The evidence is clear: Cervical cancer is best treated with brachytherapy, a form of radiation therapy. Yet the use of this potentially lifesaving treatment has been declining, and a new study from the University of Virginia School of Medicine may explain why.
UVA researchers have determined that offering brachytherapy for locally advanced cervical cancer ends up costing hospitals money. After accounting for the costs and time involved, the researchers found that Medicare reimburses four times more per minute required for a less effective alternative than it does for brachytherapy. Ultimately, providing brachytherapy results in a net loss for the providing healthcare facility, the researchers determined. This can leave hospitals – particularly smaller hospitals that don’t do a lot of brachytherapy – in the lurch.
“Studies have time and time again shown that brachytherapy is the most important part of cervical cancer treatment, because it is essential to eradicating the tumour,” said Timothy Showalter, MD, a radiation oncologist at UVA Cancer Center. “A decline in brachytherapy utilization is associated with a higher rate of mortality in cervical cancer, so there’s a direct relationship.”
The problem stems partly from the amount of physician time brachytherapy requires: It takes 80+ percent more personnel time to administer brachytherapy than it does to deliver the increasingly popular alternative, external beam radiation. Both methods deliver radiation to the tumour, but brachytherapy delivers much greater doses in a much more targeted manner. Another key difference, the researchers found: Medicare reimbursement makes external beam radiation profitable, while brachytherapy is not.
Overall, the researchers determined that it costs hospitals more than twice as much to provide brachytherapy as it does to provide external-beam radiation. But the reimbursement doesn’t reflect that.
“Brachytherapy requires a lot of physician effort and expertise and reimburses poorly for that effort,” Showalter said. “I can certainly imagine how the comparatively poor reimbursement rates compared to external beam radiation could contribute in some environments to not establishing a service for brachytherapy or just not committing physician time to it.”
He noted that healthcare providers face a cold, hard truth when deciding whether to offer brachytherapy, or any other treatment: “If practices don’t run at least a profit greater than zero,” he said, “then they fold.”
The researchers concluded that hospitals that see a high volume of patients, such as UVA, are best equipped to provide brachytherapy – and to absorb the major resource commitment that comes with it. “My job specifically involves brachytherapy,” Showalter said. “We’re at this big hospital with all the equipment we need at the ready and a wonderful streamlined process that enhances the patient experience and reduces patients’ time on the table. That makes it easier to provide efficient and effective care.”

EurekAlerthttps://tinyurl.com/y9oqfbe4

Latest addition to growing portfolio of breast and skeletal health innovations to be featured at ECR 2019

Hologic, Inc. (Nasdaq: HOLX) today announced the granting of a CE Mark to the LOCalizer™ wireless radio frequency identification (RFID) breast lesion localization system. This system is designed for precise and easy marking and targeting of lesions for breast-conserving surgery guidance.
The system is one of many in Hologic’s expanding suite of breast and skeletal health products, including screening, interventional, ultrasound and surgical solutions, that will be available for demonstration in Booths X2 – 211 and X5 – 521 at the annual European Congress of Radiology (ECR) meeting in Vienna, Austria from Feb. 27 to March 3.
The LOCalizer tag is designed to replace the traditional wire-guided localization method, helping to provide increased comfort and convenience for patients and their healthcare teams. The tag can be implanted up to 30 days prior to a breast-conserving surgery, providing increased flexibility for patients and providers. This improved workflow is designed to help reduce scheduling and logistical hurdles for care teams and aims to deliver added convenience for an enhanced patient experience. Following placement, the miniature implantable tag can be detected by a portable, handheld reader that indicates the location and distance in millimeters to the lesion, enabling the surgeon to pinpoint the correct area of breast tissue for removal.
“We look forward to showcasing the new LOCalizer system at ECR as we continue to broaden our offerings to make a positive impact on breast health at every step of the patient journey – from screening to pathology,” said Jan Verstreken, Regional President EMEA and Canada, Hologic. “This thoughtful expansion is rooted in our commitment to developing new and innovative solutions clinically proven to improve cancer detection, patient satisfaction and facility workflow, while reducing costs associated with unnecessary callbacks.”
The market leader behind the 3D Mammography™ exam, Hologic has expanded significantly in recent years through insight-driven innovation and strategic acquisitions to address the entire clinical continuum of breast health. Along with the LOCalizer system, the Company’s new products include the SmartCurve™ breast stabilization system, Clarity HD high-resolution 3D™ imaging technology, the Viera™ portable breast ultrasound system, and the Brevera^® breast biopsy system with CorLumina® imaging technology, which features real-time imaging and sample verification. Two recent acquisitions of Faxitron^® Bioptics, a leader in digital specimen radiography, and Focal Therapeutics, manufacturer of the BioZorb^® marker, have enabled Hologic to play a larger role in breast-conserving surgery and strengthened its offerings to radiologists, pathologists and breast surgeons.
Visitors to the Hologic booth at ECR can experience the A.I. Future Suite, highlighting Hologic’s long-standing commitment to incorporating artificial intelligence and machine learning into its groundbreaking technologies. Attendees will have a chance to experience current and future applications of A.I. in breast imaging, and learn more about how Hologic plans to continue to deliver significant value as a leader in the space. In addition, the Company’s entire suite of breast and skeletal health products, such as the 3Dimensions™ Mammography System and Fluoroscan^® Insight™ FD Mini C-Arm, will be on display and available for demonstration.
Throughout ECR, Hologic will host a variety of workshops and a symposium, Advances in Breast Imaging: Clinical use of CEDM across Europe. Workshop topics will offer hands-on experience and expert insight into topics including: clinical workflow using tomosynthesis guidance and real-time breast biopsy imaging; a new technique for breast lesion localization; wireless ultrasound guided biopsies; contrast-enhanced mammography in clinical practice; optimization of tomosynthesis reading time; and breast density case reviews. For more information, please visit ecr.Hologic.com or visit Hologic’s Booths X2-211 and X5-521.
The LOCalizer system is manufactured by Health Beacons, Inc. and is exclusively distributed by Hologic.

Five percent more cardiac infarctions detected and 11 percent fewer patients suffering a relapse. That is the result of a study of more than 80,000 patients in which two cardiac damage markers (conventional troponin and the newer, high-sensitive troponin T) were compared with each other.
“This can serve to motivate hospitals that have not yet adopted the high-sensitive troponin T. It is more sensitive, and a heart attack can be identified earlier,” says Maria Odqvist, a doctoral student at the Institute of Medicine at Sahlgrenska Academy and the lead author of the study “It’s also possible to determine if the problem is not a heart attack and where the patient’s chest pain is due to something else.”
The study, which is a collaboration with Karolinska Institutet, encompasses all patients who suffered heart attacks in Sweden during the 2009–2013 period. A total of 87,879 people were studied, of which 40,746 were diagnosed using high-sensitive troponin T and 47,133 were tested using conventional troponin. The groups were similar in terms of gender and age distribution and other types of illness in the patients’ history.
Similar studies have been carried out before but then on selected groups of patients, which were treated primarily in cardiac intensive care departments. This study also included patients treated in other departments to collect a broader range of cases.
Chest pain is one of the most common reasons people seek emergency medical care. To determine if a person has suffered a cardiac infarction, symptoms are assessed partly on the basis of chest pain and partly with an electrocardiogram taken to detect typical changes consistent with a heart attack.
In addition, a blood test is taken to measure levels of the protein troponin or else high-sensitive troponin T, both of which are biomarkers for heart damage. Elevated troponin values indicate that cells in parts of the heart have died from lack of oxygen after a heart attack impeded the flow of blood.
The current study showed that the more sensitive marker, troponin T, detected five percent more heart attacks, although with no impact on survival. On the other hand, the number of heart attack victims suffering a relapse was 11 percent lower in that group.
When high-sensitive troponin T started being introduced in 2009, there was concern about spending of health care resources in general and that interventions and treatments for the group of patients with suspected heart attacks would increase.
"We could see a small increase in the number of coronary angiography and balloon blasts, which are associated with finding more cardiac infractions, but the increase is quite modest”, says Maria Odqvist.

University of Gothenburgwww.gu.se/english/about_the_university/news-calendar/News_detail//increased-safety-in-diagnosing-cardiac-infarction-with-more-sensitive-analytical-method.cid1571664

EXPLORER, the world’s first medical imaging scanner that can capture a 3D picture of the whole human body at once, has produced its first scans.
The brainchild of UC Davis scientists Simon Cherry and Ramsey Badawi, EXPLORER is a combined positron emission tomography (PET) and X-ray computed tomography (CT) scanner that can image the entire body at the same time. Because the machine captures radiation far more efficiently than other scanners, EXPLORER can produce an image in as little as 1 second and, over time, produce movies that can track specially tagged drugs as they move around the entire body.
The developers expect the technology will have countless applications, from improving diagnostics to tracking disease progression to researching new drug therapies.
The scanner has been developed in partnership with Shanghai-based United Imaging Healthcare (UIH), which built the system based on its latest technology platform and will eventually manufacture the devices for the broader health care market.
“While I had imagined what the images would look like for years, nothing prepared me for the incredible detail we could see on that first scan,” said Cherry, distinguished professor in the UC Davis Department of Biomedical Engineering. “While there is still a lot of careful analysis to do, I think we already know that EXPLORER is delivering roughly what we had promised.
Badawi, chief of nuclear medicine at UC Davis Health and vice chair for research in the Department of Radiology, said he was dumbfounded when he saw the first images, which were acquired in collaboration with UIH and the Department of Nuclear Medicine at the Zhongshan Hospital in Shanghai.
“The level of detail was astonishing, especially once we got the reconstruction method a bit more optimized,” he said. “We could see features that you just don’t see on regular PET scans. And the dynamic sequence showing the radiotracer moving around the body in three dimensions over time was, frankly, mind-blowing. There is no other device that can obtain data like this in humans, so this is truly novel.”
Badawi and Cherry first conceptualized a total-body scanner 13 years ago. Their idea was kickstarted in 2011 with a $1.5 million grant from the National Cancer Institute, which allowed them to establish a wide-ranging consortium of researchers and other collaborators. And it got a giant boost in 2015 with a $15.5 million grant from the National Institutes of Health. The funding allowed them to team up with a commercial partner and get the first EXPLORER scanner built.
Cherry said he expects EXPLORER will have a profound impact on clinical research and patient care because it produces higher-quality diagnostic PET scans than have ever been possible. EXPLORER also scans up to 40 times faster than current PET scans and can produce a diagnostic scan of the whole body in as little as 20 to 30 seconds.
Alternatively, EXPLORER can scan with a radiation dose up to 40 times less than a current PET scan, opening new avenues of research and making it feasible to conduct many repeated studies in an individual, or dramatically reduce the dose in paediatric studies, where controlling cumulative radiation dose is particularly important.

UC Davis
www.ucdavis.edu/news/human-images-worlds-first-total-body-scanner-unveiled