A transverse CT image of the Iceman’s right hip joint (l) shows evidence of osteoarthritis, as manifested by proliferative bone, osteosclerosis, and small round subarticular lucent areas. A frontal radiograph (r) of the Iceman’s chest and upper abdomen shows caudal rotation of the ribs, as well as a fracture of the left humerus acquired during the recovery effort.

Imaging Reveals “Iceman” Suffered From Modern Ailments

Modern imaging techniques have revealed that the 5,300-year-old “Iceman,” discovered in 1991 in the Tyrolean Alps, suffered from such modern ailments as arthritis and vascular calcifications.
A study published in the March issue of Radiology reports that researchers were able to use x-ray, portable computed radiography, and conventional and spiral CT imaging to document the bones and tissues of the preserved body without damaging it. The research, conducted between September 1991 and June 2001 by a team of researchers led by William A. Murphy, Jr, MD, professor of radiology at the University of Texas MD Anderson Cancer Center, Houston, showed evidence of degenerative arthritis, frostbite, and calcification.
The researchers said that the first trials of 3D reconstruction from medical image data sets were done with the Iceman data and early use of the rapid prototyping technology stereolithography, which uses CT image data to build 3D models one layer at a time. According to the imaging research, the Iceman may have had degenerative disk disease in his neck, as well as painful arthritis of the right side of the pelvis and hip, common modern ailments. Radiological images also documented several types of injuries including healed rib fractures and an arrowhead lodged between the left shoulder and nearby rib cage, the likely cause of death. In fact, imaging showed that the arrow appears to have severed a blood vessel, which, combined with freezing temperatures, led to the death.
Researchers believe that the Iceman was well preserved because the combination of hot, direct sun and cold, dry air mummified the prehistoric corpse. The images also reflected tissue changes caused by natural dehydration due to the environment, which left the skin, muscle tissue, and organs severely shrunken.

Study Reports on Link Between Radiation Therapy and Lung Carcinoma

A new study that looked at the risk of lung carcinoma after radiation therapy (RT) in women treated with lumpectomy or mastectomy for primary breast carcinoma contained both good news and bad news.
The study, conducted by Lydia B. Zablotska, MD, PhD, and Alfred I. Neugut, MD, PhD, both of the College of Physicians and Surgeons, Columbia University, New York, revealed that postmastectomy RT was found to provide a moderate increased risk for ipsilateral lung carcinoma starting 10 years after exposure. However, the researchers also found that postlumpectomy RT does not appear to incur such an increased risk.
The researchers used data from the population-based Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute, encompassing about 10% of the US population, from 1973 to 1998. Of the women with nonmetastatic invasive breast carcinoma, 194,981 had been treated with mastectomy and 65,560 were treated with lumpectomy.
The authors estimated a relative risk of 2.06 and 2.09 for ipsilateral lung carcinoma at 10-14 years and 15+ years after postmastectomy RT, whereas no increased risk was observed for the contralateral lung. The excess risk of ipsilateral lung carcinoma after postmastectomy RT was found for all three major histologic subtypes of lung carcinoma: adenocarcinoma, squamous cell, and small cell. No increased risk of lung carcinoma was observed at 10-14 years after postlumpectomy RT for either lung.
Also, the increased risk was reported to persist to at least 20 years.

Scully Warns of Physician Payment Cuts

T.S. Eliot wrote that April is the cruelest month, and, in an ironic twist worthy of that notion, the restoration of Medicare physician reimbursement to 2002 levels slated to go into effect on April 1, is likely to be short-lived. A new report from the trustees of the Medicare Hospital Insurance Trust Fund presents a dire outlook for higher Medicare payments. The report on the Medicare Part B trust fund points to a significant increase in the volume of physician services contributing to the growth of Medicare spending in 2002. The fallout, according to Centers for Medicare & Medicaid Services Administrator Thomas A. Scully, will be future negative updates in the Medicare conversion factor that governs physician reimbursements.
Scully said the agency is projecting that reimbursements will be cut in 2004 and in following years. The report also predicted that the Medicare fund will run dry by 2026, 4 years earlier than projected last year. In addition, Medicare’s inpatient hospital spending rose 9.8% in 2002. Scully said that hospitals must now be prepared to accept that more information on quality of care will be made public and that Medicare reimbursement will be linked to quality measures. He also said that CMS will build a consensus with the Federation of American Hospitals and the American Hospital Association on how to release more quality information.
According to the trustees report, during 2002, Supplementary Medical Insurance benefits grew 11.3% on an aggregate basis, and 10.1% on a per capita basis. According to the report, a contributing factor was “significant growth in the volume and intensity of services performed by physicians, as well as about 20% growth in durable medical equipment and physician-administered drug expenditures.” Last year, reimbursement payments were cut by 5.4%.
That loss was scheduled to be regained when the US Senate approved a $54 billion fix in the physician update formula, resulting in a 1.6% update in the conversion factor, scheduled to take effect April 1.
The 1.6% increase will mean a net increase in technical component payments of around 6% or more for 2003, bringing Medicare payment for most of these services back to 2002 levels or higher. Final passage of the bill is expected soon, along with President Bush’s signature.

Malpractice Reform Bill Passes House

The House of Representatives has passed a new bill that would ensure fair compensation to patients injured by medical negligence and make reforms to the medical liability system.
HR 5, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003, sets limits on non-economic and punitive damages, offers proportionate liability among all parties, and allows for periodic payment for future damages. The cap on noneconomic damages would be $250,000, with no limit on actual damages.
Incidentally, the Medical Group Management Association, Boulder, Colo, recently conducted a poll of practices and physicians to determine liability premiums. Respondents faced an average premium increase of 53.15% between 2002 and 2003, and in response to that increase, 26.1% of practices indicated that their physicians would retire, relocate, or restrict their services over the next 3 years. In addition, 14.1% of practices said they would no longer treat certain high-risk patients as a result of the premium increases.
The Senate was expected to introduce its own reform bill.

Industry News

Research Systems Inc, Boulder, Colo, and the Nuclear Medicine Group of Siemens Medical Solutions USA Inc, Malvern, Pa, have announced the formation of a strategic partnership to bring RSI’s Watsyn” software development platform to Siemens’ e.soft nuclear medicine workstation…Sectra, a Swedish IT and medical technology company, has signed a partnership agreement with RIS Logic, Solon, Ohio. Through this partnership, Sectra’s PACS system will be fully integrated with RIS Logic’s radiology information system…Fuji Photo Film Co, Stamford, Conn, has announced that its medical products division in Greenwood, SC, has begun totally integrated manufacturing of the newest generation of dry medical imaging film for the North American market…Konica Medical Imaging, Wayne, NJ, has announced the new formation of its services offerings, “Konicare Technical and Professional Services.” Konicare represents the significant services infrastructure investment being made by Konica Medical Imaging in highly trained service specialists and aggressive service programs that can be customized to create unique maintenance strategies…American College of Radiology (ACR), Reston, Va, has opened a satellite office on Capitol Hill effective March 3. The new office will allow ACR officials and staff easier and more timely access to Congressional members, and will
provide a new location for ACR’s fund-raisers and receptions…TeraRecon Inc, San Mateo, Calif, has been presented with the 2002 Market Engineering Product Differentiation Innovation Award by Frost & Sullivan. The award recognizes TeraRecon’s successful adoption of new or existing technology that has become a part of its product family…Voxar Ltd, Edinburgh, Scotland, launched a newly branded upgrade of its flagship 3D software, Voxar 3D, at the European Congress of Radiology. The company also showcased the release of Voxar Colonscreen version 2.2…NightHawk Radiology Services, Coeur d’Alene, Idaho, has been nominated in two categories for the 2003 American Business Awards. NRS has been recognized in the categories for “Most Innovative Company” and the “Best Overall Company.”

Trouble Ahead

The chart illustrates the debt service coverage of more than 3,000 US hospitals. Debt service coverage equals the amount of times EBDIT (earnings before depreciation, interest, and taxes) covers the annual principal and interest payments, or debt service. According to an article in the March issue of Trustee magazine by Joshua Nemzoff, president, Nemzoff & Co, New Hope, Pa, a hospital with debt service coverage of less than 1.5X is potentially in financial trouble. For example, if the EBDIT margin is 5% or less and coverage is 1.5X or lower, very serious problems can be expected.

Room at the Top

Rosaleen Parsons, MD

Rosaleen Parsons, MD, has been appointed chair of the diagnostic imaging department at Fox Chase Cancer Center, Philadelphia. She was previously clinical director of the department. Parsons is a counselor for the Radiological Society of North America, and is an oral board examiner for the American Board of Radiology for the genitourinary section. …The American Society for Therapeutic Radiology and Oncology (ASTRO), Fairfax, Va, has announced the following staff changes: James Roberts has been hired as the division director of education, meetings, and corporate relations; and Trisha Crishock has been promoted to director of healthcare policy and economics. She previously served as assistant director…BioLucent Inc, Aliso Viejo, Calif, has announced that Jill Anderson has been appointed as company president. She has served as vice president for the previous 2 years. In that role, she created marketing, sales, and promotional tools for the Woman’s Touch? MammoPad? breast cushion, the company’s initial product. Anderson came to BioLucent from Salick Health Care Inc, Los Angeles, where she was vice president…Agfa-Gevaert has announced that the board of directors has appointed Marc Gedopt as chief financial and administration officer to succeed Andre Bergen. Most recently, Gedopt was CEO and chairman of the managing board of NIB Capital and NIB Capital Bank…Roman Janer has been appointed chief technology officer for Fischer Imaging Corp, Denver. He most recently served as vice president of technology for Hologic Inc.