Thursday, March 30, 2006

No Breast Cancer risk after Mammography

Mammogram Radiation Does Not Raise Risk of Cancer in BRCA Mutation Carriers
"Exposure to radiation through screening mammography does not contribute substantially to the burden of breast cancer in BRCA1 and BRCA2 mutation carriers, even when screening begins at an early age, investigators report in The Lancet Oncology, published online on March 22. Because BRCA mutations disrupt the repair of DNA damage, it was feared that DNA-damaging radiation from mammography would increase these patients' risk."
Reference-Reuter's Health

Monday, March 27, 2006

Clinical Experience versus working hours-what is the right balance?

European Working Time Rules ‘Make It Impossible To Train Doctors Properly'
"The European working time directive, which limits the hours employees are allowed to work, means junior hospital doctors cannot receive the training they need to become a consultant gastroenterologist, according to results of a survey presented at the Annual Scientific Meeting of the British Society of Gastroenterology. A survey of Specialist Registrars (SpRs) in gastroenterology found that limits to working hours meant that they missed out on a quarter of the clinics they were supposed to attend and a third of the ward rounds led by a consultant."
Well then what is the solution i have always believed working hours of a resident should be something which allow him to learn and work side by side. How do we strike a balance between gaining work experience and healthy working hours? Comments welcome...

Diffusion Tensor Imaging in Schizophrenia

Diffusion Tensor Imaging
Kelvin Lim is using a new brain-imaging method to understand schizophrenia.

By Emily Singer

"Flipping through a pile of brain scans, a neurologist or psychiatrist would be hard pressed to pick out the one that belonged to a schizophrenic. Although schizophrenics suffer from profound mental problems -- hallucinated conversations and imagined conspiracies are the best known -- their brains look more or less normal. This contradiction fascinated Kelvin Lim, a neuroscientist and psychiatrist at the University of Minnesota Medical School, when he began using imaging techniques such as magnetic resonance imaging (MRI) to study the schizophrenic brain in the early 1990s.Then, in 1996, a colleague told him about diffusion tensor imaging (DTI), a newly developed variation of MRI that allowed scientists to study the connections between different brain areas for the first time. His group has recently found that memory and cognitive problems associated with schizophrenia, major but undertreated aspects of the disease, are linked to flaws in nerve fibers near the hippocampus, a brain area crucial for learning and memory."
Reference

Sunday, March 26, 2006

Gaolinium-Neurotoxicity??

In an article by Maramattom BV et al, Gadolinium encephalopathy in a patient with renal failure in Neurology 2005 Apr 12;64(7):1276-8 authors discuss a case of gadolinium encephalopathy.
"Gadolinium chelates are extensively used in MRI studies. Neurotoxicity due to gadolinium chelates is minimal and uncommon. A 57-year-old woman in renal failure developed a subacute encephalopathy after inadvertent repetitive gadolinium contrast administration. An unusual MRI appearance with CSF hyperintensity due to gadolinium diffusion into the CSF is also shown"

Friday, March 24, 2006

FRCR 1 Sample MCQs and syllabus

First FRCR Examination in Clinical Radiology
Sample MCQs

The bold headings indicate the section of the syllabus that the question addresses.

1.1 Basic Physics
1 In the Compton effect:
(a) There is interaction between a photon and a free electron.
(b) The larger the angle through which the photon is scattered, the more energy it loses.
(c) The wavelength change produced depends upon the scattering material.
(d) High energy radiation is scattered more than lower energy radiation.
(e) The amount of scattering that occurs depends on the electron density of the scattering material.


1.2 Radiation Hazards and Dosimetry
2 Concerning radiation dose:
(a) PA chest x-ray effective dose is approximately 0.02 mSv.
(b) Annual effective dose limit for members of the public is 5 mSv.
(c) Average annual dose in the UK from natural background radiation is 0.1 Sv.
(d) The average annual effective dose to the UK population from medical exposure is 3 mSv.
(e) Effective dose to patients having a radionuclide bone scan with 600 MBq technetium-99m is approximately 4 mSv.


2.1 General Radiation Protection
3 In diagnostic radiology, the following values are typical:
(a) 5 mSv is the annual effective dose limit for classified staff.
(b) 1 mGy for skin dose to the patient in chest radiography.
(c) 2 mm lead equivalence for a lead rubber apron.
(d) 25 mGy per minute for entrance dose rate to patient during abdominal fluoroscopy.
(e) 4 GBq of iodine-131 for a diagnostic thyroid scan.


3.1 Ionising Radiations Regulations 1999
4 An employee must become a classified worker if
(a) they work more than three sessions per week with ionising radiation.
(b) three tenths of relevant dose limit is exceeded.
(c) they are likely to receive a whole body dose greater than 6 mSv annually.
(d) the dose to their hands is likely to exceed 150 mSv annually.
(e) they become pregnant.


3.2 & 3.3 Ionising Radiation (Medical Exposure) Regulations 2000 and Other Relevant Legislation
5 Regarding The Ionising Radiation (Medical Exposure) Regulations 2000 [IR(ME)R]:
(a) Overall responsibility for keeping dose to the patient as low as reasonably practicable rests with the practitioner.
(b) The practitioner is the only person entitled to authorise an x-ray exposure.
(c) Only doctors and dentists are permitted to request an x-ray.
(d) The person performing quality control tests on an isotope calibrator must have training as required by IR(ME)R.
(e) The enforcing authority for IR(ME)R is the Health and Safety Executive.


4.1 Diagnostic Radiology
6 Radiological image unsharpness increases
(a) if shorter exposure times are used.
(b) as the object to film distance increases.
(c) as the target angle decreases.
(d) if a grid is used.
(e) as the focal spot size increases.


4.2 Fluoroscopy and Fluorography
7 In automatic mode fluoroscopy, the patient entrance surface dose rate
(a) usually increases with image intensifier field size.
(b) depends on the added filtration.
(c) is independent of the kV-mA characteristic used.
(d) doubles if the patient-intensifier face distance is halved.
(e) should be less than 50 mGym-1.


4.3 Computed Tomography
8 Regarding computed tomography:
(a) A CT number of 0 is assigned to water.
(b) Image quality is limited by electronic noise.
(c) Axial image resolution is improved with reduction in slice width.
(d) An unfiltered x-ray beam is used.
(e) The typical effective dose for a CT head scan is 10 mSv.


4.4 Patient Dosimetry
9 The dose to a patient may be reduced by using
(a) a grid.
(b) collimators.
(c) additional copper filters.
(d) a high tube voltage.
(e) a small focal spot.


4.5 Radionuclide Radiology
10 Concerning radiopharmaceuticals:
(a) The ideal radiopharmaceutical should have as short a physical halflife as possible.
(b) The ideal imaging radiopharmaceutical should emit only gamma radiation.
(c) The gamma radiation emitted contributes a larger part of the radiation dose to the patient than any accompanying beta radiation.
(d) The effective half-life is longer than the biological half-life.
(e) The labelling isotope should remain attached to the tracer material throughout the examination.

Reference-

Google thinking about Healthcare

Google Health, what is it? by ZDNet's Garett Rogers -- It isn't a big surprise that Google is thinking about healthcare -- but now information suggests products or services for that industry are in the master plan.Adam Bosworth, former VP of Engineering at BEA Systems, is working at Google with the title "Architect, Google Health" according to the attendee list for PC Forum. [...]

Thursday, March 23, 2006

Using Google pages to create My Online Curriculum Vitae-All About Sumer Sethi

Here is an attempt to create my online CV using Google pages. Check out
Sumer Sethi's Home Page
http://sumerdoc.googlepages.com

Justification for Repeated Radiological Investigations Must

In a very touching letter to medscape a mother talks about her son's leukemia and his repeated CT scans for Head Injury 5 years back.
"After...years, the ordering physician or nurse is gone, the radiologist is gone, and the only one left is the patient, who received x-ray radiation as a child and now harbors a malignancy..."
This encapsulates the issue of the potential impact of CT radiation on children and to illuminate the river of resolve that lies beyond the sorrow over the loss of a little boy. Well somewhere down the line the responsibility for repeated CT scans has to be fixed and potential long term harmful effects should be taken into consideration.
Read the full story here-

Wednesday, March 22, 2006

Hippocampal atrophy in Alzheimer disease

In an article- Hippocampal atrophy in Alzheimer disease: age matters by Van de Pol LA et al in Neurology 2006 Jan 24;66(2):236-8. Hippocampal atrophy is a marker of Alzheimer disease (AD). It remains unclear whether this holds true for younger patients as well. Hippocampal volume was measured by MRI. Aging and AD were independently associated with smaller hippocampal volume. Both young and old AD patients have hippocampal atrophy abnormal for age. Age-dependent criteria for hippocampal atrophy, suggestive of AD, are needed.

Tuesday, March 21, 2006

Full Body CT scans-Risk of Radiation Exposure

"They promise to cut your risk of dying from cancer. Yet full-body CT scans themselves pose a real cancer risk, new calculations suggest. X-rays from a single full-body CT scan give a dose of radiation similar to cancer-associated radiation doses in A-bomb survivors, finds David J. Brenner, PhD, director of Columbia University's center for radiological research.
Richard L. Morin, PhD, chairman of the ACR's commission on medical physics, says that given lack of an established benefit, the risks Brenner identifies raise doubts about screening healthy people with full-body CT scans. "This paper is important in demonstrating explicitly that the risk from whole-body CT or any other diagnostic radiology exam is not zero," Morin tells WebMD. "It supports the thinking that screening whole-body CT scans of healthy individuals is not a wise course of action." "

Reference-CBS News (Via WebMD)

Thursday, March 16, 2006

Horseshoe Lung-A Rare Congenital Anomaly

Horseshoe lung is a rare congenital anomaly characterized by the presence of unilateral pulmonary hypoplasia and a midline isthmus bridging the right and the left lung. Almost all cases of horseshoe lung are associated with the scimitar syndrome. The scimitar syndrome, sometimes called the congenital pulmonary venolobar syndrome, is a rare but well-described constellation of cardio-pulmonary anomalies. The characteristic abnormality is anomalous pulmonary venous return from a part of or the entire right lung to the inferior vena cava.
Reference-
Horseshoe Lung Associated With Scimitar Syndrome and Pleural Lipoma.
Dikensoy, Oner MD; Kervancioglu, Resat MD; Bayram, Nazan Gulhan MD; Elbek, Osman MD; Uyar, Meral MD; Ekinci, Erhan MD

Wednesday, March 15, 2006

Leading Indian Newspaper reports the demand of security by Doctors

From the leading newspaper-The Hindu
Doctors demand security
Resident doctors at Lady Hardinge Medical College here have written to the Medical Superintendent demanding adequate security for doctors.
The letter comes in the wake of yet another incident of a patient's relative threatening an on-duty doctor at the hospital. "On March 13 around 10-30 p.m., Kalawati Saran Children Hospital's Paediatric-ICU was held hostage by a patient's relative with a gun in his hand threatening to shoot in case his already stable child was shifted from the ICU to the ward. This hostage drama paralysed routine work for about an hour and prevented emergency services. Agitated resident doctors complained to the police in the night but no action was taken. In the morning, doctors talked to the Medical Superintendent who forwarded the complaint to the police,'' said a member of the Resident Doctors' Association of the hospital on Tuesday.
"We are demanding that immediate action be taken against the culprit and that he be charged with attempt to murder. We are also demanding formation of a campus security council. A beat constable should be available round the clock on the campus,'' said the president of the Resident Doctors' Association of the hospital, Sumer Kumar Sethi.

Sumer Sethi opposes violence against Doctors

From the Newspaper Times Of India
"In yet another incident of violence against doctors, a 30-year-old man barged into the paediatric ICU at Kalawati Saran Children's Hospital with a country-made pistol and held the staff hostage for nearly two hours. An FIR has been registered at the Mandir Marg police station. The accused, Pappu, a Shakarpur resident, barged into the ICU at 10:30 pm on Monday and left only after midnight. He was reportedly in an inebriated state. His 18-month-old son, Vinayak, who was suffering from bronchopneumonia had been admitted to the ICU, but was shifted out to the ward after he became stable on Sunday. Pappu, then proceeded to take his son home against the advice of hospital doctors.
"He came back yesterday at night in a drunken state. Dr Navin Butt, who was the senior resident on duty at the ICU, has been left shaken after the incident. Why is that we have to always go on strike for our demands to be met?,"queried Dr Sumer Sethi, President, Resident Doctors' Association (RDA). The RDA has demanded that a beat constable be available round-the-clock in the college campus and that a campus security council be formed with representation of the area DCP, ACP, SHO, RDA, nurses and students. There have been several such incidents in the past couple of months which have even led to strikes at Lok Nayak and Guru Teg Bahadur hospitals. "

This Radiologist is going places!!

Radiologist throws hat in ring
Frank Macaluso Jr. eyes California governor's seat for the second time

"Frank Macaluso Jr. is married with children, lives in Exeter and works in Visalia as a radiologist. And he's hoping to become the next governor of California and has filed the necessary paperwork to run as a Democrat on the June primary ballot."

Unclassifiable Pelvic masses

Which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings and is there a way of making a correct diagnosis? By-Valentin L et al
"Papillary projections, >10 locules in a cyst without solid components, low-level echogenicity of cyst fluid, and moderate vascularization as assessed subjectively at color Doppler examination are found to be ultrasound variables associated with unclassifiable mass. Borderline malignant tumors proved to be most difficult to assess.Papillary cystadeno(fibro)mas, myomas and cases of struma ovarii were also more common among the unclassifiable masses.Borderline tumors cause great diagnostic difficulties, but so do papillary cystadeno(fibro)mas, struma ovarii and some myomas. "

Sunday, March 12, 2006

Leprotic Nerve Abscess-Sonographic Diagnosis, an Article in Applied Radiology By Dr Sumer K Sethi

The case report illustrates the sonographic appearance and management of nerve abscess, a rare complication exclusive to leprosy. Leprotic nerve abscess is an extremely rare manifestation of leprosy. However, in the appropriate clinical settings and with the characteristic sonographic appearance, a diagnosis of nerve abscess should be considered, especially in endemic areas.
Radiological Case Of the Month
Leprotic nerve abscess
By Sumer Kumar Sethi, MD; Ravi Shankar Solanki, MD; Vibhu Mendiratta, MD. Applied Radiology Volume: 35 Number: 3 March 2006 Pg-44-45.

Coffee and Radiologists

As all Radiologists will agree one intregal part of a Radiologists daily life is a cup of coffee, from Helping us concentrate for long hours of work, and fighting off drowsiness to socilaizing with other clinical counterparts; advantages are manifold.
"I think radiologists consume more coffee per capita than any other population group. I base this on my own personal experience and on the observed habits of a number of radiologists in this center. My control subjects are the other specialists who frequent the same coffee stands, and the other staff and visitors who wander by. As radiologists, we love coffee. We need coffee. We don’t trust those who don’t want it. "
Complete Article by C. Douglas Phillips, MD, FACR

Medical Education-New Directions

Something i have always wondered is being a genius or a great academics guy sufficient to be a good Doctor.. Is'nt it time that Medical Education looks into developing qualities as Compassion, caring for the patient and communication skills to the medical students.
Examining how medicine is taught - Reading and changing the culture
"Rigorous course work, state of the art laboratories, relevant textbooks and demanding clinical rotations produce technically competent physicians. But surveys say that in addition to highly qualified care givers, we want doctors who are compassionate and know how to communicate well when caring for us and our loved ones, yet the environment in which medical students become physicians is often not conducive to producing these caring qualities"
Read the Full Article here-

What do you have in Common with American Presidents?

Ok Ok agreed you are not the most powerful man in the world but you might be suffering for the same disease they suffered from.. Yes diseases dont spare even the American President..
"From George Washington's toothlessness (he has no teeth left by middle age), to Grover Cleveland's gout, to Franklin D. Roosevelt's polio, to Ronald Reagan's Alzheimer disease, and finally to George W. Bush's colon polyps, presidents throughout history suffer from the same diseases and ailments like the rest of us. "
For the interested, check the link below

Friday, March 10, 2006

Filmless Radiology

"Radiologists’ routine of gazing at dark images clipped on a wall-board and illuminated for easy reading is all but out of the picture at Advanced Medical Imaging. Silverdale-based AMI launched PACS — Picture Archiving and Communication System — last month and stopped producing film for 95 percent of the medical imaging it does. Internally, any new X-ray, CT (Computerized Tomography) scans and other images are now stored on a server with 2 terabytes of long-term archiving space. Another terabyte of memory in the newly installed Microsoft cluster of servers allows for quick retrieving of the AMI images over the Internet — locked away in a secure PACS gateway linked to AMI’s own Web site. Last week, AMI began distributing user names and passwords to area physicians who want to be able to look at the medical images they request with AMI. Every one of the doctors receives reports, but a few also want to see the images themselves, said Kurt Newcomer, AMI administrator. Those doctors now have the option of accessing all the images they’ve requested for any of their patients on the Internet."
Full Article at-

Wednesday, March 08, 2006

Gadolinium CT Angiography- an alternative in Renal failure

Remy-Jardin M et al evaluated Multi-detector row CT angiography of pulmonary circulation with gadolinium-based contrast agents: by prospective evaluation in 60 patients in Radiology 2006 Mar;238(3):1022-35. They concluded Gadolinium chelates may be used as an alternative CT contrast agent in patients who cannot receive iodine.

Radiology Residency-Trends over the years

Radiology Residents Rule! But What Happens Next?

Radiology has over years risen to the top most choice of the medical students choosing residency programmes. However, demands from a Radiologist have also increased over years, number of investigations done and expectations of a perfect diagnosis have also increased tremendously. Morever, the pay scalle difference between a university job versus a pvt practise career is too large and it is discouraging very bright students to take up university jobs as of now. I for myself would love to take a university job post my residency but the pay scale difference is very discouraging.

Since the 1970s, Radiology has been transformed from a helpful profession that may or may not have provided a definitive diagnosis, with no particular expectation of accuracy (at least from a legal standpoint), to the discipline it is today - ie, one that is expected to make the correct diagnosis with a 100% level of confidence.

Some extracts from an article in MEDSCAPE

"Radiology residents in the Unites States are:

  • Among the brightest of all medical students;
  • Hardworking and often overworked;
  • In considerable financial debt upon completion of residency;
  • Not trained in a culture that values research over revenue; and
  • Often facing a lower-paying university career vs a higher-paying private practice career.

Taking into consideration the key issues outlined above, is it any wonder that in Radiology we can start off with the brightest of medical students and, at the conclusion of residency, end up with individuals who are jaded from their training experience and whose primary motivation is making money and enjoying life?"

Sunday, March 05, 2006

Image Case-Cardiac (Mitral Valve Disease)


CXR in Mitral Stenosis: The left atrial appendage is the only portion of the left atrium that forms part of the left border of the heart. On PA radiographs it occupies the portion of the left heart border between the main pulmonary artery segment and the superior portion of the left ventricular contour. When left atrial pressure and volume are normal, this segment of the left heart border is concave. Early or mild enlargement of the left atrium may be detected as enlargement of the left atrial appendage with straightening of this segment of the left heart border. With continued enlargement, this segment will become convex. Another finding of left atrial enlargement include a "double density" in the mid-portion of the cardiac silhouette on the frontal view. Other findings which can suggest LA enlargement include posterior esophageal displacement on barium swallow, elevation of the left mainstem bronchus, and straightening of the left heart border due to enlargement of the left atrial appendage. In cases of long-standing stenosis, the LA wall may calcify. Mitral valve calcification is only seen 10% of cases. Pulmonary venous congestion can be seen as the stenosis progresses. Since the left ventricle is unaffected by mitral stenosis it will remain normal. Later there is pulmonary arterial hypertension and right ventricular enlargement.

Appendicitis in Pregnancy-Role of MRI

MRI Rules Out Acute Appendicitis In Pregnancy
"Magnetic resonance imaging (MRI) can help rule out acute appendicitis in pregnancy when ultrasound findings are inconclusive, according to a study in the March issue of Radiology. Until now, in cases where appendicitis is strongly suspected and ultrasound is inconclusive, computed tomography (CT) has been the method physicians rely on for further investigation. However, this technique involves the use of ionizing radiation, which is less desirable during pregnancy because of potential harm to the fetus."

Reference
Medical News Today

Saturday, March 04, 2006

Problem with Online Doctor recruitments

Doctors attack online recruitment
Some doctors believe talented students are missing out on jobsA new online application system for junior doctor posts is harming the job prospects of many top students, more than 80 senior doctors have warned. The Modernising Medical Careers system scraps interviews in favour of points scoring from application forms answers. In a letter to the Times, the specialists claim the process is untested and is leaving students bitter, angry and demoralised. But the Department of Health says the system "reduces waste and bureaucracy".

Thursday, March 02, 2006

Quantifying Stroke Related Brain Damage

Time is brain--quantified. By Saver JL
"The phrase "time is brain" emphasizes that human nervous tissue is rapidly lost as stroke progresses and emergent evaluation and therapy are required. The average duration of nonlacunar stroke evolution is 10 hours (range 6 to 18 hours), and the average number of neurons in the human forebrain is 22 billion. In patients experiencing a typical large vessel acute ischemic stroke, 120 million neurons, 830 billion synapses, and 714 km (447 miles) of myelinated fibers are lost each hour. In each minute, 1.9 million neurons, 14 billion synapses, and 12 km (7.5 miles) of myelinated fibers are destroyed. Compared with the normal rate of neuron loss in brain aging, the ischemic brain ages 3.6 years each hour without treatment"
Reference-

CT Colonography Versus Double Contrast Barium Enema

Comparison of Radiologists' confidence in excluding significant colorectal neoplasia with multidetector-row CT colonography compared with double contrast barium enema.
By Taylor et al
"The aim of this study was to compare the confidence of experienced radiologists in excluding colonic neoplasia with CT colonography (CTC) compared with barium enema. Radiologists stated they had confidently excluded a significant lesion in 314 (71%) and 382 (86%) of 444 segments with barium enema and CTC, respectively. Confidence was significantly higher with CTC in the in the descending and ascending colon and caecum.Confidence in excluding polyps 6 mm or larger is significantly greater with CT colonography particularly in the proximal colon."
Reference-

Wednesday, March 01, 2006

Fetal Sex Determination by USG

Fetal gender assignment by first-trimester ultrasound.
"Ultrasound determination of fetal sex can benefit decision-making regarding invasive prenatal testing in pregnancies at risk of sex-linked genetic abnormalities.
The genital region was examined in the mid-sagittal plane by the authors. The angle of the genital tubercle to a horizontal line through the lumbosacral skin surface was measured. The fetus was assigned male gender if the angle was greater than 30 degrees , and female gender if the genital tubercle was parallel or convergent less than 1o degrees to the horizontal line. At an intermediate angle of 10-30 degrees the gender was not determined. Prenatal gender assignment by ultrasound has a high accuracy rate at 12-14 weeks. "

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