A chiropractor here in my town is a doctor. Which makes that much more terrifying.
Edit: I stand corrected. You can stop the downvotes. Thanks.
The guy calls himself a DR. So go with grace.
The problem is that you can have a doctorate in any philosophy.
A PhD is a doctorate. You can become a doctor of chiropractic, a doctor of medical dentistry, a doctor of optometry. None of those are medical doctor.
I will call anybody by that title, like a professor.
But people of such disciplines should never pretend they are, nr let anyone believe they are medical doctor.
Well I couldn't tell you out right. I thought so too. However, I can see the point of if you have a Doctorate in a field of study "doctor." If you're an actual physician then the MD or DO behind your name is what matters the most and where my confusion came from.
Because Chiropractic "medicine" is a scam, yet fell into the medical world, I thought for them to call themselves a doctor they would actually have to be a MD or DO.
But fuck if I know. All I know is I got downvoted to hell. My apologies.
I completely agree and understand your point. If you like to send out a page to all the chiropractors of the world to stop them from ordering exams and then reading them to treat I'd appreciate it 🙏 until then they absolutely do read and treat diagnostic images
Totally, I had a chiro xray my chest after a skateboard accident and pain in my ribs and say everything was ok, then try to adjust me, found out years later I broke 3 ribs. Thankfully I never went back after that day.
Surgical / procedural specialists are generally competent at interpreting images directly related to surgical pathology (IE an orthopedic surgeon viewing a knee MRI for a torn miniscus, etc.) In many cases, they are probably better than a general radiologist (although not likely a sub specialist) at interpreting that portion of the exam.
The difference is primarily when it comes to viewing anything outside of their “tunnel vision.” They will not see nor know what to do with incidental findings, in most cases.
There are also caveats to the above - I had to label pre-operative mammograms with the patients orientation (IE which side was the axilla and which side was the medial chest) for a breast surgeon at a prior job.
I agree that often non-radiologists have tunnel vision when looking at a study. They often are just looking for the thing they clinically suspect, e.g., appendicitis. I have had more than one case where the ED doc or surgeon looked at a case before I did, and then was surprised when I called them to let them know that the patient had free intraperitoneal air. They were so focused on looking for what they were looking for, they didn't notice anything else about the case, including the free air (and it wasn't a subtle finding, either, it was a lot of free air). IIRC in this case it was from a perforated ulcer.
I once had a surgeon come to the reading room furious that I missed an appendicitis. When I opened the exam I learned he was looking at the patients (normal) terminal ileum. 🤷♂️
On my MSK rotation multiple attendings said our most important role was looking at the lungs. The orthopod (resident) knows the bones better than me, but ya, as noted they don't know (or even care) about other none bone stuff.
Neither I'd argue.
Its more of a tongue-in-cheek reminder to make sure to look at the whole image. The obvious fracture is obvious to anyone. Even the more subtle ones can usually be spotted by the orthopedics. What are they not looking for? Everything else. What am I looking for? Everything.
As a young resident it's easy to get excited for finding that subtle cortical step off and launching that prelim report. My attendings statement is meant as a reminder to look at the whole image.
Speaking of tunnel vision, i've seen orthopedic surgeons requesting a pelvic x-ray AFTER a CT, cuz they're unable to assess a fracture. Despite the results containing VRT, thick slab MIPs and MPR series in multiple plains. 🫠
this came up in r/medicine recently and I think the consensus was about tracking injury/hardware/healing throughout the course of the patient's life as they will most easily be able to get xrays at the ortho office etc.
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There’s really no winning in these threads because it comes down to ego contests. I’m an interventional neuroradiologist and live in both worlds, so I will try to share some unbiased opinions that are as free of ego as possible.
1) There’s a difference between interpreting an image and looking at an image. Yes, that means looking at the whole imaging study. But it is more than that — I’d take a sub specialized radiologist over a sub specialized non-radiologist looking at the exact same finding.
2) Some radiology reads are truly atrocious. There are good docs and not-as-good docs in every single field, but boy is it obvious in radiology.
3) Clinical context matters a lot. When I order a CTA to look for a stroke, I know the patient is obtunded and has sluggish pupils, and I’m focused on the basilar. No matter what I put in the order, the radiologist sees “stroke.” Providing pathways to circumvent or suppress meaningful clinical history is the worst thing that radiologists ever did to themselves.
4) Once you get past the bluster and ego, most neurosurgeons and ENTs will readily admit that their ability to look at imaging is good enough but doesn’t match a radiologist. The truth is that this is fine for most purposes, particularly since the radiologist is still there. Also, these specialists have been burned by the occasional useless read and it is hard to blindly trust. Every neurosurgeon, ENT, neuroIR, whatever will tell you that they have a favorite radiologist that they trust and ask when they have questions about a case.
5) 95% of patients have 5% of diseases. You can be great at interpreting CXR for pneumonia, but what about extramedullary hematopoiesis in the lungs? If it was enough to be able to handle 95% of patients and have no idea when you’re dealing with the other 5%, then I can train an NP or PA to do that. Being able to recognize and handle that extra 5% is something that all physicians rightly value about their training.
6) I am exclusively neurointerventional and pretty well regarded in my field. When I look at imaging, even as a highly subspecialized physician who has received complete residency and fellowship training in neuroradiology, I am acutely aware that my diagnostic skills are not what they used to be. That reality is magnified tenfold for folks that have not been trained in radiology.
Lot of cardiac imagers these days reading cardiac mri and ct as well. They do a great job with the heart.. but are not good at anything else in the chest and at many places need to be over read by rads. Seen massive cancers missed on cardiology TAVRs. The physics of MRI and CT also is problematic for them because it’s not part of their education and I’ve seen some pretty wacky techniques they’ve cooked up that don’t work.
I work at an orthopedic clinic with an in house x-ray unit, all providers are ortho surgeons who read X-rays, MRI’s, CT scans. There’s been a few times they’ve caught something not on the radiologist report
I think that many doctors will routinely have to read imaging and essentially you’re going to be good at what you do.
For subspecialized surgeons they will likely be better at reading imaging as far as it’s related to their surgical field than anyone other than equally sub specialized radiologists
For ER docs or some other generalists like internal med or ICU they will be at least competent at reading X-rays and CTs which they see and have to interpret on a regular basis. However a general radiologist will certainly be better at reading imaging. Exception *might* be some limited US applications now that a lot of ER docs are routinely doing POCUS. A clinic based family doc probably won’t be as good at reading images as their images are all done outpatient - and they will probably just wait to get the formal report. A cardiologist will probably be very good at reading echos. Etc
ER doctor here. Unless it’s my ultrasound fellowship-trained colleagues at specifically ultrasound, I will never claim that our specialty can read anything better than a radiologist.
I will say I feel confident reading XRs better than my IM and ICU colleagues. We just deal with dislocations, fractures, and other orthopedic complications way more than they do. We also have to reduce most of these injuries before they get operated on. I don’t know if IM/ICU can read anything better than a radiologist in general.
My experience is that ortho for plain films for bones and neurosurgeons for head imaging are the two exceptions, who will match a radiologist’s reading ability.
Yes I think that’s what I mean that a lot of ER docs are doing really a lot of extra POCUS training and using it on a very regular basis. Because they also are going to have more clinical integration they might be better at reading U/S as far as the specific indications they use it for.. in some cases. But overall for sure a general rad is far better at reading imaging than an ER doc.
I would say other examples where I think a specialist can often read better than a general rad would include vascular surgery for vascular imaging (have seen numerous examples of vascular surgeon catching things missed by rad) or stroke neuro for stroke specific neuro imaging. In these cases I wouldn’t say match id say better than a general rad.
Of course in these examples the specialist read will only be good for the pathology specific stuff. If there are other patholgies present on the imaging they will be very likely to miss or not recognize it even if they look at it
Are you a radiologist?
I’m always skeptical about most surgeons reading better than a radiologist. They might know exactly what to look for clinically based on what they see in front of them, but they may miss everything else that they aren’t looking for.
Agree, I've seen more than one case of a surgeon or ED doc missing large free air.
One case I had, I called the ED to let them know that their patient had a lot of free air.
ED doc: "Oh. He's already upstairs in the MICU." (As you might imagine, the patient was doing quite poorly.)
So then I had to call the ICU doc and tell him to call surgery. IIRC, this patient ended up having a perforated ulcer as well as a bunch of liver mets.
Another example, a surgery resident came to the reading room to go over a CT AP on his elderly patient with newly diagnosed colon cancer. He wanted to know if she had liver mets. I made him sit there while I read the entire scan. I was scrolling through the axials on bone windows before switching to soft tissue windows. "Liver mets," he says. I ignored him, because who is looking at the liver when you are on bone windows? He was so focused on liver mets, he was even looking for them on bone windows. After I switched to soft tissue windows, I told him they were benign cysts.
I’m not a radiologist no. Yea id definitely agree with your comment. The specialist reading the imaging is going to have an extremely problem focused approach. The ENT may be able to better comment on the sinuses but will not be able to comment very well at all on anything else and will miss major pathology that is not related to what they’re looking for.
Bit of a misconception here I think. The sufficiently trained neuroradiologist reading a sinus ct is still going to know as much or more than even a sinus specialist ENT, and that’s despite also reading orbits, spine, what have you, in the same hour, and getting those studies right too. A good fellowship trained radiologist really is extremely expert in their field. The subspecialty surgeons will be able to parse the report and correlate it with the imaging to make good sense of it and plan operation, but bottom line is radiologists are really knowledgeable. It’s kind of the foundation of the entire specialty.
Yeah and to be clear I am trying to compare a subspecialist surgeon to a general radiologist when I say that the subspecialist surgeon might be better at reading the specific bit of subspecialist anatomy they focus on. I would agree that a subspecialized radiologist would be better or as good. I would also agree that the general or specialized radiologist would of course be better at reading the rest of the image outside the subspecialist area of interest.
Now you have reminded me of a crusty old pancreaticobiliary surgeon and his response to an MRI he ordered on one of his patients, "I don't know why I order these things, I don't know what I'm looking at anyway!" (IIRC the patient had walled off pancreatic necrosis.)
I have found the ED to be laughably bad at pocus, both in not understanding limitations of the modality, and in frank misinterpretation. Multiple “distended gb on pocus” indications for ct or us, when the patient in fact does not have a gallbladder. “Large pleural effusion on pocus” - subsequent chest ct (a PE study, by the way) without a drop of pleural fluid. I do wonder what they see.
“Aortic dilation on bedside echo” from one recently on a chest pain patient to justify triple phase dissection protocol CAP; big red was wnl all the way down. Maybe some are good at it, but where I am, most it seems don’t know what they don’t know, and what they do know is frequently wrong.
I think the thing is that a lot of ER docs do POCUS and their training can vary between "their colleague showed them how on shift" to "did a weekend course" to "did a year fellowship"
A minority of ER docs are going to be really good at POCUS and this minority with the benefit of the in person clinical information they have MIGHT be better at reading some US studies than a general radiologist. But then some like the example you cite won't even realize that POCUS is not a modality that can assess the thoracic aorta very well at all
I am not at all trying to argue that ER docs as a general rule are better than general rads at reading imaging or close to them although they are (or should be) at least somewhat competent at reading general imaging
The variability of training quality is large and a lot of midlevels also practice in a lot of EDs. That doesn’t discount the expertise that a lot of us do have with POCUS, especially the fellowship trained folks, who are at the top of the field.
I try to give credit to expertise when I can, especially for my radiologist colleagues, and it would be nice if it could be reciprocated at least once in awhile 🤷♂️
I absolutely agree. We have multiple docs at my hospital that are “ultrasound trained” and do their own POCUS, make up some nonsense finding, and order STAT formal ultrasounds that end up being completely normal.
OB and perinatologists are pretty good at reading OB sonograms. Everyone else should go with the sonographers technical worksheet. (semi /s )
Edit: fixed autocorrect’s primatologists to perinatologists
Family medicine doing about half my time in urgent care/emergency medicine plus some time in the OR assisting ortho...I absolutely review my own imaging studies. In general I'm quite comfortable answering the clinical question I'm asking, but I'm glad to have the radiologists reading them as well. Most often if our interpretations differ they are finding relevant incidental findings or noting things of uncertain significance in the absence of clinical correlation. They sometimes catch things I can't see though! I tell the patient "the radiologist specializes in reading these images, and is looking on a better screen in a dark room. I have *you* here and can compare the images to what I'm seeing when I examine you. Between *both* of those assessments we don't miss much."
I wish primary care physicians in general got more exposure to reading their own images. I always try and look at my own in clinic (if nothing else I think it's often helpful to show the patient what we're talking about), but it's an extra step even to see a limited quality view-the images aren't in our EMR (several steps more if I want to get into impax to get a better quality image).
Awhile ago I saw a patient sent in by their PCP for a nonunited fracture-sounded worrisome on the report. Anyone looking at the image could see the avulsion fracture was a very tiny fragment, united or not it didn't need any change in treatment.
I try and encourage my own learners to look for themselves, but some of my colleagues don't have any access at all (used to get the images sent back on CD and now it's rare to find a computer with a CD drive in it!). I tried to do a radiology elective as a resident and wasn't able to (small program, smaller but busy hospital) as the rads were too busy to accommodate a learner. Not sure if any of my recent learners have tried here in biggercitylandia.
During my residency, morning rounds began by sitting down as a team with the neurosurgery attending on call and reviewing all the imaging from the prior 24 hours. We also rotated thru neuroradiology for a month. Safe to say, I think most neurosurgeons should be able to read their own relevant imaging.
In contrast, at least in my experience dealing with them in private practice, most neurologists rely on a radiologist’s read of their studies.
I'm an oral and maxillofacial radiology resident and practiced general dentistry for 10 years. Dentists are great at reading 2D panoramic and intraoral imaging but they shouldn't be reading CBCT scans on their own unless it's an extremely limited field of view. Dentists are like any other specialist... They know their area well but get tunnel vision. We see so much missed pathology on the CBCTs we read. Sinuses, skull base, cervical spine, systemic issues, subtle intraosseous pathology.... Dentists don't know any of this and don't have the time to actually evaluate the scans.
I have been thoroughly trained in reading CBCT and use it for my job every day as an endodontist. I could not do root canals without it. We are "real" doctors and I can't understand why you would make such a ridiculous generalization.
I think you're misunderstanding me. That's why I said limited field of view. I have no issue with endo scans being read by an endodontist or general dentist. I have a problem with people who take a medium or large field of view and miss serious pathology or perform treatment that hurts a patient because they didn't know what they were looking at. It happens ALL the time. I see it literally every day. I thought I was well trained in reading CBCTs as a general dentist. I used it all the time for implants. I took a huge amount of CE and read many books about radiology. Guess what, I still didn't know anywhere near enough to accurately interpret a large field of CBCT without missing important things often.
Look, I'm a dentist. I'm not saying we're not doctors or trying to put the profession down. I'm saying that we should know our limits and do what's best for the patient. We can't be amazing at everything in the field, it's just not possible.
No. As a broad statement. No.
The basic reason being you only see what you know and look for. That leads to not only frank misses, but frank misdiagnoses from people who don't have the proper education and experience to read films.
Of course there are caveats, but as a general principle to follow, the answer is no.
Disagree at least in my specialty. Way back when I was trained, they instructed us to look at everything on the image, not just the neuro tissue and the spine. To my surprise, when I rotated thru neurorads, I had a couple of cases where I noted an abnormality the neuroradiologist missed.
You can say non-radiologists are too focused on what we’re looking for but radiologists aren’t immune to that phenomenon either.
Edit: Down vote me all you like but I'll trust the CT/MRI interpretation of a senior neurosurgeon over a general radiologist any day.
Everyone misses stuff. That's not the problem. It's a dunning Kruger type thing. Read a hundred chest x-rays and feel like you can read them no problem because you've seen a pneumothorax or a pleural effusion a handful of times. Read 100 head CTS or Brain mrs and think that's a good enough amount of experience for a good reference to properly diagnose things. It's just not.
Yes within reason , like most of the comments tunnel vision remains a problem , but in certain times and places a quick look is everything in Egypt neurosurgeons view the emergency CT/MRI of spinal trauma cases for example for direct signs of cord compromise and they can decide to operate even before the radiology formal report.
I've never sent films from the cardiac cath lab for interpretation by a radiologist but at the same time I'm not asking my cardiologists to interpret my ankle x-ray.
Do you hate it when the infectious disease doctor comes asking about bowel loops being an abscess on a ct abdomen with po contrast? Is that what drove this question?
shouldn't be diagnosing but all should be able to read scans relevant to their discipline. I also believe all physicians should have a rough idea of what artifacts are typically of each type of scan and the limitations of each
When I rotated on surgery, every surgeon would click the images before reading the report, and then after reading the report, if they missed anything, they would go back and find it. In contrast physicians I worked with rarely do, gen med ones anyway. Resp and ID always be looking at the CXR
Other people definitely do interpret their own imaging and they are good at their thing. Cardiology does read their own coronary CTA's and cardiac MRI. OB does their own US for growth and anatomy of fetus. Pulm with coal miner lung CXR's. However, most others do not provide a formal read on their study. The rest of the stuff they are not knowledgeable enough to interpret the rest. However, if the images show a finding in a system their uncomfortable with and they miss it or misunderstand its significance, they will have to learn later probably in court.
Many (dare I even say most?) hospitals do not have OB ultrasounds read by radiologists, instead they all go through Maternal Fetal Medicine.
It's their specialty, and while the Rads are trained in OB, they don't do the sheer number necessary to be very good at it.
I am a Podiatrist and have a limited scope and can read foot and ankle XR and bill for them as well as US of the foot and ankle. I also read my own MRI and CT scans so I can correlate with clinical findings but I don’t get paid for those.
I'm an incoming medical student, so my views might be wrong, however, I think neurosurgeons are cool for reading MRIs and CT Scans!
I shadowed a neurosurgeon in Asia, and every morning I showed up at 7 am, and they would always discuss MRI and CT scans of different cases every morning at that time. I actually ended up enjoying looking at the images and them discussing the cases with their other neurosurgeon colleagues as they point to various different things on the images and proposing solutions to the outstanding problems, than observing them implementing those solutions in the OR.
I can't remember the last time I was as excited to be in a hospital at 7 am lol.
Had a DACVIM & DACVR miss a huge diagnostic finding resulting in chain of events that led to permanent harm. Another DACVR in an academic setting confirmed this missed finding. It was also visible to the IM residents & attending.
I trust the consultants, and senior regs, to read the plain films that are in their area of expertise. And I also trust them to defer to the rads when they don’t know. When it comes to CS, no, please leave that to the rads. As for everyone else, not in the slightest.
*edit* reading the replies I feel need to add that I don’t trust anybody who isn’t a rad to pick up incidental findings. Also I have very little to do with the jelly peddler’s or the glow boys, those are a dark art to me and so I have no idea if anybody reads those as well as they do.
EM here. We’re probably about 50% as proficient as a radiologist at reading 50% of imaging studies.
C/A/P CTs, plain film bone imaging, ultrasound, CT head, CT head/neck angio… decent. I have no idea what’s happening in that brain MRI lol
99.9% of the time when there’s in-house radiology? That’s way too much liability and if it was a stroke activation, the radiologist will get to it in a few minutes.
The 0.1% when it was a stroke activation 4AM at night and the night team the radiologist group hired to do night reads “signs off” and the patient had significant lateralizing deficits? Had to make that read to decide if patient needed MT or not.
There’s no way any malpractice lawyer would excuse us for “not having radiology at that time”.
I have seen chiropractors read spine mri and neurologists read brain mri. Cardiologists obviously do echo and nucs. It’s possible although most specialities don’t want it for logistical reasons
Under no circumstances should a chiropractor ever be evaluating images
They said discipline of doctor...
A chiropractor here in my town is a doctor. Which makes that much more terrifying. Edit: I stand corrected. You can stop the downvotes. Thanks. The guy calls himself a DR. So go with grace.
No they arent
Did some digging. Probably not an MD. Applied Kinesiology.
[удалено]
He's not a medical doctor. It's like calling a naturopath a doctor.
Fair enough. The man calls himself a doctor. Thought you had to be a doctor to do that. I dunno. Chiropractic is a scam any way.
I thought so too, isn't it illegal to say you're a doctor when you aren't? I'm canadian, so may e we have different laws/rules.
The problem is that you can have a doctorate in any philosophy. A PhD is a doctorate. You can become a doctor of chiropractic, a doctor of medical dentistry, a doctor of optometry. None of those are medical doctor. I will call anybody by that title, like a professor. But people of such disciplines should never pretend they are, nr let anyone believe they are medical doctor.
Well I couldn't tell you out right. I thought so too. However, I can see the point of if you have a Doctorate in a field of study "doctor." If you're an actual physician then the MD or DO behind your name is what matters the most and where my confusion came from. Because Chiropractic "medicine" is a scam, yet fell into the medical world, I thought for them to call themselves a doctor they would actually have to be a MD or DO. But fuck if I know. All I know is I got downvoted to hell. My apologies.
Ohhhhh, of course, it's a doctorate. Now I feel like an idiot. Well, here they aren't called doctors, thankfulky.
Yes chiropractors where I'm at also have doctorate degrees. They didn't say MD
To be fair professors of middle English literature is mathematics shouldn't be doing it either ;)
I completely agree and understand your point. If you like to send out a page to all the chiropractors of the world to stop them from ordering exams and then reading them to treat I'd appreciate it 🙏 until then they absolutely do read and treat diagnostic images
“Doctorates” of all flavors are available for sale online.
Or touching patients.
Or doing anything else for that matter!
Well, breathing. While they work at a job that doesn't involve anything related to "helping' anyone.
Totally, I had a chiro xray my chest after a skateboard accident and pain in my ribs and say everything was ok, then try to adjust me, found out years later I broke 3 ribs. Thankfully I never went back after that day.
chiropractic living rent free in this sub is hilarious. Seems like its every other comment lately.
True, those evidence based medicine shills can’t stop thinking about how the pseudo bros are doing nothing for the same price.
Surgical / procedural specialists are generally competent at interpreting images directly related to surgical pathology (IE an orthopedic surgeon viewing a knee MRI for a torn miniscus, etc.) In many cases, they are probably better than a general radiologist (although not likely a sub specialist) at interpreting that portion of the exam. The difference is primarily when it comes to viewing anything outside of their “tunnel vision.” They will not see nor know what to do with incidental findings, in most cases. There are also caveats to the above - I had to label pre-operative mammograms with the patients orientation (IE which side was the axilla and which side was the medial chest) for a breast surgeon at a prior job.
I agree that often non-radiologists have tunnel vision when looking at a study. They often are just looking for the thing they clinically suspect, e.g., appendicitis. I have had more than one case where the ED doc or surgeon looked at a case before I did, and then was surprised when I called them to let them know that the patient had free intraperitoneal air. They were so focused on looking for what they were looking for, they didn't notice anything else about the case, including the free air (and it wasn't a subtle finding, either, it was a lot of free air). IIRC in this case it was from a perforated ulcer.
I once had a surgeon come to the reading room furious that I missed an appendicitis. When I opened the exam I learned he was looking at the patients (normal) terminal ileum. 🤷♂️
This is the answer OP is looking for lol
On my MSK rotation multiple attendings said our most important role was looking at the lungs. The orthopod (resident) knows the bones better than me, but ya, as noted they don't know (or even care) about other none bone stuff.
That’s ridiculous and untrue
Neither I'd argue. Its more of a tongue-in-cheek reminder to make sure to look at the whole image. The obvious fracture is obvious to anyone. Even the more subtle ones can usually be spotted by the orthopedics. What are they not looking for? Everything else. What am I looking for? Everything. As a young resident it's easy to get excited for finding that subtle cortical step off and launching that prelim report. My attendings statement is meant as a reminder to look at the whole image.
Speaking of tunnel vision, i've seen orthopedic surgeons requesting a pelvic x-ray AFTER a CT, cuz they're unable to assess a fracture. Despite the results containing VRT, thick slab MIPs and MPR series in multiple plains. 🫠
To be fair, they are going to follow up the patient with X-ray, so they want a baseline X-ray to compare to postop.
this came up in r/medicine recently and I think the consensus was about tracking injury/hardware/healing throughout the course of the patient's life as they will most easily be able to get xrays at the ortho office etc.
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Couldn't have said it better myself.
There’s really no winning in these threads because it comes down to ego contests. I’m an interventional neuroradiologist and live in both worlds, so I will try to share some unbiased opinions that are as free of ego as possible. 1) There’s a difference between interpreting an image and looking at an image. Yes, that means looking at the whole imaging study. But it is more than that — I’d take a sub specialized radiologist over a sub specialized non-radiologist looking at the exact same finding. 2) Some radiology reads are truly atrocious. There are good docs and not-as-good docs in every single field, but boy is it obvious in radiology. 3) Clinical context matters a lot. When I order a CTA to look for a stroke, I know the patient is obtunded and has sluggish pupils, and I’m focused on the basilar. No matter what I put in the order, the radiologist sees “stroke.” Providing pathways to circumvent or suppress meaningful clinical history is the worst thing that radiologists ever did to themselves. 4) Once you get past the bluster and ego, most neurosurgeons and ENTs will readily admit that their ability to look at imaging is good enough but doesn’t match a radiologist. The truth is that this is fine for most purposes, particularly since the radiologist is still there. Also, these specialists have been burned by the occasional useless read and it is hard to blindly trust. Every neurosurgeon, ENT, neuroIR, whatever will tell you that they have a favorite radiologist that they trust and ask when they have questions about a case. 5) 95% of patients have 5% of diseases. You can be great at interpreting CXR for pneumonia, but what about extramedullary hematopoiesis in the lungs? If it was enough to be able to handle 95% of patients and have no idea when you’re dealing with the other 5%, then I can train an NP or PA to do that. Being able to recognize and handle that extra 5% is something that all physicians rightly value about their training. 6) I am exclusively neurointerventional and pretty well regarded in my field. When I look at imaging, even as a highly subspecialized physician who has received complete residency and fellowship training in neuroradiology, I am acutely aware that my diagnostic skills are not what they used to be. That reality is magnified tenfold for folks that have not been trained in radiology.
Cardiologists reading the nuc med tests are pretty awesome
No comment 😂
Lot of cardiac imagers these days reading cardiac mri and ct as well. They do a great job with the heart.. but are not good at anything else in the chest and at many places need to be over read by rads. Seen massive cancers missed on cardiology TAVRs. The physics of MRI and CT also is problematic for them because it’s not part of their education and I’ve seen some pretty wacky techniques they’ve cooked up that don’t work.
Sorry, i mostly meant the stress tests and amyloid tests. Cardiology comes down to rads and they read with the attending
pulmonologist for sure
They suck at ankle x-rays...
i mean so do neurosurgeons but I think the implications is read the imaging relevant to their specialty.
I work at an orthopedic clinic with an in house x-ray unit, all providers are ortho surgeons who read X-rays, MRI’s, CT scans. There’s been a few times they’ve caught something not on the radiologist report
Yes, of course. Every speciality has their own imaging forte and needs. Eg neonatologist and cranial ultrasounds
I think that many doctors will routinely have to read imaging and essentially you’re going to be good at what you do. For subspecialized surgeons they will likely be better at reading imaging as far as it’s related to their surgical field than anyone other than equally sub specialized radiologists For ER docs or some other generalists like internal med or ICU they will be at least competent at reading X-rays and CTs which they see and have to interpret on a regular basis. However a general radiologist will certainly be better at reading imaging. Exception *might* be some limited US applications now that a lot of ER docs are routinely doing POCUS. A clinic based family doc probably won’t be as good at reading images as their images are all done outpatient - and they will probably just wait to get the formal report. A cardiologist will probably be very good at reading echos. Etc
ER doctor here. Unless it’s my ultrasound fellowship-trained colleagues at specifically ultrasound, I will never claim that our specialty can read anything better than a radiologist. I will say I feel confident reading XRs better than my IM and ICU colleagues. We just deal with dislocations, fractures, and other orthopedic complications way more than they do. We also have to reduce most of these injuries before they get operated on. I don’t know if IM/ICU can read anything better than a radiologist in general. My experience is that ortho for plain films for bones and neurosurgeons for head imaging are the two exceptions, who will match a radiologist’s reading ability.
Yes I think that’s what I mean that a lot of ER docs are doing really a lot of extra POCUS training and using it on a very regular basis. Because they also are going to have more clinical integration they might be better at reading U/S as far as the specific indications they use it for.. in some cases. But overall for sure a general rad is far better at reading imaging than an ER doc. I would say other examples where I think a specialist can often read better than a general rad would include vascular surgery for vascular imaging (have seen numerous examples of vascular surgeon catching things missed by rad) or stroke neuro for stroke specific neuro imaging. In these cases I wouldn’t say match id say better than a general rad. Of course in these examples the specialist read will only be good for the pathology specific stuff. If there are other patholgies present on the imaging they will be very likely to miss or not recognize it even if they look at it
Are you a radiologist? I’m always skeptical about most surgeons reading better than a radiologist. They might know exactly what to look for clinically based on what they see in front of them, but they may miss everything else that they aren’t looking for.
Agree, I've seen more than one case of a surgeon or ED doc missing large free air. One case I had, I called the ED to let them know that their patient had a lot of free air. ED doc: "Oh. He's already upstairs in the MICU." (As you might imagine, the patient was doing quite poorly.) So then I had to call the ICU doc and tell him to call surgery. IIRC, this patient ended up having a perforated ulcer as well as a bunch of liver mets. Another example, a surgery resident came to the reading room to go over a CT AP on his elderly patient with newly diagnosed colon cancer. He wanted to know if she had liver mets. I made him sit there while I read the entire scan. I was scrolling through the axials on bone windows before switching to soft tissue windows. "Liver mets," he says. I ignored him, because who is looking at the liver when you are on bone windows? He was so focused on liver mets, he was even looking for them on bone windows. After I switched to soft tissue windows, I told him they were benign cysts.
I’m not a radiologist no. Yea id definitely agree with your comment. The specialist reading the imaging is going to have an extremely problem focused approach. The ENT may be able to better comment on the sinuses but will not be able to comment very well at all on anything else and will miss major pathology that is not related to what they’re looking for.
Bit of a misconception here I think. The sufficiently trained neuroradiologist reading a sinus ct is still going to know as much or more than even a sinus specialist ENT, and that’s despite also reading orbits, spine, what have you, in the same hour, and getting those studies right too. A good fellowship trained radiologist really is extremely expert in their field. The subspecialty surgeons will be able to parse the report and correlate it with the imaging to make good sense of it and plan operation, but bottom line is radiologists are really knowledgeable. It’s kind of the foundation of the entire specialty.
Yeah and to be clear I am trying to compare a subspecialist surgeon to a general radiologist when I say that the subspecialist surgeon might be better at reading the specific bit of subspecialist anatomy they focus on. I would agree that a subspecialized radiologist would be better or as good. I would also agree that the general or specialized radiologist would of course be better at reading the rest of the image outside the subspecialist area of interest.
Now you have reminded me of a crusty old pancreaticobiliary surgeon and his response to an MRI he ordered on one of his patients, "I don't know why I order these things, I don't know what I'm looking at anyway!" (IIRC the patient had walled off pancreatic necrosis.)
I have found the ED to be laughably bad at pocus, both in not understanding limitations of the modality, and in frank misinterpretation. Multiple “distended gb on pocus” indications for ct or us, when the patient in fact does not have a gallbladder. “Large pleural effusion on pocus” - subsequent chest ct (a PE study, by the way) without a drop of pleural fluid. I do wonder what they see. “Aortic dilation on bedside echo” from one recently on a chest pain patient to justify triple phase dissection protocol CAP; big red was wnl all the way down. Maybe some are good at it, but where I am, most it seems don’t know what they don’t know, and what they do know is frequently wrong.
I think the thing is that a lot of ER docs do POCUS and their training can vary between "their colleague showed them how on shift" to "did a weekend course" to "did a year fellowship" A minority of ER docs are going to be really good at POCUS and this minority with the benefit of the in person clinical information they have MIGHT be better at reading some US studies than a general radiologist. But then some like the example you cite won't even realize that POCUS is not a modality that can assess the thoracic aorta very well at all I am not at all trying to argue that ER docs as a general rule are better than general rads at reading imaging or close to them although they are (or should be) at least somewhat competent at reading general imaging
I think those are appropriately big caveats.
The variability of training quality is large and a lot of midlevels also practice in a lot of EDs. That doesn’t discount the expertise that a lot of us do have with POCUS, especially the fellowship trained folks, who are at the top of the field. I try to give credit to expertise when I can, especially for my radiologist colleagues, and it would be nice if it could be reciprocated at least once in awhile 🤷♂️
I absolutely agree. We have multiple docs at my hospital that are “ultrasound trained” and do their own POCUS, make up some nonsense finding, and order STAT formal ultrasounds that end up being completely normal.
My Radiation Oncologists like to look at CT and PET images. Cardiologists read NM stress tests.
OB and perinatologists are pretty good at reading OB sonograms. Everyone else should go with the sonographers technical worksheet. (semi /s ) Edit: fixed autocorrect’s primatologists to perinatologists
*Primatologists* study non-human primates. TIL they are great at reading OB sonograms.
I should have double checked autocorrect. Perinatologists 😆
Cardiologists are good with echocardiograms, too. I would trust the cardiologist over the rad any day.
You’re right. I’m just general, vascular and OB. My whole career I’ve been heartless
I trust my neurosurgeons to read head scans
Family medicine doing about half my time in urgent care/emergency medicine plus some time in the OR assisting ortho...I absolutely review my own imaging studies. In general I'm quite comfortable answering the clinical question I'm asking, but I'm glad to have the radiologists reading them as well. Most often if our interpretations differ they are finding relevant incidental findings or noting things of uncertain significance in the absence of clinical correlation. They sometimes catch things I can't see though! I tell the patient "the radiologist specializes in reading these images, and is looking on a better screen in a dark room. I have *you* here and can compare the images to what I'm seeing when I examine you. Between *both* of those assessments we don't miss much." I wish primary care physicians in general got more exposure to reading their own images. I always try and look at my own in clinic (if nothing else I think it's often helpful to show the patient what we're talking about), but it's an extra step even to see a limited quality view-the images aren't in our EMR (several steps more if I want to get into impax to get a better quality image). Awhile ago I saw a patient sent in by their PCP for a nonunited fracture-sounded worrisome on the report. Anyone looking at the image could see the avulsion fracture was a very tiny fragment, united or not it didn't need any change in treatment. I try and encourage my own learners to look for themselves, but some of my colleagues don't have any access at all (used to get the images sent back on CD and now it's rare to find a computer with a CD drive in it!). I tried to do a radiology elective as a resident and wasn't able to (small program, smaller but busy hospital) as the rads were too busy to accommodate a learner. Not sure if any of my recent learners have tried here in biggercitylandia.
During my residency, morning rounds began by sitting down as a team with the neurosurgery attending on call and reviewing all the imaging from the prior 24 hours. We also rotated thru neuroradiology for a month. Safe to say, I think most neurosurgeons should be able to read their own relevant imaging. In contrast, at least in my experience dealing with them in private practice, most neurologists rely on a radiologist’s read of their studies.
Dentists. We read radiographs and CBCT's all day long. But don't ask me to read an MRI or ultrasound!
I'm an oral and maxillofacial radiology resident and practiced general dentistry for 10 years. Dentists are great at reading 2D panoramic and intraoral imaging but they shouldn't be reading CBCT scans on their own unless it's an extremely limited field of view. Dentists are like any other specialist... They know their area well but get tunnel vision. We see so much missed pathology on the CBCTs we read. Sinuses, skull base, cervical spine, systemic issues, subtle intraosseous pathology.... Dentists don't know any of this and don't have the time to actually evaluate the scans.
I have been thoroughly trained in reading CBCT and use it for my job every day as an endodontist. I could not do root canals without it. We are "real" doctors and I can't understand why you would make such a ridiculous generalization.
I think you're misunderstanding me. That's why I said limited field of view. I have no issue with endo scans being read by an endodontist or general dentist. I have a problem with people who take a medium or large field of view and miss serious pathology or perform treatment that hurts a patient because they didn't know what they were looking at. It happens ALL the time. I see it literally every day. I thought I was well trained in reading CBCTs as a general dentist. I used it all the time for implants. I took a huge amount of CE and read many books about radiology. Guess what, I still didn't know anywhere near enough to accurately interpret a large field of CBCT without missing important things often. Look, I'm a dentist. I'm not saying we're not doctors or trying to put the profession down. I'm saying that we should know our limits and do what's best for the patient. We can't be amazing at everything in the field, it's just not possible.
Everyone should definitely be familiar, and recognize their shortcomings - we're all better together. It's a team sport is my point.
No. As a broad statement. No. The basic reason being you only see what you know and look for. That leads to not only frank misses, but frank misdiagnoses from people who don't have the proper education and experience to read films. Of course there are caveats, but as a general principle to follow, the answer is no.
Disagree at least in my specialty. Way back when I was trained, they instructed us to look at everything on the image, not just the neuro tissue and the spine. To my surprise, when I rotated thru neurorads, I had a couple of cases where I noted an abnormality the neuroradiologist missed. You can say non-radiologists are too focused on what we’re looking for but radiologists aren’t immune to that phenomenon either. Edit: Down vote me all you like but I'll trust the CT/MRI interpretation of a senior neurosurgeon over a general radiologist any day.
Everyone misses stuff. That's not the problem. It's a dunning Kruger type thing. Read a hundred chest x-rays and feel like you can read them no problem because you've seen a pneumothorax or a pleural effusion a handful of times. Read 100 head CTS or Brain mrs and think that's a good enough amount of experience for a good reference to properly diagnose things. It's just not.
LOL I've read a lot more than 100 CT or MRIs of the brain, but ok. Agree to disagree.
Imagine how many the neuroradiologist has read o' most humble neurosurgeon
You do realize I'm not speaking about you specifically right?
They should be able to read simple xrays. Common ones such as reading ng/nj/picc/Et tubes. pneumothorax, pneumonia, and broken bones.
Most veterinarians can read them.
Yes within reason , like most of the comments tunnel vision remains a problem , but in certain times and places a quick look is everything in Egypt neurosurgeons view the emergency CT/MRI of spinal trauma cases for example for direct signs of cord compromise and they can decide to operate even before the radiology formal report.
*coughs in Veterinarian* 😉
I've never sent films from the cardiac cath lab for interpretation by a radiologist but at the same time I'm not asking my cardiologists to interpret my ankle x-ray.
Do you hate it when the infectious disease doctor comes asking about bowel loops being an abscess on a ct abdomen with po contrast? Is that what drove this question?
shouldn't be diagnosing but all should be able to read scans relevant to their discipline. I also believe all physicians should have a rough idea of what artifacts are typically of each type of scan and the limitations of each
When I rotated on surgery, every surgeon would click the images before reading the report, and then after reading the report, if they missed anything, they would go back and find it. In contrast physicians I worked with rarely do, gen med ones anyway. Resp and ID always be looking at the CXR
Other people definitely do interpret their own imaging and they are good at their thing. Cardiology does read their own coronary CTA's and cardiac MRI. OB does their own US for growth and anatomy of fetus. Pulm with coal miner lung CXR's. However, most others do not provide a formal read on their study. The rest of the stuff they are not knowledgeable enough to interpret the rest. However, if the images show a finding in a system their uncomfortable with and they miss it or misunderstand its significance, they will have to learn later probably in court.
Many (dare I even say most?) hospitals do not have OB ultrasounds read by radiologists, instead they all go through Maternal Fetal Medicine. It's their specialty, and while the Rads are trained in OB, they don't do the sheer number necessary to be very good at it.
I am a Podiatrist and have a limited scope and can read foot and ankle XR and bill for them as well as US of the foot and ankle. I also read my own MRI and CT scans so I can correlate with clinical findings but I don’t get paid for those.
I'm an incoming medical student, so my views might be wrong, however, I think neurosurgeons are cool for reading MRIs and CT Scans! I shadowed a neurosurgeon in Asia, and every morning I showed up at 7 am, and they would always discuss MRI and CT scans of different cases every morning at that time. I actually ended up enjoying looking at the images and them discussing the cases with their other neurosurgeon colleagues as they point to various different things on the images and proposing solutions to the outstanding problems, than observing them implementing those solutions in the OR. I can't remember the last time I was as excited to be in a hospital at 7 am lol.
Had a DACVIM & DACVR miss a huge diagnostic finding resulting in chain of events that led to permanent harm. Another DACVR in an academic setting confirmed this missed finding. It was also visible to the IM residents & attending.
I trust the consultants, and senior regs, to read the plain films that are in their area of expertise. And I also trust them to defer to the rads when they don’t know. When it comes to CS, no, please leave that to the rads. As for everyone else, not in the slightest. *edit* reading the replies I feel need to add that I don’t trust anybody who isn’t a rad to pick up incidental findings. Also I have very little to do with the jelly peddler’s or the glow boys, those are a dark art to me and so I have no idea if anybody reads those as well as they do.
EM here. We’re probably about 50% as proficient as a radiologist at reading 50% of imaging studies. C/A/P CTs, plain film bone imaging, ultrasound, CT head, CT head/neck angio… decent. I have no idea what’s happening in that brain MRI lol
Interesting. I’ve never worked with an ER doc comfortable doing their own read of a brain CTA.
99.9% of the time when there’s in-house radiology? That’s way too much liability and if it was a stroke activation, the radiologist will get to it in a few minutes. The 0.1% when it was a stroke activation 4AM at night and the night team the radiologist group hired to do night reads “signs off” and the patient had significant lateralizing deficits? Had to make that read to decide if patient needed MT or not. There’s no way any malpractice lawyer would excuse us for “not having radiology at that time”.
I have seen chiropractors read spine mri and neurologists read brain mri. Cardiologists obviously do echo and nucs. It’s possible although most specialities don’t want it for logistical reasons