Posts tagged ‘scans’

May 1, 2014

Lung Cancer Screening and (New) Recommendations

smoking kills by André Hengst via Flickr Copyright Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)When it comes to cancer, lung cancer leads the list of the most deadly for men and women in the US. Fighting this disease has been an uphill battle, impeded by the fact that most patients are not diagnosed until late in their disease. Having an effective screening test to identify lung cancer when it is small and treatable has been a goal for years – the development of low-dose CT chest for the screening for lung cancer has brought hope.

 

We are therefore profoundly disappointed that the Centers for Medicare & Medicaid Services (CMS)’s Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) did not vote to recommend Medicare coverage of low-dose CT screening. Their primary concern is not that is does not find cancer, but that it will find too many things that are not cancer.

 

We disagree with the CMS, as do other (more important!) groups in the US. The United States Preventative Services Task Force (their statement can be found here) recently recommended coverage. This is critical, as those preventive services deemed appropriate by the Task Force are mandated to be covered under the Affordable Care Act. What does that mean? A double standard – those with health insurance will be covered, those with Medicare will not if the CMS acts on the recommendations of their advisory committee.

 

One of the (many!) advocates of low-dose CT screening is the American College of Radiology (their statement can be found here). The ACR supports the use of screening CT chests in those patients at the highest risk – in other words, heavy smokers or heavy former smokers. The National Lung Screening Trial found that there was a 20% reduction in deaths for heavy smokers due to screening (the trial report can be found here). That’s no small number. The ACR is working on developing uniform guidelines to help with interpretation and to reduce the number of false findings – those that seemed to concern the Advisory Committee.

 

Luckily, the CMS is not bound by the recommendations of MEDCAC and action based on the recommendation isn’t expected until late fall of this year. We hope that reevaluation of the data occurs between now and then, so that Medicare patients are covered.

 

If you’d like to know more about lung cancer and what you can do about it, we recommend checking out Free to Breathe. Eliminating the use of tobacco is a larger goal which will more profoundly affect lung cancer in the US – if you smoke, get help to stop.

Imagine attribution: smoking kills by André Hengst via Flickr Copyright Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

April 24, 2014

Ankles: Sprains and Pains

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For any building to be upright, it requires a solid foundation. Such is true for the human body: if what’s below the knees goes wonky it can have an effect on the body as a whole. Ankles are incredibly resilient joints but when they take a hit (or a fall or a twist) they can be problematic.

 

Ankle sprains are common, and can be seen in athletes and nonathletes alike. Sprains can result from the ankle turning from a misstep, from stepping down at an angle or from sideways movements. There are clinical rules which help determine who needs imaging- mild sprains may not need to be imaged.

 

Sprains typically result in injury to the ligaments, those soft tissue bands which connect bone to bone. If the ankle is unstable or if symptoms do not improve as expected, imaging with an MRI may be needed. This allows assessment of the bones of the ankle as well as the soft tissues, including the ligaments.

 

A fall from a height may lead to fracture or dislocation (ouch). Plain films of your ankle will be the starting point if fracture is suspected.  If a fracture is complex, CT is excellent at showing the anatomy and helping your surgeon plan treatment.

 

Achilles tendontears are often an event with a distinct injury, sometimes related to a sudden movement and abrupt tensing of the calf muscle (Remember those replays of Lebron James’ injury? Ouch!). Physical exam will often reveal a focal defect in the tendon your doctor can feel. We may want to image to see if the tendon is completely torn and the distance between the torn ends to help with surgical planning. Ultrasound can show this nicely, as can MRI.

 

Tendons about the ankle other than the Achilles can also be injured, torn or inflamed. Injuries to other ankle tendons can also be evaluated with ultrasound, although MRI is more commonly used. Tendons about the ankle include the peroneal tendons on the outer side of the ankle and the posterior tibial tendon on the inside.

 

It’s important to treat ankle injuries, because as a foundation for the body, adding a limp can lead to other problems including back pain (double ugh). If left untreated, ankle sprains can lead to chronic instability.

 

As ever, prevention is the best medicine. Some ankle strengthening exercises can be found here.

(Photo credit: Broken ankle Cast detail by FiDalwood via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

December 12, 2013

What are different types of nuclear medical scans? with Dr. Sid Crawley