UCLA Clinical Updates Breast Tomosynthesis UCLA is among the first medical centers in the region to offer breast tomosynthesis, a new breast imaging technology that improves breast cancer detection rates while reducing false-positive results. Mindful Awareness Learn about the Latest Advances from UCLA Mindful awareness, a concept focusing on attention and awareness — essentially being “in the moment” — can be a strong antidote for stress, anxiety and depression, and can help alleviate chronic pain. Pediatric Thyroid Nodules Pediatric Sports Concussion Clinic Because thyroid nodules in children are often too small to feel or cause symptoms, children at risk of thyroid cancer should be evaluated at a center with expertise in advanced diagnostic and treatment techniques. While most young athletes who suffer a concussion will recover with time and rest, some will experience unusual symptoms, delayed recovery or chronic symptoms that can best be treated in a specialized clinic. Mental Illness with Co-occurring Addiction Reproductive Medicine Obesity can have adverse effects on fertility, and women should ideally be counseled on the medical, obstetric and neonatal consequences of obesity and its longer-term implications for offspring. UCLA Obstetrics and Gynecology, Santa Monica combines the comfort and convenience of care delivered close to home with the expertise and technological capabilities featured in major academic medical centers. Neuroendocrine Tumors UCLA is the first facility on the West Coast to assess neuroendocrine tumors using DOTATATE PET/CT, which offers image quality that is clearly superior to standard octreotide SPECT imaging. Advances in growing embryos to an advanced stage of physiologic development have made single-embryo transfer a superior procedure for many patients seeking in vitro fertilization. Severe Mood Dysregulation New research is under way to determine if severe mood dysregulation should be considered a psychiatric disorder, which could ultimately affect how children with chronic and severe irritability are diagnosed and treated. Geneticists at UCLA counsel patients on the use of prenatal genetic screening, and patients referred for oncofertility receive therapy that is sensitive to oncologists’ treatment plans. Pulmonary Medicine UCLA Peninsula Pulmonary offers comprehensive pulmonary, critical care and sleep medicine services to South Bay residents. Patients undergoing breast tomosynthesis can be assured they are receiving the most advanced imaging technology available, says Anne Hoyt, MD, clinical professor and director of the Barbara Kort Women’s Imaging Center. Radiation exposure using the new Hologic C-View technology is similar to conventional mammography, and patients are likely to experience fewer call-backs for a second scan. UCLA is among the first medical centers in the region — and the only one in West Los Angeles — to offer a new breast imaging technology that improves breast cancer detection rates compared to conventional mammography while reducing the rate of false-positive results. Called digital breast tomosynthesis, the technology is now offered at two UCLA breast imaging centers and is expected to emerge as the new standard-of-care in breast imaging. More than 38 million U.S. women undergo mammography each year for screening or diagnostic purposes. Mammography is among the most-studied screening tools in medicine today. While mammography has been proven to save lives, the technology is imperfect. Digital breast tomosynthesis addresses some of the challenges associated with standard breast imaging and provides a more accurate assessment of breast health. UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) UCLAHEALTH.ORG uclahealth.org/clinicalupdates DOTATATE PET/CT represents enhanced molecular imaging for neuroendocrine tumors A new diagnosis could lead to better treatment Tomosynthesis sets a new standard in breast imaging The 3-D digital tomosynthesis image (right) reveals the spiculated (sunburst) margin of the central mass, suggesting that it is cancerous. In the conventional 2-D image (left), the same mass is partially hidden by overlapping normal breast tissue and the diagnostically significant spiculated margin is easily missed. To download these and other clinical advances at UCLA Health, go to: UCLA study to characterize severe mood dysregulation “Overlapping dense tissue gives the illusion that there is something there,” Dr. Hoyt explains. “Sometimes women are scheduled to come back, and it turns out there is nothing there. These call-backs create a lot of anxiety among women. This is one of the criticisms of mammography.” At UCLA, breast tomosynthesis is used in both screening and diagnostic settings. While breast tomosynthesis can benefit all patients, women with dense breast tissue may be the best candidates for the technology. “The number-one reason for false-negative mammograms is dense breast tissue,” Dr. Hoyt says. Resnick Hospital Recognized for Records Management The Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA is one of only two psychiatric hospitals nationwide, and the only academic psychiatric hospital, to earn HIMSS Analytics’ acute-care Stage 7 award. Achieving the award represents attainment of the highest level of electronic medical-record progress at hospitals and health systems. uclahealth.org/Stage7Award Santa Monica Obstetrics and Gynecology Simultaneous treatment of both mental illness and addiction can increase the chances for long- term recovery from alcoholism or drug addiction. Digital breast tomosynthesis marks a new era in breast imaging News from UCLA Health Over the past 15 years, children and adolescents with severe irritability and aggressive outbursts have received increased attention from medical professionals as more and more of these youths have been diagnosed with pediatric bipolar disorder. In some cases, the pediatric patients clearly meet current diagnostic criteria for bipolar disorder, but in others, the diagnosis is unclear. Without validated biomarkers to diagnose bipolar disorder, this rising trend — with some data suggesting it may have increased by as much as 400 percent from 1994 to 2003 — has become one of the greatest controversies in child and adolescent psychiatry. A growing number of researchers, however, believe that many of these pediatric patients may have a different disorder, which they have termed Severe Mood Dysregulation (SMD). With SMD a youth will exhibit outbursts that go far beyond a typical temper tantrum and require clinical intervention, but they will not experience other symptoms such as the manic and prolonged euphoria that often presents with bipolar disorder. SMD is not an official diagnosis, but new research is under way to determine whether it should be considered a psychiatric disorder, which could ultimately affect how children with chronic and severe irritability are diagnosed and subsequently treated. A new UCLA research study at the Semel Institute for Neuroscience and Human Behavior seeks to develop a better characterization of SMD. The UCLA study is one of the first to be conducted outside of the National Institute of Mental Health. UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) 1-800-UCLA-888 (1-800-825-2888) Working to make DOTATATE more available Physicians are concerned that a growing number of children and adolescents currently being diagnosed with bipolar disorder could receive more appropriate care if Severe Mood Dysregulation (SMD) were an officially recognized diagnosis. With a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, these young patient could be treated with different medications than those used for bipolar disorder, sparing them the risk of side effects from the powerful drugs used to treat that condition. In addition, an SMD diagnosis could carry less social stigma than a diagnosis of bipolar disorder. While neuroendocrine tumor imaging using DOTATATE PET/CT is well established in Europe, the technology is less well known in the United States and is dramatically underutilized, says Martin Allen-Auerbach, MD, medical director of the UCLA Nuclear Medicine Clinic. “We don’t really know the population yet,” says James J. McGough, MD, professor of clinical psychiatry in the UCLA Semel Institute Division of Child & Adolescent Psychiatry and lead investigator of the study. “But proper care always begins with an accurate diagnosis. The better we understand the underlying condition, the more precise we can be in our diagnosis and the better treatment we can offer these patients to help improve their ability to function in family, social and school settings.” 3-D PET reconstruction (left) and coronal slice of fused PET/CT image (right) showing metastatic disease in the liver (blue arrows) and the primary cancer site in the small bowel (red arrow). The site of the primary disease could not be identified prior to this scan. Neuroendocrine cancer, which is diagnosed in about 8,000 Americans each year, consists of a heterogeneous group of tumors that arise mostly in the gastrointestinal tract. These tumors are often challenging to diagnose and treat. Symptoms can be vague, consisting of diarrhea, abdominal cramps, shortness of breath, blood pressure changes, headaches and rashes. Tumors may not be detected by routine imaging. As a result, a diagnosis is often made when the disease is at an advanced stage. Appropriate treatment of neuroendocrine tumors depends on the particular type of tumor, where it originated and its stage and grade. Recent advancements in molecular imaging with PET have led to a greater ability to accurately evaluate neuroendocrine tumors. UCLA Nuclear Medicine, in a joint venture with UCLA Radiology, is the first facility on the West Coast to assess neuroendocrine tumors using positron emission tomography with computed tomography (PET/CT) and a new imaging agent called gallium-68 DOTATATE (68Ga DOTATATE). UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) “Before you decide what treatment to give patients, you need to stage and characterize the tumor,” Dr. Allen-Auerbach explains. “The image quality of the current imaging technology (octreotide SPECT) is clearly inferior to DOTATATE PET/ CT. That has been proven in the scientific literature. Many studies have compared the two modalities side by side. DOTATATE PET/CT has superior sensitivity and specificity when it comes to neuroendocrine neoplasm.” At this time, DOTATATE PET/ CT isn’t routinely covered by insurance. However, the staff of the UCLA Nuclear Medicine Clinic works with each patient to assess reimbursement. “We hope insurance reimburse- ment policies will change soon because DOTATE actually costs less than the currently covered octreotide SPECT scan,” Dr. Allen-Auerbach says. Disrupted Bond Impacts Child’s Brain Children who experience profound neglect have been found to be more prone to a behavior known as “indiscriminate friendliness,” characterized by an inappropriate willingness to approach adults, including strangers. uclahealth.org/disruptedbond Context Counts for Anxious Children and Teens Anxiety disorders are common in children and adolescents, affecting up to 25 percent of the youth population. Anxiety causes distress and functional impairment and, if left untreated, can result in bad grades, problems at home and increased rates of psychiatric disorders in adulthood. uclahealth.org/teenanxiety