Radiology

Radiologists writing on KevinMD about imaging: the radiologist shortage behind delayed reads, radiation dose, mammography and the screening argument, whole-body MRI sold as prevention, point-of-care ultrasound, and whether AI replaces the radiologist, argued by radiologists on both sides. Two maintained records draw on this archive: Cancer: what physicians say, in their own words, and Artificial intelligence: what physicians say, in their own words.

Physician burnout: The additive effect of bureaucracy on the psyche

Sid Schwab, MD

Physician

February 10, 2014

In trying to understand my own burnout, “control” (or lack thereof) is a dominant theme. This is nothing new. In fact, I doubt I’m unearthing bones not already thoroughly analyzed. But I can give instructive personal examples.

For a while I was on the board of directors of my clinic, which was then and is even more so now one of the most successful doctor-owned and -managed in the US. During …

Test overuse: Why does it happen and what can we do about it?

Kevin R. Campbell, MD

Physician

February 7, 2014

In medicine today diagnostic testing and advanced imaging is readily available and widely utilized in most every clinical setting. Many physicians have given up the stethoscope and physical exam in favor of an echocardiogram and a CT scan. Fear of missing something pervades every emergency department and has resulted in hundreds of thousands of unnecessary testing costing billions of dollars in healthcare expenditures.

Of course, the driving causes of increased testing …

Did a New York Times column unfairly attack ER doctors?

WhiteCoat, MD

Physician

February 6, 2014

Cardiologists are causing patients to get cancer.

It’s true.

Cardiologists routinely perform angiograms on patients who have no heart disease whatsoever.

As shown in this Harvard newsletter, each angiogram exposes the patients to about 7 mSv of radiation. Add in the myocardial perfusion imaging at another 25 mSv of radiation and you have enough radiation to cause cancer in an otherwise healthy individual.

And cardiologists routinely subject patients with normal …

Why imaging industry should pay attention to clinical trials

Dr. Saurabh Jha

Conditions and Diseases

February 1, 2014

Would you tell me, please, which way I ought to go from here?
That depends a good deal on where you want to get to.
I don’t much care where –
Then it doesn’t matter which way you go.
– Lewis Carroll

In the new world, payers will increasingly ask before reimbursing medical imaging: why did you bother finding out? This is why we must pay attention to clinical trials.

An instructive case is in the …

Stop asking radiologists to rule out disease

Dr. Saurabh Jha

Physician

December 23, 2013

When you get frustrated with my interpreting a chest x-ray as “atelectasis at the right lung base, pneumonia can’t be excluded,” trust me, I don’t enjoy it. But when you ask me to rule out pneumonia you leave me no choice but to tell you that pneumonia can’t be ruled out.

To rule out a disease a test must have a sensitivity of 100%, meaning there should be no false negatives. …

Doctors should hone their abilities to recognize visual patterns

Paul Bergl, MD

Medical Education

December 10, 2013

Nothing puts more fear into the heart of an internist than a dermatologic chief complaint. And for good reason: we have very little exposure to the breadth of the field. To us, all rashes seem to be maculopapular, all bumps are pustules … or was that nodules?

It’s not that we internists don’t care about the skin or don’t appreciate its complexity. Rather, we simply haven’t seen enough bumps, rashes, and …

Radiologists and primary care doctors need to talk to one another

Dr. Saurabh Jha

Physician

December 8, 2013

Recently, I spoke with a primary care physician (PCP) about a young runner who had a syncopal episode. Because of the increasing awareness of sudden cardiac death in athletes, she had an electrocardiogram and an echocardiogram to look for structural abnormalities of the heart.

The PCP was inclined to dismiss the syncope as an isolated episode. However, the echocardiogram, otherwise normal, equivocated: “possible hypertrabeculation of the left ventricular apex, consider cardiac …

I have a shellfish allergy. Can I have contrast?

Jennifer Gunter, MD

Conditions and Diseases

December 2, 2013

I hear it over and over again.

From a nurse, “She can’t have povidone prep, she has a shellfish allergy.”

From the patient, “I can’t have the contrast because I’m allergic to iodine and shellfish.”

The list of allergies placed in the chart by a doctor, “Radiocontrast. Iodine. Shellfish.”

It’s not the fault of the patients who are typically repeating the medical misinformation they have been given. However, the medical professionals who perpetuate the …

Breast density laws are based on anecdote

Dr. Saurabh Jha

Conditions and Diseases

November 24, 2013

You know that old joke. What’s a radiologist’s favorite plant? The hedge.

Radiologists are famous for equivocating, or hedging. “Pneumonia can’t be excluded, clinically correlate,” or “probably a nutrient canal but a fracture can’t be excluded with absolute certainty, correlate with point tenderness.”

Disclaiming is satisfying neither for the radiologist nor the referring physician. It confuses rather than clarifies. So one wonders why legislators have decided to codify this singularly unclinical practice …

Reduce stress for both patients and doctors: Limit tests

Matthew Katz, MD

Physician

November 11, 2013

Ordering CT, MRI, or PET scans for my patients when they feel well always makes me nervous. As a radiation oncologist, I’ve chosen to frequently make observations that potentially find active, progressive cancer. And this creates an existential crisis that scares me — but not as much as it scares my patients.

With each test, I set in to motion a real-life application …

A physician expert witness speaks out

Anonymous

Physician

November 2, 2013

I have been actively engaged in the clinical practice of radiation oncology for the last 40 years, and over the last 10 years have been asked to participate as a radiation oncology expert witness in a variety of medical malpractice cases. Radiation therapy, together with surgery and chemotherapy, is one of the major cancer treatment methods. It is estimated that 50-60% of all cancer patients seen in the USA receive treatment with …

Read more…

A physician expert witness speaks out

Why health insurance for all obstructs lowering health care costs

David Mokotoff, MD

Health Policy

November 2, 2013

If you are like millions of Americans, at some point in your adult life, your doctor will order you to have a CT or MRI scan. Quick, easy, and painless, these invaluable imaging tests provide a vast amount and array of diagnostic information about illnesses, and direct treatment paths.

However, the real pain usually begins when you receive the bill. It is not uncommon for the charges, including radiological interpretation, to …

Thermography for breast cancer screening: Where is the evidence?

Jennifer Gunter, MD

Conditions and Diseases

November 1, 2013

Thermography uses heat sensitive infrared cameras to image the body and measure heat emission.

Solid tumors, even when they are tiny, have an increased blood flow and inflammation compared with non-cancerous tissue. Theoretically this could lead to a thermal gradient between a cancer and the surrounding non-cancerous tissues. Some animal studies indicate that thermography might detect heat differences between inflamed and non inflamed tissue and so it was postulated (initially back …

Radiation from x-rays and living in Denver: They’re not the same

Jennifer Gunter, MD

Conditions and Diseases

October 9, 2013

My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation.

My son, Oliver, has had more radiation than most people will have. Ever. In fact, …

Mammograms in younger women: Is the data there?

Margaret Polaneczky, MD

Conditions and Diseases

September 17, 2013

A recent study has concluded that women with breast cancer who failed to get annual mammograms are more likely to die from their disease than those who had annual mammograms, and argues that more frequent mammograms are warranted in women under age 40. Unfortunately, despite all the media attention this study is getting, I don’t think the researcher’s conclusions are supported by the study results.

The researchers did a retrospective medical record …

How customer service mechanisms don’t exist in health care

Paul Levy

Health Policy

September 4, 2013

Now that I am a “civilian,” I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, radiology techs, lab techs and the like. On that …

CT scans and radiation: How can patients limit risk?

Roy Benaroch, MD

Conditions and Diseases

August 30, 2013

I’ve been writing a lot about CT scans lately. Why are so many being done, and which children with head trauma really need one? CTs are really kind of neat—it’s amazing that we can peer into your body to see what’s going on in there. But like every other medical intervention and treatment, there are positives and negatives, pros and cons, a ying and a yang.

I’ve mentioned some downsides …

Will lung cancer screening CT become standard of care for smokers?

Anonymous

Conditions and Diseases

August 28, 2013

Lung cancer screening CT took its most important step toward widespread implementation last week when the U.S. Preventive Services Task Force (USPSTF) released a draft of its forthcoming recommendation that the 9 million U.S. people meet entry criteria for the National Lung Screening Trial (age 55-79, with 30+ pack-years smoking history and quit < 15 years) should undergo yearly low-dose lung cancer screening CT.

The recommendation earned a Grade B in …

What is the ideal number of CT scans for headaches in children?

Christopher Johnson, MD

Conditions and Diseases

August 27, 2013

Many, myself included, have written about the overuse of head computed tomography (CT) scanning in children. This concern has become more focused now that we have some data on the radiation risk of those scans. The bottom line is not that we should stop doing head CTs in children, but that we should always balance the risk against the benefit, just as we should do with all medical testing. In …

The gratitude of a terrified parent when kindness is shown

Pat Mastors

Patient

August 5, 2013

Hospital transport arrives to take my daughter just after 9am. We’d been told her ultrasound and x-ray were scheduled for 10am, an hour away. Jess and I exchange a look. She’s just about to take another swig of the laxative drink she’s been drinking since 8:30.

“I’ll go with you,” I say.

“We’ll make sure there’s a bathroom nearby.”

Strike one for the Golden Cocoon.

We get to the ultrasound department, and are left …