Medical NEWS

Nuclear Medicine: Low-Dose Molecular Breast Imaging Evaluated in the Detection of Breast Cancer

2012-11-11T08:49:00.000-08:00

Breast-specific gamma imaging (BSGI), also known as molecular breast imaging (MBI), is a modality that identifies breast tumors overlooked by ultrasound and mammography, especially in women with dense breasts.
Although the radiation dose linked to this procedure is already low enough to be used in specific instances, new research is being conducted to find ways to additionally decrease the dose so that MBI may be used in yearly breast cancer screening for high-risk women with dense breast tissue.

The MBI procedure is now available in hundreds of breast centers United States and is typically utilized as an adjunct combined with mammography and ultrasound to aid in the diagnosis of breast cancer. New research findings were presented at the Chicago International Breast Course, held in Chicago (IL, USA), October 2012, by Dr. Marcela Bohm-Velez, the lead investigator of an ongoing trial conducted by radiologists at Weinstein Imaging Associates (Pittsburgh, PA, USA).

In the MBI procedure, the patient is imaged with a pharmaceutical tracer. Lessening the amount of tracer required for imaging reduces the radiation dose to the patient. According to the findings obtained by Dr. Bohm-Velez and her coauthors, MBI can be conducted using approximately 50% of the amount of tracer typically used, thereby exposing the patient to a much lower radiation dose. In their prospective trial, 72 patients had low-dose MBI followed by imaging at the standard dose, and their findings indicate that low-dose MBI provided the same diagnostic results as the images performed at the traditional dose.

“The pioneering research done at the Mayo Clinic [Rochester, MN, USA] indicated low-dose is an option for the dual-head MBI system and our research indicates that it is an option for the single-head MBI systems as well. We have found that it is possible to cut the dose in half and still produce diagnostically useful images,” said Dr. Bohm-Velez. “In our previous work, we found that MBI had a higher sensitivity for breast cancer than mammography or ultrasound and this work is a natural extension. The uptake of the tracer in the breast tissue is complex and highly variable, and our goal is to help the medical community develop strategies for obtaining the best images possible. We have made several observations regarding the rate of tracer washout from the breast tissue and the impact of patient’s weight on tracer uptake. We are currently working to submit our results for peer-reviewed publication this fall.”

Dilon Diagnostics’ (a brand of Dilon Technologies, Inc.; Newport News, VA, USA) flagship system, the Dilon 6800, is a high-resolution, small field-of-view (FOV) gamma camera, optimized to perform MBI/BSGI, and images the metabolic activity of breast lesions by uptake of the radiotracer. Many leading medical centers in the United States are now offering MBI/BSGI to their patients. The new declipseSPECT is the first intraoperative, handheld, three-dimensional (3D) image viewing and navigation system with applications in SLNB breast, I-125 seed localization, and sentinel lymph node biopsy (SLNB) of the head and neck.

Source:
medimaging.net

Ultrasound: Treatment Planning System Updated for Real-Time Ultrasound-Guided Prostate Cancer Brachytherapy

2012-11-08T11:56:00.001-08:00

A new partnership agreement between Siemens Healthcare (Erlangen, Germany) and Varian Medical Systems (Palo Alto, CA, USA) has been established to advance radiation treatment planning and delivery technology.
A strategic global partnership between Siemens Healthcare and Varian Medical Systems, which took effect October 26, 2012, in North America following an international rollout earlier in 2012, provides cutting-edge diagnostic and therapeutic systems and services for treating cancer with image-guided radiotherapy (IGRT) of systems for imaging and treatment in the global radiation oncology business. This collaboration also includes the development of software interfaces between Siemens and Varian treatment systems. Moreover, the two companies will investigate prospects for joint development of new technology for radiosurgery and IGRT.

Varian will represent Siemens diagnostic imaging products such as computed tomography (CT), positron emission tomography/computed tomography (PET/CT), and magnetic resonance imaging (MRI) to radiation oncology clinics in North America and in most international markets. Similarly, Siemens will represent Varian equipment and software for radiotherapy and radiosurgery within its product range to its healthcare customers. This collaboration enables both companies to offer comprehensive systems that support the complete clinical workflow from imaging to treatment.

Varian and Siemens are also developing interfaces to enable Varian’s Aria oncology information-system software to support Siemens accelerators and imaging systems, providing clinics with more ways to improve workflow and streamlining operations. The collaboration enables Siemens and Varian to codevelop and provide cancer treatment centers with new treatment and imaging systems by utilizing both companies’ technologic expertise.

Offering modulated arc therapy to Siemens’ Artiste linear accelerator, the new mARC software enables precise control of radiation delivery and is up to 65% faster than intensity-modulated radiation therapy (IMRT) for individual treatment that best suits patient needs. mARC enables continuous gantry motion by alternating beam-on, beam-off periods, with fixed apertures during beam-on periods and modified apertures during beam-off periods; treatment can be resumed at any time. Moreover, mARC provides precise delivery control for smooth quality assurance (QA).

Source:
medimaging.net

General Imaging: Prospective Drawbacks Seen in Cost-Cuts for Medical Imaging Scans

2012-11-06T14:45:00.000-08:00

A new report revealed that the timespan of the average hospital stay in the United States has risen at the same time as medical imaging use has dropped. It is not yet known if the trends are linked, but these new findings may be significant, because hospital admissions are among the fastest growing and largest healthcare costs.
More research is needed to evaluate the possible deleterious impact of government and private insurer imaging cutbacks on overall medical costs and patient safety. “Lawmakers, regulators, and medical professionals are making medical imaging policy decisions without fully understanding or examining their downstream effects, which may include an increase in hospital stays, associated costs, and other adverse events. We need to examine imaging, as it relates to a patient’s overall continuum of care, to ensure that decision makers don’t create imaging cost reduction policies which paradoxically raise overall costs, create barriers to care, and ultimately harm patients,” said Richard Duszak, MD, chief executive officer and senior research fellow of the Harvey L. Neiman Health Policy Institute (Reston, VA, USA), established by the American College of Radiology (Reston, VA, USA).

Much of the research regarding medical imaging focuses on decreasing costs and utilization of imaging. There is comparatively little study concentrated on imaging as a factor in overall patient care. For many serious indications, imaging scans have been shown to reduce the number of invasive surgeries, needless hospital admissions and length of hospital stays. Scarcer nevertheless are data on the effect of USD 6 billion in funding cutbacks for imaging diagnosis and treatment planning since 2006. The data available are not necessarily positive in terms of patient safety and access to care.

This is the first policy brief published by the Neiman Institute, which performs and backs research on medical imaging use, quality, and safety metrics, and human resources as medicine moves toward non-traditional, value-based payment and delivery. The information gathered from these efforts will serve as the basis for real life, evidence-based medical imaging policy.

“We need to take a hard look at the cost, access, and quality and safety issues related to present government and private insurer medical imaging policies and find ways to maximize the value, role and efficiency of radiology as health care systems evolve. The Neiman Institute will provide much needed information to ensure that future imaging policies benefit patients and make efficient, effective use of healthcare resources,” concluded Dr. Duszak.

Source:
medimaging.net

Nuclear Medicine: Improved possibilities of proton therapy to patient

2012-11-05T13:12:00.000-08:00

A new patient-centric proton therapy room has been designed to stimulate patient comfort during proton treatments by allowing patients to selectively add relaxing sound, light, and images to the treatment room environment before they initiate therapy.
This will help improve the patient and staff experience, transforming a sterile, detached setting into one that comforts and soothes as the patient becomes an active participant in the process.

IBA Group (Louvain-la-Neuve, Belgium), a developer of cancer diagnosis and therapy technologies, and Philips Healthcare (Best, the Netherlands) reported their first installation of a patient-centered proton therapy treatment room in the United States. A new addition to the Willis-Knighton Cancer Center (Shreveport, LA, USA) will be the first IBA installation to integrate the Philips Ambient Experience.

“This new installation is the first to come to fruition from the Philips-IBA cooperative agreement,” said Olivier Legrain, chief executive officer at IBA. “It is demonstrative of a successful collaboration with Philips in offering highly advanced, patient-centered care, and we are delighted it will be integrated into our new proton system installations.”

“Ambient Experience enhances our ability to provide superior cancer care,” said Dr. Lane Rosen of the Willis-Knighton Cancer Center. “The soothing and empowering atmosphere will make our patients more comfortable, which will allow our staff to work more efficiently. IBA and Philips have been excellent partners, so it made sense to work with them to bring this unique experience to our patients.”

Willis-Knighton will be the first center to utilize Proteus One, IBA’s single-room compact gantry system for a more cost-effective, smaller footprint option. The USD 40 million project is expected to begin treating cancer patients with protons in early 2014. Together with Philips, IBA presented a life-size model of the ProteusOne proton therapy room combined with the Philips Ambient Experience at the 54th annual meeting of ASTRO, the American Society for Radiation Oncology, in Boston (MA, USA), in October 2012.

IBA (Ion Beam Applications, SA), is a cancer diagnostics and treatment company focused in the field of proton therapy. The company’s expertise lies in the development of next-generation proton therapy technologies and radiopharmaceuticals that provide oncology care providers with quality services and equipment, including IBA’s fully integrated IntegraLab radiopharmacy system, and dosimetry systems for quality assurance (QA) of medical equipment and increased patient safety.

The Willis-Knighton Cancer Center, opened in 2000, provides a diverse range of treatment options for cancer patients, including medical oncology and hematology, radiation oncology, surgical oncology, and gynecologic oncology. A regional cancer center, Willis-Knighton provides diagnostic services such as positron emission tomography/computed tomography (PET/CT), X-ray, CT imaging, and laboratory services. In addition, it provides social services counseling, nutritional counseling, educational resources, support groups, and community education programs.

Source:
medimaging.net

General Imaging: New diagnostic displays developed for radiologists

2012-11-04T10:47:00.003-08:00

New diagnostic displays developed for radiologists offer three times the resolution of monochrome liquid crystal displays (LCDs), improving visualization for help in critical diagnoses. Sony Electronics’ medical systems division
(Park Ridge, NJ, USA) recently developed a full range of diagnostic medical imaging monitors for radiology. The displays are 510k- cleared for use in general review of images from every modality including computed tomography (CT), computed radiography/digital radiography (CR/DR), magnetic resonance imaging (MRI), and full-field digital mammography (FFDM) studies.

The Sony LMD-DM series of high-luminance, high-contrast medical displays provides well-defined images for critical diagnoses through independent sub-pixel drive (ISD) technology. The technology’s use of three independent sub-pixels in a single pixel enables a 5 MP display to achieve a resolution up to 15 MP; the capability used with the 3 MP display allows for a maximum of 9MP.

The novel ISD technology, which provides an even higher resolution output, makes sure that users can plan for the future as imaging technology modalities evolve their systems with greater outputs. The new range of radiology monitors includes 5 MP diagnostic display for full-field digital mammography; 3 MP color display; 3 MP grayscale display; 2 MP color display; and 2 MP grayscale display.

“Now radiology users can experience and benefit from the breakthrough innovation in medical display technology that Sony has been successfully delivering to other areas of healthcare, including surgery,” said Lida D’Ambrosio, marketing manager for medical systems division, Sony Electronics. “This full line of new monitors further expands Sony’s footprint in radiology, giving the market a full range of high quality radiology displays from Sony that help enhance visualization.”

All Sony displays are created particularly for radiology review and are loaded with a high-luminance, high-contrast LCD panels that can simultaneously display 1024 shades of gray and deliver precise color reproduction. They provide color or grayscale results, can be used in landscape modes and portrait, and are fully Digital Imaging and Communications in Medicine (DICOM) GSDF Part 14-conformant.

Source:
medimaging.net

MRI: MR-Conditional Pacemaker System Approved in Japan

2012-11-03T09:03:00.000-07:00

With the use of new magnetic resonance imaging (MRI)-conditional pacing technology, pacemaker patients will have access to full body scanners, without positioning restriction in the MRI scanner.

MRI is the standard of care in soft tissue imaging, providing data not seen with X-ray, computed tomography (CT) or ultrasound scan, and critical for early detection, diagnosis, and treatment. Medtronic, Inc. (Minneapolis, MN, USA), announced the Japanese regulatory approval and launch of the Advisa DR MRI SureScan pacing system. The Advisa MRI system is the first and only MR-conditional pacemaker available to patients in Japan, the world’s second largest market for medical devices.

Advisa MRI was exclusively assessed and approved for use as labeled with MRI scanners in Japan. The system includes an Advisa MRI device and two CapSureFix MRI SureScan leads, which must be used in tandem. “Until recently there was a significant unmet need for patients with pacemakers to have access to MRI technology,” said Ken Okumura MD, professor and chief, department of cardiology, Graduate School of Medicine, Hirosaki University (Aomori, Japan) and president of the Japanese Heart Rhythm Society. “Now physicians and patients have a choice of pacing systems that allow access to the invaluable benefits of MRI technology.”

The first SureScan pacemaker system was introduced in Europe in 2008 and its use in the MRI environment is supported by extensive computer modeling and clinical studies, as well as real-life data. Up to now, Medtronic has sold almost 100,000 SureScan devices worldwide, and thousands of SureScan patients have been able to safely undergo an MRI that would have been denied to them with a conventional pacemaker.

About 400,000 people in Japan have implanted pacemakers. However, until the availability of Medtronic's SureScan pacing systems, patients with pacemakers have been contraindicated in Japan from receiving MRI scans. There is the possibility for pacemakers to interact with MRI units in a way that could undesirably affect the device function or patient safety. According to estimates, 50%-75% of patients worldwide with implanted cardiac devices are expected to need an MRI scan during the lifetime of their devices.

The Advisa DR MRI SureScan pacing system is not yet available in the United States. The Revo MRI SureScan pacing system was US Food and Drug Administration (FDA) approved in February 2011.

The MRI pacing system provides patients with dedicated technology, including the MVP (managed ventricular pacing) algorithm, which is shown to reduce unnecessary ventricular pacing by 99%. Additional features include (1) complete automaticity with ventricular and atrial capture management (VCM and ACM) and antitachycardia pacing (ATP). (2) Diagnostic tools such as the Cardiac Compass Report and tachyarrhythmia management tools that assist in the early detection of atrial fibrillation (AF). (3) Remote follow-up via Medtronic’s CareLink Network, which transmits detailed arrhythmia and diagnostic device data to a doctor’s clinic. (4) Lastly, a rate drop response that identifies abrupt cardiac slowing and responds by pacing the heart at an elevated rate, which may decrease the frequency of syncopal episodes in patients with apparent cardio-inhibitory vasovagal syncope.

In collaboration with leading researchers, clinicians, and scientists worldwide, Medtronic provides a wide range of medical technology for the interventional and surgical treatment of cardiovascular disease and cardiac arrhythmias.

Source:
medimaging.net

Radiography: A new agent has been developed to treat radiation exposure.

2012-11-01T12:38:00.001-07:00

A new agent that is similar to a naturally occurring molecule found in blueberries and coffee has been developed to treat radiation exposure.
Charles R. Yates, Pharm.D., PhD, and colleagues Duane Miller, PhD, and Waleed Gaber, PhD, from the University of Tennessee Health Science Center (Memphis, USA) and Baylor College of Medicine (Houston, TX, USA), revealed that by administering this new agent, beginning 24 hours after radiation exposure, increased survival in lab animals by three-fold compared to placebo.

The study findings were presented at the 2012 American Association of Pharmaceutical Scientists (AAPS) annual meeting and Exposition, the world’s largest pharmaceutical sciences meeting, held in Chicago (IL, USA) on October 14-18, 2012. “Development of drugs for individuals who are exposed to high-dose radiation in a public health emergency has been a priority since the 9/11 terrorist attacks,” said Dr. Yates. “The ultimate goal is wide dissemination of noninvasive treatments after 24 hours of a mass casualty.”

For oral treatments, the most typical noninvasive delivery method, the high chance of vomiting after radiation exposure was shown to be challenging. Injectable medication is frequently recommended as the next choice of therapy, which comes with its own challenges. For example, training is frequently needed for injections. To try to resolve this hurdle, Dr. Yates and his coworkers devised a new delivery system that can be applied directly to the skin, similar to an adhesive bandage. “We are extremely proud to have exclusive rights to this exciting technology,” said W. Shannon McCool, DPh, president and CEO of RxBio (Johnson City, TN, USA), the company that has licensed the technology from the University of Tennessee Research Foundation.

This drug was also very successful in animal models where radiation exposure is combined with skin wounds--a probably circumstance in which people are exposed to shrapnel from dirty bombs or associated burn wounds.

Source:
medimaging.net

Nuclear Medicine: PET Radiopharmaceutical Receives European Endorsement for Imaging of β-Amyloid Density

2012-10-31T13:19:00.001-07:00

A European health agency has recommended marketing authorization for Amyvid (florbetapir 18F) as a diagnostic imaging agent in patients who are being evaluated for Alzheimer’s disease (AD) and other causes of cognitive decline.
The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) is the group responsible for providing the recommendation. Amyvid is a radiopharmaceutical agent utilized in positron emission tomography (PET) imaging in the brains of adults. It can highlight amyloid protein plaques in the brain, and aid in diagnosing AD.

AD is the most typical cause of dementia in the elderly, affecting up to 5.1 million people in the European Union (EU). Accurate diagnosis of AD has been hindered up to now by the scarcity of diagnostic tests. Postmortem autopsy is the current gold standard for validating a clinical diagnosis of AD.

PET imaging using Amyvid can provide valuable data on neuritic plaque density in the brains of patients who are being tested for cognitive decline. Following intravenous injection, the radioactive agent Amyvid binds to β-amyloid in the brain. β-amyloid protein is present in the brains of individuals with AD and other cognitive disorders.

Notably, a negative Amyvid PET scan can rule out the presence of AD, and is expected to decrease the frequency of false-positive diagnosis. However, a positive Amyvid scan is consistent with, but does not independently establish, the diagnosis of AD since β-amyloid neuritic plaque deposition may also be present in the brain of asymptomatic older individuals and some neurodegenerative dementias, including Lewy body dementia and Parkinson’s disease dementia. Typical adverse reactions include changes in taste and headache.

Because of the public health drain of AD, there is great interest in the qualification of biomarkers allowing the study of AD earlier in the disease process, and examining whether the use of possible disease-altering compound can alter the long-term progression of the illness and prevent the neurodegenerative cascade linked with the disorder.

Source:
medimaging.net

Radiography: 3D CT Breast Cancer Scanning Technology

2012-10-29T12:48:00.003-07:00

Newly developed technology provides three-dimensional (3D) X-ray imaging of the breast with a radiation dose that is lower than the current 2D X-ray imaging used in clinics.
The new technique generates 3D diagnostic computed tomography (CT) images with a spatial resolution two to three- times higher than currently used scanners, but with a radiation dose that is around 25 times lower.

This advance has the potential to resolve the critical hurdle of limiting traditional CT imaging of the breast: the high radiosensitivity of the breast glandular tissue. Synchrotron X-rays at the ESRF European Synchrotron Radiation Facility (Grenoble, France) have been used for assessing the technique that, once deployed in hospitals, will make CT scans a diagnostic tool to be used as an adjunct to dual-view mammography.

A report of this novel imaging modality was published October 23, 2012, in the online early edition of the journal Proceedings of the National Academy of Sciences of the United States of America (PNAS). The multidisciplinary group of scientists included radiologists, physicists, and mathematicians from the ESRF European Synchrotron Radiation Facility, Ludwig Maximilians University (LMU; Cluster of Excellence MAP; Munich, Germany), and the University of California at Los Angeles (UCLA; USA). The first authors were Dr. Yunzhe Zhao of UCLA and Dr. Emmanuel Brun of the LMU/ESRF.

Early detection in large part adds to an improved prognosis and findings in decreased breast cancer mortality. The breast cancer screening technology typically employed now is dual-view digital mammography. The limitation is that it only generates two images of the breast tissue, which may clarify why 10%-20% of breast tumors are not identifiable on mammograms. At times, mammograms can also appear abnormal, when no breast tumors are truly present.

Computed tomography (CT), an X-ray technique that allows a precise 3D visualization of body organs, cannot be routinely applied in breast cancer diagnosis because the risk of long-term effects in radiosensitive organs such as the breast is considered too high.

Acknowledging these limitations, scientists decided to try something new. CT scans for early detection of breast cancer may now become possible due to the combination of three components: a detection modality called phase contrast imaging, high energy X-rays, and the use of a sophisticated mathematical algorithm, known as equally sloped tomography (EST), to reconstruct the CT images from X-ray data. Tissues are more transparent to high energy X-rays and therefore less of a dose is administered (a factor of six in radiation dose reduction). Phase contrast imaging, conducted by the ESRF and the LMU-MAP teams, generates images with much less X-rays to acquire the same image contrast. Finally, the EST method, originally developed by researchers at UCLA, needs four times less radiation to obtain the same image quality.

The investigators X-rayed a human breast at multiple different angles using phase contrast tomography and applied the EST algorithm to 512 images to generate higher resolution 3D images of the organ than ever before and at a lower dose than a mammogram. In a blind assessment, five independent radiologists from the LMU categorized the resulting images as having the highest sharpness, contrast, and overall image quality compared to 3D images of breast tissue created through other conventional techniques.

“This new technique can open up the doors to the clinical use of computed tomography in the breast diagnosis, which would be a powerful tool to fight even better and earlier against breast cancer,” said Prof. Maximilian Reiser, director of the radiology department of the LMU, which provided the medical expertise for this research.

“This result has been obtained thanks to the synergy of the expertise by researchers from very different disciplines. These high-quality X-ray CT images at high energies are the result of a 10-year effort at the ESRF,” stated Alberto Bravin, head of the ESRF medical research laboratory who led the team in Grenoble. “After dramatically reducing the dose delivered during the examination of the breast, our next objective is to develop this technique in the early visualization of other human diseases and to work towards its clinical implementation,” added Paola Coan, professor of X-ray imaging at LMU and member of Munich-Center for Advanced Photonics (MAP) who led the group from Munich.

“Three-dimensional reconstructions, like the ones created in this research, are produced using sophisticated software and a powerful computer that can combine many images into one 3D image, much like slices of an orange. By rethinking the mathematic equations of the software in use today,” noted Jianwei Miao, UCLA professor of physics and astronomy and researcher with the California NanoSystems Institute at UCLA “we developed a more powerful algorithm that requires fewer slices to get a clearer 3D picture.”

The new technology is now in the research stage and will not be clinically available for a while. To be implemented in clinics, it needs an X-ray source small enough to become typically used for breast cancer screening. “Many research groups are actively working to develop this device and once this hurdle is cleared, the new X-ray technique is poised to make a big impact on society,” concluded Dr. Brun, a scientist from ESRF-LMU.

Source:
medimaging.net

MRI: MRI Proves Effective Guiding Heart Catheter Procedures

2012-10-28T00:58:00.001-07:00

Heart catheter procedures guided by magnetic resonance imaging (MRI) are as safe as X-ray-guided procedures and do not take any longer, according to a pilot study.
The findings indicate that real-time MRI-guided catheterization could be a radiation-free option to specific X-ray-guided procedures.
A report of the study, which was conducted by researchers within the intramural program of the US National Institutes of Health’s (NIH; Bethesda, MD, USA) National Heart, Lung, and Blood Institute (NHLBI), is available online October 2012 in the European Heart Journal. “This could be the first chapter of a big story,” said Robert S. Balaban, PhD, scientific director of the NHLBI’s Division of Intramural Research. “It provides evidence that clinical heart catheter procedures are possible without using radiation, which could be especially valuable in areas such as pediatrics.”

Typically, X-ray fluoroscopy pictures have higher resolution but less detail than MR images. The investigators performed transfemoral catheterization (which involves threading a catheter from the large vein in the leg to the heart) in 16 patients to evaluate the right side of the heart, including the attached veins and the pulmonary arteries. The study participants all required catheterization for heart and valve disease. The researchers conducted the procedure in the 16 patients using X-ray guidance, and then repeated it two times using real-time MRI guidance of a balloon-tipped catheter filled with air or with a contrast agent.

The X-ray and MR catheterizations were effective in 15 of the 16 participants. One patient had required the use of a wire to help guide the catheter under X-ray, and at present no guidewires are available that work under an MRI. The median procedure time for the two approaches was comparable-- approximately 20 minutes. The investigators anticipated the MRI-guided procedure to take much longer because an MRI-compatible catheter can be harder to see in an MRI-generated image than a traditional steel catheter can be in an X-ray-generated image.

“Developing safe and conspicuous catheter devices for MRI is the chief obstacle to overcome before this approach can be widely applied at hospitals,” said study lead Robert J. Lederman, MD, a senior investigator in the NHLBI’s Cardiovascular and Pulmonary Branch. “But with improved tools and further improvement of the procedure, real-time MRI catheterization may become a realistic option for many people.”

Dr. Lederman’s research group is still performing MRI catheterization on further patients, and is currently designing improved catheters and other application that will be more observable under MRI to help advance the technology. The NHLBI investigators also hope to utilize MRI to guide nonsurgical catheter treatments in the future, in addition to guiding catheter procedures.

NHLBI plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers US health education campaigns on healthy weight for children, women and heart disease, and other topics.

Source:
medimaging.net

Men's Health: Task Force Recommends Against Hormone Replacement Therapy for Postmenopausal Women

2012-10-25T11:49:00.001-07:00

The United States Preventive Services Task Force recommends against the use of estrogen and progestin for the prevention of chronic medical conditions in postmenopausal women
and the use of estrogen alone for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. Following a review of 51 articles published since 2002, the Task Force concluded that risks associated with these hormone replacement therapies (HRT) outweigh the chronic disease prevention benefits. The Task Force found that both estrogen alone and estrogen plus progestin reduce the risk for fractures, but increase risk for stroke, thromboembolic events, gallbladder disease, and urinary incontinence. Estrogen alone decreased risk for breast cancer. Estrogen plus progestin increased risk for probable dementia and breast cancer. The risk for breast cancer increased for women with prior oral contraceptive use, prior menopausal estrogen plus progestin therapy, or current smoking. The recommendations apply to average-risk women who have undergone menopause, and are not about the use of hormone therapy to treat symptoms of menopause, such as hot flashes or vaginal atrophy. These recommendations match the Task Force's 2005 recommendations on HRT.

Source:
medicalnewstoday.com

Imaging IT: New DICOM Guard Technology for high patient Data safety

2012-10-24T13:06:00.001-07:00

A new Digital Imaging and Communications in Medicine (DICOM) application features proprietary data tagging technology, which allows healthcare enterprises to have complete control over security of their patient data.Dicom Systems (San Francisco, CA, USA) recently introduced its new product, DICOM Guard. The product is part of the company’s DICOM and HL [health level] 7 Interface Engine Suite.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy rule recognizes the necessity for healthcare organizations to share patient data and allows for the release of deidentified data for specific reasons. To safeguard the privacy interests of consumers, personal identifiers, such as name and social security number, are taken out of databases containing personal information. Deidentified patient data are an extremely helpful tool for the improvement of care and researchers have been using it to develop advanced medicine and healthcare practices for decades.

But even though the data is deidentified, organizations still need to have some safeguards in position, particularly if the images and patient data are stored off-site. The DICOM tagging technology deidentifies the data by removing all real patient identifiers, therefore only the owners of the original data and/or legally authorized entities can reidentify the patient. In the event that patient data becomes publicly available, there is no risk that the individual will be identified.

When a medical facility retrieves the data from Dicom Systems’ vendor-neutral archive, the DCMSYS router rapidly reidentifies the data, using DICOM Supplement 142 and Dicom Systems’ patent-pending tagging technology. No actual patient data are stored on any of the devices--the deidentification and reidentification happen on the fly, using a secure key unique to each client to encrypt and decrypt the data.

The product is currently in beta testing and will be released for general availability later in 2012.

Dicom Systems also offers a 100% secure web-based DICOM and HL7 routing, transformation, and interface engine appliance for clinics, hospitals, and diagnostic imaging centers.

Source:
hybridcars.com

Ultrasound: Collaborative Efforts to Develop Medical Ultrasound Practice Guidelines

2012-10-22T13:36:00.000-07:00

American medical societies have collaborated on a guideline that comprises indications for an ultrasound examination for a focused reproductive endocrinology and infertility scan.
The guideline recommendations include (but are not limited) to monitoring of ovulation induction and stimulation.

The American Institute of Ultrasound in Medicine (AIUM; Laurel, MD, USA) has collaborated on the development of the AIUM Practice Guideline for the Performance of a Focused Reproductive Endocrinology and Infertility Scan. The American College of Osteopathic Obstetricians and Gynecologists, the American College of Nurse-Midwives, American College of Osteopathic Obstetricians and Gynecologists, American Society for Reproductive Medicine--Society for Reproductive Endocrinology and Infertility, and Association of Women’s Health, Obstetric and Neonatal Nurses provided input to help bring this document to completion.

Collaboration between the organizations began at the AIUM’s 2010 Ultrasound Practice Forum: Point-of-Care Use of Ultrasound, held in Orlando (FL, USA) in November 2010. Joshua Copel, MD, who chaired the collaborative group, stated, “The AIUM has a long history of collaboration with sister medical organizations in developing practice guidelines. The AIUM’s philosophy is that the specialty of the physician doing an ultrasound examination should not matter--they should be done consistently and well by all practitioners. This guideline is another step in that direction. I am grateful to the volunteers from each of the collaborating organizations for the hard work they put into writing this guideline and to the leadership of those organizations for their support of the process.”

Source:
hybridcars.com

Nuclear Medicine: The specificity and overall accuracy of F-18-FLT were considerably higher than F-18-FDG PET both during and after radiation therapy.

2012-10-21T04:49:00.002-07:00

Determining the optimal treatment course and predicting outcomes may soon become simpler for head and neck sqaumous cell carcinomas (HNSCCs) patients with the use of a new investigational imaging agent.
A new study found that positron emission tomography (PET) imaging with 3'-deoxy-3'F-18-fluorothymidine (18-F-FLT) during treatment and early follow-up has the potential to predict therapeutic responses and identify patients needing close follow-up to identify recurring or persistent.

Tumor response to therapy is typically tracked by the assessment of tumor size change by anatomic imaging modalities. Whereas several studies have demonstrated that F-18-fluorodeoxyglucose (FDG) PET may be used to gauge response, the agent may generate false-positive findings. The study’s investigators set out to determine if F-18-FLT, a recently developed imaging compound, would also be valuable in predicting response to HNSCC therapy.

“In experimental models, reduced FLT uptake preceded reduced FDG uptake, suggesting that decreased cell proliferation precedes changes in glucose metabolism,” noted Hiroshi Hoshikawa, MD, from the department of otolaryngology, faculty of medicine, Kagawa University (Kagawa, Japan), and lead author of the study. “However, there are few clinical studies comparing FLT-PET and FDG-PET findings for radiotherapy.” The study’s findings were published in the October 2012 issue of the Journal of Nuclear Medicine.

In the study, 28 patients with HNSCCs underwent F-18-FLT and F-18-FDG PET imaging before radiotherapy treatment, four weeks after the start of therapy and five weeks after the conclusion of therapy. Uptake of both of the agents was calculated in primary and metastatic lesions.

F-18-FLT uptake during the radiation therapy dissipated in 34 of 54 lesions (63%); the negative predictive value was 97%. F-18-FDG uptake also had a high negative predictive value (100%) during radiation therapy, but only nine lesions (16%) demonstrated absence of FDG. Moreover, the specificity and overall accuracy of F-18-FLT were considerably higher than F-18-FDG PET both during and after radiation therapy. These results indicate that F-18-FLT PET is more beneficial for evaluating early loco-regional clinical outcomes and helping to avoiding unnecessary radical surgery.

“With the development of new molecular imaging agents, it’s now up to clinical researchers to utilize them to assess the characteristics of malignant tumors and their therapeutic response to chemotherapy, radiotherapy and molecular targeting therapy,” concluded Dr. Hoshikawa. “We hope that our findings will be helpful in understanding the significance of F-18-FLT-PET.”

Source:
medimaging.net

Psoriasis: Investigation found a clear association between psoriasis and diabetes

2012-10-19T11:18:00.001-07:00

An analysis of 27 studies linking psoriasis in 314,000 individuals with diabetes has found strong correlation between the scaly skin rash and the blood sugar disorder that predisposes patients to heart disease, say UC Davis researchers who led the review.The findings appear in an article titled "Psoriasis and the risk of diabetes: a systematic review and meta-analysis," which is now online in the Archives of Dermatology.

"Our investigation found a clear association between psoriasis and diabetes," said April Armstrong, assistant professor of dermatology at UC Davis and principal investigator of the study. "Patients with psoriasis and their physicians need to be aware of the increased risk of developing diabetes so that patients can be screened regularly and benefit from early treatment."

Psoriasis is a common skin problem that tends to run in families. It causes a raised red, flaky and sometimes itchy rash, often on the elbows and knees, although it can appear anywhere. It is believed to be an autoimmune disease, in which the body regards its own skin as foreign and mounts an inflammatory response.

Armstrong and her colleagues combined data from 27 observational studies of patients with psoriasis, in what is known as a meta-analysis. Five of the studies assessed the incidence of diabetes - that is, how many patients with psoriasis developed diabetes during the course of a study, which ranged from 10 to 22 years. The other studies assessed the prevalence of diabetes - how many patients already had diabetes at the outset of a study. Altogether, the studies evaluated more than 314,000 people with psoriasis and compared them to 3.7 million individuals (controls) without the disease.

Some of the studies classified patients by disease severity. The aggregate data for these studies showed that patients with mild psoriasis are over 1.5 times more likely to have diabetes than the general population while those with severe disease are nearly twice as likely. Among studies that assessed incidence, patients with psoriasis had a 27 percent increased risk of developing diabetes compared with the general population.

All but one study analyzing incidence found a link between psoriasis and diabetes. These studies included patient data from outpatient clinics, insurance claims and hospitals. Diabetes rates were similar in patients despite ethnicity or country where the study was conducted.

"The large sample size and consistent association between psoriasis and diabetes make these study findings very strong and suggest an underlying physiological link between the two diseases," said Armstrong, who directs the Dermatology Clinical Research Unit at UC Davis and the teledermatology program.

While additional research is need to understand how the two diseases are associated, Armstrong believes altered immune pathways may make psoriasis patients more susceptible to developing diabetes.

"There is evidence that fat cells in psoriasis patients may not function normally," she said. "These cells secrete inflammatory substances known as cytokines that increase insulin resistance in the liver and muscle and initiate destruction of insulin-producing cells in the pancreas."

Additional research will also clarify other potential limiting factors in the current study. For example, the study's authors noted that epidemiological or observational studies can be susceptible to confounding factors, such as concurrent medications used to treat psoriasis that may modulate the risk of developing diabetes.

Armstrong's study adds to a growing body of research that shows psoriasis is not just skin deep. "We know patients with psoriasis and hypertension tend to require more aggressive therapy to bring their blood pressure under control," said Armstrong. "We also know that psoriasis patients have higher rates of heart attacks, strokes and cardiovascular-related deaths than the general population. Primary-care physicians need to be aware of these underlying predispositions to disease to provide the best care to their patients."

Armstrong and her colleagues plan to examine endothelial cells - cells that line blood vessels - to better understand the underlying physiological basis of psoriasis. They also are collaborating with other research institutions to develop a network to share clinical data on patients with psoriasis.

Source:
medicalnewstoday.com

Nuclear Medicine: New Radiation Treatment Significantly Increases Survival Rate

2012-10-17T13:15:00.002-07:00

A novel drug that mimics a naturally occurring molecule found in coffee and blueberries has been developed to treat radiation exposure. Charles R. Yates, Pharm.D., Ph.D., and colleagues Duane Miller, Ph.D., and Waleed Gaber, Ph.D.,
from the University of Tennessee Health Science Center and Baylor College of Medicine, show that application of this drug, starting 24 hours after radiation exposure, increases survival in animal models by three-fold compared to placebo.

Their work, which is funded through an NIH grant from the National Institute for Allergy and Infectious Diseases, is being presented at the 2012 American Association of Pharmaceutical Scientists (AAPS) Annual Meeting and Exposition, the world's largest pharmaceutical sciences meeting, in Chicago, Ill., Oct. 14 - 18.

"Development of drugs for individuals who are exposed to high-dose radiation in a public health emergency has been a priority since the 9/11 terrorist attacks," said Yates. "The ultimate goal is wide dissemination of non-invasive treatments after 24 hours of a mass casualty."

The high risk of vomiting after radiation exposure proves problematic for oral treatments, the most common non-invasive delivery method. Injectable medication is often proposed as the next line of defense, which comes with its own challenges. For example, training is often required for injections. To combat this problem, Yates and his team designed a new delivery system that can be applied directly to the skin, similar to an adhesive bandage.

"We are extremely proud to have exclusive rights to this exciting technology," said W. Shannon McCool, D.Ph., president & CEO of RxBio, the entity that has licensed the technology from the University of Tennessee Research Foundation.

This drug is also highly effective in models where radiation exposure is combined with skin wounds - a likely scenario in which people are exposed to shrapnel from dirty bombs or associated burn wounds.

Source:
insurancenewsnet.com

Cosmetic Medicine: Sea cucumbers and sea urchins are able to change the elasticity of collagen within their bodies

2012-10-15T12:31:00.001-07:00

Sea cucumbers and sea urchins are able to change the elasticity of collagen within their bodies, and could hold the key to maintaining a youthful appearance, according to scientists at Queen Mary, University of London.
The researchers investigated the genes of marine creatures such as sea urchins and sea cucumbers, known as echinoderms. They found the genes for "messenger molecules" known as peptides, which are released by cells and tell other cells in their bodies what to do.

The study was published online in the journals PLOS One and General and Comparative Endocrinology.

Project leader Professor Maurice Elphick, from Queen Mary's School of Biological and Chemical Sciences, said: "Probably the most exciting discovery from our research was finding genes encoding peptides that cause rapid stiffening or softening of collagen in the body wall of sea cucumbers.

"Although sea urchins and sea cucumbers may not look much like us, we are actually quite closely related to them. As we get older, changes in collagen cause wrinkling of our skin, so if we can find out how peptides cause the body wall of a sea cucumber to quickly become stiff or soft then our research might lead to new ways to keeping skin looking young and healthy."

The scientists analysed the DNA sequences of thousands of genes in the purple sea urchin Strongylocentrotus purpuratus and the edible sea cucumber Apostichopus japonicus and specifically searched for genes encoding peptide messenger molecules. Rapid advances in technology used to sequence genes made the research possible.

"When the human genome was sequenced over a decade ago it cost millions of pounds - now all of the genes in an animal can be sequenced for just a few thousand pounds," Professor Elphick said.

"We also found that sea urchins have a peptide that is very similar to calcitonin, a hormone that regulates our bones to make sure that they remain strong," Professor Elphick said.

"So it will be fascinating to find out if calcitonin-type peptides have a similar sort of role in spiny-skinned creatures like sea urchins."

"These types of advances in basic science are fascinating in their own right but they are also important because they underpin the medical breakthroughs that lead to improvement in the quality of people's lives."

Source:
medicalnewstoday.com

Drinking alcohol and smoking have to throw together

2012-10-14T05:22:00.000-07:00

New research verifies previous studies by Dr. Timothy Durazzo and his colleagues, showing that smoking, while trying to quit drinking alcohol, impairs learning, memory, and other cognitive skills, hindering successful sobriety.
Alcohol dependency, cigarettes, and the military
Dr. Durazzo comments:

"Given our strong and consistent research findings in both Veterans and civilians on the ill-effects of chronic smoking, we truly hope to see smoking cessation programs become increasingly available for our current active-duty war fighters."

Active duty US soldiers have a 10 percent higher rate of smoking than the general US population. After a soldier becomes inactive, they statistically run greater risks of alcohol and substance abuse, as well as mental illness.

In 2007, more than 375,000 Veterans Affairs patients reported suffering from a substance abuse problem, and close to 500,00 more patients had a nicotine dependence. According to the authors, cigarettes and alcohol, when combined, have a stronger derogatory effect on cognitive function and brain biology.

Dr. Darazzo explains:

"Our results suggest that it is a high priority to offer comprehensive smoking cessation treatment for all patients, especially for those seeking treatment for alcohol and substance abuse, given the high prevalence of smoking in these individuals."

Genetic variables
Earlier studies have shown that differences in the COMT and BDNF genes have an impact on cognitive function. Consequently, the researchers desired to find out if variants in these genes explained the substandard cognitive performance they constantly saw in their smoking, alcohol dependent patients.

Durazzo and his team studied 70 (majority male) Veterans seeking treatment for alcohol dependence. They examined the effects of cigarette smoking and genetic influences on cognitive function after at least 1 month of sobriety.

Findings revealed, after controlling the influence of these genotypes, that smokers performed notably worse than non-smokers on evaluations of general intelligence, learning and memory, global cognitive abilities, and processing speed. Critically, within the smoking group, more years of smoking were associated with worse cognitive function.

Complete functioning in these areas can help individuals to incorporate the treatment they receive into their everyday lives. In general, the findings, published in Frontiers, confirmed their earlier research and gives support to the rising movement to make smoking abstinence programs more common at the start of alcohol and substance abuse treatments. Studies frequently report that smokers have a greater risk of relapse to alcohol or substances than non-smokers.

Source:
medicalnewstoday.com

Value-based pricing is one potential solution to reduce the cost of drugs

2012-10-10T13:34:00.001-07:00

A virtual monopoly held by some drug manufacturers in part because of the way treatment protocols work is among the reasons cancer drugs cost so much in the United States, according to a commentary by two Mayo Clinic physicians in the October issue of the journal Mayo Clinic Proceedings. Value-based pricing is one potential solution, they write.
Cancer care is not representative of a free-market system, and the traditional checks and balances that make the free-market system work so efficiently in all other areas are absent when it comes to most cancer treatment," write authors, Mustaqeem Siddiqui, M.D., an oncologist and Vincent Rajkumar, M.D., a hematologist.

For example, when it comes to antibiotics to treat a given infection or over-the-counter painkillers, a physician or patient can choose between multiple drugs that do the same thing. But cancer drugs are administered to patients sequentially or in combination, creating a virtual monopoly for each drug. This is one of the principal reasons for the high cost of cancer therapy.

Other factors include the expense of drug development; the high price that patients and insurers are willing to pay for even modest improvement in outcomes; and a lack of regulations such as a cost effectiveness analysis to account for economic and value-based considerations in the drug approval and pricing process, the physicians write.

Solutions the authors recommend include:

    Value-based pricing that includes discrete metrics such as an incremental cost effectiveness ratio per quality-adjusted-life-years gained, as a result of a particular treatment. Quality-adjusted-life-years is an estimate of the number of years added to a patient's life by a specific drug intervention, adjusted for quality of life.
    A U.S. Food and Drug Administration mandate requiring drug companies to submit a value dossier when seeking drug approval. This information would give patients and physicians the ability to make better-informed decisions about treatment.
    Centers for Medicare and Medicaid Services powers to negotiate payments for cancer drugs.
    Improved national cancer guidelines providing evidence-based analysis of quality of life, mortality data, benefits, risks and cost for all possible treatment options.
    Monopoly rules to determine if a particular drug will operate in a monopoly situation. Such drugs would be subject to legally mandated or voluntary price controls in exchange for expedited approval or other remedy.
    Non-profit generic drug companies to manufacture and distribute generic cancer drugs at a very low cost.

Source:
medicalnewstoday.com

Subcutaneous Formulation Of ORENCIA® (Abatacept) Approved By European Commission

2012-10-09T13:38:00.000-07:00

Bristol-Myers Squibb have announced that the European Commission has granted marketing authorisation for the subcutaneous formulation of ORENCIA® (abatacept), in combination with methotrexate (MTX), for the treatment of adults with moderate to severe active rheumatoid arthritis (RA).
Most of the currently available biologics for the treatment of RA are anti-TNF (anti-tumour necrosis factor) agents. Abatacept works through a different mechanism of action (T-cell co-stimulation modulation) and is the only agent available in both self-injectable, subcutaneous (SC) and intravenous (IV) formulations. Given that some patients prefer one route of administration for specific reasons, the availability of both formulations addresses the needs and preferences of patients and physicians.[1]

"ORENCIA is a true alternative to anti-TNFs - a first-line biologic therapy for RA patients that now also offers the convenience of self-administration in a subcutaneous formulation," said Prof. Dr. Rieke Alten, Chief Physician, Department of Internal Medicine, Rheumatology, Clinical Immunology and Osteology Schlosspark Clinic, Berlin. "ORENCIA provides a choice when deciding how to treat adults with moderate to severe active RA by offering a proven mechanism of action that is different from anti-TNFs."

The European approval of the subcutaneous formulation of abatacept is based on the ACQUIRE study, a pivotal phase III registrational trial, as well as long-term efficacy and safety data from supporting phase II studies. In ACQUIRE, the single largest phase III registrational trial of biologics in RA patients, the subcutaneous and intravenous formulations of abatacept were compared and shown to be similar in terms of efficacy and safety (non-inferiority comparison).

The intravenous formulation of abatacept was first approved in the European Union in May 2007 and is a well-established treatment option for adult RA patients who have an inadequate response to methotrexate alone or who have failed a first biologic DMARD.

Abatacept, in combination with methotrexate (MTX), is indicated for the treatment of moderate to severe active RA in adult patients who responded inadequately to previous therapy with one or more disease-modifying anti-rheumatic drugs (DMARDs), including MTX or a tumour necrosis factor (TNF)-alpha inhibitor.
"Many physicians use intravenous ORENCIA for RA because it has a unique mechanism of action and a well-recognised efficacy and safety profile," said Ron Cooper, President, Bristol-Myers Squibb. Europe. "We are pleased to be able to offer physicians and patients an efficacious and convenient self-administered formulation."

Clinical Trials

ACQUIRE (Abatacept Comparison of Sub[QU]cutaneous versus Intravenous in inadequate Responders to methotrexate) [iii]
In ACQUIRE, the goal was to demonstrate non-inferiority of the efficacy and comparability of the safety of subcutaneous abatacept relative to intravenous administration in subjects with moderate to severe active RA and experiencing inadequate response to MTX.

The trial, which was a randomised, multinational phase III study of 1,457 patients, showed that abatacept achieved comparable rates of efficacy for the American College of Rheumatology criteria of 20 percent (ACR20) response at month 6 in both groups of patients receiving SC injections plus methotrexate (MTX) or IV infusions plus MTX (76.1 % vs 75.7, respectively).

ACR 50 and 70 responses were comparable between abatacept SC and IV as were improvements in all patient-reported outcomes studied - pain, physical function and global assessment of disease activity for abatacept SC and IV at month 6.

At month 6, 94% of patients receiving SC injections plus MTX and 94% of patients receiving abatacept IV plus MTX remained in the study. The rate of injection site reactions (mostly mild) was similar across both patient groups, occurring in 19 (2.6%) patients receiving subcutaneous abatacept and 18 (2.5%) patients receiving intravenous abatacept.

This study demonstrated similar safety for patients treated with subcutaneous abatacept and intravenous abatacept. These results are consistent with the safety profile of abatacept.2

About ORENCIA® (abatacept)

Abatacept is a selective co-stimulation modulator of T-cell activation. It is designed to prevent full T-cell activation and inhibit the release of chemicals leading to joint inflammation and destruction as observed in rheumatoid arthritis (RA).[iv],[v],[vi],[vii].

Abatacept is the first biologic discovered and developed by Bristol-Myers Squibb and abatacept IV was first approved for adult RA in May 2007 by the European Commission.

Abatacept, in combination with methotrexate (MTX), is indicated for the treatment of moderate to severe active RA in adult patients who responded inadequately to previous therapy with one or more disease-modifying anti-rheumatic drugs (DMARDs) including MTX or a tumor necrosis factor (TNF) inhibitor. A reduction in the progression of joint damage and improvement of physical function has been demonstrated during combination treatment with abatacept and MTX.

The new self-injectable formulation can be administered weekly through an injection under the skin following a single IV loading dose. Patients who are unable to receive an infusion may initiate weekly injections of subcutaneous abatacept without an intravenous loading dose.

The most frequently reported adverse reactions (≥ 5%) among abatacept-treated patients are headache, nausea, and upper respiratory tract infections. In younger patients, side effects are similar to adults. For the full list of all side effects reported with abatacept, see the Product Information.

Abatacept should not be prescribed to persons who are hypersensitive to abatacept or any of the other ingredients. It must not be used in patients with severe and uncontrolled infections, such as sepsis or opportunistic infections. Patients who receive abatacept are given a special alert card that explains this restriction and instructs them to contact their doctor immediately if they develop an infection during a course of treatment.[viii]

The intravenous formulation of abatacept, in combination with MTX, is also indicated for the treatment of moderate to severe active polyarticular Juvenile Idiopathic Arthritis (pJIA) in paediatric patients six years of age and older who have had an insufficient response to other DMARDs, including at least one TNF inhibitor. Abatacept has not been studied in children under six years old.

For a full description of abatacept, including efficacy and safety profile, please consult the Summary of Product Characteristics (SmPC):

About Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic, chronic, autoimmune disease characterized by inflammation in the lining of joints (or synovium), causing joint damage with chronic pain, stiffness, swelling and fatigue. RA causes limited range of motion and decreased joint function.

In Europe, more than 2.9 million people are affected by RA,[ix] a condition which can severely impact patients' quality of life and can lead to increased mortality and morbidity.[x] The condition is more common in women, who account for 75% of patients diagnosed with RA.[xi]

With appropriate treatment, patients can achieve better clinical outcomes, resulting in more active days and improved well-being.[xii]

Abatacept is one of the biologic treatment options indicated in adult patients with moderate to severely active RA for patients who respond inadequately to previous DMARDs. The approval of the new subcutaneous formulation will offer one more option, giving some patients the opportunity to treat themselves at home.

Source:
medicalnewstoday.com

Cardiology: Heart Attack Mortality Risk Greater For People With Schizophrenia

2012-10-07T01:47:00.001-07:00

The risk of death resulting from heart attack is higher in people with schizophrenia than in the general public, according to scientists at the Centre for Addiction and Mental Health (CAMH) and the Institute for Clinical Evaluative Sciences (ICES).
On average, people with schizophrenia have a lifespan 20 years shorter than the general population. This is partly due to factors such as smoking, increased rates of diabetes, and metabolic problems brought on by the use of some antipsychotic medications. These factors often worsen once a cardiac condition arises because people with schizophrenia are less likely to make the necessary lifestyle changes, such as diet and exercise, to offset the problem.

This study, published online in Schizophrenia Research, examined mortality and access to cardiac care after heart attacks (acute myocardial infarction) in those with schizophrenia.

Dr. Paul Kurdyak, Chief, Division of General and Health Systems Psychiatry at CAMH, analyzed four years of Ontario-wide patient data and tracked all incidents of heart attack among people with schizophrenia, and compared results to people without schizophrenia.

"When we looked at the data, we found that people with schizophrenia were 56 per cent more likely to die after discharge from hospital following a heart attack than those who did not have schizophrenia," says Dr. Kurdyak, also an Adjunct Scientist at ICES. "We also found that patients with schizophrenia, despite the increase in mortality risk after a heart attack, were half as likely to receive life-saving cardiac procedures and care from cardiologists than those without schizophrenia."

Specifically, the study found that people with schizophrenia were 50 per cent less likely to receive cardiac procedures or to see a cardiologist within 30 days of discharge from hospital.

"The numbers tell us that people with schizophrenia - the ones who are at most risk to develop and subsequently die from heart attacks - are not receiving adequate care," says Dr. Kurdyak. "The possible solutions are two-fold: prevention is one. We need to support patients whom we know are at risk of developing medication-related metabolic issues by working with them to provide strategies to offset weight gain, such as healthy eating and physical activity. The other part is aftercare - the mental health care team, primary care providers, and the cardiac specialists need to work together to ensure that patients are seen again after a first incident of heart attack."

Source:
medicalnewstoday.com

MRI: Supposed Benign Condition Shown to Alter Brain Function in the Elderly

2012-10-06T04:30:00.000-07:00

Researchers are reporting that a common condition called leukoaraiosis, comprised of tiny areas in the brain that have been deprived of oxygen and appear as bright white dots on magnetic resonance imaging (MRI) scans, is not a harmless part of the aging process, but instead a disease that changes brain function in the elderly.
The study’s findings were published August 2012 online in the journal Radiology. “There has been a lot of controversy over these commonly identified abnormalities on MRI scans and their clinical impact,” said Kirk M. Welker, MD, assistant professor of radiology in the College of Medicine at Mayo Clinic (Rochester, MN,USA). “In the past, leukoaraiosis has been considered a benign part of the aging process, like gray hair and wrinkles.”

Leukoaraiosis, also known as small vessel ischemia, and frequently referred to as unidentified bright objects (UBOs) on brain scans, is a disorder in which diseased blood vessels lead to small areas of damage in the white matter of the brain. The lesions are typical in the brains of people over the age of 60, although the amount of disease varies among individuals. “We know that aging is a risk factor for leukoaraiosis, and we suspect that high blood pressure may also play a role,” Dr. Kirk M. Welker said.

Dr. Welker’s team performed functional MRI (fMRI) scans on cognitively normal elderly participants recruited from the Mayo Clinic Study of Aging between 2006 and 2010. In 18 participants, the amount of leukoaraiosis was a moderate 25 milliliters, and in 18 age-matched control participants, the amount of disease was less than five milliliters.

The patients were imaged in an MRI scanner as they performed a semantic decision task by identifying word pairs and a visual perception assignment that involved differentiating straight from diagonal lines. fMRI is a specialized type of imaging that measures metabolic alterations in an active part of the brain.

Although both groups performed the tasks with equal effectiveness, the fMRI scans revealed different brain activation patterns between the two groups. Compared to members of the control group, patients with moderate levels of leukoaraiosis had atypical activation patterns, including decreased activation in the brain regions involved in language processing during the semantic decision task and increased activation in the visual-spatial areas of the brain during the visual perception task.

“Different systems of the brain respond differently to disease,” Dr. Welker explained. “White matter damage affects connections within the brain’s language network, which leads to an overall reduction in network activity.”

He pointed out that identifying leukoaraiosis in the brain is important, both for individual patients undergoing brain mapping for surgery or other treatments and for research studies.

For improved neurologic health, Dr. Welker said efforts should be taken to prevent leukoaraiosis from occurring. “Our results add to a growing body of evidence that this is a disease we need to pay attention to,” he said. “Leukoaraiosis is not a benign manifestation of aging but an important pathologic condition that alters brain function.”

Source:
medimaging.net

New Maryland Law Enables Consumers To Select Qualified Physicians

2012-10-04T14:02:00.001-07:00

A new Maryland law effective today requires physicians who publicize board certification to announce their certifying board as well as their speciality.
Additionally, the law states the only acceptable, certifying boards, are the 24 members of the American Board of Medical Specialities (ABMS), the authoritative speciality board for all U.S. physicians.

Dr. Henry Garazo, a plastic surgeon certified by the ABMS-member American Board of Plastic Surgery (ABPS), believes this bill is a step in the right direction for consumers by helping the public choose the right doctor within the correct speciality.

Particularly important for plastic surgery patients, the law will help weed out many doctors from other specialities who are not properly trained in plastic surgery.

Dr. Garazo explains:

    "An educated patient is an empowered patient. After years of confusion and delay, Maryland patients will now know if a 'cosmetic surgeon' is a real plastic surgeon. Given the recent rise in popularity of plastic surgery, many non-plastic surgery trained physicians have been calling themselves cosmetic surgeons and going to weekend courses in an attempt to perform cosmetic surgery. Previously there was no requirement, with many only stating they were 'board certified.' Many of my patients were shocked to learn that a 'cosmetic surgeon' was in fact a family medical doctor or ER physician with no formal training in plastic surgery. They didn't even know!"

Until this point, any licensed doctor could perform cosmetic surgery in a non-certified, office setting, and call themselves a "cosmetic surgeon". Without proper training, patient safety, as well as desired outcomes, could be endangered. The new Maryland law will enable patients to choose competent doctors by identifying which surgeons have proper training, and whether he or she is certified to be doing the services they advertise for.

Board certification is somewhat complicated, especially as it applies to plastic surgery. Apart from the ABMS, a nonprofit that has come up with professional standards for doctors to serve the public interest, there are many self-appointed boards in the U.S. that are not verified by the ABMS, many of which include cosmetic surgery procedures. Doctors will now be unable to advertise that they are "board-certified" by one of these unapproved boards.

Previous research has shown that most patients want a board certified plastic surgeon to perform their reconstructive or cosmetic procedures. Due to lack of regulations and controversial marketing techniques, it has been tough for the consumer to truthfully determine a doctor's speciality.

ABPS board certification is a grueling, voluntary process of peer review and examination with precise requirements on training and education. In regards to plastic surgery, to be certified by the ABPS, a candidate must complete the following:

    Must be a graduate of an accredited medical school
    Have finished a prerequisite surgical residency program (generally 3 to 5 years)
    Have completed training in an approved plastic surgery program (2 to 3 years)
    Have been recommended for ABPS certification by a chairperson of their training program
    Have passed a written and an oral exam
    Have submitted inventory of all operations performed
    Meets ABPS ethical and moral standards

The passing of this law will ensure that Maryland consumers are picking an honest and qualified plastic surgeon who was specifically trained in their specific discipline.

Source:
medicalnewstoday.com

Imaging IT: Healthcare Organizations Utilize Enterprise Services to Fast-Track Health IT Purchases

2012-10-03T15:03:00.001-07:00

New enterprise services help healthcare providers predict operational and information technology (IT) costs and control ongoing costs while deploying enterprise-wide health IT systems.
Siemens Healthcare (Erlangen, Germany) announced several recent Soarian health IT sales that were strengthened by Siemens ability to deliver a range of cloud computing and managed services. More healthcare organizations are now shifting to electronic health records (EHRs) that provide a platform for an enterprise-wide approach to health IT. In today’s reimbursement environment, it is increasingly important for those organizations to challenge conventional ideas of enterprise IT as a cost center, and Siemens is helping customers create a more sustainable approach to health IT implementations with a range of options from operations to system management to infrastructure and application support.

Helping customers deploy health IT solutions amid an unstable financial climate is a mandate of Agenda 2013, a two-year global initiative of Siemens Healthcare to increase its competitiveness and innovative capacity. “The concept of sustainability has never been more important to healthcare organizations than in today’s environment, where many of our customers do business in highly competitive markets and contend with an oftentimes challenging payor mix,” said David Hamilton, senior vice president, enterprise services, Siemens Healthcare. “Our aim is to assist customers in finding ways to more predictably budget for health IT, while helping them ensure that key operational goals are met in a timely manner.”

Katherine Shaw Bethea (KSB) Hospital (Dixon, IL, USA) is an 80-bed community hospital that signed a 10-year agreement to implement a full range of Soarian Clinicals including Soarian Critical Care and Soarian Emergency Department (ED), along with Siemens medication management solutions, Soarian Device Connect, Soarian electronic document management (EDM), Decision Support Solutions, Soarian Quality Measures, and ePrescribing.

KSB Hospital initially was operating in a best of breed IT environment and had chosen Siemens to provide only the solutions that filled the functional gaps to address the requirements to attest to Meaningful Use (MU) of a certified electronic health record. However, the cost-effective cloud computing option available for the Soarian system helped minimize capital costs and Siemens presented a roadmap to help KSB Hospital administration begin planning an enterprise-wide clinical health IT implementation. Moreover, Siemens was able to help KSB Hospital staff expedite the implementation timeline. KSB Hospital was looking for strong clinical functionality, significant computerized physician order entry (CPOE) adoption, cost-effective price, and ability to adapt the system as their needs change.

“As we evaluated solutions, we began to realize that Siemens had a road map and a commitment to helping move us beyond thinking about best-of-breed solutions and to start thinking about an enterprise clinical IT solution that could be extended all the way out to our ambulatory practice community,” said Tim Broos, vice president and chief information officer, Katherine Shaw Bethea Hospital. “In particular, Soarian’s workflow engine hard-wires efficiency across the organization to support quality of care improvement and cost reduction.”

At 342 licensed beds Woman’s Christian Association (WCA) Hospital (Jamestown, NY, USA), recently signed a four-year term extension that also included the addition of the Soarian enterprise health IT suite including Soarian Clinicals and Soarian Financials, as well as EDM, and Siemens medication management solutions. Located in a small, New York town, WCA Hospital also contends with a challenging payor mix. Soarian across the WCA Hospital enterprise will provide a smooth flow of data, while decreasing the need to use bolt-on third-party applications.

“It was readily apparent that we could realize significant efficiency gains from expanding the breadth of our Siemens health IT portfolio across clinical departments,” said Keith Robison, CIO, WCA Hospital. “Soarian will allow us to collect data in new ways and present a more complete view of the patient to our clinicians so information entered about a patient in the ED will be seamlessly presented to all acute care providers.”

Source:
medimaging.net

Ultrasound: Partnership to Offer Advanced Needle Guidance technology

2012-10-02T13:03:00.001-07:00

New needle guidance solution helps make central venous catheter procedures “point-and-shoot” simple to improve care quality and reduce healthcare costs.
SonoSite, Inc. (Bothell, WA, USA), a subsidiary of FujiFilm Corp. (Tokyo, Japan) and a leader and specialist in bedside and point-of-care ultrasound, announced a partnership with Soma Access Systems, LLC (Greenville, SC, USA) to bring AxoTrack needle visualization technology to market on SonoSite ultrasound systems.

This innovative technology combines traditional ultrasound imaging with sophisticated magnetics to provide clinicians with a real-time update of the needle position that can be visualized as it travels through tissue to its intended target. This capability is ideal for placing central venous catheters (CVC) as clinicians try to rapidly gain vascular access while avoiding critical structures.

“The integration of AxoTrack technology into SonoSite’s product portfolio will help to address the ‘multi-tasking’ challenges faced by many clinicians during the performance of CVCs,” said Kevin M. Goodwin, SonoSite’s president and CEO. “Avoiding the lung while coordinating the needle and ultrasound probe during these procedures can be difficult. Preexisting health conditions, like low blood pressure, create a greater patient risk. AxoTrack’s proprietary needle guidance capabilities coupled with its ‘point-and-shoot’ simplicity help clinicians follow the needle position and make confident decisions to successfully complete these procedures. Based on the overwhelmingly positive response already from physicians across the globe, we believe that AxoTrack will advance the practice of ultrasound-guided CVCs, improving patient outcomes, and will ultimately reduce costs from complications like pneumothorax.”

This advanced technology engineered by Soma is intended to improve the safety and accuracy of central venous access by providing clinicians with specific, real-time knowledge of the needle location throughout an entire procedure. An in vitro study using AxoTrack resulted in vascular access procedures that were effective on the first pass and first stick 99.3% of the time versus just 37.1% of the time when compared to the standard freehand method for ultrasound-guided central venous access.

“AxoTrack represents a major advance in needle guidance for medical procedures. Our patented technology, engineered during eight years of research and development, is designed to improve the safety of CVCs. We also believe that it will enhance the quality of care for a broad range of other needle-guided procedures, like biopsy, nerve block, cyst aspiration, arthrocentesis, thoracentesis, and paracentesis,” said M. Dexter Hagy, president and CEO of Soma Management, LLC. “We are proud to partner with SonoSite to bring AxoTrack to market as we work together to help make healthcare safer, simpler, and more cost effective.”

Source:
medimaging.net