The art of practicing medicine is in realizing that there is an overlap between normal variants and pathology. Being able to tell the difference can be difficult, but this where the art comes in. However, as physicians we must realize that sometimes this can not be differentiated. Radiology is no different. Many clinicians and non-health care professionals believe that radiology is cut and dry. There is no art in radiology but rather it is an exacting science. It can solve all problems and delivers the truth. One staff radiologist at my home institution coined the CT as the “truth machine.”
In reality, this is far from the truth. Certainly, just like much of remaining medicine, there are disease entities and patient presentations which are very black and white. However, a great majority of diseases and patients do not read the book. Classic presentations of disease are more often the exception than the rule. This is where an astute clinician’s experience, exam, and history can be very helpful. Even though most of radiology is not a clinical practice, the field of radiology does highly depend on clinical information. Trying to practice radiology in the absence of relevant clinical information is like driving without a map. You will sometimes get to where you want to get but you will inevitably get lost at some point.
As a clinician, this may be hard to appreciate. As a practical radiology example, imagine getting a leg radiograph on a child. The radiograph demonstrates a lytic lesion in the middle of the femur which is destroying the bone and looks nasty. This appearance can be seen in osteomyelitis or a primary bone tumor. Radiographically, those will look identical and can be nearly impossible to differentiate in the absence of clinical data. However, if the patient is presenting with more acute symptomatology, a white count, elevated sedimentation rate, etc then likelyhood of it being osteomyelitis is very high. Unfortunately, a very typical history the radiologist would get for such an exam is pain without further qualification of its onset, quality, location, etc. Even if much of radiology is not a clinical practice, we still learn clinical presentations of disease because it helps us interpret imaging studies.
The practice of a veteran radiologist is to hedge in their reports which undoubtedly and understandably can be frustrating for the ordering clinician. Some hedging is done as a part of practicing defensive medicine. However, much of it is done because we have no idea what is clinically going on with the patient. Often, the findings will be described and definitive diagnosis will not be given. Rather a list of possible etiologies are given which sometimes does not help the ordering clinician as it may raise more questions than give answers. Much of this can be avoided if we had a better clinical picture of what is going on with the patient.
So, the next time you order an imaging study, help your radiologist out and provide as much history as you can. It will not only make your radiologist happy, but it will likely produce a better and more useful report for you.
-Tashfeen Ekram is a radiologist and founder of SchedFull.com, a web based solution for cancellation management.