The possibility of a malpractice suit is constantly on the minds of radiologists. In a session this morning looking at “Minefields in Radiology,” Robert Albert Schmidt of the University of Chicago Medical Center referred to surveys taken in 2002 that 2006 that found that radiologists' mean estimate of the probability of being sued for malpractice in the next 5 years was 41 percent in 2002 and 35 percent in 2006.

One of the many pieces of information shared by Schmidt in the part of the presentation concerned with mammography is that one-third of plantiffs in mammography malpractice cases are under the age of 40. In addition,  the median age of a claimant is 44 and patients in 59 percent of these cases found lesions. So a typical profile of a patient suing is someone who is “young and has a complaint,” said Schmidt, meaning a radiologist must absolutely respond to a patient’s concerns in these cases.

The RSNA today hosted a panel of breast imaging experts to evaluate the controversy surround the U.S. Preventive Services Task Force's decision to recommend that women begin screening at age 50 (as opposed to the current age of 40), and then every two years rather than annually, as well as eliminating breast cancer screening entirely for women at age 75.

Drs. W. Phil Evans, Stephen A. Feig and Daniel B. Kopans said that the Task Force's decision was not rooted in clinical data conducted on breast cancer screening, which they said has reduced breast cancer mortality by 39 percent in the U.S. alone, despite an increase in the disease.

While they acknowledged that mammography is not a perfect technology--it has improved--and false positives leading to biopsies are preferential to women rather than death, according to Kopans.

They also cautioned that insurers, including CMS, may consider a change in reimbursements for women who are no longer recommended to receive breast cancer screening, hinting that the decision could be financially motivated and an example of care rationing.

I don't know if it's a trend, but it appears that scientific session moderators are being particularly vigilant in ensuring that presenters keep to the mandated time limits.

During one session yesterday one presenter actually had her presentation interrupted when she failed to complete it just as she was about to get to her last Powerpoint slide . During the brief Q&A session that followed the potentially embarrassing situation was resolved when a questioner--to the appreciable laughter of the audience--simply asked the presenter to talk about what was on the last slide.

In a series presentations on cardiovascular imaging, specifically cardiac MR and cardiac CT, which focused on patient outcomes, cardiac CT came up big. Among those studies, three study presenters discussed how their findings can be applied in the real-life practice.

After a study that examines patients at two-years of follow up, Ludovico La Grutta, MD, said that routine cardiac CT provides an "excellent prognostic value" in patients with normal coronary arteries or patent revascularization.

Cardiac CT is often associated with concerns about radiation dose. However, newer techniques are limiting those concerns. Dr. James Earls, who represented the ERASIR I researchers, said that use of adaptive statistical iterative reconstruction and additional dose reduction techniques allows for a "very low mean dose" for cardiac CT.

Dr. Patrick A. Colletti suggested that the findings of he and his colleagues indicate that subclinical atherosclerosis with CAC is a predictor of future systolic and diastolic function and wall motion abnormalities, even if they are not predicted by specific recorded coronary events.

Dr. Eliot Siegel from the University of Maryland began this morning’s study presentation of a new ultrasound imaging technique, addressing the lack of clinical exploration of skin imaging. He noted that this unfortunate trend is lacking in both dermatology and radiology.

“Skin is superficial, we see it all the time, and yet, there have not been any imaging studies to evaluate skin cancer,” he said. Siegel added that the due to the prevalence of skin cancer (one out of every five Americans), it demands more attention.

The researchers investigated a technique, which combines ultrasound and elastography, could potentially assess the nature of the skin tumor (as either benign or malignant). According to Siegel, the imaging technique also could assist surgeons with more accurate tumor removal.

Ultrasound is not currently commonly used by dermatologists, but Siegel hopes that this analysis, along with larger clinical studies, will increase its use in clinical practice.

It’s a little bit out of the way and not that easy to find, but the “Toward Quantitative Imaging: The Reading Room of the Future” is a worthwhile stop this week for even the busiest RSNA attendee.

Located in Hall E of the Lakeside Learning Center, the room showcases products that integrate quantitative analysis into image interpretation. The room features informational posters and computer-based demonstrations, and there are “Meet the Experts” presentations going on daily throughout the conference.

Some of the topics visitors will be able to get information on  include molecular imaging, quality assurance in quantitative imaging and the status of the technical committees of the Quantitative Imaging Biomarkers Alliance (QIBA).

Years ago, when U.S. beverage can manufacturers did away with the pull-tab, most figured that had solved the problem of accidental ingestion of those little pieces of aluminum. According to Lane Donnelly, MD, radiologist-in-chief at Cincinnati Children's Hospital Medical Center, we might need to look at the problem again.

Donnelly presented a study this morning in which he identified 19 cases of stay-tab (the replacement of the pull-tab) ingestion at Cincinnati Children's  from 1993-2009, indicating that the "redesign of beverage cans may not have reduced the number of ingestions."

Donnelly said that ingesting one of these  small pieces of metal could lead to it lodging in the gastrointestinal tract or--if sharp enough-lacerating the bowel. The problem is complicated by the fact that aluminum is radiopaque, Donnelly said, so that these tabs are not easily see on x-rays. In fact, the tabs were only visible on x-rays in four of the 19 cases. That said, all of the 19 cases were resolved without surgery.

Donnelly suggested manufacturers rethink the way their cans are constructed. Or doctors and parents can tell children  what one doctor at Cincinnati Children's wrote on one patient's hospital discharge slip--"no sucking on can tops."

The flood of data emerging from RSNA 2009 is contributing to the ever-burgeoning clinical field of thoracic imaging, which is seeking how to diagnose, manage and treat angina patients, who present in the emergency depatment and could potentially have cardiac disease.

When, who and how to image remain burning questions, which investigators are furiously studying. And the CT advocates should be pleased with the data being presented at this week's conference.

One poster presentation, conducted by Lee et al from Canada, found that the use of a CT triple rule-out protocol as an initial diagnostic tool offers an effective solution, and CT addresses multiple clinical and economic challenges in the emergent acute chest pain patient.

Another study, presented today by lead investigator Dr. Josef Matthias Kerl from Germany, found that CCTA compares favorably with conventional angiograms for diagnosing significant coronary artery disease.

Finally, another study, presented today by Dr. Girish Tyagi from Harvard, found that a new new tool has potential for the automated analysis of CCTA to assist in ruling coronary artery stenosis in hospital emergency department patients with chest pain.

This debate is sure to remain contentious due the high radiation dose and costs associated with CT scanners.

Dr. Asim F. Choudhri just presented clinical study results on the capability to accurately diagnose CT scans of acute appendicitis on the iPhone, using OsiriX software.

While the application is not yet approved by the FDA and there are concerns about patient data safety, Choudhri is suggesting that this capability allows for quick diagnosis of a common condition, which can therefore lead to expedited treatment. The regulatory considerations will vary whether this technique is used as a primary diagnosis method in the future, or simply to transfer images.

Also, Choudhri, who is a neuroradiologist at Johns Hopkins, said that these results could hold potential for other conditions, such as bleeding in the brain and potentially stroke, which require a quick diagnosis for proper patient management.

The Lakeside Learning Center was definitely one of the hot spots at RSNA this afternoon.

Hall E, Level 2 hosted hundreds of education exhibits and scientific posters in subjects ranging from pediatrics and physics to nuclear medicine and gastrointestinal imaging. Registrants looking to view presentations digitally often had to wait patiently to do so as the rows and rows of monitors available for presentation viewing were quickly taken.

The biggest crowds could be found in the breast imaging area, particularly in front of V.J. Fein-Zachary, MD, a radiologist at Beth Israel Deaconess Medical Center, who was discussing her exhibit on "Missed Breast Cancers: Learning from the Mistakes of Others."

The exhibit demonstrated mammographic, ultrasound and MRI lesions that had been incorrectly interpreted as well as a peer review process through which she and her colleagues aim to decrease false negative results and improve correct interpretations of subtle cancers.

RSNA President Dr. Gary J. Becker nearly chanted this mantra throughout his opening address to a packed audience of RSNA attendees in the Arie Crown Theater at McCormick Center in Chicago.

He noted that radiologists have been hesitant to examine the quality of their practices. However, he said that patients and regulators are demanding it, whether healthcare reform gets passed or not, so radiologists are going to have to get on the quality improvement band wagon.

To reinforce his message, Becker consistently reiterated the phrases:

What don't you measure, you cannot know; What you cannot know, you cannot improve

He said that in order to partake in quality improvement, the radiology community will need undergo both an attitudinal and technological changes—the latter of which will require a greater investment and utilization of informatics

The 2009 Radiological Society of North America (RSNA) scientific sessions and annual meeting begins today in unseasonably warm weather in Chicago.

While this week is sure to be a flurry of scientific news on the radiology space, two European vendors started the activity off with two multi-million dollar acquisitions over the Thanksgiving weekend.

Agfa HealthCare signed an agreement to buy Insight Agents, a European developer of contrast media for nearly $15 million. Also, Barco signed an agreement to acquire the Saronno, Italy-based display company FIMI, a fully owned subsidiary of Philips Healthcare for approximately $40 million.

The RSNA Opening Sessions, currently taking place, had an opening act! John Primer and the Real Deal Blues Band is welcoming in RSNA President Dr. Gary J. Becker with song, Mississippi, Here I Come!!