Tag Archives: Radiology and Imaging

Study looks at whether daily limb compressions reduce dementia

A new study is looking at whether short, daily bouts of reduced blood flow to an arm or leg can reduce the ravages of dementia.

It’s called remote conditioning, and researchers say it activates natural protective mechanisms in the brain that should help about half of dementia patients.

The approach uses a blood pressure cuff-like device to temporarily restrict blood flow to an appendage repeatedly for a few minutes each day, which increases blood flow to other body areas, including the brain, said Dr. David Hess, Chairman of the Department of Neurology at the Medical College of Georgia at Georgia Regents University.

Increased flow activates endothelial cells lining blood vessels, calling to action a series of natural protective mechanisms that can be effective wherever blood travels, Hess said. Interestingly, the mechanisms seem most active in areas of impaired flow, such as those deep inside the brain, where most dementia has its roots.

“The most powerful way to protect the brain is to cut off blood flow to it for a short period of time to condition it,” said Hess. “What it does is elicit these protective pathways so when potentially lethal ischemia comes, you can survive it.” What it also appears to do is help permanently improve blood flow to these deep regions of the brain.

Age and being a female are two of the major risk factors for dementia. With nearly 15 percent of the U.S. population age 65 and older and half being female, Hess calls dementia a major health concern. “This is a big epidemic coming. This is a big killer and disabler, and everybody is concerned about this.”

A two-year, $750,000 translational grant from the National Institute of Neurological Disorders and Stroke should help Hess and his research team do the additional animal studies needed to move this safe and inexpensive technique for dementia to human studies.

“We think reduced cerebral blood flow, particularly in the deep white matter, is a major trigger of dementia,” Hess said. The white matter is primarily composed of axons, which connect neurons and different areas of the brain to each other and enable the brain to communicate with the body. The white protective coating on the axon is why this deep brain area is called white matter.

Hess, who is also a stroke specialist, says this area is particularly vulnerable to ischemia because the blood vessels that feed it are small and have long, tortuous routes. Strokes and/or impaired blood flow can lead to classic dementia symptoms such as forgetfulness and an unsteady gait.

By age 70, essentially everyone has some white matter disease, but in some it can be devastating. “You cannot go out in a car and find where you are going. You may not even be able to find your car. You can’t cook meals without setting the house on fire,” Hess said.

“What we want to do long term is find people who are at risk for dementia – they already have some white matter damage you can see on an MRI – then we condition them chronically with this device in their home,” Hess said. Chronically is a key word because, as with exercise, when this conditioning stops, so do its benefits. In fact, this passive therapy provides blood vessels many of the same benefits as exercise. “If you can exercise, you probably don’t need this,” Hess adds.

Previous studies in their animal model of vascular dementia have shown that just two weeks of daily, short bouts of ischemia to an appendage can improve the health of the important white matter. The new grant is allowing them to use a similar approach for periods of one and four months in older mice of both genders to better understand the mechanisms of action and how long and how often therapy is needed. While they don’t make as much as human, mice do make more amyloid, a protein that deposits in the brains of patients with Alzheimer’s, when brain blood flow is impaired. Mice make less with the conditioning, so the researchers also are looking further at that result.

A small intramural grant is enabling similar studies with a pig model in collaboration with University of Georgia colleagues Dr. Simon R. Platt, professor of neurology and neurosurgery in the College of Veterinary Medicine, and Dr. Franklin D. West, assistant professor in the College of Agricultural and Environmental Sciences.

While he notes that multiple natural mechanisms are activated, Hess and his team are focusing on how the temporary bouts of increased blood flow prompt endothelial cells to make the precursor for the blood vessel dilator nitric oxide.

“The enzyme that makes nitric oxide is upregulated and stimulated quickly,” Hess said. Nitric oxide gas has a short life, but when a lot is dumped in the blood, it’s oxidized into nitrite – the same stuff put in hot dogs – which circulates throughout the bloodstream so it goes wherever blood goes. Although just how this happens is unclear, when the nitrite gets to an area of low blood flow, it is converted back to nitric oxide, which helps improve flow, Hess said.

The MCG researchers are applying for federal funding to do trials in humans who are at high risk for stroke because of small vessel disease deep in the brain. In 2012, they published results of a small study in the journal Stroke indicating that successive, vigorous bouts of leg compressions following a stroke trigger natural protective mechanisms that reduce damage and double the effectiveness of the clot buster tPA. Similar studies have been done by others in patients with heart disease.

Vascular dementia is considered the second most common cause of dementia after Alzheimer’s disease, according to the Alzheimer’s Association. There are currently no drugs approved by the U.S. Food and Drug Administration specifically for vascular dementia.

Collaborators at MCG and GRU include Dr. Mohammad B. Khan, postdoctoral fellow in Dr. Hess’ lab; Dr. Nasrul Hoda, College of Allied Health Sciences; Dr. Philip Wang, Department of Psychiatry and Health Behavior; Dr. Ali Syed Arbab, Department of Biochemistry and Molecular Biology; Dr. Nathan Eugene Yanasak, Department of Radiology and Imaging;  and Dr. Jennifer Waller, Department of Biostatistics and Epidemiology.

Rawson selected to design, lead new Commission on Patient Experience for American College of Radiology

Dr. James V. Rawson, chairman of the Department of Radiology and Imaging at the Medical College of Georgia at Georgia Regents University, will design and lead a new Commission on the Patient Experience for the American College of Radiology.

Rawson, who also holds the P.L., J. Luther, Ada Warren Chair of Radiology at MCG, was recently elected to a three-year term on the 33-member Board of Chancellors of the American College of Radiology.

He has lectured and consulted nationally on bringing the patient centered focus to radiology. Leading this new commission, he will help his big machinery, high-tech specialty shift its focus even more toward patients.

“We have to put the patient in the center of health care,” said Rawson, an advocate for doing just that during his 15-year tenure as MCG’s Radiology chairman. “Everything has to be about the patient,” from how appointments are scheduled to parking to care delivery to timely receipt of study results, he said.

Rawson had sick family members throughout his medical school years at Tufts University in Boston and while completing a diagnostic radiology residency at New York Medical College, and a Body Magnetic Resonance Imaging Fellowship at Mallinckrodt Institute of Radiology at Washington University. He believes those experiences made him a better doctor and encouraged him early on to build care around the patient.

“I never was very far from the experiences patients and families were having in health systems because I was always on both sides of the table,” said Rawson. He serves on the Patient Experience Operations Committee of Georgia Regents Medical Center and works closely with the GRHealth Center for Patient and Family Centered Care to ensure patient advisors are involved in every facility and service decision made in radiology, from the patient-friendly Breast Health Center to extensive changes still underway in the Children’s Hospital of Georgia.

“The challenge was and is to think about how you can improve a child’s experience coming to a strange place that is potentially scary,” Rawson said of changes being made at the children’s hospital that will include color, lighting, and child-friendly technology. Even large imaging machines, such as MRIs, for adults already have lighted overhead boxes with soothing scenes for patients to focus on as they prepare for their exam. Adult waiting rooms also now have the look and feel of a coffee shop. Review of patient satisfaction surveys are part of regular radiology faculty meetings.

Mounting evidence indicates that a patient and family focus also yields shorter hospital stays and better outcomes; in fact, hospital reimbursement from federal health insurance programs are now tied to patient satisfaction. “Patient satisfaction surveys are part of the culture of medicine now,” said Rawson, who is excited and honored to help further incorporate this approach into his chosen specialty. He plans to populate the new American College of Radiology commission with a strong cross section of radiologists, related administrators, as well as patients with experience and/or interest in enhancing the philosophy and practice.

Rawson’s other leadership roles with the American College of Radiology include serving as Chair of the Committee on Governmental and Regulatory Issues in Academic Radiology, and the Committee on Economic Issues in Academic Radiology. He is on the editorial board of the Journal of the American College of Radiology and just completed an 11-year term as Chair of Hospital Outpatient Prospective Payment System/Ambulatory Payment Categories for the college.

Rawson elected to American College of Radiology leadership

Dr. James V. Rawson, Chairman of the Department of Radiology and Imaging at the Medical College of Georgia at Georgia Regents University, has been elected to a three-year term on the 33-member Board of Chancellors of the American College of Radiology.

Rawson, who holds the P.L., J. Luther, Ada Warren Endowed Chair of Radiology at MCG, also was recently named President of the Georgia Radiological Society, the Georgia chapter of the national group.

His leadership roles with the American College of Radiology include serving as Chair of the Committee on Governmental and Regulatory Issues in Academic Radiology, the Committee on Economic Issues in Academic Radiology, and the Committee on Hospital Outpatient Prospective Payment System and Ambulatory Patient Classification.

He is on the editorial board of the Journal of the American College of Radiology and just completed an 11-year term as Chair of Hospital Outpatient Prospective Payment System/Ambulatory Payment Categories for the college.

Rawson has served on the Georgia Radiological Society’s Executive Committee since 1999.  His other national leadership roles in radiology include serving on the Association of University Radiologists Board of Directors, as a Councilor for the Board of the Society of Chairs of Academic Radiology Departments, and a one-year term on the Society of Health Systems Content and Connections Committee.

Read: The outsourcing explosion

Fierce Health Finance: April 21, 2015

Hospitals turn to outside firms to provide more clinical services [Special Report]

Hospital imaging often renders a disquieting financial picture. The equipment costs millions of dollars to either purchase or lease, is often manpower intensive to operate and usually needs replacement or major upgrades every few years. That’s not to mention the constant pressure to optimize patient throughput in order to pay for the equipment in the first place.

PhilipsGRHealthModel
The GRHealth-Philips health care delivery model includes everything from equipment purchasing and maintenance to volume discounts and performance improvement initiatives.

Georgia Regents Health System, which operates Georgia Regents Medical Center, … decided to outsource responsibility for much of its imaging services. In 2013, it entered into an agreement with Philips Healthcare to not only provide new imaging equipment, but manage radiology and cardiology services, clinical monitoring of patients, and the relevant education and training for GRHealth staff.

Read the full article: The outsourcing explosion

Augusta Chronicle: Aiken’s Beth Spangler wows judges on ‘The Voice’

The Augusta Chronicle: Oct. 11, 2014

Aiken’s Beth Spangler wows judges on ‘The Voice’

Long before Adam Levine’s 12-member team was completed on last Monday’s episode of NBC’s The Voice, Beth Spangler was content with living a normal life.

Beth Spangler sang Best Thing I Never Had by Beyonce and chose to be on Adam Levine's team on The Voice.  SPECIAL
Beth Spangler sang Best Thing I Never Had by Beyonce and chose to be on Adam Levine’s team on The Voice.
About four years ago, the Aiken native accepted a job at the Children’s Hospital of Georgia, commuting 30-minutes in an effort to pay bills.

“I was settling into a realistic life,” said Spangler, 30.

In May of 2012, however, Spangler’s life forever changed.

Read Aiken’s Beth Spangler wows judges on ‘The Voice’

Watch her audition on YouTube.

The TV competition resumes tonight and Tuesday at 8 p.m. on NBC. Cast your votes for Spangler, a senior radiographer at CHOG.

Mitchell named Administrator of Radiology

AUGUSTA, Ga. – Layne Mitchell has been promoted to Administrator of Radiology for the Georgia Regents enterprise. He will oversee all clinical, academic, and research operations for imaging across the university and health system.

Previously, Mitchell was Chief Radiographer and Business Manager of Imaging Services at Georgia Regents Medical Center, managing more than 120 technologists and helping the hospital achieve American College of Radiology certification in all imaging modalities and implement a state-of-the-art Picture Archiving and Communication System for storing patient images.

Mitchell joined GRHealth in 1993 as a Computed Tomography Technologist and later became the Lead CT Technologist before becoming Chief Radiographer in 2008. He earned an Employee Ambassador Award in 2006, a Superior Employee Award in 2011, and the Bob Luther Emerging Leader Travel Scholarship through the Radiology Business Managers Association in 2012.

Mitchell received A.S. and B.S. degrees in radiologic sciences from GRU’s Medical College of Georgia, where he was named Most Outstanding Student in 1994. He earned his MBA from American Public University.

His professional affiliations include the American Society of Radiologic Technologists, the Association of Administrators in Academic Radiology, the Radiological Society of North America, the Association of Medical Imaging Management, RBMA, and Georgia RBMA.

Mitchell also serves as a reviewer for the Patient-Centered Outcomes Research Institute.

Philips alliance brings novel imaging platform to Medical Center

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Dr. James V. Rawson, Chief of Radiologic Services at Georgia Regents Medical Center, and Radiologist Dr. Norman Thomson, work with Philips Intellispace PACS 4.4, a new Digital Archiving and Communication System that integrates a patient’s complete imaging and medical history into the electronic medical record.

AUGUSTA, Ga. – Georgia Regents Medical Center reached a key milestone last month in its 15-year alliance with Royal Philips with the installation of Philips IntelliSpace PACS version 4.4, an advanced single, integrated Picture Archiving and Communication System.

“The role of technology is to ease the burden on clinicians and allow them to focus on what truly matters – patient care,” said James V. Rawson, Chief of Radiologic Services at Georgia Regents Medical Center. “This new PACS platform from Philips enables us to store, access, and review everything from old X-ray films to the most advanced digital images in all modalities, including PET, CT, MRI, and ultrasound. Having a patient’s complete medical history and images incorporated into the electronic medical record and readily available, will improve patient outcomes and lower costs.”

IntelliSpace PACS is web-based, so images, patient records, and radiology reports can be delivered to workstations across the hospital network, even in low bandwidth environments. Physicians who need fast access to diagnostic quality images and advanced clinical tools can get it from anywhere within the network, which includes the Georgia Regents University Cancer Center, the Georgia Regents Radiation Therapy Center, Children’s Hospital of Georgia,  Georgia Regents Sports Medicine Center, and nearly 100  Georgia Regents Health System clinics throughout the state.

Philips IntelliSpace PACS is part of the growing portfolio within the recently-launched Philips Healthcare Informatics Solutions and Services Group.

“Innovative health systems like Georgia Regents are moving to new business models of patient-centric care, recognizing that accessible and accurate imaging data is a critical piece of the puzzle,” said Jeroen Tas, Chief Executive Officer, Philips Healthcare Informatics Solutions and Services. “This is just one of the system-wide solutions we’ll be implementing at Georgia Regents to enable clinicians to better collaborate on diagnosis and treatment, provide broader insight into patient data, and expand high quality health care to areas where it’s needed most.”

The pilot installation at GRMC started with radiology and will expand to cardiology this week. Then neurology, obstetrics and all other patient imaging services lines over the next few months. The project demonstrates Philips’ long-term commitment to Georgia Regents to work together to improve patient care solutions.

In June 2013, Philips and Georgia Regents Medical Center entered into a 15-year, $300 million agreement to improve outcomes and deliver more effective, cost-efficient health care.

“The shared ownership with Philips allows us access to scalable innovations, at a predictable cost and without interrupting workflow. We see this as a critical element to expanding quality care across the Southeast, the nation, and the world,” said Rawson.

The Wall Street Journal Market Watch: Philips and Georgia Regents Medical Center Announce Roll-Out of Enterprise-Wide Clinical IT Platform to Improve Workflows and Enhance Patient Care

The Wall Street Journal Market Watch: Feb. 21, 2014

Philips IntelliSpace PACS 4.4 integrates imaging data with EMR giving clinicians a fuller “picture” of the patient across the entire Georgia Regents Health System.

Royal Philips announced a key milestone in its 15-year alliance with Georgia Regents Medical Center (GRMC) with the installation of Philips IntelliSpace PACS version 4.4, a single, integrated clinical IT platform that allows clinicians to access a patient’s complete imaging history from any department across the care continuum. The system will not only provide clinicians with a more holistic view of a patient’s health, but will also enable GRMC to extend access to imaging data to its more remote regional care facilities. The unique managed service delivery model of Philips IntelliSpace PACS encompasses total cost of ownership, simplifies IT operations and provides built-in flexibility, scalability and interoperability. Read more about Philips and Georgia Regents Medical Center Announce Roll-Out of Enterprise-Wide Clinical IT Platform to Improve Workflows and Enhance Patient Care

Rawson leads national initiative to develop teaching tools for residents

RawsonwebfrontDr. James V. Rawson, Chairman of the Department of Radiology and Imaging at the Medical College of Georgia at Georgia Regents University, has spearheaded the development of a series of online lectures designed to help residents become better teachers.

Rawson, who chairs the American College of Radiology Committee of Government and Regulatory Issues in Academic Radiology, worked with fellow committee members Dr. Robert Novelline, Professor of Radiology at Harvard Medical School, and Dr. Braxton Fields, MCG/GR Health Neuroradiology fellow, as well as the Alliance of Medical Student Educators in Radiology and the Association of Program Directors in Radiology, to develop the concise, free online lecture series.

The series, available at http://www.acr.org/Education/e-Learning/ACR-AMSER-APDR-Lecture-Series, was developed in response to a standard of the Liaison Committee on Medical Education, which accredits medical schools and now requires that residency training include curriculum on how to teach.

It also was developed because of the reality that residents are regularly involved in medical student education. Residency, or graduate medical education, is a period of three to seven years following medical school when physicians continue their education in a particular medical specialty such as surgery, family medicine or radiology. At medical schools, residents provide a lot of the one-on-one teaching of third- and fourth-year medical students doing multi-week clinical rotations in hospitals and physician practices.

Rawson, Novelline and Fields first identified a list of topics with broad impact like problem- based learning and optimizing slide presentations then contacted experts in the areas and asked them to compress their typically longer curriculums into 10- to 15-minute Ted-like talks that could live online.

While developed by radiologists, the majority of the 13 lectures topics are applicable for a resident or faculty member in essentially any specialty, Rawson said.

To use the new tools on campus, Rawson first asked radiology faculty to the watch the talks then, starting this month, the short presentations have been incorporated into the residents’ already busy curriculum. He, Novelline and others will be monitoring activity at the site and making updates as needed.

 

GRMC named Patient-Centric Imaging Award winner

AUGUSTA, Ga. – Georgia Regents Medical Center has earned national recognition for exemplary Patient- and Family-Centered Care practices in radiology. Health Imaging magazine has chosen the hospital as one of five recipients in the inaugural Imaging 3.0: Patient-Centric Imaging Awards.
The awards – developed in conjunction with the American College of Radiology – reinforce the importance of patient engagement in healthcare delivery and honor radiology groups for using imaging to improve quality and patient outcomes.

“Beginning with a mammography renovation in 2001, we’ve included patient advisors at the design table for all imaging improvements, including equipment purchases and installations. We’ve seen patient satisfaction scores improve, and we’ve become more efficient across the department as a result,” said Dr. James V. Rawson, Chief of Radiology at the medical center.
GRMC, an international pioneer in Patient- and Family-Centered Care, was featured nationally in PBS’s 2006 series “Remaking American Medicine” and in 2010 was named a national model in PFCC by the Picker Institute.

Other imaging award winners include Cincinnati Children’s Hospital; the University of Maryland and University of California; East West Health Centers/Invision Sally Jobe Breast Network; and Radiology Ltd. in Tucson, Ariz. The winning projects are published in the September/October issue and can be viewed online at HealthImaging.com.

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