Discover and read the best of Twitter Threads about #radiology

Most recents (21)

Oh hello, Board-certified diagnostic radiologist here.

Now I’m no neurosurgeon, and I only read 1000’s of CXRs every year, but to my eyes, that CXR is stone cold normal.

Also: disregard the radiological interpretation of anyone who uses the term “infiltrates” on CXR

#Radiology
Can somebody please point out these “infiltrates” to me.

I see a normal cardiomediastinal silhouette, no evidence of effusion, normal lung volume, normal interstitial markings and clear lungs with no acute osseous abnormalities.

Infiltrate?

Lol...
Or at the very least, invite an expert on to interpret the test correctly for you.

Having a neurosurgeon interpret a radiograph live on air, then having him misinterpret it and use non-radiological language (infiltrate) to describe non-existent findings is a very bad look.
Read 3 tweets
Cada mañana hacemos controles en planta de radiografía portátil a pacientes con Covid19 o con sospecha.
Parece un laboratorio biológico:
Mesas con gel hidroalcohólico, guantes de diversos tamaños, mascarillas, batas impermeables, pantallas de acetato, cubos de desecho biológico.
Hay limpiadoras constantemente pasando mopas por suelos y paredes...
Necesitamos Comunicación constante entre todos los trabajadores.
Recuerda a los protocolos de seguridad de protección radiológica por radiación dispersa, aunque ahora no se oye tanto el asustadizo "¡rayo!"
Dedicamos la realización de la radiografía portátil con especial atención, porque también este 'carro' necesita desinfección constante porque se conduce entre ambientes aéreos de probable elevada carga viral. Este equipamiento se puede convertir en vector de contagio!!
Read 12 tweets
In response to many requests, I've collated several #COVID19 cases at one of my hospitals over the past 5 days. In this limited (non-peer reviewed) cohort:
- 100% subpleural involvement, 33% + centrolobular involvement
- 40% even apical/basilar, 27% basilar dom, 5% mid dom. 1/17
- All have ground glass, 20% with atoll, 2 with ARDS
- 66% had some + CXR finding I could correlate to a CT finding
- 66% had documented exposure, rest I couldn't find either way

I'll list age decade and + exposure documented #covid19 #coronavirus #radiology #FOAMed #radres 2/17
Read 17 tweets
Batch of #covid19 cases from the past few days. These are just a few with the most “classic” appearance and some with fibrosis/ARDS. Get used to this look. Thread of several cases. 1/7 #radres #radiology
2/7 #covid19
3/7 #covid19
Read 7 tweets
Clarification: The patchy opacities involving the upper, mid, and lower lung zones bilaterally are ground glass opacities, and do NOT represent necrosis.

This is extensive disease present, and #COVIDー19 can result in chronic lung injury to include fibrosis if not death first.
The following case study illustrates a case from China in a 46 year old male with ground glass opacities involving the bilateral lower lobes (A,B), with 2 day follow up imaging (C, D) with more extensive opacities, now involving right upper lobe as well as bilateral lower lobes.
Comparison of clinical and radiographic features of SARs, MERs, and COVID-19

#COVIDー19
Read 5 tweets
Having reviewed a bunch of radiology papers lately with the same flaws - some #ML but most not - here are my top 10 tips! #AcademicChatter #radiology #AI
1/ Start with what is already known, where is the gap in knowledge and why it's important. Some papers are doomed from the start because there is no clear impact of the work. Remember the reviewer may not be super-specialised in your research niche.
2/ I need to understand the experimental design quickly, so a flowchart is really helpful. Put yourself in the shoes of a first-time reader. If the design is easy to follow then everything else fits into place.
Read 11 tweets
Wish you’d paid more attention to your #radiology lectures in med school? Don’t worry, we’ve got you, #medtwitter. Announcing #readingroom, a new feature where we break down common rads findings into learning bites.

Let’s start with a good ol’ CXR: what’s your read?

1/6
It’s a hemithorax opacification! Now let’s level up and ask what your ddx is for such a finding.

2/6
Pleural effusion and atelectasis are most likely. What else is on your ddx, though - and what other CXR findings help you tier your ddx?

Moving on to a CT ... what’s that purple arrow pointing to?
3/6
Read 6 tweets
Thread: "Surprise billing" is something most people have heard about, where a patient goes to a hospital or physician for whatever reason and thinks she is in network with her commercial insurance, and then receives a bill for a physician or a service that is out of network.
2/ The question is, WHY is that provider or service out-of-network? Increasingly, the answer is that insurance companies refuse to negotiate to reasonable rates and in good faith with hospitals and physicians, and reduce or narrow the scope of covered services in policies.
3/ From the perspective of the insurance provider, this makes perfect strategic sense. A $200B+ revenue commercial insurer will never miss one physician or hospital but that insurer may represent 30% or patients or more for any one particular provider.
Read 8 tweets
QUICK RANDOM HANDOM TWEETORIAL TIME

attention every1 in #primarycare #urgentcare #emergency care #EM or #ortho #radiology

Here's an injury that gets missed SO FREQUENTLY

but not by you anymore, bc now YOU'RE GONNA CATCH IT!

Hx: punched a wall, pain
1/3
#medtwitter #foamed
What's that? You want another view?

BRILLIANT SUGGESTION, here it is
Think you spot the problem?

Keep scrolling!
2/3
#medtwitter #foamed
CMC DISLOCATION

The MC5-hamate articulation is outlined in orange dots

Best appreciated on a 30 deg pronated oblique

Sometimes these are subtle on AP and LAT but always a dead giveaway on the oblique

Remember THREE VIEW HAND>>TWO VIEW HAND
#2viewisNoVIew
#medtwitter #foamed
Read 5 tweets
“Around 2012 or 2013, researchers identified evidence that gadolinium retention was connected to illness in patients with normal kidney function.” scholar.google.com/scholar_case?c…
“In September 2017, after the FDA voted to add concerns about gadolinium retention on warning labels, [gadolinium-based contrast agent] manufacturers, including Defendants, issued a new joint warning to patients with normal kidney function.” scholar.google.com/scholar_case?c…
“The warning [RE: #gadolinium retention] also directed physicians to advise patients of these concerns.”

Consent: valued in the United States since the Nuremberg trials of 1947 🇺🇸 scholar.google.com/scholar_case?c…

☢️#radiology
🥼#nephrology
🏥#publichealth ⚠️#patientsafety
💉#MRIdye
Read 4 tweets
It is a bit ambitious to try and sum up the magic of MRI physics in one post but here goes! (Thread 1/11) #foamrad #meded #radiology #mri #foamed
Hydrogen atoms are abundant in all of us and are all made up of a single positively charged proton

Each proton has its own magnetic field

When placed inside a magnet (such as within an MRI scanner) the magnetic fields of the protons line up with the main magnetic field (2/11)
Whilst lined up the protons aren’t completely still but rotate 🌀(or ‘precess’) along the axis of the magnetic field

(3/11)
Read 11 tweets
Thread/
Tomorrow, I begin my PGY-31 year: 30 years since graduating med school & 25 since becoming credentialed in #Radiology. Today is #PrideNYC & a celebration of #Stonewall50. Here are some lessons for all about how times have changed & how much more we still can learn. 1/
Med school coincided with the emergence of the AIDS epidemic. As a very closeted and too young medical student (graduated at 23), I watched as too many young (mostly) men were dehumanized. There were many heroes out there. More often, we didn’t do enough. 2/
I remember the frequent “joke” told by my peers/friends in school: “What is the hardest part about having AIDS? Convincing your parents that you are Haitian.” (Ask someone older if you don’t get it). The stigma was huge; the fears were great. 3/
Read 16 tweets
“[T]he American College of Radiology have categorized the various ligands into different safety classes ... despite being grounded in purely observational data,” physiology.org/doi/full/10.11…
#gadolinium ☠️ #patientsafety #radiology #Nephrology
The “American College of Radiology] Committee on Drugs and Contrast Media considers the risk of [‘nephrogenic’ systemic fibrosis] among patients exposed to standard or lower than standard doses of group II [gadolinium-based contrast agents] is ... possibly nonexistent...”
The American College of Radiology, based on more opinion than evidence, guided Group II agents—such as MultiHance—as having “sufficiently low or possibly nonexistent” risk for gadolinium-induced systemic fibrosis. acr.org/Clinical-Resou…
#gadolinium ☠️ #radiology ☢️ #Nephrology
Read 4 tweets
“Gadolinium-based contrast agents: Stimulators of myeloid-induced renal fibrosis and major metabolic disruptors,“ is now in press—sciencedirect.com/science/articl…

#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
#toxicology
#dermatology
#nephrology
Gadolinium-based “magnetic resonance imaging contrast agent treatment impaired renal function, induced pathologic damage, and increased kidney fibrosis,” sciencedirect.com/science/articl…

#gadolinium
#nephrology
#radiology ☢️
#patientsafety
#publichealth
#toxicology
Read 11 tweets
1/ It’s been a week.

It’s well into Friday evening & I just got off the phone with a patient who had urgent radiology results. This was after spending > 40 min on the phone w another patient discussing the same this afternoon.

(18 more to come; stick with me.)
2/ I only got 2 items on today’s long “to do” list done — but that’s on me. I was finally able to sit down for a couple hours uninterrupted and dig deep into a few patient cases from the week.

(And I “don’t work” on Fridays.)
3/ As I hung up the phone, I reflected on how #directprimarycare has enabled me to get to the heart of medicine & the doctor-patient relationship.

During that call, my patient’s spouse broke down and — through sobs — simply said: “Thanks for being so kind.”
Read 19 tweets
“[I]t is known that during those at least 6 weeks [after exposure to gadolinium-based contrast agent] equilibrium has not been reached and [gadolinium] can be measured for all [gadolinium-based contrast agents] in tissue,” fda.gov/downloads/Advi…

#gadolinium
🧠
☢️
“It is important to note that the exact mechanism and in particular other co-factors that are likely needed to trigger [‘nephrogenic’ systemic fibrosis] are still unknown,” fda.gov/downloads/Advi…

#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
“[T]he levels of gadolinium in the body considered normal in the absence of any [gadolinium-based contrast agent] exposure is, for practical purposes, zero,” fda.gov/downloads/Advi…

#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
#toxicology
Read 4 tweets
“Notably, in recently published rodent studies, complete clearance of the brain took up to 6 months after injection of a large amount of” gadolinium-based contrast agents. journals.lww.com/investigativer… @HrsQuiet
#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
“[S]o it can be assumed that the total clearance—if achieved at all—might also take months in humans,” after gadolinium-based contrast administration— journals.lww.com/investigativer… @HrsQuiet
#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
#toxicology
Read 4 tweets
“A conspicuous knowledge gap now exists about” the safety of gadolinium-based contrast agents—Dr. Stephen Brown, Harvard Medical School, in
The Need for National Guidance Around Informed Consent About GBCA Safety
tandfonline.com/doi/abs/10.108…
#gadolinium #radiology #patientsafety
“The research protocol under discussion highlights where the [National Institutes of Health] Roadmap around [gadolinium-based contrast agents] falls short,” because informed consent about gadolinium deposition could be left out—Dr. Stephen Brown
tandfonline.com/doi/abs/10.108…
“The [Institutional Review Board] should first clarify that gadolinium deposition is NOT INCIDENTAL in this study,” [emphasis added]—Dr. Stephen Brown, Harvard Medical School, in
The Need for National Guidance Around Informed Consent About GBCA Safety
tandfonline.com/doi/abs/10.108…
Read 7 tweets
“Despite significant differences in the thermodynamic stability between non-ionic Omniscan and ionic Magnevist, the [#gadolinium ☠️] concentrations were about the same in the brain,” nibib.nih.gov/sites/default/…
#radiology ☢️ #patientsafety #publichealth #neurology 🧠 #dermatology
“Chronic symptoms attributed to [gadolinium-based contrast agent] exposure:” paresthesias, dysesthesias, clouded mentation, skin discoloration, skin changes, skin thickening, bone pain, bone/joint pain, muscle spasms, arthralgia, muscular weakness—nibib.nih.gov/sites/default/…
“Chronic symptoms attributed to [gadolinium-based contrast agent] exposure:” fatigue/asthenia, digestive symptoms, nausea, vomiting, diarrhea. nibib.nih.gov/sites/default/…
#gadolinium #radiology ☢️ #patientsafety #publichealth #neurology 🧠 #dermatology #nephrology #rheumatology
Read 14 tweets
"This free AI reads X-rays as well as doctors."
No, it doesn't! The first image I uploaded was an image of an apical pneumothorax from the web, and it completely missed it. This isn't something you want to miss.
snip.ly/quakd3 @FastCompany #radiology #AI
The creator's intention is a good one, but this type of headline is both inaccurate and dangerous. #DeepLearning has a lot of great potential in #medicine, but we have to be careful not to overhype #AI. Oh, btw, this patient does not have cardiomegaly. #radiology #ImagingAI
To be fair, the authors in the original article (arxiv.org/pdf/1901.11210…) do not claim to be as good as or better than radiologists but rather to "augment" or "assist" them. Good: they show potential for an #AI solution with minimal computational cost while preserving pt privacy.
Read 4 tweets
Letter to my younger self
#FOAMrad #FOAMed #radiologytrainees
A decade into #radiology
#neurorad #pedineurorad
Read on. Add your #rad life lessons too!
A lot of work in radiology can be mundane 'follow up', 'comparison' or 'surveillance'. Don't call it just a 'routine follow up study'
Make the most out of any exam by first BLINDING yourself to the history, opening the BASELINE imaging- be it any modality and QUIZZING yourself.
Read each study with your own standardized approach first.
Tumor follow ups can be much more interesting if you start by quizzing yourself on the baseline.
Also go back in time for size changes, slow growth can be missed.
Read 15 tweets

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