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.

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.

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).

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.

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.

Do you do Level 5 sonography?

Society can be analyzed in different ways. One of the ways to do that is to see how technology has affected the ways of living.

Levels

In an Editorial written in 1989, Dr. Roy A. Filly told about Level 5 Ultrasound. (1) He wrote about a call from a clinician asking whether he performed Level 4 Ultrasound. He had never heard of Level 4 sonography, but the request itself struck an unusual chord within him. He recognized this request itself as part of a growing problem in obstetric sonography. Uncharacteristically for him, he shot back

“I only perform Level 5 sonography”.

Rather than chastise him for this cavalier statement, the clinician thanked him and the patient dutifully reported the next day with a request for a Level 5 Sonogram.

In some IRADIX interacts –readers have said that the problem of regulation of Imaging equipment is unique to India where norms are not followed. This is not true.

The Editorial clearly talks about this issue in an advanced country and goes on to state

I had finished my 43^rd ultrasound of the day and clock had struck 2:30 in the afternoon. I felt uncomfortable in my pelvis and wanted to attend to the nature’s call. As I got up to leave the ultrasound room, a patient at the door stopped me and said –

“Hey Doc! Where are you off to?”

Being very polite I replied unrevealingly - “I am just coming back. Please wait for me”.

“Ohhh! I have been waiting for over two hours for my turn just to get an ultrasound examination……..and now you tell me to wait a little longer?”

“I understand you very well and I have been trying to do as fast as I can. Don’t worry, I will see you first when I get back” I tried to bargain out of the situation.

“No doc. You cannot leave this room without doing my ultrasound. I am a patient and have already waited too long.”