RSNA in Review: Mammography, Radiation Dose & iPhones

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© Apple, RadiForce GS521

If the organizers of the 95th Scientific Assembly and Annual Meeting of the Radiological Society of North America even considered the idea of putting together a conference that could skim along quietly underneath the radar, those thoughts ended Nov. 17 when the U.S. Preventive Services Task Force released its controversial revised mammography guidelines.

Radiologists were suddenly front and center of a national controversy just days before the annual meeting began—and the impact of the mammography brouhaha went on to impact the meeting itself. On Wednesday, Dec. 2, the RSNA put together a panel of breast imaging experts, who, in front of the media including crews from several national television networks, harshly panned the recommendations. Grumblings heard throughout the exhibit floor, educational sessions and Chicago nightspots were similar.

Following the task force’s recommendations might save money, said Stephen Feig, MD, a professor of radiology at the University of California Irvine School of Medicine and president-elect of the American Society of Breast Disease, but “we will lose more lives.”

The controversy spilled over into the educational sessions as well. Attendees would have been hard-pressed to find a session on breast imaging in which the mammography recommendations weren’t mentioned.

But, even as this controversy simmered, the rest of the conference rolled along. Altogether, some 1,750 scientific papers in 16 subspecialties were offered, as well as 1,735 education exhibits and 712 scientific papers. And those concerns about attendance that were so apparent last year, dissipated this year as pre-registration for professionals and guests was up by 1 percent.

As far as radiology’s future is concerned, the pressure is on, according to RSNA president Gary Becker, MD. The demand for physician transparency and accountability from patients and their families, insurers, hospitals, quality groups, accrediting organizations, regulators and government is bound to grow. So, Becker told attendees during the opening address of the RSNA scientific sessions, quality improvement will have to be a priority for radiologists.

“If radiologists and all physicians wish to avoid ceding all medical regulations to government and other external stakeholders, we must earn the public’s trust. To maintain a portion of our privilege to self regulate, we will have to deliver quality, affordable care; engage in physician performance assessment and improvement; and demonstrate our outcomes through public reporting,” Becker said.

On the exhibition show floor, the attitude seemed to be one of genuine optimism. Both the booths and floors were crowded and, while there were fewer vendors on the floor this year than in the past, many of them suggested that they were getting solid leads at RSNA 2009 and seeing fewer tire-kickers.

Read on for a synopsis of some key educational sessions.

RSNA Educational Sessions in Review

Radiation revelations revisited
The issue of radiation dose exposure continued to be a top concern at RSNA 2009, as it has the last two years, particularly with the revelation in October that over an 18-month period some 250 patients at Cedars-Sinai Medical Center in Los Angeles had received excessive doses of radiation while undergoing CT brain perfusion scans.

The FDA is investigating whether the radiation exposure problems came from human error or involved problems with CT equipment, and since then has extended its inquiry into two other hospitals in the Los Angeles area, as well as hospitals in other parts of the country.

Researchers at the University of Wisconsin certainly had Cedars-Sinai on their minds as they presented the results of a study they carried out on unnecessary abdominal/pelvic CT imaging. “Radiation exposure has been a hot topic, particularly focusing on unnecessary radiation and over-exposure in patients during CT exams,” said Kristie Guite, MD, a radiation resident at the University of Wisconsin (UW) in Madison, and one of the authors of the study. “I think the recent events at Cedars-Sinai [in Los Angeles] reminds us that we are not doing everything we can to minimize radiation exposure to patients.”

In their study, the University of Wisconsin researchers reviewed a total of 978 imaging series. They found, using the American College of Radiology Appropriateness Criteria, that 345 of those CT series (35.3 percent) were not indicated. According to the researchers,