Who Has the Final Say in Interpreting MRIs or X-Rays?

When it comes to interpreting medical images like MRIs or X-rays, it can be a complex situation. I had an MRI done on my knee, and my orthopedic doctor did not agree with the radiologist's findings. This led to a discussion on who has the final say in such scenarios.

Importance of Radiologists vs. Treating Physicians

The final say in interpreting MRIs or X-rays typically rests with the treating physician, especially in musculoskeletal issues with an orthopedic doctor. Radiologists are experts in interpreting imaging to diagnose conditions, but they do not have the full clinical context that the treating orthopedic doctor has. The orthopedic doctor combines the radiologist's insights with the patient's medical history and physical examination for a comprehensive diagnosis and treatment plan.

Disagreements and the Role of Multidisciplinary Review

Disagreements between the radiologist and the treating physician are not uncommon. These differences can arise from various factors, such as additional clinical information, prior patient history, or different expert opinions. Multidisciplinary discussion can help resolve these differences, leading to a more accurate and holistic treatment plan.

While radiologists have the final say on what goes into the radiology report, another physician or specialist can still have a different interpretation. For example, a surgeon might look at an MRI and disagree with the radiologist's findings. This can happen for various reasons, such as having additional information about the patient's clinical history or a different perspective on the imaging data.

Real-World Examples in Academic Medical Centers

In academic medical centers, there are specific processes for resolving disagreements in radiology reports. If a treating physician disagrees with the radiologist's interpretation, they often get a call to discuss the findings. This discussion can provide vital additional information, such as the patient's laboratory results or other clinical data, which can refine the diagnosis.

For example, in a case involving an ultrasound, I interpreted a pelvic ultrasound in a young woman with pelvic pain. The radiology report mentioned the possibility of an ovarian corpus luteal cyst or a rare ovarian ectopic. After discussing the case with the gynecologist, we discovered that the patient's serum beta hCG was negative, which ruled out an ectopic pregnancy. This discussion was also crucial for medicolegal reasons, as it helped to prevent potential malpractice claims based on incomplete or incorrect information.

The Role of Communication and Legal Considerations

Communication between physicians is vital, not only for improving patient care but also for legal reasons. Poor communication can lead to misunderstandings and subsequent medical malpractice claims. When treating physicians have access to the latest patient information, it helps to avoid misdiagnoses and inappropriate treatments based on incomplete data.

In conclusion, while there isn't a single definitive "final say" in interpreting medical images, the treating physician plays a crucial role in the decision-making process. Radiologists are the primary experts in imaging, but the treating physician integrates this expertise with clinical assessments to provide the best possible care for the patient.