Like Us and Follow Us on

April 13, 2012

ARDMS Updates and Headlines in the News:

ARDMS: 2012 CME AUDIT

ARDMS: Important Testing Center Update

SDMS: ARDMS to Launch Examination for Musculoskeletal sonography (MSK) Credential This Fall (This link opens a PDF document. To download the latest version of Adobe Reader, click here)

Ultrasounds and Magnetic Resonance Imaging (MRI) Can Aid Better Breast Screening

Endoscopic Ultrasound Best Detects Pancreatic Lesions Common in People at High Risk for Hereditary Pancreatic Cancer

ARDMS 2012 CME AUDIT

ARDMS has begun the 2012 CME Audit. Log on to your MYARDMS account to see if you have been selected for audit.

For more information regarding the CME audit process, CME compliance and accepted CME providers, visit the CME General Information webpage.

Back To Top

ARDMS: Important Testing Center Update

• At the test center, you must present two current, valid signature IDs, one of which must be a non-expired government-issued photo ID with your signature; see the accepted list of IDs here.
• The name on your application must EXACTLY MATCH the name on both current, valid signature IDs.
• Jane R. Doe and Jane Rachel Doe DO NOT EXACTLY MATCH.
• Failure to present two acceptable IDs will prevent your admission to the test center. If this happens, you will be marked absent and you will forfeit the entire examination fee and seat.
• If the names do not EXACTLY MATCH, update your ARDMS name of record. 

Back To Top

Ultrasounds and Magnetic Resonance Imaging (MRI) Can Aid Better Breast Screening

Women's annual breast exams could be improved by adding ultrasound and magnetic resonance imaging (MRI) scans to the usual mammogram.

The research, published in the April 4 edition of the Journal of the American Medical Association, found that those two technologies helped spot small cancers that mammograms had missed.

The study followed 2,662 women at high risk for breast cancer, particularly because of dense breasts or a family history of the disease. They agreed to undergo three independent screenings in one year, arranged in random order.

The three tests found a total of 111 cancers, for about 2.6 percent of the total group.

Mammography, which is a low-energy X-ray of the breast, turned up 59 cancers, or 53 percent of the total cancers found.

Ultrasound, a scan that uses sound waves to produce a picture of the body's internal workings and is often used for pregnant women, found 29 percent of cancers on its own, independent of other tests.

MRI scans which use a magnetic field combined with pulses of radio wave energy, found a total of eight percent of cancers that the other two methods had failed to detect.

Eleven cancers, or 10 percent, were not found by any of the three screening technologies, said the study.

"Annual ultrasound screening may detect small, node-negative breast cancers that are not seen on mammography," said the study.

"Magnetic resonance imaging may reveal additional breast cancers missed by both mammography and ultrasound screening," it said, adding however that MRI is not suitable for all patients and can carry higher costs and risks than other methods.

According to Kristin Byrne, chief of breast imaging at Lenox Hill Hospital in New York, the study shows that alternative testing methods can help spot cancers that mammograms miss.

"Nearly half of the cancers would not have been detected with mammography alone," said Byrne, who was not involved with the study.

"Breast cancer is difficult to detect on mammography in patients with dense breast tissue. Ultrasound and MRI detect a significant number of breast cancers which are not seen on mammography" in these patients, she added.

"Additional yearly screening with MRI and ultrasound is important in high risk patients with dense breasts for early detection."

A separate study released by researchers at Harvard University found that mammograms tended to over-diagnose a significant number of cancers -- between 15 and 25 percent.

That study followed nearly 40,000 women with breast cancer in Norway. It found no drop in the numbers of women with late-stage disease between those who had yearly mammograms and those who did not undergo annual tests.

Even more, between 1,169 and 1,948 women were "over-diagnosed" -- meaning they were told they had cancer when their tumors would have caused no harm had they not been found.

"Mammography might not be appropriate for use in breast cancer screening because it cannot distinguish between progressive and non-progressive cancer," said lead author Mette Kalager, a visiting scientist at Harvard and a researcher at the Telemark Hospital in Norway.

"Radiologists have been trained to find even the smallest of tumors in a bid to detect as many cancers as possible," added Kalager.

"However, the present study adds to the increasing body of evidence that this practice has caused a problem for women -- diagnosis of breast cancer that wouldn't cause symptoms or death."

Concerns about false positives in mammograms have existed for years, leading some researchers to believe less frequent exams may be the answer.

Currently, the US National Cancer Institute recommends that women age 40 or older should have a screening mammogram every one to two years.

Breast cancer is the second most common cancer among US women after non-melanoma skin cancer, with about 202,000 new diagnoses per year and some 40,000 deaths according to the US Centers for Disease Control.

View the article online.

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

Back To Top

Endoscopic Ultrasound Best Detects Pancreatic Lesions Common in People at High Risk for Hereditary Pancreatic Cancer

A team of scientists led by Johns Hopkins researchers have found that more than four in 10 people considered at high risk for hereditary pancreatic cancer have small pancreatic lesions long before they have any symptoms of the deadly disease.

Moreover, they report, the frequency of the abnormal precancerous lesions increases with age and that ultrasound via endoscopy is better than MRI and significantly better than CT scans at finding the lesions.

The researchers said their work signifies some progress in reducing the death rate from hereditary pancreatic cancer, which is generally fatal once the lesions become malignant and symptoms appear. At that point, just 25 percent of those eligible for surgery survive five years, while the rest have a less than 5 percent chance of surviving five years. The general population has a 0.5 percent lifetime risk of getting pancreatic cancer, while those in high-risk groups included in the study have risks that are 3.5- to 132-fold higher. Researchers say roughly 10 to 15 percent of all pancreatic cancers are hereditary.

"We now know that although these high-risk patients often tend to develop pancreatic lesions, we can detect the lesions, track them over time and remove them before they become cancer," said Marcia Irene Canto, M.D., M.H.S., a professor of gastroenterology and oncology at the Johns Hopkins University School of Medicine.

Canto and her team - made up of researchers from Johns Hopkins, Mayo Clinic, Dana Farber Cancer Institute, M.D. Anderson Cancer Center and the University of California, Los Angeles - studied 216 asymptomatic adults with a strong family history of pancreatic cancer, primarily those with two close blood relatives who have had the disease and those who have inherited genetic markers known to increase the risk of pancreatic cancer, including BRCA2 gene mutation that has also been linked to breast and ovarian cancers.

Doctors at each medical center performed three types of screening on each participant using CT, MRI and ultrasound conducted via endoscopy. Johns Hopkins screened more than half of the participants. Those interpreting the diagnostic images from any one test were kept unaware of the results of the others to reduce the chance of bias.

CT detected pancreatic abnormalities in 11 percent of the participants, MRI found them in 33.3 percent and endoscopic ultrasound 42.6 percent. Five participants had what doctors determined were pre-cancerous lesions and underwent surgery to remove them. These were lesions that would most likely not have been detected and removed, Canto said.

Canto's team found that the prevalence of pancreatic lesions increases with age, with doctors finding them in just 14 percent of high-risk subjects under the age of 50, 34 percent of those ages 50 to 59 and 53 percent of those 60- to 69-years old. Those with lesions who did not require surgery were recommended for regular follow up screening to see if the lesions change in size or shape. Not all pancreatic cysts or lesions become pancreatic cancer.

The findings of the study, known formally as CAPS 3 Study, are published in April issue of the journal Gastroenterology.

One advantage that endoscopic ultrasound has over MRI and CT, Canto says, is that it can also be used to collect cells from the pancreatic lesions, secretions from the pancreas, and fluid from cysts to facilitate further study. The CAPS 3 study team collected pancreatic juice for biomarker research led by Michael Goggins, M.D., aimed at better detection of pre-cancerous or cancerous lesions in the pancreas. In addition, a Johns Hopkins research team led by Bert Vogelstein, M.D., and Ralph Hruban, M.D., are developing biomarkers from pancreatic cyst fluid that appear to determine the cyst's malignant potential. Recently, they completed genomic sequences of pancreatic cysts that will help biologists understand how they develop and turn cancerous. Researchers hope those findings - in conjunction with those of the new study led by members of Hopkins' Sol Goldman Pancreatic Cancer Research Center - will enable them to find potentially lethal pancreatic cancers before they develop, saving people from a disease that has little hope for cure.

For the endoscopic procedure, a doctor passes a thin, lighted tube from a sedated patient's mouth through the stomach, and into the first part of the small intestine. At the tip of the endoscope is a device that uses sound waves that produce patterns of echoes as they bounce off internal organs. These ultrasonic patterns can help identify tumors that cannot be detected by a CT scan. Using ultrasound to help guide the way, a doctor then inserts a thin needle into the pancreas to remove cells that can be later studied.

Unlike screening for colon cancer, pancreatic cancer screening is not recommended for the general population. Canto says this is because cysts and other possibly pre-cancerous lesions are far less common in the pancreas than in the colon; because the pancreas is harder to reach than the colon; and because removing lesions requires extensive surgery, often including part of the pancreas. Potential complications are also more likely.

"Early detection is the way to go," Canto said. "We need smart screening and individualized treatments based on family history, epidemiology, biomarkers and genetics."

View the article online

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

Back To Top