radiographic tests--do you show the print interpretation

[Jack]

Do others who carry their studies around allow access to the interpretation (print) for the Radiologist's use when comparing films?

[Harrison]

Sorry, Jack, I am not sure what you mean? Can you rephrase your question?

[annapurna]

Jack, if I understand correctly, you are asking if you show both the images and the first radiologist's opinions to the second person when asking for a second opinion. Is that correct?

For all of the times that Laura and I have done this, pretty much no, but we do verbally sumarize, if in person, the findings of the first person to read the images. The few times we were sending films off but not accompanying them we split the difference and sent the report about half the time and wrote our own summary about half.

If you really question if the first person had their head on straight or was really looking at your films, don't send the report. Laura once had "pronounced narrowing of the femoral cartilage" on a knee MRI report that clearly to our eye, and other people who could tell a knee from ..., wasn't there. We later found out that the radiologist hadn't really read the film but simply called that based on it being a typical observation of a 40 year old woman. If you look through my back posts, you'll find a large number of rants about bad radiologists. I don't indict all of them, but a bad one is almost as bad for your health as a bad surgeon.

Another note, make sure that the person giving you a second opinion has some idea of what your concern is/might be. If someone is looking for your specific concern, they're more likely to spend the time to make a good call on that concern rather than be distracted by something that isn't as serious medically but is a lot more obvious radiographically. I don't know what your concern is but if you're worried about facets, for instance, but have a degenerated disk, you might need to prompt people a bit to make sure they report on the facet condition rather than focus on the disk.

[Jack]

annapurna,

Your first paragraph was phrased correctly. What I meant to say but got dyslexic. Trying to get an objective interpretation from the Radiologist, surgeon, etc.

[2cool4U]

A Radiologist's interpretation is influenced by the amount and quality of information available at the time the images are reviewed. Rarely do we get enough info from the patient or the ordering physician. Typically for a lumbar MRI we get "back pain." Pretty much could've figured that out on my own, since we usually don't do them for headaches or nausea.

A complete explanation of the exact nature and location of the pain as well as any radiation pattern (down the leg, around the waist, through to the abdomen, etc), length of the symptoms, any directly related injury to the back, prior surgeries, and whole lot of other info will really help the Radiologist focus on specific abnormalities or their absence.

We are the punching bag of the medical world, but every Radiologist I know produces quality work with very little info in a timely fashion sometimes under urgent or emergent conditions.

Annapurna, it's a shame you had bad experiences, but the majority of Radiologists in this country are quality physicians. Residency positions are in high demand, and typically people near the top of their class in medical school get accepted. This has been true for 20 yrs and continues today. There is a critical shortage of Radiologists in this country, and volume continues to increase as more patients get unnecessary examinations. Two statistics to keep in mind; #1 more than half of medical imaging studies done in this country are never seen by a Radiologist, they are done in a physician's office and looked at by that physician, usually to supplement their practice revenue and #2 various studies estimate that 25-35% of imaging studies are medically unnecessary and don't change patient care but are done for medical-legal reasons, because the patient expects it, or because the primary physician is uncomfortable treating an obvious clinical diagnosis until the films prove it.

Everyone loves to criticize Radiologists until they need one. A hospital can function w/o cardiologists or w/o oncologists for example, but remove radiology and Radiologists and you have no hospital.

There's my rant. Not meant as defensive, just informative. No anger intended or implied. Seriously.

Tim

[2cool4U]

Jack,

There is value to both approaches. Sometimes a blinded second read is good, b/c there's no bias towards looking at a specific problem while ignoring something else that may be significant. On the other hand, letting the reviewing Radiologist know the specific prior results is helpful if they are willing to go on record as agreeing or disagreeing. Most of the time we in my practice are aware of the other report. We are a large referral hospital and get many films from surrounding hospitals. We are often asked to review the images. We are willing to agree/disagree.

Something to keep in mind is that almost no one gets paid for a second review. They take longer to do b/c we are asked to make sure everything was done correctly and we usually have a lot more patient info at the time of the second read. We are then asked to provide a record or documentation of our findings and therefore accept some responsibility for that patient's care, but virtually no insurance company or Medicare pays for the review. This is something that other docs and patients don't seem to be aware of or even really care about. It's unfortunate, b/c you certainly wouldn't get your car fixed at your GM dealer and then take it down the road to an independent shop and expect to have them double-check everything and correct any mistakes for free, but by golly we expect the Radiologists to do so.

Sorry, devolved into another rant. Hope the first paragraph helped.

Tim

[kimmers]

Going on what two different tests, MRI and CT scan, I have found out that I have nothing radiological to explain my severe back pain on both tests.
Luckily, my doctor listened to me and not the tests.
One thing he did that was good was he read the films before he looked at the report every time.
I agree that the tests are done too often.
That's my two cents.

[Jack]

Thanks for all the timely advice. I go tomorrow for a low back MRI. I think I'll right a note giving the chief complaint, brief comment on the symptoms, and ask the radiologist to try to look first and then read the other Radiologist interpretation. I'll need to give them the other CTs, MRIs anyway.

I'll be getting top and bottom. I have been having recurrent left sinusitis that is responding poorly to antibiotics for 5 months now. On the list for a sinus CT as well. I hate knowing what the ENT people do for this. That is why it has been going on for 5 months.

I read somewhere that our bodies were only designed to live to age 49. The rest is due to our medical system. Last I heard, the life expectancy is now 76.