E3404. The Whole Story: A Framework for Diagnostic Interpretation
  1. Vishesh Jain; Santa Clara Valley Medical Center
Stories are universal across humanity, enabling us to make sense of our complex world and communicate that sense to others. Insofar as the creators and audiences of a radiology report are human, purposeful storytelling by radiologists may thus offer more meaning, and make it easier to grasp. Furthermore, top-down effects of expertise and expectations of a study are known to affect search patterns and imaging pattern recognition. This is one of several ways in which expert radiologists’ consumption of a study differs amongst each other, and from trainees. Hence, conscious recognition of a disease’s narrative is often a key didactic goal for expert radiology educators hoping to impress a given imaging pattern upon their trainees.

Educational Goals / Teaching Points
Derive an approach to diagnostic storytelling using generalizable components. Construct radiological illness scripts for diseases relevant to the learner’s practice. Explore a disease’s story systematically to improve diagnostic perception. Use diagnostic storytelling to improve meaningfulness of the radiology report.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In the best stories, the characters are well-characterized, and often grow or change over time. Similarly, disease processes identified on a radiological study should be meaningfully characterized, both in their current appearance and in their change from priors. Furthermore, characters are affected by and related to each other. Recognition of such relationships between diseases helps to guide further perceptual search based on an initial finding. Finally, stories have lines of causality. Describing the causes and complications of a disease help to guide search and create a more meaningful final report.

In the ideal case, diagnostic radiology synthesizes a story from current images, prior studies, and the patient’s medical history. Mindful awareness of the possible narratives expanding from a given findings may improve diagnostic accuracy and allow for more systematic teaching of common imaging patterns to trainees. Moreover, constructing the radiology report with the story in mind may help make it more meaningful to the radiologist and the audience.