Every year in the United States, more than three quarters of a million people have a stroke, and approximately every 3 minutes someone dies from a stroke. A significant portion of stroke victims are young, and left with a devastating handicap for the rest of their lives. The monetary and societal costs of stroke represent a major economic challenge to the healthcare system.  With stroke – as with heart attack – rapid treatment is essential to limit the extent of irreversible brain injury (“time-is-brain”), and rapid determination of the cause and degree of existing brain injury can be critical in deciding treatment.

CT perfusion imaging is a quick, widely available test that displays information about blood flow to the brain that can help diagnose, treat, and predict outcome in stroke patients.  When MRI is not readily available or contraindicated, CT perfusion imaging provides the best possible estimate of brain tissue likely to die without urgent, advanced therapies, including arterial “clot busting” drugs and blood clot retrieval devices.  CT perfusion imaging can also help classify reversible brain injury (“transient ischemic attacks”) that – like cardiac angina – may not require such immediate, aggressive treatment, as well as evaluate brain injury caused by arterial spasm due to bleeding from aneurysm rupture.

Published protocols for performing CT perfusion imaging at “as low a radiation dose as reasonably achievable” – a principle endorsed by the American College of Radiology and American Society of Neuroradiology – have circulated in the medical community for over a decade.  Strict protocol rules and oversight radiation protection personnel at most medical centers ensure that optimal image quality is maintained with a total radiation exposure often considerably lower than the current FDA recommended maximum dose.  Indeed, in an early, highly quoted study that compared different scanning protocols, it was shown that image quality is actually improved when CT perfusion is obtained at a lower average X-ray beam energy than is standard for routine CT imaging.

In all of medicine – and especially for stroke – the potential risks of any diagnostic test or therapeutic procedure (however rare) must be weighed against the very real benefits of preventing death or severe disability.  We believe, and the medical literature supports, that CT perfusion imaging, when appropriately performed, is justified and provides safe, valuable information that can substantially contribute to the management of acutely ill patients in an emergency setting.  Recent advances in scanner hardware and software, and the ongoing efforts of industry, offer the promise of further, significant reductions in CT radiation dose. The radiology community is committed to work hard towards this goal of reducing CT radiation dose, and continuing to offer the best imaging care to our patients.

References:

Janet C Miller, D. Phil., et al. CT Perfusion Imaging of the Brain. Radiology Rounds: A Newsletter for Referring Physicians from the Massachusetts General Hospital Department of Radiology. Volume 8, Issue 6, June 2010. http://www.mghradrounds.org/index.php?src=gendocs&ref=2010_june

Wintermark M, Lev MH. FDA investigates the safety of brain perfusion CT. AJNR Am J Neuroradiol. 2010 Jan;31(1):2-3.

Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT, Hobson R, Kidwell CS, Koroshetz WJ, Mathews V, Villablanca P, Warach S, Walters B; American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, and the Interdisciplinary Council on Peripheral Vascular Disease. Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. Stroke. 2009 Nov;40(11):3646-78.

Wintermark M, Rowley HA, Lev MH. Acute stroke triage to intravenous thrombolysis and other therapies with advanced CT or MR imaging: pro CT. Radiology. 2009 Jun;251(3):619-26.

Wintermark M, Maeder P, Verdun FR, Thiran JP, Valley JF, Schnyder P, Meuli R. Using 80 kVp versus 120 kVp in perfusion CT measurement of regional cerebral blood flow. AJNR Am J Neuroradiol. 2000 Nov-Dec;21(10):1881-4.

Broad expert consensus on the minimum requirements for CT perfusion scan acquisition can be found in Table 2 (page E25) of the following paper, which can be freely downloaded from PubMed:

Wintermark M, Albers GW, Alexandrov AV, Alger JR, Bammer R, Baron JC, Davis S, Demaerschalk BM, Derdeyn CP, Donnan GA, Eastwood JD, Fiebach JB, Fisher M, Furie KL, Goldmakher GV, Hacke W, Kidwell CS, Kloska SP, Köhrmann M, Koroshetz W, Lee TY, Lees KR, Lev MH, Liebeskind DS, Ostergaard L, Powers WJ, Provenzale J, Schellinger P, Silbergleit R, Sorensen AG, Wardlaw J, Wu O, Warach S. Acute stroke imaging research roadmap. AJNR Am J Neuroradiol. 2008 May;29(5):e23-e30.

Hynes Convention Center, Boston, Massachusetts

May 15-20, 2010

Registration

Still want to attend the ASNR Annual Meeting? You may register on-site at the Hynes Convention Center; Registration Desk is on Level 2, Hall C Foyer.
See you in Boston!

Housing

Please contact the Sheraton Boston Hotel and the Westin Copley Place Hotel for room availability.
To see a copy of the updated program schedule, click here.

New! Use Twitter to Communicate with Your ASNR Colleagues at ASNR 2010
Here are two ways you can use Twitter at the upcoming ASNR Annual Meeting to enhance your meeting experience:

1. We recommend Twitter users include the hash tag #ASNR2010 in their ‘tweets’ to identify content related to the ASNR Annual Meeting. Monitor Twitter for that hash tag to see any relevant posts, and use that hash tag in your own posts to help your ASNR colleagues to find your tweets easily.
2. Follow ASNR on Twitter. ASNR staff will send occasional tweets using the account @ASNRstaff. Sign up at Twitter to follow @ASNRstaff and receive occasional tweets with conference reminders and other information.

To set up a free Twitter account visit www.twitter.com. For a guide to using Twitter, try this site: http://mashable.com/guidebook/twitter.

Note: Twitter is an informal medium for quick, public, nonessential communication that can enhance information exchange and social networking.  ASNR does not monitor Twitter for feedback 24/7, so we recommend that questions or comments needing staff attention be communicated directly to staff and not posted to Twitter. Twitter is a public forum and ASNR has no authority over, or responsibility for, Twitter content.

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ASNR Program Planner and Abstract Viewer System

This is your direct link to view session titles and presentation names for the ASNR 48^th Annual Meeting.  It is an easy way to download and plan your itinerary for the meeting.  Click here to view: http://www.abstractsonline.com/plan/start.aspx?mkey=%7B9B99192C%2DA4E5%2D4E4D%2D972A%2D4A9C5C999A14%7D

For assistance, please review the attached file.

Itinerary Builder Info Sheet 2010.pdf

New in 2010!  Scientific Exhibits Tour

Monday, May 17, 2010

– 12:45pm
Join us on Monday, May 17 at 12:45pm in the Scientific Exhibits – Hall C, Level 2 of the Hynes Convention Center
Review Scientific Exhibits, visual presentation/educational displays designed to further the understanding of Neuroradiology by featuring cutting-edge material or by offering an instructional review of a particular topic.  The session will allow for review of visually-oriented educational displays that demonstrate novel and innovative applications for computers in Neuroradiology clinical practice, training and research.  Share this educational opportunity with your colleagues and primary Exhibit presenters and exchange in a lively Questions & Answers Session.

Another unique feature not to be missed is the Scientific Exhibit Case of the Week… See you on the tour!

Highlights of the Meeting…

• ASNR/ISMRM Symposium:  Technical Advances in Brain Tumor MR Imaging – Saturday, May 15
• NER Foundation Symposium 2010:  Cancer Imaging for the Neuroradiologists:  Fundamentals to Functional and Molecular Imaging
• Maintenance of Certification (MOC) – Reviewer Session (AR+)
• Six SAM Sessions
• Synaptic Junction Lectures and Workshops
• Keynote Speaker:  The Politics and Ethics of Health care Reform, Darrell G. Kirch, MD
• Session on…
  • Pitfalls in Practice
  • Comparative Effective Research
  • PQI:  Getting Started with Baby Steps
  • Overview of Healthcare Reform Legislation
  • Imaging Biomarkers in Dementia
  • Radiation Dose Reduction for the Neuroradiologist:  What You Need to Know
  • Research in Progress:  An Interactive Forum
  • Infomatics of Healthcare Reform
  • Tackling the Many Faces of the AJNR
  • Time is Brain

SEE YOU IN BOSTON!

It is our deepest sorrow and sadness to inform all of the recent death of Dr. William N. Hanafee, a founding member of the American Society of Neuroradiology (ASNR) and the American Society of Head and Neck Radiology (ASHNR). Dr. Hanafee died in Pauma Valley, California, after battling a series of cerebral infarctions with great dignity and his characteristically great resolve, on August 19, 2009. He was 83 years of age and surrounded by those he loved at his passing. He is survived by his beloved wife, Mrs. Constance (Connie) Hanafee, and their 4 children, Bill Jr, Linda, Michael, and Patrick and many grandchildren.

Bill Hanafee grew up in the Midwest, a native of Louisville, Kentucky. He completed his undergraduate studies at the University of Rochester, New York, and medical school at the University of Louisville. He later served in the US Navy, both as an intern and subsequently as a lieutenant while on leave from the University of California, Los Angeles (UCLA). Bill spent most of his career at UCLA, where he was a resident, staff radiologist, academician, and scientist. He completed a fellowship in neuroradiology at the University of Gothenburg in Sweden, where he extensively studied the newly emerging field of angiographic diagnosis in diseases of the brain, head, and neck. He also studied conventional angiography with Dr. Per Amundsen in Norway.

Bill was an integral member of the group of pioneering radiologists who started the subspecialty practice of neuroradiology in the United States. With a few other visionaries, Bill helped introduced the technique of transfemoral cerebral angiography, which he learned in Sweden, to the United States in the 1960s. Bill was an innovator throughout his life. His 5F “Hanafee” catheter, a pioneering step in the run-up to microcatheter technology, became a standard and is still used in practice throughout the world. Before the introduction of these newer techniques, surgeons performed angiographic procedures via direct puncture; however, the morbidity from cerebral angiography in the United States was an unacceptable 20%. When Dr. Hanafee returned from Sweden to UCLA, he was slowly able to convince referring clinicians of his expertise and the safety of these new angiographic techniques. A combined study between UCLA and the University of California, San Francisco, where Hans Newton had introduced femoral conventional angiography as well, showed that using the new Seldinger technique of cerebral angiography via the femoral approach decreased the morbidity at the 2 institutions to 0.3%. Because of Bill’s vision, creativity, and pragmatism, he became one of the founding members of the ASNR and made a lasting contribution to that society and to thousands of patients around the world.

Dr. Hanafee was Chairman of the Department of Radiology at UCLA, where he maintained phenomenal academic productivity while teaching many residents and fellows who subsequently went on to illustrious academic careers. He had a vision for radiologic research and established the Leo G. Rigler Center for Radiologic Sciences at UCLA. He published more than 300 peer-reviewed articles and gave numerous lectures worldwide. In 1974, when Dr. Hanafee stepped down as Chairman of Radiology at UCLA, he began a second career as a head and neck radiologist. He convinced Dr. Paul Ward, the Chief of Otolaryngology at UCLA, to assign his chief resident to sit at his side for the next 5 years to provide clinical information about the patients whose head and neck films he was interpreting. How is that for the way to learn head and neck radiology! This approach to learning and interpreting studies in the clinical context is the greatest gift he has passed to his many students.

In the late 1970s, Bill partnered with Drs. Dino Valvassori, Guy Potter, and Stormy Johnson to found the ASHNR. This organization, which now counts over 500 members, has done more than any other single entity to elevate the quality of care in patients with often devastating diseases. In 1982, he coauthored Computed Tomography of the Head and Neck (Williams and Wilkins), a classic reference text and one of the first textbooks detailing cross-sectional anatomy and pathology of the head and neck. In 2001, the ASHNR honored Dr. Hanafee’s contributions and achievements with its first Gold Medal. His commitment and determination as cofounder of ASHNR have lead to tremendous strides in the development of head and neck radiology as a subspecialty.

Dr. Hanafee was not only a great teacher but also an amazing storyteller. He might spend 30–45 minutes discussing 1 case (in the good old days), and the session would always end with great laughter and learning points. He loved to imitate different types of hoarseness produced by glottic and supraglottic cancers. Many clinicians visited his office with jackets of films in hand, and Bill usually provided an answer. He would often say: “Giving clinicians 10 differential diagnosis possibilities would not help them. It is useless to say that it could be tumor, or could be infection. Give them a few possibilities and suggest what the next step should be.”

Connie and Bill Hanafee retired to a lovely home along a beautiful golf course in Pauma Valley, California. In his retirement, Bill played golf every day for 17 years with Paul Ward, former Chairman of Otolaryngology/Head and Neck Surgery at UCLA and his lifetime friend. According to Connie, they were known on the course as the “pair of docs.”

Bill Hanafee had a special gift of choosing the right path and then walking that path with great humility and love. Those of us touched by him now have the responsibility of honoring this wonderful physician and human being by extending his teachings, passion, and vision, mixed with his wonderful pragmatism, to future generations. William Hanafee will be deeply missed, but he leaves a tremendous legacy through his work and through those he influenced personally and academically.