Do radiologists read the reports they sign off on?

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dianne052506
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Do radiologists read the reports they sign off on?

Postby dianne052506 » Thu Sep 08, 2011 11:10 pm

Last week I had CT scan number who-knows-how-many. Chest, abdomen, pelvis. With oral contrast and with and without IV contrast. The news is not great. Irinotecan is starting to lose its effectiveness for me, and the lung nodules are growing. Don't have a plan in place yet. My onc is very hesitant to go back to oxaliplatin after my big reaction in 2009. We're still looking at clinical trials. I'd like to explore some sort of radiation treatment, just so I could say I tried everything, but I don't know where to start ( and will take all advice). I knew this could happen at any time, so I guess I'm not too shocked, but...

In the scan report, after noting the location of several nodules and their increase in size, it reads:

A few other tiny nodules appear slighly more prominent. The thoracic skeletal lesions. No axillary lymphadenopathy Right-sided chemotherapy port is present. No other significant findings in the chest.

The thoracid skeletal lesions period? What thoracic skeletal lesions? in five years and three months worth of scans, no one has mentioned skeletal lesions, and then this idiot puts that in there and can't complete a sentence?

I realize the radiologists dictate these reports, and they are transcribed, maybe by a computer, maybe by someone in India for all I know, but then this guy signs it.

I got this report last Thursday, and my onc immediately called the radiologist and asked him to re-read the scan and do an addendum to the report. One week later, nothing is back. I went in for bloodwork today, and had my onc place another phone call to the radiology group. Nothing yet. Yes, I'm probably just angry at my situation, and want to take it out on this radiologist, but this makes me crazy. The rest of that sentence can make a big difference in whatever Plan B we come up with. Wonder if I should try calling the radiology group myself?
Just venting, but thanks for listening.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

RixInPhx
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Re: Do radiologists read the reports they sign off on?

Postby RixInPhx » Thu Sep 08, 2011 11:43 pm

You are right to be irked; there is obviously a mistake, if not of judgement or thoroughness, then a 'typo' of some sort, maybe machine, maybe human.

In your rightful state of indignation, PLEASE don't contact the rad group.
Keep pressing your onc to get IMMEDIATE clarification.

If a rebuke to the rad group is in order, register it after the propblem is resolved.

Just my 2-cents.
-Rick
M 61, Dx 6/10 CRC st 4, unknown primary CEA 843
2 kg peritoneal mass, met to skull; no surgery
Various regimens of all CRC chemo drugs
Mets to lung 8/11 CEA 135
Folfiri/Erb/Ava 12/11 CEA 320
No progression 5/12 CEA 192

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karin
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Re: Do radiologists read the reports they sign off on?

Postby karin » Fri Sep 09, 2011 12:01 am

I agree w Rick. But yes, radiologists do this all the time, I reread CXR reports that come to me saying "the shadow mass in the R hilum has grown compared with the most recent film dated ________", then, I'm like, what shadow mass??!! So I look back thru the pts. chart, no shadow mass was ever mentioned before!!! And, I do call them, but it's not always the right thing to do (sometimes I get in trouble for speaking my mind-but, hey, what's wrong with saying or stating what is true and obvious!).

I had a pharmacy CSR start out today by telling me that she got 400 faxes on Tuesday so I needed to tell her more about my issue, to which I responded, "well, I'm having an issue with a pharmacy that is abandoning a patient so I don't want to hear about how you have too many faxes to find out what happened to the fax for the medication that this patient didn't get!!". She took my number and called me back less than 20 minutes later.....so, sometimes the squeaky wheel gets the grease.

I think your onc will take care of this for you. I have my fingers and toes crossed that there is no mets to bone!!
Karin
BFF dx'd June09 w CRC & peritoneal mucinous carcinomatosis @ age 40
She beat cancer for 20 months!

dianne052506
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Re: Do radiologists read the reports they sign off on?

Postby dianne052506 » Fri Sep 09, 2011 10:41 am

My oncologist got the addendum to the scan report today, eight days and two phone calls later. Instead of saying,

"The thoracic skeletal lesions."

it now reads,

"The thoracic skeleton is unremarkable."

BIG difference. I was really too tired to freak out and worry over the error in the report, but it still made me mad. Don't know whether or not it is worth an official complaint to the radiology practice.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

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Bev G
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Re: Do radiologists read the reports they sign off on?

Postby Bev G » Fri Sep 09, 2011 11:06 am

Hi:

I don't know if anyone is really interested, but thought I would try to explain how this could happen, actually all too easily.

My husband reads "level 4" fetal ultrasound scans most of the day. There is a list on the computer when he is writing a report, and the list is really long and on the list is EVERY component in the fetal body. In his system, only the component of concern, that HE clicks on comes up on the screen (for instance, a fetal heart) and then there are about 20 measurements he makes, with comments. If he has no comments on a particular organ system, another long list comes up, and he can write "unremarkable" or "no change from prior scan". In your case, I suspect your radiologist's screen defaulted to another person's scan, and he was supposed to up date their thoracic skeletal situation, and just forgot to delete it, or complete for your results. What's awful is the terror that causes. These guys should put all their concentration into what they're doing. In my husband's practice all the docs read each others reports before they get mailed, just so this doesn't happen. All it takes is the interruption of a phone call to distract them from where they were on the report, allowing this to happen. Doesn't mean they aren't great docs though.

HTH, Bev
58 yo Type1 DM 48 years
12/09 Stage IV 2/22 nodes + liver met, colon resec
3 tx FOLFIRI, liver resec 4/10
9/10 6 mos off chemo, Neg PET&CTC CEA nl
2/11 finished total 10 rounds chemo

9/13 ^17th clean PET/CT NED for now

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Kathryn in MN
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Re: Do radiologists read the reports they sign off on?

Postby Kathryn in MN » Fri Sep 09, 2011 12:22 pm

Unremarkable skeleton! Good news!

I'm so sorry you had to go through the anxiety first before getting the real situation.

Irinotecan seems to be losing effectiveness for me as well. I am looking into SBRT. I would suggest you follow your gut on that one and look into possibilities within that avenue, and see what might be an option for you.
CRC AUG09 Age 47
Sig Res T4a N2a Mx, KRAS mut codon13
Mets bones & nodes
FOLFOX, FOLFIRI, Avastin, Radiation
Irinotecan, Zaltrap & STAR RFA
APR13 pleurisy & ascites - more chemo & draining
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surfingon
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Re: Do radiologists read the reports they sign off on?

Postby surfingon » Fri Sep 09, 2011 12:48 pm

Ditto what Bev said. We had the semi-horrifying experience of having a radiological report reading (ordered to check on whether lung nodules had grown) that stated that the had been a "interval increase" in the size of one of my husband's liver tumors-- and made no mention whatsoever of his lung tumors. At least we knew enough to realize that the radiologist reading it had not even read John's previous CT scan history and had NO idea that John had had RFA on the liver tumor in question (which was why it was bigger).

When we called out trusted interventional radiologist on this (the one who did the RFA), he was pissed, confirmed out conclusion about the liver tumor, and said: "This guy wasn't paying attention! The entire report will have to be re-written." So yes, our sad experience is that the answer to your question is, sometimes: No. Either that, or they read them over, but their brain isn't in gear...
caregiver to husband John
Stage III CC 3-05
liver+ colon resect Nov '06
FolfoxA , FolfiriA
7 liver RFA's, 1 lung RFA
died April 29, 2009
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juliej
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Re: Do radiologists read the reports they sign off on?

Postby juliej » Fri Sep 09, 2011 2:23 pm

I agree with Kathryn - unremarkable thoracic skeleton is great news!

Thanks, Bev, for the explanation of how this could happen. I did have one odd reading from a CT scan. The "impression" at the end said a lesion was smaller, but the measurements were a larger number. I mildly freaked out (not knowing which was correct) and went to the radiology department and ask for it to be reread. The radiologist left on vacation right after reading my scan, so the head of radiology did the second reading. The numbers were wrong - it had indeed gotten smaller.

I asked if it was a problem with the dictation program (voice recognition programs don't always understand what the user is saying). He said that was probably it, but all his radiologists were required to read over their transcriptions to make sure they are accurate. He apologized profusely and said a cancer patient should never be frightened like that. I have a feeling the vacationing guy got an earful when he returned!
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 9/23/2019, CEA<1

nicola smith
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Re: Do radiologists read the reports they sign off on?

Postby nicola smith » Fri Sep 09, 2011 3:02 pm

In my case, it's taken the hospital 6 months to give me the abdominal CT scan I've been asking for. Instead, they keep printing off the chest CT that was done at the same time (and charging me $10 bucks for it) :shock: . The oncologist's office did tell me the abdo scan results were fine, but imagine how great I felt yesterday to actually read the words "no evidence of disease" in the abdo for the very first time. :D
UC history
11/09: Dx, CEA 2.9
02/10: colectomy, temp ileo; pT3N1Mx
10/10: 12 Folfox6
03/11: jpouch
2010/11/12/13/14: 6 PET and/or CT's - NED
quarterly 03/2010- 03/2015: CEA range 0.8-1.3
03/2015: discharged to GP :D

dianne052506
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Re: Do radiologists read the reports they sign off on?

Postby dianne052506 » Fri Sep 09, 2011 4:57 pm

So Bev,
If I promise to be nice, do I call the radiology group and point out this error? As I said, I didn't freak, but it would have been nice not to have that week of uncertainty.
Thanks.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

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lohidoc
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Re: Do radiologists read the reports they sign off on?

Postby lohidoc » Fri Sep 09, 2011 5:09 pm

Oh those radiologists....they are a breed apart! In medical school we could pretty much tell who was going to be a radiologist.... a certain deficiency in people skills.... Bear in mind that for them human beings are nothing more than a collection of images. Yes they use voice recognition with sometimes incomprehensible results. And although they are supposed to read the reports before signing off they seem to do so with half their brain. I have had numerous instances where very obvious fetal abnormalities were missed with calamitous results, other reports where measurements were given in cm rather than mm, and garbled reports that I could not interpret.

When my colonoscopy revealed cancer I had a CT scan the next day. I sat down with the radiologist to go over my images. He was a colleague, I had consulted with him many times, discussed patients etc. As we looked at my pictures it was obvious he enjoyed his work. With relish he pointed out the tumour, its alarmingly large size. growth through the bowel wall and the involvement of numerous lymph nodes. Do you mind he said, halfway through his horror monologue, if I continue eating (a plate of raw carrots was in front of him, presumably to aid his vision in the perpetual twilight in which he spends his lonely days). No evidence of distant mets (a note of disappointment here) but he added, hopefully, an MRI may be more sensitive. Son of a bitch - I have been waiting for an opportunity to vent! Findings at surgery btw were bad enough, but nowhere near as bad as his report suggested.

Very glad for you it was a misprint!
"Half of what I know is wrong. I don't know which half."

Age 56
Dx 19/7/11
R. hemicolectomy 25/7/11
IIIc, 7 / 23 nodes,
no mets
Folfox 21/8/11
CT Scan 6/3/12 NED
CT Scan 21/6/12 30+ lung mets, 2 retroperitoneal tumours
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dianne052506
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Re: Do radiologists read the reports they sign off on?

Postby dianne052506 » Fri Sep 09, 2011 6:54 pm

lohidoc wrote:Oh those radiologists....they are a breed apart! In medical school we could pretty much tell who was going to be a radiologist.... a certain deficiency in people skills.... Bear in mind that for them human beings are nothing more than a collection of images.


To anyone who is a radiologist, or who has a good relationship with one, I do apologize, but I thought this was funny. I remember at some early scan, I had a question that the technician couldn't answer. I asked if the radiologist would be able to answer. Her response, "Oh, radiologists aren't allowed to talk to people." It sounded a little weird at the time.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

Holly
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Re: Do radiologists read the reports they sign off on?

Postby Holly » Sun Sep 11, 2011 10:33 am

While I am grateful you had the scan reread, it is my experience that most radiologists do dictate their reports and the transcribed report is then electronically signed. While this may not be the most error free process, it for negligence that licensed radiologists or any physicians hold liability insurance.

Please remember as we are human, so are the physicians, whose expertise we seek. We live in an imperfect world. If you ever have concerns about scans, treatment, or other, I would encourage you to be proactive in the management of your healthcare. You know your body and health better than anyone else. Ask questions lot of them and demand answers for which you understand.

I am sorry for the anxiety you must have felt be the first report; I am happy your oncologist worked with you as a team to see the first report was amended. All things are truly possible, if you believe.

Hugs,

Holly

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Bev G
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Re: Do radiologists read the reports they sign off on?

Postby Bev G » Mon Sep 12, 2011 1:57 am

dianne052506 wrote:So Bev,
If I promise to be nice, do I call the radiology group and point out this error? As I said, I didn't freak, but it would have been nice not to have that week of uncertainty.
Thanks.
Dianne


I wouldn't even necessarily be nice :D , but yeah, I would call first thing in the morning. I'm so sorry you went through this.
58 yo Type1 DM 48 years
12/09 Stage IV 2/22 nodes + liver met, colon resec
3 tx FOLFIRI, liver resec 4/10
9/10 6 mos off chemo, Neg PET&CTC CEA nl
2/11 finished total 10 rounds chemo

9/13 ^17th clean PET/CT NED for now

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Bev G
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Re: Do radiologists read the reports they sign off on?

Postby Bev G » Mon Sep 12, 2011 2:07 am

dianne052506 wrote:
lohidoc wrote:Oh those radiologists....they are a breed apart! In medical school we could pretty much tell who was going to be a radiologist.... a certain deficiency in people skills.... Bear in mind that for them human beings are nothing more than a collection of images.


To anyone who is a radiologist, or who has a good relationship with one, I do apologize, but I thought this was funny. I remember at some early scan, I had a question that the technician couldn't answer. I asked if the radiologist would be able to answer. Her response, "Oh, radiologists aren't allowed to talk to people." It sounded a little weird at the time.
Dianne


That's so funny. After my first PET/CT the radiologist (who I think is a wonderful man) said that he wanted to review my films with my husband. So I say, naturally I thought, well, I'm going too, they're my films. There were about 6 radiologists sitting in this cave. When I walked in there with DH the whole place froze and I thought everyone stopped breathing. OMG, it's...it's...it's..a...p-e-r-s-o-n...in...here. Not husband, mind you...me. So I stood there for about a minute while the doc was talking to my husband (I was invisible) and he was so acutely uncomfortable he was practically bleeding through his skin or something, so I left. One could practically hear the sigh of relief as I exited :lol: . However, to his credit, the guy said to my husband, "Make sure Bev has all of her scans on a day I'm here, I want to be the only one who reads them, because now I know her (whatever, guts, I guess)." This has been of real benefit to me because of the lung suckers we're watching, and he knows what my post-op liver looks like.

They certainly do seem to be a little anti-social though. Oh.... and did I tell you all the one about how the last one in July said I have CORONARY ARTERY DISEASE??!!!?? Had never seen that on a report before. DH says, well, of course you do, you've had type 1 diabetes for 45 years! Oh, OK then, thanks a lot. JERK! Gee, maybe I'll die of an MI and not cancer :wink:
Last edited by Bev G on Mon Sep 12, 2011 7:37 am, edited 1 time in total.
58 yo Type1 DM 48 years
12/09 Stage IV 2/22 nodes + liver met, colon resec
3 tx FOLFIRI, liver resec 4/10
9/10 6 mos off chemo, Neg PET&CTC CEA nl
2/11 finished total 10 rounds chemo

9/13 ^17th clean PET/CT NED for now


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