"Seeing real people"

A study presented at the RSNA suggests that the performance of radiologists is improved when they have a picture of the patient whose examination is being reported. 

Hmm...

Source:

The Placebo Journal blog

Wall Street Journal

BoneXpert: automated bone age determination

BoneXpert is a software product that computes bone age automatically based using the Greulich-Pyle and the Tanner-Whitehouse systems. It is installed on a PC and can be set up as a "PACS listener" so that the radiographer can send the hand x-ray (as a DICOM file) from PACS to the BoneXpert PC, where the analysis is carried out automatically in 10 seconds. The images then appear on the BoneXpert PC with the patient details and the name of the referring physician.

I haven't tried it myself, but the program can be downloaded from the website. The first five analyses are free. Thereafter, licensing thereafter is on a fee-per-analysis basis, currently 5 Euro per image, with discounts for developing countries. BoneXpert "conforms to the European Community Directive for Medical Devices EC 1993/42, as indicated by the CE mark".

The website also has a list of publications which have been accepted in peer-reviwed journals which suggest that the product has been validated , based on the Greulich-Pyle atlas.

Sounds interesting, and possibly even cost-effective.

Socioeconomic Status Most Important Factor in NHL Survival

I've been rich and I've been poor. Believe me, rich is better.

Mae West

Low socioeconomic status is significantly associated with a higher risk for mortality among elderly patients with non-Hodgkin's lymphoma (NHL) Low socioeconomic status is significantly associated with a higher risk for mortality among elderly patients with non-Hodgkin's lymphoma (NHL). 

Article in Medscape

Ref:

Wang M, Burau KD, Fang S, Wang H, Du XL.

Ethnic variations in diagnosis, treatment, socioeconomic status, and survival in a large population-based cohort of elderly patients with non-Hodgkin lymphoma.

Cancer. 2008 Oct 20. [Epub ahead of print]

Also:

Bray C, Morrison DS, McKay P.

Socio-economic deprivation and survival of non-Hodgkin lymphoma in Scotland.

Leuk Lymphoma. 2008 May;49(5):917-23.

X-rays generated from sticky tape

Researchers at UCLA have found that peeling sticky tape in a vacuum generated sufficient x-rays to obtain a radiograph of a finger.
ref: Camara, C. G., Escobar, J. V., Hird, J. R. & Putterman, S. J. Nature 455, 1089–1092 (2008).
Nature News Published online 22 October 2008 doi:10.1038/news.2008.1185
Read more...

(Thanks to BoingBoing)

Piero della Francesca and multiplanar recons

From Piero della Francesca's, De prospectiva pingendi, Book 3, figure lxiv. Casa Editrice Le Lettere

The brain continues to be represented using projections first devised in Renaissance Italy to illustrate the head; and for the neuroscientist 600 years later, Piero's little known illustrations provide a remarkable legacy of graphic representation that endures to this day

GD Schott
Perspectives, The art of medicine: Piero della Francesca's projections and neuroimaging today
The Lancet 2008; 372:1378-1379
DOI:10.1016/S0140-6736(08)61576-7
http://www.thelancet.com/journals/lancet/article/PIIS0140673608615767/fulltext

Auctioning Radiology Services

Jean-Léon Gérôme Slave Auction (c1884)

A new firm called Telerays has developed a novel Web-based auction approach to teleradiology services that calls for readings to be awarded to the lowest bidder. The company is currently recruiting radiologists to sign up to provide readings and is marketing its services to hospitals and imaging centers.

Read more in Aunt Minnie

I find this a bit disturbing, although I haven't exactly figured out why.

A couple of useful online utilities

Gustav Klutsis. (Latvian, 1895-1944). Maquette for Radio-Announcer. 1922. Painted cardboard, paper, wood, thread, and metal brads, 45 3/4 x 14 1/2 x 14 1/2" (106.1 x 36.8 x 36.8 cm). Sidney and Harriet Janis Collection Fund. Museum of Modern Art, New York. http://www.moma.org/

I recently discovered a usfeul online utility (free of course) called slideshare (http://www.slideshare.net/), where you can post you powerpoints online. It feels a bit like YouTube, except that it has slideshows rather than videos.

I gave a talk this morning to our surgeons about "Personalising your Internet" by using Web 2.0 applications like iGoogle, Google Reader, Google Docs, CiteuLike, and so on, which I have posted on Slideshare. (Link)

Another site I have been playing with is Survey Pro (http://www.esurveyspro.com/), which allows you to set up online surveys. There are free and paid versions. It's easy to use, and worth looking at if you ever want to conduct an online survey.

Digital rectal examination in primary care not that accurate?

Albrecht Durer Hand (21 May 1471)

http://astrodreamer.squarespace.com/blog/2008/6/19/miles-davis-irving-penn-durer-emerson.html

I found this a bit surprising:

1069 patients were referred to the University Hospital of North Staffordshire to the 14-day urgent colorectal cancer referral service. Of these, 108 patients were referred as having a 'palpable rectal tumour'. Only 32 of the 108 were found to have a rectal lesion on examination in the hospital. Ten tumours were missed by GPs' DREs.

The diagnostic value of digital rectal examination in primary care for palpable rectal tumour
C. W. Ang, R. Dawson, C. Hall and M. Farmer Colorectal Disease
Published Online: 14 Sep 2007
DOI 10.1111/j.1463-1318.2007.01381

http://www3.interscience.wiley.com/journal/120125657/abstract

New accessory for PACS workstation

Just back after 4 weeks away on an Art History summer school at the Courtauld Institute. It's been quite busy at work, and I've not had much time for lunch on some days. I've just learnt of a device that it might be possible to have installed in our PACS workstations that may come in useful at times like this: a PC toaster.

When I looked today it was only 29 US dollars from this site.

Check out this reporting station

This is the "Aura" from Poetic Technologies. Here's a review. What more could one ask for in a reporting station?

whichinterventionaldevice.com

Vittorio Carpaccio
St George and the Dragon (1502) Scuola di San Giorgio degli Schiavoni, Venice from the Web Gallery of Art

'Which Interventional Device' is a community-based website, run by interventional radiologist Philip Haslam, providing information on interventional devices with reviews from actual users.

This is fantastic! I've been looking for something like this for ages, and it is likely to be incredibly useful, as it can be difficult getting information about these products from people not employed by the vendors.

In addition to information about interventional devices, there is a training section with instructional videos of interventional procedures, and a global interventional forum for discussing cases. They are expanding into imaging equipment as well, and the site has a review of the Zonare ultrasound system. Coming up next year, from the same team, is 'Which Medical Device'.

Different technical approaches to high-end CT

Vladimir Tatlin Model of the Monument to the Third International (1920) from Essential Architecture

A few years ago, when I was trying to decide which 4-slice CT scanner to buy, the author of a famous CT textbook, whom I met at a conference, told me "They're all the same. Just choose the one who gives you the best deal".

Things are not so simple anymore. The various manufacturers have adopted quite different appoaches to high-end CT. Here's a nice article in Aunt Minnie, based on a talk by Matthias Prokop:

Fourth-generation MDCT scanners do cardiac differently

Localisation of contraceptive implants

Briton Riviere, Androcles and the Lion (1908) Auckland Art Gallery

I've been asked on a couple of occasions to localise a contraceptive implant that the referring doctors wanted to remove and had difficulty locating. I found this a bit difficult until I looked on google and found that the manufacturers had full and detailed instructions online. Here's one: http://www.implanonlocalization.com/ , with a comprehensive 18-page pdf manual, plus a couple of videos thrown in for good measure. It's obviously a bit of a problem if they've gone to all this effort. Ultrasound is the imaging method of choice. If this fails, they recommend MRI. I've not had to resort to MRI.

CT for detecting post oesphagectomy leak

Joseph Mallord William Turner Seascape with a Squall Coming Up © Tokyo Fuji Art Museum

The authors of this study found that

CT was better tolerated and more sensitive but less specific than fluoroscopy for detecting occult anastomotic leak.

Radiological detection of post-oesophagectomy anastomotic leak a comparison between multidetector CT and fluoroscopy
by: S Upponi, A Ganeshan, H Dcosta, M Betts, N Maynard, H Bungay, A Slater
British Journal of Radiology, Vol. 81, No. 967. (July 2008), pp. 545-548.
Link

Medworm RSS filter engine

Looking for an RSS feed for a journal? Can't find it on their website? You could try googling it, or you could look in Medworm. I was looking for an RSS feed for Clinical Radiology and found it through Medworm. They didn't have one for the British Journal of Radiology, though, and I couldn't find it on the BIR site either, but located it via Google.

As an aside, I used to use iGoogle as a means of getting RSS feeds, but have since switched to Google reader. On iGoogle, a maximum of 9 items are displayed, which is not sufficient for all the articles in one issue of a journal. I also find Google reader easier to organise. I'm sure there are lots of other feed readers out there, but I seem to do most things through Google, and the reader works fine for me, so I haven't bothered to try any of the others.

The National Health Service is 60 years old today

Illustration from the cover of todays BMJ

The British National Health Service started on 5 July 1948, 60 years ago today.
The online Guardian has an interesting page to mark this event, with lots of articles and features, and I recently posted a 1948 public information film explaning the new service, as well as a clip from Michael Moore's film Sicko, which you can see here.

Reducing unnecessary MRI and CT scans could cut wait times: study

Pietro Longhi. The Pharmacist. Galleria dell'Accademia, Venice

Wait times for MRI and CT scans in Ontario - and probably elsewhere in Canada - could be reduced by cutting back on unnecessary scans ordered by doctors, a new study suggests.
"I think all of Canada is experiencing challenges with wait times. And I guess our message would be if you can cut down the inappropriate use, then you can actually improve access for the people who actually will benefit," lead author Dr. John You said.

The title of this post is taken from an article in the website of the Canadian Broadcasting Corporation (CBC). Radiologists might smile wearily, but I guess it's intended for the general public who may not be aware of what we all take for granted. In fact, there are some interesting findings about variations in imaging utilisation and the diagnostic yield of various common investigations. The authors of the study suggest that:

The province should develop a web-based ordering system that would capture, in real time, the reasons why imaging tests are ordered and test results. Such a system would make it easier to audit the appropriateness of ordering patterns.

Read more here.

The study is said to have been published in the June issue of the Canadian Association of Radiologists Journal but I couldn't find it in the table of contents. Perhaps they meant July.

Surf the web, send emails, view CT scans and more on your ultrasound scanner

The Siemens Acuson P50 ultrasound scanner is powered by an Apple MacBook Pro , Apple MacBook laptop with 2 GB RAM, a 160 GB hard disk and a 2.0GHz Intel Dual-Core Pentium M processor. It's intended for cardiac and vascular applications.

Apparently they've placed an order at the Royal London.

It can be connected to the internet and function as a normal Mac laptop, and I guess you could install Osirix on it and use it as a DICOM workstation.

Safety of Buscopan (it's safe)

Buscopan (hyoscine-N-butylbromide) is widely used as a spasmolytic for barium enemas, CT colonography, and abdominal MRI to improve the quality of the examination. It's a safe drug: safer than many people realise. Here is some sensible advice from the authors of a recent review article

All radiologists and radiographers either supervising examinations where this drug is used or those administering it directly to the patient need to be aware of the true contraindications. This should not include all patients with ischaemic heart disease or those with glaucoma. We would recommend that only patients with unstable cardiac disease have Buscopan withheld and that all patients are told to attend hospital immediately if, following the examination, they develop painful, blurred vision, in one or both eyes.

R. Dyde, A.H. Chapman, R. Gale, A. Mackintosh and D.J.M. Tolan
Precautions to be taken by radiologists and radiographers when prescribing hyoscine-N-butylbromide
Clinical Radiology 2008 July; 63 (7): 739-743.
doi:10.1016/j.crad.2008.02.008

Pubmed

Most radiologists feel that Buscopan is more effective than glucagon, and there are studies to support this view, such as this one by Rogalla et al (Radiology 2005;236:184-188).

I really can't figure out why it's not licensed in the United States. In the US it is approved for the treatment of flatulent colic in horses although not if the horses are going to be eaten by humans. (Link to product info)

The Radiology Assistant

the Radiology Assistant is the educational web site of the Radiological Society of The Netherlands, focusing on common radiological issues in a problem oriented way for radiology residents and radiologists.

This is an excellent site and a superb source of reference, with lots of succinct articles written by experts in the field. Highly recommended. Check it out. It's been added as a link in the sidebar of this blog.

"A centrally funded health service, free at the point of delivery"

This public information film from 1948, when the British National Health Service was founded, is a timely reminder of what it's all about.

...the hunt for a better funding model is never called off, with each new foray unfolding along similar lines. It begins with the NHS being judged as seriously underperforming. The real reason for this, whether admitted by the government of the day or not, is because not enough money is being spent on it. Early in the hunt comes sightings of the "bottomless pit" of insatiable healthcare demands, quickly followed by assertions that substantial increases in healthcare spending are "unsustainable." When asked for their advice, economists tell politicians that a tax based system provides governments and patients with the best deal. As a sideshow to the main event are the hucksters, peddling their own funding models, hoping that some of the billions spent on the NHS might end up in their pockets, or those of their backers.

Tony Delamothe, BMJ 2008;336:1410-1412 (21 June), doi:10.1136/bmj.a292
Free full text

Here is an excerpt from Michael Moore's Sicko (2007).

"Why does a CT scan cost so much in the USA?"

There's a post in Vijay's blog from October 2007 discussing the cost of healthcare in the United States http://www.catscanman.net/blog/?p=267. It makes interesting reading, as do the comments that have been posted by various people describing their experiences.

Here is the video about the incident:



There has been a lot of grumbling in Britain about the "Stalinist" National Health Service (NHS), but there are worse ways to organise a country's healthcare. I work for the NHS, and I am only too aware of its deficiencies, but those who wish to dismantle it should consider the possible consequences of alternative systems. Privatisation of the previously state-owned British railways did not lead to improved service. There is no inherent reason why a privatised national healthcare system in the UK will fare any better. Railway journeys in the UK are extremely expensive compared to the rest of the UK. I'm always being told how cheap it is to go shopping in the US compared to the UK. What will happen if our healthcare is privatised?

Link: Keep our NHS public

Radiology party trick

"What's wrong?"
"Someone stepped on me during the last dance."
"Want me to have a look at it?"
"OH MY GOD!!"

Read on.....

I've added the Samurai Radiologist's blog Not Totally Rad to my list. His posts cover all sorts of things other than radiology. There are imaging-related article as well, of course, including this one which reviews studies from the published literature, but may nevertheless be inaccessible from hospital PCs due to "adult content": Radiology comes through for sexual imaging.

My thanks to Vijay, : I found this indirectly via his blog.

Great online resources

I became aware of an excellent free online interactive anatomy atlas :

http://www.e-anatomy.org/

through a recent article in Radiology:

Stuart R. Pomerantz Net Assets: Personal Technology for Productivity in Radiology
Radiology 2008 247: 307-310 (DOI: 10.1148/radiol.2472080187)
http://radiology.rsnajnls.org/cgi/content/full/247/2/307

The article also mentions various other search engines like Yottalook and Goldminer, which are already on the side bar of this blog.

One other tip from the article: if you are looking for CT or MRI protocols, you can, for intnce, put "MRI" and "protocol" as search terms in Yottalook. Because it's a radiology-specific search engine, you get better results than with google.

Device for optimising PACS viewing conditions

PACS monitors are ideally viewed in darkish conditions. These are difficult to achieve in your typical ward or casualty department. This device is designed for use with laptops but can probably be modified for use with single PACS monitors.

Instructions on how to make one:
http://www.instructables.com/id/Laptop-Compubody-Sock/

"The decline in positioning skills" (according to a radiographer)

A post from the blog of a radiographer who is now a PACS adminstrator:

....recently I have noticed that positioning skills have been declining or Technologists just don’t seem to care much anymore.

I have pondered as to why this seems to be happening and have come up with a few theories that I will list below in no particular order as I think they all have a part in the decline of the skills.....

In summary, the main reasons he gives are:

1. Modern radiographer training.
   
2. The effects of PACS.
3. Radiologists accepting poor quality images.
4. CT and MRI (discussed in the comments to the main article).
   

Read more here.
(From A Ferret's VIew of PACS and Life).

The picture above comes from this site which is worth a look.

Microsoft PACS, RIS, and more ...

Microsoft have entered the healthcare market in a big way with a family of products called Amalga.

I found this out yesterday via a post on Dr Dalai's blog. It's not just RIS/PACS: Amalga is a "Unified Intelligence System" for healthcare organisations that includes a HIS (Hospital Information System) "built around an Electronic Medical Record (EMR) that includes complete patient and bed management, laboratory, Medication Management, Radiology Information System/Picture Archiving and Communication System (RIS/PACS), pathology, financial accounting, materials management, and human resource systems".

It does look rather interesting. Wait and see.

Ultrasound reports: attitudes of referring clinicians to style and content

My colleague, ultrasonographer Leigh Baldock, presented the findings of a survey she carried out as part of her MSc dissertation. This is what our referrers want from us in our ultrasound reports:

• Clinical details re-stated at the beginning of the report.
• Comments on the technical quality of the examination, especially if the examination is suboptimal.
• Mention all organs that have been examined.
• Measurements of abnormal organs, giving a normal range and the measurement of the corresponding normal organ for those with a bilateral presentation.
• Avoid the use of ultrasound terminology unless it is known that the clinician receiving the report has knowledge of such terminology.
• Relate to the clinical question.
• Include significant incidental findings.
• Include differential diagnoses, but not too many.
• Suggest further steps in the investigation of the patient.
• Give advice on further patient management if the referring clinician is a GP or a medical clinician.
• End with a conclusion.
• Be clear and give a comprehensive description even if the findings are normal.

Also:

• There was no substantial difference between the preferences of GPs, medical and surgical referrers, although surgeons do not appear to value recommendations for further management of patients.
• All groups of clinicians are happy for radiologists/sonographers to arrange follow-up examinations, but examinations should not be cancelled without discussion with the referring clinician.

These findings are similar to those in previous published studies.

Leigh will be leaving us shortly to work in Colchester, and we'll miss her. Good luck, and thanks for everything, Leigh.

New version of Carl's Table

We have three Carl's Tables, and like them very much. Now there's a new version, available in Spring 2008, with even more features, such as electric monitor adjustment, independent task lighting, and even an "air circulation system" with two adjustable air ports, like the air conditioning in a car. Very nice, but at US$12950 it's just slightly more than we can afford right now.

More details on the Anthro site, including comparison charts, and a video of Carl himself playing the banjo.

New high energy ultrasound technique improves visualisation of liver tumours

A new ultrasound technique developed at Duke University known as Acoustic Radiation Force Impulse imaging (ARFI) improves visualisation of liver tumours by using the elasticity or stiffness of the tumour to improve contrast between it and the surrounding tissue.
(Credit: Image courtesy of Pratt School of Engineering, Duke University)

Siemens are working on a prototype.

There have been several articles about this in radiology websites, but I thought this one, from a non-medical scientific site, provided a nice summary:
http://www.sciencedaily.com/releases/2008/01/080107181336.htm

This is the article:
In vivo visualization of abdominal malignancies with acoustic radiation force elastography
B J Fahey et al 2008 Phys. Med. Biol. 53 279-293
doi:10.1088/0031-9155/53/1/020
Link

Global helium supplies running out

One fifth of the world's helium supplies are used in for cooling the superconducting magnets used in MRI scanners. Now supplies of helium are running out.

As it says in this article, Goodbye Helium, Goodbye Brainscans.

Here's another article.

Musculoskeletal and Orthopaedic MRI blog

Another radiology blog, this one dealing with musculoskeletal/orthopaedic MRI:
http://musculoskeletalmri.blogspot.com/.

I came across this on Sumer's blog.

PostureMinder: Automatic posture monitoring for workstations

I came across this product in a PC magazine.

PostureMinder uses any standard, off-the-shelf webcam to continually check your posture while you work. If you slump or lean consistently for a minute or two at a time, the software detects this and provides an an on-screen reminder to help you avoid spending long periods in these damaging postures.

I've not seen or tried it but it's had a good review in PC Advisor.

A useful add-on for your PACS workstation? It's only £29.

http://www.postureminder.co.uk/

The website also has some good links to ergonomics sites.

Hand Hygiene

Hand washing to prevent infection transmission is a hot topic in our hospital. Only last week we had a talk from our infection control nurse. Now I see it's the subject of an editorial in Radiology.

It's worth reading (link to article below).

The most interesting bit for me was on how to avoid skin irritation, which has been shown in studies to be a real and widespread problem.

It is important to avoid such side effects of frequent hand washing, in part because they can reduce compliance and also because fissures and lesions on damaged hands are more susceptible to colonization by microorganisms, thereby fostering transmission. Multiple steps can be taken to minimize skin irritation associated with hand hygiene.

• First, a hand-friendly hygiene agent should be readily available. Alcohol-based hand rubs containing emollients are better tolerated by health care personnel than plain soap or antimicrobial soap alone.
• Second, health care workers need to be reminded of the value of regular frequent use of hand-care products such as hand lotions or creams. In one study at the University of Wisconsin, Madison, Wis, scheduled use of an oil-containing lotion improved skin condition and led to a 50% increase in hand
  washing frequency among health care personnel who initially suffered from long-standing hand irritation.
• Routine hand washing with soap and water after using an alcohol-based rub can lead to dermatitis and should be avoided.
  

Hand Hygiene Lisa R. Delaney, and Richard B. Gunderman Radiology 2008;246:15-19

GE launches health IT educational programme

According to an article in Health Imaging News,

GE Healthcare has created a vendor-independent educational program designed specifically for biomedical and technical professionals to enhance their knowledge of IT concepts for healthcare.

It was a bit difficult to get more details about the course itself, but here's the GE site: http://www.gehealthcare.com/hcit. It turns out that the courses are all held in the USA.

While searching, I came across an interesting Healthcare IT blog, run by Adam Chee in Singapore:
www.binaryhealthcare.com, to which I've added a link on this site.

Radiopaedia.org 2.0

This looks really good. In the words of the creator of this site,

The aim of Radiopaedia.org is to develop an online text where information is up to date and relevant to the needs of radiology staff, both registrars and consultants. In addition, the wiki format will allow discussion of topics and resolution of areas of confusion. There are many worthwhile online resources already, however most are not collaborative and therefore lack the ability to respond to users needs.
Anyone can create an article. Anyone can edit an existing one. Contributions remain logged to your name, and can be included in your CV, along with a link to your User Page.
Due to the immediacy of editing, new information can be introduced immediately when it becomes available. Errors can be corrected immediately, with no need to wait for the next edition.

Among other things there's a useful section on "Staging etc". Check it out:

http://www.radiopaedia.org/

radRounds

I received an invitation to join radRounds, a new radiology social networking site, a bit like Facebook, founded by Steven Chan, a radiologist in New York State. The main purpose is "sharing one's interests, expertise, and connections with others". It looks quite good, and I've signed up. At present there are only a handful of UK members, but the site is still in its infancy. Have a look.

www.radrounds.com