The roentgenologist as a consultant.

Abstract

The rendition of a signed report to the referring physician is an important part of the practice of diagnostic roentgenology. This report, based upon examination of the patient, presents the findings of the roentgenologist and expresses his medical judgment or diagnosis. Because definite responsibilities have been assumed in the performance of such an examination, no matter how simple it may be, the report should show that these commitments have been honored. What exactly are these responsibilities? In what manner are they best discharged? Evaluation: In most cases the evaluation of an x-ray examination as to suitability, completeness, and technic requires no direct mention by the roentgenologist. This holds true particularly for the simpler and more standardized procedures. Occasionally, however, it is necessary that a statement be included pertaining to one or another of these three conditions any one of which can be of real significance to the patient and the referring physician. In order to pass on the suitability of any examination that the roentgenologist may be called upon to interpret, a clear statement is required from the referring physician as to the information sought or, in other words the purpose of the roentgen study that has been requested. Unless such information is provided, one is unable to determine whether or not the examination chosen was the one best suited to the purpose. If doubt exists in the mind of the referring physician as to the correct x-ray procedure in a particular situation, then a consultation with the roentgenologist is in order. Usually, however, it is simpler if the patient is turned over to the roentgen diagnostician who, being informed of the problem to be answered, is left free to choose the most efficient way to proceed with his work-up. Should it transpire that an inappropriate examination has been carried out, then the report must define its ill conception and state the correct method of approach to the problem. In this manner the patient's interest will be protected and similar errors may be prevented in the future. The second part of the evaluation concerns the presence of any restrictions on the conduct or execution of the roentgen examination. Restrictions which can lead to an examination that is less than complete, may emanate from the referring physician or from the patient himself. Stipulations imposed by the referring physician, although well intended, are often unwise and founded upon commonly held misconceptions. The failure to permit adequate preparation of a patient, the insistence on the use of certain types of radiopaque material, such as “thin barium,” and the rigid designation of technical matters can seriously undermine the usefulness of the roentgen method. To the extent that an x-ray study is compromised in these ways are the chances for a successful result diminished.