How to troubleshoot when stuck with an inconclusive scan

There are instances, when we are unable to come to a conclusion or not sure what the findings are or the imaging findings not correlate with the given clinical scenario or your unsure about your skill. 

Don't worry...there are many sailing in the same boat. Summarizing some of the things I follow. 

Step 1: Recheck the demographics and clinical history. If required you can give a call to the patient to try to fish out more history

Step 2: check, if you are missing a sequence or image set. Check with your technologist for complete scan

Step 3: Check if there is any other radiological investigation done prior, that may give further insight

Step 4: Re look at the scan step by step in lieu with the clinical question and other lab reports in mind. Sometimes I run the scan in a loop, take a step back and have a global view. 

Step 5: Call the referring clinical team and discuss. Most of the time things are sorted and more clarity is a rule!

Step 6: Brain storm with your colleague or check for second opinion from your attending / consultant 

Step 7: Googling medical literature with all info in hand!

Step 8: Recalling the patient for an additional scan if required as problem solving like second look ultrasound etc

Step 9: Do not hesitate to write in the report, if you are unable to come to a conclusion and not sure about your diagnosis. This keeps the window open for further investigations or brainstorming.

There are no better teachers than your own patient and referring clinician's

Prepared by  Dr. Sharad Maheshwari

14.12.2022

Updated: