Podiatric radiologist

[DYK343]

Anyone ever heard of a DPM working for a radiology group reading foot/ankle films/CT/MRIs?

Not sure if that would even be in our scope.

But the radiologists around here are terrible. Truly horrible at foot/ankle. Joint depression calc fx clear as day read as "normal xray".

Tarsal coalition with talar spurring and halo sign "normal findings".

Complete tear of ATFL "normal ligaments"

Had a calc fracture that had a decent read but they failed to point out that the brevis tendon avulsed a 2 x 1cm chunk off the base 5th met and was no longer attached.

Would be a good retirement gig.

Anyone know of anyone doing this work. Christman maybe?

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[Feli]

It's not a bad idea, but it would be out of scope and there's not enough work. I would guess that 98% of private practice DPMs read their own XR and don't send them out. It's just like how most general surgeons review their own abdominal CTs or orthos check the MRI images before even looking at the rad report. For podiatry, MSK radiologist is already a fellowship to do whole body imaging (esp advanced)... so F&A would be too narrow (even if it were legally viable without Rad board cert). You will generally get much better reads from a MSK fellowship rad then a general or other fellowship one who does mammos or head CTs all day and the odd foot XR. Most serious Univ or academic or niche referral ortho & podiatry surgeons create that relationship early on.

I've found that you can drastically improve the reads on advanced imaging (or even ER plain xrays) if you give a good history on the orders for basic or advanced imaging (dx can just be M79.67x), but clinical history filled in well makes the difference in most cases. Some will still blow the read even with a good history on the order if they are going too fast (teleRad, etc), and you can call them up (and hope to get their colleague with decent knowledge instead of the tool that missed basic pathology or doesn't even read the clinical history).

Consider "foot pain" vs "diabetic pt with central forefoot plantar nail puncture through boot and sock outdoors 11/18/21, clinical 5mm puncture with persisting 1cm erythema surrounding but no appreciable drainage.... please eval for gas or osteomyelitis or myonecrosis or other pathology"

"Ankle pain" vs "pt active in basketball with recurrent inversion sprains... please eval for talar dome pathology and lateral ligament and peroneal tendon integrity"

"Ulcer" vs "Rheumatoid patient with history of medial first metatarsal bunion ulcers recurring, clinical 1cm wound probes to bone with purulent drainage"

"Ankle pain" vs "longstanding flat foot with limited painful ROM on exam... please eval for post tibial tendon integrity and stage hindfoot arthrosis"

"Pain" vs "DM2 pt poorly controlled with history hallux IPJ Charcot changes, no current open wounds, calor to midtarsal region... please eval for midfoot Charcot changes or other path"

 

[deleted1097413]

This is just me, but I think giving bad radiologists too much clinical info can be a bad thing as far as what their read is.

 

[DYK343]

It's not a bad idea, but it would be out of scope and there's not enough work. I would guess that 98% of private practice DPMs read their own XR and don't send them out. It's just like how most general surgeons review their own abdominal CTs or orthos check the MRI images before even looking at the rad report. For podiatry, MSK radiologist is already a fellowship to do whole body imaging (esp advanced)... so F&A would be too narrow (even if it were legally viable without Rad board cert). You will generally get much better reads from a MSK fellowship rad then a general or other fellowship one who does mammos or head CTs all day and the odd foot XR. Most serious Univ or academic or niche referral ortho & podiatry surgeons create that relationship early on.

I've found that you can drastically improve the reads on advanced imaging (or even ER plain xrays) if you give a good history on the orders for basic or advanced imaging (dx can just be M79.67x), but clinical history filled in well makes the difference in most cases. Some will still blow the read even with a good history on the order if they are going too fast (teleRad, etc), and you can call them up (and hope to get their colleague with decent knowledge instead of the tool that missed basic pathology or doesn't even read the clinical history).

Consider "foot pain" vs "diabetic pt with central forefoot plantar nail puncture through boot and sock outdoors 11/18/21, clinical 5mm puncture with persisting 1cm erythema surrounding but no appreciable drainage.... please eval for gas or osteomyelitis or myonecrosis or other pathology"

"Ankle pain" vs "pt active in basketball with recurrent inversion sprains... please eval for talar dome pathology and lateral ligament and peroneal tendon integrity"

"Ulcer" vs "Rheumatoid patient with history of medial first metatarsal bunion ulcers recurring, clinical 1cm wound probes to bone with purulent drainage"

"Ankle pain" vs "longstanding flat foot with limited painful ROM on exam... please eval for post tibial tendon integrity and stage hindfoot arthrosis"

"Pain" vs "DM2 pt poorly controlled with history hallux IPJ Charcot changes, no current open wounds, calor to midtarsal region... please eval for midfoot Charcot changes or other path"

Dont kill my dreams man! JK. I agree. Only way it would be possible is in a large system like Kiser, catholic systems, etc, etc.

I try to give as much history as possible. Im alloted 100 characters to do so and I agree its important to give them an idea what youre looking for.

But if I say "rule out stress fx 2nd metatarsal" and there is a bone callus and they read it as normal (happened 2-3 weeks ago) there is just nothing that can be done.

 

[air bud]

congratulations, you just gave some podiatrist a new idea for a fellowship and set up future residents for another wasted year of their life.

 

[GreenHousePub]

congratulations, you just gave some podiatrist a new idea for a fellowship and set up future residents for another wasted year of their life.

you mean wasted two years of their life.

 

[air bud]

you mean wasted two years of their life.

Excellent

 

[wakaflocka88]

congratulations, you just gave some podiatrist a new idea for a fellowship and set up future residents for another wasted year of their life.

This just breaks my heart when I see these nerve, orthoplastic, pediatric fellowships show up and these fellows are posting on their respective IG accounts. I mean c'mon - one of the fellowships in Ohio is for 2 years.....2 years!!

As busy as my training was and even out in real world practice in an ortho/MSG setting, I have yet to see a single patient that needs the above procedures. Even if they do, are you - as a brand new fellowship trained podiatrist - ready to handle the post-op headaches that comes with it?


But ya, AirBud is on to something.....

 

[Sweatshirt]

Sounds like you need to get a new radiologist at your place. Our hospital MSK guys are awesome. Incredibly smart too, I'd trust them with anything

 

[PeaJay]

There is an unspoken rule with my msk guys/gals. If I put foot pain they give me just as little effort in the read. If I actually provide info they give me an in-depth read.

 

[GreenHousePub]

There is an unspoken rule with my msk guys/gals. If I put foot pain they give me just as little effort in the read. If I actually provide info they give me an in-depth read.

I always provide a ton of information, and always whoever inputs the subjective just puts "foot pain"

 

[PeaJay]

I always provide a ton of information, and always whoever inputs the subjective just puts "foot pain"

Well that stinks, sounds like the rad techs are being lazy and in turn making you look lazy. I am on Epic EMR and my orders/subject are automatically sent with the images to the msk rads.

 

[Pshalt]

This is just me, but I think giving bad radiologists too much clinical info can be a bad thing as far as what their read is.

Maybe but giving a good radiologist a bad history helps no one. We read a lot of cases. 95% of histories are 1-2 words, put there by a receptionist. I love a paragraph history and a specific question. This mentality of I don’t want to bias the read with clinical history is bad medicine. Garbage in garbage out.

 

[air bud]

Maybe but giving a good radiologist a bad history helps no one. We read a lot of cases. 95% of histories are 1-2 words, put there by a receptionist. I love a paragraph history and a specific question. This mentality of I don’t want to bias the read with clinical history is bad medicine. Garbage in garbage out.

The issue I have always had with different software working for a very large corporation is that the radiologist is actually not able to see the notes that I put in and it's more on the tech who do not either transfer that or something. So even when I would put in something good they would never see it. But I agree, too much information for bias is junk

 

[air bud]

and also I think calling out radiology doesn't necessarily help us or the profession....at least with blanket statemnts. Just different rules we have to play by.

 

[DYK343]

and also I think calling out radiology doesn't necessarily help us or the profession....at least with blanket statemnts. Just different rules we have to play by.

I agree. And to be clear I didnt say all radiologists. I said radiologists in my area... which I am comfortable making a blanket statement because they really do not catch anything.

Residency we had a really good MSK radiology department. But here... not so good.

From some research it looks like christman does do predominately foot/ankle radiology. It would be an interesting gig if it could be made feasible.

 

[Pshalt]

and also I think calling out radiology doesn't necessarily help us or the profession....at least with blanket statemnts. Just different rules we have to play by.

Thank you as a msk rad, but you are correct that there are radiologists who faint at the sight of a foot CT and haven’t seen a coalition since board review in the 90s.

 

[NobodyDPM]

I tried to market myself for this early in my career. I was told by my malpractice carrier they would not cover me if all I did was read x-rays/MRIs/CTs. Not lying.

 

[dtrack22]

Thank you as a msk rad, but you are correct that there are radiologists who faint at the sight of a foot CT and haven’t seen a coalition since board review in the 90s.

Yeah I’ve had reports from bigger imaging companies where it was always a msk rad reading the study and in rural settings where you get whoever is covering that day. You can tell a difference in the reports generally. Doesn’t matter to me at all on CT, a lot of times I won’t look at the report until after I’ve viewed the area of concern and made a plan in my head. But MRI…the msk folks make a big difference.