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ARDMS Headlines:
ARDMS Testing Vendor to Implement New Security Measure
ARDMS Announces the Development of a Musculoskeletal (MSK) Sonography Credential
Headlines in the News:
Why do Physicians Order Costly CTs? Ultrasound Yields Better Diagnosis, Safer, Less Costly
World-renowned radiologist speaks out on the over-use and expense of CTs ordered for women with acute pelvic conditions...
Researchers report success in using cryotherapy to treat breast cancer patients...
Nanoparticle Detonations May Be Able to Burn Vascular Plaques
A biophotonic technique adapted from oncology for precise "burning" of tissue may someday be used to treat atherosclerotic plaque...
New Uses for Focused Ultrasound to Treat Brain Diseases
Focused ultrasound can achieve targeted ablation through the skull...
ARDMS Testing Vendor to Implement New Security Measure
 The ARDMS testing vendor, Pearson VUE, will be implementing a new security feature at all test centers later this year. As part of the check-in process, candidates will be required to take part in a palm vein recognition scan for all ARDMS examinations. Palm vein recognition scans the veins of an individual’s hand to create a digital template that represents the unique palm vein pattern. This new technology offers a form of identification that is highly accurate, provides greater privacy than fingerprinting or retinal scanning, and helps safeguard the integrity of ARDMS examinations.
The digitally encrypted palm vein patterns cannot be read by any other system, and there is no direct contact with the sensor, eliminating the possibility of smudging. Palm vein patterns are invisible and virtually impossible to forge, making the system highly secure. This new technology of palm vein mapping provided by Pearson VUE, improves the check-in process, ensures that each test-taker has a unique record, and prevents people from testing under assumed names.
The palm vein recognition process will not increase the length of the admission process and should take less than a minute to complete. Other standard test center admission steps, such as photo ID and signature, will remain in place for all ARDMS candidates.
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ARDMS Announces the Development of a Musculoskeletal (MSK) Sonography Credential
In December 2009, the ARDMS Board of Directors approved the development of a Musculoskeletal (MSK) Sonography credentialing examination. One of the fastest growing sonography disciplines in the world, musculoskeletal sonography is used in the evaluation and treatment of joint and soft-tissue diseases.
“The vast majority of MSK sonography studies are performed outside of the United States,” said ARDMS CEO Dale R. Cyr. “ARDMS will be seeking experts from around the world to work with us in developing this truly global credential.”
For more information about how ARDMS examinations are developed, please read the Letter from the Chair in the Winter 2010 edition of Registry Reports. Updates on the progress of the MSK exam will be featured in future editions of NewsWire, Registry Reports, Notes for Educators and on the ARDMS website.
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Why do Physicians Order Costly CTs? Ultrasound Yields Better Diagnosis, Safer, Less Costly
World-renowned radiologist speaks out on the over-use and expense of CTs ordered for women with acute pelvic condition...
In a bold, eye-opening editorial in the March 2010 issue of the Journal of Ultrasound in Medicine, Harvard Professor, Beryl Benacerraf, MD, urges the medical community to use ultrasound instead of Computed Tomography (CT) as the first-line imaging test for better diagnosis capability in the evaluation of acute female pelvic and lower abdominal conditions. In the editorial, "Why Has Computed Tomography Won and Ultrasound Lost the Market Share of Imaging for Acute Pelvic Conditions in the Female Patient?", Dr Benacerraf raises the question:
"How have we evolved to ordering the most expensive imaging technique first for these patients, only to be followed frequently by a far less costly ultrasound examination to clarify the CT findings? Ultrasound is the established modality of choice to evaluate the female pelvis, so why do patients with pelvic masses or pain get a CT scan? In my opinion, doing a CT scan first for female patients with lower abdominal pain is dangerous and wasteful, a drain of much-needed health care dollars."
Citing a recent study from the New England Journal of Medicine regarding the vast use of imaging procedures that involved radiation exposure, Dr Benacerraf emphasizes the fact that "radiation exposure is cumulative, and each exposure adds incrementally to the long-term danger of cancer". Alternatively, ultrasound is safe, radiation-free, and most frequently has superior diagnostic capability when evaluating patients with lower abdominal conditions. The advancement of ultrasound technology has resulted in machines that are less operator-dependent with the ability to produce images that can be evaluated in multiple views with 3D volume imaging.
Dr Benacerraf concludes, "It may be time for ultrasound to regain its rightful place in the evaluation of acute female pelvic and lower abdominal conditions and save the population from the dangerous radiation exposure and excessive cost of starting a workup with CT as a first-line imaging test."
Article written by staff at genengnews.com and adapted for the purposes of this newsletter.
Breast Cancer Treated by Freezing Tumors
Researchers report success in using cryotherapy to treat breast cancer patients...
Breast cancer patients may one day be able to opt for a simple outpatient procedure to freeze their tumors as an alternative to surgery. In a small but promising study, researchers were able to kill breast cancer cells by freezing them using a technique known as image-guided, multiprobe cryotherapy.
All 13 of the women who had the procedure were alive with no clinical evidence of cancer recurrence an average of 18 months, and up to five years, after having the procedure. Their tumors ranged in size from very small to very large. The study was presented at the Society of Interventional Radiology's 35th Annual Scientific Meeting Peter J. Littrup, MD, who pioneered cryotherapy close to two decades ago, says the findings show that even large breast tumors can be successfully treated with the nonsurgical freezing technique. Littrup directs imaging research and image-guided therapy at Detroit's Barbara Ann Karmanos Cancer.
How Cryotherapy Works
The cancer-killing freeze is achieved by delivering a very low temperature gas to the tumor using needle-like probes. Littrup said that a single-probe freezing approach has been used for several years to treat breast cancer, but it is widely considered to be unsuitable for tumors larger than 1.5 centimeters.
"We've been using multiple probes for many years to treat prostate cancer with a minimum of five probes," he said. "So it just made sense to me to try multiple probes for breast cancer." He added that recent technological advances resulting in smaller and easier-to-manage probes and better ways to guide them to the tumor have made nonsurgical cryotherapy an attractive option for breast cancer.
The 13 patients included in the study had a total of 25 tumors, ranging in size from 0.5 centimeters to 5.8 centimeters. The average tumor size was 1.7 centimeters.
Using local anesthesia with mild sedation, an average of three probes per tumor were guided to the tumor site using either ultrasound alone or ultrasound with computed tomography (CT) imaging. The probes produced "ice balls" ranging in size from 2 centimeters to 10 centimeters, depending on the size of the targeted tumor.
Patients reported minimal pain and a high satisfaction with the cosmetic results following the treatment. Littrup says most patients had complete healing of the frozen area with very little or no scaring within six months. He hopes to conduct larger studies in breast cancer patients using a cryotechnology procedure that uses magnetic resonance (MR) to guide the probes. Littrup developed and has patented this technology, and he says it is potentially useful in the treatment of many types of cancer.
Cure Rates Still Unknown
Radiologist Gale A. Sisney, MD, considers cryotherapy a very promising approach for the treatment of breast cancer that could prove to be as effective as surgical treatment. Sisney is chief of breast imaging at the University of Wisconsin, Madison.
"We won't be able to say for some time how this compares with lumpectomy in terms of cure rates," she said. American Cancer Society Deputy Chief Medical Officer Len Lichtenfeld, MD, said much larger studies are needed with longer follow-up to determine cryotherapy's role in the treatment of breast cancer.
"I would be cautious about any suggestion that this treatment is appropriate for a woman with cancer that is localized to the breast and possibly regional lymph nodes," he said. "Sometimes techniques like this one, which have a lot of appeal to patients, gain a following before the research is in. I would not make assumptions based on this small study."
Article written by staff at webmd.com and adapted for the purposes of this newsletter.
Nanoparticle Detonations May Be Able to Burn Vascular Plaques
A biophotonic technique adapted from oncology for precise "burning" of tissue may someday be used to treat atherosclerotic plaque...
A biophotonic technique adapted from oncology for precise "burning" of tissue may someday be used to treat atherosclerotic plaque.
A group of researchers from Russia and the Netherlands is developing techniques for delivering silica-gold nanoparticles, 80 nm in radius, to atherosclerotic coronary plaques. When exposed to near-infrared laser, the particles "detonate" and heat up to 50°C to 150°C, while surrounding tissue stays below 40°C.
"Our skin is transparent for infrared light, and it means that we can focus on a narrow spot, and when this radiation goes to the nanoparticles, it's like a detonation—like a small balloon—it burns like plasma," Dr Alexandr Kharlamov (Urals State Medical Academy, Ekaterinburg, Russia) explained. In addition to destroying the plaque, the burning particles may also create vapor bubbles in the cytoplasm of the cells and boiling of fluid in the intracellular spaces or cause acoustic waves that could cause inflammation in the vessel wall. This damage may promote valuable healing of the vessel wall, but the technique will have to be refined to ensure that the damage does not promote too much inflammation or thrombosis, perhaps by accompanying the nanoparticles with some combination of anti-inflammatory or antithrombotic drugs, Kharlamov said.
At the recent American College of Cardiology (ACC) 2010 Scientific Sessions, Kharlamov's team presented data from a 27-patient controlled study of different nanoparticle-delivery methods. In the trial, a control group of 10 patients got just a saline solution. A second group was treated with nanoparticles placed directly into the site of the plaque via ultrasound-mediated albumin-coated gas-filled microbubbles coated with surface antibodies. In the third group of patients, nanoparticles were delivered to the plaque by circulating progenitor cells, similar to adult stem cells. The nanoparticles were exposed to the catheter-delivered laser three days after implant. All patients were given antithrombotic therapy.
On average, the progenitor-cell technique destroyed about 97% of the plaque and the microbubble technique destroyed 64.1% of plaque. Revascularization was achieved in all of the patients. The plaque's fibrous cap was destroyed in all the patients in both groups. Also, in the progenitor-cell group, intravascular ultrasound showed total degradation of the plaque's typical structure, the researchers report.
So far, the patients in the study have shown no complications within a year of the procedure, including no restenosis. However, animal data suggest that obliteration of the fibrous cap could lead to fatal atherothrombosis.
Kharlamov said his group plans to complete more experiments in pigs before proceeding with more clinical trials. The researchers are still trying to fully understand the local biophysical response of heating the tissue so they can pinpoint the ideal level of energy to deliver to the plaque site while also controlling the risk of thrombosis. He also pointed out that access to progenitor cells is difficult in most countries, and this might hinder the long-term development of the technology.
Article written by staff at theheart.org and adapted for the purposes of this newsletter.
New Uses for Focused Ultrasound to Treat Brain Diseases
Focused ultrasound can achieve targeted ablation through the skull...
Focused ultrasound therapy has a lot to offer -- it can noninvasively deliver targeted energy deep into the body, with high levels of precision. Adding MR imaging enables real-time guidance and visualization of heating and ablation effects. And while the technique may not traditionally be associated with brain treatments, focused ultrasound could prove a perfect fit for treating a wide range of brain diseases, according to Kullervo Hynynen, Ph.D., a medical physicist at Sunnybrook Health Sciences Centre in Toronto.
Hynynen explained how focused ultrasound can achieve targeted ablation through the skull. "For many years, people believed it was not possible to use focused ultrasound in the brain," he told the assembled delegates. Problems arise when the ultrasound beam traverses the skull, as this defocuses the beam, as well as causing the skull to heat up. "So in early research, the skull bone was removed," he noted.
The heating problem has now been addressed with the introduction of multi-element hemispherical transducers. Meanwhile, CT scans of the skull can be used to calculate phase delays for each transducer and correct for skull-induced beam distortion. "We now know that we can treat the middle of the brain relatively precisely," Hynynen explained. "But some areas are still problematic -- for example, tumors near the skull base."
One way to minimize skull-base heating is to reduce the total applied power. But this must be done while still achieving ablation at the focus. The answer: "Use microbubbles," Hynynen said. Bubbles injected into the bloodstream will increase absorption at the acoustic focus, enabling equivalent biological effects with less acoustic pressure.
Tests in rabbit brains, for example, have shown that the presence of such microbubbles allowed a fourfold reduction in power. Hynynen and colleagues are currently developing models to simulate bubble-enhanced heating within the vasculature. "The use of microbubbles looks promising for being able to reduce the applied power and lower skull-base heating," he said.
Blood-brain barrier disruption
But focused ultrasound can do so much more than just ablate brain tumors. A host of other ultrasound-based applications are available that could prove valuable for treating brain diseases, according to Hynynen.
For example, more than 95% of drugs used to treat central nervous system disorders don't penetrate the blood-brain barrier. Using a focused ultrasound beam to locally disrupt the barrier, without damaging the brain, could enable the use of a far greater range of drugs. It could also allow delivery of higher doses, as the nontargeted areas of the brain remain protected by the blood-brain barrier.
Hynynen cited an example in which injection of microbubbles followed by 20 seconds of sonication opened the blood-brain barrier, allowing the drug to enter only the sonicated area. Experiments in pigs have shown that focused ultrasound can also disrupt the blood-brain barrier in large animals. "Local MRI-guided disruption of the blood-brain barrier is feasible and doesn't have an adverse effect on the animals," he said.
Most chemotherapy drugs are also incapable of penetrating the brain. Hynynen described a study looking at chemotherapy of a rat brain tumor. Rats were injected with doxorubicin and microbubbles, and sonication applied. While neither doxorubicin alone nor ultrasound alone had any impact upon the animals' survival, the combination of sonication plus drug halved the tumor doubling time and increased survival.
Hynynen also highlighted a preliminary study in which focused ultrasound was employed to treat Alzheimer's disease in a mouse model. Here, ultrasound-induced disruption of the blood-brain barrier enabled delivery of antibodies that clear amyloid beta plaques in the brain. Mice were treated with the antibodies and ultrasound applied to one side of the brain. Four hours later, antibodies were detected only on the sonicated side. After four days, fewer plaques were found on the ultrasound-treated side.
Finally, Hynynen discussed the use of ultrasound as a potential treatment for stroke. In the Combined Lysis of Thrombus in Brain Ischemia with Transcranial Ultrasound and Systemic tPA (CLOTBUST) trial, for example, adding ultrasound exposure to patients receiving the clot-dissolving drug tissue plasminogen activator (tPA) was seen to enhance its effects. Elsewhere, an in vivo study of femoral arteries in rabbits showed that high-intensity focused ultrasound could eliminate clots in some animals and restore blood flow without the need for drugs.
Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.
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