iRADiX

The summer heat had set in and the sun was high in the sky. The clock had just struck noon when the idea to take a quick break flashed across my mind.

I had just finished the morning rush of patients for ultrasound.

Standing up from my chair, I told my secretary of my intention.

Receptionist entered to announce another patient from Germany with renal colic.

Considering his acute problem, I did not deem fit to delay the scan.

As the patient entered ultrasound suite, he glanced at me with a puzzled look.

The nurse draped a sheet on him and I started to take up the transducer when he suddenly sat up.

“Can you do an ultrasound examination?”

I was startled at his question and completely taken aback. Neither did I comprehend the reason for such a question nor could I justify it.

Here I was, having done more than 60,000 scans of all kinds in my career, faced with such a question.

General, Doppler and small parts ultrasound

I have been in some remote areas where people have purchased Doppler machines just to advertise that they produce color pictures. and the patients are impressed and ask for it though the physicians in those areas have not yet felt the need for a Doppler study ‘In contrast there are areas where the physicians are so much aware of Doppler that you have to do one or two vascular Doppler daily. I have worked with a physician who asked for renal Doppler in every case where he wanted to start an ACE inhibitor in a hypertensive patient. He had a good justification for it. In a reasonably good centre a radiologist has to perform at least one of the Doppler study in the areas such as thyroid, carotid, peripheral vessels and at times breast and scrotum. etc. Pediatricians will invariably send a few cases for cranial ultrasound  once in a while. In centers of remote areas ultrasound is the main revenue earner and CT takes the back seat...

Selection of a Centre to work in

Most of these centers require their radiologist to be available 24 hours. Many of them don’t want to give even a day’s off. They may call you for a simple case to do USG even on a Sunday making it as emergency case... On week days you have to work for almost 12 hours Though the salary is good around one lac or more with free accommodation and even free food at times but freedom to move around without informing them is a hurdle and even a great irritant at times. In the beginning as I did not have the experience I worked in 3 centers for two to 3 months but ultimately got fed up and left them as I did not like too much of a disturbance even during night hours A young man may work for a year or two and collect some money so that he can establish his own centre later or until he gets a better job but I had no such compulsions. I would always advise you to go and see the location and working of the centre for a few days and then negotiate and then join if you like.

Subtitle: Knowledge management systems and the universal mind

What  knowledge management systems exist in your organisation?

In our explorations and conversations together we try to seek the difference between the individual mind and the universal mind. As the relation between these two (the individual and universal) gains concrete form, and its own proper shape and appearance, one finds a life of the universal individual.

On "Inevitable Attrition"

Addressing the issue of "inevitable attrition" which Dr.Alok Varshney and Dr.Anuj Mishra raised while commenting on the article "A performance agreement'http://www.iradix.in/515-A-Performance-Agreement.html made me reflect on the nature of knowledge management systems which exist within our medical organisations. Employees must have free-flowing lines of communication between one another and need access to sources of knowledge -both inside and outside the organisation. That knowledge is often the raw material of creative thought.

Some companies have developed elaborate knowledge management systems to capture knowledge, store it, and make it easily available to reuse. These systems help ensure that what was learned by someone in Unit A doesn't have to be learned anew by someone in Unit B. Lee Sage has described DaimlerChrysler's Engineering Books of Knowledge (EBOKs), a knowledge management database containing technical data, lessons learned, and best practices that is made available to the company's engineering community. The purpose of the EBOKs, according to Sage, is to capture the expert knowledge of technical employees and use it to improve engineering productivity, speed new product development, and avoid repeating past mistakes. Consulting and tax accounting companies use knowledge management systems in similar ways (1).

An editorial in The British journal of radiology in the late eighties had rightly predicted that by the   year 2000 there would be a world wide shortage of radiologists by 50 percent. And perhaps this presumption had been the concern of only the radiology community and the clinicians who depended, on radiology services to what extent only they knew or perhaps know now, never gave radiology the respect due to it inspite of the awe -inspiring entry of Ultrasound, CT and MRI enhancing the status of radiology to the present level that the brightest of the medical students are getting attracted towards the field.

About 10 years back a very senior American radiologist remarked during an IRIA conference that the imaging technology about to come will astound you and a time will come when clinicians won’t be able to write a prescription without our help. Since then and now I am not aware what changes have taken place in the minds of the clinicians as I still perceive their usual arrogance but when they come to the point of shaking hands their attitude does softens a bit. It is not our ability to handle an advanced imaging equipment that has earned their closeness but the money associated with it as they pay the same or even more attention to a rich patient of theirs oblivious of the radiologist’s presence at times...

How easy or how difficult is to run a diagnostic center?? Any idea??

Everybody says that Radiologists are the luckiest among the Medical Profession and it is assumed by our Non radiologist friends that Radiologists make a lot of money without much sweat whether working for somebody or running own diagnostic center. .Nothing is far from the truth.

Some of the Radiologists as soon as they successfully complete their course may want to start independent diagnostic center.

The center can just have one Ultrasound machine initially with two receptionists and two helpers in the beginning

Not many problems initially faced by the radiologist and running of the center is a smooth affair.

Once the radiologist starts thinking of expansion either due to severe competition going on in the market or because of customers demanding... add on facilities…….. the problems start one by one.

So as the idea of starting a full fledged center crops up…. more and more machinery are added besides the Ultrasound machine.( the machines include, Digital xray,CT,MRI,,Complete lab equipments, Mammogram, PFT,EEG ,Nerve conduction test ,Endoscopy etc.)

Present day setting up of a diagnostic center is not as simple as one may think .Gone are the days when one was very comfortable by enjoying a decent profit...

In broad terms, diagnostic imaging offers the clinical investigator two principal types of information. Most imaging techniques provide information on macrosopic structure, by revealing the anatomy of organs and the morphology of lesions. A second major focus of imaging techniques is the circulatory system, in particular the vascularity of tissues and their perfusion by blood. Future diagnostic imaging modalities, currently used only in research settings, can provide information at the molecular level, such as the concentration of metabolites and the tissue density of proteins (e.g. receptors, enzymes).

Ultrasound (USG) provides information on both macroscopic structure and blood circulation. The capabilities of ultrasound can be improved and expanded by the use of a contrast agent, which does much more than simply improve the signal-to-noise ratio or compensate for inadequate instrumentation!

The role of contrast-enhanced ultrasound (CEUS) in liver imaging is very well established. However, its application in other organs is still controversial.

Herein I will describe a series of clinical examples to illustrate some of the varied uses of contrast-enhanced ultrasound beyond the common application in the study of focal liver lesions.

What exists appears,

Lets itself be encountered

But you can never deduce it.

Nausea, Pg 188.

Jean Paul Sartre,Existentialist Philosopher

Of the many things we shared, it was the love of the written word that bound us the most.

Every family is a ghost story

In Mitch Albom’s “For one more day” he writes about a story about a family and as there is a ghost involved you might call it a ghost story. But every family is a ghost story. The dead sit at our tables long after they have gone. Ask yourself this-Have you ever lost someone you love and wanted one more conversation, one more chance to make up for the time when you thought they would be here forever?

If so, then you know you can go your whole life collecting days, and none will outweigh the one you wish you had back.

This feeling of “One more chance for a conversation” comes strongly today, as I recall dear LC Uncle.

He taught us many little things about life.