Aa
S.T.U.P.I.D. extends to radiologists!
How does this guy keep his job?!! (I've heard a rumor that he won't much longer where he is) The guy that read my latest 3T brain MRI is the same nimrod that tortured me with my lumbar puncture then told me I had a migraine when I had a spinal headache.
OK, I got my report today. It was pretty brief, basically saying that given differences between techniques, it was pretty much the same as my previous MRI, with a couple new new discrete lesions (actually giving the location), which didn't definitely enhance. Said the deep white matter lesions are compatible with my reported history of multiple sclerosis.
A couple new lesions in the past year, I've been on Avonex less than 6 months, what does that mean?
It means the guy is an idiot. I looked again, and he compared my new 3 T MRI with the 1.5 I had done 6/17/08!
I had checked right after my MRI to make sure that the films from 4/30/09 were available for comparison, and they were. He just didn't look; grabbed the first brain MRI he came to.
I called the film library and explained the issue to them, and they are going to have him amend his report. I asked if it would be the best for him to do it, or if maybe the neuro-radiologist, who first noticed that I had MS should read it when he's back from vacation next week, but was told it was the idiots job to do the amendment. Joy. Hopefully he'll be more careful.
I think my neurologist will do a better job anyway, but I'm always curious to see the report, and I don't see Dr. C. until June. I do see the nurse practitioner in May; not sure how she is at such things. Sigh.
I feel better now, thanks!
OK, I got my report today. It was pretty brief, basically saying that given differences between techniques, it was pretty much the same as my previous MRI, with a couple new new discrete lesions (actually giving the location), which didn't definitely enhance. Said the deep white matter lesions are compatible with my reported history of multiple sclerosis.
A couple new lesions in the past year, I've been on Avonex less than 6 months, what does that mean?
It means the guy is an idiot. I looked again, and he compared my new 3 T MRI with the 1.5 I had done 6/17/08!
I had checked right after my MRI to make sure that the films from 4/30/09 were available for comparison, and they were. He just didn't look; grabbed the first brain MRI he came to.
I called the film library and explained the issue to them, and they are going to have him amend his report. I asked if it would be the best for him to do it, or if maybe the neuro-radiologist, who first noticed that I had MS should read it when he's back from vacation next week, but was told it was the idiots job to do the amendment. Joy. Hopefully he'll be more careful.
I think my neurologist will do a better job anyway, but I'm always curious to see the report, and I don't see Dr. C. until June. I do see the nurse practitioner in May; not sure how she is at such things. Sigh.
I feel better now, thanks!
Ah, I think I answered my own question. How unlike me.
http://www.medhelp.org/posts/Multiple-Sclerosis/Consortium-of-MS-Centers--MRI-Protocol-for-the-Diagnosis-and-Follow-up-of-MS/show/672070
http://www.medhelp.org/posts/Multiple-Sclerosis/Consortium-of-MS-Centers--MRI-Protocol-for-the-Diagnosis-and-Follow-up-of-MS/show/672070
Hmmm. After the gadolinium is injected, how long should they wait before taking the images that could show enhancement? I admit to paying no attention to that on Monday, but I don't think it was very long at all.
slightlybroken (I'm glad that you're recovering from the recall repairs!),
In his original report, it sounds like they are new:
" A couple of new more discete lesions are suggested, for example, just periperal to the posterior right lateral ventricle IFLAIR image #17)."
But in the amendment is is unclear what he meant! I did look at that image, and I saw what he meant; there does seem to be a small new lesion there. Nothing is enhancing after contrast, but they administered it and did the final scans in about 5 mins. total, so who knows when the new ones showed up.
It sure would be nice if there was some standard way of reporting.
Kelly, I'm disappointed for you to have a neurologist that assumes the radiologist's report is right. Glad you spoke up and had him take a look and see that lesion! That's not exactly a small thing.
I had former 3T spinal films read by radiologist as having multi-segment linear lesions. My MS specialist looked at them and said that they were seeing a blood vessel, for pete's sake!
Hey, you're in Colorado Springs! I'm going there next month for a week with a friend who's going there for a conference. Tell me if there's anything I've just got to see, or what are great places to eat. I like healthy food; heck, I like food, lol. Whole grains and veggies make me happy. I like a good pizza, too. Oh, and good chocolate.
I know there's some fabulous scenery around there; I'm so looking forward to it!
Kathy
In his original report, it sounds like they are new:
" A couple of new more discete lesions are suggested, for example, just periperal to the posterior right lateral ventricle IFLAIR image #17)."
But in the amendment is is unclear what he meant! I did look at that image, and I saw what he meant; there does seem to be a small new lesion there. Nothing is enhancing after contrast, but they administered it and did the final scans in about 5 mins. total, so who knows when the new ones showed up.
It sure would be nice if there was some standard way of reporting.
Kelly, I'm disappointed for you to have a neurologist that assumes the radiologist's report is right. Glad you spoke up and had him take a look and see that lesion! That's not exactly a small thing.
I had former 3T spinal films read by radiologist as having multi-segment linear lesions. My MS specialist looked at them and said that they were seeing a blood vessel, for pete's sake!
Hey, you're in Colorado Springs! I'm going there next month for a week with a friend who's going there for a conference. Tell me if there's anything I've just got to see, or what are great places to eat. I like healthy food; heck, I like food, lol. Whole grains and veggies make me happy. I like a good pizza, too. Oh, and good chocolate.
I know there's some fabulous scenery around there; I'm so looking forward to it!
Kathy
Oh, I'm jealous that you have access to a 3T MRI. As far as I know, we don't have one yet in Colorado Springs. Plus, I don't think my neuro looks over my MRIs; I think he just assumes that the radiologist who reads them knows what he's doing. I had to talk him into looking over my MRI image, explaining to him that yes, I do really have symptoms. After he reviewed the MRI image, he agreed that there was a lesion (about 1 1/4 inch long by 5 mm wide) on my spine that was originally listed as an artifact by the radiologist.
I'm not sure if he's saying that you have new lesions, or they are just more pronounced, or if they have increased in size.
I think they should make all radiologist interpret the same way. If they find lesions, they need to give locations, and sizes. They need to plainly put information in the report, so if things change, then it will be caught.
I hate it when these radiologist give reports that have no sizes of the lesions, sometimes not very good locations..they are mediocre reports, and not worth the paper they are printed on.
Just my opinion
I think they should make all radiologist interpret the same way. If they find lesions, they need to give locations, and sizes. They need to plainly put information in the report, so if things change, then it will be caught.
I hate it when these radiologist give reports that have no sizes of the lesions, sometimes not very good locations..they are mediocre reports, and not worth the paper they are printed on.
Just my opinion
I went and looked at your pix of your MRI, and posted on the one that Bio did. I see the spot that you mention and the smaller one, too. The bright one is larger than the ones on my MRI that the radiologist noted.
I'll be interested to hear what your neuro has to say about them. Only a couple more weeks!
I'll be interested to hear what your neuro has to say about them. Only a couple more weeks!
I dunno, Kathy. I posted three photos last night and this afternoon from the MRI I had yesterday. Am I nuts, or is there some kind of spot pretty evident on all three of them, that seems to be the same object? Just heard from my neuro's office that the radiologist's report says it's essentially unchanged from the January '09 views. I went back through those, just to make sure I hadn't missed anything, because the '09 radiologist sure hadn't described anything like what I think I see in these pix. I can't figure. Well, I have an appointment with the neuro now on May 6th. I guess we'll see what he has to say then.
I picked up the amended report yesterday. He put the reason for amendment was that a more prior exam was now available for review (like it wasn't before!?)
All he did was write a new impression, which basically used the same words as the previous report rearranged.
This is what he wrote for IMPRESSION of the 04/30/09 3T MRI:
"Again, the number and overall configuration of these numerous subcortical and periventricular T2 signal hyperintense slesions are similar. A couple of lesions are slightly more discrete in appearance including for example along the right cerebral white matte (image #17 FLAIR sequence) frontal lobe and again just peripheral to the posterior right lateral ventricle."
In the previous report (of the 07/17/08 1.5T MRI) under FINDINGS he wrote:
" Again seen are numerous scattered primarily millimeter-sized T2 hyperintense lesions throughout the subcortical and periventricular white matter, generally similar in overall extent and pattern to that seen on the prior examination, when accounting for differences in technique between studies. A couple of new more discete lesions are suggested, for example, just periperal to the posterior right lateral vntricle IFLAIR image #17). No definite areas of contrast enhancement associated iwth these lesions are seen."
And under "IMPRESSION:
Accounting for differences in technique between examinations, generally similar extent and configuration to the numerous millimeter-sized T2 hyperintense lesions scatterd about the deep white matter compatible with the patient's reported history of multiple sclerosis."
My friend in the business said that he wouldn't be paid again for reading the same MRI, but I would have to pay out-of-pocket for having another radiologist read it. I know, I know, what really counts is my neuro's reading of my MRI.
So, do you think I have a couple of new lesions, or not? I guess I really have to wait for my MS specialist's impression, but I thought I'd see what you all thought of this kind of radiologist.
Kathy
All he did was write a new impression, which basically used the same words as the previous report rearranged.
This is what he wrote for IMPRESSION of the 04/30/09 3T MRI:
"Again, the number and overall configuration of these numerous subcortical and periventricular T2 signal hyperintense slesions are similar. A couple of lesions are slightly more discrete in appearance including for example along the right cerebral white matte (image #17 FLAIR sequence) frontal lobe and again just peripheral to the posterior right lateral ventricle."
In the previous report (of the 07/17/08 1.5T MRI) under FINDINGS he wrote:
" Again seen are numerous scattered primarily millimeter-sized T2 hyperintense lesions throughout the subcortical and periventricular white matter, generally similar in overall extent and pattern to that seen on the prior examination, when accounting for differences in technique between studies. A couple of new more discete lesions are suggested, for example, just periperal to the posterior right lateral vntricle IFLAIR image #17). No definite areas of contrast enhancement associated iwth these lesions are seen."
And under "IMPRESSION:
Accounting for differences in technique between examinations, generally similar extent and configuration to the numerous millimeter-sized T2 hyperintense lesions scatterd about the deep white matter compatible with the patient's reported history of multiple sclerosis."
My friend in the business said that he wouldn't be paid again for reading the same MRI, but I would have to pay out-of-pocket for having another radiologist read it. I know, I know, what really counts is my neuro's reading of my MRI.
So, do you think I have a couple of new lesions, or not? I guess I really have to wait for my MS specialist's impression, but I thought I'd see what you all thought of this kind of radiologist.
Kathy
Thanks, my friends. I'm too familiar with this guy, having had that awful LP experience with him (and finding out later that he wasn't even an interventional radiologist; he apparently just thought he could do it and make more $$$). He also read my first full spine MRI, and did a quick job of it.
WAF, I know the group of radiologists that reads my films, both from having had many films read by them and knowing someone that works with them. No NightHawk service here! I go directly from my MRI or whatever to request a copy and sign a release of information form and arrange to pick up the report as soon as its ready.
When I go to the film library to do that, I can see the board that lists which radiologist's are assigned to what, which are on vacation, etc. This guy must have been a floater, because another doc was on the board, and he has done a decent job in the past for me. Darn! Oh well, I'll get the amended report and then see what my neuro's office says.
Kathy
WAF, I know the group of radiologists that reads my films, both from having had many films read by them and knowing someone that works with them. No NightHawk service here! I go directly from my MRI or whatever to request a copy and sign a release of information form and arrange to pick up the report as soon as its ready.
When I go to the film library to do that, I can see the board that lists which radiologist's are assigned to what, which are on vacation, etc. This guy must have been a floater, because another doc was on the board, and he has done a decent job in the past for me. Darn! Oh well, I'll get the amended report and then see what my neuro's office says.
Kathy
Right you are! And sadly, many MDs give great weight to or rely solely on the radiologist's opinions as expressed in the reports, taking them as the final word, putting roadblocks in the way of our diagnoses or treatment.
I'm aware of too many false negatives in radiology reports: One was an orthodontist's husband whose MRI was read as completely normal. Six months later, feeling worse than ever, he had the same MRI read by another radiologist and was informed he had pancreatic cancer which was absolutely true, from which he died in a few months.
Another time a mammography film was read as "negative" by a sloppy radiologist who then (lucky for the patient) threw the film in the wrong pile - in the pile of "films-to-be- read" rather than the pile of "already-read films." A different radiologist then picked up the film and found signs very suspicious for breast cancer.
Quixotic1 and I both had the experience of being told that our MRIs had one UBO (unidentified bright object) which was considered "normal for age." My deteriorating symptoms contradict that conclusion and, of course, Quixotic1 ended up with an MS diagnosis.
One thing to consider is that hospitals often use a service called "NightHawk" which is an online service of reading x-rays usually after hours. Their radiologists read them from anywhere in the world.
WAF
I'm aware of too many false negatives in radiology reports: One was an orthodontist's husband whose MRI was read as completely normal. Six months later, feeling worse than ever, he had the same MRI read by another radiologist and was informed he had pancreatic cancer which was absolutely true, from which he died in a few months.
Another time a mammography film was read as "negative" by a sloppy radiologist who then (lucky for the patient) threw the film in the wrong pile - in the pile of "films-to-be- read" rather than the pile of "already-read films." A different radiologist then picked up the film and found signs very suspicious for breast cancer.
Quixotic1 and I both had the experience of being told that our MRIs had one UBO (unidentified bright object) which was considered "normal for age." My deteriorating symptoms contradict that conclusion and, of course, Quixotic1 ended up with an MS diagnosis.
One thing to consider is that hospitals often use a service called "NightHawk" which is an online service of reading x-rays usually after hours. Their radiologists read them from anywhere in the world.
WAF
Kathy,
That wasn't funny silly!!!
Sorry you had to put up with the idiot again
Hugs,
Erin :)
I know what you mean about wanting not onlky to read your reports but to have them "Accurately" read! What a goofy coincidence that the same Radiologist read this one too.
Anyhow, good for you in calling to see about getting it compared to the "Right" (more recent) MRI.
Take Care,
~Tonya
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