iRADiX

My radiology report slightly deviates from suggested guidelines, and I will try explain it

 

One of the most important aspects of practising medicine anywhere in the world is to update the knowledge and skills of clinical medicine. Continuing Professional Development (CPD) is not only updating the knowledge and skills, but also improving teaching, communication and managerial skills.

 

The practice of radiology changes according to the need of the clinical medicine. As radiologists, we need to be on the edge of the technology to deliver high quality diagnostic and interventional knowledge and skills. It is also about attitudes and values of practising radiology.

 

In West, CPD is mandatory for all health care professionals. For example, in the UK, all consultants are required to earn 250 CPD points in 5 years by attending various courses and conferences. The Royal College of Radiologists of the UK has published extensive guidelines for the radiologists practising in the UK.

A decade ago, a dial-up Internet connection was a big bonus. Now, if there is no Internet connection, computer is nothing. Internet has opened the gates of endless source of useful and useless source of information to the extent to make us nettoholics. For people who live on net, net-books are cheap alternative to laptops and can be carried in handbags very easily. Internet is also available on all new smart phones.

Speed is the key:
With the current complexity and content on the web page, it is nearly impossible to browse the Internet with dial-up connection. Broadband speed one needs depends on the type of establishment, the amount of information sent to and received from Internet during working hours, and number of computers connected to Internet. More the speed, more the subscription. All new laptops and smart phones come withWiFi; hence there is no need of any connecting wires.

Browser:
I am sure we all know that browser is the one which primarily connected computers to the world of Internet. Hence it is the most important software in the computer which needs to be chosen with great care. As soon as we are connected to Internet, the computers are exposed to security issues (viruses, worms, Trojans, ad-wares,malwares etc). One might be having very good broadband connection, but the browser may take more time to load. There should not be too many toolbars (the ones which are on the top) so that we should get more space to read and view what we are browsing.

I am sure most of the radiologists are well versed with this topic, but I am trying to summarise what is important to us.

Which Computer?
The best ones are desktops, but laptops give flexibility.

For routine radiology reporting and printing, a basic desktop (with minimum specifications) is more than enough. Brands are not important, and there is definitely no need of any fancy accessories, or high specifications, if one is looking for a computer for typing reports, keeping statistics and finance, and typing letters. For a beginner, even a second hand desktop will do.

No body uses floppy discs now, and hence there is no point in buying a computer with one. The computer should have a CD/DVD writer to give copies of reports/ images. At least 4-6 USB outlets are necessary as most the accessories are compatible with USB ports.

You need a laptop, if you are into teaching with the help of computers, if you depend on Internet for learning, if you want to be in touch with the "www world" with blogging, socialising and tweeting.

Very high specification laptop with high resolution screen is needed if you are using laptop for remote reporting, although the laws in a particular might allow to do a formal reporting with the resolution of laptop monitors.

THEN:

When I started my residency in radiology, computer itself was a luxury and 3 1/2 inch floppy disc used to cost Rs 25/-! Internet connection was from dial-up with a speed of may be 10kbps. I did not have a computer during my radiology residency, but my elder brother and my sister-in-law had one. I still remember the day, I opened my first e-mail acccount (of course it was hotmail) well back in 1998 with help of my brother-in-law.


But during the same time, America was putting all its money on IT, and strongly believed IT is where money multiplies exponentially. As doctors, we did not understand the difference between operating system and internet, RAM and memory etc!


Few used computers (not internet) to search literature. Our medical college had a huge set of floppy discs with indexing (donated by some NRI) of medical articles. Few used to use internet for e-mails to communicate with friends and relatives living outside India, to chat with friends, and to join like minded 'groups' to read and write 'discussions'.


During the same time, radiology conferences in India slowly started using projectors with powerpoint presentation. But still, many speakers used to bring huge set of slides, which used to get stuck.

No doubt, most of our errors go unnoticed. It might be due to the fact that many clinicians do not know how to read films, or may not have access to the films. It is financially not feasible to do double blind reading of every film to make it as much fool proof as possible. Hence, we need to develop a method where we can identify the errors and learn from each others' mistakes.

1. Discrepancy meeting:

If the department has more than one radiologist, it is worth doing the exercise of discrepancy once a month. The key is keeping anonymity of the reporter, otherwise this may lead to blame culture. In a teaching hospital, the best person to take the lead of discrepancy meeting would be one of the senior residents or a final year post-graduate. All the cases should be collected by the designated person, and the cases should be shown to all the people in the meeting. 

This should not be treated like a quiz, or to test juniors or colleagues. The clinical information and all the films available at the time of reporting should be given to the audience.  Then discussion should be on the report and subsequent discrepancy on the reporting.

(I sincerely apologize for not writing any blog in April)

We are humans, and we are prejudiced. As radiologists, we are also prejudiced with our images. Here, I am trying to explore our pejudices (I call them pre-occupuations) and try to address how to avoid them, although it is humanly impossible to be completely unoccupied with ourprejudices.

Pre-occupied with clinical information:

The way we start reading a chest radiograph with history of trauma is so much different from a chest radiograph with history of cough in a smoker. The way we look at a cervical spine radiograph with history of trauma is so much different from looking at a cervical radiograph with history of radiculopathy.

How to avoid it?
1. Look at the images first before looking at the request card.
2. Step outside the request card everytime in every patient and look for something which referring clinician has not considered.
3. Keep a mental check list for every part scanned.