iRADiX

Doppler traces and Technical Thresholds

In previous entries we examined some issues arising from X-ray (Please Repeat), CT scan (high resolution), and Ultrasound (Snowstorms). Let us examine some other quality issues using the tool of “Technical Review Meeting” in the web world. Hopefully these will be applied practically. Feedback from readers regarding their experiences, pitfalls and lessons learnt will help improve the common pool of knowledge.

A fresh understanding of particulars

If a source is emitting sound waves, the frequency of reflected sound from an object in its path increases or decreases if the object is moving towards or away from the source respectively. This is the Doppler Effect (Christian Andreas Doppler-1803-1863), an Austrian mathematician) and the change in frequency is the Doppler Shift. (1)

In one of the forum discussions of IRADIX a question was asked, whether you use the Doppler mode while doing a routine ultrasound. In previous blog we had seen some Snowstorm-PRF issues. As told earlier, many vendors have targeted clinical departments as their market to sell them imaging equipments. This has led to increase in Quackery and some erosion of ‘Radiologists’ ground.

The positive outcome of this could be that we have to raise our bar so that they will still require us. It also made me reflect on the nature of sensation (Vico), reflection, education (Rousseau’s Emile) and remember the words of Francis Bacon

The Technical Review Meeting is a very useful part of any department.

The Technical Review Meeting (TRM)

Is setting up a Radiology department similar to an adventure? Things can be pretty challenging at times. In previous Blog http://www.iradix.in/488-Please-repeat.html we had touched upon this topic giving the example of plain radiographs. We can now examine how such situations may play out in other imaging modalities.

The adventurer, mountaineer and author Chris Bonnington tells of his ground rules of adventure as a journey, or a sustained endeavor, in which there are the elements of risk and of the unknown, which have to be overcome by the physical skills of the individual. Radiologists starting a new Imaging centre from scratch may have to use a lot of intellectual energy and skills and face up to many unknowns.

Working in an already running place is very different from starting a centre from naught, establishing the protocols and reputation of images and reporting and also facing up to clinicians of different training and temperament. The nuances in foreign settings add further flavor to experience (See blogs: http://www.iradix.in/413-Violence-Management-Strategies-Categories-and-Specifics.html) and http://www.iradix.in/302-Dignified-solutions-302.html

for further detailed narrations)

A critic is a man who knows the way but can’t drive the car.

Kenneth Tynan

The technician came to me looking harassed. He had a cervical spine lateral x-ray view film with him.

“Do you feel it is alright?” he breathed out in exasperation.

The whole of the cervical spine from atlanto-occipital joints to the top of the first thoracic vertebra was included. The mandible or occipital bones were not obscuring any part of the upper vertebrae. Soft tissues of the neck were included adequately. The contrast produced densities were sufficient to demonstrate soft tissue and bony detail.

I queried the technician as to what the issue was.

It was our Neurosurgeon (again) who had wanted to see the films in his OPD (without radiologist’s report) and then declared to the relatives that they were inadequate and sent them back to get them done properly.

This particular gentleman is not amenable to any discussion as he knows everything (from Germany) but cannot tell what are the criteria for a proper cervical spine lateral view. Thankfully we have the latest edition of Clark’s Positioning in Radiography to show these international experts what criteria we need to fulfill when taking a particular view. Having worked in a place where there are ‘experts’ from different universities, some of them pretty aggressive, over the years, I have armed our department with many lists of criteria, guidelines and best-practice evidence.

Having introduced the topic in previous article, we shall try to examine specific situations and try to evolve a common body of knowledge. In this I will deal with some specific situations which are within our direct “Circle of Influence” in our departmental settings and also try to name possible areas of concern which require wider inputs.

Some of my closest doctor friends and teachers have been General Surgeons.

Grey Scale Helps the Red scale

“International Health Care advisors"

Do "management experts" give advice to you on how to manage medical issues?

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My director was very tense and waiting at the reception for a group of “International Health care advisors” who were coming to see the facilities in the hospital. One of the technicians asked him for a minute, but the usually cheerful director, a cardiologist by training, who also serves as consultant to Medical Universities in Europe, snapped back,

“No! I do not have a single minute!”

The technician came back to me, a bit depressed and told how he felt snubbed.

“Maybe there is something serious coming up. Let us wait and see”

Technical experts to Board advisors

“I will throw you out of the window” shouted the tall well built bearded Member Secretary of the Board of Directors. His booming voice resounded in the corridors of the corporate hospital. The person on the receiving end was one of the senior most surgeons of the hospital. The incident did not bode well for the morale of the entire medical team.

Have you heard something like this going on in your hospital?

Which window are we looking at?
Click to enlarge

When you see your Professor and HOD who is thirty years something in the field, a respected figure in professional academic circles, having to listen to “deans-directors-commissioners” talk down upon him, persons who are lesser to him in age, experience, qualification, knowledge, character, stature, just because they hold administrative posts while our Great Man ploughed the field of the subject, how do you feel?

Conversations with a Neurologist

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What do you think of the referral slips sent by clinicians?

As radiologists, we come to know the depth of the referring clinicians by reading their referral request forms. There are some clinicians who will not even write a history. There are some who will write a few words and that is it. Some who will write detailed notes. Some who will ask specific questions on what they are looking for.