Tag: how to succeed

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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 Succeed On Hospital Plain Film Rotation

plain film rotation

Even with all the more sophisticated modalities, most radiology residencies still have a plain film rotation. Sometimes this rotation goes by the moniker chest. Other times, it is more generally called plain films and includes both chest and musculoskeletal x-rays. Regardless, since we are generally modality-based and not organ-based at my institution, today, we will go through how to succeed in this rotation’s more generalized version. To do this, we will start with some of the recommended readings for this rotation. Then we will delve into some more of the specific year-by-year recommendations for achieving success.

Recommended reading for the Plain Film Rotation

Overwhelming, upon surveying my residents, one book was the clear winner for learning the basics of reading chest films. It was easy to understand and logically arranged, using the programmed learning style. Check out Felson’s Principles Of Chest Roentgenology. (I am an Amazon affiliate and receive a small commission on any purchases through the links!) When you complete this book, you are ready to start reading films. On the other hand, for those of you who prefer an online tutorial, some of my residents like the University of Virginia chest tutorial to help with the learning process.

As I had mentioned previously in a discussion of how to succeed in MSK imaging, I would also recommend Fundamentals of Skeletal Radiology to learn the basics of reading films on this rotation. Specifically, it has a reputation for helping out with trauma and fractures. But, it will get you started reading with what you will need to know on this rotation. Finally, I would also advise you to have a copy of the Keats Atlas of Normal Roentgen Variants That May Simulate Disease: Expert Consult by your side to help you distinguish normal variants. Knowing normal vs. abnormal is probably the most challenging part of being an excellent plain film reader. And, most departments have a copy of this book lying around somewhere in the dark!

Finally, I want also to emphasize that reading is supplemental to looking at films on rotation. It will never replace sitting down and reading studies at a PACS station. So, don’t disappear to go reading books during the daily rotations. You will only be hurting your residency education!

Year By Year Learning Recommendations For Hospital Plain Film Rotation

First Year

Learning By Doing!

In the world of x-rays, reading books is not enough. Every first-year resident should be immersing themselves in reading cases live on a PACS. Even better, during the first few days to a week on this plain film rotation, they should sit with an attending and watch how they make the findings, interpret the images, and dictate cases. In the times of Covid, this exercise may be a bit more complicated. However, it is critical to read x-rays in this way and return to a semblance of normalcy, especially after the pandemic ends. (It will eventually!) You need to go through this exercise to understand the mechanics of how your faculty reads the films.

Soon afterward, all residents should dictate the cases themselves after going through the images with an attending. Remember also to try to take notes on the relevant cases before dictating. You don’t want to forget the findings that the radiology faculty told you to add to the dictation. Residents should try to get through as many cases as they can.

How Much To Read

Back in the day, we would measure the number of cases read based on boards. (I’m dating myself!) Each electric panel would have around 20-30 cases. First years would go through up to one full board of films each day on rotation. That number is a reasonable goal for most first-year residents when they finish their first rotation in plain films.

Second And Third Years

Now, it is time to take the proverbial bull by the horns. Since you have learned the basic mechanics of looking at and dictating films, it is time to mix up the equation a bit. Try to read some cases independently and then go over the results with an attending afterward as she is signing off the reports. Reading cases first by yourself allows you the independence of making decisions and gives you insight as to what you missed and what you can do better. It is the ultimate way to get feedback on every one of the cases that you read. I would also recommend occasionally sitting with an attending, especially ones that you may not have worked with as much, to get to know each faculty member’s style. You can still learn a lot about watching how each reader operates the plain film station.

At this time, you should be able to get through at least the equivalent of two boards or up to 60 films at the end of this rotation. That would be an entirely reasonable goal.

Fourth Year

During your final year, you should be reading cases entirely independently. Of course, your attending will need to sign off on the cases at the end of the day. So, at this point, you should pretend that you are the attending, except that you should check the results of your dictation with the final read. Of course, if you find a complicated case or you have a question during the day, you should ask your attending what you should dictate/do. But for the most part, you should be able to the cases entirely by yourself. As a fourth year, you are very close to reading cases independently as an attending, and you should act like one!

Plain Films- Still Part Of The World Of Radiology

As much as we love to read all the more complex and sophisticated radiology modalities, most practices have their radiologists read plain films. Chest films and basic trauma radiology serve a critical need. And, we have not found any reasonable way to replace them. So, don’t poo-poo the plain film rotation. As an attending, most practices will expect you to read lots and lots of films, even in the 2020s. So, get cracking. Start learning to read plain films well during residency so you can hit the ground running when you begin your first job!