X-rays from Scotch Tape?

It's been a couple years since I posted here. I doubt I have any readers left, but this was too good to pass up. As you know, I'm a radiologist. When I see a story like this, it peaks my interest.

He suggests that with some refinements, the process might be harnessed for making inexpensive X-ray machines for paramedics or for places where electricity is expensive or hard to get.

Supposedly they created an x-ray of their finger solely from the radiation emitted after pealing off scotch tape. I'd love to see it. This could revolutionize my industry.

Or not.

See for yourself.

Your Heart

I know I haven't updated this blog in a while. I just thought I'd share with you something I have been working on quite a bit. It's your heart.

Why Do We Miss Stuff?

Brace yourself. I miss stuff.

Whew! It almost feels better now that I’ve written it down. It’s harder to admit than you think. I’d like to think I’m the greatest radiologist on the planet, but there can only be one of those, and he’s somewhere in Texas. So, I guess I have to make due with the skills I have and try to decrease my misses – both in numbers and egregiousness.

But how? Sure, the retrospectoscope can highlight mistakes. It’s painful when the surgeon comes to you with a black colon in a jar and says, “Would you mind reviewing the CT again?” You go back and say, “damn.” You justify. You make excuses. “I was extra busy that day. There were a lot of distractions.” And so on, and so forth…

I like to confront my inadequacies head-on, so I got myself appointed as Chief of QA at a major medical center. It’s a mixed blessing. On the one hand, I get to point out every else’s mistakes, which fits real well with my need to feel superior. On the other hand, my own misses have not escaped the conference, and I’m harder on myself then anyone else.

Now that I’ve been doing this a while, I’ve started noticing trends. I’m sure none of this is new information, but I think it helps to hear it now and then. Here is what I tell my residents and fellow staff.

There are two well known ways to make a mistake in radiology:

1. Failure to see the pertinent findings.
2. Failure to synthesize what the findings mean.

Figure 1. This case was read as “Normal chest.”
Figure 2. Not normal.

If you’ve done this job for more than one or two days, you are probably guilty of both types of mistakes. Certainly, we all made these mistakes with some frequency in residency. Hopefully, the errors are fewer and further between now that we have graduated.

Now I’d like to propose a third category of mistakes, which may in fact be a subset of #2:

3. Lack of intellectual curiosity.

This is a tough one. Many things can influence your natural curiosity. How many exams did you read that day? Were there unusual distractions? When you see something you don’t understand, do you stop and look it up? Do you take the time to query your database for additional lab findings and biopsy results? Do you call your CT surgeon when you see a new type of coronary artery stent? What textbooks sit beside your reading station? What websites do you have bookmarked?

Passing boards means that we have been deemed safe, but is that enough? A periodic hard and truthful look in the mirror and an honest assessment of our shortfalls can make a difference. It won’t change your mistakes - those have already happened. What you hope is that your NEXT patient will benefit.

The Breast

The proverbial two edged sword – that’s how I have come to view the breast. On the one hand, I still have a 15 year old boy’s fascination with the breast (this is a blog about the beautiful human, afterall). I love how every breast is different, not just from woman to woman, but even two breasts from the same woman. I love how breasts age – each decade adding a new feature, a new position. I love watching women struggle to find a balance between hiding their breasts and accentuating their breasts, especially in the workplace. I love surgically enhanced breasts and the au natural.

But there is a dark side, too. One in 7 women will get breast cancer in their lifetime. It’s my job to find it early and do something about it. On my exam table, there is nothing sexy or alluring. The breast is simply a body part I have to examine. Sure, I try to maintain dignity by covering the opposite breast and only exposing the portion of the breast I need to see, but these are incidentals. These women, most of whom I’ve never met, must allow me to become more intimate with their breasts then even their significant others. I look at the mammogram, and, if necessary, I set up an ultrasound. After a quick physical exam, I begin searching for any hidden abnormalities with my magic sound waves. Occasionally, I see something and breathe a huge sigh of relief. It’s an obviously benign finding like a cyst or a lymph node. Other times, it’s not so nice.

Like yesterday.

My first patient was in her 70’s. I could tell she knew it was bad even before I started the exam. Sure enough, it was an obvious cancer. We set up the biopsy and I explained to her what I saw. Her only comment was, “Please don’t tell my husband. I don’t want to ruin his Christmas.”

My second patient was not so easy. She just turned 40 and this was her first mammogram. She felt a lump, but wasn’t convinced it was anything to worry about. Even before my technologist finished hanging the films, I knew this was bad. We grade breast lesions between 1 (normal) and 5 (really, really bad). This was a 5.

Many radiologists would prefer to have someone else have “the talk.” After all, I don’t have definitive pathology to rely on. All I have are my observations and statistics. In this case, I am 98% certain that this is cancer. I’m also certain that there is no one better to give this young woman the news than me.

There are certain things we all are good at. I’m a good father and husband. I’m halfway decent on the guitar. I’m an above average poker player.

I’m an expert on giving bad news.

The key to this interaction is keeping the conversation brief without it seeming so. I strive to answer all questions without overwhelming the patient with too much information. I’m never afraid to say, “I don’t know,” or, “it’s too soon to be asking those questions.” Most of all, it’s important that I let the patient know that whatever happens, my team will be there for them. One thing I tell all patients before they leave is this:

“When you walk out that door, you will remember a ton of questions that you wanted to or forgot to ask. Don’t worry. Write them down. You belong to us now. Even if you forget everything we talked about, please know that WE haven’t forgotten. I will personally make sure that you get seen as quickly as possible so we can find out exactly what this is and what to do about it.”

It’s never easy, but the really important things never are. The good news is that I believe what I say. That patient is someone’s mom and sister and daughter. If she were my mom or sister or daughter, I’d want her seen in my hospital and I’d want her to talk to someone like me.

The human body is beautiful. I am amazed every day by the subtle complexities and intricacies that make the “body human.” I look at the body differently than most.

I am a Radiologist.

I am a member of a select community that spent 13 + years in higher and higher education in order to look at pictures for a living. And get paid for it.

That’s right. My dad said all those years of playing video games would never amount to anything. That THAT, Dad. Since nearly everything I do in radiology is on a computer, I am basically paid to play video games.

Okay. Enough bragging. What I really mean to show you is the beauty in what I do. When I completed my residency, I had this idea to make a coffee table book of some of the more interesting images I encountered. It never materialized, but the thought still lingers. A blog is perfect for this. Perhaps, when I have enough images, a book may emerge. For now, please enjoy the following radiographs, all gathered from my daily practice.

There is an educational value here, but that is not my prime intent. Sure, you may learn a thing or two about how you function, but take a moment and try to see the art behind the image. We are pretty amazing beings.

-DrC