Thursday, June 27, 2013

A View Of The DOMA Decision

Dalai's Note: A close friend of mine, who happens to be gay and in a committed relationship, sent me this note on the recent Supreme Court decisions. I couldn't have said it better myself:
I think DOMA was a bad law and needed to go, but I am not fond of the concept of "gay marriage'. I think it's a bottom up solution for a problem that needs to be considered from the top down.

They are seeking marriage as a way to participate in the same "civil" benefits. Marriage, to me, is a religious concept and belongs to the churches/synagogues... and I won't get into the historical ownership of women that it was at one time.

What I would prefer is a complete disengagement of civil and corporate benefits from the religious concept of "marriage'. I don't think anyone should "benefit" in a civil/corporate sense, because they are in any particular type of relationship.

Our current "benefits" system is predicated on the older notions that women did not work, and were therefore "dependent". Thus health insurance, VA/military and social security benefits, you name it, etc, were set up with the idea of "taking care of the woman". We tried to equalize it for both men and women, as women entered the workplace, but the term "spouse", is the root of the problem. This set up established the notion that there had to be some sort of real or perceived sexual relationship between two people in order to purchase a product (such as insurance), or direct a benefit.

Beyond my death, I can utilize a will as an instrument to direct my property, my home and my money to anyone I choose, even my dog, if I wanted to. We ought to be able to do that in life. For anyone, for any reason. It should not be that different.

I think we would all be better off with the concept of Reciprocal Beneficiary. If I want to buy insurance for my partner, my brother, or my friend, or my Aunt Gertrude, all that should be required is that I name them as "reciprocal beneficiary", and pay the required/established cost. I shouldn't have to have a "marriage" license to purchase a product. If I want to direct benefits of any sort, to anyone, all that should be required is a contract/power of attorney or some power already inherent in the concept of Reciprocal Beneficiary, to be utilized as the appropriate legal instrument.

The government has no business moderating the personal lives of anyone. Nor should any corporation care what anyone's relationship status may be. (i.e. health insurance)

I think this would give everyone, on both sides of the issue, what they want, without the added perceived threat to those that are more conservative, that society is "falling apart". I think we are setting up a slippery slope and setting an uncomfortable precedent. Furthermore, I do not think citizenship should be so easily conferred upon someone just because they sign a paper and get married at the courthouse, as an example of civil benefit.

Instead of equalizing the opportunity for citizenship in this manner for homosexual partners via “gay marriage”, I think it should be eliminated completely, for all.

DOMA never considered Eastern European mail order brides as a threat to traditional marriage... Perhaps it should have. I do. Or rather, I consider it opening your bedroom door to the government.

I have heard of instances of government overreach in these types of cases where some government official recognizes that a particular marriage is one of convenience and orders it nullified. By what criteria did they make that decision? Lack of sexual relations? Time spent together? How was the determination made, that it was “merely” a marriage created simply for the benefits conferred, or if the couple, was truly in love? A bureaucrat decided this? Who’s to say?

Do we really want the government deciding how much love it takes to make a marriage? Who will decide for you that your personal relationship with someone is real vs. sham? Do we really want this?

I do not believe that the government should inhibit, discriminate against, nor protect or promote any particular class of citizen, any longer.

There are many churches or synagogues that will or were already performing marriage ceremonies for gay and lesbian couples if they are truly seeking consecration in a more liturgical or social sense. It is a nice thing. That isn't at issue, really. I can appreciate the notion of standing before your friends and family and making that commitment. It has social and cultural value. However, I fully support the religious institutions' rights to decide for themselves who they will and won't bond in whatever they consider to be sacred and holy matrimony.

I actually think the definition of marriage, or the defining attributes changed about 150 years or so ago. Marrying for love was not a common concept. Marriage was about alliances, politics, ownership and children. Only recently do most folks see it is a personal, loving commitment in any way. How many wives did some folks in the old testament have?

I firmly believe that everyone, and I mean EVERYONE, should have equal rights. My problem with the whole campaign, beyond my assumption that some have an agenda beyond simple equality, is that it attempts to change a definition (marriage = one man + one woman) that has been with us for thousands of years. A matter of syntax, really. But we cannot and we must not discriminate. Period. If there is some religious price to pay, that is between the individual and G-d. I'm not perfect, either, as Mrs. Dalai constantly reminds me.

And that's all I have to say about that.

Thursday, June 13, 2013

Nuclear Death

A very sad tale from the Wall Street Journal:

Equipment Collapses, Killing Patient

By TAMER EL-GHOBASHY and CHRISTOPHER WEAVERA patient at a veteran's hospital in the Bronx was killed Wednesday when a large piece of diagnostic equipment fell on him in what experts called a rare accident.

The 66-year-old victim was undergoing a procedure using a gamma camera at the James J. Peters VA Medical Center when the apparatus apparently collapsed and crushed him, officials said.

In a statement, a spokesman for the medical center said the camera was installed in 2006 and was maintained by its manufacturer. "This is a very tragic and unusual event and the details are still unfolding," said Jim Connell, a hospital spokesman.

He declined to identify the patient, citing privacy laws.

According to the New York Fire Department, a 911 call for an ambulance came from the hospital on West Kingsbridge Road at about 12:30 p.m. on Wednesday, but was quickly called off. A spokeswoman for the New York City Medical Examiner said an autopsy hadn't yet been completed and that the victim hasn't been formally identified by next of kin.

An official with knowledge of the matter said the camera was a Infinia Hawkeye 4 model, manufactured by General Electric Co. The Hawkeye line is one of the largest on the market and can weigh more than 5,000 pounds.

Mr. Connell said the camera had been used in diagnostic procedures "without incident."

"Our first concern is for our veteran patient and for their family," Mr. Connell said in the statement. " We are in the midst of conducting an investigation and when we have a conclusive report, we will provide more information."

GE Healthcare learned of the incident from the VA, and a company "team has responded and is supporting the ongoing investigation," said Benjamin Fox, a GE spokesman. He didn't respond to questions about whether the company had seen similar failures elsewhere.

Nuclear-medicine physicians use gamma cameras to scan organs such as the lungs and kidneys, and other tissue deep in the body. Doctors inject patients with radioactive fluids; the gamma camera tracks the location of those drugs within the anatomy by collecting radiation they emit from inside the body. By contrast, X-rays fire radiation at the body from the outside to create images. Virtually all major hospitals use gamma cameras, which are a staple of nuclear medicine departments, said Jamie Dildy, an analyst for MD Buyline, a health-care equipment and technology research firm. New models, manufactured by the health-care units of Siemens AG, General Electric and Philips Electronics NV, typically cost between $300,000 and $800,000, she said.

Gamma cameras, which have been in use since the 1960s, consist of large panels of crystal that convert the rays to light. The rest of the device takes a digital picture of the light, not unlike a traditional camera.

The panels, which are often designed to rotate around a prone patient, are generally insulated with thick layers of lead that focus the gamma rays. They weigh "hundreds and hundreds of pounds," said William Spies, a professor of radiology at Northwestern University Feinberg School of Medicine.

But accidents are unusual. "I've been doing nuclear medicine since 1974," Dr. Spies said. "I remember one other incident where a gamma camera fell on a patient." Even that was a long time ago, he said.
I certainly send my condolences to the family of the victim.

I haven't seen any photos of the actual accident site, but here is GE's stock photo of the Infinia Hawkeye 4:

I'm wondering just what they mean by "collapsed"...did one of the acquisition heads work loose from its mountings and fall? Was there undue fatigue in some of the fastening hardware? Did the whole darn gantry tip over?

I can't help but be reminded of the on-line argument I had over emergency CD-ROM's and viruses. It was stated (not by me): "If it were to infect an unprotected computer in a nuclear medicine camera gantry, it could lead to crushing and killing a patient, so you should think long and hard before you boldly insert any outside data into your workstation." I certainly DO NOT think this is what happened here.

I guess we will have to wait for more information.

In the meantime, it might be wise to kick the side of any similar device before getting into it.


My good friend Hussein from Kuwait found the FDA recall notice:

Product:  GE Healthcare Quasar Nuclear Medicine System, Hawkeye Option and Hawkeye 4 Option for Dual-Head Variable Angle Gamma Camera. Nuclear Medicine imaging systems. Recall includes all Infinia systems, all configurations.

Reason for Recall: Accelerated fatigue of the lateral axis motion subsystem of the Infinia Computed Emission Tomography System could result in mechanical failure causing the detector to slide; may impact patient and operators.
Sounds like this is a pretty wide recall. Time for new cameras all around!


It was pointed out to me by the editors of AuntMinnie that the date of the recall was:
Date PostedApril 10, 2013
Uh oh......

Friday, June 07, 2013

NEWS FLASH! TeraRecon Drops Taylor!

Earlier this week, the Board of Directors of TeraRecon has decided to take a new direction, releasing longtime President Robert Taylor, Ph.D., according to several of my sources with a few of Tera's larger customers.

Dr. Taylor's bio on the TeraRecon site has been purged, but here is the cached version:
Robert Taylor, Ph.DPresident and Chief Executive OfficerChairman Dr. Taylor joined TeraRecon in February 2001 with the responsibility for creating and developing the Company’s advanced visualization business in the global market. He received both his B.Sc. (1990) and his Ph.D. (1996) in physics from Imperial College of Science, Technology and Medicine, London, England. From 1999 to 2001, Dr. Taylor served as chief executive officer and director of publicly-traded AccuImage Diagnostics Corp., which was later acquired by Merge Healthcare, Inc. Dr. Taylor currently serves as Chairman, President and Chief Executive Officer (CEO) of TeraRecon, Inc. He has over 15 years of experience with advanced software and technology development and commercialization in a broad range of settings, from advanced clinical applications to distributed healthcare systems.
I'm rather in shock over this...I've met Dr. Taylor on several occasions, and I'm quite convinced his leadership helped make the product line what it is today. As you probably know, we chose TeraRecon over a number of other advanced-imaging vendors after a side-by-side comparison. We have been very pleased with our choice. It integrates quite well with our Agfa PACS, and it is user friendly.  Of course, there has been a learning curve as you would expect with a tool this powerful. Eventually, I'll get around to publishing some of the spectacular images my partners are producing daily.

Such is life in big companies, I guess. I haven't heard directly from Dr. Taylor as yet, but I'm sure he will land on his feet and find another pursuit worthy of his attention. I'll be glad to supply a letter of reference.

No word at this point as to Dr. Taylor's successor.

Wednesday, June 05, 2013

THIS Is What Happens When Patients Have Access To Their Reports

June 5, 2013 -- Earlier this year, two radiologists were physically attacked as they worked in their hospital in Belgium. One of them tells Frances Rylands-Monk, associate editor, about the frightening ordeal, and talks about the lessons for clinical radiologists who are in ever closer contact with patients.
The day had started off like any other. I was steadily working through my morning's reports when my secretary came to tell me that two men were waiting outside to talk to me about an x-ray report I had done. My secretary thought they seemed odd, agitated even. It's not routine, but it's not unusual for me to occasionally discuss images with patients, so I asked her to show them in.

The two Caucasian men entered but refused to sit or take off their gloves, and rejected my offer of a coffee. One of them presented me with a neck x-ray he had undergone three days earlier with a technician and my corresponding report, which stated that the image was "normal." They disagreed with what I had written, were convinced that there was "electric wiring" in the neck cavity, and wanted me to look again and change my report accordingly.

I took a second look, but the x-ray showed nothing strange. I told them I couldn't change the report, as it wouldn't be true. They became angry, moved about my office, shouting and waving their arms, so I got up on the pretext of finding a colleague with whom I could consult about the image. In truth, at that point I felt I needed backup to help me reason with the patient and his companion, and calm them both down. I found another colleague quickly and brought him back to my office. He also looked at the x-ray and told the men we couldn't write about visualizing electrical wire in the neck if it wasn't there.

Radiologists must be vigilant when they talk to patients, and when they feel at risk, discussion should take place in open spaces..

At that point, one of the men said, "You have 10 minutes to change the report, or you will end up like Jesus Christ."

My colleague again refused.

"OK, five minutes," the man insisted.

When my colleague once more told him it wasn't possible, the larger man grabbed him by the neck, pushed him back onto my desk and held him there while the smaller man produced large nails and a hammer from his bag. I ran from my office to find help and was back seconds later, followed by x-ray personnel, and the police were called. By this time, the men had placed a nail on my colleague's hand and had wounded him by partly driving it in, but they ran out when we came in the room, knocking over patients and throwing expensive equipment and computers to the floor as they fled the department. When the police arrived 10 or so minutes later, we were able to provide clear descriptions of the men and identify them from security videos. They were quickly caught in a nearby street and taken into custody.

Get to know your security protocolsThe experience left my colleague traumatized and myself shaken. As radiologists, traditionally away from first-line contact with patients, an unprovoked attack such as this was completely unforeseen -- and unprepared for! It struck me that neither I nor my colleague knew the correct protocol for contacting our own hospital security, or at what point this action should have been taken, if indeed such security protocols even existed in the first place.

Radiologists are being encouraged to become increasingly more clinical, involved with patients at each stage of the diagnostic and therapeutic process; therefore, I wonder if such attacks will become more commonplace as they have in accident and emergency units. Either way, it now seems important for hospital personnel, particularly those working in isolated conditions or late at night (including radiology department staff), to know what to do in this particular emergency. For a hospital that theoretically had security procedures in place, and in which corridors are fitted with closed-circuit TV cameras, it is surprising that this incident happened in the first place. On the plus side, the staff across the entire hospital now knows what they should do when threatened.

Following the incident, our hospital management together with the radiologists decided that unless dealing with an elderly or clearly infirm patient who wouldn't be capable of an attack, one-to-one discussion of images should take place in a public space such as the reporting area (in our hospital an open-plan section of the department where other staff are always present), and not in closed spaces such as personal offices. Second, radiology staff working at night, early in the mornings, or late evenings were issued with special telephones that included a "panic button" that would immediately summon hospital security in dangerous situations.

'Delusional and paranoid'The police psychologist who evaluated our assailants in custody told us later the men were highly intelligent but delusional and paranoid. They had thought Belgian Intelligence had planted wires in one of them for surveillance purposes, and our "refusal to see" these wires on the x-ray meant we were evidently part of the conspiracy. They were committed to a secure hospital for treatment for an indefinite amount of time.

In a way, we were lucky this incident happened during the middle of the day and not at night when there would have been nobody at hand to call. We were also "lucky" that our attackers were carrying a hammer and nails, rather than a knife or a gun. The police were convinced that had this been the case, we would be dead men.

Radiology departments aren't the closed impenetrable places they once appeared to be. It is good to be patient-focused, but with this comes an element of risk. Radiologists must be vigilant when they talk to patients. With those whom radiologists feel at risk, discussion should take place in open spaces, while maintaining a degree of privacy where possible. Both management and staff should ensure security protocols aren't just known in theory, but that they work in practice and that drills are taken seriously. A panic button phone system is a good idea for any hospital, but even without such a mechanism, radiologists should know their hospital's protocol: who to call, how, and when.

Copyright © 2013

Last Updated hh 6/4/2013 12:52:25 PM
OK, this is an extreme case. Still, allowing patients who don't understand what it is they are reading to peruse their charts is a VERY BAD idea. You won't convince me otherwise. Hopefully, none of my victims are lurking out there with a weapon. Or a hammer and some nails...