Interpretation of OCT is awareness!
Interpretation of an OCT image means brightening of something, explaining and laying out the findings. OCT images are some kind of a transmitter, the interpreter is the receiver of an hidden information. Your answers to an OCT image are linked to your experiences, your interest and willingness to lay down the blinders and your prejudices. The answer to a question also affects the other answers.
Put nothing into the image what is not there!
It’s a challenge to record a good OCT image. The even greater challenge is the correct interpretation! A major risk ist the danger of subjectivity and a rapid satisfaction. Search the challenge of OCT images! Nothing is more boring in your career as an eye doctor when you do the same every day.
 Pitfalls with OCT part 2 optical coherence tomography getoct (summary, PDF) |
Pitfalls with OCT getoct academy part 2
As a source of enlightenment: getoct.com database
A big help is to consider as many OCT images as possible to achieve a “cerebral calibration “. Hundreds of annotated OCT images and videos are waiting to be discovered, through you.
Don’t miss anything really occurring
Dr. Hasler says at the getoct academy 2011, that a perfect instruction of the patient leads to good OCT images. You have first to prepare a good timing to start the recording at the right moment. It is of advantage to get both: OCT scan and corresponding infrared image of the fundus. These images are linked to each other and improve the orientation. If the scans are not perfect, it is worthwhile to start again. Immediately delete useless images to keep your computer clean.
Dr. Hasler: the algorithme (red line) follows the wrong way and leads to an erroneous measurement.
Algorithme makes mistakes (red/white line): OCT mapping and thickness imaging is nonsense (X) by Dr. Hasler.
Highly myopic eyes are difficult
OCT scanners are designed for normal-sighted eyes and sometimes have a button for highly myopic eyes. An oblique cut makes the algorithm work hard and leads more frequently to errors. Thus one has to check only the individual cross-sections of whether the algorithm has done his work satisfactorily.
The quality of an individual OCT cut influences the construction and the representation of the three-dimensional volume. If the cross section is poor in quality, the 3D representation is useless.
3D images are a summary of cross-sections and if they look strange you have to switch back and look at the cross section level. The OCT scanner analyzes the samples using an algorithm, so a „ simple calculation method“. The 3D OCT has the advantage that you can quickly scroll through a lesion, to detect and to estimate the dimensions and to identify mistakes easier.
In addition, 3D OCT is a good training to discover the anatomy of the eye and the problem is explained in an impressive way to the patient.
Interpretation of OCT
The most difficult task is the correct interpretation of the OCT images. There is an enormous achievement to get a good OCT image. Good interpretation is a real challenge.
Dr. med. Peter Maloca recommends a multi-stage procedure for an accurate diagnosis:
Checklist OCT pre-interpretation:
Only practice makes perfect! Who does not look exactly on OCT images, will never learn it.
2. OCT network – calibration
Get in touch with experienced OCT users. Visit an OCT congress, for example the annual getoct academy in Lucerne (in German) and join the community at getoct.com. Upload your pictures to getoct.com, ask the community.
1. Orientation: where are you?
For a proper assessment of OCT images you have to orient yourself first. Say nothing of what you can not prove or show on the OCT images!
2. Findings: describe only what you really see in simple words.
3. Summarize the findings
4. Link the findings to a diagnosis (interpretation)
5. Be honest: self-criticism/what else?
Be honest! Say nothing what you have not checked for alternatives! Don’t skip lesions! Twist nothing! There are no stupid questions. Only someone who has no questions is stupid. Serve the OCT scans and do not abuse it for your self-expression!
6. Explain: explain to the patient the diagnostic findings. If he understood it, you have understood it.
Steps of interpretation OCT by Dr Maloca
OCT-Interpretation von Dr. med. Peter Maloca:
Für eine angemessene Bewertung der OCT-Bilder müssen Sie sich zuerst orientieren. Sagen Sie nichts, was Sie nicht beweisen können, zeigen Sie es auf den OCT-Bildern!
2. Befunde: beschreiben Sie in einfachen Worten nur, was Sie wirklich sehen.
3. Zusammenfassung der Befunde
4. Verknüpfen Sie die Befunde zu einer Diagnose (Interpretation)
5. Seien Sie ehrlich, Selbstkritik, was könnte es sonst noch sein?
Seien Sie ehrlich! Sagen Sie nichts, was sie nicht nach Alternativen geprüft haben! Lassen Sie keine Läsionen aus! Verdrehen Sie nichts! Es gibt keine dummen Fragen. Nur jemand, der keine Fragen hat, ist dumm. Missbrauchen Sie die OCT scans nicht zu Ihrer Selbstdarstellung!
6. Erkläre! Erklären Sie dem Patienten die Befunde. Wenn er es verstanden hat, haben Sie es auch verstanden.
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