Tuesday, 28 January 2014

Should non-radiologists be using ultrasound?

Cardiologists and obstetricians already use ultrasound (US) in their routine clinical practice, but should we be encouraging other specialties to grasp a transducer and start learning how to scan? This article in Aunt Minnie summarises the latest issue of the journal Global Heart, in which there are several articles about the use of point-of-care US.

Overall, I am an advocate for extending use of diagnostic techniques such as US into clinical areas where they can be a powerful adjunct to routine clinical examination. The use of bedside echocardiography, as cited in the article, is a great example. Immediate and timely decisions can be made by having the skillset to perform the US. I also feel that the old (artificial) divisions between clinical medicine and diagnostics need to be broken down. There is increasing crossover between these two entities, and we are now seeing a generation of medics emerging who are taught that using US to evaluate a pleural effusion or intraperitoneal fluid is an extension of the clinical examination, not simply a confirmation or refutation of a differential diagnosis.

Image of Signos RT portable scanner from signosticsmedical.com

Saturday, 25 January 2014

A brand new on call radiology course for 2014

"Tell me and I forget. Teach me and I remember. Involve me and I learn." (Benjamin Franklin)

Education is a passion of mine, and one of the biggest challenges of 2014 for me will be a brand new course I am starting here in Leicester. This course is for radiology trainees preparing to start their on calls. The first Leicester on call radiology course will be on 7th and 8th June 2014 at the Leicester General Hospital. 

There are other on call preparation courses but I wanted to start a course that was more interactive and allowed maximum hands-on case reviews, rather than spending a lot of time sitting through lectures.

Saturday, 18 January 2014

Pelvic floor imaging part 2: what is a proctogram?

In the first post in this 8 part series, I discussed what the pelvic floor is, and how problems with the pelvic floor may present. In this post, I will explain how the main pelvic floor xray test is done.

The xray test is called a defaecating proctogram (defecating for North American readers), sometimes known as a voiding or evacuating proctogram. It is a dynamic test, meaning that an xray movie is created during the act of straining and opening the bowels. Using some sort of scan is the only way of knowing from the outside what is actually happening to the back passage during the act of opening one's bowels. 

To start with, in my practice all female patients take a small volume of barium to drink before the test to show up the small bowel. The small bowel lies in the centre of the abdomen but sometimes can drop down into the pelvis and press on the back passage. This is less the case in men so they don't drink any barium. Just before the test, barium paste is put into the back passage and this is what is expelled.  The barium paste is also what gives patients the urge to open their bowels for the test. The patient sits on a commode next to the xray machine, and the radiologist (me!) and the radiographer are behind a screen. Xrays are then taken at rest, and then during straining and opening of the bowels.

This is what the first image usually looks like with barium (white) in the back passage. The white in the top left is barium in the small bowel.

Tuesday, 14 January 2014

Does your doctor embrace or resist technology?

This is an interesting article published in the NY Times a couple of days ago. It describes a growing trend in the USA for the employment of "scribes" by doctors, to help them complete electronic health records when seeing patients. The article quotes a Dr Sinsky, who researches physician dissatisfaction, as saying "physicians who use scribes are more satisfied with their work and choice of careers.". She goes on to say that scribes offer a triple win: “The patients get undivided attention from the physicians, the scribes are continuously learning while making an important contribution, and the physician gets the satisfaction of doing the work they went into medicine for in the first place.”

Maybe I’ve misunderstood the North American system, but in the UK that’s what junior doctors are for! Consultants (attendings) see patients on the rounds, give their undivided attention to patients, while the juniors scribe and learn from the pearls of wisdom emanating from their seniors. There is no hospital set up in the UK where doctors see patients on their own, it is a team effort. The exception to the rule is in the emergency department, which is the area that the article seems to focus on.

However, there is one simple reason why this will never catch on in the UK: privacy and confidentiality. I believe that patients will simply refuse to have a typist (one without any medical qualifications or training) be present at their consultations.

Sunday, 12 January 2014

Pelvic floor imaging part 1: do I need a proctogram?

This is the first post of an 8 part series about imaging of the pelvic floor. Pelvic floor imaging is one of my main areas of clinical interest and expertise. Problems with the pelvic floor are not as widely discussed in the media as cancer or heart disease, but my experience of seeing hundreds of patients a year has shown me that it can be incredibly distressing and disabling. Whilst a proportion of women will suffer from pelvic floor problems due to previous trauma at childbirth, in most cases the cause is unknown. Men can also be affected.

In this post, I will discuss what the pelvic floor is, what problems you may suffer from if your pelvic floor fails, and how I can help with your treatment.

The pelvic floor is made up of muscles and connective tissue, and provides support to the organs in the pelvis. The pelvis is divided into three compartments: anterior (front) containing the bladder, middle containing the vagina and uterus in women, and posterior (back) containing the anal canal and rectum. This is shown in the following image: 

(image courtesy of roboticcancersurgery.com)

Wednesday, 1 January 2014

Welcome to 2014!

Have you all had a great start to 2014? One of my resolutions this year is to try to increase awareness of what it is that radiologists do. In this day and age, pretty much every time you suffer any kind of illness, you are likely to have a scan. But most people still don't know what we actually do, what their scan images look like, and why we do a certain type of scan.

Stay in touch with my website and all my social media channels listed below to learn about what we do. Luckily it is a very visual job, so during this year I will try to share lots of interesting images and videos with you, and I'll try to spare you any long lectures!