Chest X-rays

[Quixotic]

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Well, I am just starting internship and found out that there is no overnight radiology coverage for plain films. That means we have to read our own chest x-rays and abdominal films. I didn't take a radiology elective during medical school. I am not worried about missing a large pneumothorax or pneumonia, but I don't want to miss more subtle things. I have seen too many residents think they should put in a chest tubes when their apparent pleural line turns out to be a skin fold.

Does anyone have any good suggestions for quick reads and good resources?

 

[adenocard]

http://radiologyed.org/resourcelibrary/


catalogs a lot of websites, may be able to find something there

 

[deciding]

I used Felson in my radiology rotation and it taught me the basics of Chest X-rays. If you are after something that is more portable and has higher fidelity images then try an iBook. One of my friends says his program director is trying radiology iBooks as part of their curriculum this year. Here is a link to the Chest book they are trying. Looks cool, but I haven't used it. I think you can download a chapter for free. Super cheap.


https://itunes.apple.com/us/book/fundamental-chest-radiology/id664902858?ls=1

 

[Quixotic]

Thanks for the input. I went ahead and bought the Fundamental Chest Radiology iBook. There was a free chapter I was able to download. The content seemed high yield and it was less than $15 so whatever. The rest of the book was even better. There is an anatomy section that details the lobes of the lungs, vasculature, etc. Makes it seem like reading chest x-rays should be easier. We will see how it goes when I actually have to do it on call.

 

[Quixotic]

I used Felson in my radiology rotation and it taught me the basics of Chest X-rays. If you are after something that is more portable and has higher fidelity images then try an iBook. One of my friends says his program director is trying radiology iBooks as part of their curriculum this year. Here is a link to the Chest book they are trying. Looks cool, but I haven't used it. I think you can download a chapter for free. Super cheap.

https://itunes.apple.com/book/funda...y/id664902858?l=ja&mt=11&v0=9988&ign-mpt=uo=1

Based on my experience thus far, I would say get good with chest xrays and abdominal films before you start internship. It seems like programs are so variable in whether or not radiology covers 24/7 that many people will be responsible reading thier own stuff. I do not want to be the one guy that puts in a chest tube when it is not necessary. Whatever resource you use, make sure you see enough and learn the basics of anatomy because things can be trickier than I thought.

 

[Anastomoses]

Well, I am just starting internship and found out that there is no overnight radiology coverage for plain films. That means we have to read our own chest x-rays and abdominal films. I didn't take a radiology elective during medical school. I am not worried about missing a large pneumothorax or pneumonia, but I don't want to miss more subtle things. I have seen too many residents think they should put in a chest tubes when their apparent pleural line turns out to be a skin fold.

Does anyone have any good suggestions for quick reads and good resources?

Wait, is radiology elective a common thing? I don't even know where in my schedule I'd squeeze something like that.

 

[DrBowtie]

Wait, is radiology elective a common thing? I don't even know where in my schedule I'd squeeze something like that.

If you're not taking a radiology elective in spring of 4th year, you're doing it wrong. Most are super easy where you have absolutely no responsibilities.

 

[Stellar Clouds]

If you're not taking a radiology elective in spring of 4th year, you're doing it wrong. Most are super easy where you have absolutely no responsibilities.

And some you don't even have to show up for...

 

[tco]

If you're not taking a radiology elective in spring of 4th year, you're doing it wrong. Most are super easy where you have absolutely no responsibilities.

Mine's more intense...This year, we have a new course coordinator.

We go to the reading room at 8, find our resident for the day. Read until 10:30, then go over a case (CORE case) with the coordinator that we were supposed to do the night before. We go to the resident conference at 12. Next, we meet up and go over the second case we were to do the night before. We go to a "lab" from 2 to 3 PM. Finally, we go back to the reading room until 5 PM. Usually, when we get back to the reading room, the resident looks at us like 😕 because previously, people would go home by 11 AM, and they thought we had left for the day at 10:30 AM.

The CORE cases actually take a while to do if you read everything...They're no joke. If you could fly through them in 2-3 hours, you're doing well...

To answer the OP, though, learningradiology.com is an awesome free site for exactly what you're describing. If you want to go above and beyond, Felson's is probably the best intro text (or so say the residents).

 

[survivordo]

In the middle of the night you really just need to worry about picking up the major things that are going to change your immediate management. Typically the PATIENT'S exam will tell you if you need to be doing something. Someone with a pneumothorax big enough to need a chest tube you are unlikely to miss. It's great that you want to improve your skills but I wouldn't worry about picking up on fine subtleties in the middle of the night 🙂

Survivor DO

 

[tco]

In the middle of the night you really just need to worry about picking up the major things that are going to change your immediate management. Typically the PATIENT'S exam will tell you if you need to be doing something. Someone with a pneumothorax big enough to need a chest tube you are unlikely to miss. It's great that you want to improve your skills but I wouldn't worry about picking up on fine subtleties in the middle of the night 🙂

Survivor DO

As long as their difficulty with breathing isn't due to a COPD exacerbation and you shove a chest tube through one of their pleural blebs. 😛

 

[werd]

if you have an overnight plain film that needs to be read urgently... come up with an assessment of it, but then pass it by your upper-level or available superior. if you're an entering medicine intern, you shouldn't be expected to read and act on radiology by yourself yet.
where i did internship, we looked at after-hours plain films ourselves, but there was a prelim (rads resident) read on it within an hour or two.

 

[Anastomoses]

If you're not taking a radiology elective in spring of 4th year, you're doing it wrong. Most are super easy where you have absolutely no responsibilities.

Alright then. I'm on it.

Mine's more intense...This year, we have a new course coordinator.

We go to the reading room at 8, find our resident for the day. Read until 10:30, then go over a case (CORE case) with the coordinator that we were supposed to do the night before. We go to the resident conference at 12. Next, we meet up and go over the second case we were to do the night before. We go to a "lab" from 2 to 3 PM. Finally, we go back to the reading room until 5 PM. Usually, when we get back to the reading room, the resident looks at us like 😕 because previously, people would go home by 11 AM, and they thought we had left for the day at 10:30 AM.

This actually sounds good. If I'm doing it, I'd want to really learn the most possible.

 

[evilbooyaa]

Alright then. I'm on it.



This actually sounds good. If I'm doing it, I'd want to really learn the most possible.

Oh. My. Goodness. Your outlook will change once you start MS3. TRUST me, you want to read for a few hours, and be allowed to go home before lunch time on a radiology elective. Period.

OP - Like others have stated, you're looking for massive things that should be obvious on an X-ray. You're there to pick up consolidations, effusions, perforations, pneumothorax. Not a whole lot else.

 

[Herpeto]

I used Felson in my radiology rotation and it taught me the basics of Chest X-rays. If you are after something that is more portable and has higher fidelity images then try an iBook. One of my friends says his program director is trying radiology iBooks as part of their curriculum this year. Here is a link to the Chest book they are trying. Looks cool, but I haven't used it. I think you can download a chapter for free. Super cheap.


https://itunes.apple.com/us/book/fundamental-chest-radiology/id664902858?ls=1

I agree. Interns shouldn't need to look for the subtle findings that radiology residents spend their lives doing. However, a small apical pneumothorax can quickly become large if follow up imaging isn't done. Similarly, a pneumothorax may not always show up in the lung apex. It can show up as a deep sulcus sign if the patient is supine or semi-upright. Pneumomediastinum is also difficult to see unless you train your self to actually look for it.

Learning some of those tricks is important because where I trained, we didn't have overnight radiology coverage except for CT's. I think they used teleradiology from another country. That was super inconvenient since we couldn't get ahold of them readily. I am glad I learned the basics. I think seeing images in an electronic format is more beneficial than seeing it in a book.