For years, radiograph interpretation has been taught the same way. Read the films in to out. Be·consistent. Find the abnormalities. Write down the list. There, you have your radiology report.
But·honestly what do you have? A list. And what good is a list? A list needs to be in the context of something·else to become useful. For example, go to your fridge and create a list of what is needed. Now you have·a list, a list that is useful when you go to the grocery store. Without the grocery store that list is useless.·Give that list to someone else and who knows what you’ll get back. Maybe they will go to the·wrong store and/or buy the wrong brand. Therefore, a list is only useful if you know what to do with that information.
How do we turn a useless list into something useful?
Well, we need to put it in the context of the·case. But even then the list becomes watered down by insignificant findings such as spondylosis in a·vomiting animal or shoulder arthritis in a dog with heart failure. So maybe the list approach isn’t the·best way to do it.
What alternatives exist? If you’re willing to try some new approaches to radiology, give these a whirl.
The Crime Scene Investigator (CSI) Approach
Identify your victim — patient·signalment. Factor their breed and age into your decision process from this point forward. Next, identify·your crime(s) — the clinical signs. Based on the signalment and clinical signs, create a·short list of the usual suspects or diseases that fit your victim profile and crime (I typically have three·in mind prior to evaluating radiographs). From your usual suspects list, jot down a few radiographic·findings you would expect to find. Now go investigate your radiographs for the proof that one of your·usual suspects is guilty. But be careful. Don’t try to condemn an innocent suspect just because you want·it to be so. If the crime doesn’t fit the proof, you need to reexamine your usual suspects. Lastly, if you·feel you have a strong case, take your argument to a jury of your peers and see if they would convict·with the evidence before them. If you decide to try this approach, let me know how it goes. If this one·doesn’t connect with you, then maybe the Normal/ Abnormal approach may work better.
The Normal/Abnormal Approach is a variant of the original in to out radiograph review, with a slight case-based approach. Next time you evaluate radiographs, look at each organ and decide if it’s normal or·abnormal. If its abnormal write down the organ and why you consider it abnormal. Once you have your·list make a second column listing the clinical signs. Now go through each of your radiographic findings·and try to create an association between what you found and diseases that would both fit your finding·and the clinical signs. For instance, let’s say a vomiting cat has a big liver. How could you relate the two?·How about acute hepatitis? Hepatic lymphoma? Or even hepatic lipidosis? This approach may get you·headed down the path to a diagnosis and hopefully will allow you to trivialize less important findings·such as thoracic spondylosis in a vomiting dog.
Whichever radiograph interpretation method you choose, always make sure to relate your findings back·to the question at hand.
Why is this animal sick? Radiographs — and for that matter, all imaging — are no·different than any other diagnostic such as bloodwork, CBC, or urinalysis. Above all else, keep the patient·in mind and don’t look at imaging in a vacuum.
From time to time, I will pontificate on imaging interpretation.·Let me know your thoughts. And for·those true imaging-philes out there, be sure to connect with your local radiologist or cardiologist, veterinary·continuing education program, or check out the Education and Online CE portions of our Web site·for upcoming online programs or radiology·sabbaticals being offered.