Knowing Anatomy for Radiology

[DrBB]

I'm a MS4 interested in going into radiology. The only problem is that I remember very little anatomy from MS1 year. So here's the question to residents: did you guys have a good foundation for anatomy going into residency, or did you simply have to re-learn most of it? I'm just worried because my anatomy knowledge wasn't great to begin with, and I'm worried about having to relearn all of it.

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[shark2000]

I'm a MS4 interested in going into radiology. The only problem is that I remember very little anatomy from MS1 year. So here's the question to residents: did you guys have a good foundation for anatomy going into residency, or did you simply have to re-learn most of it? I'm just worried because my anatomy knowledge wasn't great to begin with, and I'm worried about having to relearn all of it.

One of the most difficult parts of radiology is differentiating normal and abnormal and in order to do it,you need to know a huge amount of anatomy. Whoever says otherwise does not know what he is talking about. Esp some parts of radiology like MSK MRI, Neck CT, Temporal Bone CT are all about anatomy with all its details and not surprisingly these are some of the most complicated Radiology modalities.

However, anatomy in radiology means imaging anatomy and not necessarily anatomy you learn in medical school. It is mostly about anatomy of structures in cross sectional imaging which is to some extent similar and to some extent different from med school anatomy.

You will be fine. It is a never ending process. Even as attending, you constantly improve your imaging anatomy skills. Every good radiology text starts with imaging anatomy and normal variations. Basically you have to know how normal structures look on a CT or MR to call something abnormal.

Bottom line: you need to know it well. It is an ongoing process that will continue. Don't worry.

My recommendations:
1- Use requisite books for your first year reading. For chest I will do chest essentials by collins and thoracic imaging by Webb. For body I will do Webb fundamentals of CT. All of these have required discussions about anatomy.

2- Ask, Ask, Ask. In your first rotation try to name and find all the structures you see. If you don't know ask seniors, fellows or faculty.

3- See as much images as you can. Esp Statdx imaging anatomy is great.

4- It is not just knowing what is where. You have to see tons of studies to grab a normal picture of each structure including its normal variants and also positional changes. For example you may not be able to see lateral talus process just because the view is not true lateral.

5- You will develop this skill over years. There is no magic. It needs a lot of practice. You will be fine after reading thousands of studies and residency is all about it.

 

[DrBB]

One of the most difficult parts of radiology is differentiating normal and abnormal and in order to do it,you need to know a huge amount of anatomy. Whoever says otherwise does not know what he is talking about. Esp some parts of radiology like MSK MRI, Neck CT, Temporal Bone CT are all about anatomy with all its details and not surprisingly these are some of the most complicated Radiology modalities.

However, anatomy in radiology means imaging anatomy and not necessarily anatomy you learn in medical school. It is mostly about anatomy of structures in cross sectional imaging which is to some extent similar and to some extent different from med school anatomy.

You will be fine. It is a never ending process. Even as attending, you constantly improve your imaging anatomy skills. Every good radiology text starts with imaging anatomy and normal variations. Basically you have to know how normal structures look on a CT or MR to call something abnormal.

Bottom line: you need to know it well. It is an ongoing process that will continue. Don't worry.

My recommendations:
1- Use requisite books for your first year reading. For chest I will do chest essentials by collins and thoracic imaging by Webb. For body I will do Webb fundamentals of CT. All of these have required discussions about anatomy.

2- Ask, Ask, Ask. In your first rotation try to name and find all the structures you see. If you don't know ask seniors, fellows or faculty.

3- See as much images as you can. Esp Statdx imaging anatomy is great.

4- It is not just knowing what is where. You have to see tons of studies to grab a normal picture of each structure including its normal variants and also positional changes. For example you may not be able to see lateral talus process just because the view is not true lateral.

5- You will develop this skill over years. There is no magic. It needs a lot of practice. You will be fine after reading thousands of studies and residency is all about it.

I see...so my question is, what happens during your first year of residency and you are on call? What are the responsibilities of the resident? He/she will likely not know all the anatomy and will not be able to make the read. What does the resident do?

 

[shark2000]

I see...so my question is, what happens during your first year of residency and you are on call? What are the responsibilities of the resident? He/she will likely not know all the anatomy and will not be able to make the read. What does the resident do?

1- Don't worry. Don't worry.

2- At most programs you start call after 6 months or a year. In the interim, You will go through core rotations and learn the most important things. For example you will do neuroradiology, learn the basic anatomy and also the major disease processes. By the end of rotation you will get familiar with emergent disease entities. Will you be perfect ? Not at all. Nobody is. I still do not feel 100% comfortable with my even subspecilaty.

3- Most places you start call with some supervision at first and then gradually your responsibility go up. Now if you are doing Neuro, after reading 100 head CTs gradually you get comfortable ruling out ICH. Also you will know your limitations after a while and can ask for help when needed.

4- Never ever you will be able to give the best reading on all studies. BUT you have to learn emergent things. So You will have to be able to rule out stroke, read a temporal bone for fracture, read ICH, .... But more than a handful of times happened in my residency that I was on solo call and I found some abnormality that I did not know what it was.
As long as it is not emergent, it is fine. You can give a prelim report and describe your findings. Then put in your impression that there is not acute stroke, ICH or .... on this brain MRI, but there is a CP angle mass or IAC lesion that I do not know what it is. It will be reviewed in AM with our Neuroradiologist.
And this is appropriate to me. Nobody is going to take a patient to OR if you call a CP angle meningioma at 3 AM. I always tried my best to make the dx, but if I did not know non=-emergent findings, I always followed this algorithm and then called the relevant team in AM. Everybody appreciated it including my attending.

5- Man, you are really worried. Cool down. Nobody expect you to know anything about radiology the first day. But they expect you to study, do your best and they want to see you progress. My former program director told me that he enjoys seeing residents do not know anything on their first day and then on their 4th year they are competent radiologists.

 

[DrBB]

1- Don't worry. Don't worry.

2- At most programs you start call after 6 months or a year. In the interim, You will go through core rotations and learn the most important things. For example you will do neuroradiology, learn the basic anatomy and also the major disease processes. By the end of rotation you will get familiar with emergent disease entities. Will you be perfect ? Not at all. Nobody is. I still do not feel 100% comfortable with my even subspecilaty.

3- Most places you start call with some supervision at first and then gradually your responsibility go up. Now if you are doing Neuro, after reading 100 head CTs gradually you get comfortable ruling out ICH. Also you will know your limitations after a while and can ask for help when needed.

4- Never ever you will be able to give the best reading on all studies. BUT you have to learn emergent things. So You will have to be able to rule out stroke, read a temporal bone for fracture, read ICH, .... But more than a handful of times happened in my residency that I was on solo call and I found some abnormality that I did not know what it was.
As long as it is not emergent, it is fine. You can give a prelim report and describe your findings. Then put in your impression that there is not acute stroke, ICH or .... on this brain MRI, but there is a CP angle mass or IAC lesion that I do not know what it is. It will be reviewed in AM with our Neuroradiologist.
And this is appropriate to me. Nobody is going to take a patient to OR if you call a CP angle meningioma at 3 AM. I always tried my best to make the dx, but if I did not know non=-emergent findings, I always followed this algorithm and then called the relevant team in AM. Everybody appreciated it including my attending.

5- Man, you are really worried. Cool down. Nobody expect you to know anything about radiology the first day. But they expect you to study, do your best and they want to see you progress. My former program director told me that he enjoys seeing residents do not know anything on their first day and then on their 4th year they are competent radiologists.

Hey, I really appreciate your advice. I'm a MS4 and still kinda trying to figure out what specialty I want to do. Are you happy with radiology as your career choice?