How important is reading your own musculoskeletal plain films and MRI (even CT of bones??) and how good are rehab. docs at interpreting their own imaging? Do you guys wait until an "official" read is given by the radiologist or read your own MRI and treat accordingly?
PMR and Radiology
- Thread starter pmr222b
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I look at everything, try to interpret everything. I will put in my note that the official report stuff, tho. Nice habit to get into, especially important if you are considering being an interventionalist, in that you want to know wtf is down there where you are sticking a needle
It is essential that any physician be proficient in reading their own films. When you take your orals, you WILL be tested on musculoskeletal radiology. It is a good habit, you will gain respect of your peers, and your patients will appreciate the visual input. (I go over all x-rays and MRI's with patients) Finally, you will find that not all radiologists are created equal, and many downright stink.😀
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Most physiatrists are good at reading the films they see a lot. I'm sure an interventional spine doc is great at reading spine MRIs/X-rays, but might have more trouble interpreting an ankle X-ray. Whereas if you see a lot of sports patients, you should be able to read your own ankle films.
As a resident, I feel pretty comfortable with spine X-rays and MRIs (somewhat less so with other joints). There have been a few MRIs where I noticed herniations that the radiologist missed in their report so that's why it's important to read your own films.
As a resident, I feel pretty comfortable with spine X-rays and MRIs (somewhat less so with other joints). There have been a few MRIs where I noticed herniations that the radiologist missed in their report so that's why it's important to read your own films.
i didnt see any musculoskeletal imaging on my boards.
most physiatrists really arent that great at reading imaging. the good ones are, though. you wont be able to read everything well, as the field is just too big.
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Image interpretation such as MRI or xray is expected for oral boards, but perhaps not everyone gets it.
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If you cannot look at these pics and know exactly what is going, they shoul not let you graduate residency in PMR.
http://radiology.rsnajnls.org/cgi/content/figsonly/245/1/43
http://radiology.rsnajnls.org/cgi/content/figsonly/245/1/43
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Wow, great link! Thanks for posting! 🙂
I'm on my way out, but I'm going to town on those images tonight to find out of I'm allowed to graduate. 😛 Although I think if there are histological slides on the boards, I'm screwed.
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but they do.... i think we all know colleagues who cant read these. again, goes to the lack of standardization in training.
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I think it's really important
As others have said, you get good at reading the ones you read the most. I feel very comfortable with my ability to read spine imaging, and I think I am ok at the other peripheral joints. I am so-so at brain imaging
I have definitely picked up on fractures that were missed by radiologists. This is particularly true with the increased prevalence of locum and off-site radiologists, who frankly probably don't care as much.
On a very base level, you need to make sure the right body part was imaged (I've had this happen to me many times). This is especially important for images that are not quite normal protocols (e.g., imaging for coccydinia, since the coccyx is often skipped in some imaging studies, imaging of the upper lumbar spine, sports hernias (which require an oblique coronal cut), etc)
With spine, I think it is really important to know the pathway of my needle.
Additionally, radiologists don't comment on things I consider important. On the spine, they often don't comment on Tarlov cysts, z-joint cysts, annular tears, whether a herniation is a protrusion or extrusion, etc
Additionally, your clinical impression often adds considerably to the interpretation of the film. I have a patient who has clear L5 radicular symptoms, my eyes immediately zone in on the L4-L5 and L5-S1 region. Often the radiologists will focus on levels that are irrelevent to the clinical impression.
I just read an article (I can't remember where) which confirmed that radiologists read spine MRIs differently than other spine physicians
As others have said, you get good at reading the ones you read the most. I feel very comfortable with my ability to read spine imaging, and I think I am ok at the other peripheral joints. I am so-so at brain imaging
I have definitely picked up on fractures that were missed by radiologists. This is particularly true with the increased prevalence of locum and off-site radiologists, who frankly probably don't care as much.
On a very base level, you need to make sure the right body part was imaged (I've had this happen to me many times). This is especially important for images that are not quite normal protocols (e.g., imaging for coccydinia, since the coccyx is often skipped in some imaging studies, imaging of the upper lumbar spine, sports hernias (which require an oblique coronal cut), etc)
With spine, I think it is really important to know the pathway of my needle.
Additionally, radiologists don't comment on things I consider important. On the spine, they often don't comment on Tarlov cysts, z-joint cysts, annular tears, whether a herniation is a protrusion or extrusion, etc
Additionally, your clinical impression often adds considerably to the interpretation of the film. I have a patient who has clear L5 radicular symptoms, my eyes immediately zone in on the L4-L5 and L5-S1 region. Often the radiologists will focus on levels that are irrelevent to the clinical impression.
I just read an article (I can't remember where) which confirmed that radiologists read spine MRIs differently than other spine physicians
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Thats pretty much the bottom line, isnt it?
Become a good physiatrist. Get into the habit of checking the films yourself. Many reasons:
Educational purposes nice way of learning your regional anatomy.
Always good to have an extra set of eyes looking at things. Sometimes the radiologist misses things that you pick up. Sometimes vice versa.
What would you do when a patient is in front of you, with outside films in hand, but no report available? Helps if you can review the images with the patient, for their educational benefit.
You are responsible for your patient. You know your patient better than anyone, and can best interpret any normal/abnormal findings in the appropriate clinical context.
If your attending doesnt care to review films w/ you (or cant), politely ask one of the radiology. Its your education.
I could not agree more. Work hard in your training (and in practice), take nothing for granted, and you will be a good doc.
Also, if you think you see something on a film that the radiologist does not, bring it to his/her attention. That way, they know you, and know that you are paying attention!
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I could not agree more. Work hard in your training (and in practice), take nothing for granted, and you will be a good doc.
Also, if you think you see something on a film that the radiologist does not, bring it to his/her attention. That way, they know you, and know that you are paying attention!
Our clinic's radiologists (MRI readers) are spread throughout the country. They all work from home and are always available by phone (I can often hear their kids in the background...). Probably once a month I call to clarify something, ask what something is that I see that they didn't mention (90% of the time it's very benign), or to ask for an addendum for something clinically relevant but not mentioned.
I think many radiologists appreciate the opportunity to more meaningfully participate in patient care. Some, though, do seem to prefer the isolated dark cave.
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I learned my neuroimaging reading as a junior attending. We should emphasize the importance of this more strongly at the residency training level. I read brain images well--for the range of pathology that I am most clinically familiar, but still rely on the "official" radiology report to double-check that I haven't missed anything.
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http://forums.studentdoctor.net/showpost.php?p=8129178&postcount=52
Go here, come back.
If you cannot find the problem, stay one more year in residency.
😛
Go here, come back.
If you cannot find the problem, stay one more year in residency.
😛
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Left acetabulum smooth deformity indicative of old trauma. The acetabular prosthetic cup has slipped and migrated inferomedially. Right hip replacement hardware in appropriate position.
Someone needs a little OR time. I can post back after her Orthopedist decides what he can do to fix it. I may go OR with him to check it out.
SML
Someone needs a little OR time. I can post back after her Orthopedist decides what he can do to fix it. I may go OR with him to check it out.
SML
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She still clunks when she walks, but the pain is improved. It won't last her until the surgery- not a chance.
Did not know until during the course of the injection when I pistoned the C-arm more medially that her hip was FUBAR. She mentioned it clunking when she walked with heel strike, but it did not clunk when she walked on her tiptoes.
Neat.
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