR technology, 188 use DR, and 52 use film. The Ontario Association of Radiologists had recommended in 2010 the phasing out of CR machines in favor of DR technology. “In most of the provinces, it has been recommended for a number of years,” said association President Mark Prieditis, MD.

Canada’s other provinces use only a handful of CR machines—except for Quebec, where CR devices constitute 108 of 144 total mammography scanners. And Quebec plans to keep using them, even though mammography patients have been barraging their physicians’ offices with questions and concerns.

In a prepared statement in French, Réjean Hébert, MD, the Quebec health minister, said:

There is no evidence at this time that mammography equipment used in Quebec offers lower performance.

Hébert said the province was taking the study seriously and would consult experts to determine how to proceed.

One set of experts defended the decision to continue using CR machines. The president of the Association des Radiologistes du Québec, André Constantin, MD, said replacing the equipment and encouraging women to be retested would be “overreacting” and “excessive.”

He said the province would examine detection rates for its machines and use that data to plan the best course of action.

Related seminar: Chicago International Breast Course and The Society for the Advancement of Women’s Imaging

Surgeons find the models especially helpful in difficult cases. Before surgery on one patient, pediatric cardiologist Laura Olivieri, MD, created a heart model made of pieces that she could take apart. She told the Washington Post, for a story published Tuesday, that it allowed her to “look at the anatomy in 3-D and do some practice runs where the patient isn’t involved.”

She elaborated:

The cardiac anatomy of this patient is very rare. And it’s not like there’s an FDA-designed device that will solve it.

Health care providers are just beginning to use such printers (as we reported last month). The technology is expensive; Children’s paid about $250,000 for its printer. Each printing job can take a few hours to as much as a full day, and preparing the images so the printer can read them can require at least as much time. “The first one I did was not even recognizable as a heart, and it probably took me like 25 hours to do,” Dr. Olivieri said.

Doctors say the time and effort is worth it. For a surgeon who needed to close a hole in an infant’s heart, Children’s created a model that mixed hard and soft plastics so it felt like a real heart—and even accepted sutures. Another medical team used a model of a dislocated spine, complete with softer, jellylike “discs” between the harder vertebrae, to help understand and repair that injury.

Looking at a scan on a computer screen just isn’t the same, Dr. Olivieri said. “Because you’ve got a three-dimensional problem. What we’re all trying to do is reconstruct how far away X and Y are. But now you can just take [the model] and hold it and look at it and say, ‘Oh, they’re that far away.’”

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Waste from oil and gas “fracking” is setting off radiation detectors at Pennsylvania landfills. Is that a problem? For details, see our Facebook page.

Related seminar: Cardiovascular & Pulmonary Imaging (order by July 15 and save $200)

So said Thomas Just Sørensen, PhD, a chemistry researcher at the university, as quoted in the news release. Dr. Sørensen and university colleague Bo Wegge Laursen, PhD, an associate professor of chemistry, say their aza-oxa-trangulenium dyes can outperform all other fluorescent dyes currently used in imaging. In fact, said Dr. Sørensen:

Our dyes are 10 times better, far cheaper, and easier to use. The latter, I believe, lends itself to expanded opportunities and broadened use, by physicians and researchers in developing countries, for example.

Their dye is so good, the researchers say, because it solves the problem of “light noise.” Fluorescent dyes luminesce when exposed to light—but so does random body tissue. For both other dyes and body tissues, luminescence lasts 10 nanoseconds. But the triangulenium dyes luminesce for 100 nanoseconds, making them easily distinguishable because they outlast the background light.

When used for staining tissue samples, triangulenium requires only one agent while most other dyes require two, the news release says. And no specialized equipment is required to see the dyes in tissue samples—just a microscope and a lens from a pair of polarized sunglasses.

Still, adoption of the new dye has been slow. Hence the free offer. “Someone who needs to assess the health of sick people wouldn’t dare to rely on an untested substance,” Dr. Sørensen said. “Only when several researchers have shown triangulenium dyes to perform just as effectively as its predecessors can we hope for our substance to become more widely adopted.”

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Which is better for determining the sex of a mummy: a CT scan or “uncorroborated opinion”? Do you think answering that question would merit a published journal article? It did for three Australian researchers. For details, see our Facebook page.

Related seminar: UCSF Interventional Radiology Review

Enjoy it while you can.

Spending on health care has been slowing. And signs increasingly indicate that health care, like so many sectors of the economy after the Great Recession, will have to adjust to a “new normal” that involves less money.

The authors of a new report from the Robert Wood Johnson Foundation suspect so. The report concludes:

A modest economic recovery and increasingly cost-conscious payers may therefore place continued pressure on providers to find ways to operate more efficiently.

Translation: you’ll probably be paid less.

John Holahan, PhD, and Stacey McMorrow, PhD, of the Urban Institute wrote the report. Dr. Holahan directs the institute’s Health Policy Center, and Dr. McMorrow is a researcher at the center. The institute itself, founded in 1968 by the Lyndon Johnson administration, is a center-left think tank based in Washington.

The report suggests that the health care spending slowdown originated in two fundamental changes that predated the recession: a general decline in real personal income since 2000 and a shift in health insurance coverage from private, employer-sponsored plans to lower-paying Medicaid and Medicare.

And that doesn’t take into account the changes that the Affordable Care Act will bring. Nobody can definitively predict their scope or impact, but most experts, including Drs. Holahan and McMorrow, think the ACA’s effects will continue the downward pressure on reimbursements. ”The ACA is already tightening Medicare payments to hospitals and other providers,” the report notes.

In an interview with DOTmed News, Dr. Holahan summarized the report thus:

“People have less money to spend on health care, and the insurance arrangements are not as comprehensive and rich as they were before. So it all affects their ability to pay, and the health community has to respond to that.”

Related seminar: UCSF Radiology Review: COMPREHENSIVE IMAGING

The ordinance, enacted in 2011, would also have required retailers to post notices stating that cancer experts from the World Health Organization have listed the electromagnetic fields produced by cell phones as possibly carcinogenic.

The board rescinded the warning requirement reluctantly, after advice from the city attorney’s office that it was likely to lose the lawsuit. Reuters quoted Supervisor David Campos as saying:

I think the legal reality is that if we don’t approve the settlement, we’re talking about having to pay $500,000 in legal fees.

The Reuters story also asserted, “Despite mounting evidence the phones may cause brain tumors, scientists disagree and are hesitant to draw conclusions.”

Um, what “mounting evidence”? Research to date has been overwhelmingly inconclusive. The National Cancer Institute provides a matter-of-fact assessment on its Web site, summing up: “Studies thus far have not shown a consistent link between cell phone use and cancers of the brain, nerves, or other tissues of the head or neck.”

In support of its implication that dithering scientists are trying to hold back a rising tide of truth, Reuters cited a single study that found an increase from 1992 to 2006 in malignant tumors in the parts of the brain closest to where people hold their cell phones. But the study said the cause of that increase was unknown. Its lead author, Gabriel Zada of the Keck School of Medicine of the University of Southern California, “told Reuters he could not draw any conclusions about the dangers of cell phones from his findings.”

So Reuters drew conclusions instead. So did Ellen Marks, who supported the warnings. “This is just a terrible blow to public health,” she said after the vote to rescind the ordinance. She said her husband suffers from a brain tumor on the side of his head where he usually held his cell phone.

We sincerely express sympathy for Marks and her husband and hope for a recovery. We understand why she might blame cell phones and want to protect others from suffering. But a brain tumor’s appearance near where a cell phone is held does not demonstrate causation any more than would the development of a brain tumor by a person who avidly watches American Idol.

As for the World Health Organization, yes, cell phone radiation is among the 274 agents on its “possibly carcinogenic” list. So are carbon black, which is used in tires and other rubber products, and coffee. Hey, San Francisco, why no warnings at tire shops and coffee bars? Where’s your concern for public health?

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Do you have the appropriate security clearance—and bank balance—for the world’s first atomic pocket watch? To find out whether you’re a candidate, check our Facebook page.

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

The study, published in the April issue of Brain Structure and Function, used MRI to look at the brains of both males and females, and both children and adults. The authors say most dyslexia studies have been heavily weighted toward males because of “the higher prevalence of dyslexia in males.” In a news release about the study from Georgetown University Medical Center in Washington, DC, senior author Guinevere Eden, PhD, is quoted as saying dyslexia is two to three times more prevalent in males than in females.

Dr. Eden is director of the Center for the Study of Learning at Georgetown and a past president of the International Dyslexia Association. Interestingly, the association says on its Web site, “Dyslexia affects males and females nearly equally.” A 2009 study of gender ratios among those who have reading difficulties, published in Dyslexia, found conflicting evidence but did report greater variances in reading ability among males—among both those with and without dyslexia.

At any rate, nobody is disputing that research on dyslexia (defined broadly as difficulty with reading) has focused primarily on males. The new study uncovered a big surprise, Dr. Eden said:

It has been assumed that results of studies conducted in men are generalizable to both sexes. But our research suggests that researchers need to tackle dyslexia in each sex separately to address questions about its origin and, potentially, treatment.

In males with dyslexia, the study found less gray matter in areas of the brain used to process language, consistent with the findings of earlier studies. But females with dyslexia exhibited less gray matter in areas involved in sensory and motor processing.

Obviously, that has implications for both understanding the origins of dyslexia and devising potential treatments.

“There is sex-specific variance in brain anatomy,” said lead author Tanya Evans, PhD, of the Center for the Study of Learning, “and females tend to use both hemispheres for language tasks, while males just the left. It is also known that sex hormones are related to brain anatomy and that female sex hormones such as estrogen can be protective after brain injury, suggesting another avenue that might lead to the sex-specific findings reported in this study.”

Related seminar: Neuroradiology Review