RSNA 2009

What is this year's RSNA About? Well I am excited to report some highlights we should expect.

As per RSNA:
"Along with gaining insight into cutting-edge discoveries, evolving techniques and strategies that can translate into better radiology both in the coming years and in current practice, RSNA 2009 attendees will get the latest information on high-profile issues including radiation dose and informatics.

Chest Radiology
Quantitative analysis abstracts in all areas are popular in this year’s programs, but especially in chronic obstructive pulmonary disease, said H. Page McAdams, M.D., subcommit- tee chair. There is a decline in lung cancer screening studies, Dr. McAdams noted, with interest turning instead to thoracic CT dose reduction.

“It is likely that some of the new dose reduc- tion strategies for CT, as well as new quantitative imaging techniques, will significantly affect the current and future practice of chest imaging,” said Dr. McAdams. Other hot topics this year include applications for dual-energy imaging in the chest and chest tomosynthesis, he said.

Emergency Radiology
“This year we assembled an integrated special series on various issues related to practice patterns and management of emer- gency imaging,” said Diego B. Nuñez, M.D., emergency radiology subcommittee chair.

The program combines educational courses and scientific papers on imaging utilization, radiation safety and teleradiology. Scientific paper highlights include optimizing scan- ning times, comparative analysis of various protocols and CT equipment configurations to minimize radiation dose, Dr. Nuñez said. Presentation topics include the use of clinical predictors and the enforcement of appropri- ateness criteria to drive adequate utilization of resources, he said.

“In addition, scientific sessions will include presentations on whole-body CT protocols in polytrauma,” said Dr. Nuñez.

“Sessions will also compare imaging modalities for evaluating vascular and abdominal trauma, skull base, facial and cervical trauma and non-traumatic abdominal emergencies.”

Gastrointestinal Radiology
As dual-energy CT becomes increasingly available, more research is focusing on the “The issue of reduced radiation dose and decreased contrast administration is very prominent and will be particularly highlighted in the cardiac, pediatric and chest areas,” said RSNA Scientific Program Committee Chair Robert M. Quencer, M.D., a professor and chair of radiology at the University of Miami School of Medicine.

Application of 3T MR is demonstrated in a number of gastrointestinal and neuroradiology sessions, Dr. Quencer added. “As has been the trend in recent years, interest remains high in functional neuroimaging, especially with the more widespread use of higher-field magnets, and with trends in CT perfusion and susceptibility-weighted MR imaging.

“Informatics, a topic on everyone’s mind, expands every year,” continued Dr. Quencer. “We will hear of new endeavors in imaging assessment and applications, see and hear newer molecular imaging schemes and get a glimpse of where this field is headed in the future.”

This year the Scientific Program Committee received 10,891 abstracts for consideration. Over the summer, the committee, with its subcommittees, selected 1,750 abstracts as scientific papers and 2,055 for digital presentations.

Breast Imaging
Topics of interest in breast imaging include elastography, tomosynthesis, MR interpreta- tion issues such as the role of BI-RADS 3 and management of small masses, and the ongoing controversy over managing high-risk histology lesions found at core biopsy, said Jennifer A. Harvey, M.D., subcommittee chair.

“Molecular imaging is an emerging field that may provide improved breast cancer detec- tion and specificity, particularly for women at high and moderate risk,” said Dr. Harvey.

This year’s Breast/Nuclear Medicine/Mo- lecular Imaging Series is a combined effort of the Breast Imaging, Nuclear Medicine and Molecular Imaging Subcommittees. Course topics will include gamma imaging, PET and MR spectroscopy and diffusion-weighted imaging, said Dr. Harvey.

The Breast Series will focus on the impact of screening, the evaluation of breast cancer risk and the acceptance of new technolo- gies, she said. Series topics include incident versus prevalent screening for MR and ultrasound, compliance with recommendations for screening of high-risk women and new techniques such as tomosynthesis—an area of increasing interest.

“As radiologists take a more active role in identifying and managing women at high risk for breast cancer, we will have an increas- ing role in recommending imaging beyond mammography,” Dr. Harvey said. “As new technologies develop, we must consider how effective they are in a particular population and realize that results may not translate to the population at large.”

Cardiac Radiology
Cardiac Subcommittee Chair Andre J. Duerinckx, M.D., Ph.D., stressed the strong continuing interest in cardiac CT, with presen- tations focusing on radiation dose, technique development and optimizing contrast volumes. “Cardiac subcommittee members identified many great abstracts in two key areas—early population studies about the use of cardiac CT for risk stratification as well as studies to optimize and possibly reduce contrast usage in cardiac CT,” said Dr. Duerinckx.
Other sessions will cover the use of cardiac MR and CT in cardiomyopathy, valvular heart disease, plaque imaging, chest pain in emer- gency departments, myocardial ischemia and RF ablation procedures, Dr. Duerinckx said. 14

Molecular Imaging
As the specialty continues to gain momentum, molecular imaging demonstrates an increas- ing trend toward clinical applicability, said Umar Mahmood, M.D., subcommittee chair.

“We have a session dedicated to comparison of modalities across a broad spectrum of dis- eases—for example, comparing arterial wall inflammation seen with dynamic contrast- enhanced MR and fluorodeoxyglucose (FDG) PET, or comparing prostate cancer evaluation with 11C acetate verses 18F FDG PET imag- ing,” Dr. Mahmood said.

Another session focuses exclusively on ultra- sound molecular imaging while cell tracking applications have remained popular, he said.

Musculoskeletal Radiology
“T1-weighted imaging with 3T MR imag- ing continues to show promise for the early detection of meniscal degenerative changes,” said Subcommittee Chair Michelle S. Barr, M.D. “This technology can be used to study overuse injuries occurring in everyone from young athletes to weekend warriors, and may serve as an aid in developing standards for early meniscal injury treatment.”

Other notable topics include MR monitoring of inflammatory cell inhibition after admin- istration of minocycline in patients with pain caused by nerve damage, MR for evaluating blood flow in damaged nerve roots and outcomes in cartilage implant procedures. In quantitative imaging, dual-energy CT shows promise in evaluating gout by detecting monosodium urate crystals and monitoring their decrease following effective treatments.

“Many papers are addressing the use of CT to identify osteoporosis,” Dr. Barr added. “Proposals are suggesting that bone density can be evaluated with dual-energy CT, quan- titative CT and a dual technique to evaluate bone density using coronary artery calcium mass scoring software. Another addresses the consequence of long-term osteoporosis treatment with bisphophonates as observed in an atypical fracture pattern occurring in the proximal femur, easily identified once one becomes familiar with this pattern.”

Neuroradiology/Head and Neck
Important new studies in functional MR imaging and advanced MR techniques reveal demonstrable white matter and functional dif- ferences in the brains of autistic patients and characteristic neurological manifestations in those who stutter, said Mauricio Castillo, M.D., subcommittee chair.

“Advanced imaging techniques also showed differences between smokers and non- smokers, identifying the regions of the brain targeted by tobacco use,” said Dr. Castillo. “Additionally, investigators were able to find and map brain abnormalities in antisocial individuals compared to normal controls,” he continued.

Perfusion brain patterns on CT seem to pre- dict prognosis of patients with middle cerebral artery infarctions and difficulty with language generation and susceptibility-weighted brain imaging shows promise in indentifying not only brain infections but their cause as well, Dr. Castillo noted.

In the head and neck, advanced imaging modalities continue to find broader applica- tions, particularly in nodal and thyroid gland diseases.

Nuclear Medicine
Nuclear medicine shows promise in diagnos- ing both neoplastic and non-neoplastic disease, according to Subcommittee Chair Milton J. Guiberteau, M.D. Evolving new techniques such as angiogenesis-targeted tumor imaging and novel applications of existing methods such as FDG PET/CT for distinguishing acute from chronic aortic dissections are among the highlights, he said.

Neoplasm imaging studies address a wide variety of diagnostic and therapeutic response topics including the use of PET/CT in dis- tinguishing more aggressive breast cancers based on receptor characteristics, detecting occult tumors in patients with pan-neoplastic syndromes, evaluating yttrium-90 selective internal radiation therapy for liver metastases and assessing pulmonary lymphangitic tumor spread, said Dr. Guiberteau.

Other topics include combining single-photon emission CT (SPECT/CT) myocardial perfu- sion imaging with CT coronary angiography and evaluating SPECT/CT in diverse settings from iodine 131 whole body imaging to non- specific foot pain, he said.

Also of note, the American College of Surgeons Oncology Group will present initial results of the Cooperative Group Trial of FDG- PET/CT for assessing radiofrequency ablation in Stage 1A non-small cell lung cancer. “The expanding roles of FDG PET/CT quantiza- tion—of standard uptake values—in clinical oncology will be a prominent theme in both the scientific program and a follow-up special focus session,” Dr. Guiberteau said.

Pediatric Radiology

Attendees can look forward to integrated sessions combining review lectures and scientific presentations in neuroimaging, fetal imaging and chest and cardiac imaging, said Lane F. Donnelly, M.D., subcommittee chair. “There will be other important presentations on CT dose, diffusion tensor imaging for body applications and new applications in pediatric interventional radiology,” Dr. Donnelly said. He noted an increasing number of international submissions to the pediatric program.

Physics
Abstracts explore MR for early breast cancer detection, non-contrast arterial spin labeling for assessing kidney perfusion, novel dose reduction techniques in interventional flat detector CT and patient size-corrected index to estimate CT organ dose, said Martin J. Yaffe, Ph.D., subcommittee chair. Dr. Yaffe noted solid overall quality in this year’s submissions.

Radiation Oncology/Radiobiology
“Now more than ever, the scientific program is intimately integrated with the expanded Bolstering Oncoradiologic and Oncoradio- therapeutic Skills for Tomorrow (BOOST) program,” said Subcommittee Chair James S. Welsh, M.D., M.S., who said the quality of sci- entific submissions appears to grow stronger each year.

This year’s program features a roster of excellent papers and posters dealing with cancers of the breast, head and neck, central nervous system and prostate and gastrointes- tinal and gynecologic malignancies, Dr. Welsh said. “Interesting scientific papers and posters will be presented in the basic radiobiologic sciences as well,” he added.

Vascular and Interventional Radiology Trends in interventional oncology in both basic science and clinical application will be a focus this year, said John A. Kaufman, M.D., subcommittee chair. “Peripheral arterial intervention remains strong, indicating the continued important role of interventional radiology in peripheral arterial disease,” said Dr. Kaufman. “New procedures continue to emerge and increase in number and breadth.” Other hot topics will include aortic endografts and embolization therapy, Dr. Kaufman noted.

Focus on Improving Quality, Advancing Imaging Each of the subspecialties is highly focused on implementing and measuring quality im- provement initiatives, Dr. Quencer noted.

“These are but a minor portion of a wide va- riety of papers in all of the planned sessions for RSNA 2009 but this preview does point out some of the trends we expect to see and hear—and all are actively involved in advanc- ing the science of medical imaging,” he said."

Above was from RSNA.org

Please go to this year's RSNA !! http://rsna2009.rsna.org