[MissJ]

#22300

Thanks for this great forum. Recently, I was returned an X ray analysis which was ambiguous, fraught with clerical problems and errors which is unacceptable to me because it has many earmarks of the reader using ‘boiler plate’ and/or not paying attention. Hence I would like to ask if I have cause to request a re-reading based on my complaint of many inaccuracies in the communication within. I’ve included the facts, the text of the 4 ‘individual’ reports and also my letter to the radiologist. In essence, is this an example of a ‘standard’ reading or something that could arise from a radiology ‘sweat shop’ in India?

Do I have cause to request a re-reading regarding a sloppy, inattentive, ambiguous, self negating X ray analysis?

Here are the facts:

1: 4 parts of the spine were X rayed: Cervical, Thoracic, Lumbar and Sacral

2: Test names were:

a: X-RAY CERVICAL SPINE 4 OR 5 VIEWS. 2 Views were looked at
b: x-RAY TORACIC SPINE 2 VIEWS. 2 views were looked at
c: X-RAY LUMBAR SPINE 2-3 VIEWS. 2 views were looked at
d: X-RAY SACROILIAC“>SACROILIAC JOINTS 1 OR 2 VIEWS 2 views were looked at

3: CLINICAL INDICATION reads: “Lower and thoracic back pain” despite my prioritized areas of pain being communicated by me as CERVICAL and SACRAL. However, I requested the WHOLE SPINE be looked at.

4: TECHNIQUE states 4 views of the cervical spine were looked at when only 2 were looked at.

5: Except for the ‘Test NAMES’ and the ‘Exam Numbers’ listed on all 4 of the readings, EACH reading says the SAME THING because each reading is ‘stuffed’ with the (cursory) findings of the other 3. This type of stuffing or bundling kicks up self negating statements such as: “There is no spondylosis. Findings: “Cervical and lumbar spondylosis” along with other telltale marks of clerical errors, ambiguity, and inaccuracies.

6: I specifically requested a known competent radiolist to render the readings as to avoid a perfuntory reading.
——-

Here is how all of the readings read to say the same thing (after the test names and exam numbers are listed):

RESPONSIBLE INTERPRETER:
Leila Korashadi, MD-RIS ID: KHOL

EXAMINATION:

LUMBAR SPINE 2-3 VIEWS; CERVICAL SPINE 4-5 VIEWS; THORACIC SPINE 2 VIEWS; SACROILIAC JOINTS 1 OR 2 VIEWS.
—————————————————————-
CLINICAL INDICATION: Lower and thoracic back pain
——————————————-
TECHNIQUE: Two views of the lumbar spine, thoracic spine and sacroiliac“>sacroiliac joints.
Four views of the cervical spine.
———————————————
COMPARISON: None
—————————–
FINDINGS: Thoracic, lumbar and cervical spine vertebral body height and alignment/” class=”thirstylink” title=”alignment“>alignment is preserved. Foraminal are patent. There is no compression fracture. There is mild facet arthropathy at L5-S1.
—————————-
There is loss of intervertebral disc height at C4-5,C5-5, and C6-7.
———————————————————————–
Facet arthropathy is noted these levels. Oblique views demonstrate patent foramina.
————————————————————————————
Sacroiliac joints are aligned. There is right greater than left inferior spurrring, consistent with arthritis/” class=”thirstylink” title=”arthritis“>arthritis. There is no spondylosis. Sacral foramina are congruent.
———————————————————————–
IMPRESSION: Cervical and lumbar spondylosis.
——————————————
Dictated: 04/20/2016 4:37 PM
—————————–
Reported by: LEILA KHORASHADI, M.D.
———————-
Yes
———————

Here is the letter I wish to send to the doctor. It points out all the errors in communication of which there are many:

Dear Dr. Khorashadi,

I am requesting that you do a re-read of my X rays. Because in this case, there appears to be a substantial clerical problem with the analysis, leaving it ambiguous and self-contradicting. I am confident that an accurately documented analysis would give a clear and unambiguous assessment — unlike the inaccurately documented analysis that has been provided — so that is why I am requesting a re-reading.

I originally requested that Dr. Sasson do the evaluation because:

a: He did my prior one in 2011; an evaluation to the PELVIS area where he noted problems to the lumbar region (facet arthropathy) in addition to arthritis“>arthritis of the hip (s).

b: His reading provided substantial descriptive language that would be useful (and was) to another provider reading his report.

c: I made clear to the X-Ray tech. there was NO RUSH and was willing to wait longer re. my selected radiologist.

Clinical Indication:

Although ‘pain’is the most obvious reason X rays are done, my request to the PCP for them was NOT so vague as that. As to prioritizing any 2 of the 4 areas of the WHOLE spine to be X rayed, my priorities were the cervical and sacral areas. That was because I’m already aware of the degeneration to the lumbar region (both Dr. Marianacci and Sasson have reported on it.) Yet had never had a cervical X ray and the sacrum was obstructed by gas per Marianacci’s past reading. X rays to the WHOLE spine were requested by me so the thoracic area was included, in the event the neck pain“>neck pain was coming from T1 or some back pain from T12. (There was no option to select from C1-T1 or T12 to L5.) Hence, WHOLE SPINE of which there are 4 parts to check off. Ultimately, I was aimed at getting closer to a differential diagnosis (eg a crystalline arthropathy) that could relate to my description of ‘attacks’ to MANY joints OTHER than the hip that is up for replacement.

To this regard, there exist errors in communication such as:

a: ‘CLINICAL INDICATION Lower and thoractic back pain’.

I also made clear to the X ray tech. the cervical, and sacral areas were the priorities to me of the areas of the WHOLE spine. There was even some deliberation during the process as to whether or not to X ray the thoracic area. Hence, I fail to see WHY ‘ lower and thoracic’ pain was PRIORITIZED as the clinical indication for ALL the X rays. It’s an example of a substantial clerical problem regarding accurate documentation.

b: “Test Name: X RAY CERVICAL SPINE 4 OR 5 VIEWS”

You list the ‘clinical indication’ for a cervical X ray of 4 or 5 views is: “Lower and thoractic back pain”. Why would pain in the lower and throctic area be an ‘indication’ for cervical X rays?????

c: Although the generic test name is: ” X RAY CERVICAL SPINE 4 OR 5 VIEWS”, you cite in the “TECHNIQUE” that were 4 views of the cervical spine when there were only 2.

IMPRESSION: “Cervical and lumbar spondylosis”

This is a VAGUE assessment. As with many other terms to describe spinal problems, spondylosis is more of an umbrella term than it is a clinical diagnosis. Literally it can be translated to mean that one has both pain and spine degeneration, regardless of what is causing the pain or where the degeneration is occurring. The very general language yields very little information. More descriptive detail is needed when the goal of the X rays was toward differential diagnosis. Although I don’t expect you to make one, I’m asking for more detailed observation and clearer language which would be more helpful to a provider reading your report. I’m looking for attentive observation and descriptive language that could relate to my arthritis/” class=”thirstylink” title=”arthritis“>arthritis as being secondary to CPPD (or rule that out). IF indeed there exist tell tale signs for better differentiation eg. such things as the shape of the osteophytes, chondrocalcinosis,some calcification of Annulus fibrosis of lumbar intervertebral disks or anything else that would relate to this, I would want them to be noted in the report.

Other Issues with this reading:

1: ‘Bundling’ of all 4 individual areas to be assessed in each ‘individual’ area to be assessed.

4 separate areas X rayed: Cervical, Thoracic, Lumbar and Sacral which are not addressed separately.

Each separate analysis is ‘stuffed’ with the observations of the other 3 such that each reads: ‘No spondylosis’ followed by findings of; ‘spondylosis’ (cervical and lumbar). This gives the appearance of a self negating statement on the thoracic and Sacral readings. It also gives (false) impression (via the length of each ‘individual’ reading) that more observation to those areas was given where it was not. It also makes it very confusing to read.

2: Repetitive and contradictory language such as:

a: The statement for: “EXAMINATION CERVICAL SPINE 4-5 VIEWS” is inaccurate because there were only 2 views of the cervical spine taken. The analysis repeats; “4 views of the cervical spine”. There were only 2.

b: The statement: “Oblique views demonstrate patent foramina” in relation to the Cervical spine is incorrect because you did NOT look at an oblique view. Again, there were ONLY 2 views of the cervical spine. They were Anterior/Posterior (AP) and Lateral.

3: The statement: “COMPARISON: None”, is incorrect. There ARE comparisons of the lumbar observations (pelvis area) in Dr. Sasson’s past analysis which exists in the MAH system which could have been referred to and also one by Dr. Marianacci.

4: There are things to be observed on the X ray that are not noted. For example:

a: Twisting of the lower spine in the lumbar AP.

b: Numerous osteophytes along the anterior cervical spine.

c: Calcification to the neck cartilage areas below the hyphoid bone which may RELATE to issues I have such as pain when swallowing or could relate to parathyroid gland where dysfunction of such is associated with CPPD.

d: Phelboliths and/or calcifications to soft tissue areas. Would have been helpful IF you noted calcifications because something like ‘chondrocalcinosis’ would help another provider regarding exploration as to CPPD.

I got these X rays in relation to my hip problem (hip replacement surgery). IF I had CPPD, a surgery could precipitate an attack to joints which could hinder needed post operative walking. IF there were any ‘signs’ I could have that, I could pro-actively seek out a rheumatologist (referral) for appropriate meds and/or make my hip doctor (Miegel) aware. Hence, I’m asking you to take a closer look at those X rays for a more detailed observation.

I would be very grateful for a re-reading which eliminates ambiguous, contradictory, and ill-targeted observations and includes more descriptive ones, which will help my providers determine if I have a calcium crystal deposition disease or something that could put me at risk for ossification around a joint implant.

Please let me know if you need any further information from me in order to proceed promptly with a re-reading.

Cordially,

[MissJ]

#22301

I don’t know why, but html code (in blue) keeps getting introduced into my text but I did not put it there.

[Donald Corenman, MD, DC]

#22309

I don’t think there is an intentional issue to deceive you with these readings. Radiologists are generally not too specific when they read X-rays and many are not trained in alignment (angulation, kyphosis and lordosis). X-rays can be very helpful to assist with a diagnosis but do not reveal the whole picture as they are two dimensional and don’t reveal any soft tissue problems (HNP, stenosis).

It is also not uncommon to get images that don’t specifically relate to the pain area. For example, upper thoracic pain typically originates from the cervical spine and sacral pain most commonly originates from the lumbar spine.

You might have comparison earlier views but if not taken on or read by the radiological group that is reviewing your current films, they will not have any idea of previous films. I have generally found that earlier films are not too helpful as to comparing current films for current symptoms.

This radiologist was “lazy” in reporting no foraminal stenosis on oblique views as you note there were no oblique views taken. This makes me concerned that he paid little attention to your images. He also did report a 4-5 view series so he was half asleep when he read your films and may have inadvertently read someone else and misreported the findings.

CPPD (calcium pyrophosphate disease-a kin to Gout) can occasionally be diagnosed by X-ray but is generally not that important in causing pain. (It can but is rare even in the presence of this CPPD disorder) Arthritis of the spine is rarely caused by CPPD as this tends to accumulate in the disc-not the facet joint.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[MissJ]

#22312

Dear Dr. Corenman,

Thanks for your response.

Just to clarify further, I’m not contending intent of the radiologist to deceive. But just trying to ‘hit home’ where this report is a prime example of someone not paying attention and due to that making multiple errors, which are clearly demonstrated by HOW the reader reports things. It gives rise to the question of whether or not the reader was looking at my report or if the reader was NOT the ‘in house’ doctor who’s name is on the report but rather an example of something ‘jobbed out’ to a radiology sweatshop abroad.

As to earlier comparisons, they actually existed within the SAME radiology group the radiologist is associated with; Mt Auburn Hospital, both available for cross reference. One of which was recent. So, her statement: “No comparison” as would relate to a reader having none available to even search for within the radiology group is exactly the thing that makes me question IF my X rays were ‘jobbed out’ to a teleradiology group abroad.

As to CPPD, yes, the discs could give a tell tale sign of that. But the issue here is that the radiologist is NOT paying attention to any detail. For example, on the X rays, there appears to be some calcification to the outer parts of the discs in addition to calcification elsewhere that could cross correlate.

Indeed these findings are misreported and that is substantiated by the many errors observed on it.

That said, I don’t know how to proceed as to get the matter rectified with a re-reading of my X rays. I have called the radiology department of MAH to request the department head do a re read and evaluate the report. But I got no response from them. My PCP told me: “Any doctor treating me would treat the same whether or not there was a re-reading.”

Is there a standard protocol as to how a patient can report an erroneous radiology report in order to get a more accurate reading?

[Donald Corenman, MD, DC]

#22313

I would call the hospital administrator and point out the discrepancies of the report and images that were really taken. This should be obvious to this administrator and they should correct the problem.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[MissJ]

#22320

Thank you. I have already called them 3X. But with no response. I shall send along the ‘issues’ of this report in written format to document I made them aware of it

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