“Multivariate analysis showed that AAC adds incremental prognostic information over clinical variables, coronary anatomy, and left ventricular function,” the article continued.

Steven Simpson, MD, and Mouaz Al-Mallah, MD,  of the Henry Ford Heart and Vascular Institute, studied 367 patients who had had abdominal CT scans for various reasons, none of which were because of symptoms of heart disease. Within a year, though, each of them had had a coronary angiopathy. Twenty-seven months later, 65 of them had died. Of the 62 patients showing no AAC, only seven developed heart problems later. Patients ultimately having obstructive coronary artery disease totaled 134.

“It’s worth it as a cardiologist to [look at a previous abdominal scan],” Dr. Simpson said. “It can improve your judgment….Obviously we’re not implying we should order a noncontrast CT of the abdomen for the purposes of a CT coronary calcium score, but since it is free information, we might as well use it. It ups my aggressiveness in some patients.”

In an article in EurekAlert!, Dr. Al-Mallah said, “If you get a CT scan on your abdomen, there’s probably a good chance that image can provide us with more information about the health of your heart arteries. If you have heart disease and abdominal aortic calcifications, your chance of dying is higher than just having heart disease alone.”

Prior research has discovered that coronary artery calcium on CT scans was connected with heart disease and death. Both physicians connected with this current study caution that more lower-risk individuals need to be evaluated before  AAC can be used as a definite indicator.

Related seminar: Abdominal & Thoracic CT/MR/US: Optimizing Practice

Already approved by the FDA, the low temperature device utilizes radiofrequency energy and makes for a cleaner, more complete excision of the tumor itself. The pathologist’s sample, then, sustains less heat damage, and the remaining breast tissue suffers less injury and distortion.

“Nationally, close to 50 percent of malignant breast lump excisions result in positive margin status, requiring additional procedures,” according to a press release from the  University of California San Diego Medical Center. “The traditional method of tissue evaluation relies upon microscopic examination; however, electrosurgical techniques may damage tissue samples within 1-2 mm of the margin. Positive margin rates at Moores UCSD Cancer Center are found in fewer than 20 percent of cases.”

Sarah Blair, MD, associate clinical professor of surgery at the UCSD School of Medicine, and her colleagues conducted a survey of of US practices for maintaining lumpectomy surgical margins and published the results in the November 2009 issue of the Journal of the American College of Surgeons. They asked that further treatment studies be done  to minimize invasive procedures.

The pending results of the clinical trial could be welcome news for the 100,000 women each year who have lumps removed from their breasts. Even more welcome could be the prevention of the disease itself, which is still the leading cause of cancer deaths among Hispanic women. In African American, Asian/Pacific Islander, Caucasian and American Indian/Alaska Native women, it is the second most common cause of cancer deaths.

Related seminar: Breast & Women’s Imaging Seminar

According to an article in Medical News Today, the  boy was behind in growth rate and developmental milestones. He had recurring diarrhea and was visibly different from his peers. He had an enlarged liver and spleen but no other indicators toward a diagnosis. When  his cousin showed similar characteristics, when his brother was born with the same problems and when a fourth child surfaced, doctors got blood samples and found abnormalities in an area of chromosome 20. 

Jean P. Molleston, MD, an Indiana University professor of pediatrics and a gastroenterologist, and Naomi Lohr, MD, then an IU School of Medicine resident, secured the help of the boy’s father and screened other Amish children in northeastern Indiana. They found ten other boys, girls and young adults with the multisystem disorder. They were all related and were all Indiana Old Order Amish, though not all of them still lived in Indiana.

“It was recognizing autoimmune problems, including autoimmune hepatitis and lung and thyroid problems,” Dr. Molleston said, “that led us to focus our efforts to determine that the responsible gene was one identified as ITCH, one of 250 genes in the region of chromosome 20 identified by the Clinic for Special Children team,” which specializes in the search of genetic disorders in the Amish community.

“We found that all the affected children had a mutation in ITCH, a gene which helps in ubiquination, the chaperoning or transporting of proteins around the cell,” Dr. Molleston said. “Ubiquination tells proteins where to go and what to do, and it’s particularly important to damping down the immune system so it’s not overactive. Ubiquination has many other important roles in the body’s cells, possibly explaining some of the other problems these children have.”

 The doctors and their team are still working to determine if the environment or other factors cause or contribute to the condition.

Two years ago researchers identified another gene mutation that was also found mainly among the Amish, according to Science Daily and other sources. The  APOC3 gene inhibits the breakdown of triglycerides, but 5% of Amish, with the mutation, have low levels of blood triglycerides and fewer instances of hardening of the arteries.

Related seminar: Pediatric Diagnostic Imaging

The link between brain activity and the regulation of emotion in the laboratory is documented, and now brain activity and daily chains of events appear to have a similar relationship, in relationships.

An article from Medical News Today outlines the Harvard study. Researchers worked with couples who had been together for three months or more.  They placed each individual in an fMRI scanner and showed them photos of their partners with various facial expressions and recorded their neural responses. They also tested for impulse control and examined the quality and direction of their attention spans.

Study participants kept diaries for three weeks and noted their daily emotional outlook and the occurrence of any quarrels with their partners. When they were scanned after an argument, the participants with greater lateral prefrontal cortex activity were better adjusted on the days after fights, and they responded better, in neutral times, to photos of their partners with negative expressions. They also showed more cognitive control.

Though still distant from clinical applications, the results suggest that actively improving and broadening cognitive control skills could aid in regulating emotions and improving and regulating day-to-day moods.

“The key factor is that the brain activity in the scanner predicted their experience in life,” said lead author Christine Hooker, assistant professor of psychology in Harvard University’s  Faculty of Arts and Sciences. “Scientists believe that what we are looking at in the scanner has relevance to daily life, but obviously we don’t live our lives in a scanner. If we can connect what we see in the scanner to somebody’s day-to-day emotion-regulation capacity, it could help psychologists predict how well people will respond to stressful events in their lives.”

Related Seminar: Neuroradiology Review

As well as citing several recent specific glitches in computerized hospital equipment, the agency is responding, in part, to six deaths in two years that were caused by equipment malfunctions that the FDA’s Jeffrey Shuren said, “may represent the tip of the iceberg.” In one incident, a radiology workstation slowed down, which delayed therapy sessions and forced techs to repeat X-rays. Information technology staff later determined that the software had a flaw which surfaced when too many characters were typed in. In another hospital, operating room software often froze without any indication of doing so and left surgery data incomplete.

The FDA is asking that hospitals particularly note problems with laboratory, pharmacy radiology and anesthesia systems, as well as the growing number of digital patient records that will be made possible through stimulus money. Hospital staff members can alert the FDA through its Medical Product Surveillance Network, or MedSun, and the information will be placed on the FDA Web site.

Upholding its right to regulate medical technology, the agency rarely does so in practice, allowing for voluntary reporting. Past information came through its former data recording system, but it was seen as sporadic and not representational of the industry as a whole, though it did find two years of evidence of 260 potentially harmful occurrences, 44 injuries and the six deaths.

“The fundamental problem we have here is we’re dealing with an industry that really isn’t used to a transparent reporting of problems,” said Paul Egerman, co-chair of a government health information technology panel, as quoted in the article. “The more data we get - I view that as a valuable thing,” he said. His panel will go public with their findings in April.

Related seminar: Current Imaging Practice: CT, MR and US

At William Beaumont Hospital in Royal Oak, MI, researchers tested three common prostate specific supplements taken in conjunction with radiation therapy. Malignant tumor cells, they found, were not affected in either growth rate or radiosensitivity. The normal prostate cell lines, however, were.

According to an article in Medical News Today,  the supplements “have been shown to increase the radiosensitivity of normal prostate cell lines, leading to normal tissue complications…two of the supplements inhibited the growth rate of the normal prostate cell lines, while a third supplement also increased the cellular radiosensitivity of some normal cell lines by inhibiting DNA repair.”

The study, which was originally published in the March issue of the International Journal of Radiation Oncology, marks early information on the combined results of supplements and radiation therapy, though several published reports have shown negative effects on tumor cells from some supplements after chemotherapy.

Brian Marples, PhD, who is a radiologist, the study’s senior author and a clinical research professor at Oakland University William William Beaumont School of Medicine, said, “It is very important for all patients to discuss any type of supplement they may be taking with their physician and especially important for prostate cancer patients receiving radiation therapy as this study shows that it may be negatively affecting the effectiveness of their treatments.”

Related Seminar: CT/MRI of the Abdomen and Pelvis

The procedure has the added advantage of producing results in 10 minutes—or nine times faster than current methods—does not require that a patient hold his breath, is not limited by a patient’s size, is non-invasive and does not necessitate a contrast agent or general anesthesia.

Radiologist Chris Francois, and medical physicist Oliver Wieben have been studying the technology since 2007 and narrowed the project to cardiac imaging in 2009. Charles Mistretta, of the University’s department of medical physics, began the initial work in 2002.

Known as PC VIPR (Phase Contrast Vastly undersampled Isotropic Projection Reconstruction), the technique produces images in each of the spatial directions and in the fourth dimension of time. It tracks the velocity of blood flow and reveals it on the screen as blue in relaxed hearts, green during contraction and yellow or red in heart patients. The scans clearly show flow direction, deviations and obstructions.

“In designing this, we threw out all the old rules of radiology and came up with a new way to acquire data that allows us to do the imaging much faster while still getting excellent quality. We’re also developing new ways to display the complex flow data on a 2-D monitor,” Wieben said, as quoted in a PhysOrg.com article.

Wieben and Francois have tested their procedure on hundreds of patients and volunteers, thus far, and plan to conduct larger studies. They hope that their PC VIPR will be available in hospitals in three or four years. Beyond that, they foresee the system’s future capability of analyzing blood vessel walls and precluding aneurysms.

Source: University of Wisconsin, The Badger Herald

Related seminar: Thoracic Imaging

Author: Stephen R. Baker, MD. Special Presentation for Practical Reviews in Radiology

Other Signs of Free Air on Radiography

This third section of the review on diagnosing pneumoperitoneum considers supine plain film signs of abdominal free air outside the right upper quadrant.

In the anterior paramedian superior position of the abdomen, the most common manifestation is the cupola sign, which is much more frequent than the presence of air in the lesser sac.

Like a cupola, free air in this location is well delimited superiorly, but indistinctly bordered inferiorly.

Occasionally, the only evidence of pneumoperitoneum can be found in the left upper quadrant.

In the mid-abdomen, the classic finding is Rigler’s sign, otherwise known as the bas-relief sign.

It is, unfortunately, insensitive and non-specific, requiring for its presence almost a liter of extraluminal air and accompanying ascites.

However, in patients with intestinal perforation and intra-abdominal adhesions, Rigler’s sign may be encountered even though the more subtle right upper quadrant patterns of free air are absent, because the rostral migration of free air is retarded by the presence of adhesions.

Summary
In patients with intestinal perforation and intra-abdominal adhesions, Rigler’s sign may be encountered even though the more subtle right upper quadrant patterns of free air are absent, because the rostral migration of free air is retarded by the presence of adhesions.

Author: Stephen R. Baker, MD. Special Presentation for Practical Reviews in Radiology

Signs of Free Air on Radiography

The best place to look on plain films for findings of pneumoperitoneum is in the right upper quadrant, because the homogeneous shadow of the liver affords an excellent background upon which even very small collections of free air can be displayed.

However, to take advantage of the hepatic background, the entirety of the peritoneal cavity from the top to bottom must be encompassed.

That is, the radiograph or radiographs must extend from the obturator foramina inferiorly to the apex of the higher hemidiaphragm superiorly.

For most adults, a standard KUB (Kidney-ureter-bladder) cannot include the full expanse of the peritoneal cavity, and a second film of the upper abdomen must be obtained.

The most common right upper quadrant sign of free air is the anterior superior bubble which, contrary to traditional notions, can be discerned even when its diameter is much less than 1 cm and its volume less than ice.

Summary:
The most common right upper quadrant sign of free air is the anterior superior bubble which, contrary to traditional notions, can be discerned even when its diameter is much less than 1 cm and its volume less than ice.

Other signs of free air superimposed on the liver or even within it will be outlined in Part III of this discussion.

Currently the FDA has approved eight digital mammogram systems. However, none of the literature on image quality among these systems addresses measurement accuracy, the Colorado researchers say.

Using an acrylic disk. the team took measurements in various magnification views across different systems, then compared them with measurements made with electronic calipers. Here’s how the 1-cm disk measured:

First system:

• 1.05 cm (nonmagnification)
• 1.64 cm (1.6x magnification)

Second system:

• .99 cm (non magnification)
• .66 cm (1.5x magnification)

Third system:

• Accurate in both views (this system used Selenia from Hologic for acquisition and a PACS viewing station designed by Horizon Medical Imaging from McKesson.)

“This brief yet informative paper tells us that simply assuming that DICOM-compatible FDA-approved equipment will work together seamlessly is unacceptable,” says reviewer Basil Hubbi, MD. “Any practice that is transitioning to digital soft copy reading or employs equipment from various manufacturers should be aware of this potential problem.”

Related seminar: Pittsburgh Breast Imaging Seminar

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