The Journal of Healthcare Contracting

Know The Lingo
Don't get caught speechless when your radiologists return from RSNA 2005.

Prepare yourself! The Radiological Society of North America (RSNA) is preparing to host its 91st Scientific Assembly and Annual Meeting in Chicago's venerable McCormick Place. And when your radiologists come home, well, you might get an earful about a lot of new technologies out there. After all, more than 700 companies are slated to exhibit at RSNA 2005.

It's no use avoiding your returning heroes. (Remember: You can run, but you cannot hide.) So meet them halfway. Engage them in conversation. And let the Journal of Healthcare Contracting help.

Here's your chance to sound, look and act smart! JHC presents this lexicon of the latest, hottest radiologic technologies. Included are applications and (as a special reader service) intelligible sentences you can utter to get you started on a heart-to-heart with your radiologists.

Breast imaging
MR spectroscopy
What it is: A form of magnetic resonance (MR) imaging that provides chemical information on an organ or structure of the body at the cellular level.
Your sentence: "Doctor, did you know that trends indicate a greater use of MR spectroscopy for breast imaging and computer-aided diagnosis for mammography?" (Source: Valerie Jackson, M.D., chair of RSNA's subcommittee on breast imaging.)

Cardiac imaging
Multidetector CT
What it is: Current spiral computed tomography (CT) scans are called multidetector CT and are most commonly four- or 16-slice systems, though 64 detectors are now available. Applications include cardiac imaging, CT colonography and vascular imaging.
Your sentence: "Doctor, what about this trend toward using MDCT to evaluate coronary arteries?" (Source: Martin Lipton, M.D., chairman of RSNA's cardiac imaging subcommittee.)

Chest radiology
Whole-body digital radiography
What it is: Technology that uses direct digital image capture technology to convert X-rays directly into electronic signals (instead of film).
Your sentence: "Doctor, you probably already knew that whole-body digital radiography is comparable in diagnostic quality to computed radiography. But did you also know that it's faster and allows for a smaller radiation dose to the patient?" (Source: Abstract reviewed by Stuart Mirvis, M.D., chair of RSNA's subcommittee on emergency radiology.)

Emergency radiology
Whole-body CT
What it is: Scanning of the body from the chin to below the hips using computed tomography technology, producing cross-sectional images.
Your sentence: "Doctor, you have to hand it to those French! For three years, they studied the use of whole-body CT to assess polytrauma in a level 1 trauma center in Paris, and they concluded that whole-body CT was highly accurate. In fact, they recommended it for the assessment of polytrauma to enable prompt and early treatment of surgical lesions." (Source: Stuart Mirvis, chair of RSNA's subcommittee on emergency radiology.)

Gastrointestinal radiology
CT colonography
What it is: Advanced type of X-ray exam that uses computed tomography scanning to obtain an interior view of the colon (the large intestine), which ordinarily can be seen only with an endoscope inserted into the rectum.
Your sentence: "Doctor, the next time I need to be examined for polyps in my colon, I'm definitely requesting CT colonography. Two abstracts at RSNA 2005 demonstrated its use without requiring the patient to undergo a cathartic bowel preparation." (Source: Abstracts reviewed by Jay Heiken, M.D., chair of RSNA's subcommittee on gastrointestinal radiology.)

Genitourinary radiology
Cine MR
What it is: Data is acquired to form a "movie" sequence of a structure.
Your sentence: "Doctor, isn't cine MR just the thing for prenatal diagnoses? It can detect fetal arm and leg movements, swallowing, head turning and even peristalsis of the fetal gastrointestinal and urinary tracts. But you probably already knew that." (Source: Study reviewed by Philip Kenney, M.D., chair of RSNA's subcommittee on genitourinary radiology.)

Musculoskeletal radiology
High-speed cone-beam CT
What it is: Prototype technology to achieve four-dimensional analysis of the knee under dynamic loaded conditions.
Your sentence: "Doctor, this new cone-beam CT seems like a sure thing, wouldn't you agree? After all, investigators used a prototype to visualize deformations of components of the knee, such as the menisci, ligaments and cartilage." (Source: Study reviewed by Georges El-Khoury, M.D., chair of RSNA's subcommittee on musculoskeletal radiology.)

Neuroradiology/ head and neck radiology
Functional MRI (fMRI)
What it is: Relatively new procedure that uses MR imaging to measure the quick, tiny metabolic changes that take place in an active part of the brain.
Your sentence: "Talk about getting inside your head! Doctor, did you know that a study presented at RSNA 2005 showed that fMRI demonstrated functional deficits in patients with schizophrenia? We're talking decreased activation in prefrontal and parietal neural networks." (Source: Study reviewed by Robert Quencer, M.D., chair of RSNA's subcommittee on neuroradiology/head and neck radiology.)

Nuclear medicine
F-18 FDG-PET/CT
What it is: Hybrid position emission tomography/CT scanning, fusing fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) with CT scans.
Your sentence: "Mix and match, doctor. A combination of PET and CT imaging can be more sensitive in detecting breast cancer metastases to bone than PET alone or bone scans." (Source: Study reviewed by Jack Ziffer, M.D., Ph.D., chair of RSNA's subcommittee on nuclear medicine.)

Pediatric radiology
Hyperpolarized helium-3 (HHe) diffusion MR
What it is: Magnetic resonance imaging technique in which a dedicated gas (in this case, hyperpolarized helium-3) is used as a "contrast agent" to directly visualize the gas. Offers the potential to non-invasively study pulmonary physiology.
Your sentence: "Doctor, quick question: What does ÔHHe' stand for? Just kidding. Fact is, by detecting the alveolar enlargement that normally occurs with lung growth during childhood, hyperpolarized helium-3 MR may find a role in the assessment of normal development of lung microstructures as well as abnormalities resulting from disease." (Source: Paper reviewed by Donald Frush, M.D., chair of RSNA's subcommittee on pediatric radiology.)

Physics
Ultrasound imaging in an MR scanner
What it is: A method of obtaining simultaneous ultrasound and MR images by placing a custom-made MR-compatible diagnostic ultrasound transducer in a mechanical positioning device of a 1.5-Tesla MR unit.
Your sentence: "Doctor, I believe they've found a way to correlate diagnostic ultrasound and MR imaging to offer additional diagnostic information. It's hard for me to explain, though; physics was never my strong suit." (Source: Abstract reviewed by Maryellen Giger, Ph.D., chair of RSNA's subcommittee on physics.)

Radiation oncology and radiobiology
Intensity-modulated radiation therapy (IMRT)
What it is: High-precision radiotherapy that uses computer-controlled X-ray accelerators to deliver precise radiation doses to a tumor or specific areas within the tumor.
Your sentence: "IMRT is right on target, doctor, wouldn't you agree? The technology has been shown to dramatically reduce the amount of radiation delivered to normal structures surrounding the target volume. In fact, one study demonstrated how a urethra-sparing IMRT technique minimized urinary tract toxicity, a common complication of radiation therapy in patients with prostate cancer." (Source: Chul Soo Ha, M.D., chair of RSNA's subcommittee on radiation oncology and radiobiology.)

Ultrasound
Microbubble ultrasound
What it is: Technology in which tiny gas bubbles (three microns) are injected intravenously to boost ultrasound signals. There is evidence that when ultrasound is applied to microbubbles, the microbubbles are disrupted (or "pop"), causing small perforations in the target cells, which allows the DNA to enter.
Your sentence: "Doctor, one study presented at RSNA 2005 showed that microbubble ultrasound shows encouraging promise as a physical delivery system to improve gene transfer efficiency to the lung." (Study reviewed by Mitchell Tublin, M.D., chair of RSNA's subcommittee on ultrasound.)

Just The Facts
Surprise your radiologists! Spring one of these tidbits on them.

Radiologists now perform almost twice as many breast biopsies on Medicare patients than surgeons, according to a paper to be presented at RSNA 2005. (Caution: Don't mention this in front of your surgeons.)
More emergency departments are using multidetector CT to evaluate trauma and acute vascular disease, and whole-body CT to evaluate pulmonary embolism. (Source: Stuart E. Mirvis, M.D., chair of RSNA's subcommittee on emergency radiology, based on papers he reviewed for presentation at RSNA 2005.)
What's hot in the field of genitourinary radiology this year? Based on the abstracts submitted for consideration in RSNA 2005, it appears to be prostate disease imaging, fetal MR imaging and the use of MR for the evaluation of obstetric and gynecologic conditions. (Source: Philip Kenney, M.D., chair of RSNA's subcommittee on genitourinary radiology.)
Women residents considering specialties cited the following as barriers to a career choice in radiology: fear of radiation exposure, lack of accommodation for child-rearing, and the long length of training. (Abstract reviewed by Howard Forman, M.D., chair of RSNA's subcommittee on health services policy and research.)
Key trends in musculoskeletal radiology include: 1) the use of low-dose CT for the evaluation of spinal fractures; 2) whole-body CT to assess the extent of multiple myeloma; and 3) whole-body MR for the study of multiple myeloma, metastases and type I neurofibromatosis. (Source: Georges Y. El-Khoury, M.D., chair of RSNA's subcommittee on musculoskeletal radiology, based on a review of abstracts presented for RSNA 2005.)
Trends in pediatric radiology indicate a continued focus on techniques or technology to reduce radiation dose, an increase in pediatric cardiac imaging, and an increase in neuroradiology submissions. (Source: Donald Frush, M.D., chair of RSNA's subcommittee on pediatric radiology.)