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Surgeons, Do You Care At All For Clinical Correlation Recommendations From Radiology?


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Occasionally but usually not for me. Truth be told we are always clinically correlating radiological images/reports anyway and asking ourselves if the imaging makes sense given the clinical context.

 

I tend to treat it as a flag of the radiologist not being 100% sure in the diagnosis, which if the report is well dictated the radiologist makes clear anyway.

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As a surgical resident my ideal imaging report would be:

 

1) Type of imaging including list of phases. IE: CT abdo with arterial, venous, portal venous, and non contrast

 

2) Indication for imaging: Why I, or whomever, asked for imaging. Ex: RO ACUTE APPY (in all caps)

 

3) Summary including all caps answer and or all caps incidental finding. Right at the very top, the very first thing, and yes 80% of the time no one will read the rest of the report hence the caps. Just pertinent positives and negatives.IE: NO EVIDENCE OF ACUTE APPY, normal bowel gas, no free air, no free fluid, INCIDENTAL 2MM R ADRENAL MASS.

 

4) Suggestions for follow up imaging or indicate that no other imaging would be useful: IE: This is not an ideal study to look for cholelithiasis, suggest abdominal U/S. Given body mass could also attempt PTC placement +/- cholangiogram with contrast. Suggest F/U CT for incidental pulmonary nodule in 6/12.

 

5) Systems based pertinent break down. IE: Billiary tree is non dilated and free of air. Gallbladder measures 4cm with no evidence of sludge or wall thickening. Liver is unremarkable except a 3cm hemangiomatous legion in segment 5 as previously mentioned. Spleen is unremarkable with no evidence of aneurysm in splenic artery and a well shielded splenic vein. Pancreas has mild fatty infiltrates consistent with previous scan the pancreatic duct is not appreciated. Portal vein is poorly visualized in this study. There appears to be no pathological processes involving any portions of the large and small intestine. Bony structures are consistent with a patient of this age. Incidental plebolith in lower pelvis is unchanged from last image dated dec 2015.

 

Meat and potatoes, question asked, questioned answered. No buzz phrases like "clinical correlation required", nothing crazy to show off how much more you know than me like "there is an anomalous branch of the SMA that is consistent with VanHoutten syndrome which is a benign finding attributed to 5% of Philippino men born in 1960-65 that has no impact to clinical care or the reason you asked for the scan but I read about last night and have been waiting to include in a report all day". But that's just me.

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As a surgical resident my ideal imaging report would be:

 

1) Type of imaging including list of phases. IE: CT abdo with arterial, venous, portal venous, and non contrast

 

2) Indication for imaging: Why I, or whomever, asked for imaging. Ex: RO ACUTE APPY (in all caps)

 

3) Summary including all caps answer and or all caps incidental finding. Right at the very top, the very first thing, and yes 80% of the time no one will read the rest of the report hence the caps. Just pertinent positives and negatives.IE: NO EVIDENCE OF ACUTE APPY, normal bowel gas, no free air, no free fluid, INCIDENTAL 2MM R ADRENAL MASS.

 

4) Suggestions for follow up imaging or indicate that no other imaging would be useful: IE: This is not an ideal study to look for cholelithiasis, suggest abdominal U/S. Given body mass could also attempt PTC placement +/- cholangiogram with contrast. Suggest F/U CT for incidental pulmonary nodule in 6/12.

 

5) Systems based pertinent break down. IE: Billiary tree is non dilated and free of air. Gallbladder measures 4cm with no evidence of sludge or wall thickening. Liver is unremarkable except a 3cm hemangiomatous legion in segment 5 as previously mentioned. Spleen is unremarkable with no evidence of aneurysm in splenic artery and a well shielded splenic vein. Pancreas has mild fatty infiltrates consistent with previous scan the pancreatic duct is not appreciated. Portal vein is poorly visualized in this study. There appears to be no pathological processes involving any portions of the large and small intestine. Bony structures are consistent with a patient of this age. Incidental plebolith in lower pelvis is unchanged from last image dated dec 2015.

 

Meat and potatoes, question asked, questioned answered. No buzz phrases like "clinical correlation required", nothing crazy to show off how much more you know than me like "there is an anomalous branch of the SMA that is consistent with VanHoutten syndrome which is a benign finding attributed to 5% of Philippino men born in 1960-65 that has no impact to clinical care or the reason you asked for the scan but I read about last night and have been waiting to include in a report all day". But that's just me.

I agree, although I like my summary at the bottom.

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I agree, although I like my summary at the bottom.

 

ha probably because you (like most of us) don't have a summary until we get there having gone through all the steps.

 

One of the reasons this reports can be more complex is because we never know ultimately how is going to read them - we have gotten into trouble not including things completely unrelated to the presenting complaint that seems irrelevant to the referring doctor  but pops up as important later on to some one else. 

 

I find at our centre which uses a ton of templates that our reports while organized are simply huge. There is a line for everything - ever single major system. I bet almost no one ever reads all that and just jumps to the impression. 

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Thanks for your input guys.  Honestly, I don't care about those irrelevant incidentals any more than the next guy.  Unfortunately for us they matter to the supervising consultant, particularly if they're old to really old.  We are judged partly by how much we see, and the only way to prove that we saw them is by putting them in the report.

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Thanks for your input guys.  Honestly, I don't care about those irrelevant incidentals any more than the next guy.  Unfortunately for us they matter to the supervising consultant, particularly if they're old to really old.  We are judged partly by how much we see, and the only way to prove that we saw them is by putting them in the report.

 

this.

 

I think it is in part just that the report is not just for the referring doc in an academic centre. It really is our equivalent of practicing seeing everything, noting everything, learning how to describe everything (which means actually including it in a report to get the practice - learning how to describe something IS a huge part of the job). That can be annoying but it is just how the training works I guess. It is the same way when we are asked to review studies or perform studies etc at times no one in the "real world" community would actually ask for. It is a teaching centre after all. 

 

plus the clinical correlation required line can be to just to protect the radiologist (so many things lot exactly the same on imaging). Again it is self serving at times but that isn't unusual in medicine regardless of the service (how many times has say surgery asked for a consult from another service just to cover all the bases as another example). 

 

In the community the reports are vastly shorter, often just answering a single question. Some of them just look like our impressions (if that). 

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  • 2 weeks later...

Ok Ok Ok here is what I propose:

 

We will look the other way when you write "clinical correlation is required" and try not to give you too hard a time with the weird superfluous findings, but when we come to you with a CT request that is completely pointless but our semi-retired staff is unwavering in their insistence that we get the scan, you guys just take pity on us and try to keep the radiation dose as low as possible.

 

Deal?

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Ok Ok Ok here is what I propose:

 

We will look the other way when you write "clinical correlation is required" and try not to give you too hard a time with the weird superfluous findings, but when we come to you with a CT request that is completely pointless but our semi-retired staff is unwavering in their insistence that we get the scan, you guys just take pity on us and try to keep the radiation dose as low as possible.

 

Deal?

 

ha :) - in theory I agree although the issue in principle is you just exposed the patient to a small but real risk of cancer for no reason. Imagine asking any other doctor to something similar (actually doing something completely pointless that can hurt the patient). That being said I understand some people are just weird in their requests/beliefs about imaging. I certainly don't push back on much - actually cannot exactly recall the last time I declined a study. 

 

Just don't be do picky when we say we will "take care of it". Sometimes that means it will be done but done first thing am (when we don't have to read it). 

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