iRADiX

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).

What exists appears,

Lets itself be encountered

But you can never deduce it.

Nausea, Pg 188.

Jean Paul Sartre,Existentialist Philosopher

Of the many things we shared, it was the love of the written word that bound us the most.

Every family is a ghost story

In Mitch Albom’s “For one more day” he writes about a story about a family and as there is a ghost involved you might call it a ghost story. But every family is a ghost story. The dead sit at our tables long after they have gone. Ask yourself this-Have you ever lost someone you love and wanted one more conversation, one more chance to make up for the time when you thought they would be here forever?

If so, then you know you can go your whole life collecting days, and none will outweigh the one you wish you had back.

This feeling of “One more chance for a conversation” comes strongly today, as I recall dear LC Uncle.

He taught us many little things about life.

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.

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.

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

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)