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.
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.
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 firstname.lastname@example.org.
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.
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.
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.
Groopman proposes four simple questions to ask yourself to avoid making mistakes in diagnostic decision making:
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.
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.
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.
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.
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 ;-).
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).
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!
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.
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!