As usual, a thought-provoking article from Scan Man, in Diagnostic Imaging. It talks about new data released last week showing a significant increase in the diagnosis of small breast cancers and increased cancer survival as a result. This can be mainly attibuted to an increase in mammography quality control. diagnosticimaging.com

Auntminnie does report on a very interesting issue - of performing CTA in pregnant women for ruling out pulmonary thrombo-embolism. The radiation risk to the fetus is within acceptable limits and much better than V/Q scanning. The issue however is of the risk of intravenous contrast, which however does not seem to be much of a problem.

Radiology, Women's Imaging

This is an interesting article that describes the various bone marrow patterns in patients with multiple myeloma and their prognostic significance. Irrespective of treatment regimen, a diffuse pattern of involvement is associated with poor prognosis. Other patterns include a focal pattern, a variegated pattern and a normal pattern.

Prognostic significance of magnetic resonance imaging of bone marrow in previously untreated patients with multiple myeloma -- Moulopoulos et al., 10.1093/annonc/mdi362 -- Annals of Oncology

Once again the spotlight has been turned on. Two new studies have shown that there is no safe dose of radiation and that there is a cumulative risk for developing cancer based on radiation exposure.

The catchline is that 1 in 1000 will develop cancer based on the dose received from one whole body CT scan.

Radiology, CT

Just to show how the two can be different. Apparently 64-slice CT scanners are "CT" scanners and the older are "CAT" scanners.

CBC Prince Edward Island - Hospital tests new CT scan

This is really cutting edge stuff. If and when it becomes a clinical reality, the ability to pick up plaques, especially vulnerable plaques will make a difference to cardiology practicce.

06/05 MR contrast based on modified HDL enhances atherosclerotic plaques

For all those thinking of teleradiology with US based centres, this article is worth reading to understand the legal minefields involved.

SCAR 2005 - Daily News

This article from Diagnostic Imaging, looks at both sides of the story regarding using CT in the emergency room to triage patients with acute chest pain. Personally I believe that by doing a "triple rule-out" with current scanners including GE's 5-heart beat scanner will compromise the coronary study. But the ER needs may be different from stand-alone scanner sites.

03/05 Cardiac CT's triple ruleout: Is it hype or real benefit?

Sometime in the future, it may be possible to screen for breast cancer with a special CT scanner that uses an under-table tube, the patient lying prone with the breasts hanging down through the table, without compression. Enrolment for a clinical trial using a prototype scanner has begun though.

Newswise | CT Being Tested to Detect Breast Cancer Earlier

This article signals the acceptance of MRI as a method of picking up early inflammation in ankylosing spondylitis, predominantly in the dorsal spine and dorso-lumbar junction. As the use of drugs such as etanercept increases in the control of ankylosing spondylitis, it becomes important to study the effect of these drugs on inflammatory processes. This article also has a new classification of the severity of ankylosing spondylitis, based on the MRI appearances.

Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging -- Baraliakos et al. 64 (5): 730 -- Annals of the Rheumatic Diseases

Articles such as these, really help in further promoting the use of a specific modality. Though already implemented in clinical practice in most hospitals and countries in the world, this meta-analysis puts things in perspective. The negative predictive value for ruling out pulmonary thrombo-embolism is almost 99%, even with a single slice spiral CT scanner. There are advantages to using a multi-slice scanner especially for distal emboli, but a negative CT on a single slice spiral seems to be good enough. The question is whether identifying distal emboli makes a difference to management.

JAMA -- Abstract: Clinical Validity of a Negative Computed Tomography Scan in Patients With Suspected Pulmonary Embolism: A Systematic Review, April 27, 2005, Quiroz et al. 293 (16): 2012

This is one more new possible application for MRI. As time passes by there will be more and more such functional applications coming in, which will only serve to increase the utility of our imaging modalities.

This abstract describes the use of albumin bound Gd in the assessment of proteinuria using MRI. Though the study has been performed in swine, if it can be replicated in humans, it will make a big difference.

Detection and Localization of Proteinuria by Dynamic Contrast-Enhanced Magnetic Resonance Imaging Using MS325 -- Zhang et al., 10.1681/ASN.2004110981 -- Journal of the American Society of Nephrology

I guess at some point in time we need to start asking if patients are wearing transdermal patches. There have been many reports of patients getting burns when the patches have aluminium or foil backing.

This article from Hungary is an interesting article on the spectrum of HRCT findings in patients with mixed connective tissue disease (MCTD). A good number of unselected patients had interstial disease, and many of them responded to treatment.

This is an interesting pictorial essay by Broderick Lynn et al in the recent issue of Radiographics. Though many of the images appear dated, it is a simple description of some of the anatomic variants and structures that may simulate pathology to the uninitiated eye.

This article by Pearce D et al, in the recent Radiographis issue, is an exhaustive pictorial essay on avascular necrosis of the talus, almost simulating a book chapter. Everything that anyone would want to know about AVN of the talus is present in this article.

This review of the imaging findings in rheumatoid arthritis, by Sommer J et al, from Austria, published in the recent Radiographics issue, is focussed mainly on the use of MRI and a discussion on the pathologic and MRI correlates. After Don Resnick's chapter on rheumatoid arthritis in his six-volume book, this is one of the best reviews on this subject.

This article in the latest issue of JCO,, by Rockall AG et al, discusses the marked increase in senstivity (>90%) of USPIO enhanced MRI in picking up pelvic lymph node metastases in gynecologic malignancies. It is likely that in the future this will become a standard method of imaging.

This time Scanman discusses the problems facing the multi-slice CT industry and the problem of vendors taking cheap shots at each other. We've all faced this problem - because of the complex physics and the amazing differences in claims made by the vendors, it is not an easy task making a purchasing decision. If it was difficult with 16-slice scanners, it is worse with 64-slice scanners.

In fact, more often than not the decisions are often made on comfort levels with the vendor, service back-up and price, rather than actual technical issues.