Well I AM a radiologist and I confess I missed the gorilla on the CT scan. To be fair I was at work and spent about half a second looking at that CT slice. I saw the lung nodule instantly though which made me feel better. The way a CT of the lungs work we look for higher density objects (white) which are cancers, pneumonias and other things. Little that is black is bad since that is air and unless one has a pneumothorax it's not really a problem. A pneumothorax is outside the lung, not inside. Hence I missed the gorilla looking very fast.
What it points out for me is that getting a decent history from the patient or referring doctor is essential. We can miss stuff if the scan is not done the right way to optimize the thing that one is looking for. Most nonradiologists have no idea about the many variables that must be considered to do a CT or MR properly and we can't do the test right unless we know what sort is stuff is suspected based on history, physical examination and bloodwork.
Here is a short list of the variables that go into a typical CT scan of the abdomen: Kilovoltage, milliamperage, slice thickness, table speed, reconstruction algorithms, oral contrast positive (barium) or negaitive (water) or none, IV contrast yes or no, if yes what injection rate, what volume, what scan delay, reconstruction algorithms, cardiac gating, window level, window center, and what multiplanar reformations to do. I guarantee that your doc has heard of only a few of these and wouldn't know what to do.
If you are getting any high end radiology test make sure a good history is provided by your doc or yourself. Don't assume it is in our electronic medical record even if are a regular patient since I have seen examples of patients with duplicate med rec numbers and half their studies are under one # and half under another and we may not compare the scan to the correct study OR MISS THE GORILLA
