May 31, 2015

I travel for work, a lot. People ask me how I do it, and I shrug. I don't mind travel, so what's the big deal. Schipholoffice

What people forget, however, is that business travel is not holiday travel. Holiday travel is exhausting and uncomfortable, but exciting and fun and worth it. Because it's a holiday. When traveling for work, without the fun and excitement, you'll be left with the exhausting and uncomfortable part if you're not careful. So over the years, I have developed the following rules to make business travel not only doable, but actually enjoyable.

Rule number 1: Be a princess

You travel for work, not for pleasure. That means that the travel itself needs to be pleasurable, or at least as comfortable as possible. This comes at a price, so your budget will probably limit your imagined royalty status. But make sure to spend it: on first/business class, on comfortable hotels, on taxis, on 24-hour wifi (don't think, just pay). Stay in charge of your travel. Go for upgrades, ask for a better hotel room. Solo travellers are often put in the worst rooms. They know it, you know it, just don't accept it.

Rule number 2: Conserve your energy

Travel light and allow yourself plenty of time to get to the airport. There's no need to start your journey already exhausted by carrying heavy cases or sprinting for trains. Invest in a good trolley: light, good wheels, easy access to laptop and liquids. Join fast-track schemes at airports, nothing drains you more than spending half your time in noisy queues. Don't wander around in duty free. Find a quiet place, sit down, set your alarm for when you need to go to the gate. Ideally, use the lounge. If you don't have access yourself, tag along with a colleague who does.

Rule number 3: Be yourself

Make yourself at home: unpack your suitcase, switch on your favourite music instead of CNN, get food and drink supplies from the local supermarket. Stick to your routines. Be safe: use the hotel safe for your valuables. Always leave one bank card behind in the hotel, so you can still get cash in case you get pick-pocketed. Use the chain on the door. If there isn't one: use a door stop, don't travel without one.

Rule number 4: Stay fit

Use the hotel gym, go for a walk, make sure to get some fresh air: the best cure for jet lag and travel fatigue in general. I never travel without my running gear, there's always time for a 30 minute run. Organised sight-seeing runs are ideal if you have the time. Eat well, don't pig out, have fruit and unsalted nuts at hand as snacks. Order a side of vegetables or side salad, always.

Rule number 5: Enjoy!

You won't survive if you don't enjoy yourself. Stick to the 'one-hour-minimum' rule, even if that means a later flight home. One hour minimum to walk around, with a camera. If there's more time, a quick visit to a museum or exhibition. Or a little shopping :-) Don't stay cooped up in your hotel room catching up on email: get out there, and enjoy the privilege of travelling the world for work!

Dec 7, 2014

At RSNA last week I gave a lecture on non-traumatic CNS emergencies, as part of the joint ESR-RSNA symposium on Radiological emergencies. Prof. Howard Rowley covered the traumatic CNS emergencies in the same session. We had a full house, 450 participants in the lecture theatre. In addition, 400 people attended the session virtually.

If you missed it, or would like to see it again, you have until 19 December to attend RSNA's virtual meeting. And if you want to have the real-life experience: come and see us at ECR 2015.


Nov 6, 2014

8 November, the day that in 1895 X-rays were officially discovered, is International Day of Radiology. This year's theme is Neuroimaging. Our section of Neuroradiology at Erasmus MC starts celebrations early, on Friday 7 November, with a mini symposium on the Past, Present and Future of Brain Imaging. You are very welcome to join us in C-113, Erasmus MC, Rotterdam/NL, 5-6pm.

Want a sneak preview? Here's a selection of my slides: slideshare-IDOR.

Sep 21, 2014

21 September is World Alzheimer Day. To raise public understanding, awareness and money we organise several events at the Alzheimer Centre Southwest Netherlands in Rotterdam (NL).

18 September Evening Symposium on diagnosis and treatment of dementia
Free registration by sending an email to

18 September Evening Symposium on diagnosis and treatment of dementia

20 September Head First Race
Charity rowing event to raise money for dementia research. Very proudly presenting my PhD students' "The Radiology Girls" team. By supporting one of our teams, or participitating yourself in this fun day, you join us in our fight against dementia.

20 September Head First Race

Sep 14, 2014

Our review paper on the white matter tracts of speech and language is now available online, and free to download for a limited period. The paper appears in a special issue of Seminars in Ultrasound, CT and MRI on Brain white matter tracts, edited by Adam Thomas.

In this paper we describe the normal anatomy of the major language white matter tracts, namely the arcuate fasciculus, the uncinate fasciculus and the inferior fronto-occipital fasciculus. We provide a detailed description of seed and target region of interest placement for fibre tracking. Clinically, fibre tracking of these tracts is primarily performed for presurgical evaluation of brain tumour patients. From a clinical research perspective, the white matter language tracts are of interest in cerebrovascular disease and neurodegenerative disease.

Jul 30, 2011

How doctors think by dr. Jerome Groopman is not really about how doctors think. It's about how people think, and how this affects our work as doctors. Groopman states he primarily wrote the book for patients, to explain how doctors come to their decisions: which may well be wrong and may have devastating consequences. Practicing medicine is time-pressured decision making in the face of many uncertainties, over and over again. You only need a distraction, a bad night's sleep, or a stressful situation to miss a bit of information that would have been vital for correct diagnosis.

How doctors think

Groopman proposes four simple questions to ask yourself to avoid making mistakes in diagnostic decision making:

  1. What else could it be?

    Deals with errors such as premature closure, framing effect, availability from recent experience, bias towards more common disease. It helps to keep an open mind, forces to think of alternatives that are maybe less common. As students, we were taught to think in terms of differential diagnosis, but this concept is often sacrificed in a busy medical practice.

  2. Is there anything that doesn't fit?

    Deals with diagnostic momentum: once a patient receives a diagnosis, it is very difficult to change it. Critically assessing signs and symptoms that don't fit with the given diagnosis, instead of brushing them aside, again helps to come to an alternative diagnosis.

  3. Is there maybe more than one problem?

    Deals with search satisfaction. In my profession, this is a common pitfall. We read our scans, and stop looking when we've found something, particularly if it fits the given diagnosis. Obsessively going through all images, assessing all organs and structures is the way I deal with this issue.

  4. Should I consult a colleague?

    Deals with our - oversized - ego! We're often stuck in our own ways of thinking, unable to get a fresh perspective. A colleague can help.

The problem with cognitive errors is that we're not really aware of them at the time. In my experience, they are the main cause of mistakes I made, mostly when I was exhausted after working too many hours... The trouble with exhaustion is that although you're aware of your attention is slipping, you're too tired to correct for it. And that's when you stop being critical about your own thinking. Maybe the four questions should be printed on the on call beepers as a constant reminder.

From the above you would think that Groopman's book is in fact written for doctors, and not for patients. Interestingly, however, Groopman also places some responsibility with the patients, advising them to ask their doctors these same four questions.

Dec 1, 2010

Completely unrelated to RSNA, although it was pointed out to me here and it is related to Radiology, I found out today that our CHIP prediction rule - to predict intracranial complications after minor head injury - is included in the MediMath app for iPhone and iPad! It is only 3 years ago that the reviewers for our paper commented that the CHIP prediction rule may be too complicated for clinical practice, which is why we also included a simple list of risk factors for clinical use. This simplification leads to a slightly worse performance of the rule, so I'm really chuffed that the more complex rule can now also be used easily. If I hadn't found myself a justification for buying an iPhone, I definitely have found it now ;-).

Michigan Ave

Nov 30, 2010

As if yesterday's special lecture wasn't special enough.. today we've got President Bill Clinton! Most of today was therefore spent in anticipation, and in the long long queue several hours before doors opened. Well worth it: prime seats (well, relatively, for non-VIP standards anyway).

Bill Clinton

What can I say, it is incredible to hear this man speak, on health care both in our own rich countries, where we spend 10-20% of our GDP on health care, and in the developing countries, where cancer care is still virtually non-existent. What can we do? Make sure that we find ourselves in a position where we can have influence. Apparently, even in the United Nations this is not obvious, so each member every year promises that they're going to try to improve one thing... So tonight, I introduced this concept to my colleagues who I visit RSNA with every year. Each year, during RSNA, high up in the sky in the Signature Lounge overlooking Chicago, we will specify the one thing that we're going to improve in the coming year. A big promise to myself, my colleagues, my patients and to Bill!

Nov 29, 2010

Today's absolute highlight is Atul Gawande. I am a big fan of his books, which I think every doctor should read, reread and then read again. And today he's giving a talk at our own RSNA. What an honour.


Prior to his talk Sam Gambhir gave the Pendergrass new horizons lecture on strategies for early cancer detection. A truly impressive talk, on the ultra-high-tech developments for cancer detection in the earliest of stages, but it very much reminds me of the 7T MRI discussions: there's this niggling question in the back of my mind whether we can really justify all this expensive equipment and research while in large parts of the world children die of diarrhea...

The contrast with Gawande's subsequent talk therefore couldn't be bigger. The simplest technology possible, a checklist, reduces post-surgery mortality by 45-50%. It is really impossible to believe. All we can do is hope and pray that these simple measures really make their way into clinical practice as soon as possible so they can start taking their effect. We can have all the high-tech shiny toys we want, but if we don't stick to the basic principles such as hygiene, haemorrhage control, and patient follow-up, we are only making health care more expensive, but not better.

I was left deeply impressed and truly inspired, yet again, by this amazing person. Please, read his books and be a better doctor.

Nov 28, 2010

Hello Chicago!! RSNA number 8 for me and never failing to impress.. The sheer size of this meeting, incredible organisation, gathering of so much knowledge and technology every year leaves me with a slight sense of bewilderment, enhanced by the lack of sleep from jet lag and late night social events.


Excellent refresher course on advanced MR angiography: it is now possible to perform 3D time resolved (so, 4D in fact) whole brain angiography at 2 f/s with good separation of the arterial and venous phases and sub-millimeter resolution using HYPRFlow. The expectation is that time resolution of such techniques will go up to 20 f/s in the near future, unbelievable. Diagnostic DSA will really become a thing of the past.

Siemens introduced their 3T PET-MRI, yet another big shiny toy in the world of Radiology!