NEMA Currents : medical imaging

The Human Cost of Cutting Medical Imaging

goodwina — Wed, 29 Jul 2009 19:18:00 GMT

This morning, patients and patient advocacy groups presented a letter to Congress calling for the rejection of proposed deep and arbitrary reimbursement cuts to medical imaging services. If passed, the cuts would be an unnecessary hindrance to the access of these important technologies, especially in rural communities.

Medical imaging is an essential element of modern medicine—it can make a diagnosis early when treatment is easiest, save lives, and treat conditions.

More importantly, medical imaging is about more than dollar signs—it alters the course of individual lives. For my mom, advanced imaging technology was needed to identify unexpected new pain after she had back surgery. On an x-ray, her bone fusion (grafted from her hip) looked solid, but a follow-up CT myelogram showed that the bone graft had failed, necessitating further surgery. Without that scan, my mom's quality of life would be significantly diminished.

The New England Journal of Medicine called medical imaging one of eleven "developments that changed the face of clinical medicine." Why should we deprive ourselves—and our families and friends—of lifesaving and life-altering technology?

There are better ways to make sure that the right scan is given at the right time—like the use of physician-developed appropriateness criteria. Arbitrary cuts are not the answer, especially when lives really would be at stake.

Electronic Medical Records – Help Needed

Clark, Howard — Mon, 06 Apr 2009 15:08:00 GMT

Recently, I visited my internist for the obligatory six-month check up. In the course of this visit, he reached into my folder and pulled out a paper report of the results from the diagnostic laboratory that had run a battery of blood tests. Then, to help interpret them, he went back into the folder and searched for the report that had been prepared six months earlier. He carefully copied select results from that earlier report onto the present paper so we could see how cholesterol and other factors had changed in the last six months. To see if there were some trends, he went further back into the folder and searched for the results from my blood tests of one year ago. These results, also, were copied onto the current sheet of paper, and we could see that most all indicators were either stable and acceptable or moving in a "good" direction. Nice to know.

At this point, I looked him in the eye and noted that this was a terribly inefficient process. "Why, I asked, don't you have some software to handle your patients' Electronic Medical Records? This would let you call up the current data and the two or three previous sets at the click of a mouse."

"Oh, I do have EMR software," he told me. "In fact, I spent $100,000 to buy it, and it's probably one of the best systems available. But it doesn't do me any good, because computers still can't talk to one another. I need the results of your blood tests in a form that can feed directly into my system. But the labs don't deliver their data in a form that can be read by my computer and integrated into your record. They just send a "picture" of the report as an electronic file that I can store and print. Sometimes, it's worse, and I just get a fax. Then, I need to pay someone to scan that document and store the file in the computer instead of on a shelf full of paper."

Clearly, we have a long way to go in achieving a National Health Information Network that really delivers on its promise. NEMA and the members of its Medical Imaging and Technology Alliance are working on many fronts to help bring this dream to reality. Fortunately, we do not need to convince either the president or his administration about the importance of this task.

Healthcare Information Technology (IT) – Challenges and Opportunities in 2009 and Beyond

Eaton, Richard — Tue, 24 Feb 2009 18:13:00 GMT

The Economic Stimulus Package, contained within the recently enacted American Recovery and Reinvestment Act (ARRA), is a hugely important domestic initiative. Within ARRA is a $19,200,000,000 appropriation for implementation of healthcare information technology (HIT) including $2,000,000,000 for infrastructure.

A major domestic priority of the new administration, and one of the major goals of the legislation, is to implement electronic health records (EHR) for all Americans by 2014, and accelerate the adoption of healthcare information technology. The administration's objectives are to: save lives, increase health care efficiencies, reduce waste and cut healthcare costs. These goals were declared in 2004 when President Bush issued Executive Order 13335 directing the "development and nationwide implementation of an interoperable health information technology infrastructure."

By implementing EHR and a nationwide health information technology infrastructure, a physician will be able to obtain a patient's medical history, including reports, laboratory and clinical data and diagnostic imaging information, at the precise moment when it's needed. The multitude of errors which result from the use of paper records should consequently be greatly reduced and thus greatly improve healthcare delivery in the U.S.

To reach these ambitious objectives, it will require close coordination among the many key interests who have a stake in this issue. These include: healthcare providers, medical IT vendors, patient groups, government entities, e.g. The National Institute of Standards and Technology (NIST), Center for Medicare and Medicaid Services (CMS, and HIT - interested organizations such as the Health Information and Management Systems Society (HIMSS), and the Health Information Technology Standards Panel (HITSP).

MITA stands to play a pivotal role in achieving these objectives. This is because transmission of medical images, reports and data depend on the interoperability of systems in various locations. To achieve interoperability there must be a common language to enable computer systems to communicate, even if these systems are manufactured by different vendors. This cannot be done without the implementation of interoperability standards, such as the Digital Imaging and Communication in Medicine (DICOM) Standard and the Health Level - 7 (HL-7) Standard. With MITA's experience of over 80 years in the development of standards, its role as the responsible party for the development, maintenance and preservation of the integrity of the DICOM standard, and its active participation in development of the HL-7 standard, MITA is uniquely positioned to help achieve the creation and implementation of the HIT infrastructure.

In the coming weeks and months, MITA will be planning to become actively engaged in creation of a health IT infrastructure. There are also plans for MITA to work closely with NIST in the testing and certification of systems for meeting interoperability criteria. These are exciting times for MITA, and we look forward to addressing the challenges ahead in 2009 and beyond.

Justice Ginsburg's CT Scan

golds — Fri, 06 Feb 2009 21:42:00 GMT

We're thinking about Justice Ruth Bader Ginsburg today. Yesterday she had surgery to remove a 1-cm malignant tumor in her pancreas.

She's lucky, of course. A centimeter is about the width of your small fingernail, so they caught it real early. How did the find it? During her annual physical exam, the 75-year-old Supreme Court justice had a CT scan that revealed the tumor. Thank goodness for all the advancements made in medical imaging.

Readers may know that medical imaging companies belong to NEMA through its Medical Imaging & Technology Alliance. MITA's launched a campaign to educate the public about the importance of medical imaging -- and that the right scan at the right time saves lives and dollars.

The right scan at the right time has definitely prolonged Justice Ginsburg's life. Her family and millions of Americans are thankful for that.

What's Ahead For Healthcare IT in 2009

Eaton, Richard — Thu, 08 Jan 2009 14:09:00 GMT

With the election of Barack Obama, our nation will be confronting major, complex foreign and domestic issues, including a troubled economy, mounting budget deficit, a worsening housing crisis, unrest in the middle east and two wars.

One of the most pressing domestic issues will be healthcare reform. President-elect Obama has proclaimed healthcare reform as one of his top priorities when he takes office. His objectives with regard to the U.S. healthcare system include, among other things:

Universal healthcare coverage
Coverage of pre-existing conditions
Implementation of healthcare IT reforms

MITA will be playing a vital role in healthcare IT reform.

AARP, one of the most powerful lobbying groups in Washington, has also set healthcare IT reform as one of its top legislative priorities for 2009.

With respect to healthcare IT, one of the primary long-range goals is to establish a nationwide health imaging information exchange network. This network, in one scenario, would permit providers in one hospital to access a central hub to obtain patient information from other hospitals e.g. a patient's lab results, clinical findings and prior diagnostic imaging procedures.

For instance, suppose John Jones underwent a CT scan at the Mayo Clinic in Rochester, Minnesota, and one week later comes into the emergency room at Cedars-Sinai Medical Center in Los Angeles. Ordinarily, physicians outside of Cedars-Sinai would likely not know about the procedure performed at Mayo Clinic. Under the above scenario, a radiologist, or other kind of physician, at Cedars-Sinai would be able to find out not only if Mr. Jones underwent a CT scan several weeks prior at the Mayo Clinic in Rochester, Minnesota, but also could obtain his lab results and clinical findings. If the first scan provided sufficient information, together with the lab results and clinical findings, then Mr. Jones might not need a second CT scan, thus saving healthcare costs and reducing Mr. Jones' exposure to radiation.

MITA's Medical Imaging Informatics (MII) Section will be very actively involved in terms of implementation of healthcare IT reforms in the U.S. MITA's Picture Archiving and Communications Systems (PACS) manufacturers hold the key to communication among providers. It is PACS which allows transmission of images from one place to another. MITA members will be instrumental in unlocking PACs' potential through, among other things, their involvement in DICOM, HL-7, IHE and other activities.

Creation of these medical provider networks holds great promise for improvement of U.S. healthcare, and will be receiving much attention in the months ahead. Clearly, 2009 will be an exciting and challenging year for MITA. Stay tuned!

DICOM Makes a Difference

Clark, Howard — Wed, 24 Dec 2008 16:16:00 GMT

What? It's December 24, 2008 - Christmas Eve, and I just got a present. It's a book, and I can scarcely read a word of it. That's because it's a how-to book on DICOM* written in Japanese. Since I can't read it, there's no point putting in my briefcase to review on the next flight. Instead, it stands proudly on my bookshelf beside a copy of the DICOM Standard in Chinese.

So what? What makes me proud is knowing that I play a role in the maintenance and continued development of a standard that is used all around the world to ensure the interoperability of equipment used to produce, store, display, process, send, retrieve, query, or print medical images (and derived structured documents) as well as to manage related workflow. Because of medical imaging, exploratory surgery has become a thing of the past. Because of medical imaging, injuries, diseases, and many health problems can be diagnosed and treated faster and more effectively than ever before. Because the DICOM Standard ensures interoperability of medical equipment, a hospital can choose the best available equipment within its budget without worrying about compatibility with other brands of equipment it already owns. Also, because of the DICOM Standard, the X-rays that were taken this morning while you were vacationing in Mexico or China or Italy can be sent to your doctor in Duluth in just a matter of minutes and they will look just the same.

Conclusion: Feeling proud of the things you work on is a good way to enter the New Year.

*In case you're not familiar with the term, DICOM is an acronym that stands for Digital Imaging and Communications in Medicine. This is the name of a 3300 page standard whose purpose is to make sure that the next piece of medical imaging equipment you buy will work with everything that you already have.

Amazing Facts about DICOM

Clark, Howard — Wed, 12 Nov 2008 20:52:00 GMT

DICOM is the name of a very unusual standard. You won't be surprised to learn that this name is an acronym for Digital Imaging and Communications in Medicine. However, you might be surprised to learn that the DICOM Standard:

Has proved itself over a 15 year period. (This standard really works.)
Is the world's only standard for medical imaging.
Covers virtually every medical specialty that uses imaging.
Is expanded and maintained by a network of 26 separate working groups.
Benefits from the input of about 1100 persons who participate on these 26 working groups.
Grows through the addition of approximately one major supplement every month.
Receives about 150 minor updates (Correction Items) every year.
Is updated four to five times each year.
Contains 3600 pages.
Is managed by an independent, international committee consisting of 27 vendors, 13 professional societies, and 10 government agencies or trade associations.

AND BEST OF ALL

It's available for free on the Internet.

Visit http://medical.nema.org/dicom/2008/

Several Firsts in Yesterday's Elections

golds — Wed, 05 Nov 2008 21:09:00 GMT

No doubt the most remarkable event yesterday was the election of this nation's first African-American chief executive. But after that, I'd have to say the thing that amazed me most was CNN's introduction of holographic television. If you didn't see it, check out two interviews -- one with CNN reporter Jessica Yellin and one with singer (and Obama supporter) will.i.am. How cool to see these individuals "beamed in" from noisy Chicago Grant Park to a quieter CNN studios to discuss the elections.

While holographic reporting may seem like a gimmick to most people, it's successful use will lead to more significant advances in the near future -- such as 3-D medical imaging scans that can be transported across the country (and the world) for examination and diagnosis by doctors.

This truly is a new era.

The Medical Isotope Shortage

Eaton, Richard — Tue, 07 Oct 2008 13:52:00 GMT

Most people are not aware just how important a role nuclear medicine imaging procedures play in the diagnosis and treatment of disease. It is estimated that approximately one third of all hospital inpatients receive some kind of nuclear medicine scan during their stay in the hospital. Nuclear medicine imaging is critical in the diagnosis of many types of cancer, in assessing cardiac function and increasingly in evaluating neurological conditions such as Alzheimer's disease or other dementias.

It is surprising then that the medical isotopes which are needed for performing these procedures are provided by only a very few sources. The large majority of nuclear medicine procedures, nearly 80%, are performed using Tc-99m. The primary supplier for the U.S. for the parent isotope for TC-99m, Molybdenum - 99, is the Nordion National Research Universal reactor at Chalk River, Ontario. This reactor, which is operated by Atomic Energy of Canada Ltd., has undergone a number of shutdowns in the last few years due to routine maintenance, regulatory issues or problems requiring repair. When this reactor is shut down it has a direct impact on the number of nuclear imaging examinations which can be performed, and can affect the scheduling of these procedures, often causing performance of these procedures to be deferred or cancelled due to shortages in supply.

There are only a few other reactors which exist worldwide which produce this medical isotope, most of which are located in Europe. The reactor in Petten, Netherlands has recently been shut down and start-up is not anticipated until November 2008. This has already resulted in delays in scheduling of nuclear medicine imaging procedures in Europe. Since early diagnosis is critical to beginning lifesaving treatment for patients, the shutdown of this reactor has raised the level of concern among nuclear medicine physicians.

For a number of years, the U.S. Department of Energy and the Society of Nuclear Medicine have sought government appropriations for establishing a reliable U.S. supply of nuclear medicine imaging isotopes. Given that nearly all isotopes come from non-U.S. sources, many have believed this to be not only a medical issue but a national security issue as well. Unfortunately, despite repeated efforts over the years, funds have never been appropriated by Congress to create a U.S. source of supply. There have been recent discussions with regard to utilizing several existing reactors in the U.S., such as the reactor at the University of Missouri, to manufacture Molybdenum - 99. With most of the U.S. government's attention now preoccupied with bailing out the ailing U.S. financial system, as well as the wars in Afghanistan and Iraq, there is considerable concern whether this issue will receive the attention it deserves in the near future. The MITA Nuclear Section members and Society of Nuclear Medicine will be monitoring the situation and will be exploring strategies to address this important issue in 2009.

Study finds CT beneficial for colon cancer screening

Mo Zilly — Mon, 22 Sep 2008 17:09:00 GMT

Last week, the New England Journal of Medicine published the results of the National CT Colonography Trial, finding virtual colonoscopy (VC) to be a beneficial tool for colon cancer screening. The study of 2,531 asymptomatic patients, led by Dr. C. Daniel Johnson of the Mayo Clinic, was the largest of its kind.

The study measured VC sensitivity for the detection of adenoma growths 1 cm and larger, as compared to standard colonoscopy. The team found a 90% per-patient sensitivity rate, comparable to that of standard colonoscopy.

VC does not require sedation, and can be completed within 30 minutes, according to Judy Yee, MD, one of the study's co-authors. Additionally, the study found pre-cancerous lesions in 27 asymptomatic patients that were missed by traditional colonoscopy.

"These patients had no cancer symptoms," stressed Yee. "They were simply healthy older adults, typical of people who should be screened for colon cancer according to current screening standards" (from a Science Daily press release).

This information means that virtual colonoscopy is as effective as more invasive procedures, giving screening candidates more options. Considering that colon cancer is the #2 cause of cancer-related deaths in America, this study is a boon to the fight against cancer.

For more information about colon cancer screening, visit The Mayo Clinic's website.