Tuesday, February 26, 2008


Q. What's the definition of an experimental drug?

A. Anything you inject into a rat that generates a scientific paper.

A zillion years ago, I did my subspecialty training on the very first clinical MR machine on the whole West Coast. Heck, for the best part of a year, we had the only clinical MR machine on the whole West Coast. Having this machine gave us special god-like powers over the researchers at every other med school within 1500 miles. MR was such a hot-button topic in those early days that it was relatively easy to get MR papers through peer-review. It seemed as if one could throw just about any body part into an MR scanner, collect a few similar cases, and some radiology journal somewhere was hungry enough to publish the paper about it.

There was so much competition for this single scanner that each section of the radiology department got 2 scan hours / per week to use for their research. Just 2 hours meant just 2 patient scans, so every readout session became a big deal for us. Our whole section would troupe together down to the MR room twice a week to read out our single MR case for the day.

There was a clear hierarchy for these sessions: the Great Professor would sit in the comfy chair in front, and hold forth on the findings. The lesser professors would sit a bit further back. The fellows, residents, medical students and visiting foreign fellows were spaced around the lightbox according to their station in the food chain. Sometimes the Great Professor would ask a lesser being to describe the findings -- a sphincter-clenching moment for many.

One day we were looking at a pelvic MR image just like the one above, and the Great Professor asked us what we saw. A great peristaltic wave of silent clenching spread through the crowd, because we lesser beings all saw bubkes. We watched with bated breath as the Great Professor continued to gaze at the image, waiting to learn about the subtle finding that we had all missed. Finally, he said, "Looks just like a lion's face.", got up and walked away.

This was not my first experience with radiological pareidolia, but it remains one of the more stressful. In teaching conferences nowadays, I sit in the comfy chair on the front row. It's a dirty job, but I've taken up the torch from the Great Professor and periodically show my residents and fellows cases just like the one above.

Good times.

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