The annual Minnies Awards bring a best-in-category win to the UW School of Medicine and Public Health’s Department of Radiology for the second year in a row, following on last year's Most Influential Radiology Researcher win for Dr. Perry Pickhardt. Auntminnie.com, an online resource of information, news and education for medical imaging, has been awarding peer-nominated, expert panel selected awards for the past 18 years. The win for the Department of Radiology is the first in the Training Program Category. Read full article at auntminnie.com
For nearly 50 years, mammography has been the gold standard for breast imaging. This routine test has proved to be simple, inexpensive, and readily available across the world. However, that may change in the near future when more results are in on the newest technology, 3D digital breast tomosynthesis, which is currently available in all eight of UW Health’s breast imaging locations. Tomosynthesis is showing great promise to become widely recognized as an overall better imaging tool. “More studies are showing us that tomosynthesis improves our ability to see cancer over standard mammography,” said Mai Elezaby, MD, assistant professor in the UW School of Medicine and Public Health Department of Radiology’s Breast Imaging Section. With the near-three-dimensional imagery it provides, radiologists have more nuanced imaging available to review and make diagnoses. The technology used to image breast tissue to detect cancers has made great advances since the 1970s, when screen film mammography was the detection mode of choice for breast cancer. Standard mammography is a two-dimensional technology that primarily outlines the edges of the tissue. Since then, advancements in technology presented us with digital imaging, which improved on the earlier film-based mammography, making it possible to diagnose cancer in younger patients and patients with dense breast tissue. “What’s certain is that data from numerous studies since the beginning of mammography in the 1970s support that screening with standard mammography detects breast cancers when they are small enough to provide the best results with treatment,” Elezaby said. However, standard mammography (2D) is not perfect. Sometimes standard mammography does not detect all cancers, giving false negatives. The most recent improvement in this technology is digital breast tomosynthesis, also known as 3D mammography. “Tomosynthesis gives us the ability to look through the breast in multiple layers,” Elezaby said. “Studies have shown that this new way of imaging improves the ability to see cancers and in particular, better see cancers that matter more,” Elezaby continued. “Overall, it has improved our performance of making the diagnosis of invasive cancer by 40%.” In addition to helping radiologists to better see and diagnose cancers, tomosynthesis has had additional diagnostic benefits. “When we use a standard 2D mammogram, if we would see something of concern in their imaging, we would call patients back to clinic for further testing, whether it be more imaging or even biopsies where a big proportion end up being false-positive benign disease,” Elezaby said. “With 3D tomosynthesis, we have seen about a 17% drop in false-positive recalls and unnecessary imaging.” Tomosynthesis is as safe as a mammogram, delivering superior imaging with the same amount of radiation exposure. The main difference is that with tomosynthesis, the radiation is split to enable multiple views from more angles, making it more efficient. “As a research institution, we look for information to prove one diagnostic procedure is better than another,” Elezaby said. “More studies are looking into the long term benefit of 3D tomosynthesis over standard mammography. We are eagerly looking forward to the results of these studies , but all indications say 3D tomosynthesis will improve upon the performance of the standard mammogram.” Not all health care providers and insurance companies are on board yet with this new technology. “It is our hope across UW Health that more and more caregivers continue to embrace tomosynthesis,” Elezaby continued. “And likewise, that insurance companies step up their coverage. At this point, it is covered 100% by Medicare, but not all insurance companies will cover it,” she added. Breast Imaging Section Chief Elizabeth Burnside, MD, also sees the value of this new technology. “UW Health is dedicated to enhancing the patient health experience as we strive to improve outcomes ,” she said, “3D tomosynthesis enables radiologists to avoid false alarms without sacrificing early and accurate breast cancer diagnoses.” 3D tomosynthesis is available at all UW Health breast imaging locations and is becoming more frequently recognized as a first-line screening tool for breast cancers. Patients can ask their primary care doctor to have their next breast exam using digital breast tomosynthesis.
Perry Pickhardt, MD, professor in the Department of Radiology and Chief of Gastrointestinal Imaging, recently secured a multi-institutional multi-million dollar NIH R01 grant to continue his colorectal cancer and CT colonography work for the next five years. The prestigious National Institutes of Health Research Project (R01) grants are a testament to the impact and quality of Pickhardt’s work. The aim of the project is to gain insight into what dictates the progression of certain colorectal polyps into colorectal cancer. Almost all colorectal cancers develop from adenomas or serrated polyps. These polyps affect 30-50% of the adult population but only develop into cancer in 6-7% of people by the age of 80. The molecular mechanisms that determine which polyps become cancerous is virtually unknown. The principal investigators on the grant, in addition to Pickhardt, are Dr. Richard Halberg of the University of Wisconsin and Dr. William Grady of the University of Washington. The project also involves Drs. Kristina Matkowskyj and Irene Ong from the University of Wisconsin, Dr. Jerome Liang of the Stony Brook School of Medicine, and Dr. Mary Redman from the Fred Hutchinson Cancer Research Center. Pickhardt and colleagues will use a large series of human colorectal polyps whose growth patterns have been assessed over time using CT colonography. The growth patterns and other characteristics of the polyps such as textural analysis will be correlated with results from exome sequencing, gene expression studies, and high-density methylation arrays. All of this will be used to try to determine if the state of the colorectal polyp at formation dictates whether it is benign or premalignant. The resulting findings should help in identifying risk in certain individuals as well as making colorectal cancer more preventable in the larger population.
The UW Department of Radiology is pleased to announce the expansion of our radiology clinic services with the opening of new clinic space on September 11, 2017. This new clinic space is conveniently located just off of the 3rd floor G module radiology check-in area of the University of Wisconsin Hospital & Clinics campus. Providers in our radiology clinic include registered nurses, advanced practice providers and radiologists who see a variety of patients in consultation or in follow-up to image-guided procedures. Over the years, our clinic volume has grown to over 1500 patient visits per year and has prompted the need for updated and expanded clinic space in a centralized location. This new space will allow for expanded clinic services by all of our sections of the Department of Radiology and is conveniently located near check-in to allow patients greater ease in meeting with their clinicians over the course of their care.
The World Molecular Imaging Congress has awarded Steve Y. Cho, MD, the 2017 Best Clinical Paper award for his paper published last year on a new PSMA-targeted PET radiotracer. The paper was published in Molecular Imaging and Biology and titled, “PSMA-Based [18F]DCFPyL PET/CT Is Superior to Conventional Imaging for Lesion Detection in Patients with Metastatic Prostate Cancer.” Conventional imaging modalities such as CT and bone scan are limited in their detection of metastatic prostate cancer. This paper evaluates the ability of a novel second-generation (PSMA)-targeted PET radiotracer called [18F]DCFPyL in detecting metastatic prostate cancer. The study was conducted at Johns Hopkins University where Dr. Cho was a faculty member before his move to UW-Madison, with analysis done by Dr. Cho and his former resident, Dr. Steven Rowe, during Cho’s time at UW. The imaging agent 18F-DCFPyl was developed by Cho’s former mentor and colleague, Dr. Martin Pomper. Dr. Cho’s study compared the findings of conventional imaging modalities and [18F]DCFPyL PET used in the same patients. The study shows strong preliminary evidence for the effectiveness of this particular radiotracer in detecting metastatic prostate cancer and speaks to the value of PSMA-targeted PET imaging for detecting prostate cancer.
Dr. David Bluemke, visiting professor in the Department of Radiology and incoming editor of the journal Radiology, presented at the Society of Cardiovascular Computed Tomography annual meeting earlier last month. Bluemke gave two lectures at the conference on the topic of new and emerging CT technology. The first, “Emerging Technology That Will Soon Change how Cardiovascular CT is Practiced,” dealt with both the potential that machine learning algorithms have for replacing manual analysis of CT scans of the heart as well as the introduction of new CT scanners able to evaluate the entire body quickly enough to image the heart without cardiac gating. The presentation also looked at ways that dual energy or spectral CT can create a more comprehensive CT examination that can characterize myocardial infarct in a way previously only available with MRI. The second presentation was titled “Photon-Counting CT” and covered a new generation of CT scanners which have the ability to produce spatial resolution double that of conventional CT scanners. These photon-counting scanners remove several steps in the process of converting x-rays into a digital image which reduces image noise, using technology initially created for use in particle detectors at the European Organization for Nuclear Research (CERN). These scanners operate with a radiation dose 30-40% less than that of current CT scans and allow for spectral/multi-energy CT to always be available. Dr. Bluemke’s experience with photon-counting detectors dates back to his time at the National Institutes of Health where their Clinical Center investigated prototype technology early in 2016. Following his presentations Dr. Bluemke was interviewed by Dave Fornell, the editor of Diagnostic and Interventional Cardiology. The interview covered some of the content in Bluemke’s two lectures and is available at the Diagnostic and Interventional Cardiology website.
For 15 junior faculty members from around the country, the Radiological Society of North America (RSNA) is providing the opportunity to get a step ahead of the competition in the notoriously difficult world of grant applications. Dr. Paul Laeseke, an assistant professor in the Department of Radiology, is one of fifteen doctors who will be taking part in the RSNA Advanced Course in Grant Writing. The course provides insight into the grant preparation process and hands-on experience in preparing grant applications. Beginning this October the participants will attend four separate two-day meetings led by faculty members with expertise in preparing and submitting grants. The course covers all aspects of grant applications from the study design to the timeline to a justified budget. Participants go into the course with a research idea and by the end of the program will have a finalized grant proposal to submit as a principal investigator. Dr. Laeseke will be working on a proposal titled “Characterization of periablation and systemic responses to thermal and nonthermal ablative therapies.”
Congratulations to Dr. JP Yu, who has been named one of the 2017 KL2 Scholars through the UW Institute for Clinical and Translational Research (ICTR). The KL2 Scholars Program is a four-year career development program for training and supporting junior faculty from diverse backgrounds and disciplines who are actively engaged in translational research and provides junior faculty the opportunity to develop an independent research program. Dr. Yu is one of four scholars selected this year from across the UW–Madison campus and will participate in career development workshops, train in core translational research competencies, and benefit from protected research time and individualized mentorship. The Integrative Neuroimaging Systems Laboratory directed by Dr. Yu is a systems neuroimaging laboratory focused on the neuroimaging of schizophrenia, autism spectrum disorder (ASD), and other closely related neuropsychiatric diseases. Utilizing unique genetic models of both schizophrenia and ASD, Dr. Yu’s lab explores the impact of genetic mutations on global measures of neural structure and connectivity. Further recognizing the role of the environment in shaping both neural structure and behavior, Dr. Yu’s lab also investigates how environmental factors such as the gut microbiome, aerobic exercise, and stress can further influence brain structure. His mentors for the KL2 program are Elizabeth Meyerand, a professor in the Departments of Medical Physics and Biomedical Engineering, and Dr. Vaishali Bakshi, an associate professor in the Department of Psychiatry.
Dr. Christiane Burton, a research associate with the CT Protocol Optimization Team, was recently awarded the Silvia Fedoruk prize at the Canadian Organization of Medical Physics 63rd annual scientific meeting. The Silvia Fedoruk prize is awarded to the best paper on a subject in the field of medical physics relating to work carried out mainly within a Canadian institution. Burton conducted her research at the Robarts Research Institute at Western University in London, Ontario, Canada. The paper looked at energy subtraction angiography (ESA), an imaging method worked on in the 1980s at the University of Wisconsin with image quality considered poor relative to that of digital subtraction angiography (DSA), the reference standard in angiography. Burton specifically tried to determine if it was a technical or physical limitation that had initially hampered ESA and if that limitation could be overcome in a modern clinical environment. In an initial test, she found that ESA produced images of quantitatively similar quality to DSA, a contradiction of numerous previous studies. Following further investigation it was determined that scatter and detector electronic noise needed to be very low in order for energy subtraction angiography to produce images comparable to DSA, conditions not achievable in the past and difficult, though not impossible, to achieve at present. All of this suggests that ESA methods could offer a viable alternative to DSA when implemented under optimal conditions. Burton also presented on this topic at the American Association of Physicists in Medicine annual conference in 2016, receiving a 3rd place award. The group is a strong contender to receive an NIH grant this year to continue their ESA work. Burton, who is currently volunteering with medical physics at University Hospital, will be taking part in the imaging committee at the Canadian Organization of Medical Physicists next year and hopes to serve as the postdoctoral representative on the Committee on Women in the University at UW–Madison. More information about the Sylvia Fedoruk award can be found at the Canadian Organization of Medical Physicists website.
Dr. Scott Reeder, professor in the Department of Radiology, is the author of the top-cited paper published in the Journal of Magnetic Resonance Imaging (JMRI) between the years 2011 and 2014. His paper, “Quantitative Assessment of Liver Fat with Magnetic Resonance Imaging and Spectroscopy,” deals with non-invasive techniques for accurately and objectively quantifying liver fat, particularly relating to nonalcoholic fatty liver disease. The paper first appeared in the October 2011 edition of JMRI and to date has been cited 334 times. Fatty liver disease affects an estimated 80 million people in the US and the current gold standard of detection is a liver biopsy which carries certain risks. Reeder’s paper goes over non-invasive techniques of measuring liver fat using ultrasound and CT and important limitations of those methods before detailing the possibilities MR imaging presents in detecting liver fat content. This paper has played an important role quantitatively analyzing imaging methods and techniques which have the potential to fill a considerable clinical need. The full paper can be accessed at NCBI.