Thursday, January 31, 2013

Tuesday, January 29, 2013

Causes of Medical Malpractice Suits against Radiologists

In an article February 2013 Radiology, 266, 548-554 by Jeremy S Whang et al, authors have determined the most frequent causes of malpractice suits as derived from credentialing data of 8401 radiologists. According to them
  1. Errors in diagnosis are, by far, the most common generic cause of malpractice suits against radiologists.
  2.  In this category, breast cancer was the most frequently missed diagnosis, followed by nonvertebral fractures and spinal fractures. 
  3. Failure to communicate and failure to recommend additional testing are both uncommon reasons for initiating a suit.

Sunday, January 27, 2013

Grey Matter-DAMS National Quiz

After year long process of  preliminary college based and zonal rounds, finally time has come for the final round of DAMS 2012-13 grey matter quiz, which will be held in AIIMS on 5th Feb, the mecca of medical education in India and I ll be hosting this quiz. This quiz is part of our effort to spread and promote learning in medical students and working on our theme that learning can be fun.  All medicos are invited. Personally i believe quizzes are an integral way of promoting competitive learning among medical students.

Top Medical PG Coaching Institute-DAMS

It feels good to be validated by third party surveys. Last 14 years we have been working in this business to create value based medical coaching for PG aspirants in India.  Our team at DAMS PvtLtd has been tirelessly working towards this and we have delivered results year after year.  We have delivered AIIMS topper for last 4 years now in continuity and 24/top 50 were DAMSONIANS last year.   Here are some excerpts from the survey with the weblinks. Prominent medblogger has recognised DAMS as the top most institute in this business through his survey with medical students. We thank all involved and promise to work harder in years to come.

AcrossPG Team has conducted the survey for selecting The Best Medical PG Coaching Institute in Dec ’12-Jan 2013 ( Top Medical PG Coaching Institute - Survey Results). 
Here are the highlights of the survey.
400 medicos participated in survey, from various medical colleges of all states, ranging from batches 2000 to 2006.
7 PG Coaching Institutes from across the country including Bhatia, DAMS, IAMS, Speed PG Institute, MIMS Calicut, MEDPGTHRISSUR and others.
Many students were in favour that rigorous self-study is important if NEET happens, and coaching is useful only with self-study.
How the result is calculated?
We have calculated the results by counting votes from only unique IPs to remove bias from multiple votes casting.
An effective score is calculated institute-wise from the total votes submitted. This is to remove any bias occurred due to difference in number of votes for each institute.
The effective scores are then compared under 4 broad categories – Faculty, Study Material, Tests and Effectiveness for NEET PG.
Delhi Academy of Medical Sciences occupied the top position.

Some Comments by Participants:
“DAMS Exclusive club is the Best thing happening in the market for PG preparation. Faculty is always there to solve our doubt. This gives damsonian an unparalleled edge over the other institutes. Very much impressed with DAMS Delhi.”
“DAMS has good students support throughout the year. It was helpful in preparation. Though need to improve the quality of tests and explanations of questions. Although online NLTs are a good addition to the course, they helped a lot for practising for computer based NEET exam.”

Thursday, January 24, 2013

Is it ethical to add to referring physician's order?

Valid question raised in AJR February 2013 vol. 200 no. 2 W216, which questions if radiologists should or could add to the request if they feel added study will be required in the said case. Although, it sounds perfectly ok to proceed and help the patient as much as possible but does it make sense considering the reimbursement rules. Shouldn't radiologist be the person to decide on the required investigation even for reimbursments? Or the referring physician will rule over this for the time being?

What are your thoughts and comments on this?

Some of the comments so far on this debate on facebook page:

Radiologist 1::  the radiologist can give advice and indicate why.....the physician can take the final call!

Radiologist 2 : Good interdepartmental communication can sort it out.. such decisions need imputs from both sides

Sumer Sethi yes, but in a pvt stand alone diagnostic practise, how do you you sort it out. and what are the rules for reimbursement if patient is an insurance patient.

Radiologist 2 ::  I think it has to be clinician's call

Sumer Sethi even if he advised USG Pelvis for appendicitis, or he advises CT where MRI should be done or vice versa. Why should it not be just an imaging referral, where we decide what we need to do?

Radiologist 2 ::  its all because of severe lack of knowledge prevalent in india..we can advise the clinician..but i dont think we should change it if clinician is such situations, i simply advise the investigation that is required in the report

Sumer Sethi agreed, but the problem is in the end patient is the "looser", why cant we radiologists increase our role from just passive followers to more active advisers as well.

Radiologist 2 i feel such decision making by radiologists alone is not valid..may be clinicians should be legally bound to be knowing wat to advise and listen to our advise..i being in institution actually do not often face such problems.. we as radiologists always try to advise wat needs to be done.. but wat can we do if clinican is unwilling to acccept the advise. wat do u do in such a situation?
about a minute ago · Like

Sumer Sethi That is exactly my question, when someone tells me to do a CT for epilepsy in a child and he says he wants CT as it is better than MRI in this case- may he shud be bound to listen to us here??

Radiologist 2 the problem is clinicians r supposed to know it and they dont.. and its really gray area..actually who do not know this much hav not right to advise such investigations in first place..we never see a neurologist or neurosurgeon doing this

Radiologist 3 I agree with Sumer Sethi, the radiologist should take the final call. many times, we see completely inappropriate investigations are ordered, which we know are not gonna help the patient.

Radiology Department on a Hospital Ship-Africa Mercy

The Africa Mercy  is the largest nongovernmental humanitarian  hospital ship working globally today, providing medical care to a  group of 15 West African nations for more than  20 years and serving some of the most impoverished and underserved populations in the world.  It even has a small radiology department on board, along with six operating rooms and a small ICU and inpatient wards. This radiology deparment is described in article in AJR doi: 10.2214/AJR.12.9087. AJR February 2013 vol. 200 no. 2 W124-W129.  There is provision for on site and remote interpretation by voluntary radiologists. This report describes good work being done in this unique concept. Well done!

Sunday, January 20, 2013

Stroke & Smart Phones

I read with great interest the study by Demaerschalk et al in the September edition of Stroke, regarding the validity of smartphone-based assessment of brain CT scans in the context of acute stroke. The authors demonstrate a high level of agreement for identification of intracranial hemorrhage, neoplasm, or any radiological contraindication to thrombolysis on an iPhone 4 display compared with PACS and desktop. Especially in a country like ours stroke management would benefit greatly by using smart phones like iPhone & iPads. More work needs to be done n this in India in near future.

Friday, January 18, 2013

DICOM Conference in India

'First DICOM conference' ever held in India will be in Bangalore. 
Link to the event homepage:

Tuesday, January 15, 2013

Oncological CT Follow Up-Linked to Second Cancer Induction

In a study published in Health Phys. 104(1):1–8; 2013, authors evaluate the risk of second cancer developing after CT follow ups. 

" The goal of establishing prompt localization of the malignant spread or recurrence of a tumor has found a powerful solution in the definition of follow-up protocols, which include the indication for CT scans on an annual or semiannual basis. In the case of long-surviving patients, however, this approach will lead to a considerable integrated dose level over a period of several years after recovery from the illness.  According to Calandrino, R et al, the evaluated absolute additional risk of second tumor induction ranges between 0.1% and 10%, depending primarily on age and pathology. These results depict this additional risk as an issue of significant importance for clinical practice. "

Friday, January 11, 2013

Stensen's Duct-MRI

42 years old man with left sided pain on eating with old USG (2 weeks)  suggesting tiny calculus in the Stensen's duct. The MRI shows essentially normal gland (left) with asymmetrically prominent duct  (as compared to the right), within the gland / at the exit / stensen's components.  The musculature and soft tissues are normal, could represent recently passed calculus / inflammation.

Teaching points by Dr MGK Murthy, MRI Technician- Umamaheshwar:

Stensen's duct is 4 to 7 cm long and 2 to 3 mm in diameter.

MDCT Sialogram is an ideal modality for evaluation.  MR plays complementory role in ductal evaluation with excellent  resolution of the glandular anatomy as well as the surrounding  soft tissues.

An oblique X-ray along with MRI would complete the routine  evaluation without invasive ductography.

Achilles Tendinopathy-MRI

48 years female with complaints of pain posterior aspect of the foot with no trauma, shows markedly irregular and heterogeneous distal tendoachilles with areas of edema with insertional site enthesitis with enlarged and irregular retrocalcaneal bursa with suggestion of retroachilles bursa with reactive marrow edema – Achilles Tendinopathy with Enthesitis is suggested.  Case submitted by Dr MGK Murthy.

Teaching points :

Formed in the mid leg by confluencing of two head of gastrocnemius (lateral joining lower than medial) and soleus.

Is enclosed in paratendon (equivalent of synovium).

Inserted into the calcaneum posterior and lateral to the plantaris insertion.

Plantaris togather with achilles refered to as Triceps-Surae complex.

A horseshoe shaped natural retrocalcaneal bursa is invaribly present, limited anteriorly by Kager's fat pad and posteriorly by the tendon. 

An acquired retroachilles bursa posterior to the tendon is pathological.

Mucoid degeneration with interstitial tears along with hypoxic fatty degeneration leading to bulky achilles is common age related finding.

Most commonly injured tendon in the foot either because of trauma or overuse.

Tuesday, January 08, 2013

The Beatles & CT- History that you never knew

"In 1962, a new English rock-and-roll band named The Beatles signed a recording contract with Electric & Music Industries (EMI). The Beatles were so financially successful that EMI was able to fund research and development in other divisions of the company; in particular, the work of an enterprising young engineer named Godfrey Hounsfield. His groundbreaking work in x-ray imaging produced the first commercially available head-only CT scanner, and a Nobel Prize."

So, we owe the first CT scan to musical success to The Beatles Art & science are more inter-related than we can imagine at times. 

Reference & further reading:


For cardiologists and radiologists . Spasm of LAD beyond second diagonal causing rest angina. Pain and spasm cleared following intra coronary nitroglycerine. Myocardial bridging will appear as if vessel is squeezed in systole , normal in diastole . In spasm , it will look narrow persistently, irrespective of systole and diastole , and relieves completely with nitroglycerine.

Contributed by Dr Rakesh Gopal , Apollo hospital Chennai 
(Consultant Interventional Cardiologist)
Studied Interventional Cardiology at Sree Chitra Tirunal Institute for Medical Sciences and Technology

Monday, January 07, 2013

Now Sony offer innovative Radiology products.

With its Organic Light Emitting Diode (OLED) driven technology, and the successful launch of its PVM-2551MD medical monitor in 2011, Sony has launched a new medical 3D recorder, new 3D camera and five new diagnostic displays for radiology. 

Further details

Occipital Encephalocele: Fetal MRI

MRI role is to evaluate the fetal brain, particularly when an abnormality has been detected on prenatal US or when a fetus is at increased risk for neurodevelopmental anomalies. Fetal MRI has higher contrast resolution, is not affected by the shadowing from the calvarium or by low amniotic fluid volume, allows a larger field of view and can easily be performed using ultrafast T2-W sequences, making it more useful than US in late pregnancy. This patient shows bony defect in the occipital bone with associated encephalocele.

Wednesday, January 02, 2013

10th Year of RadBlogging

After posting my latest case report on 1st Jan 2013, i look back at the start i made in 2004.  Never knew that i will continue so long  & did not know about the power of Internet or power of Web 2.0 . Thank you to all my readers and weblog followers for being connected through this medium.  Wish you all a happy and prosperous New Year 2013.

Sumer Sethi, MD

Tuesday, January 01, 2013


This is 11 year old girl with seizure disorders. MRI shows presence of asymmetrical enlargement of right cerebral hemisphere relative to left with thickening of gyri, which suggests possibility of congenital hemimegalencephaly. Hemimegalencephaly is a rare congenital disorder of cortical formation with hamartomatous overgrowth of part of all of a cerebral hemisphere. This results from either increased proliferation or decreased apoptosis (or both) of developing neurons. Case submitted by Dr Swati Shah, FRCR.

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