Professional Documents
Culture Documents
Pat A. Basu, MD, MBA By William G. Bradley, Jr., MD, PhD, FACR and Steven Seltzer, MD, FACR
Faculty (On Leave)
Stanford University
In late February, the National Institute over the past decade and is likely to move closer
Jim Beckett
Vice President, Clinical Research
of Biomedical Imaging and Bioengi- to zero in the future.
Philips Medical Systems, N.A. neering (NIBIB) organized a Radia-
R. Nick Bryan, MD, PhD tion Dose Summit in Bethesda, MD. A minority opinion is that low dose radiation is
Chair, Department of Radiology CIBR was privileged to cosponsor this good for you (“hormesis”); however, most sus-
University of Pennsylvania Health System
important meeting with the NIBIB. pect that very low doses of radiation can be toler-
N. Reed Dunnick, MD, FACR The goal of the conference was to ated in normal individuals through the immune
Chair, Department of Radiology
University of Michigan Medical Center bring together opinion leaders in the surveillance mechanism. While one of the authors
field of medical imaging and to articu- of this summary and others urged research into
Daniel Garen
Vice President, Healthcare Policy and late opportunities to close the gaps in the linear no-threshold hypothesis, others felt
Clinical Affairs our scientific knowledge through re- that this would be too small of a statistical effect
Siemens Medical Solutions USA, Inc.
search. to warrant the research. Still, others felt that it
Steven Haberlein
Vice President, Sales would be worthwhile to identify those patients
FUJIFILM Medical Systems USA, Inc. This meeting discussed why radiation with a genetically determined increased risk of
dose reduction is important and how we might cancer from radiation and most agreed with this
James Jorkasky
Executive Director achieve a sub-mSv (low-dose) CT study. Drs. concept.
National Alliance for Eye and Vision Research Hedvig Hricak and Steve Seltzer pointed out that
Richard Mather, PhD many patients are avoiding potentially life-saving During the summit, there were a number of talks
Senior Manager, Clinical Programs
Toshiba Medical Research Institute
CT scans for fear of radiation-induced cancer. Dr. on how to reduce radiation exposure during a CT
Bill Bradley further noted that many of the pa- scan by using tube current modulation, iterative
Oran Muduroglu
Chief Executive Officer
tients currently scanned by CT could be scanned reconstruction techniques, and reading noisier
Medicalis Corporation by MRI without radiation, albeit at increased (i.e., lower quality) images. For cardiac CT, use of
Martha Nolan, JD
cost. prospective cardiac gating causes a significant
Vice President, Public Policy reduction in dose. Elimination of unnecessary CT
Society for Women's Health Research The crux of the issue is to determine whether exams was another major mechanism in dose
Lenny Reznik any radiation exposure, no matter how small, reduction that can be achieved through the use of
Director, Enterprise Imaging & Information to a population leads to an increased inci- computerized online decision support systems to
Agfa HealthCare Corporation
dence of cancer. The current working model, i.e., help referring physicians order only those exami-
Sheila Ross the “linear no-threshold hypothesis” assumes nations that are medically necessary. Tracking
Special Counsel
Lung Cancer Alliance that, in fact, any radiation exposure is potentially organ-specific doses in a national registry was
harmful. While this is far from proven, the “worry also deemed a useful way to ensure that medical
Paul Tuma
Regional Vice President threshold” has moved from 250 mSv to 100 mSv radiation is used responsibly.
Nuance Communications, Inc.
Nuance Healthcare Division
Coalition for Imaging and Bioengineering Research
1029 Vermont Avenue, NW, Suite 505 ● Washington, DC 20005 ● imagingcoalition.org
www.imagingcoalition.org
that must be met for purposes of reim- Radiology Research, Dr. Ronald Arenson
Imaging: How can Access bursement by the Centers for Medicare (University of California, San Francisco),
and Medicaid Services (CMS). This topic patient advocate Maureen Rigney (Lung
to Images Influence is very important to the imaging commu- Cancer Alliance), and Don Dennison of
Clinical Decisions as Part nity for sharing of image data for reim- Agfa Healthcare Corporation.
of the Use of Electronic bursement purposes. The presentations
featured several perspectives on the is- (Article continues on page 4)
Health Records? sue of images in electronic health records
including discussions by those in primary
By Renee Cruea and Sadaf Samay care, specialty care, and various stake-
holders such as patient advocacy leaders,
On January 10-11, 2011, several CIBR health information organizations, payers,
members attended a workshop spon- and integrated care providers. In addi-
sored by the Office of the National Coor- tion, there was significant discussion
dinator for Health IT (ONCHIT) and the regarding the implementation of such a
National Institute of Biomedical Imaging mechanism, including cost analysis, effi-
and Bioengineering (NIBIB) entitled cacy, interoperability and standardiza-
“Images, Electronic Health Records, tion concerns, as well as bandwidth and
and Meaningful Use: A Vision for the connectivity requirements.
Future.” The purpose of the workshop
was to discuss the inclusion of clinical Several affiliates of CIBR had the oppor- Drs. Ron Arenson (UCSF), Elizabeth
images as part of electronic health rec- tunity to speak at this workshop, includ- Krupinski (University of Arizona), and
ords and the “meaningful use” criteria ing the past president of the Academy for Steven Seltzer (Brigham and Women’s
Hospital)
Over the next weeks and months, we’ll be providing patient groups with
advocacy alerts and information, as well as event reminders for programs
that we’ll be organizing on Capitol Hill. We hope you can participate in the-
se events as much as possible, and we’re looking forward to helping you get
our collective message before policymakers.
In the meantime, please look for important grassroots action alerts and
templates that you and your membership can use. All of us in the biomedi-
cal research community are facing enormous headwinds in Washington. Mike Kalutkiewicz, Vice President
However, we can’t afford to lose ground now. of Government Affairs, CIBR
Best,
Mike
The focus for the meeting was specifically on the value of “It is the patient who
imaging as part of the use of electronic health records
and how access to images can influence clinical decisions. ultimately and truly owns
Don Dennison from Agfa HealthCare presented a vendor
perspective on incorporating both simple and advanced
the record and who needs
imaging into their EHR systems. In particular, he dis-
cussed interoperability and standards considerations
it to be with him or her
when integrating words and pixels into a patient’s EHR.
Due to advances in imaging resolution quality, data stor-
wherever they access
age and management of high-resolution image files can
present a unique challenge.
care.”
Patient Perspectives
The workshop included valuable input from the patient
advocacy groups with regards to the agenda and the
—Martha Nolan, Vice
presentations. Maureen Rigney from the Lung Cancer
Alliance highlighted patient stories about interoperabil-
President of
ity issues (e.g., CD's getting lost, procedures being repeat-
ed because of software incompatibility, etc.) and also a Public Policy, Society
perspective on how users value access to their medical
images within the wider context of access to medical for Women’s Health
information as part of their electronic health record.
Research
The workshop had immense value for everyone in the
imaging community due to the diverse viewpoints it The workshop was extremely beneficial for addressing
brought to the table. It is valuable and vital to have pa- the technical challenges of including imaging data as part
tient advocacy groups present and participating in the of EHRs. We hope to collaborate on future meetings
workshop. However, some areas such as dentistry where where other critical professions, such as dentistry, can be
imaging is highly utilized, were underrepresented. Mov- part of the discussion.
ing forward, CIBR will encourage and help
I greatly appreciated the opportunity to meet with so many Martha Nolan discusses the latest innovations in biomedical
hardworking scientists and researchers from various industry imaging during RSNA 2010
groups who were passionate about their advancements to help
patients. I had ample time to meet with each group and ask ques-
tions. In particular, many of my meetings were centered on ad- to quantify overall exposure. I brought up these stories at the
vances in breast cancer detection and treatment. The technology RSNA meeting because I believe that this issue will continue to
that was presented will hopefully transform how cancerous tu- impact medical decision making, especially since it comes on the
mors are located, removed, and treated in ways that are more heels of reports of overexposure due to CT scans. These reports
accurate, less invasive, and require less radiation. have left patients concerned, confused, and frustrated. If patients
were not aware of the issue of radiation exposure before they
During many of these meetings, I raised the issue of the need for certainly are now and, as a result, they will question the need for
patients to be more informed in order to foster effective collabo- any imaging studies. Going forward, informed patients who want
ration between them and their clinician. I explained that patients to be in the driver’s seat along with their doctors will need to
and their caregivers should not be underestimated in their abil- have the appropriate tools to make good medical decisions. Such
ity to become experts about their treatment decisions, including tools include a better understanding of how to reduce radiation
imaging and diagnostics. More and more often, especially with dose without compromising clinical outcomes, as well as an un-
the amount of information available online, patients and their derstanding of how vital organs receive and absorb radiation
loved ones are able to educate themselves about their disease dose.
and possible treatment options.
CIBR, I am proudly able to say, is the only coalition I am
Prior to the RSNA meeting in Chicago the uproar over airport aware of that is bravely attempting to address these issues
scanners hit the news, creating confusion over what the ma- while actively and consistently engaging patient advocacy
chines do and how they expose us to radiation. The fact that groups. CIBR’s diverse membership means that it is the logical
there were concerns over the amount of radiation used in the entity to advocate for more imaging research and to act as a fo-
airport scanners is of particular note since comparisons were rum for collaboration on these and other imaging-related issues.
made to the amount received in an X-ray. Even as the reports I look forward to returning to the RSNA next year and hope that
explained the various differences and attempted to put the mat- we are able to bring along other patient advocacy leaders as
ter into perspective, it raised the question for many people as to well.
what other types of radiation they had been exposed to and how
Academy Helping NIH to Identify New addition, CIBR is working to establish an online database of po-
tential reviewers.
Imaging Reviewers, Promoting Tours
and Presentations at Additional ICs During the RSNA 2010 Annual Meeting, Dr. Meltzer and Elizabeth
Krupinski, Ph.D. (University of Arizona) led a workshop on the
By Renée Cruea and Roxanne Yaghoubi grant review process. The course educated participants about
different grant mechanisms, the criteria used for grant evalua-
Radiologists as Reviewers tion, and the process of becoming a reviewer. Most of the partici-
Under the leadership of Academic Council Chair Dr. Carolyn Melt- pants had never served as a grant reviewer for the NIH but based
zer (Chair of Radiology at Emory) and the Scientific Liaison Task on what they learned they agreed that they would consider doing
Force, the Academy of Radiology Research (ARR) is working to so in the future. The next workshop will take place during RSNA
grow radiology’s relationships with all of the NIH institutes that 2011. If you are interested in participating, or would like to sug-
have a strong imaging research portfolio. An important part of gest a study section that would benefit from the presence of an
this initiative involves supporting the placement of more radiolo- imaging researcher, please contact Roxanne Yaghoubi
gists and imaging researchers on study sections and advisory (ryaghoubi@imagingcoalition.org).
committees.
Academy Expands NIH Tour Schedule
The ARR Task Force is currently working to identify study sec- Another Academy initiative currently underway is to connect
tions that could benefit from the inclusion of an imaging re- more of the Institutes at NIH with a strong imaging portfolio to
searcher. NIH is currently soliciting the help of professional or- our community of patient advocacy groups and policymakers. In
ganizations and societies to identify well-qualified researchers to March, CIBR sponsored an imaging presentation at the National
serve as volunteer reviewers. The NIH has also revamped their Institute on Aging that focused on the important contributions of
peer review system over the recent years to make it friendlier in the radiology community to aging-related research. Events such
terms of the rigorous demands already placed on academic in- as these are essential to ensuring that interested constituencies
vestigators. The new streamlined review system features a short- are aware of the breadth and scope that imaging plays within a
er application and less travel time required of reviewers. The variety of Institutes and Centers. There will be other events simi-
ARR Task Force will be reaching out to members of the Academy lar to the NIA presentation later in the year. Please contact us if
Academic Council in order to ask them to nominate potential you are interested in participating or if you would like to suggest
reviewers, which the Academy will then forward onto NIH. In an IC that has a compelling imaging story to highlight.
CIBR Sponsors Briefing on Aging showed part of a documentary entitled “The Forgetting: A Por-
trait of Alzheimer’s.” The video described the work that re-
Research searchers at the University of Pittsburgh have done on the Pitts-
burgh Compound B. This is a radioactive compound that, when
By Roxanne Yaghoubi coupled with positron
emission tomography
On February 22, 2011, CIBR sponsored a presentation on imag- (PET) scans, allows
ing research at the National Institute on Aging (NIA), which is researchers to see the
part of the National Institutes of Health (NIH). Briefings such location and distribu-
as the one at the NIA play a critical role in CIBR’s education- tion of the beta amy-
al and advocacy efforts because they give congressional loid plaque deposits
staffers and patient advocates the op- associated with Alz-
portunity to learn more about scien- heimer’s.
tific research. This was CIBR’s 11th
briefing with an NIH Institute, and its first Following the video,
with an Institute other than the National Dr. Susan Resnick Drs. Lis Nielsen, Ronald Kohanski, Chhan-
Institute for Biomedical Imaging and Bio- gave a presentation da Dutta, Neil Buckholtz, Susan Resnick,
engineering (NIBIB) that is home to a entitled “Imaging & Richard Hodes at the NIA presentation
large imaging research portfolio. Brain Aging in Health
and Disease.” The morning ended with a presentation by Dr. Lis
During the event at the aging institute, Dr. Nielsen, who spoke about neuroeconomics, which is the study
Richard Hodes, the Director of the NIA, of how humans make decisions and the role that risk, reward,
gave an introduction and overview of the and emotion play in the aging brain. Question and answer ses-
institute’s mission. He was followed by sions followed each presentation.
presentations by Dr. Ronald Kohanski and
Dr. Richard Hodes, Dr. Chhanda Dutta. Next, Dr. Neil Buck- Building on the success of the NIA event, CIBR hopes to hold a
Director of the NIA holtz, the Chief of the Dementias of Aging briefing on Alzheimer’s and aging research on Capitol Hill later
Branch of the Division of Neuroscience, this spring. If you are interested in attending, please contact
spoke about Alzheimer’s research and Roxanne Yaghoubi (ryaghoubi@imagingcoalition.org).
March 2011 Page 6
www.imagingcoalition.org
Although March marks the halfway point for Fiscal Year include a diversity of populations, they still are counted as
(FY) 2011, the yearly budget remains in limbo. The House a single large award on the NIH books. NIH Directors will
of Representatives has passed its version of the budget, a have no choice but to limit the number of clinical awards,
$65b reduction package from FY2010 levels, while the Sen- in favor of typically smaller awards, in order to stay below
ate deliberates a smaller budget reduction package. In re- the $400,000 cap.
gard to life sciences research, the House’s bill, H.R. 1, calls
for a nominal dollar reduction to the National Institutes of Whereas cost was a factor all along in the administration of
Health (NIH) to FY2008 funding levels—a reduction of science, it would now be paramount to the merit of the
$1.6b (-5.3%) from FY2010. However, when factoring in application in many clinical instances. This is unfortunate,
inflation, the reduction in real dollars gives NIH the same as the proposed policy threatens the very research that is
purchasing power as it had in FY2001. necessary to bring cures from bench to bedside. If policy-
makers want faster cures, why introduce an unprecedent-
In addition to the dramatic budget reduction, H.R. 1 ed congressional mandate that ties the hands of NIH Direc-
requires NIH to fund a minimum number of 9,000 new tors to fund promising clinical trials?
awards at an average award of $400,000 per award.
For historical context, NIH funded 8,989 awards
in FY01 and 9,583 new awards in FY10 - an an-
nual growth rate of 0.64% over the 10 year
“And herein lies the trouble with H.R. 1’s
span. language, even beyond the draconian
For those that follow appropriations report budget cuts: NIH Directors will now have
language, you’d strain to find such prescriptive
language in the past. Congress has traditionally to eschew a large number of clinical tri-
lauded the NIH’s stringent peer review process
as the gold standard for ensuring that only the als, regardless of their merit, in order to
most scientifically meritorious applications re-
ceive funding. Legislators have demonstrated a
stay below the congressionally-mandated
reticence to intrude on NIH’s autonomy for allo-
cating scarce research dollars, leaving such de-
cap of $400,000 per award.”
cisions to the volunteer scientists who review and score As the Senate continues work on their version of the FY11
applications. If the National Cancer Institute (NCI) had a spending package, the fate of the language is uncertain.
strong application for a 15 site, $1.5m clinical trial, as iden- Coalitions like CIBR and the Ad Hoc Group for Medical Re-
tified by scientists in that field, it would be judged on its search Funding have worked to inform members in both
scientific merits the same way a $200,000 basic science the House and Senate of the consequences of such lan-
application would. The $200,000 application would not guage. The process, to finalize the FY11 appropriations
have an inherent advantage over high cost applications package, however, will likely continue throughout the
solely due to its smaller overall cost. An application’s abil- spring.
ity to move the scientific paradigm forward, and to ulti-
mately advance human health, was always the deciding For more information on how to contact your Members of
factor. Congress, or to sign up for CIBR Advocacy Alerts, please
email Mike Kalutkiewicz at mkalutkie-
And herein lies the trouble with H.R. 1’s language, even wicz@imagingcoalition.org
beyond the draconian budget cuts: NIH Directors will now
have to eschew a large number of clinical trials, regardless
of their merit, in order to stay below the congressionally-
mandated cap of $400,000 per award. Even though clinical
trials are typically situated across multiple locations and