· Close-Up: MR for MS
· Pediatric Imaging: FDA Consumer Update
· Reducing Dose, Not Image Quality

Close-Up: MR for MS

Web video produced by the Multiple Sclerosis Association of America seeks to delve further into the topic of magnetic resonance and how the modality impacts the lives of those living with MS.

“A Closer Look at the Value of MRIs” is a new video produced by the Multiple Sclerosis Association of America.

“A Closer Look at the Value of MRIs” is the latest addition to the organization’s “A Closer Look” series, an online video archive that provides viewers with an extensive resource guide. Incorporating problem-solving techniques, the three-part video features an MS patient offering a firsthand experience about undergoing an MR exam, a neurologist discussing how the scanner works, and an MSAA representative explaining financial options.

“As the title suggests, we wanted to focus a positive light on the value of MRI scans and encourage clients to seek the important information these tests provide,” said Robert Rapp, MSAA vice president of programs and evaluation. “In doing so, we wanted to help lessen the potential fear and apprehension about the exam and what to expect at the imaging center by having a fellow patient share her personal account of the process and benefits, offer an easy-to-understand medical explanation of the science behind the machine and the images, and inform people about the easy process of working with MSAA to obtain an MRI exam.”

According to Rapp, during the past decade, MS research has demonstrated magnetic resonance’s value in monitoring disease activity. Furthermore, research has shown the effectiveness of early treatment with FDA-approved medications that lessen the frequency of attacks and slow the disease’s progression. Rapp pointed out that MR is one of the most important tools used to diagnose and treat MS.

“In fact, MS cannot be formally diagnosed without an MRI scan that shows lesions have formed in the brain or spine,” Rapp continued. “The value of MRI scans to clinicians does not end there. Since MS can often be subclinical with continued progression without the appearance of increased symptoms, MRI assists physicians in determining proper treatments and increases their ability to effectively manage the disease.”

Partnering with pharmaceutical companies EMD Serono Inc and Pfizer Inc, MSAA established the MRI Institute Program, which has supported more than 3,000 MRI exams that help patients to manage their illnesses.

The Institute also has gathered data over the years—information that highlights positive lifestyle adjustments made after receiving the exam. For instance, in the Institute’s most recent survey, 78% of respondents reported one or more of these such changes, which include being more proactive toward managing health, renewed adherence to an FDA-approved treatment for MS, improved diet and exercise regimens, and better quality of life.

The video was coordinated by MSAA Senior Director of Programs Peter Damiri in partnership with VCS Video Productions in Mount Laurel, NJ, a vendor that has helped MSAA with all of its Web videos. Rapp was happy to report that the organization’s video archive has garnered a number of accolades, including two Telly Awards, which are given to the best local, regional, and cable television commercials; film and video productions; and Web commercials, videos, and films.

“When we launched our new electronic platform of Web videos, we knew this program would work well in the growing trend of communication,” Rapp said. “Also, it provides us with an opportunity to use technology to reach out and educate more clients in more places than ever before.”

While the video is targeted toward individuals with MS and those interested in the disease, clinicians too can benefit from the presentation, Rapp said.

“This video is primarily directed toward the layperson, but our hope is that health care professionals are made aware of the programs and services of MSAA so they can refer their patients to our organization for assistance,” Rapp said. “Additionally, in his segment, Dr Diego Cadavid, a noted neurologist from University of Medicine and Dentistry of New Jersey, provides excellent data to support the growing need to use MRI as an effective tool to track disease progression and better monitor MS.”

Pediatric Imaging: FDA Consumer Update

With its recent article titled “Radiology and Children: Extra Care Required,” the FDA once again stressed the importance of optimizing CT settings for pediatric patients.

Donald Frush, MD, chair of the ACR Pediatric Imaging Commission, with a child in the CT suite.

“The individual risk from radiological imaging is quite small when compared to the benefits that it can provide through helping with accurate diagnosis,” the article states. “Still, unnecessary radiation exposure during medical procedures should be avoided. This is particularly important when the patient is a child.”

The article goes on to describe factors toward children’s sensitivity to radiation from medical imaging scans. For example, children have more rapidly dividing cells that can be exposed to low-level radiation. Additionally, youngsters have a longer expected lifetime for radiation exposure’s effect to manifest as cancer.

“The agency has advised radiology professionals to optimize CT settings based on patient weight or diameter and the part of the body of interest, reduce dose while maintaining diagnostic image quality, reduce the number of multiple scans with contrast material, and eliminate inappropriate patient referrals for CT,” the article expresses.

According to the American College of Radiology, the consumer update on pediatric imaging safety speaks to the objectives of the society’s Image Gently campaign, which works to increase awareness for the need to decrease CT radiation dose administered to children.

“The FDA article reemphasizes the Image Gently campaign objectives of optimizing CT settings for pediatric patients, educating parents on their role as their child’s advocate, and ensuring that the imaging facility and staff has undergone appropriate accreditation, such as the accreditation programs offered by the American College of Radiology,” the ACR said in a statement.

The ACR applauded the FDA’s recognition of children’s heightened sensitivity to radiation, compared to adults, and its acknowledgement of the possibility of adverse effects from radiological exams over time. “Their Center for Devices and Radiological Health is responsible for regulating medical imaging devices, which involves informing consumers about opportunities to minimize their radiation exposure,” the ACR continued.

Launched on January 22, the ACR’s Image Gently campaign has brought together nearly 1,200 imaging providers, representing more than 900 facilities across the country, who have taken the pledge to reduce the radiation dose estimate used in the performance of CT scans on children.

Participants in the Image Gently campaign include the Society for Pediatric Radiology, the American Society of Radiologic Technologists, and the American Association of Physicists in Medicine. The FDA has vowed to support the ACR’s initiative and help get its message out.

Reducing Dose, Not Image Quality

More than 82 million people in the United States are older than 50 years of age, therefore making them eligible for colorectal cancer screening. Yet, diagnostics are significantly underutilized, in part attributed to the invasive nature of current screening procedures.

The National CTC Trial conducted by the ACR Imaging Network, and other recent studies, have shown the effectiveness of virtual colonoscopy as a screening procedure. While virtual colonoscopy offers patients a less invasive option to conventional colonic polyp detection techniques, the amount of information it captures often entails tedious and taxing image review.

According to Abraham Dachman, MD, professor of radiology at the University of Chicago Medical Center, one of the most important tools that will help CT colonography be adapted to general clinical practice by new users is the addition of a high-quality CAD software option.

Working with Bruce Hillman, MD, and his team at the American College of Radiology’s ACR Image Metrix, Dachman will serve as the principal investigator for a new multireader, multicase clinical study that will assess the impact of iCAD Inc’s Colon CAD product on exam interpretation accuracy.

Most publications to date on CAD have been stand-alone trials, Dachman explained, adding that while there have been limited publications on evaluation by readers, none of them have been very large scale. The purpose of this trial is to have a large-scale reader study that shows CAD’s value in the interpretation of CT colonography.

“We want to look at the effectiveness of computer-aided diagnosis and improving the sensitivity and the positive predictor value of virtual colonoscopy without adversely affecting specificity and without unduly increasing the length of interpretation time,” Dachman said.

Managed and executed by ACR Image Metrix, the study will include up to 20 radiologists. It is expected to take about 6 months to complete, and it will involve the analysis of several hundred cases tested with virtual colonoscopy.

Dachman said he believes virtual colonoscopy will improve screening rates, although he pointed out that currently there is no hard data to prove it. However, Dachman speaks from experience. His department at the University of Chicago has been performing the procedure for years.

“I know that many of those patients are people who would have otherwise either had nothing or had an optical colonoscopy,” Dachman said. “Whether how many patients would have nothing rather than have this is very hard to know, but we do know that around only half of the patients who should be screened have been screened.”

Furthermore, there are a number of obstacles in the way of virtual colonoscopy’s acceptance into regular clinical practice. For one, while there’s a partial reimbursement for the procedure under various circumstances in at least 47 states, Dachman said he still waiting for the “big win”: across-the-board reimbursement for screening when there are no risk factors and when the patient did not have a previous failed optical colonoscopy. “That is reimbursed by few if any carriers, and that’s what we really need,” he continued. “We need a broad reimbursement for pure screening exams.”

Also, training can pose a challenge. “We have to train a large number of radiologists quickly in how to do this well,” Dachman said, adding that societies, such as the ACR, have been offering more courses. The key, he says, is hands-on interpretation of unknown, carefully selected cases.

“I disagree with the criticism that too many choices are confusing to the patient and to the doctors,” Dachman concluded. “They’ve had plenty of choices until now. I think adding one more choice, especially when it’s a good choice and it’s attracting people’s attention, can only improve things.”