Top 10 Common And Silly Mistakes Of Neophyte Radiology Residents
Each year, new radiologist residents repeat the same mistakes as their previous counterparts. These mistakes often make the radiology resident feel ridiculous and appear ignorant to the emergency department physicians and hospital staff. I thought it was high time to get these common mistakes out in the open so you can avoid them and you don’t have to feel ridiculous too. So, here we go!!!
Uterus Vs. Prostate Gland
No one ever seems to tell the neophyte radiologists that on occasion, enlarged prostate glands can look like uteri and vice versa. Invariably, we get a call from the downstairs physician- “How can this patient have a uterus? He is a male!!!” It happens every year. How can you prevent this from happening to you? Just look at the sex in the patient description region, silly!
Hydronephrosis Vs. Obstruction
Toward the beginning of every year, there is usually at least one resident who does not understand that hydronephrosis does not equate to urinary tract obstruction. You can get hydronephrosis (dilatation of the renal collecting system) from other etiologies such as reflux or congenital enlargement. So please, do not tell the physician that a patient with a dilated renal collecting system is obstructed if you see it on ultrasound. You need to do another test (renal scan or Whitaker test) to determine if hydronephrosis related to true mechanical urinary tract obstruction!!!
Calling A Kidney A Testicle
Often times, the resident briefly looks at an ultrasound and the images may be very nondescript- easily mistaking a kidney for a testicle. In fact, is very easy to have no idea what the technologist is looking at unless you make a concerted effort to read the ultrasound technologist captions/notes. I can’t tell you how many times a resident breaks this cardinal rule, especially as a first year resident. Don’t leave the clinician up in the air wondering what kind of radiologist you are. Always read the fine print!
Overcalling Plain Film Artifacts
I can’t tell you how many times I’ve seen first year residents intricately describe plain film findings that seem to appear on film after film. Particularly, I remember one cartridge with the same ring like finding producing film findings time after time. Some residents thought the patient ate something strange and others thought there was a foreign body. If you see the same finding on many films in a row, think artifact!
Not Doing A Rectal Exam Prior To A Barium Enema
This is a cardinal embarrassing and uncomfortable mistake that seems to also recur every few years. Invariably, there is one resident that forgets to do a rectal exam prior to inserting a rectal tube and pushes barium into the patient without checking. If you want to get yourself into trouble and vaginogram instead of a barium enema, this is the way. Be careful!!!
Aortic Rupture Vs. Aortic Aneurysm Vs. Aortic Dissection
For some reason, this is a simple but important distinction that often times seems to be lost upon the junior/neophyte resident with potentially dire consequences. Remember… Aortic rupture is a surgical emergency characterized by breakdown of the entire wall of the aorta with free flowing blood. An aortic aneurysm is an enlarged aorta (sometimes with increased risk of rupture) with intact walls. And, aortic dissection is a tear in the intima of the aorta with a true and false lumen. This can sometimes be a surgical emergency depending upon its location. Get your facts straight!!!
Calvarial Suture Vs. Fracture Confusion
The first time you are a radiology resident on call, there is a 50-50 chance you will get a pediatric head CT scan. And, you will see linear defects all over the place. I can’t tell you how many times I have seen residents overcall fractures on these studies. A. Make sure to look for symmetry of the defects… B. Look for adjacent hemorrhage C. Refer to A! If there is symmetry of the calvarial defect, it is very unlikely to be a fracture. Be careful and don’t overcall!
Transverse Sinus Bleeds
Many times a neophyte resident gives a report to another clinician when he/she is first starts out and sees a curvilinear dense region just deep to the posterior calvarium and calls a subdural hemorrhage. Well, sometimes the transverse sinus is the culprit. Look for the other sinuses and see if they merge in to this region. Don’t keep the patient overnight for normal anatomy!!!
Appendix Vs. Terminal Ileum Confusion
This is a big one. So many new radiology residents have a hard time differentiating between these two normal anatomical structures. Unfortunately, not making this distinction can sometime be dire! An appendix is a blind ending tube extending from the cecum. The terminal ileum is the end of the small bowel and you can continue to follow it down to the remainder of the small bowel proximally. Don’t confuse appendicitis for terminal ileitis!!!
Calling Flow Artifact In The SVC Thrombus
Depending on the timing of the contrast bolus, you can be headed for trouble! Often times where the azygous vein meets the SVC, you will get an intraluminal filling defect due to the contrast opacification of the SVC and the non opacified blood entering the SVC from the azygous vein. A few times a year I have seen residents call this defect a thrombus. This has significant treatment implications. Don’t let that be you!!!
These 10 mistakes may seem silly or something that you might never do as a budding neophyte radiologist, but they happen every year. Avoid these 10 mistakes and you will certainly enhance your credibility. If you do not heed these 10 pearls, you are doomed to repeat these cardinal mistakes. Lest, those physicians encountering you making these errors never take you seriously!