Communicating with the referring physician: the standard of care

OBJECTIVE

This study sought to determine whether academic radiologists achieve the standard of care that the American College of Radiology recommends for communication of unexpected significant findings to referring physicians.

CONCLUSION

Academic radiologists do achieve the recommended standard of care.

Direct disclosure by radiologists of imaging findings to patients: a survey of radiologists and medical staff members

OBJECTIVE

A previous survey revealed that patients prefer to hear the results of imaging examinations from radiologists at the time of the procedure rather than be informed later by the referring physician. This study was performed to learn, by means of questionnaires, the attitudes of members of medical staff and of radiologists.

SUBJECTS AND METHODS

Questionnaires were sent to members of the medical staff at my institution and to private and academic radiologists throughout the country. Respondents were presented with this statement: "If an adult patient who knows why a radiologic examination is being performed and what is being sought asks to know the results from the radiologist, the radiologist should answer truthfully (and immediately contact the referring physician with the results and the fact that the patient has been informed)." Five alternatives were presented: 1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree. Results were tabulated by department in the first instance and by state and character of practice in the second. The sum of the replies in each area was divided by the number replying to obtain a mean figure.

RESULTS

The mean figure for members of medical staff was 2.35, which was on the agree side of neutral, indicating at least neutrality, leaning toward agreement, on the subject. The overall mean figure of 2.18 for radiologists indicates substantial agreement with the stated proposition.

CONCLUSION

This study suggests that radiologists and referring physicians alike tend to support the proposition that, if asked, radiologists should disclose the results of imaging studies to patients.

Technical adequacy of fluoroscopic spot films of the gastrointestinal tract: comparison of residents and technologists

OBJECTIVE

We compared images obtained during gastrointestinal fluoroscopy by specially trained and experienced technologists with those obtained by radiology residents to determine if the quality of images was similar between the two groups.

MATERIALS AND METHODS

Three senior radiologists examined the fluoroscopic spot films of 80 patients who were divided evenly into four groups: barium enemas performed by technologists, barium enemas performed by residents, gastrointestinal series performed by technologists, and gastrointestinal series performed by residents. The senior radiologists graded adequacy of visualization of the esophagus, stomach, duodenum, and all parts of the colon. A grade of 1 was given for poor films, 2 for adequate films, and 3 for good films. They did not know who performed each study.

RESULTS

For barium enemas, the residents' mean score was slightly higher than that of the technologists (13.5 compared with 12.9). For gastrointestinal series, residents' mean score was again slightly higher (20.5 compared with 19.7). In neither case did the difference reach statistical significance.

CONCLUSION

Fluoroscopic films obtained by residents and by specially trained and experienced technologists for barium enemas or gastrointestinal series were statistically indistinguishable.

Disclosure of imaging findings to patients directly by radiologists: survey of patients' preferences

OBJECTIVE

The purpose of this study was to determine if patients prefer to have radiologists tell them imaging findings immediately after the examination or if they prefer to hear the results later from their referring physician.

SUBJECTS AND METHODS

A simple questionnaire was devised and distributed to 261 consecutive patients in the radiology department of a large university hospital. During a 10-day period, patients seen in several departmental sections (gastrointestinal, genitourinary, CT, sonography, mammography, chest, musculoskeletal) completed the questionnaire. Patients were asked if they wanted the radiologist to tell them if the results were normal; if the results were abnormal; if they would prefer to hear the results from their family doctor, internist, or other primary care provider; and if they felt entitled to an explanation of their test results. Results were tabulated and expressed as percentages.

RESULTS

Analysis of the 261 questionnaires disclosed that 92% of patients wanted the radiologist to tell them if the results are normal. An additional 7% answered "Yes, but only if I ask." If the results are abnormal (cancer, for example), 87% wanted the radiologist to tell them. An additional 7% answered "Yes, but only if I ask."

CONCLUSION

Our results show that most patients prefer to hear the results of imaging examinations from the radiologist at the time of the procedure rather than to hear them later from the referring physician, regardless of the findings.

Rectal diverticulosis: a case report and review of the literature

The occurrence of rectal diverticulosis is rare. We report the incidental finding of a large rectal diverticulum in a patient receiving an air-contrast barium enema. The presence of uncomplicated rectal diverticulosis is probably of little clinical significance. However, there can be associated complications such as inflammation and perforation, and potential confusion with rectal carcinoma.

Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiological evaluation of prosthetic fit in below-the-knee amputees

Fourteen artificial limbs in eight adult patients with below the knee amputations were evaluated for prosthetic fit by several radiological parameters. The best objective means of evaluation of prosthetic adequacy is piston action.

Rights, roles, and relationships in radiology

Traditionally, radiologists report their findings to the referring physician. When a patient who understands the reason for the diagnostic examination asks the radiologist to disclose the results, in most cases the radiologist should not decline but should answer truthfully.

Left ventricular aneurysm in short axis: a comparison of magnetic resonance, ultrasound and thallium-201 SPECT images

Short axis magnetic resonance images of a left ventricular aneurysm were compared to similar views obtained by echocardiography and by thallium-201 single photon emission computed tomography. Images of the dyskinetic left ventricular apex and the contractile left ventricular base were analyzed and compared. Unlike the previously reported orthogonal plane magnetic resonance images, short axis imaging provided representative and quantitative information in views comparable to those obtained by standard noninvasive imaging techniques. These data indicate that short axis magnetic resonance imaging is capable of identifying and sizing the aneurysmal and the residual segments of the left ventricle. The findings may be of prognostic value in patients with left ventricular aneurysm.

Role of indium-111 chloride imaging in osteoid osteoma

Indium-111 chloride imaging plays an important role in differentiating intracortical osteoid osteoma from chronic cortical abscess. The study also may be useful in the detection of intramedullary osteoid osteoma. Four patients who greatly benefited from indium-111 chloride imaging are presented.

Alumni perceptions of adequacy of training in diagnostic radiology

Former residents who completed an accredited university radiology residency between 1953 and 1983 were surveyed using a written questionnaire. Seventy-five percent responded with opinions concerning their satisfaction with the various aspects of their training, including whether the program had met the specific needs of their practice. Most were satisfied with their training. Many believed the program should offer formal training in nonclinical areas such as quality control, equipment selection, administration, economics, and contract negotiations. Nearly all (96%) believed they had been adequately prepared for the Board examination. The majority (75%) believed a postgraduate clinical year was important prior to entering a radiology residency. We believe the written survey is a useful means for gathering data regarding adequacy of residency training. With the current interest in residency program curricula, such data may be useful in the dynamic process of structuring residency programs.

Modified excretory urography in prehysterectomy patients

A retrospective (520 patients) and prospective study (100 patients) of prehysterectomy patients was done to determine the role of preoperative excretory urography. Potentially useful information was provided by the urogram in only a small number of patients (7.4%). It is arguable whether or not preoperative intravenous urography should be done in these patients. However, since most of these patients routinely undergo this study, we suggest that a curtailed urogram consisting of a KUB film, a postinjection 15-minute prone film, and a supine film of the contrast-filled urinary bladder is adequate for preoperative screening, thereby minimizing cost and radiation to the patient.

Lithopedion: stone baby

Two cases of lithopedion were encountered. In one case, computerized tomographic (CT) findings are illustrated. There are no classical clinical signs or symptoms that aid in the diagnosis of this rare condition. A calcified fetus and investing membranes are readily identified on a plain film of the abdomen, and these constitute an absolute sign of lithopedion. Excretory urography, barium enema examination, ultrasound, and CT represent other diagnostic modalities in the evaluation of this condition, but they are rarely indicated or valuable.

Traumatic diaphragmatic hernia into the pericardium: verification of diagnosis by computed tomography

Computed tomography (CT) is a useful modality in the evaluation of mediastinal abnormalities and in the assessment of mediastinal masses for fat content. A case of posttraumatic herniation of the omentum and large bowel into the pericardial sac is presented. The mediastinal configuration, depicted on a CT scan, is thought to be diagnostic of this extremely rare abnormality.

Intraluminal diverticulum of the esophagus

Two patients with intraluminal esophageal diverticulum are described and illustrated. Both had chronic esophagitis. One had a distal esophageal stricture, while the other showed persistent retrograde gastroesophageal reflux following hiatal hernia repair. Possible causes are considered, based on the presumption of intermittently or chronically increased intraluminal pressure associated with an area of congenital or acquired weakness of the esophageal wall.

Autonomous hyperparathyroidism in patients on maintenance home dialysis

Ninety-nine patients with end-stage renal failure treated by maintenance home dialysis whose calcium and phosphorus balance was carefully controlled were studied for radiographic evidence of hyperparathyroidism. A total of 43 showed evidence of hyperparathyroidism despite excellent medical management. In 23 the abnormality was stable and the patients were asymptomatic with regard to the skeleton. The other 20 showed progressive bone disease. Sixteen of these patients were operated upon, and 14 were relieved of their symptoms by parathyroidectomy. Following operation, the radiographic evidence of bone disease halted dramatically, and a decided return toward normal was documented on subsequent films. Thus parathyroidectomy can control the skeletal deterioration and bone pain of hyperparathyroidism in patients who develop this complication. Serial radiographic studies are a reliable indicator of this circumstance.