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Vista MRI News

Please note that the following are radiology related news items, and are not necessarily representative of services offered at Vista Diagnostics.

>> 20th May 2013 - Nationwide Scanning Locations
>> 22nd March 2013 - New 3T Scanner unveiled
>> 2nd February 2012 - We now offer breast implant screening
>> 11th September 2011 - MRI Study Confirms Altered Brain Blood Flow in Gulf War Veterans
>> 6th September 2011 - MRI spares some patients invasive cardiac studies
>> 31st July 2011 - MRI sheds light on smoking
>> 9th May 2011 - Vista now offer Neuro Studies!
>> 4th May 2011 - MRI and meditation
>> 4th April 2011 - Why we slow down with age
>> 30th March 2011 - Personality and Brain Structure
>> 4th October 2010 - Vista Diagnostics now offering private ultrasound scans
>>16th August 2010 - MRI brain scan may provide a diagnosis in Autism Spectrum Disorder
>>7th April 2010 - CT and MRI scans are associated with shorter hospital stays and consequently decreased costs
>>17th March 2010 - MRI is effective in finding tumours in the contra-lateral breast of women diagnosed with cancer in one breast
>>27th January 2010 - MR Spectroscopy can identify Aggressive Prostate Tumours
>>30th December 2009 - MRI can tell when you're lying!
>>9th December 2009 - Pelvic Organ Prolapse better diagnosed by Dynamic MRI
>>16th November 2009 - Role for MRI in predicting the outcome in infants suffering brain ischaemia at birth
>>6th November 2009 - A study of ‘Sellick’s Manoeuvre’ using open MRI – new light shed by MRI on how a long-standing patient safety procedure works.
>>3rd November 2009 - University of Minnesota installs the world’s largest animal imaging magnet
>>3rd November 2009 - A new application for MRI in football
>>4th September 2009 - Vista Diagnostics acquired by InHealth Group Ltd
>>12th August 2009 - Usefulness of MRI in the pre-operative evaluation of the pulmonary arteries in tetralogy of Fallot
>>30th July 2009 - MRI software performs well in diagnosis of Alzheimer’s Disease
>>22nd July 2009 - MRI can accurately detect and localise ‘deep’ Endometriosis
>>9th June 2009 - Cardiac MRI scans find good news for marathon runners!
>>8th June 2009 - Delayed-enhancement MRI scan for senior marathon runners injuries
>>7th June - MRI scans play a growing role in soccer injuries
>>6th June 2009 - MRI scans may be significantly better at detecting some breast cancers at an early stage than standard mammograms
>>7th April 2009 - Vista holds 2008 prices!
>>6th April 2009 - Vista announces CPD events: New Trends in Management of Shoulder Impingement and Rotator Cuff Disease
>>5th April 2009 - Vista announces CPD events: First time shoulder dislocation in athletes / How Orthopaedic Surgeons Think
>>21st March 2009 - Vista announces CPD event: Pain Management in the 21st Century
>>16th March 2009 - Vista announces CPD events: Management of Recurrent Recalictrant Tendinopathy
>>12th February 2009 - Vista announces CPD events: Forefoot Pain & Ankles that won't heal
>>3rd February 2009 - Vista announces CPD events: Understanding & Communicating MRI Scans
>>26th January 2009 - Vista announces CPD events: Beijing 2008
>>2008 News Archive
>>2007 News Archive

20th May 2013
Nationwide scans available

Vista Diagnostics are owned by InHealth Group who have a network of over 280 scanning locations nationwide. To find out which scanning location is closest to you please click here to visit the InHealth Group website. 

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22nd March 2013
New 3T Scanner!

We have a new 3T scanner that is twice as powerful as standard MRI scanners Click here to find out more.

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2nd February 2012
Vista Now Offers Breast Implant MRI Scans

We now offer breast implant scans to check for ruptures Click here to find out more.

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 11th September 2011
MRI Study Confirms Altered Brain Blood Flow in Gulf War Veterans

Gulf War Syndrome is a poorly understood, chronic condition apparently affecting an estimated 25 percent of the 700,000 military personnel deployed to the 1991 Persian Gulf War, according to the U.S. Department of Veterans Affairs’ scientific advisory committee. Three main syndromes have been so labelled with a variety of symptoms, including fatigue, neuropathy, neuralgias, memory and concentration deficits, balance disturbances, and depression.

Debate has raged about the nature of “Gulf War Syndrome” for years with various protagonists claiming a multitude of causative agents from pre-war immunisations to neurotoxic chemical or nerve gas exposure to inhalation of depleted uranium used in some munitions; others have dismissed the condition as “imaginary” or “psychological”. In this regard there are clear parallels with Chronic fatigue Syndrome which also struggles for recognition and in which sufferers are frequently suspected to be really suffering from depression or some other psychological or psychiatric condition.

Many Gulf War Syndrome neurological symptoms, such as memory loss, confusion, irritability, and disorders in motion control might suggest impairment of the hippocampus, the part of the brain responsible for forming long-term memories and helping with spatial navigation. Now a new study using MRI from the Departments of Internal Medicine and Clinical Sciences at the University of Texas (UT) South-Western Medical Centre in Dallas [1] has demonstrated blood flow abnormalities in the brains of veterans with Gulf War illness persisting for 20 years and, in some cases, getting worse.

The researchers identified a special MRI procedure that better diagnoses and distinguishes between the three main types of Gulf War illness. Each patient received intravenous infusions of saline in an initial session, and physostigmine in a second session 48 hours later. Physostigmine is a short-acting cholinesterase inhibitor, used to test the functional integrity of the cholinergic system, a neurotransmitter system involved in the regulation of memory and learning. They then utilised arterial spin labelled (ASL) MRI to assess hippocampal regional cerebral blood flow (rCBF) in 13 control participants and 35 patients with Gulf War syndromes: 1 (impaired cognition), 2 (confusion-ataxia) and 3 (central neuropathic pain).

The results confirmed that abnormal hippocampal blood flow continued or worsened over the 11-year span since first being diagnosed, indicating that the damage is ongoing and long term. The technique proved very well suited to diagnosing Gulf War illness because it picks up brain abnormalities too subtle for conventional MRI to detect.

The work confirmed the preliminary results of earlier studies using single photon emission computed tomography (SPECT) to assess hippocampal blood flow in a similar group of veterans with the syndrome. Thus an objective test has now established that there is indeed an underlying abnormality in these individuals. The next steps are to try to understand why the abnormality develops using genomic and other studies; that is to say to determine the detailed pathophysiology of the condition.

Reference 1. Li X, Spence JS, Buhner DM et al 2011 Hippocampal Dysfunction in Gulf War Veterans: Investigation with ASL Perfusion MR Imaging and Physostigmine Challenge Radiology (published September 11 2011 on line in advance of publication

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 6th September 2011
MRI spares some patients invasive cardiac studies

Invasive catheter cardiac angiography is a powerful diagnostic tool but is far from risk free, particularly in some groups of patients. In those presenting with new-onset heart failure of uncertain etiology, the role of catheter coronary angiography (CCA) is unclear. Although conventionally performed to differentiate underlying coronary artery disease from dilated cardiomyopathy, CCA is associated with a significant risk of complications and may not in the end detect an ischemic cause. As in so many medical fields MRI is providing a viable, safe, non-invasiv e alternative.

In a recent study carried out at the Brompton Hospital in London (1) the diagnostic accuracy of cardiovascular magnetic resonance imaging (CMR) with late gadolinium contrast enhancement (LGE) as a noninvasive "gatekeeper" to CCA in determining the etiology of heart failure in this subset of patients was assessed.

120 consecutive patients underwent GE-CMR and CCA. The etiology was ascribed by a consensus panel that used the results of the CMR scans; similarly, a separate consensus group ascribed an underlying cause by using the results of CCA. The diagnostic accuracy of both strategies was compared against a gold-standard panel that made a definitive judgment by reviewing all data. The study was powered to show noninferiority between the 2 techniques. The sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 97% for GE-CMR were equivalent to CCA (sensitivity, 93%; specificity, 96%; and diagnostic accuracy, 95%). As a "gatekeeper" to CCA, GE-CMR was also found to be a cheaper diagnostic strategy in a decision tree model when UK-based costs were assumed. The economic merits of this model would change, depending on the relative costs of GE-CMR and CCA in another healthcare system.

In summary, the study showed that GE-CMR is a safe, clinically effective, and potentially economical "gatekeeper" to invasive CCA in patients presenting with heart failure of uncertain etiology. This would be a boon for many of these patients.

Reference:1. Assomull RG, Shakespeare C, Kalra PR, Lloyd G, Gulati A, Strange J, Bradlow WM, Lyne J, Keegan J, Poole-Wilson P, Cowie MR, Pennell DJ, Prasad SK. Role of Cardiovascular Magnetic Resonance as a Gatekeeper to Invasive Coronary Angiography in Patients Presenting With Heart Failure of Unknown Etiology. Circulation. 2011 Sep 6.

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 31st July 2011
MRI Sheds light on smoking

MRI studies of the brain are now a powerful tool in the diagnosis of many organic disorders is delineating structural differences in a variety of disorders such as autism. Functional brain imaging by MRI is beginning to provide a fundamental understanding of brain function and aspects of psychology and behaviour. It is therefore not surprising that anatomical and functional brain imaging can shed some light on addictions such as smoking. A number of recent studies illustrate this.

1. Smokers' Brains Look Different
The cerebral cortex is a specific area of the brain responsible for many important higher-order functions, including language, information processing, and memory. Reduced cortical thickness has been associated with normal ageing, reduced intelligence, and impaired cognition. It is also an area of the brain that plays an important role in reward, impulse control and decision making.
In a recent paper published in the journal Biological Psychiatry (1), workers in Berlin report a finding of thinning of the cerebral cortex in smokers as compared to non-smoking controls. The researchers obtained high-resolution 3-D images of the brains of 22 smokers and 21 people who never smoked. Using these images, they calculated the thickness of the cerebral cortex in each participant.
Smokers exhibited cortical thinning in the left medial orbito-frontal cortex. In addition, their cortical thickness measures negatively correlated with the number of cigarettes smoked per day and the magnitude of lifetime exposure to tobacco smoke. In short, heavier smoking was associated with more pronounced thinning of cortical tissue.
The orbito-frontal cortex has frequently been implicated in drug addiction. The current findings suggest that smoking-related cortical thinning may increase the risk for addictions, including smoking.
The direction of cause and effect has not been clarified. The findings may suggest a cumulative damaging effect on the brain by smoking. Alternatively, since the brain region in which the smoking-associated thinning was found has been related to impulse control, reward processing and decision making, this might explain how nicotine addiction actually comes about.
Reference: 1. Kühn S, Schubert F, Gallinat J 2010 Reduced Thickness of Medial Orbitofrontal Cortex in Smokers” Biological Psychiatry 68 (Number 11)

2. Smokers' Brains Function Differently
A study conducted by researchers from Trinity College and the Research Institute for a Tobacco Free Society, Dublin, Ireland (1), aims to compare former smokers to current smokers in order to obtain an insight into how to stop smoking by studying the brains of those who have successfully done so.
Functional MRI (fMRI) images were obtained while groups of current smokers, former smokers and those who had never smoked performed tasks designed to assess specific cognitive skills that were reasoned to be important for smoking abstinence. These included a response inhibition task to assess impulse control and the ability to monitor one's behaviour and an attention task which assessed the ability to avoid distraction from smoking-related images, which tend to elicit an automatic attention response in smokers.
The researchers found that when doing these tasks, the current smokers compared to the never-smokers showed reduced functioning in pre-frontal regions that are related to controlling behaviour. In addition, the current smokers showed elevated activity in sub-cortical regions such as the nucleus accumbens that respond to the 'reward value' or 'salience' of the nicotine stimuli. On the other hand, the former smokers did not show this sub-cortical activity, but instead showed increased activity in the frontal lobes, the areas that are critically involved in controlling behaviour. Moreover, the former smokers were "super-normal", showing greater levels of activity in these prefrontal regions than the never-smokers.
The authors' interpretation is that the brain regions responsible for what might be considered "willpower" show more activity in those who have given up smoking. This type of willpower can be measured, can be related to specific brain regions, and would appear to be related to the ability to stop smoking. The results reinforce the value of smoking cessation therapies that stress the importance of, or that help to train, the cognitive skills involved in exercising control over drug desires.
Reference: 1. Nestor L, McCabe E, Jones J, Clancy L, Garavan H 2011 Differences in “bottom-up” and “top-down” neural activity in current and former cigarette smokers: Evidence for neural substrates which may promote nicotine abstinence through increased cognitive control. NeuroImage 56 : 2258-2275

3. Brain Scans can predict the Chances of a Smoker being able to give up
In a recent study from the University of Michigan Institute for Social Research the subject of giving up smoking was examined (1).
Previous research by the same team suggested that activity in the medial pre-frontal cortex is predictive of behavior change so functional MRI was used to examine neural activity in this region in response to ads designed to help smokers stop smoking.
The study looked at 28 heavy smokers recruited from a smoking cessation program. Functional MRI was used to monitor the participants' brain activity as they watched television ads meant to help people stop smoking.
The researchers contacted the participants one month later and found that they were smoking an average of five cigarettes a day, compared with an average of 21 a day at the start of the study. Smoking was assessed objectively via expired carbon monoxide; a biological measure of recent smoking.
There was considerable variation in how successful individual participants were in reducing their smoking and it was found that a reaction in the medial pre-frontal cortex while watching the quit-smoking ads was linked to reductions in smoking during the month after the brain scan.
It would appear that a MRI brain scan can predict if a smoker will stop successfully and may help in the design of reinforcement messages.
Reference: 1. Falk EB, Berkman ET, Whalen D, Lieberman MD. Neural activity during health messaging predicts reductions in smoking above and beyond self-report. Health Psychol. 2011 Mar;30(2):177-85.

4. Smoking scenes in movies light up smokers' brains
It has long been known that visual cues can cause drug cravings. Habitual smokers repeat the same hand motions, sometimes dozens of times a day. To determine whether the parts of the brain that control that routine gesture could be triggered by simply seeing someone else smoke, researchers from Dartmouth College, New Hampshire used functional MRI to monitor the brain activity in 17 smokers and 17 non-smokers as they watched movie scenes that featured smoking (1). The volunteers were unaware that the study was about smoking
Seeing a character in a movie light up a cigarette triggers smokers' brain areas that are known to interpret and plan hand movements to plan the same motions, as though they too were about to light a cigarette. When the participants saw those scenes, the smokers' brains showed increased activity in the parietal lobe as well as other areas responsible for the perception and coordination of actions involved in movement of the hand they use to smoke.
The findings support previous studies that show smokers who have just seen a movie that had images of smoking are more likely to crave a cigarette, compared with ones who watched a movie without them. Further studies are needed to show whether brain activity in response to movie smoking predicts relapse for a smoker trying to stop.
The researchers noted that smokers are often advised to avoid other smokers and to remove smoking paraphernalia from their homes, but they may not think to avoid seeing a movie that includes scenes of smoking. It has long been known that visual cues may induce drug cravings and the findings of this study build upon the growing body of evidence that addiction may be reinforced not just by drugs themselves, but by images and other experiences associated with those drugs.
The study also demonstrates that clever product placement in the media works.
Reference: 1. Wagner DD, Cin SD, Sargent JD, Kelley WM, Heatherton TF 2011 Spontaneous Action Representation in Smokers when Watching Movie Characters Smoke Journal of Neuroscience 19: 894-898

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 9th May 2011
Neuro Studies now available at Vista

Vista are pleased to announce that Neuro-Diagnostic studies are now available. Please click here for more information.

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 4th May 2011
Functional Magnetic Resonance Imaging demonstrates that Meditation can change the decision-making process

Human decision making does not always appear rational. It is often conceptualized as a competition between cognitive and emotional processes in the brain. Deviations from rational processes are believed to derive from inclusion of emotional factors in decision-making. So, for example, human beings will frequently reject some offer because, even though it is beneficial to them, it is thought to be unfair in some way.
Researchers at the Human Neuro-imaging Laboratory and the Department of Physics at Virginia Tech, at the Neuropsychiatry Clinic of Toronto Western Hospital and at the Centre for Addiction and Mental Health at the University of Toronto have investigated the hypothesis that successful regulation of negative emotional factors by meditation, in this case by experienced Buddhist meditators, might lead to increased acceptance rates of unfair offers. The 26 Buddist meditators were compared with 40 control subjects during economic decision-making in the 'Ultimatum Game' using a functional MRI technique (fMRI). The 'Ultimatum Game' is one in which the first player proposes how to divide a sum of money and the second can accept or reject the proposal.
The results demonstrated that the meditators accepted unfair offers on more than half of the trials, whereas controls only accept unfair offers on one-quarter of the trials. The fMRI specifically showed that controls recruited the anterior insula during unfair offers (such responses are powerful predictors of rejecting offers in social interactions) but, in contrast, the meditators displayed attenuated activity in high-level emotional representations of the anterior insula and increased activity in the low-level interoceptive representations of the posterior insula.
Additionally the researchers found a subset of control participants who played rationally (i.e., accepted >85% unfair offers) and recruited the dorso-lateral prefrontal cortex, presumably reflecting increased cognitive demands; whereas rational meditators by contrast displayed elevated activity in the somato-sensory cortex and posterior superior temporal cortex.
In summary, the broad findings of the researchers were that when assessing unfairness in the ‘Ultimatum Game’, meditators activated a different network of brain areas compared with controls, enabling them to uncouple negative emotional reactions from their behaviour. They concluded that: "Our results suggest that the lower-level interoceptive representation of the posterior insula is recruited based on individual trait levels in mindfulness. When assessing unfair offers, meditators seem to activate an almost entirely different network of brain areas than do normal controls. Controls draw upon areas involved in theory of mind, prospection, episodic memory, and fictive error. In contrast, meditators instead draw upon areas involved in interoception and attention to the present moment. This study suggests that the trick may lie not in rational calculation, but in steering away from ‘what-if’ scenarios, and concentrating on the interoceptive qualities that accompany any reward, no matter how small."
These findings would appear to highlight the clinically and socially important possibility that sustained training in meditation might impact distinct domains of human decision-making.
Reference: Ulrich K, Downar J, Montague PR 2011 Interoception drives increased rational decision-making in meditators playing the ultimatum game. Frontiers in Decision Neuroscience: 5, 49

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 4th April 2011
Why we slow down with age

It's a commonplace enough observation that we slow down mentally as well as physically with age; but it's by no means obvious why that should be so. What is actually happening in the brain? Now Dr Rachel Seidler and team at the University of Michigan have used MRI to examine the question.
In the study, researchers gave joysticks to adults between the ages of 65 and 75 and measured and compared their response times against a group approximately 20-25 years old. They used a functional MRI (fMRI) to image the blood-oxygen levels in different parts of the brain in activity, a standard fMRI technique.
Their findings were that it is unavoidable breakdowns in brain connections that slow down our physical response times as we age. This slower reactivity is associated with an age-related breakdown in the corpus callosum, a part of the brain that acts as a dam during one-sided motor activities to prevent unwanted connectivity, or cross-talk, between the two halves of the brain. At other times the corpus callosum acts at a bridge and cross-talk is helpful, in certain cognitive functions or two-sided motor skills, for example.
The UM study is the first to show that this cross-talk happens even while older adults are at rest. This resting cross-talk suggests that it is not helpful or compensatory for the two halves of the brain to communicate during one-sided motor movements because the opposite side of the brain controls the part of the body that is moving. So, when both sides of the brain talk simultaneously while one side of the body tries to move, confusion and slower responses result.
Previous studies have shown that cross-talk in the brain during certain motor tasks increases with age but it wasn't clear if that cross-talk helped or hindered brain function. However there is hope that just because we inevitably age doesn't mean it's our fate to react more slowly. Seidler's group is working on developing and piloting motor training studies that might rebuild or maintain the corpus callosum to limit overflow between hemispheres. A previous study done by another group showed that doing aerobic training for three months helped to rebuild the corpus callosum which suggests that physical activity can help to counteract the effects of the age-related degeneration.
Reference: Seidler et al 2010 Functional Implications of age differences in motor system connectivity Frontiers in Systems Neurosciences 4:17

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 30th March 2011
Personality and Brain Structure

Clearly our personalities and behaviour have their ultimate origins in our brains. MRI is one of several powerful tools being used in neuroscience to explore brain structure and function with ever more interesting results.
Colin G DeYoung, a psychologist at the University of Minnesota and colleagues have applied MRI to more than 100 adults whose personality type they had already established using a model known as "The BIg Five". The big five referred to in this model are: extroversion, agreeableness, conscientiousness, neuroticism, and openness/intellect. In the imaging they controlled the study for age, sex and whole brain volume
The results were that: extroversion covaried with volume of medial orbito-frontal cortex, a brain region involved in processing reward information. Neuroticism covaried with volume of brain regions associated with threat, punishment, and negative affect. Agreeableness covaried with volume of regions that process information about the intentions and mental states of other individuals. Conscientiousness covaried with volume of lateral pre-frontal cortex, a region involved in planning and the voluntary control of behavior.
People who exhibited openness, a personality type that is creative and enjoys new ways of thinking, did not display noticeably different sizes in any regions.
The findings are intriguing though it should be noted that form and function are different matters and differences in form, as here, do not themselves explain the resulting function. It is also important to remember that although personalities are generally stable, they can be affected by experience over a lifetime. In other words, for those with a small medial prefrontal cortex, there is hope that it may grow!
Reference: DeYoung et al 2010, Testing predictions from personality neuroscience. Brain structure and the big five. Psychol Sci 21(6): 820-8

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 4th October 2010
Vista offers Ultrasound Scans

Vista Diagnostics are delighted to announce that we now offer private ultrasound scans in central London. Ultrasound scans are useful for diagnosing musculoskeletal problems such as shoulder problems, Synovitis and Tendonitis, as well as gynaecological and other problems. For more information click here

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 16th August 2010
MRI brain scan may provide a diagnosis in Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) affects an estimated 1 in every 100 adults in the UK, most of them men. It varies from mild to very severe, and people with the condition can find the world appears chaotic and hard to understand. The disorder spans a wide spectrum and embraces conditions such as Asperger's syndrome. Individuals are affected in different ways; many lead relatively independent lives while others need specialist support. A diagnosis allows individuals to take steps to get help and improve their quality of life.
Conventional diagnosis is expensive, involving as it does a team of experts who analyse behaviour and make a complex series of assessments.
Now researchers at the Institute of Psychiatry of King’s College London claim that, based on their recent work, a simple MRI scan of the brain taking some 15 minutes could help make the diagnosis in autistic adults and children. They claim that the technique achieved 90% accuracy in the study.
The researchers, writing in the Journal of Neuroscience (1) studied 20 healthy adults, 20 adults with ASD, and 19 adults with attention deficit hyperactivity disorder (ADHD), which shares some symptoms with ASD. After being diagnosed by traditional methods - including an IQ test, psychiatric interview and physical examination – they then used the brain scanning technique as a comparator. A MRI scan of the brain was performed on each patient and then software was used to reconstruct the scan into 3D images which were then assessed by computer to determine the structure, shape and thickness of different parts of the brain. The underlying idea is that intricate measurements in the brain may reveal if someone has an autism spectrum disorder associated with abnormalities in brain development. The study did demonstrate subtle brain abnormalities with a distinctive pattern to be associated with ASD.
The hope is that a simple imaging technique may ultimately replace extensive and expensive patient assessment and will be an objective biomarker rather than a subjective clinical judgement.
References: Ecker C et al (2010). Describing the brain in autism in five dimensions - MRI-assisted diagnosis using a multi-parameter classification approach." Journal of Neuroscience (August Issue)

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 7th April 2010
CT and MRI scans are associated with shorter hospital stays and consequently decreased costs

A study in the April issue of the Journal of the American College of Radiology (www.jacr.org) suggests that advanced imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), if used early, can reduce the length of hospital stay and consequently decrease costs. In the USA in-patient costs represent 18 percent of total health care insurance premiums paid and they continue to grow at a rate of about 8 per annum.
The study was carried out at Massachusetts General Hospital in Boston, MA and included 10,005 hospital admissions that involved at least one advanced imaging study during the period from one day prior to admission through to discharge. The results showed that the length of stay was significantly shorter for those imaged on the day before, or day of, admission as compared with those imaged on day one or two for all admissions of at least three days.
The mean length of stay for abdominal CT examinations was 8.4 vs. 9.7 days and for neurological MRI examinations it was 7.6 vs. 8.7 days. The average cost of a hospital stay in the USA is $2,129 per day so even reducing stays by one day represents a substantial saving.
The study design did not establish cause and effect, but clearly suggested that early imaging can expedite in-patient management and discharge in many patients. However, the authors do not suggest that advanced imaging should replace clinical judgement.
Reference: Batlle J C et al 2010 Journal of the American College of Radiology 7: 269-276 (www.jacr.org)

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17th March 2010
MRI is effective in finding tumours in the contra-lateral breast of women diagnosed with cancer in one breast

Second tumours in the contra-lateral breast are not uncommon, particularly in older women, and clearly their presence may have significant effects on patient management. Studies have shown that MRI of the breast has a higher cancer detection rate than clinical breast examination and mammography alone in women at high risk for developing breast cancer. Women who have been diagnosed with breast cancer are at 2-6 X the risk for developing a secondary, contra-lateral breast cancer, compared to women at average risk. The combination of older age and a personal breast cancer history puts women aged 70years or older with newly diagnosed breast cancer at even higher risk for developing a contra-lateral breast cancer. Dr J R Bernard and colleagues at Mayo Clinic in Jacksonville, Florida, found that post-menopausal women, including those over 70 years old, who have been newly diagnosed with cancer in one breast had higher cancer detection rates when the other breast is scanned for tumors with MRI, compared to pre-menopausal women.
They found that 3.8 percent of 425 women had breast cancer in the undiagnosed breast that had not been found with a clinical or mammogram examination. They concluded that post-menopausal status was the only statistically significant predictor of contra-lateral cancer detected by MRI. In 72 of the 425 women, MRI detected a suspicious lesion. A follow-up biopsy showed that 16 (22 percent) of the 72 women had contra-lateral breast cancer (stage 0-1) that had not been detected with typical screening methods. Of the 16 women diagnosed with a contra-lateral cancer, seven were 70 or older.
In these women, detecting and treating cancer in both breasts at the same time may save costs, patient stress, and the potential harmful effects that may come from having to treat cancer later in the second breast when discovered later. While the increased incidence of second tumours in older patients was not a surprise, the team say they undertook the study because, to their knowledge, no published studies examining the use of MRI to screen contra-lateral breasts in women diagnosed with breast cancer have included an analysis of women 70 and older.
Since 2003, the Mayo Clinic in Jacksonville has offered MRI imaging of both breasts in women with newly diagnosed breast cancer. The authors acknowledge that there are controversial aspects to any recommendation for routine MRI in all newly diagnosed patients, the study should help focus the debate and appears to justify it in at least older age groups.

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27th January 2010
MR Spectroscopy can identify Aggressive Prostate Tumors

Prostate cancers are common among older men but most of them are so slow-growing that they pose no danger to life. Current diagnostic techniques, which include measurement of a blood marker, the “prostate-specific antigen” are unable to differentiate the more benign (or even “in situ”) tumours from the more aggressive ones needing treatment. Even biopsy has its limitations in their assessment. Given the lack of a consensus on best treatment and given the significant side effects frequently associated with all treatments, this is a very important issue.
Now evidence is emerging that magnetic resonance spectroscopy (MRS) may be capable of making a significant contribution to the problem. MRS provides information about the metabolism/chemistry of normal and malignant tissues and in a small trial recently pre-published on-line in Science Translational Medicine by Dr Cheng and colleagues at Massachusetts General Hospital yielded promising results. They had already found in 2005 that magnetic resonance spectroscopy could distinguish cancerous from normal prostate tissue on the basis of their metabolic profiles as monitored by MRS. Their new study used magnetic resonance spectroscopy on five cancerous prostate glands removed from men with the diagnosis. The results of the scans were compared with those of the standard technique, which judges a cancer by the degree of disorder produced by the malignancy. Five of seven regions identified as cancerous by that method scored high on a magnetic resonance spectroscopy malignancy index. The other two regions were near the outer edges of the glands, where exposure to air made the magnetic resonance results less clear.
The same thing could be done using guided prostate biopsies and the intention now is to move toward such a definitive trial. A validation study is estimated to require about 3 months and demonstrating effectiveness in clinical practice about 2 years.
The technology currently requires a higher magnetic field than that routinely used in general medical applications but it may be possible to adapt the technique to lower field instruments. Dr Cheng's program is one of a number of research programmes around the world tackling this important medical problem.
Magnetic resonance techniques have over recent years become more and more indispensible in the management of prostatic disease and this appears set to continue.
Reference: Cheng L LJan. Science Translational Medicine (on-line edition January 27th 2010)

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30th December 2009
MRI can tell when you’re lying!

MRI is a very powerful technology in the imaging of pathology, and there is no controversy whatsoever concerning its many and growing applications.
Less well known, at least to the general public is the fact that MRI may be used to monitor brain function; this is termed Functional MRI or fMRI. This technique detects increases in blood flow to areas of the brain which are active in certain tasks or thoughts and is being studied by many research groups around the world.
Now Dr Thomas Baumgartner and colleagues at the University of Zurich have reported an intriguing application, namely to catch out those who make false promises!
He and his colleagues used functional magnetic resonance imaging (fMRI) to catch promise-breakers in the act by setting up a game of trust between an ‘investor’ and a ‘trustee’. In this game, an investor was given real money to be invested in a chosen trustee. Giving the money to the trustee in the study increased the amount of money 5-fold, but the investor ran the risk that the trustee might not share the winnings but keep all the money for himself. The game was run twice: the first time, investors simply had to guess whether trustees would share the winnings and then made their decision accordingly; the second time, trustees could promise to share the winnings with the investor, if they wanted – although the promise was non-binding. Almost all the trustees promised always to share their winnings, thereby securing investment. While some of them remained true to their word, others consistently broke their promise, keeping the profits for themselves. Trustees had their brains scanned using fMRI during both runs, speaking to the investor from inside the scanner via an intercom.
The fMRI data revealed that certain brain areas became more active when trustees were making false promises. These regions – the dorso-lateral prefrontal cortex, anterior cingulate cortex and amygdala – are known to be involved in emotion. They could reveal an emotional conflict in a person who knows he is doing something wrong or feels guilty. These areas were active in people who were making promises that they later broke, but not in people making promises that they ended up honouring.
The finding raises the possibility of using functional brain scans for a great variety of previously unimagined purposes such as to determine the true intentions of criminals who are up for early release on parole. But a great deal more work is needed to validate such findings and to assess their reproducibility and reliability; in particular perhaps one question in particular needs to be answered: would individuals with “no conscience” or practised liars be caught out by such a technique?
Reference: Baumgartner et al. 2009 Neuron 64: 756-770

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9th December 2009
Pelvic Organ Prolapse better diagnosed by Dynamic MRI

MRI is a powerful imaging technique with increasing numbers of applications. However, like other imaging techniques, it is usually performed as a static examination and in some situations this may lead to loss of important “dynamic” information.
In a recent study, Bennett and colleagues at the NYU Langone Medical Center in New York have carried out a study of women with a clinically suspected urethral abnormality using both static and dynamic MR imaging techniques (1).
They performed MRI of the urethra in 84 women with lower urinary tract symptoms using multiplanar T2-weighted turbo spin-echo and unenhanced and contrast-enhanced gradient-echo sequences for static imaging and then added dynamic true fast imaging with steady-state free precession sequence during straining in the sagittal plane.
MRI findings evaluated independently by two Radiologists were correlated with clinical symptoms.
Urethral abnormalities were found in 10 of 84 patients (11.9%). Thirty-three patients (39.3%) were diagnosed as having pelvic organ prolapse, of whom 29 (87.9%) were diagnosed exclusively on the dynamic imaging. In 29 of 33 patients with prolapse (87.9%), the urethra was structurally normal. MRI showed 13 cystocoeles and 17 cases of urethral hypermobility not detected on physical examination. Patients with a greater number of vaginal deliveries, stress urinary incontinence, frequency of voiding, and voiding difficulty were statistically more likely to have anterior compartment prolapse (p < 0.05).
It was concluded that use of a dynamic sequence permits both structural and functional evaluation of the urethra, which may be of added value in a substantial proportion of women with lower urinary tract symptoms. Dynamic MRI also importantly allows detection of pelvic organ prolapse that is frequently not evident on either physical examination or on conventional static sequences.

Reference: 1) Bennett GL, Hecht EM, Tanpitukpongse TP, et al. MRI of the urethra in women with lower urinary tract symptoms: spectrum of findings at static and dynamic imaging. [Journal Article] Am J Roentgenol 2009;193(6):1708-15.

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16th November 2009
Role for MRI in predicting the outcome in infants suffering brain ischaemia at birth

Some 20% of cases of cerebral palsy and a substantial number of deaths of newborns are a consequence of acute ischaemic injury during birth.
In a new study from the Clinical Sciences Centre of Imperial College, London, Dr Mary Rutherford and colleagues have made two findings of considerable importance.
Firstly, they demonstrated that magnetic resonance imaging (MRI) can predict with 80% accuracy the likelihood of death or disability by age 18 months.
Secondly, they established the validity of a hypothesis that whole-body cooling might be associated with a reduction in cerebral lesions seen on MRI that are characteristic of ischaemic encephalopathy, including those predicting neuro-developmental impairment.
To test the hypothesis, they reviewed the MRI scans for 131 of 325 infants enrolled in the already published ‘TOBY’ trial (Total Body Hypothermia for Neonatal Encephalopathy trial. They found that therapeutic/prophylactic hypothermia was associated with a 30% to 40% reduction in lesions in various areas of the brain associated with neurological development. Compared with non-cooled infants, cooled infants had fewer scans that were predictive of later neuro-motor abnormalities, and were nearly 3 times more likely to have normal scans. The accuracy of prediction by MRI of death or disability to 18 months of age was similar in both groups (84% for the cooled group vs 81% for the non-cooled group).
No unusual patterns of lesions and no increase in haemorrhagic or thrombotic lesions were found in association with therapeutic hypothermia.

Reference: Rutherford M et al (2009) Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic—ischaemic encephalopathy: a nested sub-study of a randomised controlled trial.
The Lancet - early on-line publication 6th Nov 2009 (print edition January 2010)

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6th November 2009
A study of ‘Sellick’s manoeuvre’ using open MRI – new light shed by MRI on how a long-standing patient safety procedure works.

Regurgitation of stomach contents during induction of anaesthesia can result in aspiration with serious consequences. In 1961 the British physician, Dr Brian Sellick, described a manoeuvre which has become a basic skill taught to all training anaesthetists and used all over the world routinely, most often in such patients as accident victims whose stomachs might not be empty before surgery or patients who have bowel obstruction or slowed emptying of the stomach because of certain drugs or medical conditions. The fingers are pressed against the patient's throat to prevent regurgitation and consequent risk of aspiration. It is also called “cricoid pressure” and has been described in terms of the compression of the esophagus between the cricoid cartilege and the neck vertebrae.

Some physicians have questioned the efficacy of the technique and some have abandoned its use. Their doubts were reinforced by a paper in 2003 which found that in some 90 percent of cases, the esophagus moves to the side during the procedure and it became widely believed that the procedure is effective only if done precisely at the midline of the neck and that it was somewhat unreliable in practice.

Now, anaesthetists at the University of Florida College of Medicine have used an open magnetic resonance imaging (MRI) system to image the neck during the procedure. The open system allowed the individual performing the technique to do so unimpeded in a manner reproducing closely the clinical setting. The study looked at 24 non-sedated adult volunteers undergoing MRI of the neck with and without cricoid pressure (CP). Measurements were made of the post-cricoid hypopharynx, airway compression, and lateral displacement of the cricoid ring during the application of CP and the anatomical changes studied. They showed that the manoeuvre does indeed work and that those who have doubted it have misunderstood the physical/anatomical underpinning of the procedure.

The MR images clearly demonstrate that the esophagus does not exist at the point in the neck where the compression is applied. Rather, the structure involved is the hypopharynx (above the esophagus) that is compressed between the cricoid and the spine posteriorly. The esophagus exists only inferiorly so its movement has no bearing on the matter. The procedure works if not for the reasons previously thought.

Reference: Rice M J et al 2009; Anesthesiology and Analgesia 109: 1546-1552.

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3rd November 2009
University of Minnesota installs the world’s largest animal imaging magnet

The University of Minnesota has installed the world’s largest animal imaging magnet and is preparating for the arrival of the world’s largest full-body human imaging magnet, expected sometime next summer. The imaging magnets, both built by manufacturer Varian Medical Systems, cost around $10 million each.

The 50-ton animal imaging magnet, brought to campus using a giant crane, is 16.4 Tesla, ten times the strength of typical clinical magnets. The human imaging magnet will be 10.5 Tesla. The powerful magnets are expected to produce a much better image quality and faster imaging. The animal imaging magnet will be used by University researchers to look at small mammals, primarily mice and rats, to observe internal anatomy and biochemistry of organs and, in particular, aspects of metabolism.

They will also be used to achieve better Magnetic Resonance Spectroscopy (MRS), which allows study of metabolism, and for improved Functional Magnetic Resonance Imaging (FMRI), a technique used, among other applications, for mapping brain activity. The hope is that ultimately the research performed with these magnets will result in improved clinical imaging.

Another aspect of considerable interest is that by observing the behavioral and neurological effects on animals from chronic high magnetic field exposure, understanding of potential problems with human exposure to strong magnetic fields will be enhanced.

Reference: http://www.mndaily.com/2009/10/21/u-now-home-world%E2%80%99s-largest-animal-imaging-magnet

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3rd November 2009
A New Application for MRI in football

MRI has well-known applications in the assessment of sports injuries in general but in football a new and unexpected application has been found. FIFA, the governing body for international football, has launched a program of random MRI wrist screenings this month in an effort to verify the age of players competing in the under 17 World Cup Tournament that is being hosted by Nigeria.

The fielding of over-age players has been a problem for quite some time because the global competition draws talent from many parts of the world where age cannot be clearly determined.

FIFA hopes that by using this MR imaging assessment they can guarantee - with a certainty of about 99% - that all players are really biologically under 17, according to FIFA's chief medical officer, Professor Jiri Dvorak.

FIFA used to use X rays for this purpose but some member associations had raised anxieties about the use of ionising radiation.

 Reference: Diagnostic Imaging. Vol. 31 (No. 10); October 6, 2009

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4th September 2009
InHealth acquire Vista Diagnostics

I am delighted to announce that Vista Diagnostics Limited has been acquired by InHealth Group Limited, a leading provider of diagnostic services operating exclusively in the UK. 
 
Since its launch in 2007 Vista Diagnostics has established itself as a leading provider of low cost high quality MRI scans for self funded, insured, and NHS funded patients.  The Vista team is looking forward  to further developing its low cost high quality diagnostic service offerings, with the support of InHealth resources and expertise, for the benefit of its referrers and their patients.
 
Please look out for further announcements regarding service developments.

Patrick Carter
CEO, Vista Diagnostics

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12th August 2009
Usefulness of MRI in the pre-operative evaluation of the pulmonary arteries in tetralogy of Fallot

MRI continues to increase the range of its applications. One such relatively small print new but important application may be in non-invasive pre-operative assessment of patients with congenital heart disease.

Beekman and colleagues in Leiden have shown that MRI may have a useful role in patients with Tetralogy of Fallot. Pre-operative evaluation of these patients includes cine-angiography to delineate the pulmonary vasculature and the coronary artery anatomy and to demonstrate the presence of the possibly multiple ventricular septal defects (VSDs). Other information is obtained from color-Doppler-echocardiography.

The authors used MRI and cine-angiography on 18 patients with TF, four of whom had aorto-pulmonary shunts. They compared MRI and cine-angiography in the assessment of the ascending aorta, the main,  left and right pulmonary arteries and found close agreement between cine-angiography and MRI.

In assessing intracardiac anatomy, MRI was superior to color-Doppler-echocardiography in the depiction of aortic override and  right ventricular hypertrophy; in a handful of cases local stenoses in the pulmonary arteries were detected by both MRI and cine-angiography.

Hypoplasia of the main pulmonary artery was detected by MRI in six patients and by cine-angiography in five patients, cine-angiography missing one case.

In the demonstration of shunts, the spin-echo sequence demonstrated 2 out of 4 shunts in this series; gradient-recalled-echo MRI is expected to give better results.

The authors concluded that MRI may be used instead of cine-angiography to delineate the pulmonary arteries and that new developments in MRI indicate the feasibility of delineating the coronary arteries.

Reference: Magnetic resonance imaging 1997, 15, 1005-1015

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30th July 2009
MRI software performs well in diagnosis of Alzheimer’s Disease

Alzheimer’s Disease is currently diagnosed on the basis of a history, a neurological examination and written tests. Imaging is used to exclude other pathologies such as stroke or tumour. Early diagnosis is desirable as some treatments are now available, but it is difficult.

Now Dr. Rahul Desikan and colleagues at Massachusetts General Hospital have reported that they can image changes in the areas of the brain affected in early Alzheimers. They confirmed that these individuals exhibit a significant difference in thickness and volume in their entorhinal cortex, hippocampus, and supramarginal gyrus.  They use automated MRI software to detect the changes, and in a cohort of 216 patients claim a 95% accuracy in distinguishing mild cognitive impairment from normals, and 100% accuracy in diagnosing Alzheimers.

The software package is “FreeSurfer” developed at MGH and made freely available (surfer.nmr.mgh.harvard.edu). It is not yet ready for reliable clinical application and needs more and longer term assessment; it is strictly speaking not fully automated and is time-consuming and operator-dependent in its use. It should also be noted that by no means all individuals with mild cognitive impairment progress to Alzheimer’s disease.

The results are very promising in offering a possible non-invasive diagnostic tool in the foreseeable future in a disease in which currently the diagnosis can only be reliably made at post-mortem.   

Reference: Brain 2009 May 21 (epub ahead of print).

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22nd July 2009
MRI can accurately detect and localise ‘deep’ endometriosis

Endometriosis is a chronic and sometimes painful disease which is one of the most common health problems affecting women; endometrium is found in atopic positions outside the uterus. It can be found attached to other organs such as the ovaries, fallopian tubes, bowels and bladder. Symptoms include chronic pelvic pain, lower back pain, painful sexual intercourse, painful menstrual cramps, fatigue and infertility.
 
There are two types of endometriosis: superficial and sub-peritoneal (deep). Superficial endometriosis can be treated with laparoscopy. Deep endometriosis infiltrates areas of the cervix, vagina and/or the colon, and, less frequently, the bladder and ureter and sometimes requires complete surgical excision of the lesions
 
It is important that the diagnosis and staging of the disease distinguish between the two types in order to guide the surgeon to schedule the most appropriate procedure.
 
Radiologists in Brussels led by Dr Nathalie Hottat assessed the usefulness of magnetic resonance imaging (MRI) at 3T in the diagnosis and accurate localisation of deep endometriosis.
 
"Pelvic MRI at 3 Tesla is a non-invasive technique that allows a complete examination of the pelvis," said the study's lead author, Nathalie Hottat, M.D., from the Department of Radiology at Erasme Hospital and the Université Libre de Bruxelles in Brussels, Belgium. "It accurately depicts all locations of deep endometriosis."  The researchers studied 41 women, age 20 – 46, with suspected endometriosis. MRI was performed prior to surgery. MRI accurately diagnosed 26 of 27 cases of deep endometriosis. In addition, MR images accurately depicted specific locations of deep endometrial lesions. The 3-T MRI results also demonstrated a high negative predictive value of 93.3 percent meaning that MRI findings accurately ruled out deep endometriosis in patients with superficial endometriosis, allowing the surgeon to perform the less invasive laparoscopic procedure.
 
Colon wall involvement was present in 32 percent of patients with deep endometriosis and MRI was effective at distinguishing different layers of the affected colon wall and accurately depicted the degree of colon wall invasion.
 
The study has been published online in Radiology Info

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9th June 2009
Cardiac MRI scans find good news for marathon runners!

Professor Peter Dawson, Clinical Director, Vista Diagnostics has noted some recent research which provides reassuring news for marathon runners.

Using a contrast-enhanced MRI scan, a Canadian group have demonstrated that myocardial functional anomalies, such as diastolic filling irregularities on both sides of the heart and a decrease from 64% to 43% in the pumping function of the right ventricle, detected in long-distance runners after they cross the finish line should not be interpreted as signs of possible heart damage. Rather, these fluctuations do not result in any true damage of the heart. The right ventricular dysfunction is transient, recovering one week following the race. Using cardiac MRI scans, Canadian investigators have found evidence that these abnormalities are only temporary. The cardiac health of 14 non-professional athletes was studied. And the investigators found no evidence of permanent myocardial injury on follow-up cardiac MRI scan.

This is the first time cardiac MRI scans have been used to further evaluate and understand the effects of marathon running on the heart.

See full article in Diagnostic Imaging Europe

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8th June 2009
Delayed-enhancement MRI scan for senior marathon runners injuries

Exercise is good for the heart but, on the other hand, the older the individual the greater the likelihood that it may induce sudden cardiac death! Thus older marathon runners are at some risk.

A German group has studied MRI scans with late gadolinium enhancement to try to identify those at risk in advance. They performed MRI scans of the myocardium with late gadolinium enhancement in 108 asymptomatic healthy male subjects aged 50 to 72 with a minimum of five completed marathon races during a consecutive three-year period. They also enrolled a control group matched for age and risk factors and excluded subjects with known cardiovascular disease or diabetes mellitus. All subjects in the study underwent gadolinium-enhanced MRI scans, and those with late enhancement underwent additional adenosine stress perfusion imaging.

The investigators found an unexpectedly high number of the nonprofessional athletes (some 12%) had late enhancement MRI scans suggesting myocardial disease, including ischemia, myocardial fibrosis, and scarring.

The authors concluded that late gadolinium enhancement may have important prognostic implications for older athletes.

See full article in Diagnostic Imaging Europe

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7th June 2009
MRI scans play a growing role in soccer injuries

Soccer is a very hard physical game and a great variety of injuries are associated with it. For all but superficial ones, imaging is assuming an ever greater role. Imaging techniques range from plain films through ultrasound and to MRI scans. The role of the last in soft tissue injuries is growing. MRI is essential in internal derangements of the knee, shoulder injuries and in tendinitis in a variety of sites.

See full article in June edition of Diagnostic Imaging Europe

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6th June 2009
MRI scans may be significantly better at detecting some breast cancers at an early stage than standard mammograms.

Professor Peter Dawson, Clinical Director, Vista Diagnostics has noted an interesting article in The Lancet (“MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study”) which suggests the sensitivity with which ductal carcinoma in situ (DCIS) is diagnosed by MRI scans is greater than with conventional mammograms. During a 5-year period, 7319 women were studied and underwent both mammography and MRI scans for screening.

For more information see The Lancet

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7th April 2009
Vista holds 2008 prices!

Vista Diagnostics the leading provider of low cost high quality MRI scans in Central London is pleased to announce that until further notice it is maintaining its 2008 prices. 

Prices range from £200 to £400 per single region MRI scan, depending on day and time of appointment selected.

Prices vary based on daily demand, so the most affordable prices are available during less busy periods - for example, early morning. 

The fee for Intravenous contrast if clinically indicated is £125 per dose.

To book an appointment call 0845 450 3559.

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6th April 2009
Vista announces CPD events:
New Trends in Management of Shoulder Impingement and Rotator Cuff Disease

Title:

Impingement Syndrome and Rotator Cuff Disease: The Management Principles for Primary Care. The session includes physiotherapy, injection techniques and referral guidelines. It also includes some information and innovation in surgical treatment and will offer the opportunity to discuss diagnostic and treatment options with two expert shoulder surgeons of the renowned Reading Shoulder Unit..

Speaker:

Ofer Levy studied medicine at the Hebrew University and Hadassah School of Medicine, Jerusalem, from 1976 - 1982. After completion of his military service he continued his general surgical training at Kaplan Medical Centre in Rehovot, Israel. He then moved to Sheba Medical Centre, Tel Hashomer, for his higher surgical orthopaedic training programme.

In 1992 he was appointed instructor of Orthopaedic Surgery at The Sackler School of Medicine, Tel Aviv University, where his work included significant research into both clinical and basic sciences.

In 1995 he was appointed Consultant Orthopaedic Surgeon and Chief of the Shoulder Surgery Service at Soroka Medical Centre in Beer Sheva, Israel, whilst at the same time being appointed lecturer in Orthopaedic Surgery at the Faculty of Health Science at the Ben-Gurion University of the Negev, Beer Sheva.

Since 1997 he has been working with Stephen Copeland. In 1999, he was appointed Consultant Orthopaedic Surgeon at the Royal Berkshire Hospital and in the same year he and Stephen Copeland established the Shoulder Surgery Unit at The Berkshire Independent Hospital. He is a founding member of the Israeli Shoulder and Elbow Society, a member of the European Society of Shoulder and Elbow Surgery and the British Elbow and Shoulder Society (BESS) and Corresponding member of the American Shoulder and Elbow Society.

Professor Associate, the Orthopaedic Research and Learning Centre in the School of Engineering and Design, Brunel University, West London.

He has published many scientific papers, written chapters to books on Shoulder Surgery and invited to lecture worldwide.

Giuseppe Sforza studied medicine at Universita degli Studi di Bari, Italy, 1986 - 1992. After completion of his general surgical training, he continued his higher orthopaedic training at the same University. He spent periods of fellowship at the Danderyd Hospital - Karolinska Institute, Stockholm - Sweden and at the Southern California Orthopaedic Institute Los Angeles, United States, where he started research into shoulder arthroscopy and open shoulder surgery.

Between 1999 to 2000 he was appointed Shoulder Surgery Fellow at the Reading Shoulder Unit at the Royal Berkshire Hospital under Stephen Copeland and Ofer Levy, where he gained vast experience in shoulder and elbow surgery.            

In 2000 after completion of his fellowship at the Reading Shoulder Unit, he returned to Italy and was appointed Consultant Orthopaedic Surgeon at "Madonna delle Grazie Hospital" in Matera, Italy as head of the shoulder and elbow unit. Since 2001 he attended annually the Mayo Clinic in Rochester, United States for visiting fellowships under S. O'Driscoll and B. Morrey to improve his knowledge and clinical practice in elbow surgery. Since October 2004 he joined the Reading Shoulder Unit at the Capio Reading hospital, treating patients in waiting list initiatives. In 2005 he worked as Locum Consultant Orthopaedic surgeon and shoulder and elbow surgeon at St. Peter and Ashford Hospitals NHS Trust for several months. In 2007, he was appointed Consultant Orthopaedic Surgeon at the Worchester NHS Trust. He is a member of the Italian Shoulder and Elbow Society and of the Italian Arthroscopy Society where he has served on the Educational Committee, organizing some national meetings. He is member of the European Society of Shoulder and Elbow Surgery. He has published scientific papers and chapters to books on Shoulder Surgery.

Dates:

6 May 2009, 7pm – 9pm

Venue:

Vista Diagnostics, 1st Floor Capital Tower, 91 Waterloo Road, London SE1 8RT

Agenda:

18.45 – Registration

19.00 - Introduction to the evening by Mr. Patrick Carter CEO, Vista Diagnostics

19.20 - Impingement Syndrome


Professor Ofer Levy MD, MCh Orth - Master of Orthopaedic Surgery, Reading Shoulder Unit

  • Algorithm for Treatment
  • Diagnostic Tools and Management
  • Home Exercises Programme

20.00 - Break

20.10 - Rotator Cuff Disease

Mr Giuseppe Sforza, Consultant Orthopaedic Surgeon, Reading Shoulder Unit

  • Algorithm for Treatment
  • Conservative and Surgical Management
  • Discussion 

21.00 - Finish

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5th April 2009
Vista announces CPD events:
First time shoulder dislocation in athletes / How Orthopaedic Surgeons Think

Title:

First time shoulder dislocation in athletes / How Orthopaedic Surgeons Think

Speaker:

Mr. Duncan Tennent FRCS(Orth) qualified from St. Bartholomew’s Hospital in 1992. After training at the Royal National Orthopaedic Hospital, Stanmore, he spent a year on an arthroscopic fellowship in Virginia, USA. He was appointed as a Consultant Orthopaedic Surgeon with a special interest in shoulder and elbow surgery and Honorary Senior Lecturer at St. George’s Hospital, London in 2003. He also holds appointments as Shoulder Surgeon to the Metropolitan Police, special advisor in shoulder surgery to the States of Guernsey and as a visiting Lecturer to Orthopaedic Research of Virginia.

His particular interests are arthroscopic surgery of the shoulder and elbow and he also spends much of his time in the NHS on complex reconstructions of both joints following trauma. He has written a textbook of arthroscopic surgery as well as publishing a number of scientific articles on the subject and holds the patent for a revolutionary arthroscopic technique for reconstruction of the Acromio-clavicular Joint.

He lectures both nationally and internationally on shoulder and arthroscopic surgery and continues to teach undergraduate and postgraduate surgery at St. George’s Hospital. Privately Mr. Tennent consults at Parkside and St. Anthony’s Hospitals

Mr Jonathan Bell FRCS graduated in 1987 from the University of London and has held the position of Consultant Orthopaedic Surgeon at Kingston NHS Trust/Queen Mary’s University hospital since 1998.

Mr Bell has a variety of research interests including ligament injuries of the knee, tendinopathy and predictive outcome measures of total knee replacement. With a specialist interest in arthroscopic knee surgery including complex ligament reconstruction and knee replacements including partial minimally invasive joint replacement, Mr Bell is a leader in his field.

Dates:

5 May 2009, 7pm – 9pm

Venue:

Vista Diagnostics, 1st Floor Capital Tower, 91 Waterloo Road, London SE1 8RT

Agenda:

18.45 – Registration

19.00 - Introduction to the evening by Mr. Patrick Carter CEO, Vista Diagnostics

19.20 - First time shoulder dislocation in athletes


Mr Duncan Tennent FRCS(Orth), Consultant Orthopaedic Surgeon, Wimbledon Clinics

  • Traumatic anterior dislocation common
  • Recurrence common
  • Incidence of recurrence
  • Effect of doing nothing
  • At risk groups
  • Treatment options
  • Clinical cases

19.50 - Break

20.10 -How Orthopaedic Surgeons Think


Mr Jonathan Bell FRCS, Consultant Orthopaedic Surgeon, Wimbledon Clinics

  • Different styles of reasoning
  • Advantages and disadvantages of method chosen
  • Examples
  • A word about imaging

21.00 – Finish

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21st March 2009
Vista announces CPD event: Pain Management in the 21st Century

Title:

Pain Management in the 21st Century

This lecture looks at contemporary practice in pain medicine.

Dr Jenner gives an overview of all the relevant aspects of pain medicine, including basic physiology and pharmacology, and a description of a number of common pain complaints including musculoskeletal pain (lower back pain, whiplash, thoracic pain) and neuropathic pain (including complex regional pain syndrome and neuropathies). Dr Jenner explains the multimodal approach to the management of pain including the role of different medications, physiotherapy and rehabilitation, minimally invasive pain management procedures and pain psychology, pain management programmes and advanced pain management procedures, including spinal cord stimulation and intrathecal pumps.

The session is fully interactive with the course participants, which makes this a lively and interesting educational forum. There will be ample opportunity for asking questions, including questions about participants’ patients. 

Speakers:

Dr Jenner is a Consultant in Pain Medicine and Anaesthesia St Mary's Hospital, London, W2. He is also an Honorary Clinical Lecturer at Imperial College, London, SW7.

He qualified at The London Hospital Medical College in 1995. He trained in anaesthesia at The London and St Bartholomew's Hospitals, where he developed a specialist interest in pain medicine. He then underwent higher specialist training in West London, where his posts included being a Specialist Registrar in Pain Medicine and Anaesthesia at St Mary's, Central Middlesex, Chelsea and Westminster and Charing Cross Hospitals. He completed a Fellowship in Pain Medicine at The Royal Marsden Hospital, London. He is Director of London Pain Consultants, which aims to provide pain-relief and rehabilitation, allowing restoration to a productive life.

Dr. Outwaite trained in rheumatology, rehabilitation, and orthopaedic medicine. His special interests are the diagnosis and treatment of persistent painful conditions, which are not suitable for surgical treatment, including whiplash injury, persistent low back pain, complex regional pain syndrome, fibromyalgia, and knee and foot pain. He provides comprehensive programmes of exercise, and functional restoration programmes.

Dates:

21 April 2009, 7pm – 9pm

Venue:

Vista Diagnostics, 1st Floor Capital Tower, 91 Waterloo Road, London SE1 8RT

Agenda:

18.45 – Registration

19.00 - Introduction to the evening by Mr. Patrick Carter CEO, Vista Diagnostics

19.20 - Pain Management in the 21st Century

  • Dr C A Jenner

20.00 - Break

20.10 - Setting up an FRP Programme

  • Dr John Outhwaite BMBCh, FRCP (UK) MA (Oxon) Consultant Orthopaedic 
  • Physician and Physical Treatments of Pain Patients
  • Helen Dawson, Senior Pain Clinic Physiotherapist

21.00 – Finish

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16th March 2009
Vista announces CPD events: Management of Recurrent Recalictrant Tendinopathy

Title:

Management of Recurrent Recalictrant Tendinopathy

Speaker:

Dr Peter Malliaras is an experienced Physiotherapist who has worked with elite athletes at the Victorian Institute of Sport (Australia) as well as National and International level football, volleyball and basketball players and Commonwealth and Olympic track and field athletes.

Over almost the past decade, he has devoted his clinical and research time to the management of tendinopathy, completing his PhD in this area. Currently Peter divides his time between consulting in private practice, practising as an extended scope practitioner in the NHS, and tendon research at Brunel University (West London).

Dr Mark Wotherspoon MBBS Dip Sports Med (Lond) FFSEM UK qualified from St George’s Hospital in 1985 with a view to becoming a primary care physician and Sports Medicine doctor. Having worked in orthopaedics, rheumatology and A&E, he completed his GP vocational training in 1991 before obtaining his diploma in Sports and Exercise Medicine in 1992. He has extensive team doctor experience having been club doctor at Fulham FC for eight years, London Irish RFC for two years and currently at Southampton FC. He was chief Medical Officer for England and Great Britain hockey for seven years and was recently elected as one of the first fellows of the new Faculty of Sports and Exercise Medicine. His main interests are chronic groin pain, exercise related lower leg pain and under performance syndrome in athletes.

Dates:

16 April 2009, 7pm – 9pm

                             

Venue:

Vista Diagnostics, 1st Floor Capital Tower, 91 Waterloo Road, London SE1 8RT

Agenda:

18.45 – Registration

19.00 - Introduction to the evening by Mr. Patrick Carter CEO, Vista Diagnostics

19.20 - Dr Peter Malliaras, Consultant Physiotherapist Wimbledon Clinics

  • Aetiology/physiology of chronic tendinopathy
  • Eccentric rehabilitation

19.50 - Break

20.10 - Dr Mark Wotherspoon, Sports Physician Wimbledon Clinics 

  • Specific interventions as adjuncts to rehab
  • Algorithms for each region/tendon
  • Discussion on Chronic Tendinopathy clinic

21.00 – Finish

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12th February 2009
Vista announces CPD events: Forefoot Pain & Ankles that won't heal

Title:

Forefoot Pain / Ankles that won't heal
Forefoot pain is a common source of referral to all those dealing with foot and ankle problems. This talk will discuss the common causes of pain and look at the various treatment options including surgical options.

Speaker:

Mr Dominic Nielsen (FRCS Tr. and Orth.) graduated from St Georges Hospital London, and undertook his orthopaedic training in South East England. To complement his general orthopaedic training, he has 18 months specialist training in foot and ankle surgery and also spent two years in a centre for complex trauma and limb reconstruction.

He is a Consultant Orthopaedic Surgeon at St George’s Hospital, London with special interests in foot and ankle surgery and complex trauma reconstruction.

Dominic is an examiner for Medical School Finals examinations, and regularly teaches at national education meetings. He has written papers on a range of trauma and foot and ankle subjects including clavicle fractures, hip fractures, major injuries, Achilles tendon problems and has presented his work both nationally and internationally.

Dates:

12 March 2009, 7pm – 9pm

Venue:

Vista Diagnostics, 1st Floor Capital Tower, 91 Waterloo Road, London SE1 8RT

Agenda:

18.45 – Registration

19.00 - Introduction to the evening by Mr. Patrick Carter CEO, Vista Diagnostics

19.20 - Forefoot Pain

Mr Dominic Nielsen, Consultant Orthopaedic Surgeon, Wimbledon Clinics 

  • Bunions
  • Metatarsalgia
  • Morton’s Neuroma
  • Hallux Rigidus  

19.50 - Break

20.10 - The Ankle Injury That Doesn’t Get Better

Mr Dominic Nielsen, Consultant Orthopaedic Surgeon, Wimbledon Clinics 

  • Ligament Injury
  • Tibialis Posterior Injury
  • Osteochondral Defects 

21.00 – Finish

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3rd February 2009
Vista announces CPD events: Understanding & Communicating MRI Scans

Title:

Understanding and Communicating MRI Scans - An Introduction

Speaker:

Mr Colin Natali, Consultant Spinal Surgeon, Trauma and General Orthopaedic Surgeon was appointed to the Royal London Hospital, Whitechapel in December 1996. He also consults privately at The London Independent Hospital, The London Clinic, Harley Street, The Cromwell Hospital, and back2normal back and neck clinic, in London. His special interests include minimally invasive surgical procedures and the treatment of degenerative spinal conditions.

Dates:

3 March 2009, 7pm – 9pm

5 May 2009, 7pm – 9pm

Venue:

Vista Diagnostics, 1st Floor Capital Tower, 91 Waterloo Road, London SE1 8RT

Agenda:

18.45   Registration

19.00   Introduction to the evening by Mr. Patrick Carter CEO, Vista Diagnostics

19.20   Becoming an expert in MRI

  • Interpreting MRI scans
  • Relating MRI findings to clinical conditions

19.50  Break

20.10   Now you’re an expert!

  • Communicating MRI findings to patients
  • Explaining the relevance of findings to a patient’s condition
  • Case Studies and Red Flags
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26th January 2009
Vista announces CPD events: Beijing 2008 - A Sports Physicians
Perspective

Title:

Beijing 2008 - A Sports Physicians Perspective & Sporting Ankle Injuries

The aim of this lecture is to give attendees an insight into the role of a Sports Physician attending the Beijing 2008 Olympics as part of the GB team. This will cover a range of topics from pre-games preparation and living in the holding camp / Olympic Village to polyclinics, drug testing and dealing with the media! In addition we will cover common sporting ankle injuries - presentation, diagnosis & the latest treatment.

Speaker:

Dr Mike Rossiter MSc (SEM), FFSEM (UK), MRCGP qualified from The Royal Free Hospital in 1991. He initially trained as a GP and was a partner in a practice in Wiltshire before deciding on a change in direction to Sports and Exercise Medicine. He completed his Masters Degree in 2002 from the University of Bath where he is now a clinical tutor and visiting lecturer on the Sports and Exercise Medicine course. He was recently elected as one of the first Fellows of the new Faculty of Sports and Exercise Medicine.

He still maintains some General Practice but the majority of his time is now in Sports Medicine. He is one of the club doctors at Southampton Football Club and also at London Irish Rugby Club as well as the Chief Medical Officer for Great Britain Hockey (men and women).

His main interests are in exercise related lower leg pain and underperformance syndrome in athletes.

Dates:

26 February 2009, 7pm – 9pm

Venue:

Vista Diagnostics, 1st Floor Capital Tower, 91 Waterloo Road, London SE1 8RT

Agenda:

18.45 – Registration

19.00 - Introduction to the evening by Mr. Patrick Carter CEO, Vista Diagnostics

19.20 - Beijing 2008 - A Sports Physicians Perspective.

Dr Mike Rossiter, Sports Physician, Wimbledon Clinics 

  • Pre-games preparation for athletes (pollution/heat/humidity/illness prevention/asthma)
  • Holding camp in Macau (Coping with jet lag and acclimatisation, hydration issues)
  • Olympic Village (Food/mixing with other athletes from other sports/facilities)
  • Injury and illness data for GB Hockey (Comparisons and contrasts between men’s and women’s teams in general + illness and injury)

19.50 - Break

20.10 - Beijing 2008 - A Sports Physicians Perspective.

Dr Mike Rossiter, Sports Physician, Wimbledon Clinics 

  • Polyclinic (MRI/US/Xray)
  • Liaising with UK Surgeons and Radiologists
  • Dealing with media (Journalists and TV)
  • Drug testing issues
  • Security and travel

21.00 – Finish

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