DT-MRI Offers Expanding Potential in Research and Diagnosis · 2012-03-05 · NOVEMBER2002 VOLUME 12, NUMBER 11 December 1-6 • Chicago RSNA 2002 THE NEWSLETTER OF THERADIOLOGICAL

NOVE M B E R 2002 ■ VO LU M E 12, NU M B ER 11

RSNA 2002

December 1-6 • Chicago

T H E N E W S L E T T E R O F T H E R A D I O L O G I C A L S O C I E T Y O F N O R T H A M E R I C A

DT-MRI Offers Expanding Potential in Research and Diagnosis

Also Inside:■ Breast Density Best Predictor of Mammographic Sensitivity■ Many Unanswered Questions Remain in Debate Over Full-Body CT■ RSNA Fellow Bridges Gap Between Laboratory and Clinic■ IHE: Making Workflow Work for You■ Internet for You—Part 7

NOV E M B E R 2002

RSNA NewsThe newsletter of the Radiological Societyof North America

November 2002 • Volume 12, Number 11

Published monthly by the Radiological Societyof North America, Inc., at 820 Jorie Blvd., Oak Brook, IL 60523-2251. Printed in the USA.

Periodical postage pending mailing withpostage in Oak Brook, IL 60523, and additionalmailing offices. POSTMASTER: Send address correction “changes” to: RSNA News, 820 JorieBlvd., Oak Brook, IL 60523-2251.

Nonmember subscription rate is $20 per year;$10 of active members’ dues is allocated to asubscription of RSNA News.

Contents of RSNA News copyrighted ©2002 bythe Radiological Society of North America, Inc.

E X E C U T I V E E D I T O RJoseph Taylor

M A N A G I N G E D I T O RNatalie Olinger Boden

C O N T R I B U T I N G E D I T O RRobert E. Campbell, M.D.

E D I T O R I A L B O A R DSusan D. Wall, M.D.

ChairLawrence W. Bassett, M.D.Richard H. Cohan, M.D.Nancy A. Ellerbroek, M.D.David S. Hartman, M.D.C. Leon Partain, M.D., Ph.D.William T.C. Yuh, M.D., M.S.E.E.R. Gilbert Jost, M.D.

Board Liaison

C O N T R I B U T I N G W R I T E R SBruce K. DixonAmy Jenkins, M.S.C.Mary Beth Nierengarten, M.A.Mary E. NovakKen SchulzeMarilyn Idelman Soglin

G R A P H I C D E S I G N E RAdam Indyk

A D V I S O R SDave Fellers, C.A.E.

Executive Director

Roberta E. Arnold, M.A., M.H.P.E.Assistant Executive DirectorPublications and Communications

R S N A 2 0 0 2 B O A R D O F D I R E C T O R S Brian C. Lentle, M.D.

Chairman

David H. Hussey, M.D. Secretary-Treasurer

Robert R. Hattery, M.D.Liaison for Publications and Educational Materials

R. Gilbert Jost, M.D.Liaison for Communications and Corporate Relations

Theresa C. McLoud, M.D.Liaison for Education

Gary J. Becker, M.D.Secretary-Treasurer-designate

R. Nick Bryan, M.D., Ph.D.President

Peggy J. Fritzsche, M.D.President-elect

Letters to the Editor:E-mail: [email protected]: (630) 571-7837RSNA News820 Jorie Blvd.Oak Brook, IL 60523

SubscriptionsPhone: (630) 571-7873 E-mail: [email protected]

Reprints and PermissionsPhone: (630) 571-7829Fax: (630) 590-7724E-mail: [email protected]

AdvertisingPhone: (630) 571-7819E-mail: [email protected]/advertising/ratecardrsnanews.html

1 People in the News2 Announcements3 Letter to the Editor4 2002 RSNA Board of Directors Report5 RSNA 2002 Lecture/Oration Preview

Feature Articles 6 Breast Density Best Predictor of Mammographic

Sensitivity 8 Many Unanswered Questions Remain in Debate

Over Full-Body CT11 DT-MRI Offers Expanding Potential in Research

and Diagnosis13 IHE: Making Workflow Work for You14 Densitometry Courses and Certification Offered

Immediately Following RSNA 200215 Internet for You—Part 7

Funding Radiology’s Future19 RSNA Fellow Bridges Gap Between Laboratory

and Clinic20 Research and Education Foundation Donors21 Program and Grant Announcements

10 Radiology in Public Focus21 Working for You23 Meeting Watch23 Exhibitor News25 www.rsna.org

1R S N A N E W SR S N A N E W S . O R G

PEOPLE IN THE NEWS

Dean First NIBIB Deputy DirectorDonna J. Dean, Ph.D., has been nameddeputy director of the National Institute ofBiomedical Imaging and Bioengineering(NIBIB). She had been acting director ofthe one-year old institute.

“Dr. Dean took on a difficult job and hasperformed it remarkably well,” said NIBIBDirector Roderic I. Pettigrew, M.D., Ph.D.“The Institute is now on solid organization-al, administrative, scientific and fiscal footing. She has interactedwell with the extramural community and has been invaluable to me.… As deputy director, she will continue to provide the needed conti-nuity and critical support in achieving the institutes’ mission.”

Caramella New President ofEuroPACS SocietyDavide Caramella, M.D., associate profes-sor of radiology at the University of Pisa inItaly, has been elected president of theEuroPACS Society. For the next three years,he will lead EuroPACS—one of the oldestscientific societies in the field of picturearchiving and communication systems—striving to maintain its tradition to promoteresearch and foster discussion about thetechnological evolution as well as the experiences in clinical imple-mentation and evaluation of PACS in Europe and worldwide.

Amis New ACR ChairE. Stephen Amis Jr., M.D., is the newchairman of the Board of Chancellorsfor the American College of Radiology.He assumed his new post in October.Dr. Amis is also professor and chair-man of the Department of Radiology atAlbert Einstein College of Medicineand Montefiore Medical Center in theBronx.

Singleton Earns Distin-guished Faculty Award1995 RSNA Gold MedallistEdward B. Singleton, M.D., hasreceived the 2002 DistinguishedFaculty Award from Baylor Col-lege of Medicine in Houston,Texas. Dr. Singleton is the pro-fessor emeritus of radiology atBaylor and the emeritus chief ofradiology at Texas Children’sHospital. He has been a memberof RSNA since 1957.

Newman to be Featured InflightDonna Newman, B.A., R.T.(R),CNMT, president of the AmericanSociety of Radiologic Technologists, isfeatured this month as part of a specialaudio program that will be broadcast on23,000 flights for American Airlinesand Northwest Airlines. During the pro-gram, “Answering America’s Call:Associations at Work,” Newman dis-cusses issues affecting the RT profes-sion, including the personnel shortageand the Consumer Assurance Radiolog-ic Excellence bill. “I’m excited to beable to deliver ASRT’s message to such a large audi-ence,” she says. “This program is a great opportunityto educate people about the profession of radiologictechnology and the role of radiologic technologists.”

Davide Caramella, M.D.

E. Stephen Amis Jr., M.D.

Donna J. Dean, Ph.D.

Donna Newman, B.A., R.T.(R), CNMT

John Rong, Ph.D.

Benjamin W. Zeff, Ph.D.

AAPM ResidencyProgram AwardsThe residency program inMedical Physics at theUniversity of Alabama atBirmingham and at theUniversity of Texas M.D.Anderson Cancer Centerhave each earned a two-year grant from theAmerican Association ofPhysicists in Medicine (AAPM) in support of diag-nostic medical physics. The grants, sponsored bythe RSNA Research and Education Foundation,provide $18,000 per year for two years.

At UAB, Michael Yester, Ph.D., is the super-visor; Benjamin W. Zeff, Ph.D., is the resident. AtM.D. Anderson, the supervisor is John Hazle,Ph.D.; the resident is John Rong, Ph.D.

Michael Yester, Ph.D.Edward B. Singleton, M.D.

Send your submissions for People in theNews to [email protected], (630) 571-

7837 fax, or RSNA News, 820 Jorie Blvd., Oak Brook, IL 60523.Please include your full name and telephone number. You may alsoinclude a non-returnable color photo, 3x5 or larger, or electronic pho-to in high-resolution (300 dpi or higher) TIFF or JPEG format (notembedded in a document). RSNA News maintains the right to acceptinformation for print based on membership status, newsworthinessand available print space.

2 R S N A N E W S N O V E M B E R 2 0 0 2

RSNA 2002will featureoutstandingand award-winning papers

from three related societies: theAmerican Society of Neuroradi-ology (ASNR), the AmericanSociety for Therapeutic Radiolo-gy and Oncology (ASTRO), andthe Society of InterventionalRadiology (SIR).

The RSNA 2002 Scientific Program will include:

Monday, December 2 4:00–5:30 p.m.ASNR Invited Papers 7 papersASTRO Invited Papers 10 papers

Wednesday, December 4 4:00–5:30 p.m.Call Me SIR: Highlights from 6 papersthe 2002 Scientific Program

See your RSNA 2002 Scientific Program formore detailed information on the individual papersand their authors.

Electronic Walks Through the WeekDownload RSNA 2002 course information bysubspecialty at www.rsna.org/rsna/walks/index.html. These electronic Walks Through theWeek replace the previous paper brochures.These pages and portable document formatfiles will also be available at the ScientificAssembly via RSNA Link Onsite.

Residents’ Reception at RSNA 2002Residents are invited to attend a special RSNA2002 Residents’ Reception on Monday, Decem-ber 2, from 4:00 p.m. to 5:00 p.m. in theRegency Ballroom of the Hyatt McCormickPlace.

RSNA President R. Nick Bryan, M.D.,Ph.D., will greet the residents. Complimentarybeverages and light snacks will be served.

Residents’ LoungeRSNA Members-in-Training and non-member residents are invited to visitthe Residents’ Lounge, located in theLakeside Center Ballroom, duringRSNA 2002. The lounge provides aplace to relax and network with col-leagues while enjoying complimentaryrefreshments. Complimentary issues ofRadiology, RadioGraphics, RSNA Newsand the 2002 Education Center Cata-log will be available.

Residents’ LoungeLakeside Center BallroomSunday, Dec. 1 – Thursday, Dec. 58:00 a.m. – 5:30 p.m.

Education Center Storeat RSNA 2002This year, the Edu-cation Center Storewill be located inLakeside Center atMcCormick Place.RSNA 2002 atten-dees will be ablepurchase printed syllabi, the 2002RSNA Scientific Program, patienteducation brochures, and refreshercourses on videocassettes andslides/audiocassettes. In addition,Internet access to view RSNA edu-cational programs will be available.

Hours of Operation: Sat., Nov. 30 12:00 p.m. – 6:00 p.m.Sun., Dec. 1 7:00 a.m. – 6:00 p.m.Mon., Dec. 2 – Thur., Dec. 5 7:30 a.m. – 6:00 p.m.Fri., Dec. 6 7:30 a.m. – 1:00 p.m.

ANNOUNCEMENTS

RSNA CME Credit RepositoryUpdateSince its inception last May, RSNA’s onlineCME Credit Repository (www.rsna.org/cme)has generated strong interest. As of August 30,2,612 credits have been deposited. Amongthose, 1,956 were awarded by RSNA.

Members are able to view and print a cer-tificate of all of their credits stored in theCME Credit Repository. These printed certifi-cates may be used as the proof necessary forrelicensure or for hospital privileges.

A printable cumulative record of RSNA-earned credits includes the RSNA Accredita-tion Statement and signature of the RSNASecretary-Treasurer.

Medical Liability StudyRSNA is cooperating with theAmerican Medical Associationand the American College ofRadiology to conduct a studyto determine physicians’ recentexperiences with the profes-sional liability system. Thestudy findings will be used inefforts to achieve reform of theliability system.

A random sample of physi-cians was sent a postcard or e-mail message in late Septem-ber asking for theirparticipation.

Outstanding and Award-winning Papers at RSNA 2002


ANNOUNCEMENTS

Report on Quality Control in Diagnostic RadiologyThe American Association of Physicists in Medicine hasreleased a report on Quality Control in Diagnostic Radiology.The report is available to AAPM members as a PDF file atwww.aapm.org/pubs/reports/. Scroll down to report number 74.It is also available for purchase from Medical Physics Publish-ing at www.medicalphysics.org or (800) 442-5778.

To the Editor:As discussed in a recent RSNA News article (September2002), a patient’s place of origin or of residence is cer-tainly relevant to a thorough evaluation of the differen-tial diagnosis of his or her condition. However, two ofthe techniques suggested may be imperfect in determin-ing a patient’s place of origin.

In the United States, with many citizens being sever-al generations removed from their immigrant ancestorsand now having mixed ethnic origins, and with the com-mon practice of wives taking husband’s surnames, a patient’s last name may be aclue to only one of the many ancestral lands of the patient, or of her biologicallyunrelated husband.

I was also surprised by Dr. Wall’s sidebar article on the geographic assignmentof Society Security numbers. I have never lived west of Missouri, and have spentmost of my life on the East coast. Both my own and my brother’s Social Securitynumbers, issued while we were growing up in Florida, begin with a 5. Thus, theSocial Security number too is likely an imperfect clue to a patient’s origins.

As always, an interview of an available and competent patient provides themost complete clinical history.

Sincerely,DAVID L. LERNER, M.D.CLINICAL ASSISTANT PROFESSOR OF RADIOLOGY

MOUNT SINAI SCHOOL OF MEDICINE, NEW YORK

MORE CLARIFICATION ON THESOCIAL SECURITY NUMBER

What Does Your NumberMean?The nine-digit Social Security number isdivided into three parts:• The first three digits are the area number.

If your Social Security number wasassigned before 1972 when Social Securi-ty cards were issued by local offices, thearea number reflects the State where youapplied for your number. If your numberwas assigned in 1972 or later when webegan issuing Social Security cards cen-trally, the area number reflects the Stateas determined by the ZIP code in themailing address on your application forthe number.

• The middle two digits are the groupnumber. They have no special geographicor data significance but merely serve tobreak the number into conveniently sizedblocks for orderly issuance.

• The last four digits are serial numbers.They represent a straight numericalsequence of digits from 0001-9999 with-in the group.

Source: Social Security Administration

LETTER TO THE EDITOR

Send your Letters to the Editor to rsnanews@ rsna.org, (630) 571-7837 fax,or RSNA News, 820 Jorie Blvd., Oak Brook, IL 60523. Please include your

full name and telephone number. RSNA News maintains the right to accept information for printbased on membership status, newsworthiness and available print space.

Consensus Paper on Fusion Imaging TechnologistsThe Society of Nuclear Medicine Tech-nologist Section (SNMTS) and the Amer-ican Society of Radiologic Technologists(ASRT) have developed a consensuspaper concerning the education, qualifica-tions and regulations of personnel whooperate hybrid imaging equipment suchas PET-CT or SPECT-CT.

The groups determined that any regis-tered nuclear medicine technologist, radi-ographer or radiation therapist would becapable of performing the examinationswith appropriate additional education.

The full text of the consensus paper isavailable at https://www.asrt.org/asrt.htm.

2002 Nicholas E. DaviesAward AnnouncedThe Healthcare Information andManagement Systems Society(HIMSS) has presented the 2002Nicholas E. Davies award to Mai-monides Medical Center andQueens Health Network, both inNew York. “We are happy to rec-ognize two organizations that havedone an outstanding job imple-menting electronic medical recordsystems and have used them tobring value to their patients andstaff,” says Tom Payne, M.D.,chair of this year’s award commit-tee. The winners will be formallyrecognized at the 2003 HIMSSAnnual Conference and ExhibitionAwards Banquet in February.


At the September meeting of theRSNA Board of Directors in Chicago,Board members reviewed the goals andobjectives of the Society and definedthe assessment of progress in theachievement of objectives. Amongthose areas receiving the most attentionwere the RSNA Scientific Assembly,the RSNA Research and EducationFoundation and member benefits.

RSNA 2002To improve the “user friendliness” ofthe annual meeting, a series of focusgroups will meet during RSNA 2002 tohelp the Society evaluate attendees’experience of the meeting. Twelve to15 small groups will gather to discussvarious aspects of the meeting includ-ing courses, publications, registration,transportation and other logistics.

Member suggestions that will beimplemented this year include a secondscreen in classrooms in which audienceresponse is part of the curriculum.Questions will be displayed on onescreen while images are displayed onthe second. In addition, a video displayscreen will be available during the newEssentials of Radiology course.Because each of the eight sessions isnear or at the 1,100-seat capacity, thevideo display screen will give allcourse attendees a close-up view of theinstructors.

This year, some refresher coursefaculty received formal training in cur-riculum design and in conducting inter-active sessions. The training sessionwas so enthusiastically received thatthe Board has decided to extend train-ing to other faculty in the future.

In 2003, refresher courses will be

added to help peopleprepare for mainte-nance of certificationexaminations and cer-tificates of addedqualifications.

RSNA Research & Education Foundation“Funding Radiology’sFuture”—the newtheme of the Research& Education Founda-tion—points to thecritical need for fund-ing to ensure that radi-ology remains at theforefront of medicine.The research conduct-ed today is the basis for tomorrow’spractice.

Because of the volatile world eco-nomic situation, the Board has agreedto several recommendations by theR&E Board of Trustees to help encour-age contributions to the Foundation sothat it can continue to support the workof young investigators and ultimately,the fields of radiology, radiation oncol-ogy and the allied sciences.• The RSNA President’s Circle will

now include members who havedonated $1,500 or more in one year.

• The Foundation will unveil at RSNA2002 a new corporate giving pro-gram, called the “Exhibitor’s Circle,”that will encourage small- and mid-size companies to make an annualcontribution to the Foundation.

• Because the mission of the Academyof Radiology Research is the “identi-fication of sources of support forradiology research and the use of that

research to improvethe knowledge base,educational pro-grams and patientcare activities ofradiology,” RSNAand the Foundationwill continue to eachmaintain member-ship in ARR; how-ever, RSNA will paythe cost of the Foun-dation membershipand thus preservemore resources tosupport research.

Member BenefitsThe Board of Direc-

tors is exploring ways to increase thebenefits of RSNA membership. Itemsunder consideration include an RSNAmember discount with various medicaltextbook publishers, a package of edu-cational materials that will help mem-bers prepare for their maintenance ofcertification examinations, and expan-sion of popular courses to outside theannual meeting.

Relationships with Academic SocietiesAn RSNA Task Force on AcademicRadiology has been formed to discussthe relationship between RSNA andacademic radiology. Task Force mem-bers will meet with the Association ofUniversity Radiologists, the Society ofChairmen of Academic RadiologyDepartments and the Association ofProgram Directors in Radiology. Someof the issues the task force will discussare whether RSNA should continue

“A year of consistent improvement” may be one way to describe 2002 for RSNA. LastFebruary, the Board of Directors approved a strategic plan for the Society. The plan isdesigned to make RSNA more effective in meeting the needs of its membership andthe radiologic community at large. It is also intended to make the best possible use ofRSNA’s resources, both financial and human.

RSNA Board of Directors Report

RSNA:NEWS

Brian C. Lentle, M.D.Chairman, 2002 RSNA Board ofDirectors

Continued on page 18


FEATURE:RSNA 2002

Eugene P. Pendergrass New Horizons Lecture Bruce R. Rosen, M.D., Ph.D., an inter-national leader in the development andutilization of physiological and func-tional magnetic resonance imaging(fMRI) techniques, will present the NewHorizons Lecture on “Functional Imag-ing of the Brain in Space and Time.”

The last decade has witnessed anexplosion in the ability to study theworkings of the brain. Dr. Rosen willdiscuss the history of functional imag-ing using magnetic resonance and willpresent today’s latest technologicaladvances in functional MR imaging ofthe brain.

The lecture will also cover newtechnologies such as direct tomograph-ic imaging with light and novel meansto combine MR imaging with electro-magnetic recordings acquired withEEG and its magnetic cousin, MEG(magnetoencepholography). These newtechnologies will extend the ability tocapture views of brain function in “realtime” and in all populations, and ulti-mately will allow direct testing of newcomputational and physical models ofhow the brain works, grows, and is per-turbed in disease.

Dr. Rosen’s current research infMRI technique development includesthe measurement of the physiologicaland metabolic changes associated withbrain activation and cerebrovascularinsult. Dr. Rosen’s research alsoaddresses how functional imaging toolscan be applied to solve specific biologi-cal and clinical problems.

Dr. Rosen is a professor of radiolo-gy at the Harvard Medical School inBoston and director of the Athinoula A.Martinos Center for Biomedical Imag-ing at Massachusetts General Hospital,the Massachusetts Institute of Technol-ogy and Harvard Medical School.

Annual Oration in Diagnostic RadiologyValerie P. Jackson, M.D., a distin-guished scholar, popular instructor andnoted authority in diagnostic radiologyand particularly women’s imaging, willdeliver the 2002 Annual Oration inDiagnostic Radiology titled, “ScreeningMammography: Controversies andHeadlines.”

There has been agreat deal of contro-versy regarding theefficacy of screeningmammography. Thedebate has intensifiedfollowing two recentarticles by a pair ofDanish researcherswho concluded thatmammography isineffective in reducing breast cancermortality. However, most major ran-domized clinical trials have found astatistically significant decrease inbreast cancer mortality from mammog-raphy. This presentation will review thedata, the criticism, the cost of thedebate and potential future breast can-cer screening modalities.

Dr. Jackson is the John A. Camp-bell Professor of Radiology at IndianaUniversity School of Medicine in Indi-anapolis. She is also on staff at six areahospitals.

Annual Oration in Radiation OncologyInternationally respected cancerresearcher, C. Norman Coleman, M.D.,will present this year’s Annual Orationin Radiation Oncology on “LinkingRadiation Oncology and ImagingThrough Molecular Biology.”

The era of molecular medicine istransforming the practice of medicine,providing new insights that will have amajor impact on disease treatment and

prevention. The “technologically ori-ented” disciplines will be presentedwith new challenges and opportunitiesto adapt or, preferably, to lead in newdirections. Among the extraordinaryopportunities are cancer imaging,defining the signature of cancer cells,and molecular targets of prevention and

treatment. The new paradigms of “cre-dentialing” and “focused biology” haveshown that imaging and therapy arelinked by molecular biology—provid-ing an important reason for diagnosis,therapy and nuclear medicine to devel-op new research, training and educationagendas building on each other’sexpertise.

Dr. Coleman wears many hats atthe National Cancer Institute (NCI) inBethesda. He is the creator and directorof the Radiation Oncology SciencesProgram, which coordinates all radia-tion oncology activities at NCI. He isalso deputy director of the Center forCancer Research, chief of the RadiationOncology Branch of the Center forCancer Research, associate director ofthe Radiation Research Program in theDivision of Cancer Treatment andDiagnosis, and special advisor forRadiation Sciences to the director ofNCI. ■■

Lecture/Oration PreviewsThree respected leaders will deliver the honored lectures at RSNA 2002. They are Bruce R. Rosen, M.D., Ph.D., Valerie P. Jackson, M.D., and C. Norman Coleman, M.D.

Bruce R. Rosen, M.D.,Ph.D.

Valerie P. Jackson,M.D.

C. Norman Coleman,M.D.


FEATURE:RADIOLOGY

Breast Density Best Predictorof Mammographic Sensitivity

Breast density, rather than awoman’s age or hormonal status,is the best predictor of mammo-

graphic sensitivity, according to a studypublished in the October issue of Radi-ology,1 which corroborates previouslypublished research. The new study, byThomas M. Kolb, M.D., a private prac-titioner from New York City, and col-leagues also suggests that in womenwith dense breasts, an ultrasound

examination will show asignificant number oftumors that screeningmammography will not.

The researchersevaluated 27,825 con-secutive screening ses-sions that includedmammography and sub-sequent physical exami-

nation in 11,130 asymptomatic patients.If the patients were determined to havedense breasts, they also had completebilateral screening breast ultrasound.The examiner had knowledge of theprior screening results. All three exami-nations were performed during a singlevisit by a single examiner. Eachpatient’s age, hormonal status and riskfactors were recorded.

The American College of Radiologyhas developed a four-level grading sys-tem to subjectively categorize breastdensity on a scale of 1 (fatty) to 4(most dense). “We previously reportedfinding dense breasts in two thirds ofpremenopausal women, 25 percent ofpostmenopausal women not taking hor-mones and 50 percent of post-menopausal women taking hormones.”In this study, the dense breast cohortwas 49 percent of the entire patientpopulation and included all patientswith density grades 2-4.

The calculated sensitivityof mammography for allwomen studied was 77 per-cent, which Dr. Kolb says is anoverly simplistic way ofreporting performance becausesensitivity significantly variesin different subpopulations ofwomen.

“We found that density isthe single most important pre-dictor of mammographic sensi-tivity. Age was a less impor-tant predictor, and as breastdensity increases, mammo-graphic sensitivity significant-ly decreases,” says Dr. Kolb.“In those women with fattybreasts, mammography failedto show only two percent of breast can-cer. But in women with the densestbreasts, mammography failed to showover 52 percent of all cancer.”

He adds that, “Since there are largenumbers of women, predominantlyyoung and premenopausal with densebreasts, the impact of this low sensitivi-ty is very large. Interms of mammo-graphic sensitivity, itis more important fora woman to know herbreast density thanher age.”

Breast density hasbeen found to be heri-table,2 while morethan a dozen other studies have demon-strated that women with dense breastsare at increased risk for breast cancer.

Other Findings from the Kolb Study• Physical examination detected only

27 percent of cancers. When a tumorwas palpable to the examiner, on

average it measured twice as large asthose tumors that were non-palpableand only 37 percent were early stagecancers vs. 90 percent for non-palpa-ble tumors. Dr. Kolb says this con-firms the importance of findingtumors before they become palpable.

• Screening ultrasound detected anadditional 42 percentof invasive cancersthat were not detect-ed by either mam-mography or physi-cal examination inwomen with densebreasts. Dr. Kolbsays this translatesinto a 73 percent

increase in cancer detection.• Of biopsies prompted by ultrasound

alone, 37 out of 358 (approximately10 percent) were malignant. In othersingle center studies of screeningbreast ultrasound, as few as two per-cent of biopsies prompted by ultra-sound proved malignant.

Thomas M. Kolb, M.D.Private Practitioner, New York

This is a unique opportunity

to further study a possible

impact upon mortality by a

new screening procedure.—Thomas M. Kolb, M.D.


• Of the 31 cancers found by ultrasoundalone in women with dense breasts,15 (48 percent) were in women athigh-risk.

• The benefits of routine screeningbreast ultrasound must be weightedagainst the false-positive rate of 2.4percent of this examination and thecost of the subsequent diagnostic pro-cedures.

“What we’ve shown is that inwomen with dense breasts who havenormal mammograms and normalphysical examinations, you can stillfind an additional 42 percent of womenwith non-palpable invasive breast can-cer by performing ultrasound screen-ing,” he says.

He also stresses that cancers detect-ed by ultrasound alone were similar insize and stage to those detected mam-mographically only and were likely atsmaller and lower stage than if detectedas an interval cancer. This would alsoallow for easier and more varied treat-ment options.

“These findings suggest that thesurvival benefit from additional screen-ing with ultrasound would magnify thatcreated by screening mammography.For those who believe mammographicscreening does not alter mortality, it iseither because tumors in the youngerwoman are more aggressive or they aresimply being mammographicallymissed in younger women who pre-dominantly have denser breasts,” saysDr. Kolb.

Based on previous studies and thisnew work, Dr. Kolb believes cancersthat are mammographically invisible aswell as many interval cancers, whichare less prognostically favorable, maybe found prior to their dedifferentiationto more aggressive tumors. “This is aunique opportunity to further study apossible impact upon mortality by anew screening procedure.”

ACRIN Breast Cancer StudyIn a multicenter trial, co-funded by theAvon Foundation and the NationalCancer Institute, conducted through theAmerican College of Radiology Imag-ing Network (ACRIN), high-riskwomen will be screened independentlyby mammography and bilateral wholebreast ultrasound. “There have been

many barriers to widespread acceptanceof screening breast ultrasound, includ-ing its operator dependence and highlikelihood of generating an unnecessarybiopsy,” says lead investigator WendieA. Berg, M.D., Ph.D., director ofBreast Imaging at the University ofMaryland.

In addition to the primary goal ofvalidating the supplemental benefit ofultrasound after mammography, the tri-al will also evaluate important issuessuch as reproducibilty of lesion detec-tion and characterization across differ-ent radiologists. Criteria have been sug-gested to decrease the rate of benignbiopsies, but they have not yet beenvalidated across multiple centers. Acritical aim of the study is reproduciblyidentifying lesions with less than twopercent risk of malignancy that can befollowed.

The Avon Foundation is committedto improving the entire field of breastimaging. The ACRIN study is only oneof a number of breast cancer researchprojects for which the foundation isproviding funding. ■■

Reference:1. Radiology 2002; 225:165-1752. NEJM 2002; 347:886-894

Note.—Data are percentages. Data in parentheses are numbers used to calculate the percentages. NP = not performed. * Screening US was not performed in women with BI-RADS category 1 breast density.

© 2002 RSNA. Table reprinted with permission. (Radiology 2002; 225:165-175)

TABLE. Sensitivity of Combined Detection Modalities for Each Breast Density Category

Dr. Kolb presented his findings in September at the American MedicalAssociation’s annual Science ReportersConference in Washington, D.C.

A full-text version of the Kolb study is available at radiology.rsnajnls.org/.


Using full-body CT as a preventivetool is currently one of the hotlydebated topics surrounding the

use of diagnostic technologies to detectdisease before—sometimes longbefore—a disease maymanifest. Within thisdebate, the use of full-body CT has raisedpressing questions aboutits value to look for dis-ease that is not evident,and for some people, noteven likely.

Central to the con-troversy are severalquestions without anyclear answers. Does ear-ly detection of specificdiseases reduce mortali-ty? Should people beable to refer themselvesfor screening? Is themonetary cost of screen-ing CT worth the benefit? What, if any,are the criteria for people who shouldundergo full-body CT?

Early Detection / Reduced MortalityThe argument for detecting early dis-ease rests on the “intuitive” sense thatthe earlier you treat disease, the betterthe prognosis. Mammography forbreast cancer, PSA test for prostate can-cer, colonoscopy for colorectal cancer,pap smears for cervical cancer, andblood tests for cholesterol and glucoselevels are all done based on this idea,wrote Michael N. Brant-Zawadzki,M.D., in a recent article.1 Why, then, isthere such a controversy over usingfull-body CT to test for such diseasesas lung cancer, heart disease and colondisease?

With the emphasis on evidence-

based medicine, there is increaseddemand to move beyond, or at leastaugment, “intuition” with scientificallytested outcomes. Early detection fordiseases which full-body CT could

detect—notably lung cancer, coronaryartery disease and colon cancer—hasnot, to date, been proven to reducemortality. Because of this lack of scien-tific proof, the American College ofRadiology does not recommend whole-body CT screening.

But observational data, particularlyfor lung cancer, suggest that screeningcould have a major benefitin outcomes despite thedearth of randomized data.“We know that if peoplewith stage I lung cancerare not treated, about 80percent of them will bedead in five years,” saysDr. Brant-Zawadzki, aclinical professor of radi-ology at Stanford Univer-sity School of Medicine

and medical director of radiology atHoag Memorial Hospital in NewportBeach, Calif. “Compare this to peoplewith stage I lung cancer who undergosurgery—80 percent of them are alive

at five years.”

Screening for LungCancerThe difficulty ofdetecting lung can-cer in its earlieststages is a majorreason lung cancerkills so many peo-ple. Lung cancerkills more peopleevery year thanbreast, prostate,colon and pancreascancers combined,according to pulmo-nologist David E.Midthun, M.D., who

spoke to a group of journalists andphysicians attending a recent confer-ence at the Mayo Clinic in Rochester,Minn. Efforts to improve outcomeshave advanced little over the past years.Lung cancer maintains a mortality rateof 87 percent death, added Stephen J.Swensen, M.D., professor of radiologyat Mayo Medical School and chair of

the Department of Radiol-ogy at the Mayo Clinic.

Dr. Swensen report-ed on a study he and Dr.Midthun conducted atMayo to evaluate the ben-efit of CT screening inpeople at high risk ofdeveloping lung cancer.Using low-radiation-dosespiral CT and sputumcytology screening in

Many Unanswered Questions Remainin Debate over Full-Body CT

FEATURE:HOT TOPIC

Stephen J. Swensen, M.D.Chair, Department of RadiologyMayo Clinic

Michael N. Brant-Zawadzki, M.DMedical Director of RadiologyHoag Memorial Hospital

RSNA 2002 Opening SessionThe Opening Session atRSNA 2002 will be onscreening examinations. Themoderator will be George S.Bisset III, M.D. The panelistsare Bruce J. Hillman, M.D.,and Michael N. Brant-Zawadzki, M.D. Check yourRSNA Scientific Program formore information.


1,520 patients, 61 percent of whomwere smokers, the investigators madesignificant findings, such as nodulesthat needed further investigation, innearly 1,200 (79 percent) participants.2

Of the 51 lung cancer cases detected,30 (59 percent) were stage IA.

In addition to lung cancer, Dr.Swensen says ancillary findings, suchas abdominal aneurysms, were locatedin the lower portions of the CT scan.Abdominal CT scans can also detectsigns of osteoporosis and visceral fat,which in a certain distribution has beenlinked to an increased risk of cardio-vascular disease.

Encouraged by these findings, Dr.Swensen suggests that full-body CTscreening could save lives through ear-ly detection of lung cancer and otherancillary diseases, and could be cost-effective, but is absolutely unproven.

Dr. Midthun also cites a lack of evi-dence of reduced mortality associatedwith early lung cancer detection andthe problem of bias that continues tothwart the ability to evaluate reducedmortality in many studies. A recentlyinitiated multicenter study, the NationalLung Cancer Screening Trial (see theJuly issue of RSNA News), comparesspiral CT to standard chest x-rays andwill be “used as the gold standard formortality reduction of lung cancer,”says Dr. Midthun.

Self-ReferralEvidence on the effect of early diagno-sis on mortality is only one issue in thecontroversy over full-body CT scan-ning. Another issue—the dividingissue, according to Dr. Brant-Zawadz-ki—is whether patients should be ableto refer themselves for screening.

With the proliferation of free-stand-ing radiology clinics that offer full-body CT scanning just like any otheroffering in a mall, concern hasincreased in the radiology and health-care communities about the appropri-ateness, ethics and viability of theseentrepreneurial ventures.

“Self referral fits into a culture that

is already in place in the medical com-munity,” says Dr. Brant-Zawadzki.“Physician referrals for CT scans haverisen dramatically because of the sensi-tivity of CT. With increased informationavailable to patients, they are now self-referring for all sorts of exams, frommammography to genetictesting.”

A central barrier toself-referral CT scanningis that it puts diagnosticradiologists on the frontlines of healthcare, aplace where they are notused to being, says Dr.Brant-Zawadzki,

Further barriersinclude concern over theneed to establish criteriaon who would benefitfrom this type of screening and the costit will incur on the healthcare industryas a whole.

Who Should Get Full-Body CT Screening?“For people who want these scans, Iwould recommend the following,” saysE. Stephen Amis Jr., M.D., chairman ofthe Board of Chancellors for the Ameri-can College of Radiology. “First,patients should discuss the test withtheir personal physician before having itdone. Second, patients should be age 40or older. Third, patients should berequired to sign a consent form saying

that insignificant findings may requirefurther work-up, that certain tumorswill not be detected and that cumulativeradiation exposure can be dangerous.”

Although effects of radiation expo-sure may be of little concern for a sin-gle CT examination, explains Dr. Amis,

“the main problem wouldbe cumulative exposure toradiation if patients areallowed to begin seekingscreening at an early ageand repeat it at regularintervals.”

For Dr. Brant-Zawadzki,criteria for patient selectionare important. Rather thanfull-body CT scanning, Dr.Brant-Zawadzki is a propo-nent of targeted CT for theheart, lung and colon, in

that order. He also considers the age ofthe patient and their history, such assmoking, before allowing CT.

Cost Concerns“I view the additional cost to society,given the current state of whole-bodyscreening, as the largest ethical issue tobe faced,” says Dr. Amis, who is alsoprofessor and chairman of the Depart-ment of Radiology at Albert EinsteinCollege of Medicine and MontefioreMedical Center in the Bronx. “There isno doubt that CT will increase the cost

I view the additional

cost to society, given

the current state

of whole-body

screening, as the

largest ethical issue

to be faced.—E. Stephen Amis Jr., M.D.

The enlarged lymph nodeidentified on screening CTled to the diagnosis of lym-phoma in this asymptoticparticipant. 215 of the 1,520participants in the MayoClinic study had lymphaden-opathy. Three of the 215 participants with lymphaden-opathy have been determinedto have a malignancy.

Image courtesy of Dr. Swensen

Continued on next page


of healthcare overall, whether itremains consumer oriented orbecomes an accepted and reimbursedexamination.”

Dr. Brant-Zawadzki agrees, butadds that he knows of no preventivetool that cuts healthcare costs. But isthe benefit worth the cost? Dr.Swensen calculates that 907,200 newlung cancers would be detected if CTscans were performed on the U.S.

population, which would incur a costof $74.1 billion or $81,700 per can-cer. The question of whether this costburden is acceptable will remainunanswered until more evidence indi-cates a clear reduction in mortality asa result of early disease detection. ■■

Reference1. Am J Roentgenology 2002;179:319-3252. Am J Respir Crit Care Med

2002;15:165:508-513

FDA Offers InformationThe Food and Drug Administration’s Web siteoffers information on whole-body CT (www.fda.gov/cdrh/ct/), including the following state-ment:

At this time the FDA knows of no datademonstrating that whole-body CT screening iseffective in detecting any particular diseaseearly enough for the disease to be managed,treated or cured and advantageously spare aperson at least some of the detriment associat-ed with serious illness or premature death.

Radiology in Public Focus

“Picture Archiving and Communication System: Effect on Reporting of Incidental Findings”

The introduction of PACSinto a radiology practice

appears to be associated withan increased number ofreported incidental findingsand recommended follow-upstudies.

Steven C. Wagner, M.D.,and colleagues from ThomasJefferson University Hospitalin Philadelphia reviewed theresults of 2,500 lumbarspinal 1.5-T MR examina-tions—500 in the year priorto PACS, 500 during the yearof transition to PACS and500 in each of the next threeyears.

They found an increasein the number of incidentalfindings from 19 in year oneto 50 in year five. The mostcommon incidental findingsinvolved potential renal,pelvic, hepatic, pulmonaryand lymph node abnormali-

ties. The total number of rec-ommended follow-up studiesincreased from five in yearone to 18 in year five.

Follow-up expenseincreased from $4,221 per1,000 studies in year one to$8,252 in year five. (Radiology 2002; 225:500-505)

“Renal Imaging Findings inPatients with Tuberous SclerosisComplex”

Angiomyolipoma andcysts commonly occur

in pediatric patients withtuberous sclerosis complex(TSC) and tend to increase insize and number withincreasing age.

Keith A. Casper, M.S.,Lane F. Donnelly, M.D., andcolleagues from Children’sHospital Medical Center inCincinnati reviewed the renalimaging findings andchanges over time in a largeseries of young patients withTSC. They found that in

patients with initial normalexams, the mean age of pres-entation of cysts was 9.0years and angiomyolipomaswas 9.2 years.

The researchers write:“Considering the age of typi-cal occurrence of angiomy-olipoma and size criteria forincreased risk of hemor-rhage, imaging surveillancemost likely does not yieldclinically important informa-tion until late in the firstdecade of life.”(Radiology 2002; 225:451-456)

“Efficacy of Open Versus Anti-Reflux Stents for Palliation ofDistal Esophageal Carcinomaand Prevention of SymptomaticGastroesophageal Reflux”

The “Dua” anti-refluxstent is as safe and effec-

tive as the “Flamingo” stentin relieving malignant dys-phagia and very successful inreducing symptomatic gas-troesophageal reflux.

Hans-Ulrich Laasch,M.R.C.P., F.R.C.R., fromSouth Manchester UniversityHospitals NHS Trust in Eng-land, and colleagues studied50 consecutive patients withinoperable distal esophagealtumors, who had one of thetwo stents placed across thecardia.

They found improvementin dysphagia was identical inboth groups. There was alsono significant difference insurvival, complication or re-intervention rate. (Radiology 2002; 225:359-365)

RSNA press releases are avail-able at www2.rsna.org/pr/pr1.cfm.

Press releases have been sent to the medical media for the following scientific articlesappearing in the November issue of Radiology (radiology.rsnajnls.org):

JOURNALS

Continued from previous page


FEATURE:SCIENCE

The National Institutes of Healthhas signed a licensing agreementwith GE Medical Systems to pro-

duce and market diffusion tensor mag-netic resonance imaging (DT-MRI). Theexpanded availability of this technolo-gy, used in many hospital emergencyrooms to evaluate stroke patients, mayallow researchers and physicians tostudy and diagnose a wide variety ofother medical conditions.

DT-MRI is used to make detailed,three-dimensional maps of nerve path-ways in the brain, heart muscle fibersand other soft tissues.

“The basic idea is that DT-MRI canfollow the random motion of water inthree dimensions,” says Peter Basser,Ph.D., chief of the National Institute ofChild Health and Human Development(NICHD) Section on Tissue Biophysicsand Biometrics, Laboratory of Integra-tive and Medical Biophysics (LIMB).Dr. Basser is the principal inventor ofDT-MRI.

“It turns out that the jigglingmotion of water is sensitive to the localmicrostructure and com-position of the materialwith which that water isin contact,” Dr. Bassersays. “So you are able tolearn things about thegeometry—the morphol-ogy of small structures—and sometimes about thecomposition of the tissuethat the water is movingrandomly within.”

Dr. Basser says thetechnology has beenaround for more than a decade. “Theactual bench studies were performedmore than a decade ago,” he says. “Butrecently, the Office of Technology

Transfer has beensuccessful in identi-fying companies thatare interested inlicensing the technol-ogy and essentiallybringing it frombench to bedside.”

Mapping the WhiteMatter Pathways“One of the uses ofdiffusion tensor is toactually show whichway the white mattertracts in the brain arerunning,” saysWilliam G. BradleyJr., M.D., Ph.D.,chairman of theDepartment of Radi-ology at the University of California,San Diego School of Medicine, andone of the world’s leading experts inMR imaging.

Dr. Bradley says DT-MRI can shownormal anatomy as well as diseased

areas. “You can showtumors invading whitematter so the surgeonsknow how far they can cutbefore they get into whitematter that is displaced,”he says.

“Another examplewould be multiple sclero-sis,” he continues. “Nor-mally, white matter is veryanisotropic. High aniso-tropy is normal; however,MS eats at the coverings of

the wires and it destroys your insulation.So you don’t have the purely anisotropicmeasurements that you had before.”

Carlo Pierpaoli, M.D., Ph.D., a

neurologist withNICHD’s LIMB, hasdone several studiesusing DT-MRI,including its applica-tion to white matterfiber tract mapping inthe human brain.“With DT-MRI, wecan start investigatingwhite matter path-ways noninvasivelyin living subjects,” hesays. “So it’s a verypowerful tool fromthat point of view.”

DT-MRI’s abilityto identify the path-ways suggests itcould play a role ininvestigating disor-

ders such as schizophrenia, autism andattention deficit disorder.

“In many of these disorders there isa hypothesis that the functional distur-bance or the functional deficit is some-what related to an underlying anatomi-cal abnormality,” says Dr. Pierpaoli.“The potential use of DT-MRI in thediagnosis of these disorders is relatedto the powerful detection of white mat-ter pathways that DT-MRI allows.”

Dr. Basser says a number ofgroups, including the Institute of Psy-chiatry (IOP) in the United Kingdom,have been looking at what might becalled “wiring problems.” “Groups atthe IOP compute fiber tracts in whitematter to see if there are relationshipsbetween nerve pathways in normal andabnormal subjects,” he says.

Other research has focused on cog-nitive disorders. Dr. Basser says Stan-ford University Psychology Professor

DT-MRI Offers Expanding Potentialin Research and Diagnosis

Peter Basser, Ph.D.Chief, NICHD Section on Tissue Biophysics and BiometricsLaboratory of Integrative and Medical Biophysics


DT-MRI’s ability to

identify the pathways

suggests it could play

a role in investigating

disorders such as

schizophrenia, autism

and attention deficit

disorder.


John Gabrieli, Ph.D., and for-mer Stanford postdoctoralresearcher Torkel Klingbergshowed a correlation betweenone of the diffusion tensor-derived parameters and read-ing ability in dyslexia.

“Of course, these studieshave to be repeated by manygroups and findings have tobe confirmed,” he says. “Butit’s not a big stretch to imag-ine that a molecular develop-mental abnormality wouldmanifest itself in a differentwhite matter arrangementand distribution.”

Clinical ApplicationsDr. Basser says the first mainapplication of DT-MRI hasbeen in acute stroke. “Weidentified a quantity calledthe trace of the diffusion ten-sor, which is related to theaverage mobility of water,”Dr. Basser says. “It’s anintrinsic property of tissue. Ithas been used to great effectin identifying ischemic areasin stroke.”

Dr. Bradley says trauma-tic brain injury is anotherarea in which DT-MRI canbe used. “When people have

head trauma, the white mat-ter gets sheared,” he says.“It’s called diffuse axonalinjury, or shearing injury inthe vernacular. When you dodiffusion tensor imaging ofthese patients, you see lessanisotropy because the whitematter tracks have been dis-rupted in that part of thebrain.”

Dr. Pierpaoli points outthat DT-MRI can be done onvirtually all organs in thehuman body. “There are, forinstance, studies in the mus-cle fibers in the heart,” hesays. “It’s difficult to do DT-MRI in the beating heart. Butthere are groups that haveattempted to do it and haveinteresting results. So, forinstance, the organization ofmyocardial fibers in the heartdestruction following aninfarct or other cardiac disor-ders has been studied withDT-MRI.”

Radiologists are alreadyinterpreting the diffusionimages collected from strokepatients. Dr. Basser believesthey will also begin looking atsome of the maps producedby the technology, particularly

the color maps such as thosepioneered by Dr. Pierpaoli andfellow NIH researcher SinisaPajevic, Ph.D.

“I think those are particu-larly informative becausethey tell you where the whitematter is and what the local

orientation of the fibers is. Ithink that radiologists mayfind them pleasing andinformative—more so thansome of the conventionalMRIs of white matter,” hesuggests. ■■

3D rendering of computed trajectories withinthe corpus callosum. Trajectories are launchedin both directions from a multislice ROI locat-ed in the body of the corpus callosum in theproximity of the midline. The majority offiber trajectories continue upward toward thecingular cortex. The cingulum is the thin bun-dle running anteroposteriorly above the cor-pus callosum (see arrows in figure showingposterior view).

Basser et al, Magnetic Resonance in Medicine 44:625-632 (200)Images courtesy of Dr. Basser

Corpus Callosum

posterior view

sagittal plane

FPO


FEATURE:TECHNOLOGY

The Integrating the HealthcareEnterprise (IHE) initiative is anindustry-wide collaborative effort

to implement communication standardsthat improve sharing of informationand optimize clinical care. IHE pro-vides solutions to many critical prob-lems encountered in electronic radiolo-gy, such as efficiently maintaining theintegrity of patient demographic infor-mation, and optimizing workflow forscheduled patients and exception cases,including trauma patients.

Keeping images consistentAfter three years of successful vendordemonstrations, IHE will offer educa-tion in two separate venues at RSNA2002 to show how vital improvementsto workflow and information sharingare being realized in healthcare institu-tions today.

The IHE Theater will featureinformation and tools for acquiring andimplementing integrated systems:• A multimedia presentation, given

twice hourly, with the essentials onIHE: how it works, why it matters andhow you can make it work for you

• User success stories from institutionsthat have implemented integrated systems

• Tools for implementing integratedsystems including a matrix for evalu-ating products, key questions to askvendors, and requirements languagefor RFPs

The IHE Classroom will offer afull slate of in-depth, targeted educa-tional sessions about the benefits oftrue integration, the standards andimplementation process necessary toachieve it and the tools availablethrough IHE to acquire and implementit in healthcare enterprises today.

Participating in IHE helps vendorscoordinate their efforts to implementtruly integrated systems. IHE capabili-ties are now available inmany commercial productsand are being adopted byinstitutions around the world.They can be used today to help opti-mize patient care.

IHE defines a carefully documentedframework of standards and providestools and a testing process to help

implement them. In October par-ticipating companies brought theirsystems to RSNA Headquarters toparticipate in the annual Connec-

tathon and complete an extensive pro-gram of integration testing. ■■

Agfa HealthcareAlgotec Systems Ltd.Canon Medical SystemsCedara SoftwareCerner CorporationChung-Shan Institute of Science and Technology

Eastman Kodak CompanyEmageonFujifilm Medical Systems USA, Inc.

GE Medical SystemsHitachi Medical Corporation

IDX Systems CorporationIMCO TechnologiesInstrumentarium ImagingKonica Medical ImagingLorad/HologicMarotech, Inc.McKesson Information Solutions

MedconMedical Manager Health Systems, a WebMD Company

Mediface Co., Ltd.Merge eFilm

Mitra Imaging, Inc.Philips Medical SystemsRasna Imaging SystemsSiemensSoftmedicalStentorStorCOMM, Inc.Swissray Medical AGTiani Medgraph AGToshibaUltraVisual Medical SystemsVital Images, Inc.Voxar Ltd.

IHE 2002-2003 Participants

IHE: Making WorkflowWork for You

Companies participating in IHE 2002 had the unique opportunity for advancedintegration testing during the IHE Con-nectathon in October at RSNA Headquar-ters in Oak Brook, Ill.


FEATURE:ISCD

The International Society for Clini-cal Densitometry (ISCD) will hosteducational lectures on bone den-

sitometry and certification examina-tions December 7–8, 2002, at the Mar-riott’s Courtyard Downtown Chicagohotel.

Lectures and certification are avail-able for both clinicians and technolo-gists. Clinicians will learn about equip-ment technology as well asinterpretation and reporting. Technolo-gists will learn about proper positioningand procedure consistency. The coursesare open to physicians, Ph.D.s, technol-ogists, allied healthcare professionals,nurse practitioners and physician assis-tants.

“ISCD is an industry-neutral, non-profit organization committed toimproving the quality of bone densito-metry. Consequently, RSNA is delight-ed to facilitate ISCD’s educationalefforts,” says Brian C. Lentle, M.D.,chair of the RSNA Board of Directors.“RSNA wanted to work with ISCDbecause of ISCD’s interest in qualitypractice, education and research.”

The ISCD/RSNA partnershipdeveloped due to a shared target audi-ence. ISCD believes that Chicago is agood location for the courses becauseof Chicago’s accessibility and the num-ber of bone densitometry machines inuse in the metropolitan area.

“ISCD is a strong proponent of thepartnership between the technologistwho performs the bone density testsand the clinician who interprets them.We are trying to increase the number ofradiologists who accept and understandthe importance of knowledge and train-ing in interpreting bone density tests,”

explains Linda C. Hartman, a formerISCD certification manager who helpedto coordinate the partnership.

Densitometry is a radiologic tech-nique measuring bonedensity that is practicedin the United States andCanada by a variety ofpractitioners—gerontol-ogists, endocrinologists,internists, obstetriciansand radiologists.

In the past, RSNA has offered anumber of popular programs on osteo-porosis. ISCD is offering a coursebeyond osteoporosis while also provid-ing densitometry certification.

“Radiologists must stay at the fore-front of densitometry to assist our col-leagues who are using this important

technology to evaluate their patients. Ihope that an increasing number of bonedensity scans will be referred to radiol-ogists for interpretation. In addition todensitometry, radiologists must have athorough understanding of osteoporosisas well,” says Dr. Lentle.

“ISCD is an experienced organiza-tion dedicated to providing standard-ized, yet cutting-edge information inthe field of bone densitometry. ISCD’sfocus is on certification programs and

bone densitometry education as well asstandardization. Technicians should behighly skilled and capable of perform-ing everything correctly the first time.

This level of expert-ise saves moneythroughout thehealthcare industry,”Hartman says.

The RSNABoard of Directors isinterested in testing

the synergy between the two organiza-tions by scheduling one meeting fol-lowing the other. “It may be that ISCDadds an extra spark to the end of theRSNA meeting and that more peopleare able to attend ISCD because theyare already in Chicago. We hope to findthat this is a beneficial arrangement forboth groups,” adds Dr. Lentle.

The clinical track offers 11 CMEcategory 1 credit hours, while the tech-nical track offers 10.5 credit hoursaccepted by the American Registry ofRadiologic Technologists and theAmerican Society of Radiologic Tech-nologists. A certification exam for theclinical and technical tracks will begiven on Sunday, December 8, 2002.Lecture hours for both tracks can beapplied toward ISCD recertification.ISCD certification is valid for fiveyears. For more information includingpricing, contact ISCD at (202) 367-1132 or www.iscd.org. ■■

Densitometry Courses and Certification Offered ImmediatelyFollowing RSNA 2002

Radiologists must stay at the

forefront of densitometry to

assist our colleagues who are

using this important technology

to evaluate their patients.—Brian C. Lentle, M.D.


MINI TUTORIAL

VirusesComputer data can be damaged oraltered by programs called malware,pest programs or vandalware created bycomputer hackers. More typically, theseprograms are called viruses. A comput-er virus is a program that attaches itselfto a file, reproduces itself and spreadsto other programs. A virus can corruptand/or destroy data, display an irritatingmessage or disrupt computer opera-tions.

Several medical terms are used todescribe virus operation. A computer isa “host” that becomes “infected” with avirus. The virus “replicates” andspreads from one computer to another.A computer can be “inoculated” againstviruses, but when it becomes infected,“antiviral” software is used to “disin-fect” it.

Viruses can spread if an infectedfloppy disk is in the disk drive whenthe computer boots up, when the userruns an infected program or opens aninfected file. Downloading a file fromthe Internet or opening an e-mailattachment might also infect the user’scomputer. A computer virus is a seg-ment of program code that implantsitself in a computer file and spreadssystematically from one file to another,replicating itself on the hard disk.Some viruses place a virus markerinside the programs that they infect, sothey can manage the viruses’ activities.If a virus detects one of these markers,it knows that the program is alreadyinfected so it does not replicate itself inthis particular program.

Viruses attack four parts of a com-puter: its executable program files, itsfile directory system that tracks thelocation of all computer files, its bootand system areas that are needed to

start the computerand the data filesthemselves.

Types of VirusThere are four maintypes of viruses:boot sector viruses,file viruses, Trojanhorse viruses andmacro viruses.

A boot sectorvirus replaces theboot program usedto start a computerwith a modifiedinfected version ofthe boot programthat loads the virusinto the computer’smemory. Once the virus is in the mem-ory, it spreads to any disk inserted intothe computer.

A file virus attaches itself to orreplaces program files; the virus thenspreads to any file that accesses theinfected program.

A modern Trojan horse is a com-puter program that appears to performone function while it actually doessomething else. It is not a virus becauseit does not replicate itself, but it maycarry a virus. A Trojan horse usuallydestroys data or steals passwords whilelooking like a login screen. As a usertries to log in, the Trojan horse collectsthe user’s ID and password. This infor-mation is then e-mailed to a hacker foreasy access to the data stored on thenetwork. The typical purpose of a Tro-jan horse is to defeat network securitymeasures.

A macro virus uses the macro lan-guage of an application, such as wordprocessing or a spreadsheet, to hide the

virus code. When thedocument with aninfected macro isopened, the macrovirus loads into thememory. A virus isusually activated assoon as a program orfile is used, or at thespecific times or datesdetermined by thevirus creator.

A logic bomb is acomputer virus thatactivates when itdetects a certain condi-tion, such as appear-ance or disappearanceof certain data. A timebomb is a type of logic

bomb that activates when the predeter-mined time or date registers on theinternal clock of the computer.

Another type of malicious programis a worm. Worms are programsdesigned to infect networks throughsecurity holes. Like a virus, a wormreplicates itself. Unlike a virus, a wormdoes not need to be attached to a docu-ment or executable program to repro-duce. Worms travel from a networkedcomputer to another networked com-puter, replicating themselves along theway. The worm copies itself repeatedlyin the memory or disk space until nomemory or disk space remains. Wormsare not likely to affect personal com-puters, because they are designed toattack network servers.

Antiviral ApplicationsThere are three kinds of antiviral appli-cations that protect computers againstviruses: scanners, eradication programs

Internet for You—Part 7

Internet Security

Katarzyna J. Macura, M.D., Ph.D.The Russell H. Morgan Departmentof Radiology and Radiological Science, Johns Hopkins MedicalInstitutions



and inoculators. A scanner checks if the computer

has any files that have markers indicat-ing the presence of a virus. A scannermay also check the size of a program todetect any changes in file size or filecreation date. An antivirus program canidentify a virus through recognition ofa specific pattern of known virus code,called a virus signature.

An eradication program disinfects,or removes viruses from the hard disk.

An inoculator does not allow aprogram to run if it contains a virus.Currently, several thousands of knownviruses exist, but fewer than 10 causesignificant damage. The SymantecAntiVirus Research Center’s OnlineEncyclopedia offers the most up-to-date information on recent threats atwww.symantec.com/ avcenter/vinfodb.html

EncryptionEncryption is a technique for scram-bling and unscrambling information.The unscrambled information is calledclear-text and the scrambled informa-tion is called cipher-text. Once data isencrypted, it can be sent via e-mailmessages or stored just as any otherdata. To read the data, the recipientmust decrypt, or decipher, it into areadable form. To encrypt the data theoriginator of the data applies anencryption key, secret values that com-puters use along with complex mathe-matical formulas to encrypt messages.The recipient of the data then uses anencryption key to decrypt the data.

There are two basic types ofencryption, private key and public key.With private key encryption, symmetricencryption, both the originator andrecipient use the same encryption keyto encrypt and decrypt the data. Publickey encryption uses two encryptionkeys: a public key known to everyoneand a private key known by only thereceiver. To decode an encrypted mes-sage, a computer must use the publickey, provided by the originating com-

puter and its own private key.Many browsers include encryption

software that allows the user to encrypte-mail messages or other documents.Secure Socket Layer (SSL) is one ofthe more popular Internet encryptionmethods, which provides two-wayencryption along the entire route datatravels to and from a computer. Webpages that use SSL begin with the httpsprotocol, instead of http protocol. Tocheck if the communication is carriedover a secure channel that uses SSL,the user should look for a padlock iconon the browser andmake sure that theURL is in the form ofhttps:// as opposed tohttp://. Before enteringany sensitive data,such as a credit cardnumber or SocialSecurity number, it isimportant to verify thatthe user’s computer iscommunicating withthe right server and notan imposter that is try-ing to steal personalinformation. To verifythis, the user shouldcheck the authentication certificate,which could be accessed by double-clicking on the padlock icon.

FirewallsThe nature of the Internet, an open pub-lic network that allows for freeexchange of information and files,makes it vulnerable to attack. Everytime a computer connects to the Inter-net it faces potential danger of beingopen to hackers who could theoreticallybreak into the system and cause dam-age. One way of protecting the net-works and individual computers fromintruders is the installation of a firewallthat shields the internal (corporate/edu-cational/private) networks from theInternet.

A firewall is a combination of hard-ware and software used to prevent hos-tile programs from entering a network,

usually by filtering out suspicious datapackets. Firewalls can also be used toprevent unauthorized access to theinformation within the particular net-work. Recognizing the efficiency andpower of the Internet, many organiza-tions have applied Internet technologiesto their own internal networks calledintranets.

An intranet, sometimes called anenterprise network, is a small versionof the Internet used within an organiza-tion, which uses the same file exchangeprotocols, supports multimedia and

allows access viabrowsers. Intranetsgenerally make compa-ny information accessi-ble to authorized users,employers, and facili-tate working in groups.An intranet may alsoallow access byauthorized users out-side the company,forming an extranet.With a firewall, theinternal networks workas networks normallydo, with servers pro-viding internal services

such as e-mail, access to corporatedatabases and the ability to run pro-grams from servers.

When someone on the local net-work wants to access the Internet, therequest and data must go through aninternal screening router. This interiorrouter examines the packets of datatraveling in both directions, betweenthe network and the Internet. Informa-tion within the packets’ headers givesthe router the source and destination ofthe packet, the protocol being used tosend the packet and other identifyingdata. Based on the information in theheaders, the screening router will allowcertain packets to be sent or received,but will block other packets. Systemadministrators set the rules to specifyacceptable communications from loca-tions, individuals, or in certain proto-cols and to determine which packets to

Before entering any sensi-

tive data, such as a credit

card number or Social

Security number, it is

important to verify that the

user’s computer is commu-

nicating with the right serv-

er and not an imposter

that is trying to steal per-

sonal information.



allow in and which ones to block. A software firewall can be installed

on the computer at home that has anInternet connection. This computer isconsidered a gateway because it pro-vides the only point of access betweenthe home network and the Internet.With a hardware firewall, the firewallunit itself becomes a gateway, forexample, the Linksys Cable/DSLrouter. It has a built-in Ethernet cardand hub. Computers on the home net-work connect to the router, which inturn is connected to either a cable orDSL modem. The router can be config-ured via a Web-based interface that canbe accessed through the browser. Theuser can set any filters. Hardware fire-walls are secure and not very expen-sive. Home versions that include arouter, firewall and Ethernet hub forbroadband connections can be foundfor well under $100. A free firewalltesting for security flaws is available atwww.securitymetrics.com/portscan.adp.

Virtual Private NetworkA firewall is an important security fea-ture for any Internet user. However,firewalls do not protect data fromthreats within the Internet networkitself. Once the data gets outside the

firewall, the user names, passwords,account numbers, server addresses andother sensitive information are visibleto hackers. The Virtual Private Network(VPN) by using the encryption algo-rithms, give users the ability to utilizethe public shared Internetfor secure data transmis-sion after it leaves theprotection of the firewall.

The feature thatmakes a VPN “virtuallyprivate” is a tunnel. Whatmakes a VPN transmis-sion a tunnel is the factthat only the recipients at the other endof transmission can look inside the pro-tective encryption shell. Tunneling tech-nology encrypts and encapsulates thenetwork protocols within Internet Proto-col (IP). Using special tunneling proto-cols and complex encryption proce-dures, data integrity and privacy isachieved in the VPN in what seems likea dedicated point-to-point connection.At either end of the VPN tunnel there isa VPN gateway in hardware and soft-ware form. The gateway at the sendinglocation encrypts the information intocipher-text before sending the encryptedinformation through the tunnel over theInternet. The VPN gateway at the

receiving location decrypts the informa-tion back into clear-text. The encryptionalgorithm uses the secret code, a key, tocreate a unique version of cipher-text.Transmission security strength dependson the length of the keys used; the for-

mula used is 8-bit keys =256 combinations or twoto the eighth power, or16-bit keys = 65,536combinations or two tothe 16th power. In otherwords, if the key used isa 16-bit key, an intrudermight have to make

65,536 attempts at cracking the combi-nation. This would be a quick and fairlysimple task for computers. That is whymost of VPN products are using at least168-bit keys, creating two to the 168thpower possible combinations.

VPN allows connecting remotesites or users together in two ways, viaa remote-access or a site-to-site con-nection. A remote-access, called a vir-tual private dial-up network (VPDN), isused for a user-to-LAN connection setup by a company that has employeeswho need to connect to the private net-work from remote locations. Typically,a corporation that wishes to set up a

We need to remember

that while the Internet

is a vast and exciting

resource, it is also a

public place.


1. Install and regularly run anantivirus program on all of yourcomputers. Obtain updates tothe antivirus signature files. Thecost of antivirus software ismuch less than the cost ofrebuilding damaged files.

2. Write-protect your rescue diskby sliding the write-protect tabinto the write-protect position.Beware, however, that although avirus cannot transfer onto yourdisk when it is write-protected,you must remove the write-pro-tection each time you save a fileon the disk. With the write pro-tection removed, your disk isopen to virus attack.

3. Never start computer with afloppy disk in drive A. All floppydisks contain a boot sector. Dur-ing the startup process, the com-puter attempts to execute theboot sector on a disk in drive A.Even if the attempt is unsuccess-ful, any virus on the floppy disk’sboot sector can infect the com-puter’s hard disk.

4. Do not accept files from high-risk sources. Before using anyfloppy disk, use the antivirusscan program to check the diskfor viruses. Even commercialsoftware has been infected anddistributed to unsuspectingusers.

5. Do not download from sites thatdo not test and secure their files.Check all downloaded programs

for viruses. Viruses are oftenplaced in seemingly innocentprograms so they will affect alarge number of users.

6. Before opening and/or executingany e-mail attachments, ensurethat the e-mail is from a trustedsource. If an e-mail is from anunknown source, it should bedeleted without opening or exe-cuting any attachments. Avoidrunning attachments that are.EXE files, even if they comefrom your friends.

7. Back up your files regularly. Scanthe backup program prior tobacking up disks and files toensure the backup program isvirus free.

Tips for preventing virus infection:

Some symptomsof virus infection:1. Computer displays

annoying messages

2. Computer developsunusual visual orsound effects

3. Files mysteriouslydisappear or are dif-ficult to save

4. Computer rebootsunexpectedly

5. Computer suddenlyslows down

6. Executable filesincrease in size


large remote-access VPN will out-source to an enterprise service provider(ESP).

The ESP sets up a network accessserver (NAS) and provides the remoteusers with desktop client software fortheir computers. The telecommuterscan then dial a toll-free number toreach the NAS and use their VPNclient software to access the corporatenetwork. In a site-to-site link, a compa-ny can connect multiple fixed sites overa public network through the use ofdedicated equipment and large-scaleencryption.

A word on cookiesSome Web sites track users’ visits.These sites use cookies to rememberthe dates of visits, e-mail address,onsite activities and links used. A cook-ie is a message, text strings, sent from aWeb server to the user’s computer thatis stored on the user’s hard disk. Thissmall data file with the user’s name andviewing preferences is frequently usedin Webcasting, e-commerce, and other

Web applications that rely on cookiesto track information about viewers,customers, and subscribers. Any timethe user visits a particular Web site, thebrowser retrieves the cookie from thehard disk and sends data in the cookieto the Web site. A Web site can onlyread data from its own cookie file; itcannot access or view any data on theuser’s hard disk. Cookies are not harm-ful, they are just short text strings, andthey can often improve browsing byallowing a server to recall any cus-tomized information the user has set.Cookies cannot transmit viruses. Websites can use cookies for various pur-poses: for personalization, for trackingusers activities, and for targeting adver-tisements.

Some Web sites sell or trade infor-mation stored in the cookie to advertis-ers, so if the user does not want person-al information being distributed, he/sheshould limit the amount of informationprovided to a Web site during registra-tion of a cookie. Any browser can beset to accept a cookie or disable cookieuse altogether.

The advent of the Internet hasirrevocably changed the way we inter-act with the world and each other. Aswe rely more and more on the Internetin our daily activities, interests andrelationships, the potential for thespread of common computer threats isincreasing. In our world of ever-advancing technology, privacy becomesa casualty. Web server logs do not for-get and the technology for correlatinginformation and building data shadowsabout people is constantly improving.Therefore, we need to remember thatwhile the Internet is a vast and excitingresource, it is also a public place. Weshould apply common sense, put safetyfirst and protect our privacy the sameway we do while visiting other publicplaces. ■■

Editor’s Notes: This is the final installment inthe “Internet for You” series. The original mini-tutorial on the Internet by Katarzyna J. Macura,M.D., Ph.D., was published inthe AAWR Newsletter Focus.Dr. Macura updated her seriesfor RSNA News.

management services for the three soci-eties, which have missions congruentwith RSNA, and whether an academiccouncil should be formed for the pur-pose of pursuing projects of mutualinterest.

Radiology and the MediaThe Board of Directors has

approved a recommendation by theRSNA Public Communications Com-mittee to host a media briefing in NewYork to educate the medical media andthe public about the role of a radiolo-gist and the field’s contribution tohealthcare. One media briefing, thespecific topics not yet determined, willbe held in 2003. The activity will beevaluated following the briefing.

Volunteers NeededRSNA depends on the expertise of itsmany committed volunteers. The Boardof Directors has been studying ways toencourage more people to volunteer aswell as to recognize those people whohave dedicated their time and resourcesto the Society. Among the suggestionsapproved by the Board were streamlin-ing committee functions, using Webconferencing to reduce committeemember travel and featuring volunteermembers in RSNA News.

2003 Derek Harwood-Nash InternationalFellowThe Board has approved a recommen-dation from the Committee on Interna-tional Relations and Education toappoint Maka Kekelidze, M.D., from

the republic of Georgia as the 2003Derek Harwood-Nash International Fel-low. Dr. Kekelidze will spend six to 12weeks studying at a North Americaninstitution so that when she returns tothe former Soviet Union, she will beable to help improve the practice ofradiology in her home institution aswell as the radiologic community.

BRIAN C. LENTLE, M.D.CHAIRMAN, 2002 RSNA BOARD

OF DIRECTORS

Editor’s Note: In our continuing efforts to keepRSNA members informed, the chair of the RSNABoard of Directors will provide a brief report inRSNA News following each board meeting.

The next RSNA Board Meeting is in December.

Continued from page 4

The entire Internet for You series is availableon our Web site at www.rsna.org/tech/inter-net/index.html.

RSNA Board of Directors Report


www.aawr.org


RESEARCH AND EDUCATION:OUR FUTURE

RSNA Fellow Bridges GapBetween Laboratory and Clinic

Is it possible to sustainthe career link betweenpatient care and theresearch laboratory?Alan Pollack, M.D.,

Ph.D., has succeeded in doing so.He is the senior member and chair-

man of the Department of RadiationOncology at Fox Chase Cancer Centerin Philadelphia. In 1991-1992, he wasthe recipient of the RSNA Researchand Education (R&E) FoundationResearch Fellow Grant. “RSNA helpedget me back into the lab in a much big-ger way than my previous experience.Through the Fellowship, I realized Icould manage work in both the clinicand lab. I wanted to be a part of bridg-ing that gap,” he says.

Dr. Pollack conducted his Fellow-ship research in “Solid Tumor Repopu-lation Kinetics after X-IrradiationUsing Antibodies to Bromodeoxyuri-dine and Iododeoxyuridine” at the Uni-versity of Texas M.D. Anderson CancerCenter in Houston. He received supportfor the project from RSNA and theAmerican Society for TherapeuticRadiology and Oncology.

While giving him the opportunityto develop projects in cell kinetics dur-ing his Fellowship, Dr. Pollackstrengthened his interest in translationalmethods to manipulate the response ofcancer cells to radiation. He refined acell kinetics technique and then appliedit to different cancer cells. He thenstudied the response of prostate cancercells to hormone therapy.

That early training served him well.Today, he is investigating biologicagents to treat prostate cancer, as wellas combination therapy with radiationand hormone ablation.

Remembering His RSNA RootsDr. Pollack hasn’t for-gotten his ties toRSNA. He is a fre-quent contributor tothe RSNA ScientificAssembly and AnnualMeeting in Chicago.At RSNA 1999 andRSNA 2000, he wasthe invited lecturer forrefresher courses onthe management ofregionally localized,high-risk prostate can-cer. Also in 2000, hewas an invited partici-pant in “New Pathways for EducatingRadiologists for the Future” a consen-sus conference to identify future direc-tors for radiologic education, held inOak Brook, Ill.

Last year at RSNA 2001, Dr. Pol-lack was responsible for the refreshercourse, “Management of RegionallyLocalized High Risk Prostate Cancerwith Radiotherapy: A Summary ofAndrogen Deprivation Therapy plusExternal Beam Radiotherapy with anEmphasis on Survival Results.”

Dr. Pollack says his career choicewas easy because he was always inter-ested in radiation oncology. For thoseconsidering radiation oncology, Dr. Pol-lack says this is a great time to be in thefield. “Radiation oncology is an excitingarea. There are tremendous advances inthe technology of radiation delivery andimaging. New imaging modalities helpus to define and hit the cancer target. Inthe laboratory, we are researching smallmolecule and biologic agents. There isso much promise,” he adds.

Fox Chase Cancer Center prostate

cancer patients areundergoing treat-ment with intensitymodulated radiationtherapy or IMRT.“We use MRI inplanning, and dailyultrasound to moni-tor and correctprostate movement,”he says. IMRTallows radiationoncologists to pre-cisely target theprostate with muchhigher radiation dos-es and still sparehealthy organs.

Dr. Pollack and his radiation oncol-ogy colleagues at Fox Chase are partic-ularly interested in hypofractionation—the delivery of bigger doses of radiationper fraction. He is the principal investi-gator of a phase III intensity modulatedradiotherapy dose escalation trial forprostate cancer using hypofractionation.

The radiation department at FoxChase has a dedicated MR simulator todefine anatomy and tumor extent. “It’sunusual to have an MR simulator in aradiation department, but we havefound that it allows for a much greaterlevel of certainty in defining anatomyover CT,” he says.

In September, the radiology depart-ment at Fox Chase installed a CT onrails in the Liniac room. “This CT-guided treatment allows for pin-point-ing target positions in sites wheremotion is prevalent. This equipmentwill be of particular value in the appli-cation of IMRT abdominal and pelvicsites, and perhaps tumors in the chestas well,” he says.

Alan Pollack, M.D., Ph.D.1991-1992 Research Fellow



RESEARCH AND EDUCATION:OUR FUTURE

THE BOARD OF TRUSTEES of the RSNA Research and Education Foundation and its recipi-ents of research and educational grant support gratefully acknowledge the contributions

made to the Foundation between August 31, 2002 and September 30, 2002.

Research and Education Foundation Donors

Dr. Pollack earned his bachelor of science degreein chemistry from the University of Florida inGainesville. He received his Ph.D. in microbiologyand immunology from the University of Miami. Hegained his medical degree from the University ofMiami as well. He is certified in therapeutic radiologyby the American Board of Radiology.

Dr. Pollack served his residency in radiation ther-apy at the University of Texas M.D. Anderson CancerCenter in Houston. Later, he was named a professorin the Department of Radiation Oncology at the Uni-versity of Texas. He joined the Fox Chase CancerCenter in 2001. The National Cancer Institute hasdesignated the Fox Chase Cancer Center as one of thenation’s comprehensive cancer centers. ■■

...is targeted to physicians who arenearing the end of their radiologictraining. These grants are intendedto give physicians an opportunity todevote a year to research under theguidance of an experienced scientif-ic advisor. The Research Fellow willgain further insight into scientificinvestigation and develop compe-tence in research and educationaltechniques and methods. TheResearch Fellow Grant awards astipend of $45,000 to qualifiedNorth American radiologists. Theaward may be renewed for a sec-

ond year with a stipend of $50,000.In addition, the host institution willbe granted $5,000 each year to helpunderwrite a part of the researchexpenses. The deadline for applica-tions is January 15. 2003 Topic ofInterest: Molecular Imaging.

For information on this and oth-er RSNA Research and EducationFoundation grants and awards, con-tact Scott Walter at (630) 571-7816or [email protected] or look on theRSNA Web site at www.rsna.org.

The RSNA Research Fellow GrantContinued from previous page

Online donations can be made atwww.rsna.org /research/foundation/donation.

Janusz Czechowski, M.D., Ph.D.Charles J. DeMarco, M.D.Edward S. Horton Jr., M.D.Margaret Domoto & Shozo Iba,M.D.

Valorie L. & Christopher A.Jackson, M.D.

Sung M. Kim, M.D.Keith Y. Kohatsu, M.D.Gabriel P. Krestin, M.D., Ph.D.Allison H. & Andrew B. Landes,M.D.

David R. Lehnherr, M.D.May Siang Lim Lesar, M.D.Victoria C. & Felipe N. Lim, M.D.Douglas W. MacEwan, M.D.Michael J. Opatowsky, M.D.Carlos S. Restrepo, M.D.Henrietta K. Rosenberg, M.D.Robert S. Seigel, M.D.Troy R. Smith Jr., M.D.Mark J. Tenenzapf, M.D.Ina L. Tonkin, M.D.Mary & Allen F. Turcke, M.D.Robert H. Wilkinson Jr., M.D.Edward Y. Wong, M.D.Edward E. Yu, M.D.

Carolyn A. & Thaddeus Alan Laird,M.D.

Georges B. LeRoux, M.D.Martha B. Mainiero, M.D.Timothy C. McCowan, M.D.Robert C. McKinstry, M.D., Ph.D.Theodore L. Megremis, M.D.William S. Morrow, M.D.Steven R. Nokes, M.D.G. Craig Ramsay, M.D.Patricia A. Randall, M.D.Anna Scheurecker, M.D.Richard M. Seger, M.D.Pradeep K. Sharma, M.D.Ira Silberman, M.D.Viacheslav A. Solovov, M.D.Richard G. Stiles, M.D.James H. Thrall, M.D.Amy S. Thurmond, M.D.Cynthia S. & Paul T. Weatherall,M.D.

BRONZE ($1 - $199)Brian L. Anderson, M.D.Kimberly N. & J. Edward Bass, M.D.James B. Beard, D.O.Robert C. Berlin, M.D.Harold A. Bjork, M.D.Jill Alling & Joseph Bonn, M.D.Ronald M. Boyd, M.D.Leonard J. Bristol, M.D.Chin-Wei Chien, M.D.

DIAMOND ($10,000+)Cook, Inc.

PLATINUM ($1,000 - $4,999)American Association of Physicists in Medicine

Arkansas Heart HospitalDavid C. McMurray, M.D.Marvin D. Nelson Jr., M.D.Anne & Walter L. Robb, Ph.D.

GOLD ($500 - $999)Giovanna Casola, M.D.John R. Hesselink, M.D.William F. Lytle Jr., M.D.

SILVER ($200 - $499)Ronald C. Ablow, M.D.Sungkee S. Ahn, M.D.William M. Angus, M.D., Ph.D.Chin-Yu Chen, M.D.Terrence C. Demos, M.D.Kathleen G. Draths-Hanson, M.D.Andrew G. Efremov, M.D.Linda L. Gray, M.D.Tamela S. & Steven M. Greenberg,M.D.

Julius H. Grollman Jr., M.D.Wayne D. Harrison, M.D.Denzil J. Hawes-Davis, D.O.Ian Isherwood, M.D.Vilim A. Kamler, M.D.

COMMEMORATIVE GIFTSMarco A. Amendola, M.D. & Beatriz E.Amendola, M.D.In Memory of Howard Pollack, M.D.

Marcello Caratozzolo, M.D.In Memory of Riccardo Maceratini, M.D.

Ernest J. Ferris, M.D.In memory of Delmar J. Stauffer

Eli Glatstein, M.D.In Memory of Henry S. Kaplan, M.D.

Howard T. Harcke, M.D.In memory of John A. Kirkpatrick, M.D.

Hamsaveni K. & Subbia G. Jagannathan,M.D.In Memory of Subbia G. Jagannathan Sr.

Rudolph Y. Lin, M.D.In memory of Royce C. Lin, M.D.

Robin D. Clark & Mary Mackiernan, M.D.In honor of James J. McCort, M.D.

Suresh K. Patel, M.D.In honor of Jerry P. Petasnick, M.D.

Joann S. & Thomas B. Poulton, M.D.In memory of Ronald A. Wittel, M.D.

Catherine R. Allen & Bing Tai, M.D.In Memory of Arthur Reynolds, M.D.

Janet Iwatsubo & Frank R. Tamura, M.D.In honor of Hideyo Minagi, M.D.


NEW!

Fellow Needed for Cardiovascular Imaging ProgramThe first RSNA Research and Educa-tion Foundation Institutional ClinicalFellowship in Cardiovascular ImagingGrant has been awarded to the Sectionof Cardiovascular Imaging of the Divi-sion of Radiology at the ClevelandClinic Foundation. The three-year grantprovides $50,000 salary support forone fellow per year, under the scientificguidance of Richard D. White, M.D.(Head, Section of CardiovascularImaging). The Cleveland Clinic isseeking the first fellow to participate in

the program from July 2003-June 2004.Interested applicants must be citizensor permanent residents of a NorthAmerican country, have completedtheir residency training in the radiolog-ic sciences, hold an M.D. degree or theequivalent as recognized by the Ameri-can Medical Association, and must beACGME-certified in radiology or beeligible to sit for such certification.

For more information, contactRichard D. White, M.D., at (216) 444-2740 or [email protected].

RSNA:PROGRAM & GRANT ANNOUNCEMENTS

NEW!

ACRIN Seeks Four FellowsThe American College of RadiologyImaging Network (ACRIN) is acceptingapplications for four new Fellowships.The goal is to train radiologist researcherscapable of developing and leading rigor-ous, multi-disciplinary, multi-institutionalclinical trials. The National Cancer Insti-tute recently gave ACRIN a grant torecruit and train three new fellows a yearfor at least three years. These fellowsmay have interest in any subspecialty ofradiology. In addition, the Avon Founda-tion has provided funding for an addition-al fellow to pursue training specific toclinical trials in breast imaging.

Applications and additional informa-tion can be found at www.acrin.org. Theapplication deadline is January 15, 2003.

An editorial on these new Fellow-ships will appear in the December issueof Radiology (radiology.rsnajnls.org).

Register online for the BiomedicalImaging Research OpportunitiesWorkshop (BIROW) to be held Janu-ary 31–February 1, 2003, at the HyattRegency, Bethesda. The workshop isco-sponsored by RSNA, AAPM, ARR

and BMES along with support frommany other radiological, engineeringand basic imaging science societies.

To register or for more informa-tion, go to www.birow.org or send ane-mail to [email protected].

BIROW

RSNA:MEMBER BENEFITS

RSNA: Working for You

E-Zone: A New Feature of RadioGraphics OnlineBecause of the flexibility ofelectronic publishing, Radi-oGraphics Online has anew section called E-Zonethat highlights online-onlyarticles prior to publicationof the issue with whichthey will be associatedonline and in which theywill be cited. When theissue is published, the arti-cles will leave the E-Zoneand become part of theissue, as before.

The abstracts andURLs of the online-onlyarticles will continue toappear in the print version

of the issue. The reader isreminded that online-onlyarticles differ from those inthe print version only inthat they are interactive orthat the number of imagesneeded to support the pur-pose of the article is greaterthan the number that can bepublished in print. Online-only articles are reviewedwith the same rigor asthose published in the printversion.

Go to radiographics.rsnajnls.org and then clickon “E-Zone.”

Press Conferences at RSNA 2002Some of the scientific studies and exhibits at RSNA 2002 willbe presented to the new media via a series of press confer-ences. Topics include:

• Effects of violentmedia exposureby adolescentswith disruptivebehavior disorderas measured byfMRI activationpatterns in frontallobe

• Sonographic find-ings in the scro-tum and hormonaland semen pro-files in extrememountain bikers

• Breast arterial cal-cification detectedon mammographyis a risk factor forcoronary arterydisease

• Accidental falls inchildren under 5years of age

• Correlation ofproton MR spec-troscopic imagingwith GleasonScore based on

step section radi-cal prostatectomy

• A grouping ofeducation exhibitson “MedicalImaging of Terror-ist Attacks” and“The Radiologyof War”

• Radioarcheology:an advanced CTevaluation of asunken confeder-ate submarine

RSNA press releases can be viewed online atwww2.rsna.org/pr/pr1.cfm.

RSNA press releases can be viewed online at



Steve DrewSERVICE TO MEMBERS:

Through the efforts of six outstandingdirectors and their support staff, Steveis responsible for working with theBoard of Directors and committeevolunteers in conducting strategicdevelopment, management andadministrative functions related to theScientific Assembly and AnnualMeeting; internal and external infor-mation system activities; and all

issues and projects of the InformaticsDepartment. Specifics include con-tract negotiations, operations andlogistics for the Scientific Assembly(housing, transportation, educationprogram, infoRAD and technicalexhibition); management of hardwareand software for data processing andcommunications systems (needsanalyses, development, implementa-tion and operations), management ofinformatics projects and activities(DICOM and IHE technical documentdevelopment and vendor demonstra-tions, MIRC, RadLex, infoRAD andRSNA Link [Web site and onsite meet-ing information systems]).

WORK PHILOSOPHY: I believe in promotingthe understandingamong staff that westrive to serve the bestinterests of RSNA mem-bers. Rome was notbuilt in a day, so noproject or problem isinsurmountable if man-aged one brick at a time.A happy work place is aproductive one. Meetingchallenges head-on isthe quickest way to res-olution. And, teamworkis not a cliché.

WORKING FOR YOU PROFILE

NAME:Steve Drew

WITH RSNA SINCE:July 6, 1989

POSITION:Assistant Executive Director: Scientific Assembly & Informatics

Manuscript CentralSubmit manuscripts to Radiology via the Internetat radiology.manuscriptcentral.com. Since Febru-ary 1, Radiology has been accepting articlesthrough Manuscript Central, the leading Web-based peer-review application. The system allowsmanuscripts to be submitted electronically andreviewed online, saving time and postage costs. Italso allows authors to check on the status of theirmanuscripts at any time of the day or night.

If you have a colleague who would like to become an RSNA member, you can download anapplication at www.rsna.org/about/membership/memberapps.html, or contact the RSNAMembership and Subscription Department at (630) 571-7873 or membersh@ rsna.org.

Patient Link to Clinical Trials in Digital MammographyRSNA’s patient education Web site,RadiologyInfo.org, now providespatients with direct links to clinical trials in digital mammography. Thelinks are accessed from pages describing the mammography procedureand breast cancer and from an article on digital mammography.

RSNA Faculty Development Workshop

An RSNA Faculty DevelopmentWorkshop was held in Septemberin Oak Brook, Ill., as part of theRSNA Board of Director’s initia-tive to incorporate principles ofadult education into RSNA pro-grams. The next workshop will beheld in fall 2003.

RSNA:MEMBER BENEFITS

Patient Education BrochuresRSNA has developed new patient educationbrochures to help patients prepare for various radi-ologic procedures. Five brochures are available,including one on CT of the Body. This brochure

provides insight into why and how theprocedure is performed, as well as anintroduction to the physicians and pro-fessionals who perform the exam. Theother brochures are Mammography,Abdominal Ultrasound Scanning, MRIof the Musculoskeletal System andRadiology & Your Health.

For more information or to place anorder, go to www.rsna.org/practice/index.html or call (800) 272-2920.RSNA members receive a discount.


RSNA 2002 HighlightsThe Octoberissue of RSNANews contains anextensive listingof highlights andother importantinformation forRSNA 2002, aswell as a Chica-go restaurant guide. The issue is avail-able on the Internet at rsnanews.org.

MEETING WATCH:RSNA 2002

EXHIBITOR NEWS:RSNA 2002

The 2002 Buyer’s Guide: Radi-ology Products and Serviceswill be available at the end ofNovember. Each exhibitor willreceive a copy by mail. Thepublication will also be avail-able at McCormick Place andonline at www.rsna.org/buyers-guide. html.

The Buyer’s Guide is theofficial guide to the technicalexhibits at RSNA 2002 show-casing radiology product offer-ings and services. Designedfor year-round use, the Buyer’sGuide includes important ref-erence material for purchasersand decision makers.

Buyer’s Guide Available Soon Important Exhibitor Dates for RSNA 2002Nov. 15 Advanced Shipments to

Freeman Warehouse*Floral and Plant Rental/FloralExhibits Ltd.*Lead ManagementSystems/ExpoExchange*Computer Rental/Datasis*Security Services*Social Event Busing Requests*Bottled Water Service/SparklingSprings*Temporary Personnel/JudyVenn & Assoc.*

Nov. 25 Target move-in beginsNov. 29 General move-in beginsDec. 1-6 RSNA 88th Scientific Assembly

and Annual Meeting*Forms for these services can be found inside the RSNAExhibitor Service Kit

Technical Exhibit HoursSun., Dec. 1 – Wed., Dec. 4■ 10:00 a.m. – 6:00 p.m.

Thurs., Dec. 5■ 10:00 a.m. – 2:00 p.m.

Technical Exhibits InstallationFor more information aboutdates and times, refer to theTarget Floor Plan mailed in mid-September.

News about RSNA 2002

Badge WalletsRSNA 2002 badge wallets have beensent to Non-North American attendeeswho registered by October 11, 2002,and North American attendees who reg-istered by November 1, 2002.

Badge wallets contain a name badge,tickets and attendance vouchers. Thosewho did not meet the deadline will haveto register onsite. Registration ratesincrease $100 onsite. Students (techni-cal, medical and nursing) are eligible toregister onsite at no charge with properstudent identification.

Non-NorthAmerican regis-trations receivedOctober 12 –November 1require attendeesto pick up badgesand tickets onsiteat McCormickPlace, Desk A,Room S100 in the South Building.

Onsite RegistrationSouth Building, Level 1, Room S100Saturday (Nov. 30) 12:00 p.m.–6:00 p.m.Sunday–Monday (Dec. 1-2) 7:00 a.m. – 6:00 p.m.Tuesday–Thursday (Dec. 3-5) 7:00 a.m. – 5:00 p.m.Grand Concourse, Level 3, Help CenterFriday (Dec. 6) 7:30 a.m. – 12:00 p.m.

One-Day Badge A one-day badge is available to viewthe technical exhibits area only. Thebadge can be purchased onsite for $150per day at the Professional RegistrationDesk in the McCormick Place SouthBuilding, Room S100. A business cardis required.

For more information on RSNA2002, call (630) 571-7862 or [email protected].

Tour of the TechnicalExhibits at McCormick PlaceSpouses of RSNA 2002 attendees canget a firsthand view of the technicalexhibits as radiologist Anton Hasso,M.D., escorts them on an informativewalk through the exhibit halls. The touris scheduled Wednesday, December 4,2:00 p.m. – 4:00 p.m. For more infor-mation, see the RSNA Tours & Eventsbrochure at www.rsna.org/rsna/advanceregistration/pdf/RSNA2002tours_and_events.pdf, or visit the Tours & Activi-ties Desk in the McCormick PlaceGrand Concourse or in the PalmerHouse Hotel, 6th floor.

December 1 – 6McCormick Place,Chicago

Exhibit Space SummaryAs of September 30, 2002,total exhibit space sold was433,380 square feet with 614companies registered toexhibit; among them morethan 100 first-time exhibitors.

For more information,contact RSNA TechnicalExhibits at (630) 571-7851 [email protected].

ad- PatientInfo broch


What’s New at RadiologyInfo™?RSNA’s patient information Web site, a joint projectwith the American College of Radiology, has addeda few new features.

RadiologyInfo™ (www.radiologyinfo.org) nowhas a Frequently Asked Questions page. This pagecontains answers to the most frequently asked ques-tions submitted by site visitors. The FAQ page alsoprovides links to external information resources andradiologic organizations that may help visitors findanswers to their questions. The FAQ page can beaccessed from the Site Map or Contact Us page.

A “Recommend This Page To a Friend” link hasbeen added near the bottom of each procedure page.This will make it easier for site visitors to shareRadiologyInfo with their friends or family.

Patient-targeted information on MRI safety wasrecently added with a link to MRISafety.com formore detailed information. The new section coversthe following common questions/concerns:• What is MRI and how does it work?• How safe is MRI?• How will I prepare for an MRI exam?

• What if I have claustrophobia?• Pregnancy and MRI

The following patient handouts have recentlybeen completed and can be downloaded as PDFfiles from the Printable Handouts page: Ultrasound-Guided Breast Biopsy, X-ray Guided Breast Biopsy,General Nuclear Medicine, Cardiac Nuclear Medi-cine, Vascular Access Procedures, Angioplasty andVascular Stenting.

New Address for Database of FundingOpportunitiesRSNA’s Department ofResearch has relaunched itsDatabase of Funding Opportu-nities with a new Internetaddress: www3.rsna.org/dor/

Most visitors will find the revampeddatabase more attractive and easier to usethan the original. In addition to searches bytype of funding source (such as federal, foun-dation or hospital), you can now search byindividual funders. A new search-results pageprovides more information than its predeces-sor, including purpose and grant ranges. It isalso easier to navigate large numbers ofresults.

Hospitals, universities, foundations, pro-fessional societies and other organizationsthat want to update their listings or notifyRSNA of new funding opportunities shouldcontact the Department of Data Managementat (630) 368-3756 or [email protected].

New Look for Radiology OnlineThe Radiology home pageon the Internet(radiology.rsnajnls.org)has been redesigned. Thenew look makes it distinctfrom other online journalspublished in associationwith HighWire Press. Italso highlights the continu-ous publishing feature.

Most articles are pub-lished in Radiology Online several weeks before they appear in theprinted version of Radiology. These online articles are the same ver-sion that will appear in print—namely, the final version that has beenpeer reviewed, revised, edited and approved by the authors.

RadioGraphics Online Launches E-ZoneRadioGraphics has announced a new feature of RadioGraphics Onlinecalled E-Zone. This area contains online-only articles published in finalform prior to publication of the issue with which they will be associatedonline. Details are available at radiographics.rsnajnls.org/.

www.rsna.org

RSNA:ON THE WEB

Other Web NewsFDA Outlines Plansfor ImplementingBioterrorism Law The Food and DrugAdministration has addedto its Web site the text ofthe Public Health Securityand Bioterrorism Pre-paredness and ResponseAct of 2002. The site alsoincludes the FDA’s plansfor implementing sec-tions relevant to theagency.www.fda.gov/oc/bioter-rorism/bioact.html

Unwanted Radioac-tive Sealed SourcesThe Department of Ener-gy has a Web site(osrp.lanl.gov/Home.html) with detailed infor-mation about its Off-SiteSource Recovery (OSR)Project. The goal is torecover and manageunwanted radioactivesealed sources and otherradioactive material.

Medical Meetings December 2002 – March 2003

CALENDAR

NOVEMBER 30How to Write a Good Grant Application (prior to RSNA 2002), McCormick Place, Chicago • (630) 368-3758 or [email protected]

NOVEMBER 30Retirement Distribution Planning and Investment Seminars(prior to RSNA 2002), McCormickPlace, Chicago • (630) 590-7715 or [email protected]

DECEMBER 1-4Introduction to Research (during RSNA 2002), McCormickPlace, Chicago • (630) 368-3758 or [email protected]

DECEMBER 1-6RSNA 2002, 88th Scientific Assembly and Annual Meeting,McCormick Place, Chicago • www.rsna.org

DECEMBER 7–8 International Society for Clinical Densitometry (ISCD), BoneDensitometry Certification Lectures and Exam, Marriott’sCourtyard Chicago Downtown • (202) 367-1132

DECEMBER 8-11American Medical Association (AMA), Interim Meeting, NewOrleans Hilton & Towers, New Orleans • (312) 464-5000

JANUARY 4-7Indian Radiological & Imaging Association (IRIA), 56th AnnualCongress, Jaipur, India • www.56iriajaipur.net

JANUARY 23-26Radiation Therapy Oncology Group (RTOG), Hyatt RegencyHouston • (215) 574-3189

JANUARY 31–FEBRUARY 1Biomedical Imaging Research Opportunities Workshop(BIROW), RSNA/ARR/AAPM/BMES, Hyatt Regency, Bethesda • www.birow.org

FEBRUARY 1-5Mexican Society of Radiology and Imaging (SMRI), XXVIIAnnual Course of Radiology and Imaging, Sheraton Hotel Centro Historico, Mexico City •

FEBRUARY 6-7Fourth National Forum on Biomedical Imaging in Oncology,NCI/FDA/CMS/NEMA, Hyatt Regency, Bethesda • www3.cancer.gov/dctd/forum/

FEBRUARY 8-15American Board of Radiology (ABR), Winter Meeting, HualalaiResort, Kona, Hawaii • www.theabr.org

FEBRUARY 16-21Society of Gastrointestinal Radiologists (SGR), 32nd AnnualMeeting, Fiesta Americana Grand Coral Beach, Cancun, Mexico• www.sgr.org

MARCH 2-6Society of Thoracic Radiology (STR), Annual Meeting and Scientific Session, Loews Hotel, Miami Beach, Fla. • (507) 288-5620

MARCH 7-11European Congress of Radiology (ECR), Vienna, Austria • www.myecr.org

MARCH 12-163rd Annual PACS Conference, University of Rochester Depart-ment of Radiology, Westin Riverwalk Hotel, San Antonio, Texas• (585) 275-1050 or www.urmc.rochester.edu/pacs2003

MARCH 24-28Society of Computed Body Tomography and Magnetic Reso-nance (SCBT/MR), 23rd Annual Course, Westin Mission HillsResort, Rancho Mirage, Calif. • (507) 288-5620

MARCH 27 - APRIL 1Society of Interventional Radiology (SIR), Convention Center,Salt Lake City, Utah • www.sirweb.org

RSNA Link www.rsna.orgRadiology Onlineradiology.rsnajnls.orgRadiology Manuscript Centralradiology.manuscriptcentral.com

RadioGraphics Onlineradiographics.rsnajnls.orgEducation Portalwww.rsna.org/education/etoc.htmlCME Credit Repositorywww.rsna.org/cme

RSNA Index to Imaging Literaturersnaindex.rsnajnls.orgRadiologyInfo™

ACR-RSNA public informa-tion Web sitewww.radiologyinfo.org

RSNA Online Products and Serviceswww.rsna.org/memberservices

NEW ADDRESSDatabase of FundingOpportunitieswww3.rsna.org/dor/

ec o n n e c t i o n s Your online links to RSNA

Documents

DT-MRI Offers Expanding Potential in Research and Diagnosis · 2012-03-05 · NOVEMBER2002 VOLUME 12, NUMBER 11 December 1-6 • Chicago RSNA 2002 THE NEWSLETTER OF THERADIOLOGICAL