At a time when physician and nursing shortages seem to be competing for headline space with bad economic news, it is reassuring to know that interest in therapeutic radiology and oncology is thriving in one corner of the health care industry.

In April, the American Society for Therapeutic Radiology and Oncology (ASTRO) reported receiving a record number of abstract submissions for the scientific program to be held at its 50^th annual meeting September 21 to 25 in Boston.

A total of 2,036 abstracts were received—nearly 400 more than the amount received in 2007; all three of the main categories rose over the year before: clinical (1,301 from 1,205), biology (178 from 156) and physics (556 from 312).

The number of overseas submissions was also higher; some 240 abstracts from Europe came in compared to 187 the year earlier, and 312 arrived from Asia compared to 240 the previous year.

ASTRO President Patricia J. Eifel, MD, FASTRO, professor of radiation oncology, The University of Texas M. D. Anderson Cancer Center, Houston, says she is thrilled the Society has broken its record for abstract submissions (not the first time the group has done so), heightening competition for the selection process.

“The number of abstracts submitted this year is a testament to how well-respected the ASTRO Annual Meeting is among medical professionals working in the field of oncology,” Dr. Eifel says.

It is true that ASTRO, with 9,000 members worldwide, draws more than 11,000 oncologists from all disciplines as well as physicists, biologists, nurses and other health care professionals to its annual meeting. The theme of this year’s milestone gathering is “Fifty Years of Learning, Caring and Collaboration in the Treatment of Cancer Patients.”

But all back-patting aside, the abstract news is a testament to the increasing attention being paid to the field by individuals who want to play a role in it—by improving therapy planning and treatment and doctor/technologist/patient safety and comfort; individuals who want to find a way to save lives so that one day no one has to die from cancer. That is news to beam about.

It wasn't too long ago that I remember hearing how beneficial red wine--in moderation!--was for my health. Its antioxidants were found to reduce risk of cardiovascular disease, and even inhibit types of tumor growth. Additional benefits were found in its ability to aid in the formation of nerve cells, a boost for neurological conditions. A smooth Pinot Noir, a poignant Shiraz, a cozy Cab, bring ‘em on.

A study mid-month, however, out of the American Association for Cancer Research Annual Meeting in San Diego, found that both excessive and moderate amounts of alcohol drinking--no matter the type--upped a woman's risk of the most common type of breast cancer. Even a drink a day could increase this risk; in this case, the women studied were postmenopausal. Researchers from Denmark and from a Harvard (Boston) study deduced similar findings among women in general. Results support the theory that alcohol affects estrogen metabolism.

On the flip side, researchers from the University of Texas Southwestern Medical Center in Dallas last week said that exercise may reduce breast cancer risk by lowering estrogen levels--assessing that estrogen may deactivate genes in breast tissue that suppress-cancer development.

Other brief tidbits making cancer study headlines last week: Two or three cups of coffee a day can cut the risk of breast cancer by a third or delay onset by 10 years. This one needs more data for substantiation, for sure. Oh yes, and let's not forget the role of mistletoe in aiding cancer treatment--a commonly prescribed extract in Europe for boosting immune systems and fighting the effects of chemo and radiation treatments. Researchers found that evidence supporting the use of mistletoe extracts was "weak" however, and recommended more data.

With various studies coming out each week about cancer linkages, cancer prevention tips, and information about various controllable and uncontrollable risk factors, it's important to keep sight of some main messages about healthy behaviors. Don't smoke. Don't consume alcohol; if you choose to, do so on a limited basis--with increased usage comes increased risks. Get screened for cancer early--colon, breast, cervical and skin. Protect your skin from the sun...when you're outside exercising! An active lifestyle--at least three to four hours a week of exercise--can cut your risk of several cancers in half. Exercise will also help keep your body mass index (BMI) at 25 or less; being overweight significantly ups your risk of developing several cancers. By eating at least five servings of fruits and vegetables a day, you can successfully manage weight, increase energy and nourish your body with vital nutrients. Reduce intake of fried, sugary, high-calorie foods as well as processed and red meats.

Patients must be educated on these and other healthy lifestyle choices--for their overall conditions and for a reduced risk of breast and other cancers. Many factors are out of our control, so let's take hold of what we can control.

A recent survey has confirmed what we here at Enterprise Imaging realized years ago as we searched for fresh developments in the X-ray modality-X-ray usage is being supplanted by more advanced modalities.

This news comes from the staffing firm of Med Travelers, which found that demands ultrasound/vascular and interventional technologists has increased steadily over the past three years. The need for vascular/ultrasound techs leaped from 11 percent of the company's staffing assignments to 24 percent in 2007; interventional assignments jumped from 4 to 16 percent in that same three-year period. Only 9 percent of the company's staffing assignments were of the radiologic garden variety-down an unhealthy 12 percent from three years earlier.

The reason for the growth of the two aforementioned modalities? Increasing incidents of cardiovascular disease and diabetes among our population, says the company.

But perhaps an even more intriguing aspect of the Med Travelers survey lies with the reasons why technologists prefer traveling assignments to permanent work at one facility. Not surprisingly, most of them (85 percent) cite the better pay as a benefit. But what did surprise me was the second most-cited reason: 59 percent love the so-called thrill of travel. By comparison, only 45 percent cited a liberation from office politics.

I must be in the minority here, but the jolt of continual physical displacement would seem an acceptable but hardly thrilling tradeoff to higher-paying temp work-certainly not it's second-most attractive feature. Of course, this comes from a guy who feels so excruciatingly discombobulated after only three days at a Washington, D.C. Economics of Diagnostic Imaging conference that he stumbles into the hotel in the early evening of the second day, dives onto a strange bed that makes his skin crawl at the thought of where the sheets have been, wakes unrefreshed the next morning and inadvertently leaves behind several articles of clothing, never to be worn again. To live a variation of that existence for much of my professional life is unfathomable to me.

But the joy of an endless succession of honeymoon periods with each of your short-term employers, free of office backbiting, transparent attempts at one-upmanship, and the mindnumbing sameness of watching the same borderline-incompetent co-workers coast along while the same few hapless chumps shoulder the burden of that extra workload? To my mind, such a work perk would not only trump the "freedom" of travel, but it would rival any added financial incentive that comes with being a rolling stone in the rocky world of modern health care.

While proven better for women under 50 and those with very dense breasts, digital mammography appears to come with an unforeseen price tag: more repeat exams-at least initially. That's the word from an article you may have caught in the April 10^th New York Times called "In Shift to Digital, More Repeat Mammograms".

The reason centers on the difficulty radiologists have in retraining themselves in digital reads, and reconciling the differences between digital exams and a patient's film priors. The resultant uncertainty in assessing these differences is leading to not only more mammograms, but more ultrasounds and biopsies as well.

For patients, that means greater anxiety and possibly expense if insurance doesn't foot the bill. For physicians, it means more time and money as well.

The article findings are based on feedback from 10 radiologists, including mammo's heavy hitters such as University of North Carolina's Etta D. Pisano, MD, and University of Washington's Constance D. Lehman, MD, PhD. Eight said that during their transition from film to digital, recall rates shot up in women who ultimately had nothing wrong.

 But most agree that the drawbacks are worth digital's benefits-greater clarity, contrast and magnification adjustability, and workflow improvement to name a few-and the growing pains are temporary.

What did you think of the article, if you've read it? What have you found in making the film-to-digital switch-any transitional tribulations?

When "Dirty Dancing" star Patrick Swayze's pancreatic cancer diagnosis made international news last month, he unofficially became the poster boy for this killer disease that unfortunately for its victims remains under researched. Pancreatic cancer needs poster boys and girls since most advocates don't live long enough to tell their stories.

Swayze's media hyped diagnosis is impacting pancreatic cancer awareness. Reports surfaced that the celebrity was under treatment at the Stanford University Cancer Center in Palo Alto, Calif., and that his prognosis was encouraging. When I read the articles, I wondered what specifically made his caregivers so optimistic since scientific progress has been slow. Pancreatic cancer is the fourth leading cause of cancer death in the United States, and in 2008, over 33,000 Americans will die from the disease.

I recently had a conversation with leading pancreatic cancer surgeons in Philadelphia who are involved in efforts to curtail the disease, not just treating it with surgery and chemotherapy. Pancreatic cancer isn't like most cancers since it's hard to find, due to where the pancreas is positioned in the body. However, in order to increase chances of survival, the disease must be diagnosed in its early stages before it metastasizes. Often most pancreatic cancer patients don't know they have it since typically there are no early warnings. CT, MRI and especially endoscopic ultrasound are imaging modalities utilized to confirm the diagnosis. Centers that specialize in pancreatic cancer are developing a screening test with MRI and endoscopic ultrasound, especially for patients who may have a genetic predisposition for this specific cancer. The screening protocol is in its early stages, and so are a number of other efforts that rely heavily on radiology for their effectiveness. But still there's hope. In the future, patients may go in for a blood test, have their sample analyzed with lab and radiology tests, receive a diagnosis and then take a pill to cure their disease. Unfortunately, that day is a long way off. There is a lack of funding to put these ideas in motion.

 Advocates recently decided to do something about money. On the eve of Swayze's diagnosis, over 220 pancreatic cancer advocates prepared to arrive on Capitol Hill on March 11 to seek an unprecendented $170 million in federal funding to support the "National Plan to Advance Pancreatic Cancer Research," initiated by the El Segundo, Calif.-based Pancreatic Cancer Action Network (PanCAN).

One of those advocates is celebrity pancreatic cancer patient Randy Pausch, a 47-year-old computer science professor at Carnegie Mellon University in Pittsburgh, who has terminal pancreatic cancer. His moving testimony to Congress is here: http://www.pancan.org/Press/video/video_pausch_testimony.html. Pausch, who received his diagnosis in September 2006, became famous when a final lecture he gave at Carnegie Mellon hit YouTube and got millions of hits. When that happened, he quickly became an advocate for pancreatic cancer using what time he has left to raise awareness. He's made good use of his days so far appearing on "The Oprah Winfrey Show," named ABC's World News "Person of the Week," and was commissioned by Disney-owned publisher Hyperion to co-author a book called "The Last Lecture."

Perhaps the visibilty of Pauch's plight--who says he always did the right thing and never smoked, ate right and exercised--may help net increased funding from Congress. He'll appear again on ABC Wednesday, April 9th at 10 p.m. EST when the special "Primetime" edition "The Last Lecture: A Love Story for Your Life" airs and once again puts a celebrity face with an under-funded killer disease.

 Update: For those who missed the "Primetime" special, ABC made available a special DVD  for purchase with a portion of the proceeds donated to pancreatic cancer research. The information is here: http://abcnewsstore.go.com/webapp/wcs/stores/servlet/DSIProductDisplay?catalogId=11002&storeId=20051&productId=2017125&langId=-1&categoryId=100014. Supporters can choose from a drop down menu either Pancreatic Cancer Action Network (www.pancan.org) or The Lustgarten Foundation for Pancreatic Cancer Research (www.lustgarten.org) as benefactors from the DVD sales.

Last week, I attended the Digital Healthcare Information & Management Systems (DHIMS) conference at the beautiful Westin La Cantera Resort in San Antonio, Texas. I left Philadelphia on a cold, blustery Monday morning in March and arrived at 2:15 p.m. local time in a gloriously sunshiny afternoon with temperatures in the low 70s. The air was clear and so was my head, for the first time since rain (the week earlier) had penetrated my bathroom ceiling—flowing through three holes and the light fixture over my toilet; and since I had scrambled that same week to plan for my mother’s 65^th birthday and holiday weekend, while working ahead on my professional responsibilities and home chores, rushing around in a torrent of confusion and forgetfulness, not entirely focused on the actual task at hand.

A 30-minute cab ride to the resort allowed me a few additional moments to gather my thoughts before arriving at the facility where some kind of busyness would inevitably ensue. (Maybe the hotel wasn’t successfully prepaid or there was a mistake with how many nights I was staying. Maybe I had forgotten to pack the emery board after all, guaranteeing I would break a nail, leaving a jagged edge that would stab a vendor during a handshake, if I didn’t go in search of a CVS.) The cab pulled off the highway and turned onto a road leading up a curvy hill bypassing the mammoth Six Flags amusement park—not yet open for the season—and up, up and around a steep driveway leading to the gargantuan resort and grounds of La Cantera. Perched atop the highest natural point in San Antonio and over an old limestone quarry, the facility’s clean, white exterior was a stunning contrast to the green and brown rolling hills of the Texas Hill Country’s wide open landscape.

The idea of being sequestered at a hotel so far away from the hubbub of Anywhere, Texas had initially elicited mixed feelings in me. But now, knowing I was stationed at this resort with six pools connected by a manmade stream of water, two championship golf courses, modern fitness center and spa, and exquisitely decorated lobby (with a Starbucks around the corner!) in the style of traditional southwest Texas, my mind was already at ease. At about 3:30 p.m., I checked in and found out where registration would be held the next day before hauling my luggage to my room. I opened the curtains to see the sparkling pools and bathing suit-clad visitors sunning themselves on comfortable lounge chairs while golf carts zipped around in the distance. The room was clean-looking and neatly decorated.

After unpacking and checking my phone messages, the rest of that day/night consisted of a brief stop at the health center, a half-hour of pool reading, dinner in my room and my eventual collapse at 8:30 p.m. local time/9:30 p.m. biological time.

When the wake-up call woke me at 5:30 a.m., I actually felt ready to start my day of conference sessions. This is not always the case. I have arrived at conference locations the night before, only to check in, drop my bags and grab a taxi to the restaurant where the rest of my staff awaits before returning to unpack the essentials, almost forgetting to set the alarm, and falling into bed at 11:30 p.m., where I am too wired to sleep. The next morning is a blur as I stumble to the lobby, praying for the moment that coffee reaches my lips, before I spend the next few hours trying to get myself from Point A to Point B.

On this first morning of the conference, registration was a snap, and the coffee I had grabbed on the way was peeling open my eyes. The bagel I had toasted from the continental breakfast prevented my stomach from growling, and the conference materials included a legal note pad—perfect, I forgot mine!—and pen. As the opening session got rolling, I found my mind ready to absorb information on the PACS primer and excited to hear what new trends may be happening in the imaging informatics field, which may be of interest to my magazine’s readers. The usual worries were far, far away—somewhere on the East Coast. Now, well-rested, well-fed and out of my routine, I was feeling like a whole new me.

Last week, news was released regarding bullying-specifically in the health care arena. The Journal of Obstetric, Gynecologic, & Neonatal Nursing reviewed the psychological and social issues related to bullying in the workplace, and strategies for creating a respectful work environment.

The Joint Commission determined that over half of nurses had been bullied at work, and over 90 percent had witnessed it in some fashion (via physicians or peers). As I dug deeper, more studies appeared, including one detailed in a Science Daily article that points out that while sexual harassment offenses can be criminalized, belittling comments, gossiping and incivility of course cannot. Sad really, as bullying--now far more common, but often subtle--in its various forms can lead serious health problems including depression, anxiety, insomnia or worse for the victim.

I once experienced bulling in seventh grade--the boyfriend gone bad variety--that surfaced as chair kicking and hair pulling. By the third day, I told my mom I didn't want to go to school. I had to go. A decade plus years later, I experienced the wrath of an abusive, bullying manager. Each day, I wanted to stay home; I couldn't then, either. A friend of mine who works as a medical assistant at an ob/gyn practice recently vented to me about a verbally abusive colleague. This woman's antics greatly impacted my friend's self-esteem, performance and job outlook. Perhaps a topic for another post altogether, but I've also heard what I'd consider horrific tales from medical residents regarding inappropriate--not to mention illegal--treatment at their hospitals. From harsh, abusive comments to extreme successive hours "on the floor," they too suffer intense emotional distress courtesy workplace "bullying."

Bullying behaviors do indeed occur in many workplace environments--health care is clearly no exception. A negative, abusive employee may disillusion the entire crew, putting the success of your operations in harms way. Management must be aware of this unfortunate trend, and remain enough involved in the employee relations side of the job to be attuned to "bad apples." How do you smoke out your workplace bullies? What's the appropriate response to transform bad behaviors to foster a supportive, positive work environment?

With the many duties of a manager or administrator, it's hard to stay on top of everything--and everyone. But the presence of bullying--even subtle traces of abuse--will cost you.

And you thought that oil, honey bees and dollars in your 401K were the only things likely to be in perniciously short supply in 15 years.

Add doctors and nurses to the list. A recent health care report indicates that the Big Three presidential candidates don't back up their lofty "accessible and affordable health care for all" proposals with the funding and physician/nursing infrastructure needed to support them.

The report, issued earlier this year by the San Diego health care recruiting firm of AMN Healthcare Inc., notes a shortfall of 120,000 nurses in this country-and predicts a deficit of between 350,000 and 1 million by 2020, thanks to aging baby boomers and an aging nurse workforce. It also cites a physician shortage that could reach 85,000 to 200,000 docs by 2020.

Apparently none of the presidential candidates propose an adequate increase in the number of nurses in this country-and they appear to have no plans to grow the number of faculty who will train nurse applicants. And the candidates are similarly bereft of ideas to increase the number of physicians trained in the U.S. According to AMN, only the now-defunct campaign of Sen. Joe Biden had plans for increasing residency programs. (Perhaps the good senator-no stranger to the act of appropriation-will permit one lucky candidate to borrow that particular plank of his platform.)

Now is this any way to care for the nation's 47 million uninsured?

The AMN report concludes by stating how the 2008 campaign could, in theory, be the launching pad for a defining dialogue on health care reform. What we have now, though, is apparently yet another Grand Call to Action that's big on cheap rhetoric and shoddy planning and woefully short on thorough research and realistic expectations.

You can't expect to adequately care for your aging and ailing citizenry that way, any more than you can expect to win a war.

You may have read in ADVANCE’s online Daily News section (March 4—CRA Exam Results Announced) that 38 out of 84 medical imaging administrators passed the November Certified Radiology Administrator exam (www.crainfo.org), bringing the total number of CRAs to about 600. But what we didn’t know then is that the recent pass rate of 45.25 percent illustrates a downward trend.

Here's a look at previous year's CRA pass rates (for more information, visit http://www.ahraonline.org/CRA/News.asp):

July 2007: 38.89%

March 2007: 61.76%

Nov 2006: 46.15%

Aug 2006: 46.81%

March 2006: 33 passed, but no pass rate is listed on the AHRA site. However, at this point, the average pass rate for the CRA exam was 78%.

Nov 2005: 53%

Aug 2005: 69%

March 2005: 64%

Oct 2004: 65%

July 2004: 91%

Nov 2003: 74%

Aug 2003: 90%

May 2003: 88.89%

July 2002: 86.44% (inaugural exam)

So, why the decline? To find out, I asked Kathryn Keeler, CRA certification coordinator of the American Health Care Radiology Administrator. She said: "We have looked into and continue to look into why that is-all evidence points to the exam having the same degree of difficulty in the past few years as it did in 2002. We do find that candidates with greater experience tend to be more likely to be ready to pass the exam. 

"The CRA credential speaks to a high standard," she adds, "and it probably isn't surprising that professionals who have been growing and achieving in the industry for a number of years would be more likely to find themselves ready to meet that standard!  My best guess is that that, more than anything, has contributed to the difference in pass rates."

So, the exam's difficulty is about the same, but perhaps those who passed were just more prepared and experience? Makes sense. But then, why are more ill-prepared administrators taking the exam now vs. yesteryear? Is everyone busier due to belt-tightening requirements caused by reimbursement cuts (DRA, etc.)? Are they not studying as much? Did higher pass rates from the past give a false sense that the exam wasn't challenging? Or, is this recent downward trend just a fluke? We'll be watching for answers.

Meanwhile, any speculations?

Nurse Bonnie Britton grew up in a rural area of North Carolina, not thinking that she'd return to her hometown years later to help her fellow low-income community members link to a telehealth program for improving their lives. Called The Patient Provider Community Telehealth Network, the computer-based program is working for the residents of Ahoskie, N.C.

Not only have lives been extened with the telehealth program, but Britton has crunched the numbers since the program began two years ago and presented the health care community with striking financials that show cost justification for telehealth equipment. With the use of telehealth kiosks placed in senior centers, schools and the use of in-home monitors and in-home vital signs monitoring equipment Roanoke Chowan Community Health Center, Britton's employer, saved an average of $53,095 a year per patient participating in the remote disease management program. When Britton delivered that figure at the 2008 Healthcare Information and Management Systems Society meeting last week in Orlando her audience clapped loud and strong since it places a monetary value on telehealth services, justifying the technology.

Britton shared more statistics: Her poverty-stricken county ranks number one in the state for cardiovascular disease, diabetes and HIV infection. She recounted dramatic patient stories where IT technology and services made a measurable health impact. One man suffering from heart failure gained months of life by interacting remotely with caregivers; others gained years of life since the program began in 2006. The program is relatively low-tech and makes use of e-mail and the telephone for patient interactions.

Britton's project was a showcase for HIMSS and its goal to demonstrate the value of an electronic health care system. This year's event was a record-breaking HIMSS conference with more than 28,400 attendees and 900 exhibitors answering the nation's health care IT call.

The other day, I received an e-mail from a relatively large health care vendor in the medical imaging world announcing that the company was implementing a “rightsizing initiative.” I have heard a lot of public relations-speak in my 13 years as a journalist and editor but I’ve never heard of “rightsizing.”

This press release peaked my interest. What, exactly, is rightsizing? Is it anything like “downsizing?”

It turns out this initiative—a failed euphemistic attempt to slide across my eyes like skates on a freshly Zamboni’ed rink—was what you might guess: a series of employee and contractor layoffs that included the “reduction of 160 personnel,” which, combined with a group of terminations and attrition numbers, taking into account severance and other expenses, would yield annual cost savings in the multimillions and would return the company “to positive operating results.” The reason for rightsizing, the CEO explained, is the result of the Deficit Reduction Act, two financial restatements and legal expenses.

I wonder, though, if the term “rightsizing” is only reserved for journalists, who want to be kept abreast of news in the industry? Or do company officials use it when they’re giving employees the bad news? Does Mr. Manager sit John Doe down in his office to explain that his contributions over the years have been appreciated but low revenues and expenses are becoming a concern to shareholders, and the company has embarked on an endeavor to make things right? Tell him this is all to the greater good and then thank him for his years of service.

I don’t think so.

If this is offensive to a soon-to-be-out-of-work employee, who may go into foreclosure on his mortgage in a year when he still hasn’t found a well-enough paying job, or one who has to explain to his kids that, no, they won’t be going to the shore this summer, or another who has to tell his wife that the car they just bought will have to be traded in for a less reliable, used one. So why does this company think it won’t offend me?

I am appalled at this lack of consideration for these workers, who are being thrust into the panic-attack-inducing scenario of losing their steady pay, eight-hour-a-day focus and some vestige of their professional and personal identity, through no fault of theirs. I am not just an editor looking for news, I am a woman who knows what it’s like to wake up at 3 am, nightly, for six months, with a feeling of dread and terror about whether I will be able to pay the rent that month. Though my previous job departure was voluntary, I can relate to the free-fall sensation of unemployment. And I don’t have a house, a spouse or children.

So vendors and PR gurus, take note: You’re not fooling anyone. Layoffs aren’t a good thing, last time I checked, and sugar only lifts me for the short run; then I just get irritable. So let’s show some respect for the people who boosted your bottom line for so many years and not pretend that anything less is right. Forget about good public relations, let’s strive for something better—human compassion.

It’s Friday afternoon--the best part of the week. I had big plans for a fast-moving, productive day, free from the chocolates, E-cards and flowers of yesterday. I have research to do for an upcoming article, and a steady stream of emails to send and receive as usual. But…today’s not going according to plan. AT&T has informed our area that the circuits are down--all outgoing and incoming traffic has come to a halt.

GASP! Since early this morning, no email, no internet. At first I was stumped and frustrated; what would I do today? Realizing this was completely out of my control, I thought about all the things I could get done. The long follow-up emails waiting in the to-be-written wings. Articles needing edits. My mess of a desk that’s calling out for organizational TLC--not to mention an antibacterial wipe or two.

As I plow through a surge of random tasks, I suddenly realize I feel empowered, productive, calm. Indeed, without Outlook’s constant interruptions, it’s decidedly quiet… and refreshing. When’s the last time I described work that way? It got me thinking that perhaps a deliberate unplugging each day is just what we all need. Consider the phone calls or in-office conversations that will no longer get put off. What about the peace that stems from an orderly workspace? Or the satisfaction that comes from organizing that to-do list to create a scheduled plan of attack--not to mention completing some unexpected tasks (early!)? I wonder how many of you willingly “unplug” yourselves, and what benefits that provides.

Alas, as I’m flying along, there’s another piece of info that only Google can find. Stumped again, I flag for further follow-up. The post-it notes are now starting to multiply. And then I start to wonder: are friends and family trying to e-mail me about weekend plans? How tragic!

Here I am, on a disconnected island…a love-hate scenario.

You can probably guess where the conversation went from there. "What if Oprah were to come to RSNA?" Jan asked. "It's in her backyard! We could invite her to see the magnitude of this convention and what technologies are out there, particularly with regard to women's health. Could you imagine if she went to the Siemenses and the GEs and the Kodaks and the Hologics? They would just eat her up! But nobody has pursued that."

That got me to thinking: Oprah at RSNA. Her coterie alone would cause a flurry of excitement. Imagine style maven Nate Berkus doing a makeover on the two-story vendor booths! Or Dr. Phil debating the ethics of PET/MR as a glorified lie detector! And at the center of the maelstrom: the doyenne of daytime, holding court with equipment manufacturers as they jostled their way to the front of the receiving line.

But one thought lingered in my mind: Didn't the Big O dip her big toe into the waters of medical imaging at least once before? A little online digging revealed that she had--eight years ago, when she underwent a full-body computed tomography (CT) scan on her talk show. Not surprisingly, Oprah's gushing validation of the technology--which found her to be in good health overall--was later used in whole-body screening advertisements, alongside breathless endorsements by such hucksters-for-hire as Whoopi Goldberg and William Shatner.

Well, we all know how that whole-body CT screening craze panned out a couple of years later. Following mounting criticism from the medical imaging establishment, the much-ballyhooed California storefront centers closed their doors. Their owners and champions muted their rhetoric, and Whoopi and Bill moved on to greener pitchman pastures.

I said none of this to Jan, though. She'd come to her own perfectly respectable conclusion as to why Ms. Winfrey has refrained from mounting a massive breast cancer awareness campaign: "It may just be Oprah's lack of education regarding breast health that's kept her away from the issue."

If that's the reason for her reticence, then I commend Oprah for recognizing her limitations. An ill-informed national dialogue on the subject--one that might incorrectly identify certain imaging modalities as being superior to others in cancer detection, or elevate dubious homeopathic remedies to the same level as clinically proven treatments--would hardly benefit patients. And certainly, the medical community has already contended with more than its fair share of publicly traded misinformation, courtesy of the Internet.

By sticking to efforts like her book club, she's keeping the potential fallout to a minimum. At least when her audience members purchase a possibly apocryphal memoir like A Million Little Pieces, they're gambling with pocket change, not their lives.

Ever consider calling an ambulance to get the express lane to emergency care rather than driving to the ER and facing hours of moaning in purgatory, oops, I mean the waiting room? Such thoughts are blatantly wrong and would be an abuse of the system. Still, I can see the appeal-especially after experiencing both situations over the last few years (ambulance and immediate attention for internal bleeding, and self-transportation with a grueling four-hour wait for a high-grade fever due to suspected Lyme disease).

Unfortunately, more people may face the unhealthy temptation to skip to the head of the line with the recent news that waits for emergency care are expanding each year, according to a Harvard study released Jan. 15 in the journal Health Affairs. The study, which analyzed the time between a patient's arrival in the emergency department (ED) and when they were first seen by a doctor, found that the widening delays affected everyone, including those with and without health insurance, and people from all racial and ethnic groups. The study involved more than 90,000 ED visits nationwide between 1997 and 2004. Here's a recap of results:

• Severely ill patients suffered the largest increases in ED waits.Between 1997 and 2004, waits increased 36 percent for all patients-from 22 to 30 minutes on average.
• For those whom a triage nurse classified as needing immediate attention, waits soared by 40 percent (from 10 to 14 minutes).
• Waits increased the most for emergency patients suffering heart attacks, who waited only eight minutes in 1997, but 20 minutes in 2004, a 150 percent jump. A quarter of heart attack victims in 2004 waited 50 minutes or more before seeing a doctor. (It doesn't take a heart surgeon to know that such delays seriously mar chances of survival.)
• While all demographic groups experienced greater ED waits, they were slightly longer for blacks (13 percent longer than non-Hispanic whites) and Hispanics (14.5 percent longer). Women also had longer waits (5.6 longer longer than men), while rural hospital patients had the shortest waits.

It's hard to believe that the study, conducted by the Cambridge Health Alliance/Harvard Medical School, Boston, is the first detailed analysis of national trends in ED waits. But rather than complain, I applaud the researchers for bringing awareness to this dangerous situation, so solution-oriented steps can follow. I also vow to never call for an ambulance unless truly needed-I'll just pack War and Peace for the waiting room.

When my nephew got an iPhone for Christmas, it was just the latest gadget for this young teen who began using technology when just a mere tot. Afterall, he lives in the Silicon Valley where technology is the focus of most dinner table conversations.  So kids can't help but gravitate toward it.

As the Internet began evolving, he quickly learned how to utilize information, make online friends and how to play computer games, spending many afternoons mastering these skills.

With his new iPhone he watched videos from You Tube and shared his favorites with his visiting uncles, all just by touching a small keyboard and doing motions with his fingers. In the afternoons and evenings he would go online and play computer games with kids from all over the world who were logged in to zap the life-like aliens darting up and down the high-res, flatscreen monitor. I tried to keep up with all of this, but after awhile I suggested an activity outside of this tech lab; something a little more mind and body cleansing like throwing a frisbee back and forth. It just wasn't his thing.

Kids like my nephew who spend half their lives in a virtual environment may benefit from interactive health learning or watching teen tailored medical videos or Podcasts. Afterall, the medical community has the power to reach children with information over the Internet, preventing them from growing into unhealthy adults. The Society for Vascular Sugery, for example, put together an online activity book for kids who learn over the computer. You can find that at http://www.vascularweb.org//patients/PDF_Docs/composite_activity_book.pdf. The fun book instructs kids on the way oxygen and nutrients travel in their bodies and the benefits of eating right.

The time maybe right for an online series on medical imaging studies and specific needs for kids. Medical professionals recently launched a computed tomography (CT) web site: www.imagegently.org that is initially targeted to their peers to lower the dose of CT exams for children undergoing the test. In just a week since the official launch, about 400 professionals have signed on and made a pledge to cut the dose for the pediatric population. That's a real testament for the Internet's reach. The campaign had an immediate impact with 140 professionals making that same pledge just hours after the official launch. This may seem like heady information for kids, but tech savvy ones may benefit from this information on the web. If they're like my nephew, they use their Intenet ready iPhone to look up anything discussed at the dinner table, even CT scanning.

The Internet and its relevant technology has the potential to keep kids informed and healthy by bringing useful information onto their desktops, laptops or iPhones. Perhaps these devices could also include instructions on the importance of turning the gadgets off and heading outside for some frisbee tossing with a favorite uncle.