Evidence-Based Medical Practice-How Accurate is the Doctor's Interpretation of Radiographical Images?

X-ray image of an internal carotid artery aneurysm.
 Image credit
Mayfield Clinic

I heard a story of a doctor, a neurosurgeon, who operated on a patient to remove a brain tumour. The preoperative management of the patient was carried very well under this doctor's supervision; but the patient died a few days after the surgery. A post-mortem examination (autopsy) was carried out on the dead patient and it was found that he died from the rupture (very highly possible the neurosurgeon ruptured it during the surgery) of an aneurysm (a condition in which a part of the wall of an artery become inflated like a balloon because of the presence of fatty deposits in between the layers of the wall of the artery) of one of the internal carotid arteries and which has been there before the surgery was done. But this patient was said to have received a good preoperative management, meaning that he underwent X-rays, computed tomography scan and even MRI (magnetic resonance imaging) of the head and neck. Why did the preoperative management team fail to detect the internal carotid artery aneurysm? And why did the neurosurgeon also fail to detect and avoid rupturing it during the surgery?

In Nigeria and some other countries of the world, I think there are two reasons for this costly mistake. One is the poor relationship between the various members of the health management team: this is the major problem facing the healthcare delivery of many developing countries. And the other (which is not really an issue of whether the healthcare system of that country is advanced or not and hence is global) is the human error, an occasional drop of imperfection in that ocean of precision of our care of the patient.

A GOOD Healthcare Team. Image credit to
St. Mary's Good Samaritan Hospital

A harmonious relationship in the multidisciplinary management of the patient is a precious jewel that has been very difficult to mine in the healthcare system of some developing countries. The major root of this problem is the clash of egos among the various professional disciplines that make up the medical management team. With each profession clamouring to be the leader of the team; with some experts in one profession looking down on and treating with contempt the experts in some other profession---one sees a situation where a neurosurgeon verbally insults an anaesthetist during surgery in the theatre, telling him or her that they don't know anything and that he could teach them everything about anaesthesia; a situation in which a surgeon who is not sure of what the details are on an X-ray does not seek the expert advice of the radiologist for proper interpretation before going in to open up the patient, because he feels he knows everything about radiology in addition to his own area of expertise. Fortunately, everyone in the medical management team in this part of the world is beginning to identify this problem and realizing that it is not in the interest of the patient for whom they swore an oath to take care of. Efforts are being made by every one of them to preach the message that each member of this multidisciplinary team is indispensable and that everyone is equally important in our duty of giving the patient the highest of quality medical care.

Perfection in the various protocols guiding each modality of management and care of the patient comes after a long period of repeated trials during which mistakes are made (and whose end-product sometimes is the death of some patients) and lessons are learnt. But the fundamental basic goal of medicine is to give the best care to the patient, which can only be achieved by averting all possible errors that abound in the protocols of each form of patient management and care.

Technology has long been employed to help out in this area, leading to rapid advances in various areas in medicine and which in turn has greatly improved the quality of patient care. And as technology advances in itself; it magnanimously extends what it has gained to medicine. This gesture of generosity was recently witnessed in the area of interpreting X-rays of patients. A group of  medical doctors and IT experts in the Nuclear Medicine department of the Northern Ireland Cancer Centre in Belfast have teamed up to develop an iPad application called Experior, which detects where a doctor is making a wrong interpretation of a patient's X-rays. Experior, which has been reviewed by the Royal College of Radiologists, works by assessing the doctor's ability to interprete X-rays of patients taken in their hospitals through online and real-time comparison with a huge database of similar X-rays validated over time by experts who are authorities in the fields of Radiology and Anatomy; it then sends an instant feedback of that doctor's interpretation to him, highlighting the professional rating of his interpretation, giving him corrective analysis of the interpretation and clues on how to make a better interpretation of subsequent similar X-rays.

Experior Medical App on the iPad. Image credit to Experior Medical

In addition, Experior provides a vast online database of X-rays of the abnormal human anatomy as tests which the medical student, junior doctor and consultant can take, in a time-constrained setting similar to what obtains in the accident and emergency department, to improve their skills at making accurate interpretation of these images and saving patients' lives through properly guided medical care.

The Experior medical app can be used by anyone in the medical field in any part of the world; the only constraint for now is that it is only available for the iPad. If the Experior
Medical group can extend this application to the Android OS, then more doctors, especially in developing countries will have access to it. This will help to avert wrong interpretations of X-ray images, saving patients' lives.