Proof that anything is available on the net...

Someone has LSO detectors from a PET scanner that he doesn't know what to do about and may be considering selling in the open market.

Can't wait to start selling my second-hand air-filters from my CT scanner.

Selling mammo machines like cars - BET Medical

BET Medical Pvt Ltd has just announced a scheme, where for every mammography machine that you buy, you get two gold sovereigns and enter a draw for a pot of gold for 10 sovereigns.

My only question is: Would radiologists actually buy a machine based on a possible pay-out of a pot of gold? Or would they buy a machine based on their technical needs and compliance with specifications?

I am confused. Most mammography machines are bought by radiologists for their own private centres. They spend their own money...honestly do these radiologists need "incentives"? I would rather drive the price down further knowing that the company has kept a margin for these activities.

Election news 2004 - 06

Dr. Shabnam Bhandari Grover is standing for the post of Secretary of the ICRI. Since 2003, she has been the Treasurer.

Fine needle aspiration in lymphoma for diagnosis - JCO - Hehn et al. 22 (15): 3046

This article by Hehn ST et al in the August issue Journal of Clinical Oncology is about the validity of fine-needle aspiration (FNA) in patients suspected to have lymphoma, either primary or recurrent.

Their results: "Of the 93 FNA attempts at initial diagnosis, only 27 (29%) were given a specific and complete histologic diagnosis using an accepted classification system (Working Formulation, Revised European-American Classification of Lymphoid Neoplasms, WHO). For the 22 FNAs done for recurrent disease, only nine (41%) were classified using an accepted system."

This reinforces the accepted dictum that in patients suspected to have lymphoma, FNAs should not be done. The best bet is to perform tru-cut core biopsies.

CT in lung cancer staging - review

This article, from Current Opinion in Pulmonary Medicine, discusses the current role of CT in the staging of lung cancer. Newer modalities such as FDG-PET and PET-CT are discussed as well, along with EUS-guided FNA and mediastinoscopy.

The entire article is available at Medscape.

International teleradiology - Radiology 2004 Kalyanpur et al. 232 (2): 415

Arjun Kalyanpur et al in the August issue of Radiology have an article on their experiments with teleradiology from 2001.

The article shows how feasible it is for contemporaneous reading of CT scans to be done by a radiologist sitting in Bangalore.

Things have moved on quite a bit since 2001, though Arjun is still probably the only radiologist in India doing serious teleradiology for groups in the US. The body shoppers are still around but there is no data on the business that they are generating in India.

We are not immune - a public health problem

Ronald Glasser has written an article in this month's issue of Harper's magazine on the problems with public health, mainly in the US context. The full text is available at World Health News a weekly update from Harvard.

It is an interesting read, highlighting major problems with the public health system. One paragraph is telling, "Few advances were as important as the realization that merely washing one's hands could prevent the spread of disease. Life expectancy in the eighteenth century for an average male was about thirty years; by the early 1970s, it was seventy-five years. And as Garrett points out, most of that progress occurred prior to the invention of antibiotics, and "less than 4 percent of the total improvement in life expectancy since the 1700s can be credited to twentieth century advances in medical care." Ironically, the medical revolutions of the twentieth century have contributed to our overconfident and complacent neglect of the public-health infrastructure. We spend vast sums to lengthen the lives of terminally ill patients by a few days and refuse to make modest investments that would prevent millions of needless illnesses and deaths."

Garrett refers to Laurie Garrett. "The United States has no single agency responsible for public health and thus no coherent policy. As Laurie Garrett suggests in her monumental study, Betrayal of Trust: The Collapse of Global Public Health, it is no exaggeration to say that we simply lack a public-health system per se; what we do have is best described as "a hodgepodge of programs, bureaucracies, and failings.""

Sounds so much like India, though we are much worse off.

NEJM -- Case 24-2004 - A 48-Year-Old Man with Recurrent Gastrointestinal Bleeding

This CPC in this week's issue of the New England Journal of Medicine, has some great pictures of a relatively rare cause of recurrent gastrointestinal bleeding. There is also a short discussion of capsule video endoscopy for the evaluation of the small bowel - this CPC also shows us what the future of small bowel imaging is likely to be.

A link to an excellent review article on this subject can be found here.

Screening breast MRI in high-risk women

There is a landmark article from a group of Dutch authors in this week's New England Journal of Medicine regarding the usefulness of screening breast MRI as compared to mammography in women at high-risk for developing breast cancer. This population includes 398 women with genetic predisposition.

Their results: 'We screened 1909 eligible women, including 358 carriers of germ-line mutations. Within a median follow-up period of 2.9 years, 51 tumors (44 invasive cancers, 6 ductal carcinomas in situ, and 1 lymphoma) and 1 lobular carcinoma in situ were detected. The sensitivity of clinical breast examination, mammography, and MRI for detecting invasive breast cancer was 17.9 percent, 33.3 percent, and 79.5 percent, respectively, and the specificity was 98.1 percent, 95.0 percent, and 89.8 percent, respectively."

The accompanying editorial also puts this data in perspective by comparing it with other previous data.

This is one more study that ups the ante on the use of breast MRI routinely for specific indications.

MRI in patients with pacemakers

Roguin et al in this week's issue of Circulation have published a study on dogs where they inserted ICDs into the dog hearts and then scanned them on 1.5T scanners. There was no untoward incident and no damage to the ICDs.

There have been many recent articles that have shown saftey as well with proper monitoring, precautions and the ability to resuscitate if necessary. Some more information is given by Frank Shellock on his terrific site www.mrisafety.com. The site needs registration, though access is free.

Aortic valve calcification - EBCT

A study by Messika-Zeitoun et al in a recent issue of Circulation describes the usefulness of measuring aortic valve calcification using EBCT. They have shown that "AVC (aortic valve calcification) is accurately and reproducibly measured by EBCT and shows a strong association and diagnostic value for severe AS. The curvilinear relationship between AVC and AVA(aortic valve area) suggests these measures are complementary, and indeed, AVC provides independent outcome information. Thus, AVC is an important measurement in the evaluation of patients with AS."

Obviously this should also be possible with MDCT. This adds one more indication to the growing list of indications for cardiac non-coronary CT.

Glut of PET scans

In the column "Scan Man" in Diagnostic Imaging, Greg Freiherr talks about the glut in the PET and PET-CT market today, in the US. There is tremendous overcapacity and most centres on an average scan between 2-3 patients per day, when they could easily scan upto 10 patients per day. Even with increased reimbursement and increased referrals, it does not look like the overcapacity will go away at least for another 2-3 years.

Now that the companies are no longer selling enough scanners in the US, guess where they will turn to sell and flood the market. Chances are prices will crash for the Indian market and we may see quite a few PETs or PET-CTs installed in India. The only roadblock here is the BARC, which because of its stringent standards has stymied the growth of nuclear medicine in our country.

Indians from the US returning home...

The New York Times of July 24 carries an article with profiles of a few people who have returned from the US to India...actually Bangalore, where they are trying to make a difference. While enjoying the quality of life they were used to in the US, they are also able to add in the benefits of being in India. One of the persons profiled prominently is Arjun Kalyanpur who is the first and still probably the only radiology who provides teleradiology solutions for emergency services in the US.