7 troubleshooting tips to address ambiguous findings on radiographs

Often, imaging tests can produce radiographs that only create further confusion about a patient’s condition. These ambiguous findings may force radiologists to conduct even more tests, delaying treatment while subjecting individuals to unnecessary additional costs, sedation and anxiety.

Reasons for this ambiguity can vary, whether it’s an optical illusion or just a normal variation in one patient that appears to be a disease. But there are several problem-solving tips that radiologists can try to alleviate this uncertainty, researchers noted in a piece published last week (Oct. 21) in Current Problems in Diagnostic Radiology.

“Ambiguous findings are an inevitable part of radiology that have the potential to adversely affect patient care if not addressed properly. The radiologist should always consider the impact of their report and choose a course of action that minimizes any real or potential risk to the patient,” concluded Sachin Kumbhar MD, with the Medical College of Wisconsin, and colleagues.

They offered radiologists seven tips to help troubleshoot when navigating diagnostic uncertainty:

1) Radiologist believes finding is unlikely to be real: Clinicians may be inclined to skip a finding in the report if they don’t believe it’s legitimate. However, it’s beneficial to describe that thought to the referring provider to avoid creating the perception that something was missed.

2) Review patient’s prior images: Rather than reaching for a new test, it’s often helpful to peruse previous charts or x-rays, which may offer additional clues to clear up ambiguity.

3) Home in on the body part: Sometimes, findings may be located near the periphery of images, and radiologists may benefit from producing another dedicated image of the body party being examined.

4) Two-dimensional confusion: Radiographs are depicting a 3D anatomy on a 2D image, and occasionally, clothing can appear inside the body or anatomical structures may project over one another. In these cases, clinicians may benefit from a different radiographic view, or simply repeating the same radiograph.

5) Try the other side: Sometimes, variation in an image of an extremity can be confirmed by obtaining a radiograph of the opposite side for comparison. Conversing with the treating physician may be helpful to correlate with the site of a patient’s pain.

6) Think ahead: Radiologists should consider the downstream effects of the radiology report when contemplating ambiguous findings. “It may be helpful to think about the impact of dismissing a real finding as benign versus suggesting that a finding represents disease,” Kumbhar wrote.

7) Try another machine: Oftentimes obtaining an image using a different modality can help to clarify ambiguous findings while avoiding excessive radiation or other risks.

Whatever may be fueling the uncertainty, it’s clear that communication is crucial to addressing this issue, they conclude.

“An honest acknowledgement of uncertainty along with further recommendations to clarify the diagnosis can help the radiologist and the referring physician to maximize diagnostic accuracy together,” Kumbhar wrote.