Dr. Bill W.

Practice Management
Imaging self-referral: An inside manifesto
My name is Bill W. Like the fellow in the AA meetings. I'm a radiologist, and I'm addicted to imaging self-referral. Maybe you know something about this, maybe you participate too, and maybe you don't care. But you should. For your wake-up call, I think it's time to share an inside view of a very ugly issue.
March 18, 2009
2009 03 18 16 29 16 358 Silouette 70
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AR-guided localization may sub for CT for early-stage lung cancer
AR-guided localization was noninferior to conventional CT guidance and led to better patient experiences.
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Study backs LDCT lung cancer screening in Singapore
Response Evaluation Criteria in Bone Metastases (RECIBM) and metabolic criteria were used to detect a complete response missed at anatomic assessment. A 76-year-old male patient presented with 1 month of hemoptysis and was diagnosed with small cell lung cancer and bone metastases. Baseline (July 2022) F-18 FDG-PET/CT images (A, maximum intensity projection image; B–E, axial images) demonstrate FDG-avid lesions in the left lamina of the first lumbar vertebra (L1) (straight yellow arrows; maximum standardized uptake value, 2.74; peak standardized uptake value normalized to lean body mass, 1.59) and left ilium (curved yellow arrows; maximum standardized uptake value, 3.68; peak standardized uptake value normalized to lean body mass, 2.28). After seven chemotherapy cycles (December 2022), follow-up PET/CT images (F, maximum intensity projection image; G–J, axial images) show complete metabolic resolution of bony lesions (L1: maximum standardized uptake value, 1.32, and peak standardized uptake value normalized to lean body mass, 0.85; left ilium: maximum standardized uptake value, 1.48, and peak standardized uptake value normalized to lean body mass, 0.82), without apparent osteolytic or osteoblastic changes at CT. Assessment was stable disease (SD) according to the University of Texas MD Anderson Cancer Center (MDA) criteria but complete response (CR) or complete metabolic response (CMR) according to RECIBM, PET Response Criteria in Solid Tumors (PERCIST), and European Organization for Research and Treatment of Cancer (EORTC) criteria. The patient was alive as of September 30, 2025.
Clinical News
New criteria evaluates treatment response in bone metastases
Representative axial noncontrast CT images with and without the hyperdense capsule sign (HDCS). The HDCS is defined as a hyperdense capsule layer of linear shape surrounding a subdural hematoma (SDH). (A–D) Images of SDH with the HDCS (arrowheads). (E–H) Images of SDH without the HDCS.
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CT sign may flag who benefits from subdural hematoma procedure
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Classification system could improve MRI lumbar spinal stenosis grading
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AR-guided localization may sub for CT for early-stage lung cancer
By Amerigo Allegretto
AR-guided localization was noninferior to conventional CT guidance and led to better patient experiences.
July 8, 2026
Lungs 3 D Research 400
Study backs LDCT lung cancer screening in Singapore
By Will Morton
Lung cancer is the leading cause of cancer death in Singapore, with approximately 48% of cases occurring in individuals who have never smoked.
July 8, 2026
Lungs
New criteria evaluates treatment response in bone metastases
By Will Morton
RECIBM-defined response classifications showed high agreement with established criteria and reclassified 19% of patients.
July 7, 2026
Response Evaluation Criteria in Bone Metastases (RECIBM) and metabolic criteria were used to detect a complete response missed at anatomic assessment. A 76-year-old male patient presented with 1 month of hemoptysis and was diagnosed with small cell lung cancer and bone metastases. Baseline (July 2022) F-18 FDG-PET/CT images (A, maximum intensity projection image; B–E, axial images) demonstrate FDG-avid lesions in the left lamina of the first lumbar vertebra (L1) (straight yellow arrows; maximum standardized uptake value, 2.74; peak standardized uptake value normalized to lean body mass, 1.59) and left ilium (curved yellow arrows; maximum standardized uptake value, 3.68; peak standardized uptake value normalized to lean body mass, 2.28). After seven chemotherapy cycles (December 2022), follow-up PET/CT images (F, maximum intensity projection image; G–J, axial images) show complete metabolic resolution of bony lesions (L1: maximum standardized uptake value, 1.32, and peak standardized uptake value normalized to lean body mass, 0.85; left ilium: maximum standardized uptake value, 1.48, and peak standardized uptake value normalized to lean body mass, 0.82), without apparent osteolytic or osteoblastic changes at CT. Assessment was stable disease (SD) according to the University of Texas MD Anderson Cancer Center (MDA) criteria but complete response (CR) or complete metabolic response (CMR) according to RECIBM, PET Response Criteria in Solid Tumors (PERCIST), and European Organization for Research and Treatment of Cancer (EORTC) criteria. The patient was alive as of September 30, 2025.
CT sign may flag who benefits from subdural hematoma procedure
By Will Morton
Among participants with the “the hyperdense capsule sign,” middle meningeal artery embolization resulted in significant benefits over usual care.
July 7, 2026
Representative axial noncontrast CT images with and without the hyperdense capsule sign (HDCS). The HDCS is defined as a hyperdense capsule layer of linear shape surrounding a subdural hematoma (SDH). (A–D) Images of SDH with the HDCS (arrowheads). (E–H) Images of SDH without the HDCS.
Classification system could improve MRI lumbar spinal stenosis grading
By Amerigo Allegretto
An educational intervention that use a classification system led to improved overall correctness and interobserver reliability.
July 6, 2026
Spine 400
ACR/ASNC highlight changes in proposed 2027 HOPPS rule
By Will Morton
Released by the Centers for Medicare and Medicaid Services (CMS) on July 2, the proposed rule has a 60-day comment period.
July 6, 2026
Acr Logo 2023 400
Gay, trans women less likely to undergo cancer screening
By Amerigo Allegretto
Trans women are 76% less likely to receive breast cancer screening compared to cisgender women.
July 6, 2026
Patient Woman Doctor2 400
Women's Imaging MinnieCast, Episode 12: Educating the public on breast density
By Amerigo Allegretto
Co-founders of DenseBreast-info.org discuss their work in educating the public on breast density and cancer risk.
July 3, 2026
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PET/MRI can reduce the need for biopsies in prostate cancer
By Will Morton
Prostate biopsies are associated with considerable morbidity, including pain, rectal bleeding, prostatitis, and urinary tract infections.
July 2, 2026
A visual abstract of the study.
Socioeconomic conditions amplify pollution-related bone loss
By Will Morton
The findings underscore how environmental and social conditions work together to influence long-term bone health.
July 1, 2026
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Medicare Advantage cost-sharing varies for advanced imaging services
By Amerigo Allegretto
More plans require cost-sharing for advanced imaging, with a growing share of plans requiring both coinsurance and a copayment.
July 1, 2026
Insurance Policy 400
PET/CT guides treatment in men with recurrent prostate cancer
By Will Morton
F-18 fluciclovine and Ga-68 PSMA-11 PET/CT have similar benefits for sRT planning, in terms of improving cancer control without increased toxicity.
June 30, 2026
F-18 fluciclovine PET/CT images in a 59-year-old man with biochemical recurrence after prostatectomy (prostate-specific antigen level, 0.42 ng/mL; Gleason score, 5 + 4 = 9; T3BN1M0). (A) Coronal PET and (B) maximum intensity projection images show multiple retroperitoneal lymph nodes with abnormal radiotracer uptake (arrows). (C) Axial PET and (D) axial fused PET/CT images show the index lesion (arrow), measuring 13 × 10 mm, on the right precaval lymph node. The initial decision to offer radiation therapy to the prostate bed and pelvis was changed to a decision not to offer radiation therapy.
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