Whitney Palmer

Healthcare. Politics. Family.

Barium Shortage Affecting Radiology Practices

Published on the Jan. 18, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

Since last fall, radiology practices and departments nationwide have grappled with a continued shortage of barium agents used in multiple imaging studies. Recent reports indicate the shortage shows no sign of slowing, and several providers say they’ve had to alter their approach to patient care.

According to Bracco Diagnostics Inc., a leading, worldwide barium supplier, barium is in low availability globally. A September 2012 letter to customers from the company announced a significant number of barium requests are on backorder.

“With the continued efforts of our barium suppliers, we are attempting to make all of the key backordered products available as soon as possible,” Tom Ortiz, Bracco director of North America CT business and worldwide product director of oral imaging, said in the letter. “However, at this time, there are procedures for which we are unable to provide products.”

For example, Bracco has not fulfilled orders for small bowel, esophageal, and other CT studies.
Scripps Health in California is among those facilities struggling to meet patient needs with a limited barium supply, said Jeremy Enfinger, lead radiologic technologist at the Scripps Mercy Chula Vista Hospital.

“We got to the point where we had scheduled patients but not enough barium to complete the studies for the day,” he said. “There were several times that we used a courier to deliver supplies from one of our other hospitals within the organization. But, eventually, they stopped allowing us to do that because they had also run out.”

With the future barium supply level still in question, Enfinger postulated the industry might be pushed into using more water-soluble contrast agents to fulfill patient needs.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/contrast-agents/content/article/113619/2123820

 

February 4, 2013 Posted by | Healthcare | , , , , , , , | Leave a comment

MR Elastography Growing as Preferred Modality for Liver Diagnosis

Published on the Jan. 24, 2013 DiagnosticImaging.com website

By Whitney L.J. Howell

Once available only to radiologists who purchased new MRI equipment, MR elastography technology is becoming widely available as an upgrade feature to older machines. This expansion not only greatly improves patient care, industry experts said, but it also impacts costs and efficiency.

MR Elastography (MRE) — now available at 100 locations on five continents — is the industry-preferred method for assessing liver stiffness or elasticity. This condition characterizes liver disease and is most often diagnosed through palpation. However, there is a limit to how much tissue providers can feel. While conventional MRI is a powerful tool, liver disease, such as fibrosis or cirrhosis, creates no anatomical changes to the organ, making identification difficult and often requiring a needle biopsy.

“MR elastography provides a safer, more comfortable, non-invasive alternative to

Richard Ehman

Richard Ehman

liver biopsy for assessing liver disease,” said Richard Ehman, MD, professor and chair of radiology at the Mayo Clinic in Minnesota, noting that needle biopsies are often painful.

Being able to analyze liver health in a faster, more reliable way is particularly important now, he said, as the level of obesity and the associated fatty liver disease is rising in the United States. Currently 1 in 3 Americans lives with fatty liver disease, and within 10 years, he said, this condition will be the leading cause for liver transplant. MRE is also beneficial in diagnosing and treating the 25 percent of Hepatitis C patients who develop liver fibrosis, the large build-up of proteins in the liver that eventually leads to cirrhosis.

What Is MRE and How Does It Work?

Approved by the FDA in 2009, MRE is a non-invasive, highly-sensitive method for determining the level of liver disease through the use of low-frequency mechanical waves. It is designed to facilitate faster diagnosis and avoid potentially dangerous — and often inaccurate — liver biopsies, said Ehman, who pioneered the MRE technology and worked with GE Healthcare to bring it to market.

Once installed, this tool pumps 60 Hz waves through a plastic tube to a small, non-metallic drum placed over the abdomen. Slower wave movement correlates to higher stiffness. Standard MRI imaging captures the miniscule movements of the tissue, and, using a special algorithm, converts the data into a color-scale picture that corresponds to the level of liver stiffness.

MRE differs from ultrasound elastography. With the ultrasound method, a probe is pushed across tissue, and a scanner records how the tissue deforms. However, Ehman said, this doesn’t provide a quantitative measure of the tissue’s actual stiffness.

According to Ehman, an MRE scan can be completed with four breath holds — approximately a minute — and is often conducted and billed as part of other abdominal MRI protocols. Based on the color-scale picture, radiologists can instantaneously know whether the patient has a healthy or diseased liver. Liver tissue stiffness is measured in kiloPascals (kPa), with a normal liver having a stiffness of roughly 2 kPa, the same consistency of fat inside the body. Diseased livers range from 3 kPa to more than 10 kPa.

Since MRE’s FDA approval, GE Healthcare has been the main vendor for the tool with its MR Touch product. Siemens has also worked with the Mayo Clinic to provide MRE on its existing MAGNETOM Aera and Skyra MR machines.

Overall, said Richard Hausmann, GE’s president and CEO officer of global MR business, MRE greatly enhances what MRI studies provide.

“MRE offers an accurate assessment of stiffness in the liver, even for deeper tissues not reached by palpation,” he said. “It’s helped increase confidence in diagnoses in this area, and it’s one piece in an attempt to make overall diagnosis less invasive.”

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/mri/content/article/113619/2124974

February 4, 2013 Posted by | Uncategorized | , , , , , , , , , , , , , , , , , | Leave a comment

Communicating Risks of Contrast Agents to Patients

Published on the Jan. 29, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

One of the most commonly used imaging tools in a radiologist’s arsenal is the contrast agent. It enhances the appearance of structures and fluids, but it isn’t without risks and challenges. And, it’s up to radiologists, industry experts say, to make sure your patients and staff understand how to use it and why.

While less than 1 percent of patients experience a negative response to a contrast agent, according to a Mayo Clinic study, everyone involved with a scan using contrast should be aware of all possible outcomes and know how to handle them. The American College of Radiology offers guidance in how to best administer these agents, but creating the optimal experience for the patient involves more than selecting the right agent and using the correct measurement.

“You’re giving someone a drug, and there’s a risk to that. Patients have to understand that risk,” said Lawrence Marks, MD, chair of radiation oncology at the University of North Carolina at Chapel Hill School of Medicine. “They have to understand the value of the test, but like everything else in medicine, your actions should be based on a discussion with the patient before you do it.”

Educating the Patient

Although the risks can be minor, you should always consider if using contrast is even necessary, said Jeffrey Kanne, MD, associate professor of thoracic imaging and quality and safety vice chair at the University of Wisconsin School of Medicine and Public Health. If you can obtain the same information with the same level of specificity without using an agent, then do so, he said. That is always the safest option.

However, if contrast media is necessary, make it as easy to understand as possible. Like many procedures in radiology, the use of contrast media includes complex terminology that is potentially unfamiliar to patients. Always explain what the contrast media is and what it does in basic terminology — then, employ the teach-back method.

“Make sure you have patients explain back to you what you said. It’s a very valid way of ensuring patients truly understand,” Kanne said. “If they can recount back, you know they understand. If not, it’s clear you haven’t communicated effectively, and you need to try a different approach.”

One such strategy is a patient education website that addresses the risks associated with contrast media and tells patients what information you will need to ensure not only their safety, but also the best imaging results. For example, the University of Washington Medical Center maintains a patient education page that answers questions about need and risk in easy-to-understand language.

In addition, be willing to sit with patients and give them the opportunity to voice their questions and concerns. The most common worry patients have, Kanne said, is the misconception that contrast agents are radioactive. Others — many of whom experienced previous-generation contrast agents — fear the procedure will be painful and cause a burning sensation.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/contrast-agents/content/article/113619/2125650

February 4, 2013 Posted by | Healthcare | , , , , , , , , , , | Leave a comment

Duke’s Steve Nowicki finds out what songbirds have to say

Published in the Feb. 4, 2013, Raleigh News & Observer and Feb. 4, 2013, Charlotte Observer

By Whitney L.J. Howell

Deep in a North Carolina marsh, a lone swamp sparrow sits on his perch in the middle of the water. He’s singing his usual song. But he’s also aggressively flapping one wing, trying to incite a nearby male into action. Onlookers are watching – just to see what happens.

However, this is no ordinary territorial scuffle. This is bird research. The sparrow on the perch is a robot, and the chief, hip wader-clad onlooker – who is also in control of the robot’s movements – is Steve Nowicki, Ph.D., a biology, psychology, and neurobiology professor at Duke University. He’s testing whether the wing flap will actually prompt a fight.

According to Nowicki, birdsong and signaling have a surprisingly close relationship

Stephen Nowicki, Ph.D., Professor Dean of Undergraduate Education Jared Lazarus - Duke Photography

Stephen Nowicki, Ph.D., Professor Dean of Undergraduate Education
Jared Lazarus – Duke Photography

with human speech.

“It’s an unexpected and remarkable model for human speech control, development and perception,” he said. “Birds also learn their songs in much the same way humans learn to speak, and that’s an unusual trait. They have to learn their language from their parents.”

His research, though, isn’t about merely studying how birds behave and communicate. He and his team watch signals and behaviors; they run simulations and analyze hormones; they record neurons and assemble protein sets. They’re deciphering how birds promote their survival and reproductive success. In short – they’re studying evolution, past and present.

Why birds?

Nowicki, who is also dean and vice provost of undergraduate education, was almost the bird researcher who wasn’t. As a student at Tufts University in Boston, he was a declared music major. Late in his collegiate career, he discovered a love of biology – particularly the brain and behavior – and raced to complete a major in the subject. He then pursued his graduate degree in neurobiology at Cornell University.

It was there he was first introduced to the siren song of birds. When it comes to communicating, birds have far less to say than humans. But they express themselves in equally complex ways, Nowicki said.

“Humans use complicated signal communication, and we use an array of sounds to create words that have rich meanings,” he said. “When you look at sparrow songs – the number of notes per second and the frequency – it’s just as complicated as human speech. They’re just not saying much.”

All the same, they’re getting their points across.

Songs, signals

In addition to the aggressive response the swamp sparrow’s wing flap provokes, the absence or introduction of song or even a physical attribute can prompt birds to behave differently, Nowicki said.

Birds, like most animals, are territorial and will, in most cases, defend their turf. But how will neighboring birds respond if a battle ensues? Will they come to help or avoid the fight? Will they treat the male differently if he loses to the interloper? Researchers can test this reaction, Nowicki said, by removing a bird from its environment, playing a recording of another male’s song, and, then, reintroducing the bird to see how the others respond.

“It’s interesting to see what happens, because no one wants a floating male in the neighborhood,” he said. “Research has shown that with some birds, peer birds are more wary of the winner, but they might also try to encroach on a loser’s territory.”

A swamp sparrow states his case: According to Duke University biologist Steve Nowicki, birdsong and signaling have a surprisingly close relationship with human speech. PHOTOS BY ROB LACHLAN

A swamp sparrow states his case: According to Duke University biologist Steve Nowicki, birdsong and signaling have a surprisingly close relationship with human speech. PHOTOS BY ROB LACHLAN

And, just as with other species, birds can use their physical attributes to signal to and communicate with each other. For example, a trait, such as a bright red neck and throat commonly seen in the male house finch, can broadcast a bird’s prowess or superior qualities. The red-throated male finch does attract more females, Nowicki said, but it isn’t because of the color. The pigment comes from a carotenoid-rich diet that gives these males a stronger immune system, making them better mates.

Male song sparrows use their song repertoire in much the same way. The more songs they learn and exhibit, the more attractive they are to females. The reason, Nowicki said, is that birds with larger song selections appear to be smarter. They simply learn songs faster.

“Males who sing better have better developed brains, and in theory that makes them better mates,” he said. “We’re still working out why having a better brain for learning song is better for the female, but it’s clear females prefer these males as their mates.”

Impact on human activity

Understanding the role and importance of birdsong and signaling doesn’t shed much light on the evolution of human communication, but knowing what songs and signals mean to birds can directly affect human choices and behavior.

For example, researchers have evidence that stress directly affects a bird’s ability to develop song, which can ultimately impact pair bonding and mating. If scientists study the way birds living in both polluted and pristine environments sing, the data could play a role in accurately evaluating ecosystem health.

This knowledge can also impact wildlife preservation efforts. It isn’t enough to allocate a certain amount of space to a population based only on the number of animals surveyed. There are often other factors at work, Nowicki said. In the case of the small warbler ovenbird, it’s important to know that females won’t be setting in an area with fewer than 10 males. This type of information can significantly alter conservation efforts, he said.

Regardless of how the research of birdsong is used, Nowicki said, his work constantly reminds him of how intertwined birds and music are with our surroundings.

“I keep coming back to birdsong not simply because it’s a good model,” Nowicki said. “When I wake up in the morning and hear birds singing, it’s part of the wonderful aesthetic world we live in, and my job to learn more about it is a privilege.”

To read the story at its Raleigh News & Observer location: http://www.newsobserver.com/2013/02/03/2650134/what-songbirds-have-to-say.html

To read the story at its Charlotte Observer location: http://www.charlotteobserver.com/2013/02/03/3828440/what-songbirds-have-to-say.html

February 4, 2013 Posted by | Education, Science | , , , , , , , , , , , , , , | Leave a comment

   

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