PNDT ACT: FACT AND FANCY

Dear All,

It has been observed that PC & PNDT Act has become destructive tool in the hands of appropriate authorities. Every CMO uses it at its own whims and Fancy. At so many instances the ultrasound machines are being sealed on drop of a hat. The objections are being raised that improper filling of Form “F”. The referral slips do not have obstetric history, the record is not proper. Everybody knows how the record is being kept at civil hospitals versus private diagnostic centre. Every Civil Surgeon feels that by Gagging the Radiologist the female feticide will stop. But alas the results are not much encouraging. We need to dig in the details of this social evil and better results could be obtained. Not by keeping radiologist as evil doer but as a team member.

here are some suggestions to control skewed sex ratio

They are laying more focus on methodology to fill the Form F and Paperwork rather nabbing the culprits. Which generally proves to be a futile effort? As someone doing this illegal work will not keep any record of this act. And will keep the timing at odd hours when the controlling authorities are least expected to nab them. More over it is possible only in connivance with the authorities itself in some cases. But most of the civil surgeons are struggling hard to stop female feticide.

Illegal MTP's are being done by Nurses, Dai'es and Quacks and what to Talk about a [b]Recognized MTP Centre[/b]. No crackdown or raids are being conducted at these sites of "MURDER" presently. Frequent raids should be made on the quacks and illegal MTP centres for this purpose.

Perhaps Government should ensure that these illegal MTP Centres if closed or regulated forcefully may yield the results for which our Govt/CMO's are sweating their neck down.

It has been observed that Form "F" is being sold at @ Rs.10/- Per form in some parts of Punjab under Red Cross, Putting an additional burden on poor patients. This practice i feel should be discouraged.

In industrial towns so many migrant labourers live and the health facilities are not adequate. When a industrial labourer approaches for U/s FWB. An Identity proof is asked in most instances they do not have any and their scan could not be done. Hence they lie at mercy of God for their delivery resulting in increased infant mortality and maternal mortality.

To mobilize Community participation, village level vigilance committee should be formed to keep a check on the female foeticide.

I feel the departmental work such as change of machine, Radiologist, Registration should be made fast and relaxed. So that a congenial relationship may be developed and will be beneficial to Government as well as radiologist.

it has been observed that some hospitals take PC & PNDT registration by employing Radiologist for a part-time basis and then after wards they illegally use the machine for ultrasound/ ? sex determination. This fact should also be taken in considerations while granting Registration.

Maximum illegal use of the technology is done at the centres where there is MTP facility is also running. The entire act is done without leaving a trace. I am not averse to the ethical use of USG in Obstetrics but when its misuse exceeds use it should be curbed with a heavy hand.

All users are requested to air their views so that a consolidated suggestion list may be forwarded to Government to ease the living of a radiologist and stopping female feticide. Let’s take a pledge that we shall not indulge in this gruesome act of sex determination.

RADIOLOGIST BEWARE OF THE GAMES COMPANIES PLAY

After spending a decade in medical college and acquiring the much sought after degree of M.D. Radio-Diagnosis a young radiologist has two options:

1. Go and join some Job.
2. Start his own Clinic.

First option is relatively easy one and one does not have to worry about finances and other problems like getting the patients and buying Machines.

Second option is difficult preposition, as one has to face the problem of arranging the finances and buying the equipments which can be a tiring phase during the initial months.

It is that period when you finally decided to open a centre for yourself and started looking for Machine after arranging a site for your clinic. You send a signal and the representative of various companies start a bee line to you. They give you so many options, that you get confused. Every one will speak a language which you will find either Greek or Latin. This is not you have studied in your degree. There are so many confusing terms developed by individual companies to confuse customer. Like cross beam technology, Matrix probes or Aplipre, Advance Dynamic Flow, Quick view & Iassist etc.

The companies will send representatives they will speak a lot but will not give you some thing like “Factsheet” or “DATASHEET” in writing. Most of their commitment will be verbal only and the sales person will show his personal commitment to fulfill promises.

One should be very careful in dealing with companies and do not rely upon verbal assurances. One thing you will notice that all the brochure will have more of pictures and less about the machine. The Datasheet is a fact sheet every company should provide with brochure.

I tell you my recent harrowing experiences related with buying ultrasound machine for myself. So many companies visited me and showed their equipments, the machines I liked were out of my budget preview.

Then Toshiba people offered me Xario Machine claiming that this machine is a Demonstration unit and about 1.5 years old and they offered me this machine with four new probes viz. Convex, Linear, Endovaginal and Cardiac Probe. With complete package having Aplipure, Trapiziod scan, Tissue harmonic Package, Panoramic View, 3-D Imaging and Broad beam former etc. with 2kVA Online UPS (Tata Libert) with Sony Digital Thermal Printer and 2 years of Warranty for 12 lac of price. Though I wanted a new machine but this configuration was good bargain.

I went for it though their competitors warned me that the Xario has only a few installation bases due to its fragile equipment and Poor service network. I ignored their warning as I thought Toshiba is a good company and I was given 2 years of warranty. I gave my nod to buy the machine on 30^th Jan 2010 with an advance of 1.5 lac. I also asked some genuine questions like

1. What is the actual age of the machine?
2. Is it a true demo machine or a refurbished old machine?
3. Will the parts and service be available for 10 years?
4. What will be the machine up time guarantee?
5. What is complaint redressal system?
6. Will you provide me a stand by machine in case of break down more than 24 hours?

They sought some time answer and to install the machine within 2-3 weeks time. But the company defaulted this time saying that some parts were missing from the machine and being imported. They were mum and not coming clear on it and only verbal assurances were given. They did not show me the age proof.

Then they insisted that I should remove penalty clause in my purchase order which was “ in case of break down of more that 24 hours, the company will provide me a comparable standby unit and if the company fails to provide support the company shall pay me Rs 10000/- per day as compensation and the warranty shall extend accordingly”. I told them this clause will be applicable only when the company defaults, if you are assuring me a good after sales service then what is need to panic about the clause. But they insisted that I should remove the clause, perhaps in their inner mind they knew that they could not come clean on this. I deleted the clause keeping my fingers crossed.

Finally they installed the machine but the machine was not working properly as it needed two more probes as in order, Thermal printer and some parts to be replaced. They sent their engineers to rectify it and the machine collapsed all together. It refuses to even start. They told me that it needed to be moved to Delhi for repairs, I agreed and asked for a standby machine, which they flatly refused.

I was shocked that the company is dragging its feet from their written commitments, especially when the full payment is not yet made. I had my worst fears coming true before me. I again requested but they refused saying that we do not have any stand by units; I asked them “This is my new centre and I can not keep it shut for the days you will take for repair.” They didn’t seem to bother about it, and finally I had to cancel my order.

Than I had to search for another machine in emergency and place a new order. And finally installed ALOKA SSD4000 for Rs 14 Lac for 4 probes and one UPS.

Friends I have written this blog to aware our Radiologists to the tricks of the companies and evolving a transparent system to help ourselves.

I have already written about the need of Grading System about the comparison and features of the Machines and their cost effectiveness. I wish IRADIX could do something about it. I can shoulder the responsibility entrusted on me.

Tele Radiology How it works

Teleradiology is the transmission of radiological patient images, such as x-rays, CTs, and MRIs, from one location to another for the purposes of interpretation and/or consultation. Teleradiology is a growth technology given that imaging procedures are growing approximately 15% annually against an increase of only 2% in the Radiologist population.

Teleradiology improves patient care by allowing Radiologists to provide services without actually having to be at the location of the patient. This is particularly important when a sub-specialist such as a MRI Radiologist, Neuroradiologist, Pediatric Radiologist, or Musculoskeletal Radiologist is needed, since these professionals are generally only located in large metropolitan areas working during day time hours. Teleradiology allows for trained specialists to be available 24/7.

Teleradiology utilizes standard network technologies such as the internet, telephone lines, wide area network (WAN), or over a local area network (LAN). Specialized software is used to transmit the images and enable the Radiologist to effectively analyze what can be hundreds of images for a given study. Technologies such as advanced graphics processing, voice recognition, and image compression are often used in Teleradiology. Through Teleradiology, images can be sent to another part of the hospital, or to other locations around the world.

Teleradiologists can provide a Preliminary Read for emergency room cases and other emergent cases or a Final Read for the official patient record and for use in billing.

Preliminary Reports include all pertinent findings and a phone call for any critical findings. For some Teleradiology services, the turnaround time is extremely rapid with a 30 minute standard turnaround and expedited for critical and stroke studies.

Teleradiology Final Reports can be provided for emergent and non-emergent studies. Final reports include all findings and require access to prior studies and all relevant patient information for a complete diagnosis. Phone calls with any critical findings are signs of quality services.

Teleradiology Preliminary or Final Reports can be provided for all doctors and hospitals overflow studies. Teleradiology can be available for intermittent coverage as an extension of practices and will provide patients with the highest quality care.

Digital Imaging and Communications in Medicine (DICOM) is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol. The communication protocol is an application protocol that uses TCP/IP to communicate between systems. DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format. The National Electrical Manufacturers Association (NEMA) holds the copyright to this standard. It was developed by the DICOM Standards Committee, whose members are also partly members of NEMA.

DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a picture archiving and communication system (PACS). The different devices come with DICOM conformance statements which clearly state the DICOM classes they support. DICOM has been widely adopted by hospitals and is making inroads in smaller applications like dentists' and doctors' offices.

You can visit me on www.telereporting.com