A Pixel Ain’t Pathology

By Phillips CD

Those of you who know me know of my modest obsession with Hunter S Thompson. Have read most of his books enough times to have memorized large sections, have seen a myriad of tapes, movies, bootleg video productions, and interviews, etc. In my office is a framed, signed letter from the man concerning, among other things, myself. The good doctor was a writer-philosopher of the highest order and a man who enjoyed life. Among other things, however, he did not suffer fools gladly. Therein lies the origins of this screed.

I’ll create a recurrent scenario. You have all experienced it. Regardless of the imaging you do, someone at some time has pointed to a diminishingly small area of a study you are reviewing, usually tapping it repeatedly with their finger, pencil, or pen and exclaimed, “Aha! That’s it! The cause of this patient’s pain/paresis/palpable mass/globus sensation!” or whatever. And, because it’s what you do, you look.

At the pixel.

The single pixel. Which is one shade of gray different than the rest. And in your head, you’re thinking to yourself, “Sure, I could kill them here, but where would I bury the body?” No, you didn’t think that. Did you?

So, a phrase you can use in this situation has finally been brought to my attention. It is short, sweet, and infinitely better than contemplating smashing your colleague with something blunt and close by in the reading room. You can still do your thoughtful stare, your nodding of the head, the carefully articulated, “Hm-mmmm. Yes. Hm-mmmm,” and then pause with a smile before you speak. And then, this is what you say:

“A pixel ain’t pathology.”

There, in a nutshell, is the end of the discussion in most settings. I have experienced this with all breeds — medical students, residents, brand new and finishing fellows, junior staff, colleagues, vice chairs, chairs, and deans. It becomes a more confident move as people are more assured of the location where they are pointing; a medical student pointing at the wrong hemisphere, wrong study, or wrong patient usually won’t get my attention.

This is most prevalent when dealing with colleagues who have too much vested interest in finding something. They want to tell the patient they were oh so right. And this radiologist won’t help me! So, AHA! There it is!

Nope. A pixel ain’t pathology. Works like a charm. Most will back off with your phrasing and self-assurance. Try it. You may have to repeat yourself on occasion, but as most think about the facts presented, they will quickly find yet another pixel to query. And then, as they say on the shampoo bottle, lather, rinse, and repeat.

Keep doing that good work. Mahalo.

Phillips CD. (Aug 31, 2022). A Pixel Ain’t Pathology. Appl Radiol. 2022; 51(5):48.

Dr. Phillips is a Professor of Radiology, Director of Head and Neck Imaging, at Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. He is a member of the Applied Radiology Editorial Advisory Board.

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