Election news 2004 - 04

Dr. Rakesh Mishra from Bhopal called up this morning and confirmed that he is contesting the post of Secretary-General against Dr. K. Prabhakar Reddy. This settles the doubt raised in the previous post.

Spinal epidural lipomatosis

One reason for a false positive reading of epidural fat interposition, in suspected spondylolysis, is epidural lipomatosis.

Epidural lipomatosis is a condition in which there is excess fat in the epidural space producing thecal sac compression. Typically the amount of fat is twice or thrice as much as the thecal sac area and qualitatively the diagnosis is made when a stellate or irregular shaped thecal sac is seen, usually at the L5/S1 level. Googling gave me one great example with pictures and another slide from a lecture published on the net.

Qualitatively too, this condition can be graded. Borre DG et al from Argentina have published an article on this subject in European Radiology, with multiple illustrations, showing how we can grade this condition from Gd 0 (normal) to Grade III. Basically if the AP diameter of the fat (anterior and posterior to the thecal sac) is three times that of the thecal sac AP diameter, it is significant Gd III lipomatosis. All the patients with Gd III lipomatosis in their series were symptomatic. Typically they will also have an abnormal shape of the thecal sac.

There is another short but informative article by Fassett & Schmidt discussing etiology, diagnosis and treatment.

Epidural fat interposition - one more sign of spondylolysis

Sherif H & Mahfouz A from Qatar have published an elegant article in European Radiology on a new sign; epidural fat interposition between the dura and the spinous process at the level of spondylolysis.

The principle is the same as that of the "widened canal sign". Because of the break in the pars, there is separation of the anterior and posterior elements. This results in a widening of the canal even in the absence of spondylolisthesis. Simultaneously fat is seen between the spinous process and the dura to make up for the increased canal size.

Typically there is a general belief that MRI is not very good for the diagnosis of spondylolysis. A careful evaluation of the pars on parasagittal images and a high alert for the signs mentioned above actually allows pretty accurate diagnosis of lysis even in the absence of listhesis. It is rare for us to ask for thin-section CT to make this diagnosis.

One condition that may produce a false positive for the diagnosis of spondylolysis is mild spinal epidural lipomatosis, though given the clinical setting and additional findings seen in lysis, it seems highly unlikely that we could confuse the two diagnoses.

Cool Siemens

At the recent multi-detector CT conference in Stanford, Siemens went really cool. To see how cool...click here.

PACS making radiologists redundant

Auntminnie.com has an article on how PACS may make radiologists redundant in a hospital setting. The basic premise is that since all images are available STAT online, referring doctors can view them immediately and then don't really need to wait for the radiologists' opinions.

As it is orthopedic surgeons, neurosurgeons and many GI surgeons and urologists don't really care for our reports. Chest physicians are moving in the same direction. Gynecologists and many urologists are starting to perform their own ultrasounds as are a few family physicians.

We have to become good, subspecialized and available. That is the bottomline.

The kind of rubbish that gets published

The Telegraph of Kokata has a news item titled "Needless tests drain wallets".

The reporter has recounted a few incidents where patients have complained about the high cost of investigations. The figures are wrong, the contexts are incorrect and there has been no attempt made to understand the issues. The whole idea is to get a catchy title, keep saying that everything has become expensive, hint that there might be collusion and that not everything is above-board and we have an article.

The problem is they can get away with virtually anything these days...

Election news 2004 - 03

Dr. Samarjit Bhadury from Lucknow is also standing for re-election for the post of ICRI. There is no news yet of anyone else standing against him.

AuntMinnieIndia

So finally the launch is here. On 14 July, they will officially launch www.auntminnnieindia.com.

Let's see how it takes off. It may serve as a useful forum for the radiologists and trade to come together on...but only time will tell.

The only real revenue model for them would be money from advertisements. For online exercises, we have found Indian companies extremely slow to advertise on the net. Maybe auntminnieindia can persuade them to do so...that would help everyone with an online presence. Unless of course they don't really aim to break even and are willing to be subsidized by the parent site.

Depressing state of health affairs

The NY Times has published an article on 28 June, on the state of health in the US. Among the first-world, industrialized countries, it pretty much comes at the bottom. And apparently things are worsening, not improving.

Its all so deja-vu esque. Multiply or divide everything 10 times and you have our country.

Someone's going to make a hell of a lot of money....

Someone's going to be making a hell of a lot of money doing MRIs in the UK.

Alliance has just got a contract with the NHS to scan 625000 patients over 5 years using 12 mobile scanners. You do the math.

Drug companies in trouble...wonder when something like this will happen in India

A report in the Sunday NY Times describes the detail the effort that regulators in the US are taking to stop drug companies from giving inducements to doctors to prescribe drugs. Apparently the same thing that happens here, happens there and doctors have been sent cheques worth tens of thousands of dollars just to keep prescribing certain drugs.

This has especially come to light in the SEC filings by various companies as part of their quarterly financial statements.

Its almost unlikely that any kind of similar regulation or investigation would even occur in our country.

CT versus MRI in acute stroke

There is a new article in Stroke, that compares non-contrast CT, perfusion CT and CT angiography versus diffusion and perfusion MRI, in patients presenting with stroke within the first 6 hours. It shows that this combination on CT is an acceptable method for analysing acute and hyperacute stroke and can replace MRI when MRI is not available.

With the growth of multi-slice CTs and the more read availability of CT over MRI in our country, as well as the fast nature of the study, this approach may make much more sense.

In an accompany comment, Rudiger von Kummer analyses this article and makes a very interesting comment. "A normal CT excludes major ischemic damage with high specificity7 and thus allows reperfusion therapy – in my personal experience – even beyond accepted time windows". This is yet not a practice that we follow, but may have an impact on management if this is proved to be scientifically accurate.

On self-pity

The BMJ editor Richard Smith is admittedly getting more reflective as his term gets over. He talks this week about the ills of self-pity. Whining and griping about things are a great way to let off steam, but if it affects our ability to work, it can create tremendous problems.

There are many opportunities in India especially to slide into a negative feeback cycle of self-pity. Right from the way our utilities work and quality of life, to problems with getting anything done from the authorities, to problems at work, with practice, with colleagues, at home...anything can be the straw that breaks the back and starts the downward spiral.

The worst thing is that it only destroys and consumes the person, never the reasons/targets of the self-pity.

4th AUC - 2nd day today

The 4th AUC enters its second day today.

Yesterday all the 40 registrants save one were at the venue within half an hour of the first session. One registrant from Kerala didn't make it till late evening because his train ran late.

The feedback has been positive. The delegates seem to appreciate the close interaction that they have with the speakers/demonstrators, though not everyone was interested in the "hands-on" per se...i.e. not everyone was interested in holding the transducer.

Some speakers first gave a small talk on their laptops, whereas some directly started the demonstrations.

GE had a small banquet dinner at night with a presentation by Priya on the new frontiers in ultrasound.

Election news 2004 - 02

Dr. Y T Patel from Mehsana has just announced his candidature for the post of vice-chairman, ICRI, for the year 2005-2007. Wonder who else is standing.

With respect to the last election related post, there were comments that said that Dr. Rakesh Mishra is also standing for the post of Secretary-General against Dr. K Prabhakar Reddy. We don't know whether this is true.