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Saturday, June 09, 2012

A case of primitive trigeminal artery infarction

Posted by turbospinecho on June 4, 2012
Within minutes following an altercation with police, a 55-year-old man noted onset of speech difficulty and right-sided weakness without headache or neck pain. Dysarthria and right hemiparesis (grade 4/5) without ocular disturbance was found. Left ventral hemipontine infarction was documented from the ipsilateral tortuous primitive trigeminal artery (figure). Cerebral angiogram failed to reveal underlying arterial dissection.

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White arrow points to the primitive trigeminal artery (A–D). MRI, fluid-attenuated inversion recovery sequence, demonstrating the left ventral pontine infarction (A). Magnetic resonance angiography demonstrates proximal hypoplastic-stenotic vertebrobasilar system (B). Selective left internal carotid artery angiogram: lateral (C) and anteroposterior view (D) (same viewing angle as in B). Triangular arrowhead points to the left internal carotid artery (B–D).
Persistent anastomosis from a cavernous portion of internal cerebral artery to rostral basilar artery is unusual, with an estimated incidence of 0.2%.1 Although the artery has been implicated as a conduit of a carotid artery to posterior cerebral artery distribution embolic stroke,2 our case illustrates that localized occlusive process may also occur.

Monday, June 04, 2012

Saturday, June 02, 2012

What are the noises that M.R.I. machines make?

Q. What are the noises that M.R.I. machines make?
A. The banging is the vibration of metal coils in the machine caused by rapid pulses of electricity, said Dr. Keith Hentel, chief of emergency/musculoskeletal imaging at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Magnetic resonance imaging produces images of the body by causing shifts in a very strong magnetic field and measuring how tissues react, Dr. Hentel said. The principal magnet of an M.R.I. scanner commonly is strong enough to produce fields 60,000 times the strength of the earth’s natural magnetic field.
Inside the scanner are coils of metal wire called gradient coils. When electricity is passed through such a coil, a magnetic field is created. Rapid pulses of electricity cause predictable changes in the field, resulting in tissue changes that can be measured and transformed into anatomic images.
The pulses cause not just the desired changes but undesired vibrations of the gradient coils, resulting in the banging heard during an M.R.I. examination.
As stronger magnets result in stronger vibrations, the higher the field strength of the M.R.I. scanner, measured in teslas, the louder the banging, Dr. Hentel said.
In a three-tesla system, a strength common in clinical practice, he said, these sounds may be as loud as 125 decibels, equivalent to a rock concert or a balloon popping near the ear. That is why ear protection is recommended.

ViewRay™ MRI-guided radiation therapy system

ViewRay™ Incorporated, a privately held medical device company, has received U.S. FDA 510(k) premarket notification clearance for its MRI-guided radiation therapy system. The ViewRay system features a unique combination of radiotherapy delivery and simultaneous magnetic resonance imaging (MRI) for the treatment of cancer. ViewRay’s treatment planning and delivery software received 510(k) premarket notification clearance in 2011.
“FDA clearance of our integrated system is a major milestone in the development of our technology,” said ViewRay President and CEO Gregory M. Ayers, MD, PhD. “It has already been an exciting year for ViewRay, with an additional round of funding and the installation of our first research systems at major U.S. medical centers. Early clinical imaging studies have verified the quality of the system’s MR images, and now we’re looking forward to clinical applications.” The ViewRay system provides continuous soft-tissue imaging during treatment so that clinicians can see and record precisely where radiation therapy is being delivered, as it’s being delivered.ViewRay’s patented cancer treatment technology was invented by company founder James F. Dempsey, PhD, while he was a member of the radiation oncology faculty at the University of Florida. “ViewRay began with the idea that we need to see what exactly we’re doing when we treat cancer patients with radiation therapy,” said Dempsey, now ViewRay’s chief scientific officer. “Thanks to our clear vision, an outstanding engineering team, and dedicated leadership, we’re now able to bring that idea into the clinic, where it can help cancer patients.”
Potential clinical applications
ViewRay researchers are studying the motion of tumors in lung, prostate, liver, head and neck, and other types of cancer where MRI-guided radiotherapy could offer sophisticated treatments.

Tuesday, May 22, 2012

MRI database for medical implants

WebSites for Biomedical Companies
3M Healthcare -
AADCO Medical, Inc. -
Abbott Vascular Devices -
Acclarent, Inc. -
Advanced Bionics Corporation -
Advanced Neuromodulation Systems -
Aesculap, Inc. -
AGA Medical Corporation -
Alcon Laboratories Inc.-
Alcon Research, Ltd. -
Alphatec Spine -
Alveolus, Inc. -
Alsius Corporation -
Amerex Corporation -
Ampco Safety Tools -
American Medical Systems -
Angiodynamics, Inc. -
Animas Corporation -
Arbor Surgical Technologies, Inc. -
Applied Medical -
Aspire Medical -
AtriCure, Inc. -
Atritech, Inc. -
Atrium Medical Corporation -
ATS Medical -
B. Braun Medical Inc. -
Baxa Corporation -
Baxter International, Inc.
Becton, Dickinson, and Co. -
Berlex Laborotories -
Biomerix Corporation -
Biomet, Inc. -
Bioness, Inc. -
Bioplate, Inc. -
Biosensors International -
Biopsy Sciences -
Biotronik -
Blackstone Medical, Inc. -
Bolton Medical, Inc. -
Boston Scientific Corporation -
Bracco Diagnostics Inc. -
Bronchus Technologies, Inc. -
Calypso Medical Technologies -
Cardia, Inc. -
Cardica -
Cardiac Dimensions -
Cardinal Health -
CardioKinetix Inc. -
CardioMEMS, Inc. -
Cayanne Medical -
Coaxia, Inc. -
Codman, a Johnson and Johnson Company -
Coherex Medical-
Coloplast Corporation -
Conceptus Inc.-
Conor Medsystems -
ConvaTec Wound Therapeutics -
Cook, Inc. -
Cordis -
Cornova, Inc. -
C.R. Bard, Inc. -
Crux Biomedical, Inc. -
Cyberkinetics Neurotechnology Systems, Inc. -
Cyberonics, Inc. -
Datascope Corporation -
DePuy Products, Inc. -
DermaPort -
DeRoyal Technologies -
Devax, Inc. -
DexCom, Inc. –
Edwards Lifeciences -
Emphasys Medical Inc. -
Endologix, Inc. -
EndoMed, Inc. -
EnteroMedics, Inc. -
Endotex Interventional Systems, Inc. -
ev3, The Endovascular Company -
Ethicon Endo-Surgery -
Evalve, Inc. -
Ferno -
Finetech Medical Ltd. -
Hitachi Medical Systems America, Inc. -
Hollister -
HoverTech International -
Gendron, Inc. -
General Electric Healthcare -
Genstar Technologies -
GI Dynamics, Inc. -
Glaukos Corporation -
GrantAdler Corporation -
GT Urological -
Glaukos Corporation -
Gyrus -
Hollister Inc. -
Health Beacons Inc. -
Hisamitsu Pharmaceutical Co., Inc. -
Hitachi Medical Systems America – www.
Icon Interventional Systems, Inc. -
IDEV Technologies, Inc. -
I-Flow Corporation -
Impliant Ltd. -
INNERCOOL Therapies -
INRAD, Inc. -
InSound Medical -
Integra Lifesciences Corporation -
Interrad Medical, Inc. -
Intrinsic Therapeutics, Inc. -
Intuitive Surgical, Inc. -
Invatec -
JenaValve Technology -
Joint Replacement Instrumentation Limited (JRI Ltd.) -
Kaneka Corporation -
KCI USA, Inc. -
KFx Medical Corporation -
Kimberly-Clark Health Care -
Kips Bay Medical, Inc. -
LeMaitre Vascular -
LMA North America -
LSI Solutions, Inc. -
Magmedix -
Medcomp -
Medivance, Inc. -
Medline Industries, Inc. -
Medlogics -
Medtronic, Inc. -
Medtronic Xomed -
Mentor Corporation -
Micardia Corporation -
MicroVention -
Micrus Endovascular Corporation –
MiniMed, Inc. -
Minrad, Inc. -
Mylan Technologies Inc. -
Navotek Medical Ltd. -
NeuroVASx, Inc. -
Newmatic Sound Systems, Inc. -
Nfocus Neuromedical, Inc. -
NGK Metals Corporation -
NMT Medical, Inc. -
NuVasive, Inc. -
Optonol Ltd. -
OrbusNeich Medical, Inc. -
Orthofix -
Otto Bock HealthCare –
Paracor Medical, Inc. -
Percardia Inc. -
Phoenix Biomedical Corporation -
PMT Corporation -
Praxair Healthcare Services -
Prescient Medical -
ProStrakan -
Pulmonx -
Radianse, Inc. -
Rafael Medical Technologies, Inc. -
Rex Medical -
Rhythmlink International, LLC -
Rubicor Medical, Inc. -
SAM Medical Products -
Shelhigh Inc. -
Sicel Technologies, Inc. -
Siemens Medical Solutions -
Smith & Nephew, Inc. -
Smiths Medical -
Sorin Group -
Spiration Inc. -
St. Jude Medical, Inc. -
Stryker Instruments -
Sulzer Carbomedics, Inc. -
Teleflex Medical -
The Viking Corporation -
Theragenics Corporation -
Torax Medical -
TriVascular, Inc. -
Uromedica Inc. -
U.S. Surgical Corporation -
ValleyLab/Tyco -
Vascular Architects, Inc. -
Vascutek Ltd. -
VisionCare Ophthalmic Technologies Ltd. -
Vygon Ltd. -
Western Enterprises -
W.L. Gore and Associates, Inc. -
Wright Medical Technology -
Zimmer - 

3T Wide Bore: Today & Tomorrow, Dr. Meng Law

For more information visit us on the web at
3T Wide Bore: Today & Tomorrow
Meng Law, MD, FRACR
Prof. of Radiology & Neurological Surgery / Dir. of Neuroradiology
Keck School of Medicine, University of Southern California

MRI technology helps map human brain

BERKELEY, Calif. (KGO) – Researchers at the University of California are using a breakthrough technology to look at the human brain. It’s a new type of MRI and its producing images at speeds never before thought possible.
If MRI machines had wings, UC Berkeley physicist David Feinberg, Ph.D., would probably be crashing the sound barrier. As it is, he is creating images of the brain at speeds up to 30 times faster than even the most advanced research MRIs.
“When we made the first images, it was unbelievably fast,” said Feinberg. “That’s the scan, because the images are obtained simultaneously.”
He says the acceleration is the result of a breakthrough devised in a collaboration led by the University of Minnesota. It combines multiple radio frequency pulses to image different parts of the brain simultaneously. The signals are separated out by multiple receivers which measure the location and timing, producing a much faster scan.
“We used to be able to scan the brain the very fastest, with the echoplane imaging, in two to three seconds and now we’re able to image in 100 to 300 milliseconds,” said Feinberg.
With its leap in speed, researchers now believe the accelerated MRI could have an immediate impact on the most ambitious project ever undertaken to study the human brain.
It’s dubbed the Human Connectome Project. Researchers at centers around the country are attempting to map the neural pathways that support human brain function, ultimately drawing a map of the brain’s communication network.
“We’re able to identify the networks much better and see more of them and more accurately,” said Feinberg.
And by understanding the pathways of a normal brain, researchers believe they may unearth clues to disorders ranging from autism to Alzheimer’s disease — a quest that’s now being accelerated by this new generation of MRI.
Written and produced by Tim Didion

Saturday, February 18, 2012

Massive Medicare Reduction delayed forever by offsets from the Iraq War.

The direct cost of the Iraq War = $800 billion - $312 billion for 10 years of medicare payment adjustments. 

This will leave $488 billion left to spend. We can use that in other areas like Education.

WASHINGTON (MarketWatch) — The nine-year-old Iraq war came to an official end on Thursday, but paying for it will continue for decades until U.S. taxpayers have shelled out an estimated $4 trillion.
Over a 50-year period, that comes to $80 billion annually.
Although that only represents about 1% of nation’s gross domestic product, it’s more than half of the national budget deficit. It’s also roughly equal to what the U.S. spends on the Department of Justice, Homeland Security and the Environmental Protection Agency combined each year.
Near the start of the war, the U.S. Defense Department estimated it would cost $50 billion to $80 billion. White House economic adviser Lawrence Lindsey was dismissed in 2002 after suggesting the price of invading and occupying Iraq could reach $200 billion.
“The direct costs for the war were about $800 billion, but the indirect costs, the costs you can’t easily see, that payoff will outlast you and me,” said Lawrence Korb, a senior fellow at American Progress, a Washington, D.C. think tank, and a former assistant secretary of defense under Ronald Reagan.Source

According to the National Education Association's projections, the triggered cuts would hurt students who need the most help: School Improvement Grants that help failing schools are slated to lose $41.7 million. Head Start pre-school programs, which would be cut by $589.7 billion, primarily serve low-income families. All Department of Education programs -- except for Pell Grants, which are exempt -- would take a hit.source
February 17, 2012 — By a vote of 293 to 132, the US House of Representatives today approved legislation that delays a massive reduction in Medicare pay to physicians from March 1 to January 1, 2013. The Senate is expected to take up the bill and pass it as early as this afternoon.
In addition to averting the 27.4% Medicare pay cut set for March 1, the bill also extends a temporary cut to the Social Security payroll tax paid by workers through 2012 and continues unemployment compensation benefits for the long-term jobless.
The latest "doc fix" for the Medicare reimbursement crisis seems to leave everyone unhappy, especially physicians.
Rep. Phil Gingrey
Rep. Phil Gingrey, MD (R-GA), cochair of the GOP Doctors Caucus in the House, said he had to "hold his nose" to support the bill.
"It's just woefully inadequate," Dr. Gingrey told Medscape Medical News. "We're just delaying the inevitable."
Dr. Gingrey, along with organized medicine, said Congress should have ended the crisis for good by permanently repealing Medicare's sustainable growth rate (SGR) formula for calculating physician reimbursement — the reason for the looming pay cut. In lieu of a permanent fix, Dr. Gingrey and others had hoped that Congress would delay the cut for at least 2 years, as opposed to settling for a 10-month "patch."
Instead, Congress will have to return to the SGR issue later this year to avert an even larger Medicare pay cut, estimated to top 30%, on January 1, 2013. Dr. Gingrey does not expect lawmakers to muster enough gumption to repeal the SGR in an election year, or in a lame-duck Congress following the November 6 general election.
"I don't think that will happen," he said. "We'll have a very full plate during the lame-duck session, and we'll probably spend 5 or 6 weeks after the election trying to once again get past December 31 [with] another patch."
"I'm almost bitterly disappointed."
The American Medical Association (AMA) and other medical societies all chose the expression "deeply disappointed" in their responses to the bill passed by the House today. "Congress had an opportunity to permanently end this problem, which is the sound, fiscally prudent policy choice," said AMA President Peter Carmel, MD.
Dr. Carmel and others warn that postponing a repeal of the SGR formula only makes it more expensive. Earlier this year, the Congressional Budget Office (CBO) estimated that eliminating the formula and freezing Medicare rates for 10 years would cost $316 billion. Delaying repeal for another 10 months would add some $25 billion to the tab, according to Dr. Carmel.
Controversial Offsets Affect Hospitals, Public Health
Another reason why today's House bill has left a bad taste in people's mouths is how it is paid for.
According the CBO, the cost of delaying the scheduled Medicare pay cut for 10 months is $18 billion. To help offset this and other expenditures in the bill, lawmakers reduced federal payments to hospitals. Under the bill, over the course of 11 years they would receive $7 billion less in Medicare funds that make up for unpaid deductibles and copayments owed by patients. Hospitals that serve a disproportionate number of low-income patients also would receive $4.1 billion less in Medicaid payments.
Not surprisingly, the American Hospital Association has registered its protest.
"While we support ensuring that physicians will not see their Medicare payments reduced, we are extremely disappointed that once again Congress is putting senior's access to hospital services in jeopardy through arbitrary reductions to hospitals," said AHA President and Chief Executive Officer Rich Umbdenstock.
Another controversial offset in the bill is a $5 billion reduction over 11 years for the Prevention and Public Health Fund created by the Affordable Care Act. Republican lawmakers believe the fund gives the US Department of Health and Human Services freedom to spend large sums without Congressional oversight.
The Association of State and Territorial Health Officials (ASTHO) calls this budget call short-sighted.
"Unless we control the costs of healthcare through proven public health prevention programs, which result in a healthier and more productive workforce, we will not lessen the burden of health care costs on our nation's economy," ASTHO stated in a press release.Source

Economy causing more MRI accidents?

Insurers, the organizations that pay for the vast majority of MRI exams in the US, have been incrementally cutting the prices that they’ll pay hospitals and imaging centers for MRI studies. To a degree, this has been in response to ever-growing MRI scan volumes, which have lead to some economies of scale. A few years ago, Medicare / Medicaid switched from taking incremental nibbles off of the reimbursement rate, to lopping off a huge chunk with the budgetary equivalent of a machete, called the Deficit Reduction Act (DRA). Many commercial insurers followed suit.
The accumulated reimbursement cuts from the whole cadre of insurers has taken years following the initial enactment of the DRA to reach its full effect, just in time for the bottom to drop out of the broader economy. Now MRI providers are not only getting paid less for each exam, with many patients having to fork-over a 20% copay for the cost of their MRI exam, the number of patients walking in the door has also dropped.
A trend that began with the enactment of the DRA a few years ago may actually be building momentum, namely cutting staff, or cutting staff qualifications, to reduce the operating expenses of an MRI operation. Source

These reductions may be the worst thing for any hospital or outpatient center. Your greatest asset is The MRI technologist. The technologist understands MRI Safety at a level unparalleled to any one else in the diagnostic imaging environment.  As the level of training decreases of staff the level of MRI safety accidents will continue to rise inversely proportionally. This is exactly why there has been a 277%  rise in reported accidents.
This may seem a little over-simplified evaluation of a very complicated matter. However, the economy does correlate to the dramatic rise in MRI safety accidents. I can only put the pieces together. If cut backs are hurting health care at the patient level, where safety is concerned it is time to step in and make some drastic changes. Please let me know how you feel about this……

Wednesday, February 01, 2012

PET Effectively Detects Dementia Following A Decade Of Research

In a new review of imaging studies spanning more than ten years, scientists find that a method of positron emission tomography (PET) safely and accurately detectsdementia, including the most common and devastating form among the elderly, Alzheimer's disease. This research is featured in the January issue of The Journal of Nuclear Medicine

Researchers reviewed numerous PET studies to evaluate a molecular imaging technique that combines PET, which provides functional images of biological processes, with an injected biomarker called 18F-FDG to pinpoint key areas of metabolic decline in the brain indicating dementia. Having physiological evidence of neurodegenerative disease by imaging patients with PET could give clinicians the information they need to make more accurate diagnoses earlier than ever before. 

"The new data support the role of 18F-FDG PET as an effective addition to other diagnostic methods used to assess patients with symptoms of dementia," says Nicolaas Bohnen, MD, PhD, lead author of the study and professor of radiology and neurology at the University of Michigan, Ann Arbor, Mich. "The review also identified new literature showing the benefit of this imaging technique for not only helping to diagnose dementia but also for improving physician confidence when diagnosing a patient with dementia. This process can be difficult for physicians, especially when evaluating younger patients or those who have subtle signs of disease." 

Dementia is not a specific illness but a pattern of symptoms characterized by a loss of cognitive ability. These disorders can be caused by injury or progressive disease affecting areas of the brain that control attention, memory, language and mobility. While Alzheimer's is most commonly associated with progressive memory impairment, dementia with Lewy bodies, another form of the disease, can be associated with symptoms of Parkinson's and prominent hallucinations, while another disorder, called frontotemporal dementia, can be seen in patients showing uncharacteristic personality changes and difficulties in relating and communicating. Physicians can use FDG-PET with high accuracy to not only help diagnose dementia but also differentiate between the individual disorders. The role molecular imaging plays in the diagnosis of dementia has expanded enough that the official criteria physicians use to diagnose patients now includes evidence from molecular imaging studies. 

"For the first time, imaging biomarkers of Alzheimer's disease are included in the newly revised clinical diagnostic criteria for the disease," says Bohnen. "This is a major shift in disease definition, as previously an Alzheimer's diagnosis was based mainly on a process of evaluating patients to exclude possible trauma, hemorrhage, tumor or metabolic disorder. Now it is becoming a process of inclusion based on biomarker evidence from molecular imaging." 

The PET biomarker 18F-FDG comprises a radionuclide combined with fluorodeoxyglucose (FDG), which mimics glucose in the body. Cells metabolize FDG as fuel, and the variation in this uptake by cells throughout the body can then be imaged to detect a range of abnormalities. In the case of dementia, marked reductions in the metabolism of different lobes of the cerebral cortex can confirm a patient's disorder. Physicians can tell Alzheimer's disease apart from other dementias, depending on the specific cortices affected. 

This review presents the most up-to-date and salient evidence of FDG-PET's usefulness for the evaluation of patients with suspected dementia. The objective of the study was to replace prior retrospective reviews that were performed as the technique was just emerging and that suggested methodological improvements. The new review includes studies with better methodology, including confirmation of diagnoses with autopsy, more expansive recruitment of subjects and use of multi-center studies. After reviewing 11 studies that occurred since the year 2000 and that met more stringent study review standards, researchers conclude that 18F-FDG is highly effective for detecting the presence and type of dementia. 

"Using 18F-FDG PET in the evaluation of patients with dementia can improve diagnostic accuracy and lead to earlier treatment and better patient care," says Bohnen. "The earlier we make a diagnosis, the more we can alleviate uncertainty and suffering for patients and their families." 

The biomarker 18F-FDG is among a variety of imaging agents being investigated for its efficacy in Alzheimer's imaging. As treatments for dementia become available for clinical use, PET will no doubt play an important role in not only the diagnosis of these diseases, but also the assessment and monitoring of future therapies. 

According to the World Health Organization, an estimated 18 million people worldwide are currently living with Alzheimer disease. That number is projected to almost double by 2025. 



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