Aug 15, 2017
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Friends,

I'm interested in primary care and I'm worried my chest x-ray skills aren't up to snuff. Our dedicated student lectures really aren't that helpful, just too superficial. I tried looking at some myself on clerkship rounds but it just looks like white and black to me.

Are there any good resources or websites out there?
 

xffan624

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Jan 6, 2013
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Won't help you now, but in 4th year I actually took a radiology elective to help with this. Definitely felt more competent after I did it. X-rays, along with any imaging, is really about repetition and practice. So read some source material to give you some starting points and then take every opportunity to look at real x-rays that you can.
 
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Crayola227

The Oncoming Storm
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Oct 22, 2013
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I think the most important piece of advice you can get is to have a "system" and stick with it

1) Always assess the quality of the film first. Is this PA or AP? Upright or supine? Make note if they are rotated, which way (left or right) and if it's a lot or a little, and how good the exposure is. Is this inspiratory or expiratory?

two systems that I was taught:
"outside, in between, inside"
"A-Z"

The first I was taught by an excellent radiologist.
Outside meaning you first look outside the lungs. Because it's easy to overlook and "skip" to get to the fun/exciting/obvious pathology you usually are looking for inside.
-So look at the hardware, don't assume all the metal you see is supposed to be there.
-Look at the soft tissue including what's lying over the lungs and mediastinum, you might catch breast cancer in a man.
-Look at all the bones including the ribs - sometimes you'll catch Paget's or mets when you thought you were just looking for PNA, fractures that are signs of abuse, etc.
-Look underneath the diaphragm.

Remember that every image you order, you are responsible for everything in that image, even if it's not what you're looking for or you don't know how to read an MRI. You're responsible for your read and to consult, even if that means walking down to radiology and not waiting for the final read to come in days later.

-Then you can look in between the lungs - I might write more about this later.
-Follow this up by looking inside the lungs.

The other method, which you can look up, is the A-Z method.

I ended up using something of a hybrid method. I check the quality of the film, look outside the lungs, then use A-Z to do the rest.

If this post gets enough likes I may try to recreate the pocketcard I was given for CXRs that has always made me look smarter than I am, and has really helped me with Ddx and not missing some of the less common pathology.
 
Last edited:

Syncrohnize

PGY-1
7+ Year Member
Dec 28, 2010
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Friends,

I'm interested in primary care and I'm worried my chest x-ray skills aren't up to snuff. Our dedicated student lectures really aren't that helpful, just too superficial. I tried looking at some myself on clerkship rounds but it just looks like white and black to me.

Are there any good resources or websites out there?
Congrats to you on having aspirations to go above and beyond. Most times they tell MSX's or interns to interpret CXRs, they're just going to give you the ABCDE spiel and use it as a point of pimping if you didn't know it. ECGs are similar. In order to actually learn either, you need a dedicated textbook and then practice in a clinical (not textbook) setting. Listen to what other students and above here suggest, but take note most resources are interchangeable and you can use your intuition to find something that may work. They key is to stick with it and not just buy something and never use it.
 

Syncrohnize

PGY-1
7+ Year Member
Dec 28, 2010
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I think the most important piece of advice you can get is to have a "system" and stick with it

1) Always assess the quality of the film first. Is this PA or AP? Upright or supine? Make note if they are rotated and how good the exposure is. Is this inspiratory or expiratory?

two systems that I was taught:
"outside, in between, inside"
"A-Z"

The first I was taught by an excellent radiologist.
Outside meaning you first look outside the lungs. Because it's easy to overlook and "skip" to get to the fun/exciting/obvious pathology you usually are looking for inside.
-So look at the hardware, don't assume all the metal you see is supposed to be there.
-Look at the soft tissue including what's lying over the lungs and mediastinum, you might catch breast cancer in a man.
-Look at all the bones including the ribs - sometimes you'll catch Paget's or mets when you thought you were just looking for PNA, fractures that are signs of abuse, etc.
-Look underneath the diaphragm.

Remember that every image you order, you are responsible for everything in that image, even if it's not what you're looking for or you don't know how to read an MRI. You're responsible for your read and to consult, even if that means walking down to radiology and not waiting for the final read to come in days later.

-Then you can look in between the lungs - I might write more about this later.
-Follow this up by looking inside the lungs.

The other method, which you can look up, is the A-Z method.

I ended up using something of a hybrid method. I check the quality of the film, look outside the lungs, then use A-Z to do the rest.

If this post gets enough likes I may try to recreate the pocketcard I was given for CXRs that has always made me look smarter than I am, and has really helped me with Ddx and not missing some of the less common pathology.
I want this.
 
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vm26

Member
15+ Year Member
Oct 4, 2002
528
320
West coast
Status
Attending Physician
Friends,

I'm interested in primary care and I'm worried my chest x-ray skills aren't up to snuff. Our dedicated student lectures really aren't that helpful, just too superficial. I tried looking at some myself on clerkship rounds but it just looks like white and black to me.

Are there any good resources or websites out there?
I get calls from attending's regarding line placement all the time. What level of competency are you aiming for?

Regardless your best bet would be to do 2-4 week rotation with a chest radiologist (interested in teaching) going through the hundreds of radiographs (ICU portables, outpatient PA/laterals, ER etc)
 
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Anicetus

5+ Year Member
Apr 11, 2013
1,499
1,205
Status
Medical Student
Friends,

I'm interested in primary care and I'm worried my chest x-ray skills aren't up to snuff. Our dedicated student lectures really aren't that helpful, just too superficial. I tried looking at some myself on clerkship rounds but it just looks like white and black to me.

Are there any good resources or websites out there?
Since this has been necrobumped, OP have you played breath of the wild yet?
 

Syncrohnize

PGY-1
7+ Year Member
Dec 28, 2010
2,866
2,838
Status
Resident [Any Field]
I think the most important piece of advice you can get is to have a "system" and stick with it

1) Always assess the quality of the film first. Is this PA or AP? Upright or supine? Make note if they are rotated, which way (left or right) and if it's a lot or a little, and how good the exposure is. Is this inspiratory or expiratory?

two systems that I was taught:
"outside, in between, inside"
"A-Z"

The first I was taught by an excellent radiologist.
Outside meaning you first look outside the lungs. Because it's easy to overlook and "skip" to get to the fun/exciting/obvious pathology you usually are looking for inside.
-So look at the hardware, don't assume all the metal you see is supposed to be there.
-Look at the soft tissue including what's lying over the lungs and mediastinum, you might catch breast cancer in a man.
-Look at all the bones including the ribs - sometimes you'll catch Paget's or mets when you thought you were just looking for PNA, fractures that are signs of abuse, etc.
-Look underneath the diaphragm.

Remember that every image you order, you are responsible for everything in that image, even if it's not what you're looking for or you don't know how to read an MRI. You're responsible for your read and to consult, even if that means walking down to radiology and not waiting for the final read to come in days later.

-Then you can look in between the lungs - I might write more about this later.
-Follow this up by looking inside the lungs.

The other method, which you can look up, is the A-Z method.

I ended up using something of a hybrid method. I check the quality of the film, look outside the lungs, then use A-Z to do the rest.

If this post gets enough likes I may try to recreate the pocketcard I was given for CXRs that has always made me look smarter than I am, and has really helped me with Ddx and not missing some of the less common pathology.
And has the Crayola unveal her magic CXR booklet?
 

Crayola227

The Oncoming Storm
5+ Year Member
Oct 22, 2013
15,968
17,819
All of Time & Space
And has the Crayola unveal her magic CXR booklet?
sorry guys, keep on me. I went through a move and thought I knew *exactly* where it was and could put hands on it... but no. I have another idea where it might be but it might take some time....
 
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