Differing Imaging Interpretations

Educational Objectives

The goal of this program is to recognize differing imaging interpretations. After hearing and assimilating this program, the clinician will be better able to:

1. Develop strategies for resolving discrepancies in imaging interpretations.

Summary

Introduction: in medicine, after comprehensive consideration of diverse viewpoints, a definitive decision must be made; medical imaging can be ambiguous and open to various interpretations by different specialists

Five rules of medical imaging

Rule 1: looking at the images directly is important; the clinician sees the patient physically, has context about his or her condition, and may observe the patient’s progress after the imaging; by reviewing and correlating images with patient outcomes, clinicians build a valuable internal reference point; “clinical correlation” may be recommended in some imaging reports, indicating that the interpretation might be inconclusive without additional context

Rule 2: the clinician may have clinical bias when interpreting a patient’s imaging; radiologists specialize in interpreting medical images and offer a distinct viewpoint; their expertise is crucial for accurate diagnosis; collaboration between physicians and radiologists leads to better learning and patient care

Rule 3: disclose all injuries seen on imaging, regardless of perceived significance, to the patient; even minor fractures can cause pain and discomfort; explain findings in easy-to-understand language; disclosure of all injuries helps set patient expectations about recovery and potential pain, and build trust and rapport

Rule 4: be transparent about judgment calls; imaging may not always provide definitive answers; the clinician must explain their thought process and reasoning behind the chosen course of action; involving patients in understanding potential outcomes and rationale for decisions, even if the exact course remains uncertain, is important; by discussing these upfront, patients are less surprised if unforeseen issues arise later

Rule 5: action plans and the reasoning behind them must be documented; explain the thought process behind interpreting imaging results and how imaging findings fit with the patient’s clinical presentation; document conversations with patients about options and the chosen course of action; documentation provides justification for decisions made and demonstrates clear communication and transparency with the patient

Differing imaging interpretations: a radiology report might raise alarms, eg, suggesting immediate surgery; the clinician must consider the patient’s overall condition, vitals, and behaviour to make appropriate decisions; once a course of action is decided upon, the clinician must follow it through unless new information arises

Readings

Brady A, Laoide RÓ, McCarthy P, et al. Discrepancy and error in radiology: concepts, causes and consequences. Ulster Med J. 2012;81(1):3-9; Brady AP. Radiology reporting-from Hemingway to HAL?. Insights Imaging. 2018;9(2):237-246. doi:10.1007/s13244-018-0596-3; Kasaye MD, Beshir MA, Endehabtu BF, et al. Medical documentation practice and associated factors among health workers at private hospitals in the Amhara region, Ethiopia 2021. BMC Health Serv Res. 2022;22(1):465. Published 2022 Apr 9. doi:10.1186/s12913-022-07809-6; Patel SH, Stanton CL, Miller SG, et al. Risk Factors for Perceptual-versus-Interpretative Errors in Diagnostic Neuroradiology. AJNR Am J Neuroradiol. 2019;40(8):1252-1256. doi:10.3174/ajnr.A6125; Tranovich MJ, Gooch CM, Dougherty JM. Radiograph Interpretation Discrepancies in a Community Hospital Emergency Department. West J Emerg Med. 2019;20(4):626-632. doi:10.5811/westjem.2019.1.41375.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Benjamin was recorded at Mattox Vegas Trauma, Critical Care & Acute Care Surgery 2023, held March 27-29, 2023, in Las Vegas, NV, and presented by the Trauma and Critical Care Foundation. For information on upcoming CME activities from this presenter, please visit https://www.trauma-criticalcare.com. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.50 CE contact hours.

Lecture ID:

GS711302

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.