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.

The spectacular incompetence of third-party payers

Dr. Saurabh Jha

Physician

August 16, 2016

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 can be found in odd places, such as three recent examples I encountered with third-party payers.

Case 1: Downgrading caviar to boiled salmon

A patient was referred for a CT angiogram run …

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

mksap

Conditions and Diseases

July 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 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 …

A false positive is precaution by another name

Dr. Saurabh Jha

Physician

June 24, 2016

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 …

Patients are suffering while physicians are suffering

Robert Centor, MD

Physician

May 2, 2016

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 stress that the learners review all films and question radiology reads.

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

Should the USPSTF include specialists?

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

Conditions and Diseases

March 9, 2016

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?

How palm reading helps this physician today

Divya Yerramilli, MD

Physician

March 9, 2016

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 …

A surprising amount of thought goes into the radiology report

Dr. Saurabh Jha

Physician

March 3, 2016

“‘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 …

The financial costs of treating CT-induced cancer

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

Conditions and Diseases

January 12, 2016

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 …

The mystery of false positive mammograms and cancer risk

Dr. Saurabh Jha

Conditions and Diseases

January 12, 2016

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 …

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

Kerri Vincenti, MD

Medical Education

January 8, 2016

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 — …

This is the greatest flaw in medical training

Cory Michael, MD

Physician

December 18, 2015

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 …

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

Dr. Saurabh Jha

Physician

December 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, 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 …

The new mammogram guidelines emphasize that screening is a personal decision

John Schumann, MD

Conditions and Diseases

November 3, 2015

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 …

5 ways radiologists can reduce unnecessary tests

Dr. Saurabh Jha

Physician

November 2, 2015

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 following weeks. This will improve patient care by avoiding unnecessary tests.

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

Radiologists don’t have to fear Watson. Yet.

Howard Chen, MD

Health Technology

August 2, 2015

IBM_Watson

Arthur C. Clark and Stanley Kubrick predicted supercomputers more intelligent than humans. In 2001: A Space Odyssey, HAL states, with typical human immodesty, “The 9000 series is the most reliable computer ever made … We are all, by any practical definition of the words, foolproof and incapable of error.” Forty years later, IBM’s Watson pummeled humans in Jeopardy – a distinctly human …

MD? Who cares about that? The virtues of doctoring in a small town.

Cory Michael, MD

Physician

July 16, 2015

I had spent medical school and the better part of my adult life in another state by the time I matched into a medical internship back home. Such an opportunity allowed me the opportunity to enjoy a more familiar setting complete with the more bucolic and relaxing lifestyle I had missed for so long. Though not quite in my rural hometown, …

Alzheimer’s disease and the dawn of preventive neuroradiology

Cyrus Raji, MD

Conditions and Diseases

July 15, 2015

In 1735, Benjamin Franklin wrote, “An ounce of prevention is worth a pound of cure.” Now 280 years later, this basic concept of human health has been refined and applied throughout medicine. Recently, the emphasis on prevention has been amplified by the passage of the Affordable Care Act that prioritizes such services. Radiology remains uniquely poised for this change with its …

Should radiologists disclose results to patients? The answer isn’t what you think.

Samuel Friedman, MD

Physician

June 29, 2015

Merriam-Webster defines “value” as follows:

The amount of money that something is worth: the price or cost of something
Something that can be bought for a low or fair price
Usefulness or importance

I find this intuitive, really. The value of something is what it is worth. However, is that something worth the same to me as it is to you? And if I give …

Indian radiologists have more to worry about than teleradiology

Dr. Saurabh Jha

Physician

June 29, 2015

Teleradiology has the same effect on radiologists as Lord Voldemort has on Muggles. It’s the feared end point of the commoditization of imaging, with Rajeev in Bangalore outpricing Rajeev in Chicago for reading follow-up CTs for lung nodules.

But despite the fears of U.S. radiologists, their counterparts in India have more pressing things on their mind.

“U.S. radiologists think that Indian radiologists are …

It’s time for radiologists to stop hedging

Dr. Saurabh Jha

Physician

June 24, 2015

There’s a simple way to define value. Ask why we exist.

Imaging exists because clinicians are uncomfortable with uncertainty. Imaging exists because emergency physicians feel that being 98 percent correct about the absence of pulmonary embolism is not good enough. Radiologists exist because imaging is not an assay on a Western blot with a 100 percent accuracy. Radiologists exist because information is …

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