iRADiX

Forming Special focus groups

Forming Special Focus groups can help appreciate nuances otherwise lost in our “tunnel-vision-view-box” worlds. In previous entry we have discussed the VINDICATE grid to set protocols as per diseases.

The Pediatric Neurology Special focus group

“I initially missed out on this case,” Dr.Majdi Kara (See blog: http://www.iradix.in/309-Measuring-Referral-Slips.html ) admitted and told how Dr.Olivier had raised the possibility of this mentally retarded child having Muscular dystrophy.

Click on following image to watch Video

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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.

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

'Man was born free, and he is everywhere in chains'

The Social Contract

Jean Jacques Rousseau(1)

In the previous entry we looked at some “high resolution” issues.

It has been a heartening fortnight for IRADIX with Dr. Alok and Dr. Sridhar using their energies and expertise to enlighten us with Full-fledged articles. Alok’s article on Cut Practice http://www.iradix.in/489-Cut-practice.html and the discussions following it reminded me of the “Book of the world” from which Rousseau told he will educate a simple and natural child for life in a world from which social man is estranged.

Coming back to the topic of quality control, within a hospital there are many departments which have sonology units. This issue was examined in the Blog Self Referrals in which we also looked into the meaning of Quackery and how Vendors have identified their potential market within non-radiology departments to sell imaging equipment. Quackery is defined as a person posing to having knowledge-training of a particular field and practicing it, while not having had any formal training, qualification or experience in it.

See blog: http://www.iradix.in/282-Self-Referrals.html

Can the technical review meeting have a look into this?

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.