A great day to be a radiologist

If I remember correctly, it was cool, clear and crisp on that September day in 2012 when I walked into my office. September is my month; I love this weather. My recollection of early morning sunshine coming through the window may now be biased by the events that transpired. It was early, 6:30 or 7, in the morning. I immediately noticed a rather generous basket of individually wrapped Lifesavers candies on my chair. My first thought was that the team had realized my birthday was just a few days away. An envelope was tucked between the candies. This letter was enclosed in the envelope:

It reads,

Dear Dr. Channin, 

 A few months back you read a chest x-ray on a patient named XXX. In the report you recommended that he have a CT scan to determine if something you saw in the area of the right lower lobe was something to be concerned about. We would like to thank you for that recommendation. The recommendation that you made led to the finding of a cancerous mass in its early stages. XXX underwent surgery on XXX to remove the lesion and the lower lobe of his right lung, and the preliminary testing shows no sign of metastasis. As far as we are concerned it was your recommendation that saved his life and made sure that we will have our husband, father and grandfather far into the future. We wanted to send you a thank you and let you know that in our minds you are a life saver.

Sincerely, 

There is nothing that washes away the cares and woes of the day better than a letter like this. I will tell you that you walk a little taller and you whistle a fine tune. For all the talk of radiologists getting out of the reading room to 'meet and greet' the patient, 'make rounds', etc. to make sure of our piece of the pie, there should be an equal amount of talk about hunkering down in the reading room, and doing what we do best for each and every patient. At many institutions, including ours, patients see the radiology reports shortly after the referring providers. We touch every patient, the shadow of whom we see, with the words we put in our reports. Let us not forget this in the day and age of structured reports (RSNA Reporting Initiative) and computer assisted coding and billing. That extra bit of explanation or detail, especially in your recommendations can make all the difference. Reports can be both machine and human readable. Focus on the whistle not the pie.

Day 2: River Road to Rochester

It is cooler today but more importantly less humid. I feel as if a
front has come through but if it stormed last night I made no notice
of it.
We spend the morning in PdC (code for Prairie du Chien; rhymes with
Charlie Sheen). We visited the Fort Crawford museum and what a gem of
a museum it is. Located on the grounds of what was the second Fort
Crawford (then US Sec'y of War), the only remaining building was the
medical building. And what a history it has. For Fort Crawford was
where William Beaumont did much of his work on digestion studying a
french canadien who was shot in the stomach and survived with a skin
flap.
Also of note is that PdC is the birthplace of Walter B Cannon. Those
of a clinical bent attending SiiM by more mundane means will note that
Cannon was the first Gastrointestinal Radiologist having invented the
barium swallow <as a medical student> at Harvard! His likeness adorns
the gold medal given by the SGR to this day, I believe.
The museum though only 3 rooms has a tremendous collection of
medical and military arcana. Very well presented and explained. There
were even early radiographs and a hand held fluoroscope.
Adjacent to this museum is a small museum of the town, also a fun,
quick stop.
We rode north out of PdC along Rt. 35. Here, the Great River Road
lives up to its name. It flows alongside the great river itself. The
river, a deep azure, reaches north and south to both horizons. It is
matched by an endless expanse of clear blue sky. They, together, are
shouldered in an infinite array of greens.
We meander up to La Crosse and Crosse over to Minnesota, there. We
hop on to 90 and zip out to the mecca of medicine. We hope to visit
Mayo tomorrow. Maybe we can pick up Brad with his hog for the end of
the trip. If not, we will at least have a picture of the XRay bike in
front of the clinic!

--
David S. Channin MD
Evanston, IL
David.Channin@gmail.com
(312) 725 - XRAY (9729)
(866) 844 - 6643 (FAX)

5th Annual Ride-2-SiiM is ON: Day 1

Well, another beautiful spring, a hot summer day and another
Ride-2-SiiM. We left Skokie around 2 PM. Atypical, but that, I feel,
will be the key word to this trip. I am accompanied this year, by the
family, in the <sweep vehicle>. Alex, my usual road mate is utterly
occupied with his lovely wife and their beautiful 1 year old. (Astute
readers will remember that she was born just before SiiM 2009!).
We drove westward out of Chicagoland. The heat on the road was
opressive, at least 85. I could feel it beating off the road. High
humidity and an ugly glare only made things worse. The downside to
living in Chicagoland is that you have to ride for an hour and a half
to get anywhere decent.
Eventually, we hit Route 20, the great way west, identified in
Illinois as Grant's highway. Not coincidentally we will follow his way
west to Galena, his home. We have followed this route on many
occasions as Galena is a very nice place to weekend. Lots of outdoor
activities and a lovely downtown strip of fun shops. It is always a
pleasure to wind your way through the rolling farms to get there. Your
wrist tires of waving to all the bikers you pass.
We wend our way north to the Great River Road, paralleling the
mother river north toward her source. Ironically, you cannot see the
river from the Great River Road, at least not the Wisconsin side.
Somehow this fact is missing from the online tour guides. Still we
wind our way through more and more beautiful farmland, the sky pinking
as the sun sets behind imposing yet ultimately impotent high cumulus
clouds. The road winds agreeably through some twisties that challenge
my end of day riding skills but yet invigorate me by reminding why we
ride.
We stop for the night in Prairie du Chien; pronounced not at all the
way my French wife would like. Another great example of small town
mid America.

--
David S. Channin MD
Evanston, IL
David.Channin@gmail.com
(312) 725 - XRAY (9729)
(866) 844 - 6643 (FAX)

Day 3, Mile 1945: Home

<The greatest plans of mice and men oft go astray>. A beautiful morning found us in Robinson, IL, a quick 200 miles from home. A quick refill of the tank and we sped for a mile before my bike quit. Just lost power and slowed as I rolled to a driveway of a cement plant. Starter would not crank, nothing...now they say, all you need is spark, fuel and oxygen to fly down the highway, but the devil is <always> in the details. So, luggage off, seat off, fuel tank up, lots of side covers off...(You have to strip these metric bikes to the bone to service them). Did I mention it is now 90 degrees? I called the guys in service at Riva Motorsports in Pompano Beach, FL (where my Dad shops). Thanks, Carlo. They were great in talking me through a few debug steps but ultimately couldn't help. I found the fuse box and lo and behold the 15 A ignition circuit fuse had blown! Being the saavy traveller I happen to have some spares, two in fact. I replace the fuse and it immediately blows. I try one more and lo, the bike starts. I re-assemble but go nowhere as that last fuse shorts out. Now at this point I should have started a search for the short that is causing the problem...but I opt for the AMA (the other one) Roadside assistance.
Two hours later, we load the bike on a flatbed and head off for Thompson's Motor Sports in Terra Haute, IN. First a shout out to Poor Boy's towing: Thanks Steve and Grayson. Second, let me just say that the reception I got at thompson's was great. The service guys told me they realized I was on a trip and would do their best to get us back on the road. And boy, did they!
We wandered the Honey Creek Mall for two hours. Our return to Thompson's showed Xray ready to roll again. The cause (as explained in great detail by the mechanic): a short just under the fuse box!! I was inches from having been able to fix this myself.
Be that as it may, thanks to the great folk at Thompson's we were back on the road by 4 PM. A four hour jaunt up on the backroads to 94 finally brought us home. A temperature of 57 degrees as night fell added insult to injury caused by the horrible road conditions in Chicago.

An ignomious end, but an end none-the-less. The light was on, the hearth was on and the steaks were ready as we walked in the door. A warm embrace from the wife, the kids and the dog sealed the deal. There is no place like home.

The 4th ride is now in the bag. We'll have to see where the fundraising leads.

Dsc


-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 3, Mile 1735, Robinson, IL

The home stretch. We are approximately 250 miles out after a lovely evening ride through the heartland of Illinois. We rode up IL 1 along the border of the state. We have avoided most of the heavy weather with the severe thunder storms now below us and moving east.
An easy if not hot and humid ride to the Windy City and back to the real world.

Dsc

-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 2, Mile 15xx, Take the last to Clarksville

We can be there by 4:30; don't be slow...oh no, no, no...

Well, the rain gear only stayed on for about 15 minutes. Then the heat and humidity were killing us so off they came. The rain was the tail of a front passing north of us so we are in the clear heading north.

Our train will leave Clarksville then head to Evansville, IN. From there, its a straight shot up the IL/IN border home.

Dsc


-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 2, Mile 1378; the road to Nashville

Bustin' out the rain gear...there's got be a country song there somewhere.

-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 1, Mile 1316; The nameless road to the secret city

We rode through Gatlinburg which turns into a real tourist town with restaurants, souvenir shops, attractions, etc. It was packed on this hot, gorgeous day. Cars and motorcycles clog the main drag.
We continue on TN 321 but then turn back into the Smokey Mtn National Forest. Rather than continue south down 411 (toward the Dragon), we turn right toward Townsend. What do we find? You guessed YABRR! But this river has a difference: tubers and swimmers! Absolutely enticing. Great pictures.
We continue from Townsend to Maryville and then on US 140 to Oak Ridge, the secret city; home of the Oak Ridge National Laboratory and the Y-12 Security Complex.
Tomorrow, we turn North.


-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 1, Mile ??, Gatlinburg, TN

We came over 74 West to 26 to Asheville, then picked up 40 over the Smokies. 40 is the park is a great slab; 70 mph through twisting forest.
We then found a small gem, the Foothills Parkway that connects 40 to Maryville, TN. Beautiful. We are continuing 321 S to Maryville re-entering the park.



-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 1, Mile 1035, Charlotte

The ride home begins. Our first stop is Knoxville, TN. That means, we are <forced> to ride west through the smoky mountains again. Some of the best greenward twisties foisted upon us. It is a dirty job but someone besides Mike Rowe must do it.

Westward, Ho!


-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 2, Mile 879.5, Brevard NC

A great start to a great day. I decided to head south on 441 to get to 64 E as the latter is marked as a scenic route. THAT is quite an understatement. 64 E is YASRR (yet another spectacular river road). When the road begins with a warning sign, <narrow road and sharp turns next 40 miles; trucks consider alternate> you know life is going to be good. 64 serpentines itself next to the Cullsuja (Tuskagee?) River and then other branches of the savannah river basin. Between the rapids and the waterfalls along the way there is an abondance of spots just beggin' for a visit and a photo (I only gave in half the time). At the end of the first part of 64 just before Highlands is a rest area built into a waterfall. You can even drive dehind the water! Spectacular.
Highlands is a lovely tourist/nature town set as a gateway to wilderness.
From Highlands to Brevard is more of the same; beatuiful twisties, with residential communities springing up left and right. I hope all the folks here are bikers as this is some of the finest bikin' land.
Now on to Charlotte. Gotta meet up with the Old Man.



-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 2, Mile 810, Dillsboro, NC

What can I say about the Dragon that has not yet been said? It is justifiably the #1 motorcycle road in the US.
US 129 meanders down from Maryville, preparing you gently and progressively for the curves ahead.
The lake formed downstream from the Fontana dam is a saphire gem that extends infinitely in both directions. It concentrates and amplifies the blue of the sky beyond belief.
I enjoyed the Dragon. I would say that it is not so much a question of difficulty as it is a question of concentration. On each curve, you try to remember everything you have learned and then execute. You have to do that 318 times.
I found that a reasonable speed of 35 +/- worked well. I stayed mostly in second, occaisionally third gear. Of course there were a bunch of sport bike riders who zipped by on a number of dangerous occaisions. I can understand why there have been deaths here.
Then you arrive at Deal's Gap: the motorcycle equivalent of the cantina scene from Star Wars. Bikers of every flavor and then some either coming down from the rush or gearing up to go. I get the impression that some of the racers (why would they wear track suits with knee plates if they weren't racers) go back and forth a few times in a day. Yet a lot of casual tourists, yours truly included.
The way out on the NC side takes 28 S through more of the same: twisty passages of green (with a quick stop at the Fontana dam for some grey/brown concrete). Smoky Moutain National Park goes on forever but I finally found a road and more importantly a hotel in the outside world.
All in all a great experience.



-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 2, Mile 513, Morning from Manchester

Headed out east from Manchester and picked up 66 heading south. 66 is magnificient; a meandering, tunnel through the Daniel Boone National Forest. It was pretty cool as I started out, enough to merit an extra layer. The sun, heading east as I was, was brilliant, reflecting off every drop of dew it could find. At one point I rode through a cloud of fog just in the process of burning off. I caught a photo of a lingering path of said fog peeking out from the treetops where it was caught like cotton on a carpet.
The curves on 66 were just the warmup I would need for the Dragon. In fact, it was a bit reveresed; instead of riding a ridge, I was often carving through (limestone?) canyons.
As a reminder that this is coal country I passed two functioning coal mines as well as a handful of (ungated!) rail crossings.
I stopped for a coffe at a tiny little general store at the edge of the woods. A perfect start to the day.


-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 2, mile 600, Mid-day

I rolled south from DBoone trying to get back to civilization and Maryville, TN;the mouth of the Dragon.
I noticed that 66 dumped into 25. And 25 leads to the Cumberland Gap! I took a quick (very nice on/off access) detoru into the park. For nothing but to drive up to the outlook point. Lo and behold another baby dragon; a well tended national park rode that switched its way up the Cumberland hills. The view from the outlook is spectacular. You look out on three states; KY, TN and VA.
From there you dip through a tunnel to the other side. And then a quick ride over to Maryville, right?
Easier said then done.
The damn Garmin GPS failed me in my hour of need. It has got some power problems. It doesn't recognize the cradle and doesn't charge from it. I had charged it the night before and was turning it on and off to spare the battery. Unfortunately, now it won't come on. This will be the third time back to Garmin for service! Not recommended!
To top it off, my BB with Google maps had low battery. To its credit, it surviced the day! So I am about 40 miles out from Knoxville trying to figure out how to get to Maryville. Turns out you can't there from here; or just about. There's a lot of construction around Kville, right where I needed to go. So to make a long story short, I spent an hour or so in an involuntary tour of Kville wending a maze of twisty passages trying to get OUT. Did I mention it was 90 degrees! Yikes.

In the end, the brotherhood of the bike came to the rescue. A fellow rider at a gas station pointed me in the right direction to face the Dragon. (He even pointed out the speed trap they set).

Next...the Dragon....


-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 1, Mile 513; Manchester, KY

Well, what can I say? Another fantastic voyage through rural America. I stand (can't sit after 513 miles) in awe of this great land.
I decided to slab it from Chicago through Indiana; to get to the good stuff.... The only downside to biking in Chicago is that you have to ride an hour and a half to get to something nice and rural. So, I did the obligatory 90/94 dance to northwest IN, then picked up 65 S to IN'apolis. As I mentioned, <classic> farmland slab (in need of repair).
I continued 65 S to Louisville. I could smell the fear and sweat from the ABR exam and slight chill ran down my spine despite the temp in the high 70's. At Louisville, I picked up the 64 E slab to Lexington. As nice a ride as slab can be. I passed, though did not visit, the Kentucky Bourbon Trail; something to be sampled, I'm sure, perhaps with RDC driving. I also passed the National Retirement Home for Retired Thoroughbred Horses. Had to stop and take a picture to show the REL. As I was stopped by the side of the highway, a very nice fellow rider (in military fatigues) stopped just to make sure I was OK. What a great gesture!
But that was just the start. Just east of Lexington, I picked up the Kentucky Mountainway (402) instead of slabbin' 75 S. In retrospect, the wisest decision I've made in quite some time... For this route, itself in great condition and equally adequatelly hilly and twisty, led me through Natural Bridge Resort State Park (I didn't see the bridge) to KY 11. KY 11 is, as my friend AP, also a rider, says, is a <little slice of heaven>. In addition to passing through small hamlets with names like, <travellers rest>, I had the opportunity to visit Morrocco (IN), Paris (KY?) and Egypt (KY) all in one day. Without even knowing exactly where I was going 11 led me to 30 led me to 421 all three winding their way to and through the Daniel Boone National Forest. A thousand shades of green surrounded me as I leaned into each and every curve. The road curves in all 6 degrees of freedom (if you count the bank of the road); truly a challenge. I could not have thought of a better training course for the Dragon that awaits me.
When my buttocks just couldn't take any more, I GPS'd the nearest hotel and followed the forest to Manchester.
Another note, I must have passed at least 500 bikers today; all out enjoying the beautiful day and the graceful curves of Kentucky.

To think, I get to do this again, tomorrow?!



-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 1, Mile 297 Near Louisville

The ride continues well. This part of Indiana starts to look like what I imagine Kentucky to be. Now scattered in amongst the corn and soybean farm there is the occaisional horse farm. Several with horses grazing at their leisure. The number of horse trailers on the road is increasing; as is the number of bikers! It is a glorious day for riding and everyone is taking advantage. Gas up and onward.


----------------------------------------- This message and any
included attachments are intended only for the addressee. The
information contained in this message is confidential and may
constitute proprietary or non-public information under
international, federal, or state laws. Unauthorized forwarding,
printing, copying, distribution, or use of such information is
strictly prohibited and may be unlawful. If you are not the
addressee, please promptly delete this message and notify the
sender of the delivery error by e-mail.

Day 1, Mile 173 Indiana part 1

A quick jaunt through Chicago to northwest Indiana. 65 south to Indianapolis. A perfect day for riding: great weather, light traffic. Though the roads show numerous opportunity for <shovel ready> stimulus work.
The farmland is a patchwork of greens and brown. The air (beyond Gary) is clean and fresh.



-----------------------------------------
This message and any included attachments are intended only for the
addressee. The information contained in this message is
confidential and may constitute proprietary or non-public
information under international, federal, or state laws.
Unauthorized forwarding, printing, copying, distribution, or use of
such information is strictly prohibited and may be unlawful. If you
are not the addressee, please promptly delete this message and
notify the sender of the delivery error by e-mail.

Day 1, Mile 0: Home on the Range

It is a beautiful morning, the sun shining brightly in a clear blue sky. A welcome change after a long winter, and a rather cold and rainy spring. It is the perfect weather for an early start. The trajectory begins with a jaunt through Chicago to the Skyway. Down 65 to Indianapolis. More later...

4th Annual Ride-2-SIIM BEGINS!!

Well, it's that time of the year. Time to saddle up XRAY and take her through the Tail of the Dragon to the Society of Imaging Informatics in Medicine meeting, this year in Charlotte, NC!

"We do these things, not because they are easy but because they are hard" fun. They also support the SiiM Research and Education in Imaging Informatics through sponsorships of the ride. Read more about the Ride and please, consider a small donation!

Let the Backpedaling Begin

It is to laugh:

NYTimes: "Health Care Leaders Say Obama Overstated Their Promise to Control Costs"