A question to other members of this community here. However, I just wanted to compare other hospitals to what we do.
Our chief radiologist has a strict policy that ONLY thick slice images should be sent to PACS - for example, for a body CT or a head CT, only the 5 mm slices should be saved. In some cases, for example, CTPA, 3 mm are allowed, and 2 mm are allowed for ? Skull fracture. For something like a mesenteric angio CT, you can scan at 1mm, but the techs should do 10 mm MIPs, and only the MIPs should be saved.
Similarly, he doesn't allow the use of volume sequences in MRI. At a previous site, we would always do an MPRAGE 1mm for epilepsy, brain tumors, etc. This radiologist is adamant that MPRAGE/FLAIR3D, etc should NEVER be done, except for neurosurgery planning. So, for example, a brain tumor patient may get an MPRAGE on the 1st scan for surgical planning - but all follow-ups have to be done at 4 mm.
Interestingly, some of the other radiologists don't always agree with this - and we sometimes get scans protocolled like "Epilepsy protocol + add MPRAGE and 3DFLAIR on my authority. Mark as Dr X only to report. Signed Dr X".
The chief is a medico-legal specialist in medical malpractice, so spends a huge amount of time in court dealing with malpractice cases as a medical expert. His argument goes like this:
If you have 5 mm slices, then you may miss a small tumor or other lesion. This is because the images are blurred or the lesion is indistinct and it is not possible to tell what it is. Missing a tumor because it is not clearly visible IS NOT malpractice - it is a limitation of imaging.
However, if you have 1 mm slices, you have to look 5 times harder (actually more, because the tumor might only be visible on special reformats). You may still miss a small tumour. However, if you can manipulate the images with MPR, MIPs, curved reformats, then a clever lawyer or radiologist might be able to bring out enough detail to make the tumor clearly visible. If you miss a "clearly visible" tumor, even if to see it requires very extensive processing and review, that IS malpractice.
While I can kind of see the point, it just seems a very odd sort of argument to make, and I have to bend to his experience. But surely, an argument could be made that doing thick slice imaging when thin slice is better, is in itself malpractice.
What are other people's experiences?
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source https://www.reddit.com/r/Radiology/comments/hc2jr7/sending_images_to_pacs/
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