Payment structures influence dental radiography utilisation?

NHS dentists were traditionally paid for individual “items of treatment”: each X-ray they took resulted in a payment. In England, the number of X-rays taken in 2003/04 averaged 53.2 per 100 “courses of treatment”. Since 2006, however, NHS dentists in England have not received payments for individual X-rays, but only for completed courses of treatment. Preliminary results for 2007/08 show that the number of X-rays taken by dentists in England has decreased to 31.5 per 100 courses of treatment. In Scotland, by contrast, where the traditional method of payment for dentists continues, there has been no equivalent reduction.

Margaret McCarthy
Financial Times 11 April 2009
link
blogs.ft.com/mccartney

Screening for occult cancer in idiopathic DVT?

From:

Should patients with venous thrombosis have cancer screening?

RK Patel

Thrombus, 2009 Apr. Volume 13, Number 1.

http://www.thrombus.co.uk/thrombus/View_article.asp?AID=1988

Other Refs:

Venous Thromboembolism and Occult Malignancy: Simultaneous Detection During Pulmonary CT Angiography with CT Venography
Bierry et al. Am. J. Roentgenol 2008; 191: 885-889
DOI:10.2214/AJR.07.3516
http://www.ajronline.org/cgi/content/abstract/191/3/885

Occult malignancy in patients with venous thromboembolism: risk indicators and a...
Oktar et al. Phlebology.2007; 22: 75-79
http://phleb.rsmjournals.com/cgi/content/abstract/22/2/75

Screening for occult cancer in patients with acute venous thromboembolism.
Monreal M, Trujillo-Santos J.
Curr Opin Pulm Med. 2007 Sep;13(5):368-71.

[Occult cancer and venous thromboembolism: which screening in patients with inaugural deep vein thrombosis?]
Pathol Biol (Paris). 2008 Jun;56(4):205-10.
Lévesque H.[Article in French]

Recently completed trial:

Screening for Occult Malignancy in Idiopathic Venous Thromboembolism (Univeristy of Padova)

http://clinicaltrials.gov/ct2/show/NCT00361647

Twitter

MidEssexRay is now tweeting at http://twitter.com/midessexray .
My tweets are on the top of this blog.

Other radiology tweets include
http://twitter.com/scanman
http://twitter.com/radrounds

There are discussions about twitter in medicine here and here , and here is a link to a list of medical tweets.

More on Speech Recognition

We've been using it for a while.
I like it but I'm the first to admit that there are problems, one of which is errors in transcription, aggravated by the fact that I'm not a very good proofreader.

Here's an interesting post from Dr Dalai discussing recent publications in the literature.
Speech Recognition Sucks and it Costs More

Picture of robot sculptures by Clayton Bailey from
http://www.c2i.ntu.edu.sg/AI+CI/Resources/AI_Artwork/RobotSculptures-Bailey97.html

www.academicproductivity.com

I found this site while googling "online reference management software". It's a blog with lots of interesting articles, for those who are interested in such things.
Apart from periodic reviews on reference managers, other articles I liked were:
Stop Powerpointing and Start Outlining in which the author points out the disadvantages of using powerpoint to plan your talk, and suggests n alternative method,
and a discussion of a post from Luis Ahn discussing the difference between research and publishing papers.

http://www.academicproductivity.com/

So does it matter if your workforce is unhappy?

Almost one half of radiologists actively interpreting mammograms do not enjoy that part of their job. Reported enjoyment was not related to performance

Radiologists' performance and their enjoyment of interpreting screening mammograms.

Geller BM, Bowles EJ, Sohng HY, Brenner RJ, Miglioretti DL, Carney PA, Elmore JG.

AJR Am J Roentgenol. 2009 Feb;192(2):361-9.
Link

Portable CT scanner

I came across this product on the internet: The CereTom 8-slice portable CT scanner.

Radiographer ghholt has a picture of it on Flickr parked in a hospital corridor with the comment

When I started CT Scanning 28 years ago I never thought I would ever be pushing a portable again. Now all the CT Tech's out there have something to look forward to...

"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.