iRADiX

What is that Clinicians want or rather expect from radiology reports?

In good old days Radiology Practice means nothing but interpreting the x-rays ordered by the clinicians.

All that clinician wanted to know was whether there is TB in the x ray chest, whether any duodenal/gastric ulcer in the barium meal studies, or any fracture of bones etc.The life of the Radiologists was very simple and care free ( without much responsibility )  in those days and no surprise…. no takers for Radiology Postgraduate seats. Anybody, did radiology PG in those days is not out of Love of the specialty but due to helplessness, and I remember People with MD in radiology settled happily in General Practice, since they just wanted MD tag

From 70’s onwards,   things have changed and Radiology advanced rapidly and radiologist started playing a role along with the clinicians in patient management and even earned respect as “clinician’s clinician”

21 st century saw Radiologist in a different mould and even started treating the patients in the form of interventional radiologist.

Inspite of all these achievements…it is sad to note that most of the clinicians are unhappy with the way Radiologist Reports.

As you are aware, the Radiologist’s Report is the final product which reflects the knowledge, the radiologist possesses which in turn makes the clinician to judge the competence of the radiologist.

Clinician always complain that majority of the radiologists report are

1. Vague
2. Incomplete
3. Non conclusive and even
4. Confuse the ref.clinician.

This remember, inspite of many chapters written by seasoned and experienced Radiologists on “how to report “.

Our own Iradix having published the elaborate blog article of Dr.Keshav Kulkarni (we are grateful to him). I am providing the web address below for the benefit of those graduates who (I am sure) are not finding enough time to go through the old blog articles of Iradix and I request them to go through the same and get immensely benefited.

1. My radiology report format

http://www.iradix.in/blogs/my-radiology-report-format.html

2. The art and Science of Radiology reporting in Radiology (six part blog article)

http://www.iradix.in/blogs/The-Art-and-Science-of-Reporting-in-Radiology-Part-1/blogger/keshrad/

http://www.iradix.in/blogs/The-Art-and-Science-of-Reporting-in-Radiology-Part-2/blogger/keshrad/

http://www.iradix.in/blogs/The-Art-and-Science-of-Reporting-in-Radiology-Part-3/blogger/keshrad/

http://www.iradix.in/blogs/The-Art-and-Science-of-Rerporting-in-Radiology-Part-4/blogger/keshrad/

http://www.iradix.in/blogs/The-Art-and-Science-of-Rerporting-in-Radiology-Part-5/blogger/keshrad/

http://www.iradix.in/blogs/The-Art-and-Science-of-Rerporting-in-Radiology-Part-6/blogger/keshrad/

Herewith I am giving just 2 of various samples reports I have come across, which shows that our community is yet to go long way in reaching international standards.

Looks like we are very firm and united in our attitude…….Just don’t care!!

Example of USG

Example of a CT report.

The patient underwent CT thrice….in different scan centers...

The reports in all the scan centers were more or less similar. (Scan was repeated with a gap of 3-11 months, as patient was avoiding surgery and scan was to assess the status of the aorta).I am providing just the report on …AORTA

AORTA

Evidence of aneurysmal dilatation (Degenerative) of supra renal portion of the abdominal aorta, predominantly at the left lobe of liver region. The aneurysm also involving the lower third of descending thoracic aorta. This segment is tortuous and placed on right side of vertebral body. The lesion measures 117x58x81 mm. No calcification or thrombus seen.

On third occasion, after seeing the report, the ref .physician, who was taking care of the patient all this time,  advised the patient to have opinion from the specialist (cardio thoracic surgeon), since the patient started having difficulty in walking and numbness of the feet.

Now read the prompt response from the cardio thoracic surgeon

The cardio thoracic surgeon wanted clarifications on SIX points ….which were not addressed in any of the three reports.

This clearly shows that we, the radiologists are not at all up to the expectations of the clinicians / super specialists

Similar complaints can also come from ENT surgeon where radiologist is not able to live up to their expectations in giving a report on HRCT of temporal bone.

Less said better about MRI reports

So do you think sub specialization is the only answer to overcome these limitations of the radiologists?

It is high time Radiologists ‘tune’ themselves to be able to speak the language of clinicians / specialists / super specialists.

Another Example of how insurance firm objected to the confusing radiologist’s report.

http://radiology.med.sc.edu/1radclspec.htm

‘To correlate clinically’

‘Unremarkable’

‘Suspicious looking’  ‘Doubtful shadows”

‘To correlate with lab parameters’

Similarly clinicians are uncomfortable if the DD given is more than 2 or 3

The Challenges, Opportunities, and Imperative of Structured Reporting in Medical Imaging

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782125/

The above article mentions 8 Cs for a Good Radiology Report

Clarity, Correctness, Confidence, Conclusion, Completeness, Consistency, Communication, Consultation.

Lesson learnt……. We, the radiologists must learn to modify our reporting style, suiting the needs of that particular specialist whoever has ordered the test. Just do not mechanically write the report!!

Now coming to

What is that Radiologists want or rather expect from clinicians?

1. Radiology is a referral speciality.Radiologist depends upon referrals from the clinicians. This makes clinicians at a slightly advantageous position.

Clinician should not be too demanding and treat the radiologists with equal respect

“Treat others as you want them to treat you because what goes around comes around”

Arthu Wing Pinero

2. Clinician should mention the provisional diagnosis without fail in the requisition form.

3. In a hurry sometimes clinician gives incorrect information. This should be avoided. (E.g. mentioning RT instead of Lt)

4. Clinician should have adequate knowledge regarding as to which particular   radiological investigations to be ordered. E.g. Asking for CT pelvis when actually patient needs Dorso lumbar CT... Asking for Venous Doppler of leg instead of arterial Doppler in diabetic cases. Or at least he should discuss with the radiologist prior

5. Abbreviations should not be used while ordering a radiology test.

6. Without fail, feed back of the case should be provided to the radiologist.

7. Many times clinicians demand urgent report, irrespective of Urgency and radiologists   report can miss important observations because of ‘Speedy Report’ (reminds one, of speed post delivery!)

Collective responsibility starts with the people involving in the patient’s wellbeing.

“You must be the ‘change’ you want to see in the world”

Mahatma Gandhi.