Is Self-Imaging a Temptation for Radiologists?

One of the dividends of growing longer in the tooth and maintaining a challenging exercise regimen is a daily roll of the dice as to what aches and pains may come a calling. This past week, one morning’s surprise was a ticklish sort of pain in my calf.

I proceeded to hobble around the house, grateful that I work from home and wouldn’t have to walk all that much, certainly not during my hours at the workstation. A gentle aspect of these random ailments is that, as long as they aren’t blatantly challenged (for instance, by hopping right back on the treadmill), they tend to fade as spontaneously as they arrive.

Still, we health-care types can be hypochondriacs. While symptoms linger, our minds can buzz with all sorts of worrisome diagnoses, however unrealistic. I see multiple DVT ultrasounds and CTAs for PE every workday. Guess where my mind went. It also seemed that, with all the running I do, a rupturedBaker cyst wouldn’t be out of the question.

None of this had me remotely considering a time wasting trip to local “urgent care” offices, let alone an ER. If I were in a more traditional, onsite radiology job, I might have taken a couple of minutes to find an unused sonography room and rub a transducer on my leg. I might even be able to detect an unhappy tendon if the radiological gods allowed.

The thought stuck with me, and I found myself wondering how feasible it would be to get a low-end sono unit for myself, maybe something used and old enough that no health-care facility would want it now. It may be something not even worth salvaging for parts. I could keep it in some out-of-the-way corner of my house for times like this.

As with many flights of Internet fancy, the inquiry didn’t last more than a few clicks. I stumbled sideways into a world of point-of-care devices that get plugged into tablets one is likely to own already (iPad, etc). It was a dead end. Even the lowest prices I saw were well above my “what the heck, let’s throw some money at this” frame of mind. Really, they never stood a chance of making a sale to me. I would want to put hands on the unit and do some actual scanning in any event.

Part of this daydream’s appeal is that sono’s a tool of our trade that most of us could realistically own, short of possessing an imaging center. I can’t imagine wanting to put an X-ray or MR unit in my house, but if I did have such a desire, I am sure I would abandon it less than 30 seconds after I started investigating the logistical and regulatory issues involved.

Even though residency training does, theoretically, enable a radiologist to perform diagnostic imaging, most of us don’t. The real world gets its best value out of us merely interpreting images others have acquired. I haven’t heard any rads gripe about that, but it does feel like we are only using part of the vast skill set we were required to learn. The notion that we could do the actual imaging, if we wanted to, is rather satisfying.

Taking a step back, I suppose it’s worthy to consider whether there are any ethical issues in self-imaging. I learned back in med school that one shouldn’t self-treat, and that even treating friends/fam was a bad move. If nothing else, it impaired one’s objectivity.

Nobody spelled out at that point whether “treating” referred to all medical practice or if it was meant literally. If it was the latter, that should leave diagnostics out of the ethical picture. As long as you are not taking resources away from other patients (say, putting yourself or your bestie into the scanner while actual patients wait), there doesn’t seem to be any harm.

Suppose, for instance, you do your diminished objectivity imaging and think you find something actionable. Unless you go ahead and take that action, what happens next is that the person with the imaging abnormality goes to his or her own doc or other health-care provider and gets treated. Maybe that other professional looks at the imaging you did and agrees with what you thought it showed but the doc won’t treat something you thought you found if he or she disagrees. Even if the doc agrees, he or she will probably do his or her own imaging to get the diagnosis on the formal record.

However, all of this is kind of academic. It took less than two years after fellowship for me to see that most docs have no compunction about treating themselves or anyone else. The rad across the hall from me, upon hearing my reluctance to write a prescription for myself (some altitude sickness prevention for a pending trip), practically laughed me out of the room.

This being said, I have made precious little personal use of imaging equipment in my 25.5-year stint of having access to it. The first time was in residency. I heard our neuro chief talk about undergoing multiple scans when the MR unit needed volunteers for calibration (he explained that it was nice to go somewhere he couldn’t be paged for a while).

It got me thinking that it might be a good idea for me to know what undergoing such a scan was like, what with the loud noises, having to lie still, etc. So, on a particularly uneventful weekend morning when the tech was bored to tears and I had nothing to read, I asked if he would mind scanning my noggin. It seemed a reasonable thing to have a baseline scan.

I still have the films on my shelf today. He described it as disappointingly normal. He had hoped that, me being in my early 30s, I might have a smidge of cerebral atrophy to poke fun at.

I figured that, now and then, I might get other MR baselines of this or that...but the one time I tried (for occasional exercise-related shoulder aches and pains), I feel asleep in the unit and unconsciously moved just enough to create the sort of study I would dismissively call “limited” in the reading room. For whatever reason, those nearly non-diagnostic films are still on my shelf as well.