Bioethics, Volume 36, Issue 2, Page 121-133, February 2022.

One of the dominant behavioral markers of visual-expert search strategy, Holistic Visual Processing (HVP), suggests that experts process information from a larger region of space in conjunction with a more focused gaze pattern in order to improve search speed and accuracy. To date, extant literature suggests that visual search expertise is domain specific, including HVP and its associated behaviors. The current study is the first to use eye tracking to directly measure the HVP strategies of two expert groups, radiologists (...) and architects, in comparison to one another and a novice control. In doing so, we replicated and extended this prior research: visual expertise is domain specific. However, our eye tracking data indicate that contrary to this prior work, HVP strategies are transferable across domains. Yet, despite the transfer of HVP strategies, there is neither reduced search time nor greater accuracy in visual search outside of an expert’s domain. Therefore, our data suggest that HVP behaviors are a particular form of visual search mechanism that, outside of an expert’s native search-ecology, are not necessarily conducive to more general visual search success. It is in addition to explicit knowledge of an expert’s domain, how to search, and where to search, that HVP strategies are their most effective for visual search success. (shrink)

The purpose of this study was to evaluate recognition of pathologists and radiologists as coauthors in case reports in the field of surgical oncology. The MEDLINE database was searched for all full free text case reports involving human material published from April 1, 2011 until March 31, 2016, using search terms: “case report” + “tumors” + “surgery” + “malignant”. The search strategy identified a total of 1427 case reports of which 907 were included in this analysis. Of 807 articles (...) with histopathological images and/or descriptions, 352 did not acknowledge or include the pathologist as a coauthor. Of 662 case reports with radiographic images and/or their description, 537 did not list the radiologist as coauthor nor acknowledge them. In case reports containing histopathological images, significantly more pathologists were either listed as coauthors or acknowledged compared to those who were not. However, among case reports containing radiographic images, there were significantly less articles either listing radiologists as coauthors or acknowledging them compared to a larger proportion of articles in which radiologists were omitted. In conclusion, pathologists and radiologists are underrecognized as coauthors in surgical oncology case reports in spite of obvious proof of their contribution to manuscript preparation. When involved in research and publishing, all physicians should be aware of fair and honest collaboration with specialists in other clinical and non-clinical disciplines to better serve the scientific community. (shrink)

Purpose: The purposes of this study were to assess the knowledge, attitude, and practice of radiologists and paramedics regarding accident and emergency preparedness in hospitals in the southern region of the Kingdom of Saudi Arabia and how to improve their role. Materials and methods: This was a descriptive, cross‑sectional online survey that was carried out among radiologists and paramedics in the Kingdom of Saudi Arabia. A self-structured, close-ended questionnaire that was administered that consisted of 19 questions was included. (...) The questionnaire validity and reliability were evaluated for vetting and remarks. The questions were circulated through Google Forms, and it was circulated among the study participants through online mode. The data were collected systematically, and SPSS Statistics version 26.0 was used for data analysis Results: There were 139 responses, (77 specialist's radiology and 62 paramedics) participated in the study through Google Forms. In the study group, 84 (61.4%) were know the main steps for emergency response in major emergencies (p-value 0.000). Among the 19 questions used to assess the KAP, 12 questions were significant with a p-value less than 0.05. More than 72.6% agree the Management must be adequately prepared when emergencies and accidents occur. The respondents’ attitude toward emergency preparedness was generally positiveو Only a minority, that is, 43 (30.9%) of the respondents think it is possible for cooperation between radiologists and paramedics to interpret emergency cases and develop treatment plans in the emergency department. Conclusion: The level of knowledge was satisfactory among the radiologists and paramedics with a neutral level of attitudes, practice and knowledge regarding disaster preparedness. Follow-up research is essential to maximize the preparedness of the accident and emergency department. (shrink)

Expertise is a cognitive achievement that clearly involves experience and learning, and often requires explicit, time-consuming training specific to the relevant domain. It is also intuitive that this kind of achievement is, in a rich sense, genuinely perceptual. Many experts—be they radiologists, bird watchers, or fingerprint examiners—are better perceivers in the domain(s) of their expertise. The goal of this paper is to motivate three related claims, by substantial appeal to recent empirical research on perceptual expertise: Perceptual expertise is genuinely (...) perceptual and genuinely cognitive, and this phenomenon reveals how we can become epistemically better perceivers. These claims are defended against sceptical opponents that deny significant top-down or cognitive effects on perception, and opponents who maintain that any such effects on perception are epistemically pernicious. (shrink)

Experts from wine tasters to radiologists to bird watchers have all undergone perceptual learning-long-term changes in perception that result from practice or experience. Philosophers have been discussing such cases for centuries, from the 14th-century Indian philosopher Vedanta Desika to the 18th-century Scottish philosopher Thomas Reid, and into contemporary times. -/- This book uses recent evidence from psychology and neuroscience to show that perceptual learning is genuinely perceptual, rather than post-perceptual. It also offers a taxonomy for classifying cases in the (...) philosophical literature. In some cases, perceptual learning involves changes in how one attends; in other cases, it involves a learned ability to differentiate two properties, or to perceive two properties as unified. Connolly uses this taxonomy to rethink several domains of perception in terms of perceptual learning, including multisensory perception, color perception, and speech perception. -/- As a whole, the book offers a theory of the function of perceptual learning. Perceptual learning embeds into our quick perceptual systems what would be a slower task were it to be done in a controlled, cognitive manner. A novice wine taster drinking a Cabernet Sauvignon might have to think about its features first and then infer the type of wine, while an expert can identify it immediately. This learned ability to immediately identify the wine enables the expert to think about other things like the vineyard or the vintage of the wine. More generally, perceptual learning serves to free up cognitive resources for other tasks. This book offers a comprehensive empirically-informed account, and explores the nature, scope, and theoretical implications of perceptual learning. (shrink)

The question of how to handle incidental findings has sparked a heated debate among neuroimaging researchers and medical ethicists, a debate whose urgency stems largely from the recent explosion in the number of imaging studies being conducted and in the sheer volume of scans being acquired. Perhaps the point of greatest controversy within this debate is whether the magnetic resonance imaging scans of all research participants should be reviewed in an active search for pathology and, moreover, whether this search should (...) be performed by a radiologist. Resistance to routine readings performed by radiologists, as opposed to selective review of those scans on which investigators have spotted a possible IF, has been fueled in part by the obvious and enormous cost — financial and logistical — of engaging radiologists to read massive numbers of scans. This cost would be especially burdensome, even prohibitive, to investigators who are not affiliated with a medical center, because of their limited access to radiologists and other medical expertise. (shrink)

This article analyzes how the medical gaze made possible by MRI operates in radiological laboratories. It argues that although computer-assisted medical imaging technologies such as MRI shift radiological analysis to the realm of cyborg visuality, radiological analysis continues to depend on visualization produced by other technologies and diagnostic inputs. In the radiological laboratory, MRI is used to produce diverse sets of images of the internal parts of the body to zero in and visually extract the pathology. Visual extraction of pathology (...) becomes possible, however, because of the visual training of the radiologists in understanding and interpreting anatomic details of the whole body. These two levels of viewing constitute the bifocal vision of the radiologists. To make these levels of viewing work complementarily, the body, as it is presented in the body atlases, is made notational. (shrink)

This is the first book to explore the epistemology and ethics of advanced imaging tests, in order to improve the critical understanding of the nature of knowledge they provide and the practical consequences of their utilization in healthcare. Advanced medical imaging tests, such as PET and MRI, have gained center stage in medical research and in patients’ care. They also increasingly raise questions that pertain to philosophy: What is required to be an expert in reading images? How are standards for (...) interpretation to be fixed? Is there a problem of overutilization of such tests? How should uncertainty be communicated to patients? How to cope with incidental findings? This book is of interest and importance to scholars of philosophy of medicine at all levels, from undergraduates to researchers, to medical researchers and practitioners (radiologists and nuclear physicians) interested in a critical appraisal of the methodology of their discipline and in the ethical principles and consequences of their work. -/- . (shrink)

Studies in the neurobiological underpinnings of social information processing bypsychologists, neurobiologists, psychiatrists, radiologists, and neurologists, using methods thatrange from brain imaging techniques to comparative analyses.

In this issue, Pila (2009) has criticised the recommendations made by requirements engineers involved in the design of a grid technology for the support of distributed readings of mammograms made by Jirotka et al. (2005). The disagreement between them turns on the notion of “biographical familiarity” and whether it can be a sound basis for trust for the performances of professionals such as radiologists. In the first two sections, this paper gives an interpretation of the position of each side (...) in this disagreement and their recommendation for the design of technology for distributed reading, and in the third the underlying reasons for this disagreement are discussed. It is argued that Pila, in attempting to make room for mistrust as well as trust, brings to the fore the question of having and reflecting upon reasons for trust or mistrust. Pila holds that biographical familiarity is not a sound reason for trust/mistrust, as it seems to obliterate the possibility of mistrust. In response to her proposal, an analysis is proposed of the forms of trust involved in biographical familiarity. In particular, implicit trust is focused upon—as a form of trust in advance of reasons, and as a form of trust contained (in the logical sense) within other reasons. It is proposed that implicit trust has an important role in establishing an intersubjectively shared world in which what counts as a reason for the acceptability of performances such as readings of X-rays is established. Implicit trust, therefore, is necessary for professionals to enter into a “space of reasons”. To insist upon judgements made in the absence of the form of implicit trust at play in biographical familiarity is to demand that radiologists (and other relevantly similar professionals) make judgements regarding whether to trust or mistrust on the basis of reasons capable of being reflected upon, but at the same time leave them without reasons upon which to reflect. (shrink)

Human subject research involving brain imaging is likely to reveal signifcant incidental fndings of abnormal brain morphology. Because of this fact and because of the fduciary relationship between researcher and subject, board-certi-fed or board-eligible radiologists should review the scans to look for any abnormality, the scans should be conducted in accordance with standard medical practice for reviewing the clinical status of the whole brain, and the informed consent process should disclose the possibility that incidental fndings may be revealed and (...) what consequences will follow. In the event such fndings are revealed, qualifed physicians should explain to the subject the signifcance of the fndings and the alternatives available. (shrink)

According to Peter Galison , science has a highly fractionated structure with multiple sub-sub-disciplines, each with its own agenda. Cooperative trading between groups is necessary for most scientific work to move forward, and it is this trading that preserves the stability of science. We argue that it is not trading per se, but trading in a gift economy that guarantees stability. We support our claims with an examination of contemporary work on magnetic resonance imaging instrumentation. Specifically, we consider: How a (...) feature improvement, intended to reduce scan time, led to substantial medical mis-diagnosis; How a technical error, when corrected, created a consumer crisis in which radiologists preferred technically flawed instruments; How new magnetic resonance theory radically altered the physical interpretation of MRI images; How the MRI instrument at first was financially supported by, and--ironically--ultimately invalidated, the accepted understanding of the nature, source and management of chronic back pain. Ultimately there are three reasons stability requires gifting. First, without a general sense of shared purpose traders will not be committed to mutual engagement; profit does not provide an adequate shared purpose for the MRI community. Second, stability requires trust, and profits are not an adequate foundation for trust. Finally, knowledge is a gift that will not keep on giving if treated simply as a source of profit. (shrink)

Shortly after X-ray technology was discovered, it was utilized in war medicine. In this paper, the authors consider how the challenging context of war created fertile conditions for learning, as early radiologists were forced to find solutions to the unique problems posed during wartime. The “battlefield” became the “classroom” where radiologists constructed knowledge in X-ray instrumentation, methods, and education, as well as in medicine generally. Through an examination of two broad historical wartime examples, the authors illustrate how X-rays (...) were used as part of war medicine and offer a detailed sketch of instances of knowledge construction in war radiology. With a sociology of knowledge perspective, they conclude that the knowledge generated in war belongs also to civilian medicine. An understanding of war radiology’s role as a “springboard” for knowledge construction is thus crucial for a complete understanding of the history of radiology. (shrink)

In a recent paper, Pila has criticised the recommendations made by requirements engineers involved in the design of a grid technology for the support of distributed readings of mammograms made by Jirotka et al. The disagreement between them turns on the notion of ‘biographical familiarity’ and whether it can be a sound basis for trust for the performances of professionals such as radiologists. In the first two sections, the paper gives an interpretation of the position of each side in (...) this disagreement and their recommendation for the design of technology for distributed reading, and in the third the underlying reasons for this disagreement are discussed. It is argued that Pila, in attempting to make room for mistrust as well as trust, brings to the fore the question of having and reflecting upon reasons for trust or mistrust. Pila holds that biographical familiarity is not a sound reason for trust/mistrust, as it seems to obliterate the possibility of mistrust. In response to her proposal, an analysis is proposed of the forms of trust involved in biographical familiarity. In particular, implicit trust is focused upon, as a form of trust in advance of reasons, and as a form of trust contained within other reasons. It is proposed that implicit trust has an important role in establishing an intersubjectively shared world in which what counts as a reason for the acceptability of performances such as readings of x-rays is established. Implicit trust, therefore, is necessary for professionals to enter into a ‘space of reasons’. To insist upon judgements made in the absence of the form of implicit trust at play in biographical familiarity is to demand that radiologists make judgements regarding whether to trust or mistrust on the basis of reasons capable of being reflected upon, but at the same time to leave them without reasons upon which to reflect. (shrink)

The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles ofnon-maleficence, beneficence, AutonomyandJusticeas an analytic framework.Suboptimal referrals can causeharmby (...) hindering safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patientbenefitsfrom the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patientautonomyis compromised from the lack of information needed to facilitate benefit–risk communication. Finally, suboptimal referrals challengejusticebased on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct. (shrink)

After the U.S. dropped atomic bombs on Hiroshima and Nagasaki in Japan in 1945, both nations experienced a profound need for a new and encompassing story of what it meant to be Japanese, and to be American, in the permanent nuclear age. This article is a thought experiment to juxtapose the writings and personas of two people who helped their respective societies answer those needs and questions during the early Cold War: Takashi Nagai—medical radiologist, and survivor of the American atomic (...) bombing of Nagasaki, and Albert Wohlstetter—leading American civilian nuclear strategist for the RAND Corporation in the 1950s. Using a combination of mythopeic analysis, biography and illuminative juxtaposition, the study discovers surprising similarities and analogies between the two cases. They each enact and propose interesting variations of sacrificial causalities—claims that human nuclear sacrifices past or promised can bring peace by deterrence now or peace by abolition soon enough. This is an important study now, as both Japan’s nuclear pacifism and the American nuclear umbrella in Northeast Asia are coming under more severe questioning than perhaps ever before. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:An Encounter with the Art and Science of MedicineAnonymous Five“Let Nothing Upset YouLet Nothing Frighten YouEverything is ChangingOnly God is Changeless”—St. Theresa of AvilaSt. Teresa’s prayer is on the front cover of each of four binders dedicated to storing insurance authorizations, studies, references, and reports about our daughter’s brain tumor treatment. They represent our experience, what we learned, the information we were given, and the information we sought out. (...) I kept them in case our daughter ever wanted to understand how my husband and I arrived at a decision for her treatment that was in direct opposition to the strong recommendation of her primary treatment team of physicians.On December 10, 2003, I received an urgent call from our daughter’s neurologist requesting that we meet with the doctor late that afternoon. For six months prior to that appointment, our daughter had been telling us about odd sensations with breathing, nausea, and balance. Sometimes she would seem extremely distressed for a short period of time or report that her friends told her about doing or saying things that didn’t make sense and that she didn’t remember. We consulted a series of physicians as her symptoms became steadily more intense and more prevalent. Our family practice physician referred us to an allergy specialist and a pulmonologist. There were a number of tests for allergies and lung problems. As the tests and treatments did not help, our daughter became increasingly unwilling to go to doctor’s appointments. My husband and I were confused and deeply concerned about the lack of progress. The next series of referrals included a gastroenterologist and a neurologist. The gastroenterologist suggested our daughter had partial–complex epilepsy, concurred with our plan to see a neurologist, and mentioned she should have an MRI.I remember the neurologist putting the MRI scans up, pointing to the large dark spot which he called a “large mass” (5 cm), that could be either a cluster of blood vessels or a neoplasm. He said his office had arranged for us to meet a neurosurgeon the following day. We all remember the same thing about that visit—the image of the large dark mass on the scan—and the neurologists flat, brisk tone. We met with the neuro-surgeon the next day. Her team was kind and sympathetic—she was positive, up beat and direct. She did not think this mass was blood vessels. She thought it was a large tumor that needed to be removed right away. Our daughters surgery was scheduled for the following Friday—December 19, 2003. She had turned 15 on November 5.Four and a half hours after our daughter was wheeled into the operating room, her surgeon told us they had removed 98% of the tumor. She said there was no cure, but there was a good prognosis based on the surgical outcome. Several days later, she called us and said she had more data, and it looked like the resection was closer to 90%. The first pathology report, a “first impression” directly after surgery, described our daughter’s tumor as an astrocytoma, probably high grade. Three weeks after surgery, we met with a panel of doctors—two oncologists and radiologist—who explained that based on the final pathology report, our daughter’s tumor was classified as an ependymoma, grade 2. We were dismayed. First, there had been the change in the estimated success of the resection and now a complete shift in both grade and tumor type.The team recommended radiation to follow her surgery, which they said was standard treatment. We began to try to inform ourselves about her tumor. Her father, an agronomist, did an extensive search in PubMed to evaluate and sort through the literature on low–grade gliomas and radiation. What he could find was inconclusive and grim. Most reports in the literature suggested at best delayed mortality at five years after radiation. [End Page E7] Meanwhile, our daughter went through a spinal MRI and the preparatory “fitting” of the mask to immobilize her head during radiation.E7I consulted with a friend who had worked as an EKG tech. She urged... (shrink)

Computational design uses artificial intelligence (AI) to optimise designs towards user-determined goals. When combined with 3D printing, it is possible to develop and construct physical products in a wide range of geometries and materials and encapsulating a range of functionality, with minimal input from human designers. One potential application is the development of bespoke surgical tools, whereby computational design optimises a tool’s morphology for a specific patient’s anatomy and the requirements of the surgical procedure to improve surgical outcomes. This emerging (...) application of AI and 3D printing provides an opportunity to examine whether new technologies affect the ethical responsibilities of those operating in high-consequence domains such as healthcare. This research draws on stakeholder interviews to identify how a range of different professions involved in the design, production, and adoption of computationally designed surgical tools, identify and attribute responsibility within the different stages of a computationally designed tool’s development and deployment. Those interviewed included surgeons and radiologists, fabricators experienced with 3D printing, computational designers, healthcare regulators, bioethicists, and patient advocates. Based on our findings, we identify additional responsibilities that surround the process of creating and using these tools. Additionally, the responsibilities of most professional stakeholders are not limited to individual stages of the tool design and deployment process, and the close collaboration between stakeholders at various stages of the process suggests that collective ethical responsibility may be appropriate in these cases. The role responsibilities of the stakeholders involved in developing the process to create computationally designed tools also change as the technology moves from research and development (R&D) to approved use. (shrink)

Pila (2009) has criticised the recommendations made by requirements engineers involved in the design of a grid technology for the support of distributed readings of mammograms made by Jirotka et al. (2005). The disagreement between them turns on the notion of “biographical familiarity” and whether it can be a sound basis for trust for the performances of professionals such as radiologists. In the first two sections, this paper gives an interpretation of the position of each side in this disagreement (...) and their recommendation for the design of technology for distributed reading, and in the third the underlying reasons for this is agreement are discussed. It is argued that Pila, in attempting to make room for mistrust as well as trust, brings to the fore the question of having and reflecting upon reasons for trust or mistrust. Pila holds that biographical familiarity is not a sound reason for trust/mistrust, as it seems to obliterate the possibility of mistrust. In response to her proposal, an analysis is proposed of the forms of trust involved in biographical familiarity. In particular, implicit trust is focused upon — as a form of trust in advance of reasons, and as a form of trust contained (in the logical sense) within other reasons. It is proposed that implicit trust has an important role in establishing an intersubjectively shared world in which what counts as a reason for the acceptability of performances such as readings of X-rays is established. Implicit trust, therefore, is necessary for professionals to enter into a “space of reasons”. To insist upon judgements made in the absence of the form of implicit trust at play in biographical familiarity is to demand that radiologists (and other relevantly similar professionals) make judgements regarding whether to trust or mistrust on the basis of reasons capable of being reflected upon, but at the same time leave them without reasons upon which to reflect. (shrink)

What does the word clinic mean? The clinic is first a place to diagnose and treat sick persons. The clinic is also a way of thinking and speaking; it is a discursive practice that links health with knowledge. For Michel Foucault the clinic is a mode of perception and enunciation that allows us to see and name disease and to place statements about illness among statements about birth and death. Within the clinic resides understanding of disease visible on the surface, (...) yet hidden within the tissual depths, of an ailing patient. Foucault shows that by the dawn of the nineteenth-century medicine is no longer a two-dimensional reading of symptoms, but a three-dimensional probing from symptomatic surface into disease interior. The anatomical site of disorder hidden within tissual depths is visible to the scrutiny of pathologist, endoscopist or radiologist. The clinic, a discourse that enables us to think about disease when we make statements about health and death, operates not only in its familiar textual domain, the medical journal, but in pictures of the scene at the sickbed, and poetry about disease. The truth of disease and placement of that truth in a general plan of the world in Renaissance woodcuts and John Donne's poetry is different from the regime of truth after the birth of the clinic in Bichat'sTreatise on Membranes, the paintings of Laennec, Agnew and Gross, the modern lithographs and the verse of Walt Whitman and L. E. Sissman. Foucault's clinic is where knowledge and sickness some together in the modern period. (shrink)

After his father passed away, James Nolan's mother gave him a box of materials that his dad had kept private. To Nolan's complete surprise, the contents revealed the role his grandfather had played as a doctor in the Manhattan Project. Dr. Nolan, it turned out, had been a significant figure. A talented radiologist, he cared for the scientists on the Project, helped organize the safety and evacuation plans for the Trinity Test at Alamogordo, escorted the "Little Boy" bomb from Los (...) Alamos to Japan, and was one of the first Americans to enter the irradiated ruins of Hiroshima and Nagasaki. The documents set Nolan on a hunt for more information about his grandfather and more generally about the conflicted role that medical personnel played in the early years of atomic testing. The result is a compelling history of the dawn of the atomic age as seen through the eyes of men and women torn between their duty and desire to win the war and their oath to protect life. Nolan follows his grandfather and medical colleagues as they seek to maximize safety while serving leaders determined to minimize delays, and as they consider the ethics of ending the deadliest of all wars with the most lethal of all weapons. The result, Nolan shows, was a very human pattern of caution, co-optation, and complicity. A vital and vivid account of a largely unknown chapter in atomic history, Delivering Little Boy is also a profound meditation on the professional and moral dilemmas that ordinary people face in extraordinary times. (shrink)

An empirical study of human expert reasoning processes is presented. Its purpose is to test a model of how a human expert's cognitive system learns to detect, and does detect, pertinent data and hypotheses. This process is called pertinence generation. The model is based on the phenomenon of spreading activation within semantic networks. Twenty‐two radiologists were asked to produce diagnoses from two very difficult X‐ray films. As the model predicted, pertinence increased with experience and with semantic network integration. However, (...) the experts whose daily work involved explicit reasoning were able, in addition, to go beyond and to generate more pertinence. The results suggest that two qualitatively different kinds of expertise, basic and super, should be distinguished. A reinterpretation of the results of Lesgold et al. (1988) is proposed, suggesting that apparent nonmonotonicities in performance are not representative of common radiological expertise acquisition but result from the inclusion of basic and super expertise on the same curve. (shrink)

Rheumatoid arthritis is a progressive systemic autoimmune disease characterized by inflammation of the joints and surrounding tissues, which seriously affects the life of patients. The Sharp/van der Heijde method has been widely used in clinical evaluation for the RA disease. However, this manual method is time-consuming and laborious. Even if two radiologists evaluate a specific location, their subjective evaluation may lead to low inter-rater reliability. Here, we developed an efficient model powered by deep convolutional neural networks to solve these (...) problems and automated the overall scoring on hand X-rays. The depthwise separable convolution technique is used based on ResNet-50 due to the high resolution of hand X-rays. An inverted residual block is introduced to devise a ResNet-Dwise50 model to enhance the efficiency of the model. The model was trained and tested using bilateral posteroanterior images of 3818 patients. The experiment results show the ResNet-Dwise50 model achieved an MAE of 14.90 and RMSE of 22.01 while ensuring high efficiency. There was no statistical difference between the average scores given by two experienced radiologists and predicted scores from our model. (shrink)

The article is based on research conducted at the actual radiology department. It presents a range of descriptions and analyses of concrete operations performed by radiologists during their daily professional routine. After careful ethnographic observations, phenomenological analysis is employed with a view to examining the enactive cognition in the radiologist’s “life-world”. The paper uses both ethnography and phenomenology in order to reveal the essential regularities and sedimentations of everyday radiological processes, and the “everyday background” of certain scientific-cognitive operations. The (...) method of research includes “enactive proofs”— observations and analysis of the externalization of a radiologist’s professional memory through the enaction of medical imaging and imageconsciousness. The findings of this research have much to offer to both philosophy and radiological praxis. While the observations strongly support the development of enactive phenomenology, critique of representationalism, primacy of inference in cognition, and shared intentions, they also provide insight into concrete operations in coping with radiology’s paraphernalia, habituality, the origin of mistakes, multilayered communication, and improving professional praxis. (shrink)

The progressive dissemination of artificial intelligence (AI) systems in work settings raises numerous questions and concerns regarding their consequences, whether positive or negative, on work activities and organizations. This paper presents an empirical study that was designed to identify and analyze these consequences in radiology. This study focuses on two AI systems: a voice recognition dictation system for radiological reports and a system for detecting fractures on X-rays images. Based on a qualitative analysis of field observations of work activities and (...) interviews with radiologists, emergency physicians, and medical secretaries, our findings help to provide a nuanced view on how AI may affect work in this sector. In contrast to the speculative discourse where AI is seen as a “positive” technology or as “threat” for workers, this study shows, on the one hand, how these kinds of AI systems help or may help these workers in their activities, and, on the other hand, how these systems raise problematic issues regarding their consequences not only for physicians but also for other workers such as medical assistants. (shrink)

Background: Falls in older adults are a major public health problem. White matter hyperintensities are highly prevalent in older adults and are a risk factor for falls. In the absence of a cure for WMHs, identifying potential strategies to counteract the risk of WMHs on falls are of great importance. Physical activity is a promising countermeasure to reduce both WMHs and falls risk. However, no study has yet investigated whether PA attenuates the association of WMHs with falls risk. We hypothesized (...) that PA moderates the association between WMHs and falls risk.Methods: Seventy-six community-dwelling older adults aged 70–80 years old were included in this cross-sectional study. We indexed PA using the Physical Activity Score for the Elderly Questionnaire. Falls risk was assessed using the Physiological Profile Assessment, and WMH volume was determined by an experienced radiologist on T2-weighted and PD-weighted MRI scans. We first examined the independent associations of WMH volume and PASE score with PPA. Subsequently, we examined whether PASE moderated the relationship between WMH volume and PPA. We plotted simple slopes to interpret the interaction effects. Age, sex, and Montreal Cognitive Assessment score were included as covariates in all models.Results: Participants had a mean age of 74 years and 54 were female. Forty-nine participants had a Fazekas score of 1, 19 had a score of 2, and 6 a score of 3. Both PASE and WMH volume were each independently associated with PPA score. The interaction model indicated that PASE score moderated the association between WMH volume and PPA, whereby higher PASE score attenuated the association between WMHs and falls risk.Conclusion: PA is an important moderator of falls risk. Importantly, older adults with WMH can reduce their risk of falls by increasing their PA. (shrink)

In the outpatient ultrasound suite of a major urban medical center, the mood is somber. A young woman lies tense and anxious. Pregnant for the first time, she has experienced early first-trimester bleeding. The radiologist relates the ultrasound findings: there has been a small hemorrhage, but there is a six-week-size fetus with normal cardiac activity. Translation: the baby is alive! The woman quietly sobs, happy but apprehensive.Across the drive, in the main hospital building, a young boy lies unresponsively comatose in (...) the Pediatric Intensive Care Unit. He was hit by a car while riding his bicycle. He is relying on a ventilator to breath, but his cardiovascular system is supporting itself. After a series... (shrink)

Introduction: It is essential to detect sacroiliitis earlier to decrease morbidity and unwanted complications such as ankylosing of sacroiliac joints. In recent studies, magnetic resonance imaging (MRI) serves as a key diagnostic tool for identifying sacroiliitis and is now included in the diagnostic criteria. We aim to detect the utility of diffusion-weighted imaging on the MRI in diagnosing sacroiliitis and measure ADC values for the response to treatment in future studies. Materials -methods: There were 39 patients (16 male, 20 female). (...) A 1.5 Tesla MR device with a pelvic coil was used. The sequences were T1 (before and after intravenous contrast administration of gadolinium), T2-weighted fast field echo, short tau inversion recovery (STIR), diffusion-weighted (DW) images, and apparent diffusion coefficient (ADC) mapping. Sacroiliac joints were divided into four quadrants, and two radiologists interpreted all the sequences by giving scores from 0 to 3 depending on bone marrow edema from none to severe. The concordance of scores assigned to STIR, T1-weighted gadolinium-enhanced images, ADC mapping, and diffusion-weighted MR images was evaluated by calculating intraclass correlation coefficients. Results: A statistically significant positive correlation was observed between the activity scores derived from short tau inversion recovery (STIR) and other magnetic resonance (MR) sequences, namely T1-weighted gadolinium-enhanced images, apparent diffusion coefficient (ADC) mapping, and diffusion-weighted MR images. Conclusion: Active bone marrow abnormalities were identified with comparable efficacy using STIR imaging and other MR sequences (T1W-Gad, ADC mapping, DW-MR). In our study, we tried to emphasize the role of the diffusion-weighted images near the other sequences. Diffusion is a fast, easy-applied sequence. After increased experience in the diffusion-weighted images, routine application of this sequence will increase, and even becoming one of the diagnostic criteria will be inevitable. The difference in DWI from the other sequences is that it is measurable. The response to treatment may be followed up by ADC values. (shrink)

Important lessons must be learned from the Bristol inquiryI was disturbed when I first read the following in an October 1998 issue of the Medical Journal of Australia."In June 1998, the Professional Conduct Committee of the General Medical Council of the United Kingdom concluded the longest running case it has considered [this] century. Three medical practitioners were accused of serious professional misconduct relating to 29 deaths in 53 paediatric cardiac operations undertaken at the Bristol Royal Infirmary between 1988 and 1995. (...) All three denied the charges but, after 65 days of evidence over eight months , all three were found guilty." "The doctors concerned are Mr James Wisheart, a paediatric and adult cardiac surgeon and the former Medical Director of the United Bristol Healthcare Trust; Mr Janardan Dhasmana, paediatric and adult cardiac surgeon; and Dr John Roylance, a former radiologist, and Chief Executive of the Trust." "The central allegations were that the Chief Executive and the Medical Director allowed to be carried out, and the two paediatric cardiac surgeons carried out, operations on children knowing that the mortality rates for these operations, in the hands of these surgeons, were high. Furthermore, the surgeons were accused of not communicating to the parents the correct risk of death for these operations in their hands.1"Mr Wisheart and Dr Roylance were subsequently struck off the medical register. Mr Dhasmana was disqualified from practising paediatric cardiac surgery for three years. The doctors required police protection as they left the General Medical Council hearing as furious parents shouted “murderer” and “bastard”.2Why did this occur?Dr Stephen Bolsin has presented a …. (shrink)

The article is based on research conducted at Le Bonheur Children’s Hospital, Radiology Department (Memphis, Tennessee, USA). It examines embodied cognition embedded in radiological diagnostics relating image perception with normative judgment constitution. The research follows the causal thesis in that it is possible to grasp categories and causality via visual experience (causal impressions) and language (causal verbs), which in turn heavily depends on strategies of the enaction of imaging technology and intersubjective corroboration. In this way, the pre-reflective and intersubjective constitution (...) of categorial fulfillments of diagnostic experiences is disclosed by phenomenological ethnography of radiologists’ praxis showing how professional knowledge is structurally interrelated with certain kinesthetic and kinetic experiences, multilayered image apprehension and enactive metaphors. (shrink)

This paper aims to trace individual as well as collective aspects of ‘sight styles’ in diagnostic computed tomography. Radiologists need to efficiently translate the visualized data from the living human body into a reliable and significant diagnosis. During this process, their visual thinking and the created images are incorporated into a complex network of other visualizations, communication strategies, professional traditions, and (tacit) visual knowledge. To investigate the interplay of collective as well as individual dimensions of diagnostic seeing, the concept (...) of ‘sight collective’ (Sehkollektiv) is developed. On the one hand, this concept is based on critical reading of Ludwik Fleck’s epistemological writings and his notions of thought collective (Denkkollektiv) and thought style (Denkstil). On the other hand, it is tested by means of qualitative empirical studies in a radiological university clinic (participatory observations and informal interviews). By employing this approach, the paper traces the collective foundations of a certain diagnostic sight. Moreover, it shows how the individual abilities of radiologists to perform stylized seeing rely remarkably on software-based interactions with the processed images and on tacit dimensions of visual knowledge. (shrink)

Hospital waiting lists are a feature ofpublicly funded health services that resultswhen demand appears to exceed supply. Whilemuch has been written about hospital waitinglists, little is known about the dynamics ofdiagnostic waiting lists, or more generally whyhospital waiting lists behave in perverse andoften counter-intuitive ways. This paperattempts to address this gap by applying arecent development in critical systems thinkingcalled boundary critique to understand how aparticular ultrasound waiting list was managed.A new waiting list metaphor based on waitinglists as ritual forms is (...) proposed. (shrink)