MR Elastography Growing as Preferred Modality for Liver Diagnosis
Published on the Jan. 24, 2013 DiagnosticImaging.com website
By Whitney L.J. Howell
Once available only to radiologists who purchased new MRI equipment, MR elastography technology is becoming widely available as an upgrade feature to older machines. This expansion not only greatly improves patient care, industry experts said, but it also impacts costs and efficiency.
MR Elastography (MRE) — now available at 100 locations on five continents — is the industry-preferred method for assessing liver stiffness or elasticity. This condition characterizes liver disease and is most often diagnosed through palpation. However, there is a limit to how much tissue providers can feel. While conventional MRI is a powerful tool, liver disease, such as fibrosis or cirrhosis, creates no anatomical changes to the organ, making identification difficult and often requiring a needle biopsy.
“MR elastography provides a safer, more comfortable, non-invasive alternative to
Richard Ehman
liver biopsy for assessing liver disease,” said Richard Ehman, MD, professor and chair of radiology at the Mayo Clinic in Minnesota, noting that needle biopsies are often painful.
Being able to analyze liver health in a faster, more reliable way is particularly important now, he said, as the level of obesity and the associated fatty liver disease is rising in the United States. Currently 1 in 3 Americans lives with fatty liver disease, and within 10 years, he said, this condition will be the leading cause for liver transplant. MRE is also beneficial in diagnosing and treating the 25 percent of Hepatitis C patients who develop liver fibrosis, the large build-up of proteins in the liver that eventually leads to cirrhosis.
What Is MRE and How Does It Work?
Approved by the FDA in 2009, MRE is a non-invasive, highly-sensitive method for determining the level of liver disease through the use of low-frequency mechanical waves. It is designed to facilitate faster diagnosis and avoid potentially dangerous — and often inaccurate — liver biopsies, said Ehman, who pioneered the MRE technology and worked with GE Healthcare to bring it to market.
Once installed, this tool pumps 60 Hz waves through a plastic tube to a small, non-metallic drum placed over the abdomen. Slower wave movement correlates to higher stiffness. Standard MRI imaging captures the miniscule movements of the tissue, and, using a special algorithm, converts the data into a color-scale picture that corresponds to the level of liver stiffness.
MRE differs from ultrasound elastography. With the ultrasound method, a probe is pushed across tissue, and a scanner records how the tissue deforms. However, Ehman said, this doesn’t provide a quantitative measure of the tissue’s actual stiffness.
According to Ehman, an MRE scan can be completed with four breath holds — approximately a minute — and is often conducted and billed as part of other abdominal MRI protocols. Based on the color-scale picture, radiologists can instantaneously know whether the patient has a healthy or diseased liver. Liver tissue stiffness is measured in kiloPascals (kPa), with a normal liver having a stiffness of roughly 2 kPa, the same consistency of fat inside the body. Diseased livers range from 3 kPa to more than 10 kPa.
Since MRE’s FDA approval, GE Healthcare has been the main vendor for the tool with its MR Touch product. Siemens has also worked with the Mayo Clinic to provide MRE on its existing MAGNETOM Aera and Skyra MR machines.
Overall, said Richard Hausmann, GE’s president and CEO officer of global MR business, MRE greatly enhances what MRI studies provide.
“MRE offers an accurate assessment of stiffness in the liver, even for deeper tissues not reached by palpation,” he said. “It’s helped increase confidence in diagnoses in this area, and it’s one piece in an attempt to make overall diagnosis less invasive.”
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/mri/content/article/113619/2124974
Communicating Risks of Contrast Agents to Patients
Published on the Jan. 29, 2013, DiagnosticImaging.com website
By Whitney L.J. Howell
One of the most commonly used imaging tools in a radiologist’s arsenal is the contrast agent. It enhances the appearance of structures and fluids, but it isn’t without risks and challenges. And, it’s up to radiologists, industry experts say, to make sure your patients and staff understand how to use it and why.
While less than 1 percent of patients experience a negative response to a contrast agent, according to a Mayo Clinic study, everyone involved with a scan using contrast should be aware of all possible outcomes and know how to handle them. The American College of Radiology offers guidance in how to best administer these agents, but creating the optimal experience for the patient involves more than selecting the right agent and using the correct measurement.
“You’re giving someone a drug, and there’s a risk to that. Patients have to understand that risk,” said Lawrence Marks, MD, chair of radiation oncology at the University of North Carolina at Chapel Hill School of Medicine. “They have to understand the value of the test, but like everything else in medicine, your actions should be based on a discussion with the patient before you do it.”
Educating the Patient
Although the risks can be minor, you should always consider if using contrast is even necessary, said Jeffrey Kanne, MD, associate professor of thoracic imaging and quality and safety vice chair at the University of Wisconsin School of Medicine and Public Health. If you can obtain the same information with the same level of specificity without using an agent, then do so, he said. That is always the safest option.
However, if contrast media is necessary, make it as easy to understand as possible. Like many procedures in radiology, the use of contrast media includes complex terminology that is potentially unfamiliar to patients. Always explain what the contrast media is and what it does in basic terminology — then, employ the teach-back method.
“Make sure you have patients explain back to you what you said. It’s a very valid way of ensuring patients truly understand,” Kanne said. “If they can recount back, you know they understand. If not, it’s clear you haven’t communicated effectively, and you need to try a different approach.”
One such strategy is a patient education website that addresses the risks associated with contrast media and tells patients what information you will need to ensure not only their safety, but also the best imaging results. For example, the University of Washington Medical Center maintains a patient education page that answers questions about need and risk in easy-to-understand language.
In addition, be willing to sit with patients and give them the opportunity to voice their questions and concerns. The most common worry patients have, Kanne said, is the misconception that contrast agents are radioactive. Others — many of whom experienced previous-generation contrast agents — fear the procedure will be painful and cause a burning sensation.
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/contrast-agents/content/article/113619/2125650
Duke’s Steve Nowicki finds out what songbirds have to say
Published in the Feb. 4, 2013, Raleigh News & Observer and Feb. 4, 2013, Charlotte Observer
By Whitney L.J. Howell
Deep in a North Carolina marsh, a lone swamp sparrow sits on his perch in the middle of the water. He’s singing his usual song. But he’s also aggressively flapping one wing, trying to incite a nearby male into action. Onlookers are watching – just to see what happens.
However, this is no ordinary territorial scuffle. This is bird research. The sparrow on the perch is a robot, and the chief, hip wader-clad onlooker – who is also in control of the robot’s movements – is Steve Nowicki, Ph.D., a biology, psychology, and neurobiology professor at Duke University. He’s testing whether the wing flap will actually prompt a fight.
According to Nowicki, birdsong and signaling have a surprisingly close relationship
Stephen Nowicki, Ph.D., Professor Dean of Undergraduate Education
Jared Lazarus – Duke Photography
with human speech.
“It’s an unexpected and remarkable model for human speech control, development and perception,” he said. “Birds also learn their songs in much the same way humans learn to speak, and that’s an unusual trait. They have to learn their language from their parents.”
His research, though, isn’t about merely studying how birds behave and communicate. He and his team watch signals and behaviors; they run simulations and analyze hormones; they record neurons and assemble protein sets. They’re deciphering how birds promote their survival and reproductive success. In short – they’re studying evolution, past and present.
Why birds?
Nowicki, who is also dean and vice provost of undergraduate education, was almost the bird researcher who wasn’t. As a student at Tufts University in Boston, he was a declared music major. Late in his collegiate career, he discovered a love of biology – particularly the brain and behavior – and raced to complete a major in the subject. He then pursued his graduate degree in neurobiology at Cornell University.
It was there he was first introduced to the siren song of birds. When it comes to communicating, birds have far less to say than humans. But they express themselves in equally complex ways, Nowicki said.
“Humans use complicated signal communication, and we use an array of sounds to create words that have rich meanings,” he said. “When you look at sparrow songs – the number of notes per second and the frequency – it’s just as complicated as human speech. They’re just not saying much.”
All the same, they’re getting their points across.
Songs, signals
In addition to the aggressive response the swamp sparrow’s wing flap provokes, the absence or introduction of song or even a physical attribute can prompt birds to behave differently, Nowicki said.
Birds, like most animals, are territorial and will, in most cases, defend their turf. But how will neighboring birds respond if a battle ensues? Will they come to help or avoid the fight? Will they treat the male differently if he loses to the interloper? Researchers can test this reaction, Nowicki said, by removing a bird from its environment, playing a recording of another male’s song, and, then, reintroducing the bird to see how the others respond.
“It’s interesting to see what happens, because no one wants a floating male in the neighborhood,” he said. “Research has shown that with some birds, peer birds are more wary of the winner, but they might also try to encroach on a loser’s territory.”
A swamp sparrow states his case: According to Duke University biologist Steve Nowicki, birdsong and signaling have a surprisingly close relationship with human speech. PHOTOS BY ROB LACHLAN
And, just as with other species, birds can use their physical attributes to signal to and communicate with each other. For example, a trait, such as a bright red neck and throat commonly seen in the male house finch, can broadcast a bird’s prowess or superior qualities. The red-throated male finch does attract more females, Nowicki said, but it isn’t because of the color. The pigment comes from a carotenoid-rich diet that gives these males a stronger immune system, making them better mates.
Male song sparrows use their song repertoire in much the same way. The more songs they learn and exhibit, the more attractive they are to females. The reason, Nowicki said, is that birds with larger song selections appear to be smarter. They simply learn songs faster.
“Males who sing better have better developed brains, and in theory that makes them better mates,” he said. “We’re still working out why having a better brain for learning song is better for the female, but it’s clear females prefer these males as their mates.”
Impact on human activity
Understanding the role and importance of birdsong and signaling doesn’t shed much light on the evolution of human communication, but knowing what songs and signals mean to birds can directly affect human choices and behavior.
For example, researchers have evidence that stress directly affects a bird’s ability to develop song, which can ultimately impact pair bonding and mating. If scientists study the way birds living in both polluted and pristine environments sing, the data could play a role in accurately evaluating ecosystem health.
This knowledge can also impact wildlife preservation efforts. It isn’t enough to allocate a certain amount of space to a population based only on the number of animals surveyed. There are often other factors at work, Nowicki said. In the case of the small warbler ovenbird, it’s important to know that females won’t be setting in an area with fewer than 10 males. This type of information can significantly alter conservation efforts, he said.
Regardless of how the research of birdsong is used, Nowicki said, his work constantly reminds him of how intertwined birds and music are with our surroundings.
“I keep coming back to birdsong not simply because it’s a good model,” Nowicki said. “When I wake up in the morning and hear birds singing, it’s part of the wonderful aesthetic world we live in, and my job to learn more about it is a privilege.”
Radiologists Should Worry About Medical Device Tax, Too
Published on the Jan. 10, 2013, DiagnosticImaging.com website
By Whitney L.J. Howell
On January 1, the long-debated and much-opposed medical device tax went into effect. To date, medical device manufacturers have clearly stated their opposition, but industry leaders portend practicing radiologists also have reason to be concerned.
Barely a week old, this measure levies a 2.3 percent tax on all medical devices. The law calls for manufacturers to pay for the tax added to the sale price of the device, but many worry the cost will not only trickle down to providers, but will also, ultimately, stymy the progression of patient care by hindering research and development efforts.
“As radiologists, most of us chose the specialty because it’s a field that incentivizes technological innovation that can make enormous differences in patient care,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Economics Commission. “Payment or health care policies that would, in any way, negatively impact innovation are things that make us feel uncomfortable.”
The device tax will inevitably impact practitioners’ bottom lines, she said. The actual dollar amount is yet unknown, but manufacturers will be forced to pass some of the tax increase on to their customers. The price hike will likely be an unwelcome addition to existing imaging reimbursement cuts and the difficulties radiologists already face with collecting payments from patients. Equipment purchasing decisions could become more complicated or could be postponed, she said.
In addition to individual monetary concerns, radiologists should also worry about what the medical device tax could mean for their ability to provide the most up-to-date patient care. According to the Medical Imaging and Technological Alliance (MITA), this initiative is a job-killer because it makes outsourcing jobs overseas more attractive. But research and development efforts will also be a casualty, said MITA Executive Director Gail Rodriguez.
According to a recent MITA survey, 29 percent of manufacturers anticipate slicing into their research and development budgets as a way to cover the anticipated $287 million associated with the device tax. This change could leave providers without new technological innovations for treating patients, MITA said.
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2122393
Radiation-induced Cancer Risk: Timing Is Important
Published on the Dec. 24, 2012, Diagnostic Imaging website
By Whitney L.J. Howell
Are medical imaging tests as dangerous — or perhaps more so — than the disease they’re used to detect? It’s a question often asked by patients, referring physicians, and the news media. As radiologists have acknowledged the risk associated with CT scans, the industry has taken steps to keep doses as low as possible without compromising the quality of the study.
However, when making decisions about the use of certain imaging, the timing of radiation-induced cancer risks is also important to consider, according to Harvard assistant professor of radiology Pari Pandharipande, MD, MPH. In the January 2013 issue of Radiology, Pandharipande, also an abdominal radiologist at Massachusetts
Harvard assistant professor of radiology Pari Pandharipande, MD, MPH
General Hospital, and her colleagues explored the importance of considering the relative timing of when a patient experiences a disease and when they incur radiation-induced cancer risks from an imaging study.
Diagnostic Imaging spoke with Pandharipande about this research.
Why did you decide to look at the risk associated with disease versus the risk of radiation-induced cancer from CT?
I’m a genitourinary and gastrointestinal radiologist by training, and I read a lot of scans for patients who are being followed with CT after treatment for testicular cancer. As part of my clinical practice, I know they receive a lot of scans at a young age. In collaboration with one of the oncologists here at Massachusetts General Hospital, I became interested in looking at what the radiation-induced cancer risks of those scans were over a lifetime relative to the risks of the disease itself.
When we conducted this analysis, we found that while the lifetime mortality risks from surveillance CT scans are slightly less than from testicular cancer, the loss of life expectancy attributable to the CT scans is much less. This is because of the delayed timing of deaths from radiation-induced cancers relative to deaths from testicular cancer itself.
That’s how this project came about: We want to do the best by these patients, and in that process, we have to try and understand how the risks from CT might affect them. Our goal is to reduce CT-related cancer risks for this patient group, but as a first step, we need to understand how these risks manifest over the lives of these patients.
Why is it important that people are aware of the timing of cancer risks from CT?
The concepts that we present regarding the importance of the timing of radiation-induced cancer risks can be applied to any disease process in which there’s an immediate risk that a physician is trying to avoid through imaging — one that would occur sooner in life than the risk of radiation-induced cancer from imaging. The difference in timing must be considered when you make an imaging decision because timing changes the relevance.
Risks incurred later in life are not the same as those faced in the present. That is the take-home message.
When you boil down this comparison, what is it that policymakers and referring physicians need to realize?
An important element to recognize is that while the metric of “life expectancy loss” does capture the timing of different risks over a population’s lifetime, reported life expectancy loss, in modeling studies, is averaged over a population and isn’t experienced by an individual patient. Most people understand risk as a certain chance of experiencing a particular event in their lives. It’s a challenge to figure out how to explain the importance of timing to a person — to explain what it means and deconstruct it in a way that’s understandable.
I hope this paper highlights that risks from radiation-induced cancers are conceptually difficult and that more research and effort should be placed on risk communication and physician and patient decision-making. Simply pointing out a risk to someone, be it a physician or a patient, is not enough guidance. We have to include the idea of timing, as well.
To read the remainder of the Q&A at its original location: http://www.diagnosticimaging.com/low-dose/content/article/113619/2121105?pageNumber=1
Clinical Decision Support in Radiology: Its Time Is Now
Published on the Dec. 27, 2012 Diagnostic Imaging website
By Whitney L.J. Howell
There’s been a great deal of discussion in recent years about using clinical decision support (CDS) systems to ensure that imaging studies ordered and performed are appropriate. But the use of such systems in radiology isn’t a new idea. For the past decade providers and policymakers have discussed the proper use and implementation of CDS programs.
In the December issue of the Journal of the American College of Radiology, Hanna Zafar, MD,
Hanna Zafar, MD, assistant professor radiology at the Hospital of the University of Pennsylvania
assistant professor radiology at the Hospital of the University of Pennsylvania, discussed the history, benefits, and challenges associated with CDS systems in radiology. Diagnostic Imaging spoke with her about this paper.
We were trying to convey that the policies regarding clinical decision support addressed in the American Recovery and Reinvestment Act (ARRA) did not appear overnight but were built on a long legislative history. Since 2003 policymakers have been interested in the use of CDS both for health care in general, as well as public reporting and radiology through the use of financial incentives and penalties. ARRA builds on the foundation established by this prior legislation in order to try and improve the quality, deliver and reporting of imaging procedures.
What are the major benefits of using CDS? What is the impact?
It’s important to understand that the implementation of CDS in imaging is part of a continued pattern to improve the quality, delivery and reporting of imaging procedures. Imaging CDS was not created to penalize radiologists or target imaging negatively. It is also important to remember that CDS is only applicable to those situations where evidence based guidelines exist.
CDS provides several benefits to clinicians, radiologists and patients. The chief benefit to clinicians is that it educates providers on evidence-based guidelines relating to imaging at the time of image order entry. That last phrase is critical because although many excellent guidelines exist, it’s not feasible for clinicians to refer to those guidelines at the time of ordering an imaging examination. The fact that these guidelines can be distilled into key clinical questions allows the system to interact with and give feedback to the provider in a seamless manner. Imaging CDS can also reduce inappropriate or redundant studies by providing alternative imaging procedures that are better suited to answer a clinical question per evidence-based guidelines or by highlighting the results of prior, potentially relevant, imaging procedures to help reduce redundant testing.
CDS also provides several benefits to radiologists. On a concrete level, it requires the input of relevant and pertinent pieces of clinical history into the physician order entry at the time of the clinical study order. If available to radiologists at the time of study interpretation, this clinical information can be extremely helpful in how we evaluate and interpret reports.
Specifically, this clinical data can help us to better understand why a clinician is ordering a study and to ensure that our report answers the critical clinical question for the provider and the patient. Reduction of inappropriate and redundant testing is also beneficial to radiologists in that it allows us to focus on appropriate imaging procedures. Radiologists, similar to other specialties, want to improve patient care through the optimal use of diagnostic imaging and of health care resources.
Finally, from the patient perspective, imaging CDS can improve patient safety through avoidance of unnecessary radiation from inappropriate or redundant procedures and the effect of unnecessary downstream procedures, such as the management of incidental findings.
On a more global note, imaging CDS offers a very exciting and novel opportunity to tie utilization of evidence-based imaging guidelines with patient outcomes. Imaging-related outcomes have long been a grey zone for radiologists because we don’t order imaging procedures, and we often don’t have easy or reliable access to relevant clinical history. Access to outcomes data will be valuable for us as radiologists, and it will be increasingly important for future policy and legislative decisions.
Are there challenges to implementing a clinical decision support system on a large scale?
The success of imaging CDS in reducing inappropriate imaging procedures thus far has been demonstrated in single institutional or health system studies and within a handful of states. We are optimistic that these results can be replicated on a larger national scale. However, this remains to be seen. An important point to remember is that even though there are no guarantees that imaging CDS utilization will translate necessarily or easily into improved quality and outcomes, it will bring us closer to understanding the relationship between guidelines and patient outcomes. This knowledge will allow us to begin to improve imaging utilization.
As for challenges in imaging CDS implementation, there are several that we can anticipate and others that we will likely have to address as they come. One of the main anticipated challenges is that imaging CDS relies on the existence of high quality guidelines. To date, imaging CDS has focused on clinical areas involving such guidelines as the use of lumbar spine MRI for lower back pain or CT pulmonary angiography for suspected pulmonary embolism. However, there are many imaging procedures that involve clinical scenarios for which we don’t have high quality guidelines. This will be an obstacle.
Another challenge for imaging CDS is variability in practice patterns among geographic regions, specialties and even individual providers. For some clinicians, imaging CDS is perceived as “cookie-cutter medicine” or a waste of time. There will always be some degree of resistance to any change in medicine, but nothing powerful enough to deter the need to explore the potential of imaging CDS to improve the deliver of radiology procedures.
To read the remainder of the Q&A at its original location: http://www.diagnosticimaging.com/informatics-pacs/content/article/113619/2121063?pageNumber=1
If mice could talk and sing… (Well, maybe they can)
Published in the Dec. 24, 2012, Raleigh News & Observer and Charlotte Observer
By Whitney L.J. Howell
It’s a pretty common scene in a bar or club on any given Friday or Saturday night. One, maybe two, guys are eagerly chatting-up the hot girl with the cocktail in her hand. They’re trying their best to be witty, to be charming, to do anything to potentially win her affections – even using each other’s best lines.
Until now, however, no one considered that mice might be doing the same thing. But they could be. In fact, they’re probably more aggressive about it. Male mice don’t stop at pleasant conversation. They’ll chase a female while singing to her and trying to smell her.
Strange as it all may sound – and it does defy conventionally held beliefs about the ability of mice to “talk” – Erich Jarvis, Ph.D., neurobiology associate professor at Duke University, and his team
Erich Jarvis, Ph.D., neurobiology associate professor at Duke University, and his team have discovered that mice may have some of the same brain features that humans and song birds use for vocalizations and pitch changes. Erich Jarvis, Ph.D., neurobiology associate professor at Duke University, and his team have discovered that mice may have some of the same brain features that humans and song birds use for vocalizations and pitch changes. (2006 AP file photo)
have discovered that mice may have some of the same brain features that humans and songbirds use for vocalizations and pitch changes.
“It’s accepted dogma that humans and songbirds are the only beings that have the four brain areas needed to produce vocalizations,” said Jarvis, who is also a Howard Hughes Medical Institute investigator. “Based on our research, we believe mice have more limited versions of these behavior and brain traits.”
The HHMI, National Science Foundation, and the National Institutes of Health funded Jarvis’ research.
The findings indicate that male mice may be able to learn how to change their vocalizations to match another male mouse. If correct, scientists may be forced to reconsider a belief they’ve held for 60 years – that vocal learning is unique to humans and a small cadre of songbirds.
The experiment
With his former grad student Gustavo Arriaga, Jarvis used gene expression markers, which lit up neurons in the motor cortex – the part of the brain involved in planning, control and voluntary movement – of each mouse’s brain while they sang. When these song-specific neurons were damaged, the mice couldn’t keep their songs on-pitch or consistently repeat them, verifying their connection to vocalization.
In addition to the markers, the team injected a tracer to map the signals that controlled the songs as they migrated from neurons in the motor cortex to the brainstem and on to the larynx muscles. According to Jarvis, this direct channeling from motor cortex to larynx was the biggest surprise and puts into question whether these projections in mice work the same way as in humans and birds: Can mice learn vocalizations?
To make this determination, the team first had to record the sounds
Post-doctoral research assistant Gustavo Arriaga, left, and neurobiologist Erich Jarvis study singing mice at Duke University’s Bryan Research Building.
JARED LAZARUS – DUKE UNIVERSITY
mice make. They placed a pair of male mice in a cage with a single female to prompt communication and used a 4-inch high-sensitivity microphone to capture the sounds. The powerful microphone was necessary because mice “speak” at a frequency between 30 and 40 KHz – too high-pitched for humans to detect. Humans hear sounds between 14 and 15 KHz.
Jarvis’s team monitored 12 pairs of male mice over an 8-week period to see whether they began to imitate each other or the pitch of their songs converged. They conducted the experiment twice, and by the eighth week, he said, the less-dominant mouse had modified its song to emulate the dominant male.
By digitally modulating the recordings to a frequency audible to humans, the investigators demonstrated that, by the end of the experiment, the male mice had virtually identical songs.
“The mice were changing their pitch so the smaller animal matched the song of the larger male,” Jarvis said. “This is a simple form of imitation – it’s pitch. Until now, it was thought that they didn’t have this ability for vocal learning.”
The controversy
Not everyone agrees with these findings, however. Kurt Hammerschmidt, a vocalization expert at the German Primate Center, is reticent to fully accept that mice can be true vocal learners. The problem, he said, is that Jarvis’ team simply didn’t analyze a large enough number of mice.
“Fewer animals is OK in neurobiological studies because we know anatomical structures found in one animal are also present in other animals,” Hammerschmidt said. “But with behavioral studies, we need more animals to look at motivation, arousal and experience.”
Hammerschmidt and other scientists worldwide have conducted experiments similar to Jarvis’s and have not replicated his findings. Hammerschmidt also disagrees that pitch convergence alone indicates that mice are vocal learners.
“All other studies focused on male courtship songs failed to find any evidence that learning is involved in the development of these vocalizations,” he wrote. “None of all other terrestrial mammals, except humans, are able to produce new sounds.”
Future implications
Additional research is needed, Hammerschmidt said, to verify whether Jarvis’s findings are correct.
If Jarvis and his team are correct, though, these findings could impact both science and health care.
Although mice don’t have the same speaking ability as humans have, understanding their potential capacity for vocal learning could shed light on how speech works in people, as well. It could open the door for further research into the brain’s circuitry and the basic principles of speech, Jarvis said.
The greatest impact of this research, however, could be its effect on neurological disease, he said. In particular, autism is the brain disorder that has the biggest impact on speech, and the NIH and Congress have invested millions to study the causes and biological makeup of this condition. In these studies, investigators have been able to take the gene variant from a child with autism and put it into the mouse genome, but they’ve been unable to pinpoint which area of the brain is affected. This research eliminates that limitation.
“Now, we have the brain pathway for them to look and play around with,” Jarvis said. “It could open the door for some gene drug therapy on this part of the brain or help determine how we can affect the whole system.”
Interventional Radiology and Radiation Oncology: Together Again?
Published on the Dec. 6, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
Decades ago, radiology and radiation oncology decided to separate, giving rise to two distinct specialties. But times and technologies have changed, and it is, perhaps, time for two branches of radiology to consider a close relationship, said one industry expert.
During this year’s RSNA annual meeting last month in Chicago, William Shipley, MD, a radiation oncology professor at Harvard Medical School and chair of the Massachusetts General Hospital Genitourinary Oncology unit, proposed a partnership between radiation oncology (RO) and interventional radiology (IR).
“With all our new training and new societies, perhaps we’ve gone too far away from each other,” he said. “To survive as a specialty, we must adapt and look at which areas could marry.”
But is such a pairing necessary? According to Shipley, yes. Both RO and IR are facing challenges that they could better weather together. A paradox exists in RO, he said. As the specialty has become for technologically advanced, it has ceded many of its duties to other types of providers. For example, medical oncologists and surgeons frequently conduct patient evaluations, ablation, and brachytherapy procedures. IR faces a similar concern — unless these providers assume clinical responsibility for patients, they will lose ground to physicians who can acquire and learn to use the same imaging equipment.
“There are remarkable parallels between interventional radiology and radiation oncology,” he said. “I believe they’re running on the same track and at the same gauge. It’s time for their train tracks to merge.”
RO and IR would still continue as separate specialties. The goal, he said, would be to create a new certification — image-targeted oncology — for those residents interested in mastering skills in both areas. There’s already a great deal of overlap. RO has already become more imaging based, mirroring IR with its use of 3D, 4D, and stereotactic imaging. In addition, both types of providers use the same technologies, such as needles and ultrasound equipment. And, both still hold to continuing the oral exam.
In order for this merger to work, RO and IR must both bring attributes to the table. According to Shipley, RO would bring model of training that includes cancer biology, staging, chemotherapy strategy, and a process of care that incorporates medical and surgical oncology. Conversely, IR would offer a broad portfolio of therapies, including an ablative therapy that is complementary to radiation therapy.
“Radiation oncology is very good at irradiating the microbes of small-volume disease. And, most ablative technologies handle larger tumors, but they don’t address microscopic disease,” Shipley said. “Imagine how powerful it could be if we put them together.”
The advantages of combining these two branches of radiology would extend beyond offering a new training track to medical students and residents, he said. Patients who need these services would also benefit.
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2118473
Wanted: Radiology Resident Leaders
Published on the Nov. 26, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
CHICAGO — With challenges looming on nearly every front, radiology needs a new group of strong leaders to navigate the trials and strengthen the profession, industry experts said at this year’s RSNA annual meeting.
Given proper leadership training, current radiology residents are positioned to be the profession’s next generation of leaders. But their training — if not already underway — must begin now if they’re going to fill the current void in the industry, said Richard Gunderman, MD, professor and vice chair of radiology at the University of Indiana.
“There are lots of radiology departments in the United States that lack leadership. Many have titular leaders, but in fact, they’re not being led or they’re being led poorly,” he said. “A lot of capability of the faculty and resident is lying dormant, and people are becoming more disengaged and discouraged than invigorated and encouraged.”
He recommended that faculty engrain in their residents the importance of team work — group accomplishment over individual successes — and embrace a leadership model that encourages others to work to their potential and contribute to either their practice or department.
It’s also paramount, he said, to encourage residents to think creatively so they will be best prepared to tackle future roadblocks.
“The single most important aspect of our residents isn’t their technical skills or their cognitive knowledge base. It’s their imagination,” Gunderman said. “What are we doing to foster the development of imagination in this next generation of radiologists?”
And, that creativity and outside-the-box thinking will be vital to addressing the difficulties the industry already knows are coming. Declining reimbursement, a new payment model, decreasing case volume, and encroaching teleradiology companies are just a few of the changes that threaten to erode the influence radiology departments and practices currently enjoy, said Vijay Rao, MD, chair of radiology at Jefferson Medical College at Thomas Jefferson University.
Surviving these trials requires a cultural shift in priorities that must start with residents, she said. Rather than perpetuate the culture of entitlement that is pervasive in many corners of radiology, faculty and private practitioners should teach residents to focus on quality and putting the patient first.
“We need to cultivate professionalism and eradicate apathy in the profession,” she said. “We must focus on reducing or eliminating inappropriate studies and doing the right thing by the patient.”
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2116427
Who am I?
I’m a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree
in international print journalism from The American University in Washington, D.C. I launched my journalism career as a stringer for UPI on Sept. 11, 2001, on Capitol Hill. That day led to a two-year stint as a daily political reporter in Montgomery County, Md. As a staff writer for the Association of American Medical Colleges, a public relations specialist for the Duke University Medical Center and the public relations director for the UNC-Chapel Hill School of Nursing, I’ve earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.
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