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Donna Magid, M.D., M.Ed.

THOU SHALT:

1. LOCALIZE WITH ONE FINGER: "Trust No One, Believe No One ".
2. CONE and CENTER: True area of interest gets center stage.
3. Remember that ONE VIEW IS NO VIEW. “The Truth Is Out There".
4. Clinician, COMMUNICATE with the Radiologist and Technologist. CRF, HIV, Hep C, Allergies, Altered MS, all matter.
5. EMBRACE DESCRIPTIVE PROCESS and PRECISION: DESCRIBE first (Telephone or Sketchpad Model) DIFFERENTIAL second
6. Be VERITABLE WITNESSES (Heinlein) Assumptions about the inadequately seen can be lethal.
7. PURGE (most) "DEAD WHITE GUYS'', SLANG, and MALLBONICS from thy medical speech. Medical Expression is both art and skill. Adieu ''Chip Fracture'' ''Sorta'' Like...ummm..'' "Colles Fracture''
   
8. Treat THE PATIENT, Not The RADIOGRAPH. FOLLOW Up, 10-14 Days, if hx/exam/gut suggest fracture.
9. LEND NO FOOTHOLD TO LAWYERS. "Resist or Perish'' ... " Fight The Future".
10. Distinguish between (invisible) ENERGY (i.e., x-rays) and (visible) IMAGES (i.e., Radiographs, Studies, Images, Views...).

2018 - Donna Magid, M.D., M.Ed.

Opinions are mine alone, and do not reflect the Dept., Institution, or American Board of Radiology.  Potential errors also mine alone, accuracy not guaranteed. For orientation/introductory purposes only, do not disseminate or quote.

Brief History

• Nov. 1895: Roentgen publishes description of ‘x-rays’, capable of penetrating tissue and creating an image on photographic plates.
• 1896: 1st 1000 articles (some of dubious medical value) follow (Lancet 1897 described locating a baker’s ring in a freshly baked cake).  (Over the next few years, an x-ray crazy public would start exchanging hand images instead of photographs—although the first report of radiation burn to the hand also appeared this year, in “Deutsche medicinische Wochenschrift”-- or other tokens, and would be offered irrelevant and dangerous products and services such as a 15 minute x-ray exposure ‘guaranteed to cure headaches”, similar ‘x-ray headache tablets,' x-ray-associated shoe polishes,radium-laced  toothpastes, cocktails, stove cleaners,and  golf balls [more bounce?], and - perhaps most horrifying—radioactive “disease-preventing prophylactics,” aka condoms).  
• 1896: was also the year a child with a gunshot injury (GSW) to the head was brought to Vanderbilt.  Before attempting a head study, a physicist asked the Dean of Medicine to sit for a trial exposure.  One hour with the tube close to the head produced an image, but also led to toal hair loss and skin irritation within 3 weeks.  Later that year, a man with an old intracranial GSW asked Minnesota physicians to find his bullet.  Allegedly that exposure was fourteen hours -- producing the desired localizing images but also leading to ferocious blistering and marked swelling within 24 hours, with hair loss, massive skin breakdown and ulcerations within the field.                                                                                                                         
• 1897: Osler proposes acquiring a ‘Roentgen Ray Apparatus” (RRA) which does not arrive until 1901, with Drs.Baetjer and Cushing.
• 1901: Roentgen awarded first Physics Nobel prize.  Exposure times at this point ranged from the shortest - 5 minutes - up to 20 minutes.
• 1902: 1st skin neoplasm reported
• 1910: 1st published report of Roentgen ray ‘poisoning’ (see 1896-- slow learners?)
• 1928: 1st Committee on Protection and Mortality.  Established measurement units, little else.
  
• 1929: Committee advised ‘Skiagraphers’ to wear ‘kid gloves”. Great Depression Oct. 1929.
• 1936: “X-Ray Martyrs” published; a monument to ‘radium martyrs’ inscribed with the names of those dying of radiation-associated disease was also erected in Hamburg, Germany. Dr. Baetjer had died, age 59, in 1933 of radiation-related disease. Extensive over-exposure of his hands in particular had led to decades of non-healing ulcerations and lesions, over 100 surgical procedures and progressive amputations,  and death from radiation-induced neoplasms.
• 1976: First mandated room shielding. NOW: Radiation protection, monitoring and usage rules at national, state and Institutional levels; mandated protection of individuals and adjacent rooms; mandated monitoring, inspection, licensing, quality assessment, performance reviews......We’ve come a long way!
• 2006: ‘SENTINEL EVENT’: First time that medical/dental/human-generated exposure dose per capita on planet exceed natural/background radiation levels. Biggest contributor to this 600% increase over 25 preceding years:  CT.

Donna Magid, M.D., M.Ed.

VENOUS CATHETERS

Central venous placement: the longer the line will be in the patient, the more important meticulous placement becomes. Interventional radiology is assuming a larger role as the need for long-term catheters grows.

Indications for long-term placement:

• Infusion of fluids: antibiotics, chemotherapy, parenteral nutrition
• Hemodialysis: requires high volume, simultaneous inflow and outflow (400-450 cc/min in and out compared to 0.4 - 0.7mL/sec for an IV)
• Pheresis: also two way, but slightly slower rate requirement than hemodialysis

Anatomic variants result from failures of formation and or regression during embryonic development. Prior catheterization also modifies anatomy and ease of access.