Each year, new radiologist residents repeat the same mistakes as their previous counterparts. These mistakes often make radiology residents 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 to avoid them, so you don’t have to feel ridiculous. Here we go!!!
Uterus Vs. Prostate Gland
No one ever seems to tell the neophyte radiology residents 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 causes 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 is related to actual mechanical urinary tract obstruction!!!
Calling A Kidney A Testicle
Often, the resident briefly looks at an ultrasound, and the images may be very nondescript- easily mistaking a kidney for a testicle. You may 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 As Radiology Residents
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. Mainly, 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 markings on many films in a row, think artifact!
Not Doing A Rectal Exam Before A Barium Enema
Not performing a rectal exam is a cardinal embarrassing and uncomfortable mistake that also seems to recur every few years. Invariably, one resident forgets to do a rectal exam before inserting a rectal tube and pushes barium into the patient without checking. If you want to get yourself into trouble and perform a “vaginogram” instead of a barium enema, this is the way. Be careful!!!
Radiology Residents Calling Aortic Rupture Vs. Aneurysm Vs. Dissection
For some reason, this is a simple but important distinction that frequently seems to confuse junior/neophyte radiology residents with potentially dire consequences. Remember… Aortic rupture is a surgical emergency characterized by a 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 diagnosis 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 at the calvarial defect, it is doubtful to be a fracture. Be careful and don’t overcall!
Transverse Sinus Bleeds
Many times, neophyte residents report a dense curvilinear region to another clinician deep to the posterior calvarium and call it a subdural hemorrhage. Well, sometimes, the transverse sinus is the culprit. Look for the other sinuses and see if they merge into this region. Don’t keep the patient overnight for normal anatomy!!!
Appendix Vs. Terminal Ileum Confusion For New Radiology Residents
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 sometimes 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 Vs. SVC Thrombus
Depending on the timing of the contrast bolus, this timing issue can lead you into trouble! Usually, where the azygous vein meets the SVC, you will get an intraluminal filling defect due to the contrast within the SVC and the non opacified blood entering the SVC from the azygous vein. A few times a year, I see residents call this defect a thrombus. This “pseudo-finding” has significant treatment implications. Don’t let that be you!!!
Establishing Credibility As Radiology Residents
These ten mistakes may seem silly or something that you might never do as a budding neophyte radiologist, but they happen every year. Avoid these ten mistakes, and you will certainly enhance your credibility. If you do not heed these ten pearls, you are doomed to repeat these cardinal mistakes lest your referring physicians will never take you seriously!