Simple for a Radiologist, Complex for Everyone Else

It looked like an innocent little chest CT out to cause no trouble. It was a follow-up scan for some lung nodules, or surveillance for treated malignancy.

As I set about for the read, however, it mildly spiked my blood pressure. The patient had undergone a CTA of the chest literally minutes earlier (also for follow-up in that case regarding aortic ectasia). The CTA was perfectly adequate for both diagnostic purposes, but this patient had been dosed with extra contrast and radiation for no reason that I could identify.

I had been to this rodeo many times before, getting good and angry about things like excessive utilization and inefficiency. When you work in a highly scrutinized job like diagnostic radiology, it can feel like the whole world is watching for opportunities to condemn any imperfect move you allegedly make.

That can include your failing to police the errors of others in the radiology sphere. Why did you let the tech do an extra scan on this patient? Why didn’t your scheduling people catch the double appointment? Are you about to be denied payment on one of the reports you had to furnish and/or audited for double dipping?

When you ride enough of these miniature emotional rollercoasters, you come to see that a lot of the trips were not really necessary. There turns out to be a reasonable explanation or at least one that means you need not have gotten vexed. Sometimes there wasn’t even a situation at all, just your own misunderstanding. For example, I could have gotten worked up about two chest CTs on October 27 because I failed to notice that one of them was from 2025.

The other thing that happens with enough of these episodes is that no matter how much anger, frustration, despair, etc., they generate in you, in the fullness of time, you see that your internal suffering has no impact on the world outside of your mind and endocrine system.

Part of my reconciliation has been noting that while these systemic flubs seem retrospectively easy to identify and avoid from my reading room armchair, they are rarely so simple and straightforward to the non-radiologists committing them.

For instance, perhaps the chest scans were separately ordered by an oncologist and a vascular guy. They were originally scheduled on different days. The patient then called to ask if they could be moved to the same day for convenience, and whoever moved the appointment failed to notice that two nearly identical exams were being done back-to-back.

They might not have understood that, outside of the “STAT” setting when a patient might be huffing and puffing from a possible PE, a CTA could be just fine for confirming stability of lung nodules. Upon the patient’s arrival, the tech, seeing that he or she was about to do redundant scans, might have picked up the phone and failed to get ahold of anyone with authority to cancel the non-CTA. Perhaps behind schedule, the tech just shrugged and pushed the buttons.

I just made all that up off the top of my head. There could be any number of contributing details complicating the issue for people who don’t understand radiology. Meanwhile, we rads see things only after the scans have been done and “Monday morning quarterback” the whole affair.

Coincidentally, I was on the other side of this sort of situation during the past week or two with the HVAC system in my house needing some attention.

We have had a few iterations of climate control here since I bought the place in 2014. Originally, it had a geothermal system, which is rare for my neck of the woods but a big plus in my mind. When they work properly, they practically seem magical.

Unfortunately, that wasn’t the case for our installation. After years of flogging a bad situation, we moved away from it in a stepwise fashion. First, we had a small propane furnace to augment one zone, then an AC unit, and then some air-based heat-pumps. Eventually those pumps had to be switched out for other pumps, and another propane burner got added for a different zone.

Looking back, it is a murky memory and hard to recall exactly what we had when. For every change of equipment, there were several intermediate steps of service calls to try making the old equipment suffice. If one were to draw a flow chart with geothermal being the first frame and my current setup being the last, there might only be five stages. However, with all those partial steps, I can forgive myself for having some details slip through my memory’s cracks.

So when one of my zones failed to come up to temperature this past week, I requested a service call. I had what I thought was a good theory about what bit of equipment was at fault and should be looked at first. It sounded reasonable to the HVAC guy, who proceeded to investigate. We then wasted half an hour because the piece of equipment I blamed turned out to be the heat pump for a different zone.

Much like an after-the-fact rad casting aspersions on techs, schedulers, referrers, and patients getting simple things wrong, the HVAC guy might have internally thought, “What a dummy, owning this four-zone house and paying for all this work to be done, and he can’t even keep track of what he has. Now he has put me behind schedule.”

If he did think this, he kept it tightly under wraps. His pleasant demeanor never wavered. He cracked jokes but stayed on task and waved off my apologies for being less savvy than I would have wished.