Reading radiographs like a crime scene investigator (Proceedings)

Reading radiographs and crime scene investigation require similar skills. Both require identifying a victim, crime, considering the most likely suspects, looking for clues and then building your case or "telling the story". Sticking to these principles will result in a higher conviction rate.

Taking the analogy to veterinary medicine requires replacing the victim with the patient and the crime with the clinical signs. The most likely suspects are based on signalment, history and clinical signs. The clues are your radiographic or roentgen findings. The last and most important final step is telling the story. Here is where you, the clinician, put everything together to conclude what is most likely going on without shutting out other secondary and tertiary possibilities.

A very bright colleague of mine once said:

"Common things in an uncommon location or presentation happen more commonly than uncommon things in a common location or presentation".

This statement should be a guiding principle prior to your radiographic investigation reinforcing the importance of associating the clinical patient (signalment) and history with the radiographic images. One phenomenon that I witness with radiograph interpretation is what I term dissociation. Dissociation is the act of unconsciously separating the radiographs from the clinical patient. For whatever reason some people will interpret radiographs without keeping the big picture in mind. Dissociative interpretation can lead to erroneous conclusions and improper case management. Relating your radiographic findings, and ultimately your story, back to the clinical picture is a big part of radiographic interpretation.

Another important aspect of proper radiographic interpretation is having a list of "possibles" in your mind prior to reviewing your radiographs. I am in no way advocating making your radiographic findings fit your predetermined diagnosis but I do believe having a few differential diagnosis in mind prior to interpretation will help you get into the correct mindset and minimize your chance of dissociation.

The last aspect of proper radiographic interpretation centers around telling the story. Your story needs to be based in facts or radiographic findings and logic. Consider your story to be your closing argument in a court case. Would a jury of your peers agree with you?