Projectdetails

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Do medical doctors follow the recommendation of the radiologist and what happens to the patient if they do not?

Keywords:
medical imaging Advice Recommendation

Researchers:
Dr. T.C. Kwee
Dr. D. Yakar

Nature of the research:
Cross-sectional research

Fields of study:
general internal medicine radiology nuclear medicine

Background / introduction
Medical imaging involves the use of technologies such as x-ray, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging techniques, to visualize the human body and diseases for diagnostic and treatment purposes. They are routinely requested by virtually all medical doctors, ranging from general practitioners to surgeons, and from cardiologists to neurologists. In the UMC Groningen, more than 200,000 medical imaging procedures are performed annually. Radiologists are medical specialists who are trained in the evaluation of these often complex examinations.

Sometimes, findings on medical imaging examinations are not clear-cut for a certain diagnosis. In such a case, the radiologist may advice the doctor who requested the examination, to do another examination (e.g. MRI after an initial CT-scan) or biopsy (i.e. acquisition of tissue material) to clarify the nature of the perceived abnormality (the attached figure shows such an example). Usually, the advice of the radiologist is followed, but this is not always the case. This may be due to the referring physician's belief that the imaging examination was overinterpreted (i.e. the perceived abnormality was considered clinically irrelevant to the patient). However, the consequences of disregarding this recommendation are not clear yet.
Research question / problem definition
1. How often are recommendations by the radiologist not followed by the referring medical doctor?
2. What are the clinical consequences to the patient if this advice is not followed?
Workplan
This project is suited for a medical student (either Bachelor or Master phase) for a period of 3 (minimum) to 6 months. The final product will be a co-authored scientific article. Time schedule: part 1: familiarisation with the topic; part 2: data collection; part 3: data analysis and manuscript writing. During this research internship, there is also the possibility to accompany the radiologist with daily clinical activities and attend clinical meetings with other medical specialists.
References
1. Sistrom CL, Dreyer KJ, Dang PP, Weilburg JB, Boland GW, Rosenthal DI, Thrall JH. Recommendations for additional imaging in radiology reports: multifactorial analysis of 5.9 million examinations. Radiology 2009;253:453-461
2. Arenson RL. Recommendations for additional imaging in radiology reports: radiologists' self-referral or good clinical practice? Radiology 2009;253:291-292
3. Karantanis D, Kalkanis D, Czernin J, Herrmann K, Pomykala KL, Bogsrud TV, Subramaniam RM, Lowe VJ, Allen-Auerbach MS. Perceived misinterpretation rates in oncologic 18F-FDG PET/CT studies: a survey of referring physicians. J Nucl Med 2014;55:1925-1929
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