More about Medical Tourism on TIME Magazine

Outsourcing Your HeartElective surgery in India?

From TIME Magazine

Complete Article-LINK

Medical tourism is booming, and U.S. companies trying to contain health-care costs are starting to take notice.

"Whiplash was just the first agony that Kevin Miller, 45, suffered in a car accident last July. The second was sticker shock. The self-employed and uninsured chiropractor from Eunice, La., learned that it would cost $90,000 to get the herniated disk in his neck repaired. So, over the objections of his doctors, he turned to the Internet and made an appointment with Bumrungrad Hospital in Bangkok, the marble-floored mecca of the medical trade that--with its liveried bellhops, fountains and restaurants--resembles a grand hotel more than a clinic. There a U.S.-trained surgeon fixed Miller's injured disk for less than $10,000. "I wouldn't hesitate to come back for another procedure," says Miller, who was recovering last week at the Westin Grande in Bangkok. Wayne Steinard, 59, a general contractor from Winter Haven, Fla., is one of those U.S. patients "who fall through the cracks" of the health-care system, as he says. Steinard landed in New Delhi last week with his daughter Beth Keigans to get a clogged artery cleared and a stent installed. Steinard, too rich for Medicaid and too poor for insurance, certainly didn't have the $60,000 he would have had to pay back home. So he contacted PlanetHospital, a Malibu, Calif., medical-tourism agency, and learned he could get it done for about a tenth as much at Max Healthcare's Devki Devi Heart & Vascular Institute. Things have not gone as Steinard expected. When surgeon Pradeep Chandra scanned Steinard's angiogram last week, he found the artery 90% blocked. "A stent is out of the question," he told Keigans. "Your father is going to need a double bypass, and he needs it immediately." The blood drained from Keigans' face. While she loved their plush hospital suite and the staff had been superb, this was all happening too far from home. Steinard, though, was blunt about his choices. It's either this, he said, or a fatal heart attack back home. The surgery last week was successful; the hospital's bill: $6,650.

Yet as the medical-cost crisis deepens, the corporations who pay insurers are likely to find the lure of outsourcing as irresistible in health care as it is in software."

Sonography in Neonatal Brain Imaging

Imaging of the brain in full-term neonates: does sonography still play a role?

By Daneman A, Epelman M, Blaser S, Jarrin JR

"To date the literature comparing the usefulness of US and MR examinations of the neonatal brain suggests that US is not as effective a modality as MR. While MR imaging may reveal abnormalities of the brain more floridly than sonography, authors believe that sonography remains an extremely useful modality for evaluation of the full-term neonatal brain and it is probably a more accurate modality in this age group than the current literature suggests. Further prospective studies comparing sonographic and MR imaging findings are required to document the accuracy of sonography better and to help us define the role of this modality better. Such studies may help select which patients really require MR imaging."

Reference- Pediatr Radiol 2006 May 16; [Epub ahead of print]

How many Teleradiology centers are there in India actually?

Here is a pointer to an excellent and eye opening post here Radiology outsourcing is mainly a myth and with comments from Dr Bhavin Jankharia summary of which goes like-

"According to Dr Bhavin-

That there is only one company in India that provides outsourcing radiology services to the US
The other truths are-

Companies within the US with branches in Switzerland, Hawaii and Australia do much more outsourcing

That there has to be a significant, usually family-based reason for someone to give up a 350K USD job to come back to India to do teleradiology

That there are some who run sweat-shops and pay 10-20USD for CT scan and MRI reports, but that's really illegal from the US perspective, though not from the Indian perspective - but these are few and far between as well"

This means although there is much hype about Radiology outsourcing to India truth is just a small fraction of the hype with American Board Certification being a must to report studies of a US patient. Till the time Radiology Outsourcing seems to be more of a Hype than actual promise.

Functional MR Imaging

The clinical potential of functional magnetic resonance imaging.

"Functional magnetic resonance imaging (fMRI) has had a huge impact on understanding the healthy human brain. To date it has had much less impact in clinical neuroscience or clinical practice. The reasons for this are in part that the image acquisition, paradigm design, and data analysis strategies used presently are not sufficiently standardized. This makes the comparison of results across individuals, scanning sessions, and centers difficult. Nevertheless, there are emerging applications for clinical fMRI, and as the field matures the number of applications is likely to grow. It seems certain that fMRI has an important role to play in helping us understand the mechanisms of neuropsychiatric diseases and in helping to identify effective therapeutic strategies."

Reference-J Magn Reson Imaging 2006 Apr 28; [Epub ahead of print] by Jezzard P, Buxton RB.

Diffusion-Weighted Imaging-Radiology Resident Corner

Diffusion imaging makes use of the variability of Brownian motion of water molecules in brain tissue. Brownian motion refers to the random movement of molecules. Water molecules are in constant motion, and the rate of movement or diffusion depends on the kinetic energy of the molecules and is temperature dependent. In biological tissues, diffusion is not truly random because tissue has structure. Cell membranes, vascular structures, and axon cylinders, for example, limit or restrict the amount of diffusion. Also, chemical interactions of water and macromolecules affect diffusion properties. Therefore, in the brain, water diffusion is referred to as apparent diffusion. To obtain diffusion-weighted images, a pair of strong gradient pulses are added to the pulse sequence. The first pulse dephases the spins, and the second pulse rephases the spins if no net movement occurs. If net movement of spins occurs between the gradient pulses, signal attenuation occurs. The degree of attenuation depends on the magnitude of molecular translation and diffusion weighting. The amount of diffusion weighting is determined by the strength of the diffusion gradients, the duration of the gradients, and the time between the gradient pulses. The diffusion data can be presented as signal intensity or as an image map of the apparent diffusion coefficient (ADC). Calculation of the ADC requires 2 or more acquisitions with different diffusion weightings. A low ADC corresponds to high signal intensity (restricted diffusion), and a high ADC to low signal intensity on diffusion-weighted images. In the setting of acute cerebral ischemia, if the cerebral blood flow is lowered to 10 ml/100gm/min, the cell membrane ion pump fails and excess sodium enters the cell, which is followed by a net movement of water from the extracellular to intracellular compartment and cytotoxic edema. Diffusion of the intracellular water molecules is restricted by the cell membranes. The restricted diffusion results in a decreased ADC and increased signal intensity on diffusion-weighted images. Severe ischemia can lower the ADC by as much as 56% of normal tissue at 6 hours. In patients who present with symptoms of cerebral ischemia, diffusion-weighted images are very helpful to identify any area of acute ischemia and to separate the acute infarction from old strokes and other chronic changes in the brain. Only the acute infarcts appear hyperintense on the diffusion images. Subacute and chronic infarcts, vasogenic edema, the punctate and confluent changes of deep white matter ischemia, and dilated VR spaces are not bright. Bacterial abscesses may exhibit restricted diffusion due to thick cellular debri within the central cavity. Other diseases of the brain, such as non-bacterial infections, neoplasia, contusions, and demyelinating diseases, are not associated with cytotoxic edema, and therefore as a rule, they are not hyperintense on the diffusion images. One exception is epidermoid tumors, which have restricted diffusion due to the waxy consistency of their contents. Also, the central portions of some primary and secondary brain tumors may exhibit restriction diffusion as they outgrow their blood supply and become ischemic. Occasionally, an acute MS plaque may be mildly hyperintense with diffusion weighting. Lesions with prolonged T2 relaxation times are commonly mildly hyperintense on diffusion-weighted images. This phenomenon of T2 shine-through can easily be distinguished from true restricted diffusion on the ADC map. Only true restricted diffusion is low signal on the ADC map.

Reference

http://spinwarp.ucsd.edu/NeuroWeb/Text/br-710dwi.htm

San Pablo City: Random Photos

Just some random shots of San Pablo City, Laguna, while on a visit to Gerry Alanguilan's house by the lake.

Ultrasound Machines to be sold only to Licensed Medical Practitioners

California Lawmaker Proposes 'Tom Cruise' Law

"The celebrity couple dubbed TomKat is in the news again and have sparked a fresh debate. When Tom Cruise announced he had bought an ultrasound machine so he could see his unborn daughter, a California lawmaker thought the "Mission Impossible" star had gone too far. The California Assembly is scheduled to debate a bill Thursday that would ban manufacturers in the state from selling the imaging devices to anyone but a licensed medical professional."

Full story here-

http://www.nbc11.com/news/9155194/detail.html

Tubercular Meningitis-CT criteria

Objective CT criteria to determine the presence of abnormal basal enhancement in children with suspected tuberculous meningitis.

"There are no widely accepted objective criteria to determine the presence of basal enhancement on CT in children with suspected tuberculous meningitis (TBM). Przybojewski S et al in Pediatr Radiol 2006 Apr 26; [Epub ahead of print] have tested nine recently described objective CT criteria for the presence of abnormal basal enhancement in children with suspected TBM against the definite diagnosis as determined by cerebrospinal fluid (CSF) culture. The criteria have been named: the 'Y-sign', 'linear enhancement', 'double lines', 'infundibular recess of the third', 'ill-defined edge', 'nodular enhancement', 'join the dots', 'contrast filling the cisterns', and 'asymmetry'. Very high specificity was demonstrated for all nine criteria, including 100% specificity for four individual criteria. Sensitivity was at best 82%, but improved to 91% when more than one criterion was present."

Migraine-MRI Findings

"Migraineurs are at increased risk of cerebellar infarcts and supratentorial white matter lesions. The prevalence, frequency, and distribution of infratentorial hyperintense lesions in migraine are unknown. Authors found an increased prevalence of infratentorial (mostly pontine) hyperintensities in migraineurs from the general population. This extends the knowledge about vulnerable brain regions and type of lesions in migraine brains. A hemodynamic ischemic pathogenesis is likely, but further research is needed."

Reference-

Brain stem and cerebellar hyperintense lesions in migraine. By Kruit MC, Launer LJ, Ferrari MD, van Buchem MA in Stroke 2006 Apr;37(4):1109-12. Epub 2006 Feb 23.

Doctor-Are You Planning to Work abroad?

Clinical Cases And Images Blog points to a very useful series of articles from BMJ Career Focus which features several articles with advice for physicians planning to pursue their career in different parts of the world including Australia, Newzealand, Canada, USA, Europe etc.

Extremely useful information.

A Guide for Doctors Planning to Relocate Abroad

Medical Tourism On the Rise in India

"India's tertiary healthcare sector is on the road to global fame. A growing number of spotlessly clean private hospitals are on the threshold of a boom in medical tourism, positioning themselves as the best destinations for procedures ranging from coronary bypasses to orthopaedic surgery at the most affordable costs. These hospitals offer high-quality care for international patients, whose numbers are reportedly rising 15 per cent annually; the prices that they charge are a fraction of what prevails in the developed world. India's corporate hospitals are fully equipped, up market and efficient. With their toll-free helplines, interactive websites, online quotes and time-bound treatment access, they appear to be a world apart from the overburdened, often badly managed and poorly funded public health system of India."

As medical tourism looks set to expand further, India must make use of the opportunity while ensuring that it does not create a health divide.

From The Hindu Newspaper