Ever watched an expert radiologist read a CT scan or an MRI? They gaze at a scan, digest the information in one fell swoop, and spit out impressive findings and differentials with the single Gestalt.
If the world’s greatest radiologists can do it this way, why can’t you?
Well, what if I was to tell you to avoid this expert radiologist’s approach? You might think I was crazy, even though it may be hazardous to your career! But this “Gestalt approach” is most likely the wrong one for you.
But why? Why does this Gestalt approach to films, used by expert radiologists, not work well for the neophyte radiologist? To answer this question, we will define Gestalt and explain why this approach can be dangerous for early radiologists. Then, instead, we will tackle why and how radiology residents should read films using the “segmental approach.”
Defining Gestalt
Let’s start by defining the principles of Gestalt. According to Wikipedia, these are “the idea that natural systems and their properties should be viewed as wholes, not as collections of parts.”
Radiologists use the Gestalt approach when they sense the findings and diagnosis without processing the individual steps. I like to think of the Gestalt approach like The Dog Whisperer, Cesar Milan. He can naturally sense the overall picture of a dog that others cannot. With this sixth sense, he can train dogs to do whatever he wants while mere mortals struggle to figure out exactly how to do what he does.
Why Avoid the Gestalt Approach When Starting?
Since you have not been practicing radiology for long, you will miss half the findings in the film. You don’t know what you don’t know. And, if you don’t look for a finding, you won’t mention it or find it. So, if you read a chest film and don’t know to look at the pulmonary arteries, you won’t find that case of pulmonary hypertension. The Gestalt approach does not allow for evaluating each of the individual sectors of the film to ensure you have looked at it.
How long have you been practicing radiology? At most, for residents, three or four years. Rarely is that enough time to build a network in your brain allowing you to look at a film rapidly once and then create a framework for arriving at a final impression of the study. You have not trained your eyes to search everything in the image in a short period. And, therefore, you will not catch everything.
Take it from me; the Gestalt approach is a fast way for a resident to look like a fool. When you review a case with another clinician, they will catch things you missed. What could be more embarrassing?
What Approach Should You Use?
Instead of the Gestalt approach, the beginner radiologist should utilize a segmental approach. What do I mean by that? The segmental system divides the film into individual parts. You then review the entire image until you have completed your search pattern. In essence, it is a glorified checklist.
In addition, the segmental approach can vary for each reader based on personal preference. For some, you may divide the chest film into quadrants. For others, on the chest film, you may look at the technique, the heart, the soft tissues, the bones, and the lungs. Whatever the pattern, it usually doesn’t matter except that you cover all bases. As a beginning radiologist, this approach will prevent you from missing critical findings. And you will look much more intelligent than the new radiologist that uses a Gestalt approach.
The Bottom Line About the Gestalt Versus Segmental Approach
The Gestalt approach does not work well for beginning radiologists unless they have a tremendous gift. Most learners cannot look at the whole to identify the abnormalities in each part. Instead, the new learner is more adept at looking at all the pieces to determine what went wrong with the whole. Therefore, until you have the experience to identify abnormalities with a glance rapidly, the Gestalt approach is a recipe for disaster.
So, create a great, all-inclusive search pattern to avoid missing individual findings. Who knows? Maybe someday you will become that great radiologist who uses that Gestalt approach!
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