These moments remind me how crucial it is to combine skillful interpretation with an intimate patient relationship. But it’s also a reminder of how messy this process can be behind the scenes.
My colleague, Jeff, is an expert neuroradiologist—truly top-notch—but he’s constantly beating himself up when he thinks he’s missed minor findings in these comprehensive scans. He’s used to looking for the “big stuff,” the life-threatening cancers, the massive aneurysms. Full-body MRI is a different animal. You’re scanning entire anatomy from crown to toe, often with limited sequences, trying to catch anything that might matter. Yet it’s impossible to focus on every subtlety, especially when the clinical history is a black hole.
“Reading blind,” Jeff calls it. No mention of prior thyroidectomy, so he has no idea why the thyroid bed looks odd. No mention of TMJ issues, so he isn’t paying extra attention to the condyle. Then I meet the patient face-to-face and hear those details for the first time. Suddenly, I’m updating Jeff: “Hey, did you know she had jaw pain for years, or that the woman with the suspicious neck region actually had her thyroid removed?” And now he has to add an amendment, and he hates doing that—it feels like a personal failure, even though it’s simply how these screenings unfold sometimes.
I get it, though. No one wants to seem like an intern again, scrambling for answers after the fact. No one wants to look like they didn’t do their homework. And certainly no one wants to disappoint patients who’ve invested so much trust (and money) into these full-body scans. But the truth is, real medical practice is rarely neat and tidy. We collect bits of history in drips and drabs. We rely on the patient’s recollection, or random notes from a phone call with their referring doctor, or maybe an incidental comment they make as I walk them to the door. It can be frustrating, but that’s how real human stories unfold.
So I told Jeff the following story:
“I clearly remember the day the patient walked into my office, visibly drained and holding a stack of three full-body MRI reports, and one CD (who uses CDs anymore? he complained later begrudgingly). He’d spent thousands of dollars at a big screening center three consecutive years— paying and hoping to catch any hidden illness early. The first year, he got a clean bill of health. Next year they noted a “6 mm dilated perivascular space”—no big deal they told him, and “it has been stable” they added reassuringly. Then came the third year. Suddenly, a “new lesion” in the brainstem appeared in the report, all time present and unnoticed, the entire time. They said it is a possible brainstem glioma (this is NOT a trivial diagnosis). They wanted him to undergo a contrast study immediately. He told them to go to hell. And came to me.
He was terrified. You could see it in his eyes—this was a man who thought he might have a brain tumor. 6 mm is small, but not small for a brainstem which carries the entire output of the largest mammalian hemispheres, measuring 3 cm from one edge to the other.
When I reviewed those exact same scans, I realized the supposed glioma wasn’t even intraparenchymal. It was extra-axial—a meningioma—and it had been completely stable for three years. No urgent procedure. No biopsy. No last-minute scramble. Just a simple explanation of what it was, and a plan to keep an eye on it. The look of relief on his face was heartbreaking. He had poured so much money, time, and emotional energy into those prior scans—only to face a misdiagnosis that threw his life into chaos.”
“Compared to what is happening out there”, I reassured and praised Jeff, “you are giving these patients a much required subspecialists’ expertise”.
In these 55 or so FBMRI cases we’ve done so far, I’ve watched Jeff wrestle with his nerves, worried that we’re missing something that might harm someone. Yet in that same time, we’ve identified at least five serious conditions—things that would have blindsided those patients otherwise. We likely saved their lives, or at least gave them a fighting chance to avoid complications down the road. Every time we confirm a suspicious lesion that needs rapid follow-up, I think back to how ephemeral life is. How a few images can change the course of someone’s entire future, or spare a family unimaginable grief.
I realize it’s not a perfect system. Sometimes you find small issues that will never matter, and sometimes you miss tiny things that turn out to be relevant. But I keep coming back to the point that this is why we do it: to catch the big stuff in time and to help real people sleep easier at night. Yes, it’s uncomfortable for a radiologist like Jeff to read a case first, only to have me add clinical details later. Yes, it forces us to issue addenda, which can feel awkward. But at the end of the day, these patients see that we care enough to revisit the scans, talk with them, and make sure the report reflects the whole story.
It’s hard work. It’s draining. And sometimes it’s maddening. But in the chaos, we find moments that matter: a man walking away with the knowledge he has a benign meningioma that’s been stable for years, or a woman discovering a life-threatening tumor early enough to treat it. We hold on to those moments. They remind us why we’re here, pushing against the odds, making sense of thousands of images with incomplete histories. They remind us that behind every email exchange about “missed” TMJ abnormalities or overlooked thyroid remnants stands a real human being—and the chance that our diligence might save a life.