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!
