Tag: books

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How To Succeed In Neuroradiology

neuroradiology

In the last part of the “how to be successful” series, we will finally discuss the ultimate rotation, neuroradiology. In our department, most residents go through MRI at the hospital as a neuroradiology rotation because most hospital-based MRI cases image the brain. Most hospital departments throughout the country work the same way.

So, what are the critical baseline keys to being successful in neuroradiology? Well, it comes down to primarily one main area of knowledge, anatomy. Location allows you to hone your differential diagnoses. So, let’s go through the primary reading material best suited to learn your anatomy. Then, we talk about a few other sources that are helpful for residents. Finally, we will discuss additional useful hints for being successful in neuroradiology with a year-by-year systemic bent.

Resources For Neuroradiology

The Best Anatomy Book

To learn your anatomy, one of the best tools is a book that many of you have read in medical school, Sidman and Sidman, Neuroanatomy. A few days ago, I found the same book, an older edition from 1965, sitting on my bookcase. The publisher again updated the book in 2007. But, the principles of programmed learning remain the same. It is very repetitive, but repetition is worth the pain. By the time you complete the book, you will remember your neuroanatomy and the terminology cold. And, you will be ready for everything else that the neuroradiology rotation can offer.

Other Valuable Resources

Several of my residents touted RadPrimer as a great way to conquer neuroradiology reading once you know your anatomy. But, if you want a great review of neuropathology, I would also check out the original edition of Osborn’s Brain. I have been hearing from several resident sources that the newer books are a bit too long. However, although a little bit dated, her original book is an excellent concise review of MRI brain pathology. It feels very thick. Once you start reading it, you realize that it contains mostly pictures with brief explanations that she organized rather well. So, look for that book if you can find it. You will not regret it.

Head and neck imaging has always been a difficult area to find excellent resources. Anatomy tends to be a bit more complicated. And, there is wide-ranging pathology. You can try the book called Imaging Anatomy: Head and Neck to help get you started along your way with the anatomy. Some of my residents liked the website headneckbrainspine.com to review head and neck pathology as well.

Year By Year: How To Succeed In Neuroradiology

Year One

As I said before, you need to learn your anatomy starting day one of the rotation. You should finish the Sidman and Sidman Neuroanatomy book as soon as possible, if not even before the rotation, so that you have a basic understanding of what you will need to know.

During the beginning days of this first-year rotation, my recommendation would be to sit down next to the neuroradiology attending and watch them dictate the cases. Initially, neuroradiology may seem like a foreign language because you will not be accustomed to the MRI lingo, sequences, and images. But, by watching the neuroradiology attending in action, you will fill in most of these gaps. By the end of the first week, you should start dictating the cases. Dictating cases will help you get the language under your belt and enable you to begin to understand how neuroradiology works.

It would help if you were emphasizing the bread and butter neuroradiology cases at this point. These include all the different types of imaging that is key to nighttime call- once again, those entities that will kill patients or are more common. So, this year you should be emphasizing bleeds, infarcts, masses, cord compression, and so forth. Although necessary eventually, the rare pediatric metabolic neurodegenerative disease should not be your focus. 

For head and neck, think about learning similarly. Again, foreign bodies, mumps, and tonsillar abscesses should take precedence over rare head and neck tumors. Also, make sure to emphasize and head and neck anatomy with all the spaces. Head and neck anatomy can be challenging for the novice MRI Neuro reader. Know not only the primary diseases, but that you can also make the findings real-time. That involves reading lots (and lots) of cases on the PACs. Don’t be a bookworm without coming out to read on a work station. (A widespread mistake!)

Years Two And Three

Now you are in “Full Metal Jacket” mode. You have the basics under your belt. And boards are a stone’s throw away. So, make sure to fill in all the gaps. You should worry about all the non-lethal, less common diseases. Read through the more significant books (like Osborne), or you should have completed the RadPrimer. Regardless, you need to know “everything” for the boards. Therefore, know your less common differentials, diseases, and more.

Also, try to take some of the cases before your attending grabs them. Then, be sure to dictate them. Pre-dictating will get you in the habit of becoming an independent reader. Don’t be a wallflower and wait. You will lose out on the critical skills of becoming an attending.

Year Four

Hopefully, you have passed your core exam by now. So, try to emphasize learning about all the other areas that you may have missed studying for call and your core exam. I would check out subjects like MR Spectrography, tract mapping, and those areas you may never see again if you do not pursue an MR neuroradiology fellowship. Here lies your last chance to learn about these more esoteric areas that you will not come across as a general radiologist. If you decide to do an elective this year, try to also work with either a neuro interventionalist or a neurosurgeon to see their perspectives on the rarer vascular cases. Bottom line: Check out all those areas you may not see again once you graduate. You never know when this more esoteric knowledge will come in handy!

How To Succeed In Neuroradiology: A Whirlwind Tour!

So there you go, anatomy once again is key to your success as a resident. (check out the books in the first section!) Localizing lesions is often the key to unlocking the differential diagnoses that you need. And, the only way to learn that is via anatomy! Of course, remember once again, take cases as much as you can because studying books by themselves will only take you so far. Finally, make sure to start your neuroradiology rotation with the most common and deadly diseases. Then, expand your repertoire on a year-by-year basis from there. With all this strategy, you will be sure to succeed on your next “tour-of-duty” through neuroradiology!

 

(I am an affiliate of Amazon and get a small commission if you click on the links to the books!)

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How To Succeed On Pediatric Radiology Rotation

pediatric radiology

One of the statements that you will often hear when performing pediatric radiology is the following, “Children are not just little adults.” And, nothing could be further from the truth. Many of the rules and diseases you have learned for the adult population do not apply to kids. You will find a whole new vocabulary and subset of conditions that are unique to this population. So, what does this mean for residents trying to learn pediatric radiology? Well, there is a lot to learn! So, as in the other “how to be successful” series, let’s go through some of the reading materials you will need to know, and then we will delve into what you should be doing and learn on a year-by-year rotation basis.

Reading Materials For Pediatric Radiology

Reading, like in other modalities, is critical to performing well. Therefore, I wanted to give you what I think are some of the best resources. Overwhelmingly, our residents recommended the Cleveland Clinic Pediatric Modules. And, having checked out the site myself, I have to agree. It is an excellent resource with useful summaries and pictures. Moreover, at the moment, it is free! So, I would recommend you to take a look at the site. 

If you are interested in a more traditional book, you can try the Pediatric Requisites. However, having seen the website and the online information’s high quality, I am more biased toward the modules. Plus, the modules give you excellent pre-and post-test questions. What more can you ask?

Year-By-Year Summary: What You Need To Do

Year One

Pediatrics has more procedures than you may have thought. Of course, you will need to know how to do the basics such as VCUGs, barium work, intussception reductions, and g-tube placements. Plus, you need to complete all these procedures on babies and children, some of which are very scared. And you must also deal with their parents. All this is part of your first year’s introduction to pediatric radiology. So, get familiar with these procedures and learn how to handle the interpersonal situations you will encounter. The attendings will want to have a “go-t0* resident that can help them out during the day. Learning these skills is what it takes to become part of the team. It is all key to having a successful first month.

Also, you will need to learn the basics of pediatric chest and abdominal x-rays. The litany of diseases and findings markedly differs from the adult population. Moreover, there are tons of these films you will need to interpret. So, get cracking! Also, be sure to read lots of pediatric trauma films. Fracture patterns in pediatrics do differ from adults. So, make sure to learn these. Most residents will spend the majority of their time on these plain films.

However, also get to know the disease entities in other modalities that you will encounter on-call that you will need to interpret. These include ultrasound and CT scan for pediatric appendicitis, ultrasound for intussceptions, and ultrasound for pyloric stenosis. Indeed, you don’t want to miss these pathologies at night time. So, you will need to know these entities and findings cold.

Years Two And Three

Now that you know some of the basics, concentrate on other pediatric radiology areas, you will need to know. Start getting to know the other critical disease entities that you may encounter on CT scan and MRI. I’m talking about hepatic tumors, pediatric cancers such as neuroblastoma, Wilm’s tumors, lymphomas, and more. You will need to know these disease entities for the boards.

Become more adept at pediatric ultrasound. For kids, pediatric ultrasound is a critical tool for making all sorts of diagnoses. Why? Because kids are much smaller than adults, it’s a lot easier to see delicate structures that you cannot penetrate in an adult. Pediatric radiologists, therefore, tend to play a more hands-on role than ultrasound in adults. So, be sure to watch how some of the more senior radiologists do their exams and make their more complex diagnoses.

Year Four

Esoterica should be the theme for this last year. Make sure to try to see and participate in cases that you may never see again. Maybe it is brain ultrasounds or pediatric neurointerventional workups. By the way, if there is a pediatric interventionalist, stop by the interventional radiology department and follow some of the compelling cases you started to work up in pediatric radiology. Hang out with the pediatric surgeons for a bit, especially when they workup unusual congenital abnormality cases. You may also learn a lot about new and fascinating disease entities from these folks.

Make sure to also learn about some of the other areas you may have skipped over the years. Check out the unusual congenital abnormality cases. Pediatric radiologists love them. And, most pediatric departments have collections of these either on film or on PACS. Bottom line. You should fill this year with all the gaps that you would have missed out on otherwise.

Learning Pediatric Radiology: Like Starting From Scratch!

Learning about pediatric radiology differs from the rest of radiology because the disease entities are so different. But, all with the online resources, procedures, and hands-on experiences, you will be sure to learn most of them. Additionally, clinical acumen and bedside manner will go hand in hand on this rotation. It is more critical than ever. So, don’t expect only to sit by the PACS workstations. Instead, roll up your sleeves and be prepared to get up and work. Only this way will you succeed in this excellent rotation experience!

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How To Be Successful In Nuclear Medicine

successful in nuclear medicine

For the next several weeks (and possibly months), we will start with a new theme: how to be successful in each of your subspecialty rotations. (and of course, today how to be successful in nuclear medicine!) Why should I even bother to tackle this theme? I mean, most residency programs have some guidelines about what residents need to do each month. Well, I can tell you that most of the time, these guidelines are only set up as a way to satisfy the needs of the ACGME and may not be all that relevant to what you need to know. Often, they are very boilerplate and merely copied from one institution to the next. Moreover, these summaries are “oh-so-boring” to read and likely outdated. Additionally, I aim to give this a bit more entertainment value (as I usually do!) and provide some more relevancy to what you actually should do on your rotations. 

To organize this series, I am going to mirror the subspecialty rotations at our institution. At Barnabas (my humble program), we have a mix of modality and organ-based rotations. Now, you may ask, how can this be relevant to your situation if your program arranges your month slightly differently? Well, regardless of how it’s sliced and diced, you can infer many of the same themes at your institution. The information is still here to help you out. These include the books you need to read, how you should learn the material during each year of residency, and the actions to succeed in your rotations.

So, why start with nuclear medicine? Well, for one, it is my area of expertise. And, of course, what better place to start than my home base?

What You Should Read

Hands down, there is one resource that I like the most. It used to be Nuclear Medicine, The Requisites (which is OK). But all that has changed since the newest version of Mettler. (I am an affiliate of Amazon if you decide to click on the links and buy them!) I found Mettler to be comprehensive and reasonable to tackle. It was straightforward to read when I had to study for my recertification examination in nuclear medicine/radiology. Also, it covers most of the nuclear medicine topics. And I believe that is an excellent way to go.

When To Study Topics In Nuclear Medicine

During that first year of nuclear medicine, you need to first start by concentrating on the studies that can kill patients or cause severe morbidity if you miss something. What are these sorts of cases? These include V/Q scans (you don’t want to miss pulmonary emboli). Then, check out myocardial perfusion scans (you don’t want to miss ischemia from a left main coronary artery widow-maker lesion). Go through GI bleeding scans (you don’t want your patients exsanguinating). And finally, read about renal transplant scans (missing dying kidneys).

Then, next, you need to study what is most common when you’ve covered these bases. Of course, what occurs frequently can vary somewhat from institution to institution. But, for the most part, we are talking about bone scans, hepatobiliary scans, infection detection studies (gallium, indium-WBC, and Ceretec-WBC), and iodine scans for thyroid disease. Or perhaps, your institution may specialize in procedures such as parathyroid adenomas (as we do at ours). The bottom line is that you should study what you see most often to communicate intelligently with your attending.

Finally, you should study everything else. And, in nuclear medicine, that can be a lot. But, the core exam will pretty much cover most of nuclear medicine. That includes anything from PET-CTs of all types to DAT SPECT studies to evaluate Parkinson’s disease (or even the rare salivagram!) This order should allow you to be successful in your successive nuclear medicine rotations.

How You Should Learn Nuclear Medicine As A First Through Fourth Year Resident

First Year

Try to sit with your attending as much as possible at the beginning. Get a feel for what your faculty dictates and why. Then, without much further ado, be aggressive and ask to dictate cases as soon as possible on your own. Why? Because you want to convert what your attendings are thinking into a viable and logical report. That is what we do as radiologists. Without this skill, all your learning with be for naught!

Also, try to spend a little bit of time with the technologists. See how they operate the machinery. Check out how the patients undergo stress tests. Watch how the cameras work. All this observation is essential for understanding how technology translates into clinical operations and patient care.

Second and Third Years

During these years, you need to become a bit more independent. Now that you know some of the basics, you should try to pre-dictate cases even before the nuclear medicine attending arrives on the scene. Grab that bone scan and give it a whirl. What’s the worst that can happen? You will miss a few findings and learn something!

Fourth Year

Instead of only concentrating on the less complicated material, try learning the nuts and bolts of some more esoteric studies. Also, be sure to understand how the software works. You might need it at your first job. For instance, ask how your attendings process the PET-FDG brains for quantification. Or, maybe you should try to interpret some of the more arcane PET scans like Amyvid, Axumin, and Dotatate. Bottom line: this is your last chance to learn nuclear medicine before starting your fellowship. Maximize what you know before it is too late. You don’t want to be struggling with nuclear medicine’s nuances when you take your first job if they assign you to tackle that specialty.

The Basics Of How To Be Successful In Nuclear Medicine

Let’s be honest. Nuclear medicine is not the most formidable rotation of all. (A little biased coming from a nuclear guy!) Or, what I mean is that you are usually not worked to the bone. However, it certainly has its challenges.

To summarize, I would concentrate on those studies that have the most clinical impact first, dictate soon after starting, spend some time with the technologists, and be somewhat aggressive and attempt to preview and dictate studies when you are ready. This targeted approach is how I would proceed if I were starting anew. These guidelines can give you a bit of a boost when starting out and give you the tools to be successful in nuclear medicine. Go for it!

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What Are The Best Resources For Learning Ultrasound?

learning ultrasound

Question:

Hi! I was wondering what source you would recommend as the best to teach ultrasound to radiology residents?
Thank you!!

Answer About Learning Ultrasound:

So, I did a little bit of “market research” for you. And, I asked a few of my best radiology residents what they preferred to read to learn ultrasound. I did this because the best ways to learn regularly change. So, this is what they told me.
When they first started, they used the Ultrasound Requisites to get a solid background on the topic. Afterward, they would use what they would like to call the big blue book- “Rumack”  (Diagnostic Ultrasound) to look up additional information about any specific case. Most importantly, however, each of the residents said it was most critical to go inside the room to scan at the beginning to experience how they get the pictures and to understand the basic ultrasound anatomy. And, I have to agree with this method for learning ultrasound. I utilized a similar approach and it worked for me.
One of my great radiology mentors always said the following: “Ultrasound is not a spectator sport.” That was one of my favorite phrases. And, I continue to tell the same to my residents. You need to go into the rooms at the beginning and learn how it all works to get to know the world of ultrasound. Otherwise, all you will see are a bunch of disconnected grainy pictures!
Let me know if you have any other questions!
Barry Julius, MD
(All links are to books are at Amazon where I am an affiliate)
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Radiology Book Favorites – A Local Poll

I thought it would be interesting to informally poll my residents to find out their favorite radiology book by residency year and share the information with the readers of the website. Why? First of all, I figured many readers have a vague idea of what books to read, but sometimes they purchase radiology books without checking out what their colleagues liked the most. Second, I performed a brief survey by residency year to get a more specific idea about what you may want at your stage of residency. And finally, I was hoping to find a few patterns (which I did).

Well, these are the basics about what I found. Core Radiology was the only book that all years found to be useful. Brandt and Helms and Felson’s were popular in all years except the 4th year. Otherwise, there is a smattering of favorites throughout all 4 years of residency.

Check out the results from my informal radiology book poll (the first of its kind on this website!) at the bottom of this blog in order of popularity for each residency year.

Let’s Create A Radsresident Favorite Radiology Book Poll!

And lastly, I thought it would be a good idea to also have you, the reader, take a survey to determine which books were your favorites. If we gather enough data, we can create another list compiled from all my readers. I think that this information would also be helpful to decide upon which books to read. So, fill out the survey at the bottom of the page to give your opinion!

The Final Results!

So, now I present you a list of the results from my informal poll with links to the same books on Amazon (where I am an affiliate!)

4th Year

Crack The Core Exam,  Prometheus Lionhart

Core Radiology,  Jacob Mandell

The Requisites: Vascular And Interventional Radiology, John Kaufman and Michael Lee

Fundamentals of Pediatric Radiology, Lane F. Donnelly

Fundamentals of Body CT, W. Richard Webb, William E. Brant, and Nancy M. Major

3rd Year

Core Radiology,  Jacob Mandell

Felson’s Principles Of Chest Roentgenology, Lawrence R. Goodman

Arthritis in Black And White: Expert Consult, Anne C. Bower and Donald J. Flemming

Essentials of Nuclear Medicine And Molecular Imaging, Fred A Mettler, Jr, and Milton J. Guiberteau

Brant And Helms’ Fundamentals of Diagnostic Radiology, Jeffrey S. Klein, William E. Brant, Clyde A. Helms, and Emily N. Vinson

2nd Year

Core Radiology,  Jacob Mandell

Brant And Helms’ Fundamentals of Diagnostic Radiology, Jeffrey S. Klein, William E. Brant, Clyde A. Helms, and Emily N. Vinson

Fundamentals of Skeletal Radiology, Clyde A Helms

Felson’s Principles Of Chest Roentgenology, Lawrence R. Goodman

Duke Review Of MRI Principles, Wells I Mangrum, et al.

1st Year

Felson’s Principles Of Chest Roentgenology, Lawrence R. Goodman

Core Radiology,  Jacob Mandell

Brant And Helms’ Fundamentals of Diagnostic Radiology, Jeffrey S. Klein, William E. Brant, Clyde A. Helms, and Emily N. Vinson

Duke Review Of MRI Principles, Wells I Mangrum, et al.

Mayo Clinic Gastrointestinal Imaging Review, C. Daniel Johnson

Gray’s Clinical Neuroanatomy: The Anatomic Basis For Neuroscience, Elliot L. Mancall, and David G. Brock

Fundamentals of Skeletal Radiology, Clyde A Helms

Fundamentals of Body CT, W. Richard Webb, William E. Brant, and Nancy M. Major

 

Please fill out the survey below if you want to contribute your opinion to the “best of” radiology list of books for all readers of radsresident.com. If you cannot see the survey for whatever reason, you can click on the adjacent link that will take you directly to the survey site. Once again, thanks!!!

 

 

https://www.surveymonkey.com/r/RRLT759

 

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About To Start Radiology Residency-What Should I Do To Prepare?

prepare

Here are some scenarios: You’re about to finish medical school, and you’ve matched in radiology.  Or, you are in the middle of your internship year, and you have begun to ponder your next year. If you find yourself in either of these situations, you most likely receive mixed messages on whether or not to prepare for your first year. Some of your “mentors” have probably relayed to you how they readied (if they did anything) for their first year of radiology.

When you hear some of these stories, many of those folks have some hidden motivations. Perhaps, they want to appear like they know it all. Or maybe, they want to make it seem like their decision was the right one. (Even though it may not have been) So, please listen to me. Having seen many incoming waves of medical students and residents coming through the department, I will give you the real lowdown. Here’s what you need to know when you start.

Should You Read Anything Radiology Related Before Starting Radiology Residency?

The short answer is yes. But, of course, I will go into a little bit more detail than that!

So, what do you need to know before beginning? For everyone, if nothing else, I would recommend that you at least relearn basic anatomy. Why is that? Since it is difficult to know what you need to learn in radiology when you have not entered into the field yet and radiology is so “anatomy intensive,” you are better off starting by reinforcing the general anatomy that you learned in medical school. For general anatomy, an anatomy book like Netter that you used during medical school will help you to recall the basics.

However, instead of learning anatomy the same way as your medical school course, I would take more of a cross-sectional anatomy approach. To do so, make sure to find a decent cross-sectional anatomy book to supplement Netter. Not only can you use it to learn cross-sectional anatomy, but this book would also be an invaluable reference source during residency and beyond. Even now, as an “old-timer,” I often use the Atlas of Human Cross-Sectional Anatomy: With CT and MR Images whenever I need a reference. A book such as this almost “pays for itself.”

Why is it so important to have a cross-sectional anatomy book to study? Well, that is how most of us radiologists interpret images. You need to know the anatomy to catch the pathology. So, when you begin, you will have the tools to learn the basics of radiology rapidly (since we are an anatomy intensive specialty!). If you prepare your cross-sectional anatomy before arrival, you will have a certain headstart over your colleagues.

How To Go About Additional Radiology Reading Before Starting Radiology

Fourth Year Medical Students

Since fourth-year medical students typically have a bit more time on their hands, what material would I recommend if you want to learn more than just cross-sectional anatomy? First, you can review the essential medical student texts like Learning Radiology. These sorts of books tend to contain the most basic information like how to read chest films, and so on. Also, they will review the essentials of the primary radiological modalities that you need to know.  However, these texts will not go into enough detail to make you stand out.

But, if you are even more motivated, consider looking at the pictures and captions in a book like Brant and Helms. Then, you can review the subtext to reinforce the images. But beware! It is a long series. And, believe or not, even though it is long, it does not cover enough of the information you need to know to prepare. Most importantly, however, do not get discouraged if you cannot complete it. Any bit that you accomplish before starting residency helps.

Interns

OK. For interns, the first step is to make it through the year. You are probably going to be exhausted and lucky to pick up anything additional to read. So, I would probably stick with reviewing some basic cross-sectional anatomy at this point. In general, lack of time will prevent you from reading through a Brant and Helms type of book. But, if you feel you must go for it, by all means, try to read a little bit. Just don’t push it!

Final Advice On How To Prepare For The Beginning of Radiology Residency

Finally, my last bit of wisdom for the pre-radiology resident is that what you are doing now is very different from your radiology career! So, don’t wrap yourself up in the miseries of your clinical year. Remember… Your life will be very different from your medical colleagues. So, soldier forth, read a little bit if you can, and before you know it, the year will be over. Follow my advice, and you’ll grasp what you need to prepare to start your radiology residency!

 

Radsresident.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com

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The Mega Five: The Ultimate Resources For The First-Year Radiology Resident

Wow, what a feeling! You did it! You’re officially a first-year Radiology resident! And, you just took your first step toward the rest of your life!! One full year has gone in the blink of an eye and you molded yourself into an unbeatable intern! Your mastery of surgical knots, writing extensive progress notes, rounding, and discharging patients have you feeling like you can tackle the world! In fact, you’re so eager to show off all your skills as a first-year radiology resident to your new Radiology Attendings on your first rotation that you jump right in and introduce yourself. You find a really comfy chair next to him, eagerly waiting to learn.

So, your attending opens the very first case and you already know the answer is pneumonia. Let’s face it on those long ICU rotations when was it not? To your surprise, it’s a head CT. He then gives it a quick scroll and asks those fateful words “Normal or abnormal?” … You sit there in silence… Chills run down your spine…sweat appears on your forehead…What just happened? Uttering the word ”I” a few times, you finally commit to the full sentence “I don’t know”. You have failed. You know nothing and feel like you are nothing… At least that’s how you feel for a short while. But hey, it’s your first day!

Get used to it… In the beginning months of the first year, the phrase “I don’t know” will become all too familiar because let’s face it, you don’t know! Not a thing! As an intern, you haven’t picked up a single book relating to radiology. And, you may have only looked at the impression to relay the information to your higher-ups when needed. You just did not have the time! So? What now? Where do you turn? Who can help you? You feel smaller than an insect. How can you possibly turn this around? Get ready to take all your years of what you learned and flush it down the toilet! You’re about to enter a whole new realm, the world of radiology.

The Mega Five

Enter the Mega Five. What is the Mega Five you say? Only the five most powerful resources at your fingertips for the first-year radiology resident! Sure, there are a ton more but these have been the most help in my experience. So, let’s start!

Case review series, Case review series, Case review series!!!

I cannot say it enough but these reviews are incredible. Most importantly, you don’t need a lot of background in order to learn as you go. And, the series takes excerpts of information from the Requisites (longer and wordier than the case review series!) and summarizes the material. Each case has questions and pictures. In addition, it literally contains every subject with increasingly difficult sections as you progress within each of the books.

Core Radiology

I love this book! It contains high-yield pictures and information, especially the Aunt Minnies. And, the book goes system-by-system, image-by-image. It even gives mini dictations of how you should describe the entity.  I can honestly say Core Radiology has helped bolster all my dictations positively. With all the knowledge you attain during 1st year, this book serves to solidify and maintain a steady foundation.

Radiopedia

I can’t believe I’m saying this but yes…Radiopedia is an incredible resource. First, you get fast information, pictures you can scroll through including CT and MRI studies, differential diagnoses, and links and videos. You can also sign up for these links and videos if you so choose (I did for emergency radiology before taking call). Finally, you can think of it as an underused gem like Wikipedia for radiology but even better!

RADPrimer

Oh, RADPrimer how I love you so… RADPrimer makes the list because let’s face it… What are facts without questions to test yourself? With over 4000 questions, you better just dive in and do 10 a day because it has a UWorld feel to it. And, if you’re like me, UWorld was the Holy Bible for USMLE Step 1, 2, and 3. So, why let this opportunity go to waste? Get cracking now…  Just start RADPrimer and crank out questions. You’ll see how much you really know from your studies.

Radiology Assistant

Last but not least, we have Radiology Assistant. To put it mildly, this website is incredible with detailed information, videos, pictures, and cartoons. You name it and they have it. In fact, I utilize this website as much as possible. There are even lectures to watch that break down hard topics, an amazing bonus.

But Wait There’s More…

In addition to my top five resources, of course, there are a ton more. Some of the other resources that I have used include Felsons Roentgenology,  E-Anatomy (application), headneckbrainspine.com, and Lieberman’s eRadiology. Although I poked fun at it above, I still need to mention the radiology requisites series in a better light. As wordy as they may be, you must read them. Why? Well, I’ve noticed that the question banks gather much of their information from the requisites. And finally, please do not be afraid to use free resources like Google, Google images, and even YouTube!

My Final Thoughts

The Mega Five worked well for me during my as a first-year radiology resident because these resources were readily available and came with a wealth of knowledge. If you take advantage of the Mega Five too,  your hard work, diligence, and dedication will pay off. You too will be saving lives “radiographically” one day at a time (A catchphrase for my dating app. I am a single resident, so don’t take it, it’s mine and copyrighted!) So, best of luck to you. Remember, being a first-year radiology resident is tough but there are lots of quality resources to help you out. So, never give up!

 

 

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Curriculum/Teaching Issues In The United States And Abroad

curriculum

Question About Curriculum And Teaching In United States And Abroad:

Hello Barry,

Thank you for your outstanding posts and the constant stream of current topics promoting the dissemination of Radiology as both a profession and a collective guild. I’ve been hanging on every word you’ve written, and it’s almost as if you anticipate my questions in advance. So, I am very much encouraged by the relevancy of your blogs and posts.

I am a Canadian who is a first-year diagnostic radiology resident in Targu Mures, Romania. Here, we follow a five-year path outlined by the EU and the European Society of Radiology (ESR). The problem is that the actual ” teaching ” element is virtually non-existent, and the program expects us to follow or shadow senior residents all day and read on our own. I am lost and overwhelmed by all the modalities I see here daily. For example, a typical day involves spending a few hours in an ultrasonography clinic, seeing conventional or plain film radiography cases, and a CT or MRI following a patient scan.

Most often, the radiologists on staff consult with other physicians, and it’s not like they have the time to point out things. I’ve decided to follow a structured plan and would appreciate your curriculum. What should I cover in my first two years? I know I’m asking a lot of you. Perhaps you can abbreviate your own institution’s plan for me? The first thing I’ve begun to do is revisit skeletal anatomy, including the head and neck. I don’t have a lot of textbooks here (in English, that is), but I have a ton of PDF books on my PC. This lack of physical textbooks is another problem because I miss the tactile experience of actual texts, and looking at a laptop all day is tiring. I will digress and hope to hear from you. Take your time 🙂

Sincerely,

A Tired Romanian Resident

 

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Answer:

 

Thanks for the great compliments. It is much appreciated and makes writing these posts all worth it!

Teaching Differences

Interestingly, you mention that teaching is “non-existent” in Romania. It’s almost the opposite problem in the United States, where everything seems regulated by the government. We need to have x number of noon conferences, etc. I almost wish we had a model for teaching somewhere between the Romanian and the United States models. Residents seem to get bogged down by the regulations and spend less time learning by reading films. (It’s an essential ingredient for radiology!!!!) So, in a sense, you can consider yourself lucky, but you are also missing out on some types of the more didactic teachings.

Curriculum

Regarding the curriculum, the plain vanilla answer is that residents study all the material on the ABR website under the core study guide. It would help if you looked at that to understand everything you theoretically need to know. However, I find it a bit overwhelming, and you need to focus on studying for your time as a resident. So, in the real world, I recommend reading some of the basic overall books in each modality when you begin a rotation each month, such as Mettler for nuclear medicine and the requisite series for some other subjects. You can check out some of the curriculum and books on the web in U.S. Residency programs to get an idea of what you need to know and the books they use. You can also look at some of the books my residents like in the book links section of radsresident.

Most importantly, emphasize the pictures and captions and then secondarily look at the text to understand the images and captions. And keep in mind the ABR blueprints and core material when you are studying. Subsequently, go through the case review series to learn how to go through cases once you have the fundamental knowledge of each primary modality. This process will reinforce all that you studied.

You also make an essential point about missing the tactile experience of textbooks and looking at laptops. It happens to be the subject matter of my next article!!! PDF articles are great because you can download them easily. On the other hand, retention rates for PDFs are probably not as high as reading directly from a printed textbook.

I hope this helps a bit,

Barry Julius

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Ten Surefire Ways To Destroy Your Radiology Experience (And Your Colleagues’ Too!!!)

radiology experience

I have seen it all. Some radiology residents make sure to glean every last drop of radiology experience from their residency so that by the time they graduate, they are ready to hit the ground running. But then other radiology residency graduates never quite live up to their full potential during their residency training. Many of these folks are great people, but when they are about to leave, I am not quite sure if they will handle the pressures of radiology practice.

In the end, I have learned some residents are late bloomers and do pull themselves up by the bootstraps once they leave residency, but a large percentage unfortunately constantly shift from job to job. Many of those folks are the same ones who seemed to do whatever they could to destroy their own residency experience during their four years of residency. And yes, we hear about them again when the paperwork comes back to us each time they change jobs when out in practice. Today I figured I would talk about those characteristics that are a surefire way to ruin your residency radiology experience. Don’t make those same awful mistakes!

Sweat The Small Stuff

In the heat of battle, it is effortless to forget the end goal of radiology residency, to be well trained and ready for practice when you leave. Remember… residency is only a 4-year experience. However, some residents get caught up in the moment and forget about the end game. They concern themselves with relatively minor things such as rising prices in the cafeteria, having to do a few extra shifts, or hearing some disheartening comments from one of their annoying colleagues. Sure, there is a place and time to worry about those things. But, it should not become an all-encompassing mission. Some never get over these issues and forget to learn what they need to know when they leave residency. In the process, they also upset their colleagues, distracting everyone from their training. Get over it!!!

Argue With Your Colleagues

Some residency classes always get along. Others have permanent hatred toward one another. The inability to get along spills over to other areas in a radiology residency. Studying suffers because some folks are left behind, and no one seems to care. Tempers flare and prevent classmates from covering each other when they need it. Everyone becomes exhausted and upset. Next thing you know, residency is over, and everyone is worse for the wear. Do whatever it takes to get along! It is not worth four years of frustration!

Sabotage Your Team

Every once in a while, one resident does not play fairly in the sandbox. Perhaps, he/she refuses to help out with a call. Or maybe, this person does not show up to work and constantly needs to have additional coverage. Not playing nicely with others affects the entire team. If you want to ruin the experience for everyone, it is elementary. But in the end, it will haunt you when you need your residency team the most!

Don’t Read

Radiology residency is a marathon, not a sprint. That means you constantly need to keep up with reading books and articles. I can guarantee that you will fall behind your classmates if you do not adequately read enough starting year one. You will not comprehend or perform well at conferences. Likewise, your call and board experiences will suffer. And, your colleagues will not want to have you’ve as a study partner since you are so far behind. You came to radiology residency to become a radiologist. Part of learning radiology is reading a lot. Why would you want to sabotage your training?

Always Compare Yourself To Others

Everybody learns and reads at different rates; and, some residents click with the material earlier than others. That is OK. As long as you are doing your due diligence during radiology residency, you will eventually get to the promised land of radiology competence and graduation. Don’t worry if some of your colleagues always seem to get things right and you don’t. The quickest path to misery is worrying about how everyone else is doing. Undue competition ruins the experience for everyone. Care first and foremost about your progress!

Don’t Show Up To Readouts

There are two main pillars to becoming a great radiologist, knowing the material and experience. If you were going through the hassle of completing a residency, why would you shortchange yourself and not try to get as much experience as possible? You will never understand the context of reading radiology without having the readout experience. Not being at the readout also affects your mentors’ day. Sit down with your residency mentor, and don’t miss the readout. You are only hurting your career and your relationship with your superiors. You never know when you will need their recommendations!

Do Not Improve Upon Your Weaknesses

You have been getting inadequate evaluations in the area of mammography. So, what do you do about it? Nothing. The complaints continue to come streaming in from attendings. But, you persist in not reading the material or studying your misses. Behaviors become habitual and will likely continue even after you graduate if you do not learn from your mistakes. These folks are the same folks that can never keep a job and never improve their lot. Ignoring practice-based improvement hurts you, your patients, and your colleagues. Residency is all about self-improvement to become the best you can so that you can help your patients. Why would you not pursue the same avenues during training?

Procedures Are Not For Me!

Some residents hate procedures and will do whatever they can to avoid them. I understand these folks may not become interventional radiologists. But, they still need to know the basics of specific procedures such as needle localization, arthrograms, and more. Sure, they can get away with this during residency. But, when they try to land their first job, they may have frustrations as they find the only jobs available require “light interventional” work. Not learning procedures may affect your future partners and colleagues. By not trying to feel comfortable with procedures during residency, you are only hurting yourself!

I Am Always Right

Some residents do not accept criticism. Residency is the time to learn and change harmful behaviors before they become ingrained in practice. We are in the game of treating people, not always thinking we are correct. Why would you not want to correct what you are doing wrong? It makes no sense. You are only hurting your patients and colleagues. There is no room for not accepting criticism both during and after residency!

Don’t Take On Extra Responsibilities

Each year of radiology residency, you accrue new responsibilities. Shirking your responsibilities is a surefire way to become a needy radiologist when you graduate. When the technologist comes along to ask a question, please don’t send them to someone else to answer it. Take charge of your situation and section. Those folks that never take on those additional responsibilities never learn to become an independent radiologist!!! Go forth and makes your path.

Avoid Destroying Your Residency Radiology Experience

It is far easier than one might think to destroy your own residency radiology experience. Sometimes you have to put a bit more effort in to get more out of residency. Please, please, don’t succumb to the pitfalls and traps that can prevent you from growing and improving as a person and a radiologist. Get over your issues… It is not worth it!

 

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eBooks vs. Printed Radiology Books- A Death Match Part II

books

The days of radiology residents lugging ten-pound textbooks around the department are over. I, too, prefer having a list of books to access at any time on my Ipad for convenience. I even reviewed and studied my Mettler textbook for nuclear medicine on my Ipad just before my recertification ABR examination a while back, and it worked out just fine. But based on recent literature, maybe we should not be giving up on carrying around that 10-pound book. Today I will review the arguments for and against buying and reading electronic radiology books versus carrying around and reading those unseemly heavy old-fashioned radiology textbooks.

Arguments For Reading Physical Radiology Books

Comprehension Retention Issues

When it comes explicitly to reading and retaining knowledge from radiology-specific books, I could not find much information on the web. However, significant studies discuss comparing the retention of general information from print materials vs. e-readers. Some of these studies are generally applicable to the radiology resident audience. In addition, some other issues can support the use of printed texts over e-readers.

Back in 2013, in the International Journal of Educational Research, lead author Anne Mangen in an article, studied 72 tenth graders and compared reading retention in PDF format on a computer screen and in print. She found that students reading the texts in print had significantly better retention of the material than those reading the material electronically. However, there are some differences in applicability to the radiologist. We tend to read images and look at the captions and text. So, perhaps there is some difference regarding the radiology resident.

Subjectively, there are also several surveys of readers touting the comprehension advantages of printed books. In an article in Scientific American, one survey reported a conclusion that “when it comes to reading a book, even they prefer good, old-fashioned print,” and another stated that readers “prefer to read text on paper as opposed to on a screen to ‘understand it with clarity.'” So, maybe there is something to the perception of increased retention with old-fashioned printed texts.

Miscellaneous Other Issues

In addition, you may have difficulty getting to sleep after reading with an electronic device. A study called “Sleep and use of electronic devices in adolescence: results from a large population-based study” concluded a negative relationship between the use of technology and sleep. Now, radiology residents are a bit past adolescence for the most part, but I still think you can generalize this information to the insomniac radiology resident, knowing how I feel after reading the news on my iPhone just prior to bedtime.

Also, there is the issue of eyestrain and reading eBooks. The information here is a bit more mixed as to the amount of eyestrain using eReaders vs. printed text. But, there was an interesting article presenting some of the issues regarding eye strain called “eReader Vs. Printed Book: Which Is Better For Your Eyesight?” They reported that Computer Vision Syndrome (CVS) is an actual entity that can affect readers using electronic readers. However, the claim that backlit devices and softer e-readers like the Nook and Kindle may help some readers counterbalance this argument.

And finally, there is the issue of diversion. When you read a printed textbook, you certainly do not have to worry about essential emails popping up, your spouse calling you, a silly text from your friend, or the thought that you need to click on the most recent exciting blog from radsresident.com! Instead, you can concentrate on the information with much less interruption.

Arguments For Reading Electronic Radiology Texts

Here I think the first and foremost issue supporting using the eReader is sheer convenience and instant availability. Carrying 1000 books in your pocket or your hand is a remarkable technological achievement. Furthermore, at any given moment, you can easily click on a link from your text and go directly to a source document you can confirm on your iPhone. You can’t do these sorts of things in a printed textbook.

Multiple new e-readers use different proprietary technologies to reduce eyestrain. In fact, one article reports eInk from the Kindle and the Nook is a significant improvement over other e-readers. Also, according to the same article, people with poor eyesight tended to read better with a backlit screen than on paper. In addition, for those with poor vision, one can easily adjust the text size with an e-reader, allowing the reader to enjoy an electronic text that they may not be able to read in the printed version.

Once you write on a printed text, you alter the text forever. On the other hand, you can highlight or write electronically in an ebook’s margins without worrying about destroying the book. Furthermore, you cannot write in someone else’s printed book without vandalizing someone else’s property. Another win for the electronic device!!!

This borrowing of books brings me to the next significant advantage of eReaders- sharing. Sharing a chapter, phrase, or critical point with a fellow reader is easy. All it takes is clicking a button with a message or email; many people have the same information. Printed text is just not the same when it comes to sharing.

And finally, there is the issue of bookmarks. Most eReaders automatically bookmark the last page that you look at. If you lose your page on a standard text, there is a good chance that if you return to it without a bookmark, you will not remember the last page you read. At least, this is a significant advantage for me!

So Who Wins This Death Match?

Unfortunately, convincing someone about how to read a radiology book is challenging. We all have our set ways and opinions about how to read and what is more effective for us as an individual. And there are real advantages and disadvantages to both. Although not conclusive, the body of evidence points to increased retention for paper, but for many, the convenience of e-texts outweighs the incremental retention. You can easily share an eBook, but you may have more eyestrain reading the same book. So what do you do in today’s world? I think it depends upon you as an individual and the available resources. The bottom line as a radiology resident is to read a lot regardless of the book type. It will serve as a permanent foundation for the rest of your career!

 

Other relevant articles

http://www.huffingtonpost.com/the-national-book-review/drop-that-kindle-10-reaso_b_8234890.html