Here are some questions and answers which have come through the workshops.
Do we really have to know all this stuff?
No, you don’t!
In ‘The role of the Interpreting radiographer’ I have written that I think you are there to say an image is normal, diagnose what you can, or say that it’s abnormal but you don’t know what the abnormality is. (That’s the role of the radiologist too, by the way).
I don’t for a moment suggest that you are going to be telling anybody that the patient has an osteogenic sarcoma. But you certainly could tell them that the X-ray is abnormal, and that somebody with more experience in interpretation needs to see the image and the patient.
The ten common conditions that I listed in that post are what you need to be looking for, and I hope you will be or will become confident in making those diagnoses. For the other let’s say 290 conditions (I haven’t counted) that are mentioned in the Topics, you don’t need to worry about them.
So why are they even there? Because I think that knowing more than you absolutely need to know is a good thing. Diseases don’t read textbooks and they can appear in all sorts of slightly different ways, so a broad background is helpful.
Your images don’t look like mine!
Film image, photographed on a mobile phone.
Many of you will be using film and manual processing, under difficult conditions of supply of electricity, water and chemicals, along with challenging temperature and humidity. Quality assurance under these conditions is, I am sure, a constant challenge. But ensuring that as far as possible the screens are clean, the chemicals are fresh and the darkroom is dark will make a big difference.
Digital image.
Almost all the images on this site are digital, which brings different challenges of its own particularly around radiation dose. But digital images do tend to have wider latitude, and this makes them less contrasty. They have a more uniform, flatter look which does take a bit of getting used to. But they are better for seeing everything on the image over a wide range of exposures, and of course they can be adjusted on a workstation if necessary.
I’m sorry that I can’t exactly mimic films, but using digital images is what has made the site possible. If it helps you can think of them as very high-quality diagrams!
What’s the point of getting better at diagnosing conditions that we can’t treat?
(I made this one up myself. But I think it’s worth asking, and answering).
Drs Ostensen and Petterssen, while travelling through Africa, did a survey of X-rays for which they could find a report. They estimated the error rate to be about 30%. Harald Ostensen told me this and I don’t know if the reports were by radiographers, clinical assistants or doctors, or perhaps a combination.
So you could say that before we start worrying about untreatable conditions, we need to raise the baseline level of reporting skill to bring that error rate down so as to provide better diagnosis and better care for patients with treatable disease.
I don’t think that will be hard to do if people can get some value out of this website. Even if everybody reporting X-rays knew what an air bronchogram was and what it meant, we would be well on the way.
And as for the question about untreatable conditions, well, it’s a recurring pattern that as diagnosis improves treatment improves. Diagnosis shines a light on what’s there, and thoughful people start to see patterns and wonder if things can be done differently. That’s how advances in science are made.
And even if the condition is untreatable, most patients want to know what’s going on and what the future holds for them.
Increasing clarity of diagnosis, perhaps through a better search pattern which lets you see the mass hiding behind the heart, is doing a major service for your patient.
What are all the little white dots on some of the chest X-rays?
They are ECG buttons. They are stuck to the skin and connected with wires to an ECG machine when a patient arrives at an emerency department. The wires can be disconnected and removed to give a better view on the X-ray, but the buttons stay behind.
Why do some of the side markers have TEL on them? Are they all taken by the same radiographer with those initials?
TEL is a shorthand way of saying that the image is taken PA erect with a 6-foot tube to film distance. In other words a standard department image. For some reason it has been used at Christchurch Hospital in New Zealand for decades, although less so now.
It’s short for ‘Teleroentgenogram’ which is German for ‘X-ray taken from a distance.”