Are Doctors Required to Obtain Patient Permission For Posting Non-Identifiable X-Rays, CT Scans, Etc Online?

The blunt answer is no... as long as there is no way the patient can be identified by looking at the image. (in other words, anonymous).

Dr. Ves Dimov at CasesBlog has written a very good article regarding this very question and the guidelines used to determine whether patient permission is required or not.

Read his blog article here.

Bilateral Lateral Hypopharyngocele (Cervical Esophageal Diverticulum)

I recently was asked to review this interesting (and rare) disorder in which a diverticulum or pouch has formed on both sides of a patient's upper esophagus. This condition which I'll call bilateral lateral "hypopharyngocele" is even more rare than Zenker's Diverticulum which is also not very common.

Check out the barium swallow which shows a barbell like image. The "barbell" part is the abnormal pouch and is found on both sides.

A paper was actually written about this condition by Dr. Chang.

Reference:
Bilateral Pharyngoceles (versus Branchial Cleft Anomalies?) and Endoscopic Surgical Considerations. Annals of Otology, Rhinology, & Laryngology. 114(7):529-532, 2005.

Hotels Offering Hypoallergenic Rooms

Recently, a few hotel chains including Hyatt, Wyndham, and NYLO have introduced hypoallergenic rooms for those suffering from asthma, allergies, or just want a room with a clean breathing environment.

At least for Hyatt, the rooms are called "Respire" and as per their website:

"Respire by Hyatt rooms undergo an additional six-step process to reduce airborne particles and minimize the presence of potential irritants. This process includes installation of a state-of-the-art air purification system and treatment of all fabrics and surfaces in the guestroom. All Respire by Hyatt rooms are installed and maintained on an ongoing basis by PURE Solutions NA.

The Respire by Hyatt – Hypo-Allergenic Rooms purification process includes:

• Application of PURE Shield and PURE Clean to minimize presence of allergens on carpet, upholstery and other surfaces in the room.
• One-time shock treatment to minimize irritants.
• Complete disinfection of Air Handling Unit and Installation of removable tea tree oil cartridge to maintain these conditions.
• Installation of hypo-allergenic mattress & pillow encasings.
• Installation of a powerful air purifier by Healthway, listed as a Class II Medical device by the F.D.A.
• Recertification every six months."

These rooms (regardless of the hotel) are implemented by New York–based company Pure Solutions.

Read more about what exactly is done to these rooms here.

Large Metal Hook In Person's Head (No Kidding)

An ENT colleague brought this x-ray to my attention. Apparently, there was an accident during which a large hook got embedded in this patient's head.

Wearable Camcorders for Video-Recording Surgeries From the Surgeon's Viewpoint?

An avid snow-boarder, I had the bright idea of using the ContourHD wearable camcorder I purchased to record snow-boarding runs... to instead video-record surgical cases. This wearable type of video-recording has many advantages over traditional camcorders which requires an assistant to shoot the video.

First, the angle of a wearable camcorder is from the surgeon's viewpoint and has minimal distraction impact. Having an assistant video-recording over the surgeon's shoulder during a surgical case is not ideal on both these points.

Second, the surgeon has complete control over what is being recorded rather than depending on a 3rd party making that decision.

Third, when these wearable cameras are attached... it is incredibly secure. It will NOT fall off accidentally or otherwise. When an assistant is doing the recording... there is always the chance they may drop the camera into a sterile surgical field which would be a disaster. Here is a picture of me with the camcorder attached:

There is also the cost factor... These consumer wearable camcorders are around $275 or less on Amazon.com. Compare that with dedicated surgical headlight camera systems like the MicroLux® DLX by Integra which cost way more.

SO... how well did the ContourHD camcorder work? Not too good...

Unfortunately, the focal length of these camcorders are set to 2 feet to infinity resulting in blurry videos when shooting at closer distances, like dissecting out a parotid tumor (believe me... I tried). These wearable camcorders also are not focus-adjustable.

Hopefully, a manufacturer will address this key shortcoming and make one with either an adjustable focus OR enable the user to swap out the lens set to different focal lengths OR designing an adapter over the built-in lens that would adjust the focal length. Here is a concept of what I have in mind:

It would be pretty cool to record surgical cases with as much "pop" and detail as this snowboarding video (not mine).

Wearable camcorders I am monitoring (hoping) for such innovation that is usable in the operating room theater include ContourHD and GoPro Camera.

There are other wearable camcorders such as the Looxcie which is not as well-suited for recording surgical fields. The main problem with such "social" camcorders like the Looxcie is that it can only record (the previous) 30 second video snippets and is not in HD quality. Read more about Looxcie here.