If a lump is found in the breast of an adolescent girl, she often will undergo an excisional biopsy.
However, breast cancer is rare in adolescents, and the vast majority of teenage breast lumps turn out to be benign masses that are related to hormones.

A recent Loyola University Health System study published in the American Journal of Roentgenology suggests that a breast ultrasound examination might eliminate the need for biopsy in many cases.

Loyola radiologists performed ultrasound examinations on 20 girls ages 13 to 19 who had lumps in their breasts, including one girl who had a lump in each breast. The ultrasound studies indicated that 15 of the 21 lumps appeared to be benign, while and six were suspicious.

Follow-up biopsies or clinical examinations found that all 21 lumps were benign. These findings suggest that if a breast ultrasound finds nothing suspicious, the patient likely does not need to have an excisional biopsy, said lead author Dr. Aruna Vade, a professor in the Department of Radiology at Loyola University Chicago Stritch School of Medicine.

In an excisional biopsy, the surgeon makes an incision along the contour of the breast and removes the lump. However, this procedure can be painful, change the shape of the breast and leave a small scar.

Vade and her colleagues indicated that excisional biopsies should be reserved for solid breast masses that are suspicious or show progressive growth or masses that are found in patients who are known to have a primary malignant tumor or family history of cancer. Their study is published in the September, 2008 issue of the American Journal of Roentgenology.

Among girls younger than 19, there are fewer than 25 cases of breast cancer per 100,000 per year, according to the National Cancer Institute.

The vast majority of breast lumps in adolescents are benign and tend to wax and wane. Over time, many disappear. Many teenage girls undergo biopsy of breast lumps because of parental anxiety and surgeons' concerns, Vade said.

Vade and colleagues wrote that for adolescents who present with solid masses that appear benign on ultrasound examination, "we conclude that excisional biopsy may not always be necessary."

Vade's co-authors are Dr. Kathleen Ward, medical director of Women's Health Imaging, Loyola University Health System; Dr. Jennifer Lim-Dunham, clinical associate professor in the Department of Radiology, Loyola University Chicago Stritch School of Medicine; Dr. Davide Bova, assistant professor of radiology at Stritch and Dr. Vaishali Lafita, a radiology resident at Loyola University Medical Center

Some patients with large tumors on their larynx can preserve their speech by opting for chemotherapy and radiation over surgery to remove the voice box.

A new study from the University of Michigan Comprehensive Cancer Center found that a single round of chemotherapy could identify those patients most likely to benefit from this approach.

"Organ preservation studies have excluded these patients because their tumors are so large. We found that if a patient's tumor does not respond to chemotherapy, the patient can be instantly referred for a laryngectomy, which is the standard of care. But if the tumor responded to the drugs, perhaps some of those people could survive the cancer with their voice box intact," says lead study author Francis P. Worden, M.D., associate professor of internal medicine at the U-M Medical School.

Researchers reviewed data from two U-M studies of advanced laryngeal cancer patients, looking specifically at patients who had the largest tumors, called T4. In addition to being large, T4 tumors have often invaded the nearby cartilage, making them particularly difficult to treat.

Study participants were given one round of induction chemotherapy, an initial dose designed to see if the cancer responds. If the tumor shrank by more than 50 percent after that first round, study participants were given three more rounds of chemotherapy, combined with daily radiation therapy.

Those whose tumors did not respond to the induction chemotherapy were referred for surgery.

Thirty-six people with T4 disease were enrolled in the two studies. Eighty-one percent responded to the induction chemotherapy and many saw their tumors shrink completely. After three years, 78 percent of the T4 study participants were still alive, and 58 percent still had an intact larynx.

Results of the study appear online in the journal Laryngoscope.

While chemotherapy and radiation come with unpleasant and serious side effects, avoiding surgery allows patients to retain their voice. The study found that people who preserved their larynx reported better quality of life and less depression than those who had surgery. Few people required a feeding tube or tracheostomy.

"If the patient failed chemotherapy up front, he or she could go straight to surgery and avoid the side effects of chemo-radiation," Worden says. "Meanwhile, a large group of patients get to preserve their voice box by avoiding laryngectomy."

"We saw no survival difference between the smallest and the largest tumors, which suggests that organ preservation is a viable alternative to surgery for some of the largest laryngeal cancers," he adds.

Laryngeal cancer statistics: 12,290 Americans will be diagnosed with laryngeal cancer this year and 3,660 will die from the disease, according to the National Cancer Institute

Additional authors: Jeffrey Moyer, M.D.; Julia S. Lee; Jeremy M.G. Taylor, Ph.D.; Susan G. Urba, M.D.; Avraham Eisbruch, M.D.; Theodoros N. Teknos, M.D.; Douglas B. Chepeha, M.D.; Mark E. Prince, M.D.; Norman Hogikyan, M.D.; Amy Anne D. Lassig, M.D.; Kevin Emerick, M.D.; Suresh Mukherji, M.D.; Lubomir Hadjiski, Ph.D.; Christina I. Tsien, M.D.; Tamara H. Miller; Nancy E. Wallace; Heidi L. Mason, N.P.; Carol R. Bradford, M.D.; and Gregory T. Wolf, M.D.

Funding: National Institutes of Health, U-M Head and Neck Cancer SPORE grant, U-M Comprehensive Cancer Center support grant

---Researchers have developed a new breast biopsy technique that could lead to decreased procedure times and reduced patient discomfort and morbidity, according to a study performed at Roberts Research Institute, the University of Western Ontario and London Health Sciences Centre, London, ON, Canada. The new technique uses a mechanical arm to guide the needle for the biopsy and has a braking system to allow for accurate placement of the needle and to avoid needle motion.

Breast biopsy procedures, using both methods, were performed on phantoms during the study. "Our results showed that biopsy success rates were greater when using our new guidance system," said Aaron Fenster, MD, lead author of the study. "We also showed that experienced and inexperienced radiologists performed a biopsy significantly faster when using our needle guidance system," said Dr. Fenster. The success rate using the needle guidance system was 95.9 percent compared to a success rate of 91.3 percent using the freehand technique. Using the freehand technique, experienced radiologists had a procedure time of approximately 31 seconds. Using the needle guidance system, experienced radiologists had a procedure time of approximately 10 seconds.

"Techniques for improving biopsy procedures are needed to make the procedures more efficient and reduce the variability due to physician experience and size of the target lesion. Breast biopsy using the developed needle guidance system is feasible and I believe it will enable physicians to diagnose early-stage carcinomas more efficiently and accurately, thus decreasing patient morbidity," said Dr. Fenster.

"The system we designed is a prototype and is required to be redesigned for routine clinical use. Tests with human subjects are planned for the fall of 2009," he said.

This study appears in the June issue of the American Journal of Roentgenology.

June 30, 2009---Emergency physicians who evaluate patients with non-specific chest pain using whole chest multi-detector CT (MDCT) combined with retrospective electrocardiogram (ECG) gating can reduce the patient radiation dose by 71 percent using MDCT combined with prospective ECG triggering instead, according to a study performed at the University of Washington School of Medicine, Seattle, Wash.. Prospective ECG triggering enables the CT scanner to monitor the ECG signal of several heart beats in real time and turns the radiation beam on only during alternate beats; retrospective ECG gating also monitors the ECG signal of heartbeats but turns the radiation beam on throughout several consecutive beats, thus delivering more radiation.

Seventy-two emergency department patients with non-specific chest pain were referred for MDCT of the whole chest. A total of 41 patients were scanned using retrospective gating and 31 were scanned using prospective triggering. "The average radiation dose delivered with retrospective gating was approximately 32 mSv; the average radiation dose delivered with prospective triggering was 9 mSv," said William P. Shuman, MD, lead author of the study. In addition, image quality was slightly better with prospective triggering.

"As our study suggests, patients benefit from MDCT scans using ECG triggering because it delivers a much lower radiation dose-opening the utility of CT to more patients. This lower dose is particularly useful when non-specific indications suggest scanning of the whole chest, such as in the "triple rule-out." Emergency rooms face severe congestion and cost constraints in today's world, plus a need for accurate, swift diagnosis. Lower dose, high image quality ECG triggered CT will help significantly on all of those fronts," said Dr. Shuman.

This study appears in the June issue of the American Journal of Roentgenology.

The American College of Radiology (ACR) and the North Dakota Department of Health have partnered to distribute 70 copies of the College's Mammography Case Review (MCR4) educational CD-ROM free of charge to radiologists in the 43 ACR-accredited mammography facilities throughout North Dakota.

Mammography Case Review (MCR4), a self-evaluation educational tool, enables radiologists to test and improve their skills regarding the detection of cancers and other abnormalities via mammography by allowing them to evaluate multiple cases in a controlled electronic setting, supplementing their real world experience with case types that they may not have previously experienced.

"Mammography has undoubtedly served to reduce breast cancer deaths nationwide and is the gold standard for detection of breast cancer. However, mammograms remain one of the most challenging exams for radiologists to interpret. The ACR is proud to offer this important tool to help radiologists better interpret this extremely important exam which is of paramount importance in the battle against breast cancer," said Harvey L. Neiman, MD, FACR, chief executive officer of the ACR.

The CD-based Mammography Case Review provides instant feedback to the user identifying abnormalities that they may have missed (if any) and prepares them to better detect such indications in the future.

"Mammography Case Review enables radiologists to improve their mammography skills on challenging cases and allows any learning curve to take place online instead of on patients," said Mark Kristy, MD, radiologist at West River Health Services, Hettinger, ND, and Women's Way Medical Advisory Board member. "This vital training will benefit radiologists and their patients throughout North Dakota just as it does nationwide."  

Participants may claim up to 9 American Medical Association (AMA) PRA Category 1 credits for completing the MCR4 program which, under this agreement, is provided free of charge to North Dakota radiologists who interpret mammography procedures in North Dakota. In addition, radiologists who successfully complete this program may obtain up to three (3) Self Assessment Module credits from the American Board of Radiology (ABR).

North Dakota is the second state to partner with the ACR to distribute Mammography Case Review to radiologists in 2009. The ACR and the New York State Department of Health distributed MCR4 to facilities in the Empire State earlier this year.

For more information regarding the ACR Mammography Case Review product, please visit: http://www.acr.org/mcr <http://www.acr.org/mcr> .

The American Society for Radiation Oncology (ASTRO) has selected Theodore Lawrence, MD, PhD, FASTRO, and William Shipley, MD, FASTRO, as its 2009 Gold Medal recipients--the highest honor bestowed by ASTRO. Dr. Lawrence and Dr. Shipley will receive their awards at the Gold Medal Ceremony, to be held Nov. 3 during ASTRO's 51st Annual Meeting in Chicago.

Dr. Lawrence is an Isadore Lampe professor of radiation oncology, chair of the department of radiation oncology and a professor in the department of environmental health, School of Public Health at the University of Michigan in Ann Arbor, Mich. He is also co-chair of the radiation sciences program and head of the Experimental Irradiation Core of the University of Michigan Comprehensive Cancer Center. Dr. Lawrence joined the faculty of the University of Michigan in 1987, following a fellowship in medical oncology and a residency in radiation oncology at the National Cancer Institute. He is the chair of the National Cancer Institute Board of Scientific Councilors and a member of the Institute of Medicine. He is also the editor of Translational Oncology, an editor of The Cancer Journal: Journal of the Principles and Practice of Oncology, and the associate editor of Seminars in Radiation Oncology. Dr. Lawrence is an ASTRO past president and former board chairman, and a past member of the ASCO board of directors. He was also named by the ASTRO Board of Directors as one of the first general co-chairs of the Radiation Oncology Institute's Vision of Value fundraising campaign, which will raise money to develop innovative ways of enhancing the profile of radiation oncology in the world cancer community and prepare the specialty for the future.

Dr. Shipley is chair of the genitourinary oncology unit at Massachusetts General Hospital and the Andres Soriano professor of radiation oncology at Harvard Medical School, both in Boston. He earned his doctorate from Harvard Medical School and completed a surgical internship and residency at Massachusetts General Hospital. Dr. Shipley then completed a residency at the Harvard Medical School Joint Center for Radiation Therapy, where he served as chief resident. Since 1974, he has worked in various academic appointments for Harvard Medical School and in various hospital appointments at Massachusetts General Hospital; he also served as a visiting scientist at the Institute of Cancer Research at the Royal Marsden Hospital in Surrey, England, for two years in the early 1980s. Dr. Shipley is active in medical societies in the U.S. and abroad and has held committee appointments with several of these organizations. He has authored and co-authored over 160 medical reports, three text books on genitourinary oncology and more than 140 book chapters. He was named a fellow of the American College of Radiology (ACR) in 1988 and an ASTRO Fellow in 2006. Dr. Shipley has been actively involved with ASTRO's International Education Subcommittee since 2003, and in 2006, he organized the first ASTRO-led international scientific and educational meeting in the Philippines, which was designed to help strengthen ASTRO's involvement in radiation oncology abroad and collaborate with related specialty societies in other countries.

Researchers at the National Cancer Institute (NCI), have determined how a genetic variation in the SOD2 gene may affect how a person responds to the chemotherapy drug cyclophosphamide, which is used to treat breast and other cancers.

The findings represent the first preliminary evidence pointing toward a mechanism and a potential biomarker for cyclophosphamide resistance in breast cancer patients. The study appeared online June 9 in Clinical Cancer Research.

"This study shows how, with the progress of individualized medicine, a diagnostic test may be developed that determines whether a patient has certain genetic variations that may modify the effect of certain chemotherapies," says study author Sharon Glynn, PhD, a cancer prevention fellow at NCI's Center for Cancer Research.

"In the future, such tests may be used to guide the treatment of patients with the SOD2 variation, ensuring that they receive a therapy that is more effective than cyclophosphamide-based therapies," says senior author Stefan Ambs, PhD, principal investigator at the Center for Cancer Research.

Cancer patients over age 65 have poorer physical health--and, in some cases, mental health--when compared with people of the same age group without cancer, according to a study in the June 9 online issue of the Journal of the National Cancer Institute.

Because health-related quality of life (HRQOL) before cancer often isn't measured, cancer's impact on HRQOL is poorly understood. To quantify changes before and up to two years after cancer diagnosis, a research team led by Bryce B. Reeve, psychometrician and program director in the Outcomes Research Branch of the Applied Research Program at the National Cancer Institute in Bethesda, Md., examined changes in HRQOL from 1998 through 2003 in 1,432 patients aged 65 years or older. They compared the patients who were enrolled in Medicare managed care plans with 7,160 matched control subjects by using data from the Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare Health Outcomes Survey (MHOS).

For patients diagnosed with prostate, breast, bladder, colorectal, kidney, nonsmall cell lung cancers or non-Hodgkin lymphoma, the researchers observed a statistically significantly greater decline in physical health of patients compared with control subjects without cancer. They also found that patients with prostate, colorectal or nonsmall cell lung cancer experienced statistically significantly decreased mental health relative to matched control subjects without cancer.

The Society for Imaging Informatics in Medicine (SIIM) recently announced the recipients of its 2009 Resident Scholarship Awards and New Investigator Travel Awards.

SIIM Resident Scholarship Award winners received complimentary meeting registration and travel expense reimbursement to attend the SIIM 2009 Annual Meeting, held June 4-7 in Charlotte, N.C.; they also received a one-year complimentary SIIM membership. Applicants wrote essays on the topic "Besides PACS, what one piece of software most improves workflow efficiency for radiologists?" They were judged by a panel of SIIM experts. The two recipients are Tessa S. Cook, MD, PhD, of the Hospital of the University of Pennsylvania, Philadelphia; and Yun Robert Sheu, MD, of the University of Pittsburgh Medical Center.

The winning essays will be published in an upcoming issue of SIIM News.

Travel awards are presented to new investigators with an area of study and interest in imaging informatics who are enrolled in a full-time training program or who have completed their training program within two years of the SIIM annual meeting.

The 2009 New Investigator Travel Award recipients are:

•  Andrew Wu, MD, University of Iowa Health Care, Iowa City, for his essay "Valuation of negation detection and its impact on precision in search."

•  Ryan Woods, MD, MPH, University of Wisconsin School of Medicine and Public Health, Madison, for "Using knowledge discovery techniques to identify a novel predictor of breast cancer: Breast mass density."

•  Amee Patel, MD, University of Maryland School of Medicine, Baltimore, for "Walking while working: The effect of a treadmill-based workstation on radiologists' interpretation of lung nodules."

•  Scott L. DuVall, University of Utah, Salt Lake City, for "IHE for everybody: Adding TCE functionality to applications."

Travel Award recipients presented their research findings at SIIM 2009.

A set of expert consensus-based, quality-of-care indicators identified considerable variability in the quality of pancreatic cancer care among hospitals and may be used to evaluate and identify areas for improvement, according to a new study in the June 9 online issue of the Journal of the National Cancer Institute.

Factors responsible for variability in pancreatic cancer patient outcomes among hospitals in the United States have been difficult to identify because valid indicators of high-quality care have not been available. Researchers undertook this study because pancreatic cancer care has shown substantial hospital-to-hospital variability in outcomes.

To identify such indicators, Karl Y. Bilimoria, MD, MS, of the American College Surgeons and the Department of Surgery at Northwestern University in Chicago, and colleagues gathered a panel of  20 pancreatic cancer experts to rank potential quality indicators based on the RAND/UCLA Appropriateness Methodology, rating each at high or moderate validity or not valid. Adherence with the indicators at both the patient and hospital levels was assessed using data from the National Cancer Data Base of the American College of Surgeons (2004-2005) for almost 50,000 patients treated at 1,134 hospitals in the U.S.

The panel identified 43 valid indicators, which assessed structural factors, clinical processes of care, treatment appropriateness, efficiency, and outcomes.  Patient-level adherence with indicators ranged from 49.6 percent to 97.2 percent, whereas hospital-level adherence ranged from 6.8 percent to 99.9 percent. Of the 10 component indicators that were used to develop a composite score, most hospitals were adherent with fewer than half of the indicators.

"Because the future of health care will certainly involve more measurement of the quality of care, there is a need for rigorously developed quality indicators put forth by clinicians," the authors write. "Moreover, individual quality measures can be used to develop a data-driven composite measure of hospital pancreatic cancer care that assesses care across multiple domains. These quality indicators offer an opportunity to monitor, standardize, and improve the care of patients with pancreatic cancer."

In an accompanying editorial, Murray F. Brennan, MD, of Memorial Sloan-Kettering Cancer Center in New York, agrees that there is considerable variability in the management of pancreatic cancer in the U.S., but questions the study's suggestion that there is variability in the "quality" of pancreatic cancer management.

"Operative mortality and, to a lesser extent, morbidity, do vary widely among hospitals, and for the patient, operative mortality is a crucial matrix," writes Brennan. "However, given the cost of medical care, it seems facetious to suggest that pancreatic cancer patients in most major cities could improve their perioperative survival by 200 percent to 400 percent by spending relatively little money to travel to a hospital with a higher quality of pancreatic cancer management."

Centralizing care in high-volume institutions, according to Brennan, would seem to be an appropriate way to improve patient survival. He also points out that one factor, surgeon case volume, was not considered a valid measure in this study, but perhaps should have been because it has been repeatedly associated with hospital performance.

For eight consecutive years, ARRT has been reporting upward trends in primary exam volume, but what goes up...

2008's increases are smaller than those of recent years. The exam volume numbers parallel reports of declining educational program enrollments.

Growth in 2008 was most significant in Nuclear Medicine Technology, at 5.5% compared to 2007. In the preceding four years, however, NMT volume increases averaged 17%. Radiography has been virtually flat for two years, with 0.5% increases in candidate numbers. Radiation Therapy volume, on the heels of a 5.3% drop in 2007 volume, dropped 1.9% in 2008.

Primary exam volume over time is detailed in Table 1.

"ARRT examination volume closely follows the number of program graduates, and the number of graduates goes through cycles driven by supply and demand for technologists," notes Jerry B. Reid, Ph.D., ARRT executive director. "When there are more positions available than there are technologists to fill them, educational programs increase enrollment. We typically overshoot the mark - to the point where there are more technologists than there are positions, and the programs reduce enrollments. These cycles have been observed for decades, but the overall trend across the years is increased volume."

ARRT's 2008 Annual Report of Examinations is available at www.arrt.org under "Examinations," along with a more detailed Technical Appendix. In addition to reporting volume, ARRT's Annual Report of Examinations also reports scores - by exam section, percentile rank, and comparative means for educational programs; as well as by state.

Post-Primary. 

CT in the Lead, Up 36% Over Previous Year

Post-primary ARRT exam volume for first-time candidates increased for the seventh consecutive year in 2008.

The increase for 2008 was 25%. Previous increases were 15% for 2007, 19% in 2006, 14% in 2005, and 7% in 2004.

The big gainer among the high-volume disciplines was CT, with a 36% increase. Mammography grew by 22%.

Candidate numbers by discipline (including primary-pathway exams) are detailed in Table 2.

Table 1.  Primary Exam Volume

Table 2.  2008 Exam Volume, Average Scores, Pass Percentage

Women are under-represented in clinical cancer research published in high-impact journals, according to a new study by researchers at the University of Michigan Comprehensive Cancer Center.

Taking into account the incidence of particular types of cancer among women, studies included a smaller proportion of women than should be expected. The analysis looked specifically at studies of cancer types that were not gender specific, including colon cancer, oral cancers, lung cancer, brain tumors and lymphomas.

The authors looked at 661 prospective clinical studies with more than 1 million total participants. Results of this study appear online in the journal Cancer and will be published in the July 15 print issue.

"In the vast majority of individual studies we analyzed, fewer women were enrolled than we would expect given the proportion of women diagnosed with the type of cancer being studied. We're seeing it across the board in all cancer types," says study author Reshma Jagsi, MD, DPhil., assistant professor of radiation oncology at the U-M Medical School.

"It's so important that women are appropriately represented in research. We know there are biological differences between the sexes, as well as social and cultural differences. Studies need to be able to assess whether there are differences in responses to treatment, for example, between women and men," she adds.

The National Institutes of Health's Revitalization Act of 1993 explicitly calls out the importance of including women in clinical research, noting that clinical trials should enroll adequate numbers of women to allow for subgroup analysis.

The U-M researchers found that studies reporting government funding did include higher numbers of women participants, but the impact was modest--41 percent, compared to 37 percent for studies not receiving government funding.

Traditionally, researchers were told not to include people of vulnerable populations in their studies. This group included women of childbearing age. "By protecting them from research, we're excluding them," Jagsi notes.

Previous studies have found some barriers to clinical trial participation are lack of information, fear and a perception of interfering with personal responsibilities, such as child care.

"Sometimes participating in research studies can be time intensive. Women today are often stretched very thin trying to deal with the balance between domestic responsibilities, their cancer diagnosis, and often a career as well. They may be particularly likely to find clinical trials too burdensome. In that case, researchers should consider providing compensation to help with transportation or child care expenses," Jagsi says.

This under-representation of women is not necessarily the result of conscious decisions, points out senior author Peter Ubel, M.D., director of the Center for Behavioral and Decision Sciences in Medicine at U-M.

"Clinical researchers are not purposely trying to exclude women from their studies. All the more reason they need to consciously and earnestly revise their recruitment methods to give more women a chance to volunteer," Ubel says.

Methodology: The researchers looked at all original clinical cancer research published in five top oncology journals and three top general medical journals in 2006. The journals included were the New England Journal of Medicine, the Journal of the American Medical Association, the Lancet, the Journal of Clinical Oncology, the Journal of the National Cancer Institute, Lancet Oncology, Clinical Cancer Research and Cancer.

Articles were analyzed to determine factors including the number of participants, gender of participants, type of cancer and funding source.

The percent of women was summarized in two ways: The overall percent of women from all studies; and the average percent from each study that were women. The first method gives greater weight to larger studies, while the second method allows each study to have equal weight. Women's representation was lower than expected, based on general population incidence data, according to both analyses.

A new study finds that, in sharp contrast to the overall declining rates of colorectal cancer in the United States, incidence rates among adults younger than age 50 years are increasing. The authors theorize that these increases may be related to rising rates of obesity and changes in dietary patterns, including increased consumption of fast food. The study, which appears in the June 2009 issue of Cancer Epidemiology Biomarkers and Prevention, says further studies are necessary to elucidate causes for this trend and to identify potential prevention and early detection strategies.

Overall incidence rates for colorectal cancer in the United States have been on the decline since the mid-1980s, with the drop accelerating in the most recent time period. Rates are now dropping 2.8 percent per year in men and 2.2 percent per year in women, largely due to an increase in screening, particularly colonoscopy, among individuals ages 50 years and older. Screening can reduce colorectal cancer incidence by detecting and removing polyps before they become cancerous. But recent incidence trends among adults younger than 50 years, for whom routine screening is not recommended, have not been analyzed thoroughly. A previous study did find an increase in incidence from 1973 to 1999 for all races combined, but that study did not include 40 to 49 year-olds, who represent 73 percent of colorectal cancer patients under age 50.

In a new analysis, American Cancer Society researchers led by Rebecca L. Siegel, MPH, looked at trends in colorectal cancer incidence rates between 1992 and 2005 among young adults (ages 20 to 49) by sex, race/ethnicity, age, stage at diagnosis, and anatomic subsite. The study found that among individuals ages 20 to 49, incidence rates of colorectal cancer increased 1.5 percent per year in men and 1.6 percent per year in women from 1992 to 2005. Among non-Hispanic Whites, rates increased for both men and women in each 10-year age grouping (20-29, 30-39, and 40-49 years) and for every stage of diagnosis. They found the largest annual percent increase in colorectal cancer incidence was in the youngest age group (20-29 years), in whom incidence rates rose by 5.2% per year in men and 5.6% per year in women. They say the rises are due to an increase in left-sided tumors, particularly in the rectum.

The researchers address several possibilities for the rise, including rising rates of obesity, which is a major risk factor for colorectal cancer. Dietary factors may also come into play. The researchers note that between the late 1970s and the mid-1990s, fast-food consumption in the United States increased 5-fold among children and 3-fold among adults. A diet high in fast food is associated with both greater meat consumption and reduced milk consumption. Increased consumption of red and processed meat has been shown to increase risk of cancers of the distal colon and rectum, while milk and calcium consumption have shown a protective effect against the subsites in which the rise in incidence was most prominent. They say it is plausible that the emergence of unfavorable dietary patterns in children and young adults over the past three decades may have contributed to the increase in CRC among young adults observed in the study.

The authors conclude: "The disparate increase in left-sided CRC suggests that particular attention be given to studies to elucidate the behavioral and environmental risk factors responsible for this trend and potential prevention and early detection strategies."

In July 2009, the American College of Radiology (ACR) will launch the National Mammography Database (NMD), the newest addition to the National Radiology Dose Registry (NRDR), a warehouse of ACR registry databases that compiles data to allow radiology facilities to compare themselves to other facilities regionally and nationally according to facility type.

The NMD, which is based on BI-RADS, will allow mammography facilities to compare their practice performance and outcome data to practices similar to their own, advance the practice of mammography and implement successful quality improvement programs to improve patient care.

"The College recognized the limited access mammography facilities have to comparative information for national and regional benchmarking," said Carl D'Orsi, MD, FACR, chair of Committee on BI-RADS. "One of the best methods to improve life-saving early breast cancer detection is through a national approach to breast imaging, with data we can only achieve through a unified mammography database."

The NMD will leverage data that mammography practices are already collecting under federal mandate. Facilities can quickly and easily upload their data to the NMD through a Web-based system that integrates with BI-RADS software partners. The data will be compiled to provide benchmarks on individual practice processes and patient outcomes such as cancer detection rates, positive predictive values, and recall rates.

"The NMD represents a valuable tool that will allow breast imagers to track their results in a meaningful, comprehensive way," said Carol Lee, MD, FACR, chair of ACR Commission on Breast Imaging. "It also affords the opportunity for us to set benchmarks and improve our performance where needed. The NMD will allow us in the breast imaging community to demonstrate our ongoing commitment to quality care."

Participants will receive semiannual feedback reports that include comparisons with important medical audit benchmark data.

A practice or facility that chooses to participate in the NMD can also take advantage of the other ACR registries as appropriate for the practice. When a facility joins more than one registry, the NRDR warehouse allows information to be shared across registries within the facility. In addition to the NMD, NRDR includes the National Oncology PET Registry, CT Colonography Registry, General Radiology Improvement Database, Dose Index Registry and IV Contrast Extravasation Registry.

Facilities registered for the NMD by January 2010 will be named charter members and are eligible for a 50 percent discount off the 2009 and 2010 annual membership fees. The goal is to provide accurate, up-to-date information for mammography facilities and enable them to provide the best care possible to their patients.

Downward-trending reimbursement under the Medicare Physician Fee Schedule and the prevalence of nonradiologist specialists performing interventional radiology (IR) procedures are the two main factors affecting IR practice, according to a study in the June issue of the Journal of the American College of Radiology.

In Reimbursement Trends for Outpatient Interventional Radiology Procedures: Comparison of Hospital and Freestanding Physician Office Sites of Service, authors project that reimbursements will drop by 36 percent in freestanding offices from 2006-2010, and by 16 percent in hospital outpatient departments.

Arteriovenous fistula declotting was the most frequently reported interventional radiology procedure, and was performed by radiologists four times as frequently as the next most commonly reported procedure, the peripheral insertion of a central venous catheter.

Salary reductions caused by the Deficit Reduction Act of 2005 (DRA) varied by modality, with MRI topping the list at more than 34 percent, according to a study in the June issue of the Journal of the American College of Radiology.

The DRA, which capped the technical component of Medicare payments for nonhospital imaging services, also caused many practices to delay new equipment purchases, although they were less likely to reduce imaging services as a result of DRA cuts.

ACR conducted a survey in May and June of 2007 to determine how the DRA affected the professional and technical components of income, income derived from Medicare patients, practice changes resulting from Medicare payment cuts, and outside readings.

The 2007 Survey of Radiologists: Source of Income and Impact of the Deficit Reduction Act of 2005, by James W. Moser, PhD, and Dawn M. Hastreiter, MD, PhD, reports on the survey results of approximately 600 ACR members. The authors determined that an average of 18 percent of radiologists' income comes from the technical component, and nearly all received income from the professional component.

A single high dose of radiation therapy is as effective in relieving pain from vertebral bone metastases as 10 smaller treatments, according to research released last week from the Radiation Therapy Oncology Group (RTOG).

RTOG researchers previously reported that breast and prostate cancer patients with painful bone metastases who received a single radiation therapy treatment of 8 Gy had the same pain relief and narcotic use three months after treatment as patients who received 10 radiotherapy treatments each consisting of 2 Gy for a total of 30 Gy. They also found that patients who received the 8 Gy regimen reported fewer side effects, although those patients required retreatment more often than patients who received the higher dose.

To evaluate the effectiveness of short course radiation therapy in patients with painful vertebral bone metastases, the RTOG investigators examined a 235 patient subset of the 909 patients entered on the original study, RTOG 9714. The RTOG researchers found the short course to be equally effective as the longer course (8 Gy vs. 30 Gy), showing no statistically significant difference in pain relief (70 percent vs. 62 percent, p=0.59) or narcotic use (27 percent vs. 24 percent, p=0.76) at three months.

RTOG, an NCI-funded national clinical trials group, is a clinical research component of the American College of Radiology (ACR).

Staffing rates for radiation therapy facilities have stayed relatively stable over the past two years, according to a recent study by the American Society of Radiologic Technologists (ASRT).

The 2009 ASRT Radiation Therapy Staffing Survey focused on medical facilities that employ full-time radiation therapists. Facilities with a 2009 budget for radiation therapists reported having 4.97 full-time therapists on staff, down slightly when compared to the 2007 survey, which reported 5.20 full-time therapists.

The survey also showed the vacancy rate for radiation therapists has slightly risen to 7.6 percent from 5.4 percent in 2007.

Vacancy rates, defined as the percentage of budgeted full-time equivalent positions vacant and actively recruited, were 8.2  percent for medical dosimetrists, 12.1 percent for medical physicists, 9.2 percent for radiation oncologist positions, 7.1 percent for nurses, and 6.1 percent and 10.2 percent respectively for ancillary and administrative staff positions.

An additional finding: Approximately 89 percent of respondents indicated that their facility has a CT device for treatment simulation. Of these facilities, 81 percent of the respondents said the simulator was in the radiation therapy department, and about 15 percent said it was in the radiology department-results that show widespread use of CT in therapy treatment planning, according to an ASRT press release.

More than 530 chief radiation therapists, chief dosimetrists, managers and directors of radiation therapy facilities responded to the ASRT survey, which was completed in April.

Almost one in three Medicare patients with uncomplicated, acute low back pain underwent imaging within 28 days of diagnosis despite a lack of evidence that such scans are useful without specific complications or comorbid conditions, according to a study published last week in Archives of Internal Medicine.

An analysis by the Center for Studying Health System Change of more than 35,000 Medicare claims from 2000-02 and 2004-06 also revealed that higher-income and white patients received faster, more advanced imaging, such as CT and MRI scans, than lower-income and minority patients. Patients treated in larger practices or settings less reliant on Medicaid also received faster, more advanced imaging, and one-third of imaging services were performed within the referring physician's own organization.

"Since large groups are more likely to have the resources to invest in imaging equipment," write the authors, "our results are consistent with other studies suggesting that practice-owned equipment results in supplier-induced demand and physician self-referral."