In radiology, almost anything can change our sensitivity to detecting disease. Problems with electronics and hardware such as PACS, the RIS, imaging software, or even dictation software can cause us to miss out on information. Phone calls and texts can interrupt our train of thought. Many of these problems can be beyond our control. But, there are also ways that we are directly responsible for our daily reads that can affect our sensitivity. So, what are some main ways radiologists can knowingly skimp on sensitivity to negatively affect patient care?
Not Getting Priors- A Template For Decreasing Sensitivity
Out of all the ways we can negatively affect patient care, this one likely has the most bang for the buck. Whether we need to search for changes that can affect chemotherapeutic regimens or determine if a pulmonary embolus is acute or chronic, we can severely decrease pathology detection and change patient management when we neglect priors. It is certainly worth the extra time to look at the prior studies!
Not Reading The Prior Reports
Just as critically, it is not just about searching the priors but also about reading the previous reports. I can’t tell you how often I have discovered items in the information that are the reason for performing the following study that may not be so obvious if you don’t read the prior dictation in addition to looking at it. It could be an incidental tiny pancreatic cyst or a subtle rib sclerotic rib lesion that you might not realize by just skimming the previous images . In either case, you must also make sure to peruse the prior reports to maximize sensitivity.
Using The Correct Software For Imaging
It is effortless to skimp on interpreting images when the programs are slow or unwieldy. However, we are obligated to look at studies in a way that will maximize sensitivity. That may involve looking at a PET scan on the appropriate interpretation platform or using the reconstruction software for coronary artery CTAs. If you skimp on this step, you are much more likely to miss disease that can negatively affect patient management.
Windowing/Protocols
It is much easier to go through a study if you don’t take the time to go through bone and liver windows on a CT scan or neglect the diffusion-weighted sequences on an MRI of the abdomen. However, by forgoing these steps, you are also sacrificing sensitivity. Sure, it’s nice to get home a bit earlier. But is it worth the outcome of missing a liver lesion or a hidden enlarged abdominal mesenteric lymph node?
Not Waiting For All The Images To Arrive
I get impatient when the computer sends the studies over slowly. That happens to almost everyone once in a while. And, it is very tempting to interpret the images based on the images that you have alone. But, for instance, axial CT scans images without the coronals, and sagittal can cause you to miss compression fractures, renal masses, and more. Don’t skimp on the waiting for these last images to cross over.
Skimping on Sensitivity!
We, radiologists, have taken a Hippocratic oath. This oath obliges us to do no harm. Although we are under pressure to complete all our cases, we must best answer the clinical question appropriately without sacrificing sensitivity. Or else the study can become worthless or, even worse, harmful to the patient. So, make sure to cross all your t’s and dot all your i’s by checking for priors, using the correct software, looking at all the windows/sequences, and not being impatient before interpretation. These are simple ways to increase our sensitivity and ultimately improve patient care!
