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      <h1 class="highwire-cite-title" id="page-title">Paternalism in Radiology?</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">R.T. Fitzgerald</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E8; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3438 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12410--6319504541" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">R.T. Fitzgerald </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Neuroradiology Division, Department of Radiology
University of Arkansas for Medical Sciences
Little Rock, Arkansas</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.T.%2BFitzgerald%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fitzgerald%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.T.%2BFitzgerald%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view"><span class="highwire-journal-article-marker-start"></span><p id="p-1">I read with great interest the article “Vertebral Endplate Changes Are Not Associated with Chronic Low Back Pain among Southern European Subjects: A Case Control Study” by Kovacs et al.<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> Their article demonstrates the challenges we face when attempting to correlate imaging findings with clinical symptoms in patients with back pain.</p><p id="p-2">In their discussion, the authors state, “In the case of vertebral endplate changes, refraining from including this finding in radiologic reports or mentioning it as a finding that is associated with disk degeneration but is likely to be clinically irrelevant may be a way of protecting patients from unnecessarily aggressive forms of treatment or overtreatment.” Are the data strong enough to support the authors' view? This opinion, potentially stemming from the personal experience of the authors and well-publicized articles examining the overuse of spinal fusion surgery,<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> merits further examination and raises a general question on the role of paternalism in radiology.</p><p id="p-3">What motivations lie behind the propensity to include or exclude certain findings in our reports? I suspect that all neuroradiologists, at one time or another, have downplayed what we perceived as inconsequential findings by our choice of wording or omission from the radiologic report. In fact, in most groups, some partners may be thought of as “overcallers” or “undercallers” based on their long-term pattern of reporting. We all want what is best for our patients and thus are undoubtedly influenced when we encounter the negative sequelae of surgical procedures performed for questionable indications. Are choices of what to include or omit from our reports always backed by scientific evidence? Although Kovacs et al<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a></sup> provide robust data on the question of endplate changes and back pain, are these results conclusive enough to eliminate discussion of endplate changes in all of our patients referred for spine MR imaging in the setting of back pain? To what degree does the paucity or absence of relevant clinical information on examination requisitions confound how we apply significance to imaging findings? Does it constitute radiologic paternalism to under-report certain imaging findings on the basis of our own perception of clinical relevance? By our choice of whether to report a finding, are we truly “protecting patients from unnecessarily aggressive forms of treatment or overtreatment” as Kovacs et al suggest?</p><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.1.E8.1" data-doi="10.3174/ajnr.A3087"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Kovacs</span>  <span class="cit-name-given-names">FM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Arana</span>  <span class="cit-name-given-names">E</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Royuela</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Endplate changes are not associated with chronic low back pain among Southern European subjects: a case control study</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2012</span>;<span class="cit-vol">33</span>:<span class="cit-fpage">1519</span>–<span class="cit-lpage">24</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIzMy84LzE1MTkiO3M6NDoiYXRvbSI7czoxODoiL2FqbnIvMzQvMS9FOC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a>

<div class="cit ref-cit ref-journal" id="cit-34.1.E8.2" data-doi="10.1056/NEJMsb031771"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Deyo</span>  <span class="cit-name-given-names">RA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Nachemson</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mirza</span>  <span class="cit-name-given-names">SK</span></span></li></ol><cite>. <span class="cit-article-title">Spinal-fusion surgery; the case for restraint</span>. <abbr class="cit-jnl-abbrev">N Engl J Med</abbr> <span class="cit-pub-date">2004</span>;<span class="cit-vol">350</span>:<span class="cit-fpage">722</span>–<span class="cit-lpage">26</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1056/NEJMsb031771&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=14960750&amp;link_type=MED&amp;atom=%2Fajnr%2F34%2F1%2FE8.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2013 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 34</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 1 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jan 2013 </div></div>
      
      
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