iRADiX

What is that Clinicians want or rather expect from radiology reports?

In good old days Radiology Practice means nothing but interpreting the x-rays ordered by the clinicians.

All that clinician wanted to know was whether there is TB in the x ray chest, whether any duodenal/gastric ulcer in the barium meal studies, or any fracture of bones etc.The life of the Radiologists was very simple and care free ( without much responsibility )  in those days and no surprise…. no takers for Radiology Postgraduate seats. Anybody, did radiology PG in those days is not out of Love of the specialty but due to helplessness, and I remember People with MD in radiology settled happily in General Practice, since they just wanted MD tag

From 70’s onwards,   things have changed and Radiology advanced rapidly and radiologist started playing a role along with the clinicians in patient management and even earned respect as “clinician’s clinician”

Definition of Bias

‘To lean towards something because you don’t like something else, or you like something more than something else, goes hand in hand with discrimination and prejudice’

‘Someone who already has their mind made up and preset towards a one sided view of a situation’

Scene 1

Patient having RT hypochondrial pain.

Two scan centers gave USG report as Multiple Gall stones with sludge and a third scan center gave the report as ‘echogenic mass lesion with acoustic shadow-to rule out growth’

(Nobody knows why the patient visits so many scan centers for the same problem.)

In response the Blog Article ‘Limitations and Radiologists’, Dr. Himanshu Maniar brought out a very sensible and realistic issue.

He said

“While taking a stance on such issue, we should keep in mind that it may not be possible to change machine so frequently in a private set up. The problem is when you give your machine for buyback the deal is invariably against you as either you get a very small amount (Which may not even cover the loan margins) or you are made to pay more” -

However...Medico legally…Can we safely argue that …… due to the financial limitations resulting in difficulties to upgrade the machinery ….there was error in my diagnosis and my lord… pardon me!

This seems really a burning (business) issue among individual radiologists and sonologists, running own diagnostic centers. Unfortunately switching over to better machines is not that simple as buying a cell phone or laptop or buying a new dress every week for the favorite secretary.

Time and again it was stressed about the importance of a proper language to be used whether in

Radiology practices (radiology report) or be  in Clinical practice (Clinical diagnosis as mentioned

In the requisition form by clinicians)

Ultimately the aim is to have a proper language communication so that patient is benefited and region of interest is thoroughly assessed.

Are Abbreviations and Acronyms a must?? I always wonder.

Does not it remind you of a quiz program?

It may be a time saving formula for one party …. However it is likely to be a time consuming for the other party concerned.

Incidence 1.

Mr. X went to a scan center and had MRI of Knee joint. The scan picked up no abnormality and pt was happy and went back home. Since the knee pain became worse in the same night he went to an institute to have advice. The orthopedician advised him to have another MRI in spite of pt showing him the MRI scan taken on the same day.

Pt became furious and started putting embarrassing questions to this orthopedician.

This orthopedician being a senior man got annoyed and told him to either get a fresh scan at so and so place or get lost.

Relatives convinced the patient to have another scan preferred by the Orthopedician and patient reluctantly agreed to have the scan

Now the report came as meniscus tear... Patient was operated and subsequently doing well.

‘Hygiene is two thirds of health’ Lebanese Proverb

A. ‘Hygiene’ derived from the Greek Word ‘HYGIES’ meaning Healthy, Sound.

In other words ‘Conditions & Practice’ that serve to protect or preserve ’Health’ (source- The Free Dictionary)

Hygiene to be observed both at place of work and also on a personal level.

B .Civic sense is basic ethics to be followed by the people in public.

1. Civic sense and Mobile phone etiquette

‘Switch off your phone when in scan room please ’

The big display board says in the reception For Certain clients and their relatives it is convenient to ignore this display and just do the opposite while in scan room. When the Radiologist is doing a serious study, suddenly all sorts of funny..Sometimes very loud ring tones are heard shocking the radiologist for a moment, diverting the attention.

‘Keep your voice down’

Having realized that an error was made …What is your next step?

“To err is Human”

Can we safely apply this principle to our Practice and expect protection against the errors made in our reports?

A search for Medical errors in Medscape provides you mind-boggling 4284 references. These errors include contribution not just from Radiology also from other branches including paramedics errors.

Dr. Keshav Kulkarni in his 4 part blog ‘to err is human’ has excellently dealt in detail, various causes and lacunae that are responsible for the errors and how to prevent the same along with remedial measures.

My request to the fresh members of Iradix, is…... please go through his blog.

Errors in Radiology Practice are common and I am sure All of us make some mistake at one time or other, since all of us are in the Ever learning process through out our career.

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.

How easy or how difficult is to run a diagnostic center?? Any idea??

Everybody says that Radiologists are the luckiest among the Medical Profession and it is assumed by our Non radiologist friends that Radiologists make a lot of money without much sweat whether working for somebody or running own diagnostic center. .Nothing is far from the truth.

Some of the Radiologists as soon as they successfully complete their course may want to start independent diagnostic center.

The center can just have one Ultrasound machine initially with two receptionists and two helpers in the beginning

Not many problems initially faced by the radiologist and running of the center is a smooth affair.

Once the radiologist starts thinking of expansion either due to severe competition going on in the market or because of customers demanding... add on facilities…….. the problems start one by one.

So as the idea of starting a full fledged center crops up…. more and more machinery are added besides the Ultrasound machine.( the machines include, Digital xray,CT,MRI,,Complete lab equipments, Mammogram, PFT,EEG ,Nerve conduction test ,Endoscopy etc.)

Present day setting up of a diagnostic center is not as simple as one may think .Gone are the days when one was very comfortable by enjoying a decent profit...

To what extent Individual beliefs and practices based on one’s religion can be acceptable especially when the life of the individual is in danger or the person in question needs immediate Hospital admission and attention? Are these beliefs and practices interfering with timely medical diagnosis and treatment?

If the patient refuses Medical advice on religious grounds, are doctors subjected to liability?

Situation 1

Patient A came with severe abdominal pain .He was vomiting continuously and screaming with pain, making fellow patients in the Reception area restless. He was accompanied by four attendants, adding to the confusion and chaos, (by their constant shouting and questioning why the delay in taking the patient in for scanning, and that doctors are heartless souls etc,).

I was already doing scan on x and rest of the rooms were also occupied by the patients and Assistants attending on them.

Suddenly there was commotion in the Front Office with lots of shouting as if the patient is going to die in the centre itself, if the scan was not done immediately.