Volume 91, Issue 1, Pages 1-276 (February 2011)
Diagnostic Imaging for the General Surgeon
Edited by Thomas H. Cogbill, Benjamin T. Jarman
Medical imaging isn’t all that much different from creative photography in some ways. Most of the images we use don’t really look like the real subject at all. Livers aren’t some Hounsfield gray color. Pulmonary arteries don’t have bright white blood running through them. Yet, we get used to looking at these images and making the translation in our minds. Even though current imaging devices are far more sophisticated in terms of digital manipulation of the acquired data, the images are still shadows of reality. To really understand what these shadows mean, one has to do two things: understand the process by which the images are created and compare a lot of images to the gold standard of reality.
The constant fractionation of care has divided the medical community into two nonequal groups: those who look at the images they request and those who read the reports. Perhaps one of my most annoying professional disappointments is when someone calls me about a patient and tells me what the “report” of an imaging study states without having looked at the images, even when the person calling requested the study be performed. One night on call, I was asked by a calling physician to see a patient because “the CT said (sic) the patient had a bowel obstruction.” I asked if he had seen the images of the patient he was calling me about. He replied, “Why should I? I am not a radiologist.” It turned out he had not seen the patient either---disappointing on many levels.
To get the best out of imaging, we need to choose imaging studies wisely and interpret them correctly. In order to do that, we have to understand the power and limitations of imaging and its applications, especially how these studies complement clinical evaluation instead of replacing the history and physical exam. Drs Cogbill and Jarman, along with their colleagues, have assembled a collection of articles that will give the reader a much better foundation upon which to improve their understanding of imaging. Still, practice will be required in order to refine these skills. One will only see what one looks for but only if one actually looks.
http://rapidshare.com/files/449298301/scna_feb_2011.rar
