Category: Technology

Getting physicians to think seriously about radiation exposure

published date
April 26th, 2007 by

I’ve mentioned a few times on this blog that I’m concerned about the levels of radiation patients are being exposed to as a result of medical imaging, especially CT. Radiologists and referring physicians haven’t taken the issue too seriously because:

  • The scans are useful and, of course, well reimbursed
  • They weren’t aware of the issue
  • There’s generally no easy way to track how much radiation patients have been exposed to

I’ve reported on anecdotal evidence of radiation exposure in the past, and ways to reduce dosages by adjusting scanners. Now a study has reported overall information on exposure. The numbers are high: per capita exposure is up 6x since 1980, and it’s disproportionately due to CT.

Consciousness raising among physicians is a good first step, but patients need to keep track of their own exposure and work in conjunction with their physicians to balance risks and benefits. One thing that’s really unacceptable is having a scan repeated because a previous one is lost or inaccessible.
I’ve always thought one good use of a personal health record is to keep track of lifetime radiation exposure, even if the numbers are just estimates. (The real figures would be even better.) I haven’t seen this functionality yet, though maybe it exists somewhere.

Guarding against overexposure to radiation

published date
April 13th, 2007 by

I’m happy to see radiologists talking about strategies to minimize radiation exposure in these articles: Strategies for reducing ‘dose creep’ in digital x-ray and Study suggests ways to cut CR radiation.

Most patients have no idea how much radiation they’ve been exposed to and their doctors don’t know either. I’ve always thought one of the useful elements of a personal health record would be a radiation exposure diary to measure cumulative dose. These articles are about digital X-ray, but CT is a bigger problem.

The wisdom of wikis

published date
April 9th, 2007 by

Thanks to Mickey for these thoughts on wikis.

From the New York Times (Open-Source Spying)

When Matthew Burton arrived at the Defense Intelligence Agency in January 2003, he was excited about getting to his computer. Burton, who was then 22, had long been interested in international relations: he had studied Russian politics and interned at the U.S. consulate in Ukraine, helping to speed refugee applications of politically persecuted Ukrainians. But he was also a big high-tech geek fluent in Web-page engineering, and he spent hours every day chatting online with friends and updating his own blog. When he was hired by the D.I.A., he told me recently, his mind boggled at the futuristic, secret spy technology he would get to play with: search engines that can read minds, he figured. Desktop video conferencing with colleagues around the world. If the everyday Internet was so awesome, just imagine how much better the spy tools would be.

But when he got to his cubicle, his high-tech dreams collapsed. “The reality,” he later wrote ruefully, “was a colossal letdown.”

The spy agencies were saddled with technology that might have seemed cutting edge in 1995. When he went onto Intelink — the spy agencies’ secure internal computer network — the search engines were a pale shadow of Google, flooding him with thousands of useless results.

They decided to try wikis and blogs:

Intelligence heads wanted to try to find some new answers to this problem. So the C.I.A. set up a competition, later taken over by the D.N.I., called the Galileo Awards: any employee at any intelligence agency could submit an essay describing a new idea to improve information sharing, and the best ones would win a prize. The first essay selected was by Calvin Andrus, chief technology officer of the Center for Mission Innovation at the C.I.A. In his essay, “The Wiki and the Blog: Toward a Complex Adaptive Intelligence Community,” Andrus posed a deceptively simple question: How did the Internet become so useful in helping people find information?

Andrus argued that the real power of the Internet comes from the boom in self-publishing: everyday people surging online to impart their thoughts and views. He was particularly intrigued by Wikipedia, the “reader-authored” encyclopedia, where anyone can edit an entry or create a new one without seeking permission from Wikipedia’s owners. This open-door policy, as Andrus noted, allows Wikipedia to cover new subjects quickly. The day of the London terrorist bombings, Andrus visited Wikipedia and noticed that barely minutes after the attacks, someone had posted a page describing them. Over the next hour, other contributors — some physically in London, with access to on-the-spot details — began adding more information and correcting inaccurate news reports. “You could just sit there and hit refresh, refresh, refresh, and get a sort of ticker-tape experience,” Andrus told me. What most impressed Andrus was Wikipedia’s self-governing nature. No central editor decreed what subjects would be covered. Individuals simply wrote pages on subjects that interested them — and then like-minded readers would add new facts or fix errors. Blogs, Andrus noted, had the same effect: they leveraged the wisdom of the crowd. When a blogger finds an interesting tidbit of news, he posts a link to it, along with a bit of commentary. Then other bloggers find that link and, if they agree it’s an interesting news item, post their own links pointing to it. This produces a cascade effect. Whatever the first blogger pointed toward can quickly amass so many links pointing in its direction that it rockets to worldwide notoriety in a matter of hours.

The obvious hole in this approach is security. The spooks set up several levels of access, but concern remains that someone will compromise the information. There is no perfect solution to the problem but here are two ways of making it likely that people misusing information will get caught:

1. Learn from similar situations in medicine, where doctors have wide access to medical information but their use is tracked. Misuse happens, but the people can be nailed, as illustrated in the instance of President Clinton at Columbia Presbyterian.

2. Learn from dealing with officials leaking to journalists by providing slightly different versions to different readers, as has been used to catch leakers.

DNA snatchers

published date
April 5th, 2007 by

Mickey was alarmed by the behavior documented in Stalking Strangers’ DNA to Fill in the Family Tree and sent me this commentary:

To do DNA tests on a patient, a doctor needs to get consent from a patient, and sometimes from an Institutional Review Board.  Outside of medicine, the atmosphere is somewhere between the Wild West and Transylvania:

They swab the cheeks of strangers and pluck hairs from corpses. They travel hundreds of miles to entice their suspects with an old photograph, or sometimes a free drink. Cooperation is preferred, but not necessarily required to achieve their ends.

Derrell Teat, 63, a wastewater coordinator, recently found herself staking out a McDonald’s. The man she believed was the last male descendant of her great-great-great grandfather’s brother had refused to give her his DNA. So she decided to get it another way.

“I was going to take his coffee cup out of the garbage can,” said Ms. Teat, who traveled to the Georgia mountains from Tampa, Fla., with her test kit. “I was willing to do whatever it took.”

The talismans come mostly from people trying to glean genealogical information on dead relatives. But they could also be purloined from the living, as the police do with suspects. The law views such DNA as “abandoned.”

“If you won’t give me your DNA but I run after your cigarette butt and I don’t contaminate it, can we get your DNA?” said Bennett Greenspan, president of Family Tree DNA, which nearly doubled its kit sales last year. “The answer is yes.”

We’ll see if that remains the case after people see what is going on.  If a doctor did that to a patient without consent they would be violating the patient’s rights.  What is next?  Stalking that cousin who doesn’t look like the rest of the family?

Rebekah Lloyd, 53, of Denver wrestles with her conscience as she plots to visit an 86-year-old aunt, who has dementia. “I feel a little like a DNA vampire,” Ms. Lloyd said. But her aunt’s cells, Ms. Lloyd believes, may hold crucial confirmation of her own American Indian ancestry.

Bob Grieve, 55, stores a DNA kit in his refrigerator to use upon his father’s death.

After testing his own DNA at the request of a distant cousin, Mr. Grieve was shaken to discover that he did not match any of his extended family, including his first cousin, the son of his father’s brother.

That could only mean an occurrence of what genetic genealogists call a “nonpaternal event.” Either his father was not his father, or his grandfather was not his father’s father. But the elder Mr. Grieve has refused to surrender to the swab.

Wal-Mart, U of AR, BCBS AR partner on health care IT

published date
March 28th, 2007 by

Wal-Mart is partnering with the University of Arkansas and Blue Cross Blue Shield of Arkansas to establish the Center for Innovation in Health Care Logistics. According to the press release:

The Center’s initial work will address information technology-based innovations for bringing visibility and tracking to every level of health care procurement and distribution processes.

Experience shows that such transparency leads to significant cost savings by eliminating duplication and confusion, enhancing collaboration among participating organizations and avoiding mistakes that can lead to dangerous errors.

Health care will definitely benefit from Wal-Mart’s expertise in supply chain management. It will be interesting to see where this leads. Wal-Mart’s committing just $1 million over five years, which may buy a lot generics at a Wal-Mart but won’t cover too many researchers. The Center plans to raise additional funds to cover its operations.