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Friday, 22 April 2016
Final Weeks to Submit Photos to HereNow: Rutgers 250,Zimmerli’s First Crowdsourced Exhibition and Celebration of University’s Anniversary


 Final Weeks to Submit Photos to HereNow: Rutgers 250,Zimmerli’s First Crowdsourced Exhibition and Celebration of University’s Anniversary


Over the last three months, the Zimmerli Art Museum’s special exhibition galleries have filled up with nearly 1,400 photographs, as part of the HereNow: Rutgers 250 initiative to celebrate the university’s milestone anniversary. Photos submitted by students, faculty, alumni, and visitors have fondly highlighted iconic scenes of student life and campus sights, uncovered hidden nooks, and captured treasured moments. Together, these images celebrate the Rutgers experience and create a dynamic, once-in-a-lifetime collage. As the final submission deadline for the museum’s first ever crowdsourced exhibition approaches on May 15, we invite the global Rutgers community to share their photos, and support our vision to capture the past, present, and future of our university. Images can be submitted via the microsite herenow250.rutgers.edu, which launched last November, and will be added to the growing exhibition.


As part of the culmination of the initiative, following the final submission deadline, all of the images will be reviewed by a panel of arts professionals, and 250 will be chosen to be featured in a full-color art book that will be available prior to Charter Day, November 10, 2016. We encourage you not to miss the opportunity to participate, and encapsulate your Rutgers moments for future generations.


“The photos represent the broad range of people who interact with Rutgers and their individual experiences,” says Donna Gustafson, Curator of American Art and Mellon Director for Academic Programs at the Zimmerli. “Some general themes have emerged, but there is no one subject that dominates the project.


Most photographs have been taken on campus in New Brunswick, Piscataway, Camden, and Newark; but university and club events held around the state and nation, as well as in study abroad locations, also appear. The collage features selfies and photos of football games and classroom scenes, but also unique abstracts of familiar places and images of singular extracurricular activities such as those from the Rutgers Equestrian Team. The collage is vibrant, lively, and, most importantly, like the university, diverse.


Gustafson adds, “Of course, with the semester winding down, we look forward to receiving photos of spring semester classes, students outside, Alumni Weekend, and Rutgers Day, as well as Commencement in May.”



  • Anyone can submit images for the initiative
  • Images can be uploaded to herenow250.rutgers.edu
  • Images are loosely categorized into Academics, Campus Life, Arts, Athletics, and Global Experiences
  • Images must reflect the experience of Rutgers-affiliated individuals and be dated between January 1, 2015 and May 15, 2016, to be considered for inclusion in the book
  • Use #RUHERENOW250 to share images on social media
  • Come by the museum often to see the exhibition grow and change.


Rutgers 250 is a yearlong celebration marking Rutgers University's founding in 1766, honoring the university’s past, present, and future with a series of events, programs, and gatherings. The history of Rutgers begins on November 10, 1766, when William Franklin, the last Colonial governor of New Jersey, signed the charter that brought Queen’s College into existence. In 1825, the school was renamed to honor Colonel Henry Rutgers, a Revolutionary War veteran. In 2015, poised to celebrate 250 years, Rutgers is one of the most highly regarded institutions of higher education in the nation, with more than 65,000 students and 24,400 faculty and staff in New Brunswick, Newark, and Camden, and at locations throughout the state. Complete information and a list of related events can be found at 250.rutgers.edu.


The exhibition HereNow: Rutgers 250 is supported by the Estate of Ralph Voorhees, and donors to the Zimmerli's Major Exhibition Fund: James and Kathrin Bergin, Alvin and Joyce Glasgold, Charles and Caryl Sills, Voorhees Family Endowment, and the Jerome A. Yavitz Charitable Foundation, Inc.--Stephen Cyphen, President. Related public programs are supported by the Friends of the Zimmerli Endowment Fund.


The book HereNow: Rutgers 250 is supported by the Class of 1937 Publications Endowment Fund.


Posted by tammyduffy at 7:27 PM EDT
Friday, 15 April 2016
A New Desitination For Hair

A New Destination for Hair 
By Tammy Duffy 


Cranbury-based Hairports Wash & Blow Dry Bar has opened a second location in Hamilton. Founder Jennifer Powell launched Hairports in 2013 as the first-­ever blow-dry only bar. 


Blow dry bars have become a popular trend in many major cities throughout the United States.  A new establishment has opened in Hamilton, NJ, The Hairports: Wash  & Blow dry bar, located at 825 Rt 33. Their phone number us 609-395-8424.


They specialize in blow dry's only.  This focused offering gears them to allow their styles to be flawless. They use only the most elite products, like Unite hair care product line and Mirabella makeup lines. They also host parties, girls nights out, bacheloreette parties, and birthdays.


The Hairports Wash & Blow Dry Bar offers several Destinations (services)-like NYC, Los Angeles, Bahamas, Paris, No Fly Away Zone, and more that you can choose from depending on your preference of wash, style, make up, and more. The Fly Guy, which is their signature shampoo, conditioner and style only costs $25.


This location in Hamilton has unique qualities. They create an entire experience for those who enter. The nanosecond you walk in, you are pleasantly greeted by one of the "flight crew". It is not an overwhelming greeting, but a welcome of genuine kindness.  The decor resembles that of an airplane. There are no details that owner, Jennifer Powell has forgotten. The salon is a whimsical, fun, relaxing atmosphere for all who enter. The mirrors, the paint, the signage all make you feel like you are on your way to Fantasy Island. I only wish airlines were like this! I imagined being on a transcontinental flight for 16 hours and having this service available.  


The airline industry can learn from The Hairports Wash & Blow Dry Bar. When you get your hair washed you are made to feel like you are in a reclining business class seat. When business class actually was comfortable.  These hair sinks are wonderfully comfortable. You are then treated to a 5-10 minute scalp massage as they wash your hair. The scalp massage is something everyone must experience!! It was epically relaxing.





The attention to detail that owner, Jennifer Powell, has placed in her new establishment is refreshing.  She is bringing first class back to travel in her salon. In the past, travel was something people looked forward to. In the past people wanted to travel, they wanted to look beautiful at the airport. Today, travel has become a fashionable pigpen for most and an annoying experience. Hairports, Wash & blow dry bar is bringing us back the good old days when travel was comfortable, relaxing and fashionable.


The "hair traffic controllers" are dressed like the skygirls from the 1960's.  It's lovely! I have been in so many salons where the stylists are dressed like absolute slobs, and they are tasked with making me pretty?  How is that even possible? If they do not care about their own looks and presentation how are they going to care about mine? 

The Skygirls at Hairports wash & blow dry bar want everyone to experience first class service, and you get it. They are open 7 days a week. They even open early for those "travelers" that need an early departure.


Jennifer Powell came up with her idea for The Hairports after a relative from California told her about blow dry bars and suggested she open her own. “She came out and said we’re missing an opportunity — I was missing an opportunity,” Powell said. “And I thought, ‘Wow, what a great idea!".


Powell plans to take her Hairports brand and open salons in major airports, she said. She hopes to open her first airport location in two years.


"Eventually we will be branching out to all airports, here and international,” she said.  She wants to open a store behind the security gates, so travelers on layovers or delays can relax and have their hair styled while they wait for their planes to depart.


Powell has been a licensed cosmetologist since 1991 and has worked in a number of salons. She and all of her hair traffic controllers are required to be licensed by the state Board of Cosmetology and Hairstyling.







Posted by tammyduffy at 5:06 PM EDT
Updated: Friday, 15 April 2016 10:27 PM EDT
Sunday, 10 April 2016

On April 1, Duffy's Cultural Couture did a story on the lead level testing for the children in Hamilton, NJ, Mercer county. 
 According to a report by the  N.J. Department of Health from 2014, the township of Hamilton demonstrated they had 1,814 children who were in the age bracket of 6 to 26 months of age. Only 22% of these children were tested for lead. These results demonstrate one of the lowest in the state out of the large municipalities evaluated.


  • 392 children in this age bracket were found to have lead levels below 5 BLL (µg/dL)
  • 9 children in this age bracket were found to have lead levels between 5-9 BLL (µg/dL)
  • 1 child in this age bracket were found to have lead levels above10 BLL (µg/dL)
  • Only 22% of the children were tested



N.J.A.C. 8:51A requires the protection of children less than six years of age from the toxic effects of lead exposure by requiring lead screening pursuant to N.J.S.A. 26:2-137.2 et seq. (P.L. 1995, c 328. So why is the Township of Hamilton ignoring this law?  Why are only 22% of the children being evaluated in Hamilton township, Mercer County?


According to a report by the  N.J. Department of Health from 2014, the township of Hamilton demonstrated they had 5,480 children who were in the age bracket of less than 6 years of age. Only 14.9% of these children were tested for lead in Hamilton township, Mercer County. These results demonstrate one of the lowest in the state out of the large municipalities evaluated.


  • 749 children in this age bracket were found to have lead levels below 5 BLL (µg/dL)
  • 18 children in this age bracket were found to have lead levels between 5-9 BLL (µg/dL)
  • 1 child in this age bracket were found to have lead levels above10 BLL (µg/dL)
  • 1 child in this age bracket was found to have lead levels between 20-44 BLL
  • Only 14.9% of the children were tested


The link below will take you to the original story by DUFFY 

On Friday, the Superintendent of Hamilton released this statement
In light of the heightened concerns of the possibility of lead being in the potable water supply, the district implemented a plan of action to test for lead in all the district’s owned schools and buildings water supplies.  Under the direction of the district’s environmental consultant, Karl and Associates, we began testing over spring break following the U.S. Environmental Protection Agency’s (EPA) guidelines for testing for lead in school water supplies.  
According to EPA guidelines, samples should be taken from all sources of drinking outlets, such as water fountains, classrooms with faucet/drinking spigot combination sinks, faculty rooms, kitchens and nurse’s office sinks.  This is a more thorough and in depth look at the drinking water supply in a school than random sampling provides for.  According to the EPA guidelines, it is not necessary to sample faucets such as custodial sinks, bathroom sinks and outside hose bibs as these are not an intended source of drinking water.  Karl and Associates contacted the State of New Jersey Department of Health to ascertain if this method of testing was consistent with State requirements and acceptable to the State. He was advised the listed testing procedures were fine.
The testing process involves taking two samples at each drinking source.  The first sample will be drawn first thing in the morning before the building has been placed in use for the day and without running the water first.  If the results of the first sample are within the EPA acceptable limits for lead in drinking water, than the water source is deemed fine.  If the results are above the acceptable limits determined by the EPA, a second sample will be drawn from the same outlet source after flushing the line for a predetermined amount of time.  If the second sample is within the EPA limits than the source of the contamination is the fountain or faucet.  If the second sample is above the EPA limits the source of contamination could be somewhere in the supply lines and would require a more intensive process to locate the source of contamination.    
Testing began over spring break and will continue systematically throughout the district.  As soon as the district is notified a source is above the EPA limits, that source will be shut off.  The district will immediately inform parents of that school community as soon as results are known and will continue to inform the parents as testing and reports are issued. 
The district will take every precaution to ensure the safety and well-being of all of our students and staff.
Morgan School Results
The district verbally received the first sample results for Morgan School late Thursday, April 7, 2016, after school hours.  Some of those samples tested above the acceptable levels for lead.  In order to take every precautionary measure, the decision was made to shut off all drinking fountains and faucets used for drinking pending the results of the second samples and the written report.  The district requested the expedited return of the second samples and written report for Morgan.
The district immediately arranged for bottled water for Morgan students and staff on Friday morning and by the afternoon, water coolers were delivered.    All cooking for food service at Morgan will be done off-site with only heating of food on site. The first samples indicated the kitchen faucets are within acceptable levels, but we will continue to cook off site until the issuance of the final written report.  
Greenwood School Results
The district verbally received the first sample results for Greenwood School Friday morning, April 8, 2016.  Those results showed that one of the drinking fountains tested above the acceptable levels for lead.  The district immediately shut off the water to that one drinking fountain pending results of the second sample and final written report.


Posted by tammyduffy at 7:08 PM EDT
Updated: Sunday, 10 April 2016 7:18 PM EDT
Friday, 8 April 2016
MCCC Gallery to Host “Visual Arts Student Exhibition” April 11 to May 3 Community Invited to Opening Reception April 13


MCCC Gallery to Host “Visual Arts Student Exhibition” April 11 to May 3
Community Invited to Opening Reception April 13
Visual Arts students at Mercer County Community College (MCCC) are ready to shine as the Gallery at Mercer presents the final show of its 2015-16 season.  The annual “Visual Arts Student Exhibition” is on display from Monday, April 11 to Tuesday, May 3, and is free and open to the public. The Gallery is located on the second floor of the college's Communications Building on the West Windsor campus, 1200 Old Trenton Road.  
The community is invited to an Opening Reception on Wednesday, April 13, 5 to 7:30 p.m. 
The exhibition includes 69 works by 39 student artists.  Works are by students from all of MCCC’s visual and graphic arts programs, including Fine Arts, Advertising and Graphic Design, Digital Arts, Photography and Sculpture.
“This show reflects the evolution of our student artists, whose very best works have been selected for display. It also gives the arts programs an opportunity to invite families, other students, and the wider art community to view the talent and creative expression of our diverse mix of students, some of whom are emerging and others who have been producing work for decades,” said Dylan Wolfe, MCCC Gallery Director.  “We fully expect visitors to appreciate the range and depth of this exhibit.” 
Featured students artists include: Ivana Airo of Allentown, Jonathan Barbosa of Lawrenceville, Michele Bouchard of West Windsor, Priscila Cervilieri of Pennington, Sue Chiu of Lawrenceville, Anna Cook of Hamilton, Jennifer Dalle Pazze of Titusville, Katja De Ruyter of Princeton, Chase Blanchard Easley of West Windsor, Daisy Elmes of Ewing, Lynne Faridy Levittown, Elda Funez of Robbinsville, Nayab Goraya of Cranbury, Amanda Hutton of Ewing, Megan Jean of Burlington, Jo Krish of Princeton Junction, Ronald A. LeMahieu of Princeton, Taylor Leonardo of Hamilton, Aisha Lopez of Lawrenceville, Concetta A. Maglione of West Windsor, Lizzie Mayer of Allentown , Suzanne Migliori of Groveville, Gabi Muenzel of Plainsboro, Kathleen Nademus of Fords, Ghislaine Pasteur of Princeton, Michelle Perkins of Pennington, Rachelle Nielsen Picarello of Lawrenceville , John Pietrowski of Ewing, Danielle Rackowski of Hamilton, Uriel Levi Richman of East Windsor, Regina Ritter of Trenton,  Benjamin Schachter of East Windsor, Nevin Schleider of Mercerville, Christa Schneider of Princeton, Courtney Smith of Hamilton, Ruth Strohl-Palmer of Crosswicks, Alyssa Udijohn of Trenton, Lucinda Weller of Trenton, and Joan Wheeler of Shamong.

Gallery hours are Mondays through Thursdays, 11 a.m. to 3 p.m., with Wednesday hours extended until 7 p.m.  More information about this and other exhibits at the MCCC Gallery is available at www.mccc.edu/gallery.  Directions to the campus and a campus map can be found at www.mccc.edu.

Posted by tammyduffy at 6:28 PM EDT
Family Fun Day of Free Art and Entertainment at HAM


 Family Fun Day of Free Art and Entertainment at HAM

Enjoy an afternoon of arts and entertainment at the Hunterdon Art Museum’s annual HAM It Up! community day on Sunday, May 1 from 1 to 4 p.m.
This year’s free HAM It Up! event invites children and adults to participate in an assortment of family-fun art projects on the Museum’s Terrace. Guests can paint a wooden fish and add it to a large 3-D fish tank, or get inspired by the Raritan River to help create a mural on the Museum’s popular giant chalkboard. (Ever wonder what an octopus or whale would look like swimming in the Raritan River? Well, come draw them on the wall!)
Guests can also make jewelry, paper-bag hats and create Monet-inspired watercolor paintings. Easels will be set up on Lower Center Street where adults and children can stop and paint various still lifes.
HAM It Up! features live music with Raritan Valley Recovery, a talented acoustic band that performs a variety of traditional and contemporary music, and the award-winning Macheis Wind, whose music has been called brilliant and artistic. The Millstone River Morris Dancers will also entertain. 
Anyone who’s ever wanted to try spinning plates, ropes or a Chinese yoyo will enjoy visiting with performer Brenn Swanson. She’ll also teach everyone how to juggle and twist balloon animals.
Everyone can stop by and greet the alpacas from Bluebird Alpaca Farm of Peapack, NJ.
Flavorganics, lead sponsor of HAM It Up!, will offer samples of its organic syrups to please your palate. Additional HAM It Up! sponsors are Unity Bank and Citispot Tea and Coffee.
The event will be held rain or shine. Please note that much of Lower Center Street will be closed to traffic during the event.
Participating HAM faculty members are: Linda Schroeder, Joe Agabiti, Wendy Hallstrom, Amanda Esposito, Matt Esposito, Duffy Dillinger, Jim Pruznick and Leah Cahill.

For more information, visit the Museum’s website at www.hunterdonartmuseum.org or call 908-735-8415.

Posted by tammyduffy at 6:24 PM EDT
Friday, 1 April 2016
Hamilton Leadership Ignores Lead Laws



Hamilton Leadership Ignores Lead Laws


By Tammy Duffy





The man-made drinking water crisis in Flint has made international headlines. For more than a year, state officials -- from Gov. Snyder to his appointed Flint emergency managers to the Michigan Department of Environmental Quality -- exposed an entire city to the risk of lead poisoning in their drinking water. It's a public health catastrophe with long-lasting consequences for the children under the age of six in Flint who will suffer neurological damage for the rest of their lives. 


A Hamilton resident, age 4, died in his sleep Sept. 25 from EVD68. In 2014, the United States experienced a nationwide outbreak of EVD68 associated with severe respiratory illness. For months prior to the death of a Hamilton resident, there was a nationwide epidemic occurring. The CDC was contacting the nation and health workers on how to help elevate this epidemic in towns. Several health departments and mayors in towns in Mercer county, not including Hamilton, were proactive in educating their schools, residents know what to do as it pertained to hand washing and cleanliness. The township of Hamilton was silent on this issue.  There were zero proactive measures made during the EVD68 outbreak. It was not until after the death of a 4 year old resident that the local health department and mayor made any type of announcement or educated the community.


During several of the press conferences, after the death of a resident, the mayor of Hamilton Township, stated, "Does anyone even know what EVD68 is?  This was a startling statement for residents. How can the leader of a town, when a nationwide epidemic is occurring not know about it?  This same leader was oblivious to the fact that there was a heroin epidemic in her own town and named her town, "the Big H" at another press conference. "The Big H" is the street name for heroin. What does this leader know about the lead crisis in America?  There is zero information on the township website to educate residents on what to do for their children as it pertains to lead in the water. Upon calling the HAMSTAT headquarters and the Department of Health in Hamilton we learned that there are nothing as well. The people we spoke to knew of no programs, mandatory testing or could speak to the results demonstrated in the NJ State Department of Health report. Is Hamilton the next Flint? Why are the children not being tested? Where is the plan to protect the residents?


N.J.A.C. 8:51A requires the protection of children less than six years of age from the toxic effects of lead exposure by requiring lead screening pursuant to N.J.S.A. 26:2-137.2 et seq. (P.L. 1995, c 328.  An EBLL: Elevated Blood Lead Level  is 10 µg/dL or greater.


The number of children tested for lead in NJ as 220,787, which represents an increase of 2.9% over the 214,478 children tested during SFY 2011. The SFY 2012 number of children tested also includes 103,380 children, or 48%, who are between six and 29 months of age, the ages at which all children must be tested under State law.


While 213,020 (99.5%) children tested during SFY 2012 had blood lead levels below the Centers for Disease Control and Prevention (CDC) threshold of 10 μg/dL, there were 1,155 (0.52%) children with a test result above this threshold, including 236 children, who had at least one test result of 20 μg/dL or greater. In 2014, only 83% of the investigations of Pb levels above 20 μg/dL  in NJ were completed. However, only 48% of the abatements were completed according to a Department of Health report from 2014.  The reports states that this lack of follow up are occurring due to the following issues:


  • difficulty in identifying and communicating with absentee property owners
  • lengthy enforcement actions and court proceedings against recalcitrant property owners;
  • delays in contracting with and scheduling work to be performed by State-certified lead abatement contractors; and,  inability of property owners to obtain financial assistance to pay for the cost of the required abatement


In New Jersey, all children are to be tested at both one and two years of age. At a minimum all children should have at least one blood lead test before their sixth birthday. Approximately 78% of children in New Jersey have had at least one blood lead test prior to reaching three years of age. In Hamilton the numbers are significantly lower. The numbers are as low as 14% of children being tested. There was a new gun range built in a residential neighborhood in Hamilton, costing more than $500,000 according to sources. There are two other ranges within 3 miles of the town that the township police could use. Why was this money spent on a range vs. the children to get them tested?


Lead is a heavy metal that has been widely used in industrial processes and consumer products. When absorbed into the human body, lead affects the blood, kidneys and nervous system. Lead’s effects on the nervous system are particularly serious and can cause learning disabilities, hyperactivity, decreased hearing, mental retardation and possible death. Lead is particularly hazardous to children between six months and six years of age because their neurological system and organs are still developing. Children who have suffered from the adverse effects of lead exposure for an extended period of time are frequently in need of special health and educational services in order to assist them to develop to their potential as productive members of society. The primary method for lead to enter the body is the ingestion of lead containing substances.


Lead was removed from gasoline in the United States in the early 1980’s. This action is credited with reducing the level of lead in the air, and thereby the amount of lead inhaled by children. However, significant amounts of lead remain in the environment where it poses a threat to children. Some common lead containing substances that are ingested or inhaled by children include:


·         lead-based paint

·         dust and soil;

·         tap water;

·         food stored in lead soldered cans or improperly      glazed pottery

·         traditional folk remedies and cosmetics     containing lead.


All children in New Jersey are at risk because lead-based paint and other lead-containing substances are present throughout the environment. Some children, however, are at particularly high risk due to exposure to high dose sources of lead in their immediate environment.


These potential high dose sources include:  leaded paint that is peeling, chipping or otherwise in a deteriorated condition; lead-contaminated dust created during removal or disturbance of leaded paint in the process of home renovation; and  lead-contaminated dust brought into the home by adults who work in an occupation that involves lead or materials containing lead, or who engage in a hobby where lead is used. Recently, there has been much attention focused by the media on the increasing number of foreign imports coming into the United States being tainted with dangerous levels of lead.


This has been alarming especially when these imports consist of toys and other products used primarily by children. However, in New Jersey, today, the primary lead hazard to children comes from leadbased paint. In recognition of the danger that lead-based paint presents to children, such paint was regulated for residential use in New Jersey in 1971, and banned nationwide in 1978. There are numerous dollar stores in the township of Hamilton that carry many of these lead contained toys that the children are playing with. 

This ban has effectively reduced the risk of lead exposure for children who live in houses built after 1978, but any house built before 1978 may still contain leaded paint. The highest risk for children is found in houses built before 1950, when paints contained a very high percentage of lead. There are nearly one million housing units in New Jersey, 30% of the housing in the state, which were built before 1950. Every county in the State has more than 9,000 housing units built before 1950 and more than 2.5 million housing units built prior to 1980




New Jersey Takes Childhood Lead Poisoning Seriously By Acting Health Commissioner Cathleen D. Bennett Every day in New Jersey, in local health departments, community health centers, doctors’ offices, WIC clinics and in home visits with at-risk populations, health professionals test children for elevated lead levels and educate families about preventing lead poisoning, which can cause behavior and learning problems, lower IQ, hyperactivity, slowed growth, hearing problems, anemia and kidney damage. New Jersey is one of 17 states that require universal lead screening of all children at ages 1 and 2.


Other states target screening only to children at increased risk for lead exposure. New Jersey’s approach is far more protective. More than 205,600 children were screened for lead last year. And the number of children with elevated blood lead levels has dramatically declined over the past 20 years.


There were 27,295 cases in 2000 compared to 3,426 so far this year. That is a public health success story. More than 100 WIC clinics in New Jersey ask every mother and caregiver if their child has been tested for lead. If they have not, they are referred to a clinic or to their physician for testing. If their child’s test shows elevated levels, they are counseled on the importance of nutritious foods rich in Iron, Vitamin C and Calcium and warned about potential sources of lead exposure such as chipping paint and imported products. Each year, the Department of Health provides $11 million to the Department of Children and Families to support its evidence-based home visitation programs, which bring nurses, community health workers and, in some cases, trained parents into the homes of at-risk families to provide information and referrals on child health and safety issues including strategies to reduce exposures to lead. New Jersey’s poison control center, the New Jersey Poison Information and Education System (NJPIES), has used state funding for years to educate the public on lead poisoning and to counsel callers to its 24/7 hotline (1-800-222-1222). It has also issued numerous warnings about non-traditional sources of lead including imported candies, jewelry, cosmetics, spices, pottery and home remedies. The Department also funds continuing medical education so that health care providers understand how to identify lead poisoning. Yet, there is zero information in Hamilton to educate the residents.


After Superstorm Sandy devastated New Jersey—heightening the risk of lead exposure due to extensive debris from thousands of destroyed homes and businesses--the Department of Health asked the federal government for and received $5.4 million for a Lead Poisoning Prevention Initiative.


According to a report by the  N.J. Department of Health from 2014, the township of Hamilton demonstrated they had 1,814 children who were in the age bracket of 6 to 26 months of age. Only 22% of these children were tested for lead. These results demonstrate one of the lowest in the state out of the large municipalities evaluated.


  • 392 children in this age bracket were found to have lead levels below 5 BLL (µg/dL)
  • 9 children in this age bracket were found to have lead levels between 5-9 BLL (µg/dL)
  • 1 child in this age bracket were found to have lead levels above10 BLL (µg/dL)
  • Only 22% of the children were tested



N.J.A.C. 8:51A requires the protection of children less than six years of age from the toxic effects of lead exposure by requiring lead screening pursuant to N.J.S.A. 26:2-137.2 et seq. (P.L. 1995, c 328. So why is the Township of Hamilton ignoring this law?  Why are only 22% of the children being evaluated in Hamilton township, Mercer County?


According to a report by the  N.J. Department of Health from 2014, the township of Hamilton demonstrated they had 5,480 children who were in the age bracket of less than 6 years of age. Only 14.9% of these children were tested for lead in Hamilton township, Mercer County. These results demonstrate one of the lowest in the state out of the large municipalities evaluated.


  • 749 children in this age bracket were found to have lead levels below 5 BLL (µg/dL)
  • 18 children in this age bracket were found to have lead levels between 5-9 BLL (µg/dL)
  • 1 child in this age bracket were found to have lead levels above10 BLL (µg/dL)
  • 1 child in this age bracket was found to have lead levels between 20-44 BLL
  • Only 14.9% of the children were tested



New Jersey law (N.J.S.A. § 24:14A-6) requires Local Boards of Health to investigate all reported cases of childhood lead poisoning (N.J.A.C. § 8:51) within their jurisdiction and to order the abatement of all lead hazards identified in the course of the investigation. The procedures for conducting environmental investigations in response to a lead-poisoned child are specified in N.J.A.C. § 8:51.


The Local Board of Health must conduct an inspection of the child’s primary residence and any secondary address, such as a child care center, the home of a relative or babysitter, or wherever the child spends at least 10 hours per week. If the child moves, the property where the child resided when the blood lead test was performed must be inspected. The environmental inspection includes a determination of the presence of lead-based paint and leaded dust; the identification of locations where that paint is in a hazardous condition such as peeling, chipping, or flaking; and, as appropriate, the presence of lead on the dwelling’s exterior or soil. The inspector, with the public health nurse, speaks to the child’s parent/guardian and completes a questionnaire to help determine any other potential sources of exposure to lead. In addition, the Local Board of Health arranges for a home visit by a public health nurse to educate the parent/guardian about lead poisoning and the steps that he or she can take to protect the child from further exposure. The public health nurse also provides ongoing case management services to assist the family, including but not limited to, receiving follow-up testing, medical treatment, and social services that may be necessary to address the effects of the child’s exposure to lead.







Posted by tammyduffy at 8:02 AM EDT
Thursday, 31 March 2016





By Tammy Duffy


Crowdfunding, whether the target is financing a philanthropic initiative, an art project or a business proposal – is a sexy concept and has turned Kickstarter into a household name.


By pooling the resources of investors or donors with relatively tiny amounts of money to put to work, in numbers large enough to offset that small per capita sum – has helped get movies into development and launched new products.


The approach is akin to angel investing, with the key differences being that investors will get publicly traded stock and that angel investors tend to be savvy, experienced folks not looking at the deals they fund as a way to strike it rich. Most of them are already wealthy, having made millions as entrepreneurs or executives and who now are risking a relatively tiny portion of their net worth. Moreover, these angels typically are investing in a business in which they have some kind of specialized knowledge: An e-commerce angel might have been an early investor in eBay or Amazon.com, for instance, while someone putting a few thousand dollars into a health-care technology company is likely to have spent his career in that business and be familiar with what’s in hot demand and what technologies are likely to work.


But Kickstarter's most-buzzed-about projects -- the ones that blow through their funding goals and draw in thousands of backers -- have a spottier track record. Anecdotal reports abound of flawed products (try Googling "jellyfish death trap"), overambitious creators who can't pull off what they promised, and epic delays. An investigation found that 84% of Kickstarter's 50 top-funded projects missed their estimated delivery dates or never happen.


84% is a large number of potential scams occurring.


Like many of the projects it launched, Kickstarter is in some ways a victim of its own runaway success. Indiegogo does not have any better of a track record.  They both hide behind the cloak of their terms and conditions and take zero responsibility for what is going on. 


Kickstarter, founded in 2009 to fund "creative projects," the site wasn't intended to hatch things like new gadgets that require multi-million-dollar manufacturing lines in Asia. It began as a way for artistic types to raise a few thousand dollars for their gallery shows, records, and books.


"We had a lot of musicians and artists at first, and that's still 95% of the platform," says Kickstarter co-founder Yancey Strickler. "But we've always had a broad definition of 'creativity,' and that's led to some contemporary definitions of the word. Maybe it's not what Beethoven was doing, but if they had 3-D printers in his time, he probably would have been into it."


Such quips are common from Strickler, who looks like Central Casting's vision of a startup founder. He's got the requisite thick-rimmed glasses, casually floppy brown hair, and an omnipresent half-grin whenever he talks about the platform he created.


Thanks to the rise of crowdfunding, some amazing, otherwise impossible product ideas have made it to the masses. Risky, wildly imaginative, and innovative are some of the adjectives used to describe the most notable projects. At the time of writing this, Kickstarter has provided the means for $1.89 Billion in pledges towards 99,475 successful projects. Though Indiegogo’s statistics are kept private, you can bet their pledges are substantial as well.


A dark side to this is emerging, however; some of these campaigns are leaving their investors high and dry. Scammers are seeing these platforms as a way raise tons of money and then disappear without a trace. There are now numerous poorly-executed projects floating around the web, and even more exploited investors floating around right behind them. Just like investing in the “real world”, it has become critical that you perform your due diligence as a backer before throwing your money at the next big thing.


Thankfully we are seeing efforts to mitigate these dangers, from backers, authorities and the platform makers themselves.  Last year, a few developments set a new tone for accountability. Kickstarter hired Mark Harris, a well known tech journalist, to investigate the high-profile failure known as Zano. Zano raised an incredible $3.4 Million to bring their video recording drone project to the public. They failed not only to deliver on the actual product, but also failed to provide adequate transparency as to where the funds went or why backers still hadn’t received their drones.


To help the overall cause, last spring the FTC successfully pursued and settled charges with a different scammer who canceled his project and then used backers’ money to pack up and move.


Though most crowd funding supporters will agree that the defensive moves mentioned above do set a positive precedent in protecting backers, they are simply not practical in each case. Not every project is fortunate enough to be properly investigated, and even “verified” LinkedIn and Facebook accounts may not be effective to ensure you’re dealing with someone who is who they claim to be, or selling a product that exists in the form they suggest.


Take a good look at the prototype being offered. You must ask yourself: what credentials does the project creator possess? Besides having access to the technical resources, do they have the ability to manage the project from conception to fruition? What does your gut tell you about the project you’re looking to back? Or ask them – what do they tell you? If it seems too good to be true or too far out there, it likely is.


On the flipside, not every delayed project is automatically a scam either. Anyone who has worked in design, manufacturing, or development will tell you that “things” happen. Delays caused by issues sourcing specialized parts, inconsistencies in manufacturing quality, or shifting shipment timelines may all be genuine reasons to postpone a project. What is not acceptable, however, is refraining from explaining the reason(s) to backers and failing to keep them informed on how issues are being resolved.


It is up to you as a consumer and potential backer to invest wisely, just as if you were pouring capital into some risky new stocks. There is a bit of risk inherent with each project you back because there is only so much Kickstarter, Indiegogo, or GoFundMe can do in each case to ensure legitimacy, and even less to ensure success. Understandably, no one wants to spend their hard-earned cash on something that will never materialize. On the bright side, there’s still always Amazon.


Some Kickstarter scams:


Stone Tether: 6,927 backers pledged $366,199 to help bring this project to life.

Juicebee: 758 backers pledged $57,852 to help bring this project to life.

Agent Watch: 5,685 backers pledged $1,012,742 to help bring this project to life.

Coolest Cooler: 62,642 backers pledged $13,285,226 to help bring this project to life.


Indiegogo scam: Triton Gills: 2,409 backers pledged $878,180


Let the buyer beware.



Posted by tammyduffy at 7:32 PM EDT
Tuesday, 22 March 2016



Court: Sex Offenders Can Volunteer With Church Youth Groups

 A New Jersey appeals court has ruled that sex offenders subject to Megan's Law community notification requirements are not barred from volunteering with church-related youth programs.

In a published opinion issued March 22, a three-judge Appellate Division panel affirmed a trial judge's decision to dismiss a criminal charge against a convicted Somerset County sex offender, identified only as S.B., who is a volunteer with his church's youth group.


Appellate Division Judge Marie Lihotz, joined by Judges William Nugent and Carol Higbee, said the Legislature purposefully excluded church groups from the statute, N.J.S.A. 2C:7-1 to -23, that bars sex offenders from holding "a position or otherwise participate, in a paid or unpaid capacity, in a youth serving organization."


A Somerset County grand jury indicted S.B., who has a conviction for sexual assault involving a victim under the age of 18, for violating the statute, which is a third-degree crime punishable by a prison sentence of between three and five years.


S.B. is a congregant at the Eternal Life Christian Center in Somerset, according to the appeals court's opinion. He is a youth leader, counselor, mentor and chaperon for children ranging in age from 12 to 17 for the church's No Limits Youth Ministry. As such, he supervises children at outings, movie nights, concerts, youth group meetings and day camps.


Somerset County Superior Court Judge Julie Marino dismissed the indictment last June, finding that the youth ministry did not meet the definition of a "youth serving organization." The Somerset County Prosecutor's Office appealed.


"The sole question for our determination is whether a youth ministry associated with a church, where defendant is a congregant volunteer, is a 'youth serving organization' defined to 'mean a sports team, league, athletic association or any other corporation, excluding public schools, which provides recreational, educational, cultural, social, charitable or other activities or services to persons under 18 years of age,'" Lihotz said, quoting the relevant portion of the statute. "We conclude it is not and affirm."

Posted by tammyduffy at 8:06 PM EDT
Monday, 21 March 2016
Board of Education To Stop Cameras From Rolling


 I wanted to make you aware of a very important issue -
The BOE is meeting tonight and policy #0168 will be voted on. This policy is to turn off the cameras for all future meetings. They also will no longer be available on the district website or via Cable Access channels. It was suggested to just turn off the cameras just for the public portion but that was shot down.
If this is changed to audio how will it be disseminated to the public since we do not have a radio station? If it is placed on the district website audio will be very confusing to listen to since there are so many BOE members talking.
The vote will allow the public to record the meeting via audio or camera as long as the Board Secretary is given five days advance notice. Why would we want the public to have this access? The BOE should maintain complete control.
There is no doubt that grand standing can occur from the public due to the cameras. However, one could argue that many people do not speak because there are cameras. The best solution is to just turn the cameras off for the public portion. In an era where communication is a necessity why limit our access to the Board meetings? Many people do not have the time to attend the meetings and they watch via the website or cable. Now that will no longer be available.

Posted by tammyduffy at 8:21 PM EDT
Saturday, 19 March 2016
3D Breast Tomosynthesis, Not What it is Cracked Up To Be!




3D Breast Tomosynthesis

Not What it is Cracked Up To Be!






This article is the direct dialogue from a patient, who has a genetic ability to create microcalcification clusters, during her recent mammogram.  This patient also has a rare genetic mutation. The mutation is also evident in almost everyone from her father's side of the family.  They all have tested positive for the Met 30 gene.

The patient walks into the imaging center for her annual mammogram. She is actually 18 months late for her follow-up exam. She sees signs all over the waiting room, WE HAVE TOMO! As she is taken back to the room, the x-ray technician explains to her that they have a new mammo system that can do breast tomosynthesis. The patient is very well versed in this topic and says, "No, I do not want it, there is too much dose. The benefits are yet to be seen for my type of history."


The technician goes on to say," But it gives you a more complete exam. If we have to do extra pictures or magnification views , the dose from that is about the same as the tomo."  The technician was extremely pushy as it pertained to the tomo. There were signs all over the office about tomo, even in the dressing room. The signs explained that if you choose to have this done there is an extra charge, a charge that insurance may not pay for.  This is not a unique scenario, hospitals and breast centers that have tomosynthesis as pushing it hard.


Patient says," No, I will pass."


They go into the room and the mammogram is performed on a new GE system with tomo. No tomo is performed. At the end of the exam the technician says to the patient," I give you a lot of credit for pushing back on me about the tomo. This new system with tomo cannot see microcalcifiations. You still have to do magnification views even with the tomo. It's not a good test." If you would have said, "Yes, do the tomo." , we then have to charge you. The liklihood that your insurance would pay is unlikely. If, however, the doctor reads your films, and because this is a diagnostic mammo and not a screening mammo, says do tomo......there is no cost.


Does this make sense to you? A patient who has no idea what tomo is 9 times out of 10 has the right to order the test and be charged for it. If the doctor orders it, there is no charge. We thought this was unique for this facility. It is not. This is how it works everywhere. We called 60 sites.

So ladies, always say no......to tomo.....in the event a doctor wants to do it, let him/her order it, this way you are not charged. However, once you read this article, you will opt out of getting tomo, even if its free.  Many sites have not stopped charging for it due to the fact they have seen such a decrease in patients saying yes up front. Ladies unite....just say no.


The patient then smiled at the xray technologist. Knowledge is power, less dose and the patient gets a better exam in the end. This patient also does her due diligence on who is reading her exam.  You could have the best system in the world; but if a blind radiologist or someone how finished last in their class is reading your films, you could die. Every single woman who schedules her mammogram needs to ask, "Who will be reading my films that day?". They need to research the doctors and every year make sure their "wonder doc" reads their films.


The American public is being duped that this new technology, breast tomosynthesis  is the best thing since sliced bread. Insurance companies are being duped, or are they? This could be why many insurance companies won't pay for it.


Digital tomosynthesis (pronounced toh-moh-SIN-thah-sis) creates a 3-dimensional picture of the breast using X-rays. Digital tomosynthesis is approved by the U.S. Food and Drug Administration, for some medical device vendors, but is not yet considered the standard of care for breast cancer screening. Because it is relatively new, it is available at a limited number of hospitals and outpatient centers. There are not many PACS (picture archiving systems) that can display the digital tomo images. It is too much data. A special workstation is needed in this case, which leashes the doctor during the reading of these exams.  This creates havoc on the workflow of a hospital or imaging center.


Digital tomosynthesis of the breast is different from a standard mammogram in the same way a CT scan of the chest is different from a standard chest X-ray. Or think of the difference between a ball and a circle. One is 3-dimensional, the other is flat.

Mammography usually takes two X-rays of each breast from different angles: top to bottom and side to side. The breast is pulled away from the body, compressed, and held between two glass plates to ensure that the whole breast is viewed. Regular mammography records the pictures on film, and digital mammography records the pictures on the computer. The images are then read by a radiologist. Breast cancer, which is denser than most healthy nearby breast tissue, appears as irregular white areas — sometimes called shadows.


Mammograms are very good, but they have some significant limitations:

The compression of the breast that's required during a mammogram can be uncomfortable. Some women hate it, and it could deter them from getting the test.

The compression also causes overlapping of the breast tissue. A breast cancer can be hidden in the overlapping tissue and not show up on the mammogram.


Mammograms take only one picture, across the entire breast, in two directions: top to bottom and side to side. It's like standing on the edge of a forest, looking for a bird somewhere inside. To find the bird, it would be better to take 10 steps at a time through the forest and look all around you with each move.


Digital tomosynthesis is a new kind of test that's trying to overcome these three big issues. It takes multiple X-ray pictures of each breast from many angles. The breast is positioned the same way it is in a conventional mammogram, but only a little pressure is applied — just enough to keep the breast in a stable position during the procedure. The X-ray tube moves in an arc around the breast while 11 images are taken during a 7-second examination. Then the information is sent to a computer, where it is assembled to produce clear, highly focused 3-dimensional images throughout the breast.


Early results with digital tomosynthesis are promising. It does not work on fatty breasts at all. Yet, owners and manufacturers of these machines are aggressively marketing this test as the holy grail of cancer detection for al patients.  This is not the case.  Researchers believe that this new breast imaging technique will make breast cancers easier to see in dense breast tissue and will make breast screening more comfortable. This reminds me of when CAD (computerized added diagnosis) first came out for mammography. Will tomo be the new CAD? Many facilities hardly use their CAD devices anymore, they do not trust their accuracy and create more false positives. This drives up health care costs.


Why is the FDA approving this technology and allowing the behaviors to exist in the marketing of this product? Why is the FDA not doing follow up studies on these new technologies to see if they are draining the healthcare system?  If they add cost and do not make a positive impact on the health of patients then why have it? Once a device is approved its approved.  There is rarely follow up unless something bad happens to a patient from the device. This new technology is being actively marketed by vendors and mammography facilities as the best thing since sliced bread...however, bread it is not. 


Prior to making the mammogram appointment the patient was adamant about who would read her mammogram. This is an important step in the process. If the Stevie Wonder of mammogram readers reads your films, cancer could be your next experience. The patient fully trusting the doctor who is reading her films, sat in the dressing booth awaiting her results.


The doctor came out, who is very well respected in the world of mammography and radiology said, "No additional films are needed, you are all good. This new tomo system we have cannot see microcalcifications with the tomo, its not a good technology," the doctor said.


So why can't they see the microcals using a technique that takes "slices" and dices of your breast?  They cannot see the edges, they are all blurry of the calcifications. This is not good.


3d breast tomo manufacturers vary the arc of movement (typically 11-60°), the number of individual exposures (typically 9-25), use of continuous or pulsed exposure, stability or movement of the detector, exposure parameters, total dose, effective size of pixels, X-ray source/filter source, single or binned pixels, and patient position. These theoretical and engineering decisions may lead to different clinical outcomes and different reading recommendations for the different manufacturers. Of particular importance is the assessment of microcalcifications and whether one attempts to accurately depict microcalcifications by DBT. Because of the limited angle of scanning, the images are only “quasi” 3D. The x-y plane perpendicular to the x-ray beam has the highest resolution. There is less resolution in the parallel plane or z axis. One may reconstruct the data set for the radiologist to read by displaying different thicknesses. For example, if a 60 cm compressed breast is reconstructed at 1 mm thickness, there will be 60 slices for the physician to review. If the images are reconstructed at 0.5 mm thicknesses, there will be 120 images to be reviewed. If the images are reconstructed at 10 mm thick “slabs” using maximum intensity projection (MIP) thick slices, there will be 6 images to review.


This below is a snapshot from one vendors product brochure that is available on the web.


  • SenoClaire uses ASiRDBT, a calcification artifact correction iterative reconstruction algorithm that delivers off-plane images much improved in terms of both in-plane and out-of-plane artifacts versus the traditional Filtered Back Projection (FBP) algorithm. 
  • SenoClaire’s 3D MLO sequence requires only nine exposures with an even distribution of the dose. 
  • The SenoClaire grid in 3D reduces scattered radiation while preserving dose and performance. 
  • The dual-track X-ray tube (Mo/Rh) delivers optimized X-ray spectra to penetrate the breast based on breast density and compressed breast thickness. Automatic Optimization of Parameters (AOP) helps you identify the densest breast regions and automatically selects the appropriate anode, filter, kV and mAs to ensure repeatable image quality at optimized radiation dose.


The dose is the same for each of the 9 exposures the systems takes. This is radically unacceptable. The system can only evaluate the breast in that instant of the exposure.  A standard technique and dose is used, no matter that the issue characteristics are at each angle that the system takes a picture. Again, this is radically unacceptable.  The exposure is cut off prematurely to rush to the next exposure.  God knows what data is actually collected. The systems specifications go on to say that they use Mo/Rh to best optimize the spectra, based on breast density and compressed thickness. This is a target filter combination utilized in mammography. The Mo/Rh will not correct for the use of the same dose for each angled projection. There are many target filter combinations used in mammography, Mo-Mo, Mo-Rh, W/Rh, etc.


This technology at best is completely contradictory and incomplete. A woman should not be subjecting herself to unnecessary dose to say, "I got my 3d mammo."  This is not to point the finger at one vendor, all of the systems currently in clinical use demonstrate these same type of contradictory, incomplete characteristics. The global public has been tricked into thinking 3d tomo for mammo is and should be standard practice. The mammmography facilities are pushing this hard.


A major consideration for DBT (digital breast tomosynthesis) manufacturers and regulators is the balance between dose and image quality. Because image quality tends to be directly related to dose, compromises are necessary. All manufacturers have produced equipment with dosing parameters less than current FDA limit of 300 millrads per exposure. Common conventional mammographic dose per view is 150-250 millirads. However, achieving lower doses is optimal. Variations in target filter, breast thickness, and breast density further complicate this analysis. However, if DBT could lead to reduction in recall rate or improvement in sensitivity and specificity, a minimally higher dose may be acceptable.

Reconstruction techniques include shift-and-add, tuned aperture computed tomography, matrix inversion, filtered back projection, maximum likelihood reconstruction, and simultaneous algebraic reconstruction technique. Certain reconstruction methods may be better for masses and other methods better for calcifications. They use one algorithm for all types of tissue, which is not stellar. 

These are old techniques, where is the innovation>  Once an facility decides to invest in the technology (there 3D technology is creating quite the competitive market between facilities, they feel as if they have to have it to get patients) they are biased to use the machine.


There is also only one algorithm used in the post processing of the images for all types of tissue with DBT. This is not optimal either.  The problem is "scale-space". Scale-space theory is a framework for multi-scale signal representation developed by the computer vision, image processing and signal processing communities with complementary motivations from physics and biological vision. It is a formal theory for handling image structures at different scales, by representing an image as a one-parameter family of smoothed images.


The creators of these machines need  a matched filter for each scale of concern, from tiny microcalcifications to bigger calcifications to smaller masses to larger masses - the optimal filter varies as a function of size. This is not what the current machines can do. None of them. So what use is the technology?  Corporations have spent millions of dollars to develop systems that are not optimal.


There are other technologies on the horizon that use honey-combed detectors, and other types of imaging, including the use of contrast, that have demonstrated in research some promising results. The current technologies and those in the works utilize a detector that have 50, 70 or 100 micron resolution in size.  None of which are useful for 3d breast tomo. One cannot obtain the crystal clear margins of a microcalcification using tomo at 50,70 and 100 micron resolution. There is some promise with contrast enhancement and spectral imaging, but its too early to say whether this is useful technology. However, there needs to be absolute proof that the true positive and true negative performance of the contrast enhanced systems  are  in comparison with (or in combination with) other settings/modalities.

One manufacturer is focused on spectral breast density measurements. A published white paper demonstrates that the results of the phantom study suggest that photon counting spectral mammography systems may potentially be implemented for an accurate quantification of volumetric breast density; the study resulted in a  root-mean-square (RMS) error of less than 2%, using the proposed  spectral imaging technique.

Accurate density estimation (purported risk estimation) is an intermediate  goal. The end goal remains high accuracy: true positives and true negatives. The intermediate goal may bias a decision not to investigate further (save a buck where possible), but the end goal is the holy grail,isn't it? I would want to see a benefit of using the former to get to the latter.  An alternative may be - go directly for the latter.

It is the shared goal is to save the most lives possible from breast cancer, the American College of Radiology (ACR) and Society of Breast Imaging (SBI) continue to recommend that women get yearly mammograms starting at age 40. New American Cancer Society (ACS) breast cancer screening guidelines, and previous data used by the United States Preventive Services Task Force (USPSTF) to create their recommendations, state that starting annual mammography at age 40 saves the most lives.


“The ACS has strongly reaffirmed that mammography screening saves lives. The new ACS guidelines show that if a woman wants to reduce, as much as possible, her risk of dying of breast cancer, she will choose yearly mammography starting at age 40. A recent study in the British Medical Journal confirms this, showing that early detection of breast cancer is critical for improving breast cancer survival, regardless of therapy advances. Moving away from annual screening of women ages 40 and older puts women’s lives at risk,” said Debra Monticciolo, MD, FACR, chair of the American College of Radiology Breast Imaging Commission.


The ACR and SBI agree with the ACS and others that overdiagnosis claims are vastly inflated due to key methodological flaws in many studies. Overdiagnosis is likely 1 to 10 percent — largely due to inclusion of ductal carcinoma in situ (DCIS). Few, if any, invasive cancers are over-diagnosed.

Pulished research shows that nearly all women who experience a false-positive exam endorse regular screening and want to know their status. The ACR and SBI agree with ACS that women 40 and older should have access to mammograms. We also recommend that women, 40 to 45, get screened and would expect that mammography critics would agree that Medicare and private insurers should be required to cover women 40 and older for these exams,” said SBI President, Elizabeth Morris, MD, FACR.


While ACS states that transitioning to biennial screening is an option for older women, they note that either one or two year intervals would be appropriate as a woman ages. The ACR and SBI strongly encourage women to obtain the maximum lifesaving benefits from mammography by continuing to get annual screening.


The ACR and SBI commend ACS for using the modern IOM guideline development process — which is more trustworthy than the antiquated USPSTF methods. The ACS performed an extensive evidence review, including randomized control trials, population-based observational studies, case-control studies and cohort studies. This goes beyond the USPSTF limited review of only selected studies that underestimate the lifesaving benefit of mammography screening. Many of those studies were decades old and used what would now be considered outdated equipment.


The ACS included individuals on its panel who have experience in breast cancer and sought input from breast cancer experts. The USPSTF methodology lacks transparency, has limited input from cancer experts and does not engage all stakeholders which are needed to form meaningful and trustworthy guidelines.


Reading mammograms is about picking out malignant abnormalities from a sometimes confusing field of patches and threads and spots. In up to 1 in 2 women, dense tissue makes it even more difficult. 


Women with dense breast tissue — the sort that can hide potentially deadly tumors from routine mammograms — must be notified in writing and encouraged to consider additional tests under a new state law that is effective Monday.

While mammograms remain the gold standard for detecting breast tumors, they're less reliable in almost half of women with dense breast tissue. Dense or fibrous tissue shows up as splotches of white on a mammogram — so do tumors.


Digital breast tomosynthesis (DBT) is a new technique in the clinical breast imaging armamentarium that uses low-dose images obtained at multiple angles to reconstruct thinslice images through the breast. The Selenia Dimensions (Hologic) received United States Food and Drug Administration (FDA) approval on February 11, 2011, and other manufacturers are also developing breast tomosynthesis equipment.


Implementation of DBT into a clinical breast imaging practice requires consideration of image acquisition, interpretation, storage, technologist and radiologist training, patient selection, billing, radiation dosage, and marketing.


Patient positioning and breast compression are similar to conventional mammography. For each projection, the technologist positions the patient’s breast in mammographic compression just as for conventional mammography. The patient is instructed to hold her breath, and the x-ray tube source moves through a 15° arc with pulsed exposures to acquire 15 low-dose projection images, moving 1° between each projection image. One tomosynthesis unit uses a tungsten anode and aluminum filtration to obtain these 15 low-dose projection images. This takes approximately 4 seconds, and the grid is out during acquisition of the projection images. While the breast remains in compression, the patient is instructed to breathe out as the grid is returned and to breathe in and hold her breath while the conventional 2D full-field digital mammography (FFDM) image is acquired using a tungsten anode and rhodium filtration. For larger breasts, silver filtration is used for the FFDM images to provide better penetration without increasing exposure time. The compression paddle automatically releases and the patient is instructed to breathe normally. The entire process for acquisition of the 15 projection images and the conventional 2D image takes approximately 12 seconds, not significantly longer than the time required to perform FFDM alone. The technologist then positions the patient’s breast in compression for the next view. For a bilateral screening mammogram incorporating tomosynthesis, the patient is positioned and compressed four times to create bilateral craniocaudal and bilateral mediolateral oblique views using both tomosynthesis and conventional 2D FFDM imaging. With tomosynthesis, the use of radiopaque markers on skin lesions or nipples that are not in profile is no longer necessary. Some practices exclude women with implants from undergoing tomosynthesis imaging. Interpretation of DBT Images Raw data from the 15 tomosynthesis projection images obtained in each projection (craniocaudal and mediolateral oblique projections bilaterally) are reconstructed into a stack of tomosynthesis slices separated by 1 mm and oriented parallel to the plane of the mammography machine’s platform. These tomographic slices are displayed on the tomosynthesis vendor’s proprietary workstation for interpretation. The radiologist can scroll through each stack of images manually or in a dynamic cine mode. The number of tomosynthesis slices for interpretation is equal to the thickness of the patient’s breast in compression plus five. Five additional slices are added on the compression paddle side of each stack of images to ensure that the entire breast is imaged because the compression paddle’s location is mobile to accommodate various-sized breasts. On the platform-receptor side of the stack, no additional slices are necessary because the platform-receptor’s location is fixed. This is important to understand to avoid misinterpreting a skin lesion on the cranial aspect of the breast (in craniocaudal projection) as an ovoid asymmetry within the breast tissue because it will occur five slices “into” the top of the tomosynthesis stack. The slice on which the caves of Kopans and Rusby  are in focus identifies the skin surface. This can also occur on the superomedial aspect of the breast in mediolateral oblique projections. Not surprisingly, radiologists require additional time to interpret the tomosynthesis images in addition to conventional FFDM images.


A prospective study of 10 radiologists with at least 17 months of experience using DBT in their clinical practice found that DBT plus FFMD interpretation required an average of 47% longer than the time needed to interpret FFDM alone in a clinical screening mammography setting. Another study found an average reading time of 77 seconds for DBT examinations versus 33 seconds for FFDM examinations  and a third reported 91 seconds for DBT plus FFDM versus 45 seconds for FFDM alone. This approximate doubling of interpretation times must be considered before a practice implements DBT.

Although interpretation time for mammography using DBT plus FFDM increases relative to interpretation time for FFDM alone, the reduction in recall rates when DBT plus FFDM is used [3–5] decreases the amount of time that radiologists devote to interpreting the recall examinations from a given population of screening patients. This can be considered “time accounted” to compensate for the increased reading time required to interpret the screening mammograms of that population using DBT plus FFDM. When an interpreting radiologist annotates an area of concern on a DBT slice, a screen capture of that slice is sent to the PACS and is displayed as an additional single annotated tomosynthesis slice. There is no currently commercially available computer-assisted detection system for DBT imaging. Conventional mammographic computer-assisted detection is available on the 2D FFDM images from combination imaging


In accordance with Mammography Quality Standards Act (MQSA) requirements, radiologists must undergo 8 hours of training in this new technology before interpreting DBT images independently. Several continuing medical education companies now offer the required 8 hours of DBT training.



Posted by tammyduffy at 2:48 PM EDT
Updated: Saturday, 19 March 2016 3:06 PM EDT

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