Thursday, June 29, 2006

Bad Radiology in Comics-Great Post on The Polite Dissent

I came across this one in the Blog known as the Polite Dissent and couldnt stop laughing, real entertaining one.. Its all about Common Comic Book Writer Medical Errors
Here is a select part of the post dealing with Radiological Errors in comic books, Dont forget to read the whole article its a must read!!

Bad Radiology

"One of the trickier aspects of medicine to learn is which radiology study to order when. For certain situations, an x-ray is best. For others, a CT scan or MRI is betters. Sometimes, a less common test such as a myelogram or PET scan may be the right choice.Writers will often choose the incorrect test for the situation, and their most common choice seems to be the plain old x-ray. It’s certainly understandable that a layperson would call everything an “x-ray”, but don’t put those words in the mouths of doctors, who would certainly know better.Notable bad examples: Mutopia X #5, Phantom #1408, Amazing Spider-Man #3, Strange Tales #115.

Sometimes the artist is to blame, drawing x-rays or other films that are anatomically impossible, or are far from realistic.Notable bad example: Batman: Legends of the Dark Knight #192 "

Wednesday, June 28, 2006

MDCT Useful for In-stent Restenosis

"Sixteen-slice multidetector computed tomography (MDCT) is "highly accurate" in the detection of in-stent restenoses and can be more accurate than coronary angiography in some cases. When compared with the accuracy of coronary angiography it was found that the 16-slice MDCT could detect in-stent restenosis with high accuracy. It is a promising method for noninvasive assessment of in-stent restenosis."
Reference- Int J Cardiol 2006;109:188-194.

Effect of Litigation on Mammography Practice

Does litigation influence medical practice? The influence of community radiologists' medical malpractice perceptions and experience on screening mammography.
"To assess the relationship between radiologists' perception of and experience with medical malpractice and their patient-recall rates in actual community-based clinical settings. The majority of the radiologists who responded to a question regarding the degree of stress caused by a medical malpractice claim described the experience as very or extremely stressful. More than three of every four radiologists expressed concern about the impact medical malpractice has on mammography practice, with over half indicating that their concern moderately to greatly increased the number of their recommendations for breast biopsies. Radiologists' estimates of their future malpractice risk were substantially higher than the actual historical risk. Almost one of every three radiologists had considered withdrawing from mammogram interpretation because of malpractice concerns. No significant association was found between recall rates and radiologists' experiences or perceptions of medical malpractice. U.S. radiologists are extremely concerned about medical malpractice and report that this concern affects their recall rates and biopsy recommendations."

Friday, June 23, 2006

Radiology Grand Rounds Volume-I

THE CARNIVAL OF MEDICAL IMAGING

Welcome to the debut of Radiology Grand Rounds, the monthly summary of the best of the Radiology blogosphere.
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Concept Behind “Radiology Grand Rounds” Or Carnival of Medical Imaging
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Lately it seems that there is a Blog Carnival for every conceivable topic or group of like minded individuals. For the readers who are new to the concept of Blog Carnivals-

A Blog Carnival is a particular kind of blog community. There are many kinds of blogs and websites, and they contain articles on many kinds of topics. Blog Carnivals typically collect together links pointing to blog articles on a particular topic. A Blog Carnival is like a magazine. It has a title, a topic, editors, contributors, and an audience. Editions of the carnival typically come out on a regular basis (e.g. every monday, or on the first of the month). Each edition is a special blog article that consists of links to all the contributions that have been submitted, often with the editors opinions or remarks.

Grand Rounds is an old tradition that doctors have. Once a week, they get together and talk about one case in detail. Keeping up with this tradition this Carnival of Medical Imaging has been named “Radiology Grand Rounds”.

In recent few years Radiology has become a very important part of the clinical practice. Role of physician in current day practice is not only to examine and treat the patient, but also to guide the investigations.
I regularly submit posts to the Grand Rounds and I think that the blogosphere would benefit from one stop shopping for Radiology specific posts. Most of the posts from The field of Radiology or Medical Imaging tend to be more scientific or physician oriented and they somehow appear out of place in the traditional grand rounds where the posts are more of a General interest. Every physician would agree that Subspecializtion is the need of the hour in medical field, hence the concept of a specialized Radiology Grand Rounds. Radiology Grand Rounds will be hosted on last Sunday of each month, the schedule and archive will be available at- Radiology Grand Rounds I would like to thank all the contributors for this edition of Radiology Grand Rounds. It was a great experience and I discovered a few new Radiology related blogs/websites in this process. Hope this is just a beginning to a whole new world of Rad-Blogging.

Radiology In The Past

Scan man , a radiologist practising in Tamil Nadu, India has sent a post entitled Radiology FlashBack-I

In this, he talks about a Foreword written by Dr. Roger C. Sanders, the Guest Editor of the December 1975 issue of Radiologic Clinics of North America (RCNA)., ‘Symposium on B-Scan Ultrasound’ issue. This is what Dr Sanders had to say about ultrasound then-
“Ultrasonography remains a filed that demands both intellectual capability and manual dexterity, and it …is not a discipline that can be acquired after reading a textbook or attending a one-week course. Practical experience in transducer handling and echographic interpretation is essential. It is also true that the best way to learn ultrasonography is as an apprentice to an experienced sonographer.”

Remains as true today as it was then, I am sure all my Radiologist colleagues practicing ultrasound would agree.


Things to think about

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A very thought provoking post from Nuclear Vision this week, Ramblings of a night shift
After a series of examples from his routine practice he talks about something which is in so true so evident yet so often ignored are we overusing radiological investigations?

Imaging is accurate, and mostly safe. But at times, you can't help but think it is a crutch or at the very least overutilized. The technology continues to amaze me, but it all comes with a cost...... A rough guide: One CTPA=1/1000 risk of an inducible cancer. This does NOT account for breast dose in young females. We are irradiating too many patients..but you can't stop it as a Radiologist.”

Indian Radiology And Imaging Association’s blog gives a pointer to an article on Evidence Based Imaging in Medscape


Radiology Mystery (Editor’s Choice)

Dr Craig Hildreth of The Cheerful Oncologist sends us a little mystery… don’t we all get the obvious diagnosis?

"I had the pleasure recently of meeting a man hospitalized for colon cancer. He had undergone a successful resection of his tumor and was being considered for chemotherapy. As I examined him I produced my stethoscope and placed it on his chest in order to ausculate his heart sounds. He turned toward me and gave me a sly grin as I bent over him. His grin broadened as the seconds ticked by, until I took the stethoscope out of my ears and looked at him like a bartender at a Texas roadhouse who has just been asked to mix a Harvey Wallbanger.
"He said to me, 'When I was drafted in 1950 at least six doctors were called in to examine me during my physical. I laughed at them, too, but when all was said and done they still sent me to Korea.'
"Later that day I took a copy of his chest x-ray and showed it to my office staff. I asked them if I should file a formal complaint against the x-ray techs for bungling the printing of this radiograph. When my staff agreed that a mistake was made, I then gave them the same Cheshire Cat grin and chortled:"'Don't you guys know a trick question when you hear one?'
"So my question to you all is this: What is the diagnosis?"

……………………….

Still don’t get it-Situs Inversus!!


Image Cases

Dr Bhavin on his Case Based Blog “Spot Diagnosis” has a case of Renal injury with very characteristic or as the name of the blog suggests Spotter CT images and links to comprehensive articles discussing imaging of Renal Trauma. A must read for all Radiology Residents.


In his other blog on Cardiac Imaging Bhavin has CT angiographic images of a Young patient with multi-vessel coronary disease along with its angiographic correlation.

Filmjacket.com shows us CT images of 17 year old playing Darts at the bar with the dart embedded in the anterior aspect of the right ethmoid sinus.

Latest In Radiology

Tim Gee has submitted a post on data storage technology. Titled “Data Storage Technology Advances”, this post describes how new open systems storage solutions are changing PACS. Older PACS stored archive data in proprietary ways, creating an unanticipated changing cost (data migration) when replacing PACS system vendors. New storage technologies have allowed PACS vendors to focus their R&D where they add the most value, and made it easier for buyers to change vendors.


Dr.Subrahmanyam Karuturi points towards an article about role of Multidetector Computed Tomography for Acute Pulmonary Embolism in The New England Journal of Medicine.


Dr Sidharth, a Pediatrician has a post on pediatric interventional radiology. He gives pointer towards a symposium on Pediatric vascular access with the Ultrasound being the best modality.




Soccer Mania captures Radiology Grand Rounds too

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As rest of world is enjoying The World Cup Football this week Sumer’s Radiology Site has a post on The FootBall Sign, a supine film radiological sign of pneumoperitoneum.


That wraps up this month's highlights of the Radiology blogosphere. Hope the readers enjoyed the first edition of the Radiology Grand Rounds. If you liked any of these blogs, keep visiting them. Please email me at sumerdoc@yahoo.com if you are interested in hosting future Radiology Grand Rounds. Archive for the Radiology Grand Rounds here-Radiology Grand Rounds
Be sure to tune in Next Month Last Sunday 30th July , when Grand Rounds will be hosted by Me again at Sumer's Radiology Site

Thursday, June 22, 2006

Submissions requested for the First Radiology Grand Rounds

Submissions are requested for The First Radiology Grand Rounds to be hosted here on Sumer's Radiology Site on 25-6-2006 the last Sunday of this month. Submit all your Radiology or medical imaging related posts in this carnival. It doesn't matter if you are a Radiologist, Physician, Technician or a patient all are welcome to submit. And dont forget to log on to the first edition of the Radiology Grand Rounds here on 25th June For a Carnival of Medical Imaging.
Send your submissions to sumerdoc-AT-yahoo-DOT-com or leave it in the comments section.
Archives and Future Schedule of Radiology Grand Rounds here-

Sunday, June 18, 2006

Soccer influence in Radiology too...


The Football Sign
The football sign, which is seen on supine abdominal radiographs, refers to a large oval radiolucency in the shape of an American football. The long axis of the "football" runs cephalocaudad, and the blunted ends are defined by the diaphragm and pelvic floor. The oval radiolucency seen in the football sign represents massive pneumoperitoneum, which distends the peritoneal cavity. In the supine position, free air collects anterior to the abdominal viscera, producing a sharp interface with the parietal peritoneum and thereby creating the football outline. The pneumoperitoneum may outline the falciform ligament, which is seen as a faint linear opacity situated longitudinally within the right upper abdomen.

CT Densitometry in Otosclerosis

An article by Setsuko Kawase et al "Relationship between CT densitometry with a slice thickness of 0.5 mm and audiometry in otosclerosis" in European Radiology June 2006 authors determined The appropriate cutoff Hounsfield unit (HU) value for the diagnosis of otosclerosis and investigated the correlation between the bone conduction threshold and the findings of computed tomography (CT) densitometry. Based on receiver operating characteristic (ROC) analysis, the cutoff HU value in area anterior to the oval window (A-OW) was determined to be 2,187.3 HU. A statistically significant correlation was found between the density of the area A-OW and the hearing level at 500 and 1,000 Hz, and between the density of the area around the cochlea and the hearing level at most frequencies. These results suggest the semi-automated diagnosis of otosclerosis may be possible.
Reference-

Friday, June 16, 2006

Schedule For Radiology Grand Rounds



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Finally the Date for the first Radiology Grand Rounds is decided, it will be hosted on Sumer's Radiology Site on every Last Sunday of the month. This June The First Ever Radiology Grand Rounds will be Hosted on 25-6-2006. Archive For Future Radiology Grand Rounds will be available here- Radiology Grand Rounds
I will accept anything that is relevant to Radiology or Medical Imaging but you don't have to be a Radiologist to contribute. I'd love to hear from physicians, Patients, Nurses, Medical Students,Radiographers, Imaging Technicians etc, etc. Send submissions to sumerdoc@yahoo.com and anybody interested in Hosting Radiology Grand Rounds in future.

Nanotechnology In Medical Imaging

New contrast agents may be on horizon for better medical imaging
"Research by Kenneth Watkin, a professor in the department of speech and hearing science and the Beckman Institute for Advanced Science and Technology, may lead to the development of a new breed of “multimodal” contrast agents that could work within a host of medical imaging platforms – from ultrasound and computed tomography (CT) to magnetic resonance imaging and molecular imaging. In their work with gadolinium oxide nanoparticles, Watkin and McDonald started by breaking nanoparticles down into even smaller particles. Next, they successfully coated the particles with dextran, a naturally occurring carbohydrate."
Reference-
(Hat Tip-Medgadget,Internet Journal Of Emerging Medical Technologies )

Wednesday, June 14, 2006

Carotid Calcium Evaluation by MSCT

Kiran R. Nandalur et al in AJR 2006; 186:547-552, "Carotid Artery Calcification on CT May Independently Predict Stroke Risk" quantitatively evaluated calcified atherosclerotic burden in the cervical carotid arteries using MDCT to determine the relationship of scores with luminal stenosis and symptomatology. Volume scores were calculated by summing the area of calcium in the common and extracranial internal carotid arteries on axial slices and multiplying by the slice increment. Controlling for cardiovascular risk factors and luminal stenosis, authors found that scores were significantly related to the occurrence of symptoms. Calcium scores in the cervical carotid arteries may represent an independent marker for luminal stenosis and ischemic symptoms.

Tuesday, June 13, 2006

Radiology has role both in War & Peace

In a very interesting article in RT-Image.com
From Iraq to the Arena authors talk about people who use medical imaging beyond the hospital settings, it goes something like-
Radiology outside of the hospital setting
"In most of our articles, we cover the radiology professional from the hospital setting. In this cover story, RT Image looks at five individuals who use their medical imaging expertise to go beyond the hospital walls to help their patients. Encompassing an RT imaging U.S. soldiers in Iraq, a veterinary radiologist, an RT working in major league sports, a physical therapist and a forensic radiologist, these professionals demonstrate how radiology plays a role in many different aspects of life. [more] "
A must read for all who thought that the role of a radiology professional was limited to the hospital setting alone!!

Dual Source CT

In an Article First performance evaluation of a dual-source CT (DSCT) system in European Radiology Thomas G. Flohr et al present first patient scans to illustrate the performance of DSCT for ECG-gated cardiac imaging, and demonstrate first results using a dual-energy acquisition mode. First clinical experience shows a considerably increased robustness for the imaging of patients with high heart rates. As a potential application of the dual-energy acquisition mode, the automatic separation of bones and iodine-filled vessels is demonstrated.
Reference-
European Radiology
Publisher: Springer Berlin / Heidelberg
ISSN: 0938-7994 (Paper) 1432-1084 (Online)
DOI: 10.1007/s00330-005-2919-2
Issue: Volume 16, Number 2
Date: February 2006
Pages: 256 - 268

Sunday, June 11, 2006

Wikipedia For Medicine is The Future-Medscape

According to Peter Frishauf, founder of Medscape
"For readers, Wikipedia is a win. In traditional publishing, readers must wade through many articles on a subject, each written by a few experts, published at 1 moment in time. In Wikipedia you read 1 living article written by many, continually updated by many. Who needs 50 articles on avian flu when 1 will do? And Wikipedia content is often the best on the Web, which means the best anywhere. For writers, Wikipedia offers neither authorship, recognition, reward, nor punishment. Articles aren't indexed, but with Google and Yahoo!, who needs it? The motivation for writing is love of information and a desire to share it. I say a variant of Wikipedia for medicine is the future -- and it's good."
Full Article here-

Friday, June 09, 2006

Radiology Grand Rounds

In recent few years Radiology has become a very important subject both in clinical practice as well as undergraduate teaching. Role of physician in current day practice is not only to examine and treat the patient, but also to guide the investigations.
Lately it seems that there is a Blog Carnival for every conceivable topic or group of like minded individuals. I regularly submit posts to the Grand Rounds and I think that the blogosphere would benefit from one stop shopping for Radiology specific posts as well so I am now accepting submissions for the first edition of the Radiology Grand Rounds. I will accept anything that is relevant to Radiology or Medical Imaging but you don't have to be a Radiologist to contribute. I'd love to hear from physicians, Patients, Nurses, Medical Students,Radiographers, Imaging Technicians etc, etc. I won't peg down a date just yet. I'll just see what kind of response I get first.
Send submissions to sumerdoc@yahoo.com and anybody interested in Hosting Radiology Grand Rounds in future.

Thursday, June 08, 2006

Role Of Antenatal MRI

"Ultrasound is the imaging modality of choice for pregnant patients. However, MRI is increasingly utilized in patients in whom the sonographic diagnosis is unclear. These include maternal conditions unique to pregnancy such as ectopic pregnancy, placenta accreta, and uterine dehiscence. MRI is also being increasingly utilized in the assessment of abdominopelvic pain in pregnancy, in particular in assessment for appendicitis. Fetal MRI is performed to assess central nervous system (CNS) abnormalities and patients who are considering fetal surgery for conditions such as neural tube defects, congenital diaphragmatic hernia, and masses that obstruct the airway. In the future, functional MRI and fetal volumetry may provide additional information that can aid in our care of complicated pregnancies."

Tuesday, June 06, 2006

Interesting Article on Radiology Outsourcing In LA times


Borders Fall for These Doctors
Physicians, primarily radiologists, are getting swift diagnostic aid from distant time zones. The trend is likely to grow, but it has its critics.
Full Story Here-LA Times
"Some doctors say such services relieve the strain on radiologists in this country, who are in short supply as demand climbs in emergency rooms nationwide. Specialists stationed in time zones hours ahead of the United States have the benefit of working regular day shifts."If you are up all night doing this work, then essentially you're useless the next day," said Dr. Sanjay Saini, chairman of Emory University School of Medicine's radiology department in Atlanta. However, the estimated $65 per case that the hospital pays NightHawk is "much, much less" than it would cost to pay U.S.-based radiologists at those hours, he added.Nighttime aid also allows solo practitioners like Dr. Michael Fischer at Monterey Park Hospital to provide coverage more easily. Fischer usually has cases sent to NightHawk for preliminary readings after 11 p.m. and sometimes on weekends, depending on how busy he is. He then reviews and does final dictations on each case in the morning. Some doctors say these international services are a dangerous expansion of the outsourcing trend — with the potential to compromise the quality of patient care. They question the feasibility of tracking doctors and the quality of their work, and whether they can be brought to task if they make mistakes."

Sunday, June 04, 2006

Contrast Induced Nephropathy

Elicker BM et al in AJR Am J Roentgenol 2006 Jun;186(6):1651-8 , surveyed radiologists to identify the current practice patterns and to determine those areas in which guidelines are most needed. They found no widely accepted practice guidelines exist for the screening and prevention of contrast nephropathy in patients receiving iodinated IV contrast agents for CT examinations. Issues include screening to identify at-risk patients, discriminatory levels of renal insufficiency beyond which IV contrast material is contraindicated, and the use of preventive measures. They found that-"Serum creatinine is the most commonly used screening method: 92% of respondents for inpatient examinations and 66% for outpatient examinations. Only 2% use estimated creatinine clearance. The average threshold serum creatinine value used to determine that patients should not receive IV contrast material is 1.5 mg/dL in 35%, 1.7 mg/dL in 27%, and 2.0 mg/dL in 31% (mean, 1.78 mg/dL). Diabetes slightly lowers the threshold creatinine (mean, 1.68 mg/dL). Fewer than 30% of respondents frequently administer IV contrast material to patients with a renal transplant or multiple myeloma. The most commonly used preventive measures include hydration (93%), reduction of contrast dose (77%), and administration of acetylcysteine (39%). Overall, no important differences were found among practice settings or level of specialization."
Reference-IV contrast administration for CT: a survey of practices for the screening and prevention of contrast nephropathy. Elicker BM, Cypel YS, Weinreb JC

Saturday, June 03, 2006

Beta Blockers For Cardiac CT

In Am J Roentgenol 2006 Jun;186(6 Suppl 2):S341-5 - "Beta-blockers for cardiac CT: a primer for the radiologist" Pannu HK et al discuss the role of Beta Blockers for Cardiac CT.
"A low and regular heart rate is necessary for optimal visualization of the coronary arteries on CT and can be achieved by the administration of medications. Beta-blockers can be safely given, orally or IV, to most patients to lower the heart rate for cardiac CT. A protocol can be implemented and patients can be screened for certain contraindications to allow successful administration of these medications by radiologists."

Thursday, June 01, 2006

Helium MRI useful in Early Emphysema

In an article-Early emphysematous changes in asymptomatic smokers: detection with 3He MR imaging by Fain SB et al in Radiology 2006 Jun;239(3):875-83 Authors prospectively compared apparent diffusion coefficient (ADC) measurements derived from diffusion-weighted hyperpolarized helium 3 (3He) magnetic resonance (MR) imaging with functional and structural findings using spirometric tests and thin-section computed tomography (CT) of the lungs in asymptomatic smokers and healthy nonsmokers of similar age. Correlations between mean ADC values and pulmonary function test measurements for diagnosing emphysema, especially Dlco, were statistically significant.

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