Posted in Work stuff

About 6 weeks ago, I accepted a research associate position at Duke University. A big jump for me, although mostly in a lateral direction.

My current employer, the Radiology Department at MUSC, likes me so much that they're trying to tempt me to stay with a substantial increase in salary.

Should I stay, even though I've already accepted the new job, or go on to newer fresher pastures and new challenges. It's a tough decision to make, more so because I don't think either decision will be a bad one.

My wife is spending the summer working in a medical research lab, part of a summer research program at MUSC for undergraduate students. She's got mice to take care of as part of her research project, which means working late during the day, then making another trip in sometime in the evening to do more things with the mice.

State inspectors are going to be cruising through the department the rest of the week on one of their bi-annual surveys. This means there are a lot of people scurrying about (myself included) making sure that everything is where it needs to be, and stuff that needs to be posted is posted. And then later on this year, I think there's supposed to be a JCAHO survey going on. Luckily for me, I think I'll be gone by the time that happens.

The Exploranium GR-135 we've been waiting for finally arrived. It's a radiation survey meter with brains. The thing I like about it most is that if you find something, you can acquire an energy spectrum and the unit will even tell you what it is, if it's something that's stored in its library. It will even send data to the PC via serial cable too. Pretty slick device. Made by Canadians too!

The guys over at Radiation Safety got one about a year ago, and we couldn't let them trump us with cooler toys, so we got one too. It's going to be a fun tool to play with.

After being busy with other things the past couple of months, time for me to start whittling down the list of x-ray equipment I need to get tested by the end of the year. Spend a couple of months doing pretty much nothing except testing, then take the next couple of months to work on other projects. I do this maybe 4 or 5 times throughout the year to break up the monotony of doing all the annual surveys. With all the side projects I keep coming up for me to do, I find this works out better for me instead of spacing out all the testing evenly through the year. The breaks between equipment testing give me some time to work on projects and research. Makes getting back to testing easier too, after taking a break.

In a few short weeks, JCAHO surveyors will be descending on our institution to check on how well we do things. This will be the second JCAHO accreditation survey I've been through here. Prior to the first one, there was much scurrying and commotion as everyone tried to get ready for the survey. This time around, most of the scurrying and commotion was spread out over the past year and a half. Still, with a few weeks to go, there's more and more activity to get everyone ready.

JCAHO accreditation is a big deal for hospitals. Being accredited and getting a good score on surveys is a good marketing tool, and shows the institution follows a tight set of standards and practices. Plus it's also required to qualifiy for Medicare/Medicaid funding.

Our survey is scheduled for Nov 17. As far as my little portion of the survey, I don't expect to see much activity. My records are in pretty good shape (much better than when I first started here), and I can pretty much account for everything that I'm responsible for. Since I'm not directly involved with anything patient care related, I will be surprised if surveyors stop by to ask me for anything at all.

Bring it on, JCAHO...

Ever have one of those problems where the more you dig into it to find a solution, the more complicated it becomes?

A couple of days ago, I started digging into a problem we were having with one of our computed radiography (CR) readers. Techs were complaining that they were starting to have to use much higher x-ray techniques than normal to get properly exposed images. So, I head over, and run some quick checks with some of my test objects, and narrow it down to the CR reader. Sure enough, the reader in question was producing a lower exposure index (a number that's related to how much radiation the CR plate was exposed to) than an older CR reader next to it.

The next day, I head over there with some more test objects to get some more quantitative data, and confirmed just how much lower the CR reader was responding.

Today, I decided I had better check our other CR readers. They were all relatively new (installed April 2003), and I had data for some of them when they were first installed. The testing is something I usually try to do on a monthly basis, but the summer was a pretty busy one, so I hadn't been able to get to doing my regular tests on them. Much to my surprise, I found all of the other CR readers producing lower exposure index values too. And to make it worse, they were all lower by the same amount. Each of the CR readers runs a set of diagnostics periodically on various systems, which is very useful. A quick check of those results didn't reveal anything significantly wrong that I thought would cause the problem though. So now, instead of trying to figure out what the problem with one unit is, I have to figure out what could be causing the same problem on 5 different units. Could it be the laser assembly? The light guide? A photomultiplier tube?

At first my guess was the laser starting to fail. But how does it happen to 5 different units by the same amount? A bad batch of lasers perhaps? Who knows. The more I dig into it, the more perplexing the problem becomes.

Joint Commission is cruising through the hospital this week. Time for me to lay low and keep a low profile. Not that much of what I do will draw their attention, but the less of it I have to deal with, the better.

Joint Commission survey is over, and I hear we scored pretty high with no Type 1 findings. This is a good thing. So we're good for another 3 years. Excellent.

Ooops, with the holidays and last minute rush to get stuff done in December, the AAPM CT Noise Metric TG task I volunteered for completely slipped my mind. Much research and writing to do now before the end of the month.

My assignment for the AAPM task group I'm on is to write a background blurb on the effect of reconstruction filters on CT images.

It's always hard for me to get started when it comes to writing stuff like this, or writing papers. Where to begin, what to talk about, how to organize it... Once I can get started, I'm usually OK though. Getting started is the hard part.

So far, my plan is to have a brief overview of the image reconstruction algorithm, emphasizing the filter. Then a discussion on different classes of filters along with how they affect the image.

Today I get to mess around with our newest cath lab acquisition. Actually I did some initial messing with it doing the acceptance testing earlier this month, but now I get to play and have some geeky medical physicist fun with it.

It's a fairly unique (for the US) system and very cutting edge. As far as I've been told, it's the first system to be installed in the US. A Siemens Axiom Artis with a couple of really large magnets from Stereotaxis used for steering a sepcially designed catheter guide wire through the arteries of the heart.

The x-ray system itself is the first flat panel fluoroscopy unit I've laid my hands on for testing. These things are impressively small and compact. Image quality and performance was ok, but not stunning. Noticed some pixellation getting to the smaller mag modes, but nothing severe.

At long last, almost 3 years after the initial purchase, our final gamma camera has been delivered and installed. Joining our department is a new Philips/Adac Argus Epic single head gamma camera which will do a good portion of our routine and planar imaging, particularly for patients coming down in hospital beds.

Tomorrow I should be able to get in and do the acceptance testing on the unit. Looking forward to it. It's been a while since I've done anything on an Argus. Should be pretty easy this time. Only two sets of collimators and one head to do.

When your chairman and director pop their heads into your office and ask if you're happy in here, it's usually not a good sign.

Around here, space is at a premium, and someone's always after the space you're in. Things are always getting shifted and shuffled around. Our department has a space committee looking at our space and other peoples' space and seeing what we can re-arrange or annex. Up until now, I didn't think my space was in anybody's plans, but now I'm a little worried.

If they give me some bigger space, I think I wouldn't mind. But I don't think I could fit into a much smaller space.

Just finished doing the acceptance testing of our new 64 slice CT scanner. This thing will generate a whole bucketload of images without even thinking about it. After two days of playing around, testing and scanning various phantoms, I ended up with a little over 3700 images to send to our PACS. Ended up with some very impressive looking reconstructed images showing a lot more detail in the reformatted coronal and sagittal planes than I expected. It's a cool machine, but radiologists are going to need new visualization tools to handle all the images these things can spit out.

On another note, the article about blogging I was interviewed for a couple of weeks ago was published today in The State newspaper. It's a short little fluffy piece with quotes and stuff from a few other webloggers (including me).

This week we're making the final long awaited steps toward going completely filmless in our department. Installation of a CD/DVD burning system to put patient images onto CD/DVD instead of handing patients a stack of films is expected to save the department a ton of money in film supplies and printing costs. It's something we've been able to do before on a limited basis, but it's always been very labour intensive. The new system is pretty much completely automated and so far is being very well received.

The other step is the conversion to digital in one of the last bastions of film: mammography. Last week we had the first of 4 digital mammography units installed, replacing one of our conventional film/screen units. This week applications training started. From what I've heard from the residents, images are great and far superior to regular film/screen. A few snafus with printing and workstation workflow, but probably nothing that won't be solved with a little bit of training and tweaking. By the end of the year, our mammography department will be completely digital and we'll finally be almost completely filmless after almost a decade of digital imaging.

At work I have a number of phantoms that I use for various purposes. The techs always know i'm up to something when I roll up with one them. I call them my patients.

There is one set in particular that the techs always give me grief over, the solid and fillable breast attachments that go along with my cardiac phantom. They always get a good laugh when I pull them out to work with. "Playin' with your boobs again?" and other cracks like that.

All in good fun though I suppose. They are kind of unusual tools to work with.

A few weeks ago I received word that a small research project proposal that I submitted had gotten funding approval from the sponsoring company. Terrific! My first research grant! This is a big event for me. Most of the grant funds will be used to purchase another phantom, but first there's paperwork to be filled out. And I'll have to navigate the hospital's research and grant administration process. Fine, no problem. There are plenty of people around here with lots of experience in this kind of thing.

First snag I encounter is that I learn is that the hospital takes 25% off the top for overhead. Ok, nobody told me about that when I was coming up with a budget for my proposal so I might have to go back and say I'll need more money. But the people helping me with this tell me that I can probably get an exemption from this overhead charge. Good.

Then, I discover that because I don't have a faculty appointment I can't be the principle investigator (PI) for the grant. I guess the hospital doesn't want to take research money brought in by the unwashed and unlearned masses. But there's yet another exemption that can be applied for that will take a couple of weeks for approval. Fortunately the physician I'm going to be working with is faculty, so he can be the PI instead. I'll just be the one doing all the work. Maybe I'll be able to call myself a co-PI. In any case, I don't think it'll be a big deal. Sounds like it's just one of those administrative things. My project, my paper/poster/abstract. First author is what it's all about.

So now all I need to do is finish up responding to the questions from the sponsoring company, wait for the paperwork to be filled out and hopefully I'll be able to start this project soon.

As soon as you send your exposure meters out for calibration, there are at least 2 pieces of new x-ray equipment that need acceptance testing the next week.

For the past few months, I've been digging through our PACS database extracting all sorts of gory stats on the storage requirements for CT images. After the first of our 64 slice CT scanners was installed and hearing early reports about 1000 slice studies being stored, I started to get curious about the impact of multi-slice/multi-detector CT (MDCT) scans on our PACS archive.

Our PACS archive goes all the way back to 1996 when it was first installed, so there were a lot of numbers to go through.