Dr. Conway is a Diagnostic Radiologist and Principal of
Delphi Radiology Associates, Lake Forest, IL. The firm specializes in
diagnostic imaging consulting.
It’s the year 2023. A
patient-customer steps up to the counter of the IV Contrast Bistro,
shouting out the following order: “I’ll have one single-shot IV contrast
low-dose CT with coronal reconstruction images, please.”
The future? Possibly.
are taking an increasingly active role in making their own health care
choices. Whether they conduct their research via the internet or by
flipping through shiny pages of women’s magazines, patients want more
say. They also want their imaging faster, cheaper, and safer—and all of
it right now.
Gone are the days of the heavy film jackets, teeming
with unnecessary CT exams, which we as residents could barely lift from
the old wooden countertops of the reading rooms. Patients and
radiologists alike now need to take ownership of the radiation doses
administered with each CT exam.
During my first CT abdomen case
review, my attending radiologist showed me an oval paraaortic structure,
and tried to convince me that it represented an abnormally enlarged
lymph node—only to present me with a contrast-enhanced image of the same
structure, confirming a beautifully opacified normal inferior vena
“Our job as radiologists is to detect disease, not to give a
faulty diagnosis (in this case lymphoma) to an otherwise healthy
patient,” my attending said. If we had misdiagnosed the condition as
lymphoma, we could have exposed the patient to unnecessary treatments
and more unnecessary radiation via follow-up CT exams. We could have
potentially created that lymphoma.
The take-away message is: Take ownership of your role as a diagnostic radiologist.
seem to have lost that function somewhere along the way, as our
practices have become busier, and we have become more akin to
assembly-line workers under the gun to boost productivity.
we are the imaging experts and, whenever possible, we should advise our
physician colleagues how to order “smarter” and, consequently, how to
save our patients from excessive radiation dose. Now that ionizing
radiation has officially been deemed a carcinogen, we have that
obligation now more than ever. Remember to consider ultrasound as a
viable option and to perform CT examinations judiciously.
Here are some situations where we should assert our role as the imaging experts:
An over-imaged simple renal cyst?
you are faced with a request for a follow-up CT for a simple renal
cyst, which has already been proven as such on a prior renal CT exam,
suggest that the referring doctor have the patient follow up with a
surveillance ultrasound. We should be advising our primary care
colleagues when needed to save our patients from excessive radiation
dose. Although the effects of radiation are felt to be stochastic, it is
agreed that avoiding unnecessary radiation dose is a prudent course of
Unnecessary repeat CT exams?
Give a call out
to the referring doctor to inform him or her that the patient has
already had the test a few days ago, and clarify the need to repeat the
exam, if any.
Now, back to the future: The barista replies: “Shall
I make that one a single-shot IV contrast low-dose CT—or shall we
direct you to the Ultrasound Bistro?”