riahi
See fights over: mammography, serum PSA, Lung cancer screening, colonoscopy, etc.
I wouldn’t say most frontline doctors are personally against screening, but they hate fighting with insurance companies over this stuff, and would rather not deal with it.
I was referring to random small businesses like this guy. I have seen the images from his centers; they are excellent.
Mirovita is a similar price point.
My problem with Prenuvo is not the screening aspect; it’s that Prenuvo is poor value. For the cost you pay out of pocket, I can find you conventional imaging centers that will charge the same (or less!) for fully diagnostic images and a fully diagnostic report. And they will give you the images on disk (or a link to a portal) right there.
If you want to be screened and have the cash to pay for it, go right ahead! Knowledge (can be) power! With the caveat that imaging is step 1 and you may need further work up. Don’t go to the Theranos of imaging; go some place truly diagnostic.
It's multiple things. It never shows the subscapularis in the way that people actually look the tendon. It hyper fixates on the axial when I find the sagittal much more useful for subscapularis.
Figure 7. There's an arrow pointing "to the acromial undersurface". The arrow is not pointed to that location.
Figure 5. "thin bursal fluid". This is within physiologic variation, but is calling bursitis.
It keeps bringing up irrelevant normal things like the shape of the coracromipal arch, I assume because lots of websites have information about that as a patient focused possible cause for rotator cuff impingement.
I am reminded of the recent Stanford MIRAGE study which found that LLMs will happily hallucinate answers about medical images if the medical images are omitted.
They don’t want to vaccinate due to literal decades of propaganda campaigns turning anti vaccination into a tribal identity.
They just want some “reason” to blame others for the way they want to behave. It reminds me of the Matt Bors comic
https://www.dailykos.com/stories/2020/9/30/1981821/-Cartoon-...
In clinical practice, those doses are about 2-3x what I see on the machine dose reports every day at my place of work.
In thin patients who can hold still, I've done full-cycle cardiac CT and achieved a < 1 mSv dose. We are always trying to get the dose down while still being diagnostic.
Source: Practicing radiologist.
https://www.politico.com/news/magazine/2024/04/25/new-york-t...
https://www.the-independent.com/news/world/americas/us-polit...
The repair takes about 20 minutes the first time you do it and the ribbon cable is on amazon for about $7.
However, the oral bioavailability is zero.
This is an example of using something off label that’s approved for something else. Sometimes it’s fine. And sometimes, it’s dumb.
I actually am not sure of the subtleties on this grammatical point.
You can get a ton from a worknumber query.
There are several papers in the dermatology literature suggesting low dose oral minoxidil for hair loss. I think dermatologists or hair surgeons who do this every day will know the literature. The average pcp likely won’t unless asked.
My own personal experience with deceased donor transplantation is the pre-donor screening imaging to make sure there’s not a surprise cancer hiding for the recipient…
This had the flavor of being written by one of those types who’d rather write breathless blog posts about taking care of patients than actually taking care of them.
If you’ve been to medical school, you know the type.
The new world is that we are becoming bound to hospitals / private equity in a way akin to sharecroppers on a plantation, mostly because of regulatory uncertainty which requires tremendous capital to overcome.
Some states are making it easier for surgeons to open surgicenters, but those are still very tightly regulated. Same with freestanding ERs, birthing centers, radiation therapy treatment centers, or freestanding imaging centers. Even if I wanted to raise the capital myself, the regulatory uncertainty makes the playing ground so unfair that it is functionally impossible without bringing in PE money to fund the legal fight for approval.
——— I trawled the approvals this year in my state.
Hospital joint venture with PE-backed imaging chain gets approval to open new freestanding imaging centers. They have the funds to fight back against the other systems’ legal challenges.
Radiologist owned 20 year old magnet who literally charges cash price of $499 (compared to above hospital planning to charge $1911 vs $6000 in hospital) was denied permission to upgrade to a newer magnet.
Physician practice request to buy a PETCT blocked by a competing hospital for 2 years of litigation, now referred to state Supreme Court…
——————- It doesn’t make sense that I can open a medispa and offer laser dermabrasion and other cosmetic services easier than I can open an imaging center. My options are join a hospital or join PE (rad partners or USRS).
Honestly I should move.
A large problem is that people are coming out with insurmountable debt burdens from professional school and are simply unable to balance that and the start up costs of a new practice.
Combine that with states having adopted certificate of need requirements since the late 1980s, it is literally illegal for some doctors to even try to open their own practice.
In my state, I legally cannot open a radiology imaging center without spending thousands of dollars on a petition to the department of community health begging “please approve my imaging center” which then is posted publicly on a tracker website where in-house counsel for every single health system / competitor can sue to block you from ever opening.
They can also sue to block you from upgrading your equipment when it’s long out of date.
It’s untenable. While I agree there are many problems with poor financial savvy amongst highly trained professionals, I also realize that the average debt burden is over 250k and practice start up costs are not getting cheaper.
A PET or MR or CT could easily cost 500k-1million alone, without including real estate costs, building/renovation costs, or bribes/legal fees battling for the right to open your doors.
They did address this and noted that in patients with tubal ligation the talc distribution was different and lymphatic rather than “mechanical” through the fallopian tubes.
Still not sure what your angle is here.
It’s known that talc is inflammatory. It’s literally used with that intention medically. We don’t use powdered latex gloves in the modern day nearly as frequently as before, mostly because of latex allergy but also due to concerns that talc exposure leads to worse peritoneal scarring/adhesions.
The fact that talc is present inside the surgical specimens is bad in and of itself, regardless of how it got there. That implies an environmental cause for the malignancy, a la asbestos or smoking.
Talc introduced into the peritoneum is similarly inflammatory and has been known since at least 1943:
https://jamanetwork.com/journals/jama/article-abstract/26104...
Work has been done to demonstrate that talc can migrate from external perineal application into the female reproductive tract.
When a patient who has had a pleurodesis gets an FDG PETCT, they will have intense accumulation of radiotracer for years. It is very inflammatory. Even more so than asbestos.
I wouldn’t want talc anywhere inside my reproductive tract or anywhere inside my body if I could avoid it.
If you buy the chronic inflammation leads to cancer hypothesis, talc leading to cancer is not so far fetched.
However, healthcare in the US is very fragmented. Many patients seek cheaper imaging at freestanding imaging centers. Those places often don't have the same HIT integrations to have similar medical context.
And in those settings, I only know what's on the images and maybe 200-300 characters on the "reason for study" box.
This is not to say I think everyone should get scanned at expensive sites; more an indictment on how annoying the current EMR situation is.
As a radiologist, I sometimes wonder about whether I make too many recommendations to referring doctors (consider endocrine evaluation for a potentially hormonally active adrenal nodule).
A FREQUENT attack on us as a specialty is that we "find too many incidentals" (see attacks on mammography, breast cancer screening, other sorts of screening, ad nauseam).
Perhaps I'll keep doing the adrenal nodule recommendation, although I usually only make the recommendation if it's 1cm or larger.
Pheos don’t typically make aldosterone. They tend to make epinephrine and derivatives. Different cell lineage; different endocrine responsibility.
I also have some small ACL reconstruction hardware in the knee which might interact and predispose that leg to moving…
I am well acquainted with high SAR abdominal scans in a 3T from my time doing scan certification in a petmr. Even though I “know” that tissue heating from high SAR is a thing, it always surprises me when my abdomen gets warm.
Source: Radiologist (and personal experience in the bore)
https://data.oecd.org/conversion/purchasing-power-parities-p...
This has India at 23:1 for USA.
An extremely simplistic analysis would say assuming that conversion factor holds true for all costs, you are “spending” $100,000 dollars of US value when you spend $4300 USD in India.