Radiology in the community

[tsbqb]

Question for the attendings practicing in community hospitals:

Do you have radiology reading ALL your studies 24/7?

Maybe just CTs 24/7 but you read your own plain films at night?

Do you have 24/7 official ultrasound studies and reads?

Just curious because I do not feel particularly strong about my ability to read films and CT and Im wonderign if I should really put an emphasis on this before I graduate.

Thanks!

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[Angry Birds]

I've really never heard of a place where ER docs read their own ct scans, so no fear of that.

X-rays, after hours, yes you gotta read your own.

So yeah start now. That way you can compare your reads to the radiologists. Do it with every film you get. Look at it and interpret it before looking at official read. Do the same for CTs just for your own learning sake.

Also start doing it for EKGs too.

 

[medic4lyfe]

I took an IR rotation specifically to learn from someone who does it for a living. If you get the chance, do it. It was a good way to end my clinicals before graduation.

Edit: Sorry, missed the part where you were addressing attendings. So, take my post as you will.

 

[Janders]

radiology reads from 8-5, sometimes from 8-8 if they feel like staying late.

After hours, CT and U/S go to the virtual radiologist. Often reads take an hour+.

You CAN send an X-ray off to be read in the same manner, but you can't do that all the time. SO you read your own.

Frankly, I find the ability to ready my own CTs VERY VERY useful. I have a read back 1+ hour earlier. It helps to correlate it the history ,and clinical exam. In critically ill patients, or smaller places where you have to transfer a lot, the ability to read acute CTs (not the lung nodules) is very helpful.

 

[brk81144]

radiology reads from 8-5, sometimes from 8-8 if they feel like staying late.

After hours, CT and U/S go to the virtual radiologist. Often reads take an hour+.

You CAN send an X-ray off to be read in the same manner, but you can't do that all the time. SO you read your own.

Frankly, I find the ability to ready my own CTs VERY VERY useful. I have a read back 1+ hour earlier. It helps to correlate it the history ,and clinical exam. In critically ill patients, or smaller places where you have to transfer a lot, the ability to read acute CTs (not the lung nodules) is very helpful.

I work at four different shops right now all of which read all imaging 24/7. Where I trained we read all at night so I think it's location dependent

 

[Groove]

Our rads reads everything from 7a-6p. After that, CT's are prelim studies with short, concise reports that are hand typed with relevant findings applicable to the ER. Plain films are read by the ED physician though you can "push" it to the radiologist to be read if you have a head scratcher. It's a suboptimal system and I've fought for a nighthawk or better quality reads at night to absolutely no avail. Our radiology group is protected and insulated beyond belief.

So, your best shop will be either 24/7 reads (everything) or a nighthawk that reads everything overnight but yes, you will have many shops where you will be expected to read your own plain films but not your own CTs. My advice to every resident is to work on reading plain films and CTs as good as a radiologist from day 1 even if that might seem unrealistic. Look at the image, interpret, read the official report, go back to catch what you didn't see and then file it away for next time. Rinse, repeat. By the end of residency, you should be fairly comfortable reading and recognizing most of the major pathology in your own imaging studies. Much of it is pattern recognition. I still try to keep the habit to this day and occasionally I'm either calling a surgeon, or calling NSGY for a CT that I've already read and interpreted before I get a call back from rads. If you have time to do a rads elective, it helps but you'll not get more than a basic skeleton framework for reading say... chest x-ray's or body CT's during that month. It would be far more high yield to be pro-active from day 1. There are some good texts. I read 2-3 during residency and they helped. I'll see if I can dig them up if you're interested in the names.

As for US, you should be able to read your own by the end of residency. Again, be proactive, get with your US director and practice. I think I had 1K logged studies by the end. In the real world you'll be getting formal reads but you should still be able to read most of your own. We have 24/7 US and MRI can be called in at nights.

 

[tsbqb]

Thanks for the responses!

 

[The White Coat Investor]

Our rads read everything 24/7 at all hospitals in our community. I don't want to use the term standard of care due to its legal implications, but it probably is.

 

[goodoldalky]

24/7 rads for everything as well. I find minimal issue with reading your own plain films overnight, but if you are doing so, you better be billing for and getting paid for these reads, not radiology who over-reads the next day. I find if your group is lacking radiology coverage overnight for something like plain radiographs, and you interpret and then your group starts billing for it (preventing rads from billing for it the next day), your radiology department will quickly find a way to find coverage to capture that billing. And if they do not you will find a very lucrative add to your bottom line, one which your group is already doing the work and assuming the liability for. It's a win-win. Your radiology department will not like your billing for these reads overnight but it is not logically or legally justifiable for them to bill in this circumstance.

 

[hoot504]

24/7 rads for everything as well. I find minimal issue with reading your own plain films overnight, but if you are doing so, you better be billing for and getting paid for these reads, not radiology who over-reads the next day. I find if your group is lacking radiology coverage overnight for something like plain radiographs, and you interpret and then your group starts billing for it (preventing rads from billing for it the next day), your radiology department will quickly find a way to find coverage to capture that billing. And if they do not you will find a very lucrative add to your bottom line, one which your group is already doing the work and assuming the liability for. It's a win-win. Your radiology department will not like your billing for these reads overnight but it is not logically or legally justifiable for them to bill in this circumstance.

On that note, here's a gem from Billy Mallon

http://epmonthly.com/article/the-life-cycle-of-a-parasitic-specialist/

Probably unnecessarily inflammatory, but it's an interesting read. Funny too

 

[em1234]

24/7 rads for everything as well. I find minimal issue with reading your own plain films overnight, but if you are doing so, you better be billing for and getting paid for these reads, not radiology who over-reads the next day. I find if your group is lacking radiology coverage overnight for something like plain radiographs, and you interpret and then your group starts billing for it (preventing rads from billing for it the next day), your radiology department will quickly find a way to find coverage to capture that billing. And if they do not you will find a very lucrative add to your bottom line, one which your group is already doing the work and assuming the liability for. It's a win-win. Your radiology department will not like your billing for these reads overnight but it is not logically or legally justifiable for them to bill in this circumstance.

this is exactly what happened at my old group. We had for years read our own plain films after 5p. We started billing for the reads, (which in turn meant that radiology was no longer able to bill for their read of the same XR), and they had a conniption about it, complained to the hospital administration who told them if they wanted to bill for it, they should read them. We refused to stop billing...

And all of a sudden we had a lot more radiology coverage, and my rate of pediatric elbow CT's decreased dramatically,
-1234

 

[Greenbbs]

Attending reads till midnight and resident reads overnight with ability to get an attending over read.

24/7 us and mr coverage as well

 

[EM Junkie]

24/7/365 reads of all imaging modalities by an attending

24/7/365 in house availability of all imaging modalities, including MRI

60K volume community ED

And yes, we're hiring 2 doctors right now.


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[Vandalia]

As mentioned earlier, I don't want to use the "s" word, but lack of 24/7 radiology coverage these days would be fairly unusual. Who does the reads at night/weekends (local group or "Nighthawk"), and the quality of those reads can be an issue, but not the fact that it is being done by a radiologist.

For the students, to bill you have to generate a report, and if you generate a report you will be held to the standard of a radiologist. While I might be as good at doing the obvious findings as a radiologist (given that I have the advantage of having a detailed history and actually seeing the patient), what can get you in deep trouble is the missed incidental findings, i.e., a nodule in the sliver of lung field in the image, etc. My 10 year old can find the bright dot on CT that represents a kidney stone, but it is with the unexpected stuff that radiologists earn their keep. Even if it were an option, I would not be comfortable taking that liability for $10/image. (As I understand it, at least under the law/precedents of my state, if I view the images and use them in formulating treatment but do not generate a report, I am held to the standard of an EM physician. That I can live with. At least here.)

 

[goodoldalky]

As mentioned earlier, I don't want to use the "s" word, but lack of 24/7 radiology coverage these days would be fairly unusual. Who does the reads at night/weekends (local group or "Nighthawk"), and the quality of those reads can be an issue, but not the fact that it is being done by a radiologist.

For the students, to bill you have to generate a report, and if you generate a report you will be held to the standard of a radiologist. While I might be as good at doing the obvious findings as a radiologist (given that I have the advantage of having a detailed history and actually seeing the patient), what can get you in deep trouble is the missed incidental findings, i.e., a nodule in the sliver of lung field in the image, etc. My 10 year old can find the bright dot on CT that represents a kidney stone, but it is with the unexpected stuff that radiologists earn their keep. Even if it were an option, I would not be comfortable taking that liability for $10/image. (As I understand it, at least under the law/precedents of my state, if I view the images and use them in formulating treatment but do not generate a report, I am held to the standard of an EM physician. That I can live with. At least here.)

I got news for ya, you're still liable for that nodule on that that patient who you discharged that you didn't pick it up on their plain film... Whether rads saw it the next day or not...

Will you lose this case should the worst case scenario happen depends on what state you're in... Generally you'll be okay, but you have liability whether you read the film and get paid or you read the film and don't get paid. There will be plenty of people to line up and comment on that mediastinum in court.. Reasonable, no, but anything can be purchased these days.

My only point is the liability is there no matter what (also can be argued still there even with 24/7 rads).. Get paid if you're doing this work.

 

[gman33]

I got news for ya, you're still liable for that nodule on that that patient who you discharged that you didn't pick it up on their plain film... Whether rads saw it the next day or not...

Will you lose this case should the worst case scenario happen depends on what state you're in... Generally you'll be okay, but you have liability whether you read the film and get paid or you read the film and don't get paid. There will be plenty of people to line up and comment on that mediastinum in court.. Reasonable, no, but anything can be purchased these days.

My only point is the liability is there no matter what (also can be argued still there even with 24/7 rads).. Get paid if you're doing this work.

But if rads reads this the next day, you can contact the patient and have no liability. They can keep the $10.

 

[RustedFox]

Its a designated "duty" for the 6am-3pm doc to "reconcile the radiology discrepancies" from the night before at my primary job site.

 

[filhodeinferno]

On that note, here's a gem from Billy Mallon

http://epmonthly.com/article/the-life-cycle-of-a-parasitic-specialist/

Probably unnecessarily inflammatory, but it's an interesting read. Funny too

Holy cow, that article trolled radiologists hard. Like 1,000 angry comments by them below. My question is why are so many of them reading epmonthly?

 

[b-real]

Holy cow, that article trolled radiologists hard. Like 1,000 angry comments by them below. My question is why are so many of them reading epmonthly?

Ya I came upon that article a few months ago. It probably got forwarded to a bunch of radiology blogs/facebook pages.

 

[deleted547339]

Its a designated "duty" for the 6am-3pm doc to "reconcile the radiology discrepancies" from the night before at my primary job site.

What sort of fresh hell.....????

Your radiology dept must have some big pull in the hospital.

 

[n2b8me]

we don't have ultrasound or MRI from 8p-8a, but all the CTs are formally read overnight now.

 

[filhodeinferno]

Ya I came upon that article a few months ago. It probably got forwarded to a bunch of radiology blogs/facebook pages.

I just don't see that kind of animosity between EM and Rads at my site. I am thankful for their 24/7 reads and they don't mind if we order a ton of stuff because they know it's job security and money in the bank for them.

 

[RustedFox]

What sort of fresh hell.....????

Your radiology dept must have some big pull in the hospital.

Its just for the ER cases. They're generally not many; maybe 2 or 3 a day. Takes 5 minutes, max.

 

[shoal]

no in house coverage overnight. nighthawk reads for us,ct. mri rads gets called in.

daytime doctor also does call backs for missed findings. takes 1-2 hours for reads at night. got a trauma? better hope you see their injuries. i find this very annoying. xrs read by er doc and if missed findings gets called the next day by us.

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[meister]

On that note, here's a gem from Billy Mallon

http://epmonthly.com/article/the-life-cycle-of-a-parasitic-specialist/

Probably unnecessarily inflammatory, but it's an interesting read. Funny too

I always troll hardest whilst wearing a beret.

 

[future_dr_house]

24/7 reads on all images. Mri and US available 24/7. We have a nurse coordinator who calls all patients with incidental findings on imaging and makes sure they understand they need close follow up.


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