Notes of a Radiology Watcher

Notes of a Radiology Watcher

Stephen R. Baker Notes of a Radiology Watcher

Stephen R. Baker, MD Department of Radiology UMDNJ-New Jersey Medical School Newark, NJ USA ISBN 978-3-319-01676-4 ISBN 978-3-319-01677-1 (ebook) DOI 10.1007/978-3-319-01677-1 Springer Cham Heidelberg Dordrecht London New York Library of Congress Control Number: 2013955904 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 (www.springer.com)

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

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

Contents Part I Early Residency: Preparation and Participation 1 Centralized Interviews for Prospective Radiology Residents................................... 3 Reference............................................ 7 2 A Critique of the Transitional Internship................. 9 Summary............................................ 11 References........................................... 12 3 Looking Back at the Value of the Internship............... 13 Reference............................................ 14 4 Radiology Residents: Internship Survey.................. 15 Reference............................................ 17 5 The Debt Crisis and Radiology.......................... 19 Summary............................................ 19 6 Radiology Residency Positions: Growth, Distribution and California........................................ 23 Reference............................................ 25 7 Radiology Resident Recruitment: Robustness in an Uncertain Environment........................... 27 Reference............................................ 29 8 Radiology Residencies: Disasters and Preparedness........ 31 Part II Late Residency, Fellowship and Just Beyond 9 Reorganizing the Fourth Year: Curricular Organization How Will the Fourth Year Be Redesigned? Part I............................... 37 Summary............................................ 39 Reference............................................ 40 10 Reorganizing the Fourth Year: The Fourth Year After the Boards Change How Should It Be Constructed? Part II............................ 41 Reference............................................ 43 ix

x Contents 11 Reorganizing the Fourth Year: Reimagining the Fourth Year of Training in the of Training in the Era of Subspecialization Part III.......................... 45 Reference............................................ 46 12 Are We Losing the Certification Wars?................... 47 Summary............................................ 49 Reference............................................ 50 13 The Trouble with Fellowships........................... 51 Summary............................................ 54 Reference............................................ 54 14 The Changing Board Exam Schedule in the U.S.: Will General Radiologists and Emergency Radiologists Become Synonymous?................................. 55 Reference............................................ 57 15 Bubble Trouble....................................... 59 Summary............................................ 61 Reference............................................ 61 16 Regulation Without Representation...................... 63 Reference............................................ 65 Part III Radiology Elsewhere in the World 17 O.E.C.D. Health Data: Where Does the U.S. Stack Up?..... 69 Reference............................................ 72 18 Characteristics of Radiology Training Programs in Europe in Comparison with Those in The United States... 73 Reference............................................ 76 19 Japan: A Country with a Currently Successful Radiology Model of Health Care................................. 77 Reference............................................ 78 20 Radiology in Cuba: A Different Path with Fewer Resources and More Compulsion................................. 79 References........................................... 81 21 Geography and Radiology: Perfect Together.............. 83 Part IV Radiologist Inclusiveness: Minority Features 22 Who Will Be the New Radiologists?: A 2012 Assessment.... 89 Reference............................................ 91 23 Women in Radiology.................................. 93 Reference............................................ 95

Contents xi 24 South Asians in Radiology in the United States, Part I...... 97 Reference............................................ 99 25 South Asians in Radiology in the United States, Part II..... 101 Reference............................................ 102 Part V The Appearances and Implications of the Radiology Report 26 Towards More Literate Reports: Avoiding Words and Phrases You Should Not Say........................ 105 Reference............................................ 109 27 The Radiology Report................................. 111 Reference............................................ 113 28 More Jargon......................................... 115 Summary............................................ 117 Reference............................................ 117 29 Anything Is Possible so Is Possible Anything?............. 119 30 The Radiology Report: The Value of the Impression........ 121 Summary............................................ 123 Reference............................................ 124 31 Metaphors in Radiology............................... 125 Reference............................................ 127 32 Metaphor: Redux..................................... 129 Reference............................................ 131 33 Electronic Health Records and the Expectations of the Transformation of the Work of Radiologists......... 133 Summary............................................ 135 Reference............................................ 135 34 Telling Patients Results................................ 137 Reference............................................ 139 Part VI Radiologist Responsibilities 35 Fallacies in Reasoning: Part 1........................... 143 Reference............................................ 146 36 Fallacies in Reasoning: Part 2........................... 147 Reference............................................ 148 37 We Are Radiologists. What Business Are We in?........... 149 Reference............................................ 152 38 Communication vs. Consultation: Two Duties We Must Pursue...................................... 153 Reference............................................ 156

xii Contents Part VII Quality Considerations 39 Quality: Metrics in Radiology........................... 159 40 Quality: Measures in Radiology......................... 163 41 Quality: Initiatives You Should Know About But May Not Have Heard About................................ 167 42 Quality: Some Simple Things You Might Change.......... 171 Part VIII Malpractice Apology and Appropriateness 43 U.S. Medical Malpractice: Some Data-Driven Facts........ 177 Reference............................................ 179 44 Malpractice Suits Against Radiologists................... 181 Reference............................................ 183 45 Radiology Malpractice: The Demography of Medical Malpractice Regarding Radiology............. 185 Reference............................................ 187 46 Apology: It s Elements and Legal Intrusions.............. 189 References........................................... 191 47 Is It Appropriate to Have Appropriateness Criteria for Radiology Testing?................................. 193 References........................................... 195 48 Authorization or Appropriateness or the Lady or the Tiger Redux.................................... 197 References........................................... 199 Part IX Opportunities for Radiologists 49 Teleradiology: From the Confines of Place to the Freedom of Space............................... 203 Reference............................................ 204 50 Medical Tourism, Opportunities for American Radiologists?.. 205 Summary............................................ 207 Reference............................................ 207 51 Geriatric Radiology A Proto-Manifesto................... 209 Reference............................................ 211 52 Self-Referral Remedies................................ 213 Reference............................................ 214

Contents xiii Part X The Challenges Facing American Radiologists 53 The Radiologist Assistant: Do We Need This Job Title?..... 217 Reference............................................ 220 54 Challenges to Radiology From Below, Astride and Afar..... 221 Reference............................................ 224 55 The Coming Revolution in Radiology: Beware and Prepare.. 225 56 Teleradiology and GATS-An-800 lb Gorilla Down the Hall.. 229 Reference............................................ 232 57 Commodity Policy and the Vulnerability of Radiology...... 233 Commodity Problem One: The Danes, the Nazis and Contrast Material................................... 233 Reference............................................ 236 58 Radiologists and the Press.............................. 237 Reference............................................ 239 59 Will the Job Market for Radiologists Remain Grim?: A Contrarian Perspective-A 2013 Assessment............. 241 Reference............................................ 243 60 American Radiologists at a Crossroad.................... 245 Reference............................................ 247 Part XI Research 61 Peer Review-Peering Over Its Shoulder.................. 251 Reference............................................ 254 62 Peer Review-Innovations and Ethical Issues............... 255 Reference............................................ 257 63 Electronic Publishing: A Boon or a Bugbear.............. 259 References........................................... 260 64 The Tendentious Tendency in Radiology Clinical Research.. 261 Part XII Radiation Dose 65 Radiation Dose: A Primer of Units and Limits............. 265 Reference............................................ 267 66 CT-ER-Dose and Cost and What to Do About It........... 269 Reference............................................ 271 67 Radiation Dose Redux................................. 273 References........................................... 276 68 CT Techniques: Risk and Challenges Who Will Control Radiology................................ 277 Reference............................................ 279

xiv Contents 69 CT Utilization and Thyroid Cancer: Is There a Connection?.. 281 Reference............................................ 283 70 MR Safety Another Look.............................. 285 MR Safety Another Look................................ 285 Reference............................................ 287 Part XIII Nooks and Crannies in General Radiology Including Some Forgotten Observations 71 From Nipple Shadows to Bullet Holes.................... 291 Reference............................................ 293 72 Pelvic Phleboliths..................................... 295 Reference............................................ 297 73 Eponymous Abdominal Hernias, Part I................... 299 Reference............................................ 301 74 Eponymous Abdominal Hernias, Part II.................. 303 Reference............................................ 305 75 Other Radiology Bits and Pieces of Lore.................. 307 Pills................................................ 307 Grading Pneumothorax................................. 308 The Chest X-Ray and Sickle Cell Disease................... 308 Bowel Obstruction..................................... 308 Reference............................................ 309 76 It Ain t What You Don t Know, It s What You Do Know That Ain t So................................ 311 77 Illicit Drug Transport................................. 315 Reference............................................ 317 78 The Spleen: The Forgotten Organ, Is There Anything To Say?............................................. 319 Wandering Spleen..................................... 319 Splenic Calcification................................... 319 Tumors of the Spleen................................... 320 Lucencies in the Spleen................................. 321 Reference............................................ 321 79 Acute Pancreatitis: What and When Is There Room for Imaging in the Diagnosis and Followup of Patients with Acute Inflammation of the Pancreatic Gland?......... 323 Index................................................... 325