Not Totally Rad

The Apple Store: role model for clinics & FEMA

2010-04-05T17:53:00.001-07:00

Two quick insights after picking up my iPad on Saturday:

Medical clinics could learn a lot about customer care and clinic efficiency from watching Apple Stores on normal days.

FEMA could learn a lot about efficient emergency response from watching Apple Stores on iProduct Launch days.

iClothing

2010-04-04T13:32:00.000-07:00

I've been a fan of the Scott eVest for some time now, ever since my spouse gifted one to me. It is the perfect layered garment for a geek living in an occasionally chilly part of the country (plus, you have to love a company that puts X-Ray views of their clothing on their website). It comes with 22 pockets for electronic gear which are connected by a network of cloth conduits for cables. So far, I've only been brave enough to use 2 or 3 of these pockets. As it is, I have a hard enough time with only 4 pants pockets trying to keep MiFi routers and USB drives from an unplanned session of data laundry. However, once I finish installing our home laundry fluoroscopy unit, I'll feel brave enough to start using some of the more arcane chambers in my vest.

When the iPad was first announced, Scott was quick to point out that their eVest was probably the only stock garment on the planet that would hold a iPad without alterations. My iPad does, indeed, fit nicely in my left eVest pocket. However, I feel like I'm listing a bit to the left when I carry it there.

Where vests lead, can pants not follow? I spotted the following ad last month, and am still not sure whether it is actually a legitimate product. However, I'm glad that someone is thinking way outside the box on this issue, gag or no.

Exogenous Brainfreeze

2010-04-04T11:37:00.000-07:00

I'm no stranger to brain freeze. Once or twice a year I'll snarf down some really cold ice cream a bit too greedily and then relive that nasty dull ache that seems to fill the center of my skull.

Yesterday was different. Cabin fever drove me out of the house for a quick bike ride during a break in the chilly rain we've been having lately. This hole closed a lot quicker than I expected, and I found myself totally soaked a mile from home.

I've been wet before and I've been cold before, but this was something new:

40 degree rain + 30 mph wind + drafty bike helmet = a whole new type of brain freeze.

It's an odd thing to have that old, familiar frigid ache now covering the entire outer part of one's skull. Exhilarating but painful at the same time. I would ride a few hundred yards until it became too intense, and then pull over under a tree to let it subside. I repeated this cycle several times until I got home to a hot shower and dry clothes.

Oops, gotta go — we're having another sunbreak. It's time for me to roll the biking weather dice again…

Waking Up is Hard to Do

2009-11-19T13:10:00.001-08:00

If these 5 Minnesota nurse-anesthetists can pass gas as well as they can sing, I want my next surgery in their hospital.

LOGICOMIX: An Epic Search for Truth

2009-10-11T12:17:00.000-07:00

Yesterday was to have been a day of writing and programming. Instead, I surprised myself by buzzing through a 300+ page graphic novel on the life of Bertand Russell and his quest for the foundations of mathematics.

This "comic" was an impulse buy in our local indie bookstore yesterday. It's browsing for and finding jewels like this that remind me why I still love physical bookstores so much.

The authors and illustrators tell a great story, mixing romance, two world wars, politics, philosophy, logic, math and human failings into a narrative compelling enough to distract me from A Lot of Other Stuff I Needed to Get Done.

A fine tale well told. I've passed it on to my son, to see how it fares with the tastes of a 15.9 year old.

I'm off to a play this afternoon, and then it's back to the joys of XCode and Objective C.

All Clear

2009-09-29T11:40:00.001-07:00

Okey, doke. Lesion out and the margins are clear. The dermatopathology fellow was kind enough to give me a tour of my biopsy. It turns out that one *can* use an iPhone for photomicroscopy as long as one's expectations aren't too high.

Here is a chunk of my normal skin at medium power. I took this by just holding my iPhone 3GS up to the microscope's eyepiece. By no means diagnostic, but good enough for blogging purposes.

Once they stitch me up, I'll head over to my office and work on ARRS and AUR abstracts like a crazed ferret for the rest of the afternoon.

The Smell of Long Pig in the Morning

2009-09-29T09:54:00.000-07:00

Turns out I'm live-blogging my outpatient surgery today via my iPhone.

I'm having a minor skin lesion removed today in our university's rather slick dermatology outpatient surgery center. The drill here is:

1. Remove the lesion
2. Take a 45 minute break while a dermatopathologist processes and analyzes the tissue.
3. Repeat until the margins of the lesion are clear.

I'm grateful for this built-in break. I came to my appointment NPO (ate nothing after midnight) and I'm hungry.

To make matters worse, the electrocautery unit they use to stop the minor bleeding creates a smell that is disturbingly similar to barbequed pork.

I used my first break to run to the espresso stand next door for a bite. There I spotted a "bacon, sausage, egg and cheese, French toast bagel sandwich" for sale. No shit. However, like a car wreck you can't turn away from, I just couldn't stop looking at it. OK, OK, I bought the damned thing.

However, the unwillingly tasty scent of sizzling long pig was still fresh in my nostrils. Fresh enough, that when the espresso lady asked: "Can I heat that up for you?", I had to say,

"Uhhhh… No!"

A Pilingual Month for Me

2009-09-21T14:03:00.001-07:00

Blogging has taken a backseat this month to computer programming. Most of the words I've written over the past month have been in Ruby, PHP or SQL, with English way back in 4th place. I've therefore appropriated Douglas Hofstadter's neologism "pilingual" to title this post.

Besides my usual penchant for screwing around with cool technology, my latest programming has been aimed at several potential papers for the 2010 ARRS and AUR meetings, whose abstract deadlines loom next week.

Blogging here will thus continue to be lean until all abstracts have been safely excreted.

Rap ID Advice for H1N1

2009-09-06T16:48:00.001-07:00

If you get H1N1 influenza or any other infectious disease (ID) this year, chances are really, really good that it won't be from a radiologist. If you are auscultated, touched or sneezed upon by a physician, we're not the 'droids you're looking for.

However, there are a lot of other major disease vectors out there to contend with, i.e., your friends and family and co-workers. To protect yourself from them, here are a few helpful hints from Dr. John D. Clarke, medical director of Long Island Railroad:

HT to Medgadget

Maybe There is Hope for Humans, After All

2009-09-06T01:45:00.001-07:00

I recently posted about a very cool high speed robotic hand that could beat most humans in a finger race.

However, I was somewhat comforted today when I ran across this video of the real thing, playing guitar at speeds I would not have believed possible.

Rest easy, John Henry -- we're still ahead of the steam drills at a few things.

World Record Guitar Speed 2008 Tiago Della Vega

The Chronophage: a Clock That Eats Time

2009-09-01T18:55:00.001-07:00

What a wonderful device...

(thanks to Suture for a Living)

Violin-Playing Robot

2009-08-31T21:09:00.001-07:00

Okay, dammit. It's not just the banjo players that will be losing gigs. Looks like fiddlers had also better keep an eye on their rear-view mirrors.

I'm almost afraid to look at YouTube these days, lest I see an X-ray-reading robot looking back at me...

Lightning Fast Robot Hand

2009-08-31T20:53:00.001-07:00

A friend's reaction to the following video:

I bet this thing could do wicked good banjo triplets.

No kidding. This thing could play a banjo faster than Bela Fleck, which is really saying something.

With a bit more development, it's not just musicians that this thing might put out of work -- surgeons could lose a few gigs too.

As Dr. Wes has pointed out, this thing could also have amazing benefits for the differently abled.

This robot hand would be an especially good match with the brain-computer interface described on the 8/9/09 episode of 60 minutes (the good stuff starts at the 15:00 mark).

This is great technology -- especially from the point of view of a precocious geezer who may need some of it one of these days.

Hat tip to Anita Anderson

The Samurai Journal of Radiology

2009-08-31T05:41:00.001-07:00

Sipping from a firehose -- that's what it feels like to keep up with the medical literature these days.

Even an info nerd like myself can't keep up with all of it. However, I do have a few online tools that make my own personal information overload a lot easier to deal with.

NetNewsWire

I've used this awesome newsreader program for years. It currently grabs over 100 newsfeeds and converts them into what I like to call The Samurai Journal of Radiology™. This journal caters to my own peculiar tastes, and includes not just radiology articles, but also a fair amount of infogeek stuff and a comics section.

NetNewsWire is a Mac only program, but shares a lot of features and synchronizes with Google Reader, a non-denominational newsreader that I also use, especially on my iPhone.

These two programs do the following really, really well:

they insure that I will at least scan the titles of all the latest radiology articles in my field
they make it easy to read my literature at any level of granularity I desire: title only, title and abstract only, or full article
they keep track of what I've read and what I've not read

The main downside of NetNewsWire or Google Reader is that they make it way too easy for Type A people like me to become a newsfeed slut. Even though I've trimmed my feed list way back, I still have over 100 feeds that I somehow can't bear to delete. Sigh....

HubMed

Just about all of the radiology journals now provide RSS feeds on their websites. Radiology and the American Journal of Roentgenology also provide subspecialty feeds (such as just neuro or just musculoskeletal), keeping my reading list blissfully free of all barium articles.

However, there are some parts of my specialty that are more fascinating than others, and HubMed helps me keep up with them. Let's say that I have a special interest in one particular dysplasia: the bird-headed dwarf syndrome of Seckel. Not surprisingly, Radiology and AJR tend to have pretty spotty coverage of this rare syndrome.

However, if I type in the term "bird-headed dwarf" into HubMed's search window, it generates a special newsfeed for me on that very topic:

http://www.hubmed.org/feeds/atom.cgi?q=bird-headed%20dwarf

When I point my newsreader at this feed, it will always show me the latest 20 articles on this topic from PubMed, from all of the zillion medical journals in its database.

Very cool.

Fever

For the past week, I've been using a very cool new newsreader called Fever.

Fever, unlike conventional newsreaders, actually works better when you fill it up with a zillion newsfeeds. When you import your list of feeds into Fever, you first sort them into two piles:

stuff that you like to read every day
stuff that you read once in a while

Fever calls these 2 categories respectively "Kindling" and "Sparks". It then distills from them topics that are hot enough to be worth reading using the following principles:

if only one person writes about a topic, it's cold
if two people write about it, it's warm
if three or people more write about it, it's hot

The greater the number of posts on a topic, the hotter it is.

The downside: You'll need access to a server running Unix Apache, PHP and MySQL in order to install Fever. You don't have to be an alpha geek to get it up and running, but it doesn't hurt.

The upside: Fever has so far done a pretty good job of spotting gems that I would have otherwise missed. Well worth the $30 it cost and the few hours of time I spent configuring myserver and installing it. This alpha geek gives it two thumbs up.

How Science Publishing Works

2009-08-31T02:53:00.001-07:00

I've become a big fan of the online comic Saturday Morning Breakfast Cereal by Zach Weiner.

I especially enjoyed his treatment today of the Least Publishable Unit.

MR Fail

2009-08-30T01:12:00.001-07:00

We who work around MR scanners well know that odd sensation when something you forgot to take out of your pocket starts tugging you firmly toward the giant magnet.

Most of us have also idly speculated about the following question...

So, what if you actually did push a really big ferromagnetic object (like a whole ICU bed) into the scan room?

This picture from Fail Blog pretty well answers that question.

Hat tip to Better Health.

Dead-On Anatomic Art

2009-08-18T21:28:00.001-07:00

This smoking shelter is located on the campus of a local community college. I love the artwork...

Sunscreen Advice from a Radiologist

2009-08-14T01:38:00.001-07:00

My views on sun protection are a bit more conservative than most -- after all, what do you expect from someone whose favorite sunscreen is a lead-lined room?

However, after reading A Guide to Summer Sun Protection in the latest issue of the New Yorker, I just may switch to some of that SPF 233...

Oregon

2009-08-14T00:32:00.001-07:00

A bit of history of the Upper North Left from XKCD.

This would explain that odd (really odd) surge in population we saw in Washington and California back in 1852...

Write When Inspired

2009-08-09T15:29:00.001-07:00

Interesting piece by Jeffrey Zeldman on writing quality. His main point:

Write when inspired; rest when tired.

Fine words in the abstract, but not always practical in a deadline-driven world, such as medical care. I'd love to only work when I'm well rested, but some things just have to be done now, regardless of how I feel. I would counter with another aphorism:

In theory, theory and practice are the same. In practice, they're not.

Some of my orthopedic colleagues would put it more bluntly:

Sometimes best is the enemy of good enough.

The reader commentary ( and Mr. Zeldman's reply) make for a great point-counterpoint on this theme. I especially enjoyed Glenn Fleishman's comments.

Inspiration is uneven; work must be even.

(hat tip to Daring Fireball)

Mysterious iProd in the Works...

2009-08-09T05:07:00.001-07:00

This just in from Ars Technica:

An updated USBConfiguration.plist in the most recent version of iPhone OS 3.1 beta offers compelling evidence that Apple has continued development on an unknown device, referred to as "iProd," that was first discovered in March.

The mind boggles.

Of course, my mental image of an "iProd" may be a bit skewed, having grown up in the ranch country of West Texas. Out there, a prod is a sort of cow taser, used by some to herd stubborn animals. We preferred positive incentives -- a shake of a feed bucket is all it took to make our cattle come running. The only cattle prod I've seen in several decades is the one hanging over the waiting line in Rudy's, my favorite Austin barbeque spot.

Of course, I would never actually use an iProd at work. As with cattle, so with radiology residents -- I prefer positive incentives, such as chocolate.

However, one would look swell hanging up in our reading room over the PACS stations. Until I find out the identity of Apple's latest mystery device, I'll keep an eye peeled for something similar on the iTunes Store. As the Apple ads say, "there's an app for everything..."

The Power of the Pentatonic Scale

2009-08-02T01:06:00.001-07:00

An old friend (and discerning reader of this blog) pointed me to the following video, wherein Bobby McFerrin demonstrates the power of the pentatonic scale at the World Science Festival 2009.

As Mr. McFerrin shows, the pentatonic scale is a great scale for improvisation -- it's hard to sing a wrong note. On a guitar, just noodling around on the simple 1-4, 1-3, 1-3, 1-3, 1-4, 1-4 pentatonic pattern is a fine way to spend a happy hour or two. It's impressive how many classic rock and blues licks fall out of this simple scale.

Pentatonicity is also the basis for a number of great old-time fiddle tunes, of which Billy in the Low Ground is an examplar. This version of BITLG shows the Blue Ridge Mountain Boys flinging a tasty torrent of notes about a pentatonic C scale.

I'll have to ask our physicists to program a pentatonic pulse sequence for me to use on our MRI machine. Seems like that ought to be handy for imaging the elusive banjo center of the brain.

(Hat tip to Anita Anderson)

Haphazardly Hunting Hieronymus

2009-07-24T23:59:00.001-07:00

We visited the wonderful Metropolitan Museum of Art in New York today. As with any museum of this stature, there is way too much stuff to see, even with a dozen visits.

My secret master plan for handling big art museum overload: chop the impossible down to something I can actually do. In my case, that means hunting for Hieronymus Bosch. I can't see everything in the museum, but I can darned well see all of their Bosch collection. Other than than, I just wander around randomly until I get tired.

It's a humble plan, but it's my plan.

Why Bosch? Beats me. I ran across some of his quirky and troubling work during my formative years, and it appealed to me oddly. His works are rare enough world-wide, with only 25 currently attributed to him. They are so rare on this side of the Atlantic that finding any of them is often an interesting challenge all by itself.

Finding anything at the Met also turned out to be a real challenge. Besides being huge, its hallways are convoluted enough that the best docent advice I got was to walk in some general direction for a while, and then to ask someone else. It was rare that any of the specific directions I got from them turned out to be helpful.

For a while, it was tricky finding a docent who had even heard of Bosch. Finally, though, I found two of them on the second floor. Both, however, told me that the Met had no actual Bosch -- just one that was "painted in the style of Bosch".

Our Bosch-ward course through the museum was probably pretty similar to the classic 3-dimensional drunkard's walk. However, our wanderings finally led us to the room of the imitation Bosch, which was titled Christ's Descent into Hell.

This painting was accompanied by the following blurb:
The panel was painted during a Bosch revival in the sixteenth century, when the artist's fiery scenes of hell were enormously popular throughout Europe, and especially in Italy, where they were prized for their nightmarish and visionary qualities.
However, we were delighted to find, just two paintings away, an actual Bosch, titled Adoration of the Magi.

Not one of his more bizarre works, but pretty swell nonetheless. Its blurb:

Long thought to be a later pastiche, this Adoration of the Magi can now be placed among Bosch's earliest autograph works ca. 1470-75. The salient features of its underdrawing, the tunnel-like perspective, and certain of the rather wooden figure types with sensitively rendered faces are closely related to Bosch's Ecce Homo in the Städel Kunstinstitut, Frankfurt, of approximately the same date.

Thus endeth my current round of Hunt for Hieronymus. My cumulative Bosch-score for the U. S. now shows New York in a tie with Washington, D.C., with one H-point apiece. Given the current planetary paucity of Bosch's, I may be running out of U. S. cities that actually have one. However, I'll keep an eye out for him on my next trips to Los Angeles, Chicago and San Francisco.

Bone Scans and DNA Testing by Major League Baseball

2009-07-24T23:59:00.000-07:00

The New York Times published a very interesting piece a few days ago called Baseball's Use of DNA Raises Questions.

The impetus for these tests:

Dozens of Latin American prospects in recent years have been caught purporting to be younger than they actually were as a way to make themselves more enticing to major league teams.

Apparently, such players have been able to borrow the birth certificate of a younger child from some other family.

Can these tests actually reveal one's age? In the case of DNA, no. However, it can be used to check whether a given player is actually related to the parents listed on the birth certificate. According to the Times, this alone was enough to void the signing of a Yankee prospect last year from the Dominican Republic.

In the case of a bone "scan", I presume the Times actually means a bone age study, in which an X-ray of a subject's hand and wrist (and sometimes other body parts) is compared to a standardized atlas of age-matched X-rays for various ages. How reliable is a bone age study? Not very.

I interpret these occasionally in my practice. When I give my estimate of someone's skeletal age, it is accompanied with considerable variation -- usually one standard deviation equals about a year. In the specific case of a boy with a chronological age of exactly 16 years (192 months), the mean of the expected skeletal age is 195.3 months, where one standard deviation = 12.9 months. From these figures, we can calculate that 95 % of 16 year old boys should have a skeletal age varying between 169.2 and 220.8 months, i.e. 14.1 and 18.4 years old. This 95 % confidence interval of 4.3 years makes a bone age study pretty darned unreliable.

While bone age studies may be of dubious value, they don't lead to a lot of ethical dilemmas. DNA testing, on the other hand, does.

So far, MLB only seems to be using DNA testing to help verify a player's age. However, it's not hard to imagine how they might use other genetic information as well.

Mark Rothstein, a professor of bioethics at the University of Louisville School of Medicine, said: “The funny thing about this all is that the most famous baseball player with a genetic disorder was Lou Gehrig. Would they have signed him if they knew he was predisposed to A.L.S.?”

Hand Dryer Fu

2009-07-22T21:06:00.001-07:00

After a tasty but messy dinner tonight, I went to the restroom to wash my hands. No paper towels for this restaurant -- they had an Xlerator XL-SB dryer. This creature cranks out a torrent of air and sounds like a jet engine revving up. The manufacturer claims this will dry your hands in 10 - 15 seconds, a lot faster than those girly man hand dryers we've all tried to use for years.

I'm a bit skeptical of this claim, as was the reviewer for the Poop Report. Though this device truly honks , my hands took more like 20 - 25 seconds to dry. In my case, this just meant more time for mischief.

As the air blasted the water off my hands, I noticed that my hand position was similar to the one I used to use for two-hand whistling. With a few conscious positional adjustments, my hands began to howl with loud keening sound. This was fun, so I played with my intonation and tone for a while. Finally, however, I realized that it was giving the willies (so to speak) to a guy at a nearby urinal. So I stopped. For now.

We have five more days in Manhattan. Hopefully I can find another one of these units. If so, The Phantom of the XL-SB will ride again...

Autostitching the Big Apple v 4.0

2009-07-22T15:01:00.001-07:00

Since it was next door to our hotel, we took a college tour of the Juilliard School this morning. Looks like a swell place, but probably not the best fit for my son, whose musical tastes, shall we say, are somewhat orthogonal to most Juilliard norms. I did use part of the tour time to grab this quick Autostich panorama of the Paul Recital Hall there, using 6 images:

Then we hopped the D train up to the Bronx, and watched the Yankees beat the Orioles 6 - 4. It's a very nice stadium -- if they can consistently fill it up with enough hungry and thirsty fans every game, they might just be able to make payroll on their team of millionaires. I grabbed two panoramas -- an exterior view (3 images), and an interior view (28 images):

The Orioles hit two successive home runs in the last inning, which elicited some interesting crowd behavior from the Yankee fans.

The first was caught by a lady about 50 feet from us. The Yankees fans began yelling, "Throw it back! Throw it back!" Then, when she tossed it back to the left fielder, they all cheered. We were puzzled by this behavior, so my brother quizzed a local about it. Apparently, home run balls hit by Yankees are highly prized and kept. Balls hit by opposing teams are regarded as offal, and are expelled back onto the field as waste.

The same thing happened with the next home run ball to right field. From our left field seats, it looked like a mighty amoeba snarfing up a food particle and then spitting it back out in disgust.

Autostitching the Big Apple v 3.0

2009-07-21T23:59:00.000-07:00

I hope it doesn't seem as if I've gone completely off the deep end about Autostich here in NYC. It never came up at all during most of the things we did today, including several tasty meals, the Hayden Planetarium show or the Broadway production (Westside Story) we saw this evening.

However, we also spent the afternoon at the wonderful American Museum of Natural History, where there were way too many large photogenic objects that were beyond my ability to resist. Here are my favorites, along with the number of images I used to create them.

Ginormous Northwest Native American dugout canoe, 6 images:

Same canoe, different angle, 3 images:

Views from both ends of the Hall of Biodiversity -- a stunning way to convey the concept of just how many species we have on this planet, 4 and 5 images, respectively:

Beryl exhibit in Hall of Minerals. Stills like this are easy to get with the iPhone even in low light -- pasting the phone against the glass case steadies it as well as any tripod -- 7 images:

Ichthyosaurus skeleton, 2 images:

Pterodactyl skeleton, 2 images:

Brontosaurus, 8 images:

Tyrannosaurus rex, 8 images:

Stegosaurus, 12 images:

Triceratops skull, 4 images:

Triceratops skeleton, 4 images:

Mammoth and mastodon skeletons, 4 images:

Tomorrow, Autostitch meets the new Yankee Stadium!

Autostitching the Big Apple, v 2.0

2009-07-20T23:38:00.001-07:00

I tried out a few more panoramas again today in Manhattan, using my iPhone 3GS and Autostich.

The image on the left was built from four shots of a tower crane which was hauling up a big container of wet cement up many stories into the sky. The waviness of the tower is, fortunately, an artifact of the process, as well as my inexact positioning of the camera.

Vertical panoramas seem to be a weak point of Autostitch -- at least when one is pretty close to the subject. The following shot of Rockefeller Center (built from 11 shots) demonstrates this well -- the actual main building is much taller than it appears here. Autostitch's big brothers may well have settings to control for this prominent shortening effect.

While the kids were sacking and pillaging the M&M and Hershey store in Times Square, I stayed outside and shot 20 shots that were combined into the following panorama, covering about 135 degrees. The black areas in this and the prior shot make it easy to see where I should have gathered a bit more data.

My most successful shot was the sign at the Staten Island Ferry. The algorithms in Autostitch had little trouble with a purely horizontal pan. Four shots were combined to form this image.

Despite some of the distortions revealed with these shots, I'm quite happy with the results. I'll try to grab a few more panoramas while we're here. The Yankees vs. Orioles game on Wednesday afternoon in the new stadium should be a fine time to experiment.

AutoStitching the Big Apple

2009-07-19T22:37:00.001-07:00

We just spent the day visiting a few cultural icons here in Manhattan. This seemed like a fine time to play with a new iPhone app called Autostich, which merges multiple separate pictures into a much larger panoramic image.

I've actually used one of this program's big brothers (Calico) for several years to stitch together mountain photos from my big Nikon into cool panoramas. Both programs are based on image-processing research from the University of British Columbia, which has licensed its algorithms to other developers, including Industrial Light & Magic. We also use similar software at work to stitch together life-sized vertical panoramas of the entire human spine from several smaller shots.

To kick things off, here are 4 iPhone 3GS photos of the Time Warner Center at dusk...

The resulting AutoStitched panorama shows a bit of distortion, but still looks pretty swell.

With a bit of PhotoShopping, it looks even better.

We visited the 5th Avenue Apple Store, which is extremely keen for many reasons. Even in a town with a lot of eye-grabbing architecture, this store stands out.

All of the action at this 24 x 7 x 365 store takes place in a giant underground room beneath the cube. Here's a hasty 6-picture panorama of this store, which earns more money per square foot than Tiffany's:

We also spent some time at the American Museum of Natural History. Here's a panorama of the foyer, which is filled with dinosaurs, including a big brachiosaur. This image was stitched together from fifteen 3.0 megapixel images.

My one-word review: awesome.

It's been quite a while since I have gotten so much pleasure for a buck ninety-nine. It's also pretty incredible to know the sort of image-processing power I now carry in my pocket.

Holy crap.

Made Men

2009-07-18T21:44:00.001-07:00

We flew to NY City today for a week with my brother and his kids. A courtesy copy of the July/August issue of Manhattan magazine awaited us in our room. My spouse made sure that I read the following two paragraphs from a restaurant review on page 100...

"Il Molino!" a friend squealed when I told her I'd be visiting the storied West Village Italian restaurant for dinner. I'd been in New York for more than a decade and had passed the large plate-glass windows with their drawn eyelet curtains hundreds of times, but had never actually dined there. "I love that place," she chimed "They give you so much free stuff!"

A week later my friend Lawrence and I crowd into the waiting area near the restaurant's entrance, coming within earshot of a group of thick-necked guys with bellowing voices. "Made men?" I ask Lawrence. "From the sound of it, actually radiologists, " he says.

In-Flight WiFi -- At Last!!

2009-07-18T21:06:00.001-07:00

Boy, do I love red-eye flights. Not. We just took one from LA to New York on an American Airlines 767. Great plane, great weather, great flight, and great service, but still -- a red-eye.

The intrinsic horror of this kind of trip was mitigated somewhat by learning that the plane had WiFi available for $5.95 per flight. I've somehow always missed flights that featured this, but finally hit the jackpot last night. I did sleep for a few hours along the way, but spent at lot of time at both ends of the flight consuming internettage via my iPhone 3GS.

The bandwidth was not too shabby. Here's a speedtest.net screenshot from not too long after takeoff:

My brother's family awoke to a pile of short messages and screenshots sent during the flight, such as the following:

Somewhere over Pennsylvania, I checked the bandwidth again. Much zippier downloads this time, probably because all of the other bandwidth hogs were now lying obtunded elsewhere in the plane.

Of course, your mileage may vary -- things might be a lot different during a blue-eye flight, when a whole planeload hits YouTube at the same time.

Hopefully, WiFi up high will soon spread to most major flights. I would love to used to this service, and think $6/flight is a good value. I just hope I never get as jaded as the dudes nailed by Louis CK below...

Buy Art Instead

2009-07-15T23:59:00.001-07:00

I spotted this bumper sticker a few weeks ago at a fiddle festival in Port Townsend, WA, and grabbed a quick snapshot with my new iPhone 3GS.

As a radiologist, I'm a real sucker for anatomic art. I wish I could find out more about this bumper sticker -- however, I can't find anything about "Pindellopia" on Bing or The Google.

Hmmmm....

Oleophobia

2009-07-14T23:47:00.001-07:00

I've spent entire years without ever uttering the word "oleophobic".

That changed a few weeks ago when I upgraded my iPhone 3G to a 3GS. There's a lot to love about the new hardware and software goodies added to this phone.

However, I find some of the subtle touches even more impressive. My favorite is the iPhone's new oleophobic screen. The roots "oleo" (fat) and "phobic" (fearful) tell it all -- the coating on the screen repels oils, particularly fingerprint oils.

In two years of iPhone usage, the cumulative finger oils I've left on my screens probably weigh more than the iPhone itself. The new screen doesn't completely eliminate fingerprints and smears, but it sure cuts them down a bunch. Even when they finally become noticeable, a quick swipe on my shirt clears them off right away.

This humble feature is pretty addictive, and like most addictions, makes you want more, more more... What I want more of is oleophobic screens everywhere else in my life: on my laptop screen, on my flat screen TV, on my PACS workstation, on my kitchen appliances, and on my car's windshield. But most of all, what I really want to know is:

Dude, where's my oleophobic glasses??!!

Gigapixel Image of an Ant

2009-07-14T00:06:00.001-07:00

I love this .28 Gigapixel image, formed by stitching together 40 scanning electron microscopy images of an ant. This particular image is part of the NanoGigaPan project.

It would be extremely cool to use this technology stitch together multiple hi-res medical images.

Hat tip to John Gruber of Daring Fireball, who puts it thusly:

The intersection of horrifying and wonderful.

Grand Rounds Vol. 5, No. 43 is Up

2009-07-13T21:45:00.001-07:00

This week's edition of Grand Rounds is hosted by Joe Kim at the Medicine and Technology blog.

This week's episode includes my latest post on finding the optimal background music for dictating ICU chest films.

What is the Best Background Music for Dictating ICU Chest Films?

2009-07-13T02:40:00.001-07:00

I was on call this weekend, where I dictated reports on about two hundred ICU chest films. This turned out to be a fine time to test an iPhone app called White Noise, which was a software pick of the week on last week's MacBreak Weekly podcast by Scott Bourne and Alex Lindsay.

White Noise generates random background sounds to replace the background sounds you already have, but don't want. Besides playing actual white noise, this app also plays brown, pink, blue and violet noise as well as other sounds, including 6 different intensities of rainstorm.

Even in my relatively quiet reading room, there was a surprising variety of annoying background noises this weekend, and White Noise did a fine job of covering them all. This got me to thinking about another topic from the same podcast, where Scott and Alex debated whether there were optimal background sounds for different activities. What would be the best background for dictating ICU chest films?

I listen to a lot of audiobooks and podcasts when performing mindless tasks like laundry, dishwashing or commuting. However, I find these way too distracting for cognitive work like film interpretation. So, I designed a quick and dirty controlled study on myself (n = 1), pitting White Noise against three different styles of music: Cajun/swing (Red Stick Ramblers), heavy metal (Metallica), and baroque (Glenn Gould playing Bach's Goldberg Variations).

My results are summarized in the bar chart above, where the vertical axis shows the number of minutes it took me to read 10 ICU chest cases while listening to a particular background. Despite my dubious experimental design, the results are intriguing: I seem to be about twice as efficient while listening to Bach as I am while listening to Cajun/swing. Just in case the first run of Bach was a fluke, I did an additional run of 10 films on a few more of the Goldberg variations. This second run was pretty similar to the first Bach run. However, before I could replicate runs on other styles of music, I ran out of films to interpret.

Taking this at face value, maybe these results are not so surprising. Maybe Lewis Thomas was right when he said:

Music is the effort we make to explain to ourselves how our brains work. We listen to Bach transfixed because this is listening to a human mind.

A quick googling of this topic shows that I am not the first to tread this ground. I quickly found a paper by Cassidy and MacDonald, titled "The effect of background music and background noise on the task performance", published in 2007 in the journal Psychology of Music (vol. 35; pp 517-537). One of their conclusions:

In conclusion, the current study has highlighted the detrimental effect of sound (noise and music) on task performance, in comparison to silence...

(Oops -- forgot to collect data for silence alone...)

They also found that introverts (e.g. radiology nerds) find music and noise more distracting than extroverts (e.g. orthopedic surgeons). Hmmm...

I also ran across a recent article on the work of Warren Brodsky of Ben-Gurion University, who has studied the effects of music on high-risk driving behavior. In a nutshell: fast music makes you drive faster -- and less safely.

For example, while listening to a piece of music, drivers are immersed in much cognitive work including aural analysis and processing of the music components at various levels related to understanding, operations of short- and long-term memory, emotions, and of course extra-musical associations which continually surface from music stimuli.

In other words, music may not relax your brain -- it may make it work even harder.

Nevertheless, I'm not quite ready to give up on music just yet. So, to add some rationality to my rationale, I'll collect some more data the next time I'm on call. Just in case silence is actually golden, I will add an arm to the study in which I dictate to silence alone. However, despite the growing evidence that background music is distracting, I secretly hope that Bach wins again.

The Future of Folk Music is in Great Hands

2009-07-10T02:28:00.001-07:00

My day job is teaching radiology to residents and fellows. This educational model of young whippersnappers learning from the geezers is also pretty common in the world of fiddle music.

It's a huge pleasure to see young radiologists and young musicians coming into their powers, especially when one sees them making diagnoses or playing tunes that even the geezers find challenging.

This was definitely true last week at the Festival of American Fiddle Tunes. It was hard to hear some of the young musicians play without feeling like a giant truck was coming up fast in my rearview mirror. Here are two examples of the many talented teens at Fiddle Tunes:

First, listen to Emma Beaton (cello) and Tatiana Hargreaves (fiddle) play the living heck out of this old fiddle tune...

Finally, watch the 204 Trio, with Lea Kirstein (cello), Scott Leach (fiddle), and Ethan Jodziewicz (bass) play their arrangement of Liz Carroll's tune: "Lost in the Loop".

I'd say that the future of folk music is in great hands...

Capo -- Cool Tool for Musicians or Radiology Residents

2009-07-08T14:33:00.001-07:00

If you are a musician, the word "capo" brings to mind the device that we guitar and banjo players clamp on the necks of our instruments to change key.

However, Capo also refers to a new and rather swell Mac program for learning tunes from recordings. Capo does this by playing a torrent of music at a speed slow enough for one to comprehend. Here's the really cool thing: it does this without changing the pitch of the music!

The following screenshot shows Capo playing "Heather Bonne", a swell tune I snagged last week at a jam session at the Festival of American Fiddle Tunes.

As a fiddle player, I learn a lot of tunes from field recordings made at festivals, jam sessions and concerts. Although I'm a quick study, some intricate or especially twisty tunes are a lot easier to learn when slowed down in this way. Then, once I've worked out the notes, I can play along with the original at a slower speed until I've learned it well enough to play it at full speed.

Capo is not the first Mac program to do this job. I've used The Amazing Slow Downer and Transcribe for years. These fine programs work quite well, but their interface clearly shows their original Windows roots. Capo, on the other hand, was born on the Mac, and is simply gorgeous. It also ably meets the classic Mac software test: "Can I use this without reading the instructions?"

How is this relevant to radiology? The fiddler in me would answer, "Bite me -- who cares!" However, the radiology geek in me would point out that music isn't the only thing you can slow down with this application. If I were the sort of person who transcribed lecture notes or speeches, Capo would be a huge help.

I could also imagine using this app for learning other languages. I suspect that Capo would work pretty well in slowing down foreign language broadcasts to a more understandable pace. It may also be useful among native English speakers separated by their common language. As a long-displaced Southerner, I have gotten pretty good at decoding the Uzi-paced speech patterns of Yankees. However, newly displaced immigrants from below the Muffin-Biscuit Line may find Capo handy for this now and then.

But wait, there's more: Capo is currently on sale at half-price. I paid full price when I bought it a while back, but am now considering grabbing a few extra licenses as gifts for deserving pals.

The only thing that would make Capo even better would be to release an iPhone version. I've suggested this to Capo's developer, so don't touch that dial...

Radiology Blog Compendium

2009-07-08T13:36:00.001-07:00

The folks over at e-Health News Blog have compiled a list of Top 50 Blogs to Help You Further Your Healthcare Career.

My blog is listed there under Medgeek Toys. I would add only that if something I mention on my blog helps you further your career, I'd consider it a tool rather than a toy. Besides, "tools" are tax-deductible, and "toys" are not. :)

Why is Six Afraid of Seven?

2009-07-08T00:21:00.001-07:00

The title of this post is in honor of today's date, which is the answer to the question posed in the title:

Because 7 8 9!

My son liked this joke when he was four. I still like it.

So there.

Back in the Saddle Again...

2009-07-07T23:56:00.001-07:00

I spent much of April through June preparing for many talks at many meetings, which involved 3 trips to the East Coast in one month. Great fun, but a bit draining.

To recharge, I just spent all of last week with my son at the wonderful Festival of American Fiddle Tunes in Port Townsend, WA.

I first went to Fiddle Tunes back in 1985, and have been back many times since. This year I spent my mornings in a truly excellent swing fiddle workshop by Kevin Wimmer, afternoons in an exhilirating bandlab led by the Red Stick Ramblers, and evenings until real-late-thirty jamming with pals. After a week of this much fun, going back to work was actually kind of restful.

Besides spending many hours pushing an analog stick back and forth over an analog sound box, I spent a few hours recording some highlights with my new iPhone 3GS and my Flip Mino HD recorder. In past years, I've taken several bags of technology along with me to this festival. This year, it was mostly a bag of chargers for the items above, and a laptop to dump files to every night.

The 3GS came pretty darned close to being the One True Device last week. Besides tuning my fiddle, its built-in video recorder grabbed a lot of fine musical homework for me for the rest of the year. In previous festivals, I've recorded tons of audio. However, video is light-years better -- the 3GS let me record not only the music, but also the bow strokes, fiddle finger positions, guitar and banjo chords, body language, and smiles of the musicians. It would be pretty hard to go back to mere audio files alone after this.

It's also very nice to have the time and energy to blog again.

Ahhhhh........

Grand Rounds Vol. 5 No. 30 is up

2009-04-15T02:23:00.001-07:00

This week's edition of Grand Rounds is hosted by Flavio over at Pharmamotion.

I hope to read a few of these when I come up for air in between feverish bouts of lecture preparation.

A Lean Month for Blogging

2009-04-14T10:17:00.001-07:00

Until I meet a few deadlines, this will be a lean month for personal blogging.

I'm hitting the road for the ARRS meeting next week, followed by a few days of visiting professorships around the country. This means putting 7 new lectures together over the next 2 weeks.

Good thing I enjoy show biz...

CT Colonography -Train at Home

2009-04-14T10:13:00.001-07:00

The day is young, but the leading contender for Spam-of-the-Day is already in my e-mail inbox: CT colonography training at home.

I guess I'll file this tidbit under activities for consenting adults.

Crikey, I'd rather have my spleen removed through my nose...

Grand Rounds Vol 5. No. 29 is up

2009-04-07T04:36:00.001-07:00

The latest issue of Grand Rounds is hosted this week by Leslie, at Getting Closer to Myself.

This week's theme is "reflections on the way life used to be".

Along these lines, I used to carry a stethoscope, but gave it up long ago for the rock star lifestyle of an academic radiologist. My Grand Rounds contribution, Just Say No to Stethoscopes, has more to say on why this is a Good Thing.

Just Say No to Stethoscopes

2009-04-03T01:24:00.001-07:00

Rats of the Middle Ages, move over -- there's a new disease vector in town: health-care workers, and they're packing methicillin-resistant Staphylococcus aureus (MRSA) in their stethoscopes.

This story crawled out into the TV news recently, in reaction to a recent paper in Prehospital Emergency Care.

In a study of emergency medical services providers, 50 stethoscopes were cultured, and 16 (32%) grew MRSA. Oddly enough, 32% of the same providers had no clue when they had last cleaned their stethoscopes. Coincidence, or satanic confluence?

This isn't a new idea. My cursory search of PubMed turned up a number of other articles on the same topic, including a 1995 study showing that 89% of the stethoscopes carried by ER workers were contaminated with staphylococcus. What's new is that this ubiquitous staph is lately more and more likely to be the more dangerous MRSA variety.

However, if you are going to catch a disease because you were auscultated, touched or sneezed on by a physician, chances are really, really good that it won't be from a radiologist. I'm proud to say that my specialty is leading the fight against this scourge. While the internists are obsessively scrubbing their stethoscopes between patients, we have an far more effective plan: we don't even know where our stethoscopes are.

We invite other physicians to join our crusade -- "Just Say No!" -- to stethoscopes.

Grand Rounds Vol 5. No 28 is up

2009-03-31T00:12:00.001-07:00

The latest issue of Grand Rounds is hosted this week by Paul Levy, at Running a Hospital.

This week's episode is devoted to "When things go awry". My contribution -- "Getting the Finger From a Patient" -- is about 4th from the top.

Hook 'em Horns

2009-03-30T14:14:00.001-07:00

My undergraduate education was at Texas A & M, which has long had a friendly rivalry with the University of Texas.

It was always our contention that the Hook'em Horns gesture was merely the sign of a careless carpenter ordering 4 beers.

I don't know if the person above is actually from Austin, but it's possible...

Getting the Finger from a Patient

2009-03-29T19:11:00.001-07:00

A patient gave me the finger not long ago.

Not once, but twice.

How did that make me feel?

The first time, intrigued.

The second time, embarassed but relieved.

Here's why:

It started when her dematologist ordered an MR scan to "R/O glomus tumor" of the middle finger. In case you're not completely up on your small, rare, soft tissue tumor lore, here are a few facts: glomus tumors are usually small (often 1 - 2 millimeters in diameter), benign , rare (we only see a few a year), typically occur in the tissues under the nail bed, and can be exquisitely painful.

Looking for something this small is a real challenge -- even with current MR technology. Most MR machines are optimized to look at large chunks of human tissue -- sometimes as large as the abdomen on a 350 pound dude. In this patient's case, we were pushing the other extreme, and trying to focus all of the resolution of this giant machine down on a single finger. Tumors this small sometimes end up in the small gap between MR slices -- making them invisible. Even when things work perfectly, we may be lucky to see a lesion on only one image out of hundreds that we scan from that patient.

Despite these challenges, I enjoy looking for these intriguing little lesions.

To improve our odds of seeing this millimetric lesion, we gave her an intravenous injection of a gadolinium solution, which is designed to concentrate in tumor tissue, and make it stand out better against normal tissue.

Alas. We screwed up. My MR technologists omitted the critical sagittal image sequence that best shows the nail bed. To make matters worse, I didn't get around to looking at her study until she had already gone home.

Merde.

It's painful to have to admit to a patient that you, a professor at Enormous Medical Center, have screwed up, and need her to come back in for another scan.

Painful, but we did it. She took off from work yet again, endured a new IV injection of gadolinium, and gave us her finger for another session in our scanner. However, we finally got the crucial sagittal images. This time, I was standing by the scanner and looked at her images before we ended the study.

The happy ending: we saw the tumor this time -- it was indeed so small that it only showed up on a single sagittal image. Small, but unmistakeable.

Afterwards, I showed her the key image, and offered one more abject apology for the extra imaging hassles.

Her reaction? She forgave us our mistakes, and was delighted to finally know what had been causing her pain for so long. We both left that encounter a lot happier than we entered it.

In the past few months, I've become pleasantly used to hearing a president willing to claim responsibility for his mistakes. Are my patients any different? Admitting mistakes to patients is not yet a universal practice , but it sure felt good this time, to me and my patient.

Finally, there is the concept of grace -- an ecclesiastical term for unearned forgiveness. Being a physician or a parent gives one endless opportunities to screw up someone else's life. Happily, kids seem to dispense a boundless supply of grace when this happens. Fortunately, some patients give it too.

Generations

2009-03-29T17:11:00.001-07:00

We just got home from one of the sweetest events I've been to in a long time -- a surprise 70th birthday party for an old friend.

This friend is part of the large extended family of folk musicians and dancers that we have fallen in with since we moved to town years ago. For this occasion, our family became even more extended, with folks driving in from hundreds of miles away.

Our local folk community reminds me a bit of Eureka, the TV series about a mythical town in the Pacific Northwest where everyone is a scientific super-brainiac. In our community, however, the norm is that practically everyone you know plays several musical instruments, sings and performs music, dance or some other art.

For this kind of crowd, it long ago became a conditioned reflex to bring an instrument along to any gathering. This means that the usual tasty food and conversation are also well-mixed with great live music and dancing. Several of our gang composed original tunes and dances in honor of our pal and performed them on the spot. It was a hard choice for me between watching them perform and watching the look on his face.

However, the sweetest parts of a very sweet event were when my friend's children sang to him. This began when he walked in the door to find the place filled with friends, a 15-person live band, and his daughter singing Bei Mir Bist Du Shoen. Soon after, his son stood up and sang a touching but funny song he wrote about his long and continuing friendship with his dad. Not too many dry eyes in the house at this point.

We're back home now. Since we got back, I've been wrapping up a statistical analysis, tweaking some lectures and doing a bit of blogging.

As I write this, the sounds of my own son singing and playing his guitar are filtering up from the basement below -- a sound as beautiful as any I've heard today. It gives me high hopes for my own incipient geezerhood...

Readability

2009-03-24T23:09:00.001-07:00

A radiologist makes her living by spotting tiny details in a sea of noise, and does this hundreds of times every day. However, sifting subtle diagnostic findings out of the visual clutter that forms the rest of a human body can be tiring work.

Even if you're not a radiologist, you probably have the same experience trying to read many of today's web pages. Most of my favorite online newspaper and magazine articles are filled with zillions of navigation bars, ads, images, links, headings and other visual cruft.

However, this just got a lot easier, due to two cool little tools called Readability and Quietube, that run in most web browsers.

Readability

Readability works this way:

1. you tell the Readability website a few reading preferences (i.e. format, text size and margin size).

2. Readability creates a custom "bookmarklet" -- a link that you drag to your web browser's bookmark toolbar.

These two things are done only once. Later, when you find a web page worth reading, you do one more thing:

3. click the Readability bookmark on your toolbar.

That's it!

The Readability bookmarklet is actually a short Javascript program that filters out most of the non-content from an online article. I use it all the time to reduce the visually busy New York Times website to a calmer, simpler page of text.

I also use Readability as a pre-processor before converting an article from text to speech. I do this so that I can listen to these articles during my work commute. Once Readability has removed web links and other crud I'd rather not have read to me ("aitch-tee-tee-pee-colon-slash-slash....."), clicking an icon on TextCast converts this laundered text into a speech file on my iPhone's playlist.

Readability works fine for most of the newspapers and magazines I read online. However, with online radiology journals, it fails to remove all of the special tables of content and references these articles include. My personal solution for this is a custom program I wrote in Ruby. I'll demo this program to some AJR pals at the upcoming ARRS meeting in Boston next month before releasing it into the wild.

Maybe one of my next projects should be to write a bookmarklet version of this in Javascript. We'll see...

(via Daring Fireball)

Quietube

Quietube is even easier to set up than Readability. Just drag the button on the Quietube site to your toolbar. Clicking it will then perform a wondrous cleansing of a cluttered YouTube page. Cooool.

(via Daring Fireball)

Society Doesn’t Need Newspapers

2009-03-24T10:39:00.001-07:00

It's a bit sobering when a 146 year-old newspaper like the Seattle PI holds the presses for good and goes web-only. With this in mind, Clay Shirky's Newspapers and Thinking the Unthinkable is a very smart analysis of our planet's current move from paper to pixels. My favorite quote:

Society doesn’t need newspapers. What we need is journalism.

Steven Berlin Johnson's Old Growth Media and the Future of News makes a fine companion piece, and offers some upsides:

In fact, I think in the long run, we’re going to look back at many facets of old media and realize that we were living in a desert disguised as a rain forest.

Newspaper publishers are not the only ones taking trembling steps to digital publication. Most scientific journals, including the ones I write, review and edit for, are also somewhere along this path. This is an especially acute issue for learned societies that have long relied upon journal revenues as their cash cow. Finding an economic model that will pay for the stuff we need to read is going to take a lot of trial and error. On the plus side, it should be a great time for radical forces (such as myself) to try out all sorts of wacky experiments in radiology publishing. As Shirky concludes:

Many of these models will fail. No one experiment is going to replace what we are now losing with the demise of news on paper, but over time, the collection of new experiments that do work might give us the journalism we need.

(via Daring Fireball)

Extreme Sheepherding

2009-03-24T09:41:00.001-07:00

Awesome use of sheep-as-pixels from Wales.

If I had had access to sheep-sized LED suits while growing up on a West Texas ranch, this is probably the sort of thing my friends and I would have done in the evenings.

Now that I dwell far away from the land of sheep and Mensa-smart border collies, I'd have to find some alternative animal model. Hmmm... I wonder how this would work with medical students and radiology residents...

How Do You Hide a Dollar From A Radiologist?

2009-03-12T08:19:00.001-07:00

Financial security tips from Movin' Meat:

How do you hide a dollar from a radiologist?

Pin it to the patient.

How do you hide a dollar from a surgeon?

Put it in a textbook.

How do you hide a dollar from an internist?

Put it under a surgical dressing.

How do you hide a dollar from a plastic surgeon?

Ah, that's a trick question: there is no way to hide a dollar from a plastic surgeon!

But wait, there's more!

To find out several ways to hide a dollar from an ER doc, check out the comments on the original post. My favorite is the suggestion by scalpel...

Kindle 2: Some Features Better Than Reality

2009-03-12T08:06:00.001-07:00

Usability pundit Jakob Nielsen’s take on the Kindle 2 and the Kindle iPhone app:

11 years ago, I wrote that electronic books were a bad idea. Has Kindle 2 changed my mind? Yes. The two factors that convinced me were (a) equal-to-print readability and (b) multi-device integration.

(via Daring Fireball)

CPR Will Never Be Quite the Same for Me Again

2009-03-12T07:47:00.001-07:00

The latest issue of Dinosaur Comics has a handy mnemonic for getting your chest compression rate just right...

(via Dave Goldman)

Lots of Kindle News Lately

2009-03-11T14:38:00.001-07:00

There has been a torrent of news lately on Amazon's Kindle, and I've had little time to write about it. For those who have been living in a cave, here's a quick summary and a few links.

Kindle 2

David Pogue has a favorable review of the Kindle 2. The title of his post sums it up pretty well: "Good Before, Better Now".

For comparison, he also recently reviewed the Sony PRS-700 e-book reader. He liked some of the design features, but gives the nod to the Kindle because of its wireless connection and Amazon's much larger collection of e-books.

I now have a Kindle 2, and will blog later about my experience with it, particularly with respect to how it does with displaying medical images (short version: improved, but still not optimal).

Kindle 2 text-to-speech controversy

One of the coolest features of the Kindle 2 -- built-in text-to-speech conversion -- has excited a bit of controversy among members of the Author's Guild. AG president Roy Blount wrote a recent opinion piece expressing the AG's point of view. I'm of two minds about this. On the one hand, I'm very sympathetic to an author wanting control of one's intellectual property. On the other hand, while the Kindle's computer voice is nice, it's no Jim Dale. Some books are at their best when read by someone as compelling as Mr. Dale; others are just fine read by a Kindle. There's a part of me that feels "Dude, if your performance can be replaced by a Kindle, you deserve to be."

In any event, it looks like Amazon will leave it up to authors and publishers as to whether the text-to-speech function is enabled on a given work on a case-by-case basis.

Kindle App for iPhone

The biggest news, though, is that Amazon just released a free reader application for the iPhone. This app lets one read any book in the Kindle library without having to buy a Kindle.

This is huge.

I've had a Kindle reader for over a year now, and read from it daily. However, the iPhone is always in my pocket, and follows me places that the Kindle never will. In general, the app works really, really well, with only minor syncing bugs.

I'll give a more in depth report on the iPhone app in later post, particularly on how it handles gray scale images (short version: great!).

Several pundits (1, 2) have pointed out that by releasing the iPhone app, Amazon is giving away the razor but hoping to make a zillion dollars selling razor blades. I agree. No one outside Amazon really knows how many Kindles have so far been sold (possibly up to 500,000). However, this number is dwarfed by the millions of iPhone now out there. In one swell foop and with minimal marginal cost, Amazon has multiplied its potential customer base for books manyfold. Brilliant.

I also enjoyed a recent review of the Kindle iPhone app by Glenn Fleishman of TidBITS.

Weird X-rays

2009-03-11T13:28:00.001-07:00

A friend sent me a link to some weird X-rays on the Asylum site.

Weird, for sure. Looks like some of the stuff we see in our emergency room.

A bonus story at the same link tells of a Chilean man who carried his stash in form of a cast made entirely out of cocaine covering his own broken leg.

Wow. Gotta give him some points for imagination, if not for intelligence.

I've Been Programming

2009-03-05T23:12:00.001-08:00

I haven't posted much lately, mostly because I've been tightly focused on a computer programming project. Let's just say that programming is easily as jealous a consort of one's time as blogging.

I've programmed personal computers ever since my first Radio Shack TRS-80 Model I back in 1976. I got my first Apple II a year later, and have stayed in the Apple fold ever since. Since 1976, I've programmed in Basic, Fortran, assembly language, several machine languages, Pascal, Python, S, R, C, Perl and a few others.

For the past few years, I've been closely eyeing Ruby, a relatively new language, but haven't had the right incentive to dive into it. However, there's nothing like building a cool, new project to learn a new language.

I've spent much of my academic time in the past two weeks writing a web-based text-to-speech application in Ruby. My goal: type in the volume, issue and page number of some article in a major radiology journal and get back an .mp3 version of that article, read by a fairly decent computerized voice.

It turned out to be a lot easier than I thought it would be, even with a few years of web-apps under my belt. Ruby is a fine language, with a fine library of built-in tools, making it easy to scrape a whole web page with just a few lines of Ruby code. For example, the following code is all that's necessary to grab a whole article from the American Journal of Roentgenology and assign it to the variable ajr_html:

urlRaw = "http://www.ajronline.org/cgi/content/full/"
   + ajrVolume +"/" + ajrIssue + "/" + ajrPage
ajr_url = open(urlRaw)
ajr_html = ajr_url.read

I have recently become a big fan of text-to-speech conversion. In December, I discovered a new Mac program called Textcast. Since then, I've used Textcast to make one or two hundred podcasts for my iPhone from NY Times articles and various blogs I follow. These have been a major defense against boredom during my work commutes -- sort of like having an NPR station where all the stories are interesting.

The only issue I have with Textcast is that it is optimized only for pages from Safari or NetNewsWire. If I want to use it to grab and convert an article from AJR or Radiology, I need to first do some serious hand-scrubbing of the text from their websites before I can feed it into Textcast. I got pretty tired of this after laundering a few articles by hand. My new Ruby script takes virtually all of the drudgery out of this process.

Now that I've refined my program into a reasonably stable version, I've asked several of my residents, fellows and fellow faculty to do some alpha testing. Once I get their feedback, I'll write it up for one of our radiology journals. Might as well get some academic mileage out of it.

Grand Rounds Vol 5. No 23 is up

2009-02-24T11:26:00.001-08:00

The latest issue of Grand Rounds is up at The Blog That Ate Manhattan.

This week's episode has a food-related theme. My contribution is filed under "Lunch". Since my comic is set in a noon conference, it is technically on topic. Also, as TBTAM points out, further relevance comes from a veiled reference to an important food group.

Samurai Radiology Comics No. 002

2009-02-22T04:31:00.001-08:00

This is a true story.

File it under the heading of "Things You Wish You Hadn't Said in Noon Conference".

(click to embiggen)

Doctors' Opinions of the Financial Bailout Package

2009-02-15T21:15:00.001-08:00

What do different medical specialties think of the bailout? Here's a sample...

The Psychiatrists thought the whole idea was madness, the Radiologists could see right through it, and the Surgeons decided to wash their hands of the whole thing.

Check out the whole list of specialties at The Happy Hospitalist.

(via Movin' Meat)

Anatomic Valentines for Your Sweetie

2009-02-15T02:05:00.001-08:00

For Valentine's Day, I don't think I can improve on my post from last year.

You should be able to find a "heart" there to suit even the most jaded valentine on your list.

Grand Rounds, Vol 5, no. 21

2009-02-12T01:54:00.001-08:00

The latest issue of Grand Rounds is up at The Health Care Blog.

Happy Darwin Day 2009

2009-02-12T01:41:00.001-08:00

Happy 200th birthday to Charles Darwin!

I'm on the clinical schedule today, so I probably won't be able to mark the occasion other than with a mental hat tip and this post. However, as I move through my workday, I'm sure that I'll run into many little bits of Darwinian detritus in my patients.

If you prefer to mark this occasion by a wild rumpus, check out the Darwin Day website. There you will find a list of over 200 local events where you can celebrate Darwin and his grand ideas about as much as you can stand.

Five Out of Five Radiologists Agree

2009-02-11T23:42:00.000-08:00

We had to reboot our PACS workstations several times today. Alas, this happens all too commonly.

After a particularly demoralizing crash, I called a brief work timeout. I gathered my four residents and fellows together for a few minutes of catharsis, and showed them the Onion video I posted yesterday. My instructions:

"Whenever you hear the word 'Sony', substitute the name of our 'POS PACS Vendor'".

We spent several hilarious minutes with tears rolling down our cheeks. It's not often I need to thank an Onion for making me cry.

Not Safe for Work

2009-02-10T20:56:00.003-08:00

NSFW is an appropriate term for the video clip below. Alas, it also applies to our web-based radiology-information-system (RIS) when it's having a bad day.

Sony didn't build our RIS -- it was some other Enormous Multinational Company. However, this video summarizes really, really well the frustration that many of us feel with our EMC POS RIS...

(click here if embedded clip doesn't play properly)

(via Daring Fireball)

A Busy Work Day in Radiologyville

2009-02-10T20:56:00.001-08:00

Unlike private practice radiologists, I live the rockstar lifestyle of the academic radiologist. Up in my ivory tower, some of my work is done by serfs (residents and fellows), freeing up time for teaching and research projects.

However, even an academician's caseload can be pretty high. On our busy days, our workload edges way up into private practice territory. We had so many cases to read today that it felt like we were trying to drain a bathtub that was being filled by a firehose. In other words, a lot like the video clip below...

ARRS and ACR = BFF

2009-02-06T23:45:00.000-08:00

The American Roentgen Ray Society (ARRS) and the American College of Radiology (ACR) announced today their intent to be BFF:

The governing boards of the American College of Radiology (ACR) and the American Roentgen Ray Society (ARRS) have reached an agreement in principle for a strategic integration that would leverage the unique strengths of each organization and provide the potential for enhanced service to radiologists and medical physicists seeking continuing medical education, quality and safety programs and a strong voice in Washington.

Non-radiologists could probably care less about this announcement. However, as a member of both of these fine groups, I wish them well on their betrothal. Combining the educational prowess of the ARRS with the political clout of the ACR could make for a mighty group indeed.

My main concern is what they will call this new "strategic integration". At the very least, I'm hoping for an acronym that doesn't suck too badly. I just can't think of any way to pronounce "ARRS-ACR" that doesn't sound like a synonym for glutealgia.

In hopes of finding a more pleasing arrangement of these letters, I helpfully fed "ARRSACR" into an internet anagram server. Alas, that server was stumped by this letter combo. However, when I fed in "The ARRS and ACR", I got a lot more hits (4537). I didn't bother to read them all, but did like "Rad Rat Ranches", "Rather Rad Scan" and "Drear Trashcan". Hopefully, this merger will make good financial sense, and not turn out to be "Errant Rad Cash".

Of course, there is a certain amount of redundancy between their two maiden names. Maybe they could get by with just one "American" between them. Likewise "Radiology" sort of implies "Roentgen Ray" and "College" is a synonym for "Society". What we're looking for here, is some new name that means:

Big American Radiology Society

While they probably won't pick this exact name, they could sure do a lot worse acronym-wise than BARS.

I guess we'll just have to wait until July 1 to learn just which group got dibs on naming rights in their pre-nuptial agreement.

Samurai Radiology Comics No. 001

2009-02-04T18:58:00.001-08:00

I had a lot of fun making the comics for an earlier post this week, so I thought I'd try it again.

This is a true story, told to me by one of my truly brilliant attendings long, long ago...

(click to embiggen)

Another Use of Radiology to Stop Smoking

2009-02-04T02:12:00.001-08:00

We use chest X-rays all the time to diagnose the horrible diseases caused by smoking.

100 points to Gryffindor (Saatchi & Saatchi London) for this creative adbin, which shows another clever use: to graphically show the effects of smoking on the lungs.

(via Street Anatomy & MarketingBlurb)

Putting the P in iPhone

2009-02-03T22:47:00.001-08:00

I often listen to my iPhone while editing my radiology reports. At other times, I carry my earbuds draped around my neck like one of those internist dudes carrying a stethoscope.

This backfired last week during a call of nature, when my earbuds slid off my neck right into the line of fire, shall we say.

Oddly enough, the Apple website doesn't have a single tech support note containing the word "urine".

So, I cleaned and dried my desecrated earbuds as best I could, using simple nearby tools. Once I felt safe putting them back in my ears, the left earbud was dead.

The main silver lining for me is that the iPhone itself stayed in my pocket. Otherwise, I have a feeling that this would have totally voided, so to speak, my warranty.

Samurai Radiologist Featured on Medscape Pre-Rounds

2009-02-03T20:31:00.001-08:00

As this week's host of Grand Rounds, I am featured in this week's edition of the Medscape Pre-Rounds interview (alas, viewing this may require login).

Grand Rounds - Vol 5, no. 20

2009-02-03T03:40:00.000-08:00

Welcome to the latest edition of Grand Rounds!

This edition coincides almost exactly with my first anniversary as a blogger. Therefore, as a loose theme for this week, I've suggested an anniversary theme, and have asked contributors to write about something cool or imporant that they have learned in the past year.

Read on to find out what has recently crawled out of the tasty brains in the medical blogosphere...

Introducing Our Leadoff Post

Many of us do stuff with no expectation of pay, and blogging usually falls into that category. Although we blog for many reasons, most of us are probably in it just for the eyeballs -- we don't expect to convert our posts into large bags of cash. If we do manage to boil down a piece of our life into a set of useful insights, we'd like to get credit for said insights.

This is a common theme in the world of academic medicine. We give away research findings and data all the time. We tell the world: "Read this. Use this. Extend it. Just give us credit for the work we did." Even if this academic output doesn't get us promoted or invited to speak in swell places, we still expect to receive this basic currency of academia: getting credit for our ideas. Giving credit where it is due is also a standard practice in the incestuous world of blogging, where we endlessly quote and link to each other.

Linking to and extending the ideas of others is fair game. However, there is also a dark side to linking and quoting. Many of us have already noted blogbots mirroring bits of our content to certain robosites, probably to up their ad revenue. To me, these isolated events have so far been merely irksome. However, when someone sets up an automated strip-mine that grabs all of the intellectual output of thousands of blogs, it goes far beyond galling and becomes outrageous.

This is a long-winded way of introducing our lead-off post by Val Jones: How the Health Blogosphere was Scammed -- required reading for all health bloggers.

Dmitriy of the Trusted.MD blog has additional commentary on this same scam.

Anniversaries

Leslie of Getting Closer to Myself describes the not-so-happy first anniversary of seeing her rheumatologist for the first time.

What if you have something that can't be cured? The chief psychiatrist at How to Cope with Pain suggests some alternative goals.

Lessons Learned

IcedLatte at Medical Marginalia has learned how expensive fresh food can be in Ohio. She therefore offers some budget ideas for the dietarily challenged.

Medaholic reminds us that there is more than just medicine to life.

Jay and Louise of Colorado Health Insurance Insider have learned that the invisible hand of the market sometimes acts more like an invisible fist to patients with pre-existing conditions. As moles inside the insurance industry, Jay and Louise have an interesting vantage point on The Failings of the Free Market in Health Care.

A one-armed person can be a real drag -- just ask Richard Kimble (or my spouse). The worst part for me after biceps surgery: learning to use toilet paper with the wrong hand. The best part: Dude, I'm a radiologist -- I could do all of my work in a body cast. Jenni of ChronicBabe has recently visited this territory, and shares her experiences in "What I've Learned from Being One-Armed".

Dr. Zhang of The Cockroach Catcher straddles two themes this week. For one, he just celebrated a one-year anniversary of blogging and publishing a book. Also, this year he finally learned the cause of a mysterious coma that afflicted one of his patients 30 years ago.

Doc Gurley shares an important thing she has learned this year in America -- Most expensive pee in the world. Gee, I may never be thirsty again...

Have your psych patients stopped responding to the usual sessions and drugs? Maybe it's time to drop that girly-man stuff and try pro-wrestling. It worked for the Mudphudder. Check it out in Can You See What the Mudphudder is Cooking?

Alvaro Fernandez of SharpBrains shares some recent highlights and reflections on cognitive health.

The Skaw, a humanist-turned-medical student, writes The Humours blog and has submitted Baby Steps to this episode of GR. Come for the insights of a larval physician, stay for the really neat typographical visualizations of the brachial plexus.

The eponymic Laika of Laika's MedLibLog chronicles her journey from Web 1.0 Padawan to Web 2.0 Jedi in What I learned in 2008 (about Web 2.0). It's also her first blogoversary -- congratulations!

Diabetes Blogs

The prolific diabetes bloggers have earned their own category this week.

Allison from Lemonade Life just celebrated an anniversary of her own: fifteen years since her diagnosis of Type I diabetes mellitus. For this anniversary, she asked her readers to share something good that is going on in their lives and then describes her own fifteen years of something good in the face of Something Bad.

Amy of Diabetes Mine has learned the impact of harnessing the collective wisdom of an online community. This wisdom has been collected into an eBook called Nuggets of Wisdom from the Diabetes Community.

Wouldn't it be great if you could drop your serum glucose level merely by blogging about it? Kerri of Six Until Me points out that great diabetes blogging doesn't necessarily equate to great serum glucose control.

Other Chronic Diseases

Now that the U.S. has elected its first black president, maybe it's time to start breaking other barriers, such as electing a gay woman the next time. Duncan Cross suggests a less obvious barrier, and wonders if we will ever see a person with a chronic illness be elected to the U.S. presidency...

Barbara at In Sickness and in Health points out that chronic diseases affect not only patients, but also their spouses in Invisible Illness: a Two-Way Street for Couples.

Dean Moyer of The Back Pain Blog comments on a recent study of massage therapy for pain control in his post: Back Pain Relief and Massage Therapy.

Humor in Medicine

Bob at the Insureblog points out the real reason some people are fat. If this is true, I'm going to start wearing a mask 24 x 7 from now on.

Ves at Clinical Cases and Images has some tough news for cello players carrying the diagnosis of "cello scrotum". The original physician who described this particular disease has come clean, and now tells us that the syndrome doesn't actually exist. So soldier on, cello dudes -- good luck in finding scrotal surcease elsewhere.

Dr. Shock writes about the dark side of medical humor: derogatory and cynical humor towards patients that can emerge as part of the professional socialisation process of physicians.

Ethics

Most of us love sharing war stories about our medical adventures. However, when some of these war stories happen in a real war, sharing them can have unexpected ethical implications. Canadian Medicine tells the story of a Canadian doctor whose journalistic ethics collided with the somewhat different ethical obligations of a physician when he published a story about a dead soldier.

Even humble radiologists have been the targets of corporate marketing. Film companies, contrast makers and MR manufacturers have all tried to buy my soul at one time or another. David Williams of the Health Business Blog discusses why we should ban CME sponsored by pharmaceutical companies.

Do patients lie to their doctors? Dude, how would I know? -- I'm a radiologist! However, Dr Rich at the Covert Rationing Blog is not, and shares his thoughts on this topic.

Why are Division I colleges like cheerleaders? Because they'd both rather date jocks than kids with high SAT scores. I don't blame Nancy Brown of Teen Health 411 for being peeved about this inequity. For further details, read SAT Scores and Athletics.

The recent birth of octuplets in California raises a zillion ethical points: should a single unemployed mother of six kids try to have more kids? Should she seek or be given fertility treatments to try to have a lot more? Dr. Bates of Suture for a Living covers these and other issues in Eight Too Many.

Other Delicacies

Daniel at Neuroanthropology weighs in on the design of effective waiting rooms. Apparently, cool magazines aren't enough -- the cultural expectations of waiting also matter.

For those of you already reeling from the recent peanut recall, here's some more bad news from Allergy Notes: it would seem that childhood peanut allergies affect mothers' quality of life more than fathers'.

Doc Childneuro of the Mind, Soul and Body blog takes on a tough topic: dignity.

Dr. Rosh at Receiving interviews one of the leading lights in emergency medicine: Mark Reiter.

Radiology Action Comics

2009-02-02T21:42:00.001-08:00

Anyone who has ever published in a scientific journal has run head-first into the Instructions for Authors page of said journal. Usually the stylistic rules for a radiology paper are stodgy but sensible.

I was tickled to learn that the alternate universe of comic book publishing has its own grammatical and lettering traditions, as nicely depicted in this illuminating post by Nate Piekos.

For example, the word balloon in the image above commits the venial sin of...

OVERLAPPING BORDERS

I generally disapprove of placing a balloon over a border unless absolutely necessary due to space constraints. If at all possible, you're better off butting balloons to a border.

However, I have redeemed myself in the panel below by not using...

SOUND EFFECTS PUNCTUATION

Sound effects lack punctuation with the one exception of when you intend to seem cartoony. A noise is not a word, and the emphasis and design aesthetic you impart when designing your sound effects should be enough to give it "punch".

I'll have to keep these style points on speed dial in my browser. They'll come in really handy when I put together the next issue of Radiology Action Comics™...

(via Daring Fireball)

Boy, Did That Year Go By Fast!

2009-02-02T16:39:00.001-08:00

Today is my first anniversary as a blogger. Boy, did that year fly by quickly!

Despite initial worries about finding something to say, I am somewhat amazed to find that 228 posts have somehow transpired here. I started the blog with the idea of writing mostly about radiology. I think I've mostly managed to do that. However, after perusing the list of tags that have accumulated over the year, I can see that I've also veered off into a few other directions. I must say that I'm looking forward to seeing what will crawl out of my brain over the next year.

Regular writing teaches several lessons. One of the most pleasant things I've learned from this experience is just how much fun it is to write when I’m not on deadline, and the only editor I have to please is myself.

I’ve spent my whole career writing scientific manuscripts, book chapters and other academic fodder. However, scientific writing tends to be pretty darned formulaic -- it’s rarely great literature. This blog is the first thing that I’ve ever written just for the fun of it.

As a way of marking this bloggoversary, I'll be hosting tomorrow's episode of Grand Rounds in this space with a loose anniversary theme.

Don't touch that dial...

The Banjo Rules on Saturday Night Live

2009-02-02T16:06:00.001-08:00

Saturday Night Live was especially excellent this past Saturday, mostly because of host Steve Martin. My favorite moment was when he stepped on stage with his banjo and cut loose with an original song punctuated by some great clawhammer banjo licks.

The icing on the cake was today's New York Times article on this very topic.

Happy Birthday to the ABR

2009-01-31T23:57:00.001-08:00

The American Board of Radiology turns 75 today.

The mission of The American Board of Radiology is to serve patients, the public, and the medical profession by certifying that its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill and understanding essential to the practice of Diagnostic Radiology, Radiation Oncology and Radiologic Physics.

Happy birthday!

Zombies Invade Austin

2009-01-31T01:54:00.001-08:00

It seems that my favorite town in Texas now has something besides the economy to worry about: zombies.

For details, check out the following clip from The Rachel Maddow Show (the zombie part begins at the 50 second mark):

My favorite part was the public service advice:

Run for cold climates.

Ha! I've been telling my Austin brother that for years...

There Must Be a Story Behind That Name

2009-01-24T17:24:00.001-08:00

One of the great pleasures of traveling is getting to savor the tasty names that people give their towns and streets.

When I drove home from college, I would occasionally pass through the tiny town of Hye, Texas. Entering town, I'd pass a sign that said "Hye", and then, a few hundred feet later, see a sign that said "Bye" on my way out of town.

Since then, I've driven through Old Dime Box, TX, Truth or Consequences, NM, Boring, OR and George, WA.

However, England has been at this a lot longer than we have. They seem to have a definite lead in the wacky name department, as evidenced by this hilarious report just out in the New York Times.

And don't get me started on Austrian town names...

(via Movin' Meat)

Windows: Yesterday's Technology -- Tomorrow!

2009-01-24T16:03:00.001-08:00

It takes a lot of computing power to sustain the rockstar lifestyle of an academic radiologist. Whether I'm reading my usual 4 GB of images per day or crunching numbers and statistics for research projects, I'd be dead in the water without my computers.

Therefore, I've spent quite a bit of my academic career dealing with medical center and radiology IT people. We generally get along just fine, but occasionally butt heads.

The main point of contention is that I am a Mac dude. IT has been on my butt for over 20 years to convert my office computer to a PC. However, despite their dire predictions and occasional threats of non-support, I have continued to thwart them. I grudgingly use our PC-based workstations to do my image interpretations, but use a Mac for everything else. It's not just my contrary nature -- the mix of Mac and open source programs I use in my research and teaching either isn't available on the PC (e.g. OsiriX) or isn't as easy to use.

It was therefore interesting to read that other medical centers and the new Obama administration have been having the same difficulties.

One member of the White House new-media team came to work on Tuesday, right after the swearing-in ceremony, only to discover that it was impossible to know which programs could be updated, or even which computers could be used for which purposes. The team members, accustomed to working on Macintoshes, found computers outfitted with six-year-old versions of Microsoft software. Laptops were scarce, assigned to only a few people in the West Wing. The team was left struggling to put closed captions on online videos.
Senior advisers chafed at the new arrangements, which severely limit mobility -- partly by tradition but also for security reasons and to ensure that all official work is preserved under the Presidential Records Act.

"It is kind of like going from an Xbox to an Atari," Obama spokesman Bill Burton said of his new digs.

(via Orac)

Tomographic View of Every Single Presidential Inaugural Address

2009-01-21T14:19:00.001-08:00

Again, hats off to the New York Times, who posted yet another great interactive graphic. This one allows you to scroll through every U. S. presidential inaugural address since George Washington and see the most-used words in that speech.

This view of these speeches gives me the same feeling I get when I "slice" up a patient with CT or MR, and take a real-time stroll through their body from different angles. This Times chart gives a fascinating overview of the events of the times faced by each president, as echoed in their address. It also lets one to instantly dive down into the context of a given speech to see how a particular word was used.

For example, the word "women" was used more than twice in only 4 of the inaugural addresses in the past 100 years: by presidents Wilson, FDR, Bush-1 and Obama.

Wilson, FDR and Obama used the word respectively 4, 3 and 4 times, and then only in the context of the phrase "men and women". Bush-1 used "women" four times, and is the only president to have singled out the word "women" twice:

...There are young women to be helped who are about to become mothers of children they can't care for and might not love.

... who will throw a salute by himself when the flag goes by, and the women who will tell her sons the words of the battle hymns.

It must have taken the graphics gremlins at the Times a ton of time to create this Flash-based graphic. However, it seems like the process should lend itself to automation.

I'd love to have a generalized software tool that would allow me to grab multiple text and images sources and create an instant interactive concordance like this excellent Times graphic. Such a program could be an amazing tool for education. Any developers listening out there?

Awesome Panoramic Images from Inauguration

2009-01-21T13:22:00.001-08:00

Today's New York Times has some awesome interactive panoramic images from the inauguration yesterday.

Seems like this kind of image would be a swell tool for teaching radiology, if only one were clever enough. I will ponder how to do this.

What Would Woody Say?

2009-01-20T13:24:00.001-08:00

In a further ironic twist, a video clip of Pete Seeger singing This Land is Your Land is now back on YouTube, courtesy of a German news channel. Thanks, N24!

What Would Woody Say about this? Here's a copyright warning he included on his recordings in the early 40's.

This song is Copyrighted in U.S., under Seal of Copyright # 154085, for a period of 28 years, and anybody caught singin it without our permission, will be mighty good friends of ourn, cause we don’t give a dern. Publish it. Write it. Sing it. Swing to it. Yodel it. We wrote it, that’s all we wanted to do.

(via John Hodgman)

This Land is Our Land

2009-01-20T03:41:00.001-08:00

The video clip I linked to yesterday of Pete Seeger singing "This Land is Your Land" on the Capitol Mall has since been removed from YouTube by HBO, who claims copyright for the broadcast.

In that clip, Pete sang the following verse:

There was a big high wall there that tried to stop me;
Sign was painted, it said private property;
But on the back side it didn't say nothing;
That side was made for you and me.

Apparently, the irony of this is completely lost on HBO...

(via John Hodgman)

Let's Keep Grownups in the White House

2009-01-20T02:48:00.001-08:00

My recent post about Rachel Maddow garnered an interesting comment. Rather than post my reply there, where it would be buried down below the fold, I thought I'd share it here.

Paa said:

Let's see if I understand...
Katrina was a kitten, rather than a man eating lion, OK.
Bush was Edward Scissorhands rather than Indiana Jones.
Wonder how radiologists look running a real code?

@ Paa:

We will apparently have to agree to disagree concerning the wit of Rachel Maddow. However, I'm pretty sure that her point was that Bush handled the response to Katrina very badly -- not the more concrete interpretation that Katrina was a wimpy storm.

On the other hand, I could be wrong. Maybe she did mean to suggest that Bush's isolation from real life and real people is frighteningly close to that of Edward Scissorhands. If so, she crafted her simile with such subtlety that it went whiffling right over my head. If this is the case, my respect for Rachel Maddow has only deepened.

You may have intended your final question to be rhetorical, but I'll give it a shot anyway. How do radiologists look running a real code? Hopefully, like we're grownups giving it all we've got.

If "real" means doing CPR at a car crash 20 miles from town with no in-house amenities such as drugs, crash carts, and on-call specialists, I know exactly how that feels. If "real" means restarting a friend's heart with an AED on an island way too far from a hospital, I also know how that feels. Compared to these two events, every one of the in-house codes I ran my during internship was a walk in the park.

What if the code in question is a 300 year hurricane called Katrina? I'm pretty sure the country would be a lot better off with even a bottom-feeding radiologist running the disaster response than it has been following Bush's paltry effort.

So, here's my inauguration day wish for all of us: regardless of which way we lean politically, let's do our best to keep grownups in the White House from now on, starting today at noon, Eastern Standard Time.

Anatomically Explicit Cake

2009-01-19T23:32:00.001-08:00

The Cake Wrecks site posted some swell anatomically explicit cakes last week. Unlike the treats made by some bakeries, these are actually safe for work. At least my work.

These cake decorators are welcome to make a birthday cake for me anytime. That is, assuming they can find enough gray icing to make a proper radiology cake...

(via Anita Anderson)

This Land is Your Land

2009-01-19T06:19:00.001-08:00

Pete Seeger has been one of my musical and political heroes for most of my life. Although I've heard him sing this Woody Guthrie song a zillion times, it especially moved me in this Obama Inaugural Celebration performance with Woody's original lyrics:

(via John Hodgman)

White House Goes Digital

2009-01-14T15:21:00.001-08:00

Barack Obama's official presidential portrait was released today.

Besides being a nice photo, this marks the first time that an official presidential portrait has been taken with a digital camera.

The White House trails radiology by several years with this new-fangled digital stuff. However, they will still beat the FCC and U.S. TV broadcasters by over a month.

(via Daring Fireball)

A Post-Holiday Health Quiz

2009-01-14T00:26:00.001-08:00

Test your medical knowledge with the following true/false questions:

1. sugar causes hyperactivity in children

2. suicides increase over the holidays

3. poinsettias are a poisonous plant

4. a large fraction of body heat is lost through the head

5. nocturnal feasting makes you fat

6. there are ways to prevent or cure a hangover

7. you should drink at least 8 glasses of water a day

8. we only use 10% of our brains

9. hair and fingernails continue to grow after death

10. shaving hair causes it to grow back faster, darker or coarser

11. reading in dim light ruins your eyesight

12. eating turkey makes people especially drowsy

13. mobile phones cause considerable electromagnetic interference in hospitals

Done? Grading should be easy, since all 13 questions are almost certainly false. While some of these myths lack sufficient evidence to confirm them, others have been well-studied and proven wrong.

I answered a number of these questions as true, but hey -- I'm a radiologist -- what do I know about clinical medicine? My pediatrician spouse also missed a few, but fared better than I did.

These questions were compiled and researched by Rachel Vreeman and Aaron Carroll, pediatric researchers at the Indiana University School of Medicine. Their results [1, 2] are freely available on the British Medical Journal site, and make for a fun read. I especially enjoyed reading about the questions I got wrong.

The authors conclude:

Physicians would do well to understand the evidence supporting their medical decision making. They should at least recognise when their practice is based on tradition, anecdote, or art. While belief in the described myths is unlikely to cause harm, recommending medical treatment for which there is little evidence certainly can. Speaking from a position of authority, as physicians do, requires constant evaluation of the validity of our knowledge.

For extra points, try some of these questions out on your friends -- better yet, on your doctor.

(via Freakonomics)

1. BMJ 2007;335:1288-1289
2. BMJ 2008;337:a2769

Step Away from the Tip Jar...

2009-01-13T10:05:00.001-08:00

Just read this article about an armed robber in Paris who was stabbed to death with a sushi knife by angry waiters when he tried to steal their tips.

The next time you eye a radiology tip jar, just keep in mind that we are armed with barium enema bags...

(via Waiter Rant)

Rachel Maddow Rocks

2009-01-13T01:57:00.001-08:00

Rachel Maddow nailed it on MSNBC this evening with her simile for George W. Bush's handling of Hurricane Katrina:

"...like Edward Scissorhands handling a kitten..."

Self-Adjusting Eyeglasses

2009-01-13T01:33:00.001-08:00

I still remember the day my dad took me down to get my first pair of glasses. I was 6 years old, and had no idea why I was at the optician's. That is, until I put the glasses on.

Seeing life come into focus for the first time was for me a bit like Dorothy stepping out of a black and white Kansas into all the colors of Oz. I kept putting my glasses on and off for quite a while, just to convince myself that this new vision was really real.

I suppose it's therefore a bit ironic that I ended up in radiology, shunning color to work in a world that's All-Gray, All-The-Time.

But I digress.

Glasses were a miracle to me. I could now see the blackboards at school. I could see snow-capped peaks off in the distance. Heck, I could even see the frakking house across the street!

Decades of wearing corrective lenses have since led me to take this miracle for granted. I'm not used to waiting more than a few days for an optometry appointment. If LensCrafters doesn't have the color of frames I want or takes more than an hour to make my new prescription, I get cranky.

It was, therefore good for my soul to read about physicist Joshua Silver, and his plan to bring glasses to the planet's poorest people. It was also quite humbling to learn that one of the biggest barriers to universal eye correction has been the medical profession itself.

Don't get me wrong -- doctors are not trying to keep glasses away from people who need them. The problem is that most people have to go to an eye specialist with expensive optical gear before they can get their glasses. This isn't so bad in a country where every mall has at least one optician. But it sucks somewhat more if you live in sub-sahelian Africa, where there's only one optometrist per million people.

This is where Joshua Silver comes in. His brilliant 1985 epiphany: what if you could adjust your own glasses? What if you didn't need expensive optical gear or a specialist? What if these glasses could be made cheaply?

After 2 decades of work, he now thinks he has the answer: self-adjusting glasses that are simple enough for almost anyone to use. The basic concept: the thicker the lens, the greater the correction. Using this idea, he has created glasses with tough plastic lenses containing inner sacs of clear fluid. A wearer can adjust the amount of fluid in these sacs by turning a dial on a syringe until their vision is just right.

The current model of these glasses is like Henry Ford's model A -- it comes in just one model and just one color: black. So far, Silver has distributed 30,000 of these goggle-like glasses to people in over 15 countries. However, he's just getting started. His Secret Master Plan: get these glasses to everyone on the planet who needs them, which could be up to half of all living humans. I must say that the mental image of 3 billion people all wearing Woody Allen glasses makes me a bit dizzy.

In a recent Guardian article on Silver's invention, we hear the story of a tailor from Ghana,

whose sight had deteriorated with age, as all human sight does, and who had been forced to retire as a tailor because he could no longer see to thread the needle of his sewing machine. "So he retires. He was about 35. He could have worked for at least another 20 years. We put these specs on him, and he smiled, and threaded his needle, and sped up with this sewing machine. He can work now. He can see."

For me, stories like this help to neutralize a lot of the depressing crap on the news these days. My soul would smile even more if Adaptive Eyecare, Dr. Silver's research group, had a PayPal button on their website. I'd love to donate a small bag of cash to this excellent work.

Happy New Year!

2008-12-31T02:28:00.000-08:00

I'm going to spend the next few days being as non-radiological as possible.

My family and I will be spending this time at a wild rumpus of folk music and dancing with 120 other pals. We'll ring in the new year with singing, dancing and a ton of fiddle music, while someone else cooks and washes the dishes.

Best wishes for a great new year to all.

Pandora's Other Box

2008-12-28T11:37:00.001-08:00

Text-messaging and online social networks are just two of the current tools teens use to make their parents feel hopelessly old. Now it's their turn to feel like clueless geezers, because texting has moved on to the womb.

Expectant moms can now strap on Kickbee, a sensor-filled elastic band that turns fetal kicks into Twitters like the following:

Kickbee: I kicked Mommy at 06:45PM on Thu, Dec 18!

The UK Daily Mail is leading so far in the pun war with this headline:

Pregnancy belt allows unborn babies to open Facebook 'chat-womb'

Uterine hacking (so to speak) is no longer confined to caesarean deliveries. Geeky parents can now consider other possibilities, such as tracking fetal movements with GPS chips and ultrasonic fetal webcams.

Is that a tiny keyboard clutched in that fetal fist?...

(via Smart Mobs)

Text to Speech Just Got a Lot Easier

2008-12-26T18:05:00.001-08:00

A new program called Textcast has just made it a lot easier for Mac users to produce audible speech from text files.

If you are a geek like me, your reaction to this is probably, "Dude, we've been able to do this for years."

If you're not a geek, then your response is more like, "Dude, who cares?"

Valid points, both. Let me first suggest why a non-geek would care about this technology. In a nutshell, text-to-speech software is part of my anti-boredom survival kit. Although I am endlessly capable of entertaining myself, my capacity for self-amusement is pretty limited when I'm driving.

I spend at least an hour per day in my car, commuting or running errands. This interstitial part of my life can be pretty darned boring. To keep from going nuts while driving, I listen voraciously to all sorts of audio files, including NPR broadcasts, podcasts and audio books.

However, for all the stuff that I can listen to, there are a zillion other things I'd love to hear but that just aren't available in audio format. For example, I'd love to be able to listen to newspaper stories and radiology journal articles in my car. This is where text-to-speech programs come in.

Text-to-speech software has come a long way. In the old days (5 years ago), most of these programs sounded about as lifelike as Gorgo the Space Robot. Fortunately, things are getting better. Nowadays this software is not only inexpensive, but produces fairly decent speech [1].

For the past few years I've been using several "voices" by Cepstral, which cost me a whopping $30 apiece for the premium editions. Depending on your tastes, they will sell you male or female voices speaking not only with American, but also British, German, Scottish, Italian French and Spanish accents.

Besides the vocal quality, another thing I like about Cepstral voices is that I can control them via the command line. If I want my computer to chat about its urinary habits in a British accent, I just type:

swift -n Lawrence -o ipee3.wav -p speech/rate=150,speech/pitch/shift=0.9 "I pee three times a day"

With several similar commands, I can automate the following process:

grab a page of text from my web browser and save a copy in a folder on my computer
convert a whole folder of these text files into speech
shove these speech files into iTunes
move all of these speech files to my iPhone

If you are a non-geek, this process may leave you a bit cold. In fact, you'd probably rather take out your own spleen through your nose than write a shell script. For you, there is salvation, courtesy of BitMaki Software: Textcast will do all of this heavy lifting for you for $25.

I haven't yet figured out how to get Textcast to use any of my Cepstral voices, but it will use any of the built-in voices on my Mac, including a rather nice voice called "Alex". To my ear, Alex sounds at least as good as any of my Cepstral voices.

Some Clean-up May Be Necessary...

1. Convert the print version of a webpage

Textcast generally does a fine job of converting webpages to speech. However, it will convert every frakking bit of text on the page into speech. This includes headers, navigation bars, URL's, and other cruft. One easy way to clear a lot of this stuff off the page is to select a "print" version of that page, if available. For example, just about every article in the online version of the New York Times has a link to display that article with the headers, footers and nav bars stripped off.

2. Connecticut and Maryand must die!!

It's the odd radiology journal article that doesn't have the abbreviations "CT", "MD" and "MR" sprayed liberally throughout. Unless you want to hear "Connecticut", "Maryland" and "mister" in a lot of unexpected places, replace these abbreviations with "computed tomography", "em dee" and "magnetic resonance imaging", respectively, before converting your articles to speech.

3. Do some quick hand-editing before conversion

Before you point Textcast or some other program at a text file, consider doing a bit more judicious hand-editing. It's usually easy to spot large piles of cruft and delete them. Unfortunately, this can quickly become waaaaaaay tedious. If you find certain recurrent patterns of cruft (i.e. tables of content) scattered throughout your text, a quick global search and replace may be just the thing. For more complex patterns, geeks will want to trot out their grep tool on the command line to properly flense their files.

4. Use a medical phonetic dictionary

Medical and other technical journals contain a boatload of jargon. Thus, for your average AJR article, Textcast or Cepstral will mispronounce these words as badly as a TV doctor. Cepstral can help prevent this by letting you create a custom phonetic dictionary of your own particular jargon. Alex can likewise be taught certain words using Apple's VoiceOver utility.

5. Use a voice with a foreign accent

Here's one final tactic to make your text-to-speech sound less like a robot -- use a voice with a foreign accent. That way, when a word is oddly pronounced, the accent will cancel out the brain's tendency to interpret it as a speech defect. Don't tell your friends that you used a computer to produce these files -- they'll just assume that the speaker is Texan...

[1] I would even call it life-like, albeit like a live person with a mild speech defect.

Holiday Gift Ideas for Radiologists

2008-12-22T02:30:00.001-08:00

Vanessa at Street Anatomy just posted some great anatomy-related holiday gift ideas.

One of these could be just the thing to give your hard-to-shop-for, friendly, local radiologist...

A Solstice Present for Bio Majors

2008-12-22T01:36:00.001-08:00

XKCD continues to be my favorite internet cartoon.

Speaking as a physics major who jumped ship to medical school, I especially enjoyed this latest strip (click to embiggen)...

MRI = Mind Reading Imaging?

2008-12-22T00:22:00.001-08:00

Can you read someone's mind with magnetic resonance imaging (MRI)?

The short answer is: yes, of course -- we've done it for years.

However, don't get too spooked. The stuff that we are able to read has so far been extremely limited.

Consider the book as a metaphor for a brain. Until recently, we've only been able to read the shape of the book. However, functional magnetic resonance imaging (fMRI) has advanced to the point that we can now read some of the Cliff Notes of that book as well.

The latest issue of Neuron describes some fascinating work by Miyawaki et al: Visual Image Reconstruction from Human Brain Activity using a Combination of Multiscale Local Image Decoder. In this study, the authors presented simple visual patterns to volunteers. The authors were then were able to reconstruct the patterns seen from the volunteers' brains using fMRI. Check out the following reconstructed images:

As Michael Russell commented:

It looks like the JPEG compressor in the test subject's brain is set WAAAY too high.

Agreed. Even so: Wow.

The keys to this god-like power are topological maps of the cerebral cortex, such as the well-known sensory and motor homunculi first mapped out by Wilder Penfield.

It turns out that there are also retinotopic maps, connecting retinal stimuli to certain areas in the visual cortex. By imaging functional information directly from volunteers' occipital lobes with fMRI, Miyawaki et al were able to use such retinotopic maps to reconstruct what the subjects saw.

At the moment, it takes a lot of time and equipment to pull off this kind of mind-reading. So, by the time your coworker realizes that you've been undressing them in your mind, you will have already put their clothes back on and decided that they look a lot better that way.

In any event, this procedure will probably only work on information from the sensory and visual cortices, i.e. stuff that you are currently feeling or seeing. It won't work with stuff you are thinking or remembering.

No matter how many medical and legal uses we find for this technology, adolescent males of all ages will immediately leap to more prurient applications. What could horny geeks do with direct visual and sensory recording technology? The internet porn industry immediately comes to mind (so to speak).

For the moment it will be fairly easy to spot fMRI voyeurs -- just look for someone aiming a 7 foot ** roll of toilet paper at your skull. So, until this technology becomes a lot more portable, I won't be guarding my thoughts too closely. Sadly (or gladly), it will be a long time before nerds with iPhones can pull this off. However, that won't stop us from fantasizing about it...

(via Pharyngula)

** the approximate diameter of your typical fMRI scanner

Legs Optional Dancing

2008-12-15T13:48:00.001-08:00

Dancing, particularly folk-dancing, has changed the lives of me and my spouse in ways we could never have imagined, and we both have 2 working legs.

As this video clip shows, legs are optional for awesome dancing, as long as the spirit is willing.