ICUS Weekly News Monitor 1-8-2016

1.  The Boston Globe,  Dec 28, 2015,  Ultrasounds on the rise     By Curt Woodward
 
2.  Journal of Translational Medicine,  Dec 18, 2015,  Radiation treatment monitoring using multimodal functional imaging: PET/CT ( 18 F-Fluoromisonidazole & 18 F-Fluorocholine) and DCE-US     Authors: Natalia Arteaga-Marrero, et al
 
3.  Physics in Medecine and Biology,  Oct 13, 2015,  Cumulative phase delay imaging for contrast-enhanced ultrasound tomography     Authors: Libertario Demi, Ruud J G van Sloun, Hessel Wijkstra and Massimo Mischi
 
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The Boston Globe
Dec 28, 2015
 
Ultrasounds on the rise
By Curt Woodward
 
Doctors these days have quite a few high-tech methods for peering inside the human body. But several of those tools are becoming less popular with patients, new research has found, while the use of ultrasounds keeps growing.
 
Though the reasons why aren’t completely clear, the Boston University researchers behind the findings believe one might be that consumers are shouldering more of their healthcare bills.
 
In a recent study, a group from BU’s School of Public Health looked at private insurance claims generated by more than 35 million people from 2007 to 2013.
 
The data showed that, for patients who weren’t currently hospitalized, CT and PET scans have been in decline since 2011, while the use of MRIs peaked in 2012.
 
Ultrasounds for those patients, meanwhile, have increased steadily since 2010.
 
The data didn’t reveal why ultrasounds have been climbing while other scans are in retreat. As with any big healthcare trend, there are likely to be multiple overlapping causes. But the team has some theories that they plan to keep testing.
 
One big driver could be cost. Ultrasounds are generally much less expensive than CT scans, PET scans, or MRIs, so patients might opt for an ultrasound if they have an option, said Michal Horný, a graduate student who led the research.
 
That theory would fit with the big-picture trend in healthcare costs being shifted to consumers. According to the Kaiser Family Foundation, the cost of health insurance deductibles has spiked 67 percent since 2010, compared with a 24 percent increase in premiums and a roughly 10 percent increase in employee pay.
 
“When patients pay a greater portion of medical care costs out of their own pockets, they are more likely to shop for more-affordable options, or even change their mind about undergoing the imaging procedure,” the study said.
 
Patients might also be avoiding scans that use radiation because of some increased risk of cancers, the researchers said.
 
“There’s certainly some general evidence that patients are considering these risks themselves more than they used to in the past, and they have access to the Internet to look up these kind of risks,” said James Burgess, a health policy professor who worked on the study.
 
Patients also could be influenced by the “Choosing Wisely” public education campaign, launched in early 2012 by the American Board of Internal Medicine “to avoid wasteful or unnecessary medical tests, treatments, and procedures,” the study said.
 
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Journal of Translational Medicine
Journal of Translational Medicine 2015, 13:383  doi:10.1186/s12967-015-0708-5
Dec 18, 2015
 
Radiation treatment monitoring using multimodal functional imaging: PET/CT ( 18 F-Fluoromisonidazole & 18 F-Fluorocholine) and DCE-US
 
Authors: Natalia Arteaga-Marrero1*, Cecilie Brekke Rygh23, Jose F. Mainou-Gomez4, Tom C. H. Adamsen56, Nataliya Lutay7, Rolf K. Reed28 and Dag R. Olsen1
 
* Corresponding author: Natalia Arteaga-Marrero This email address is being protected from spambots. You need JavaScript enabled to view it.
Author Affiliations
1 Department of Physics and Technology, University of Bergen, Bergen 5020, Norway
2 Department of Biomedicine, University of Bergen, Bergen, Norway
3 Department of Health Sciences, Bergen University College, Bergen, Norway
4 Department of Clinical Medicine, University of Bergen, Bergen, Norway
5 Department of Radiology, Haukeland University Hospital, Bergen, Norway
6 Department of Chemistry, University of Bergen, Bergen, Norway
7 Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
8 Centre for Cancer Biomarkers (CCBIO), University of Bergen, Bergen, Norway
 
The electronic version of this article is the complete one and can be found online at: http://www.translational-medicine.com/content/13/1/383
 
Abstract
 
Background
This study aims to assess the effect of radiation treatment on the tumour vasculature and its downstream effects on hypoxia and choline metabolism using a multimodal approach in the murine prostate tumour model CWR22. Functional parameters derived from Positron Emission Tomography (PET)/Computer Tomography (CT) with 18 F-Fluoromisonidazole ( 18 F-FMISO) and 18 F-Fluorocholine ( 18 F-FCH) as well as Dynamic Contrast-Enhanced Ultrasound (DCE-US) were employed to determine the relationship between metabolic parameters and microvascular parameters that reflect the tumour microenvironment. Immunohistochemical analysis was employed for validation.
 
Methods
PET/CT and DCE-US were acquired pre- and post-treatment, at day 0 and day 3, respectively. At day 1, radiation treatment was delivered as a single fraction of 10 Gy. Two experimental groups were tested for treatment response with 18 F-FMISO and 18 F-FCH.
 
Results
The maximum Standardized Uptake Values (SUVmax) and the mean SUV (SUVmean) for the 18 F-FMISO group were decreased after treatment, and the SUVmean of the tumour-to-muscle ratio was correlated to microvessel density (MVD) at day 3. The kurtosis of the amplitude of the contrast uptake A was significantly decreased for the control tumours in the 18 F-FCH group. Furthermore, the eliminating rate constant of the contrast agent from the plasma k el derived from DCE-US was negatively correlated to the SUVmean of tumour-to-muscle ratio, necrosis and MVD.
 
Conclusions
The present study suggests that the multimodal approach using 18 F-FMISO PET/CT and DCE-US seems reliable in the assessment of both microvasculature and necrosis as validated by histology. Thus, it has valuable diagnostic and prognostic potential for early non-invasive evaluation of radiotherapy.
 
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Physics in Medecine and Biology
© 2015 Institute of Physics and Engineering in Medicine •   Physics in Medicine and Biology,  Volume 60,  Number 21
Oct 13, 2015
 
Cumulative phase delay imaging for contrast-enhanced ultrasound tomography
 
Authors: Libertario Demi1, Ruud J G van Sloun1, Hessel Wijkstra1,2 and Massimo Mischi1
 
Abstract
Standard dynamic-contrast enhanced ultrasound (DCE-US) imaging detects and estimates ultrasound-contrast-agent (UCA) concentration based on the amplitude of the nonlinear (harmonic) components generated during ultrasound (US) propagation through UCAs. However, harmonic components generation is not specific to UCAs, as it also occurs for US propagating through tissue. Moreover, nonlinear artifacts affect standard DCE-US imaging, causing contrast to tissue ratio reduction, and resulting in possible misclassification of tissue and misinterpretation of UCA concentration. Furthermore, no contrast-specific modality exists for DCE-US tomography; in particular speed-of-sound changes due to UCAs are well within those caused by different tissue types. Recently, a new marker for UCAs has been introduced. A cumulative phase delay (CPD) between the second harmonic and fundamental component is in fact observable for US propagating through UCAs, and is absent in tissue. In this paper, tomographic US images based on CPD are for the first time presented and compared to speed-of-sound US tomography. Results show the applicability of this marker for contrast specific US imaging, with cumulative phase delay imaging (CPDI) showing superior capabilities in detecting and localizing UCA, as compared to speed-of-sound US tomography. Cavities (filled with UCA) which were down to 1 mm in diameter were clearly detectable. Moreover, CPDI is free of the above mentioned nonlinear artifacts. These results open important possibilities to DCE-US tomography, with potential applications to breast imaging for cancer localization.

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