RSNA: Meet the clinical diagnostic radiologist

CHICAGO--PACS has revolutionized radiology, but has separated radiologists from their clinical colleagues. It’s essential for radiologists to re-define their role and become clinical diagnostic radiologists, according to a poster presentation on Nov. 29 at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

In order for radiologists to regain their roles as consultants in the healthcare process, they need to become clinical diagnostic radiologists, said Mark D. Mamlouk, MD, of the University of California, Irvine.

Mamlouk defined the clinical diagnostic radiologist as one who succinctly and effectively relays information to the referring clinician with a clinical perspective and considers the patient at all times.

Suggesting “clinical correlation” in the report, said Mamlouk, is the antithesis of this approach. Other habits to be avoided include reliance on vague terminology and omitting or providing only a limited impression in the report.

Mamlouk acknowledged that the lack of clinical history can make it challenging to shift to the clinical approach, but argued that clinical history can be readily accessed in the EMR. “No clinician gets a free history. In the age of EMRs, a pertinent history is only a mouse click away from the radiologist.”

According to Mamlouk, radiologists’ Achilles’ heel is not the lack of knowledge or time or inadequate detection abilities; it is failure to provide clinicians what they want.

Watch your words
The phrase "clinical correlation suggested" epitomizes vague radiology vernacular and often does not aid the referring clinician. If it must be used, said Mamlouk, the radiologist should provide specifics to correlate.

“Clinically indicated” is another fallback phrase. Mamlouk recommended that radiologists consider whether or not subsequent imaging is clinically useful. For example, suggesting further imaging is clinically indicated on a thyroid nodule in an 87 year old with metastatic prostate cancer may incite a chain of follow-up imaging that is likely to be of little clinical value. It does, however, add to costs.

A poll of 703 clinicians indicated that 94 percent believe reports of more than a few lines should include a separate impression. “A significant number of radiologists forego an impression,” said Mamlouk.

The best approach to impressions, said Mamlouk, is concise and relevant and answers the clinical question. For example, “satisfactory PICC placement” is a satisfactory impression, said Mamlouk.

Mamlouk concluded with a few tips for customer service. He said:

• Understand that radiologists are not independent physicians. Their role is to serve others.
• Communicate well and cater reports to the audience.
• Be prompt.
• When uncertain about whether or not customer service meets the mark, ask clinicians and patients.