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Saturday, December 9, 2006 |
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The Impact of Emerging Technologies: Cancer's "World Wide Web" - Technology Review The Impact of Emerging Technologies: Cancer's "World Wide Web" - Technology Review:
In the past year or so, Buetow and his team have collected more than 50,000 images of lung cancers obtained from medical trials and archived them in a secure electronic repository at NCI. Their effort is part of a three-year, $60 million pilot project launched in 2004, which involves 50 cancer centers and more than 600 researchers. The archive is now available on the Internet at http://ncia.nci.nih.gov. In addition to other imaging projects, it contains a large collection of lung cancer cases followed throughout their therapy. |
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BBC NEWS | Health | Chest X-rays 'may up breast risk' BBC NEWS | Health | Chest X-rays 'may up breast risk': " Chest X-rays 'may up breast risk' X-rays are a form of ionizing radiation Chest X-rays may increase the chances of breast cancer in women with high risk genes, research suggests. An analysis of 1,600 women with high risk BRCA1 and 2 gene mutations suggested exposure to low-level X-rays did have an effect. The study found exposure before the age of 20 may be linked to particularly heightened risk. The Journal of Clinical Oncology study"
Hopefully our colleagues remember this in the ER. Even worse is the proliferation of CT for pulmonary embolism. The rate of positive CT's has decreased from 25% to 3% in our institution. The number of young females (males too) who get monthly rule out PE studies in the ER is truly alarming. |
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Wednesday, April 5, 2006 |
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BBC NEWS | Health | X-rays predict bird flu 'toll' BBC NEWS | Health | X-rays predict bird flu 'toll': X-rays predict bird flu 'toll' The patients' x-rays showed distinctive disease patterns Doctors say they can predict how deadly a case of bird flu might be by looking at an infected person's chest x-ray. Their findings are based on their experience from 14 people with bird flu treated at the Ho Chi Minh City Hospital in Vietnam. The patients' x-rays showed distinctive disease patterns. However, these patterns do vary from patient to patient and could indicate what treatment each needs, radiologists at the Unive" 8:52:59 AMGoogle It! 
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Tuesday, October 11, 2005 |
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Role model "So this is radiology, part one" Unfortunately, this happens much too often in medical schools. One cannot condone the actions of the faculty. Unfortunately, work is about getting the clinical work done and not about teaching. The clinical staff could care less whether the medical students learn, they just want the radiology results so that they can get their work done. This is reality that we all just have to deal with. In the last 20 years, we have less and less time to teach the medical students. When we tried to move teaching into the early moring hours (before 7 am) or into the late afternoon this was considered medical student abuse. So we just muddle along.6:42:26 AMGoogle It!
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Sunday, January 23, 2005 |
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The New York Times: Rapid Rise and Fall for Body-Scanning Clinics The New York Times: Rapid Rise and Fall for Body-Scanning Clinics:
The CT screening bubble burst. The New York Time article discusses the rapid rise and sudden demise of screening CT. AmeriScan closed. CT Screening International closed. ScanQuest closed. Highly marketed and endorsed by numerous celebrities, it looked as is there would be a gold rush for radiologists for CT screening. One needed to be a little bit of a snake oil salesman, but if you could sleep at night with the claims of early detection, one could easily become rich running your own business. However, it was not to be. Once the smoke passed, the public just couldn't forke out large sums of money for claims of early detection. Once those with large discretionary incomes were gone, there was nothing left. Was the marketing wrong? "...from the neck to the pelvis, almost all diseases uncovered at asymptomatic stages can be modified, reversed, or cured" - seems to me to be appealing. Was the public paying attention to professional societies admonition that it was unproven - I doubt it. Most of these chain stores have now gone by the wayside and those that are left barely do business. I've always thought that if patients had to pay for their medical care, even if it was just a small amount, that much of the needless testing would go away. Even though the article doesn't talk about this, I'm sure it's the cost as much as anything that is the problem. Most get "free" health care, that is, even though they pay health premiums, that just don't pay for their own health bills. What they do pay is small compared to the bill. Here however, they were on their own and decided it just wasn't worth it, no matter what the hype. When the public pays out of its own pocket, they become much more discriminating. Something to think about when considering future policies for healthcare. 9:37:01 AMGoogle It!
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Wednesday, December 15, 2004 |
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From The New Yorker: The Picture Problem The New Yorker Fact: "The Picture Problem: Mammograph, air power, and the limits of looking"
Definitely the best article for layman on the difficulties of visual interpretation. Using the military experience with WWII bombing and finding Scud missiles in Iraq, Malcolm Gladwell guides the reader through the art of seeing and the inherent limitations of the "Perfect Picture". The article deals with mammography and early breast cancer but applies to interpreting any radiographic images. As an added bonus, what is an "early" cancer is also explored. |
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Thursday, October 7, 2004 |
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B Readers grub for money Gitlin et. al. published a most interesting study in the September issue of 2004. In this study the authors collected nearly 500 chest radiographs from plaintiffs' attorneys and had them blindly reread by 7 "B" readers. What they found is that unethical radiologists like to work for money and will say whatever the attorneys want them to say. For example, the attorneys "B" readers found that 96% of the cases had abnormalities consistent with pneumoconiosis whereas the consultants found only 6.2%. Only one of the 394 films rated as "1/0" or greater by an initial reader, indicating pneumoconiosis, was similarly rated by all six consultants. The implications of the article are clear, there are radiologists who will lie and falsify reports, presumably to collect fees from the lawyers. This was not a shock to me or many of us who've participated in the B reader program. I've had many a lawyer send me a film for interpretation, only to question me as to whether I was "sure" that the film was normal. One was so bold to tell me "I didn't get it." Needless to say, I never heard from them again. Lawyers develop their own network and eventually find those willing to cooperate.
First, let's realize that radiographic interpretations are very subjective. There was only fair agreement among the consultants with regards to the presence or absence of pneumoconiosis (kappa 0.31). In regards to the agreement as to the profusion of small opacities (indicating interstitial lung disease) the agreement was only slight (kappa 0.19). Interestingly, other abnormalities, those special symbols which usually have nothing to do with compensation, the consultants found more individuals with abnormalities of cardiac size and shape (38.1% vs 22.1% for the initial readers) and definite emphysema (20.6% vs 10.1%) than did those who initially interpreted the films.
Not investigated is the opposite situation. That is, reading the films deliberately negative even though the films are abnormal. There is a network of "B" readers across the country with such a reputation, many of them at famous institutions. This situation is just as bad and serious. Denying individuals who've been harmed by dusts is just as unethical and immoral as those who would scam industry. I'd like to remind you that the plaintiff's lawyers are not the only ones with dirty hands. 7:56:05 AMGoogle It!
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Tuesday, August 24, 2004 |
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Successful Implementation of a Novel Internet Hybrid Surgery Curriculum An interesting article (Successful Implementation of a Novel Internet Hybrid Surgery Curriculum; The Early Phase Outcome of Thoracic Surgery Prerequisite Curriculum E-Learning Project) published in Ann Surg (2004;240: 499-509) details the use of the Internet for education. Specifically a prematriculation curriculum for thoracic surgery residents. The authors conclude that the project was "exciting and successful." The authors spent $340,000 dollars producing the content. Yes that's not a mistake - $340,000 dollars. 138 residents were randomized to 2 groups, one receiving the educational materials, the other did not. Outcomes included the results of an inservice examination and subjective evalutions by thoracic surgery faculty. The authors report a positive correlation between exam performance and use of the E-materials and a significant difference for faculty evaluations. My interpretation: Even though this generation of residents grew up with Nintendo, 32% (22/69) did not click once ie. did not use the materials in the 24 month evaluation period. Interestingly, 12 self-reported that they used the materials, but did not (that is, the authors reviewed server logs and found that that they never logged in.) Thus 12% lied. Onle 31 residents used the E-materials more than 20 times. Considering that there were 75 total segments, most of the material went unused and unviewed. These 31 were busy, however, as the average number of sessions per resident was 144. If we assume that the only good to come out of this was these 31 residents, then the authors spend close to $11,000 to educate them. Luckily this was not a government grant. Now let's examine the results. There was NO difference in the test scores between those who used the E-materials (experimental group) and the control group. NO DIFFERENCE. There was a crude positive correlation between the number of sessions used by the residents and their percent correct on the examination. Close examination of Figure 1 reveals that this correlation is due to 3 outliers, otherwise there would be NO correlation. And the Faculty assessments. Faculty were asked to rate the residents on a 5 point "Expectation" scale. Statistically significant differences were found for resident overall knowledge (3.54 control vs 3.65 experimental group) and resident application of knowledge (3.55 control vs 3.62 experimental). It appears that the authors have taken an ordinal scale and used the wrong statistics to generate this result so that this conclusion is dubious. (What is the real difference between a 3.55 vs 3.62 expectation scale? [ Since the statistical tests used were incorrect, the authors should probably review section XII: Research methodology and professional info, it was accessed only 68 times suggesting by the residents suggesting that statisitical prowess won't be the new generations thing either].
All in all, I don't really see what these authors are so excited about. |
Last update: 12/9/06; 12:39:56 PM .
