Because medical images significantly affect all aspects of patient care, Janice Honeyman-Buck, Ph.D., stressed the importance of imaging informatics being an integral part of any hospital’s planned healthcare IT upgrade to receive American Recovery and Reinvestment Act (ARRA) stimulus funds.

There was some irony associated with this message, however: The HIMSS 2010 meeting dedicated only two educational programs out of more than 300 to imaging-related topics, a fact not lost upon the more than 200 commercial exhibitors offering imaging informatics products and services.

Using a fable and the analogy of a line drawn in the sand, over which neither healthcare IT nor radiology PACS professionals crossed, Honeyman-Buck, a consultant with Medical Imaging Consultants of Gainesville, FL, bluntly explained why this situation needs to change.

“Health IT support may not have the skill set to manage images, and radiology support does not have the skill set to manage integration of all hospital information, so we need both groups to work together to create a much stronger system,” she said.

The difference in perspectives is considerable. For hospital IT staff, priority is placed on utilizing the HL-7 standard for fast processing of text data rapidly, privately, and securely. For dedicated radiology IT staff, concerns are focused on image acquisition, manipulation, and image storage, as well as the ability to provide rapid access to online and archived images both within an internal network and through Internet access.

This is a major task, she explained, because storing all diagnostic images performed at a 600-bed hospital can easily exceed 25 terabytes a year. Electronic storage, itself, is not the expense it used to be, but managing the storage is expensive. Storage also needs to be secure and redundant, as downtime of a PACS is unacceptable.

What needs to be overcome is territorial turf protection. Everyone wants ownership of the network, according to Honeyman-Buck, who is also a fellow of the Society for Imaging Informatics in Medicine (SIIM), co-sponsor of the session. But healthcare reform demands interoperability of medical records among healthcare providers, and diagnostic imaging is a critical part of the medical record. An EHR must contain images as well as a way to display at least a subset of images identified as key, she explained.

This capability was first proved with the VistA electronic medical record system that manages text, DICOM, and non-DICOM images for all hospitals and outpatient clinics of the Veterans Health Administration. It is becoming commercially available as well. A number of vendors at the HIMSS meeting were demonstrating EMR products and electronic dashboards that merged text and images.

Medical images in a patient’s record are not limited to diagnostic radiology and advanced visualization 3D reconstructed images. They also include endoscopy images, cardiology images with huge datasets, dental images, and pathology images, which may contain as much as 40 GB per slide. JPEGs such as dermatology images, documentation of anatomy, and/or a patient ID photo should also be part of an EMR.

Honeyman-Buck recommended that hospital administrators start now to create a bridge between imaging informatics and hospital IT, fostering an environment for these professionals to work together to create a system with meaningful use.

She pointed out that while imaging does not appear to be addressed until 2015 with multimedia support in the national healthcare IT implementation schedule, hospital administrators must realize they need to add imaging and multimedia to the meaningful use scenarios as soon as reasonably possible.

She concluded by referencing an open letter written to Dr. David Blumenthal, national coordinator for health IT of the U.S. Department of Health and Human Services, from Joe Marion, a healthcare industry consultant with more than 30 years of experience in diagnostic imaging communications technology, and a principal with the consulting firm Healthcare Integration Strategies of Waukesha, WI.

“It appears that the healthcare providers I have spoken with are consumed with just addressing their own priorities in order to be positioned to take advantage of ARRA. … What is being missed is imaging, which has the largest impact on systems capacity with respect to infrastructure and EHRs,” Marion wrote in a blog posted August 23, 2009, on the Healthcare Informatics magazine Web site.

“The travesty in waiting to address imaging in terms of a priority will be that whatever early initiatives are put in place may not be capable of supporting imaging when 2015 multimedia support rolls around,” he warned. “As one who has lived through inception and implementation of DICOM, letting nature take its course will never enable the objectives of meaningful use to be achieved in the time frame suggested.”

By Cynthia E. Keen
AuntMinnie.com staff writer
March 9, 2010

“Implementing evidence-based practice [EBP] into your radiography department is not an overwhelming or impossible task — and, once you do it, you will find that it enhances your job satisfaction as well as the quality of your practice,” said Nina Kleven-Madsen of Haukeland University Hospital in Bergen, Norway.

In an attempt to show that the advantages of evidence-based practice can translate into superior service and experience for patients, a research group comprising students and management evaluated the benefits of introducing EBP to a pediatric diagnostic radiography department.

Radiographers are skilled in their practice and tend to seek the most efficient and effective methods. Yet, the challenge to base EBP routinely at the heart of decisions is exacerbated by their lack of time, knowledge, and specific evidence-interrogation competencies.

Many overworked radiographers will choose to consult with senior colleagues in preference (and in place of) scanning the published evidence and research. Other barriers include a lack of support from peers and a “human resistance to change.”

With a team comprising both experienced and student (2nd and 3rd year) radiographers, plus a university librarian, Kleven-Madsen assessed their cooperation in performing effective literature searches and procedure evaluation, and judged their collective ability to distill and implement the best practice available.

Participants were tasked specifically with finding the best answer to the question, “Is there a dose reduction to mammary glands when anteroposterior is switched to posteroanterior in scoliosis imaging of adolescent girls?”

The exercise revealed that while contemporary practice is to a degree aligned with evidence-based practice, more systematic work would help to establish consensus on best practice — thereby raising the advantages of EBP in imaging in general.

The Norwegian researchers also concluded that collaboration in implementing evidence-based practice might improve the learning environment for students, making them more accountable during their practical placements.

The project was a joint program between Haukeland University Hospital and Bergen University College, also in Norway. In summing up, Kleven-Madsen encouraged the full room of ECR delegates to see beyond the barriers in bringing EBP into routine practice.

“An evidence-based approach to your work is not difficult — team up with colleagues who are interested and just get started,” she said.

New thinking from Switzerland

In another presentation, early findings were offered from a collaboration between three tertiary health schools and one teaching referral hospital in the French-speaking area of Switzerland that partnered up to develop a new initiative in evidence-based practice, titled BEST (Bureau d’echanges des savoirs pour des pratiques exemplaires de soins).

The two-year pilot study, led by the University of Applied Sciences of Western Switzerland in Lausanne, is currently ongoing and was set up to evaluate BEST as a new tool to assist local radiographers in embracing EBP.

In the study, radiographers gather evidence to produce the “best practice” answer to a wealth of clinical questions, with the ultimate aim of improving the quality of care for patients through EBP.

For French-speaking researchers in this part of Europe, the common use of English in publishing and presenting “evidence” is an additional barrier to EBP implementation, as was noted in BEST.

Lead researcher Nicole Richli Meystre’s Swiss team commenced a six-step process bringing together clinical expertise, patient preferences, and locally relevant standards under a single EBP umbrella:

1. Formulate the right clinical question.
2. Perform a targeted literature search.
3. Provide a critical appraisal of the evidence.
4. Feed local experience and expertise into the process, and assess how to implement.
5. Implement best practice.
6. Reflect and embed EBP into daily practice.

Initial results available to date suggest that with the right approach, the benefits of EBP can be translated into clinical advantages in radiography, and that projects such as BEST are useful in spotlighting means for improvement and encouraging progress within busy radiography departments.

Supporting evidence in ethical dilemmas

Finally, a group from the Oulu University of Applied Sciences in Oulu, Finland, recognized the need for clear EBP, as the continually expanding job role of radiographers now means they face increasingly difficult ethical dilemmas, calling for moral clarity and robust decision-making support. These include the use of radiation (with access to higher doses) and patient care, requests to deal with more complex medical cases, plus escalating demands to operate a broader range of technical equipment efficiently.

The aim of the study was to shine the light on a range of issues where comparatively little research has been undertaken.

Through interviews with a small group of radiographers (n = 8), the Finnish group ascertained that “in the use of radiation, justification and optimization principles were found to be lacking.”

They noted, too, that radiographers frequently encounter dilemmas in patient care, feeling powerless and unable to intervene in ethical problems when trying to deal with particularly challenging patients.

“However, often they do not recognize these issues as ethical dilemmas; rather, they simply see them as problems in daily practice,” the Oulu team observed.

“The concept of ‘ethics’ seems separate and distant, as these issues and feelings are simply part of the everyday world, occurring in everyday situations across Europe.”

In conclusion, the group highlighted the importance of recognizing ethical dilemmas in radiographers’ work community to act effectively and appropriately, in accordance with the evidence for best practice.

The study is ongoing, with further results scheduled for presentation at ECR 2011.

By Rob Skelding
AuntMinnie.com contributing writer
March 7, 2010

“Most of the cancers missed by mammography will be found by automated whole-breast ultrasound [AWBU],” said Dr. Kevin Kelly of the Huntington Hill Breast Center in Los Angeles.

“The performance of all readers in this study improved from using mammography alone to mammography plus AWBU — however, there is considerable variability in breast ultrasound screening skills between radiologists,” he said. “This is a problem that needs to be addressed with teaching specifically tailored to the technique.”

His work aimed to evaluate the impact of AWBU on the diagnostic competence of 12 community radiologists experienced in mammography, after just four hours of training on the 2D automated system. Kelly, inventor of the SonoCine ABS scanner used in the study (and majority stockholder in the company), noted that ABS could be performed successfully on a high-resolution ultrasound scanner.

Reader performance in diagnosing breast cancer in women with high breast density was assessed using mammography alone, and then again with the addition of ABS. Location information was recorded, along with ACR BI-RADS and Digital Mammographic Imaging Screening Trial (DMIST) likelihood ratings.

Average reading time using AWBU was approximately eight minutes, ranging from slightly less than six minutes to almost 13 minutes. Reader performance across the screening modalities was compared using jackknife alternative free-response receiver operator characteristics (JAFROC).

This defines a figure of merit (FOM), reflecting the probability that a cancer on an abnormal image is scored higher than a falsely marked location on a normal image. Higher FOM indicates superior reader performance, similar to ROC analysis.

Enhanced performance

AWBU added to standard digital mammography, versus mammography alone, saw reader-averaged FOM scores improve significantly by BI-RADS (0.783 versus 0.671; p < 0 .001) and likelihood (0.789 versus 0.674; p < 0.001).

Overall, Kelly observed that AWBU plus mammography saw the average performance of every reader in the study improve across the board:

“Over the past 30 years, there has been considerable debate about screening breast ultrasound, but now AWBU has given us a standardized method for testing ultrasound as an adjunct to mammography,” Kelly noted.

Discrepancy between readers

However, the study also revealed considerable variation in skill between breast radiologists when using AWBU. Kelly deemed the degree of inconsistency as unacceptably extensive, a feature highlighted also by a separate new, Norwegian study presented at ECR.

“ABS as adjunct to mammography in screening should be performed by the same radiologist that interprets the original mammogram,” asserted Dr. Per Skaane, of Ullevaal University Hospital in Oslo.

His team examined 114 breasts using digital mammography (Senographe D/DS, GE Healthcare, Chalfont St. Giles, U.K.) and a 3D ABS system (SomoVu, Siemens Healthcare, Erlangen, Germany).

Five radiologists experienced in breast imaging using BI-RADS assessment categories 1-5 interpreted the images, using ABS alone at first reading; this was followed by ABS plus mammography six weeks later. Reader performance was assessed with ROC analysis.

Echoing the findings from Kelly’s study, Skaane too observed universal improvement in reader competence for diagnosis of breast cancer through combined ABS-mammographic interpretation, though the degree of improvement between readers was significant.

Sensitivity varied from 50% to 97% and specificity ranged between 33% and 96%.

“ABS is a promising technology,” he noted. “However, there was considerable interobserver variability” — which he accounted for through differences in the interpretation environment, ABS reading protocol, and the learning curve.

ABS versus handheld ultrasound — first results

A third new study presented on Friday reported preliminary results from a comparison of ABS with a more traditional handheld ultrasound device for breast cancer identification and diagnosis.

A team led by Dr. Dirk Clevert of the University of Munich in Germany compared lesion visibility in 53 breasts between March and May 2009 using ABS (Acuson S2000 ABVS, Siemens Healthcare, Erlangen, Germany) with images acquired using a handheld ultrasound device with a 13-MHz transducer (Acuson Antares, Siemens). All lesions were classified according to BI-RADS assessment.

The handheld ultrasound device depicted 25 lesions in 17 of a total 27 patients, which were confirmed by the ABVS. Lesion size ranged from 5 to 35 mm (median, 17 mm). Median scanning time for the ABVS was 8.2 minutes for each breast, with interpretation time spanning three to 18 minutes.

The ABVS found all breast cancers, and there was good agreement regarding BI-RADS classification with the handheld method.

Based on these initial findings, Clevert suggested that ABVS imaging allows “detection of solid and cystic lesions and their BI-RADS classification with a high reliability,” in comparison to handheld ultrasound.

In summary, the three new studies appear to align in their findings that automated breast ultrasound scanning can improve breast cancer detection and diagnosis, whether added to standard digital mammography or as a standalone modality.

The challenge surrounding ABS lies in the implementation of bespoke training for radiologists on its use during breast scanning, with the aim of achieving greater consistency between readers and translating the enhanced performance into tangible clinical benefits.

By Rob Skelding
AuntMinnie.com contributing writer
March 5, 2010

The research from University Hospital of Ioannina in Greece also found that MRI can estimate the local extent of disease in patients with malignant tumors. The lead author of the study, Dr. Athina Tsili, is from the hospital’s department of clinical radiology (AJR, Vol. 194:3, pp. 682-689).

Although sonography traditionally has been the primary imaging modality to evaluate scrotal contents, the authors noted previous research indicating the technology does not always offer “confident characterization” of the nature of testicular masses.

MRI, on the other hand, can simultaneously image both testicles and both sides of the inguinal region and provides adequate anatomic information and tissue contrast. Past studies also have concluded that MRI may be beneficial when sonography’s results are equivocal or inconclusive for testicular disease.

Patient enrollment

For the current study, the researchers enrolled 33 patients with a mean age of 35 years, ranging from 17 to 70 years. All patients had the presence of masses conformed by surgery, pathology, or both. Radical orchiectomy was performed on 29 patients, three patients had a testicular biopsy, and one patient had both radical orchiectomy and biopsy of the contralateral testis.

MRI scans were performed on a 1.5-tesla system (Gyroscan and Intera, Philips Healthcare, Andover, MA), with a 17-cm circular surface coil used with 27 patients and a pelvic phased-array coil with the other six patients. The patients were examined in the supine position, and gadolinium contrast was administered intravenously in all cases.

Two radiologists blinded to the surgical and histopathologic results interpreted the MR images. The researchers also recorded the presence or absence of intratesticular lesions and evaluated tumor size, signal homogeneity or heterogeneity, and patterns of contrast enhancement, among other variables.

Lesion detection

Through surgery and histopathologic examination, the study tallied 36 intratesticular lesions among the 33 patients. Of those 36 masses, 28 (78%) lesions were malignant, while eight lesions (22%) were found to be benign.

Within the group, 27 patients had intratesticular malignant tumors, three patients had benign testicular lesions, two patients had benign intratesticular masses in both testicles, and one patient had both a malignant and a benign testicular lesion.

Analysis showed that MRI produced correct preoperative characterization of all intratesticular malignant tumors and seven of eight benign testicular lesions. Sensitivity and specificity in differentiating benign from malignant intratesticular lesions were 100% and 88%, respectively.

The mean diameter of testicular neoplasms detected at MRI was 5.2 cm, ranging from 1.1 to 12 cm, “which was in accordance with the histopathologic results,” the authors noted.

In addition, MRI showed its prowess in accurately staging the tumors. Twelve (92%) of 13 category T1 testicular tumors were correctly staged by MRI, while the modality accurately assessed the local extent of 11 (92%) of 12 category T2 malignant testicular tumors.

The authors noted one major limitation of the study: “Although all patients underwent both sonography and MRI evaluation of the scrotum, no direct evaluation of the results with these techniques was performed,” they stated. “A comparison of the diagnostic performances of sonography and MRI might justify the role of MRI compared with ultrasound in the diagnosis and characterization of testicular disease.”

Images are of a 40-year-old man with right testicular seminoma invading the spermatic cord. Left: Transverse T1-weighted MR image of a large right testicular tumor. The area of high signal intensity (arrow) within the lesion corresponds to histopathologic finding of hemorrhage. Center and right images are coronal T2-weighted MR, depicting a tumor of mainly low signal intensity invading the distal part of the ipsilateral spermatic cord (arrow). All images courtesy of the American Journal of Roentgenology.

Based on the results, the researchers concluded that MRI is an “efficient diagnostic tool for the evaluation of testicular masses,” adding that the modality is “accurate in the preoperative differentiation of benign and malignant intratesticular masses, facilitating accurate estimation of the local extent of disease in patients with malignant tumors.”

By Wayne Forrest
AuntMinnie.com staff writer
March 4, 2010

Dr. Christiane Kuhl, from the University of Bonn in Germany, and colleagues investigated the effectiveness in terms of cancer yield and stage at diagnosis of clinical breast examination (CBE), mammography, ultrasound, and breast MRI. The researchers assessed each modality alone and in combination for screening women at elevated risk for breast cancer as part of the Evista Alendronate Comparison (EVA) trial, a multicenter randomized study (JCO, online February 22, 2010).

Between 2002 and 2007, the trial recruited 687 women with moderately increased risk of breast cancer (lifetime risk of 20% or greater). The women had 1,679 annual screening rounds with the different screening options. In a subgroup of 371 women, additional half-yearly ultrasound and CBE were performed in more than 869 screening rounds.

Twenty-seven women were diagnosed with ductal carcinoma in situ (DCIS) or invasive cancer: 11 had DCIS (41%) and 16 had invasive cancers (59%). Three (11%) of the 27 were node positive. All of the found cancers were detected during annual screening, Kuhl and colleagues wrote.

Of the imaging methods under investigation (digital mammography, ultrasound, and MRI), MRI was the most sensitive, finding 93% of breast cancers. Ultrasound found 37% and digital mammography found 33%.

MRI’s superior performance suggests that in high-risk women it should be used as the annual screening exam, according to the authors.

“Our findings suggest that in these [high-risk] women, MRI is essential for early diagnosis — and that a mammogram or an ultrasound examination does not increase the ‘cancer yield’ compared to what is achieved by MRI alone,” they wrote. “We conclude that annual MRI is not only necessary, but in fact sufficient for screening young women at elevated risk of breast cancer. In women undergoing screening MRI, mammograms will have no benefit and should be discontinued.”

Although the radiation dose associated with regular mammographic screening is safe, high-risk women, who begin annual screening earlier, at age 25 or 30, will be exposed to more cumulative lifetime radiation dose — and these women have breast tissue that is already more vulnerable to cancer, according to the researchers.

“It is no longer justifiable to insist on annual mammographic screening for women in their 30s if they have access to screening MRI,” they wrote.

The Department of Radiology at the King Faisal Specialist Hospital and Research Centre in Jeddah, Saudi Arabia, has 6 radiologists on staff and provides services such as General Radiography (x-ray), CT/MRI, Ultrasound, Nuclear Medicine, Mammography, and Bone Mineral Densitometry (BMD).
Requirements

* American Boards or Canadian FRCPC in Radiology.
* A minimum of ten years post-specialty certification experience in Radiology in North America, including a minimum of three years of experience as a department head.

Benefits

* Tax-free income
* Married-status contract
* Accommodations provided
* Relocation allowance
* Education allowance for up to four eligible dependents
* Professional leave and allowance
* Six calendar weeks of vacation

Apply to this Job

To apply to this job please email your resume to hza@hziegler.com or call u at 1-800-387-4616.

Since we are a North American based recruitment company we are only able to recruit citizens of Canada and the United States.

The Job

You will perform PET, CT and Nuclear Medicine Imaging Procedures on patients to produce quality images for diagnostic interpretation.

Requirements

*Degree or Diploma in Radiography or Medical Imaging Science
*Experience in CT Imaging will be an advantage

Interested applicants are invited to send in a detailed resume , stating full personal particulars, educational qualifications, career history, present and expected salary to:

Singapore General Hospital
Human Resource Division
167 Jalan Bukit Merah
Connection One,Tower 5,#19-10
Singapore 150617

Alternatively you can also submit your application online via website www.sgh.com.sg/JoinUs

We regret only shortlisted candidates will be notified.

We wish to invite committed individuals to fill the above positions in our dynamic team delivering compassionate care in a fully integrated setting.

Radiologic Technologist for Bangkok Hospital Phuket 1 position

* Bachelor’s degree in Radiological Science.
* Completed Radiology License Certificate.
* At least 2 years experience.
* Be able to work in Phuket.

Please apply in person or mail application to:

Corporate Human Resources
Bangkok Dusit Medical Services Public Co.,LTD.
2 Soi Soonvijai 7, New Petchburi Rd., Bangkapi, Huaykwang, Bangkok 10310
Tel. 0-2310-3303 Fax: 0-2755-1108
Email: nattaya.wi@bgh.co.th

The Department of Radiology at the King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia, includes: general radiography, ultrasound, special procedures (e.g. fluoroscopy and angiography), nuclear medicine, computed tomography, and magnetic resonance imaging. In 2006, the department performed more than 160,000 diagnostic and interventional examinations.

The department’s information system is RIS/RadNet from CERNER. And in 2004, as part of the department’s goal to become film-free, the Picture Archive Communication System (PACS) was implemented to transfers radiology images from the various diagnostic imaging equipment to workstations and web browsers.

There are eight ultrasound suites, and the equipment includes an ATL 1500 (for invasive examinations), and 3D imaging equipment (e.g., Phillips HDI 5000, GE Logiq 9, and a Phillips Envisor).

Click here for more information

http://www.radjobs78.com/

Researchers at Stony Brook University in New York are working with Dr. David Schlyer at Brookhaven National Laboratory (BNL) in Upton, NY, on the project. Bosky Ravindranath, research assistant and lead author of a study, presented details on the prototype’s progress on Tuesday at the SNM annual meeting.

The motivation behind the project is to develop a high-resolution PET imaging system that can work inside an MRI scanner, combining MRI’s high-resolution anatomic images with quantitative biochemical information from PET. “The combination of these two pieces of information will lead to better diagnosis, staging, and evaluation of breast cancer,” Ravindranath said, “as well as research applications, such as radiotracers, MR imaging agents, and pulse sequences.”

Prototype conception

The detector design for the PET/MRI prototype is based on a small animal imaging system developed at BNL called the Rat Conscious Animal PET, or RatCAP. The miniature PET scanner was designed to acquire 3D images of a rat’s brain.

The prototype includes a modular 3D tomographic PET scanner that fits inside a dedicated breast MRI coil (Aurora Imaging Technology, North Andover, MA). “When the patient is positioned on the RF coil,” she said, “the breast region to be imaged is surrounded by the PET system and is in the field-of-view of the RF coil as well. Therefore, we are able to obtain simultaneous PET/MR images.”

The prototype has an inner diameter of 145 mm and an axial length of 96 mm. The design uses vertical stacks of lutetium orthosilicate (LSO) crystals arranged in a modular circle. By using this configuration, Ravindranath said there is “a possibility of expanding the field-of-view in order to accommodate a larger breast.”

Phantom results

Using phantoms to test the prototype, Ravindranath said the results show that the researchers have obtained “good PET spatial resolution throughout the field-of-view using the prototype system.” In addition, MRI tests with the PET insert also have shown good signal intensity and fat suppression capability.

“We have shown that PET can be operated unshielded inside the MRI, but we can improve the MR image quality by filtering the power supply cables to the MRI penetration panels,” she added. “This way the RF shielding of the MRI room is maintained. That also has been reducing the noise and frequency artifacts.”

The researchers plan next to begin working on the acquisition of simultaneous PET and MR images. Based on the preliminary results, they also soon expect to start testing the system on breast cancer patients.

The project is supported by the U.S. Department of Energy.

By Wayne Forrest
AuntMinnie.com staff writer
June 16, 2009