How do we improve radiology reports?

Radiology reports are appalling in Nigeria and it underscores the paucity of training for radiologists. Some of the radiologists who report MRI and CT scan of the brain and spine are untrained in neuroradiology. They dabble, moonlighting in the many diagnostic centres, reporting on scans they know nothing or very little about.

There is a radiologist in Abuja who is so bad as to be criminal. His reports are so abysmal you wonder if he needs glasses or suffers from glaucoma. His brain and eyes are certainly not connected. This one is particularly horrible he should be certified as fit for a lobotomy. I cannot remember the last time he got the diagnosis right and someone should put him out of his misery. But, his health is actually not the problem. It is the profound risk he puts ordinary Nigerians to that is important.

The fact is that doctors rely on the reports to make a diagnosis and guide treatment. We rely on the reports to know if the patient should be referred to a specialist or not. In essence, the reports can be the difference between life and death for the patient. MRI and CT scans are so expensive that the quality of the report is equally as important as the quality of the imaging. Since, many imaging centres utilise poor quality equipment, the radiologist has to be particularly astute. To have bad equipment and a bad radiologist therefore compounds the problem.

Take for example; arthritis of the spine can lead to pressure on the nerves in the back. The nerves supplying the legs, private parts, bladder and the anus can be under pressure. MRI scan showing such pressure must be correctly diagnosed and indeed flagged as an EMERGENCY problem that requires urgent treatment by a spine surgeon. Delay in diagnosis and treatment can lead to permanent damage to the nerves making the patient incontinent of urine and faeces. It can affect sexual function, cause untold pain and even paralysis of the legs.

The radiologist must correctly diagnose this. Therefore, for a radiologist to not even see that nerves are under pressure is a big problem. For a radiologist to not highlight the severity of the condition is a bigger problem. Finally, for a radiologist to misdiagnose it as infection and therefore send the doctors down the wrong treatment path is the biggest problem of all.

There are pertinent issues of course that bedevils medical practice in Nigeria. There are also special problems related to the practice of radiology through our diagnostic centres. Some of these issues are as below:

Information

One problem is that radiology requests are often deficient in information that will help the radiologist. Many do not state the correct age of the patient preferring to write ‘ADULT’ in the column for age. Yet, many diseases are age related. Secondly, full history and suspected diagnosis are often missing, so without adequate information, the radiologist sometimes needs a crystal ball or the services of a clairvoyant to make the right diagnosis. Garbage in, garbage out!

Communication

There is disconnection between the radiologist and the radiographer. In many centres, the radiographers do the imaging and send the patient away. The radiologist then comes later to report on what may be inadequate or incomplete imaging. Other types of images that may have helped are then nigh impossible since the patient has already left the building. Of course, fresh imaging often means additional costs that may be unaffordable for the patient. So, radiologists make do with inadequate examination to the detriment of their reputation and the patient.

Secondly, of course and more important is the recognition of urgent cases and diagnosis. The radiographer and the radiologist need to be able to recognise cases that are emergencies and flag this up immediately. Conditions such as pneumothorax (air in the chest cavity outside the lungs), massive stroke and bleeding into the brain sometimes require immediate attention. There is therefore a duty of the radiology personnel to highlight these conditions with despatch. Delays often lead to loss of limbs and life.

Collaboration

It is rare for radiologists to phone the referring doctor to ask for more information. It is also rare in private practice especially for them to ask for feedback from the surgeon. This is sad, does not improve learning and perpetuates ‘quackery’ in radiology. Feedback from the surgeon and more important from the pathologists should be integral parts of the process for making the right diagnosis for the patient. Many teaching hospitals encourage radiology meetings between departments just to facilitate this level of collaboration and learning. It is vitally important but sorely lacking in private diagnostic facilities.

What are we to do?

How do we improve radiology reporting and share expertise, experience in a way that stimulates and improves quality of care for the majority of our patients? How can specialists provide feedback for radiologists and help improve their practice? How do we do this without bruising some over inflated egos? Especially in those without perception!

What are we to do in order to save lives?