SMV Skull and Sinuses

http://www.youtube.com/user/TopicsInRadiography

Medicare Cuts for Imaging?

We all sit and wait for a glimpse at the ugly head of healthcare reform.  Nobody knows exactly what it looks like or what it will mean for their own care, the care of their families, or for us Radiographers, our jobs.  This article from the Wall Street Journal was posted in July:

http://online.wsj.com/article/SB124646885862181139.html

It outlines plans for Radiologists to receive up to 20% cuts for reimbursement for MRI and CT scans.  It also mentions Cardiologists receiving 25% reduction in cardiac catheterization procedures and 42% cuts for echocardiograms.  These are among just a few of the cuts that are reported to be re-channeled toward primary care in hopes of attracting more medical students by increasing GPs' wages.

The American College of Radiology has been fighting President Obama on some of these changes with the backing of U.S. senators on both sides of the isle, including Kerry (Democrat from MA), Kohl (Democrat from WI),and Alexander (Republican from TN).  The imaging community has already seen cuts of $5 billion over the last 5 years, and as of September, we are now facing increased expectations of not 20%, but up to 60% cuts for CT and MRI reimbursement from Medicare.  The last time I checked, most hospitals are already in the red.

According to Obama's Deficit Reduction Plan (page 38), patients will even need "prior authorization" for the more expensive imaging studies starting in 2013 in order to patrol the actual necessity of more expensive studies.  There is a common opinion going around that too many CT and MRI exams are being ordered when they are not really necessary in order to make the pockets of Physicians a little bulkier.  The pre-authorization is supposed to prevent this sort of thing, but what concerns me is that the plan does not identify WHO would be doing this pre-screening.

I can't think of too many people who would not be biased in the pre-screening process.  A Physician panel may side on lining the pockets of their own.  Insurance companies are going to find a way to make a buck off of it themselves.  The most likely responsible party will be Big Gov - and now we open the can of worms that everyone's been talking about for some time... government regulated health care.  Is this the beginning of a long-term agenda to force everyone to switch over?  Who knows... but I would like to encourage everyone to write their Congressmen and Senators and support the ACR.

What will this mean for Radiographers?  It could mean more plain x-ray exams being performed - we may continue to be the work horse of the imaging department.  It could also mean less Physicians specializing in Radiology.  We live in interesting times in the health care field.  I have serious doubts that plain x-ray examinations are going anywhere soon.  I do think, however, that we will most likely see a slower growth in imaging technology if this goes through.

Free Category A CE Credits

This is primarily for Nuclear Medicine techs, but you never know who may need them and how soon:

http://www.advanceweb.com/EBlasts/2011/9/NOINSERTION/2964IR20110923.html

New Twitter and Facebook

Hi everyone,

Just a quick note to say that due to some recent privacy changes on a particular social networking site, I am changing some links in attempt to separate some private vs. blog-related material:

New Twitter... Please feel free to follow.  There are just some things that I would like to share with family or friends, and there are some things that are Radiography-related that my family and friends just don't want to hear about.  Freedom of expression is great, but freedom to "un-follow" is also available and I would like to avoid that.

New Facebook... Please feel free to add me.  If you were a personal friend on my old facebook page, you can find me on Google+... I have kept a facebook page just for the blog/youtube topics and related material.  I'm much more pleased with this because instead of the old facebook page, I will now be able to receive messages directly instead of having to check the page periodically, allowing me to have better interactions with you all.

Note:  YouTube, LinkedIn, Feedburner, and E-mail have all remained the same.

Thanks to everyone who has continued to follow along all of these years, as well as my most recent connections.  I hope these changes can be more beneficial to all of my readers to avoid having to sift through some of my more personal content.

MIC-KEY Gastrostomy Tube Kit - Package Opening and Content Discussed

If you haven't seen one of these yet, please make sure to watch.  I have started to see these more and more in California, and they're really great because of the no-mess feeding.  In order to inject through one, you need a special extension/port that comes in the insertion kit.

Here's some of the better images from the package insert:

Balloon Inflation:

Cross-section of balloon inflated through gastrostomy:

To connect tube to MIC-KEY, line up black line on button and black line on extension (provided with kit).  Push tip of extension into one-way valve and turn clock-wise to lock:

Lateral Skull and Sinus Positioning and Film Critique

Please visit my YouTube Channel to view in High Definition.

Oblique Rib Views: Which Views Should be Performed and Why?

I just received an email today asking for an explanation on obliques... I'm fairly certain that it was about ribs, but I thought I would go ahead and post this because it can be difficult to understand why we position oblique ribs the way we do.  The rule of thumb for most obliques is to simply place the anatomy of interest closest to the image receptor to visualize the most detail possible.  This does not apply with every oblique view of the ribs, however.

Reasons vary for why we position most body parts in certain obliques, and ribs are very different as well.  Typically, if an area of interest is anterior, an anterior oblique is performed (RAO or LAO), and if an area of interest is posterior, a posterior oblique is performed (RPO or LPO).  

Posterior rib pain:  If your patient is complaining of right posterior oblique pain, you would perform RPO.  If the pain is left posterior, perform LPO.

Anterior rib pain (this is where it gets tricky):  If there is right anterior rib pain, perform an LAO.  This seems like the opposite of what should be done, but if a RAO is performed, the thoracic spine will superimpose the area of interest.  You need to move the spine out of the way with an LAO.  This position still places the anterior ribs closer than a posterior oblique would, providing better detail by getting the anatomy closer to the image receptor, and still prevents the superimposition of the spine.  If there's left anterior rib pain, perform an RAO for the same reason - get the part of interest closer to the image receptor, and move the spine out of the way.

It's always a good idea to mark the area of interest with a bb marker or annotate some arrows on the image just to help out the Physicians viewing the images as well.