[Reblog] False Positives and Real Dollars: Why $88 won’t effectively screen for lung cancer

 

On a related note, during Peace Corps training in Nashville (1979) I came down with a bad cough, often coughing for 5-10 minutes at a time. Don’t think the rainy weather and me going around with an umbrella or raincoat helped. Anyways, was sent to an area doctor and after a few tests, told me and the Peace Corps staff not to be concerned. Just a dormant fungus (and I do live a bit north of the Ohio River Valley). Anyways, after a few days in Monrovia, Liberia (6 am temps of about 85), I stopped coughing.

PS We were boarded in motels. One late night was awakened by a few young men  in the group coughing loudly and giggling outside my window. Chalk it up now to some late night drinking and the men still being, well, young.

On another note, my husband quit smoking back in the 80’s after about 25 years of smoking. He had a lung X-ray and a dark spot on the lungs was noticed. He had quit smoking the month before. So now I’m wondering…cancer or fungus? He has not had any firm diagnosis of cancer since.

Beschreibung: Konventionelles Röntgenbild des Thorax (der Lunge) mit rundlicher Verdichtung in der linken Lunge Quelle: selbst erstellt –Benutzer:Lange123 17:18, 11. Nov. 2004 (CEST) (Photo credit: Wikipedia)

From the 9 February 2015 article By MATT HAWKINS, MD at The Health Care Blog

…Histoplasma capsulatum is a fungus endemic to the Ohio and Mississippi River Valleys.  It is everywhere.  You get it by breathing.  Prior studies suggest that >80% of those living in these regions have contracted the fungus.  The majority of people with histo don’t get sick.  But – they get lung nodules.  Lots of them.  The nodules are benign but often indistinguishable on imaging from “early” lung cancer.

The entrepreneurial owners of the pictured urgent care center likely know this.  They also know that Medicare and other carriers have limited coverage (reasonably so) to patients between the ages of 55 and 74 with at least a 30 pack year history of smoking.  If patients have quit smoking, they must have quit within 15 years to be eligible for coverage.  At first glance, it may seem like offering cheap, $88 screening for Americans ineligible for lung cancer screening coverage, or those eligible citizens too busy to get a physician order for a screening exam, is a good deed.  But, $88 is just the tip of the iceberg.  Additional screening exams and subsequent procedures/biopsies will all incur additional costs.

Our collective fear of malignancy, the unfortunately high frequency of lung cancer, and the promise of low dose CT screening for this disease will drive people outside of the NLST’s strict inclusion criteria into these low-cost, high-volume CT-scanning conveyor belts to “catch the cancer early.”

And what will they find in the Ohio River Valley?

Lots and lots of lung nodules.

…

The markedly increased propensity of patients in this region to have pulmonary nodules is likely to lead to an increased number of image-guided and open surgical biopsies (when the image-guided biopsy provides insufficient tissue for analysis).  More invasive procedures will naturally lead to more cost-inducing complications (such as pneumothorax and pulmonary hemorrhage) and, in some instances, death.

….

 

 

 

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[Reblog] One nanoparticle, six types of medical imaging – University at Buffalo

One nanoparticle, six types of medical imaging – University at Buffalo.

Tomorrow’s doctors could use this technology to obtain a super-clear picture of patients’ organs and tissues By Charlotte Hsu

Release Date: January 20, 2015

University at Buffalo researchers and colleagues have designed a nanoparticle detectable by six medical imaging techniques. This illustration depicts the particles as they are struck by beams of energy and emit signals that can be detected by the six methods: CT and PET scanning, along with photoacoustic, fluorescence, upconversion and Cerenkov luminescence imaging.

This transmission electron microscopy image shows the nanoparticles, which consist of a core that glows blue when struck by near-infrared light, and an outer fabric of porphyrin-phospholipids (PoP) that wraps around the core. Credit: Jonathan Lovell

“A patient could theoretically go in for one scan with one machine instead of multiple scans with multiple machines.”

Jonathan Lovell, assistant professor of biomedical engineering

University at Buffalo

BUFFALO, N.Y. — It’s technology so advanced that the machine capable of using it doesn’t yet exist.

Using two biocompatible parts, University at Buffalo researchers and their colleagues have designed a nanoparticle that can be detected by six medical imaging techniques:

• computed tomography (CT) scanning;
• positron emission tomography (PET) scanning;
• photoacoustic imaging;
• fluorescence imaging;
• upconversion imaging; and
• Cerenkov luminescence imaging.

In the future, patients could receive a single injection of the nanoparticles to have all six types of imaging done.

This kind of “hypermodal” imaging — if it came to fruition — would give doctors a much clearer picture of patients’ organs and tissues than a single method alone could provide. It could help medical professionals diagnose disease and identify the boundaries of tumors.

“This nanoparticle may open the door for new ‘hypermodal’ imaging systems that allow a lot of new information to be obtained using just one contrast agent,” says researcher Jonathan Lovell, PhD, UB assistant professor of biomedical engineering. “Once such systems are developed, a patient could theoretically go in for one scan with one machine instead of multiple scans with multiple machines.”

When Lovell and colleagues used the nanoparticles to examine the lymph nodes of mice, they found that CT and PET scans provided the deepest tissue penetration, while the photoacoustic imaging showed blood vessel details that the first two techniques missed.

Differences like these mean doctors can get a much clearer picture of what’s happening inside the body by merging the results of multiple modalities.

– See more at: http://www.buffalo.edu/news/releases/2015/01/015.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Science360NewsServiceComplete+%28Science360+News+Service%3A+Complete%29&utm_content=Netvibes#sthash.uBpXDk8L.dpuf

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[Press release] Do no harm: Pediatrician calls for safely cutting back on tests, treatments





http://www.portaldemisterios.com/videos/yt-MyfqSZg3RLw


http://www.eurekalert.org/pub_releases/2014-10/aaop-dnh100314.php

From the October 2014 press release

SAN DIEGO – When parents take a sick or injured child to the doctor or emergency room, they often expect tests to be done and treatments given. So if the physician sends them on their way with the reassurance that their child will get better in a few days, they might ask: “Shouldn’t you do a CT scan?” or “Can you prescribe an antibiotic?”

What families — and even doctors — may not understand is that many medical interventions done “just to be safe” not only are unnecessary and costly but they also can harm patients, said Alan R. Schroeder, MD, FAAP, who will present a plenary session at the American Academy of Pediatrics (AAP) National Conference & Exhibition. Titled “Safely Doing Less: A Solution to the Epidemic of Overuse in Healthcare,” the session will be held from 11:30-11:50 a.m. PDT Monday, Oct. 13 in Ballroom 20 of the San Diego Convention Center.

Dr. Schroeder, chief of pediatric inpatient services and medical director of the pediatric intensive care unit at Santa Clara Valley Medical Center in San Jose, Calif., will discuss some of the reasons why doctors provide unnecessary care (i.e., barriers to safely doing less), including pressure from parents and a fear of missing something.

“We all have cases where we’re haunted by something bad happening to a patient. Those tend to be cases where we missed something,” he said. “We tend to react by doing more and overtreating similar patients.”

He also will give examples of where overuse commonly occurs in pediatrics, such as performing a CT scan on a child with a minor head injury, and the negative consequences.

“You may find a tiny bleed or a tiny skull fracture, and once you’ve found that you’re compelled to act on it. And generally acting on it means at a minimum admitting the child to an intensive care unit for observation even if the child looks perfectly fine,” Dr. Schroeder said. “The term for that is overdiagnosis. You detect an abnormality that will never cause harm.”

Finally, he will suggest ways to minimize overtesting and overtreatment, highlighting the Choosing Wisely campaign. More than 60 medical societies including the AAP have joined the initiative and have identified more than 250 tests and procedures that are considered overused or inappropriate in their fields.

“I’ve devoted much of my research to identify areas in inpatient pediatrics where we can safely do less — which therapies that we are doing now are unnecessary or overkill,” Dr. Schroeder said.

###

The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

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[Reposting] A medical-testing lesson from Minnesota: Less can be more

 

The state’s approach to cutting unneeded medical scans could be a model for federal Medicare savings.

 

From the 6 January 2013 article at Star Tribune – Health

 

A novel strategy that has saved Minnesota millions of dollars in unnecessary medical-imaging scans — and probably prevented dozens of patient deaths — might soon go national.

Leaders from Minnesota’s medical and insurance communities met Monday morning to celebrate the project — which has leveled off the skyrocketing growth of MRI and CT scans for back pain, headaches and other problems — and to promote legislation by Rep. Erik Paulsen that would bring it to bear on the federal government’s vast Medicare program.

Minnesota’s “decision support” strategy, enacted in 2006, created a single set of standards for doctors to follow in deciding when patients need the costly scans. It also created a green-yellow-red coding system to show patients when scans were recommended and when they weren’t. The use of such scans, which had been growing at a 7 percent annual clip, grew just 1 percent from 2007 to 2012.

…

….officials in other states often view Minnesota as “quite peculiar” because of its small, cooperative community of insurers and physician groups, and don’t believe its innovations can be repeated elsewhere, said Dr. Pat Courneya, medical director of HealthPartners, the Bloomington-based health plan.

Getting this type of approach to succeed in Medicare, on the other hand, would cause it to spread to other states, he said.

More than 80 percent of imaging scans in Minnesota are now ordered only after doctors seek out decision-support guidance to make sure they are recommended based on their patients’ conditions and medical histories.

Courneya said the initial guidelines were based on the clinical expertise and recommendations of Minnesota doctors. They have since been revised as studies refine when imaging scans should be used. Research, for example, has identified the types of patients who are suitable for scans to screen for breast or lung cancers.

 

Read the entire article here

 

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Huge Increase In Radiation Exposure From Diagnostic Imaging

From the 13 June 2012 Medical News Today article

As imaging technology advances and medical devices improve, healthcare professionals are more inclined to use these state-of-the art scanners to look inside patients’ bodies. Computed tomography usage, for example, more than tripled between 1996 and 2010. Over the same period, MRI (magnetic resonance imaging) usage increased fourfold. It is not surprising, therefore, that patient radiation exposure has also risen.

An article in JAMA, published today, asks the question to see if this technological dependance is going too far or even putting patients in danger with too many scans. Some people are worried about raditation from mobile phones, so stepping inside a multi-million dollar machine that blasts the body with one type of electromagnetic resonance or another, is going to draw warranted safety questions…

..One of the main points made in the article is that there has never been a comprehensive study of how much use healthcare providers are making of imaging technology. The studies that have been done are usually based around private practices and done for insurance purposes, and in these cases, imaging is usually encouraged. Looking at a wider range of patients and facilities enables the authors to provide us with a clear picture.

The authors summarize the use of various imaging techniques:

• Radiography and angiography/fluoroscopy rates were relatively stable over time: radiography increased 1.2 percent per year, and angiography/fluoroscopy decreased 1.3 percent per year.
• Computed tomography examinations tripled (52/1000 enrollees in 1996 to 149/1000 in 2010, 7.8 percent annual growth)
• MRIs quadrupled (17/1000 to 65/1000,10 percent annual growth)…

…while healthcare has obviously improved with the use of technology, given the high costs of imaging, some $100 Billion annually, combined with the cancer risks and other possible side effects, the benefits of sending patients for scans, should be balanced by weighing the medical needs against both financial and heath risks of the technology itself.

Related Resource

   Choosing Wisely (US Agency for Healthcare Research and Quality)

Choosing Wisely™ aims to get physicians, patients and other health care stakeholders thinking and talking about the overuse or misuse of medical tests and procedures that provide little benefit, and in some instances harm.
Includes tips,scenarios, and information to get the most out of doctor visits.

 

English: Osteoarthritis Initiative (OAI) researchers at Ohio State University look through the opening of an MRI machine, used to image the knees of patients. The OAI, a public-private partnership, led by NIAMS and the National Institute on Aging with additional support from five other Institutes and Centers, funds research and information sharing resources to aid in the identification of biological markers for osteoarthritis. (Photo credit: Wikipedia)

 

Related articles

• Huge Increase In Radiation Exposure From Diagnostic Imaging (medicalnewstoday.com)
• Substantial increase in rate of advanced diagnostic imaging, associated radiation exposure (eurekalert.org)
• Diagnosing Disease (nlm.nih.gov)
• Locally, precautions taken to reduce radiation risk (jacksonville.com)
• Patients’ radiation levels boosted by increased medical scans – CBS News (cbsnews.com)
• Huge Rise in CT, MRI, Ultrasound Scan Use (nlm.nih.gov)
• Greater use of imaging tests raises radiation fears (sfgate.com)
• MRI and CT scan use spikes, study finds (vitals.msnbc.msn.com)
• MITA Statement On JAMA Article On Imaging Utilization Trends (medicalnewstoday.com)
• Locally, precaustions taken to reduce radiation risk (jacksonville.com)
• Imaging, Radiation Exposure Up, Even At HMOs (huffingtonpost.com)
• CT scans warning after study claims too many could lead to brain cancer (guardian.co.uk)