Saturday, December 31, 2005

Sumer's Radiology Site nominated for following categories in Annual Medical Weblog awards

The second annual Medical Weblog Awards! These awards are designed to honor the very best in the medical blogosphere, as decided by the readers of these fine medical blogs.
It's been another year filled with explosive growth, stirring debate, and excellent writing -- in a number of fields. Sumer's Radiology Site has been nominated in following categories. Sumer's Radiology Site is the only weblog to be nominated in three categories!! Thanks to all readers and visitors...

-- Best Medical Weblog
-- Best Clinical Sciences Weblog
-- Best Medical Technologies/Informatics Weblog

Click here to see the other nominees

Please note-Polls will be open from Tuesday, January 3, 2006 and will close at midnight on Sunday, January 15, 2005 (PST).

I ll put up the link shortly...

Friday, December 30, 2005

Image Quiz-GIT

Image Quiz

A 38 year old woman presented with dyspepsia. A Barium swallow was done. What is the diagnosis?

Answer-Sliding Hiatus Hernia
Winners-Jon Mikel, Sharon, Alireza, K Sudhakar

Leave your answers in the comments section. The correct answer and winners will be published on the site next week.

Monday, December 26, 2005

Ultrasound in Ascariasis

Ascaris lumbricoides is a common nematode infesting a major percentage of human beings worldwide. It grows to a maximum length of 35 cm. This species is host specific to human beings and lives longer (1-2 years) with in the small intestine.
However, as the bowel loops are just under the abdominal wall, the detection of intestinal ascariasis is difficult by routine abdominal probes. It demands the use of a higher frequency high-density probe of 5 - 10 MHz. The live worm on longitudinal section appears as a writhing tubular shadow having brighter margins described by some as 'strip sign'. There is a hypoechoic core producing the 'inner tube sign'. The coiled worm appears as 'spaghetti'. The cross-sectional picture is also characteristic of a tubular body described as the ring sign or bull's eye sign if seen with in the CBD or a narrow lumen.
Full article with images here(Full free text available)-
Ind J Radiol Imag 2005 15:1:107-108

Radiology Upcoming events from India

59th Annual Congress of IRIA (IRIA 2006),
ChennaiDates: 5-8 Jan, 2006
Feb 10-12, 2006:USCON XV,Lucknow
15 Feb 2006: Workshop on Neuromuscular Ultrasound
Organized by: RARE, Dr. PM VenkataSai at Chennai
18 Feb 2006: Diagnostic Imaging ConclaveVenue: The Leela, Mumbai

Sunday, December 25, 2005

Which speciality are you best suited?

Every year this time a lot of medical students finishing their internship from various hospitals and medical colleges come to me with their queries on which speciality is best suited to them. I came across this very interesting link in bmj. A must see for all physicians. Click here for some good advice and humour too...

Algorithm on Which speciality is best for you

via Clinical Cases and Images - Blog

Thursday, December 22, 2005

Few Important Questions in Obstretics For MD Radiology Examination

Continuing with the series to help Radiology Residents in various Medical colleges and Hospitals preparing for their final MD/DMRD/DNB examinations. Here are a few questions on obstretics-

  1. Role of USG in IUGR.
  2. US in diagnosis of ectopic pregnancy.
  3. Imaging of placenta and Grading of Placenta.
  4. Alimentary Tract lesions diagnosable in-utero.
  5. Role of US in 1st trimester bleeding.
  6. Radiological finding in IUD.
  7. Molar Pregnancy.
  8. Describe fetal circulation and discuss the high risk obs application of color doppler.
  9. Congenital brain abnormalities.

Keep studying!! Leave your queries in comments section and any suggestions are welcome.

Corpus callosum-Relationship to Acdemic performance

Morphometry of the corpus callosum in Chinese children: relationship with gender and academic performance.
Ng WH, Chan YL, Au KS, Yeung KW, Kwan TF, To CY
Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Shatin, Hong Kong, SAR.
The corpus callosum has been widely studied, but no study has demonstrated whether its size and shape have any relationship with language and calculation performance.
Apart from the normal average dimension of the different parts of the corpus callosum, thickness at the body-splenium junction in the average-to-good performance group was significantly greater than the below-average performance group in Chinese language (P=0.005), English language (P=0.02) and mathematics (P=0.01). The remainder of the callosal thickness showed no significant relationship with academic performance. There was no significant sex difference in the thickness of any part of the corpus callosum.
Full article at-

Handling a neonate for radiograph-needed or not needed?

Neonates do not need to be handled for radiographs.
Slade D, Harrison S, Morris S, Alfaham M, Davis P, Guildea Z, Tuthill D.
Department of Child Health, Llandough Hospital, Penarth, Cardiff CF64 4XX, UK.
The handling of sick neonates may have detrimental effects such as hypoxia or bradycardia. Such handling is inevitable due to the frequent need for practical procedures; however, minimising handling reduces these adverse events and may improve outcome. Radiography is one of the commonest procedures performed on neonates. Usually the infant is lifted and placed onto the radiographic cassette; however, modern incubators often incorporate a tray beneath the mattress in which the radiographic cassette can be placed without the need to disturb the infant. The under-tray method for taking radiographs may produce films of at least equivalent quality to the standard method. Since the standard method involves handling with potential desaturation and bradycardia, this technique should cease.
Full article in-

Wednesday, December 21, 2005

About Sumer Sethi

A webpage with links to my publications, books and information about my presentations is now available.

Check out-
About Sumer Sethi

Tuesday, December 20, 2005

Possible Hazards of marrying a Radiologist

Well believe it or not this is an editorial article from a prestigious Radiology Journal. It is a must read for all Radiologists and possibly they can share it with their family too. A MUST READ....
Just ponder over a few points from this article first, if you want read the full article click here
Linda R. Mirvis, MLS

"I’ve explained that a technician takes the
X-rays and a radiologist interprets the studies. I’m never fully
convinced my audience gets the point, however"

"When watching
television or a movie with your radiological significant
other, are X-ray films always hung backward or upside-down?"

"Then there are those situations, such as on an airplane, when
the dreaded question is posed: “Is there a doctor on board?”
Our spouses face the age-old dilemma: Does a radiologist
count? Should they wait to see if a “clinical” physician steps
forward before they decide? Should they ask the flight attendant
if there is a multislice CT or state-of-the-art MR on board
before they commit to volunteering?"

"My husband will sometimes point out animals and inanimate
objects in clouds, which just look like, well, clouds to me. He
tells me that he often sees animals, people, etc. in stomach and
colon contents while reading CT scans."
And much more-FULL ARTICLE HERE-
Applied Radiology, December 2005. Volume: 34 Number: 12 December 2005
All Radiologists and possibly their spouses are welcome to comment and possibly share a story!!

Saturday, December 17, 2005

Chest X-Ray in ICU setting

Thoracic Imaging in the Intensive Care Unit
Joel E. Fishman, MD, PhD; Steven L. Primack, MD
Physical examination is often difficult in the intensive care unit (ICU) setting and for many years has been complemented by the portable chest radiograph (CXR). The interpretation of portable ICU radiographs may also be difficult because of the limitations of applying optimal radiographic technique in the ICU setting, as well as the patient's condition and the presence of monitoring and other devices (either in or on the patient) that might obscure portions of the chest.
The American College of Radiology has addressed these issues in its Appropriateness Criteria, stating that a daily CXR is indicated for patients with acute cardiopulmonary problems and for patients on mechanical ventilation. In patients with a central venous catheter, a Swan-Ganz catheter, a feeding tube, or a chest tube placement, only postprocedure radiographs are indicated. Stable cardiac monitoring patients and those with purely extrathoracic disease require only admission films upon entry into the ICU.
Full article in-

Thursday, December 15, 2005


As far as possible, a uniform “style” is desirable for our radiology reports, because it prevents discordances in terminology between reports and portrays the section as a group of like-minded radiologists. This guide is a brief outline of desirable common features for our reporting terminology. This guide addresses “style”, as distinct from “content”. The radiology report is a formal medicolegal document that is often the primary means of communication between radiologist and referring physician, and therefore the terminology should be concise, clear, and pertinent.
Some very interesting points from the article-

The term “is evidence of...” should only be used for findings which are inferred and not directly observed. E.g., “No evidence of portal venous hypertension”. Conversely, it is inappropriate to say “no evidence of pleural effusion”, since the phrase “no pleural effusion” is preferable.

Avoid the adjective “significant”. E.g., “No significant adenopathy” – does this mean there is insignificant adenopathy?

Use the active rather than the passive tense. E.g., “The pancreatic head mass obstructs the common bile duct”, rather than “The pancreatic head masses causes obstruction of the common bile duct”.

The phrase “cannot be excluded” should be avoided as far as possible; it is a grammatically undesirable double negative, and is used differently by radiologists. E.g., stating “spiculated 4 cm lung mass, bronchogenic carcinomas cannot be excluded” when the actual intended meaning is “spiculated 4 cm lung mass, bronchogenic carcinoma is likely”. When a diagnosis is mentioned, but considered unlikely, other options are to state “x is a remote possibility/consideration” – this expresses the intended meaning without using an unwieldy double negative.

And many more practical points--



Pelvis CT in upper abdominal malignancy in children-is it a justifiable practise

CT in children with abdominal cancer: should we routinely include the pelvis?
Gnanasambandam S, Olsen OE
Radiology Department, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK,

It has been suggested that the pelvis should not be habitually included on abdominal CT examinations, but the potential benefit of such a practice in childhood abdominal malignancies is unknown.
From a paediatric tertiary referral hospital authors retrospectively included patients having abdominal CT for primary upper abdominal tumours (1997-2004), the scan range routinely including the pelvis. Their data suggest that diagnostically significant findings in the pelvis are rare; consequently, the habitual inclusion of the pelvis on abdominal CT for primary malignant tumours in the abdomen is not justified.
Full article at-

Monday, December 12, 2005

Why less women are opting for Radiology-RSNA News

Some points from the article in RSNA news dealing with a very interesting discussion on Why More Women are Not Choosing Radiology as a Specialty-
Both men and women rank direct patient contact and intellectual stimulation as the most important factors influencing career decisions. For those who did not consider radiology as a possible career, lack of direct patient contact was the most important factor. For women, competitiveness involved in obtaining a residency position was also important.
Most medicals students do not get any significant exposure to radiology as a career until late in the third year or early in their fourth year, often after they’ve made a career choice. Lack of exposure to the specialty and lack of radiologists as role models are also additional reasons for not choosing radiology as a specialty.
Another important issue is radiation safety, particularly pregnant residents.
Something from my side, isnt this high time that such an important subject as Radiology is introduced as a proper subject in Undergraduate medical school... atleast in India the exposure of undergraduates to this speciality is minimal.. any comments from the experts?
Full article at

Saturday, December 10, 2005

Role of contrast enhanced sonography in active bleeding

Active abdominal bleeding: contrast-enhanced sonography.
Catalano O, Cusati B, Nunziata A, Siani A.
Department of Radiology, Istituto Pascale, via Semmola, Naples, 80131, Italy,
Active contrast medium extravasation is a recognized and important angiographic and computed tomographic (CT) sign of bleeding. It is an indicator of active, ongoing, and potentially life-threatening hemorrhage and, hence, of the need for an immediate surgical or interventional treatment.
Sonography (US) is frequently used as the first imaging option for screening patients with traumatic and nontraumatic abdominal emergencies. Owing to the current possibilities of low-mechanical index, real-time, contrast-specific systems, it is now possible to detect a contrast leakage by using US. This finding opens new possibilities in the assessment and management of several abdominal emergencies, including trauma (initial workup and monitoring), spontaneous hematomas, and rupture of aneurysms or masses.
Full Article in-

Wednesday, December 07, 2005

Chest X-ray (CXR) teaching files

Chest radiology is one of the most interesting and challenging parts of Radiology. In particular CXR interpretation.
A useful link which is intended as a self-tutorial for residents and medical students to learn to interpret chest radiographs with confidence. Technique, normal anatomy and common pathology are presented. Quizzes are provided for practice and self-assessment.
Check out-

Medical Litigation issues and Mammography

Screening mammography, public perceptions, and medical liability.
Mavroforou A, Mavrophoros D, Michalodimitrakis E
Department of Forensic Sciences, University of Crete Medical School, 40 Daliani Street, 71306 Heraklion, Crete, Greece.
To outline the most common sources of raising malpractice claims in screening mammography and to discuss the related medical litigation issues in the light of the evidence-based medicine.
The most common cause of malpractice is the delayed diagnosis of breast cancer. The plaintiff must establish that the radiologist was negligent and the delay in diagnosis caused injury to the patient. Literature shows that mammography does not always detect breast cancer, and even skilled radiologists may periodically miss malignant lesions. Also, delay in diagnosis does not always affect treatment and prognosis.
Over-promotion of screening mammography has made disproportionately difficult for a defendant radiologist to prevail in a malpractice lawsuit.
Thus, screening mammography is at stake, although it saves lives. The public and legal system should be educated about biological processes, medical practice, and the limitations of screening mammography.

Full article at-
Eur J Radiol 2005 Nov 28; [Epub ahead of print]

Med School Curriculum

Well I have always believed that the medical school curriculum should be made more apt for a general physician and then let him specialize later on and thereby reducing probably a year of time in his undergraduation. Nowadays at least in India specialization is a must. Sometimes I wonder as a practising radiologist now... Why did I study Biochemistry, DNA Polymerases, etc in my med school......

Excellent thoughts here-

Saturday, December 03, 2005

Virtual Bronchoscopy

Virtual Bronchoscopy: Accuracy and Usefulness—An Overview
W. De Wever MD, , J. Bogaert MD, PhD and J.A. Verschakelen MD, PhD Department of Radiology, University Hospitals Gasthuisberg, Leuven, Belgium.
Multidetector CT generated virtual bronchoscopy (VB) represents one of the most recent developments in three-dimensional (3D) visualization techniques which allows a 3D evaluation of the airways down to the sixth- to seventh-generation. In comparison with real bronchoscopy, VB has some advantages: it is a non-invasive procedure that can visualize areas inaccessible to the flexible bronchoscope. Virtual bronchoscopy is able to evaluate bronchial stenosis and obstruction caused by both endoluminal pathology (tumor, mucus, foreign bodies) and external compression (anatomical structures, tumor, lymph nodes), can be helpful in the preoperative planning of stent placement and can be used to evaluate surgical sutures after lung transplantations, lobectomy or pneumectomy. In children, in some indications, VB can replace fiber optical bronchoscopy (FB) when this technique is considered too invasive. Finally, VB can also be used to evaluate anatomical malformations and bronchial variants. Virtual bronchoscopy is accurate but its accuracy is not 100% because false-positives and false-negatives occur. Virtual bronchoscopy contributes to a better understanding of tracheo-bronchial pathology. Fiber optical bronchoscopy will, without doubt, remain the golden standard but it can be expected that in the near future, the technique of VB will find a place in the daily routine.
Full article in-

Thursday, December 01, 2005

Imaging in Oncology-New horizons

PET/CT in oncology—a major advance
K. Wechalekar, B. Sharma and G. Cook
The concept of hardware fusion between positron emission tomography (PET) and computed tomography (CT) has only been introduced commercially in the last 4 years. The advantages of this combined technique over PET alone have become obvious. There is increasing evidence to suggest that PET/CT adds complementary information in staging, re-staging and follow-up in oncology patients, leading to changes in management plans. The present paper is a review of the strengths, weaknesses, current evidence and future directions of this technique.

Keywords: 18F-fluorodeoxyglucose; Positron emission tomography/computed tomography (PET/CT); Oncology
Full article at-

Residents are learners FIRST..

Well here is something which is close to my heart, i have always felt that learning should be the top priorty for a resident and his working hours should be adjusted according to this.
Same is reflected in a new Compact Between Resident Physicians and Their Teachers, which articulates the principles underlying the education of U.S. residents, was announced by the AAMC (Association of American Medical Colleges) in November-2005.

The AAMC initiated the development of the compact to re-focus attention on the primary goal of U.S. residency training-physician education-following the ACGME's imposition of restrictions on resident duty hours in 2003. The compact, which will be sent to all residency programs directors and their institutional sponsors this month, articulates the three core tenets of graduate medical education:

  • Residents are, first and foremost, learners
  • Residents must learn in clinical settings that embody the highest standards of medical practice and patient safety
  • Residents' well being must be a high priority.

Read the full text here-

Medical Education is Core Focus of Landmark Compact for Residents and Faculty

As expected Doctors say sonography should be done by sonographers not actors!

DOCTORS have warned Tom Cruise to stop carrying out ultrasound scans on his pregnant fiancee Katie Holmes...

Full Article on-

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