Tuesday, June 09, 2009

See? I Am Too Here!

...Spent the morning at the orthopedic surgeons, having my bum knee poked, prodded, flexed and X-rayed from multiple angles, all while wearing cute (not!) little paper shorts, even during my long wait in the X-ray lobby, oh the shame and horror.

This is the knee I wrecked, which gave me much trouble most of May and has tapered off some since. X-rays show fluid and possibly some bone weirdness, though not -- hooray! -- on the side that was bone-on-bone, where the surgeon's attempt at getting some useful scarring going seems to have worked. Nor is the hardware left in (three screws) irritating anything. This adds up to something of A Mystery and, nifty views from three different angles notwithstanding, I get an MRI-or-CT scan next week: MRI if "scatter" from the steel hardware doesn't obscure too much, otherwise CT scan. They do a simple scouting run with the MRI to find out.

But that is just the details. The cool thing -- the really cool thing -- is their high-end information storage and retrieval system. Dr. Surgeon (Brits, bear with) never soils his hands with X-ray film or paper files; nope, it's on computer. And when his 18-months-ago recollection falters, all previous images, his notes, all of that, are just a mouse-click away. Once they've called your folder up (and the interview nurse did that ahead of time), it's all right there. The amount of time, fumbling and explaination ("No, you took the big fish plate and four screws out last time") this saves is simply staggering, plus the doc's got a little more time to clue the patient in on what he sees and what he thinks about it. They've also gone wireless for the interview nurses -- she (or he) walks in with her laptop running, quizzes you, and before the nurse has even left the room, the doc's got the details.

A lot of modern medical practice has left physicians in the position of a highly-skilled assembly-line worker, at the mercy of the systems shoving patients past them as quickly as possible; this one appears to instead maximize the ease and speed the doc gets the information needed, with fewer (zero!) papers to shuffle and more time for doctorin'. I'm impressed.


falnfenix said...

the Hopkins system of hospitals and clinics (my former employer) are all completely digital, and when patients are given their images, it's always by CD or DVD(in the case of large image sets, like an MRI). it saves time and money, and this way you won't have degrading xrays lying around your house.

...and, well, the discs always have a viewer on them, so you can see everything they did on your computer.

i still wish i'd had an opportunity to get a copy of the tortoise's CT scans...one of our faculty members brought in a tortoise from the local zoo and performed a full CT scan of the shelled one because none of the local vet offices had a CT scanner. the images were really freaking cool.

D.W. Drang said...

Is this all on the Intarwebz, where any hacker can get at it, like His Imperial Majesty wants?

Joanna said...

Nifty shifty. The med center at Ball State has something like that (or did when I was there - they've probably upgraded at least a little) where they used tablet PCs and in-room docks instead of clipboards with ED drug logos at the top.

My sister the soon-to-be nurse is looking at getting an iPhone; as she put it, she can get a drug guide as a $2 app instead of paying $40 for PDA software.

reflectoscope said...

The wonders of modern radiography: No more film; just this sheet of black stuff which isn't sensitive to daylight and doesn't require any unpleasant/toxic processing steps. Much less exposure time, too, no less. The only downside is that the display alone to make proper use of the images is like twenty thousand bucks.


Rick T said...

And the goggles to read them are about $65,000. I help sell the storage systems that back up the magic and we aren't the expensive part of the system!

Joe said...

As long as we are talking about new tech...

A friend's wife blew her knee all to hell last year. the cartilage was totally shot. they took a chunk of it out, regrew a new disk in a petri dish and completely replaced the shredded old one. took about 6 weeks.

Might want to check it out.

Turk Turon said...

After I had my ultrasound ("lithotrypsy") procedure to get rid of a kidney stone, the doctor showed me my 3-D ultrascan on his desktop computer, called up from the hospital miles away. He spun the display this way and that and pronounced me cured! Or "asymptomatic" as doctors put it.

wv: worginva

Joseph said...

Love those paper shorts...so dignified. I do hope the knee turns out ok, Roberta. I have a bad back as well, fortunetly it isn't spinal or the disks.

perlhaqr said...

There are downsides to all this computer tech hitting the hospitals.

My Dear Wife is a pharmacist in the ER at the local hospital. She checks doctor's orders in the ER, and helps out with advice during trauma calls.

Sometimes, doctors will write for the wrong drug. There are lots of drugs, and many of them have similar sounding names, but just because clonopin and clozapine have similar sounding names, doesn't mean they do similar things.

So, a large portion of the time, these things will be caught because the doctor orders the wrong drug with the right dose. "325 mg ibuprofin" "do you mean acetaminophen?" "Oh, yes."

The electronic order entry system gives you a drop down menu once you've selected the drug. So you can't choose the "wrong" strength anymore, which means the pharmacists have less chance to catch a misorder.

But none of the docs seem to care, and none of the higher ups will listen, so, expect to see a lot more people getting the wrong drugs.

Lorimor said...

The nifty computer system you describe is known as a "PACS" system. "Picture Archiving and Communications System." They're pretty commonplace nowadays. PACS systems increase productivity in any radiology department tenfold.

Once the system has gone live, it is indispensable and if it should break down, panic and much stress ensues.

Not only do the images from every modality the patient has had a procedure performed appear, the reports are available as well. Documents, hard copy xray films etc can be scanned in and become part of the system.

The hardware in your knee won't cause "scatter" in an MRI system. The metal essentially "sucks up" the signal from surrounding tissue and possibly can make the images useless. Many variables involved.

Now, the hardware can and will cause "scatter" in the CT scans. Again, the severity is dependent on the proximity and amount of metal present. Sometimes the anatomy can be positioned to minimize scatter but it cannot be eliminated if the xray beam passes through the hardware.

The MRI scan will generally yield more and better information if soft tissue, such as ligaments and tendons are in question. MRI also has an additional advantage in that the images can be acquired at any angle whereas CT is very limited. Of course, the CT images can be reconstructed afterwards to cut through the area as desired.

CT is far superior for imaging bone and is much, much, much faster than MRI.

CT also doesn't sound like a large diesel engine is running at 5000 rpm in the room with you.

However, for imaging soft tissue, MRI is unequaled. For instance, MRI can detect MS plaques in brains and brain stems. CT can't detect it.

I betcha you get an MRI. It's preferred for knee work.