Dining Out for the Indecisive

Here's yet another swell iPhone app that is just the thing for a radiologist or anyone else with decision commitment issues.

The next time you're hovering helplessly between "consistent with but not diagnostic of Thai" and "raises the question of Chinese", it might be time for you to try the Urbanspoon app for the iPhone.

If you have some residual standards, you can lock in a certain neighborhood, ethnicity or price range. Hitting the "Shake" button will run a cute little slot machine simulation on your phone and show you where you are headed for supper. Reviews for that restaurant are then just a click away.


If you have no absolutely no will of your own, leave all of the variables unlocked, and the app will pick place, cuisine and price for you.

This should also be handy the next time you're at the RSNA meeting and some GE sales-droid is trying to buy your soul with dinner.  Just whip this app out and set the dial to $$$$.  If you're going to sell out, sell out for something really tasty...

WTF CME

Although I attend quite a few radiology meetings, the bulk of my continuing medical education (CME) comes from a much different source. Staid organizations such as the AMA call this "point-of-care" CME. Personally, I prefer the term: "WTF CME™". 


It works like this:

1. You read through a worklist of images (or hey, actually see a patient) and spot some finding you can't explain. As the image above suggests, you then ponder this finding and its significance.

(N.B.: If you are not au courant with the latest in internet abbreviations, let's just say that WTF stands for "What's that finding?")

2. If you work with other radiologists, you ask their opinion. They either know the answer, or utter a quizzical remark similar to yours.

3. If none of you know, you head for a website like Google or PubMed. Occasionally you get lucky and one of these sources resolves your question.

At this point, you may be wondering where the CME part comes in. Can it be that this sort of activity counts as a legitimate professional learning activity?

The answer is yes, indeed. The time you spend doing this counts as Category II CME (at least in my state). All you need to do is to keep track of it, which you can do on the back of an envelope. Alas, this scrap-of-paper logging method doesn't work too well for me -- most likely because I'm too lazy to tally up all of the scraps at the end of each year.

Fortunately, there is an easier way to keep track of this stuff -- colleagues at the University of Washington Department of Radiology have put together a handy, dandy web-based program called UDubMed that tracks all of one's PubMed searches. The interface is pretty much bare-bones, but the service is free and the basic features work just fine.

Once you set up a free UDubMed account, you log your searches thusly:

1. type in your PubMed search term in the box labeled (oddly enough) "Search Terms"
   
2. hit the search button
   
3. UDubMed records your search terms in a database, flings your search terms off to PubMed, and then returns the result of this search
   
4. repeat prn

Eventually (usually around license-renewal time), you realize that you need to rake together all of the CME you've amassed over the past few years. Like me, you may need to apply your rake to many piles of stuff. Raking the UDubMed pile, at least, will be pretty darned easy -- the report button will generate a list of the date, time and search terms of every search you've ever made. Printing out this list as a thick slab of paper should be just the thing to repel boarders during even the most anal CME audit.

Just to see how this might work for me personally, I did a brief one month experiment, in which I used UDubMed for all of the literature searches I did while reading out with my residents. By the end of the month, I'd done over 300 searches -- not too shabby.


That's a nice number, but how many CME hours can I get for that? There's the rub -- some searches are over in a minute, while others might lead to a series of articles that you then download and read for the next hour. Is there an easy way to keep track of this?

I was too lazy to count the actual search time, so I decided to greatly simplify my life by using an algorithm I learned years ago in the U. S. Air Force, known as the WAG (wild-assed guess) method. Using this, I assumed that each search ate up an average of 5 minutes of my life. This converted my 300+ searches into about 27 hours of CME.

I admit that I initially felt a bit guilty about setting the average search time so ridiculously high at 5 minutes. However, any guilt vanished when I found out how much time the American Medical Association was willing to give me per search for their Physician's Recognition Award (PRA): thirty (count 'em, 30) minutes! Using this even more wildly generous algorithm, my search time for the month swelled to 73 hours. Extrapolating to a whole year, this rate of searching would give me an outrageous 876 hours of Category II CME. Since I only need 50 hours per year -- Dude, I'm done!!

My sources at UDubMed tell me that this same system can be used to log searches for Category I CME credits, once they add a few simple, automated questions to their system and convince their CME department that This Is Actually A Good Idea -- No, Really. I hope they accomplish this really, really soon. Encouragement and feedback can be sent to them via this web form. 

In the meantime, I'll keep converting all of my many personal WTF moments into a truly ludicrous pile of Cat II CME.

The Marauder's Map

Have you ever tried to describe a really cool and obviously useful program to your friends, only to get nothing but blank looks back from them?

I used to grope for words like this while trying to describe Loopt. The official website blurb doesn't help much: "Loopt turns your mobile phone into a social compass".

However, this past weekend a colleague pointed out a perfect metaphor for Loopt: The Marauder's Map from the Harry Potter books. Instead of a parchment map of Hogwarts, you get a tiny Virtual Earth map on your phone, showing the position of you and all of your nearby friends.

Besides outing you and your friends, it also shows nearby restaurants, pharmacies, and things of that ilk.

I could have used Loopt last week at my radiology meeting in Vail. A number of us were going to meet in the lobby for dinner at 6 pm. However, only 2 of us showed up. Although a few phone calls eventually cleared things up, Loopt would have provided a really elegant solution. If all of the other cool kids had already gone to a restaurant, it would have been easy to zoom in on the map and hunt them down.


Something like this would be really, really useful at large or noisy events, particularly where it's not easy or appropriate to take calls. Examples include outdoor music festivals, malls, or sporting events. I'd love to use something like this to filter out the teeming hordes (60,000+) of folks I don't know at the next RSNA meeting and just show the locations of a few friends.

Finally, there are times when you really don't want anyone to know where you are and what you are up to. Rest assured, I made darned sure that there was an off switch before I signed up for my Loopt account.

Cool iPhone Crap for Radiologists

I just got back from a radiology meeting in Colorado, where I gave a short presentation subtitled "Cool Internet Crap for Radiologists".

Not surprisingly, a number of these applications were ones that can be installed on the new iPhone 2.0 software. Some of these apps are cool enough to warrant their own posting. Others I'll mention below.

For anyone teaching anatomy to students, apps such as Netter's Anatomy Flash Cards are pretty obvious choices. Pulling up an organ or a muscle on my iPhone is sometimes a lot quicker than dumpster-diving for a similar web-based picture on our workstations.


The audience especially liked my description of Shazam, which has nothing at all to do with radiology.

It works like this:

1. you hear an unfamiliar song on the radio
   
2. you hit the "Tag Now" button
   
3. the app listens for about 15 seconds, and then queries the Shazam server
   
4. you then get back a reply that looks like this:
   

As you can see, a successful hit not only returns the name of the tune, album and band, but also cover art and a link to the iTunes store where you can get your own copy. When available, a YouTube video link also pops up.  At the end of a session of listening, Shazam displays a list of all the songs you've just been listening to.

How does it work? The Shazam site says it is "powered by the world's leading music recognition technology". However, for all I know, this "technology" may actually be students chained in dungeons and fed beer and pizza through IV tubing.

However it works, my son and I had a rather large time using this app on our drive back and forth between the Denver airport and the meeting site in Vail.  Shazam worked fine with most of the pop, rock and country stations we monitored. However, it had no luck at all with the few ethnic and classical stations we tried.

It's not much of a stretch to imagine a Shazam-like iPhone app for radiological diagnosis. Non-radiologists could someday point their iPhones at an image, and then upload image features somewhere into the cloud for interpretation. Fortunately for the bottom lines (and bottoms) of radiologists everywhere, medical image analysis seems to be a lot tougher problem than top-40 musical analysis.

I Want 3G iPhone

Sunday night, as I awaited some Chinese takeout at a local restaurant, I overheard one of the waiters there telling the other, "I want 3G iPhone".

So do I.

I'm already used to hearing this sentiment at work and from geeky friends. Hearing it in the wild like this suggests to me that the 3G is getting even more traction than I realized.

My year-old original iPhone continues to rock along spiffingly with the new 2.0 software. This is great, of course, but there's a part of me that would rejoice if it died tomorrow, giving me an easy out for upgrading to the newer model. 

Sigh...

Bathroom Humor

I ran across this while googling for something completely different.

One-Buttock Playing

I have always been a big fan of buttocks and of musical performances. However, their intersection had not occurred to me until I heard the following TED talk by Boston Philharmonic Orchestra conductor Benjamin Zander.

Zander's "one-buttock" metaphor is something I'll try hard to remember during my next musical gig or medical lecture.



(via Presentation Zen)

Bronchitis from Hell

After about 10 days of coughing and feeling miserable, I'm just about over the Bronchitis from Hell. After some of the horrific coughing spells I've had in the last few days, I was almost afraid to look at my sputum, just in case I really had brought up little bits of lung tissue in my latest spasm.


Normally, I'd stay home and keep my misery to myself. Alas, due to thin staffing during the vacation season, I had to work right through some of the worst of it. I wore a mask during my few mandatory patient contacts, and after each readout session, my residents and fellows treated our radiology workstations as HazMat sites, swabbing them down with toxic chemicals.

aarrgghh....

Grand Rounds - Vol 4, No. 42

After being on vacation for a week and then being sick for a week, I'm playing a bit of blog catchup. Therefore, I'm posting this tardy link to the penultimate edition of Grand Rounds, hosted by The Blog That Ate Manhattan, who notes:

Most things in life can be related, one way or another, to an episode of Seinfeld.

TBTAM has therefore cleverly arranged all of the submissions to this edition in a Seinfeld theme. My submission was listed as part of The Chinese Restaurant episode:

The wait for the restaurant on the show occurs in real time - 23 minutes. During which time, basically nothing happens. Well, nothing other than the earth moving. And The Samurai Radiologist can tell you exactly how far it moved during that wait in the restaurant. Or during the time you had sex. Or any thing you happen to be doing. Pretty cool.

The CT Showed Marked Brain Enema

Yet more more dictation errors, courtesy of a transcriptionist friend:

The patient sustained a displaced skull fracture and a subarachnoid hemorrhoid.

The patient broke his wrist when he fell rollerblading on an outstretched right wrist.

He looked like a kidney stone when he arrived.

She injured her ankle. She has been keeping it home since that time.

She fell and hit the back of her chest.

The patient looks older than her stated age. (97 y/o)

The patient has a relatively constipated gynecologic history.

The CT showed marked brain enema. (edema)

The Patient Underwent a Baloney Amputation

Here are a few tasty medical malaprops, courtesy of a transcriptionist friend.

Paramedics were called and he appeared to be pulseless and nonverbal.

Patient has minimal facial grimace in the upper and lower extremities.

He plans to go swimming in the Caribbean, looking for a sunken Spanish gold bullion carrying Spanish galleon.

After testing for adequate anesthesia and waiting a few more months for that to take effect, the procedure was begun.

Mild dementia related to his prostatism (parkinsonism).

We got descent of the maternal buttocks, but we did not get descent of the fetal head.

The patient is undergoing hysterectomy by Dr. ______ who has had ongoing incontinence for several years.

The patient states he is tired of breathing.

The patient underwent a baloney amputation. (below knee)

Fluoro Off, Fiddle On!

Happy 4th of July!

I'm off with my fiddle for a week of vacation with my family in a place where the Internet doesn't shine.

We'll be spending the week at a music and dance festival in the foothills of California. About the only thing digital going on there will be fingers playing fiddles, guitars and other musical instruments.

In my absence, I've scheduled a few posts to pop up automatically in this space.

Type at you soon...

Some Days in Radiology Are Like This...

I look at things for a living, presumably because I am good at spotting tiny abnormalities in a sea of noise. Some days, however, The Force is clearly not with one...



(via Bad Astronomy)

Did the Earth Move for You?

How far does the earth travel during sex? Or, if your tastes run in that direction, during a barium enema? You'll be happy to know that:

The Quirkology team joined forces with Professor John C. Brown, Astronomer Royal for Scotland, to provide an answer to the age-old question "did the earth move for you?"

Taking into consideration rotational and orbital motion of the earth, solar and galactic motion, and the duration of your own personal earth-moving act, the following website will give you a pretty good estimate of how far you traveled:

www.earthmove.info

Note: This online calculator neglects any local motion occurring in your own personal bed or fluoroscopy suite. Feel free to add this correction factor to your final result.

(via Quirkology)

Sesquicentennial of Natural Selection

This timely reminder from PZ Myers of the Pharyngula blog:

It was on 1 July 1858, 150 years ago today, that the idea of natural selection was first presented to the public in a joint reading of Darwin's and Wallace's papers at the Linnean Society of London (an event which they did not recognize as important at the time), which makes today analogous to the Fourth of July for the biology revolution. Celebrate! 

Grand Rounds - Vol 4, No. 41

Happy Tuesday! The latest edition of Grand Rounds is arranged in a 4th-of-July-centric theme, listing the latest in swell medical blogging. This patient-care picnic is hosted by DrRich of The Covert Rationing Blog.

Coming Soon to a Child's Stomach Near You... is my contribution to the table. Bon appétit!