How to Read a Chest X-ray

To succeed is to struggle.  Indeed, up to now, an accomplishment was the result of sweat, study, setbacks, discipline, collaboration and hopefully triumph.   Of course, the latter result is never guaranteed which makes this outcome so much more satisfying.  This process of struggling for success is well known to athletes, musicians, scientists, students, writers, chefs, farmers and many others.  All of us go through the same process in more mundane pursuits such as doing a crossword puzzle, learning a new language, testing out a new recipe or reaching a new goal in our exercise routine.

I recall a very small personal struggle I engaged with during my internship and residency days decades ago.  Every patient that physicians-in-training cared for had x-ray studies done.  Checking the results was one of the myriad tasks that fell to interns and medical residents.  Not only was this important medical data, but we wanted to be prepared with the result just in case any of our superiors queried us.  If the senior resident in charge, or worse yet – the attending physician – stopped us in the hall and asked about the x-ray findings, “I didn’t have a chance to check it yet”, was not a good intern look!

There were two ways to obtain x-ray results. 

Show the films to a radiologist who would interpret the findings

Read the film yourself and then assess your reading with the radiologist.

I always pursued the second approach.  I read the film pretending that I was the only one available in the hospital to do so.  When I was scrutinizing a chest x-ray, I committed myself to a radiographic diagnosis.  I made preliminary diagnoses of pneumonia, heart failure, a lung tumor, an enlarged heart or abnormal chest fluid. Oftentimes, I couldn’t detect any abnormality on the film.  Then, I brought the film to a real professional for analysis.  

Hmm,  something doesn't look right here.

Over the first several months of training, I was nearly always wrong, but over time my skills improved.  I struggled over each film and learned from my prior errors.  By the conclusion of my training years, I was reasonably competent at x-ray interpretation.  I  assume that colleagues who habitually brought films directly to an expert for reading did not acquire a similar skill level or confidence.  No struggle, no gain.

Now we are entering the era of artificial intelligence which will transform the medical profession – as well as society  – beyond what we can imagine.  AI will make a traditional internet search engine to seem like an abacus.  We can look forward to levels of performance and quality far beyond human capacity to achieve.  And it will all be dropped at our feet without any necessary struggle.  Will we need writers, actors, artists, professors, therapists and so many others if a machine can deliver the end products to us?  How this feel?   There will still be struggle, however,  We will struggle to find meaning in our lives.