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It is quite likely that an important measure of your expertise, a determinant of your value as a diagnostic radiologist is how well you handle the little things. It has been said that if you take care of the little things, the big things will take care of themselves. Indeed, little things mean a lot.
But how do you take care of the little things? Ah, therein lies the secret and the vexation: now that you have identified those little things, what do you do with them? In radiology those little things, like "ditzels," can drive you crazy.
Mighty oaks from little acorns grow. If a radiologist is unsure of a little finding, such uncertainty can plant the seed of doubt which, in turn, may generate sufficient concern in both the interpreting radiologist's and the referring physician's minds to initiate a veritable cascade of inquiry. Further imaging studies and additional laboratory examinations are ordered and performed. Or the patient is asked to sit on the hot seat and worry for a month or more before a follow-up examination is performed to determine if, in the interim, any change has occurred in the ditzel in question. All this extra effort may ultimately prove not only time-consuming and expensive, but unnecessary.
Overreading and overreacting spell trouble. It is better all around if a definitive statement as to the nature of a finding on a diagnostic image is made at the outset, on initial discovery. But, alas, I realize that is sometimes impossible. Sometimes more studies and/or follow-ups are required. But the fewer of these requested, the better for all concerned.
What is done with what is found is a matter of judgment; the better and more informed the judge, the better the outcome.
At times, the hardest thing to do with small findings is nothing—that is, to dismiss the finding as irrelevant and unimportant. A good diagnostician is one who is willing to overlook, or has the ability to dismiss, such ditzels with certainty and not request further examinations or follow-up studies in an effort to further elucidate or clarify their meaning; whereas, these same small things may be a source of consternation for diagnosticians with less confidence and fewer powers of discernment. It is a matter of judgment, and some of us are better at this than others.
In this issue, Munden and Hess [1] report on a survey of experts regarding how to manage ditzels, those little things that show up in the lungs on various forms of chest imaging, and which, for this study, showed up on chest CT.
Although the term is of uncertain origin, "ditzel" may be related to ditsy or ditzy, slang meaning stupid, silly, scatterbrained, or airhead [2]. All in all, ditzel seems an apt descriptor for those little things found on imaging examinations, be it radiographs, CTs, or other images, because those darn little things can drive you to distraction.
Well, what is to be done with these ditzels? To be honest, it varies. It depends. But Munden and Hess offer reasonable and helpful guidelines that may well improve your judgment when faced with ditzels. Yes, what to do with ditzels is a common problem and the article makes for interesting reading. I am certain you will find the advice of these experts valuable to you in your practice.
A little time spent with Munden and Hess is certain to improve your confidence and comfort index in dealing with ditzels.
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