A recent study published in the European Journal of Radiology sought to see if there was any truth to the notion that orthopedic surgeons do not consult radiology reports before explaining a diagnosis to a patient. To add our own insight to the study, we posed questions to Dr. Lance Silverman, an orthopedic surgeon, and Dr. Hollis Fritts, a board-certified musculoskeletal radiologist, to see how their experiences compare to the findings of the study. Below, we take a closer look at the study and then have a roundtable discussion about the findings and their personal experiences.
Do Orthopedic Surgeons Consult Radiology Reports?
Before we dive into the study, lets talk about standard operating practice. When an orthopedic specialist wants to use imaging techniques as part of a diagnosis, they’ll send the patient to radiology. There, a radiologist will conduct the imaging scans, examine the results and issue a report on their findings. Orthopedic surgeons then get this radiology report along with the images that were taken.
In some instances, the orthopedic surgeon just looks at the images and comes to their own conclusion. In other instances, they rely heavily on the report. They study sought to determine how often these radiology reports were consulted or ignored by the orthopedic specialists when making a diagnosis.
You can view the full study here, but here’s a look at some of the highlights.
- 20 percent of orthopedic surgeons said they never consult a radiograph (x-ray) report.
- 4 percent say they never consult a CT report.
- All orthopedic surgeons said they always consulted a prepared MRI report.
- 51 percent of orthopedic surgeons would consult the radiologist if they disagreed with their report.
- The most common complaint from orthopedic surgeons was the slow creation of radiology reports (24 percent).
Roundtable Discussion
Here’s what Dr. Silverman and Dr. Fritts had to say about the study and their personal experience creating and reading radiology reports.
1a. What is the most common reason you consult with a radiologist about their read?
Dr. Silverman – “Radiologists know so much more about the mechanics of radiation in CT and magnetic effects in MRI. If I have a question about something they saw that I did not, I reach out to learn more about how they made that interpretation. Sometimes, I call to highlight a problem I saw clinically that was not highlighted in the report. It helps bring attention to areas that might have been overlooked in light of other more obvious findings but are clinically relevant. “
1b. What’s the most common reason that an orthopedist asks to consult with you about your read?
Dr. Fritts – Clarification and disagreement. It’s not uncommon to get a call asking for clarification of location or terminology of descriptive findings. Second, there are times when there may be some disagreement of the findings or their significance, and it is great to be able to discuss and come to consensus agreement. That said, perhaps as common or even more so, is a call from an orthopedist to relay additional clinical information which might influence interpretation.
2. Are their substantial patient benefits to having the orthopedic specialist and the radiologist consult about their interpretation of the imaging results?
Dr. Silverman – “One brain plus one brain is much great than two brains. When we work together, we can help patients so much more. It is for that reason that in training we have routine multidisciplinary imaging conferences where doctors and residents get together to learn from each other during presentation. When I text a radiologist and we review, both of us leave the conversation smarter and more experienced and the patient gets even more benefit. In medical-legal concerns, making sure all objective findings are remarked upon keeps everything clear. Less findings are exaggerated from importance and less important positives are dismissed as random variation.”
Dr. Fritts – “Yes, most definitely. The orthopedist knows the patient on a more personal level, including detailed history, and especially important, the clinical physical examination. MRI is a wonderful modality that allows global soft tissue and bony anatomy information and we are able to detail all of the finding in the area that is included on the imaging. However, not all abnormal findings are significant or pertinent to the patient’s clinical presentation and problem. Without the detailed information of the patient history and physical examination findings, we are are not always certain of clinical significance of those findings. A discussion with the orthopedist can be very helpful to determine relative significance of each of the abnormalities.”
3. The study says that a fair portion of orthopedists do not consult radiology reads. Do you ever interpret the imaging results on your own without consulting the read?
Dr. Silverman – “I always do my own first and then read the report. I first treat it as a test of my knowledge. Then, I review the radiology report. If the two are not equal, I look for the differences and reach out if I have other questions.”
4a. What are some of the obstacles you’ve encountered to getting a read from a radiologist?
Dr. Silverman – “Radiologists in Minnesota, especially the musculoskeletal radiologists, are really quite good. They cluster their diagnoses in a summary paragraph most of the time and refer to the body of the dictation for specific details. If I do not recognize the radiologist, I will more commonly reach out and establish a relationship to improve this communication.”
4b. What are some of the obstacles you face in getting an accurate radiology report to an orthopaedist?
Dr. Fritts – “Not having much in the way of clinical information or the clinical indication for what the imaging is performed is probably the biggest obstacle to being able to relay not only the anatomical/pathological findings, but also the relative clinical significance. Some imaging findings may be very prominent, yet may not be particularly significant to the patient’s clinical presentation. On the other hand, sometimes findings are relatively minimal, perhaps even to the point of being either overlooked or not appreciated with respect to significance. The more clinical information we have, the more clinically relevant we can make the interpretation of findings.”
5a. What do you do when you disagree with a radiologist about their read?
“I call them up and tell them I disagree and why; I do so in a polite, respectful and academic way. I am known for bluntness and it is always appreciated. Beating around the bush wastes time and doesn’t help the patients.”
5b. What happens when an orthopedist contacts you about a disagreement with your read?
“That is a welcome opportunity to be able to have a discussion, which can be very helpful, as the orthopedist can relay any additional clinical information and specific clinical concerns. Then we can come to a consensus agreement of findings and their significance. If needed, an addendum to the imaging report can be created.”
6. An orthopedic specialist has the benefit of clinical history and an in-person patient exam when reading imaging results, but radiologists have a deeper understanding of reading and interpreting imaging results. With that in mind, who should have the final say when it comes to providing a patient with a diagnosis, or is a collaborative approach always best?
Dr. Silverman – “My review is my review, their review is theirs. In a collaborative team approach, when I communicate to the patient, I provide both. When we disagree (and I almost never disagree with Dr. Fritts,) it is usually of minor significance. In those rare circumstances, I will order a secondary study, using a different modality to help highlight the problem that is too subtle to be seen on the test. For example, if the hindfoot ligaments do not show abnormalities on MRI, I will perform a stress ultrasound to document the problem vs the other side.
Dr. Fritts – “The orthopedist has the personal face to face personal connection with the patient, and best able to combine the clinical information, physical examination findings, and then with the additional input of an accurate anatomical/pathological read of a musculoskeletal radiologist, can best relay the information to the patient regarding the diagnosis as well as discussion of conservative versus surgical management, and rehabilitation.”
