iRADiX

How do you deal when you discover ‘Incidentalomas’ while doing a scan …be USG, CT or MRI??

Definition of Incidentaloma:

“An incidentally discovered mass or lesion, detected by CT, MRI, or other imaging modality performed for an unrelated reason.”

From    Free Dictionary

 

Sometime back a patient came for routine USG study of Abdomen while undergoing Master Check Up. The USG picked up a cystic lesion with internal echoes in the pelvis of the Kidney.

 

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).

 

Did you identify any training needs for yourself in this exercise of reflecting on scanning protocols ? In previous entry we saw some issues relating to abdomen imaging.

As we jogged down the different systems we identified other areas where people are hesitant.

For it matters not how small the beginning may seem to be:

what is once well done is done forever.

Henry Thoreau, Civil Disobedience

The G7-G8 group of countries named “Lifelong learning” as a main strategy against unemployment. Having worked in the international “Global-work place” in a private corporate set-up and seen many “corporate-cruelties” in the name of “nothing-personal-just-business” one of the survival strategies is to have dedicated working groups.

A performance agreement

I will try to make you a technologist, and not remain a technician all your life.

Buyer’s Guide: How to buy a good Ultrasound Scanner.

After spending a decade in medical college and acquiring the much sought after degree of M.D. Radio-Diagnosis a young radiologist has two options:

1. Go and join some Job.
2. Start his own Clinic.

First option is relatively easy one and one does not have to worry about finances and other problems like getting the patients and buying Machines.

Second option is difficult preposition, as one has to face the problem of arranging the finances and buying the equipments which can be a tiring phase during the initial months.

It is that period when you finally decided to open a centre for yourself and started looking for Machine after arranging a site for your clinic. You send a signal and the representative of various companies start a bee line to you. They give you so many options, that you get confused. Every one will speak a language which you will find either Greek or Latin. This is not you have studied in your degree. There are so many confusing terms developed by individual companies to confuse customer. Like cross beam technology, Matrix probes or Aplipre, Advance Dynamic Flow, Quick view & Iassist etc.

Starting a MRI unit from scratch is an interesting and challenging exercise. Establishing one’s professional reputation is also a question of survival in different settings with referring consultants of different universities, training and temperament.

The layers of this were first set during early residency.

See blog: http://www.iradix.in/284-Pedagogy.html

There is a difference between the pressures faced in government hospitals and those that a private organizer puts on you when starting a new centre.

The commercially available protocols of most vendors will have to be tried in your setting. This involves planning as one sets out to test each and every protocol on test patients. Catching hold of staff who want to be scanned, (and finding unexpected things-one completely normal helper had a large syrinx in his entire cord but was roaming around absolutely normal, so we never told him...he is still normal). One cannot have a patient come in and then find that the particular sequence is not optimal.

“Ring him up personally and explain how and why you felt that one of the prominent collaterals of the ECA was the ICA. Otherwise in future, he will lose faith in your reports.”

One of my mentors told me to explain to a senior Neurologist how I had reported on the ICA as narrowed on MR Angiography when the Doppler report had shown it to be completely occluded.

He could have done it himself, and ticked off the junior. He knew the senior Neurologist very well. But he left it to me to do this difficult part of the communication which was also a multilayered lesson.

How independent can one be in a modern technology driven specialty branch dependent on referring physicians?

Systems and communities of practice

In the previous blog we had examined some practice options (Part Time?)

As Dr. Sridhar rightly pointed out that we are a referral dependent specialty and in his interact on Forum of Super specialty in Radiology has observed that one really does not often meet radiologists who are practicing as independent super specialists. We meet Neurologists, Cardiologists..but…super specialist radiologists?

In Blog End of Individual Goliaths we had examined how if one has to hold ground one has to be part of some system of practice.

Does the person who is working “For Himself” really work alone or are they part of several practices.

One surgeon friend did not want to initially invest on costly radiology equipment as he had invested in operation theatre and Intensive care units. He asked his radiology friend to invest and set up the radiology department.

“I am a man of limited means and you can use your real estate to become independent any time, once the initial loss making ‘teething’ period is over” the radiologist replied frankly.

What is a life without problems?

Idealists to pragmatists
My fellow radiologist was pleading to the director to be released as he wanted to go back to India. “My father is not well,” he said. The director who had administrative powers to withhold his exit from the country answered in a clichéd manner-“Everyone has problems”, not wanting to go into the specifics.

Earlier I was more vocal in personal cases, but now, having taught by many colleagues how dynamics and motivations change, I am a bit reserved and pragmatic.

As department or section incharge, one has to have a roster and someone will have to man the C-arm when the surgeon comes. No excuses.

The Roster
My chief resident was one of the first organizers I recall who was tough enough to withstand all pressures, personal attacks, back biting and would stick to the roster.

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.