Health Imaging & IT - September 2008 - (Page 12)

Imaging Weighs the Evidence: Studies Build the Case for CCTA, FFDM & PET/CT this cohort, 26,593 (16.3 percent) had FFDM performed on a Sectra MDM, Hologic Lorad Selenia, or a GE Healthcare Essential digital mammography system. The remaining patients (136,438 or 83.7 percent) had images acquired via a GE 800T or a Siemens Medical Solutions Mammomat 3000 SFM system. Images from the national screening program were reviewed by six dedicated breast radiologists using standard mammography alternators for the SFM exams and via a Sectra PACS ID55 mammography review workstation for the FFDM studies. Two radiologists independently read each mammogram and assigned a Breast Image and Data Reporting System (BIRADS) category of 1 to 5 for each image. All solid masses, category 3 to 5 microcalcifications and other suspicious lesions, were biopsied, according to Hambly. “All samples were evaluated by a dedicated breast pathologist and all cases biopsied were discussed at a multidisciplinary meeting within a week,” she notes. pet/ct powers patient care An effort to address the lack of prospective, randomized studies in nuclear medicine imaging was launched in November 2005, with the creation of the National Oncologic PET Registry (NOPR). NOPR was developed in response to the Centers for Medicare & Medicaid Services (CMS) proposal to expand coverage for positron emission tomography with F18-FDG PET to include cancers and indications not presently eligible for Medicare reimbursement. The registry is sponsored by the Academy of Molecular Imaging (AMI) and managed by the American College of Radiology (ACR) and ACRIN. In addition, the American Society of Clinical Oncology (ASCO) and SNM also have played key roles in guiding the project’s development. The NOPR working group is chaired by Hillner, and co-chaired by Siegel, Coleman, and Anthony F. Shields, MD, professor of medicine and oncology at the Karmanos Cancer Institute at Wayne State University in Detroit. The registry collects information from a PET facility, from the physician requesting a PET scan for a Medicare beneficiary, and from the interpreting physician’s PET report for cancers not currently covered for PET imaging by CMS. Diagnostic findings from FDG-PET imaging changed the intended care of more than one in three cancer patients, according to a study of first-year data from NOPR, published in the Journal of Clinical Oncology (May 2008). The study analyzed data regarding nearly 23,000 patients contributed to the NOPR by more than 1,200 facilities in the United States that provide PET scans. The research found that FDG-PET utilization is associated with a 36.5 percent change in the decision of whether or how to treat a patient’s cancer, a management change in almost 75 percent of patients, and it revealed that for patients with a pre-PET plan of biopsy, the post-PET plan had a significant impact on care, with these patients avoiding biopsy in about 75 percent of the cases. The registry is still open and continues to accept patients, according to Shields. “As of late March this year, we had 75,000 patients enrolled,” he says. “We are currently running about 200 patients a day; I don’t think any of us expected that we would see this amount of participation when we began.” SNM president Alexander J. McEwan, MD, professor and chair of the department of oncology, faculty of medicine, at the University of Alberta and director of oncologic imaging at Cross Cancer Institute in Edmonton, Canada, believes that the NOPR model holds great promise as a structure for future evidence-based imaging indications. “The NOPR trial has shown that you can, on a multi-center basis, collect the type of change of management leading to change of outcomes data that we have to build into imaging trials,” McEwan says. “I think as a base skeleton, with a bit more refinement depending on the complexity of procedure, we can use this model as a starting point for future evidence-based imaging trials.” HealthImaging.com “the irish national Breast screening program study represents one of the ﬁrst reviews into the widespread use of digital mammography in a population-based breast screening program. the results are very favorable showing a cancer detection rate that is higher than for screen-ﬁlm mammography. the beneﬁt was apparent in both initial and subsequent screening groups.” Niamh Hambly, MD, department of radiology, Mater Misericordiae University Hospital, Dublin, Ireland Recall and cancer detection rates were calculated for FFDM and SFM; recall was defined as the percentage of women screened who were recalled for further diagnostic workup, and the cancer detection rate was defined as the number of cancers detected per 1,000 women screened. The researchers reported 5,458 women were recalled for further diagnostic work, for an overall recall rate of 3.35 percent. For the SFM cohort, the recall rate was 3.23 percent (4,408 of 136,438) and for the FFDM group, the recall rate was 3.95 percent (1,050 of 26,593). The overall cancer detection rate was 5.6 per 1,000 women screened. Hambly stated that the cancer detection rate was higher in the FFDM cohort, 6.24 per 1,000 women screened, than in the SFM group, 5.48 per 1,000 women screened. “This study represents one of the first reviews into the widespread use of digital mammography in a population-based breast screening program,” she says. “The results are very favorable showing a cancer detection rate that is higher than for screen-film mammography. The benefit was apparent in both initial and subsequent screening groups.” 12 Health Imaging & IT | September 2008

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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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