Books for ICU chest radiography

[NunquamDormio]

Does anyone have any books to recommend for learning chest radiography as it pertains to the ICU?

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[MirrorTodd]

I don't really think such a thing is needed. CXR's in the ICU are notoriously ****e...poorly positioned patients w/ poorly positioned xray machines with poor image technique leads to a "well the tube is probably between 3-7cm from the carina, the heart is probably enlarged and s/he probably has some atelectasis. Overall impression is that this is a poor xray."
I would search for any number of youtube videos or medical school websites detailing the method. Here is one such site I used in the past. Chest radiograph assessment using ABCDEFGHI | Radiology Reference Article | Radiopaedia.org

 

[Siggy]

Felson's Principles of Chest Roentgenology. It's written in the same fill in the blank style as Rapid Interpretation of EKGs.

Amazon product ASIN 1455774839

 

[jdh71]

Bah!!

Who needs a book.

It either looks like ****. It looks less or more like **** than the day before. Or it's clear.

The way to get good at the barbarism that is the portable icu cxr is to just look at them yourself every single day.

Don't forget to do that clinical correlation!!!

 

[deleted547339]

Felson’s is fine if you want a book, but I agree with above: the way to get decent at it is to look at every film and every read every day. Let’s say you only do 12 months of icu through your training, doing 25 days a month with a census of 16 patients daily and half of them get a chest x-ray plus 3 extra a day for intubation, line placement or following something up. That’s 3,300 chest x-rays that you’ve learned on - and a lot of people do a lot more time in the unit than that, and you’re not done learning when you finish training.

 

[deleted547339]

Also, what you’re looking for is relatively simple,

Placement of lines and tubes
Pneumothorax
Pleural effusion
Atalectasis/pneumonia/ards
Edema

And that’s about it. You also have clinical data to support you. If you have an infiltrate on a cxr and the patient is getting more febrile, tachy and with a worsening P:F and secretions, you anticipate their infiltrate is worse. If they had a pleural effusion and edema yesterday and you diuresed off 3L, you expect it to improve.

Sure, you’ll notice scarring, but it’s rarely clinically relavent. Finding masses isn’t your job. I think a lot of our radiologists, and some can see amazingly subtle things on CXR, but a CXR in the icu isn’t their most taxing task. It’s like judging an ER doc by how well he deals with a twisted ankle or a an internist deals with a patient with mild hypertension.

You’ll get it. There’s a lot bigger fish to fry in learning CCM.

 

[Dr.CCM]

Any good recs for CT chest interpret? That’s what I need more help with.

 

[jdh71]

Any good recs for CT chest interpret? That’s what I need more help with.

look at them

I mean you'll likely never get radiology good at reading a WHOLE chest CT (because there is more there than we are terribly interested in), but if what you are interested is the lungs (and the pleura), just keep looking whenever you order, and correlate with your clinical picture

 

[SpacemanSpifff]

Any good recs for CT chest interpret? That’s what I need more help with.

Here's a starter pack for chest CT interpretation, with major signs and patterns