Educational sessions: What matters to radiology
Few seats were available in the Arie Crown Theater during the plenary sessions during RSNA 2006. Attendees gathered for the Opening Address, the New Horizons Lecture and the annual orations.

In his Opening Address, RSNA President Robert R. Hattery, MD, urged attendees to make a renewed commitment to professionalism. “Many of our colleagues need to put ethics on the front page,” he said. “We have the freedom to determine our own destiny. It’s up to us. If we abuse our freedom or fall short of our stewardship of trust, we risk losing our privileges.”

Hattery said that physicians are debtors to the profession and owe society something. Physicians have a responsibility to give back their time, energy, financial support and commitment, he said. “We pay our debt by strengthening professionalism, so we must better understand it. We know it when we see it and I believe we feel it when we have achieved it. Professionalism is at the very core of the art and science of medicine.”

Hattery urged attendees to get reacquainted with ethical codes, including the Hippocratic Oath — “not a glib and empty promise but an enduring reminder for each day” — and the ethical code of the American Medical Association.

To keep professionalism “front and center,” Hattery said physicians should become engaged in self assessment and periodically gauge themselves against medical standards. They should teach and mentor, proactively deal with unprofessional behavior, help bolster public confidence in medicine, and take this conversation to the PACS workstations. “That is where we connect as professionals.”

Interventional oncology has emerged as the preferred treatment method in recent years, J. William Charboneau, MD, department of radiology at the Mayo Clinic in Rochester, Minn., confirmed as he delivered the Eugene P. Pendergrass New Horizons Lecture, “Image-guided Cancer Treatment: The Science and Vision of an Emerging Field.”

Scholarship is one way to track the emergency of newer treatments, Charboneau said. In 1996, almost no abstracts on minimally invasive procedures were presented for RSNA. This year, 450 abstracts were submitted to RSNA.

Radiologists need to take cardiac imaging back from cardiologists, said Kerry Link, MD, director of the Center for Biomolecular Imaging at Wake Forest University Health Sciences, during the Annual Oration on Diagnostic Radiology: “Cardiac Imaging — A Second Chance.”

Radiologists’ recent resurgence of interest in cardiac imaging reflects proficiency with coronary CT angiography and a healthy concern over losing the turf. Ongoing advances will have “profound and long-lasting effects on medicine and especially the field of radiology. This is a defining moment,” he said.

“Pathoanatomy is only one piece of the puzzle of coronary heart disease,” he said. The underlying theme of cardiac disease is pathophysiology. The current advances in cardiac imaging mark “a major turning point in radiology” and radiologists can take back cardiac imaging by revamping training programs, focusing on research and putting a greater emphasis on pathophysiology rather than pathoanatomy.

Biologically-guided and functional image-guided radiation therapy are changing how radiation oncologists treat cancer, said Theodore Lawrence, MD, PhD, during “Looking Beyond Anatomic-Based Treatment in Radiation Oncology,” the Annual Oration in Radiation Oncology.

Advanced treatment planning and delivery systems allow radiation oncologists to treat tumors but save normal tissue with greater precision than could be imagined 20 years ago, Lawrence said. Research has shown that we can predict a patient’s response to treatment during treatment rather than waiting weeks or months when it’s too late to make adjustments. Treatment based solely on anatomy means clinicians guess a dose based on hundreds of previous patients and base the risk of damage on the most sensitive five percent of the population. Now, treatment can be based on aberrant growth factor pathways and individual measurements. “Now we can adjust treatments during the course of treatment,” said Lawrence. A multimodality therapy approach keeps improving technology capabilities. Now we view cancer treatment in a much broader context, he said.

“Radiation oncology was born from radiology,” Lawrence said. The last 30 years were its adolescence, he added, and hopefully, over the next 30 years we will be working more closely together for further advances in cancer treatment.

Clinical Studies in Brief

The following studies were presented at RSNA:

A new ultrasound technique has proven to be highly effective in helping radiologists distinguish between benign and malignant breast lesions. The elasticity imaging technique — which was studied at Northeastern Ohio University — could reduce the number of annual biopsies.

Cardiovascular disease can be difficult to identify in healthy marathon runners over age 50 because it is difficult to distinguish from the effects of training the heart muscle. MRI scans at University Hospital, Munich University in Germany showed that although cardiac chambers were not enlarged, left ventricular mass (LVM) in the marathon runners was significantly higher than in the general population.

Smoking changes brain chemistry by affecting nerve cells and altering chemical makeup of the brain, according to a proton MR spectroscopy study done at the University of Bonn in Germany — the first to relate brain metabolites and nicotine dependence.

New research shows that sitting in an upright position places considerable strain on your back. Researchers from Woodend Hospital in Aberdeen, Scotland, used MRI scans to lead them to the conclusion that the optimal body-thigh sitting posture is 135 degrees.

Product branding has been shown to actually provoke strong activity in your brain, thanks to new functional MRI research at University Hospital, Ludwig-Maximilians University in Munich, Germany.

Spermatic vein embolization — a minimally invasive treatment for a common cause of infertility in men — combined with anti-inflammatory treatment can dramatically help a couple’s chances for pregnancy, according to a study from the University of Bonn in Germany.

Milk could be used as a cheaper contrast agent in gastrointestinal CT exams, according to research from St. Luke’s-Roosevelt Hospital in New York City. It works because the milk makes the intestinal cavity appear dark, while the intestinal wall appears bright and the contrast makes disease easier to see.