Known Unknowns of Everyday Radiology Practice

Known Unknowns of Everyday Radiology Practice. Bhavin Jankharia and Akshay Beheti (eds). CBS Publishers, New Delhi, 2018. 87pp, price not mentioned. ISBN 978–93–87085–87–9.

Radiologists are often faced with dilemmas of ‘what to do if…’, or ‘how to proceed if…’ while doing their daily investigations. These relate to dealing with a wide variety of situations ranging from contrast administration and radiation safety to legalities of reporting and licensing processes for equipment.

Practical and reliable solutions for many of these problems are not given in most standard textbooks. Also, there is a lack of standard operating procedures (SOPs) in many departments and hospitals to address these issues. As a result, the vast majority of radiologists remain unclear on how to deal with such situations. In this small book, the authors have tried to address these myriad queries that trouble the radiologist.

The book, organized in 11 chapters, covers a diverse range of topics such as contrast administration, radiation issues in children, adults and pregnant patients, pre-conception and prenatal diagnostic techniques (PC-PNDT), the Atomic Energy Regulation Board (AERB), etc. The common thread is the practical use of these topics in the day-to-day working of a radiologist.

In the beginning of some of the chapters, the reader is quizzed on how to manage certain clinical scenarios. Following this, the concerned topic is discussed in detail, with extensive use of flow charts, tabulated information and important points, etc., summed up in ‘At a glance’ and finally explanatory answers to the initial questions have been provided. Besides the text, updated references and links to pertinent websites have been given at the end of each chapter for further information.

The first chapter on the current status of radiation and patient safety gives an overall practical perspective of radiation risks, whereas the guidelines for use of CT and MRI in pregnancy are dealt with in another chapter. These give an accurate picture of the actual risks versus the commonly prevalent perceived risks and myths about the dangers of radiation in the general population and pregnant women, in particular. The practical scenarios used as examples help in understanding the risk, without muddling the reader with radiation units and calculations.

The chapters on contrast media cover both iodinated and MR contrast media. Illustrative examples of practical situations in the interpretation of serum creatinine levels, calculating the estimated glomerular filtration rate (eGFR) and their applications, have been dealt with in a simple and systematic manner. The management of contrast reactions and of patients who are at risk—a very common problem for the radiologist—has also been covered in detail.

A typographical error in Table 2.2 classifies Prohance as a linear ionic agent, whereas it should be placed in the column of macrocyclic agents.

‘Contraindications to MRI’ clarifies the basic terminology with respect to MR compatibility and explains the current contraindications for MRI, a very common dilemma faced by radiologists.

Customized checklists required for performing different types of image-guided procedures, taking into account the patients’ clinical condition have been provided. This is a ‘must read’ especially for beginners performing such procedures.

The book also has a ready reference to guidelines pertaining to medico-legal aspects of reporting, obtaining consent, rights of patients and radiologists, etc. The final two chapters deal with the legalities of the PC-PNDT and AERB regulations, which all practising radiologists should know. Establishing an imaging setup, purchasing and licensing equipment, quality assurance checks and other issues related to equipment management within the statutory norms have been dealt with in a nutshell.

The book is small in size, very handy and can be easily carried or kept on every radiologist’s table. It has short chapters and highlights important points. The insertion of relevant comic illustrations make for delightful reading with a wealth of knowledge presented in a concise, simple and reader-friendly manner.

Overall, I would recommend this book not only to all practising radiologists, but also to postgraduate students in radiology who will find it extremely useful to answer questions posed to them in practical examinations.

I look forward to more handbooks on other equally important topics.