No radiologist on staff? Teleradiology report taking too long to get back? Fluffy’s owner wants to know NOW if he needs emergency surgery? Here are a few tips to help ensure you are set up for success when interpreting your practice’s radiographs:
1. Turn down the lights
Are you trying to interpret an x-ray in the middle of the treatment area? Try and find a place where you can briefly dim or turn off the lights. The room doesn't need to be (and ideally shouldn’t be) completely dark. A small amount of ambient or indirect lighting works best. Sit at a chair that puts the screens at eye-level. If necessary, rotate the images so that they’re facing the correct way. Set up your software so that you can see at least 2 images at once so that you can compare the lateral to the VD. Do your best to not get distracted and take 2-3 uninterrupted minutes to interpret the radiographs.
2. Take that additional view
All studies should be at least two views, ideally three. We have all seen an example of a non-displaced spinal fracture that you could only see on one view, or a foreign body that was only visible on the left lateral projection, etc. Orthogonal views are a valuable part of your diagnostic toolkit. Each projection is an opportunity to gain more information to help you guide next steps and make the best treatment plans. Remember, if Lucky is trying to murder your staff for that V/D, remember sedation is your friend!
3. Use appropriate positioning
Do your techs have training in appropriate positioning? Having straight, collimated radiographs makes a huge difference when it comes time for interpretation. Taking good quality radiographs takes time and experience. Get a poster or textbook that shows your staff how to position patients and can serve as a reference while performing studies. Spend time reviewing the studies with your staff and provide feedback (e.g., pull the legs forward) to help them get the studies that you want and need. Training and learning together with your techs will lead to better quality radiographs and improve patient outcomes.
4. Read the entire image
So, you found the fracture you were expecting based on your PE but missed the nodule on the edge of the image? This error is often explained by “satisfaction of search”, an all-too-common phenomenon in radiology, whereby the reader prematurely ends their radiographic interpretation after finding the lesion that they expect to be the primary problem. This can result in missing important information in your radiographs and can lead to some embarrassing moments. One way to avoid this is to develop a routine when you read cases, and do not deviate from it. For example, a thorax checklist could be, “heart, lungs, mediastinum, pleural space, musculoskeletal”. Write a list and put it up on the wall where you review x-rays. This will help remind you to evaluate each organ as you interpret the images.
5. Catalog that weird case
Take some time to make a log of cases to refer back to. Writing down cases that have clear diagnoses or ones that initially stumped you so that you can compare them to radiographs from a different patient in the future can save you time and help you feel more confident in your assessment. Young dogs with open physes are always good ones to save for comparison at a later date.
6. Practice, practice, practice!
Nothing can take the place of experience. Invest in a good atlas (see above) and look through it. Learn from your colleagues' cases or attend a radiology CE. Even if you send your radiographs out to a teleradiologist, take the time to interpret them yourself before sending them, and then check to see if you were correct. Radiology is mostly about pattern recognition. The more you see, the more you know!
Here are two great textbooks to help your interpretations:
This book is particularly helpful in showing normal anatomy in juvenile patients at various ages. For example, have a limping 16-week-old puppy and you’re not sure what the elbow should look like? Could that opacity be a normal thymus? This is your text!
7. Have Radimal read your radiographs for you
Whether it's Radimal teleradiology or the Radimal AI reporting, your job is to work with a radiographic interpretation to diagnose and treat your patient. Save yourself the interpretation time and let us help you get your patient the treatment they need.