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What leads to a fracture like that? So that’s what it looks like when a tumor metastases to the spine. How exactly did the crayon get all the way up junior’s nose?

These are the questions I asked as I surfed Radiopaedia, a sort of Wikipedia for radiologists, complete with just about any kind of X-ray, CT scan and MRI you can imagine. The site’s Twitter handle is always good for a tweet or two each day of some bizarre condition or injury. For non-physicians, the cases uploaded and briefly explained by radiologists from around the world provide a strange glimpse into people’s health — or lack thereof.

But the goals extend beyond entertaining morbid curiosities. Australian radiologist Frank Gaillard, the founder, wants the site to be a real tool for physicians. Using radiologist editors from around the globe for different specializations he’s trying to create a repository of scans so doctors can sharpen their skills. He hacked together the site in 2005 with a number of opensource projects to have a wiki for his board exam notes — “I’m a radiologist by training, geek by vocation” — but it has since grown to a resource that saw over four million pageviews in January.

But Radiopaedia does invite more questions. The slides are crowdsourced — are the diagnoses accurate? Do people have to worry about their X-rays being posted online without their knowledge? And perhaps most importantly, is this actually useful for doctors?

I asked Dr Michael Federle, professor of radiology at Stanford Medical School, to take a look at Radiopaedia and give me his thoughts. He’d heard of the site but had never really examined it closely. “I am favorably impressed,” he said, and noted he’d make the site part of his recommended tools for future students.

However, Federle said he’d still do so with some trepidation. “I’m afraid they’ll use it to the exclusion of more comprehensive learning.” While the slides on Radiopaedia are extensive, Federle points out that one of the biggest questions is how a physician arrived at taking that test in the first place, which isn’t discussed in much detail on the site’s pages. Understanding the decisions that resulted in a scan being taken is as important as understanding the scan itself. That’s where reading comprehensive textbooks, of which Federle has authored dozens, can be critical — longtime experts lay out vetted thought processes.

But Federle concedes that textbooks and many teaching materials do have a natural distortion to them. Even though radiologists sift through hundreds of scans to find the image that triggers a diagnosis — in practice — textbooks and most internet sites tend to select the best couple images when presenting a case. But a doctor should have to sift through many images to understand the case.

“The editing of material for maximum teaching value is a very challenging situation,” Federle says.

But part of Gaillard’s hope is to subvert those incumbents — seeing models like Radiopaedia’s as the future of medical educations. Big publishing companies hold most of the cards, charging a pretty penny for textbooks and slides. “To make a buck off that feels wrong to me,” he says. “It adds another layer of inequity between countries and institutions that have the resources to pay for it.”

(It’s worth pointing out that many textbook companies offer discounted rates to customers in third world countries — though you might call that market segmentation rather than charity.)

There is no shortage of medical websites. WikiDoc offers a crowdsourced medical textbook. Companies like Sermo offer online discussion groups for specialists. WebMD, Healthline, Medicine.net, MedLine and PubMed all overflow with diagrams, pictures, advice and research on how to approach developing situations with the body. But for Radiopaedia Gaillard wants to keep the site free and avoid ever limiting or being selective with the slides and cases. The more the better — as long as they’re accurate.

Wikipedia has proven a lot can get done with a small community of editors. But due to the complicated subject matter, Radiopaedia’s physician editors need to go a step further. Until a submitter has had ten positive editor reviews, their cases won’t automatically appear to the rest of the community.

But there’s a balance. “We don’t want to make it so hard that they’ll never come back — they’re doing it for free,” Gaillard says. “That means you accept some stuff that’s not as good as it could be.” To really do expert editing for curriculum level content, you need a lot of altruistic people. Crowdsourced sites require a critical tipping point of momentum and doctors are a busy bunch.

A lot this comes down to keeping the community engaged — despite its millions of monthly pageviews, the site only has about 28,000 registered accounts — and that’s where Gaillard hopes social media comes into play. The Radiopaedia Twitter account (and sister account Radiology Signs) broadcasts pictures of injuries and asks for a diagnosis, sometimes playfully enough to border on trolling.

“At the end of the day we want people to become involved,” Gaillard says.

Judging by the responses, a good deal of folks seeing the tweets are not physicians, or at least physicians that want to answer. For five recent tweets from Radiopaedia (5,300+ followers), there were only five attempts at answers. But the set still had 66 retweets. People are interested, they just might not be doctors. They might just be people like you and me.

Which could be a problem in its own right. As Lee Tien at the Electronic Frontier Foundation says, there’s one thing you don’t want a viewer saying: “Hey, that’s me.”

Gaillard points out that physician editors should be working in environments that already have their own privacy policies — though different countries have different standards. “We’re trying to steer the same course as textbooks and journals there,” he says, but he concedes, “it is an area that’s potentially problematic.”

As Stanford’s Federle perused Radiopaedia he didn’t see any violations of the Health Insurance Portability and Accountability Act (HIPAA), the US law the governs health data, and does say it’s pretty simple for physicians to remove any personal information from slides. One tricky situation is if an injury is news-worthy and it’s easy to tie it back to the scan, and then the person.

“I would be surprised if errors didn’t show up in spite of their best efforts,” Federle says.

Time will tell. For now Gaillard says he’s content with the number of cases that address common ailments. The plan now is to urge the community to submit the rarer cases and presentations.

“We have lots of the common stuff, now we need more of the good stuff,” he says.

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