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Well we're back. We had an unforgettable experience and certainly want to thank the Diefenthal's KCMC, the ACR, and the University of Washington for their support. We will hopefully be giving a presentation of our travels here at UW as well as at the ACR meeting this Spring. Please feel free to contact us if there are any particular questions or comments. Thanks for tuning in.

IR demo

This past week Matt and I demonstrated some basic percutaneous procedures using the materials generously donated from the University of Washington and its associated vendors. Using a bovine liver, a few drainage bags, and a Sonosite ultrasound we showed groups from the radiology and surgery departments how to place a drain, perform a core biopsy, and obtain central venous access. A few of the attendings and upper level trainees took turns practicing with the needles and catheters. The performance was well received and it is our hope that this introduction might lend confidence to both referring clinicians and the radiologists in development of an interventional practice at KCMC.

Kili

Matt and I took advantage of our proximity to Mt. Kilimanjaro and climbed it over the New Year's holiday weekend.

Clinical service

In addition to working with Dr. Diefenthal and the radiology staff, Matt and I have had exposure to many of the other clinical services. Beyond the daily conferences and Wednesday didactic sessions, we have met informally with members of the obstetric, medical, surgical, and pathological departments. In addition to learning about the challenges facing their respective fields we shared cases and teaching materials and also tried to get a sense of how radiology benefits them and where it could be improved. Similar to more industrialized nations, radiology is relied upon more and more to make and/or confirm diagnoses, though at KCMC this power, particularly as it applies to the use of CT, is often tempered by limitations in technical availability, patient financial resources, and in some cases treatment options. Given some of these limitations, the radiological and clinical staff at KCMC are very collaborative using face-to-face consultation to optimize the imaging available and reduce redundant or low-yield testing.

Up and down

We apologize to those readers expecting more than an entry every few weeks. The Internet, though available, often doesn't work as well as one would hope and has reduced our blog.

IR at KCMC

In addition to observing the daily practice here at KCMC, Matt and I are trying to provide some instruction for basic percutaneous techniques for simple procedures such as abscess/fluid drainage and central venous catheter access. Thanks to the generous donations from the University of Washington and its associated vendors we have a supply of needles, wires, dilators, and catheters needed to carry out many of these procedures. We are currently working on a model to better demonstrate ultrasound guidance and the steps involved with placing a device into a patient. We have both given lectures on some of the basics of interventional practice and though there were many questions the topics seemed well received.

Interventional "Stock Room"

Dan and I brought basic interventional devices to donate to the department. We hope that given the local ultrasound expertise, they will also be able to do basic ultrasound guided procedures in the future such as abscess drainage. Here we are organizing the equipment for them. We hope to create a model to allow them to practice.

Maasai Village

We stopped at a Massai Village in the area; several Maasai are treated at KCMC. See wikipedia for more info.

A day at KCMC

A day at KCMC begins at 0730 with review of plain films for the medical and surgical services. Additional subspecialties such as orthopedics, pediatrics, urology, and otolaryngology have dedicated radiology rounds as well, though they occur less frequently throughout the week. Cases are displayed on a view box and a resident covers the findings and impression with Dr. Diefenthal present for further consultation.

Following rounds, the staff, comprised of assistant medical officers (i.e. PAs), residents, technicians, and attendings break to cover the CT, plain film, and ultrasound services. The majority of the time is spent doing ultrasound, where two machines are dedicated to general and obstetric exams, one for echocardiography, and one for pediatrics. Exams are performed/overseen by residents with assistance from an attending, though Dr. Diefenthal performs all pediatric exams himself. There are approximately 5 to 10 CT exams daily with each study monitored by a technician and an attending. Plain films are performed throughout the day and read in batches by the residents and attendings.

By 1500 the last remaining ultrasounds are completed and the staff breaks for lunch and an afternoon break. Dr. Diefenthal, the AMOs, and residents then reconvene at 1800 for a teaching session. Dr. Diefenthal instructs on the basics of radiologic physics as well as presenting cases within the pertinent modalities. Guest lectures are welcomed at this time.

Finally, the group returns to the hospital to read the remaining films of the day and to give a chance to the more junior trainees to take cases in a public forum. We return home around 1930 to have dinner and unwind. The residents take first call with the attendings serving as back up.

Taste of Safari

Grand Rounds

Wednesday mornings are hospital wide grand rounds which occur here. This week was on the TMJ including radiology(plain films) and surgical techniques.

Multipurpose Room

This room hosts clinician/radiologist conferences every morning from 7:30 AM until approximately 9:00 AM. It also serves as the plain film reading room and a room for evening "at the box" teaching by Dr. Diefenthal.