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Updates for Professionals
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October 2011: Report on First Year’s Experience with MRI Prostate using Dynamic Contrast Enhancement at LDC. Dr. George Privett, Medical Director at Lexington Diagnostic Center reported in the September edition of M.D. Update that the first years experience with this new computer aided test for prostate cancer. Dr. Privett reported that the indication for DCE MRI are; A. Rising/High PSA for Pre-biopsy Planning. DCE MRI is not indicated for routine screening. For a look at the whole article click here or go to www.MD-Update.com (page 26). |
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2010: MRI Prostate using Dynamic Contrast Enhancement now available at LDC. Free one-hour CME courses on DCE-MRI are available. New MRI imaging software picks out abnormal blood flow in tumor and gives first clear look at location and size of prostate cancer. For more, go to Prostate Cancer Tests . Medical Professionals in the Ky Bluegrass area can receive an educational PowerPoint® presentation and additional research information on DCE-MRI at no charge by e-mailing gwprivett@aol.com with your Name, Speciality, Office Mailing Address, and Telephone number. Click here for a printable Doctor’s Order Form for DCE-MRI There are 3 excellent FREE 1 hour archived webinars on this new procedure from ICPME®. These can be taken on demand. To register and view these go to: http://courses.icpme.us/class_learn?course=148 |
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April 2010: Orders for Diagnostic Tests Must now be Signed Legibly Under New Medicare & Medicaid Requirements Guidelines were enacted in April 16, 2010, which requires physician and non-physician practitioners to sign all orders (including those for out-patient imaging tests). The requirements are:
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February 2010: Safety Notice for Medtronic Pumps and MRI Important New Safety Guidelines for MRI Scans of Patients with Implanted Medtronic Pumps Many patients with chronic pain or spasticity have had pumps implanted to deliver constant doses of medication into the spinal canal for pain treatment, to control spasticity or to deliver cancer chemotherapy . Medtronic® is a major supplier of these pumps. Many of those patients also require MRI scans and in the past we have successfully performed many MRI scans in both our Open (0.6T) and High Field (1.5) MRI. It has long been known that the MRI magnet will temporarily stop the pump action for the duration of the scan, but the pump will restart on its own. Our past procedure has been to have the proper pump action checked by the pain management doctor after the scan. Medtronic Corporation, has recently issued new safety notifications for the Synchromed EL® and Synchromed II® pumps relative to potential problems for MRI scanning in all 1.5 T and 3.0 T MRI conventional scanners if the Z axis of the static magnetic field is oriented 90 degrees to the flat side of the pump. In some cases, the pump motor has been permanently disabled requiring that a new pump be inserted. For patients on Lioresal Intrathecal® (baclofen) for spasticity, the sudden stopping of baclofen can be dangerous and even life threatening. For patients on pain medications, this will result in resumption of pain. These pumps are usually placed under the skin so that the flat side of the pump (access port side) is parallel to the surface of the torso. In conventional 1.5 T and 3.0 T scanners, the Z Axis travels through the center of the bore through the long axis of the patient from head to foot, therefore the Z axis is zero degrees to the flat side of the pump, and in this situation the MRI will stop the pump temporarily, but not permanently damage it. Medtronics states that they have not tested the pumps in the open or standing MRIs they also indicate verbally that they have received no reported incidents of pump failure in the Open MRI. We have performed MRIs on numerous patients with Medtronic pumps without any known incidence of permanent pump failure. In Open or (standing) MRIs, the Z axis goes from top to bottom (or side to side) in an anterior-posterior direction through the body so that the Z axis is, in fact, 90 degrees to the face of the pump. However, most Open or standing MRIs have magnetic field strengths of 0.6T, which is considerably lower than the field strength of conventional MRI scanners. Effective immediately, at Lexington Diagnostic Center & Open MRI, before performing MRI scans on pump patients with our 1.5 T conventional MRI we will have our technologist, nurse or doctor ascertain that the flat side (port access side) of the pump is in its normal position facing the outside of the body. We will continue to perform OPEN MRI (0.6 T) scans on patients who have implanted Medtronic pumps (Synchromed®models EL and II). For more information go to the MedtronicII® web site: http://www.professional.medtronic.com/devices/synchromed-II-for-spasticity/mri-guidelines/#synchromedII |
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For Information about ALL MRI Safety issues, go to: |
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November 2009 Safety Notice for Gadolinium and MRI LDC Policies Reduce the Risk of Serious Side Effects from Gadolinium Contrast for MRI Nephrogenic Systemic Fibrosis (NSF) The contrast agent commonly used in MRI is a compound that contains and binds gadolinium. (Unbound free gadolinium is very toxic.) There are several of these compounds including Magnevist®, Omniscan®, OptiMark®, ProHance®, and Multihance®. For years we thought that all of these agents were very safe and without serious side effects. However, in 2006 there began to be reports of several cases of an unusual serious debilitating and usually lethal condition in which the patient developed thickening and stiffness of the skin and underlying connective tissue, joints, eyes and internal organs. All of these patients had two things in common, all had renal failure and all had received one or more of the gadolinium compounds for MRI contrast. This condition is called Nephrogenic Systemic Fibrosis (NSF). There seemed to be higher rates of NSF associated with Omniscan®, Magnevist®, and OptiMark® and almost none with ProHance® and Multihance®. Fortunately, we were not aware of any cases of NSF in patients we had scanned. In June 2007 Lexington Diagnostic Center instituted a two policies relating to the use of gadolinium contrast. The first policy was to use only half dose Multihance®. We did this for several reasons:
The second policy was to screen patients who were at risk for renal disease with a blood test to test kidney function (serum creatinine). If the patient has some degree of renal failure, then we will only give Multihance® after consultation with the patient’s referring physician and weighing the risk vs. the benefit. In October 2008, we revised our criteria based on new information and have eased the restrictions on mild kidney failure. We continue to be fortunate to have experienced no known cases of NSF in our patient population. In October 2009, the results of a study at Emory Hospital in Atlanta and University of North Carolina, Chapel Hill were published in the Journal Radiology. In this study, these two institutions instituted similar changes and guide lines in the use of gadolinium for MRI contrast as we did and the study showed that no new cases of NSF have been diagnosed. Based on this new study we believe that we have adopted a very safe strategy to best protect our patients from serious side effects from MRI contrast agents. We will continue to monitor the situation and adapt to any new recommendations. |
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For Current FDA information about Gadolinium safety guidelines go to: |
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July 2009 Screening Virtual Colonoscopy Kentucky Insurance Companies now Required to Pay for Screening Virtual Colonoscopy The 2008 Kentucky General Assembly has passed legislation requiring Kentucky commercial insurance companies to pay for Screening Virtual Colonoscopies just as they would for any colon cancer screening test approved by the American Cancer Society. Medicare and Medicaid do not yet do so, however strong pressure is being applied to do so. Virtual Colonoscopy is recommended every 5 years for people 50 and older. For people at high risk, starting earlier and repeating more frequently may be appropriate. Lexington Diagnostic Center and OPEN MRI was the first in Lexington to perform virtual CT colonoscopy and has been doing so since 2004. |
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September 2008 Virtual Colonoscopy Virtual Colonoscopy found to be as accurate as traditional optical colonoscopy. The American College of Radiology (ACR) Imaging Network published results from their National CT colonography Trial that found that the accuracy of CT Colongraphy (virtual CT colonoscopy) was comparable to that of traditional optical colonoscopy for the detection of clinically significant colon polyps. The report was published in the New England Journal of Medicine*in September. The American Cancer Society has recommended that virtual CT Colonoscopy be included in the list of Recommended Screening tools for Colorectal Cancer in New Screening Guidelines. The ACR has supported this position by the American Cancer Society. Lexington Diagnostic Center and OPEN MRI was the first in Lexington to perform virtual CT colonoscopy and has been doing so since 2004. *Johnson CD, Chen MH, Toledano AY, et al.: Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359 (12): 1207-17, 20 |
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2008 Image Gently® Program for Children For additional information on the Image Gently program visit |
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July 2009 FDA Releases Silicone Breast Implants for Use. Recommends Breast MRI to detect ruptures. Silicone breast implants were removed from the market for several years due to concerns about the health implication of rupture. After much research, the suspected side effects of rupture were found to be very low and silicone implants have again been released for use. However, because of concerns about local reactions or migration of the silicone from the chest wall to other organs, MRI has been recommended every 3 years to detect silent rupture. Lexington Diagnostic Center has been on the forefront of providing Breast MRI for implant rupture determination as well as for Cancer detection in women with high risk for breast cancer, or who have very dense breasts or implants. (See press release below) |
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May 2007, Breast MRI now recommended annually by the American Cancer Society and the American College of Radiology in High Risk Patients Women at high risk for Breast Cancer include:
The recommendations for all other patients not at high risk is to continue to have annual mammograms and do self examinations. |
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