Radiology and imaging

386 articles · Since 2005

Articles, page 7

What a radiologist learned about a thoracentesis from a pulmonologist

January 10, 2017Jan 10, 2017

It was 1989. While alternating between NCAA basketball tournament games on broadcast television, reruns of an older version of the game show Wipeout on cable, and the 8-bit Nintendo game Top Gun, a child sat in a hospital bed in the middle of rural America wondering why he was there. All he knew was that he had a sharp pain in the left side of his chest and that couldn’t …

Physician voices

Does lead-time bias have a place in court?

Dr. Saurabh Jha

January 3, 2017Jan 3, 201714

In 2014, a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47 for a missed cancer on a chest X-ray. The verdict reminds me of the words of John Bradford, a heretic who was burned at the stake: “There, but for the grace of God, go I.” Many radiologists will sympathize with both the patient …

Physician voices

Why can’t we control outrageous health care costs?

Michael Kirsch, MD

December 14, 2016Dec 14, 201618

Most of us are skeptical that insurance companies are devoted to our health. Answer the following question: Do you think your insurance company is more interested in your health or in controlling costs? Pretty tough, huh? There is a tension…

Pretty tough, huh?

There is a tension between medical quality and medical costs. If we had a system that offered perfect quality, it would be unaffordable. If we imposed rigid cost controls, then medical quality would be compromised. Where …

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Physician voices

Please dear doctor, give me my results. My life is on hold.

Uzma Yunus, MD

December 8, 2016Dec 8, 20167

You will probably never meet me in person. Your name will be on the bill my insurance receives from the hospital. Your signature will be on the line after the end of the report as you mumble report after report into the system. You will never know my story. I am my organs to you; organs will anomalies that you have to squint and sometimes lean back to look for. You …

Conditions and diseases

Does the increased frequency of repair of AAA in the United States reap benefits?

Dr. Saurabh Jha

December 2, 2016Dec 2, 2016

A popular meme is that the U.S. spends more on health care than other developed nations but has nothing to show for that spending. This is different from saying that the U.S. spends more, but achieves something, but the something it achieves is so little that it isn’t worth the public purse. The latter is difficult to assert because the asserter must then say how little is too little in …

Conditions and diseases

5 cases where bedside ultrasound helped this doctor

Janice Boughton, MD

October 3, 2016Oct 3, 20162

After five years of doing bedside ultrasound, I'm still excited about it. Bedside, or point-of-care ultrasound is using an ultrasound machine during the physical examination of a patient in order to make a diagnosis. I use a pretty tiny machine…

After five years of doing bedside ultrasound, I’m still excited about it. Bedside, or point-of-care ultrasound is using an ultrasound machine during the physical examination of a patient in order to make a diagnosis. I use a pretty tiny machine that fits in my pocket. As an internist who works in the hospital and in rural clinic outpatient settings, I get to use my ultrasound all the time, and it’s …

Physician voices

The spectacular incompetence of third-party payers

Dr. Saurabh Jha

August 16, 2016Aug 16, 201619

To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In health care, incompetence…

Case 1: Downgrading caviar to boiled salmon

A patient was referred for a CT angiogram run …

Conditions and diseases

MKSAP: 52-year-old man is evaluated for low back pain

mksap

July 9, 2016Jul 9, 2016

A 52-year-old man is evaluated for low back pain of 3 months' duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has…

A 52-year-old man is evaluated for low back pain of 3 months’ duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time. His only medication is as-needed acetaminophen.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 132/82 mm Hg, pulse rate is 70/min, and …

Physician voices

A false positive is precaution by another name

Dr. Saurabh Jha

June 24, 2016Jun 24, 20165

Diagnostic tests such as CT scans are not perfect. A test can make two errors. It can call a diseased person healthy: a false negative. This is like acquitting a person guilty of a crime. Or a test can falsely call a healthy person diseased: a false positive. This is like convicting an innocent person of a crime that she did not commit. There is a trade-off between false negatives and false positives. To …

Physician voices

Patients are suffering while physicians are suffering

Robert Centor, MD

May 2, 2016May 2, 201610

Ran into a radiology colleague today. He will retire soon, and was happy to discuss the stress on radiology. I have observed more interpretation errors (or at least I think I have) over the past five years. We now strongly…

My friend opined that volume expectations have become unsustainable. We order too many imaging studies. When you ask physicians to ramp …

Conditions and diseases

Should the USPSTF include specialists?

Matthew F. Covington, MD & Phillip H. Kuo, MD, PhD

March 9, 2016Mar 9, 20165

The United States Preventive Services Task Force (USPSTF) was created by the federal government in 1984 to provide recommendations to primary care practitioners on the scientific efficacy of screening. In 2010, the federal government linked USPSTF recommendations with national healthcare policy when the Affordable Care Act mandated free coverage by Medicare and private insurance for all screening exams that receive a USPSTF recommendation of A or B. …

Read more…

Should the USPSTF include specialists?

Physician voices

How palm reading helps this physician today

Divya Yerramilli, MD

March 9, 2016Mar 9, 20163

I grew up in a house of spirituality, homeopathy, palmistry, astrology, art, and science alike. My father, with a masters degree in statistics, is a computer systems architect. He also fancies himself an amateur palm reader. The irritation with which I reluctantly used to give my hands over to my father, before the SATs, college decisions, medical school admissions, and my residency match results was real, but I was always …

Physician voices

A surprising amount of thought goes into the radiology report

Dr. Saurabh Jha

March 3, 2016Mar 3, 20162

"'Normal' is one of the most powerful words a radiologist can use." - Curtis P. Langlotz, professor of radiology, Stanford University After I used “clinically correlate” thrice in a row in my report, the attending radiologist asked, “How would you…

“‘Normal’ is one of the most powerful words a radiologist can use.”
– Curtis P. Langlotz, professor of radiology, Stanford University

After I used “clinically correlate” thrice in a row in my report, the attending radiologist asked, “How would you feel if the referring clinician said on the requisition for the study ‘correlate with images’? When you ask them to clinically correlate, you’re reminding them to do their job.”

I had been a …

Conditions and diseases

The financial costs of treating CT-induced cancer

Matthew F. Covington, MD & Phillip H. Kuo, MD, PhD

January 12, 2016Jan 12, 20166

Computed tomography (CT) is a powerful diagnostic tool that allows rapid diagnosis of disease. CT is widely available in the U.S. and is a mainstay of medical diagnosis. Estimates state that 85 million CT scans were performed in the U.S. in 2012. To create images, CT scanners pass ionizing radiation (x-rays) through the body thereby exposing patients to radiation. Patients who are imaged with CT have …

Conditions and diseases

The mystery of false positive mammograms and cancer risk

Dr. Saurabh Jha

January 12, 2016Jan 12, 20162

I enjoyed Agatha Christie’s Hercule Poirot. Not only did the ingenious Belgian solve the murder so artfully. But someone identifiable is killed, and someone identifiable is the killer. Epidemiological studies are whodunits, too. Except you don’t know who has been…

I enjoyed Agatha Christie’s Hercule Poirot. Not only did the ingenious Belgian solve the murder so artfully. But someone identifiable is killed, and someone identifiable is the killer.

Epidemiological studies are whodunits, too. Except you don’t know who has been killed, what the murder weapon is, or who the killer is. You only know that a murder may have happened.

A study found a higher incidence of breast cancer with …

Medical education

From medicine intern to radiology resident: Is the grass greener?

Kerri Vincenti, MD

January 8, 2016Jan 8, 201610

When I was an intern in medicine, I couldn’t wait to start my role as a radiology resident. Even though I cared for my patients to the best of my ability and studied their diseases, I knew that my time in the department was limited. I wish I could say that I put my whole heart into my work, but with all of the extraneous demands of intern year — …

Physician voices

This is the greatest flaw in medical training

Cory Michael, MD

December 18, 2015Dec 18, 20154

Perhaps the greatest flaw in medical training is our blatant avoidance of any education related to the business of medicine. Primarily focused on treating illness, trainees often don’t want to hear about how they are going to be compensated in the future, and medical school administrators fear that such training would further decrease interest in specialties that reimburse at a lower rate per unit time. Some doctors get 10s and …

Physician voices

The general radiologist is still valued. Here’s why.

Dr. Saurabh Jha

December 4, 2015Dec 4, 2015

In times of shortage, we find out what we value most. And in these times of relative penury in the job market for radiologists, it appears that employers value -- above and beyond anything else -- the general radiologist. Yes,…

In times of shortage, we find out what we value most. And in these times of relative penury in the job market for radiologists, it appears that employers value — above and beyond anything else — the general radiologist.

Yes, the general radiologist. The radiologist who is able and willing in one shift to perform a barium enema, follow the intricate anatomy of the inner ear on an MRI of the …

Conditions and diseases

The new mammogram guidelines emphasize that screening is a personal decision

John Schumann, MD

November 3, 2015Nov 3, 201513

The big story recently is that the American Cancer Society issued an updated guideline recommending that women undergo mammography less frequently than before. This announcement was denounced on both “sides” of the perennial debate. Those in the “mammograms save lives”…

The big story recently is that the American Cancer Society issued an updated guideline recommending that women undergo mammography less frequently than before.

This announcement was denounced on both “sides” of the perennial debate. Those in the “mammograms save lives” camp are outraged that a scientific society dedicated to cancer prevention and treatment would issue a proclamation that seems to run counter to the notion that “early detection saves lives.”

Those …

Physician voices

5 ways radiologists can reduce unnecessary tests

Dr. Saurabh Jha

November 2, 2015Nov 2, 20152

The Lown Institute advocates rational use of medical resources. This is a noble goal and worthy of the attention of radiologists. It was recently RightCare Action Week: Here are five simple things any radiologist can do that week, and the…

1. Speak to the referring clinician, at least sometimes, if not often, perhaps twice a day. The conversation need not …

Radiology and imaging

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