Radiographic Analysis Critique - Report Example

Radiographic Report Critique By student’s name Course code+ name Professor’s name University name City, state Date of submission Radiographic Report Critique Introduction A radiological report is an expert opinion given by a radiologist after assessing and weighing the evidence contained in radiographic images (Brady et al. 2011, 3). The purpose of Radiological reports is to provide an expert interpretation of the images presented and relate the findings to the clinical symptoms and signs of the patient. The process provides a diagnosis of the medical condition of the patient in question. Such reports are crucial for further management of the patient’s condition. The aspect of patient management that is linked to the radiological report makes the accuracy of image interpretation crucial (Board of the Faculty of Clinical Radiology 2006, 6). The importance attached to radiological reports means that the personnel preparing them have to be trained. Radiologists are responsible for the provision of radiological reports to ensure accuracy and reliability. In areas where radiological services are provided by non-qualified personnel, it is recommended that such people should work in teams where there is a trained radiologist for advice. The purpose of such a strategy is to ensure that the chances of discrepancies and errors in radiology are reduced. This paper provides a critical analysis of reports for 3 cases referred for appendicular radiography. The paper focuses on the quality of the reports, the status of the reporter and the influence such factors have on patient management. Case Study One Case one involves a patient with difficulty in walking where an x-ray on her right knee was performed and presented to a radiologist. The information relating to the nature of the study is well provided at the beginning of the report. The report also includes the background information of the patient. The report states that she had fallen and as a result had difficulty in walking. It is evident from the images that the patient suffered a fracture on the inferior pole of the patella. The images are of high quality allowing the radiologist to assess the state of the knee. However, the report does not meet the basic requirements that are required in a radiological report. Though there is no universally accepted rule on the structure of a radiological report, it is recommended that such a report should be well ordered. The purpose is to ensure that the report is easy for the referrers who rely on the information provided in the report. According to the European Society of Radiology (2011, p94), a radiological report should have at least five sections namely the clinical referral, technique, findings, conclusion and advice sections. However, in situations where the referrer is a qualified physician the technique and advice stages may be omitted since they do not form the main part of the report. This is because in such a situation, the physician is mainly interested in the findings and the conclusion of the radiologist. The clinical referral section consists of a brief summary of the reason for the referral. It provides the clinical history of the patient as provided by the referring physician which is aimed at helping in the interpretation of the image. This means that the section should contain all the relevant clinical information about the patient. In the report for case study one, the clinical referral section is provided as the first part of the report. It explains the reason for the referral. This enables the referrer to ensure that the radiologist based his/her findings on the instructions from the referrer. It shows consistency in the findings of the radiologist and the instructions given by the referrer (European Society of Radiology 2011, 94). The technique section should have a description of the procedure performed and should include information on the standard of the elements of the investigation process such as the standard of the imaging (American College of Radiology 2014, 3). The radiological report in this case has omitted this section. It does not mention the quality of the images and whether or not such quality affected interpretation. The radiographer is usually the first person to view the diagnostic images focusing on the patient. Radiographers have the opportunity to communicate their observations to the medical practitioner who has made the referral such as clinicians and general practitioners. This means that they have an influence on patient care. The reports made are used to determine the course of treatment for the patient. The lack of critical information such as the techniques used by the radiographer may adversely affect the treatment plan for the patient. Such information is, therefore, important for subsequent patient management. The findings section provides a comprehensive description of the abnormalities observed by the radiographer. The information is displayed in a way that addresses the features that are related to the clinical request. The purpose of this section is to provide the radiographer’s expert opinion on the results of their assessment regarding the questions raised by the referring clinician (European Society of Radiology 2011, 94). In the case study, this section is provided. The report states that the difficulty in walking is as a result of an undisplaced fracture. The discussion that follows is a further description of the abnormality observed. The conclusion section is also well provided in the report. The section comprises of the interpretation of the investigation. The section takes into account the features of the images, relevant clinical information and laboratory findings, if any, to come up with the radiologist’s impression. It is the part of the report that makes a specific diagnosis. Finally, the advice section gives suggestions for further action. Such section may include a referral to a specialist or further investigations to improve on the diagnosis. The section is missing from the report since, as stated by the radiologist, the patient left before the results could be explained to her. The report, therefore, has omitted the advice section. There is no indication as to the recommended action that should be taken based on the expertise and observation by the radiologist. Since the patient’s condition is acute, the radiologist ought to have recommended immediate close observation of the patient, through admission, to ensure that the condition does not progress (European Society of Radiology 2011, 95). Though the fracture was acute, the fact that the patient left before the results were out means that there is probability of further harm if the fracture is not treated. The fact that the patient did not get to be attended in casualty means that the fracture may become chronic at which point at which point the treatment and recovery process would take long. Case Study Two The neck of the second metacarpal of the patient is fractured resulting in a slight volar angulation of the fragment. Metacarpal shaft fractures have the effect of angulating the apex dorsal such that the head becomes displaced as a result of the deforming pull of the muscles. Due to the limited mobility of the second metacarpals, only a small degree of angulation is acceptable. Where the degree of angulation is high, a treatment plan is implemented to improve the functioning of the hand. Though the report states that the angulation is slight, there is no further information as to the steps that should be taken based on the radiologist’s opinion as to the seriousness of the condition. There is also no mention of the duration of the fracture which is an important aspect in the choice of the patient management plan to be used. Based on the image, the fracture is probably a recent one. The clinical data gives an indication of trauma. However, there is no mention of clinical findings related to trauma such as pain and swelling. In diagnostic imaging, effective communication is an important element. The personnel making the report should endeavor to communicate in a way that promotes optimal patient care and minimize the risk of errors in the communication as a way to show support to the physician providing care (The American College of Radiology 2014, 2). Though the report mentions the fracture affecting the head and neck of the second metacarpal bone, it does not mention further details of the fracture which is the clinical question. The report ought to have mentioned the type of fracture, that is, whether it is a displaced, non-displaced, open or closed fracture to help in the selection of a treatment plan. The reporter also failed to mention other abnormalities that are evident from the image. Another fracture is visible involving the mid-shaft of the proximal phalanx of the index finger. Such information should have been provided even though it seems like an old fracture. There was need to make reference to old images of the fracture of the index finger to determine whether or not they are connected. It is also important because such information would help the referrer to treat both structures. The failure to use the images and to include information on the other fracture may lead to a malpractice suit. Radiological investigations and reports are different from other clinical procedures such as the examination of patients or the findings made during surgery. Radiological examination is subject to future scrutiny hence, it must be well recorded. Further, such reports can be used for studies to help in the formulation of guidelines for the report making process. The responsibility of the radiologist is to ensure that the information provided is helpful to any person who refers to report for the treatment of the patient or for any purposes. All information that is relevant to the case at hand should be included in the report. The objective is to ensure that findings and the opinion of the radiologist are well communicated to the referrer (Brady et al. 2011, 3) The essential steps in the production of a radiological report ensure that the clinical opinion presented in the report is relevant to the case at hand and, therefore, useful in patient management. One of these essential steps is the requirement that all the personnel involved in the process of the preparation of the report have technical knowledge. The production of the images to be used in making the report must be done by qualified personnel to ensure that only images of diagnostic quality are produced. The person making the report must be capable of evaluating the quality of the images and their relevance to the diagnosis of the suspected condition (Board of the Faculty of Clinical Radiology 2006, 7). The reporter must have sufficient technical knowledge to know the effect of the report on the choice of patient management plan. Radiologists are the trained personnel to assess imaging reports and provide radiological reports for use by clinicians and other personnel involved in patient care. According to Bosmans et al. (2011, p187), radiologists and other personnel with similar training, such as radiographers, provide higher-quality radiological reports compared to non-radiologists. Such personnel have the required training and experience compared to non-radiologists who may not be trained in image interpretation (Bosmans et al. 2011, p187). The increasing complexity of radiologic examinations arising from an increase in the number of images and the need to conduct analysis for three-dimensional data sets means that non-radiologists, other than radiographers, should not make radiological reports. The training and experience by radiologists and radiographers make them accustomed to interpreting complex imaging and, therefore, suitable for making the imaging reports (Woznitza 2014, 66). The fact that the report was made by a radiographer makes it credible since today they are also trained in image interpretation. The report for this case study, though prepared by trained personnel, does not contain all the parts that are necessary for a report. The advice and technique sections have been excluded from the report. Other details that are evident in the image relating to the condition of the patient have also not been mentioned. The written radiological report is important because it forms part of the permanent health record of the patient and makes an interpretation of the investigation in the clinical context. The implication for this is that the clinicians and other medical practitioners will refer to the report when assessing the medical condition of the patient hence, the need to include all relevant information. Case Study Three The report has sufficiently met the requirement regarding the parts that should be contained in radiological report. The clinical referral, findings, conclusion and advice sections are present in the report. However, the technique section is not provided. The reference to osteoarthritis made in the clinical referral section of the report forms the base for the examination conducted by the radiologist. Though the clinical question is the foundation on which the report is made, the radiologist or radiographer may also make findings on other observations from the images. A diagnosis of osteoarthritis must be preceded by three other conditions namely joint space narrowing, osteophytosis and sclerosis which diminishes due to osteoporosis (Swagery & Hellinger 2001, 1). The report confirms the existence of joint space narrowing leading to the conclusion that there may be some degree of osteoarthritis. However, due to the absence of the rest of the conditions the radiologist makes a further assessment to avoid a misdiagnosis. The abnormal shape of the bones of the hip makes them rub against each other because they do not fit together causing damage to the hip joint. This explains the pain in the left groin and scrotum especially while walking (Swagery & Hellinger 2001, 1). In the report, the radiologist has not mentioned anything concerning the sclerotic areas that are evident in the image. The presence of sclerotic areas can be evidence suggesting that the patient is suffering from osteopoikilosis (Primio 2011, 456). The failure to mention such an important aspect means that the radiologist and the referrer do not consider the possibility that the patient may be suffering from osteopoikilosis. Such errors could be attributed to the failure of the referrer to avail the patient’s previous history to the radiologist. It is important to review past radiological reports to identify recurring conditions in the patient and also to understand the condition of the patient in the course of making the report. The failure to refer to the old reports creates room for radiological error which leads to malpractice suits (Berlin 2008, 48). Since previous reports enable the radiologist to identify and avoid any errors made by the previous radiologist, historical reports should be looked at before reporting (Berlin 2008, 48). Though a report may be amended based on information obtained in historical report, such a move raises concern because of the possibility that the referrer may have formulated and begun a treatment plan with the patient based on wrong or incomplete information. The reference to the previous imaging by the radiologist revealed the presence of a geode but fails to mention the sclerotic areas. This can partly be attributed to the failure by the referrer to submit previous history to guide the radiologist in making proper findings. The lack of previous history also led to the failure to include details of the metastasis as evidence of previous cancers (Suva et al. 2011, 208). The failure to provide the previous history of the patient contributed to the omissions made by the radiologist. Such omissions pose a threat to the health and wellbeing of the patient since it affects the treatment plan. The medical opinion given by the radiologist in the report regarding the patient’s condition requires great attention and expertise to ensure that chances of discrepancies on the report are eliminated. The radiologist has to ensure that the opinion made does not amount to a misdiagnosis which may lead to treatment for the wrong condition. In such a complex case, the radiologist needs to make reference to all the available medical information regarding the patient. The report states that the previous medical history of the patient was not availed to the radiologist on request. The failure to provide such information could lead to a discrepancy such as a misdiagnosis that could affect the choice of the treatment plan. The fractures that commonly affect different areas of the pelvis such as the pubic ramus and the sacrum are regarded to as insufficiency fractures. These fractures are in most cases dismissed as isolated fractures that can easily be stabilized and treated. However, these fractures can at times cause injury to the posterior arch of the pelvic ring. Such an injury is a serious risk to the health of the patient. According to Storey and Thomas (2009, p7), pelvic fractures are as dangerous as hip fractures and have similar statistics regarding the reduced quality of life and fracture-related deaths on the patients affected. Due to the serious nature of such fractures, patients with isolated pubic ramus fractures, as evident in the patient in case study three, should be examined for posterior pelvic arch tenderness. However, since the injury in this case is old, there is no need for further imaging or examination (Storey and Thomas 2009, 7). Conclusion Radiological reports should be well structured to ensure that the personnel making reference to them can rely on the reports to effectively come up with a patient management plan. The clinical referral, techniques, findings, conclusion and advice sections should be incorporated in radiological reports to help the clinicians in interpreting the information in the reports. It is also necessary to ensure that only qualified personnel are allowed to participate in the production of radiological images and the making of radiological reports for the sake of the patient’s health and well-being. References Beardmore, C 2013, Preliminary clinical evaluation and clinical reporting by radiographers: Policy and practice guidelines, The Society of Radiographers. Berlin L 2008, Comparing new radiographs with those obtained previously, Radiology Today, Vol. 9, No. 23, p48. Board of the Faculty of Clinical Radiology 2006, Standards for the reporting and interpretation of imaging investigations, Royal College of Radiologists, London. 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