Notes of a Radiology Watcher

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1 Notes of a Radiology Watcher

2

3 Stephen R. Baker Notes of a Radiology Watcher

4 Stephen R. Baker, MD Department of Radiology UMDNJ-New Jersey Medical School Newark, NJ USA ISBN ISBN (ebook) DOI / Springer Cham Heidelberg Dordrecht London New York Library of Congress Control Number: Springer International Publishing Switzerland 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

5 To the many medical students I have mentored, who by their enthusiasm and energy, make my work a pleasure.

6

7 Preface This book, a compendium of many subjects all related to diagnostic imaging, is not the result of an organized, predetermined plan. Instead, it emerged in an organic fashion. The editorial style of each chapter grew out of an obligation to provide a monthly audio discussion in my capacity as coordinating editor of Practical Reviews in Radiology, a digest of contemporary radiology articles for CME content. I have edited and expanded on each of the topics I initially presented, and added many new ones, each similar in length to the other. Over the past decade, this exercise became a delightful habit for me. As I became aware of a potential or actual issue related to radiology, I researched it and consolidated my thoughts by putting them on paper. The model for these remunerations was the column, Notes of a Biology Watcher by the late Lewis Thomas which appeared regularly in The New England Journal of Medicine. I was impressed by the eclectic mix of his musings, his wide and deep erudition, and the trenchant comments that stick in one s mind years later. I tried to bring the same characteristics to these collections of essays. They reflect my long experiences as an image interpreter, teacher of medical students and residents, program director, dean of Graduate Medical Education, member of the Radiology RRC, chairman, demographer, and geographer as well as my obsessive commitment to jargon-free reports and regular personal consultations between radiologists and referrers. This format gives me a splendid opportunity to make known my opinions some of which you may approve of and some of which you may not have thought about. If I pique your interest, I regard that as being a success, even though I may not necessarily persuade you by the force and content of my arguments. I could not have organized this material alone. The coordination of various sections of the book and careful revision of the text required the dedicated efforts of six medical students Shyam Patel, David Hansberry, Tekchand Ramchand, Hamid Bagce, Shivam Shah, and Jin Jung, all of whom I believe will become outstanding radiologists. They are all in my debt. Newark, NJ, USA Stephen R. Baker, MD vii

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9 Contents Part I Early Residency: Preparation and Participation 1 Centralized Interviews for Prospective Radiology Residents Reference A Critique of the Transitional Internship Summary References Looking Back at the Value of the Internship Reference Radiology Residents: Internship Survey Reference The Debt Crisis and Radiology Summary Radiology Residency Positions: Growth, Distribution and California Reference Radiology Resident Recruitment: Robustness in an Uncertain Environment Reference Radiology Residencies: Disasters and Preparedness Part II Late Residency, Fellowship and Just Beyond 9 Reorganizing the Fourth Year: Curricular Organization How Will the Fourth Year Be Redesigned? Part I Summary Reference Reorganizing the Fourth Year: The Fourth Year After the Boards Change How Should It Be Constructed? Part II Reference ix

10 x Contents 11 Reorganizing the Fourth Year: Reimagining the Fourth Year of Training in the of Training in the Era of Subspecialization Part III Reference Are We Losing the Certification Wars? Summary Reference The Trouble with Fellowships Summary Reference The Changing Board Exam Schedule in the U.S.: Will General Radiologists and Emergency Radiologists Become Synonymous? Reference Bubble Trouble Summary Reference Regulation Without Representation Reference Part III Radiology Elsewhere in the World 17 O.E.C.D. Health Data: Where Does the U.S. Stack Up? Reference Characteristics of Radiology Training Programs in Europe in Comparison with Those in The United States Reference Japan: A Country with a Currently Successful Radiology Model of Health Care Reference Radiology in Cuba: A Different Path with Fewer Resources and More Compulsion References Geography and Radiology: Perfect Together Part IV Radiologist Inclusiveness: Minority Features 22 Who Will Be the New Radiologists?: A 2012 Assessment Reference Women in Radiology Reference

11 Contents xi 24 South Asians in Radiology in the United States, Part I Reference South Asians in Radiology in the United States, Part II Reference Part V The Appearances and Implications of the Radiology Report 26 Towards More Literate Reports: Avoiding Words and Phrases You Should Not Say Reference The Radiology Report Reference More Jargon Summary Reference Anything Is Possible so Is Possible Anything? The Radiology Report: The Value of the Impression Summary Reference Metaphors in Radiology Reference Metaphor: Redux Reference Electronic Health Records and the Expectations of the Transformation of the Work of Radiologists Summary Reference Telling Patients Results Reference Part VI Radiologist Responsibilities 35 Fallacies in Reasoning: Part Reference Fallacies in Reasoning: Part Reference We Are Radiologists. What Business Are We in? Reference Communication vs. Consultation: Two Duties We Must Pursue Reference

12 xii Contents Part VII Quality Considerations 39 Quality: Metrics in Radiology Quality: Measures in Radiology Quality: Initiatives You Should Know About But May Not Have Heard About Quality: Some Simple Things You Might Change Part VIII Malpractice Apology and Appropriateness 43 U.S. Medical Malpractice: Some Data-Driven Facts Reference Malpractice Suits Against Radiologists Reference Radiology Malpractice: The Demography of Medical Malpractice Regarding Radiology Reference Apology: It s Elements and Legal Intrusions References Is It Appropriate to Have Appropriateness Criteria for Radiology Testing? References Authorization or Appropriateness or the Lady or the Tiger Redux References Part IX Opportunities for Radiologists 49 Teleradiology: From the Confines of Place to the Freedom of Space Reference Medical Tourism, Opportunities for American Radiologists? Summary Reference Geriatric Radiology A Proto-Manifesto Reference Self-Referral Remedies Reference

13 Contents xiii Part X The Challenges Facing American Radiologists 53 The Radiologist Assistant: Do We Need This Job Title? Reference Challenges to Radiology From Below, Astride and Afar Reference The Coming Revolution in Radiology: Beware and Prepare Teleradiology and GATS-An-800 lb Gorilla Down the Hall Reference Commodity Policy and the Vulnerability of Radiology Commodity Problem One: The Danes, the Nazis and Contrast Material Reference Radiologists and the Press Reference Will the Job Market for Radiologists Remain Grim?: A Contrarian Perspective-A 2013 Assessment Reference American Radiologists at a Crossroad Reference Part XI Research 61 Peer Review-Peering Over Its Shoulder Reference Peer Review-Innovations and Ethical Issues Reference Electronic Publishing: A Boon or a Bugbear References The Tendentious Tendency in Radiology Clinical Research Part XII Radiation Dose 65 Radiation Dose: A Primer of Units and Limits Reference CT-ER-Dose and Cost and What to Do About It Reference Radiation Dose Redux References CT Techniques: Risk and Challenges Who Will Control Radiology Reference

14 xiv Contents 69 CT Utilization and Thyroid Cancer: Is There a Connection? Reference MR Safety Another Look MR Safety Another Look Reference Part XIII Nooks and Crannies in General Radiology Including Some Forgotten Observations 71 From Nipple Shadows to Bullet Holes Reference Pelvic Phleboliths Reference Eponymous Abdominal Hernias, Part I Reference Eponymous Abdominal Hernias, Part II Reference Other Radiology Bits and Pieces of Lore Pills Grading Pneumothorax The Chest X-Ray and Sickle Cell Disease Bowel Obstruction Reference It Ain t What You Don t Know, It s What You Do Know That Ain t So Illicit Drug Transport Reference The Spleen: The Forgotten Organ, Is There Anything To Say? Wandering Spleen Splenic Calcification Tumors of the Spleen Lucencies in the Spleen Reference Acute Pancreatitis: What and When Is There Room for Imaging in the Diagnosis and Followup of Patients with Acute Inflammation of the Pancreatic Gland? Index

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