4th Advanced Ultrasound Course - Registration problems solved & other issues

There was a problem during registration for this course. If a delegate had registered once and wanted to try again, either because of problems with the credit card portal or changes in the program, etc. it wasn't possible if the same email ID was used in the registration form, as in the earlier registrations.

This problem has now been solved and it is possible for one person to fill in multiple registrations. Eventually we will select only one registration, after the payment formalities are completed. Only then will the counters attached to the various programs change.

As per the current status, S Suresh - Abnormal Fetus (Day 1, Session 2), Madhav Nagarkar - Renal Doppler (Day 1, Session 3), B Ramamoorthy - Obstetric Doppler (Day 2, Session 1) and Milind Gune - Peripheral Venous Doppler (Day 2, Session 2) are full and no longer available.

The later the delegates wait to register, the fewer will be the choices that will be available to them.

Smoking improves restenosis rate after intervention...& other beneficial effects

This kind of a heading is sure to gather publicity and that is precisely what has happened. This article by Schillinger M et al has been published in the June issue of Radiology, and concludes that in those who smoke more than 10 cigarettes a day, the rate of intermediate-term restenosis in lower limb vessels after endovascular interventions, is less than in the other groups of patients.

Apparently, this is due to the increased levels of carbon monoxide, which is a natural vasodilator.

This has led to a flurry of articles in the lay press, e.g
Carbon Monoxide From Smoking Helps Keep Arteries Open Following Angioplasty
Smoking is Healthy for your Arteries, etc
Other similar articles can be found here.

To complete this post, I then ran a search of the "benefits of smoking" and was taken aback by the number of hits that I got. One site in particular is very vocal about the benefits of smoking and they list everything from reduced incidence of gum disease, Parkinsonism, Alzheimer's disease, ulcerative colitis and a few other diseases, as actual therapeutic effects of smoking. This site of course is very radical and rants about global conspiracies that prevent these truths from being known. As we all know these days, it is politically completely incorrect to say anything good about smoking.

In a similar vein, there was a Czech report sometime in 2001 that said that if the government encouraged smoking or at the least, did nothing to discourage it, early death in smokers would result in significant savings for public health expenditure, as compared to the amount that would needed to be spent on geriatric care, if all those who smoked were to stop smoking. Obviously, it was immediately panned and criticized, but think about it! If everyone stopped smoking or using tobacco, where would our oral surgeons go? And, most chest surgeons would go out of business as well, as would chest physicians dealing with COPDs, etc. Obviously, just kidding... (have to maintain the political correctness stuff...)

4th Advanced Ultrasound Course

The registrations for the 4th Advanced Ultrasound Course have reached the halfway mark, i.e. 20 registrations are already done. Along with this, some programs in a couple of sessions are already full. The program in the registration form, accurately reflects the current status. There is also a list of registrants that is updated every three days.

This entire program is completely experimental. It was thought up by Bijal primarily as an alternative to the conventional lecture/work-shop method that is used in most conferences, including our first three advanced ultrasound review courses. Though theory is an important part of an ultrasound seminar, in many instances the ability to see how a particular methodology is actually applied on a patient and to have someone holding your hand while doing so, may actually be more important. Obviously, in such hands-on sessions, there has to be a restricted number of registrants so that the speakers and the delegates can do justice to the subject.

I am sure others have thought of doing a similar seminar in the past. The problem is that with conventional mailers and methods of registration, this is very difficult, since it becomes virtually impossible to co-ordinate the different choices that the delegates might want to make. It can of course be done by ensuring that every registration is made in person, over the phone. The use of sophisticated computing techniques and the Internet however makes this now relatively easy and the delegates are able to pick and choose the programs they want to attend, provided they are available.

We are seeing already that all the Doppler topics are "hot favorites". The next in line are fetal, breast and musculoskeletal imaging, followed by 3D and other miscellaneous subjects. We will use this information in future meetings to tailor the choice of programs and sessions in a better manner.

The REF would love to have more opinions and comments on this conference and the way that is being organized.

About pharmacyclics and the imaging of vulnerable plaque

The imaging of vulnerable plaque is one of the exciting frontiers in medicine today. We have already started looking for vulnerable plaque in the carotids by using special high-resolution coils made by Machnet.

However there is a whole new generation of targetted molecular agents that allows evaluation of the vulnerable plaque, especially in the coronary arteries. In principle, these agents tagged with gadolinium are injected intravenously - they accumulate at the sites of vulnerable plaques and can then be imaged with MRI. This will make a huge difference to management as when the technology becomes available.

Currently, these studies have been performed on animals using texaphyrin compounds at Johns Hopkins with the help of a pharma company called Pharmacyclics that designs these small molecules.

Hopefully in a few years we will be able to use these molecules along with MRI successfully.

Sanjay Saini & David Lu - Why do Mumbai radiologists....A retraction & apology

Drs Sanjay Saini and David Lu are being brought to India by Amersham to deliver lectures related to Body Imaging, at various centres in India.

There was an earlier post yesterday regarding the issue that the programs arranged at other centres in India are free for invited doctors, but that is not the case in Mumbai.

This post was due to a misunderstanding and I apologize to all the parties concerned. This happened because of misinterpretation of the information given to me.

David & Sanjay are speaking in the CT & MRI Update being held this weekend in Mumbai at Taj Land's End. Being part of an update, they will be delivering many more lectures than at the other centres, which is a good thing, considering they are such excellent speakers and teachers.

It is because they are part of a 2-day conference that there is a registration fee, which is reasonably nominal, considering the breadth of the program and the people who are speaking in it throughout the two days.

It would be a good idea for radiologists, both residents and consultants, to attend this program. More details are available here.

How our leading newspapers misreport medical news...a story involving biliary stenting

Today's TOI and the Express Service have made a big deal about a report from PGI Chandigarh, where the Gastroenterology department has treated 18 patients of type II malignant biliary obstruction with unilateral metal stenting without injecting contrast into the biliary tree during the stenting. The big deal is obviously not the metal stenting per se, but the fact that since the stenting was performed without contrast injection into the biliary system, the incidence of cholangitis and infection after the procedure was 0%. This has been reported in the Journal of Gastroenterology & Hepatology, which is the official journal of the Asian Pacific Association of Gastroenterology, one of the minor and less important journals in the field.

The titles of both newspaper reports are sensationalistic to say the least. One is titled "New Hope for Cancer Patients" and the other "New Treatment For Cancer Patients with Jaundice". New hope? New treatment? Just because infection was prevented by avoiding the injection of contrast into the biliary tree, that becomes the New Big Thing? Jeez!

There is also a footnote on the use of brachytherapy to treat these tumors, which is also not a new method, something a simple Pubmed search would have unearthed.

The newspapers never exercise due diligence. If the concerned reporter had cross-checked with the available literature or with another gastroenterologist or gastroenterology department, he/she would have figured out the importance (or lack of) of this issue. But journalists and the press are not the only ones to blame. Obviously the press was contacted and a "press report" or its equivalent was issued to obtain the requisite publicity...

The kidney trade is much bigger internationally....

While the trade in organs, mainly for kidneys, still continues in India unabatedly, despite the regular arrests of agents and doctors, it is also a big issue worldwide. I didn't know how big until I read this New York times article today. The trade is truly international, the kidneys coming from Brazil, the patients from the US and other parts of the world, the surgeries occuring in South Africa and the co-ordination in Israel.

As is often the case with things Indian, even our illegal rings seem to be small fries as compared to the international scene. One such ring was recently exposed in Mumbai in January 2004 and it is likely that many more doctors are going to be in trouble as well, in the near future.

Why bother? Because each time such things get exposed, outlining the venality and greed of the doctors concerned, the esteem that the general public holds us in, goes down one more notch.

Unprofitable x-rays

There is an interesting editorial in the March issue of Imaging Economics on how plain x-rays in the US, both in private practice and in university hospitals seem to be completely unprofitable. This article actually talks about a cost analysis done at one hospital that showed that the running costs, not taking into account the physician interpretation fees, far exceeded the revenues obtained for the radiographs. This situation has arisen because of fixed reimbursements from Medicare, where there is no scope therefore of adjusting the charges for radiographs to account for the expenditure. And apparently it isn't possible to do any cost cutting as well.

Currently with the explosion of CR sytems in the country, I wonder if some of us are already facing such a situation. Our charges for a chest x-ray are between Rs 150 & 200 and even with a "digital x-ray", the most that can be charged is around Rs 200 per radiograph. In such a situation, unless the volumes are over 75-100 radiographs are day, I am not sure there is any money to be made. Already some of the insurance companies have started dictating terms, reimbursing only Rs 120 or so for a chest radiograph.

As the article goes on to say, this kind of a situation is probably acceptable to US practices, because by offering conventional radiology on a "sacrificial limb", higher reimbursements can be obtained for the higher cost modalities. In multi-modality practices in our country, this may be true as well. Plain x-rays get in larger numbers of patients and "eyeballs" and opportunities to interact with patients and referring doctors, which may eventually translate into more referrals for USG, CT and/or MRI, thus offsetting any possible loss in running a conventional radiology practice. And the tag "digital" today is definitely a buzzword, bringing in patients from the "non-digital" competition as well.

New cartoon by Morparia

Hemant Morparia has finally come out with one more cartoon on the refindia site. Links to his previous contributions can also be found on this page. He is an amazingly prolific cartoonist and caricaturist, who is now with Mid-Day and is published there virtually on a daily basis. His non-radiology work can be viewed here.

Oh, did I forget to mention that he is a practising radiologist?

MRI of muscle injuries

There is an interesting full-text article on MRI in muscle injuries, published in Applied Radiology, in the April 2004 issue. This subject has not been well covered in text-books or in other articles in literature. The images nicely depict the pathologies described in the article, which is available here. The article is available in the .pdf format, but access may require registration, which is also free.