January 30, 2009

ARDMS Headlines:         

• Sonography Principles and Instrumentation (SPI) Examination*: 
  
  On April 6, 2009, ARDMS will introduce the new Sonography Principles and Instrumentation (SPI) examination which will meet the fundamental physical principles and instrumentation requirements for the RDMS, RDCS and RVT credentials.  Please visit www.ARDMS.org/SPI for complete information and take note of the upcoming dates below.
  
  Mark your Calendars for SPI!
  
  February 9, 2009: ARDMS begins accepting online applications for SPI

  April 4, 2009: Final day that UPI, CPI, & VPI examinations will be administered

  April 6, 2009: Administration of the SPI examination begins

  *Note: by clicking on this link, you will be redirected to the ARDMS website.

Ultrasound Screens For Pancreatic Cancer In High-Risk Populations
Ultrasound detected small pancreatic cancers even CT and MRI couldn't visualize.

Ultrasound detected small pancreatic cancers even CT and MRI couldn't visualize in a novel Dutch screening program aimed at high-risk patients with a family history of the disease. The researchers hope to transform their successful pilot study into an international multicenter trial aimed at finding pancreatic cancer in high-risk patients while it's still resectable.

Pancreatic cancer is one of the largest cancer killers in both the U.S. and Europe, with a dismal overall five-year survival rate of about 3%, said Dr. Jan-Werner Poley from Erasmus University Rotterdam in the Netherlands.

"This is at least partly due to the fact that only a small minority [10% to 20%] of patients are amenable to surgical resection at diagnosis, and even with resection, five-year survival is only 10% to 20%," Poley said.

Of course, the low incidence of the disease precludes screening in the general population, but it's a different story in patients at high risk of disease. Of the approximately 1,700 new cases of pancreatic cancer reported each year in the Netherlands, about 10% to 15% have a hereditary component.

Hereditary pancreatic cancer patients consist mainly of two broad types, with familial pancreatic cancers (FPCs) comprising the largest group, and a much smaller group of inherited tumor syndromes and diseases, Poley explained.

FPCs "have no underlying gene defect, but presumed disease-causing mutations appear to inherit in an autosomal dominant pattern," he said. Inherited syndromes, on the other hand, are associated with a gene defect and comprise about 20% of hereditary pancreatic cancer cases. Disease prevalence and survival vary widely depending on the particular syndrome and the family that inherits it, with a cumulative lifetime risk in these patients ranging from 3% to 40%.

For high-risk populations such as these, screening makes sense for several reasons, Poley said.

"Hereditary cases tend to develop cancer at a considerably younger age compared with controls, and the odds for a cure are minimal once pancreatic cancer has become symptomatic," he said. "Moreover, in recent year it's become clear that precancerous precursor lesions exist."

Also, the ability to visualize precursor lesions such as intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasia (IPMN), and small solid lesions means it's possible to perform curative resection in some cases before cancer develops.

And if one is determined to screen, endoscopic ultrasonography (EUS) is the way to do it, Poley said. Recently, Canto and colleagues (Clinical Gastroenterology and Hepatology , 2005, 2006) showed that EUS has the highest sensitivity of all imaging modalities for detecting pancreatic cancer, especially in hereditary populations. EUS can safely guide fine-needle aspiration and has virtually no complications, Poley said.

On the other hand, EUS is invasive, usually requires conscious sedation, and is highly operator-dependent. But the sonographers at Erasmus University Medical Center in Rotterdam, along with their colleagues at the Dutch Cancer Center and Academic Medical Centre in Amsterdam, had performed EUS thousands of times, Poley said.

Their pilot study aimed to demonstrate the feasibility of screening high-risk patients with EUS at the centers.

In all, they scanned 43 asymptomatic patients (18 men, 25 women; mean age, 51) who were known mutation carriers, were at 50% or greater risk of pancreatic cancer, or had a lifetime risk of 10% or greater. The three experienced sonographers used radial or linear instruments according to their personal preference. If abnormalities were detected at EUS, the patient was followed up with CT and/or MRI.

View the article online.

Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.

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Fast Ultrasound-Targeted Thrombolysis Brings Down Bleeding Risk

Endovascular sonic lysis system reduces thrombolytic dosage for treating peripheral thrombi while lessening the risk of hemorrhage and dissolving clots.

A new endovascular sonic lysis system reduces thrombolytic dosage for treating peripheral thrombi while lessening the risk of hemorrhage and dissolving clots in as little as 12 hours, according to a report from southern Florida interventionalists at the 2009 International Symposium on Endovascular Therapy (ISET).

Catheter-directed thrombolysis remains the standard of care for the treatment of thrombi that cause deep vein thrombosis or peripheral arterial occlusive disease, conditions that may lead to limb amputation, pulmonary embolism, or death. The procedure is time-consuming and costly, however, and may be marred by severe hemorrhages.

Several new techniques that combine conventional thrombolysis with mechanical thrombectomy or ultrasound-enhanced delivery devices have proven effective and so fast that treatment times have been cut from three days to about one day. A new commercially available system could do the job in a fraction of even that time, according to Dr. Constantino Peña, an interventional radiologist at the Baptist Cardiac & Vascular Institute (BCVI) in Miami.

"(The device) is one of several techniques that allow us to treat patients faster and more safely," Peña said in an interview with Diagnostic Imaging. "It would hopefully give patients better outcomes and diminish the risk of complications from these procedures."

Peña showed how the procedure works during a live televised case demonstration at ISET. A 74-year-old patient with a blocked leg artery underwent ultrasound-enhanced catheter thrombolysis with a tenecteplase/heparin infusion. The procedure required only half the thrombolytic dose and ended with a completely dissolved blood clot 12 hours later. BCVI specialists have performed the procedure on more than 100 patients over the last four years using this technique, Peña said.

Interventional radiologists know that treatment time and thrombolytic dose factor into the bleeding risk and that some patients face a higher likelihood of hemorrhage when treatment goes beyond 24 hours, Peña said. Bleeding complications lessen if physicians apply lower doses in a shorter period of time, precisely what the ultrasound device helps to accomplish.

During conventional catheter thrombolysis, physicians infuse the drug in the clogged area and wait for results. The endovascular ultrasound system combines the catheter with a soundwave-emitting ultrasound wire that helps the lytic infusion macerate and break the clot faster. BCVI physicians are planning to incorporate soon another, even faster computer-controlled endovascular ultrasound-enhanced thrombolysis device.

"It's supposed to increase the speed of lysis up to four times," Peña said.