The Radiologist as Physician Consultant

By: AMFS Board Certified Radiologist

Radiologists are physicians who specialize in diagnostic imaging and are specifically trained to be consultants. A radiologist has undergone at least five years of residency training that is equal in time to most surgical training programs including general and orthopedic surgery and longer than many other programs such as emergency medicine,obstetrics/gynecology, and primary care. Experienced radiologists have interpreted hundreds of thousands of X-ray, computed tomography (CT), ultrasound (US), and magnetic resonance imaging (MRI) images and are certified by the American Board of Radiology only after passing both written and oral examinations.

Don’t Believe Everything You Read

Radiologist’s reports are interpretations and opinions of imaging exams, not objective results like laboratory tests. The report is ideally performed in conjunction with clinical history, physical exam, and laboratory results, but even given perfect conditions radiologists may disagree with one another whether a finding is a tumor, infection, bleed,or even a more complex combination such as a bleeding tumor. Or, another radiologist may believe that the “finding” was simply a normal physiologic variant. The report is not immutable fact; it is the opinion of a radiologist, and opinions can vary so if in doubt,have another radiologist review the images for an independent interpretation.

To Err Is Human

Radiologists make mistakes just like everyone else; radiologists can misinterpret findings or miss them altogether, most commonly nasal bone fractures and soft tissue contusions seen on head CT for assault. Aside from inherent differences in opinion, the fact is radiologists can err, either perceptually (the finding was not seen) or conceptually (the finding was seen but interpreted incorrectly). The good news is images can be reviewed, reinterpreted and correlated with the original report, so if there is any consideration of a possible error, have an expert radiologist take another look.

Quality Counts

Image quality can vary significantly which can affect diagnostic accuracy. The most advanced scanner-software combinations produce images that look like the newest high definition TV, but others might look like an old fuzzy TV set from the 1950s. Furthermore, images can be affected by artifacts from any number of sources including surgical implants, jewelry, or even motion artifact from breathing. For instance, a common artifact in the brain can be mistaken for subdural bleeding. A radiologist is inthe best position to comment on image quality and artifacts which may limit interpretation or even be misinterpreted as pathology.

Timing is Everything

Experienced radiologists have reviewed an enormous number of images which generates a vast internal database; radiologists have the best chance to assess the timing of pathology such as fractures, strokes, and bleeds by comparing the images to this huge internalized database of experience. Timing of pathology is rarely easy, but radiologists have the best chance to predict if an event occurred in the last day, week, or month; in fact in many cases an active bleed can be seen on CT!

Do the Right Thing

Radiologists should follow guidelines developed by the American College of Radiology regarding such things as ambient light levels, monitor resolution and luminance, and certain components of the reports themselves such as differential diagnosis and suggestions for further imaging. Furthermore, mammography is federally regulated by FDA under the Mammography Quality Standards Act (MQSA). If there have been deviations from these standard guidelines, a radiologist can tell you.

The Final Word

An expert radiologist’s experience in diagnostic imaging can be an invaluable asset, particularly in evaluating image quality and report accuracy. If there are any questions regarding imaging appropriateness, image quality, or the report or recommendations,consulting an expert radiologist can significantly clarify and strengthen your position.