Digital Pathology Blog

CMS rejects Medicare coverage for virtual colonoscopy

In the past I have blogged about virtual colonoscopy and concern over how in the future this may diminish the number of colon biopsies done to be reviewed.  Others have argued this might actually increase the number of colonoscopies performed and subsequent biopsies, citing a number of reasons, including more people getting at least virtual colonoscopy when age appropriate rather than putting off the more invasive procedure or not getting one at all.  Yesterday CMS rejected the latest proposal to pay for this sevice claiming it wasn't ready for "prime time", as the radiology community has felt. 

So, for the time being it looks like this is not an immediate threat to GI pathologists (if you believe as I do), although I can see the arguments for reimbursement and how this technology may cost costs and save lives. Gastroenterologists are safe from the CT scan as well for now.

As the digital pathology community advances the technology, garners FDA clearances for clinical use and promotes reimbursement for these services, I wonder how CMS will address the issue. 

CPT codes are in place for image assisted IHC interpretation, providing a driver to use the technology with appropriate validation perhaps but will scanned archives, image-linked or enhanced reports, image repositories for data mining or content based image retrieval or enterprise wide PACS image uploads be"compensated".  I think there will be some opportunities to have these services paid for to pathologists and laboratories but will require a tremendous amount of validation of the technologies and will not likely occur for many years to come, particularly if virtual colonoscopy is any indicator.

By Eric Barnes AuntMinnie.com staff writer May 12, 2009

The U.S. Centers for Medicare and Medicaid Services (CMS) today rejected a proposal to pay for virtual colonoscopy (also known as CT colonography or CTC) for routine colon cancer screening of Medicare patients in the U.S., saying that VC, while promising for detecting colorectal polyps and cancer, is "not yet ready for widespread screening use."

"The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under §1861(pp)(1) of the Social Security Act. CT colonography for colorectal cancer screening remains noncovered," the May 12 memo states.

The decision comes as a blow to advocates of CTC, who held out hope that the agency would reverse its proposed February 11 decision to deny reimbursement for screening CTC based on the body of evidence presented to it since the analysis of CTC as a screening tool began last year.

Advocates for virtual colonoscopy were quick to criticize the decision.

"The news is obviously disappointing, but not unexpected, given the inseparable politics and purse strings involved," said Dr. Perry Pickhardt, associate professor of radiology at the University of Wisconsin in Madison. "In the end, CTC will ultimately prevail as a highly effective screening test -- it's simply too good to hold down for much longer."

Dr. James Thrall, chair of the American College of Radiology Board of Chancellors, was even more emphatic.

“Make no mistake: If it stands, this CMS decision not to pay for CT colonography will cost lives. More than 140,000 Americans are diagnosed with colorectal cancer each year. Nearly 50,000 of them die due to late detection. How can CMS ignore the fact that people are dying because they do not want to have the tests that are currently covered?” Thrall said in a statement to the American College of Radiology.

“For CMS to turn its back to a technology that can attract more patients to be screened and save countless lives is deeply concerning," he continued. "CMS should reverse this determination immediately, or Congress should step in and vote to mandate coverage of CTC."

"The decision is understandable in these tough economic times," said Dr. Judy Yee, professor and vice chair of radiology and biomedical imaging at the University of California, San Francisco. "The decision is unacceptable when considering the large body of scientific evidence clearly documenting that CTC has been proven to be as effective as colonoscopy for the detection of clinically significant polyps in adults."

While CMS states that the evidence is insufficient to conclude that CTC improves health outcomes, "the same can be stated for other colorectal cancer screening tests that are currently covered by CMS," Yee told AuntMinnie.com in an e-mail. "We know that colorectal cancer is preventable. We know that a very large percentage of the American public remains unscreened for colorectal cancer. A positive decision from CMS could have helped to change this."

Dr. Abraham Dachman, professor and chair of radiology at the University of Chicago, told AuntMinnie.com that VC utilization is inseparable from efforts to cut healthcare costs.

"CTC experts strongly believe that current data support use of screening CTC in the Medicare aged population as do a large bipartisan group of members of Congress who signed a letter urging CMS to approve coverage of CTC for screening," Dachman wrote in an e-mail. "Even as the nation discusses ways to reign in the cost of healthcare, CTC screening makes sense. Use of CTC for colorectal cancer screening is consistent with President Obama's push for prevention and use of new technology to benefit patients. The public and the medical community at large should work to get this decision reversed."

Radiologists should work to publish data focused on individuals ages 65 and older, he said, and third-party payors should encourage CTC use as radiologists continue to attend courses to ensure that CTC providers continue to offer high-quality services.

"The public and the medical community at large should work to get this decision reversed," Dachman wrote. ... I am confident that CTC will eventually achieve full reimbursement status."

Urgency of screening

Colorectal cancer is the third most commonly diagnosed cancer and the second most common cause of cancer deaths in the U.S. The U.S. Centers for Disease Control and Prevention (CDC) estimates that as many as 60% of deaths caused by colorectal cancer could be prevented if all Americans older than 50 years of age underwent regular screening.

The issue is particularly critical for older patients. Of the approximately 75 million Americans older than 50 who are eligible for colorectal cancer screening, fewer than 50% present for screening due to myriad factors that include, for some, a fear of invasive examination with a colonoscope, which virtual colonoscopy avoids.

Yet patient surveys also suggest that it is the purgative bowel preparation, generally required for virtual colonoscopy and always needed for conventional optical colonoscopy, that patients most dislike about colorectal cancer screening.

Some adults eligible for screening refuse to be examined with optical colonoscopy or cannot undergo the procedure due to contraindications. Virtual colonoscopy advocates believe that Medicare access to VC would improve screening compliance and reduce the death toll from colorectal cancer. Because 90% of colon cancers are diagnosed in people older than 50, they note, colorectal cancer screening is critical for Medicare recipients, who are denied the noninvasive screening option as a result of today's decision.

Private insurance more promising

Although national Medicare coverage may be off the table for now, VC has fared better among private payors. Twenty-six states already mandate that patients with private healthcare coverage are ensured access to virtual colonoscopy. Many regions also cover virtual colonoscopy exams under Medicare local coverage decisions.

Based on early results of the multicenter ACRIN 6664 trial that found equivalent sensitivities for virtual and optical colonoscopy exams, the American Cancer Society (ACS) added CTC to its five-year colon screening guidelines in March 2008.

Other ACS-approved screening exams include optical colonoscopy (every 10 years), flexible sigmoidoscopy (every five years), double contrast barium enema (every five years), annual guaiac fecal occult blood testing (gFOBT), annual fecal immunochemical testing (FIT), and stool DNA testing.

Of these, only virtual colonoscopy remains ineligible for Medicare reimbursement following today's decision. In addition to many physicians and public health advocates, Medicare coverage for CTC is supported by the American College of Radiology, the American Gastroenterological Association, and the U.S. Multisociety Task Force on Colorectal Cancer.

Detractors argue that the evidence remains insufficient to recommend VC screening as a cost-effective alternative to colonoscopy.

In March, the U.S. House of Representatives passed Congressional Resolution 60, calling for increased support for colorectal cancer screening for Americans ages 50 and older. Forty-two representatives also signed a letter to CMS expressing their concerns with CMS' proposed denial of coverage for routine screening with CTC.

The lobbying group CTC Coalition, which includes the Colon Cancer Alliance, the American College of Radiology, and the Medical Imaging and Technology Alliance, argued that Medicare coverage for VC screening would break down barriers to screening for the populations most at risk of the disease.

Observers of all persuasions have complained that a protracted tug-of-war between radiology and gastroenterology interests is more about who will make a living from colorectal cancer screening than the adequacy of CTC. For now, at least, the gastroenterology interests appear to have the upper hand.

Related Reading

Pressure builds on CMS to pay for VC, April 2, 2009

CMS rejects case for virtual colonoscopy reimbursement, February 12, 2009

MedCAC panel members question VC's effectiveness, November 25, 2008

CMS announces VC evidence meeting, September 26, 2008

Definiens LymphExpert (TM)

From Definiens - a merger of pathology and radiology or enhancement to radiology?

Either way, some interesting technology and increased clinical use with links below.

Definiens LymphExpert™

Lymph nodes play a critical role in the assessment of the spread of cancer through the lymphatic system and the staging of almost all types of cancer and therapy control. The earlier the metastatic spread of cancer can be detected, the higher the chances are for successful treatment.

Definiens LymphExpert™ is Definiens first medical imaging application and facilitates the automated analysis of lymph nodes.

Definiens LymphExpert™ helps radiologists to identify, analyze and measure the size of lymph nodes over time which facilitates the early detection of the metastatic spread of cancer. Designed to accurately measure the size of lymph nodes, Definiens LymphExpert™ builds a 3-dimensional volumetric picture of the nodes and identifies whether they are growing, shrinking or stable.



Definiens LymphExpert™ enables physicians to target their efforts more effectively, avoiding costly and unnecessary treatment and providing better outcomes for patients.


Features and benefits

Definiens LymphExpert™ quantifies standard lymph node parameters in computer tomography (CT) datasets as a second reader in a clinical environment. Quantification results are in accordance with WHO and RECIST guidelines and lead to standard parameters.

Key features

• Import of DICOM CT Series                                                          
• Manual detection of lymph nodes via seed point
• Automatic segmentation and analysis of lymph nodes
• Standard parameters (RECIST/WHO etc.) and visualization
  in 2D and 3D

Clinical benefit

• Early detection of metastasizing cancer
• More targeted efforts avoiding unnecessary treatment
  and reducing costs
• Better outcomes for patients

Clinical results

RECIST criteria [cm] WHO criteria [cm²]

Average density in Hounsfield Standard deviation of density

Volume in [cm³] Diameter 3D [cm]

Please download our NEW Data Sheet Definiens LymphExpert™ and read what clinical experts say about our innovative medical imaging software (the article was published in Nov 2008 by European Hospital).

New Technique Images Tumor Vessel Leakiness To Predict Breast Cancer Chemotherapy Outcome

Yesterday I had a post about radiology and pathology merging services.  If you look at what is going on in the radiology literature - both research and practical news the reality is that radiology in many ways is increasingly impacting diagnosis and management beyond location, size, characteristics and likely diagnoses (also called "impressions" by radiology).  Here is another example of the work going on in radiology that has increased prognostic information beyond traditional radiology tools and reporting.

I think the last paragraph sums it up: "We want to study the molecular basis for blood vessel leakiness," said Bellamkonda. "We want to understand why there is variation in leakiness and chemotherapy effectiveness among individuals with tumors of the same type, size and stage."

That's the kind of information pathologists try to derive with morphology and tissue-based studies.

Article adapted by Medical News Today from original press release

Chemotherapy is an integral part of modern cancer treatment, but it's not always effective. Successful chemotherapy depends on the ability of anticancer drugs to escape from the bloodstream through the leaky blood vessels that often surround tumors.

Predicting chemotherapy's efficacy could save thousands of individuals from unnecessary toxicity and the often difficult side effects of the treatments.

In a study published in the February issue of the journal Radiology, researchers describe a technique for determining the "leakiness" of tumor blood vessels using a simple digital mammography unit. The researchers designed nanometer-sized capsules containing a contrast agent that could only leak into tumors with blood vessels that were growing and therefore leaky. The digital mammography-based quantification of "leakiness" is closely correlated to the ability of a clinically approved chemotherapy agent to enter the tumor, allowing the researchers to predict the agent's therapeutic efficacy.

"We developed a quantitative way to measure the leakiness of the blood vessels, which is directly linked to the amount of drug that gets to the cancer and in turn determines effectiveness," said Ravi Bellamkonda, a professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University. "By simply measuring how much contrast agent reaches the tumor, we can predict how much of a clinically approved chemotherapeutic will reach the tumor, allowing physicians to personalize the dose and predict effectiveness."

In some cases, one chemotherapy drug may not be effective in treating the tumor, but this new technique allows oncologists to investigate other drugs sooner since they know the drug is reaching the tumor. Studies are currently underway to determine if mammography can predict the optimal dose of a wide range of breast cancer chemotherapeutics.

Bellamkonda and Coulter Department postdoctoral fellow Efstathios Karathanasis collaborated on this study with Ioannis Sechopoulos, an assistant professor in radiology at Emory University; Andrew Karellas, a former professor in the Emory University Winship Cancer Institute currently at the University of Massachusetts Medical School; and Ananth Annapragada, an associate professor of health information sciences at the University of Texas, Houston. The project was funded by the National Science Foundation and Georgia Cancer Coalition.

For the study, a long-circulating nanometer-scale liposomal capsule filled with iodinated contrast agent was injected into rats with six-day-old breast cancer tumors. For the next three days, the researchers collected digital mammography images of the animals and compared the pre- and post-injection grayscale intensity values to study the dynamics of how the contrast agent accumulated in the tumor over time.

"During the three-day time course, some tumors exhibited a rapid and significant increase in image brightness, meaning the contrast agent was accumulating in the tumor, whereas other tumors showed a slow and low increase," said Bellamkonda, who is also a Georgia Cancer Coalition Distinguished Scholar.

While the brightness of the tumors in the images changed significantly, no variations were observed in non-tumor areas or in the tumors of animals that did not receive the contrast agent. Immediately after the imaging was completed and the leakiness of each individual cancer vessel was quantified, the animals were intravenously injected with a clinically approved chemotherapy drug, liposomal doxorubicin.

Results showed that the chemotherapeutic drug slowed the progress of the tumor. The variability in uptake of the contrast agent by the tumors, as measured during the three-day imaging sessions, provided an accurate prognosis of the effect of liposomal doxorubicin on tumor growth rate.

"When we plotted the post-treatment tumor growth rate versus the intensity of leakiness, there was a significant and strong correlation," noted Bellamkonda. "The tumors in which the nanocarrier leaked out and accumulated the most in the tumors during the initial three-day test were the ones that responded best to the treatment."

To verify that the intensity changes in the images were caused by the nanocarrier and not endogenous changes in the tumor tissue, liposomal probes tagged with a fluorescent dye were injected into the animals. By looking at histological tumor sections, the researchers showed that the location of the increased image brightness and the fluorescent dye were the same.

"This study showed that higher uptake of the probe by the tumor related to leakier vasculature and suggested a better therapeutic outcome of liposomal doxorubicin," said Bellamkonda. "Imaging the integrity of the tumor vasculature like this may allow cancer treatment to be more patient-specific and potentially spare patients from chemotherapy if it is not going to be effective."

While the goal of the study reported in the journal was not to induce tumor regression, the researchers plan to investigate whether the liposomal probes can be used for this purpose in the future. To further develop and commercialize these multifunctional probes, Bellamkonda and Annapragada founded a start-up company called Marval Biosciences, Inc.

The researchers also want to investigate whether the leakiness of tumor vasculature represents a parameter that is useful for clinical diagnosis or tumor characterization.

"We want to study the molecular basis for blood vessel leakiness," said Bellamkonda. "We want to understand why there is variation in leakiness and chemotherapy effectiveness among individuals with tumors of the same type, size and stage."

Departments of Diagnostic Medicine?

Awhile back I wrote a few notes entitled "Stethoscopes, EMRs and EHRs - what is all the data worth?"

They were essentially musings about my own experiences with health records, patient data and some thoughts dealing with "evidence-based medicine" from some experiences I had the time. 

Recently I had the opportunity to meet several of the over 120 radiologists at my institution.  I asked about a dozen of them about the "merger of radiology and pathology services" I have been hearing and reading about in pathology for some time;

See - 10 reasons for radiology-pathology merger, "In diagnosis, a tale of two specialties" and Why Pathology should not merge with Radiology

With the exception of a few radiologists such as Dr. Li at MD Anderson in the above CAP Today article, it is hard to find any radiologists who have heard of this or have any thoughts on the matter. 

It is not entirely clear to me if this will happen or what it will look like, I think there are convincing reasons both for and against why it should or will happen.  Nonetheless, it appears to be largely driven by pathology with either little interest or thought from radiology. 

I haven't thought about business models for "diagnostic medicine", "molecular radiology", or "radiologic pathology" yet but gather there would be room for both specialties in such a field.  And perhaps if and when the radiology community looks at this, the cost-benefits of doing so will determine to what, if any extent this happens. 

Dark Daily had a piece on this as well.

One thing is certain - the next real department of diagnostic medicine beyond Princeton-Plainsboro Teaching Hospital on Fox will likely not look like this one.

GE launches India’s first digital X-ray system

Kolkata, India, January 7: India may soon update its prolonged and outdated X-ray technology to the advanced digital system for better healthcare quality and reliability. GE Healthcare is to launch India’s first digital X-ray system, ‘Tejas DR-F’.

X-ray, which is the primary and most widely used diagnostic imaging tool, has remained most under-developed imaging specialty in India. The fact that every Indian citizen on an average undergoes a medical x-ray examination annually makes it imperative that high quality healthcare technology should be employed in this front.

Digital X-ray system promises high-end and higher quality diagnostic systems for a better healthcare. As asserted by Dr. Rajarshi Bahadur of Atulya Healthcare, Chandigarh, digital X-ray machine can aid in better diagnosis as it provides better image quality with lesser artifacts, leaving no room for doubt. Post processing which is possible only in the case of digital images can further improve the image quality, hence leading to better diagnosis.

IBM gets nano-view with new super microscope

This sounds like technology that is far superior to current electron microscopy for resolution and depending on cost of course may one day replace the light microscope itself for routine microscopy with nano technologies they claim are "100 million times the display resolution of MRI machines..."

These technologies may also facilitate the convergence of pathology/laboratory medicine and radiology that has become popular in the pathology community with arguments for and against doing so.

January 12, 2009 (Computerworld) -- Scientists at IBM have built a microscope that they say has 100 million times the display resolution of MRI machines used in hospitals.

The new microscope is designed to study complex 3-D structures at the atomic level. Scientists say they're hoping the microscope could help researchers who are investigating diseases and creating new medications.

"This technology stands to revolutionize the way we look at viruses, bacteria, proteins, and other biological elements," said IBM Fellow Mark Dean, vice president of strategy and operations for IBM Research, in a statement.

A year ago, scientists at Lawrence Berkeley National Laboratory announced that scientists had begun using the world's most powerful microscope -- a 12-foot-tall electron microscope that officials said enables researchers to see 3-D images of atomic structures. The Transmission Electron Aberration-Corrected Microscope lets scientists see smaller objects than is possible with a traditional light microscope, according to Peter Denes, director of the TEAM project at the Berkeley, Calif.-based lab.

IBM noted that the resolution of its latest microscope was enabled by a technique called magnetic resonance force microscopy (MRFM), which relies on detecting ultrasmall magnetic forces. The technology boasts high-resolution imaging but also can give scientists a view of the object below the surface. It also reportedly isn't destructive to sensitive biological materials.

IBM said its team, which worked with the Center for Probing the Nanoscale at Stanford University, boosted the sensitivity of MRFM and then combined it with an advanced 3-D image reconstruction technique.

"MRI is well known as a powerful tool for medical imaging, but its capability for microscopy has always been very limited," said Dan Rugar, manager of nanoscale studies at IBM Research, in a statement. "Our hope is that nano MRI will eventually allow us to directly image the internal structure of individual protein molecules and molecular complexes, which is key to understanding biological function."

Last July, researchers at the California Institute of Technology announced that they had developed a high-resolution microscope that is small enough to sit on a computer chip.

The device, dubbed the optofluidic microscope, has the magnifying power of a top-quality optical microscope and is designed so scientists can use it in the field to analyze blood samples for malaria or to check water supplies for pathogens.

Researchers say including patients' photos with CT scans could yield better results.

A study being presented at the RSNA meeting in Chicago looked at impact of radiologists looking at radiology studies with snapshots of the patients faces themselves and what the investigators found.

 

Workflows in radiology and surgical pathology are similar in several ways.  A batch of cases may be waiting to be read in the morning and acute or critical studies are reviewed during the course of the day in addition to other cases being processed to be read. 

 

In both cases the studies or slides to be read simply contain no more than basic demographic information. 

 

In some transplant centers facial snapshots are incorporated in the summary sheets as part of the documentation for pre- and post-transplant care as it is done here.  Occassionally, I will come across this wallet-sized photo in the paperwork when looking at the explant or subsequent biopsies. 

 

I can say that whether I see the picture (or not), what the patient looks like and not just their liver sections do, impacts what I do to sign out their case, but it would be an interesting study to replicate in surgical pathology and look at with several pathologists and biopsies/surgical specimens.

 

The AP (12/2) reported that an "Israeli study found adding photos of patients' faces to the file made...doctors more meticulous when looking at the X-rays. They reported more details and said they felt more empathy for patients who were otherwise strangers."

 

According to HealthDay (12/2, McKeever), "clipping a photo of the patient next to their radiological scans helps humanize each case, and boosts the accuracy with which scans are read by radiologists," a study presented at the annual meeting of the Radiological Society of North America suggests. Yehonatan N. Turner, M.D., of Shaare Zedek Medical Center in Jerusalem, and colleagues, asked radiologists to review "patients' files electronically via their hospital's picture archiving and communication system (PACS), a network for the storage and retrieval of medical images."

 

MedPage Today (12/2, Fiore) added that the "patients were divided into three groups. In the 'face first' group, the radiologist saw a photo of the patient at the initial interpretation." For "the 'face later group,' scans were interpreted without the radiologist seeing a photo and then again three months later with a photo attached." There were no photos for the third group, who served as controls. Next, the investigators "analyzed four separate parameters of the radiologists' reports: the number of words in the report, the number of incidental findings noted, and the presence or absence of a summary section, and further recommendations."

 

They found that "When the CT [computed tomography] image was read with a photo attached, the summary consisted of significantly more words and the number of incidental findings was approximately double what it was when no photo was attached," Medscape (12/2, Kerr) noted.

 

In fact, there "was an 80 percent drop in incidental findings, such as identifying a tumor while looking for kidney stones, when the personal photograph was absent," Scott Hensley wrote in the Wall Street Journal (12/2) Health Blog. Still, "some doctors questioned whether the effect was a novelty that would fade with use," while "others said patient anonymity can have advantages when it comes to suppressing racial biases, for instance." The U.S. News and World Report (12/2) Comarow On Quality blog also covered the story.

New breast cancer screening tool shows promise

News story of study findings from my institution using molecular breast imaging to detect breast cancers, particularly in patients with dense breast tissue to see small tumors.

By Will Dunham

WASHINGTON (Reuters) - A new screening tool works three times better than mammography at finding tumors in women who have dense breast tissue, which can confound mammograms, U.S. researchers said on Wednesday.

Mammography, an X-ray of the breasts, detected fewer than a third of the tumors found using a new technique called molecular breast imaging, or MBI, the researchers said ahead of a breast cancer meeting sponsored by the American Society of Clinical Oncology and other groups.

Mammography is used commonly to screen for breast cancer, but about a quarter of women have dense breast tissue -- and mammogram X-rays may not see through this to spot small tumors. Doctors are eager for other methods that perform better.

The study, involving 940 women, is the largest to date to compare MBI to mammography. MBI is still experimental and is not commonly available to women.

The women, considered at high risk for breast cancer due to a family history of the disease, genetic susceptibility or other factors, underwent both screening methods.

With MBI, patients are injected with a radioactive agent that gets absorbed by breast tissue. Cancer cells tend to absorb more of it than healthy cells, and specialized cameras that detect gamma rays from the agent then differentiate tumors from healthy tissue.

"We're certainly not advocating replacing mammography in any way. But we think it (MBI) would have a role as an additional test for those women that aren't served as well by mammography as we would like," Carrie Hruska of the Mayo Clinic in Rochester, Minnesota, who led the study, told reporters.

Using MBI, the ability to see a tumor is not affected by the density of the surrounding breast tissue, so it offers great promise for women whose mammograms may not provide an accurate assessment, Hruska said.

Among the 940 women, 13 tumors were found in 12 women. MBI found 10 and mammography found three, the researchers said.

Dr. Eric Winer of Harvard Medical School and Dana-Farber Cancer Institute in Boston, commenting for the American Society of Clinical Oncology, said between 10 percent and 15 percent of breast cancers cannot be detected using mammograms.

"More and more we may be getting away from one-size-fits-all in terms of screening approaches, and instead think about screening approaches that are directed more to an individual women based on her risk and on the characteristics of her breasts," Winer told reporters in a conference call.

There has been increasing use of costly MRI exams on some women with dense breasts or with high risk for breast cancer.

Hruska said MBI may be a lower-cost alternative. She estimated it would cost about $500 to perform, and expressed hope its availability would increase in the next year.

The technology used special cameras developed by GE Medical Systems and privately held Gamma Medica-Ideas, Hruska said. The study was funded in part by Bristol-Myers Squibb, which provided the radioactive agent, Hruska added.

The radioactive agent typically exits the body in a day.

Hruska said MBI as currently used presents a very low risk of radiation if a woman has it a few times in a lifetime, but the researchers must lower the radiation if the technology begins to be used as a screening test every year or two.

Arizona Breastnet Completes One Year of Digital Mammography

Arizona Breastnet, a full service breast diagnostic center located in Scottsdale, specializing in breast mammography and breast ultrasound, announces the completion of one full year of providing digital mammograms to their patients in the Valley.

"Being one of the first to offer digital in Arizona, we are very pleased with the technology used in the mammagraphy process and the speed and comfort in which it is delivered," states Dr. Belinda Barclay-White, Board Certified Radiologist and founder of Breastnet. This state-of-the-art digital mammography used at Breastnet makes the mammogram experience much less time consuming and more thorough. "We understand the stress that can accompany having a mammogram and we focus on making the experience as stress-free as possible," according to Barclay-White.

Breastnet is one of few imaging centers in the Valley to offer digital because of the financial investment and commitment involved. But the results of using digital are profound.

. Digital mammography is faster

. The radiologists no longer have to wait for films to be developed in the darkroom.

. Quicker results are provided to their patients at the time of their visit.

. The images are spectacular and allow the radiologist to see calcifications more easily, which translates to fewer additional views before a diagnosis can be made.

. Fewer compression views are needed to distinguish normal overlapping tissue from real breast lumps.

"With all the conflicting messages heard by women about the importance of mammograms, all women need to know that a mammogram is still the first most important step in diagnosing breast cancer and catching it early - practicing good breast health is the key," according to Barclay-White.

About Breastnet:
Arizona Breastnet LLC. was founded in 1998 by Dr. Belinda Barclay-White, who has been practicing radiology in Phoenix since 1983. Breastnet specializes in medical conditions related to the breast. Dr. Barclay-White has gained a reputation as an expert mammographer among general surgeons, breast surgeons, gynecologists and primary care physicians, and has acquired a following of patients in the Valley for whom she has diagnosed breast cancer and other various breast conditions. Patients meet with her at the time of the appointment and she reviews the exam with them so they no longer have to worry, wonder and wait for results.

Arizona Breastnet is located at 8994 Desert Cove Road, Scottsdale, AZ, 85260. More information can be found at www.AZBreastnet.com.

Cancer fears as X-rays increase

New Zealand's Medicare is investigating a sharp rise in digital imaging procedures such as X-rays and CT scans amid fears that some tests could be putting patients at risk of cancer.

Government figures show the number of digital imaging tests conducted over the past five years has increased by 1 million to 4.8 million, taking the cost to the health system from $1.1 billion in 2002 to $1.6 billion last year.

Medicare's fraud watchdog is concerned about practitioners rorting the system, but radiologists say unnecessary CT scans could also be exposing patients to cancer without good reason.

Some CT scans, including those of the chest and abdomen, carry a one-in-1000 risk of cancer per scan compared with a one-in-1 million risk for other X-ray procedures. The most common cancers associated with radiation are leukaemia, and thyroid and breast cancer.

Medicare's head of fraud and compliance, Colin Bridge, said doctors had been caught ordering imaging procedures in recent years when they were not required or were premature in the clinical process. He declined to comment on how many doctors had been forced to repay Medicare for such procedures but said strict laws that came into effect last month had made it easier to investigate and prosecute practitioners for such rorts.

Mr Bridge said Medicare was also closely monitoring the "corporatisation" of general practices amid fears they may be more profit driven. He said the clinics, which usually employed their own radiology and pathology services, could be more prone to ordering unnecessary tests to boost income from Medicare benefits.

"We're looking at the overall claiming patterns. Are there things that seem to be different in the way corporate practices work compared to other practices? If there is, we will be asking questions," he said.

Liaison radiologist for the Royal Australian & New Zealand College of Radiologists, Catherine Mandel, said the profession was concerned about the increasing number of CT scans being conducted because of proven links between ionising radiation and cancer.

http://www.ranzcr.edu.au

This story by Julia Medew was found at: http://www.theage.com.au/articles/2008/04/11/1207856836855.html