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.

Radiation exposure is related to the rise of a lawsuit culture

Dr. Charles

Physician

July 15, 2013

A study published in the British Medical Journal highlights the importance of carefully choosing which children should receive diagnostic CT scans. As a diagnostic test, CT scans utilize ionizing radiation that can cause cellular DNA damage, increasing the risk of cancer. Children who received a CT scan were 25% more likely to develop a cancer in 10 years after radiation exposure, according to a study of 11 …

Judiciously order CT scans to protect our children

Wendy Sue Swanson, MD

Physician

July 15, 2013

A JAMA Pediatrics article found that the use of pediatric CT scans rose in the late 1990′s and early 2000′s. Further, research shows that these CT scans can increase risk for future cancer diagnoses. Authors calculated the risk: they estimate that for every 4 million pediatric CT scans preformed annually, some 4800 children will go on to develop cancer as a result. Like many studies published this decade, the …

Ultrasounds don’t cause autism

Roy Benaroch, MD

Conditions and Diseases

July 10, 2013

Emily wrote in about an article about prenatal ultrasounds and autism: “I saw this on The Daily Beast today. Is the media trying to freak us expecting couples out or what? How big of a question is this in scientific circles or is this just sensational stuff? Sometimes I think there should be studies about how the internet causes anxiety disorders!”

A good question, and another post that I’m going to put …

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Ultrasounds don’t cause autism

Respect diagnostic radiation, but don’t have an irrational fear of it

Christopher Johnson, MD

Physician

July 6, 2013

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I’ve written before about the increased risk for future cancer, if any, of diagnostic radiation. These posts have generated a large number of comments and questions from parents. Most take the form of fear they have needlessly increased their child’s future cancer risk by agreeing to a CT scan. A new research study give us some important new information about …

The FDA is regulating the wrong things

Janice Boughton, MD

Medications

June 16, 2013

The Food and Drug Administration was created in 1927 in order to carry out the mission of the Food and Drug Act put into effect by Theodore Roosevelt in 1906. In the early 1900’s and before, medicines killed and maimed people in gruesome ways and adding chemical substances to foods to mask the fact that they were rotten or substandard was felt to need some sort of legal response. The …

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The FDA is regulating the wrong things

Who should be able to certify medical necessity?

Marjorie Stiegler, MD

Physician

May 25, 2013

These days, there is a lot of talk about expanding scopes of practice for the group of folks who used to be called physician extenders and then midlevel providers and more recently non-physician providers, many of whom are now getting degrees with the title “doctor” incorporated.

While it seems to vary, these folks may include nurses, physician assistants (one day to be called physician associates perhaps), pharmacists, and more. Lots …

A radiologist reflects on indeterminate findings

Paul Dorio, MD

Physician

May 7, 2013

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Radiologists care about their patients, even though most diagnostic radiologists don’t meet and greet their patients the same way direct-care clinicians do.

Some people have the erroneous perspective that radiologists and pathologists don’t care about the welfare of their patients. It is possible for us to understand that view if we look at radiologists and pathologists as isolated workers who work …

Female feticide: The ethical issues of ultrasound in India and China

Janice Boughton, MD

Physician

May 6, 2013

The use of ultrasound has had a large impact on health care in resource poor countries. This article details some of the research that has been done overseas to look at the impact on bedside ultrasound by caregivers to deliver more appropriate care for injured and ill patients in Africa, Asia and Mexico.

Using an ultrasound to determine how dehydrated a child …

Ordering tests just to reassure patients doesn’t work

Albert Fuchs, MD

Physician

May 5, 2013

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Every primary care doctor has been faced with this situation. A patient reports vague symptoms and is very worried that they are a sign of a catastrophic illness. The symptoms aren’t even slightly suggestive of the disease the patient is worried about, but the patient’s neighbor’s brother-in-law was just diagnosed with the same disease, and so the patient is pretty sure that …

Medical residents expect the data to be fed to them

Wes Fisher, MD

Physician

May 1, 2013

“What’s the most important finding on this chest x-ray?”

There he was, standing before 5 ICU residents, each peering at a chest film on displayed on the over-sized computer screen.

“Um, the pleural effusion?” whimpered a third-year resident.

“No!” barked the attending.

The others, standing dumbfounded in front of the computer display, searching for another finding but finding none, stood silently.

“Come on, folks! Look!”

And try as they may, no one saw it.

“The name, folks, …

Is outsourcing medical diagnoses a good idea?

Joyce Ho, MD

Health Policy

April 25, 2013

I’m sure that many of you have read the New York Times post titled “Job Prospects are Dimming for Radiology Trainees.”

I don’t know about you, but this article made me feel more than ever that in order to choose the right specialty, you have to predict the future of the field. Don’t choose a field that’s going to be heavily affected …

Reduce the chance that you will be harmed by an incidentaloma

Kenneth Lin, MD

Physician

April 18, 2013

Mrs. Smith (not her real name) fidgeted in her chair in my examination room as I scanned the radiology report she had given me. She had visited the emergency room the previous evening with severe abdominal pain that had eventually been diagnosed as gastritis, or swelling of the stomach lining due to a virus. During her evaluation, the ER physician had ordered a CT scan of her abdomen and pelvis. …

The fallout of chance medical findings

Kevin R. Campbell, MD

Physician

April 15, 2013

I can remember making rounds with a seasoned surgical attending in medical school. In typical fashion, surgical rounds were a lot like the military. The “General” (attending physician) at the front, always commanding respect (and often fear) followed by the chief resident, junior residents, interns and finally medical students. Cases were presented, statuses were updated and plans were formulated. Then came the barrage of medical fact questions–mostly directed at the …

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The fallout of chance medical findings

The Wax Pencil Sign will soon be obsolete

Bruce Campbell, MD

Medical Education

April 9, 2013

Tell me to what you pay attention and I will tell you who you are.
-Jose Ortega y Gasset

The senior resident hauled our little band of medical students down to the radiology file room. As he dug through the heavy manila x-ray jacket searching for films, he told us the patient’s story. “This 63-year-old lady was really sick when she came in. Heart attack a couple of years ago. New trouble …

Should Medicare cover PET scans for the diagnosis of dementia?

Leslie Kernisan, MD, MPH

Conditions and Diseases

March 27, 2013

Do they need a PET scan to confirm the presence or absence of amyloid plaque?

More importantly, would doing such PET scans make meaningful impacts on patients’ health?

Those are the questions that a Medicare expert panel recently considered, and their impression, after carefully reviewing lots of high-quality research, is that we don’t yet have evidence supporting the benefit of using the PET scans. Unsurprisingly, some experts disagree, including a working group …

Just sign here: That isn’t real informed consent

Peter Ubel, MD

Physician

March 26, 2013

Before patients can become savvy consumers of healthcare, they need information about their healthcare choices. Too often, such information is nearly impossible to get, especially when it requires doctors to give patients useful statistics about things like treatment side effects.

Since publishing Critical Decisions this fall, I have received a number of emails from readers who have recognized their own medical histories in the pages of my book. I received …

Questions to ask before your CT scan

Toni Brayer, MD

Physician

March 18, 2013

The United States is higher in its use of computed tomography (CT) scans than any other industrialized country. There were about 3 million scans done in the U.S. in 1980. By 2007 that number had risen to 70 million. A number of articles published in medical journals over the past few years have reported that excess radiation delivered by these scans will …

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Questions to ask before your CT scan

Incidentalomas: The real cost of ordering tests

Edward Pullen, MD

Conditions and Diseases

March 2, 2013

I recently read a very good article in the New York Times about a patient found to have the classic incidentaloma, a small mass in the adrenal gland. This is estimated to be seen in 4% of abdominal CT scans, and is rarely serious but typically leads to recommendations for additional testing and follow up CT scans to assure that it is not either a metastatic cancer …

Medicine requires doctors to constantly manage probabilities

Robert Fenster, MD

Physician

February 14, 2013

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“I’d really feel better if we got the MRI,” Ms. James said. “I understand you think it’s a migraine, but I want to know, just in case. Wouldn’t you?”

Ms. James and I sat in her darkened hospital room—the light bothered her eyes and exacerbated her headache. She was a dialysis nurse with many years of experience in the healthcare field, and I …

I didn’t become a doctor to bankrupt my patients

Jordan Grumet, MD

Physician

February 8, 2013

I have come to terms with making difficult decisions. I accept the possibility of committing a mistake that will cost a life. But I never signed on to bankrupting my patients. Never!

I had been up all night tossing and turning. The stat CT scan was deemed unnecessary by the insurance company. My patient called crying saying he couldn’t afford the thousands of dollars in charges. Never …

Radiology

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