Photos Increase Radiologist-Patient Connection

Seeing a patient's face in a photograph alongside a CT study prompts radiologists to give a more meticulous reading, according to a study presented at RSNA 2008.

"Including a patient photograph with the CT exam increased both the length of the report and the rate of reported incidental findings," said presenter Yehonatan Turner, M.D., a radiology resident at Shaare Zedek Medical Center in Jerusalem. Dr. Turner's study received significant mainstream media coverage during RSNA 2008.

Yehonatan Turner, M.D. Shaare Zedek Medical Center, Jerusalem

For the study, 267 patients referred for CT agreed to be photographed before their examinations. Patient consent was obtained and oncologic or emergency cases were excluded. The photographs were added to the patients' files on the department PACS among a total of 1,137 CT examinations performed at a single tertiary care hospital in January 2008. The photos appeared automatically when the patient files were opened.

To assess the effect on interpretation, 30 examinations containing incidental findings from the study group were shown again in a blinded fashion to the same radiologists three months later, without the patients' photographs.

Researchers examined the resulting reports, measuring the number of words in the report, number of incidental findings, the presence or absence of a summary section and the presence or absence of recommendation for care management. The 17 radiologists in the participating department also completed a questionnaire in which they rated their experience with the photographs in the exams.

Comparisons with the 30 cases presented blindly revealed that 80 percent of previous incidental findings were not reported when the photograph was omitted from the file. In their responses to the questionnaire, radiologists reported feeling more empathy for patients whose photos they saw, said Dr. Turner. "All radiologists involved reported that while the addition of the photograph did not lengthen the duration of the interpretation, it did render the interpretation more meticulous," he said.

Photos Make Each Scan Unique

Dr. Turner noted that radiologists surveyed agreed strongly with the statements "The patient photograph prompted me to relate in more detail to the CT" and "It enabled me to feel more of a physician." All those surveyed recommended adopting the practice to routine interpretation, he said.

"I think the most important statement they agreed with was that the photo makes each CT scan unique," said Dr. Turner, adding that including a photo could also be helpful in reducing patient identification errors. "The photographs also offered some additional medical information, such as signs of suffering or physical signs of disease—neurological signs, skin discoloration and hematoma," he said.

Dr. Turner acknowledged that routinely including photos in radiologic exams could invite interpretation bias on the basis of aesthetics—the radiologist could find the person attractive or unattractive. "However, that is relevant to all physician contact—physicians who meet patients face-to-face each day likely have those same biases," he said. "Our radiologists reported that attractiveness had no effect on their interpretation, but of course there is no way to measure that."

The idea for the study originated from realizing the different attitudes toward patients during ultrasound exams—performed by the radiologist—and CT exams, performed by the technologist, Dr. Turner explained. He noted that radiologists often review CT images at a later time or from remote locations and miss out on physician-patient contact.

"The addition of a photograph enables a more personal approach to the interpretation, especially when the radiologist is not in physical contact with the patient," said Dr. Turner. "It is important for radiologists to be aware that radiographs represent a patient, not merely just another case."

Sound Processing Differences in Autistic Children Draw Media Attention

A study showing that magnetoencephalography (MEG) can detect short but extremely significant delays in the ability of autistic children to process sound and language was also the subject of considerable media coverage during RSNA 2008.

Timothy Roberts, Ph.D. Children's Hospital, Philadelphia

"You hear a sound, and maybe a 10th of a second later there'll be a big burst of neuronal activity," said presenter Timothy Roberts, Ph.D., vice-chair of research in the Department of Radiology at Children's Hospital in Philadelphia. "That gets significantly and reproducibly delayed in children with autism. The delay is only a fraction of a second, about a 50th of a second, but we can capture that fraction very easily."

For the study, 64 children, ages six to 15, with a diagnosis of autism spectrum disorder along with a control group of typically developing children were evaluated with MEG. Audio stimulation was introduced to the children in the form of beeps, tones in pairs, vowels or sentences.

Sounds were presented at different frequencies and in tone pairs in rapid succession, including unusual streams of incongruous tones and vowels—for example, a "u" sound in a series of "a" sounds.

In the autistic children, there was a delay in the response of the superior temporal gyrus while processing the rapid succession sounds and the unusual streams. "These delays—fractions of seconds—don't sound like very much, but they're critically important when you consider every syllable we speak only lasts a quarter of a second," Dr. Roberts continued.

"Take the word 'elephant,'" he said. "If you're still dealing with the 'ele' and everyone else has moved on to the 'phant,' you can never catch up."

Because autistic children can have delays in developing speech, said Dr. Roberts, learning more about how their brains process sound is vital to designing more effective therapies tailored to each child's individual profile.

"We expect these results may someday identify those who may be good candidates for intensive speech therapy and those who may be candidates for another type of therapy," he said. "There may be emerging therapies and this will help stratify the patients. There's no such thing as one universal type of speech therapy.

"This is one way you'd be able to monitor the responsiveness, maybe before there's even any obvious behavioral response, because you'd be able to figure out whether the brain's actually processing the sound even if the child can't articulate a response," Dr. Roberts concluded.

Media Coverage of RSNA 2008

A study on an emerging condition known as self-embedding disorder proved popular with the mainstream media at RSNA 2008. "Radiologists are in a unique position to be the first to detect self-embedding disorder, make the appropriate diagnosis and mobilize the healthcare system for early and effective intervention and treatment," said study principal investigator William E. Shiels II, D.O. (at podium), chief of the Department of Radiology at Nationwide Children's Hospital in Columbus, Ohio.

Dr. Yehonatan Turner's study of adding photographs to imaging studies was one of 13 news conferences held during RSNA 2008. More than 4,000 stories have been carried by print, broadcast and online media outlets, reaching an estimated 2.9 billion person audience.

News conferences held during the annual meeting resulted in coverage in such publications as USA Today, Los Angeles Times and The Wall Street Journal, as well as placement on broadcast outlets including CBS News, CNN Headline News and ABC Newsradio. Stories also appeared on such Web sites as The New York Times and Washington Post online editions.