Winter Landscape

The Winter Landscape was painted by John Hardrick (1891-1968) an American painter who was influenced by the work of Paul Gauguin and Vincent van Gogh, and adopted their impressionist style with its emotional sense of color. 

He favored the picturesque environs of Brown County, south of Indianapolis, Indiana, where he found woodlands and waterways.

In Winter Landscape, all seems pristine in this fantasy-like snowscape, with decaying twigs and leaves on the forest floor well concealed in a serene setting by the snow.

Likewise one may find tranquility and life free from stress and pain, perhaps in a rustic cabin nestled in a peaceful wood or in the rhythm of waves in a remote lighthouse up on a high cliff at water’s edge.

Winter Landscape, by John W Hardrick, 1945. Courtesy of the Indianapolis Museum of Art (http://www.imamuseum.org/)

Modified from an article at JAMA

Little gain from supplemental ultrasound in women with dense breasts

Since many US states require by law that mammography providers inform women with dense breasts about the option of supplemental screening.  Sprague et al reported in the Ann Intern Med the cost-effectiveness of supplemental ultrasonography screening for women with dense breasts using data from SEER (Surveillance, Epidemiology, and End Results Program). 

Breast cancer deaths averted, quality-adjusted life-years (QALYs) gained, biopsies recommended after a false-positive ultrasonography result, and costs.

They found that supplemental ultrasonography screening after a negative mammography result for women aged 50 to 74 years with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models, 0.14 to 0.75 deaths), gained 1.7 QALYs (range, 0.9 to 4.7 QALYs), and resulted in 354 biopsy recommendations after a false-positive ultrasonography result (range, 345 to 421 recommendations) per 1000 women with dense breasts compared with biennial screening by mammography alone. Supplemental ultrasonography screening for only women with extremely dense breasts cost $246 000 per QALY gained (range, $74 000 to $535 000 per QALY gained).

They concluded that supplemental ultrasonography screening for women with dense breasts would substantially increase costs while producing relatively small benefits.

CMS approves CT Lung Cancer Screening

The Centers for Medicare and MedicaidServices on February 6, 2015 issued its final decision approving Medicare coverage for lung cancer screening by low-dose CT.  Medicare will cover annual screenings for beneficiaries aged 55-77 who are current smokers or who quit in the last 15 years, and who have a history of at least 30 “pack years.”   According to the American Cancer Society, lung cancer kills nearly 158,000 patients a year.

Incidental Findings on Non-Enhanced CT on Patients with Renal Colic

Samim et al in their article published by the Journal of AmericanCollege of Radiology report the prevalence and types of incidental findings on non-enhanced computed tomograms performed on patients with renal colic in the Emergency Department.

They reviewed 5,383 consecutive reports retrospectively of non-enhanced CT performed on adult patients using renal colic protocol at 2 emergency departments over a 5.5-year period. Incidental findings were defined as those unrelated to symptoms and were categorized as “important” if follow-up was recommended based on recently published consensus recommendations.

Important incidental findings (IF) were identified in 12.7% of scans. Prevalence of important incidental findings increased with age: important IF in individuals age >80 years were 4 times more common than for those aged 18-30 years: 28.9% versus 6.9%, respectively, (P ≤ .05). Women had a higher prevalence of important IF compared with men: 13.4% versus 11.9%, but the difference was not statically significant (P = .09). There was substantial inter-rater agreement (kappa ≥ 0.69) regarding presence and classification of important incidental findings using published guidelines.

The authors concluded that important incidental findings occurred in 12.7% of non-enhanced CT scans performed for suspected renal colic in the emergency department and are more common in older individuals.