!nsights

A monthly / fortnightly column from our consultants about a challenging case / topic in diagnostic radiology / interventional radiology / management strategies / evolving technologies / career path / Life lessons / artistic pursuit / humor in Radiology / any topic of general interest...

RAD drives me bonkers! "Where on earth have those delightful days gone? They seem like a distant memory now." Ah, the good old days of practicing radiology when reporting was an art and science. All I had to do was look at a lesion, describe it, and wrap it up nicely with a concise diagnosis or a few possibilities if I wasn't entirely sure. I was content, considering myself a decent radiologist.

But alas, about two decades ago, out of nowhere, the term BIRADS popped up. It had something to do with the reporting standards in mammography. At first, I wasn't too bothered since I wasn't reporting mammograms. However, as time went by, it became quite embarrassing. VIPs from the city would drop by, clutching their reports, and scrutinise my face as I delved into those confusing numbers. What did they even mean?

So, I decided to do some research, and, to some extent, I deciphered the mysteries of 1, 2, 3, 4, and 5. Just when I thought I had it figured out, someone came in with a BIRADS 6 Lesion report. I was utterly dumbfounded. I mean, if 5 was bad, then 6 had to be a nightmare, right? I had to excuse myself from the meeting to double-check quickly. Can you believe it? The report basically stated that BIRADS was just a fancy way of saying biopsy-proven breast cancer. Why on earth do they need these numbers? Wouldn't it be simpler to start the report by saying "biopsy-proven breast cancer"? But no, the breast radiologists know that simplicity would never bring them joy. They had to make people like me feel like absolute idiots, even when they weren't watching.

That is when I came up with a stroke of genius for the department. I implemented a rule stating that a footnote should contain a paragraph explaining all these numbers. Oh, how satisfying it felt to give them a taste of their own medicine and prove that I was no fool! Now, armed with that paragraph, I appear rather intelligent. Little did I know that this would be the beginning of even more complicated troubles as each specialty tried to outdo the previous one. All I can say is, why? Why should I be caught in the crossfire of their battle, where each one tries to prove they're smarter than the other?

Up until this very moment, while all the other specialists in their respective sub-specialties were sleeping, a genius in the field of abdominal imaging thought it was about time to spice things up. Enter LIRADS, the brainchild of this maverick. But of course, they couldn't make it that simple by using plain old numbers 1 to 5 and throwing in a confusing 6. Oh no, they had to add a dash of complexity by throwing in a couple of alphabets to keep us all on our toes. LR NC - prepare to be mind-blown! Basically, it's just a fancy way of saying that the image quality isn't up to par. They could've just said, "Hey, patient, this image isn't great. Let's redo it, shall we?" But no, and then they had to come up with LR-M because, apparently, M sounds a lot like metastasis, so why not confuse us even more, right? When I looked it up, it said it's probably a definite malignancy, but not HCC. I mean, seriously, couldn't they have just said, "It suggests a malignancy, and we should probably do a biopsy"? Any dimwit would've understood that! But no, they had to say it in a way that only a handful of enlightened radiologists can decipher. And to top it all off, I can't even rely on a cheat sheet anymore because the meanings behind these numbers and alphabets fill up an entire page.

Now! It appears that everyone has suddenly jumped on the bandwagon of having their own personalised version of RAD. The thyroid group, in a clever attempt to confuse the competition, has created an exclusive version just for themselves. To add to the chaos, they've split 4 into sections A and B. The amusing part is that they're not even sure if it should be classified as malignant or not. Who will come out on top in the A vs. B battle TIRAD 4? I do not know!

Not to be outshined, the prostate team said, "Let's create our own version and make sure we stay ahead of the game!" So they threw in a PX. It's quite a challenge, really, because that X clearly indicates that they have no clue. So, why not throw in some more imaging for good measure?

Now, the bowel enthusiasts felt left out, but the issue was that B was already taken by Breast, so they decided to split the bowel and focus on the colon instead. This is typically called the "backdoor entry." The brainy folks in Neuroimaging couldn't come up with a better plan since B for the brain was taken ages ago by the Breast radiologists, so they settled for a WHO classification, an even more complicated system. The prostate team is ahead of the game when it comes to individuals handling the male organ. Well, the Andrologists might have to divide it further, but the problem is that the T for testis is already taken by the thyroid group. I wonder how they'll solve this dilemma. Maybe they can start with the scrotum. Since nobody has claimed the letter S so far, they can work their way up from there.

Ah, the ovarian group has already claimed the letter O. The oral cavity experts have been brainstorming to solve this predicament since T for the tongue is also taken. We're quickly running out of letters here! Soon enough, it'll be as complicated as car registration plates. They'll have one for every P - P1 for the prostate, P2 for the penis, P3 for the pancreas, and P4 for the pinna. How exciting!

If you happen to be a general Radiologist, the RADS will keep you up day and night. Without them, you wouldn't even be considered a radiologist at all. Even if you're a specialist, you'll still face challenges because they've decided to divide a single organ into multiple parts. They've even created a RAD specifically for the gallbladder, just in case anyone thought it wasn't important enough.

I'm sure all of you are well-versed in your RADs, and you must be chuckling at me, an unprepared RAD radiologist. But here's the news: the AI guys will have the last laugh. All this effort to create RAD has paved the way for artificial intelligence to take over. Their goal is to have a system that can be easily managed by AI. So, thanks to RAD, most of the reporting will be taken over by artificial intelligence. It's a far cry from the days when reporting was descriptive and everyone had their own unique style that couldn't be replicated by AI. The final report used to be a product of human intelligence, but welcome to this crazy world where madness reigns..

... Adapted from the song SOS (ABBA)

Where are those happy days, they seem so hard to find

I tried to reach for you, but you have closed your mind.

Whatever happened to our words?

I wish I understood

It used to be so nice, it used to be so good.

So when reports were sane I looked at every  plane. 

S. O. S.

The confidence  you gave, nothing else can save 

S. O. S.

When you're gone

How can I even try to go on?

When you're gone

Though I try, how can I carry on?

You seem so far away. I know I’ve lost you now.

You say I am alive, but something died, I fear.

I really tried to make it out.

I wish I understood

What happened to our branch? It used to be so good.

So when I’m reporting now, it’s all mechanical. 

S. O. S.

The love I  gave you, nothing else can save me.

S. O. S.

When you're gone

How can I even try to go on?

When you're gone

Though I try, how can I carry on?

AI is near me now, oh can't you hear me.

S. O. S.

The love you gave me, nothing else can save me.

S. O. S.

When you're gone

How can I even try to go on?

When you're gone

Though I try, how can I carry on?

When you're gone

How can I even try to go on?

When you're gone

Though I try, how can I carry on?