MDCT or X-Ray for Lung Cancer Screening?

Stopping short of an endorsement for using MDCT scanning to screen for lung cancer, a review article in The New England Journal of Medicine calls the technique “very promising” but suggested that high-risk persons interested in CT screening should enroll in a screening-management trial.

Lead author James L. Mulshine, MD, head of the Intervention Section of the Cell and Cancer Biology Department in the Medicine Branch of the Division of Clinical Studies at the National Cancer Institute, Bethesda, Md, notes that several randomized trials are currently under way, but none have results available to assess whether CT screening reduces mortality.

“It has the potential for finding much earlier cancer on a routine basis if done by experts,” Mulshine says of CT screening. “However, at this point in time, we have no evidence that this will be associated with mortality reduction. The information we have is necessary for objective benefit, but not sufficient to prove objective benefit.”

The paper analyzed several studies whose subjects have a high risk for lung cancer—current smokers and former smokers with a 20-pack-year or more history. In those studies, 55% to 80% of cancers detected in baseline scans, and 60% to 100% of cancers detected in annual follow-up scans, were stage 1. Only 16% of cancers detected with routine clinical care in the United States are found in stage 1, according to the paper.

An observational study conducted in Japan that was cited in the article found a reduction in mortality rates among its patients when lung cancer was found using CT: the overall 5-year survival rate improved from 49% in cases detected with a chest x-ray to 84% for those detected by CT.

“The relative value of CT compared to chest x-ray has never been formally done,” Mulshine says, “and they’re doing that in the [National Lung Screening Trial (NLCST)]. So at the point in time when that trial was started [2002], people had done parallel series and it looks like CT is superior, but a large comprehensive, nose-to-nose comparison has never been done before.”

The NLST trial (see article, page 53) includes 50,000 people who were randomly assigned to undergo chest radiography or spiral CT scanning with mostly four row detectors annually for 3 years. A follow-up for mortality is planned through 2009.

Even though preliminary results of CT scanning for lung cancer appear to suggest that cancer can be detected at an earlier stage than with chest radiographs, the jury is still out as to whether earlier detection results in reduced morbidity and mortality.

But as the trials progress, several areas of uncertainty have arisen: the effect of advancing technology, and the cost-effectiveness of CT screening.

With rapid advances in CT, the technology being used in these studies is becoming outdated very quickly. At the outset of CT lung cancer screening, investigators were using single-slice detectors. Current studies are using four-slice or 16-slice detectors. And with 64-slice detectors on the market, “it’s hard to predict when you’re crossing a critical threshold where you’re going to make a quantum leap in the capabilities of the machine,” Mulshine says.

“We’re talking about major changes. Not only do you have a change in the hardware, but you also have this very rapid evolution of the ability to look at the [data],” Mulshine says. “You have software tools to be able to look at 3D reconstructions and volume comparisons of the nodules. The more data you get, the harder it is for radiologists to deal with, but the easier it is for computers to make comparisons.”

Two studies cited in the article gave very different numbers when it came to cost. According to a study by Mahadevia published in a 2003 issue of JAMA, the cost of additional health care associated with lung cancer would be $116,300 per quality-adjusted life-year gained. In another analysis by Wisnivesky published in a 2003 issue of Chest and based on data from the Early Lung Cancer Action Project (ELCAP), workups using a noninvasive technique would cost only $2,500 per person-year of life saved. The Wisnivesky article was based on actual experience while the Mahadevia article was based on some assumptions, Mulshine said.

“I can’t explain why they’re all so very, very different because there are lots of aspects that come into these things that affect price,” he says. “I concluded in that paper that it’s an open question in which we’d like to have more information.”

In his recommendations, Mulshine suggested people seeking screening for lung cancer who do not have the equivalent of a 20-pack-year history could be doing more harm than benefit.

“It is certainly reasonable to talk to [someone with a 20-pack-year or more history] about all the strengths and weaknesses, and if they choose to go forward I think it’s a reasonable decision and that’s fine,” he says.

ASTRO, Ronald McDonald Houses Charities to Fete Cancer Survivors

During its 47th annual meeting in Denver, the American Society for Therapeutic Radiology and Oncology (ASTRO), Fairfax, Va, will partner up with Ronald McDonald House Charities of Denver Inc to raise awareness of cancer survivorship. Ronald McDonald House Charities of Denver is a nonprofit organization that provides a place for families to stay when they travel to Denver for medical treatment for their children.

The Survivor Circle, which will be featured in an exhibit at the Colorado Convention Center on October 16-20, 2005, was created to recognize those who have been diagnosed with cancer, and focuses on programs offered by organizations to help patients and their families cope with cancer treatment. A ribbon-cutting ceremony will be held October 16. The event will coincide with the opening of the annual ASTRO scientific meeting.

Within the exhibit, visitors can see pictures of Ronald McDonald House events offered to patients, survivors, and their families, as well as leave a 100% tax-deductible donation for local cancer programs.

For more information on Ronald McDonald House Charities of Denver Inc, visit www.ronaldhouse.org. For more information on ASTRO or its upcoming meeting, visit www.astro.org.

Health Spending in the United States and Other Industrialized Countries

A study published in the July 2005 issue of Health Affairs reports that Americans pay more for health care than people in other countries in the Organization for Economic Cooperation and Development (OECD) because the price for health services is higher in the United States—but that does not mean Americans are getting more services. The results show that fee differences are the primary cause for the spending gap, not malpractice lawsuits or even the proliferation of technology as is commonly believed. The United States did have 50% more malpractice claims filed per 1,000 people than the United Kingdom, however, two thirds of those claims were dropped or found in favor of the defendant. In the United Kingdom, from 1995 to 2002, only 36% of claims were dropped; 60% were settled. An increase in defensive medicine might contribute to more health spending, but it is difficult to establish, the study found. In 2002, spending on health care accounted for 14.6% of the US gross domestic product. While the United States spends the most per capita on health care, it has not resulted in better quality of care or better patient satisfaction.

Source: Anderson, GF, et al. Health Spending in the United States and the Rest of the Industrialized World. Health Affairs. 2005;24(4):903-914

Court Date Set in Oregon Antitrust Lawsuit

An antitrust lawsuit filed by two Portland, Ore, imaging centers against Providence Health System is moving forward, with a trial date set for February 14, 2006.

“We’re just looking forward to having a hearing on the matter and getting it resolved,” says Gary Walker, senior public relations coordinator for Providence. “We continue to believe that we have the right to choose the firms with whom we do business…just like any other business and we look forward to having that discussion in court.”

EPIC Imaging and Body Imaging Radiology had also filed an injunction to stop Providence from terminating their services without cause effective July 1. The injunction was withdrawn in June after Providence submitted hundreds of pages of documents, and attorneys for the imaging centers did not feel they had enough time to assess the information to provide the court with adequate information for an informed ruling.

“We didn’t have enough information to pursue asking for the injunction, so we dropped that and asked for a speedy trial,” says Gerald Warnock, MD, founder and medical director of EPIC Imaging.

“It all boils down, as we knew all along, to their percentage of the market share,” he says.

At the center of the imaging centers’ argument is an economic report submitted by a Providence-hired economist. That report—which is among documents submitted under seal to the court—had numbers the imaging centers found questionable and believe to be a serious understatement of Providence’s true market share.

“They contend [to have] only 8% or something of the market, which is ridiculous,” Warnock says.

A study conduced by an economist hired by the imaging centers says Providence has nearly a 40% market share of the Portland area. “[Our] economist came up with nearly 40%, but that was Medicare data, which is the only data that is available publicly,” Warnock says. “There were a couple of flaws in the way he interpreted it. I don’t think 40% was valid.”

“Hopefully, they’ll give us the numbers they’ve done,” he says. “If the numbers come down or if they’re only 15%, I don’t think we have a case. But if they’re anywhere near 30%, we have a very good case. We’re cautiously optimistic.”

While EPIC Imaging’s contract with Providence was terminated July 1, the contract with Body Imaging Radiology has been extended through August 31 because a joint venture imaging center between Providence and Advanced Medical Imaging was not opening until July 18.

“[Extending the contract with Body Imaging Radiology] allows us to bring our west side imaging center up and online,” Walker says. “We have the one open on the east side and the one on the west side is opening, and that will allow us to make a smooth transition into that west side facility.”

AHRA Names New Executive Director

Edward J. Cronin, Jr, CAE

Looking forward to working in his home state of Massachusetts, Boston-native Edward J. Cronin, Jr, CAE, has been named executive director of American Healthcare Radiology Administrators (AHRA), Sudbury, Mass.

With more than 20 years of experience in the profit and nonprofit sectors, Cronin, who holds a bachelor degree from Harvard University and an MBA from Northwestern University, will take the helm of the association of managers in imaging sciences.

“It’s a great opportunity to work with one of the country’s premier associations,” he says. “I’m very excited about it.”

He has held positions with the Foundation Fighting Blindness, Technomed International Inc, American Management Services Inc, Joyce Funeral Service, and the Circuit Court of Cook County, Illinois, and spent the last 6 years in Chicago as executive director of the American College of Prosthodontists.

“In many ways [working for AHRA] is not very different,” Cronin says. “Basically, the challenge is to understand the issues that affect our members in their workplace and to provide the benefits that are relevant to them.” One of the hurdles he faces is getting to know the rapidly changing field of radiology.

“There are two parts to running an association,” Cronin says. “One is the association itself. But the challenge for any new executive is to really get to feel comfortable with the industry that we are working in.”

Hitting the ground running is what he will be doing at AHRA’s annual conference in San Antonio, Tex.

“It is important for me as the executive director to meet with as many members as I can,” he says. “I hope to start doing that at our annual meeting and then just be open, constantly talking to our members to see what the issues are that are affecting them.”

Industry News

Philips Medical Systems, Andover, Mass, announced it has acquired PACS provider Stentor Inc, Brisbane, Calif, for approximately $280 million. Philips previously had partnered with Sectra, Linköping, Sweden, to sell PACS. Sectra President Jan-Olof Brüer said the cooperation between his company and Philips will be terminated. In addition, Philips has been ranked No. 1 in cardiac ultrasound equipment sales for 2004 by Klein Biomedical Consultants…Tyco International and Mallinckrodt Imaging, New York, have launched a Web site to provide information on appendicitis and abdominal pain: www.appendicitisinfo.com…Imaging Dynamics Company (IDC), Calgary, Alberta, Canada, announced the Toronto Stock Exchange has conditionally approved the listing of IDC common shares…Springfield, Mo-based McKesson’s InfoCenter Web site, which supports home care, hospice and telehealth products, has been recognized by the Association of Support Professionals as one of the 2005 “Ten Best Web Support Sites”…INFINITT Co Ltd, Seoul, Korea, and SmartPACS, Phillipsburg, NJ, announced a joint venture between the two companies. SmartPACS will officially change its name to INFINITT North America Inc…Guardian Technologies International Inc, Herndon, Va, has filed two utility patents applications in the US Patent Office titled System and Method for Identifying Objects of Interest in Image Data. Guardian has also submitted applications under the International Patent Cooperation Treaty (PCT) designating all PCT countries as well as direct foreign patent applications in non-PCT countries of strategic importance to Guardian…SG&A Consulting, Arlington, Tex, will be collaborating with Clarkson College, Omaha, Neb, to offer a bachelor of science degree in medical imaging with a concentration in PACS and related medical informatics…The American Society for Therapeutic Radiology and Oncology, Fairfax, Va, has published two patient information brochures to help patients with lymphoma understand treatment options: Radiation Therapy for Non-Hodgkins Lymphoma and Radiation Therapy for Hodgkins Lymphoma…Toshiba America Medical Systems, Albuquerque, NM, has renewed its bronze level sponsorship of the ASRT Education and Research Foundation’s Health Care Industry Advisory Council…Dynamic Imaging, Allendale, NJ, announced that its IntegratedWeb PACS has been rated No. 1 in the KLAS Top 20: 2005 Mid-Year Report Card’s ambulatory and imaging center PACS specialty niche category…GE Healthcare, Waukesha, Wis, will be partnering with the department of radiology at Stanford University School of Medicine, Stanford, Calif, to develop molecular imaging technologies…Misys Radiology ™ and Misys Laboratory from Misys Healthcare Systems, Raleigh, NC, were rated the No. 1 choices for radiology and laboratory vendors in the acute care setting in the Top 20: 2005 Mid-Year KLAS Report Card…The Society for Computer Applications in Radiology, Great Falls, Va, is offering two $40,000 grants for original research in imaging informatics for 2006…Brain Matters Inc, Denver, and Harbor-UCLA Faculty Practice Plan, Torrance, Calif, have entered into a joint venture to operate a brain function imaging facility at the Harbor-UCLA Professional Building.

People

Peter S Conti, MD, PhD

The Society of Nuclear Medicine (SNM), Reston, Va, has elected Peter S. Conti, MD, PhD, as its 2005-2006 president during its 52nd annual meeting in Toronto. Conti is a professor of radiology, clinical pharmacy, and biomedical engineering at the University of Southern California, Los Angeles. Martin P. Sandler, MD, has been named 2005-2006 SNM president-elect; Alexander J.B. McEwan, MD, has been named SNM vice president-elect; Valerie R. Cronin, CNMT, FSNMTS, has been named 2005-2006 president of the Society of Nuclear Medicine Technologist Section (SNMTS); and D. Scott Holbrook, BS, CNMT, RT(N), PET, FSNMTS, has been named 2005-2006 president-elect of SNMTS. SNM also named Jan Winn, MEd, RT(N), CNMT, an associate professor in the Department of Radiologic Technology at the University of Oklahoma Health Sciences Center, Oklahoma City, the recipient of the Outstanding Educator Award…Jeff O’Neal has been named chief financial officer of SmartPACS, Irvington, NJ…Deb Knapp has been appointed general manager Americas IIS sales and marketing for GE Healthcare, Waukesha, Wis…Toshiba America Medical Systems Inc, Tustin, Calif, has promoted Robb Young to senior manager for Market Segment Cardiology CT…David James Brooks, MD, DSc, FRCP, FMedSci, has been honored with the 2005 Kuhl-Lassen Award by the Society of Nuclear Medicine and its Brain Imaging Council. The award goes to scientists who have made significant contributions in functional brain imaging using single photon emission computed tomography and positron emission tomography.