The 92nd Annual Meeting of the Radiological Society of North America (RSNA of Oak Brook, Ill) is just around the corner, and I have to be honest: I hope I can walk.

In late September, the weather in Los Angeles was still warm enough to wear flip-flops. Unfortunately, I chose to wear them and run down the sidewalk, which is broken apart and uneven from the tree roots underneath pushing up on the concrete. Needless to say, I tripped, fell, and broke my foot—and blew out my flip-flop. For a week, I was on crutches with a splint, and for 4 weeks now, I’ve been in a walking cast. Other than not being able to drive (it had to be my right foot!), it hasn’t been so bad.

I’ll tell you, though; the diagnosis process wasn’t what I had expected. I first went to my primary care physician (PCP), who has an x-ray system in-house. He could see a slight fracture, but wasn’t sure exactly how to proceed—save for not putting any weight on my foot—so he sent the films (gasp!) to a radiologist for a read. It actually took 2 days for the report to come back, and instead of providing a clear diagnosis, the radiologist hedged, saying that it could possibly be a slight fracture.

So, my PCP sent me to an orthopedic group in Santa Monica, Calif, where the in-house foot and ankle specialist saw me. He diagnosed it as an avulsion fracture, where my ligament tore off part of my cuboid. He used the same x-rays as the radiologist, and he held them up to the fluorescent ceiling light. (As of this writing, I’m due back for a visit to the orthopedic group, where I’ll get more x-rays and a new prognosis.)

(Click image for larger view.)

Here, I’ve included my foot x-ray. I know it’s small,* and I know it isn’t on a viewing box, but I’m curious to know if you would have been able to diagnose the avulsion fracture. I must admit that I was disappointed with the radiologist’s report, as was my PCP, because it didn’t give us any additional information. Yes, that’s why we have subspecialty groups who just read musculoskeletal images. And yes, we all know that the more often you read a particular type of image, the better skilled you become at reading them. And maybe the radiologist was tired. There could be a million reasons why my report was less than stellar.

But with orthopedic groups threatening to take away a good portion of radiologists’ business, I wonder why this would have happened. Sure, I want the best diagnosis and care for my foot. But I also wish that the radiologist’s report would have been less vague so that my PCP could have given me a clear diagnosis, and the orthopedist would have been left out altogether.

So, what’s your take on this situation? I’d love to hear your opinion. Please send me an e-mail, give me a call, or let’s meet up at RSNA. Along with the Medical Imaging staff, I’ll be in the South Hall at Booth 3115—hopefully wearing a pair of shoes.

Andi Lucas, editor