Do radiologists guess?
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Radiology
Do radiologists guess?
Chat about radiology with radiologists and those who want to get into the speciality
At a time when imaging is now heavily relied on for revealing diagnoses (perhaps at the cost of a reduciton in bedside diagnostic skills in the process) has anyone stopped to consider that much of wh
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Forums » Open clinical » Radiology » Do radiologists guess?
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Do radiologists guess?
posted at 12/7/2012 11:07 AM BST
on bmj.com
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Posts: 317
First: 27/10/2011 Last: 8/5/2013 |
At a time when imaging is now heavily relied on for revealing diagnoses (perhaps at the cost of a reduciton in bedside diagnostic skills in the process) has anyone stopped to consider that much of what is seen in clinical imaging has to be guessed at? Heuristics refers to problem solving, discovery and learning from experience rather than calculation. It may involve judgement from rules of thumb rather than fixed criteria, which is fairly representative of a lot of reporting activity in radiology. This is compounded by the fact that there is a limit to image resolution, most techniques being anatomy-based, and many different diagnosis having the same appearance. Furthermore, some features are commonly seen, but poorly understood (non-aggressive bone lesions are a fine example), being left in the knowledge that they will (probably!) not have an impact on the patient. So this begs the question of whether radiologists are the last guessers in clinical medicine? Has the buck been passed on from the clinicians and does it now stop in radiology?
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Re: Do radiologists guess?
posted at 12/7/2012 12:52 PM BST
on bmj.com
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Posts: 25
First: 11/7/2012 Last: 28/9/2012 |
When I read radiologists’ reports I find that they often list differential diagnoses (sometimes with probabilities attached) when interpreting data, and comment when imaging is inadequate, artefacted or inappropriate. I don’t know how much they guess, but I wonder how much the advent of computer vision and machine learning will change radiographic reporting in the next few years? |
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Re: Do radiologists guess?
posted at 12/7/2012 1:08 PM BST
on bmj.com
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Posts: 317
First: 27/10/2011 Last: 8/5/2013 |
Hi MustafaA - I think that is a valid comment. Perhaps it is not so much guessing, rather making calls on experience and accepting that you can't give a discrete answer. Your comment on machine learning is very apt given that machine learning can use heuristic models for computer-aided diagnosis in imaging. |
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Re: Do radiologists guess?
posted at 12/7/2012 7:45 PM BST
on bmj.com
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Posts: 7
First: 31/7/2011 Last: 23/8/2012 |
to me i dont depend on the radiological report when it is doesnt comes with my my clinical examination even to asmall degree.i think they depend on subjective feelings too much rather than using scientific parameters |
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Re: Do radiologists guess?
posted at 12/7/2012 10:24 PM BST
on bmj.com
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Posts: 2947
First: 10/3/2009 Last: 29/4/2013 |
I don't know about the guessing but I do observe the missing. I frequently send radiology reports back for a "supplementary report" having drawn the missing abnormality on the chest radiograph report or CT. Nine times out of ten I am right. I therefore think that the radiology-clinical interface should be dynamic and interactive. The more you know the bloke at the other end the better the outcome. I also hate it when patients bring along their films when the thoughtless doctor before has removed the report and not left a copy. This is dangerous and my pet hate. As for guessing, I am surprised sometimes about the poor clinical knowledge of some radiologists. I recently saw a patient referred because of multiple small calcified nodules on both lungs. Not a mention in the report of the bleedingly obvious; P.H. of chicken pox lung. A subsequent radiologist agreed with me when I suggested it. No more tests. Game over. |
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Re: Do radiologists guess?
posted at 13/7/2012 11:42 AM BST
on bmj.com
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Posts: 2947
First: 10/3/2009 Last: 29/4/2013 |
In Response to Re: Do radiologists guess?: Sounds like you live in the dark ages of films and lightboxes, Oddi! Posted by hip radiologist No, we have things on line but patients may come from the outer reaches of the Shire, thousands of miles across burning plains, croc-infested billabongs and flooded rivers fifty miles wide to see me and some even bring celluloid films as in days of yore. I do not look down on these as they may still be around when you are but an imagination in iCloud, or a few million bytes on FaceBook. We have numerous radiographic practices here as we are not run by a socialised monopoly. I guess we do live in the Dark Ages now you have enlightened me. Thank you, my friend. |
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Re: Do radiologists guess?
posted at 16/7/2012 2:58 PM BST
on bmj.com
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Posts: 1177
First: 19/4/2010 Last: 16/5/2013 |
One of the registrars on call this weekend was most put out when he went to ask for a radioogical opinion following a CT scan - the radiologist pulled up Wikipedia to explain the appearances on the CT. I think a big issue with radiology is a parallel to the issues we have in medicine - there are no generalists any more, we don't train that way, yet we are expected to work that way. Chest Ct scans are reported by a whole range of radiologists, not just the two who are chest experts in our hospital, so the first thing I do is read who reported it, and adjust pinch of salt-ometer accordingly. If you wanted an EEC reported, would you ask a chest physician? If you wanted an ECHO reported, would you ask a neurologist? I, like Odysseus, pick up many previously unreported chest abnormalities, and, also, fend off many calcified nodules of no, or little significance that have been suggested as "Chest clinic referral may be of use". But I wouldn't have any confidence below the diaphragm, and certainly wouldn't traipse off to the dark rooms to argue with my colleagues about their interpretation. The radiologists tell me that the hardest imaging modality to interpret is the CXR, yet we get reports back from all radiologists, of all grades, and non-chest physicians rely on the reports.... Now, where are those nerve conduction studies I fancy having a crack at reporting....?
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Re: Do radiologists guess?
posted at 17/7/2012 5:29 PM BST
on bmj.com
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Posts: 1280
First: 9/12/2011 Last: 14/5/2013 |
I think educated Guess is a better term, Radiologists make assessments and determinations on best compilation of visual evidence they have. Science in general makes huge guesses. With the discovery of the Higgs Boson we may find alot of our Guesses Wrong. DuaneF |
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