Imaging Help

[jubb]

So I've been working on interpreting imaging studies that we order on patients all the time. I'm kinda annoyed that in med school i've only been asked to interpret chest films myself like 2-3 times my entire career and asked to follow up on the final report like thousands of times. Half way through 3rd year I realized that you gotta take the initiative to try to read films yourself or you'll never learn how to do more than read a radiology report. I developed a system for myself that I'm pretty comfortable with for chest x-rays and feel that I'm not going to miss anything major on them, checking placement of lines and ET tubes, and for pneumothorax, air under the diaphragm and stuff like that.

However, I've never any formal teaching on or developed a good system for CT Abd/Pelvis or for abdominal x-rays, I usually just eye ball it and it always makes me feel like I don't know how to read them and that I'm always missing something. Does anyone have a good system or know any good references on how to evaluate these images?

I guess one for Head CT's in trauma would be useful too. I've seen a trauma team drop off a trauma in the sicu saying all his imaging was negative, I looked it over myself and saw obvious blood in his head and really wish I could have got the lovenox stopped before it was given.

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[XoQo]

So I've been working on interpreting imaging studies that we order on patients all the time. I'm kinda annoyed that in med school i've only been asked to interpret chest films myself like 2-3 times my entire career and asked to follow up on the final report like thousands of times. Half way through 3rd year I realized that you gotta take the initiative to try to read films yourself or you'll never learn how to do more than read a radiology report. I developed a system for myself that I'm pretty comfortable with for chest x-rays and feel that I'm not going to miss anything major on them, checking placement of lines and ET tubes, and for pneumothorax, air under the diaphragm and stuff like that.

However, I've never any formal teaching on or developed a good system for CT Abd/Pelvis or for abdominal x-rays, I usually just eye ball it and it always makes me feel like I don't know how to read them and that I'm always missing something. Does anyone have a good system or know any good references on how to evaluate these images?

I guess one for Head CT's in trauma would be useful too. I've seen a trauma team drop off a trauma in the sicu saying all his imaging was negative, I looked it over myself and saw obvious blood in his head and really wish I could have got the lovenox stopped before it was given.

Nothing beats a 4 week radiology elective. Tons of films. My school lets you tailor the clerkship to your specialty so i saw tons of belly CTs, AAS's, CXRs till i was sick of them. I think Winged Scapula mentioned in an earlier thread that nothing beats just viewing many many films and developing a gestalt feeling about things.

That being said, I was in the same boat as you and wanted something a little more ordered. What helped me was the two texts they gave us at the beginning of the clerkship. These books are thick...for GS you probably need only half the sections in each. but they were well written, lots of annotated films so you know what you're looking for. And some diagrams to explain random stuff:


Squire's Fundamentals of Radiology 6th Edition (ISBN 0674012798)
Clinical Radiology: The Essentials (ISBN 0781799686)

For me, reading a billion films with the radiologists over 4 weeks helped me get much more comfortable with the "system" that the books teach.

have fun

 

[dynx]

I've seen a trauma team drop off a trauma in the sicu saying all his imaging was negative, I looked it over myself and saw obvious blood in his head and really wish I could have got the lovenox stopped before it was given.

Wow, you guys have a wierd combo of agressive DVT prophylaxis and Carefull observation if you admit Traumas that are thought to have totally negative imaging to the SICU then fire them up with Lovenox before you even have a final read.

 

[Blade28]

Wow, you guys have a wierd combo of agressive DVT prophylaxis and Carefull observation if you admit Traumas that are thought to have totally negative imaging to the SICU then fire them up with Lovenox before you even have a final read.

I was just going to post the same thing.

 

[Bitsy3221]

If you ever sit with a Radiologist while s/he is reading an Abd CT, you will notice they keep scrolling back and forth multiple, multiple times. When I first started out, I thought they were just ADD, but eventually realized it is because that is how you are supposed to read a CT.

Rather than trying to "take it all in" at once on each slice, look at each organ individually, in its entirety. Start at the dome of the liver and scroll though to the bottom of the organ. Then scroll back up and look at the spleen. Then the stomach. You get the pictures. As with CXRs, find a sequence and a pattern and do it the same way every time. When looking at the intestines, see if you can follow the path of the intestines starting at the pylorus down to the rectum (rather than just looking at them all at once). If you get "lost" in the intestines, look for the IC valve in the RLQ, it is often seen as a distinct thickness in the bowel wall or even as a small soft tissue density. Don't forget to look at the different windows (i.e. lung windows to look for free air, bone windows) and the recon images as they can help you tremendously.

Obviously it depends on what you are looking at the CT for--trauma vs. ?SBO vs. abd pain. But like with CXRs, if you develop a system and do it the same way every time you will get better. The more normal CTs you see, the easier it is to find the abnormalities in the others.

 

[jubb]

Thanks for the advice. I found copies to borrow of the two books recommended. I wish I would have done a radiology month now, I elected not to because so many talked about how big of a slacker rotation it was. I've been trying to carefully examine 5 abdominal CTs a day and I've realized why I chose not to be a radiologist, it's really slow and boring as I'm not very efficient and reading them yet.