Radiology

The benefits of scanning war corpses

The military is learning from the dead.

In the past five years, every soldier who was killed in Iraq and Afghanistan has been given a CT scan. Why? In the hopes of creating a database of war injuries, which can be used to better equip and treat future soldiers.

The effort has already paid dividends. While examining the data, it was noticed that chest tubes used to treat pneumothoraces …

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Lung cancer CT screening produces false positives and isn’t ready for prime time

Controversy continues to swirl over chest CT scans to screen for lung cancer.

MedPage Today reports on a recent study that continues to suggest that it isn’t ready for general use yet.  Not surprisingly, CT scans had more false positives than traditional chest x-rays when used to look for pulmonary masses.

The probability of a false positive was 21 percent after one scan, and 33 percent after two. This is …

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Gratuitous and grisly x-ray images

A bizarrely morbid slide show of radiology images showing various patients impaled by foreign objects.

If you need more reasons to be wary of nail guns, fishing spears, keys, or knives, look no further.

knife x-ray

harpoon xray

keys in eye

nailgun ...

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Covering a virtual colonoscopy, or not, will test the cost-cutting will of Medicare

Medicare is in the midst of deciding whether to cover virtual colonoscopies.

I wrote two prior pieces on their pending decision::

Should Medicare cover a virtual colonoscopy?

Medicare will not cover virtual colonoscopies, gastroenterologists breathe a sigh of relief

In February, after reviewing the evidence, a federal agency simply said, “The evidence is inadequate.”

Predictably, the move created instant dissent, mainly from CT-scan …

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An animated CT scan, set to music

In what may be a first, here are two CT scan music videos.

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(via Shadowfax)

What happens if you swallow a pair of scissors

Cool x-rays, but more importantly, why was this man cleaning his teeth with a pair of scissors in the first place?

(via Shadowfax)

Nighthawks, dayhawks, and the demise of the American radiologist

More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.

It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.

Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term …

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How much radiation am I getting with my X-ray, CT scan, or nuclear medicine test?

Here’s a handy resource for patients to calculate their radiation exposure to a variety of imaging tests.

Radiation exposure, and the subsequent risk of cancer, is a small, but very real, risk of X-rays, CT scans, and other radiology procedures. But, how much is too much, and what is the cumulative effect?

That’s a question I encounter daily, and …

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Remember to remove medication patches prior to your MRI

I wrote a few months ago that MRI suites can be the most germ-infested room in the hospital.

Now, comes another precaution patients have to consider prior to undergoing an MRI.

MedPage Today reports on a recent FDA announcement, warning patients to remove medication patches, like the fentanyl or nicotine transdermal systems, prior to having an MRI.

“Some patches contain small amounts of aluminum or other …

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The quality of CT and MRI scans vary, and how old machines can affect the treatment course

Medical imaging is one of the largest drivers of health care spending.

In a recent NY Times piece, Gina Kolata points to the fact 20 to 50 percent of scans ordered are not necessary. Indeed, as health reformers like to point out vis-a-vis the Dartmouth Atlas study, more care isn’t necessarily better.

In fact, it can lead to worse outcomes, as these scans can point to …

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CT scans in the ER, are emergency doctors ordering too many tests?

Internist Robert Centor provides some suggestions to fix health care.

On one point, he calls out emergency physicians, saying because of high exposure to malpractice claims, “technology trumps the history and physical examination.” Often times, “when in doubt, they image.”

This draws a sharp rebuke from Texas emergency physician GruntDoc, who points out that “ED care was 3.5% of the total healthcare budget. Squeeze …

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More trouble for CT scans of the heart

I wrote lost month that cardiac CT scans were not ready for widespread use, citing the unacceptable false positive rate.

The specificity problem got a whole lot worse if this recent study is to be believed, says cardiologist Steven Nissen, who added “in more than 50% of subjects, CT angiography’detected’ coronary obstructions that simply were not there.”

False positives encourage more invasive testing that can expose …

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Why too many CT and MRI scans can be dangerous for patients

This is an important article to read.

Many of the incentives today encourage doctors to order more advanced imaging scans, like CTs and MRIs. This expensive practice is invariably caused by this common scenario, as “patients who are in pain often demand scans hoping to find out what is wrong, doctors are tempted to offer scans to those patients, and then, once a scan is done, it …

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How is the recession affecting radiologists?

It depends on who you ask.

Some are finding that their budgets are being slashed, preventing them from buying the latest imaging equipment. One factor is decreasing reimbursement, as “having the money to buy big-ticket technology is one part of the equation, getting paid for it is another.”

Although this is leading some centers to sell themselves or go bankrupt, others are simply more judicious as …

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Do personal pictures affect radiology readings?

I’m not sure what to make of the finding that the interpretation of CT scans improved when the images were place alongside a picture of the patient.

There was an 80 percent drop in incidental findings if a picture wasn’t included. Apparently they looked more closely if the patient photograph was there.

Will patients start bringing personal pictures and demand they be placed in the …

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Key penetrates a toddler’s eyelid into his brain

Despite chilling x-rays, he had a full recovery. Very lucky.

Strengthen visual spacialization with a 3-D MRI block puzzle

Neil Fraser took an MRI scan and reconstructed it into 60 one-inch cubes, resulting in a challenging puzzle for the visual-specially inclined.

Pretty cool stuff.

Should Medicare cover a virtual colonoscopy?

Merrill Goozner writes that the Agency for Healthcare Quality and Research (AHRQ) – the somewhat impotent American version of a comparative effectiveness body – has concluded that CT, or “virtual”, colonoscopies are not cost effective. I’ve written in the past about how the media hype surrounding the test needs to be tempered.

The price of the scans need to go down by about $200 before it can compete with …

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Can radiology pre-authorizations lead to turf wars?

To curb costs, physicians are increasingly going through pre-authorization procedures prior to ordering expensive MRIs, CTs, and nuclear heart studies.

They are mostly geared towards primary care physicians who order the majority of the tests.

Now, pre-authorizations are moving into specialty territory, requiring cardiologists and oncologists to endure the cumbersome procedure:

Two of the three biggest companies in the imaging field “” CareCore National and WellPoint’s American …

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Exploding MRIs

A disturbing trend that often goes unreported. See it to believe it.

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(via The Medical Quack)

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