In the News

Charlotte Radiology would like to clarify the findings from a recent study published in the NEJM, “Bone-Density Testing Interval and Transition to Osteoporosis in Older Women.” The study results have been misinterpreted by the media, indicating there is an overuse of DEXA testing in this population. The population of the study was made up of healthy women with normal or low bone mineral density, not those diagnosed with osteoporosis or prior fractures. Therefore, the osteoporosis patients should continue working with their healthcare providers to have bone density screenings every 2 years, or as recommended, to monitor their condition.

Please refer to the following links for more detailed information as provided by two reputable organizations, the National Osteoporosis Foundation and The International Society for Clinical Densitometry.

National Osteoporosis Foundation

http://www.nof.org/node/692

American Bone Health http://www.americanbonehealth.org/images/stories/BMD_Testing_Interval_ISCD_Response_to_NEJM_Article.pdf

Charlotte Radiology

Orthopedic Radiology Section

Robert Raible, MD

James Coumas, MD

Brian Howard, MD

Ken Wolfson, MD

Robert Lopez, MD

W. Carey Werthmuller, MD

Tom Jones, MD

Recent news stories have focused on another mammography study that challenges the benefits of screening mammography. While this latest study noted in the Archives of Internal Medicine points out statistically relevant information about screening mammography's impact on mortality rates from breast cancer, it fails to address the many benefits of screening mammography's ability to catch breast cancers early, such as fewer surgeries and mastectomies and less need for chemotherapy and radiation cancer treatments. Instead their focus is on the many women whose screening mammogram detected a cancer that might not have taken their life.

An analogy could be to compare the suggestions made in the study to wearing seat belts:

Wearing seat belts saves lives --- of those that are in an accident.
(Having mammograms save lives for early detected, moderately aggressive cancers).

Wearing seat belts doesn't save lives -- of people who are not in an accident.
(Having mammograms doesn't save the lives of people who never get cancer, or have non-aggressive cancers).

One of the limits with today's technologies is that we have no way of knowing which breast cancers detected during mammography will in fact become aggressive, life-threatening cancers. Thus the choice of what to treat and what not to treat is sometimes in the hands of the patients, many of whom choose to treat the cancer rather than wait and see if it is going to develop further.

When referencing reduced mortality rates from screening mammography, Charlotte Radiology's physicians quote the American College of Radiology (ACR). The ACR states that since screening began in the U.S. more than 25 years ago, the death rate from breast cancer has declined by more than 30% since 1990. Additionally, Professor Laszlo Tabar, MD, conducted one of the longest running studies on the effects of screening mammography and found mortality reductions as high as 40% for screening mammography.

As Charlotte Radiology is one of the largest breast cancer screening programs in the country, we reviewed our own data to provide a local perspective. From June 1996 - December 2008, Charlotte Radiology performed nearly 625,000 screening mammograms. Of the breast cancers detected in our screening program, 21.4% were found in women ages 40-49. Breast cancer risk rises with age, but our 40-49 group had two-thirds the incidence of cancer compared to the 50-59 group (2.5 compared to 3.8 per thousand screens). These data are consistent with national statistics and confirm that age 50 is not a threshold for cancer.

Finally, Charlotte Radiology recommends the breast cancer detection guidelines as posted by the American Cancer Society and American College of Radiology.

Reference to Welch and Frankel Study in Archives of Internal Medicine:
http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.476

ACR Response to Welch and Frankel Study in Archives of Internal Medicine:
http://www.acr.org/HomePageCategories/News/ACRNewsCenter/ACR-Statement-on-Welch-and-Frankel.aspx

Recent news stories have focused on another mammography study that challenges the benefits of screening mammography. While this latest study noted in the Archives of Internal Medicine points out statistically relevant information about screening mammography's impact on mortality rates from breast cancer, it fails to address the many benefits of screening mammography's ability to catch breast cancers early, such as fewer surgeries and mastectomies and less need for chemotherapy and radiation cancer treatments. Instead their focus is on the many women whose screening mammogram detected a cancer that might not have taken their life.

An analogy could be to compare the suggestions made in the study to wearing seat belts:

Wearing seat belts saves lives --- of those that are in an accident.
(Having mammograms save lives for early detected, moderately aggressive cancers).

Wearing seat belts doesn't save lives -- of people who are not in an accident.
(Having mammograms doesn't save the lives of people who never get cancer, or have non-aggressive cancers).

One of the limits with today's technologies is that we have no way of knowing which breast cancers detected during mammography will in fact become aggressive, life-threatening cancers. Thus the choice of what to treat and what not to treat is sometimes in the hands of the patients, many of whom choose to treat the cancer rather than wait and see if it is going to develop further.

When referencing reduced mortality rates from screening mammography, Charlotte Radiology's physicians quote the American College of Radiology (ACR). The ACR states that since screening began in the U.S. more than 25 years ago, the death rate from breast cancer has declined by more than 30% since 1990. Additionally, Professor Laszlo Tabar, MD, conducted one of the longest running studies on the effects of screening mammography and found mortality reductions as high as 40% for screening mammography.

As Charlotte Radiology is one of the largest breast cancer screening programs in the country, we reviewed our own data to provide a local perspective. From June 1996 - December 2008, Charlotte Radiology performed nearly 625,000 screening mammograms. Of the breast cancers detected in our screening program, 21.4% were found in women ages 40-49. Breast cancer risk rises with age, but our 40-49 group had two-thirds the incidence of cancer compared to the 50-59 group (2.5 compared to 3.8 per thousand screens). These data are consistent with national statistics and confirm that age 50 is not a threshold for cancer.

Finally, Charlotte Radiology recommends the breast cancer detection guidelines as posted by the American Cancer Society and American College of Radiology.

Reference to Welch and Frankel Study in Archives of Internal Medicine:
http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.476

ACR Response to Welch and Frankel Study in Archives of Internal Medicine:
http://www.acr.org/HomePageCategories/News/ACRNewsCenter/ACR-Statement-on-Welch-and-Frankel.aspx

In light of recent media reports, questioning the early detection benefits of Computer Aided Detection (CAD) for breast cancer, we have reposted a study performed by Dr. Matthew Gromet, Charlotte Radiology’s Chief of Mammography. The study, published in the April 2008 issue of the American Journal of Roentgenology, compared the recall rate, sensitivity, positive predictive value and cancer detection rate for single reading with CAD, verses double reading without CAD. Dr. Gromet found that a single reader with CAD had a statistically significant increase in sensitivity and a smaller increase in recall rate, when compared to a single reader without CAD assistance. The study also found single reading with CAD, when compared to independent double reading, resulted in the same sensitivity, but lower recall rates. The conclusion is that CAD appears to provide an effective alternative with similar and potentially greater breast cancer detection benefits. More: http://www.ajronline.org/content/190/4/854.full

Reston, VA (August 30, 2011) — Six eminent leaders from academic and private practice radiology have been appointed by the American College of Radiology (ACR) to serve on the board of directors for ACR's Radiology Leadership Institute (RLI). RLI is radiology's first professional development and leadership academy. "While leadership skills may be consistent across practice settings, what can differ are professional development paths and the skills needed to advance in private practice radiology and academia," said Cynthia S. Sherry, MD, FACR, medical director of RLI and chair of the ACR Commission on Leadership and Practice Development. "The collaboration of academic and private practice radiology leaders on the board of directors will help RLI develop a balanced and robust curriculum that targets all levels of radiology experience, whether participants are in private practice or academia." Representing more than 100 years of combined service in radiology, the following academic and private practice radiologists have been selected to serve on the RLI Board of Directors: Cynthia Sherry, MD, FACR, FACPE, is the medical director of RLI and chair of the ACR Commission on Leadership and Practice Development. She is chair of the radiology department at Presbyterian Hospital in Dallas, TX. Sherry served on the ACR Task Force on Relationships between Radiology Groups and Hospitals and Other Healthcare Organizations. She is also a member and past president of the American College of Physician Executives. Cheri Canon, MD, is professor and chair of radiology at the University of Alabama at Birmingham School of Medicine. She is currently chair of the ACR Commission on Education and serves on the ACR Board of Chancellors and education advisory board for the American Institute for Radiologic Pathology. Arl Van Moore Jr, MD, FACR, is a practicing radiologist and president of Charlotte Radiology in Charlotte, NC. He is former chair of the ACR Board of Chancellors and ACR Task Force on International Teleradiology. Moore has been active in ACR on the state and national level for many years. He is also chairman of the Board of Strategic Radiology, a radiology group founded by 15 of the largest radiology groups in the U.S. consisting of more than 800 radiologists. Lawrence Muroff, MD, FACR, is CEO and president of Imaging Consultants, Inc. He is also a clinical professor of radiology at the University of Florida and the University of South Florida College of Medicine. Muroff is president emeritus of Educational Symposia, Inc., one of the nation's largest educators of diagnostic imagers. Alexander Norbash, MD, MHCM, FACR, is chairman and professor of radiology, and assistant dean for diversity at Boston University. He is an active interventional neuroradiologist. Geoffrey Rubin, MD, is the George Barth Geller professor for cardiovascular research; chairman of the department of radiology at the Duke University School of Medicine and radiologist-in-chief at Duke University Hospital. Over the next several months and beyond, board members will work closely with RLI faculty, ACR education department staff and other subject matter experts to continue to develop the RLI curriculum. The Institute's inaugural event is July 12¬–15, 2012, at Northwestern University's Evanston, IL campus. More information about RLI is available at www.acr.org/RLI.

A National Cancer Institute trial of 53,000 smokers and ex-smokers has shown that using CT to screen for lung cancer instead of a chest X-ray has reduced deaths from lung cancer by 20 percent over just five years. If you or a loved one are at high risk for lung cancer, the imaging experts at Charlotte Radiology encourage you to speak with your primary care physician about using CT to screen protocol.

Click here for more information on CT Lung Cancer Screening at Charlotte Radiology.

For more information on the National Cancer Institute Trial:

» National Institutes of Health
» American Cancer Society
» CNN Story
» Reuters Story
» Yahoo News Story

29-year long study proves benefits of annual screening mammograms, showing that 30% fewer women in the screening group died of breast cancer.

» Click here to learn more

The American College of Radiology (ACR) Board of Chancellors awarded the College’s highest honor, the ACR Gold Medal, to Charlotte Radiology President Arl Van Moore, Jr., MD, FACR, of Charlotte, at their spring conference in Washington, DC on May 15, 2011.

Annually, the ACR Board of Chancellors considers and votes on no more than three candidates for the Gold Medal Award. Candidates are recommended based on their distinguished and extraordinary service to the ACR or the discipline of radiology.

Dr. Moore has been active in the ACR on both the state and national levels. He is a past Chairman of the ACR Board of Chancellors and a recent past President of the ACR. As a member of the Board of Chancellors, he also held the office of Secretary Treasurer and Vice-Chairman of the Board. He chaired the ACR Task Force on Disaster Preparedness, and the International Teleradiology Task Force. He has served on the Council Steering Committee and has held numerous offices in the North Carolina Chapter of the ACR including President and Councilor. He has also distinguished himself serving as the ACR delegate to American Medical Association since 1998.

“Dr. Moore’s service to both the ACR and to the Charlotte medical community has been outstanding,” said fellow radiologist Christopher Ullrich, MD FACR, Neuroradiologist and Board Member for Charlotte Radiology. “His many contributions to the field of radiology have allowed us to make great strides over the years, and his insights and leadership are especially valued in recent months as we respond to the new healthcare reforms.”

Dr. Moore is a practicing radiologist and President of Charlotte Radiology in Charlotte, North Carolina, and serves as Chairman for Strategic Radiology, a national consortium of more than 890 radiologists partnered to share best-practice approaches to radiology. He received his BS at the University of Mississippi in Chemical Engineering and was commissioned as a line officer in the US Navy. He received postgraduate training in nuclear engineering and subsequently served as a nuclear engineer in the US Navy Nuclear Submarine Service. After his naval service he went to the University of Arkansas School of Medicine where he received his MD degree. After completing his radiology residency and fellowship at Duke University Medical Center, he continued at Duke on the Radiology Department teaching faculty. He joined Charlotte Radiology in 1983. He is ABR certified in Diagnostic Radiology and has an ABR certificate of added qualification in Interventional Radiology. He is currently a Clinical Assistant Professor of Radiology at Duke. He has published several papers and book chapters.

Dr. Moore and his wife Marie reside in Charlotte, North Carolina where he has been in the practice of radiology as an interventional radiologist and cross sectional imager for over 26 years.

Charlotte Radiology's Traveling Breast Center Improves Women's Access to Annual Screenings

A new mobile mammography unit will offer women in Mecklenburg, Gaston, Union and York counties easy access to early screening for breast cancer and could increase the number of women who get an annual screening mammogram.

Charlotte Radiology's mobile breast center hits the road Jan. 24, 2011 and will bring early breast cancer detection to locations in and around Charlotte. It's the first and only mobile mammography center dedicated to the four counties it serves.

The mobile center is a 38-foot long, state-of-the-art breast screening center on wheels. The vehicle is staffed by two mammography certified technologists and includes a registration and waiting area, two private dressing rooms and an exam room for completing the mammogram.

The Charlotte Radiology mobile unit will perform digital mammography exams, which improves exam quality, reduces radiation and shortens exam times.

Each exam will be interpreted by a board certified physician specialized in breast imaging. Most appointments take less than 30 minutes.

"Meeting our community's breast health needs and saving patients' lives is our top priority," said Charlotte Radiology president, Van Moore, M.D., F.A.C.R. "By offering our breast health expertise on wheels, we hope to bring early breast cancer detection services to women in a convenient, accessible way."

Only 68% of women ages 40 and above have had a mammogram within the past two years, according to the Centers for Disease Control. Charlotte Radiology hopes to improve that number.

"Our mobile breast center will allow Charlotte Radiology to reach women in the workplace and underserved areas," explained Cathleen Bates, Charlotte Radiology Breast Center Manager. "Our goal is to improve access and educate women about the importance of early detection, ultimately increasing the number of women getting their annual mammogram."

With the mobile center, Charlotte Radiology will be able to partner with local health departments and organizations to improve access to breast screening for the uninsured and underinsured.

Mecklenburg County has a reported breast cancer rate of more than 120 cases per 100,000 people, according to the National Cancer Institute — higher than the national average.

To learn more about our mobile breast center or to schedule a visit for your business or organization, please click here.. To schedule a screening mammography exam, call Charlotte Radiology at (704) 367-2232 or (877) 362-2232 toll free. A physician referral is not necessary for a screening mammogram, but patients will need to provide their physician's name to forward exam results.

A major critique of the Norway mammography study and other recent screening mammography studies is that they only measure one benefit of mammography — the decreased rate of mortality. But early detection of cancer — the purpose of mammography — is important for reasons beyond the lives it saves.

"For cancers detected early, surgery is less drastic and usually allows for preservation of the breast. In addition, fewer cases of early cancer spread to lymph nodes as well as reduced use of chemotherapy which is often expensive and debilitating," explains Dr. Matthew Gromet, breast imaging specialist with Charlotte Radiology.

The most recent article in the New England Journal of Medicine by Kalager et al (New Eng J Med 2010. 363:1203-1210) attributed a small benefit in mortality reduction to screening mammography, however the women weren't followed long enough. Cancers detected at a later stage are more difficult to treat and more likely to advance and/or return at a later time.

The breast cancer death rate has declined by 30% since 1990 when screening guidelines were enforced in the US. Why reverse this encouraging trend by discouraging early detection through mammography? Awareness and better treatments certainly attribute to this decrease, but it is no coincidence that the declining trends are consistent with more women getting screened.

In fact, new regulations by the Department of Health and Human Services (HHS) will require private health insurers to cover preventive and early detection services, including annual screening mammography for women age 40 and older, with no cost sharing or co-pays in health plans issued or renewed after September 23, 2010.

The recommendation from breast health experts is consistent. 40 is the age to schedule your first mammogram and start an annual routine. Since 75% of women with breast cancer have no family history, there's no reason to wait. Following the American Cancer Society's guidelines for the early detection of breast cancer improves the chances that breast cancer can be diagnosed at an early stage and treated successfully.

For more Information please see:

American College of Radiology Response: Issues With NEJM Mammography Study: Follow-Up Time Too Short and Other Shortcomings

American Cancer Society Blog Response: What Norway Tells Us About Screening Mammograms And Access To Care

Charlotte Radiology FAQs on Screening Mammography: Screening Mammography Facts

Strategic Radiology (SR) announced today that it has named Mark J. Kleinschmidt as CEO. Kleinschmidt has worked in the radiology field for twenty two years and most recently served as CEO of St. Paul Radiology and Senior Vice President of Business Services for NightHawk Radiology.

Press release: Strategic Radiology names Kleinschmidt as CEO

Revised draft recommendations released by the US Preventative Services Task Force this week suggest that women at higher risk for osteoporosis be screened sooner than women who are at average risk for the bone-loss disease. The new draft recommendation from the USPS Task Force is an update to their 2002 recommendation and is based on a report from the Annals of Internal Medicine. You can read more at:

AP News Story: Task force urges bone-density tests for more women

To find out if you are at a higher risk, take our Risk Assessment at: Questionaire

For more information on Bone Density Testing and the our sub-specialized musculoskeletal radiologists at Charlotte Radiology, visit: Bone Density Testing

For ten years, the Mecklenburg County Health Department (MCHD) has provided screening mammography services to the uninsured and underinsured women of Mecklenburg County. Charlotte Radiology Breast Center has been a partner of the MCHD, providing their patients with screening mammography readings, in addition to performing diagnostic exams when needed. To improve accessibility to state-of-the-art technology, the MCHD has discontinued on-site screening mammography and is now referring patients for digital screening mammography to Charlotte Radiology, which has nine convenient breast centers in Mecklenburg County.

Press Release: New Mammography Resources for Low Income Women in Mecklenburg County

Dr. Gromet, Charlotte Radiology's Chief of Breast Imaging, exposes many of the flaws in the Task Force mammogram recommendations released in November 2009. His article, published in the Atlanta Journal Constitution, reinforces the fact that women need to begin their annual screening mammogram routine at age 40.

AJC: The Bottom Line: Mammograms Save Lives

The U.S. Food and Drug Administration (FDA) is hosting a two-day hearing to learn more about efforts being made to reduce patient exposure to radiation in medical imaging. Speakers range from equipment vendors who have added features to their imaging units that will reduce exposure, to the American College of Radiology (ACR). Both of these groups have implemented awareness campaigns and quality assurance initiatives.

Charlotte Radiology is proud to be closely aligned with the ACR, an industry leader in managing radiation exposure. Our group has embraced the "Image Gently" campaign which has raised awareness of pediatric radiation from medical imaging and how to limit radiation dose in children. Additionally, we participate in the ACR's quality assurance programs and have had the imaging equipment at our sites accredited to ensure that minimal doses of radiation are used. We recognize the risks involved with certain imaging studies and are committed to a continual review of our processes. We are currently developing protocols which seek ways to further limit radiation exposure while maintaining image quality for accurate diagnoses.

To learn more about radiation risks from medical imaging and how Charlotte Radiology is leading the way in managing those risks for the safety of our patients, visit: http://www.charlotteradiology.com/exposure_risks.php

Learn more about the FDA's Hearings at: http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/ucm201448.htm#agenda

Learn more about the ACR's participation in the hearings at:

• Adult Imaging Info
• Image Gently Info

New study in the Journal of the American College of Surgeons finds US Preventative Services Task Force mammography recommendations could hinder early detection.

Palpable breast cancers are more common in women not undergoing annual mammography

Having founded a formal organization in 2009, thirteen private-practice radiology groups across the country representing over 750 physicians today publicly announced the formation of Strategic Radiology (SR), an entity that embodies the vision and clinical goals of this network of like-minded regional medical practices, according to Van Moore, MD, Chairman of SR and president of Charlotte Radiology.

Press release: Regional Radiology Groups Form a National Consortium

Recent concerns over radiation exposure from imaging studies have left some patients unsure about the radiology studies ordered by their physicians. Radiology studies like CT, MRI, Nuclear Medicine, Ultrasound, X-ray and mammography are imaging tools used to help diagnosis patients medical conditions. Some of these studies use radiation to obtain the picture, including CT, X-ray, Nuclear Medicine and mammography. The amount of radiation exposure varies by procedure, but typically radiation doses from imaging exams are relatively small and the clinical benefit of an exam far outweighs the risks.

Charlotte Radiology is committed to quality, accurate reads and participates in the American College of Radiology's (ACR) quality initiative programs. As a result we are actively involved in understanding and weighing the benefits and risk of our imaging procedures. Our "Radiation Risks" flier outlines some frequently asked questions as well as provides some questions you can ask your doctor about the test he or she recommended. You can learn more or download a PDF of the flier here.

Also notable, is a research story that broke last week indicating that women get 22% less radiation from Digital Mammography than from traditional analogue mammography. Charlotte Radiology is pleased to be the areas first provider for digital mammography; today all 12 of our Breast Imaging Centers are fully digital! Learn more here.

For more information or questions about radiation used in imaging studies, please call 704-334-7810.

Charlotte Radiology and Cabarrus Radiologists are pleased to announce the completion of their merger, January 1, 2010. The groups have agreed to keep Charlotte Radiology's name and together employee more than 80 radiologists in 10 sub-specialty areas ranging from pediatric imaging and breast imaging to neuroradiology and musculoskeletal radiology. The merger provides opportunities for the group to further improve their quality patient care, allowing for expanded sub-specialized radiology coverage and the integration of their medical systems, which will further enhance access to patient records and reports.

They will provide sub-specialized radiology services to several hospitals in NC, including Carolinas Healthcare System hospitals in Mecklenburg, Cabarrus, Union, Lincoln and Anson counties, as well as Scotland Memorial Hospital, Davis Regional Medical Center and First Health Richmond Memorial Hospital. In addition to the radiology services they provide to CHS, Charlotte Radiology now jointly owns five outpatient imaging centers, a vein and vascular center, an interventional clinic, 12 breast imaging centers, two mobile MRIs and a mobile ultrasound.

Press release: Local Radiology Groups Merger Complete