Letter from the President

From the Laboratory to the Reading Room

The 37th Annual Meeting of the American Society of Head and Neck Radiology was held October 1–5, 2003 in Rancho Mirage, California. The meeting focused on head and neck cancer, including normal anatomy, staging, and post-treatment imaging. There were 240 attendees, and four major corporate sponsors. We want to thank Amersham Health, Berlex Laboratories, Philips Medical Systems NA, and Siemens Medical Systems, for supporting the Annual Meeting. For the first time, the ASHNR had an audience response system, supported by Berlex Laboratories. Questions about CT and MR usage, as well as contrast administration, were included. A summary of the audience responses will be forthcoming. Next year’s meeting, emphasizing problem based imaging, is being planned by Dr. Vijay Rao, and will be held at the Loews Philadelphia Hotel in Philadelphia, Pennsylvannia.

The Annual Meeting themes are chosen based on feedback from ASHNR members, and technical and imaging developments are highlighted. This year, with the increasing importance of CT-PET fused imaging for oncologic disease, head and neck cancer was an appropriate theme. The recent scientific paper authored by Dr. Laurie Loevner, from the University of Pennsylvania, was a “wake up call” for head and neck radiologists. The work from her group showed a disturbingly high “miss rate” by academic and private practice radiologists alike when it came to staging head and neck cancer. Although a tumor board often brings to light clinical information that the initial interpreting radiologist did not have available, there were still significant interpretive errors. It is essential that radiologists interpreting head and neck images increase the accuracy rate. It is the ethical, and, with non-radiologists increasingly interested in interpreting images themselves, the financially correct thing to do. One of the stated goals of the 2003 Annual Meeting was to familiarize radiologists with staging issues in head and neck radiology. Based on written evaluations, most attendees felt they had increased their fund of knowledge, and had attained information they could immediately apply to their practice. Ultimately, that is the goal of the Annual Meeting!

The evolving role of PET/CT fused imaging was also addressed. Early anecdotal experience suggests that the combination of a contrast-enhanced CT scan (no greater than 3 mm slice thickness) and a PET study performed at the same time is the most sensitive, and specific modality to detect early recurrence, as well as treatment complications. In some practices, two different physicians would be involved in study interpretation, one reading the nuclear medicine portion of the study, and the second interpreting the cross-sectional contrast-enhanced CT. In the next several months, I will investigate billing issues unique to such an approach, and report back to the membership. In my own early clinical experience, PET and fused non-contrast-enhanced CT alone are not enough. There are too many false positive PET findings (increased uptake in the genioglossus muscles and true vocal cords, increased uptake in flaps, etc). The contrast enhanced CT or MRI, is necessary to filter out the noise from the clinically important findings.

With each new radiologic scientific and technical development, the Education Committee of the ASHNR keeps the membership informed about the scientific, technical and financial details. For example, when otolaryngologists in the laboratory discovered that sinusitis is exacerbated by sinus outflow obstruction, and the health of each individual sinus could be restored not by stripping the mucosa, but by gentle, endoscopic, mechanical relief of the sinus obstruction (removing a strategically located polyp, widening the maxillary sinus ostium, resecting a large concha bullosa or ethmoid bulla), the role of pre-operative coronal sinus CT became important. Almost immediately, head and neck radiologists who worked closely with innovative endoscopic sinus surgeons reported on their experience, and developed instructional courses that were presented at the ASHNR. Dr. S. James Zinreich, a head and neck radiologist from Johns Hopkins University, was one of the first pioneers to report on incidental findings on sinus CT scans that might predispose the patient to recurrent or chronic sinusitis. Now we take coronal sinus CT for granted, phrases like “ostiomeatal complex” slide into our voice recognition systems as easily as “left lower lobe atelectasis.” The OMU anatomy was not taught in my radiology residency or fellowship. Instead, it was a concept I learned from attending ASHNR Annual Meetings, and reading the radiologic journals.

The process that begins in the laboratory, often at the university, ultimately ends in a significant change in our daily clinical practice. From the discovery, to the application, to the billing and financial ramifications, radiology organizations are essential to guide and maintain our specialty. With respect to CT-PET and other fusion modalities, we are only in the discovery phase. Stay tuned for scientific and financial updates, as they are sure to be forthcoming. Soon, interpreting a CT-PET will be as comfortable as dictating a screening sinus CT!

One of the stated purposes of the ASHNR, listed in our bylaws, is “to foster the continuing development of head and neck imaging as an art and a science.” It is with that goal in mind that each new Annual Meeting gets from the drawing board to the lecture room. That is the driving thought in Dr. Vijay Rao’s mind now as she plans lectures and hand picks the best speakers for next year’s meeting. Thank you for your support, input and membership in the ASHNR. At all levels, the role of the Executive Committee is to keep the membership informed.

Patricia A. Hudgins, M.D.

ASHNR President