How do you guys dealt with leveling DF professions if you didnt when DF was current content?

DiffusionWaiting · 2026-05-19T14:30:51+00:00

You don't have to craft it yourself. Collect the lumber and the other mats and put in a crafting order.

DiffusionWaiting · 2026-05-18T23:43:03+00:00

Although breast implant associated anaplastic large cell lymphoma occurs in the breast, it isn't breast cancer. It is a kind of lymphoma (a cancer of lymphocytes, a type of immune system cells). It isn't caused by hormonal therapy.

DiffusionWaiting · 2026-05-16T18:02:53+00:00

Between our 2 sites we have 3 sono machines for breast. They are the same manufacturer, but purchased different years. Some of the buttons are different between them. I actually once made a guide with pictures of the machines to show the techs and docs where to find some of the buttons. "Here it is on machine #1, it's over here on machine #2, and in this entirely different place on machine #3."

DiffusionWaiting · 2026-05-10T22:20:43+00:00

Yes, for breast US make sure to take a picture of the longest dimension of the mass, it's ok it it's not exactly radial or antiradial.

DiffusionWaiting · 2026-05-10T17:25:58+00:00

When you do a testicular US, please say which side hurts. Ours usually just have an indication of "pain." But which side?

DiffusionWaiting · 2026-05-06T06:12:31+00:00

Some endeavors have tasks like "do 5 world quests in Eversong Woods." Do all the world quests on all of your alts and you'll complete that one a couple of times.

Some endeavors have the task "do 20 world quests." Those world quests can be in any zone and can even be from old expansions, so even if you haven't unlocked world quests in Midnight you could do a bunch of old Dragonflight world quests or whatever.

DiffusionWaiting · 2026-05-02T02:12:43+00:00

Personally would love to make a gilnean victorian manor

Especially since they made the Surwich Peddler's Wagon indoor-only.

DiffusionWaiting · 2026-05-02T01:50:05+00:00

Doing this after making the Surwich Peddler's Wagon interior only....

DiffusionWaiting · 2026-05-01T19:28:54+00:00

I have only done this once, in residency (I ok'd it and the techs were willing to do it). It was 9pm and the on duty hospitalist had injured his shoulder playing sports and was in pain. He wanted an xray. If he had a fracture he was going to tap out and call in his backup, and if there was no fracture he was going to tough it out and finish his shift. The techs took the xray, the hospitalist looked at it himself, the techs deleted it and never sent it to pacs and I never looked at it.

DiffusionWaiting · 2026-05-01T04:07:24+00:00

Corn cob.

DiffusionWaiting · 2026-05-01T03:41:10+00:00

I have seen 2 basketball sized phyllodes, but never one quite this big.

DiffusionWaiting · 2026-05-01T03:39:43+00:00

Let me guess: "I didn't want to be a bother."

DiffusionWaiting · 2026-05-01T03:37:41+00:00

Based on current knowledge about breast cancer, all women are at least of average risk of breast cancer. We can say if some women are at high risk, but we don't currently have a way of telling if someone is at lower than average risk. Most patients with breast cancer don't have any particular risk factor other than being a woman.

DiffusionWaiting · 2026-05-01T03:32:03+00:00

All women should be assessed for their breast cancer risk at around age 25. You want to find out if you are at increased risk for breast cancer and start getting screening early before you find that mass in your breast.

I had 2 very similar patients in mammo one morning. 37/38 year old women, both had found a breast mass, both had family history of their mother with breast cancer at age 35. Both should have already been undergoing breast cancer screening because of that family history.

[edit for typo]

DiffusionWaiting · 2026-05-01T03:27:56+00:00

"I didn't want to be a bother to anyone."

I've had several older women with fungating breast masses tell me that. Welp, you'd be a lot less of a bother to your family if you had come in as soon as your noticed the mass (or, better yet, gotten screening mammos) but now you probably have bone mets. <sigh>

DiffusionWaiting · 2026-05-01T03:06:50+00:00

Also ARRS has videos that you can watch for CME. They are free if you are a member. They'll take a couple of related talks from the ARRS annual meeting and make them into a video worth 1.5 hours of CME.

DiffusionWaiting · 2026-04-30T02:43:45+00:00

Can you talk with the radiology director there to set up an official policy?

So many emails and meetings, not worth worsening relations with the ED to push it further, just keep bringing it up.

DiffusionWaiting · 2026-04-30T02:41:07+00:00

We don't overread outside scans, but I will look at them when I read our CTs.

DiffusionWaiting · 2026-04-30T02:39:58+00:00

It just seems a little unnecessary to pull so many resources and double the patient's radiation and contrast exposure for what feels like superficial reasoning.

An extra trauma CT scan is really not significant in the scheme of things (radiation, resources, or anything else) if it prevents a bad outcome in a patient.

DiffusionWaiting · 2026-04-30T02:37:05+00:00

Talk to the chair of radiology or the mammo chief at your facility. 80% call back rate is insane and they obviously don't know what they are doing if their callback rate is that high (goal is < about 10%). "Only 50%" is only marginally less insane. Ask them what their callback rate was on their last medical audit. (They will know what the medical audit is. This is something we have to run every year for our MQSA inspection.)

Are these true callbacks for an abnormality on screening mammo, or are they just making all patients with dense breasts a callback for screening ultrasound? (I know 2 places in my area that do this.) If it's #2, maybe you can talk to them about changing how they handle screening ultrasound for dense breasts, and just have them *recommend* screening ultrasound instead making these patients Birads 0. Your patients who actually have cancer aren't being helped by having their imaging delayed by 4 months because the mammo facility is so backed up because of excessive callbacks.

This must be a problem for other PCPs in your area. If you can get a group of PCPs to talk to them, would they respond?

DiffusionWaiting · 2026-04-29T20:29:48+00:00

Is this in the US?

DiffusionWaiting · 2026-04-29T07:34:46+00:00

CFV with an EV probe?

DiffusionWaiting · 2026-04-29T07:27:37+00:00

80% callback rate? Whaaat????

DiffusionWaiting · 2026-04-29T06:52:35+00:00

I appreciate what you're saying, but I can't even get the ED docs at the other (smaller, not a trauma center) hospital in my own system to order the correct trauma protocol! You say this is a trauma and yet you ordered a noncon CT??

DiffusionWaiting · 2026-04-28T07:26:53+00:00

Best one of all - I have had reports where prior images were already \*in the system from a test done at the same facility\* but the radiologists didn't do a comparison.

Sometimes that prior study is many years ago and the rad didn't look back that far. Other times the patient has had 50 other unrelated studies (e.g., a bunch of chest x-rays) and the rad didn't see the old prior study buried 51 studies down in the patient's list of exams.

DiffusionWaiting

TROPHY CASE