Neurosurgeon's Perspective on Radiology Second Opinion of MRI Brain

Neurosurgeons generally resort to MRI Scans more than often; it may be related to the brain, spine, and other parts of the nervous system. MRI Imaging technology is distinguishably helpful in identifying tumors, diagnosing stroke, and evaluating head injuries. Convincingly, Neurosurgeons map out surgical procedures with help of MRI Images and Reports from experience radiologists. Like others, even Neurosurgeons feel confident if fed with better neuro- radiology opinions on MRI brain or MRI Spines. Following is a an attempt to extract the Neurosurgeon's Perspective on radiology Second Opinion of MRI Brain and other. 

Being human to have MRI and CT reporting Errors

According to RSNA (Radiological Society of North America), there could be judgmental errors in MRI or CT reporting. Renfrew et al. 5 in 1992, revised by Kim and Mansfield in 2014 remains the most widely accepted classification of 12 types of reporting error. To resolve serious errors in MRI Brain, a review mechanism is a need of an hour. Such a mechanism would add the same value to 'diagnostics and healthcare' as 'quality control process' adds to Industrial Engineering. There are second opinion platforms that bring in review mechanisms in the marketplace to attract radiology experts. Enablement Specialists assist patients and doctors in seeking multidisciplinary second opinions of MRI Brain in just 4-7 hours at TeleradiologyHub. 

Talk: Senior Neurosurgeon on MRI Brain Second Opinion

Let's hear from a practicing  Neurosurgeon, Dr Dilaj  Kadlas, on constraints in fostering quality review culture in the radiology sphere around neuro MRI Brain cases that need extra diligence.

Stephen Q1: Welcome Dr Dilraj to TeleradiologyHub Panel Discussions Room! We know that we are stealing time from your busy day; but thank you very much.

How are you today?

Dr Dilraj Kadlas (NeuroSurgeon): I am fine. Thanks for inviting me to this Talk. I will try to answer the questions with my limited experience and knowledge positively.

Stephen Q2: Thanks Doctor. There are a few pressing questions; mostly concerning MRI or CT scans. 

The first one is how often do you get to see MRI Brain in a month?

Dr Dilraj Kadlas (NeuroSurgeon) : Very often. Earlier we used to depend on  X-rays. Then came the age of CT scans. CT Scans still has a more practiced diagnostic tool when it comes to Brain. More investments by Diagnostic facilities into MRI set-ups have played role in reducing MRI scanning prices. Our dependence on  MRI Brain scans has increased, now the order of the day. MRI screening for Head Injury cases and MRI studies  for tumors and special studies like angiogram makes an impact at all levels, especially guides the Neurosurgery.

Stephen Q3: Do you take interest in reading other Radiologist's reports ? Or more depend on self-reading  MRI Brain images?

Dr Dilraj Kadlas (NeuroSurgeon): Well most of the Neurosurgeons are trained to look into imaging.  We first try to interpret by ourselves. For me, however, I always see the radiologist report with interest and check it not only to ascertain  my doubts but also reconfirm if anything missed- any abnormal findings.

Stephen Q4: What are important elements in the report that makes you happy as a neurosurgeon?

Dr Dilraj Kadlas (NeuroSurgeon): I get more impressed with the style, structure and concise nature of the radiologists report. If it is diagrammatic it is too good. I know it takes time to do so but some radiologists take pains to do so. These days smart templates are helping them. It's a creative way to show your report to the world. Coming back to quality, I often give high marks to reports with descriptions of the pathology and the logic or impression or judgment behind the diagnosis. I guess it is more driven by the experience of the radiologist.

Stephen Q5: As a practicing neuro-surgeon, do you feel the absence of specialist radiologists?

Dr Dilraj Kadlas (NeuroSurgeon): Absence does not matter much. Sometimes it does make a difference if you have a sub-speciality radiologist who has practiced over the years in the Neuro. I do feel the presence of a quality conscious ecosystem in radiology provides more incentive to the Neurosurgeon fraternity.

Stephen Q6: If made available, would you insist on a report on MRI Brain from a neuro-radiologist or a second opinion from an experienced radiologist before deciding to operate?

Dr Dilraj Kadlas (NeuroSurgeon): Getting a routine second opinion from an experienced Radiologist can be an expensive part on behalf of patients. In 90% of the cases, the reading is normal and interpretable. Only in 10% of the cases, when I need to extract additional information, and when I'm in doubt, I feel like resorting to an experienced radiologist. However 10% of the cases is still a good opportunity to have experienced radiologists on the click.

Stephen Q7: Do you think healthy exchanges and synergy between different experts from radiology and neurology would help to resolve judgment errors and better the diagnostic outcomes? Do you see a positive future for an Interdisciplinary Second Opinion Panel?

Dr Dilraj Kadlas (NeuroSurgeon) : That is a million dollar question. Healthcare is converging with the advent of new technology and therapies. We are talking about customized treatment plans with gene protocols. In neurosurgery, scientists are bringing in Micro-Robots. There is huge learning available for Neurosurgeon. Now every discipline has by its own depth generates the scope for speciality. The synergy of experts in medical sciences from different disciplines gives rise to perfection. Unlike in cooking where the famous saying goes: too many cooks spoil the broth. Interdisciplinary team efforts are always welcomed. But how do we evolve in a multidisciplinary team when we have less time even for familie. Needs help from tech enabled platforms like TeleradiologyHub to do so. In that case within discipline , geographical presence matters and experience sharing across junior-senior and mentorship can also work.

Stephen Q8: For a patient diagnosed with a brain tumor, how good it is to get a Second Opinion from any other Expert Neurosurgeon?

Dr Dilraj Kadlas ( NeuroSurgeon): As we all know that there are 100 different types of brain tumors.. There are differentiated brain tumors classified under ependymoma, astrocytoma, medulloblastoma or oligodendroglioma. They follow different pathologies. Therefore images are important before going for surgical intervention. In any case, no one stops neurosurgeons, to get a second opinion when in doubt. There needs a platform to connect with fellow Neurosurgeon or an experienced Neuro-radiologist. Just like Brain Tumor, it could be any other area like brain stroke or head injury.

During my neuro- training, I learnt the essentials of Neuro-radiology from a clinical perspective. It helps. It was a good time when we had qualitative access to other disciplinary faculty meetings. During meetings, different cases were presented, discussed and the opinion of the seniors and house were taken. More than competitive edge, it creates knowledge sharing patient centric ecosystems . Conclusively, the more discussions or opinions you generate it helps in patient management. That includes conflicting or dissenting opinions.

Stephen: Thanks Dr Dilraj for your Inputs. We will get back to you on further questions if you are free next week.