Would you tell me, please, which way I ought to go from here? That depends a good deal on where you want to get to. I don't much care where – Then it doesn't matter which way you go. - Lewis Carroll In the new world, payers will increasingly ask before reimbursing medical imaging: why did you bother finding out? This is why we must pay attention to clinical trials. An instructive case is in the ...

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When you get frustrated with my interpreting a chest x-ray as “atelectasis at the right lung base, pneumonia can't be excluded,” trust me, I don’t enjoy it. But when you ask me to rule out pneumonia you leave me no choice but to tell you that pneumonia can’t be ruled out. To rule out a disease a test must have a sensitivity of 100%, meaning there should be no false negatives. ...

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Nothing puts more fear into the heart of an internist than a dermatologic chief complaint. And for good reason: we have very little exposure to the breadth of the field. To us, all rashes seem to be maculopapular, all bumps are pustules … or was that nodules? It’s not that we internists don’t care about the skin or don’t appreciate its complexity. Rather, we simply haven’t seen enough bumps, rashes, and ...

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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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