Podiatric Radiologists/Radiology

[cool_vkb]

hey since i was busy in MCAT i forgot to ask this question. A lot of MRIs reffered by Podiatrists to our Imaging Center now require it to be interpretted by a DPM rather than a MD radiologist. The traditional protocol is that after we take the MRI we forward the images to the Radiologist who interprets it and issues a report which gets forwarded to the referring Physician or DPM. I first thought it was some mistake and i didnt understood it. But i confirmed it with my dad and other staff and they said that its true. DPM referred MRIs go to a DPM for interpretation.I dont know the additional qualifications of that DPM who we send our reports for interpretation but i found it really cool. A DPM dedicated only to interpret MRIs. I know Chiros do this from a long time because they have their own Chiro radiologist, so they dont get their reports interpreted by MD radiologists. But DPMs doing this. Its kind of confusing as we are an integral part of regular allopathic medicine.

Is this common, and how would this place us in front of MD radiologists and is there any fellowship or some kind of additional training in Podiatric radiology after Pod school which people do to do interpret Imaging reports.

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[jonwill]

hey since i was busy in MCAT i forgot to ask this question. A lot of MRIs reffered by Podiatrists to our Imaging Center now require it to be interpretted by a DPM rather than a MD radiologist. The traditional protocol is that after we take the MRI we forward the images to the Radiologist who interprets it and issues a report which gets forwarded to the referring Physician or DPM. I first thought it was some mistake and i didnt understood it. But i confirmed it with my dad and other staff and they said that its true. DPM referred MRIs go to a DPM for interpretation.I dont know the additional qualifications of that DPM who we send our reports for interpretation but i found it really cool. A DPM dedicated only to interpret MRIs. I know Chiros do this from a long time because they have their own Chiro radiologist, so they dont get their reports interpreted by MD radiologists. But DPMs doing this. Its kind of confusing as we are an integral part of regular allopathic medicine.

Is this common, and how would this place us in front of MD radiologists and is there any fellowship or some kind of additional training in Podiatric radiology after Pod school which people do to do interpret Imaging reports.

I am not aware of any fellowship for such a thing. I have a few friends that are radiologists and they both say the same thing: Unless you look at foot and ankle radiology a lot, it is extremely difficult to read. Since we see it all of the time, we get pretty good at it.

I have been to quite a few hospitals where this has been the case. Foot CT and MRI's can be extremely challenging to read.

 

[cool_vkb]

I have a few friends that are radiologists and they both say the same thing: Unless you look at foot and ankle radiology a lot, it is extremely difficult to read. Since we see it all of the time, we get pretty good at it.

I have been to quite a few hospitals where this has been the case. Foot CT and MRI's can be extremely challenging to read.

Oh then its cool! Bcoz i thought again we are heading towards debates with radiologists over this issue in near future. Just as we have debates and rivalry between Pods and F & A orthos.

 

[Dr_Feelgood]

I am not aware of any fellowship for such a thing. I have a few friends that are radiologists and they both say the same thing: Unless you look at foot and ankle radiology a lot, it is extremely difficult to read. Since we see it all of the time, we get pretty good at it.

I have been to quite a few hospitals where this has been the case. Foot CT and MRI's can be extremely challenging to read.

Agreed I've read a few reports that basically said all is good. And their have been major pathology when we've looked at it.

It is not b/c the radiologist is not good at his/her job, it is the number of LE images we look at in comparision.

 

[dpmgrad]

hey since i was busy in MCAT i forgot to ask this question. A lot of MRIs reffered by Podiatrists to our Imaging Center now require it to be interpretted by a DPM rather than a MD radiologist. The traditional protocol is that after we take the MRI we forward the images to the Radiologist who interprets it and issues a report which gets forwarded to the referring Physician or DPM. I first thought it was some mistake and i didnt understood it. But i confirmed it with my dad and other staff and they said that its true. DPM referred MRIs go to a DPM for interpretation.I dont know the additional qualifications of that DPM who we send our reports for interpretation but i found it really cool. A DPM dedicated only to interpret MRIs. I know Chiros do this from a long time because they have their own Chiro radiologist, so they dont get their reports interpreted by MD radiologists. But DPMs doing this. Its kind of confusing as we are an integral part of regular allopathic medicine.

Is this common, and how would this place us in front of MD radiologists and is there any fellowship or some kind of additional training in Podiatric radiology after Pod school which people do to do interpret Imaging reports.

The majority of the official reports for MRI and CT still come from Radiologist. There are a few MRIs that I have seen that are officially reported by a DPM and those are in places like TUSPM where they have their own Lower Extremity MRI on site and the Podiatric Radiologist does the primary readings. Dr. Christman at TUSPM does get a lot of second opinion reading requests on MRI and other imaging studies from the local DPMs. Of course, DPM can always document their own reading, despite what the official report says. Yes, I agree with the jonwill and dr feelgood that not all radiologists are good at reading foot and ankle x-rays, CT and MRI. There are some excellent Musculoskeletal Radiologist (Radiologist that did a fellowship in Musculoskeletal Imaging) that sometimes pick up stuff that a DPM would not. When I did my radiology rotation with one of the Musculoskeletal Radiologist, I learn that Radiologist are frustrated because the ordering physician is not specific as to why he or she is ordering the imaging study. During my rotation, I see many of the DPMs, Family Physician, an IM docs writing only foot pain. It does not help the radiologist when interpreting the film since they don't get to chat with the patient in regards to where the pain is located. This can possibly explain why sometimes DPM can offer a better reading of the imaging study than a Radiologist because the DPM can exaimine the patient and figure out which area they should be concentrating on for the pathology.

As jonwill and dr feelgood said, there is no formal fellowship for Podiatric Radiology. There is a Podiatric Radiology society.

 

[krabmas]

Most DPMs that read MRIs well are self taught.

THere is a musculoskeletal radiologist who specializes in the LE at Hospital for SPecial Surgery in NYC. SHe gave a few lectures at the NY clinical conference this past weekend.

Basically she said that if you want to see toe pathology you cannot ask for a foot and ankle MRI, the slices will be too fat and you will get 1 or 2 slices of the toe. THey have special coils for the toes and she even changes the angles if there are hammertoes.

LE MRIs are especially difficult to read because the MRIs are taken in cardinal planes but the tendons and ligaments do not always follow the planes. In addition the patient could be holding their feet in a weird position

As a tip - you should read all your own MRIs and ask for the films from the radiologist. This way you will become proficient as well.

 

[kmyprimeval]

i shadowed two different DPMs in two different states while they were interpreting x-rays...both claim that DPMs have wayyy more expertise in interpreting these things than MD radiologists (foot area of course).

There was this case where this person had a fractured toe for months and didnt even know it. This person was limping and the primary physician didn't know what was wrong with her x-ray. That person was sent to different doctors and they started to believe that she was lying. Till she was referred to a podiatrist ... and to DPMs, her toe fracture was that obvious.

 

[krabmas]

i shadowed two different DPMs in two different states while they were interpreting x-rays...both claim that DPMs have wayyy more expertise in interpreting these things than MD radiologists (foot area of course).

There was this case where this person had a fractured toe for months and didnt even know it. This person was limping and the primary physician didn't know what was wrong with her x-ray. That person was sent to different doctors and they started to believe that she was lying. Till she was referred to a podiatrist ... and to DPMs, her toe fracture was that obvious.

Many DPMs will tell you that DPMs are better at everything foot and ankle than any MD even an orthopod. This is not always true and depends on who the DPM is and who the orthopod is.

Dr. Potter is a world renowned (sp?) radiologist who specializes in LE musculoskeletal radiology. I do not think there is anyone better than her out there. She can tell the difference between Neuropathic edema and infectious edema on an MRI.