2018_04_12 - Concept: CT & MRI

Insert patient to continue!

Very cool, and in a choice of four colours! Will the radiographers operate these machines remotely like they do in real life? Would be a nice touch if we have to make the rooms for the machines (XRAY shielded or magnet safe zones) then construct the room for the radiographers to operate the machines with a viewport in!

Loving what you guys are doing, very excited to finally get to play this game!

Yes, they will operate it remotly ... and the layout of rooms is completely up to player, only condition to make it work is "fill it with proper equipment" and hire radiologist of course

very nice - the rooms should be have speical room - techical room where speical machincry are located there - usually in ct rooms - there no extra room just control room
in MRI - there might be a extra room attached with it and extra proction for mri rooms

Do you guys planning to add randomly anaphylactic choc from the contrast product?

Paramedic14 wrote:Do you guys planning to add randomly anaphylactic choc from the contrast product?

According to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059752/

As the use of computed tomography (CT) is rapidly growing, iodine based radiocontrast media (RCM) is administered about 75,000,000 times per year worldwide

[...]anaphylactic deaths still occur in 1–3 per 100,000–1,000,000 administrations[...]

If we say 3 per 1 million, that's a 0.000003 risk for a patient to die from it. It is, however, evident that it would happen more often as these numbers only count deaths, but it is probably NOT way higher. I won't be researching further to find actual figures about occurrences of contrast anaphylaxis.
Would it be worth creating content for something that players most likely will never encounter? If they decide to, but instead make it more likely to happen, it would greatly misrepresent reality. They have the artistic freedom to do so, but I would probably advice to put their efforts and focus elsewhere, so the game does not lose the sought after scientific integrity.

Dysp wrote:

Paramedic14 wrote:Do you guys planning to add randomly anaphylactic choc from the contrast product?

According to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059752/

As the use of computed tomography (CT) is rapidly growing, iodine based radiocontrast media (RCM) is administered about 75,000,000 times per year worldwide

[...]anaphylactic deaths still occur in 1–3 per 100,000–1,000,000 administrations[...]

If we say 3 per 1 million, that's a 0.000003 risk for a patient to die from it. It is, however, evident that it would happen more often as these numbers only count deaths, but it is probably NOT way higher. I won't be researching further to find actual figures about occurrences of contrast anaphylaxis.
Would it be worth creating content for something that players most likely will never encounter? If they decide to, but instead make it more likely to happen, it would greatly misrepresent reality. They have the artistic freedom to do so, but I would probably advice to put their efforts and focus elsewhere, so the game does not lose the sought after scientific integrity.

Yes i agree! i was just wondering because when i still was a paramedic we used to go about once a month in the radiology center of my city for anaphylactic chocs from the contrast product, i was wondering if this was something that occurs often or not. But none of my patient died from this so yeah, after thinking i dont think it will be realistic my bad

Paramedic14 wrote:

Dysp wrote:

Paramedic14 wrote:Do you guys planning to add randomly anaphylactic choc from the contrast product?

According to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059752/

As the use of computed tomography (CT) is rapidly growing, iodine based radiocontrast media (RCM) is administered about 75,000,000 times per year worldwide

[...]anaphylactic deaths still occur in 1–3 per 100,000–1,000,000 administrations[...]

If we say 3 per 1 million, that's a 0.000003 risk for a patient to die from it. It is, however, evident that it would happen more often as these numbers only count deaths, but it is probably NOT way higher. I won't be researching further to find actual figures about occurrences of contrast anaphylaxis.
Would it be worth creating content for something that players most likely will never encounter? If they decide to, but instead make it more likely to happen, it would greatly misrepresent reality. They have the artistic freedom to do so, but I would probably advice to put their efforts and focus elsewhere, so the game does not lose the sought after scientific integrity.

Yes i agree! i was just wondering because when i still was a paramedic we used to go about once a month in the radiology center of my city for anaphylactic chocs from the contrast product, i was wondering if this was something that occurs often or not. But none of my patient died from this so yeah, after thinking i dont think it will be realistic my bad

No worries, discussion is a good thing. Anaphylactic shock is definetly a relevant situation that could be somehow represented in the game, but I would probably say that it should be merged into just 'shock', which is severe hypotension that can be due to several reasons (where anaphylaxis is one of them). However if 'shock' is put in the game, it should probably be cardiogenic and hypovolemic shock. This could actually make for a very interesting 'ACT FAST!' event. Will you put the patient in Trendelenburg position? If the shock is hypovolemic, Trendelenburg will help. If the shock is cardiogenic, it will often make things worse.

See! Your suggestion sparked so much discussion, that I had to read up on Trendelburg position and now I am unsure as to whether it should be used in Shock or not, due to the following article:

https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/myth-the-trendelenburg-position-improves-circulation-in-cases-of-shock/F9DA98ABD97594B0F857F9665049F88F

Dysp wrote:See! Your suggestion sparked so much discussion, that I had to read up on Trendelburg position and now I am unsure as to whether it should be used in Shock or not, due to the following article:

https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/myth-the-trendelenburg-position-improves-circulation-in-cases-of-shock/F9DA98ABD97594B0F857F9665049F88F

well that's something we can discuss, any other doctor out there ? from what i remember we used to put the patient in that position but maybe now things have changed

I can not uderstand how we have reached to trandelemburg discussion starting with a MRI and CT concept topic.
However Tren position is still used in prehospital above all in Basic Life Support where you have not other ways to treat low pressure or shock situation. Actually is controversial theres no clear evidenve against or supporting it so....I think it dependce of your equipment and where you are.

An MRI for endocarditis? All my what?

As to the contrast debate, it would more common to have an adverse event if there is renal impairment, and that would be a cool mechanic to have to work around that.

Vicex wrote:An MRI for endocarditis? All my what?

As to the contrast debate, it would more common to have an adverse event if there is renal impairment, and that would be a cool mechanic to have to work around that.

Yes, MRI makes no sense to diagnose endocarditis. The things shown here are work in progress and not final. The developers have done an amazing job trying to navigate the medical field and hopefully the beta testing will help resolve discrepancies.

Dysp wrote:

Vicex wrote:An MRI for endocarditis? All my what?

As to the contrast debate, it would more common to have an adverse event if there is renal impairment, and that would be a cool mechanic to have to work around that.

Yes, MRI makes no sense to diagnose endocarditis. The things shown here are work in progress and not final. The developers have done an amazing job trying to navigate the medical field and hopefully the beta testing will help resolve discrepancies.

Yes, there was a study done in 2013 by University of Istanbul that showed an Cardiac MRI can be used as part of a diagnosis for IE. With the use of correct imaging sequences it can detect valvular vegetation which are causes of Infective Endocarditis, however its generally done along with several tests such as Echo, CRP & ESR.

Study can be found here: https://academic.oup.com/eurheartj/article/35/10/624/429981

cfarrar1 wrote:

Dysp wrote:

Vicex wrote:An MRI for endocarditis? All my what?

As to the contrast debate, it would more common to have an adverse event if there is renal impairment, and that would be a cool mechanic to have to work around that.

Yes, MRI makes no sense to diagnose endocarditis. The things shown here are work in progress and not final. The developers have done an amazing job trying to navigate the medical field and hopefully the beta testing will help resolve discrepancies.

Yes, there was a study done in 2013 by University of Istanbul that showed an Cardiac MRI can be used as part of a diagnosis for IE. With the use of correct imaging sequences it can detect valvular vegetation which are causes of Infective Endocarditis, however its generally done along with several tests such as Echo, CRP & ESR.

Study can be found here: https://academic.oup.com/eurheartj/article/35/10/624/429981

Of course you can diagnose endocarditis with MRI. You can also diagnose a bone fracture with an MRI, but that would be considered pretty wasteful.
Doing an ultrasound of the heart is way cheaper and is, I believe, the standard today.

Hi all, thanks for the discussion, I think we'll just switch endocarditis to be diagnosed using Echo
I expect we'll bump into some cases where we'll unfortunately have to sacrifice some realism for a working game design, but if it's only a matter of choosing a correct diagnostic method like here, that should be a simple change.

jan.oxymoron wrote:Hi all, thanks for the discussion, I think we'll just switch endocarditis to be diagnosed using Echo
I expect we'll bump into some cases where we'll unfortunately have to sacrifice some realism for a working game design, but if it's only a matter of choosing a correct diagnostic method like here, that should be a simple change.

Okay this i love, dev's that actually look and read the topics then alter the game based on a topic between only a few people, where as some devs would just blow it off!

Kudo's Oxymoron!!!

roman.oxymoron wrote:Yes, they will operate it remotly ... and the layout of rooms is completely up to player, only condition to make it work is "fill it with proper equipment" and hire radiologist of course  

Will the CT and Radiology Wards also have outpatient type access and changing rooms to change into gowns etc. for the scans? No metal objects in the scanners! (Have you seen the videos of chairs and other objects being sucked into MRIs? Crazy!)