Posted on

How To Be Successful On CT Rotation

CT rotation

CT imaging is often by far the busiest radiology rotation at many hospitals. Emergency departments order more studies every day to reduce disposition times and cover themselves. Physicians of all sorts bombard you with multiple phone calls.

With all these pressures for increasing attending output and less teaching every year, how can you succeed on your hospital CT rotation? Well, I will tell you the reading materials that will help you get through this rotation. Then, we will go through a year-by-year analysis of the processes you should take to succeed in this rotation. Finally, we will summarize the most critical components of having a successful hospital CT rotation.

Reading Materials On CT Rotation

There are so many areas to cover with so little time for CT rotations. Therefore, efficiency is the general theme for CT learning. You need materials that are concise and easy to understand. I am going to provide you with some of those resources.

Let’s divide the hospital CT rotation into four different areas to cover what you need to know: CT anatomy, CT chest, abdomen, and pelvis (body imaging), CT head (neuroradiology), and CT extremities (MSK). Of course, you will need to know all of them. But, the details you need to know will not be the same as the in-depth dive into MSK, neuroradiology, and chest rotations you might have. Therefore, I would start by limiting myself to materials that cover those topics that are most efficient and that are essential: cross-sectional anatomy basics, the basics of CT scans, disease entities that will kill or severely injure patients, and finally, common disease entities. Reading summary books and case review series will most likely give you the most bang for your buck in reading.

Anatomy Reading

I recommend you check out one of the cross-sectional atlases to cover the basics. I often use Cross-sectional Anatomy CT & MRI to review anatomical structures if I have a question. If you are a more junior resident, I would recommend going through this book cover to cover and looking through all the CT cross-sectional correlative images. This atlas will get you up to speed so you can make the findings for your rotation.

Body CT Reading

Next, I recommend going through a short book called Fundamentals of Body CT by Webb for your chest, abdomen, and pelvis basics of interpretation. Universally, all my residents recommend this easy-to-read summary of the key elements you need to know to understand how to read body CT scans. I used the same book (albeit an older version!) as a resident eons ago. The Emergency Imaging Case Review Series can also give you cases with acute diseases that you must know on rotation and call.

Neuroradiology CT Reading

A lot of neuroradiology comes down to knowing your anatomy. So, check out the programmed text called Sidman’s Neuroanatomy. Residents consistently hail this book as a great way to review the critical anatomy you will need to interpret brain CT scans. Additionally, many of my residents recommended Radprimer to learn the basics of neuroimaging. Finally, you may want to have Osborn’s Brain around to read about more specific disease entities. I recommend reading this book cover to cover, not as much while on CT (because of lack of time) but rather when you are on neuroradiology rotation.

Regarding head and neck cases, consider going through the Head and Neck Imaging: Case Review Series to review the morbid and familiar disease entities. It is hard to go through an entire textbook on this rotation because of the wide variety of diseases and the complexity of anatomy. However, this book will allow you to learn what you need to know about this topic. One of my residents also recommended headneckbrainspine.com as a great way to review anatomy and disease entities that you will find on this rotation. Check that website out. You will like it.

MSK CT Reading

Finally, you will need to know the basics of MSK to interpret CTs of the extremities. Once again, I would refer to Fundamentals Of Skeletal Radiology (as I discussed in the How to Be Successful in MSK blog) to cover the basics of what you will need to know at night. Many residents also touted the MSK section of Core Radiology as a great way to review this area.

Spine CT has also become much more common since I was a resident. So, it also pays to review lots of real-time cases. In particular, if you want a book, you may want to explore the Spine Imaging: Case Review Series: Expert Consult to cover your bases.

Year By Year Summary Of The CT Rotation

Year One

During this first year, you should be emphasizing anatomy the most. So, I would suggest cracking open the atlases as I described above. Anatomy will be the key to your success.

In the beginning, try to sit with your attendings and see how they interpret and dictate cases. Shortly afterward, no more than a week later, you should start reviewing and dictating cases. The more you see and do, the more confident you will be on call. So, make sure to read out as much as you can.

Also, especially in the first round through this rotation, you will need to understand the mechanics of reading CT scans. Out of all the resources provided above, the Fundamentals of Body CT is probably the best for this purpose. It will help if you read this book before you have finished the first week of your first rotation. In addition to body imaging, make sure you also read some neuro-CT materials because CT brain work is prevalent.

Finally, review the diseases and CT scans of the critical disease entities that will kill patients or cause severe morbidity and common disease entities. You need to know all these CT appearances and make the disease findings before you start taking calls in year 2.

Years Two And Three

Now that you have completed your first year and are most likely already taking calls, you must take responsibility for the cases you read. So, it would help if you pre-dictate as many cases as possible. It would also be best if you compare your reads with your attending. By reading the images first, you will get practice making your own independent decisions. This independent streak is critical for becoming a great radiologist. 

Also, start reading less common disease entities than before. Now might be a great time to explore and review head and neck CT cases, spine CT cases, and more complicated MSK CT cases now that you have more than likely become competent in essential body imaging and CT brains. It would also help if you considered reading the case series and the more detailed books to round out your education in the different areas of CT imaging.

Building speed is also a critical part of these “middle years.” You should ramp up during your four years of residency so that by the end of your time in radiology, you should be able to read as quickly as an attending. 

Year Four

At this point, you should be honing your craft. Dictations should be very accurate and efficient. You should be reviewing the source materials for all the areas of CT, just like an attending. If I have questions, I regularly look up the diseases/questions I need to know for a case. Often, it is the original paper on the topic. It would be best if you were doing the same at this point in your career. This process is called practice-based improvement. It is critical to become a great radiologist. As a fourth-year resident, you should be all about practice-based improvement!

Succeeding On CT Rotation

The knowledge base is daunting since you cover so many organ-based areas on CT scan rotations. Following the general precepts of learning your anatomy, finding suitable summary materials, and going over lots of real-time cases with case-based series books for reinforcement will give you what you need to know during your four years of CT rotations. Books are essential for this rotation, but reviewing many cases is even more critical. So, plug away and read as many cases as you can. It is the cornerstone of becoming an excellent radiologist!

Posted on

How To Be Successful In MSK Imaging

successful in msk imaging

We’ve been through the first two parts of the how to be successful series, nuclear medicine, and breast imaging. Part three, today, is all about how to be successful in MSK imaging. Like the previous weeks, I will talk a bit about the reading materials for this rotation and discuss when you should learn what. All the text links to books in this summary will lead you to Amazon, where I am an affiliate. Afterward, I will give you some more final thoughts about MSK imaging in general and how you can succeed in this rotation.

MSK Reading

MSK reading is a bit more varied than some of the other rotations and more decentralized. Different books are better than others for various topics. Because you need several different books on this rotation, it can be a bit more expensive. If you can try to borrow some of the books, you can save a bit of money. But if you decide to purchase them, they are good references to have nonetheless. Either way, using multiple books on this rotation will be much more efficient for studying MSK than using just one because no one book is comprehensive and intelligible enough for both the core examination and real-world practice.

In the following sections, I will divide what you need to read by each year of MSK. We will cover the following topics: trauma MSK, arthritis, musculoskeletal MRI, bone tumors, and other miscellaneous topics like musculoskeletal ultrasound.

First Year

First, you need to learn bone and joint plain film anatomy. So, in the beginning, especially, you will want to know about normal anatomy to get a better sense of how the different sorts of fractures look. If you are a first-year resident, review your anatomy books again from medical school (i.e., Netter’s or a cross-sectional atlas like Cross Sectional anatomy CT & MRI). You will then want to start with a book of the basics about common types of fractures, especially in an emergency setting. One of the resident-recommended books for this stage as a first-year resident would be the Fundamentals Of Skeletal Radiology. I used something similar many years ago. This book gives you some of the essentials of what you will need to know.

First Or Second Year

After knowing the critical information about MSK injuries, you will want to continue staying on the plain film theme and learning the arthritides. This topic is more about outpatient MSK imaging, but it is also critical for learning to become a consummate MSK imager. One classic book that I found very helpful is the book called Arthritis in Black and White. It is a classic, but it briefly summarizes the findings and distributions of different types of arthritides with pictures to help you out as well. You can read this one also during the first year of MSK or early in your second year.

Second Or Third Year

As a second and or third year, you also need an intelligible MRI MSK book that will give you all you will need to understand and interpret MSK MRI, a common area of difficulty in residency because of lack of exposure. Be careful not to buy the wrong book because many books make this fairly intuitive topic into something more complicated than necessary. So for this subject, check out Musculoskeletal MRI. I found this book “way back when” to be an excellent source for elucidating MSK MRI’s mysteries. It was one of my all-time favorite books in radiology because the author’s style is easy to read and logical. My residents still like it to this day.

Final Year

Finally, toward your last rotations before the core exam, you need some resources to fill in the blanks like bone tumors and MSK ultrasound. For these topics, many residents will look at MSK Case Series Review. Cases are the key to knowing the different types of bone tumors. If you want a more generic overall summary of these miscellaneous topics, you can check out the Musculoskeletal Requisites book.

All Years

Be sure to use a reference tool to check out normal variants, especially for the bones. Have a copy of Keats Normal Variants Atlas available when you read cases. You can also google your images, but it is easier to have a normal variant book handy. I often use this book when I am unsure if what I am seeing is pathological or normal.

Other Thoughts About MSK Imaging

In MSK imaging, especially, you need to be a little more definitive than other areas in radiology. If you see a fracture, call it a fracture. Don’t beat around the bush. You will find that Orthopedists and Emergency Physicians alike will need your final diagnosis to make their final treatment plans or surgeries. So, saying that you are not sure won’t cut the mustard unless, of course, there is real uncertainty in what you see on imaging.

Also, try to get to know your Orthopedists and ER physicians to determine how your calls correspond to what they see clinically or in surgery. Or, even better, examine the patients yourself after making a call. It is a great way to get to know if your diagnoses are correct.

And finally, for those who don’t have as much exposure to MSK MR, I would try to look at the cases that your attendings read on your own time. Then, compare your conclusions based on the history and images to the dictations of your attending. It’s a great way to learn what you need to know.

How To Be Successful In MSK Imaging

To become successful in MSK imaging, you need several ingredients. First, you need the right books (unfortunately, a lot of them for MSK!). It would then be best if you had the right attitude (coming down a little bit harder on diagnoses than some other subspecialties!) And then finally, you need a good point of reference for your calls (correlate with your patients, ER physicians, and Orthopedists.) If you utilize these resources, you are bound to become an excellent MSK imager!