Health Imaging & IT - September 2008 - (Page 11)

form prospective data collection and sufficiently randomize patients. He said this may be due to a lack of tradition in the imaging community to follow the paradigm of the therapeutic community that does clinical trials. A major reason for this may be imaging’s role as the middleman in the clinical continuum of care. Imaging clinicians usually are not a patient’s primary-care provider, and typically they do not deliver therapeutic care to a patient as a result of their findings. As such, they generally do not have access to a complete patient history prior to performing an imaging exam and are rarely apprised of a patient’s outcome after delivering their imaging interpretation. “The kinds of studies that radiologists and nuclear medicine physicians have been used to doing look at the sensitivity and specificity of diagnostic tests and are very uncommonly linked to outcomes; but it’s hard to look at outcomes when you’re only one tiny piece in the chain,” says Barry A. Siegel, MD, professor of radiology and chief of the division of nuclear medicine at the Mallinckrodt Institute of Radiology at Washington University in St. Louis. “Randomized, controlled trials are very hard to do in diagnostic imaging,” he adds. “Clinicians are reluctant to have patients participate in those trials and patients are reluctant to participate.” gauntlet for evidence-based studies and demonstrated that their use can positively impact the delivery of patient care. Full-ﬁeld evidence Starting in October 2001, the Digital Mammographic Imaging Screening Trial (DMIST) enrolled 49,528 women who had no signs of breast cancer at 33 sites in the United States and Canada. As you may know, women in the trial were given both digital and film examinations. Examinations were interpreted independently by two different radiologists. Breast cancer status was determined through available breast biopsy information within 15 months of study entry or through follow-up mammography 10 months or later after study entry. The trial, sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health, was conducted by a network of researchers led by the American College of Radiology Imaging Network (ACRIN). ccta controversy Cardiac CT angiography (CCTA) is an imaging procedure that has recently drawn fire from policy-makers eager to rein in imaging expenditures. Despite more than 14,000 published studies on CCTA available via the U.S. National Library of Medicine’s PubMed web site, the procedure’s critics are demanding more evidence-based research. Although numerous single-site studies have demonstrated the efficacy of CCTA compared with conventional invasive angiography in terms of both cost and outcome in thousands of patients, to date there has not been a comprehensive, nationwide study of the procedure. In the face of overwhelming scientific data supporting utilization for many indications, CCTA detractors point to this omission as justification for their opposition. However, financing for large-scale clinical trials that can deliver evidence-based data for imaging exams, such as CCTA, is scarce to non-existent. R. Edward Coleman, MD, professor of radiology and chief of the division of nuclear medicine at Duke University School of Medicine in Durham, N.C., observes that the same governmental and privatepayor organizations that are demanding evidence-based imaging data are often reluctant to bankroll the necessary studies. “The challenges are getting the funding to get the studies performed, actually getting the studies performed, getting government approval, and then getting reimbursement from the third-party payors,” he says. When funding is forthcoming, evidence-based imaging trials can present compelling data for utilization, and reimbursement for, modalities and procedures. Two imaging technologies—full-field digital mammography (FFDM) and PET—cleared the funding HealthImaging.com “the challenges are getting the funding to get the studies performed, actually getting the studies performed, getting government approval, and then getting reimbursement from the third-party payors.” R. Edward Coleman, MD, professor of radiology and chief of the division of nuclear medicine, Duke University School of Medicine, Durham, N.C. Results from the study showed no difference in detecting breast cancer for the general population of women in the trial. However, those women with dense breasts, who are pre- or perimenopausal (women who had a last menstrual period within 12 months of their mammograms), or who are younger than age 50 may benefit from having a digital rather than a film mammogram. Results from a similar study with a larger patient cohort suggest that FFDM is a superior mammography screening technology for all eligible patients. The utilization of FFDM technology provided higher cancer detection rates than conventional screen-film mammography (SFM) in the Irish National Breast Screening Program, the results of which were presented earlier this summer at the 2008 International Workshop on Digital Mammography (IWDM) in Tucson, Ariz. “The aim of our study was to retrospectively review the performance of FFDM in a population-based screening program and compare it to the gold standard of SFM with respect to recall rate and cancer detection rate,” according to Niamh Hambly, MD, from the department of radiology at Mater Misericordiae University Hospital in Dublin, Ireland, who discussed the results at IWDM. The study examined 163,031 women who underwent breast cancer screening in Ireland between Jan. 1, 2005, and Sept. 30, 2007. Of September 2008 | Health Imaging & IT 11 http://HealthImaging.com

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Health Imaging & IT - September 2008 Table of Contents On the Web The Enterprise News Update Imaging Weighs the Evidence Radiation Oncology Tackles IT Integration PET/CT: Diagnosing Cardiac Disease—Adding Function to Form Modality Update People & Technology In Practice Reader's Resource Technology Outlook

Health Imaging & IT - September 2008

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