Connecticut House Bill 5635, an Act Concerning Sonography Procedures for Medical and Diagnostic Purposes, was signed into law by Governor M. Jodi Rell effective July 1, 2009.  The new law limits obstetrical ultrasound procedures to only those ordered by a licensed healthcare professional and are needed for a medical or diagnostic purpose.

The bill passed due to a growing use of ultrasound for entertainment “keepsake” purposes. Evidence to support the passing of the bill included DVD recordings of the procedures and “family viewings.” One woman reportedly had 19 non-medical ultrasounds taken during the course of a pregnancy.

Governor Rell pointed out the hazard in abusing the diagnostic procedure when used excessively for extended periods of time saying, "… ultrasound is a form of radiated energy--and any such energy has the potential to affect human tissue."

According to the Food and Drug Administration (FDA), “using ultrasound equipment only through a prescription ensures that pregnant women will receive professional care that contributes to their health and to the health of their babies, and that ultrasound will be used when medically indicated.”

The ARDMS Legislative and External Affairs Committee will continue to monitor the developments of the legislative activities and provide updates via the ARDMS website (www.ARDMS.org), and in future editions of Registry Reports and NewsWire.

Sources: HealthImaging.com, “Connecticut Bans “Keepsake” Ultrasound.  Follow this link to read the full article.

Sonography is cheaper, more reproducible, and faster than scintigraphy for evaluating gallbladder function using sincalide cholecystokinin (CCK), according to research published in the September issue of the Journal of Ultrasound in Medicine.

“Scintigraphy estimated a lower [ejection fraction (EF)] than sonography, had wider EF variability than sonography, and required additional time (> 30 minutes more) to complete the study," wrote a research team led by Dr. Richard Barr of Radiology Consultants in Youngstown, OH.

Both sonography and scintigraphy have been used to evaluate gallbladder function using CCK, but they often report different ejection fractions because they measure slightly different parameters. To directly compare the two methods, the Ohio research team evaluated 20 healthy volunteers using both imaging modalities simultaneously (J Ultrasound Med, September 2009, Vol. 28:9, pp. 1015-1018).
The nine males and 11 females participating in the study ranged in age between 21 and 60, with a mean of 41.6 years. They did not have a history of gallbladder disease or right upper quadrant pain, were not taking any medications, and had normal gallbladder sonographic findings.

All participants of childbearing potential had a negative urine beta-human chorionic gonadotropin test result, and any potential participants found to have gallstones or gallbladder wall thickening (greater than 3 mm) were excluded from the final study group, according to the authors.

After fasting overnight, the volunteers received CCK (Kinevac, Bracco Diagnostics, Princeton, NJ); a standard dose (0.12 µg/kg of body weight) was placed in 50 mL of normal saline and administered intravenously at 100 mL/hour. They were placed on a standard single-head scintigraphy camera, and an ultrasound scanner was placed next to participants to allow for simultaneous evaluation.
A single sonographer performed the sonographic examinations on a Spectra VST ultrasound unit (Diasonics) using a 4-MHz curved-array probe. For scintigraphy, 6-8 mCi of technetium-99m mebrofenin (Choletec, Bracco Diagnostics) was injected intravenously.
After the start of the CCK injection, volume measurements were obtained at approximately five-minute intervals alternating between the two modalities. The researchers then calculated the statistical significance between the different gallbladder ejection fractions recorded by the two techniques.

Sonography produced mean EFs of 66.3% ± 20%, whereas scintigraphy yielded mean EFs of 49% ± 29 (p = 0.19). Mean times to the peak EF were 38 ± 12 minutes for sonography and 33 ± 9 minutes for scintigraphy.

The researchers also noted an average time of 34 minutes after radiopharmaceutical injection before CCK administration was performed for the scintigraphic studies.

"Scintigraphy could not be performed in 5% of the participants because of nonfilling of the gallbladder," the authors wrote.
The earliest time to peak EF for sonography was 15 minutes, and the latest time was 60 minutes (mode, 40 minutes). As for scintigraphy, the earliest and latest times were 15 and 50 minutes (mode, 30 minutes).

Scintigraphy also demonstrated a larger standard deviation of the gallbladder ejection fraction than did sonography.
"CCK gallbladder EF calculations by sonography are less time-consuming, more reproducible, and less costly," the authors wrote. "With these techniques, the range of normal gallbladder EFs should be adjusted for the technique used."

View the article online.

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

It's hard to imagine that cells and sound are related, but they are. According to one Ryerson University researcher, this relationship could mean big changes in cancer treatment, including more effective treatment monitoring, less invasive procedures and health care savings.

Dr. Michael Kolios, an Associate Professor in Ryerson's Department of Physics and a Tier II Canada Research Chair in the Biomedical Applications of Ultrasound is examining how dying cancer cells scatter sound in ultrasound procedures.

"It's like a rock falling into a pond," explained Dr. Kolios. "Bigger rocks create bigger splashes and scatter ripples. In contrast, when cancer cells die and break into smaller pieces, that's when their 'splash' scatters sound." In particular, Dr. Kolios is analyzing the frequency emitted by cancer cells. The smaller the cells, the higher the frequency. Ultrasound operates in the same general way as radar sounds waves are sent out and when they hit something, they bounce back. In this case, instead of detecting airplanes or ships, ultrasound is used to pinpoint and evaluate disease in the human body.

With the use of high-frequency ultrasound, doctors could determine a tumor's response to therapy early on in treatment. As a result, better-informed decisions could be made as to whether to continue with the prescribed treatment plan or develop a different one. That's the premise behind Dr. Kolios' newest research endeavor. The project is part of Dr. Kolios' larger research on ultrasound as a non-invasive way to investigate cell death, a collaboration with Gregory Czarnota, an Adjunct Physics Professor at Ryerson and a researcher at Sunnybrook Health Sciences Centre, and Assistant Ryerson Physics Professor Carl Kumaradas.

Dr. Kolios' work could have significant impact on the way cancer treatments are monitored. Currently, patients must undergo a full course of radiation or chemotherapy before doctors assess whether or not the treatment has achieved its intended effect. Depending on the type of therapy, the cost of care can start at $60,000.

High-frequency ultrasound could also help patients improve their quality of life by avoiding the unpleasant side effects of traditional treatment, while potentially save the health-care system tens of thousands of dollars per treatment. That money, in turn, could be put toward the cost of another, more effective therapy.

Research on the use and outcomes of high-frequency ultrasound is timely. "As the population ages, more people are getting cancer," said Dr. Kolios. In fact, according to the Canadian Cancer Society, approximately one in four Canadians will die of cancer, with the risk being slightly greater among men than women.

While Dr. Kolios is studying high-ultrasound frequencies (10 - 60 MHz), his research assistant Eric Strohm, a master's student in Biomedical Physics is exploring ultra-high frequencies of more than 100 MHz. Frequencies in this range make up the field of acoustic microscopy and facilitate high-resolution viewing of single cells. Eric has co-authored two papers on acoustic microscopy with Dr. Kolios and will present the findings at a pair of international conferences this September.

Ryerson has the only physics department in Canada fully dedicated to medical physics, a specialized branch of applied physics that is at the forefront of advancements in the prevention, diagnosis and treatment of diseases such as cancer and heart disease through the use of physics and technology. Dr. Kolios' research on mid to high frequency ultrasound imaging and spectroscopy for cancer treatment monitoring is being funded by the Canadian Institutes of Health Research.

View the article online.

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

A new chemical imaging technique could one day help in the fight against atherosclerosis, suggested research published in the August 2009 edition of the Journal of the Royal Society Interface.

Atherosclerosis is the disease underlying most heart attacks and strokes and it is characterized by lesions in the arteries, made of fats, collagen and cells. The lesions cause artery walls to harden and thicken, which severely restricts the flow of blood around the body and they can also rupture, leading to heart attacks and strokes. Understanding the precise chemical composition of an individual’s lesions is important because the ones with higher levels of a type of fat called cholesterol ester are more prone to rupture.

The team behind the new imaging technique, which is known as Attenuated Total Reflection Fourier Transform Infrared Spectroscopic Imaging (ATR-FTIR imaging), believe that with further refinement, it could become a useful tool for doctors wanting to assess a patient’s lesions. For example, by combining fiber optic technology with ATR-FTIR imaging, the researchers believe doctors could carry out real-time inspections of patients with atherosclerosis, in order to assess the progress of the disease and establish which patients are at the greatest risk of complications.

Currently, doctors can use ultrasound to assess the size and location of lesions but they need to take biopsies of lesions in order to determine their chemistry. This is a complex and invasive procedure.

The researchers say the ATR-FTIR imaging could potentially improve current imaging techniques because it could combine imaging and chemical analysis, which would provide a comprehensive and accurate picture of a patient’s lesions in one procedure. In the present study, the researchers demonstrated that ATR-FTIR imaging was able to reveal the precise composition and size of the lesions and the levels of elastin, collagen and cholesterol ester in them.

The ATR-FTIR imaging technology works by using infrared light to identify different chemical molecules, which are mapped by an array detector to create a ‘chemical photograph’.

The researchers used the technique to study the effects of age and an amino acid called L-arginine on the composition of lesions in cholesterol-fed rabbits. The work appeared to confirm that dietary L-arginine can remove lesions in the arteries of mature rabbits. The researchers said further studies need to be done before the ATR-FTIR imaging could be used for patient care.

Lead-author, Professor Sergei Kazarian, from the Department of Chemical Engineering and Chemical Technology at Imperial College London, said: “Atherosclerosis can be a dangerous condition and our hope is that with further work, our approaches could ultimately be used to determine which patients are most at risk of complications. That way, doctors can target treatments at those patients who most need it, in order to prevent strokes and heart attacks.”

View the article online.

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