In terms of duration of treatment and cost, patients with early stage breast cancer may benefit from accelerated partial breast irradiation (APBI) with proton therapy versus whole breast irradiation (WBI), according to new research from The University of Texas MD Anderson Proton Therapy Center. 

In a cost analysis study based on typical patient characteristics, researchers used Medicare reimbursement codes to analyse allowable charges for eight different types of partial and whole breast irradiation therapies and treatment schedules available to early stage breast cancer patients. Taken together, these represent roughly 98% of the treatment options available to these patients. The cost of proton therapy when used for APBI, introduced to decrease overall treatment time and toxicity, was estimated at $13,833. Comparatively, WBI using IMRT (x-ray) therapy resulted in the highest Medicare charges at $19,599. The average charges across the eight treatment regimens were $12,784; thus, proton costs were similar to that of other types of radiation.

A study of portable ultrasound performed in the United States, Canada, and India has revealed the potential of this technology for identifying plaques in peripheral arteries that can lead to heart attacks and stroke before symptoms occur, in both developed and developing country environments, allowing preventive treatment in those affected.

The study was conducted by Dr. Ram Bedi, affiliate assistant professor, department of bioengineering, University of Washington (Seattle, WA, USA), and Prof. Jagat Narula, editor-in-chief of Global Heart and Icahn School of Medicine at Mount Sinai (New York, NY, USA), and colleagues.

Many research studies have shown that it is possible to evaluate subclinical atherosclerotic cardiovascular disease (ASCVD) using ultrasound imaging. Because more portable and lower cost ultrasound devices are now available, combined with increased automation and enhancements, it may be possible in the near future to typically examine people with ultrasound to establish any ASCVD present before symptoms arise, so that future disease can be prevented, for example using medication. In this study, ASCVD was determined using ultrasound of both the carotid arteries and the ileofemoral arteries. The findings were summarized in an easy to understand index called the Fuster-Narula (FUN) Score.

Data were gathered from four cohorts, two Indian and two North American. In India, a medical camp setting was used, and screening with automated ultrasound imaging was conducted over eight days in 941 comparatively young (mean age 44 years, 34% female) asymptomatic volunteers recruited from the semi-urban town of Sirsa (Haryana) and urban city of Jaipur (Rajasthan) in northern India. The cohort from Sirsa was specifically recruited because all participants had already undergone aggressive lifestyle changes (smoking cessation, no alcohol, vegetarian diet, physically active lifestyles, daily meditation), radiology resident physicians who had no earlier training in vascular ultrasound were trained right on the spot to perform the ultrasound examinations.

To compare the imaging findings with traditional risk factors, two cohorts (481 persons) were recruited from primary care clinics in North America (one in Richmond, TX, USA, the other in Toronto, Canada). As well as the same ultrasound examinations given in the Indian cohort, comprehensive ASCVD risk factor information collected from these participants, all of whom were self-referred asymptomatic individuals (mean age 60 years, 39% female). Data collected included cholesterol levels, blood pressure, glucose level, weight, height, smoking and family history. These people were attending clinics for routine health examinations in most cases. Effectiveness of established ASCVD prevention guidelines was then compared to findings from direct imaging; ultrasound was performed by trained experts at each center.

In India, ultrasound revealed plaques in at least one artery in almost a quarter (24%) of those examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. If just the carotids had been examined, 177 (19%) of the asymptomatic individuals would have been identified with plaques; by adding the iliofemoral examination, 47 additional individuals (5% of the total) were identified with plaque. Older age and male sex were associated with the presence of plaque both in urban and semi-urban populations (the much higher levels of smoking in men could account for their higher risk).

Data from the American and Canadian clinics showed that 203 subjects (42%) had carotid plaque; 166 of these (82% of those with plaque) would not have qualified for lipid-lowering therapy such as statins under the most widely used guidelines known as ATP III (Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel]) guidelines. Using the recently published, more rigid ATP IV guidelines, 67 people (one-third of those with plaque and 14% of the total US/Canadian cohort) individuals with carotid plaque would also have failed to qualify for treatment.

Furthermore, the study revealed 34 individuals in the United States and Canada who qualified for treatment under ATP III but did not have any plaques, and this number increased to 81 under ATP IV (if receiving treatment such as statins, these people could be said to be overtreated, since no plaques were seen).

The investigators reported,

Chest pain doesn’t necessarily come from the heart. An estimated 200,000 Americans each year experience non-cardiac chest pain, which in addition to pain can involve painful swallowing, discomfort and anxiety. Non-cardiac chest pain can be frightening for patients and result in visits to the emergency room because the painful symptoms, while often originating in the esophagus, can mimic a heart attack. Current treatment

The liver transplant team at Mayo Clinic in Florida has found, based on 12 years of experience, that more than half of patients receiving a new liver can be

In new research, investigators concluded that overuse of cardiac stress testing using advanced imaging technology has led to increasing healthcare costs in the United States and unnecessary radiation exposure to patients.
Researchers from the New York University Langone Medical Center in what is believed to be the first comprehensive examination of trends in cardiac stress testing utilizing imaging, also revealed that there are no significant racial or ethnic health disparities in its use. They also made US estimates of the cost of unnecessary cardiac stress testing with imaging and the health burden of this testing, in relation to cancer risk due to radiation exposure.
Cardiac stress testing, especially with imaging, has been at the forefront of debate about rising healthcare costs, inappropriate use, and patient safety in the context of radiation exposure. Joseph Ladapo, MD, PhD, assistant professor in the departments of medicine and population health at NYU Langone, and the lead author of the study, and colleagues wanted to determine whether US trends in cardiac stress testing with imaging may be attributable to population shifts in demographics, risk factors, and provider characteristics, and to assess whether racial/ethnic discrepancies exist in physician decision making.
The investigators designed their study utilizing data from the US National Ambulatory Medical Care Survey and US National Hospital Ambulatory Medical Care Survey from 1993 to 2010. Patients chosen for the study were adults without coronary heart disease who were referred for cardiac stress tests.
Between 1993