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New in this IssueRESEARCHRadiation Lowers Relapse Risk In Noninvasive Breast Cancer New Criteria For Measuring Tumor Size And Progression Will Help Ease Workloads In Clinical Trials UC Davis researchers seek to map the brain patterns of Alzheimer’s disease Use of Magnetic Resonance Imaging Improves Diagnosis of Patients in Vegetative State High Intensity Focused Ultrasound Holds Promise as Prostate Cancer Treatment Breast Cancer Patients not Getting Needed Radiation Therapy Radiation did not increase toxicity when used with capecitabine and cisplatin U.S. experts foresee more effective cancer radiation TechnologyMaking MRI Scanning Safer - Early Warning Metal Detector Launches For sharper pictures of the body’s interior An Intraoperative Brain Shift Monitor Using Shear Mode Transcranial Ultrasound GeneralCancer patients ’given excess radiation’ at Coffs Harbour Wanted: Medical physics and engineering feature articles, news and meeting reports Expansion of PET Coverage May Not Increase Use SNM supports long-term objective of National Academy of Sciences report on medical isotopes Radiation From Cardiac CT Scans Varies FDAFDA Issues Public Health Advisory Regarding Topical Anesthetics GAO Releases Report Validating Current 510(k) Review Process MedicareMedical imaging hopes to cut losses in Medicare reform debate Funding Opportunities09 Summer School Scholarships -Deadline February 20, 2009
News from NIHNew Federal Nuclear Response Guide Announced Risk reduction in radiotherapy SF424 (R&R) Application and Electronic Submission Information
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To submit articles for future e-News, please email Meetings CalendarOperations Research in Radiation Oncology Workshop; February 16-18 2009, Melbourne, Australia SPECT/CT Hands-on Short Course; February 27- March 1, 2009, Houston, TX USA 30th Int’l Acoustical Imaging Symposium; March 1-4, 2009, Monterey, CA Spring 2009 Florida Chapter Meeting March 5 - 7, 2009 in Kissimmee, FL SEAAPM 2009 Annual Symposium and Scientific Meeting; March 12-14 2009 in Chapel Hill, NC 2009 NW AAPM and AAMD Region I Spring Meeting & Symposium; March 20-21, 2009 in Skamania Lodge, Stevenson, WA Annual Congress & Workshop of the South African Association for Physicists in Medicine and Biology (SAAPMB); March 24-28 2009, Bloemfontein, South Africa Short Course on Monte Carlo Treatment Planning; April 2-4 2009, Philadelphia, PA 40th San Francisco Radiation Oncology Conference; April 17-19, 2009, San Francisco, CA Respiratory Motion Management for Radiation Therapy; April 24-25, 2009, St Louis, MO Diagnostic Radiologic Physics Mock Board Examination; April 25-26, 2009, Houston, TX International Conference on Advances in Radiation Oncology (ICARO); April 27-29, 2009, Vienna, Austria Occupational and Environmental Radiation Protection: Principles and Practices of Radiation Safety; April 27-30, 2009, Boston, MA ACMP Annual Meeting; May 2-5, 2009, Virginia Beach, VA A Symposium on the Promises and Perils of Proton Radiotherapy; May 8 - 9, 2009, Baltimore, MD AAPM Website UpdatesDiagnostic Imaging Medical Physicists List (DXIMGMEDPHYS)
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Placement & Committee AdsPlacement Service Ads as of Febuary 2, 2009 AAPM Committee Classifieds as of February 2, 2009 |
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RESEARCHRadiation Lowers Relapse Risk In Noninvasive Breast CancerA new review confirms that the addition of radiation therapy to lumpectomy in the treatment of ductal carcinoma in situ (DCIS), a noninvasive early form of breast cancer, substantially decreases the risk of recurrence of either DCIS or invasive breast cancer in the affected breast... [see full article] New Criteria For Measuring Tumor Size And Progression Will Help Ease Workloads In Clinical TrialsThe first, formal revision of specific guidelines, known as RECIST, used by clinicians to measure tumour size and response to treatment, has been published January 20 in a special issue of the European Journal of Cancer (the official journal of ECCO – the European CanCer Organisation)... [see full article] UC Davis researchers seek to map the brain patterns of Alzheimer’s diseaseResearchers at UC Davis have launched an innovative study to determine whether closer examination of magnetic resonance imaging (MRI) scans can detect the onset of Alzheimer’s disease even before patients begin to show the symptoms of cognitive decline that are the hallmarks of the condition... [see full article] Neoadjuvant Chemoradiation Associated With Improved Survival in Resectable Gastric Cancer: Presented at ASCO-GIPatients who undergo neoadjuvant chemoradiation before surgery for treatment of gastric cancer achieve a median overall survival that exceeds 5 years... [see full article] Use of Magnetic Resonance Imaging Improves Diagnosis of Patients in Vegetative StateA study led by researchers from Catalonia analyses the importance of the use of magnetic resonance imaging to improve the diagnosis and treatment of patients in a vegetative state. Until now these tests have not been performed in this type of patient... [see full article] High Intensity Focused Ultrasound Holds Promise as Prostate Cancer TreatmentHigh intensity focused ultrasound is a minimally invasive treatment option for prostate cancer. Data from the literature show promising early oncological outcomes and a favorable side effect profile. This study is a preliminary report of the Italian experience (Perugia and Turin) of patients treated with the Sonablate(R)500 high intensity focused ultrasound device... [see full article] Breast Cancer Patients not Getting Needed Radiation TherapyAlmost 1 in 5 women who undergo mastectomies after a breast cancer diagnosis are not getting the radiation therapy they need, according to a study to be published in the March 15 issue of the American Cancer Society's journal Cancer... [see full article] Radiation did not increase toxicity when used with capecitabine and cisplatinRadiation in conjunction with capecitabine and cisplatin was as safe as capecitabine and cisplatin alone for patients with resected gastric cancer with D2 nodal dissection, according to the safety results of the phase-3 ARTIST trial... [see full article] U.S. experts foresee more effective cancer radiationU.S. researchers think they now understand why some cancers grow back after radiation treatment. They said a specialized type of cell known as a cancer stem cell has a protective mechanism that keeps radiation from damaging the DNA and proteins inside the cell... [see full article] Technology Making MRI Scanning Safer - Early Warning Metal Detector LaunchesA unique metal detection system for MRI scanning suites, designed by Metrasens and Smallfry, two Midlands-based specialists, is already saving money and saving lives across the UK and in the US... [see full article] For sharper pictures of the body’s interiorSnap-shots of a diseased heart or deep insights into cancer cells - a 7-tesla magnetic resonance tomograph promises scientists novel possibilities. The magnetic field of this so-called ultra-high field magnetic resonance tomograph (MRT) is 140 000 times as strong as that of the Earth and can make the most minute structures of the human body visible... [see full article] Novel Treatment Approach Demonstrates Improvement In Diagnostic Accuracy For Patients With Acute Myocardial InfarctionCardiovascular magnetic resonance imaging offers the ability to measure after therapy the size a myocardial infarction would have had if no therapy had been performed (Salvage-imaging)... [see full article] An Intraoperative Brain Shift Monitor Using Shear Mode Transcranial UltrasoundVarious methods of intraoperative structural monitoring during neurosurgery are used to localize lesions after brain shift and to guide surgically introduced probes such as biopsy needles or stimulation electrodes... [see full article] General Cancer patients ’given excess radiation’ at Coffs HarbourAn equipment error at a northern NSW health clinic has led to scores of cancer patients receiving too much radiation, health officials say. Investigations are underway to establish how a radiotherapy machine at the Coffs Harbour Integrated Cancer Care Centre came to be incorrectly calibrated for some 17 months, meaning 72 patients received elevated radiation doses... [see full article] Expansion of PET Coverage May Not Increase UseA CMS proposal to expand Medicare coverage of PET scans that are used to diagnosis and stage cancer may provide a clinical boon to patients and some increased reimbursement opportunities for providers, but hospitals aren’t likely to rush out and buy the equipment should the proposal prevail, according to healthcare experts... [see full article] SNM supports long-term objective of National Academy of Sciences report on medical isotopesAccording to a report released Jan. 14, 2009, by the National Academy of Sciences (NAS), eliminating the highly enriched uranium process (HEU)—the primary source of medical isotopes in the U.S.—would be technically and economically feasible. However, the conversion to an alternative source will be years away, is likely to be more costly than the report estimates, and will not alleviate the current ongoing shortages of medically necessary isotopes... [see full article] Radiation From Cardiac CT Scans VariesRadiation doses from scans used to diagnose heart and vascular disease vary widely, and they could be reduced significantly if strategies for minimizing exposure were more widely followed, a new study shows... [see full article] FDA FDA Issues Public Health Advisory Regarding Topical AnestheticsFDA issued a public health advisory to remind patients, healthcare professionals, and caregivers about potentially serious hazards of using skin numbing products, also known as topical anesthetics, for relieving pain from mammography and other medical tests and conditions... [see full article] GAO Releases Report Validating Current 510(k) Review ProcessJanuary 15, 2009 -The Government Accountability Office (GAO) published a report on FDA’s 510(k) review process. The report validates the current 510(k) review process. However, the GAO recommended that FDA expeditiously take steps to issue regulations for Class III device types currently allowed to enter the market via the 510(k) process by requiring premarket approvals (PMA) or reclassifying the device to a lower class. The Department of Health and Human Services (HHS) agreed with the GAO’s recommendation... [see full article] Medicare Medical imaging hopes to cut losses in Medicare reform debateThe U.S. medical imaging community is experiencing both anticipation and angst as Congress and the Obama administration prepare to tackle rising healthcare spending. Many imaging observers are concerned that the government may repeat recent history by approaching imaging reimbursement with a hatchet rather than a scalpel. Former Secretary of Health and Human Services Mike Leavitt said in December that Medicare is "drifting toward disaster," and that Congress and the new administration should implement Medicare reform this year to improve the U.S healthcare system. Many Capitol watchers also believe that the Obama administration may want to cut costs in some areas of Medicare and Medicaid to free up funds in other areas, such as expanding access to care. Imaging services are an easy target. Imaging is one of the fastest growing areas of healthcare spending, with federal payments for imaging rising from $7 billion in 2000 to $14 billion in 2006. That’s an average annual growth rate of 13%, according to the Congressional Budget Office (CBO). Spending for advanced imaging procedures, such as MRI and CT, grew even faster at a 17% annual rate. Imaging industry proponents are watching the maneuvering with some trepidation. In particular, many Capitol watchers are nervous about a repeat of the Deficit Reduction Act (DRA) of 2005, when Congress slashed Medicare reimbursement for outpatient imaging services as part of an 11th-hour move that was implemented with little data or input from the imaging community. The CBO report The urgency of the task was underscored by a CBO report in December 2008 that suggested a number of changes in Medicare payment policies for medical imaging services. The report lists 115 options for reducing (or in a few cases, increasing) federal spending on healthcare. Options that pertain specifically to medical imaging include: * Modifying the equipment utilization factor The equipment utilization factor is basically the Centers for Medicare and Medicaid Services’ (CMS) estimate of the percentage of time that equipment is in operation at a healthcare practice. Currently, that utilization factor is 50%, but if the factor is raised, it would spread the cost of the equipment over more units of service, resulting in a smaller payment per service, according to the report. For example, if the equipment utilization factor were raised from 50% to 75%, Medicare would save $130 million in 2010 and $970 million from 2010 to 2014. If the factor were raised to 95%, Medicare would save $200 million in 2010 and $1.45 billion from 2010 to 2014. In supporting the option, the CBO report noted that data presented by the Medicare Payment Advisory Commission (MedPAC) in a June 2006 report to Congress indicate that the average rate of MRI scanner use was 91% and the average rate of CT scanner use was 73%. MedPAC is expected to recommend the factor be moved from 50% to 90% in its March 2009 report to Congress. A change in the equipment utilization factor could have the single biggest impact on Medicare imaging reimbursement and would be a "second body blow" to the freestanding imaging center community that suffered from the reimbursement reductions under the DRA, according to Dr. James Thrall, chairman of the American College of Radiology (ACR) Board of Chancellors in Reston, VA. The impact of such a change could be so great that it affects access to imaging services, as noted in the CBO report. Rural practitioners might be discouraged from providing imaging because they might not use the equipment often enough to cover the capital costs incurred in purchasing it, the report notes. Requiring preauthorization Option 41 in the CBO report is to require preauthorization for imaging services. Although anathema to imaging providers, the concept is beginning to win increased attention from government regulators who are looking for a way to reduce imaging utilization that’s more proactive than driving down reimbursement after the scan has already taken place. The CBO report notes that private payors are already using preauthorization, and Medicare could begin to do so by hiring radiology benefits management firms to make decisions on its behalf as to whether to approve payment for a specific imaging service. The report notes that Medicare could save $20 million starting in 2011 and $220 million from 2010 to 2014 by implementing preauthorization. The self-referral question As policymakers prepare to attack rising imaging costs, radiology’s proponents try to make their point that much of the growth in imaging utilization is coming from in-office physician self-referral as nonradiologist physicians adopt imaging technology. CMS has made halting efforts to tackle self-referral, with one mechanism being the so-called antimarkup rule, established in 2007 but not put into effect until 2009. The rule states that, except under certain circumstances, physicians can’t profit from a test ordered when their practice bills for that test. However, exceptions to the rule have become so commonplace that many physician practices will find a way to escape its impact, at least with respect to the technical component of imaging services. The CMS has proposed revisions to the rule, and some feel the exceptions have practically swallowed the rule’s intent. "They didn’t succeed to the degree they hoped, but they made some significant efforts in that regard," said Thomas Greeson, an attorney at Reed Smith in Falls Church, VA. "It is too easy under the new rules to avoid the antimarkup restrictions." Another proposal that could clamp down on physician self-referral is a requirement that physician groups that want to bill Medicare for imaging enroll as independent diagnostic testing facilities (IDTFs) and be subject to the standards that govern them. This includes rules on staff licensure, proficiency requirements for supervising physicians, and prohibitions on sharing, leasing, or subleasing equipment. Some imaging observers believe that many nonradiology practices may simply stop offering imaging altogether rather than go through the hassle of qualifying as an IDTF. Another recent government initiative that could slow down physician self-referral is accreditation. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 mandated that all nonhospital providers of imaging services must be accredited and meet quality requirements by 2012. CMS will be required to select accrediting bodies by 2010, and both the ACR and the American College of Cardiology are involved in formulating an approach to accreditation for CMS. "The [ACR] has an outstanding program in place, and we would like to be deemed by CMS as a provider of those accreditation services," Thrall said. MIPPA revisited? Legislators may also revisit the sustainable growth rate (SGR) formula for setting the Medicare Physician Fee Schedule (MPFS), which mandates cuts in physician payments whenever real growth in healthcare spending outstrips projected growth. Many healthcare observers believe the calculations underlying the SGR are fatally flawed; for example, the SGR would have required a 10.6% pay cut in the MPFS last year unless Congress took action. The passage of MIPPA temporarily averted that pay cut, but the SGR formula is still in place, and another MPFS reduction is looming unless Congress takes action. "There’s now a strong appetite in Congress for a longer-term and ideally permanent solution to this flawed SGR formula," Thrall said. "It really just takes a huge amount of time, energy, and effort for Congress to go through this each year to no real lasting change or benefit." Don’t be hasty As recommendations like the CBO report continue to flow in Washington, policymakers feel the pressure to find a timely solution to a flawed healthcare system. But rushed policies could mean trouble. Greeson said Congress would be unwise to jump immediately on the CBO recommendations. "They need to let some of Medicare’s initiatives percolate, like the antimarkup rule and the IDTF performance standards," Greeson said. And, he added, the possibility of a Democratic Congress and the Obama administration looking toward imaging as a funding vehicle to reduce spending and direct the savings to other areas would be a serious mistake. "Further cuts could have a significant impact on access.... Congress should not adopt across-the-board cuts ... and should tailor their policy response to the root cause of the increased utilization," Greeson said. A voice for imaging With the uncertainty of the coming legislation in 2009, some organizations such as the Medical Imaging and Technology Alliance (MITA) in Roslyn, VA, will continue to work with what is in place. "We just want to make sure that we are actively engaged in the [legislative] process and ... have the right approach to address the availability and utilization of medical imaging," said Ilyse Schuman, MITA managing director. "We want to build on some provisions that are already included in MIPPA ... [such as] the provision for appropriateness and accreditation." For medical imaging, the implementation of broad and sweeping changes as exemplified by the DRA is a major concern. "One size does not fit all," Schuman said. "What works in large urban areas is very different from what’s happening in rural areas. Or it’s different depending upon the age and health condition of a patient and, unfortunately, both the CBO and MedPAC options ... were based on a survey that was really not representative of what’s going on across the nation." It remains to be seen whether the Obama administration will be more or less sympathetic to efforts to rein in spending in radiology. "I think the new Congress and administration are going to be very distracted by what’s happening with the economy," Thrall said. "One of the issues that has already come up is how healthcare will play a role in turning the economy around. What opportunities are there in healthcare to pump money into the economy in a way that will have a stimulatory but also lasting benefit to the health system? One obvious point is to include healthcare IT as part of the stimulus package." By Lin <mailto:editorial@auntminnie.com> Muschlitz
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2009 - 2011 AAPM Support for Clinical Residency in Imaging
