Muto: Animated Street Art

A polymathic physician friend (family practitioner/software magnate/science fiction writer) with excellent taste sent me a link to the following wonderful bit of animated street art.

The bits of anatomy whizzing by in it are all I need to make a specious claim of radiologic relevance...

MUTO a wall-painted animation by BLU from blu on Vimeo.

Grand Rounds - Vol 4, No. 36

This week's edition of Grand Rounds is hosted by Dr. Emer of the Parallel Universes Blog.

Grand Rounds is a weekly anthology of the best medical blogging on the web.

Intermittent Leftness of His Numb Hand is my contribution to this edition of Rounds.  John Henry remains a apt metaphor for certain jobs in medicine.  I, for one, am glad that not all medical transcriptionists have been replaced by a steam drill.  Not only do they continue to save us from medical malaprops that no computer will ever spot, but they are also kind enough to share the funniest ones with the rest of us.

These Naughty, Naughty Roentgen Rays

The official website of the Nobel Foundation has launched Imaging Life, an educational site showing how Nobel Prizes in scientific and medical imaging have affected medicine and popular culture.

Reactions in the media to the discovery of X-rays included the following bit of doggerel:

X-actly So!

The Roentgen Ray, the Roentgen Rays,
What is this craze?
The town's ablaze
With the new phase
Of X-ray's ways.

I'm full of daze,
Shock and amaze;
For nowadays
I hear they'll gaze
Thro' cloak and gown -- and even stays,
These naughty, naughty Roentgen Rays.

Once word of X-rays leaked out of the lab to the populace, it's interesting (and not too surprising) that one of the first applications they thought of was to look at naked ladies. Interest in this certainly hasn't waned -- if anything, we're even more obsessed with it now than ever.

Interestingly enough, this presentation has at least one notable omission: Egas Moniz, who won the Nobel Prize for Medicine in 1949. Although his prize was awarded for his work on prefrontal leucotomy (a.k.a lobotomy) for treatment of psychosis, he also pioneered the technique of cerebral angiography in 1927, and it has remained one of the premier methods of brain imaging ever since.

Intermittent Leftness of His Numb Hand

Even radiologists have to periodically relive the old story of John Henry vs. the Steam Drill.

My personal steam drill is the voice recognition system I use to dictate my reports. What it achieves in efficiency it lacks in even rudimentary human common sense. The dictation software is not the only thing lacking common sense. The humans who compiled its expensive "medical" dictionary option put in zillions of highly inappropriate words. It is unlikely that I will ever use "Microsoft", "Mickey Mouse" or "Godzilla" in an X-ray report, yet they visit my dictations all too often. I really miss John Henry.

I have a good friend who is a medical transcriptionist. Annually she and her plural of transcriptionists assemble months of medical malaprops into a canonical collection that they share with the rest of the hospital. She was kind enough to pass these on to me.

The patient's first name is Margaret, with an M, like in Margaret.

Complains of intermittent leftness of his numb hand.

Complains of some difficulty breathing for the last couple of hours with some shortness of breath which she says is only present when she breathes.

Recommendations: I have told the patient if she has another seizure and becomes unconscious, she is to call 911 immediately

The lower extremity was then carefully moved with the patient to the bed maintaining abduction and neutral rotation.

He normally will blink his eyes to say "yes" and will frown to say "no", but that is the extent of his verbal abilities.

Delightful elderly gentleman (56 y/o)

Conscious sedation was delivered by a registered nurse during conscious sedation.

Neosporin to his buttocks, 1 PO bid

The patient has evidence of a limping date. (gait)

Patient had circumcision in 1998 secondary to recurrent otitis. (balanitis)

She will have a blood taste today. (test)

The patient’s urine put-put was adequate. (out-put)

Six Things That Don't Cause Autism

The internet seems to teem nowadays with wacky claims about links between vaccinations and autism. What do actual doctors have to say about this?

I offer for your consideration the alpha and the omega of medical blogs on this topic: the always excellent Science-Based Medicine, which gives all the details one would ever want to know on the topic, and the differently-excellent Crap-Based Medicine, which cuts right to the chase:

Q: Do vaccines cause autism?

A: No. Total crap. And while we’re at it, here are five more things that don’t cause autism:

1. Pirates

2. iPods

3. Television

4. Gnomes

5. Jesus

It's hard to improve on this masterly summary, but I will add one more item to the list:

6. Radiologists

Red Marrow and Lady Chatterly's Lover

When one sees a bare-chested man juxtaposed with a buxom female on the cover of a bodice-ripper, radiologists don't automatically come to mind.

However, still waters run deep. Radiologists are just as obsessed as anyone else with body part interactions between consenting adults. Moreover, as previously posted on this site, you can get some interesting insights into sex when you have giant radiology machines at your behest.

I am apparently not the only radiologist-blogger to find their marrow stirred by medical images. The Musculoskeletal and Orthopedic MRI blog combines literary allusions with imaging tips in
Red Marrow and Lady Chatterly's Lover.

Skull Fonts from Skull-A-Day

I just learned of this great free font, called Skullphabet #1.  It's just the thing for pirates, radiologists, anatomy geeks, or for anyone about to pen a ransom note.

It also has a younger brother, known as Skullphabet #2.  Both can be found on the Skull-A-Day site, where the author has the self-imposed task of "making a skull image every day for a year".  Episode 351 was just posted today, so don't miss the exciting denouement, showing soon on a web browser near you.  This site also looks like a great place to buy things (i.e. T shirts and other skull paraphernalia) for that hard-to-shop-for radiologist in your life.

(via Street Anatomy)

Anatomical Tattoos

Imagine an alternative reality in which Frank Netter dropped out of medical school and became a tattoo artist.

If that had happened, there would be some choice tattoos out there -- much better than that skull on the dude on the left margin.  I'll bet Netter's work would look a lot like some of the specimens posted on the excellent Street Anatomy site. Check out the original Anatomy Tattoos there, with some recent additions.

I especially liked the black light tattoo -- to me it looks a lot like just another day at work.

Beware the Ides of May

I've administered barrels of barium to patients during my career. However, my hat goes off to the radiology dudes at Scripps Hospital, who seem to be working from a whole different part of the periodic table (about 30 places back, to be exact)...

Murrugun The Mystic Swallows first one sword,Then Three swords For Doctors at Scripps Hospital.



Just for good measure, here's the same same feat by the same guy, but recorded with visible light:

Google Mirth

Our chief MR tech just sent this to me:



This could get even creepier if Google starts adding medical imaging gear on their Street View trucks.  For some unsettling possibilities, see here and here.

The Radiologic Appearance of Acute Kindle-itis

If possible, my life has just become even geekier. As of 4 days ago, I am now the owner of a Kindle -- Amazon's new digital reading device.

I am not a digital book newbie. I have read books for years on my Palm -- usually in the form of bedtime reading. I have to say that a Palm screen is not the most exciting way to read a book. However, this is actually a good thing. Since my main goal with the Palm is to put myself to sleep, anything that makes the reading process more boring is actually an asset.

I was intrigued by the Kindle when it first came out, but was put off by the fact that it sold out in 5 hours and remained out of stock for months. One index of its scarcity is that to this day, I have still never seen another one in the wild. To put this into perspective, consider that I am a geeky book addict living in a city full of high tech companies and obsessive readers even geekier than I am. Having gone through the hassle of trying to buy one artificially scarce object -- the Wii -- for my son last year, I wasn't eager to go through that process again.

What changed? Amazon finally started making enough of them to meet the demand. When one of my favorite Mac podcasts mentioned that the Kindle was, at long last, actually in stock, I decided to take the plunge.

Along the way, my interest had been further piqued by Andy Ihnatko's revelatory column on the Kindle: It's About More Than Just Waffles. As usual, he nailed it: forget the official Amazon marketing. A Kindle is actually a wireless, hand-held web-browser/blog-reader with free EVDO wireless connectivity. Forever. Or, at least as long as you or your Kindle or Amazon continue to function. If you, like me, are already paying $60 / month for your iPhone or for your laptop EVDO connection, you can see what a compelling bargain this is all by itself. The fact that the Kindle also lets you buy, read and store books is a pretty nice secondary feature.

For a more visual argument for why you should consider getting one of these gadgets, the following 9+ minute video by Andy Ihnatko may do the trick. A capsule summary:

"This is the least Apple-like, least iPod-like, cool piece of techology made."

It would be hard to top Andy's reviews for why you should buy one, or MacInTouch's very complete review of what you would get for your money. Therefore, I'll swerve off in a different direction and cover the radiology angle, i.e. how it well it might work in teaching and learning radiology.

Text

First of all, text is a non-issue. The Kindle displays text quite well, with nicely anti-aliased fonts in several easy-to-change sizes. The Kindle allows one to do standard bookish things such as placing digital bookmarks, making notes and highlighting passages. However, it also allows one to do some things that are difficult in physical books, such as looking up the definition of an unfamiliar word or searching one's whole library for a particular word/phrase/quote.

Images

Images are another matter, and it all boils down to the particular display used by the Kindle -- a novel display technology known as electronic ink. Specifically, the Kindle uses a piece of Vizplex™ imaging film to create a 6" diagonal display with 600 x 800 pixel resolution at 166 dpi.

One of the beauties of words printed in electronic ink is that you actually read them with the device turned off. When one "turns" to a new page, the Kindle turns itself on, writes the new page, and then turns itself back off. This change from one page to the next is accompanied by a flash that can initially be rather distracting (like a visual fart, as Andy Ihnatko put it). However, it didn't take me very long before I didn't even notice this.

The screen uses actual black and white ink particles of pigment that are contained in teensy capsules within the screen. These ink particles move to different positions of a capsules when an appropriate electrical charge is applied to them. The pigments rest in their last position without power, and the display only consumes power when it changes.


The switching speed for a new page is typically about 740 msec. This is fine for reading a book, but it means that you won't be viewing video files on your Kindle anytime soon.

The result is a screen that is easy to read under indoor lights or direct sunlight. However, without some sort of external lighting, you won't be able to read it in the dark. By dark, I mean most radiology reading and conference rooms.

Vizplex supports 8 shades of gray, but according to MacInTouch, the Kindle only displays 4 of them. This is fine for displaying diagrams and line drawings. However, for those of us used to viewing images with 2^10 grays, this will be a bit of a let-down. The Kindle's workaround is to dither the images. Dithering is akin to the half-tone process used to print photos in newspapers and magazines. It has the effect of reducing spatial resolution, but fools the eye into perceiving more gray shades than are actually present. The Kindle comes with many exemplars of this, in the form of many attractively dithered images that fill its screen in sleep mode.

As an experiment, I used GraphicConverter to dither the following case of sarcoidosis of the great toe (Effect -> Black&White -> Atkinson). I then moved them over to my Kindle for viewing. Click on the following image to see three different versions at full resolution:

Original image in 256 grays, 4 grays using Atkinson dithering, and 4 grays using Floyd-Steinberg dithering.

The results? Not too shabby. Although it wouldn't fly for diagnostic purposes, the lace-like pattern of sarcoid in the distal phalanx can still be seen well enough for educational purposes. Of the two dithering modes, I think I prefer the Atkinson algorithm. Also, I have found that an image looks a lot better when it is sized large enough to completely fill the Kindle screen.

As another experiment, I moved two Word documents full of medical images over to the Kindle using Amazon's e-mail conversion service. The first document contained images embedded in Word in .jpg format. In the second document, I carefully dithered all of the images down to 4 grays with GraphicConverter and re-pasted them back into the document. I was a bit surprised (and miffed) to find that the images in my hand-optimized file sucked badly, while those dithered by Amazon's automatic online converter were actually rather decent. This means that any manuscript, review notes, case studies or personal documents in Word format can easily be transferred into Kindle format and shared.

How about radiology books on the Kindle? As of the moment, there are 263 radiology titles available in the online Kindle Store online. I picked out a few likely-looking titles and had the Store send sample chapters to my device. The text was fine, but the images in the books I've viewed so far have sucked rather badly. This suckage is due to the images being rather small relative to the Kindle display, and the fact that they seem to have been posterized rather than dithered.  This makes them look like bad paint-by-numbers X-rays.

Even with sucky images, I'd strongly consider buying a Kindle version of some of my large multi-volume reference texts, just for the ability to easily look things up in them.

Alas, Amazon's converter does not yet handle PDF files. Therefore, if I want to shove a stack of journal articles onto my Kindle, I'll first have to save then onto my Mac in HTML format and then let Amazon convert them for me.

Wireless

The built-in EVDO wireless connection is very cool. I've already used this several times during lectures, conversations or podcasts. As the speaker mentions a cool book, it's amazingly seductive to search for it, buy it and even start reading it in real-time. Within minutes of hearing a great podcast book review, I was 99 cents poorer, and had all six volumes of Edward Gibbon's 1776 classic, The History of the Decline and Fall of the Roman Empire, on my Kindle, ready to read.

Interface

By and large, the interface is relatively logical and easy to learn. To turn a page, you click a large "next page" button along the right side of the screen. The left side of the screen has, alas, both a "previous page" and a "next page" button. This extra damned "next" button keeps me going to the wrong page a lot often more than I'd like. It feels a bit like the UK car rental we once got that was a perfect mirror-image of our car at home -- particularly the turn signals and windshield wipers. You can imagine how well that turned out.


Also, IMHO, these next/previous page buttons are TOO DARNED BIG! These buttons cover so much of the Kindle's edges that there isn't a whole lot left to grab. I cope by keeping my Kindle in its case. At least grabbing that won't send won't send me flying off to unexpected places.

Comparing the Kindle to the other great technological joy of my life -- my iPhone -- is both unfair and inevitable. Juxtaposing these two devices is very reminiscent of the Apollo-Soyuz exhibit at the Smithsonian National Air and Space Museum. While both devices get the job done, it's pretty easy to tell which one is by Apple and which one is the latest Soviet design.


The Bottom Line

In one short week, the Kindle has joined my iPhone as one of the two techie tools that I'm never without. The idea of killing time in a checkout line, airport boarding gate or doctor's waiting room without both of these devices has become unthinkable to me. Amazon got so many things right with the Kindle that I can live with its occasional oddities. If you are a demon reader like myself with a multi-hour daily reading habit, you inhabit the perfect demographic for this device, and it is Good Enough for That Right Now.

How about medical education? Physicians who can exist on a diet of words alone (internists, pediatricians, psychiatrists, etc.) should have no trouble learning from the Kindle. However, for us obligatory imagevores, the jury is still out. From my experiments so far, I think that there is a lot of promise, provided that great care is taken to minimize image suckosity.

Chances are that if we someday attend the same radiology meeting, I'll be the one in the back of the room reading my Kindle between talks. In case you see several of us holding one, I'll be the one grumbling about the "Effing windshield wipers!"

Grand Rounds - Vol 4, No. 34

This week's edition of Grand Rounds is hosted by David E. Williams of the Health Business Blog.

Grand Rounds is a weekly roundup that features some of the best medical blogging on the web.

Radiology Party Tricks is my addition to this round of Rounds, and details my latest Secret Master Plan™ for dealing with cocktail party consultations.

Radiology Party Tricks

At a recent folk dance, I was resting on the sidelines, and noticed that a friend had her foot propped up on a chair with an ice pack on it.

SR: "What's wrong?"

Friend: "Someone stepped on me during the last dance."

SR: "Want me to have a look at it?"

I had preloaded a picture of foot X-ray on my iPhone, and when I put it on her foot, the effect on her was all that I have could asked for.

Friend: "OH MY GOD!!"

We tried the same trick on other friends walking by, with pretty much the same results. Now, most of my friends are not radiologists, but are well aware of my geeky nature and love of gadgets.  Therefore, the idea of my carrying around an actual iFluoroscope in my pocket is probably not completely out of the question to them. However, one of my radiology techs at work gave the same universal "OMG" reaction, so I suspect that the illusion relies more on its unexpectedness than on any technical expertise of the audience.

Future plans for this:

Every professional I know gets hit up for free consultations at cocktail parties, and has their own way of dealing with them. One lawyer friend listens politely for a minute, and then says in a loud voice, "Well, if you haven't actually been indicted yet for rape or murder, I can't do much to help you!"

I've decided that my iPhone is going to be my new secret weapon to help repel boarders. I've started loading it up with all sorts of evil things, such as gout, Alzheimer's disease and impalement injuries, like the one above.

Hmmm, maybe also a few STD cases and rectal foreign bodies for good measure...

Working Where the Sun Don't Shine

I'm not a colorectal surgeon, but like them, I spend most of my day toiling away in dark places. 

Having done more than a few barium enemas in my time, I can appreciate the subtle innuendos (so to speak) of the following song by Bowser and Blue.  

Note to self:  try to get these guys booked at a radiology meeting.

Sex and Financial Risk Linked in Brain

There are probably few people who have not seen some version of this cartoon showing the differences between male and female brains.

Functional magnetic resonance imaging (fMRI) is beginning to uncover a much more realistic -- but no less wacky -- map of brain differences between men and women. For example, take the following report from the journal NeuroReport:

Knutson B, Wimmer GE, Kuhnen CM, Winkielman P. Nucleus accumbens activation mediates the influence of reward cues on financial risk taking. NeuroReport March 26, 2008 19(5):509-513.

The money quote (so to speak):

"...we predicted and found that anticipation of viewing rewarding stimuli (erotic pictures for 15 heterosexual men) increased financial risk taking..."

In other words, erotic pictures caused these men to take bigger monetary gambles than pictures of neutral (household appliances) or scary objects (snakes and spiders).

Who could have seen that coming? Let's just hope that the casinos and advertising agencies never get wind of this.

(via Chicago Tribune)