Enterprise Imaging's ADVANCE Perspective

Congress Sides with Doctors, and Overrides Medicare Veto

Jill Hoffman — Fri, 25 Jul 2008 15:54:00 GMT

Last week, the U.S. Congress voted to override President George W. Bush’s veto of a bill that rescinds a 10.6 percent payment reduction to doctors treating elderly Medicare patients.

The 70-26 Senate vote and 383-41 House of Representatives vote came just hours after President Bush vetoed HR 6331. The bill, now law, finds the nearly 11 percent pay at issue for Medicare physicians by slashing funds to the large insurers that have contracts with the Medicare program.

Before the vote, supporters of the bill argued that physician pay cuts would discourage doctors from taking on Medicare patients. Expressing greater concern for the insurer side, President Bush countered in a statement that $13 billion in reimbursement cuts to insurers would discourage their participation in the program, and reduce choices for the elderly.

The Congressional vote may not be good news for President Bush’s big business friends at insurance companies such as United Health Group and Aetna Inc., but it is good news for physicians, and it’s good news for patients—especially those who are part of one of this country’s most fragile populations. It is doctors who treat these patients, not health insurance companies. If every insurance company bailed out of the Medicare program tomorrow, it would be the responsibility of leaders in this country to find the money to pick up the slack so physicians could continue to provide care to these older Americans. Capitalist country or not, the real sign of the health and well-being of a society is how well it treats those least able to care for themselves. Beyond that, Medicare is a moral imperative that even the most conservative politicians threaten at their own peril.

Hopefully, this vote is a sign of this country’s priorities as it heads into a new administration; as the economy crawls through a slowdown experts may one day call a recession; as health care costs soar; and as the poor and elderly continue to be the last in line for basic necessities. Let’s give the senators and House reps who took the bold step to override the veto the credit they deserve, and keep a close watch on their next moves.

Tennis Anyone? Top Player Funding Research at MSKCC

Kerri Reeves — Mon, 14 Jul 2008 15:11:00 GMT

As soon as I could walk and hold a racket, I played tennis. It's the ultimate in competition--a true battle of skill, endurance, hustle, acuity and last but certainly not least, mental toughness. An intense one-on-one fight, you leave it all out on the court, or you lose and go home.

My favorite player, the ultimate fighter both on and off the court, is James Blake. Seeking to up his professional ranking in 2004, he sustained a career-threatening injury. While practicing in Italy for a Masters event, Blake ran full-speed, head-first into a net post, breaking his neck. He returned home to the states to recover to find his father, Thomas Blake Sr., battling stomach cancer. He died six weeks later. James seriously struggled to cope; his dad was his hero and inspiration. Most likely, it was the stress and devastation of his father's death that triggered a severe viral infection, a major case of shingles. James got extremely ill; half his face became paralyzed, compromising both his sight and hearing.

James Blake waged on, training as hard as he could to make it back on tour. He later detailed his journey in his best-selling book, Breaking Back: How I Lost Everything and Won Back My Life. Indeed he did. He lived by his father's advice: you can't control your level of talent, but you can control you level of effort. After many tournament match wins, Blake sits at No. 8 in the world.

Now, James Blake is establishing a research fund in his father's name at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City. His goal is to raise $1 million through 2009 via various fundraising initiatives, including the J-Block merchandise program (through a partnership with Nike), a charity tennis exhibition called Anthem LIVE!, and individual and corporate contributions. The Fund has so far raised more than $500,000 and will support research into the early detection and screening of cancer. Here's the mission statement:

"James Blake believes that progress against cancer should never be hampered by a lack of resources. The Thomas Blake, Sr. Memorial Research Fund, founded in memory of his father, supports early detection research at Memorial Sloan-Kettering--the nation's preeminent cancer center. The Blake Research Fund invests vital seed money at the leading-edge of science: speeding the most promising work, and shortening the time it takes for discoveries at the lab bench to become better treatments at patients' bedsides. One hundred percent of every dollar donated to the Fund goes directly to cancer research--One Set, One Match, One Cure."

More information about the fund or to contribute, please visit www.mskcc.org/jamesblake.

This September, during my annual trip to New York's U.S. Open, I'll have my eye on James and that J-Block merchandise!

Radiologist Pay: Up, Up and Away

Jeff Bell — Tue, 01 Jul 2008 15:45:00 GMT

All together now: It pays to be a radiologist.

That’s certainly one way to look at the results of a new physician recruiting incentive survey from the search firm of Merritt, Hawkins.

Average salaries for radiologists shot up from $381,000 to $401,000 this year, according to the survey--despite the fact that the number of requests Merritt, Hawkins received for radiology searches actually dropped from the previous year. (The reason for the hike in pay amid a drop in demand: More of the firm’s clients are looking for subspecialists, and they’re willing to pay more to get them.)

Check your envy at the door, radiologists might say. Forget the country club membership fees and the Mercedes--are you willing to assume the debt for my med school student loans? How about my annual malpractice insurance bill? Invariably, these radiologists will rationalize the pay increase as money well spent--provided the doc receiving it is a good one.

And those close to radiologists--administrators and technologists--will likely temper any knee-jerk flashes of envy with the first-hand knowledge that a radiologist’s professional burdens can be at least as weighty as his wallet.

And the stray layperson who stumbles upon the survey results? He’ll probably decry the news as one more symptom of a health care system gone awry--unless, perhaps, he’s a cancer survivor who credits his borrowed years to the radiologist who spotted the disease.

CMS Reclassifies Radiopharmaceuticals, SNM Reacts

Scott Hatfield — Tue, 17 Jun 2008 15:31:00 GMT

The Society of Nuclear Medicine (SNM) is reacting to the Centers for Medicare and Medicaid Services' (CMS) reclassification of diagnostic radiopharmaceuticals.

The SNM circulated information at its annual meeting in New Orleans this week on the issue: Bascially, CMS recently reclassified diagnostic radiopharmaceuticals as "supplies" instead of "drugs." This distinction has bundled payment for diagnostic radiopharmaceuticals into the payment for nuclear medicine procedures, thus threatening Medicare and other patient acess to critical drugs, SNM officials say.

"Treatments exist today that can radically improve the prognosis for patients suffering from many devastating diseases, and yet reimbursement by CMS for these drugs is sometimes less than half the actual cost of producing them," says 2008-09 SNM President Robert W. Atcher, PhD, MBA. "As we develop new therapeutic radiopharmaceuticals that have the potential to dramatically change disease outcomes, we need to ensure that they will be adequately reimbursed in order to be effectively utilized."

In response to the issue, the SNM released the following recommendations:

1. All radiopharmaceuticals should be recognized and treated as drugs, not supplies.

2. CMS should continue to reimburse radiopharmaceuticals at charges reduced to cost in 2008 while working with the nuclear medicine industry (nuclear pharmacies and manufacturers) to develop standard payment methodology based on the average radiopharmaceutical invoice price at the distributor or nuclear pharmacy level (patterned after the average sales price model for drugs).

3. All radiopharmaceuticals should qualify for the same bundling threshold in 2008 ($60) as all other drugs.

4. CMS should accept and utilize external data sources to identify and appropriately reimburse radiopharmaceuticals under the government's Hospital Outpatient Perspective Payment System, as the agency does for all other drugs. The most accurate sources of radiopharmaceutical cost data are nuclear pharmacies and manufacturers.

For more information on SNM's policy statement on reforming radiopharmaceutical reimbursement under Medicare, check out www.snm.org/cmspolicy.

ARRT Exam Volume Still Rising

Jill Hoffman — Thu, 12 Jun 2008 17:19:00 GMT

There is good news for the field of radiation therapy. The American Registry of Radiologic Technologists (ARRT), the St. Paul, Minn., body that evaluates, certifies and annually registers more than a quarter-of-a-million radiologic technologists across the U.S., reported in May that it sees an upward trend in primary exam volume for the seventh consecutive year, and in post-primary exams for the sixth consecutive year, in several disciplines.

This news may mean that staffing shortages happening in other areas of medicine are not taking place here. Data comes from ARRT’s 2007 Annual Report of Examinations (available at www.arrt.org).

In primary exams, the discipline of nuclear medicine rose a whopping 17 percent in 2007 over 2006, although radiography was virtually level in that time, and radiation therapy dropped by 5.3 percent.

Also encouraging for primary exams: In 2007, a total of 15,915 first-time exams were administered. The following areas comprised these portions of the total: radiography, 89 percent; radiation therapy, 6 percent; and nuclear medicine, 5 percent.

“Examinee volumes for all three exams have substantially increased since the late 1990s,” the report adds.

Post-primary exam volume for first-time candidates has grown by the following levels for the last five years: 15 percent in 2007, 19 percent in 2006, 14 percent in 2005, 7 percent in 2004 and 8 percent in 2003. The discipline of CT saw the hugest jump in 2007 (23 percent). MRI grew by 15.8 percent.

Scores are broken down by state as well as by exam section, percentile rank and comparative means for educational programs. Interestingly, the following states had the highest mean scores in these disciplines: Hawaii (radiography, 91.9), Missouri (nuclear medicine, 92.0) and Connecticut (radiation therapy, 89.4).

All in all, the ARRT data is a ray of sunshine—for health care in general and patients, more specifically, who can only be treated for their cancers when and if RTs are there to help them.

Cancer, Cell Phones and Going “Hands-Free”

Kerri Reeves — Tue, 03 Jun 2008 19:11:00 GMT

Last week, Larry King hosted three prominent neurosurgeons on his show who stressed the importance of keeping cell phones as far from the brain as possible. Whether or not cellular phones are hazardous to one's health--linking increased usage with increased brain tumor incidence--has been an ongoing debate. Recently, the news of Sen. Kennedy's glioma diagnosis, a type of tumor critics associate with cell phone use, has added more fuel to the fire of the debate, which was also covered in a recent New York Times article.

Sanjay Gupta, MD, a neurosurgeon at Emory University Hospital, Atlanta; Vini Khurana, MBBS, BSc(Med), PhD, FRACS, an associate professor of neurosurgery at the Australian National University, Canberra; and Keith Black, MD, a surgeon at Cedars-Sinai Medical Center in Los Angeles, all say they never hold cell phones to their ears, but prefer speakerphone or headset options, Dr. Black calling it "safe practice."

Research on the issue is ongoing, including a comprehensive 13-country study called Interphone. The FDA says three large epidemiology studies since 2000 have shown no harmful effects, yet the average period they studied was only three years, and they did not differentiate between casual and heavy use. The American Cancer Society has also dismissed risk allegations. Conversely, the American Journal of Epidemiology last year showed a 58 percent higher risk of parotid gland tumors among heavy users of cell phones. And a Swedish analysis of 16 studies published in Occupational and Environmental Medicine revealed a doubling of the risk for acoustic neuroma and glioma after 10 years of heavy use.

Cell phones emit only non-ionizing radiation, however, and defenders of the mobile method say there's currently no biological mechanism to explain how non-ionizing radiation could lead to cancer. Opponents point out that even though medical science can't explain it, that doesn't mean it can't happen. Opponents theorize that heat generated by cell phones and radio frequencies are absorbed by the head and neck, causing harm. Studies also suggest that tumors tend to occur on the same side of the head where the patient typically holds their phone.

The main concern is for the future--a generation of lifetime cell phone users. Once utilized as a quick communication device for the car, cell phones have become as ubiquitous as "landlines." I haven't had a traditional phone in my home in years, as is the case with most of my peers. Consider the implications of a cancer/cell phone correlation if billions worldwide are using the technology with such frequency.

Possible preventative measures for this alleged risk include using the phone's speaker option as well as Bluetooth headsets. However, critics are worried as well about the effects of a transmitter in the ear. But I look at the neurosurgeons taking a stand on this cellular risk issue and think, this is their livelihood. What's the harm in using a headset? While driving, the safety benefits alone are huge. While our neighbors New York and New Jersey enforce cell phone bands, Pennsylvania has not. It's my choice to use a "hands-free," and I can't conceive of one reason why drivers do not across the board. I use it in my home as well, and will continue to; long-term cell effects are in no way quantified. Safety first, as Dr. Black points out, and I can fold laundry or dry the dishes while I'm at it. If you go "hands-free," you'll never go back.

Is paperless more?

Jeff Bell — Wed, 28 May 2008 01:17:00 GMT

I'm not sure of the eco-unfriendly equivalent of the term "feminazi"-is "tree hugger" really the best we can do? I'm sure Rush Limbaugh has coined a more inflammatory disparagement by now. (Where's a conservative talking points memo when you need one?)

Perhaps it's just as well that I don't have anything stronger in my vocabulary. I don't want my jests to be misperceived as vicious attacks on the noble desire to conserve natural resources. And that's precisely the idea behind the emerging "paperless" trend at medical imaging conferences. Far be it for me to deprive robust saplings of their implied constitutional right to live a long, fruitful life (even if they aren't of the fruit-bearing variety).

That said, when the Radiology Business Management Association (RBMA) announced that it would eliminate on-site session handouts and continuing education forms beginning with its spring 2008 conference, I grumbled. I'm guessing many of you felt the same way.

I certainly didn't bemoan the lack of continuing ed forms at this year's meeting. Filling out said forms once you return home sounds reasonable to me (although I suspect that the number of returned forms is down from previous years). But it's frustrating to head to a conference with little idea of how many of the session handouts you should print in advance, should you care to use those handouts to take detailed notes on each session.

So to be safe, I printed 70 to 75 percent of the handouts, which were available for downloading on the conference Web site. Even that amount turned out to be heftier than either I or my office's printer had bargained for-it was practically wheezing by the time it spat out the last sheet. And then, on the eve of my travel day, I looked at that imposing pile and attempted-in vain-to shoehorn it into my travel bag. Eventually, I made an educated guess regarding which handouts I'd actually need, and trimmed that stack to a semi-manageable size that still threatened to split the seams of my satchel.

Once I arrived at the conference and heard a few of the sessions, I realized that I wasn't actually all that interested in some of their related handouts. Truth be told, I only needed roughly half of the handouts I'd printed and lugged with me to Vegas.

My ecological footprint now resembles a Bigfoot plaster cast. Paper was still wasted-only this time, it was my company's printer paper, and not the conference's. Mother Earth, is that a stifled sob I hear?

Clearly, more associations and societies will be going paperless, with session handouts available on an online-only basis or on CD. And if you're anything like me, you'll continue printing more of those handouts a week before the conference, unsure of exactly what you will and won't need, only to split that pile in half the day before you hop on a plane.

Or maybe you'll wait until you get to the airport to make your final determination. At that point, your educated guess may have less to do with the perceived relevancy of those handouts in your bag-and more to do with that fact that a last-minute paper purging could mean the difference between a no-charge carry-on item and a costly checked bag on American Airlines.

Eat, Drink and Be Wary: The Cancer Factor

Sharon Breske — Tue, 20 May 2008 16:27:00 GMT

When I was growing up in the (gulp) ‘70s, it was hard to escape the phrase “You are what you eat.” It seemed as popular as the ever-caustic “Burnt You” or, a few years later, “Gag me with a spoon.” (Funny how food infiltrates every kernel of our lives, vernacular included.)

As a kid, the phrase was sometimes taken literally, prompting an avoidance of nuts, bananas and turkey in the school cafeteria. But even at a squirmy young age, we secretly got the message: If you gobbled scrapple, deep-fried marshmallows dunked in chocolate and three Cokes before lunch, not only would you pack on the pounds, you’d be at risk for, well, a buffet of health problems.

If memory serves, these problems were tied primarily to the likes of diabetes and heart disease. But as the saying goes, “My how time has changed!” Research is showing more links to food, drink and the nation’s No. 2 killer: cancer. In fact, last month the American Association for Cancer Research (AACR) released several new studies reinforcing that what and how much we eat and drink affects cancer risk. Here are some nuggets to chew on:

One of the largest studies of its kind has found that alcohol is a substantial risk factor for development of the most common type of breast cancer-the 70 percent of tumors that are classified as positive for both the estrogen and progesterone receptors (ER+/PR+). Researchers report that even moderate alcohol consumption, defined as one or two drinks per day, increased risk of developing ER+/PR+ cancer, and the more a woman drank, the higher her risk. Compared to female teetotalers, women who had three or more glasses of alcohol daily had as much as a 51 percent increased risk of ER+/PR+ breast cancer.
Specific variations within two genes (ADH1B and ADH1C) involved with alcohol metabolism are associated with an increased risk (up to 50 percent) for breast cancer in postmenopausal women.
Consuming too many calories may increase risk for melanoma. More specifically, dietary energy balance may affect the risk for skin tumor development. Researchers believe that these effects are mediated by changes in signaling through the epidermal growth factor receptor (EGFR) and the insulin-like growth factor 1 receptor (IGF-1R).
Timing matters with folic acid and colon cancer prevention. Although folic acid fortification has proven to lower rates of neural tube defects and some childhood cancers, too much folic acid may increase risk of developing colorectal cancer. A new study suggests that folic acid supplementation provided in utero, but not postnatally, may protect offspring from developing colorectal cancer. Foods rich in folic acid include fortified cereal, spinach, beef liver, black-eyed peas and asparagus. Visit http://ods.od.nih.gov/factsheets/folate.asp#h2 for a broader list.

For more information on these AACR studies, email me at sbreske@merion.com, or contact the AACR at http://www.aacr.org/.

And one last word: Don't just take these findings to heart--take them to the belly.

Cancer Survivor Pitches MLB No-Hitter

Kerri Reeves — Tue, 20 May 2008 16:24:00 GMT

Last night was fairly typical--my return from work was followed by exercise, then dinner, then baseball. Usually it's all Phillies in the Reeves' household, but Monday's TV bled red. Boston Red Sox, that is, as we watched 24-year-old cancer survivor Jon Lester pitch a no-hitter at Fenway against the K.C. Royals. The 7-0 win was also his first MLB complete game.

Just 20 months ago, Lester was diagnosed with anaplastic large cell lymphoma, a rare cancer accounting for 1 to 2 percent of all lymphomas. Lester originally had complained of back pain, which he attributed to a minor car accident, but was later admitted to Massachusetts General Hospital with enlarged lymph nodes. After the diagnosis, he underwent chemotherapy for four months, eradicating the disease. The intense training for his return ensued, and ultimately led to a 2007 World Series title for the ‘Sox.

After clenching the series win in game four last October, Lester had this to say: "If I can help out one person who's down in the dumps because they have cancer and it's not going well, maybe they'll say, ‘If he could do it, I could do it, too.'"

With last night's heroic performance, he again inspires the fight.

Medical Record Bandits

Scott Hatfield — Tue, 13 May 2008 15:53:00 GMT

Patient information thieves are snooping into hospital-based electronic medical records and stealing credit card and insurance numbers, and any other medical identity data that can turn a profit.

Published accounts appeared in USA Today last week (http://www.usatoday.com/news/health/2008-05-06-privacy_N.htm) of perpetrators, that included hospital employees, downloading checking account numbers or other financial information and selling the information or billing insurance companies and netting millions of dollars.

The report cited a Healthcare Information Management Systems Society (www.himss.org) Analytics survey that revealed 13 percent of the study's health care provider particpants experienced some sort of data breach.

But what's being done to stop the injustice? I contacted HIMSS, and got a response to the article. Here's some advice from Lisa Gallagher, BSEE, CISM, HIMSS senior director, privacy and security.

"Establishing basic safeguards to security can help avoid some of the security issues cited in the USA Today article. Additionally health care organizations must know what employees are doing by monitoring their behavior related to accessing patient information. The compliance officer can conduct random audits or simply, talk to employees about how they access patient records. 'Do they share passwords? Do they provide access to an unauthorized person?' Such conversations can provide both information and insight."

She continued, "It's also important to train all employees who access patient data so that they understand how patient information can, and should, be retrieved. This training must be mandatory, establishing the importance of protecting patient data, while also developing a culture where the security of patient health information is both valued and enforced. Finally, the organization should consider implementing record monitoring/intrusion detection systems on the network and actively review audit logs to detect potential instructions and/or unauthorized access."

The informatics industry also reacted from the manufacturer side with a substantial product announcement expected Thursday, May 15, following the "host of high-profile patient privacy breaches and increased attention to patient medical records." The product will allow patients to specify in advance who is granted access to their electronic health record, what information can be accessed and when.

Heading off to the 2008 Society for Imaging Informatics in Medicine (www.siimweb.org) meeting in Seattle taking place this week, I'm armed with notebook and prepared to find out more solutions from industry. And just for safety, I've cleared all banking information off my personal electronic devices

ASTRO Abstract Numbers Good News for Patients

Jill Hoffman — Tue, 06 May 2008 11:35:00 GMT

At a time when physician and nursing shortages seem to be competing for headline space with bad economic news, it is reassuring to know that interest in therapeutic radiology and oncology is thriving in one corner of the health care industry.

In April, the American Society for Therapeutic Radiology and Oncology (ASTRO) reported receiving a record number of abstract submissions for the scientific program to be held at its 50^th annual meeting September 21 to 25 in Boston.

A total of 2,036 abstracts were received—nearly 400 more than the amount received in 2007; all three of the main categories rose over the year before: clinical (1,301 from 1,205), biology (178 from 156) and physics (556 from 312).

The number of overseas submissions was also higher; some 240 abstracts from Europe came in compared to 187 the year earlier, and 312 arrived from Asia compared to 240 the previous year.

ASTRO President Patricia J. Eifel, MD, FASTRO, professor of radiation oncology, The University of Texas M. D. Anderson Cancer Center, Houston, says she is thrilled the Society has broken its record for abstract submissions (not the first time the group has done so), heightening competition for the selection process.

“The number of abstracts submitted this year is a testament to how well-respected the ASTRO Annual Meeting is among medical professionals working in the field of oncology,” Dr. Eifel says.

It is true that ASTRO, with 9,000 members worldwide, draws more than 11,000 oncologists from all disciplines as well as physicists, biologists, nurses and other health care professionals to its annual meeting. The theme of this year’s milestone gathering is “Fifty Years of Learning, Caring and Collaboration in the Treatment of Cancer Patients.”

But all back-patting aside, the abstract news is a testament to the increasing attention being paid to the field by individuals who want to play a role in it—by improving therapy planning and treatment and doctor/technologist/patient safety and comfort; individuals who want to find a way to save lives so that one day no one has to die from cancer. That is news to beam about.

Breast Cancer Studies Examine Impact of Drinking, Exercise

Kerri Reeves — Tue, 29 Apr 2008 12:55:00 GMT

It wasn't too long ago that I remember hearing how beneficial red wine--in moderation!--was for my health. Its antioxidants were found to reduce risk of cardiovascular disease, and even inhibit types of tumor growth. Additional benefits were found in its ability to aid in the formation of nerve cells, a boost for neurological conditions. A smooth Pinot Noir, a poignant Shiraz, a cozy Cab, bring ‘em on.

A study mid-month, however, out of the American Association for Cancer Research Annual Meeting in San Diego, found that both excessive and moderate amounts of alcohol drinking--no matter the type--upped a woman's risk of the most common type of breast cancer. Even a drink a day could increase this risk; in this case, the women studied were postmenopausal. Researchers from Denmark and from a Harvard (Boston) study deduced similar findings among women in general. Results support the theory that alcohol affects estrogen metabolism.

On the flip side, researchers from the University of Texas Southwestern Medical Center in Dallas last week said that exercise may reduce breast cancer risk by lowering estrogen levels--assessing that estrogen may deactivate genes in breast tissue that suppress-cancer development.

Other brief tidbits making cancer study headlines last week: Two or three cups of coffee a day can cut the risk of breast cancer by a third or delay onset by 10 years. This one needs more data for substantiation, for sure. Oh yes, and let's not forget the role of mistletoe in aiding cancer treatment--a commonly prescribed extract in Europe for boosting immune systems and fighting the effects of chemo and radiation treatments. Researchers found that evidence supporting the use of mistletoe extracts was "weak" however, and recommended more data.

With various studies coming out each week about cancer linkages, cancer prevention tips, and information about various controllable and uncontrollable risk factors, it's important to keep sight of some main messages about healthy behaviors. Don't smoke. Don't consume alcohol; if you choose to, do so on a limited basis--with increased usage comes increased risks. Get screened for cancer early--colon, breast, cervical and skin. Protect your skin from the sun...when you're outside exercising! An active lifestyle--at least three to four hours a week of exercise--can cut your risk of several cancers in half. Exercise will also help keep your body mass index (BMI) at 25 or less; being overweight significantly ups your risk of developing several cancers. By eating at least five servings of fruits and vegetables a day, you can successfully manage weight, increase energy and nourish your body with vital nutrients. Reduce intake of fried, sugary, high-calorie foods as well as processed and red meats.

Patients must be educated on these and other healthy lifestyle choices--for their overall conditions and for a reduced risk of breast and other cancers. Many factors are out of our control, so let's take hold of what we can control.

Staffing survey says...

Jeff Bell — Tue, 22 Apr 2008 16:41:00 GMT

A recent survey has confirmed what we here at Enterprise Imaging realized years ago as we searched for fresh developments in the X-ray modality-X-ray usage is being supplanted by more advanced modalities.

This news comes from the staffing firm of Med Travelers, which found that demands ultrasound/vascular and interventional technologists has increased steadily over the past three years. The need for vascular/ultrasound techs leaped from 11 percent of the company's staffing assignments to 24 percent in 2007; interventional assignments jumped from 4 to 16 percent in that same three-year period. Only 9 percent of the company's staffing assignments were of the radiologic garden variety-down an unhealthy 12 percent from three years earlier.

The reason for the growth of the two aforementioned modalities? Increasing incidents of cardiovascular disease and diabetes among our population, says the company.

But perhaps an even more intriguing aspect of the Med Travelers survey lies with the reasons why technologists prefer traveling assignments to permanent work at one facility. Not surprisingly, most of them (85 percent) cite the better pay as a benefit. But what did surprise me was the second most-cited reason: 59 percent love the so-called thrill of travel. By comparison, only 45 percent cited a liberation from office politics.

I must be in the minority here, but the jolt of continual physical displacement would seem an acceptable but hardly thrilling tradeoff to higher-paying temp work-certainly not it's second-most attractive feature. Of course, this comes from a guy who feels so excruciatingly discombobulated after only three days at a Washington, D.C. Economics of Diagnostic Imaging conference that he stumbles into the hotel in the early evening of the second day, dives onto a strange bed that makes his skin crawl at the thought of where the sheets have been, wakes unrefreshed the next morning and inadvertently leaves behind several articles of clothing, never to be worn again. To live a variation of that existence for much of my professional life is unfathomable to me.

But the joy of an endless succession of honeymoon periods with each of your short-term employers, free of office backbiting, transparent attempts at one-upmanship, and the mindnumbing sameness of watching the same borderline-incompetent co-workers coast along while the same few hapless chumps shoulder the burden of that extra workload? To my mind, such a work perk would not only trump the "freedom" of travel, but it would rival any added financial incentive that comes with being a rolling stone in the rocky world of modern health care.

Times Article on Transitional Price of Digital Mammo

Sharon Breske — Mon, 14 Apr 2008 15:00:00 GMT

While proven better for women under 50 and those with very dense breasts, digital mammography appears to come with an unforeseen price tag: more repeat exams-at least initially. That's the word from an article you may have caught in the April 10^th New York Times called "In Shift to Digital, More Repeat Mammograms".

The reason centers on the difficulty radiologists have in retraining themselves in digital reads, and reconciling the differences between digital exams and a patient's film priors. The resultant uncertainty in assessing these differences is leading to not only more mammograms, but more ultrasounds and biopsies as well.

For patients, that means greater anxiety and possibly expense if insurance doesn't foot the bill. For physicians, it means more time and money as well.

The article findings are based on feedback from 10 radiologists, including mammo's heavy hitters such as University of North Carolina's Etta D. Pisano, MD, and University of Washington's Constance D. Lehman, MD, PhD. Eight said that during their transition from film to digital, recall rates shot up in women who ultimately had nothing wrong.

But most agree that the drawbacks are worth digital's benefits-greater clarity, contrast and magnification adjustability, and workflow improvement to name a few-and the growing pains are temporary.

What did you think of the article, if you've read it? What have you found in making the film-to-digital switch-any transitional tribulations?

Celebrities Raise Deadly Cancer's Awareness

Scott Hatfield — Tue, 08 Apr 2008 16:56:00 GMT

When "Dirty Dancing" star Patrick Swayze's pancreatic cancer diagnosis made international news last month, he unofficially became the poster boy for this killer disease that unfortunately for its victims remains under researched. Pancreatic cancer needs poster boys and girls since most advocates don't live long enough to tell their stories.

Swayze's media hyped diagnosis is impacting pancreatic cancer awareness. Reports surfaced that the celebrity was under treatment at the Stanford University Cancer Center in Palo Alto, Calif., and that his prognosis was encouraging. When I read the articles, I wondered what specifically made his caregivers so optimistic since scientific progress has been slow. Pancreatic cancer is the fourth leading cause of cancer death in the United States, and in 2008, over 33,000 Americans will die from the disease.

I recently had a conversation with leading pancreatic cancer surgeons in Philadelphia who are involved in efforts to curtail the disease, not just treating it with surgery and chemotherapy. Pancreatic cancer isn't like most cancers since it's hard to find, due to where the pancreas is positioned in the body. However, in order to increase chances of survival, the disease must be diagnosed in its early stages before it metastasizes. Often most pancreatic cancer patients don't know they have it since typically there are no early warnings. CT, MRI and especially endoscopic ultrasound are imaging modalities utilized to confirm the diagnosis. Centers that specialize in pancreatic cancer are developing a screening test with MRI and endoscopic ultrasound, especially for patients who may have a genetic predisposition for this specific cancer. The screening protocol is in its early stages, and so are a number of other efforts that rely heavily on radiology for their effectiveness. But still there's hope. In the future, patients may go in for a blood test, have their sample analyzed with lab and radiology tests, receive a diagnosis and then take a pill to cure their disease. Unfortunately, that day is a long way off. There is a lack of funding to put these ideas in motion.

Advocates recently decided to do something about money. On the eve of Swayze's diagnosis, over 220 pancreatic cancer advocates prepared to arrive on Capitol Hill on March 11 to seek an unprecendented $170 million in federal funding to support the "National Plan to Advance Pancreatic Cancer Research," initiated by the El Segundo, Calif.-based Pancreatic Cancer Action Network (PanCAN).

One of those advocates is celebrity pancreatic cancer patient Randy Pausch, a 47-year-old computer science professor at Carnegie Mellon University in Pittsburgh, who has terminal pancreatic cancer. His moving testimony to Congress is here: http://www.pancan.org/Press/video/video_pausch_testimony.html. Pausch, who received his diagnosis in September 2006, became famous when a final lecture he gave at Carnegie Mellon hit YouTube and got millions of hits. When that happened, he quickly became an advocate for pancreatic cancer using what time he has left to raise awareness. He's made good use of his days so far appearing on "The Oprah Winfrey Show," named ABC's World News "Person of the Week," and was commissioned by Disney-owned publisher Hyperion to co-author a book called "The Last Lecture."

Perhaps the visibilty of Pauch's plight--who says he always did the right thing and never smoked, ate right and exercised--may help net increased funding from Congress. He'll appear again on ABC Wednesday, April 9th at 10 p.m. EST when the special "Primetime" edition "The Last Lecture: A Love Story for Your Life" airs and once again puts a celebrity face with an under-funded killer disease.

Update: For those who missed the "Primetime" special, ABC made available a special DVD for purchase with a portion of the proceeds donated to pancreatic cancer research. The information is here: http://abcnewsstore.go.com/webapp/wcs/stores/servlet/DSIProductDisplay?catalogId=11002&storeId=20051&productId=2017125&langId=-1&categoryId=100014. Supporters can choose from a drop down menu either Pancreatic Cancer Action Network (www.pancan.org) or The Lustgarten Foundation for Pancreatic Cancer Research (www.lustgarten.org) as benefactors from the DVD sales.