Errors in Radiology

How often we have seen that showing a same chest xray or mammogram to two different radiologists will get us different results. Do they get counted as errors? Often somebody labels the bronchovascular markings as prominent while other will call it normal. Even PNS xrays sometimes, one radiologist will call sinus hazy and other will call it clear. Looking back at the medical college days where each report was double or triple read, junior resident-then registrar then-faculty. Probably makes some sense to have some kind of standard double reads in the process to increase accuracy and to cut down on ambiguity.  It is also often postulated that computer may play a significant role in future in pattern recognition and radiologists will superread the studies, this will increase the efficiency and reduce errors of missing a significant pathology.

What do you think of this? How you ever tried reporting same xray on two different days and found yourself writing different reports? Comments and suggestions are welcome.

Desmoid Tumour-MRI

Desmoid tumors are classified as extra-abdominal, intra-abdominal, or located within the abdominal wall. Abdominal wall desmoid tumors arise most commonly from the aponeurosis of the rectus abdominus muscle with out without intraabdominal extension.. Extra-abdominal tumors typically occur in the shoulder, chest wall, thigh, inguinal region, and back. Clinical symptoms are masked by the slow growth of the tumor and depend on the site to tumor involvement.
Desmoid tumors have a similar attenuation to muscle on contrast-enhanced CT images. However, CT cannot distinguish a desmoid tumor from similar soft tissue tumors, making histological diagnosis necessary. MRI enables better tissue characterization of desmoid tumors by demonstrating intratumoral areas of low signal intensity on all pulse sequences. The low signal intensity is due to the presence of abundant collagen within the lesion. Desmoid tumors appear as low-signal intensity masses in a background of high-signal intensity fat on T1-weighted MR images. These tumors have variable signal intensity on T2-weighted MR images. In mature desmoids, areas of abundant fibrosis results in low signal intensity on T2-weighted images. Longstanding tumors are low in signal intensity on T1 and T2-weighted MR images and enhance only minimally after intravenous gadolinium chelate. In the acute phase, tumors may have regions of high signal intensity on T2-weighted images that also show heterogeneous increased enhancement. Tumor recurrence is a frequent finding after surgery and is easily detected using MRI.

Second opinion by- Teleradiology Providers

Supraspinatus Calcific Tendonitis-CT

"Painter described calcification in the shoulder in 1907. Codman established that the calcification was within the tendons of the rotator cuff. Calcifying tendinitis of the shoulder is characterized by the presence of macroscopic deposits of hydroxyapatite (a crystalline calcium phosphate) in any tendon of the rotator cuffEven supraspinatus tendons that are macroscopically normal contain minute amounts of calcium deposits. Degenerative tendons that have ruptured contain more calcium deposits, but it is not always in the form of calcium phosphate. The increase in calcium deposits is due to degenerative calcification.In contrast, the calcium in tendons with radiographically visible calcification is in the form of crystalline hydroxyapatite. Calcifying tendinitis is a different condition from that of degenerative tendons in which there is a small increase in calcium content. genral asymptomatic population in 30 to 50 yrs display calccificatin in about 3 to 20%The supraspinatus tendon is affected most often. Calcification is observed with decreasing frequency in the infraspinatus, teres minor, and subscapularis tendons. More than one tendon may be involved. Women are affected slightly more frequently than are men (housewives and clerical workers account for most cases), and the right shoulder is affected slightly more often than the left is. Both shoulders can have or develop calcific deposits in 13-47% of subjects, and the calcific deposit usually is described as being approximately 1-2 cm proximal to the tendon insertion on the greater tuberosity. Computed tomography (CT) scanning may be used to accurately localize the calcific deposit."

Case by Dr MGK Murthy, Sr Consultant Radiologist

&

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

Mesenchymal Hamartoma Shoulder-MRI

MR shows well defined heterogenous SOL in subacromial and superior aspect shoulder with no marrow oedema or joint involvemnt or rotator cuff involvement Smooth muscle hamartoma is an uncommon, usually congenital, cutaneous hyperplasia of the arrectores pilorum muscles. We report a case of this rare tumor in a 19-year-old man. The disease started several years ago as multiple small skin-colored papules that subsequently coalesced to form a large soft plaque on the back of the left shoulder. The diagnosis of acquired smooth muscle hamartoma was confirmed on histopathology. The patient was reassured about the benign nature of the lesion and was not advised any treatment.

Case by Dr MGK Murthy,Sr Consultant Radiologist

&

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

About Telesonography

According to a recent article in AJR-The Feasibility of Real-Time Transmission of Sonographic Images from a Remote Location over Low-Bandwidth Internet Links: A Pilot Study. AJR 2007; 188:W219-W222

"Authors sought to show that sonography can be performed in teleconference settings, "telesonography," in which a remotely located sonography interpreter can monitor the examination in real-time and guide the examiner with voice commands while the patient simultaneously undergoes imaging, albeit at low resolution, thus helping to overcome the lack of trained operators in certain areas. According to them, this system of image transfer offers the potential for sonography to be performed at a remote underdeveloped region and interpreted in real-time at a distant site by trained radiologists, thereby extending the presence of physicians in virtual space. "