Study Compares MRI and PET to Detect Mets

In a study designed to compare fluorine 18-labeled deoxyglucose (FDG) PET and contrast-enhanced MRI to determine if patients’ gastrointestinal cancer had spread to the liver, MRI detected more and smaller lesions than FDG PET. Because the number and size of lesions found plays a critical role in determining the treatment a patient receives for cancer, the results of this study challenge existing patient management protocol.

“Our study did not aim to denigrate FDG PET examinations, but to make sure the results of PET and MRI are examined appropriately, especially in patient management,” says Dushyant Sahani, MD, clinical instructor at Harvard Medical School and assistant radiologist at Massachusetts General Hospital, Boston, and one of the authors of the study. “PET is very popular for looking at metastases right now, but PET has its deficiencies; it does not have the resolution to look at small lesions, especially in the liver.”

For the study, 30 patients with 97 metastatic lesions were examined. Mangafodipir trisodium was used as the contrast agent; the agent allowed radiologists to obtain thinner image slices at a higher resolution due to the long window of contrast it provided. MRI detected 79 of the lesions, of which 33 were less than 1 cm. PET detected 65 lesions, of which 12 were less than 1 cm. According to Sahani, in a per lesion analysis, MRI had an accuracy rate of 75.5% compared to 64.1% for PET.

“Because PET works off the metabolism of tumors, it can produce false positives, especially in patients with colon cancer,” says Sahani. “Chemotherapy builds up fat, and imaging results show 30% of cancer patients have fat infiltration. When there is fat in the liver, it changes the metabolic activity there.”

According to Sahani, decision-making for liver metastases should be based on MRI. He notes that there could be tremendous economical implications of using MRI versus PET for liver examinations, since PET is more expensive than MRI, but MRI is more accurate.

The study results were presented on May 6, 2004, at the American Roentgen Ray Society Annual Meeting, Miami Beach, Fla, and is currently in the review process for publication.

ISMP Issues Transdermal Patch Warning

As many health care workers may be unaware that transdermal patches contain metallic components that may cause burning during MRI scanning, the Institute for Safe Medication Practices (ISMP) issued a warning that medication patches containing aluminized backings could cause injury if not removed before a MRI procedure.

In a case reported to the Food and Drug Administration, a patient entered the MRI scanner wearing a Habitrol 21 mg patch. His tests were stopped when he felt a burning sensation in his upper arm. Upon examination, a small, denuded blister was found where the patch was placed.

Other patches that contain metallic components and should be removed prior to MRI scanning are: Androderm, Transderm-Nitro and Deponit, Transdermscop, and Catapress-TTS.

Hospitals Face Staggering Debt

In an article featured in the May 3, 2004, issue of BusinessWeek , executives from top hospitals expressed their concerns at the grim fate of hospital finances due to increased bad debts. Faced with a growing number of patients who cannot pay their medical bills, hospitals are eating up the unclaimed costs.

Hospital stocks tumbled on Wall Street after recent statements from the nation’s largest for-profit hospital chains HCA Inc, Nashville, Tenn, Tenet Healthcare Corp, Dallas, and Universal Health Services Inc, King of Prussia, Pa, announcing warnings of low earnings for the first quarter due to bad debts.

The article cites numerous reasons for the increase in unpaid medical bills, including a high number of unemployed patients, and employers passing the burden of health care costs to employees, causing the employees to pay higher deductibles. According to the story, the nation’s hospitals piled up $22.3 billion in bad loans in 2003, nearly twice as much as there was in 1990. The amount of debt may not be decreasing in the near future, since fewer companies are providing medical coverage to employees (66% today versus 69% in 2000).

Since a 1986 federal law mandates that hospitals must accept everyone regardless of their financial means, hospital executives are implementing plans to recover some of the debt payments. HCA, Tenet, and others have begun providing discounts to low-income patients, hoping that the smaller bills will prompt people to sign a payment plan. HCA is also sending nonemergency cases to less expensive venues. With these measures, executives say they may recoup less than 10% of the outstanding bills.

PET, PET-CT, Imaging IT To Fuel Industry Growth in 2004

Source: Frost and Sullivan

Researchers at Frost & Sullivan, Palo Alto, Calif, projected that in 2004, the medical imaging industry is expected to grow at a rate of approximately 10% over 2003 and top revenues of $12.6 billion. Although CT, MRI, and ultrasound are expected to continue to be major revenue drivers within the industry, the segments with the highest growth rates are represented by PET and PET-CT with approximately 40% growth, and imaging IT with 18% growth.

Industry News

Submillimeter CT study of the carotid arteries with 0.4 mm resolution performed in 6 seconds.

Siemens Medical Solutions , Malvern, Pa, released the first clinical images produced through Siemens’ Somatom Sensation 64″, a 64-slice CT system that can visualize extremely minute vessels in less than 10 seconds. The images were acquired from the Friedrich-Alexander University Erlangen-Nuremberg, Germany, where the Sensation 64 is operated by both the Institute of Diagnostic Radiology and the Institute of Medical Physics. The system will be commercially available in the fall of 2004… HealthHelp , Houston, a radiology service management company, has released “RadExcell Module 4: Patient Safety and CT,” the fourth module of its self-guided RadExcell program, which focuses on the specifics of ordering CT examinations, and current patient safety issues and regulations… InSiteOne Inc , Wallingford, Conn, was named Best Expansion Stage Company for 2004 at the 11th annual Crossroads Venture Fair, a meeting of Northeast venture capital companies…After receiving multiple reports of malfunctioning devices, Boston Scientific Corp , Natick, Mass, will make a small change to its Taxus coronary stent system to prevent the problem of the balloons failing to deflate when already placed within patients. The change will be in the laser-bonding process of joining the balloon and catheter before the stent is packaged around them. With this fix, the company hopes to dissuade the Food and Drug Administration from sending out formal notification letters to physicians… NEC-Mitsubishi Electronics Displayof America Inc , Chicago, has started the GovClub membership program to offer exclusive pricing, marketing tools, and bid support for solution providers who sell to the government sector. Among other benefits, club membership includes priority technical support and discounted demonstration pricing…Quantum Medical Imaging, Ronkonkoma, NY, received Conformité Européenne (CE) certification for its product line… Barco , Kortrijk, Belgium, has started the implementation of the Six Sigma methodology in its BarcoView division… SourceOne Healthcare Technologies Inc , Mentor, Ohio, and Del Medical Systems Group , Chicago, inked an agreement that gives SourceOne nationwide marketing, distribution, and service rights to Del’s radiography and imaging systems product lines… Agfa , Ridgefield Park, NJ, and Network Appliance Inc , Sunnyvale, Calif, have entered into a strategic alliance, in which NetApp® network storage solutions will be available to Agfa’s IMPAX™ PACS customers…Business Ethics magazine ranked Eastman Kodak Co , Rochester, NY, among the 100 Best Corporate Citizens for 2004. The ranking is based on quantitative measures of corporate service to seven stakeholder groups: shareholders, employees, customers, the community, the environment, overseas stakeholders, and women and minorities… Merge Technologies Inc , Milwaukee, announced the initiation of an Academic Licensing Program for its eFilm Workstation diagnostic imaging software. When it is used solely for teaching, learning, or research purposes, an annual subscription for the eFilm Workstation software is available for $100 under an academic license…The American Society for Therapeutic Radiology and Oncology (ASTRO) has launched a legislative and advocacy program to funding for cancer research, enacting patient safety legislation, and correcting the Medicare Physician Fee Schedule…The CPT Editorial Panel of the American Medical Association has issued temporary Category III CPT codes for CT colonography. The codes are aimed at collecting data to demonstrate widespread usage, and to analyze potential reimbursement for the procedure. The scheduled implementation date for the codes is July 1, 2004.


David J. Brailer

David J. Brailer , MD, PhD, has been named the nation’s national health information technology coordinator, a new position in the Department of Health and Human Services (HHS) that reports directly to the HHS Secretary. Brailer’s responsibilities include facilitating the President’s plan to implement electronic medical records for most Americans within 10 years, coordinating partnerships between government agencies and private sector stakeholders, and guiding ongoing health information standards development. Brailer is currently the Senior Fellow at the Health Technology Center in San Francisco. He holds numerous prestigious academic awards, and was the founder of CareScience Inc, Philadelphia, where he served as chairman and CEO for 10 years… Greg Arnsdorff , former vice president and deputy general manager of McKesson Information Solutions, Atlanta, succeeded Greg Peet as vice president and general manager of McKesson’s Medical Imaging Group on April 1. Peet will retire in July. Arnsdorff founded CADx in 1999, and previously held executive positions with Biochem Immunosystems, Inc, and Abbott Laboratories. McKesson also announced that Mike Brozino has been promoted to vice president of medical imaging sales, and Bing Teng was promoted to vice president and executive staff assistant… Tibor Duliskovich , MD, is the new medical director of StorCOMM, Jacksonville, Fla. He will be responsible for performing clinical beta testing with selected customers, and for the clinical end-user training program… Mike Brokloff was named manager of glassware solutions at Dunlee, Aurora, Ill, a division of Philips Medical Systems, Bothell, Wash,… Doug Albregts was promoted to vice president of marketing of NEC-Mitsubishi Electronics Display of America Inc, Chicago. Albregts will oversee strategic sales and marketing of the company’s LCD and CRT monitors in North America… Jack Plummer joins ETS-Lindgren, Glendale Heights, Ill, as the Western regional sales manager, responsible for expanding the medical sales and customer base in the Western territory…At its annual convention, the American Institute of Ultrasound in Medicine (AIUM) will award the 2004 Joseph H. Holmes Pioneer Award to Roy A. Filly , MD, in the category of clinical science, and to Kenneth R. Erikson in basic science. The Joseph H. Holmes Award recognizes individuals who have contributed to the growth and development of diagnostic ultrasound. Filly is currently a professor of radiology, surgery, and obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco (UCSF). He is chief of diagnostic sonography and cofounder of the UCSF Fetal Treatment Program. In his career, Erikson pioneered a semiautomated axial length measurement system for cataract surgery planning, and a real-time 3D ultrasonic camera. Erikson has been the inventor or coinventor on 26 patents and is currently developing an advanced sonar system for the US Navy. Paula Woletz, RDMS, RDCS, MPH , will receive the Distinguished Sonographer Award in recognition of her oustanding contributions to diagnostic ultrasound.