A multi-site clinical trial including the University of Colorado Cancer Center shows that the benefit of Bright IDEAS problem-solving skills training goes beyond teaching parents to navigate the complex medical, educational, and other systems that accompany a child
Amid increasing fear of overexposure to radiation from CT scans, a panel of experts has recommended more research on the health effects of medical imaging and ways to reduce unnecessary CT tests, as well as industry standardisation of CT machines.
The recommendations were developed at the Radiation Dose Summit, organised by the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The summit included more than 100 medical physicists, radiologists, cardiologists, engineers, industry representatives and patient advocates. The proceedings, held in Bethesda, MD in early 2011, covered currently understood risks of radiation exposure from CT scans, set priorities for future research, and called for changes to industry practices.
‘The number of CT exams in the U.S. has increased by about 10 percent each year over the past decade,’ said John Boone, UC Davis professor of radiology and lead author of the Radiology article. ‘This trend underscores the importance of developing a better understanding of the health risks of radiation exposure versus the benefits of enhanced diagnosis.’
The experts conceded that despite widespread public concern about radiation risks, the biologic effects from medical imaging tests are not entirely understood. Most direct evidence comes from the effects of instantaneous, high-dose, whole-body exposures due to industrial accidents and from survivors of the atomic bombs in Hiroshima and Nagasaki, Japan. Whether these findings can be extrapolated to people exposed to occasional and much smaller dosages applied to only parts of the body is uncertain.
‘The standards regarding ‘safe levels’ of radiation were designed for workplace safety and are very conservative,’ said Boone. ‘We don’t know whether the established thresholds are really meaningful for exposure from medical testing.’
The experts pointed out that because there is a high background incidence of cancer world-wide, the small incremental increase in cancer that may be attributable to low doses of radiation from medical imaging is extremely difficult to ascertain. They stated that national and international registries that track cancers and patient exposures to medical radiation may one day make it possible to conduct large epidemiological studies that could help make such associations.
‘In reaction to media coverage of radiation overexposure cases, some patients refuse to undergo medical imaging procedures,’ said Boone. ‘Yet for almost all patients, the risks of foregoing a needed medical procedure far outweigh any potential radiation-associated risks.’
Even accurately recording patient exposures of radiation from medical imaging is extremely difficult, according to the authors. Although it is easy to ascertain how much radiation a machine administers during an imaging study, the amount actually received by a patient depends on various factors including body size. For example, because of differences in body mass, children and small adults can receive a dose of radiation two to three times that of larger people, even when the dose administered is the same.
Other factors, such as whether the patient lies on a moving or stationary table, also affect the radiation dose received. Federally sponsored research is needed to develop methods to more accurately measure patient exposures from different types of CT scans, the authors suggested.
UC Davis Comprehensive Cancer Center
By using swarms of untethered grippers, each as small as a speck of dust, Johns Hopkins engineers and physicians say they have devised a new way to perform biopsies that could provide a more effective way to access narrow conduits in the body as well as find early signs of cancer or other diseases.
In two recent peer-reviewed journal articles, the team reported successful animal testing of the tiny tools, which require no batteries, wires or tethers as they seize internal tissue samples. The devices are called ‘mu-grippers,’ incorporating the Greek letter that represents the term for ‘micro.’ Instead of relying on electric or pneumatic power, these star-shaped tools are autonomously activated by the body
Scientists from Israel and China found the test was 90% accurate at detecting and distinguishing cancers from other stomach complaints in 130 patients. The British Journal of Cancer says the test could revolutionise and speed up the way this cancer is diagnosed.
About 7,000 UK people develop stomach cancer each year and most have an advanced stage of the disease. Two-fifths of patients survive for at least a year, but only a fifth are still alive after five years, despite treatment.
Currently doctors diagnose stomach cancer by taking a biopsy of the stomach lining using a probe and a flexible camera passed via mouth and down the gullet. The new test looks for chemical profiles in exhaled breath that are unique to patients with stomach cancer.
Cancer appears to give off a signature smell of volatile organic compounds that can be detected using the right technical medical kit – and perhaps even dogs.
The science behind the test itself is not new – many researchers have been working on the possibility of breath tests for a number of cancers, including lung.
In the study, 37 of the patients had stomach cancer, 32 had stomach ulcers and 61 had other stomach complaints.
As well as accurately distinguishing between these conditions 90% of the time, the breath test could tell the difference between early and late-stage stomach cancers.
The team are now running a bigger study in more patients to validate their test.
Kate Law, director of clinical research at Cancer Research UK, said: ‘The results of this latest study are promising – although large scale trials will now be needed to confirm these findings.
‘Only one in five people are able to have surgery as part of their treatment as most stomach cancers are diagnosed at stages that are too advanced for surgery. Any test that could help diagnose stomach cancers earlier would make a difference to patients’ long-term survival.’
BBCThe 29th Korea International Medical & Hospital Show will take place at COEX in Seoul from 21st to 24th March 2013. The Asian
Researchers at the University of Warwick and The Royal Marsden NHS Foundation Trust have completed a study that may lead to clinicians being able to more accurately predict which patients will suffer from the side effects of radiotherapy.
Gastrointestinal side effects are commonplace in radiotherapy patients and occasionally severe, yet there is no existing means of predicting which patients will suffer from them. The results of the pilot study outline how the use of an electronic nose and a newer technology, FAIMS (Field Asymmetric Ion Mobility Spectrometry) might help identify those at higher risk.
Warwick Medical School, working in collaboration with the School of Engineering and The Royal Marsden NHS Foundation Trust (led by Dr J Andreyev), carried out a pilot study to look into the relationship between levels of toxicity in the gut and the likelihood of experiencing side effects.
Dr Ramesh Arasaradnam, of Warwick Medical School and Gastroenterologist at University Hospitals Coventry & Warwickshire, outlines the results of the study. ‘In the simplest terms, we believe that patterns in toxicity levels arise from differences in a patient
A new therapy for Parkinson’s cancels out brain signals causing the characteristic tremors.
A new therapy could help suppress tremors in people with Parkinson’s disease, an Oxford University study suggests.
The technique
A new listening device, developed by scientists from the University of Southampton, is being used to monitor the effectiveness of the treatment of kidney stones – saving patients unnecessary repeat therapy and x-ray monitoring.
If kidney stones cannot be dissolved by drugs, the favoured procedure is lithotripsy. Lithotripsy works by focusing thousands of shock waves onto the kidney stones in an effort to break them into pieces small enough to urinate out of the body or be dissolved by drugs.
However, it is difficult to discover exactly when the treatment has succeeded in breaking the stone and patients frequently have to experience more shocks than necessary, or be sent home when an insufficient number of shocks have been delivered to break the stone.
The new ‘Smart stethoscope’ has been developed by a team from the University’s Faculty of Engineering and the Environment in collaboration with Guy’s and St Thomas’ Foundation Trust (GSTT) and Precision Acoustics Ltd. The programme was led by Professor Tim Leighton from the University’s Institute of Sound and Vibration Research (ISVR).
The ‘Smart stethoscope’ is placed on a patient’s skin as they undergo shock wave treatment for kidney stones and assesses whether the treatment is working. It listens to the echoes, which reverberate around the body after each shock wave hits the stone. The device is now being used clinically at the London hospitals of GSTT.
Professor Leighton says: ‘It’s an imperfect analogy, but consider a railwayman walking along the length of a train, hitting the metal wheels with a hammer, If the wheel rings nicely, he knows that it’s not cracked. If the wheel is cracked, it gives a duller sound.
‘We are looking for the stone to go from being intact at the start of treatment (when it will give a nice ring ‘tick’ sound) to being fragmented at the end of the treatment (when it will give a duller ‘tock’ sound).’
Professor Leighton’s research, which includes the computational fluid dynamics (CFD) use to inform judgements underpinning the invention of the smart stethoscope, is published in the latest issue of the Royal Society journal Proceedings of the Royal Society A.
Dr Fiammetta Fedele of GSTT said: ‘Professor Leighton’s CFD predictions of the acoustic signals emitted when bubbles collapse against kidney stones during SWL led (through collaboration with GSTT and Precision Acoustics Ltd.) to a
The European Society of Anaesthesiology (ESA) is to launch a safety starter kit containing a wide variety of essential resources to help raise safety standards in anaesthesiology across Europe. The kit will be distributed on a memory stick at this year
People who receive primary care from free clinics are less likely to use the emergency department for minor issues, according to a team of medical researchers.
Nationally, the number of emergency departments (EDs) has decreased yet the number of ED visits has gone up, the team reported. Therefore, it is important to figure out how to reduce unnecessary ED visits.
According to the National Association of Free and Charitable Clinics, there are more than 1,200 free clinics nationwide. Many of these clinics work in co-operation with one of their local hospitals.
Wenke Hwang, associate professor of public health sciences at Penn State College of Medicine, and his colleagues analysed records of uninsured patients from five hospitals and four free clinics across neighbouring Virginia communities.
Over three years, 52,010 individual uninsured patients visited at least one of the hospitals’ five emergency departments a total of 99,576 times. The researchers found that approximately 10 percent of those ED visits were by patients who had been treated at free clinics associated with the hospitals in the first two years studied
Hwang compared the diagnoses at the time of admittance to the emergency department between the free clinic patients and the non-free clinic patients. The five most common diagnoses were identical for both groups — sprains and strains, disorders of teeth and jaw, superficial injury or contusion, abdominal pain and back problems. The secondary diagnoses were not as similar for the two groups, but the researchers found mental health and substance abuse to be the most common underlying condition for both groups of uninsured patients.
‘Emergency department visits by free clinic patients were less likely to require the lowest levels of care, suggesting uninsured free clinic users were less likely to use the emergency department as their primary care provider,’ the researchers wrote.
The researchers determined that half of the ED visits in this study were avoidable, using the measurements the hospitals themselves use. By providing primary care for the uninsured, free clinics are able to help reduce non-emergency visits to the ED.
‘The emergency department is an extremely expensive and inefficient way to handle many problems that show up there,’ said Hwang. ‘If hospitals support local free clinics, the ED will be less crowded and therefore have less need for expensive expansions. Free clinics are the cheaper solution.’ Penn State University
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