Traditionally, the field of imaging has been the domain of the physician. Rehabilitation clinicians have generally excluded themselves from interaction with imaging. This self-imposed professional boundary evolved from a misconception that information gained from viewing images was pertinent only to the medical diagnosis and therefore pertinent only to the physician. Studying the patient's diagnostic images was rarely considered, and simply reading the radiologist's “x-ray report.” was accepted as sufficient. A long-held erroneous belief of clinicians was that even if images contained a wealth of information that could enhance patient treatment, they were incapable of finding it on their own.
Traditions change. Rehabilitation clinicians have discovered that their knowledge of functional anatomy is an excellent foundation for visually comprehending diagnostic images as well as correlating clinical findings with imaging findings. The inclusion of diagnostic imaging courses in educational and professional settings is giving clinicians the confidence to engage in dialogue with radiologists, gain relevant information from radiologists' reports, and, most significantly, view diagnostic images with their own eyes.
Traditions change slowly. Although it is accepted as logical that rehabilitation clinicians need to be aware of the patient's medical diagnosis, it is considered novel by some for these clinicians to view diagnostic images themselves. For others the idea is more than novel—it can appear threatening if physicians mistakenly perceive it as a move toward diagnosis or second-guessing the diagnosis or if clinicians mistakenly perceive it as either an opportunity or a responsibility to do just that. Professional collaboration to enhance the quality of patient care is the single most important goal.
Traditions change for good reasons. Why do clinicians need to view diagnostic images?
A more comprehensive evaluation is obtained. The success of rehabilitation depends on the effectiveness of the clinician's evaluation. The more thorough the evaluation, the more substance the clinician has on which to build the rehabilitation program. Many of the clinician's evaluation tools—observation, palpation, goniometry, manual muscle testing, ligamentous stress testing, joint-end feels, joint mobility testing—are dependent on the clinician's own perceptive skills and have an inherent degree of subjectivity and limitation. Imaging can provide an objective, visual aspect to the evaluation that makes the expertise of the clinician more comprehensive. Supplementing the initial evaluation and reevaluations with musculoskeletal images increases the clinician's awareness of the patient in an added dimension. The clinician's knowledge of functional anatomy becomes more dynamically effective by allowing direct visualization of the processes of growth, development, healing, disease, and dysfunction.
The information the clinician seeks is often of a different nature from the information the physician seeks and of a different nature from what may be described in the radiologist's report. For example, a physician needs to know whether a fracture of the distal radius that has united with a malunion deformity is clinically stable; if so, the cast can be removed and the patient can be sent for ...