Many radiology textbooks teach imaging technology and the abnormalities found on medical images. Most of those abnormalities or “findings” will never be seen (or require interpretation) by the majority of clinicians throughout a long career. The basics of radiology imaging and interpretation are important, but there is much more stuff beyond a collection of radiological findings to make a textbook useful for medical professionals who have no intention to specialize in radiology.
Even in these times in which The System reigns supreme, some of us stll believe that what we do for the patient is the only thing that really matters. Being able to identify unusual radiographic findings or “signs” may be good for self esteem, but that does not guarantee that the patient will benefit.
Using radiology well for the benefit of patients is not that easy, although some seem to think so. I feel sorry for their patients. It isn’t always that easy to decide if the patient will benefit from, say, CT or MRI, or if the patient would be better off with no medical imaging at all. Radiographic findings may be subtle or indeterminate. Older individuals often accumulate many “findings” after the wear and tear of decades, and the one finding that matters can be buried in an avalanche of imaging abnormalities.
Radiology reports (not just images) may need interpetive skills, both to interpet imaging findings for patients and for a clinician to decide what to do next. Modern imaging technologies are amazing, but often it is patient characteristics and how a study is ordered that matter – more than the technology itself – in determining if a patient gets an appropriate and clinically useful radiology exam. And even we purists concede that cost matters to many patients.
These various issues are addressed throughout Practical Radiology: A Symptom-Based Approach, and are emphasized in a chapter called “Clinical Practice Issues in Medical Imaging.” I and my coauthors (an orthopedic PA and anatomy professor) constantly focused on illustrating the use of radiology to optimize patient care. We illustrate with clinical stories how radiology can work well (or not, in one case we relate) to progress from a patient’s symptoms to diagnosis and treatment.
Ed Weber started out with a surgical internship at Philadelphia’s Albert Einstein Medical Center and then stayed there for his radiology residency. He just retired from his primary clinical practice but still consults, loves to teach and write, and loves going to the Cleveland zoo with his 15 month old grandaughter. He wants to teach her to ski and to sail, but not until she is two.