Recently, I spoke with a primary care physician (PCP) about a young runner who had a syncopal episode. Because of the increasing awareness of sudden cardiac death in athletes, she had an electrocardiogram and an echocardiogram to look for structural abnormalities of the heart. The PCP was inclined to dismiss the syncope as an isolated episode. However, the echocardiogram, otherwise normal, equivocated: “possible hypertrabeculation of the left ventricular apex, consider cardiac ...

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I hear it over and over again. From a nurse, “She can’t have providine prep, she has a shellfish allergy.” From the patient, “I can’t have the contrast because I’m allergic to iodine and shellfish.” The list of allergies placed in the chart by a doctor, “Radiocontrast. Iodine. Shellfish.” It’s not the fault of the patients who are typically repeating the medical misinformation they have been given. However, the medical professionals who perpetuate the ...

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You know that old joke. What's a radiologist's favorite plant? The hedge. Radiologists are famous for equivocating, or hedging. "Pneumonia can't be excluded, clinically correlate," or "probably a nutrient canal but a fracture can't be excluded with absolute certainty, correlate with point tenderness." Disclaiming is satisfying neither for the radiologist nor the referring physician. It confuses rather than clarifies. So one wonders why legislators have decided to codify this singularly unclinical practice ...

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Reduce stress for both patients and doctors: Limit testsOrdering CT, MRI, or PET scans for my patients when they feel well always makes me nervous. As a radiation oncologist, I’ve chosen to frequently make observations that potentially find active, progressive cancer. And this creates an existential crisis that scares me -- but not as much as it scares my patients. With each test, I set in to motion a real-life application ...

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I have been actively engaged in the clinical practice of radiation oncology for the last 40 years, and over the last 10 years have been asked to participate as a radiation oncology expert witness in a variety of medical malpractice cases. Radiation therapy, together with surgery and chemotherapy, is one of the major cancer treatment methods. It is estimated that 50-60% of all cancer patients seen in the USA receive treatment with ...

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If you are like millions of Americans, at some point in your adult life, your doctor will order you to have a CT or MRI scan. Quick, easy, and painless, these invaluable imaging tests provide a vast amount and array of diagnostic information about illnesses, and direct treatment paths. However, the real pain usually begins when you receive the bill. It is not uncommon for the charges, including radiological interpretation, to ...

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Thermography uses heat sensitive infrared cameras to image the body and measure heat emission. Solid tumors, even when they are tiny, have an increased blood flow and inflammation compared with non-cancerous tissue. Theoretically this could lead to a thermal gradient between a cancer and the surrounding non-cancerous tissues. Some animal studies indicate that thermography might detect heat differences between inflamed and non inflamed tissue and so it was postulated (initially back ...

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My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation. My son, Oliver, has had more radiation than most people will have. Ever. In fact, ...

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A recent study has concluded that women with breast cancer who failed to get annual mammograms are more likely to die from their disease than those who had annual mammograms, and argues that more frequent mammograms are warranted in women under age 40. Unfortunately, despite all the media attention this study is getting, I don’t think the researcher’s conclusions are supported by the study results. The researchers did a retrospective ...

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Now that I am a "civilian," I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, radiology techs, lab techs and the like. On that ...

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