Communicating with the referring physician: the standard of care.

OBJECTIVE: This study sought to determine whether academic radiologists achieve the standard of care that the American College of Radiology recommends for communication of unexpected significant findings to referring physicians. CONCLUSION: Academic radiologists do achieve the recommended standard of care.

Direct disclosure by radiologists of imaging findings to patients: a survey of radiologists and medical staff members.

OBJECTIVE: A previous survey revealed that patients prefer to hear the results of imaging examinations from radiologists at the time of the procedure rather than be informed later by the referring physician. This study was performed to learn, by means of questionnaires, the attitudes of members of medical staff and of radiologists. SUBJECTS AND METHODS: Questionnaires were sent to members of the medical staff at my institution and to private and academic radiologists throughout the country. Respondents were presented with this statement: "If an adult patient who knows why a radiologic examination is being performed and what is being sought asks to know the results from the radiologist, the radiologist should answer truthfully (and immediately contact the referring physician with the results and the fact that the patient has been informed)." Five alternatives were presented: 1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree. Results were tabulated by department in the first instance and by state and character of practice in the second. The sum of the replies in each area was divided by the number replying to obtain a mean figure. RESULTS: The mean figure for members of medical staff was 2.35, which was on the agree side of neutral, indicating at least neutrality, leaning toward agreement, on the subject. The overall mean figure of 2.18 for radiologists indicates substantial agreement with the stated proposition. CONCLUSION: This study suggests that radiologists and referring physicians alike tend to support the proposition that, if asked, radiologists should disclose the results of imaging studies to patients.

Technical adequacy of fluoroscopic spot films of the gastrointestinal tract: comparison of residents and technologists.

OBJECTIVE: We compared images obtained during gastrointestinal fluoroscopy by specially trained and experienced technologists with those obtained by radiology residents to determine if the quality of images was similar between the two groups. MATERIALS AND METHODS: Three senior radiologists examined the fluoroscopic spot films of 80 patients who were divided evenly into four groups: barium enemas performed by technologists, barium enemas performed by residents, gastrointestinal series performed by technologists, and gastrointestinal series performed by residents. The senior radiologists graded adequacy of visualization of the esophagus, stomach, duodenum, and all parts of the colon. A grade of 1 was given for poor films, 2 for adequate films, and 3 for good films. They did not know who performed each study. RESULTS: For barium enemas, the residents' mean score was slightly higher than that of the technologists (13.5 compared with 12.9). For gastrointestinal series, residents' mean score was again slightly higher (20.5 compared with 19.7). In neither case did the difference reach statistical significance. CONCLUSION: Fluoroscopic films obtained by residents and by specially trained and experienced technologists for barium enemas or gastrointestinal series were statistically indistinguishable.

Disclosure of imaging findings to patients directly by radiologists: survey of patients' preferences.

OBJECTIVE: The purpose of this study was to determine if patients prefer to have radiologists tell them imaging findings immediately after the examination or if they prefer to hear the results later from their referring physician. SUBJECTS AND METHODS: A simple questionnaire was devised and distributed to 261 consecutive patients in the radiology department of a large university hospital. During a 10-day period, patients seen in several departmental sections (gastrointestinal, genitourinary, CT, sonography, mammography, chest, musculoskeletal) completed the questionnaire. Patients were asked if they wanted the radiologist to tell them if the results were normal; if the results were abnormal; if they would prefer to hear the results from their family doctor, internist, or other primary care provider; and if they felt entitled to an explanation of their test results. Results were tabulated and expressed as percentages. RESULTS: Analysis of the 261 questionnaires disclosed that 92% of patients wanted the radiologist to tell them if the results are normal. An additional 7% answered "Yes, but only if I ask." If the results are abnormal (cancer, for example), 87% wanted the radiologist to tell them. An additional 7% answered "Yes, but only if I ask." CONCLUSION: Our results show that most patients prefer to hear the results of imaging examinations from the radiologist at the time of the procedure rather than to hear them later from the referring physician, regardless of the findings.

Rectal diverticulosis: a case report and review of the literature.

The occurrence of rectal diverticulosis is rare. We report the incidental finding of a large rectal diverticulum in a patient receiving an air-contrast barium enema. The presence of uncomplicated rectal diverticulosis is probably of little clinical significance. However, there can be associated complications such as inflammation and perforation, and potential confusion with rectal carcinoma.

Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals.

The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina.(ABSTRACT TRUNCATED AT 250 WORDS)