Introduction to Bedside Ultrasound

Source: Introduction to Bedside Ultrasound

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Coronary Artery Calcium Scan Embraced By New AHA/ACC Cholesterol Guidelines: Will Insurance Coverage Follow?

Thank you Dr. Pearson.

The Skeptical Cardiologist

The skeptical cardiologist has been utilizing coronary artery calcium (CAC) scans to help decide which patients are at high risk for heart attacks, and sudden cardiac death for the last decade. As I first described in 2014, (see here) those with higher than expected calcium scores warrant more aggressive treatment and those with lower scores less aggrressive treatment.

Although , as I have discussed previously, CAC is not the “mammography of the heart” it is incredibly helpful in sorting out personalized cardiovascular risk. We use standard risk factors like lipids, smoking, age, gender and diabetes to stratify individuals according to their 10 year risk of atherosclerotic cardiovascular disease (ASCVD) but many apparent low risk individuals (often due to inherited familial risk) drop dead from ASCVD and many apparent high risk individuals don’t need statin therapy.

Previously, major guidelines from organizations like the AHA and the ACC did not recommend…

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NCI Study: MRI of the Prostate Misses Cancers

About 16% of lesions were missed, and approximately 5% of clinically important prostate cancers (>5 mm, Gleason score > 3+3) were underestimated on MP MRI, according to Baris Turkbey, MD, of the Molecular Imaging Program at the National Cancer Institute in Bethesda, Maryland, and colleagues. Overall, prostate cancer size was underestimated by at least 30% in eight (8%) of 100 patients. Their study was published online October 20 in Radiology.

Source: NCI Study: MRI of the Prostate Misses Cancers

Jargon Muddies Radiology Reports

The study, for which Dr Gunn was lead author, was a survey of 59 radiologists and 100 primary care physicians at Massachusetts General Hospital (MGH), which he undertook during his training there (J Am Coll Radiol. 2013;10:122-127).

Both groups of doctors were asked to consider hypothetical radiology reports and interpret the statistical likelihood (0% to 25%, 26% to 50%, and so on) of the presence of metastatic disease based on the terms used in the report.

The modifying terms were “diagnostic for,” “represents,” “likely represents,” “probably,” “consistent with,” “compatible with,” “concerning for,” “suspicious for,” “may represent,” and “cannot exclude.”

Source: Jargon Muddies Radiology Reports, Including About Cancers

The article comments are priceless.  For example, Dr. Mark Walters writes:

This is a made up problem.  I have never had a clinician, in 30 years of Radiology practice, come to me and say they did not understand the meaning of ” consistent with” or “cannot exclude”.

Clear as mud.

Abdominal Aortic Calcification Among Individuals With and Without Diabetes: The Jackson Heart Study

In the Jackson Heart Study (JHS), we examined the association of diabetes with abdominal aortic calcification (AAC) among African Americans. Among included individuals (n = 1,664), the mean age was 57 (± 11) years, 69% were female, and 18.3% had diabetes (based on fasting blood glucose [FBG], HbA1c, use of glucose-lowering medications, or physician diagnosis). The median AAC and coronary artery calcification (CAC) scores were 904.15 (interquartile range 0–1093.10) and 0 (0–96.19), respectively. The prevalence of any AAC or CAC was 69% and 49%, respectively. Individuals with diabetes were older, had higher BMI, had higher systolic blood pressure and prevalence of hypertension, had lower HDL levels, were less affluent or physically active, had poorer nutritional intake, and had higher levels of hs-CRP.

Source: Diabetes Care

Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults Clinical Perspective | Circulation

Conclusions: Our findings suggest that left ventricular longitudinal relaxation velocity declines as a part of healthy aging and is largely prognostically benign. The use of age-based normative values when considering an elderly population improves the risk discrimination of diastolic measures for incident HF or death.

Source: Contemporary Assessment of Left Ventricular Diastolic Function in Older AdultsClinical Perspective | Circulation

Prognostically benign!