Meet Dr. Edwin van Beek, MD, PhD, Diagnose.me expert on Pulmonary Radiology, Cardiac Imaging, Vascular Imaging, Oncology Imaging and PET Imaging and find out what he thinks about second opinion:
My main interest is related to cardiothoracic imaging and oncologic imaging. I specify cardiothoracic as a single entity, as my experience has taught me that you need to look at the entire chest and many additional important diagnoses may be evident from CT scans ordered for either cardiac of pulmonary referring physicians. The way I see this (and increasingly I am not the only one!) is that radiology forms a bridge between the various specialities. Patients present with similar symptoms, and often the referral to diagnostic radiology and the questions asked depend on which specialist has seen the patient.
“For instance, a cardiologist will approach chest pain differently than a pulmonologist. It takes a comprehensive evaluation by a dedicated radiologist to reach conclusions that will aid the correct treatment decision for the patient.”
There are challenging cases, often due to the way a patient has entered the diagnostic pathway. In addition, the chest is a tricky area due to the many moving organs, breathing artefacts, cardiac motion and pulsation artefacts that can all lead to difficult evaluations of the images. It isn’t always feasible to give a 100% conclusion in these cases, but with experience it is possible to offer a preferred diagnosis.
Another problem is related to the clinical information provided to the radiologist.
“It is quite easy to mislead a radiologist, which may result in a different preferred diagnosis. This is a true challenge and it is often the case that clinical information needs further details prior to a final report being issued.”
Lastly, multi-modality imaging offers a great new capability to diagnostics, but also causes potential problems due to conflicting findings, image misregistration or because the parts of a single integrated investigation are not correctly aligned.
There have been episodes where a second opinion has led to a change in diagnosis or therapeutic management. It is well known that radiologists may disagree on the interpretation, and having particular knowledge and experience often help come to a correct conclusion. Furthermore, the radiologist may easily oversee a finding due to the huge amount of imaging data and information that now form part of a single exam – not infrequently 3000 – 5000 images may be obtained in a single diagnostic test! The use of interpretation software only goes so far – in the end it is the radiologist who needs to come up with the correct (differential) diagnosis.
“Diagnose.me offers a platform for patients to directly seek help in their diagnostic pathway. A second opinion is not a bad thing and should not be seen as a sign of mistrust of the patient towards the radiologist.”
We already commonly “double” read examinations (by two experienced radiologists) as two pairs of eyes just see more. This isn’t too vastly different from that approach, although it is now in the hand of the patient to decide whether the diagnosis is adequately represented or that all avenues towards a diagnosis have been considered. I am pleased to be able to offer these services to patients through Diagnose.me.