Saturday, August 30, 2014

Congreso Interamericano de Radiologia (CIR), Cartagena, Columbia

At the invitation of SAR member and Medellin native Jorge Soto, I was privileged to participate in the CIR organized by the Columbian Association of Radiology (ACR) in the beautiful city of Cartagena, Columbia. Happily, I was not alone, as I was in the company of other SAR members Jorge Soto, Cooky Menias, Koenraad Mortele, and Dejana Radulovic. Even Reed Dunnick did a cameo at the meeting as a representative of the RSNA, so the SAR had a strong presence. The CIR is like the RSNA, except on a smaller scale and with much, much, much better weather. 

SAR travels to Columbia: Cooky, Jorge, Koenraad, and Dejana with our Chilean friends
 at the President's reception. 
(I'm really much taller in real life.) 

Cartagena proved to be a worthy venue with a rich history and friendly people. Smiles were abundant, even when I butchered what little Spanish I learned from my $8 phrase book on the flight over. I’m pretty sure the waitress at the hotel bar is still wondering why I asked her if she had any badgers in her undergarments. I actually just wanted a diet coke, but the two expressions sound remarkably similar in Spanish (or maybe it’s just me). Pronunciation aside, those little travel phrase books do really come in handy when travelling to places where English is rarely spoken (like the Miami airport). I usually focus on the essential phrases like, “Where can I get a beer?”, “What kind of beer do you serve?”, “May I please have another beer?”, and “Where is the nearest bathroom…quickly?” Sometimes, the phrase book falls short and I have to resort to sign language. After 25 minutes of gesticulating to the AV attendant in my meeting room, I learned to turn on the microphone. I think I also inadvertently proposed marriage, but I assume he’ll figure out eventually that it was all an innocent mistake (but just in case, I am looking up the phrase, “There’s nothing wrong with you, it’s me”).

See, just like Chicago in December... NOT!

I delivered 4 MRI talks at the meeting (renal mass, pelvic floor, MRU, and pelvic mass). Translation was provided real-time and was amazingly accurate.  The atmosphere was very relaxed but professional, and the audience appreciative. I've discovered that the key to giving a talk with live/real-time translation is to go slow. Not the kind of loud and slow technique used by ugly Americans when speaking to non-english-speakers abroad. Words should be chosen carefully to communicate as simply and efficiently as possible, avoiding colloquialisms and slang. Humor is particularly difficult to pull off in a translated talk, so as with this blog, I usually try to avoid it. I recommend one slide per minute with as few abbreviations as possible. Slides should be uncluttered and image rich, because a picture is literally worth a thousand words when the talk is being translated.

While an image is worth a thousand words, a dollar is worth about 1850 Columbian pesos. More than once, our small group ran up a 7 digit dinner bill (at least I think it was in pesos). There is no shortage of restaurants in the old city, but plan to spend the entire evening dining, as meals start late and end much later than most North Americans are used to. My favorite spot was a Peruvian restaurant recommended by our Chilean colleagues called Peru Mar. The meal was nothing short of spectacular. If you find yourself in Cartagena, be sure to also stop by the Café del Mar on the old city walls at sunset.

The ACR President’s reception was an amazing spectacle (unlike most SAR President’s receptions, I was actually invited to this one). I don’t think I've ever been served dinner with 5 forks before. After a brief etiquette coaching session from some of my more polished colleagues, we had a spectacular meal accompanied by the usual discussion about kidneys and the colon (can’t take us anywhere). The dinner was served on the stage of a beautiful historic theater. I was told that the same theater had been used for Miss Columbia pageants in the past, so as of my visit, they can now brag that both extremes of the beauty spectrum have graced that theater. Regardless, in my guayabera, I felt like the most interesting man in the world.


On a tour of the city, we saw some implements of torture from the Spanish Inquisition. I took notes to send to my friends at the ABR. It turns out that their method of divining witches was at least as accurate as the first core exam was at identifying competent radiologists. 

We also visited the “Isla del Rosario” where SAR member Cooky Menias joined me for an “eco” tour that included a tippy canoe ride through a mangrove swamp (Translation was provided by our good friend and cardiothoracic radiologist Sanjeev Bhalla). Mangrove swamps are often taken for granted but constitute a critical part of the coastal ecosystem. They help protect coastal areas from erosion and surging water caused by hurricanes and tsunamis. They also facilitate deposition of sediments that contain toxins such as heavy metals, removing them from circulation. Finally, their extensive root system provides shelter for young aquatic organisms.  Mangroves can survive in their saline environment because their roots contain suberin, a waxy hydrophobic substance that help the trees remove over 90% of the salt at the root level. Mangroves also survive in a hypoxic environment that would be inhospitable to most plants through specialized structures that sit above the water level and allow them to “breath”. Unlike the portrayal in Life of Pi, Mangrove forests are not carnivorous. 

A trip through the mangroves in a very unstable canoe

Wednesday, August 13, 2014

Maine Medical Center, Portland Maine

I just returned from a trip to Maine Medical Center in Portland Maine at the invitation of my friend and abdominal imaging colleague Steve Winn to give a talk on Prostate MRI. They recently installed a new 3T magnet (MR750w), and we had a chance to compare protocols and image quality across vendors. Like most centers, MMC is anticipating increasing volumes in prostate MR imaging related to improved imaging techniques, expanded indications, and wider acceptance among urologists. As with our urologists, Steve’s referral base prefers to avoid endorectal MRI when possible, and just having a higher field strength system will likely further contribute to referrals. Aside from helping to build academic careers and contributing to seminal fluid, I list the prostate among those mostly useless organs/structures like the appendix, epiploic appendages, pineal gland, and toenails. Much like our House of Representatives, it's primary function seems to be obstructive. 

Residents and faculty at Maine Medical Center (Dr. Winn to my left)

While larger than Winston Salem, Portland Maine still maintains a small town charm; or at least it would if you could remove the throngs of tourists who flock there each summer to escape the heat and move the lobster one step closer to the endangered species list. For now, lobsters are everywhere in Maine. Go to any fast food joint in Portland and the guy with the PhD in sociology behind the counter is bound to ask, “you want lobstah with theyat?” While there, we got to see a rare blue lobster. Lucky for him; he’s destined for a local aquarium instead of the dinner table.

Steve was an amazing host and saw to the enjoyment of my family while providing ample opportunity for me to tour his facility and interact with residents and faculty. I was very pleased to see an imaging department with an appropriate emphasis placed on reading room ergonomics. In addition to the adjustable tables and monitors that should be standard in any reading room, the radiologists at MMC believe that every reading room should have a set of big balls. From an ergonomic perspective, big balls are low hanging fruit. They help to keep your posture ideally aligned while reading out without the outrageous expense of most office furniture. Based on personal experience, I have to admit that they are comfortable. I discussed the idea of getting some big balls with Ray Dyer, but he said he preferred not having any.  

Sitting on one of the big balls in the MMC reading room

After we visited with Steve and his family for a bit on his boat, my family and I went on to vacation in Nova Scotia. Nova Scotia impressed us with its stunning natural beauty, unique mix of cultures, and friendly people. Most of all, I enjoyed taking a boat tour of the bird islands to see puffins and other assorted sea birds. In addition to pegging the cuteness meter, Atlantic puffins are interesting birds. They are pelagic, meaning that they only gather on land for a few weeks each year to mate (like radiology residents gathering at AIRP but with slightly better accommodations). At one point, puffins nearly disappeared from the Maine coast due to demand for their eggs and feathers, but they made a comeback after being transplanted from colonies in Newfoundland by Stephen Kress and colleagues; one of his early collaborators was Intel co-founder Robert Noyce. Unfortunately, Atlantic puffins are again disappearing from Maine waters as warming seas have displaced their chicks’ primary food source (white hake and Atlantic herring). In Nova Scotia, puffins appeared plentiful, although that might change as the very healthy bald eagle population increases on the bird islands.

Two of the absurdly cute puffins we saw

Unlike eagles and puffins, I can’t fly. This is painfully obvious every time my flight is delayed or canceled as once again happened on this trip; our plane had a flat tire. Of course, the airlines never fully disclose the nature or true duration of a delay even when they know it’ll be hours before wheels up for the fear full disclosure will result in human sacrifice, dogs and cats living together, mass hysteria, etc. Instead, a 4.5 hour delay was announced in 30 minute aliquots. First to inform us of the delay, then to tell us there was a mechanical issue, then to tell us that they needed a new tire, then to tell us that the new tire is at a different airport, then to tell us that the tire arrived but that the paperwork was incorrect, then to tell us the tire was taking longer than expected to install, etc, etc. Maybe I’m being unfair to the airlines, but since they started charging for checked bags and designing plane interiors to the specifications of hobbits, I don’t exactly feel an obligation to play nice. As I am writing this, the plane is taking off. I am about to find out if the new tire wo