For many patients, early access to private diagnostic services has been transformative in their ability to receive prompt treatment. However, rapid access to imaging is not the only point along the diagnostic pathway where value can be delivered to patients.

In fact, the absence of a robust diagnostic pathway can negatively affect patient care even when the imaging itself is readily available. Here, we will explore why and where value is delivered at each point along the diagnostic pathway.

Getting Off To A Good Start: The Referral

The clinical question on a referral shapes everything downstream, including which imaging modality is chosen, how the study is performed and reported, and ultimately what route down the pathway the patient takes. If the clinical question on the referral is suboptimal or lacking in detail, it can send a patient down the wrong diagnostic route entirely, while a precise one leads to better radiology reporting and a better patient outcome.

For example, take the case of a patient presenting with nondescript lower back pain. Without clinical context to differentiate between lumbo-sacral pain and renal colic, the correct scan may not be performed and as a result the right diagnosis is not reached. If the history was more suggestive of renal colic with loin to groin radiation and/or renal angle pain, then a CT KUB should be performed. If this history was more in line with lumbo-sacral pain with possible neuropathic symptoms, then an MRI of the lumbar spine would be better.

Without the correct imaging, the right diagnosis may be missed, which will have negative effects on the overall quality of patient care.

Why Context Matters

Providing greater clinical context, such as medical history, risk factors, prior results and a timeline of symptoms, not only helps the radiologist but also actively changes technique, prioritisation, interpretation and the actions taken after the scan.

For example, consider a patient presenting with a headache. If the referral simply stated "intense headache, please scan" it could be triaged as routine. But adding the context of, for example, " this is the worst headache of my life, it felt like a baseball bat hitting the back of my head” and the same request is immediately flagged as a possible subarachnoid haemorrhage. This triggers an emergency CT head within the hour rather than being scheduled days later.

The precise words used to describe onset and severity, not the anatomical request itself, are what moves the patient from a routine list to an emergency pathway.

From Data To Insights: Interpreting Scan Results

Once a scan is completed, the radiologist’s interpretation is key to providing clinically useful information for the doctor who can then decide which speciality to refer the patient to and the speed at which this is required.

This is helped by scoring criteria that help decide the speed of onward care. For example, the PIRAD scoring system in prostate MRI. This standardised scoring system used by radiologists helps interpret multiparametric MRI (mpMRI) of the prostate to estimate the likelihood that a visible lesion represents clinically significant prostate cancer. The system plays a crucial role alongside PSA and symptoms in determining which patients need to see a urologist and go on to have a biopsy.  

What Happens When The Diagnostic Pathway Breaks Down?

In the absence of a clearly set out diagnostic pathway, delays are almost inevitable. The effects on patient care are numerous, with key consequences including:

1) Delayed access to a specialist

If the diagnostic pathway is unclear, a patient may have a report indicating a finding but not have the knowledge of how to act on the report or the ability to see the right person.

2) Delayed diagnosis

Scans may be performed quickly, but delays in reporting and communicating results, arranging biopsies and/or referring patients can prolong the diagnostic process.

3) Overdiagnosis and overtreatment

Extremely sensitive imaging can identify abnormalities that are benign or clinically insignificant. Without appropriate interpretation and risk stratification, this can lead to unnecessary biopsies and treatment.

4) Unnecessary patient anxiety

A patient may receive an abnormal imaging result without timely explanation or a clear plan, increasing uncertainty and causing unnecessary anxiety.

5) Reduced clinical value of imaging

The benefit of advanced imaging depends not just on detecting abnormalities, but on ensuring that the findings lead to the right clinical decision at the right time.

Access Timely Diagnostic Clarity For Your Patients

At Vista Health, we support clinicians at every step of the diagnostic pathway, from our intuitive, failsafe referral portal and our single point of contact for referrer queries to our use of the Sectra Image Exchange Portal and our expert reporting overseen by experienced consultant radiologists.

For easy referrals to support your patient care, take advantage of our online referral portal.