At times I find myself missing findings that are so clear when I read out with my attendings. Examples include rib fractures, rib deformities, nodules.
Also I find myself flustered and unable to find anything when I have a referring doc right behind me for a new scan. I had a extremity CT to eval a hematoma from a AV graft and ended up protocoling it when the patient was on the CT scanner. The surgeons where right there too. The scan was done and I reviewed the image, told them to do delays, reviewed the image again briefly... surgeons ask, what do you see...... I was a deer in headlights.
I'm assuming it gets better. But I feel like I am so slow.
1- Don't worry about speed. You will get fast over time, esp in first year of your pp.
2- Anatomy, anatomy and learn anatomy. This is the backbone of radiology. Without anatomy, you are like a mechanic without tools.
3- Search pattern. You will develop it over time. I personally believe in search pattern. Everyone has his own style. Some go slice by slice (region by region) on CT and MR (which needs more experience) or some go organ by organ. For a resident and even junior attending esp outside your area of fellowship, organ by organ works better.
4- Basics of imaging modality, esp if you are reading MR or abdomen CT. For example, what is dark on T2? what is GRE sequence for? Which sequence is the key for diagnosis of PVNS or Amyloid angiopathy? Why should we give contrast? Why do we do delayed phase in Liver CT? What is the importance of arterial phase? If you look for liver malignancy how the protocol is different for RCC, HCC or colorectal cancer? What if the patient is post TACE?
Example: If you read a chest CTA, first know the protocol. Know why we do gated if the clinical question is aortic dissection. Also what is retrospective versus prospective gating. Once you have the study, first look just at Pulmonary arteries for PE in appropriate window (I barely use preset windows. I window myself, But at the beginning just use system presets). Then, lungs and airways in lung window. You can use MIP images for nodules which work great. Then mediastinum in soft tissue window including lymph nodes and heart. For example, as a newbie you have to look meticulously for pericardial effusion to call it, otherwise you will miss it. With the same window, look at the axillary LNs, chest wall, Thyroid and upper abdomen esp adrenals. Then for the bones use bone window both sagital and axials.
Look at all available planes, coronal, sag and axials. As you go through your training and after that, you will start to add things to your search pattern, esp if you miss it. For example, you will learn not to miss thyroid nodules on CT chest or sacral insufficiency fracture on CT abdomen pelvis, because you will probably miss these things during your residency multiple times. Also you will get more efficient and faster.
Something like extremity CT needs a lot of anatomy to know. but still you can divide it into bones, joints, muscles, arteries, veins, nerves, and subQ fat/tissues. If this is a trauma case, you have to know the anatomy of all joints and fracture/dislocation patterns (if you don't know about Lisfranc fracture-dislocation you will not call it). If you are reading a CTA with run off you need to know the anatomy. Comparison with other side is also very helpful.
It is a never ending learning process. The learning curve is very steep at the beginning. After first month of solo overnight call, you will become much better. And also you will learn that radiology is not as easy as you may think.
I can understand your feeling. I was in the same boat. You will get better and better over time. Don't worry about it. Just try your best and know that your feelings are very common.
