Technologists Can Make Or Break You: Three Sample Cases
Here is the real world: Technologists sometimes forget to report on or miss findings. Other times, they may perform a new protocol without checking it with a radiologist. And, this is just the tip of the iceberg. All sorts of technologist mistakes and judgment errors can happen that can affect our interpretations. And since most of us rely on them so heavily, these errors can make our jobs just a bit more complicated.
Why do these errors happen? Well, technologists are human. In some cases, just like some physicians, a few technologists want to do the least amount of work possible. But, that is the minority. More commonly, they may be exhausted from a tough night. Or, perhaps, it’s just an erroneous judgment call. The bottom line is that their work can be very subjective. And any of these errant cases can ruin your day (and the patient’s too!) if you miss the opportunity to correct it. It’s why we need to check and double-check. Recently, I had some cases that reminded me of the fallibility of the technologist. So, I am discussing them to reinforce my point: don’t accept all the information provided by a technologist at face value!
A New Fibroid In a 65-year Old
For those of you that have completed an ultrasound rotation, you probably have learned about the subjective nature of finding uterine fibroids. Some technologists need to see a very well-defined mass before calling them. And, others will measure almost anything with a slightly different echotexture. Nevertheless, standards can vary widely. (One of the reasons it is better to have the same technologist to perform case after case)
So, in my situation, I had recently reported on a small intramural uterine mass that was not there in the prior study three years earlier. And, I could not define a lesion in the previous study based on the images provided. So, I called it a “new” intramural uterine mass, most likely a fibroid. This time around, I received a phone call from an irate physician, saying that it is impossible to have a new fibroid crop up in a post-menopausal female. (Although not true) And for this reason, she said she was ready to take out the uterus.
Meanwhile, I had to calm her down by saying that the most common cause for a new lesion in the uterus is technical subjectivity. (Unless there was other clinical information that I was not aware of) Although, of course, weird lesions like leiomyosarcomas can occur. However, they are rare. And, it would be clinically appropriate to monitor the uterus for any significant changes closely. The clinician finally backed down. Who knew that an errant fibroid could cause such a problem? Just another example of how “minor” differences in the subjectivity of ultrasound technologists can have considerable ramifications!
A New Intussception- Get The Pediatric Surgeon Down Now!
A few weeks ago, as I was packing my bags to leave at 10:01 pm as my shift had just ended, one of my residents runs into the reading room. He yells, “Don’t leave! We have to reduce an intussception.”
So, I looked at the initial ultrasound images, and I saw bowel loops containing echogenic material. But, there was no significant bowel wall thickening or abnormal flow. It was almost a target sign, but it did not look quite right. Moreover, the technologist did not provide any real-time images to support her claim.
Therefore, like any half-way decent radiologist, I went back and looked at the priors. So, I checked a previous abdominal series performed right before the ultrasound. In it, you can see dense inspissated oral contrast through the colon, especially filling the entire cecum and a good majority of the large bowel. Well, there was my explanation for the appearance of hyperechoic material within the intestine on an ultrasound, not an intussception. Just because a technologist makes a diagnosis, doesn’t mean it is correct. Use all the information at hand!
New MRI Sequence Withdrawn
Finally, a while back, one day, we performed a brain MRI to follow a patient with multiple sclerosis. And, the technologist called me after the patient had left, stating that they have a new protocol for multiple sclerosis patients, handed down from the administration. No one consulted me about this until this point. So, I look at the case, and I see that the typical most sensitive sequence for detecting plaques, the FLAIR sequence, is entirely missing. Additionally, I have no means to compare this study with his priors that had this same sequence. So, how can I say if the case is better, worse, or unchanged?
I consulted with my neuroradiologist colleague to confer about this situation because it didn’t make any sense. He agreed the patient needed to return and didn’t understand why the protocol was changed. Yet, the change in protocol forced a busy patient to return for additional imaging, wasting everyone’s time. A little bit of communication upfront could have resolved the situation. As you can see, protocol tweaks without communicating the change to the reading radiologist can have negative consequences!
Check And Double-Check- Technologists Can Make Or Break You!
Now, my primary goal is not to berate technologists. Instead, these examples show you that it is mission-critical to check and double-check their work, just like they should do the same for us. One wrong technical misstep can derail our ability to interpret images or provide quality patient care. Therefore, we need to catch them as best we can. We are all on the same team. So, remember that technologists, like radiologists, are fallible. Keep your eyes wide open and your head in the game!