Underwater Medical Mission Uses Radiology Telementoring


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Underwater Medical Mission Uses Radiology Telementoring

  1. 1. DECEMBER 2004 ■ VOLUME 14, NUMBER 12 Photos courtesy of NEEMO 7Underwater Medical Mission Uses Radiology TelementoringAlso Inside:■ Radiology Should Assume Leadership Role in Cardiac Imaging, Experts Say■ Radiologists Can Help Patients Avoid Triggering Security Detectors■ RSNA Visiting Professors Share Experiences with Argentine Radiologists ks t Boo■ Private Practice Radiation Oncologist Promotes Strong Research Base Tex al dic■ iPod Helps Radiologists Manage Medical Images n Me side so In unt See Disco
  2. 2. DECEMBER 2004 EDITOR Susan D. Wall, M.D. DEPUTY EDITOR Bruce L. McClennan, M.D. CONTRIBUTING EDITOR Robert E. Campbell, M.D. 1 People in the News MANAGING EDITOR 2 Announcements Natalie Olinger Boden EXECUTIVE EDITOR Feature Articles Joseph Taylor 4 Radiology Should Assume Leadership Role EDITORIAL ADVISORS in Cardiac Imaging, Experts Say Dave Fellers, C.A.E. Executive Director 6 Radiologists Can Help Patients Avoid Triggering Roberta E. Arnold, M.A., M.H.P.E. Security Detectors Assistant Executive Director 8 RSNA Visiting Professors Share Experiences Publications and Communications with Argentine Radiologists EDITORIAL BOARD Susan D. Wall, M.D.10 iPod Helps Radiologists Manage Medical Images Chair12 Underwater Medical Mission Uses Radiology Bruce L. McClennan, M.D. Telementoring Vice-Chair Lawrence W. Bassett, M.D.15 Publisher Partners Richard H. Cohan, M.D. David S. Hartman, M.D. Funding Radiology’s Future Richard T. Hoppe, M.D.22 Private Practice Radiation Oncologist Promotes William T.C. Yuh, M.D., M.S.E.E. Strong Research Base Hedvig Hricak, M.D., Ph.D. Board Liaison23 R&E Foundation Donors CONTRIBUTING WRITERS19 Journal Highlights Joan Drummond Amy Jenkins, M.S.C.20 Radiology in Public Focus Mary E. Novak21 RSNA: Working for You Marilyn Idelman Soglin Lydia Steck, M.S.24 Program and Grant Announcements GRAPHIC DESIGNER25 Product News Adam Indyk25 Meeting Watch WEBMASTERS James Georgi27 Exhibitor News Ken Schulze28 RSNA.org 2004 RSNA BOARD OF DIRECTORS Robert R. Hattery, M.D. Chairman R. Gilbert Jost, M.D.RSNA News Letters to the Editor Liaison for Annual Meeting and TechnologyDecember 2004 • Volume 14, Number 12 E-mail: rsnanews@rsna.orgPublished monthly by the Radiological Society Fax: (630) 571-7837 Theresa C. McLoud, M.D.of North America, Inc., at 820 Jorie Blvd., RSNA News Liaison for EducationOak Brook, IL 60523-2251. Printed in the USA. 820 Jorie Blvd. Oak Brook, IL 60523 Gary J. Becker, M.D.POSTMASTER: Send address correction Liaison for Science Subscriptions“changes” to: RSNA News, 820 Jorie Blvd., Hedvig Hricak, M.D., Ph.D. Phone: (630) 571-7873Oak Brook, IL 60523-2251. E-mail: subscribe@rsna.org Liaison for Publications and CommunicationsNonmember subscription rate is $20 per year; Reprints and Permissions Burton P. Drayer, M.D.$10 of active members’ dues is allocated to a Phone: (630) 571-7829 Liaison-designate for Annual Meeting andsubscription of RSNA News. Fax: (630) 590-7724 TechnologyContents of RSNA News copyrighted ©2004 by E-mail: permissions@rsna.orgthe Radiological Society of North America, Inc. RSNA Membership: Brian C. Lentle, M.D. (877) RSNA-MEM President David H. Hussey, M.D. President-elect
  3. 3. PEOPLE IN THE NEWS Fritzsche Calls for Involvement2003 RSNA President Peggy J. tance of educating our legis- delegate to theFritzsche, M.D., is calling on her med- lators on issues related to American Medicalical colleagues to get involved in poli- medicine. They honestly do Association, and istics to help protect patients and the not understand our view a member of themedical profession. unless we make the effort to Key Contact Pro- In a cover story in the September inform them.” gram for CMA andissue of Southern California Physician, Dr. Fritzsche sits on the for the AmericanDr. Fritzsche said: “I have observed executive committee of the California College of Radiology.firsthand, on visits to legislators’ local Medical Association (CMA) Political To read the article, go tooffices and to Sacramento, the impor- Action Committee, is the RSNA www.socalphys.com/sep04/feature1.pdf.Vannier Earns Faculty Post at University of Chicago Som ReceivesMichael W. Vannier, M.D., a pio- fessor of radiology and industrial ASHNR Goldneer in the collection and presenta- engineering at the University of Medaltion of medical images, has been Iowa. The American Societyappointed professor of radiology at He holds six image-processing of Head and Neck Radi-the University of Chicago. patents, including one for a ology (ASHNR) has A member of the NASA/U.S. method of gastrointestinal tract awarded its 2004 goldSpace Foundation Hall of Fame, unraveling and two for computer- medal to Peter M. Som,Dr. Vannier was previously a pro- based upper-extremity evaluation. M.D., a professor of radiology, otolaryngol- Peter M. Som, M.D.Phlegar Steps Down at Erlanger, ADR ogy and radiation oncol-Robert F. Phlegar, M.D., has left “For the last four years I have ogy at Mount Sinai Hospital in New York City.his post as chief of radiology at been going to meetings early in Dr. Som, recognized as one of the world’sErlanger Medical Center in Chat- the mornings and at night. Now I foremost head and neck radiologists, is a found-tanooga, Tenn., and as president will be spending more time with ing member of ASHNR.and CEO of Associates in Diag- my family,” said Dr. Phlegar, whonostic Radiology (ADR). recently turned 61.Two Radiology Residents HonoredJulia J. Choo, M.D., and Stephanie inter-institutional exchange of infor-H. Swope, M.D., have been awarded mation.the inaugural Steven M. Pinsky, Dr. Choo is a radiation oncologyM.D., Resident Research Awards. resident at Rush University Medical Presented by the Illinois Radio- Center in Chicago. Dr. Swope is alogical Society (IRS) at its annual diagnostic radiology resident atmeeting in September, the award is Southern Illinois University Hospi-designed to encourage radiology and tals in Springfield.radiation oncology members-in-train- A committed educator and former Julia J. Choo, M.D. Stephanie H. Swope,ing to do research, to enhance their IRS president, Dr. Pinsky died last M.D.academic careers and to promote an April. Send your submissions for People in the News to rsnanews@rsna.org, (630) 571-7837 fax, or RSNA News, 820 Jorie Blvd., Oak Brook, IL 60523. Please include your full name and telephone number. You may also include a non-returnable color photo, 3x5 orlarger, or electronic photo in high-resolution (300 dpi or higher) TIFF or JPEG format (not embedded in a document). RSNA News maintains the right toaccept information for print based on membership status, newsworthiness and available print space. RSNANEWS.ORG RSNA NEWS 1
  4. 4. PEOPLE IN THE NEWS Van Houten to Head John Becomes First Female UMass Radiology UT Chair Francis X. Van Houten, M.D., is the Susan D. John, M.D., has been new director of radiology services for named the John S. Dunn Sr. Distin- the Memorial and Hahnemann Cam- guished Chair of Radiology at the puses of the University of Massachu- University of Texas Houston Medical setts Memorial Medical Center. School. Her appointment makes her Dr. Van Houten is also an associ- the first female chair in the history of ate professor of clinical radiology at the medical school. Francis X. Van Houten, the University of Massachusetts Dr. John is also the chief of Susan D. John, M.D. M.D. Medical School. pediatric radiology for Memorial Hermann Hospital in Houston. ANNOUNCEMENTS RSNA Membership Approaches 37,000 (as of 12/1/04) NCI Launches New Integrative Cancer Biology Program NIH Awards 1,400 New The National Cancer Institute (NCI) is communicated to other scientists in the Student Loan Repayment providing $14.9 million in funding for cancer research community. The ICBP Contracts a new Integrative Cancer Biology Pro- centers also will interact and collabo- In fiscal year 2004, the National Insti- gram (ICBP). rate with other NCI programs and tutes of Health (NIH) awarded student ICBP is a unique initiative external groups. NCI’s Cancer Bio- loan repayment contracts, totaling nearly designed to gain new insights into the medical Information Grid (caBIG, $68 million to more than 1,400 health development and progression of cancer cabig.nci.nih.gov) program will coordi- researchers. through a systems-wide approach. The nate all the bioinformatics software More than half of the awards were to multi-disciplinary effort will incorpo- needed by the ICBP as part of caBIG’s researchers who completed their doctoral rate new technologies such as ongoing effort to simplify and integrate degrees within the past five years. In genomics, proteomics and molecular the sharing and usage of data by pro- addition, more than 40 percent of the imaging to generate computer and viding access to NCI’s cancer research awardees hold M.D. degrees, 34 percent mathematical models that could predict communities. hold Ph.D. degrees, nine percent M.D., the cancer process. Fore more information on this proj- Ph.D. degrees, and seven percent other Nine ICBP centers will serve as ect, go to www.nih.gov/news/pr/ doctoral degrees. training and outreach programs, oct2004/nci-26.htm. For more information, go to enabling developing technologies to be www.lrp.nih.gov.2 RSNA NEWS DECEMBER 2004
  5. 5. ANNOUNCEMENTS20 0 4 R S N AOutstanding Educatorand Outstanding ResearcherAt RSNA 2004, the Society honored twoindividuals for their commitment to educationor research. ■ The 2004 RSNA OutstandingEducator award was presented to Henry I. Henry I. Goldberg, M.D. Steven M. Larson, M.D.Goldberg, M.D. The 2004 RSNA OutstandingResearcher was Steven M. Larson, M.D. R. GOLDBERG has been an influential and respected R. LARSON IS one of the world’s foremost experts inD educator and mentor for more than 30 years. He has earned numerous teaching awards from the Univer-sity of California, San Francisco (UCSF) School of Medi- D targeted radiotherapy and molecular imaging. His research, which spans three decades, has resulted in many novel findings especially in understanding cancer.cine, including “Teacher of the Year” and several clinical Using carbon-14 labeled media and a sensitive radiodetec-teaching awards. tor system, Dr. Larson was able to rapidly identify bacterial Former residents and fellows strongly credit Dr. Gold- and cell growth, a technology that is used widely today forberg for enhancing their educational experiences, and detecting mycobacterium tuberculosis.many former medical students have cited Dr. Goldberg as Dr. Larson has successfully tackled the problems ofthe influencing factor for their decision to pursue careers in antibody production, radiolabeling, humanization of theradiology. His teaching methods and curricula develop- antibody, minimizing host immune response and develop-ment are innovative and effective. One former resident ing methodologies to quantify response. His research inrecalls Dr. Goldberg using a Japanese kite to explain the detection of colorectal cancer has been successfully appliedwindsock sign seen in duodenal diverticulum, “He showed in the treatment of patients with advanced tumors.me how to describe this case as a case report and that aca- He also has made significant contributions to thedemic writing can be fun.” advancement of positron emission tomography (PET) as a Dr. Goldberg’s CD-ROM, “Introduction to Clinical clinical tool for oncology. He was recruited to the NationalImaging,” and his Radiology 100 syllabus are examples of Institutes of Health (NIH) in 1983, in part to establish aenduring educational materials that have been widely used state-of-the-art PET center for NIH researchers. His successat his institution and at several other medical schools in the in this endeavor led to an NIH Directors Medal in 1987 forcountry. Additionally, he has authored at least 160 original him and his colleagues.reports, 51 chapters and four electronic publications. While conducting cutting-edge research in targeted A leader in medical education at both the undergradu- therapy and related molecular imaging, Dr. Larson contin-ate and continuing medical education levels, Dr. Goldberg ues to be heavily involved in teaching, administration andcurrently serves as director of the Radiology Learning clinical care. Dr. Larson currently serves as chief of theCenter at the UCSF School of Medicine and has been nuclear medicine service at Memorial Sloan-Kettering Can-director of all medical student radiology teaching since cer Center (MSKCC), director of radiology research and1994. director of the PET Center at MSKCC. He is also a profes- He is a founding member and past-president of the sor of radiology at Cornell University Medical College.Alliance of Medical Student Educators in Radiology, and is Dr. Larson has authored or co-authored 430 manu-a charter member of the Haile T. Debas Academy of Med- scripts in major peer-reviewed journals, including Science,ical Educators at UCSF—an honor society and service Nature Medicine, Nature Biotechnology, Radiology, Theorganization to promote excellence in teaching, to foster New England Journal of Medicine, and Journal of Nuclearinnovation in the medical school curriculum and to support Medicine.and reward outstanding teachers. He is one of only three He has also served on several governmental advisoryradiologists who are surveyors for the Accreditation Coun- committees and study sections at NIH, the Department ofcil for Continuing Medical Education. Energy and the U.S. Food and Drug Administration (FDA). RSNANEWS.ORG RSNA NEWS 3
  6. 6. RSNA HOT TOPIC Radiology Should Assume Leadership Role in Cardiac Imaging, Experts Say technological phy, echocardiography and E XTRAORDINARY advancements and increasing inter- at least half of nuclear med- est in cardiac imaging present a icine exams. These are the unique opportunity for radiologists. Are established diagnostic they prepared for the challenge? imaging tools for patient “Radiologists are as prepared as management,” says Dr. Lip- cardiologists for CT studies of coronary ton, who is educated in both calcium and for coronary angiograms. cardiology and radiology. Radiologists must simply learn about Now that cardiac CT cholesterol, Framingham risk score, and and MR imaging are feasi- the National Cholesterol Education Pro- ble, Dr. Lipton suggests tection Guidelines APT III,” says radiology departments Melvin E. Clouse, M.D. Martin J. Lipton, M.D. Melvin E. Clouse, M.D., vice-chairman become vigorously and director of research at Beth Israel involved. “This is a very Deaconess Medical Center and profes- serious issue for radiology,” sor of radiology at Harvard Medical he says. “Cardiac imaging School. Dr. Clouse was a panelist dur- is an enormous field and ing a focus session on cardiac imaging will continue to grow.” at RSNA 2004. Incidents such as former “Radiologists need to study and President Clinton’s heart apply what we’ve learned in practice. surgery bring a heightened The technology and the patients are awareness to the detection here,” he says. of subclinical disease in The session, “Cardiac Imaging in completely asymptomatic the 21st Century: Is Radiology Ready individuals or those with David Bluemke, M.D., Thomas J. Brady, M.D. Ph.D. for Prime Time?,” was moderated by minor symptoms previously Martin J. Lipton, M.D. thought not to be life threat- cardiac imaging, it is also one of the “Interest in cardiac imaging has ening. hottest topics in medicine. Cardiac CT accelerated over the last few years “New technologies are largely allows the entire heart to be scanned in because of scanners that are now able focused on the evaluation of very early approximately 10 to 15 seconds with a to provide high- disease before peo- bolus injection of contrast material, speed, ECG-gated This is a very serious issue ple have heart which generates remarkable images of images of good diag- attacks and strokes. nostic quality,” says for radiology. Cardiac imaging Good examples of the coronary anatomy. Radiologists can examine cardiac function and coronary Dr. Lipton, a profes- is an enormous field and will that are evaluations artery plaque while assessing cardiac sor of radiology at of coronary artery structure for other diseases. Brigham and continue to grow. disease using MR “It’s a unique exam,” says focus Women’s Hospital in Martin J. Lipton, M.D. angiography depict- session panelist Thomas J. Brady, M.D., Boston. ing plaque to iden- director of the cardiac MR/CT program In the past, radiologists were tify the buildup of atherosclerotic at Massachusetts General Hospital and involved in cardiac imaging but times lesions,” adds focus session panelist the Robbins Professor of Radiology at have changed. “In the last two to three David Bluemke, M.D., Ph.D. Harvard Medical School. “Cardiologists decades, cardiologists have taken at Massachusetts General have used responsibility for nearly all of the car- Hot Topics in Cardiac Imaging cardiac CT extensively and have signif- diac imaging, including angiocardiogra- Cardiac CT is not just a hot topic in icantly altered management of patients4 RSNA NEWS DECEMBER 2004
  7. 7. with coronary artery disease. They pre-dict cardiac CT will replace diagnosticcoronary angiography in the next sev-eral years. I believe that in the right sit-uation with the right patient population,we can actually get patients to thecatheter lab earlier and perhaps savemore lives.” Another hot area is cardiac MRimaging. “It is in prime time right now,especially in the areas such as the eval-uation of left and right ventricle func-tion and myocardial viability,” says Dr.Bluemke, an associate professor andclinical director of MRI at the JohnsHopkins Medical School in Baltimore,Md. “In the future, I believe that theseMR imaging applications will be cen-tral within the realm of patient manage-ment for coronary disease.” Heart imaging is highly complex.Currently, 3D imaging of the heart canbe performed within a breath hold. Leftventricle function can be rapidly deter- Calcium Scoring events,” says Dr. Clouse. “This provesmined and areas of myocardial viability The coronary calcium score is also a the calcium score is an important pre-can be established during one or more controversial topic in cardiac imaging. dictor for future myocardial events. Ibreath holds, avoiding more compli- Previously, it was thought that variabil- think it should be used in those patientscated diagnostic procedures. ity and reproducibility made the score that are at intermediate and high risk.” In a very short period of time, via- unreliable. Dr. Clouse says this technol-bility imaging has become the gold ogy has now been validated for both Educating Residents in Cardiac Imagingstandard for assessing myocardial via- electron beam and multidetector CT. Major issues facing chairs of radiologybility using standard MR imaging con- “The reproducibility and variability departments today include recruitingtrast agents. Dr. Bluemke predicts that are such that radiologists should begin and/or training the necessary cardiacother novel approaches, such as MR using it to detect early or asymptomatic imaging faculty and adequately educat-assessment of unstable plaque, are soon disease so that patients can be treated to ing residents. “Cardiac imaging is veryto be developed and evaluated. “MR is prevent progression,” says Dr. Clouse, complex,” says Dr. Lipton. “Manythe best noninvasive method for identi- adding that the negative predictive aspects of cardiac diagnosis and manage-fying substructure within atheroscle- value of a zero calcium score is approx- ment are clouded by the self-referral pat-rotic plaque and has been used to show imately 97 percent. terns of cardiologists. Radiologistsregression of plaque after statin ther- He says total plaque burden is the should not use this as an excuse to deterapy,” he says. most important predictor for future them from participating and offering Contrast materials used in cardiac myocardial events. “Recently published imaging services to referring physicians.”MR imaging are also being improved research in The Journal of the American All the experts in the focus sessionand used in novel ways. Dr. Bluemke Medical Association indicates that the agree that radiology must take an activesays that the latest generation of calcium score is additive to the Fram- role in cardiac imaging or run the riskintravascular contrast agents for MR ingham risk score—the gold standard of being left out of this burgeoningimaging provides prolonged imaging for predicting future myocardial field. ■periods of 10 to 15 minutes allowingmuch higher potential resolution of vas- CVI Fellowshipscular detail, while existing contrast Several cardiovascular imaging fellowships are available through programs established asagents are being used to evaluate stem a result of grants from the RSNA Research & Education Foundation. See page 24 for morecell therapy of myocardial infarction information.and cardiomyopathy. RSNANEWS.ORG RSNA NEWS 5
  8. 8. RSNA HOT TOPIC Radiologists Can Help Patients Avoid Triggering Security Detectors certain nuclear A FTER UNDERGOING medicine procedures, patients can trigger radiation detectors for up to three months—something radiolo- gists must discuss with their patients, according to a scientific paper presenta- tion at RSNA 2004. Lionel Zuckier, M.D., a professor of radiology at the University of Medi- cine and Dentistry of New Jersey, and colleagues found that patients who undergo exams, such as bone and thy- roid scans, cardiac exams and iodine therapy, are at risk of setting off Home- land Security detectors for much longer periods than previously imagined. “The nuclear medicine community has known for some time that these Lionel Zuckier, M.D., participated in a press conference at RSNA 2004 during patients can set off radiation detectors. which he urged patients to talk with their doctors about getting official documen- It’s becoming a more common occur- tation when undergoing certain medical procedures such as bone and thyroid scans, cardiac exams and iodine therapy. rence with the increasing number of very sensitive portable Homeland Secu- of The New England Journal of Medi- security, Dr. Zuckier and his colleagues rity radiation detectors given to police cine, “Problems on Pennsylvania wondered how long patients undergo- officers, airport security personnel and Avenue,” described how, in two sepa- ing diagnostic and therapeutic nuclear border patrols,” says Dr. Zuckier, who rate incidents, nuclear medicine medicine procedures could potentially is also the director of nuclear medicine patients set off detectors at the White set off detectors—such as those used and PET at University Hospital in House. by Homeland Security personnel. The Newark. More recently, the NRC has alerted researchers tested the sensitivity of a He supports recommendations users to an event where panel of detectors to vari- made by the Society of Nuclear Medi- a patient who had We found that even ous radionuclides and, cine (SNM) and the U.S. Nuclear Reg- undergone a nuclear ulatory Commission (NRC) that radiol- medicine procedure miniscule amounts of making the assumption that personal radiation ogists and hospitals should provide ignored written safety radionuclides could set detectors worn by security official documentation to the more than instructions not to officers could be posi- 18-million patients who undergo travel for two days. off the detectors. tioned as close as one nuclear medicine and therapeutic pro- The patient boarded a Lionel Zuckier, M.D. meter away from a cedures each year. His study suggests bus traveling from patient, calculated the guidelines as to how long this docu- New York City to Atlantic City. The threshold of radionuclides that would mentation should be retained. bus was subsequently pulled over when trigger these devices. a radiation alarm sounded in a tunnel. In collaboration with Michael G. Not a New Problem While there was no danger to those on Stabin, Ph.D., from Vanderbilt Univer- Dr. Zuckier says initial reports of the bus, this incident did cause unnec- sity in Nashville, Tenn., who provided nuclear medicine patients setting off essary concern for travelers and law expertise regarding rates of excretion of radiation detectors came almost two enforcement officials. radiopharmaceuticals from the body, decades ago. A 1986 letter to the editor With today’s state of heightened the authors then calculated how long it6 RSNA NEWS DECEMBER 2004
  9. 9. would take for the patient to drop verification. Outside of normalbelow the thresholds needed to trigger working hours, the contact personthe alarms. should have access to an appropri- “In our experimental measure- ate source of information such as aments, we found that even miniscule hospital or radiology informationamounts of radionuclides could set off system, so that the letter can bethe detectors,” says Dr. Zuckier. “Con- independently confirmed.sequently, the length of time it took for While this is an extremelythe human body to excrete the radio- important matter, Dr. Zuckier sayspharmaceuticals to below threshold lev- his study should not alarm the pub-els was much longer than expected.” lic nor should patients avoid As indicated by the study, trace needed procedures for fear of trig-quantities of radionuclides remaining in gering radiation alarms. Thethe body can set off radiation detectors amount of radiation a patient ➊for variable periods of time: receives from a typical nuclearPET scan . . . . . . . . . . . . . . . Less than one medicine procedure is minimal, but day he says under the current climateBone and thyroid scan . . . . Three days of security consciousness, patientsCardiac thallium exams. . . . Up to 30 days should be provided with a noteIodine or Bexxar* therapy . . Up to 95 days from their doctors.*Bexxar therapy involves an antibody conjugated In addition to presenting theto radiolabeled iodine. scientific paper at RSNA 2004, Dr. ➋ ➌ Zuckier also participated in anWhat Should Radiologists Do? RSNA press conference in whichSNM says radiologists can help he discussed his findings with thepatients and security personnel by pro- medical news media. To view theviding patients who will be traveling on news releases from the annualpublic transportation (such as airplanes, meeting, go to rsna.org/press04.trains and rapid transit) or visiting To view the abstract of Dr.secure facilities with a letter that con- Zuckier’s scientific paper, go to To search for presentations from RSNAtains the following information: rsna2004.rsna.org/rsna2004/V2004/ 2004, go to rsna2004.rsna.org ➊, click• Patient name on Meeting Program ➋ in the left-hand conference/event_display.cfm?em_id=• Name and date of nuclear medicine column, then click on search ➌ within 4407767. procedure the course type. For more information on develop-• Radionuclide ing a letter for patients, see the SNM• Half-life Web site at www.snm.org. Type the• Administered activity term “security authorities” in the search• 24-hour contact information box and hit Enter. Click on the article, SNM says the letter should also “SNM Working With Security Authori-provide specific details about who ties To Develop Procedures To Expe-should be contacted, if necessary, for dite Radiation Monitoring.” ■ ❚Webcasts of RSNA 2004 Press Conferences D R.ZUCKIER’S press confer- ence was among 20 held during RSNA 2004. Six of the and then click on Access the Webcast Archive. Press conferences include: • Imaging Tool May Help Physicians Diagnose Bipolar Disorder – John DeWitt Port, • Brain Imaging with MRI Could Replace Lie Detector – Scott H. Faro, M.D. press conferences were offered • Thyroid Treatment Can Trig- M.D. • CT Helps Find Cause of Puz- via Webcast. ger Homeland Security Detec- • Brain Remapping May Be Key zling Cough in WTC Rescue To view the press confer- tors – Lionel Zuckier, M.D. to Recovery from Stroke – Workers – David S. Mendel- ences, go to rsna.org, click on • Patients’ Own Stem Cells Kristine M. Mosier, D.M.D., son, M.D. Media in the left-hand naviga- Used to Cure Incontinence – Ph.D. tion bar, click on RSNA 2004 Ferdinand Frauscher, M.D. RSNANEWS.ORG RSNA NEWS 7
  10. 10. FEATURE EDUCATION RSNA Visiting Professors Share Experiences with Argentine Radiologists conjures up A RGENTINA OFTEN visions of the tango, gauchos or Eva Peron. But after participating in this year’s RSNA International Visit- ing Professor (IVP) Program and see- ing the country firsthand, three RSNA members will remember other images. “As we were leaving for the airport, we saw families having picnics on the median strips of the highway to enjoy what greenery there was in the city,” says Theodore Dubinsky, M.D., one of three visiting professors who attended the 50th Argentine Congress of Radiol- ogy in Buenos Aires this September. The team saw both the beauty of South America’s second largest nation as well RSNA’s three International Visiting Professors to Argentina are pictured with as the devastating impact Argentina’s Sociedad Argentina de Radiologica (SAR) President Ricardo García Mónaco at the economic crisis has had on its citizens 50th Argentine Congress of Radiology in Buenos Aires. (from left to right) William Brant, M.D., Gia DeAngelis, M.D., Theodore Dubinsky, M.D., and Professor García and their healthcare. Mónaco. Dr. Dubinsky is an associate pro- fessor of radiology at the University of trained. But they are being challenged nals. “I heard one story of a doctor’s Washington School of Medicine, and by their economy,” says Dr. Dubinsky. child being held at gunpoint while he serves as director of the Body Imaging “Costs are difficult to manage and their and his family were forced to drive to a Center at Harborview Medical Center equipment is not as up to date as ours.” bank and withdraw money,” he says. in Seattle. The team also included The Argentine economy collapsed “The child and his parents escaped William Brant, M.D., a professor and in December 2001. After several days of unharmed when the robbers ran off acting chairman of the Department of violent street protests that left 27 people with the cash.” Radiology at the University of Virginia, dead, Argentine President Fernando de Despite the uncertain economic cli- Charlottesville, and Gia DeAngelis, la Rúa resigned and a state of emer- mate, Argentine physicians warmly M.D., an associate professor of clinical gency was declared. The value of the welcomed the RSNA contingent and radiology at the University of Virginia. peso plummeted and has stayed low treated them very well. “It’s an honor The IVP Program allows small teams while unemployment and poverty have being a visiting professor representing of imaging professionals to lecture at increased. For the medical community, RSNA,” says Dr. Brant. the national radiology meeting of the impact has meant less of every- In return, Drs. Dubinsky, Brant and emerging nations, as well as at the host thing—training, equipment and space to DeAngelis say they worked hard during institution. perform exams and medical tests. their visit, doing extra lectures, teach- All three physicians attending the Dr. Dubinsky says the state of the ing conferences and making hospital congress made presentations to well- economy was a popular topic of con- visits to regions outside the meeting attended sessions. “Overall, my impres- versation at the congress, noting that site in Buenos Aires. Dr. Brant’s host sion is of wonderful people and, for the some physicians fear their perceived took him around the city of Mendoza, most part, the physicians are very well- wealth makes them targets for crimi- near the Andes Mountains, to medical8 RSNA NEWS DECEMBER 2004
  11. 11. (left) The ruins of a hotel destroyed in an avalanche at 9,000 feet in the Andes. (above) The most colorful barrio in La Boca, Buenos Aires, was settled by Ital- ian immigrants to Argentina. It is currently an artists colony and a home of the tango.Images courtesy of William Brant, M.D.facilities at the National University of tube burned out. A new tube would “Ultimately, some patients haveCuyo. need to be imported and the hospital is less access to medical treatment,” says In the region’s central hospital, he dependent on public funds, so they can- Dr. DeAngelis, who adds that part ofsaw how physicians and students cope not afford to get another one,” she says. the solution may be to train more radi-with a lack of sufficient medical fund- “The radiologists have to make do. ologists in subspecialties. “We take soing and outdated equipment. “It’s like They perform angiography with equip- much for granted. One prominent radi-seeing a county or public hospital here. ment that had been dedicated to cardiac ologist I met considered it one of theThere are large numbers of ill, indigent imaging and adapt their technique to highlights of her career to get a posterpatients, but the situation is magnified,” obtain high-quality images.” accepted at the RSNA annual meeting.Dr. Brant says. A physician surplus in Argentina has They’re so appreciative when they He saw radiology residents act as created fierce competition for medical receive an accolade from a radiologytechnicians, performing ultrasounds and residency spots—especially in the bet- society or have a chance to speak or beother scans, but Dr. Brant says that may ter-equipped private practices. “There published.”have had a positive effect on patient are only about 500 paid medical resi- As part of the IVP Program,care. “The tests were tai- dency opportunities for RSNA’s Committee on Internationallored to the patient’s They have a CT scanner approximately 8,000 Relations and Education provides forproblem and the resident that has not been used graduates a year,” says donation of educational materials to thewas right there to make a Dr. Brant. “There are host institutions.decision,” he explains. for two years since the about 1,000 more Also this fall, an IVP team visited“The quality of the equip- tube burned out. A new unpaid residency slots. Romania, and in a separate but similarment is some generations So residents in the program, a team of visiting professorsbehind what we have. For tube would need to be unpaid programs com- traveled to Mexico City.instance, they’re using imported and the hospital pete for the chance to Next year, IVP teams will go tosingle-slice CT units but take night call for Brazil, Thailand and Sri Lanka. Dr.the quality of the studies is dependent on public extra money.” Brant says it’s important for U.S. radi-was high. They push the funds, so they cannot Because the value ologists to play a role as internationalscanner for quality.” of the Argentine peso teachers. “RSNA is very highly At the region’s central afford to get another one. is so low, only a few respected in Argentina. Physicians lookhospital, thousands of Gia DeAngelis, M.D. wealthy students can at it as the standard of where radiologypatients are seen each go abroad for training. is going,” he says.year in the one room where fluoroscopy While most of the faculty at medical The 2004 RSNA IVP program wasstudies can be done. Dr. DeAngelis schools is devoted to training young funded through an endowment from thefound similar conditions at a public physicians, the professional surplus Agfa Corporation. In 2005, the IVPhospital in Cordoba, a major city out- with the concurrent lack of adequate program will be funded through endow-side of Buenos Aires. specialty training could make some ments from Agfa and FUJIFILM Med- “They have a CT scanner that has physicians reluctant to train residents ical Systems. ■not been used for two years since the for fear of the competition. RSNANEWS.ORG RSNA NEWS 9
  12. 12. FEATURE TECHNOLOGY iPod Helps Radiologists Manage Medical Images HE IPOD is not just for music any T more. Radiologists from the Uni- versity of California, Los Angeles (UCLA), and their colleagues at other institutions from as far away as Europe and Australia are now using iPod devices to store medical images. “This is what we call using off the shelf, consumer market technology,” says Osman Ratib, M.D., Ph.D., profes- sor and vice-chairman of radiologic services at UCLA. “Technology com- ing from the consumer market is changing the way we do things in the radiology department.” Dr. Ratib and Antoine Rosset, M.D., a radiologist in Geneva, Switzer- land, recently developed OsiriX, Mac- The authors of the Osirix Software, Osman Ratib, M.D., Ph.D. (front), and Antoine intosh-based software for display and Rosset, M.D. (back), review images stored on the iPod portable device. manipulation of complex medical Images courtesy of Osman Ratib, M.D., Ph.D. image data. “We chose to do it on the Macin- twice as big as my disk on my laptop copy data from work to my laptop, but tosh because of the high performance and I’m using only 10 percent of it for I don’t have to do it if I don’t want to.” of Mac graphics,” Dr. Ratib says. “The my music. So, why don’t I use it as a Dr. Ratib sees the iPod as a kind of purpose is to be able to quickly and hard disk for storing medical images?” giant memory stick, “The performance interactively manipulate very large data Dr. Rosset set up the OsiriX soft- is amazing.” sets in 3D, 4D and even 5D. It’s amaz- ware to automatically recognize and Large data sets can be transferred ing how much perform- search for medical directly to the iPod through the firewire ance we get.” Technology coming from the images on the connection. “I use my software to How did the devel- iPod. When it download images from the PACS or opers go from a music consumer market is changing detects the from any imaging source,” Dr. Ratib player to a medical the way we do things in the images, they auto- says. “OsiriX follows the most univer- storage device? “We matically appear sal way of accessing any image and it basically wanted some- radiology department. on the list of covers virtually every DICOM format thing that everybody Osman Ratib, M.D., Ph.D. image data avail- possible. It’s very, very flexible.” could use,” explains Dr. able—similar to Once the images are on the iPod, Ratib. “That’s why OsiriX can be used the way music files are accessible by they can be carried from one machine with the iPod, iChat and other tools.” the iTune music application. to another, as long as the computer is a “Radiologists deal with a very large “It’s easy to use and you don’t have Macintosh. “You can see the images amount of medical imaging data,” Dr. to worry about how to load and unload and display them as you would do with Ratib explains. “I never have enough it from the iPod,” Dr. Ratib says. “But any other file that’s on your hard disk,” space on my disk, no matter how big the real beauty of it is that I can use the Dr. Ratib says. my disk is—I always need more space. images directly on the iPod. I don’t OsiriX allows users to upload One day I realized, I have an iPod that have to take the time to copy them to images to the Internet. It also supports has 40 gigabytes of storage on it. It’s my computer. The iPod allows me to iChat instant messaging, which is com-10 RSNA NEWS DECEMBER 2004
  13. 13. OsiriX converts virtually every DICOM format possible.This teleradiology setting shows an inserted live PET-CT reconstruction on thevideo image (upper right corner of the screen) of a iPod Photo as displayed on a TVvideoconference session using iChat software for through the S-Video interfaceinstant messaging that is available on all Macintoshplatforms.patible with AOL instant messaging. believes actual usage is about three to Free Software DownloadThis allows the user to take advantage five times that number. OsiriX software can be downloaded atof the video-conferencing capability. Among the respondents to the sur- homepage.mac.com/rossetantoine/But instead of seeing the user’s face on vey, more than one quarter of the osirix/.a Webcam, it is modified to show the OsiriX users were radiologists, half of The software was featured at RSNAuser’s screen at the other end of the them at university hospitals. Forty-one 2004 on 30-inch, high-definition colorconversation. percent of the total survey respondents screens during two presentations in the “For us, it’s a way of doing infoRAD area. The presentationsvery cheap, very convenient telera- were titled, “OsiriX: Multimodal-diology,” Dr. Ratib explains. “I ity Open Source Image Displaycould be chatting with one of my and Navigation Software,” andbuddies and he can see my screen, “Navigating the Fifth Dimen-so I can show him what I’m doing sion—Innovative Interface forwith an image.” Multidimensional Multimodality “I can also send him that Image Navigation.”image at high resolution as an OsiriX was also featured in theattachment,” he continues. “He’ll scientific poster, “Merging Imag-immediately receive it, open it and ing Modalities: Practical Applica-we can continue to talk about it.” tions,” and in the scientific paper, The software is free, distrib- “Display and Interpretation ofuted under Open Source Licens- Multidimensional and Multi-ing, and has found users around the said they use OsiriX daily, while 46 modality Images.”world. “I want everybody to partici- percent use it weekly. The most fre- “We’re not trying to reinvent some-pate,” Dr. Ratib says. quent usage was for research (53 per- thing that’s completely different,” Dr. A recent survey of OsiriX users cent), followed by presentations (37 Ratib concludes. “We’re trying to adaptfound that it has been very well percent), PACS at home (34 percent), to the very rapidly changing environ-received. One thousand people down- PACS at work (29 percent), 3D station ment, and provide ourselves with toolsloaded the software within the first (26 percent) and fun (24 percent). that industry would take years to givemonth of distribution. Dr. Ratib us.” ■ RSNANEWS.ORG RSNA NEWS 11
  14. 14. FEATURE SCIENCE Underwater Medical Mission Uses Radiology Telementoring ECENTLY, a Canadian radiologist R successfully drained a patient’s abscess. Sound routine? Maybe, but in this case, the patient was hun- dreds of miles away lying 19 meters beneath the surface of the waters off Key Largo, Fla. It was all in a days work for Julian Dobranowski, M.D., and the crew of NEEMO 7, otherwise known as the National Aeronautics and Space Administration (NASA) Extreme Envi- ronment Mission Operation. The goal of this joint venture by NASA, the Canadian Space Agency (CSA) and the Centre for Minimal Access Surgery (CMAS), a surgical center affiliated with McMaster Uni- versity that develops techniques to be Julian Dobranowski, M.D., in the telerobotics lab at St. Joseph’s Healthcare in used in remote medical care, was to Hamilton, Ontario. test and evaluate the latest in remote medical diagnostic and therapeutic the very first hospital-to-hospital afforded aquanauts, astronauts and technologies. remote surgery in 2003. medical professionals an unprecedented “We want to be able to deliver the The underwater crew included mis- opportunity to test state-of-the-art highest quality diagnostic and surgical sion commander and CSA astronaut remote medical techniques in real-time care to remote areas of the world as Bob Thirsk, M.D., and real-life situations. well as in space,” says Dr. Dobra- NASA astronauts Mike We want to be able to Someday, these tech- nowski, chief of the Department of Barratt, M.D., and niques could be used in Diagnostic Imaging and medical direc- Cady Coleman, Cana- deliver the highest quality long-duration, manned tor of the Imaging Research Centre at dian surgeon Craig diagnostic and surgical space flights to the St. Joseph’s Healthcare in Hamilton, McKinley, M.D., and Moon and Mars,” says Ontario. habitat technicians care to remote areas of the Dave Williams, M.D., James Talacek and world as well as in space. CSA astronaut/ aqua- The Crew Billy Cooksey. The naut and trauma physi- The crew for the 10-day October mis- underwater team con- Julian Dobranowski, M.D. cian, who was slated to sion was split into two teams—a land- ducted their work from be mission commander based team and the underwater team. the Aquarius Undersea Laboratory in of the Aquarius before a last-minute St. Joseph’s Healthcare was the the Florida Keys Marine Sanctuary. surgery prevented him from making the base for the land crew. The team com- The steel cylinder Aquarius habitat is trip. prised a number of experts including similar in size to that of the service Dr. Dobranowski, NASA astronaut Bill module for the International Space Sta- Mission Objectives Todd, who was the mission director, tion. The mission had two diagnostic imag- and Mehran Anvari, M.D., CMAS “The extreme conditions of a long ing objectives. The first objective was founder and director. Dr. Anvari is underwater mission are similar to those to experiment with telementoring by world renowned for having performed of space. The NEEMO 7 mission having Dr. Dobranowski and his team12 RSNA NEWS DECEMBER 2004
  15. 15. Julian Dobranowski, M.D. (topphoto, left), and registered diag-nostic medical sonographersPatty Harkness (top photo, center)and Terry Popowicz (top photo,right) guide the NEEMO 7 crewthrough an ultrasound procedure.guide medical and non-medical person- designed to help non-medical personnel technology to its limits to find outnel aboard the Aquarius through an use the ultrasound machine and identify where it begins to fail and break downevaluation of the abdomen and neck key organs in an emergency situation so that we can learn how to develop theusing a portable ultrasound unit. were effective and valuable. next generation of technology,” says The second objective was telemen- Dr. Williams. “We truly believe that wetoring of a percutaneous drainage of a Mission Complications are changing the face of how wesimulated abscess under ultrasound In the past, signal delay has been an deliver healthcare. In so doing, we areguidance. Other mission objectives area of concern for remote surgical reducing or eliminating the geographicincluded telementoring the crew applications. However, Dr. Anvari’s disparity in healthcare.”through various procedures including research has shown a delay of up to From radiology’s perspective, sig-intubation, suturing of a nerve and three-quarters of a second is tolerable nal delay has not been as much of anartery, and laparoscopic cholo-appen- during surgical procedures as long as issue. “We didn’t find that the delaydectomy or nephroscopy. it’s constant. But, with the signal delay impeded our mission objectives what- The mission was successful and to the International Space Station esti- soever. It was all quite fluid and wentproved that medical and non-medical mated at one second and the delay to very smoothly,” says Dr. Dobranowski.personnel could successfully locate key the Moon thought to be about three The only real complication for theorgans and perform accurate and repro- seconds, how long is too long? mission arose when St. Joseph’s tem-ducible ultrasound-guided tasks. It also “In many ways we are trying to porarily lost real-time visual contactshowed that educational manuals push the edge of the envelope and take Continued on next page RSNANEWS.ORG RSNA NEWS 13
  16. 16. (top left photo) Mehran Anvari, M.D. (right), demonstrates laparoscopic techniques on a medical dummy with NEEMO 7 Mission Com- mander Bob Thirsk, M.D. (top right photo) Craig McKinley, M.D., prepares to splash down into the Aquarius Habitat in the waters off Key Largo, Fla. (left) Drs. Anvari and McKinley. Photos courtesy of NEEMO 7. Continued from previous page sound as a modality,” he says. “Experi- The first journal manuscript submitted and was unable to see into the Aquar- mentation with digital radiography in from the International Space Station is ius. “At that point we communicated these types of extreme environments now available on Radiology Online instructions to the astronauts using our and at the space station would be an (rsna.org/radiologyjnl). See page 20 for cell phones and they were able to per- important step.” more information. form their duties successfully even in With the NEEMO 7 mission firmly that scenario,” says Dr. Dobranowski. under their belts, the crew is satisfied In the end, the team successfully that the information collected will help completed all surgical and radiologic to further refine medical technique, objectives. equipment and resources needed for the delivery of medical care in remote What’s Next? locations now and in the future. As telecommunications and robotic A NEEMO 9 mission to further technologies continue to improve and explore telehealth is tentatively sched- expand, so to will telehealth capabilities. uled for next fall. ■ For now, Dr. Dobranowski feels that a logical next step might be pursu- ing research with other imaging tech- niques. “We’re very limited with ultra-14 RSNA NEWS DECEMBER 2004
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