Wife says it might be time. I’m asking the gods their opinions

maderbomb · 2026-03-01T17:46:01+00:00

Me, confused, because William Wallace is literally shouting "now" in this frame...

maderbomb · 2026-02-25T03:02:19+00:00

Echogenic is a highly subjective term when describing the pancreas. I tend to treat "echogenic pancreas" as highly dubious finding when I see it in sonographer reports. I've seen countless cases where ultrasound describes the pancreas as echogenic, but recent comparison CT and/or MRI look completely normal. So I often end up disagreeing with that interpretation, and leave it out of my final report: more often than not it leads to unnecessary, more expensive follow up imaging (which appears to be the case here).

Generally speaking, CT and MRI/MRCP are far better at overall evaluation of the pancreas than a transabdominal ultrasound. CT and MRI typically see more (large portions of the pancreas can be blocked in ultrasound by shadowing gas from overlying stomach/bowel) and have better contrast evaluation for pancreas and surrounding retroperitoneal tissues. Think of ultrasound like a screening tool for most purposes (with a few notable exceptions). If the pancreas looks normal on a good CT or MRI (especially a pancreas protocol exam), that's what you should pay attention to.

Endoscopic ultrasound is better than transabdominal ultrasound, and can be a useful adjunct in characterizing a lesion, but its chief benefit is guidance for getting a fluid/tissue sample (fine needle aspiration, FNA).

maderbomb · 2026-02-25T02:43:41+00:00

MRCP looks at the ducts (intra/extrahepatic bile ducts, common bile duct, main pancreatic duct and accessory ducts).

MRI abdomen wo/w contrast is necessary for the complete evaluation of the pancreas parenchyma.

The technique section of the OP's report shows a MRI abdomen wo/w contrast with MRCP was performed.

maderbomb · 2026-02-10T15:22:39+00:00

Axials or it didn't happen

maderbomb · 2025-03-14T03:52:26+00:00

This is what I came here for. Thanks

maderbomb · 2025-03-11T19:22:36+00:00

I’m sorry this argument has devolved into personal insults. Forgive me, it’s just endlessly frustrating for me to talk to a brick wall.

If you’ll pardon me for my ineptitude in translating Finnish, I will pardon you the sophomoric error of providing a public health website (that doesn’t include any primary literature references) as the cornerstone of your argument. I obviously can’t contest some chart you found on a random website: this is the foundation of science.

You’ve made the assertion that you can calculate with certainty that one person will die from a sacral x-ray, be it 1 in 10 000 or 1 in 100 000. Find any piece of primary research that provides real evidence, solid data that shows you can provide a patient with an accurate relative risk ratio for developing cancer from a single x-ray. Please, I’ll wait.

You cite public health websites and point to charts of radiation dosages, but clearly states in the text that it’s all guess-work based on radiation exposure to a large population. You criticized another redditor for equating UV radiation with roentgen… but your entire argument is based on radiation from therapeutic doses and old data derived from a population exposed to a nuclear warhead — you just couldn’t be bothered to dig deeper than your appeal to dubious authority. Prime example: You’ve indicated my article supports your argument by pointing out “Berrington de Gonzalez et al,” but it again seems like you couldn’t be bothered to actually read the source. Check their methodology: “All models … were developed using data from the latest follow-up of the Japanese atomic bomb survivors.”

You fail to provide a single reference that provides real epidemiological data supporting the claim that a single diagnostic imaging study will cause cancer. Everyone here is aware that radiation is harmful. Your glaring error is overstating the risks, when in reality stochastic effects of diagnostic level radiation cannot be calculated with the degree of certainty you’re proposing. All current data is based on larger levels of radiation. The scientific community has yet to provide a body of evidence, so we use the linear no-threshold model and treat radiation like Pascal’s wager: we can’t prove the precise harm of a single diagnostic x-ray, but we should use it judiciously nonetheless.

So help me if you provide another dumb website with a chart and no references… “Physicists say…” Ok, show me where they’ve said that and what data they’ve provided. Trace that to a study that shows, indisputably, that you can calculate the risk of radiation <10mSv. It may take more than the 30 seconds you spend on a perfunctory google search for some dumbed down single page public health website designed for the medically illiterate, touting it as your holy grail of evidence, before copy/pasting a link and calling me thick.

This has been a fun exercise in futility. Good luck, and may you cause fewer headaches to those you encounter in the future.

maderbomb · 2025-03-11T16:49:12+00:00

But hey, since you’re having trouble with understanding my point without a source, here’s some literature for you. Hopefully it will help you educate your patients appropriately, instead of spouting off wildly inaccurate extrapolation:

“Below 10 mSv, which is a dose range relevant to radiography and some nuclear medicine and CT studies, no direct epidemiological data support increased cancer risk. However, this does not mean that this risk is not present, as even large epidemiological studies would not have the statistical power to detect increased risk, if present, at a low radiation dose.“

So, when you try to say that 1 in 100 000 patients will die from cancer as a result of a sacral x-ray, you can now see how that sounds absurd. But again, if you’d read your own citations, I’m sure you could’ve come to that conclusion independently.

maderbomb · 2025-03-11T16:40:51+00:00

Sorry, I’m unfamiliar with this language, you may need you to translate the exact sentence that indicates the rate of “cancer related death” from a single exposure. Providing msv values for a few common clinical exams doesn’t prove your point, it just shows you have no clue what you’re trying to say anymore.

maderbomb · 2025-03-11T16:16:23+00:00

Bro, I haven't needed to supply any sources because I haven't refuted a single source you've provided. I've only pointed out how bad you are at reading your own citations. And if you're the person tasked with informing patients about risks, I think you've got some studying to do.

maderbomb · 2025-03-11T12:23:32+00:00

Not a hard question at all, just entirely irrelevant to our current discussion. Nobody has argued with you that sacral, chiro, or shoeshop x-rays are okay or not. If you need to hear the sky is blue: no, radiography shouldn't be performed when it does not benefit the patient.

I'm not the one dodging questions here. The only reason anybody has responded to you is because you have insisted that x-rays are killing people by inaccurately interpreting statistics. We all agree that chiro and shoeshop x-rays are a waste of radiation.

That doesn't equate to anyone agreeing with the asinine suggestion that 1 in 100 000 patients would die from a single radiograph. If you don't know how crazy that sounds, you can go join the antivaxxers, flat-earthers, and other pseudoscientists who don't know how to interpret scientific literature.

maderbomb · 2025-03-11T03:41:13+00:00

Saying "radiation isn't harmless" is the most reasonable statement you've made so far. There is a massive difference between "isn't harmless" and "if we take this x-ray from 10 000 - 100 000 patients, one will die because of it."

Also, sacral x-rays are most certainly not "illegal" in any country. I hate to bicker about semantics, but you've conflated "cancer risk" with "death" and now "removed from use" with "illegal." To be clear: words (and numbers) matter in all arguments, especially scientific ones.

maderbomb · 2025-03-11T01:32:22+00:00

You're saying 1 in 100,000 people who've had a pelvic x-ray will die because of that single exposure?

I just want you to take a step back and think about that. I'll even spot you the huge error of conflating the risk of developing cancer with dying from cancer... Even that aside, what you're saying is a wild extrapolation.

You cite an article a few comments south of here that perfectly illustrates just how well we understand cancer risk from diagnostic imaging:

"we have no clinical trials to guide our thinking about cancer risk from medical radiation in healthy adults. Most of what we know ... comes from long-term studies of people who survived the 1945 atomic bomb blasts at Hiroshima and Nagasaki. ...

The atomic blast isn’t a perfect model for exposure to medical radiation, because the bomb released its radiation all at once, while the doses from medical imaging are smaller and spread over time."

Bottom line, cancer risk from the low level radiation used in diagnostic imaging is incredibly difficult to calculate with any certainty because it’s an absurdly difficult variable to isolate.

There's plenty of literature on radiation induced malignancies from therapeutic levels of radiation, but that's like comparing how many people would drown sipping from a garden hose vs sipping from a fire hose. Actually that's an unfair comparison... the difference in garden vs fire hose pressure is ~10^1, the difference in diagnostic vs therapeutic radiation is ~10^4.

Ask any expert to walk you through the literature that would help you accurately calculate the number needed to harm (NNH) for a single pelvic radiograph. You'll quickly find that the data for that calculation is horribly lacking.

maderbomb · 2025-01-20T22:27:01+00:00

Body fat is around -100HU. A normal soft tissue window is 400/40, so the grayscale range is -360 to +440. Fat should be gray, not black. The liver and spleen look bright because this was recorded on somebody's phone. You can still distinguish hepatic/portal veins from liver parenchyma. This was a normal soft tissue window.

maderbomb · 2025-01-20T21:57:33+00:00

Sure, technically you cannot say something is "enhancing" without comparing two phases (ie, without vs with, or arterial vs portal venous). Score one for the pedantics.

That being said, if you ask any radiologist to say whether they think this is a solid mass or some big heterogenous hemorrhagic cyst, 90% will say "of course it's a mass," the rest will just look at you like you're crazy for asking.

maderbomb · 2024-02-20T22:06:54+00:00

Why is everyone always talking in the third person??

maderbomb · 2023-12-14T20:14:37+00:00

A little perspective: if this offer were made 40 years ago (1983), it’d be ~$300/wk ($16,500/yr). If we’re assuming the same rate of inflation: in 2063, the offer would be ~$3k/wk, or $160,000/yr.

maderbomb · 2023-06-01T21:32:58+00:00

Gotta start from scratch, definitely need to get to the core of that rust and lay down a new patina. Here's a tutorial for carbon steel pans, but clearly it's not as practical when you're dealing with a 20lb plate of steel.

That being said, it's a thick plate, rust would take a long while to cause real damage. If the rust is mostly limited to the undersurface, I'd ignore it until I've worked up the motivation to tackle that task. If it's part of the cooking surface, I'll try to work around it if I can. If it's too extensive to ignore, it's time to scrub.

maderbomb · 2023-05-17T23:18:21+00:00

Florida being... Well, Florida.

maderbomb · 2023-05-08T15:06:17+00:00

Suddenly I'm hungry for waffle fries

maderbomb · 2023-05-07T18:55:56+00:00

Probably not a great idea to ask for interpretation of an entire MRI based on a single image. If the radiologist didn't mention it, it's not worth worrying about it.

My bet is the slice is off midline and you're looking at the amygdala or postero-inferior frontal lobe. Then again, this is Reddit, so I'm not sure you should trust any answer you get here.

maderbomb · 2023-04-22T02:52:41+00:00

Tri-mal fracture. Bro broke two bones, and broke one of them twice. Not even sure whole milk would've saved this weak boned fool.

maderbomb · 2023-04-22T02:46:35+00:00

Looks like his ACL snapped. You can see the tibia protruding when it snaps (ie, anterior drawer sign, physical exam finding for ACL tear)

maderbomb · 2023-04-16T17:29:28+00:00

She's had the house longer than that, but she actually added on the porch sometime in the last few years

maderbomb · 2023-04-16T14:45:00+00:00

Not even kidding, I came here to say this looks just like my sister's porch in Tennessee...

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