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How-To Procedure Manual For The Klutzy Radiologist

procedure manual

Some of us are not born to be athletic and coordinated like Michael Jordan or Pele. It’s just not in the cards. As a part of this group, I can remember many simple radiology procedural activities challenging me that would make the average resident wonder! Simple things like putting on sterile gloves and coiling interventional wires seemed like rocket science. However, hope springs eternal. And, believe it or not, many strategies exist to allow the klutzy radiology resident to become an expert at performing a procedure. We will discuss these today in this mini procedure manual.

Read Everything You Can About The Procedure

Procedural work is not just about performing manual tasks. It involves significant preparation and planning, both from a hands-on and an intellectual standpoint. Therefore, your role is to know all you can before performing the procedure. Some of the questions you need to be able to answer before any procedure include: What is the reason for the technique? Is it appropriate for the patient? What are all the tools and equipment needed to complete it? How can you avoid complications? And, if a difficulty arises during the test, do you know what you have to do next? And, of course, what are the appropriate ways to manage the patient after you have completed the procedure?

In addition, nowadays, most procedures have an associated “how-to” article or procedure manual in the literature that can help you understand step-by-step how to perform a technique. Not only do you want to read each of these articles, but you also want to live and breathe all the information in it. What do I mean by that? If you can, mentally picture yourself performing the procedure steps before stepping into the interventional suite.

Gather All The Relevant Patient Information

Patient research beforehand can be just as important as the procedure itself. You need to be able to complete the appropriate test for your patient. If not, you can cause additional radiation exposure and potentially irreparable harm.

Therefore, gathering relevant patient information is essential before performing any procedure. What do I mean by that? Here are some of the pertinent questions you want to answer. Does the reason for the technique match the history of the patient? Is the patient able to consent? Are all the appropriate blood tests completed before starting it? Do you know of anything about the patient’s history that would increase the likelihood of complications? And so forth. Ensure that if your attending asks you something about the patient before its performance, you know the answer. It will come back to bite you if you don’t.

Practice Outside The Interventional Suite

As Malcolm Gladwell states in his book Outliers, you need to do something 10,000 hours to become an expert. Therefore, your work mustn’t end after the initial steps. If you have problems coiling a wire, practice the maneuver at off-times at work or home. When you have difficulty putting on sterile gloves the right way, take a pair and practice. If you have problems with suturing, learn needlework. Especially if you are not a member of the athletic/coordinated club, you will need to practice, practice, practice until you get it right!

Volunteer Ad Nauseum

Lastly, you need to develop the qualities of grit and perseverance. When a procedure is available, take the opportunity to participate. Don’t be a wallflower. One of my program directors during my residency repeatedly stated, “Radiology is not a spectator sport!” He was right. Procedural comfort is directly related to the number of times you have completed a procedure. So, go forth and participate as much as possible!

Read This Procedure Manual Again If You Have Doubts!

Everyone has some deficiencies, and we are not born perfect. We need to proceed with hard work and determination to overcome these weaknesses. Procedural skills for the klutzy resident are no different. So go forth and read avidly about procedures, gather the appropriate patient information, practice outside the interventional suite, and volunteer repeatedly. No matter if you are a bit klutzy. You, too, will have the power to master any procedure if you follow these basic guidelines!

 

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Want To Be A Successful Radiology Resident? Learn To Triage!

triage

When program directors hear complaints about their residents, we find most do not stem from resident incompetence. Nor do the complaints relate to professionalism issues. Instead, a good majority arises from a lack of a timely response to reading cases. And these delayed reports result from a lack of appropriate triage. So, I think you know what we will talk about today. You guessed it! The topic is tadaaaa… how to triage your cases.

A Common Scenario

It’s 2 AM, and a bleary-eyed resident starts to pick off STAT CT scans from the worklist to catch up on his reading from the nighttime. A house physician rushes down from the floors to speak with the resident in a huff. She explains that she needs to discuss a case from a week ago that she must present for the tumor board the following day. The resident obliges. Thirty minutes pass, and the house physician leaves.

Next, a few minutes later, an ultrasound technologist stops by the reading room because she questions whether a renal cyst is simple or complex. Like a robot, the resident scans the patient in the ultrasound room to make the determination. Another 30 minutes go by.

While scanning the patient, the resident gets two beeps which he needs to call back. He gets to both those phone calls. One of the phone calls comes from a patient’s father, who asks a question about his son’s chest film from the previous day. The conversation drones on for 15 minutes, and the resident can barely get off the phone. But he does eventually. Right afterward, he quickly responds to the other phone call and promptly answers the nurse’s question on the other end.

The resident starts to reread the CT list, and a technologist interrupts his train of thought as he walks into the room. Solemnly, the technologist asks, “How much contrast should we give this patient with a slightly low GFR?”. Immediately, the resident attends to the technologist. However, the resident is unsure and looks through the literature to find the appropriate answer. After 10-15 minutes, he finds a piece of paper and says, “75 ccs of Visipaque.”

Finally, an angry emergency department attending calls to the radiology reading room, “Where the hell are the results from the nighttime CT scans? We have been waiting 4 hours. Sorry, but we are going to have to write this up as an incident in the morning!” Where did the time go by?

Ways To Triage In The Above Scenario

So, what could this poor weary resident have done differently to prevent himself from getting written up by the ER doc? Well, lots of things. For one, did he have to review the tumor board case with the house physician? No. Should he have spent 30 minutes determining whether the renal cyst was simple? Probably not. The resident could have delayed until the morning. Did the resident need to speak to the patient’s father for so long? I don’t think so.

To summarize some of the problems the resident experienced with triaging in the scenario above, I have divided some of the main concepts about radiology triage into the following paragraphs. Here are some general recommendations for triaging cases to avoid situations like this.

Keep Your Eye On The Prize

Remember… When you are on call, the first goal is not to kill anyone, and the second is not to injure anyone. By ignoring the STAT list and tending to other people’s “problems,” you are increasing your chances that something terrible will occur. Perhaps, the CT Abdomen/Pelvis for appendicitis with a positive study will get delayed. Or, you will miss that opportunity to catch that hemorrhagic stroke before it is too late. Delaying STAT reads can theoretically cause irreparable morbidity to your patients. Therefore… Keep your eye on the prize. Complete those studies that are urgent first!

Also, if the activity is not critical, you can delay it until the following morning. In the case of the ultrasound technologist questioning a cyst above, sure, it is an important question to answer. But not so much when you have a list of 5 or 10 STAT CT scans you need to look at. You always have the option of delaying such study until the AM.

It’s OK To Say No

At nighttime, you are going to get all sorts of requests. Some are important, and others are nonsense. Do not let your colleagues bully you into concentrating on peripheral activities that do not directly affect patient care. If you don’t have time to look at that tumor board case, simply say so. Sometimes saying no is just the right thing to do.

Attend To Your Study First, Then Your Colleagues

According to my previous blog, Should Radiologists Ignore The Phone?, residents pay a significant penalty when discontinuing their thoughts midstream. Error rates increase dramatically. More relevant to this post, however, the time to complete a study increases significantly, increasing your chance of causing an angry ER physician. Therefore, it is imperative that you briefly let your colleagues know that you need to complete the study first and will answer their questions as soon as you finish.

Triage And You

One of the most essential facets of the nighttime experience is learning to triage. Believe it or not, you will use these skills for the rest of your career regardless if you take call or not as an attending. What studies do you need to complete first? Who should you attend to? These are all triaging skills you need to learn to succeed. Using some basic triage concepts above, ensure your nights are shorter and safer!

 

 

 

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Ten Disastrous Consequences Of Poor Study Habits

poor study habits

 

Studying for radiology is intense and unlike anything that you have done before. If you think shirking your duties only hurts yourself, you are entirely and utterly wrong. For those of you that don’t yet get it but are willing to listen, here are 10 of some of the disastrous consequences of your poor study habits!

Harming The Patient

First and foremost, you took a Hippocratic oath at the end of medical school, right? Well, by not reading, that certainly goes out the window. Not studying well leaves you more prone to interpretation errors when reading films. Ultimately, this will affect patient care. Who needs unnecessary biopsies and increased morbidity/mortality? You don’t care about that!

Your Colleagues Don’t Take You Seriously

Notice that your colleagues never approach you for consultations on their cases and second opinions. You feel out of place. Why is that? If you read something, you would go over more interesting cases because your colleagues would have a good reason to talk to you. You may become a better film reader. Well, maybe you are not interested in films and consults?

You Go From Practice To Practice

You know this type of individual. Probably, you have seen an attending or two who do not last long at your program. Sometimes you are not quite sure why they left. But many times, they can’t interpret films well. Perhaps, if they had read and studied a bit more…

Can’t Pass The Core Examination

This statement cuts right to the heart of the first through 3rd-year radiology residents. What is a radiology resident’s worst nightmare? That they need to take the core examination twice. Why would you want to do that? Just study!!!

Difficulty Obtaining The Fellowship You Want

Your dream is to go into interventional radiology. Forget about it. You always wanted to do an MSK fellowship. No way. To get into the more competitive specialties, you need recommendations. Who will give you a good one when you have not read a lick and never attempted to change your study habits? Did you think about that?

Your Attending Dreads When You Are On Call

Have you noticed that sigh that seems to emanate from your attending’s mouth when you say you will be on call the night before his CT rotation? Well, you better get used to it! Who wants to be the attending of record after you make all those interpretation errors due to lack of reading?

No Job Connections

Finally, you graduate from your residency program. But, no one seems to let you know when that next great job is available. Why not? It is straightforward. Who would want to recommend you to a position when you don’t have the background to merit it?

Attendings Won’t Let You Perform Procedures

In interventional radiology, you realize that your colleagues are getting to do a whole lot more procedures independently than you get to complete. Why is that? Hmm… Maybe, no one trusts you to touch a patient because you haven’t read about the procedure at all!

Consults Walk By You

Have you ever noticed how any clinical physician that has a questi0n walks right by you to the other guy in the corner of the room? Well, you have established a reputation for yourself because you have not been studying the right way. You are no help to anybody. Maybe this is what you wanted- you now have less work. Congratulations!

Losing Out To The Competition

You are beginning to notice that your patient loads are dropping precipitously? Around the corner, another practice opened up that now reads studies that you don’t feel comfortable reading because you are unwilling to study and learn about the new image modalities in radiology. Your wallet begins to suffer!

Bottom Line For Poor Study Habits

Reading, studying, and continually learning are all part of becoming a great image interpreter. A radiologist cannot exist in today’s climate without these tools as a resident and beyond. Why would you want to destroy your reputation and have to deal with the ten disastrous consequences of poor studying habits!!!

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A Student/Resident Guide To Research

 

Introduction:

Participating in research is a great way to contribute to medicine. Well-conducted research and literature reviews help advance both scientific understanding and clinical practice. Additionally, it enables you to develop expertise in a topic, while simultaneously showing dedication to your field. Peer-reviewed publication and presentation of your research should ultimately be your goal. Although you may want to get involved in research, you might not know how to go about it. Beginning a project can often present a challenge for residents and students with a limited research background. Here, I offer some advice and recommendations that I would give anyone just starting. Much of this I have learned through trial and error. Learn from my mistakes!

Identifying research mentors:                               

Your choice in mentorship can dictate whether or not a project will be successful, especially when just beginning your research career. Try to identify a project mentor (usually a physician or Ph.D.) with a proven track record of publication. Even better, if you can find someone with institutional or national grant funding, you can be confident that your research will likely be published. These are not essential, but finding the correct mentor can mean the difference between publication and fruitless pursuit.

First of all you should approach attendings, residents, and students. Ask if there are any ongoing or projects in the department. If you identify something that piques your interest, offer to assist in any way! Offer to carry out a literature or chart review. Attendings and residents are busy, so help them with the work that no one wants to do. The more you do, the higher up on the author list you will be. Make sure you show initiative and interest!

Although clinical research in your dedicated field might help you more as an applicant, any well-conducted research can be a great interview discussion topic, as long as you can speak intelligently about it.

Research takes time and patience:

What many don’t realize is that conducting research takes time, and that manuscript preparation and submission can take equally long. When you read a newly published paper, often the presented data is up to a year or two old. In many cases, a you need to submit a publication to several journals before being accepted. Especially true, if an author is seeking publication in a high-impact journal. My advice: start your research early. Students should seek out research from the first day of medical school, and residents should look for research during the intern year (if they can find the time!). Not to say that you cannot accomplish research in a short timeframe. However, you must be realistic about your goals and recognize that you cannot completed all projects if you are limited on time (i.e., close to residency or fellowship applications).

If you budget your time wisely, you will be able to edit thoroughly and compose a more eloquent article with a comprehensive review of the literature.

How to minimize your time for completing projects

Remember you are legally/ethically obligated to submit your paper to one journal at a time. Some review cycles can take several months for the first decision, so look up their average turnaround time if this might be concerning. Also, if you plan to submit to notable journals, there is always the possibility of rejection. Resubmission to another journal will likely require reformatting and an additional wait period. The time between finishing an experiment and publishing can add up. Remain conscious of this reality.

If you are limited on time, but still want to conduct a small project, one option to consider is a conference abstract. Conference abstracts allow you to showcase your research often through a poster presentation. The beautiful thing about conference submissions is that you can submit an abstract with preliminary findings, and later expand upon these in the full poster if accepted. Certain conferences/societies will even publish your work in their journal afterward.

As a bonus, getting an abstract accepted allows you to attend a conference and network with your colleagues. Most large meetings are held in either the spring or the winter. And, abstracts are generally due approximately six months before the conference. Deadlines may vary so identify these times if you have an ideal meeting in mind.

As a side note, the societies that hold conferences often have student/trainee travel scholarships or discounted conference fees. Any young professionals with funding concerns should apply. Again, be aware of scholarship applications deadlines.

Where to publish:

Everyone should strive for publication in high-quality, peer-reviewed journals. Things to consider are impact factor (IF) and indexing in scientific databases. High IFs are in journals like Nature or Science. However, it is essential to realize that a journal’s audience can impact this number. For instance, Nature has an impact factor of approximately 40, while Radiology has an impact factor of around 6-7, and the Journal of Vascular and Interventional Radiology (JVIR) has an impact of about 3.

If each is an example of a high quality-peer reviewed publication, then why the difference in IF? The reason is the audience and journal scope. Nature covers a wide range of disciplines. And therefore, it has a larger audience. On the other hand the other two have smaller audiences. By sheer readership, this means that fewer people read them and cite their articles.

Although everyone might aim for publication in big-name journals, we often have to settle for lesser-known, lower-impact publications. This is ok, as long as you consider several things. Journal reputation, peer-review, and indexing. Ultimately, we want our research to be visible to the scientific community. Therefore, we want our papers indexed in PubMed, Medline, Web of Science, etc.

Why you should consider open access:

Professional scientists often have a “publish or perish” mentality. For a Ph.D. actively conducting full-time research, publication in large name journals can provide major career and funding opportunities. This is especially true for young postdocs. However, the pressure to get published in major journals like Nature, Science, or the New England Journal of Medicine reflects a major flaw in the scientific community. Scientists often delay submitting their findings until a more thorough narrative can be told. This can involve years of additional experiments, and, unfortunately, deceptive and unethical practices in some cases. Additionally, it also prevents experiments from being repeated and perfected, as the drive to submit “novel” findings fuels these major publications. This also discourages the presentation of negative results, or when an experiment or intervention fails. These findings are equally as important for scientific progress.

Although research output is not as essential for becoming a successful practicing physician, a publication can augment your career opportunities, especially at major academic centers. As physician-scientists, this pressure is not felt as strongly, thus we have a unique opportunity to help change the industry and combat these practices.

One movement in response to the publishing business is open access. This model of publishing promotes freely available, online publications with a quick review turnaround time and lower publishing costs. However, certain concerns over the quality of these publications have been raised. Not every open access journal is created equally. There are certain predatory publishers who will publish anything without peer review as long as a fee is paid.

More information about open access:

Be aware of journal quality when you are considering the submission. One great resource, the Directory of Open Access Journals (www.doaj.org), continuously compiles a list of reputable open access publications organized by specialty and database indexing. Another interesting response to the flaws of the publishing industry takes the form of the publisher, Matters (https://www.sciencematters.io/why-matters). Matters takes the stance that those individual findings should be reported. They suggest that observations should again be the basis of good science, not embellished narratives like major journals tend to favor.

Rapid dissemination of new data could provide the missing piece to a colleague’s research on the other side of the world. Knowledge and its access should be easier in the age of information. Give open access a try, and get your data out there!

Know your reviewer and audience:

Before submitting any publication be sure to edit your content for grammar and spelling. It is not uncommon for a great idea to get rejected because of poor presentation! No matter how groundbreaking your findings may be, sloppy grammar, spelling errors, and disorganization will instantly raise red flags among reviewers. “They were not meticulous with their writing, were they meticulous with their research?”, a reviewer might think. Share your paper with anyone willing to read it. A fresh set of eyes always picks up something you might have missed.

Also, always try to write with your reader in mind. In reality, radiology journals will likely be read by radiologists, but try to consider an extended readership. Think of your reader as a scientific/educated person, but from a field different than your own. You should compose a logical and concise piece, with appropriate references for the majority of your statements. Something that might seem intuitive to you or a radiologist, might not be as clear to another professional. Provide the extra detail, or at the very least, a resource if more information is sought.

Be aware of the publication scope and adhere to manuscript formatting requirements:

Every journal has its own formatting and organizational requirements. These are usually clearly stated online. Read these carefully and make sure every item has been accounted for. You don’t want to wait several weeks for a decision only to get a request to re-upload a version with double-spacing and times new roman 12-point font, and then have to wait again! Also, make sure your paper fits within the journal scope. Again, this is usually clearly stated online. Don’t submit a surgery paper to a radiology journal. Don’t submit a case report to a journal that doesn’t’ publish them. Use your common sense! You can always look up what they have published in previous years to get an idea of the style and types of papers that are accepted.

Important items that are often omitted from the discussion section:

  1. Make sure you have a sound basis for why you carried out your study. If you state a fact, technique, or clinical approach, cite the literature. Even if a statement might seem like common knowledge to you, it might not be to a reviewer or reader. Reference everything!
  2. Do not embellish. You should discuss the limitations of your study. Every study has shortcomings. Be upfront about them. Offer solutions to these limitations for future research. This shows maturity and that the scientist has thought about the holes.
  3. State how you think your findings can advance the literature, science, or clinical practice.

Avoid frustration by using a citation manager from the start:

When you’ve finished your project, and are ready to write, be sure to use a citation manager such as Endnote. Often when writing, you will reorganize your thoughts and shift your references. By using a citation manager like Endnote linked to Microsoft Word, you will save yourself hours of frustration trying to organize citations and manually create a bibliography. You can create a free online account on www.myendnoteweb.com and if you purchase or get a copy of Endnote for Mac or PC, you will be able to “cite while you write.” Trust me! This is a HUGE help! Often your institution will provide you with access to a research database, like Web of Science. You can link this account to your endnote account and export references easily. Alternatively, you can download a citation file from PubMed and upload to your citation manager. Either way, you will save time and avoid frustration! How-to guides can be found online and on YouTube.

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The Midnight Radiology Resident Discrepancy

discrepancy

If you haven’t had a discrepancy with the covering morning radiologist as a resident on call, then one of you encountered one of three outcomes. You either haven’t read enough cases. Two, you are the long-lost great-great-grandson of William Roentgen; Or finally, perhaps your name is Watson, the artificial intelligence computer, and you work for IBM!!!

The truth that very few attendings seem to admit is that everyone, including themselves, will miss something every once in a while. One study reported radiologists clinically miss something important between 2-20% of the time. (1) From my experience, that number looks pretty high, but the rate is significant enough. So, when, and notice, I don’t say if you miss something and have a discrepancy at night, you are an ordinary radiology resident. I would even go as far as to say that you are fortunate, in a sense, because you didn’t miss the finding as a full-fledged attending. You have someone to back you up, and hopefully, you will never forget that finding again.

Accepting The Inevitable Discrepancy!

The first step, of course, is to prevent major misses. The cases you need to study leading up to taking calls are the cases that are common and lead to significant morbidity and mortality. You want to view hundreds of different types of appendicitis, aortic ruptures, pulmonary emboli, and so forth so that when the time comes for you to take a call, the chance of missing the critical finding is significantly lower. Unfortunately, however, we can’t prevent all the inevitable misses, and frankly, we have to admit to ourselves first and foremost that this will be the case.

So, what do you do when you have a significant miss? Maybe you sent a patient home with acute appendicitis or a patient with a ruptured ectopic pregnancy. Perhaps you missed an early retroperitoneal bleed. There are specific keys to making the discrepancy in any of these cases, not just another horrible encounter, but rather a learning experience that is valuable for the remainder of your career. We will go through a few rules that you need to follow in the rest of this chapter.

Don’t Perseverate Over The Discrepancy

The first important point is how you emotionally react to the discrepancy. It is also a life lesson. We can’t undo what you did. You need to move on… Perseverating on a miss is counterproductive at best and, even worse, can cause future misses. Remember, just because you made a significant miss does not mean you are or will be a horrible radiologist. So, you need to get over it. The same rules apply to questions on written exams, future failures, etc. One miss does not a radiologist make!

Make Sure To Follow-up The Patient In The Morning

When you find out about the bad news, it is inappropriate to leave the department sulking, not attempting to make good on the miss you made. Try to do what you can to make sure that the physicians in the emergency room know there was a discrepancy. Or, you may need to call the patient back yourself, if need be. Bottom line… You need to make an effort to clean up your mess. It is partially your responsibility.

Read All You Can About the Miss To Not Make the Mistake Again

Reading about the disease, reviewing the films, looking at other similar cases: These are all the things you should be doing soon after the miss. This miss is a real opportunity to understand and fix the incomplete knowledge you had on the subject before, and, of course, to never make the same mistake again.

Teach Others

One of the most rewarding ways of compensating for the discrepancy is to make your fellow residents and junior residents aware of the miss. Teaching your colleagues protects them from making the same mistake that you have made. And, even better, it reinforces the knowledge you have, thereby making it much less likely that you will repeat the same mistake. Just like lightning, it rarely strikes twice!!!

Learning From Midnight Discrepancies

Midnight discrepancies are part of the everyday learning ritual for a radiology resident. It is not the discrepancy itself that is a problem. That is expected and is part of the typical routine residency learning experience. But instead, the issue is how you as a radiology resident learn and grow from the experience. Make the best of a challenging situation!!!

 

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How To Create A Killer Radiology Personal Statement

radiology personal statement

 

Personal statements in the radiology field are the least effective way to bolster your application. (1) Rarely, do they help an applicant. Occasionally, they hurt the applicant’s case. Regardless, I am aware that the personal statement will often become essential to many viewers of this article who apply to radiology regardless of whatever I say.  Therefore, I am creating this blog for anyone that is applying for a radiology related job to learn to create that killer radiology personal statement. And, today I am going to recount some of the basics for creating one. Specifically, I am going to start by explaining the parts of a great radiology personal statement and then give you some general tips that I have learned over the years from blogging and reading many personal statements.

First Paragraph:

The Hook

After having rummaged through thousands of radiology personal statements and writing lots of blogs, I can definitely say that the key paragraph for the reader begins at the beginning. If it is average/boring, I have almost zero desire to read the rest of the statement, especially when you have another 10 more to read that day. Something in the few first few sentences needs to draw the reader in quickly. You are not writing a short story or novel where you can slowly develop your characters and plot. Rather, you need to write using a technique that I like to call the hook. Reel that program director in.

There are several techniques that I have seen over the years. Let’s start by using the writing technique of irony. Notice the irony I chose in the first paragraph of this article. I started by saying personal statements are the least effective way to bolster your application. Whoa, wait a minute! The title of the article is How To Create A Killer Personal Statement. That’s somewhat interesting. The dissonance in that first paragraph draws the reader in.

So, what other techniques can you use to maintain the interest of the reader? Sometimes quotes can certainly help. Once in a while, I come across a quote that really interests me. I tend to like quotes from Albert Einstein. They tend to be witty and have double meanings. But, there are certainly millions to choose from. A good quote can set the tone for the rest of the personal statement.

Finally, you can write about an interesting theatrical description of a life-altering event that caused you to want to go into radiology. Use descriptive novel-like adjectives and adverbs. Go to town. However, be careful. Don’t choose the same events as everyone else. Read my other blog called Radiology Personal Statement Mythbusters to give you some other ideas about what not to choose!

Tell Why You Are Interested In Radiology

The first paragraph is also an important place to tell the reader why you are interested in radiology. Many times I will read a radiology personal statement and say to myself that was kind of interesting, but why does this person want to go into the radiology field? He/she never quite answers the question and I am left feeling that this person does not know why they want to enter the field. Don’t let that be you!

Second Paragraph:

Explain Any Problems/Issues

I like the applicant to be upfront with the reader rather quickly if there was an issue that may cause a program director or resident to discard an application. It could be addressing something as serious as a former conviction for drunk driving when you were young and stupid. Or, it could be something milder like a questionable quotation from a mentor that you found in your Deans Letter. Either way, you need to explain yourself. Otherwise, the problem/issue can declare itself as a red flag. Subsequently, it can prevent you from getting the interview that you really want.

Second and Third Paragraphs

Expand Upon Your Application

Let’s say you don’t really have any red flags in your application. Well then, now you can write about some of the things that you accomplished that you want to bring to the attention of your reader. Typically, these may be items in your application that are partially explained in the experience or research sections of the ERAS application but really deserve further emphasis or explanation.

Show Not Tell

In addition, the meat of any personal statement should contain information about what you did. Do not, instead, describe all the characteristics you had to allow you to do it. This is a cardinal mistake I often see in many personal statements. What do I mean by that? If you have been working at NASA on the Webb Space Telescope, you don’t want to say I was a hard worker and was well liked by everybody. Rather you would want to say I spent 1000 hours building the mirror for the telescope constantly correcting for mistakes to such a fine degree that the engineering societies considered it to be almost perfect. And to show you were well liked by everybody, you can say when you were done completing the telescope, NASA held a ticker tape parade for me!!! (Well, that’s probably not the case. But, hopefully, you get the idea.)

Final Paragraph

Time to Sum Up

This can be the most difficult part of writing a personal statement (and blog too!) How do you tie everything together into a tight knot so that everything comes together and makes sense? Well, one thing you can write about is what you will bring to the table if your residency program selects you based on what you have stated in your radiology personal statement. Back to the Webb telescope example: Given my experience with my successful quest for perfection by creating an almost perfect telescope mirror, similarly, I plan to hone my skills to become an incredible radiologist by always learning from others and my fellow clinicians to get as close to perfection as possible. Bottom line. You want to make sure to apply your experiences to the job that you want to get.

General Issues With Editing

1. I have learned a few things about writing over the past years, whether it is blogs, personal statements, letters, or whatever else you need to write. However, the most important is the obsessive need to review and re-review whatever you are writing for editing. It may take 100 edits to get it right!!!

2. Have a friend or a relative read your personal statement to catch errors you may not see. Your brain is trained to already know what you have written. Many times the only way to catch your own mistakes is to have another person read your writings.

3. Also, make sure to the read the personal statement out loud. Sometimes you can only detect errors by listening to what you have actually written. It happened many times when I edited my book Radsresident: A Guidebook For The Radiology Applicant And Radiology Resident

4. Finally, I recommend the use of grammar correcting programs. The one that I would like to bring to your attention is the program called Grammarly. I am an affiliate of Grammarly. However, that is only because I use the program myself for my blogs all the time. It has saved me from really stupid mistakes. One version is for free and corrects simple critical errors. The other uses more complex grammatical corrections and is a paid service. Regardless, either version will assist you in catching those silly errors. In addition, I usually paste my blogs into the Microsoft Word program to correct any other possible errors. I have found both programs to be complementary.

Other Useful Tidbits

Avoid Too Many I Words

When writing a radiology personal statement, try to reduce the usage of the word I for multiple reasons. First, it begins to sound very redundant. Second, you appear selfish. (It’s always about you, isn’t it?) And finally, you want to create the impression that you are going to be a team player, not in the field of radiology just for yourself.

Active Not Passive Tense

If you want a passage to sound great, make sure to almost always use the active tense, not the passive variety. When using the passive form, the reader has more work to do because he/she has to figure out who is doing the activity. In addition, the environment appears to control you rather than you controlling the environment. And finally, sentences sound more verbose when using the passive tense. Think about the following phrases: The job of creating a computer algorithm was completed over the course of 10 years vs. My colleagues and I created a computer algorithm over the course of 10 years. Which sounds better to you?

Use Sentence Transitions

If you want your personal statement to sound smooth, I find words other than the subject at the beginning of the sentence help to diversify the sound of the individual sentence. Also (notice this transition word!), it allows for a change of idea without being so abrupt.

Don’t Use The Same Word At The Beginning Of Each Sentence

In that same train of thought, try not to use the same word to begin a sentence over and over again. It’s a surefire way to bore the reader!!!

Creating That Perfect Radiology Personal Statement

Now you know some of the rules I would utilize to create an interesting radiology personal statement. Some of these are general rules that I apply to my blog on a weekly basis that I also see in the best personal statements. Therefore, I know that they work well. So, go forth and write that killer radiology personal statement. You now have all the tools you need!!!

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Radiology Call- A Rite of Passage

call

Every year around the beginning of July, I see some of the most haunted radiology resident faces, right around 10:00 pm, just after the attending evening shift ends and the resident night shift begins. It is almost always a second-year radiology resident who happens to be starting their first night of call. What if I miss something important? What if I say something stupid? Will I be able to handle the intensity? Will I fall asleep? And most importantly, will I kill someone?

The resident only unlocks the answers to these burning questions on the first night. Only after this event does the resident and the program director know whether or not they can handle the burdens of a radiologist. Everything in the first year leads to this point: the precall quiz, the intense reading, the conferences, and the studying. It’s crunch time.

Just before the first night of the dreaded call, my famous last words are: you begin the night as a kid, and you will end the night as an adult. Why do I say that? Because I think the truth lies embedded in that statement. You can never become a full-fledged radiologist until you are responsible for independently making patient decisions. It’s like all those ancient traditions in all religions/cultures, like hunting that first wild boar, the confirmation, the bar mitzvah, etc. The residency now allows you to function as an independent, freethinking human being who can make decisions on your own. Until then, you are merely an observer, not an active participant.

Since taking night coverage is such an intense and essential experience, you must follow certain tenets to make it valuable and safe. I will enumerate eight simple golden rules of call I wish I had known before beginning those fated first nights to come. I urge that you follow all of them to enrich your education safely. Do not stir the wrath of your fellow staff members and program directors in the morning by breaching these rules!

Look at every film with these primary thoughts- what will kill the patient, and what is common?

I can guarantee that if you look at every film with these thoughts at the forefront of your brain and have done the prerequisite work to get to call, you will not severely harm any of your patients. When you look at a chest film, always think pneumothorax. If you see a female pelvic ultrasound, always think ruptured ectopic. When you look at a CT scan in a patient with right lower quadrant pain, always think of acute appendicitis. And so forth. Thinking about badness will prevent undiscovered horribleness in the morning.

Likewise, when you look at films, always think about the most common diagnoses first, and you will be right much more often than wrong. For instance: Opacity on a chest film- pneumonia, not Hampton’s hump. Restricted diffusion on a brain MRI- infarct, not ependymoma. Abnormality on a GI bleeding scan, think primary GI bleed, not Meckel’s diverticulum with bleeding gastric remnant. I can guarantee your attending faculty will look at you funny if you come up with too many zebras!

Always, always, always maintain your search pattern in every study.

In the radiology world, one of the main ways to miss something is not to look for it. Sometimes in the middle of the night, the pressure will seem impossible, and you must deliver an answer at that second. Perhaps, a team of 4 angry surgeons comes down and asks, “What is going on with the film?” and needs to know now! Or, an inpatient resident shoves a chest film in front of your face and says, “What’s going on here?” Maybe, the emergency medicine doctor calls incessantly to get a read on that CT chest for dissection.

In each of these cases, I don’t care how emergent and immediate they need the answer, always step back and go through your search pattern. Everyone makes this cardinal error at one time or another. Avoid it! Step back and say give me a moment. Go through each organ or region rigorously. You will look much less stupid than blurting a diagnosis/finding out only later to realize it was wrong because you haven’t thoroughly analyzed the study. One of the worst feelings is finding the doctor who just left your department with the wrong answer, who is getting ready to begin an unnecessary surgery on a patient, or a doctor who will discharge a patient that needs to stay in the hospital!!

If there is no harm to the patient, it is easier to do the study than to fight it.

Most residents take a while to learn this one piece of sage advice. At nighttime, you will have limited time for everything. Interruptions will pull you in fourteen different directions at once. You will receive calls from the emergency department, the floors, the surgeons, etc. And often, these events tend to happen all at once. So, I urge you that if a study is reasonable, do it.

You will spend more time and energy preventing a study from getting done than just completing it. Of course, if it significantly harms a patient, then obviously avoid it. But that is the exception rather than the rule. That fluoroscopy study to rule out a foreign body that you try to block after the resident ordered it: I can guarantee it will come back hours later when you are either exhausted or have lots of things going on at once. So, just do the study!!!

Don’t let your temper get the best of you. You will hear about it in the morning!

Every resident encounters a curt gynecologist, a rude surgeon, a loud, demanding resident, and so on at some point. You are likely going to be grumpy and tired as well. It may seem like a good idea to talk back to that person similarly rudely and unprofessionally. Or, you may want to take a swing at one of these annoying chaps. But don’t do it. One of the most common complaints at nighttime is a letter written by an attending or a resident colleague saying this radiology resident was unprofessional and handled the situation poorly under pressure. This complaint will come regardless of whether the radiology resident is right or wrong. And often, it will stay in the resident’s file/record. Don’t let that be you!!!

Residents best handle resident matters. Attending matters are best handled by attendings.

At nighttime, many times, a clinician may need an attending radiologist. So, make sure you don’t go in over your head. Call your attending when necessary. The worst thing you can do in the morning is to perform a procedure that your attending should have done or make a phone call that really should have been handled by your attending, only to find out that the wrong thing happened. It will become the talk of the town in the department, not in a good way. An attending should always read a brain scan because of litigation issues. A faculty radiologist should always be present for an intussusception reduction. And so on. Don’t go over your head!

On the other hand, if you have a resident issue at nighttime, try to handle it yourself. If the Emergency Department asks you whether to give the contrast, make that decision. If a resident comes down to ask a question, answer it. You will only learn how to make the more minor decisions by playing the role of a radiology resident.

Ask for help if you can’t handle something at nighttime.

Sometimes, the job may be too much to bear for one person. (A disaster happened with every patient getting a total body CT scan) Perhaps, it is a question that an expert needs to answer. (A subtle abnormality on an emergent Neuro CTA) And, other times, administrative issues that only your chair or program director can handle. (The MRI broke – should we recommend sending patients to another hospital?) If such problems arise at nighttime, make sure to call the appropriate channels going from lowest to highest in command. If it is a patient question that you are not sure about, ask your chief resident. Then, if they can’t answer the question, you may want to ask the assigned attending on-call. And, up the chain, it goes.

If you decide to handle everything yourself and it is inappropriate for your level, you can almost be sure that repercussions will occur in the morning. So please, ask for help when it is needed and appropriate!!

Always answer your beeper/phone/pager.

Occasionally, we hear about a resident sleeping and not answering their pager at nighttime. Unfortunately, those residents will often get written up in the morning for lack of timely dictation. So, jack up the sound on your beeper/phone/pager. And, take all calls!!!

Look at the films. Don’t rely on the ER or Nighthawk reads.

Being on call is the time to remove the umbilical cord and develop independence from your mentors/attendings. So, do not repeat a dictation or reading that is already present. You should do everything de novo/from scratch, although you should look at their reads afterward. It also seems silly when the resident’s dictation matches the Nighthawk dictation verbatim and hints that the resident may not have looked at the films. When I am on in the morning, I appreciate the extra set of eyes that a resident used to check the cases even though others have looked at the study. And, it is not infrequent that our residents catch essential findings that the nighthawk didn’t notice. So please, do your independent reads/dictations!!!

Summary statement

Call is a challenging but integral part of raising a radiology resident right. It is a time of trials and tribulations. You can and will make it through this harrowing trial if you follow the golden rules. Good luck!

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Need some help with what you need to learn before taking call? Check out the following books on Amazon!

Emergency Radiology Case Review Series

Core Radiology

 

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This article is featured on auntminnie.com!!! Click here for the Aunt Minnie version of the article. 

 

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How to Make a Good Impression as a First Year Radiology Resident

impression

It may be your first day, your first month, or maybe you started residency several months ago. Perhaps, you want to make that great first impression on your program director. Or, maybe things are not going as well as you might have liked during your first year. Having worked with numerous first-year residents rotating in our residency and having completed a full four years of residency, I have learned the ingredients you need to become a great first-year resident. As a former resident, I wish I had a list of tips on how to start my radiology resident experience on the best footing possible.

Well, now it’s here. I have a list of 12 ways to improve your radiology residency experience starting in the first year of your diagnostic radiology residency program. Also, I will give you examples of what not to do (these scenarios are real!). Then, I will explain how to make the best of each piece of advice. To all- ENJOY AND HEED THIS ADVICE!!!

Be Enthusiastic

On your first day of radiology residency, you walk into the reading room for the first time, and you are nervous and hesitant. You begin to yawn, mouth wide open. An attending sits in the corner about to read films. You slink back and worm your way into a corner. You don’t introduce yourself for fear of disturbing the attending radiologist. Instead, you start talking to your resident colleagues. Is that a way to start your career? By all means, NO!!!!

My words of advice:

Always make sure to put on your best face forward toward your staff. What does that mean? Well, it’s pretty much common sense. Always introduce yourself. Always ask how you can help. And, always volunteer to participate in a readout or procedure. You have only one chance to learn the things you need to know before practicing as an attending, and that way is RADIOLOGY RESIDENCY. Make it the best learning experience you can, and that involves going that extra mile to show your enthusiasm/interest.

Be On-Time

You wander into the reading room, and it’s 10 AM. When you see your attending radiologist reading out films, he pauses for a moment. You decide to say, “When can we start reading out together?” The attending looks at you with a confused quizzical face. Was I supposed to have a resident today?

My words of advice:

When you arrive in the morning, always let your attending know that you are today’s resident. If you have to step out for a few moments, let him know that you need to leave. It is a sign of respect to let your attending see that you are going to be around to help out, learn, dictate, and ask questions. It will go a long way to establishing a rapport between yourself and your residency staff!

Be Nice to Everyone

It’s your first day, and you walk into the residency coordinator’s office. You sit in her chair, never having seen or met her. And then, you start playing games on her computer. The coordinator walks into the office and stares at you and is thinking: who the heck is this guy?

My words of advice:

Make sure when you are beginning that you are kind to everyone!!! I don’t care if it is the residency coordinator, janitor, technologist, attending, senior resident, or nurse. We are all part of the same team. Moreover, we always hear about our resident’s behavior, good or bad. As residency director, we receive 360-degree evaluations, reviews of the residents from potentially all these sources, and more. I can tell you that if you want to destroy your reputation as a resident, the worst thing you can do is misbehave with your team members, especially the residency coordinator!!!!

Dress Appropriately

You are upstairs on the floors in a t-shirt and ripped jeans. Your ID badge sits in your back pocket with the list of patients to consent. In your morning haze, you stumble up to the door of the 3rd patient with informed consent in hand. You introduce yourself to the patient, and she gives you that look- who are you really, and what are you doing here? You go through your pat explanation of the procedure, the risks, and the alternatives. The patient warily signs the consent form. Great! The last consent of the morning.

Later that afternoon, the program director calls you into the office. It turns out, the patient was the wife of a hospital executive and called the emergency hotline. The program director now has two complaints about this resident, one from the patient’s husband and another from the doctor in the hallway. Both are furious because they did not know who you were and felt uncomfortable confronting you. The program director states, “Go home and change immediately!”

My words of advice:

Always make sure you look and play the part of a physician. Some patients and physicians are easily offended by an inappropriate appearance/uniform. In our world, radiology is a service-oriented profession. Furthermore, appearances fortunately or unfortunately lend credence to your skills, personality, and the department. Please make sure to represent your department in the best light!

Play the Role of An Attending From Day One- Take Responsibility for Your Patients and Department

You roll on into the nuclear medicine department and arrive at the department early. Briefly, you look at the list of patients in the computer. A bone scan and a gallium scan lies waiting as unread. You think to yourself, I know those topics well. I also know it would be much more productive to read a nuclear medicine book on a new subject. As you are waiting for your attending to arrive, you pull out your text and learn about nuclear medicine. The attending walks through the door a few minutes after you started to read and says, “Have you looked at the cases from last night?” You reply, “I was hoping to get my reading done for the day. Didn’t get a chance to look at the cases.”

My words of advice:

When you are on any service, good learners become great radiologists by reading lots of cases. You may know a given topic well, but you can only learn normal from abnormal by reading thousands of cases in different contexts. Unfortunately, you cannot learn this from merely reading a book. The only way to get that experience is to look at lots of cases every day. Take an active role as if you are an “attending.” Radiology is not a spectator sport!

Be Knowledgeable

You are in the second week of your first CT rotation. So, you sit down with the CT attending to go over the day’s work. The attending goes through each of the cases slowly. Finally, she happens upon an abdominal CT scan. You stare at the images, and she asks you about an ovoid cystic density structure just inferior to the liver. You blurt out, oh, that’s easy. It’s an aorta!!! Your attending begins to shake her head slowly and becomes silent. She doesn’t say much for the rest of the day.

My words of advice:

There’s an old radiology adage. The difference between a bad, OK, good, and great radiology resident is the amount you read every night. A bad resident doesn’t read. An OK resident reads 1 hour a night. A good resident reads 2 hours a night. And, a great radiology resident reads 3 hours a night. Don’t be that bad radiology resident! When you start, I encourage you to read a lot, especially emphasizing the basics and anatomy!

Read a Lot, but Make Sure to Study the Images

It is your first day on the new chest film rotation. You have just finished reading an entire textbook on chest radiology. As you start looking at the cases with your attending, you figure that you will try to impress him with your in-depth knowledge of the findings associated with sarcoidosis. So, you start going through a small presentation about your newfound knowledge based on the textual information. After your serenade, he begins to look at the first few cases of the day. Then, he pauses as he starts on the third case of the day.

He asks, “What do you think about this chest film in front of you?” You stay silent as you search the film up and down, left and right. Nothing seems to register as abnormal ton the film. Your attending points out a significant opacity obliterating the vessels behind the heart and obscuring the left hemidiaphragm. He then asks, “Where is the opacity located?” You realize that you have read tons of information on pneumonia but never looked at the pictures. Uh oh! You cannot identify the location based on a mental reference point. Your heart sinks as you realize you have more reading to do…

My words of advice:

Reading a radiology text differs dramatically from reading an internal medicine book, a novel, or other sorts of written information. The most important features of a radiology textbook are usually the pictures and captions below the pictures. So, it behooves the resident to concentrate on these films, often more than the text itself. Of course, you need to understand and remember the disease entities, but radiology is most often about the images!

If a Radiology Attending Asks You a Question, Always Look Up the Answer

So, it’s the end of the day, and you are sitting with your favorite attending. For the few days that you have worked with her, she has a habit of teaching interesting topics while taking cases. It feels like you just read an entire book without even touching a page. She enthusiastically asks you a question about a patient with breast cancer. She says, “I wonder what a sclerotic metastasis would look like on a PET-FDG scan? Maybe you can look it up, and we will go over it tomorrow.”

You go home exhausted and fall asleep slumped over your computer, without even getting a chance to read a word about the topic. You get up in the morning and realize you are running late. Hurriedly, you grab your stuff and arrive barely on time. Sweating profusely, you run into the reading room. Your attending almost sits down at her workstation. And she says, “Did you look that topic up for me?” Unfortunately, you don’t have a satisfactory answer. For the rest of the day and weeks afterward, she barely spends time on her cases with you. You’ve lost many opportunities to learn with your mentor.

My words of advice:

You sow what you reap! When someone, specifically a radiology attending, takes the time out of the day to teach. And, she goes over cases with you out of his/her own free will, it is essential to pay back that person with attention, diligence, and care. By under-appreciating the attending’s time, you change the willingness of a teacher to teach. Remember, most hospitals do not pay radiologists stipends for their time with their residents. Teaching emanates from the goodwill of the staff!

Always get a good history

It is late in the day, and you are about to read the last hepatobiliary scan of the day. But you have to do it quickly because you need to get home to your family. Instead of entering into the electronic health records, you promptly peruse the one-word order on the top of the dictation page. It says pain. So you start reading and dictating the case promptly for the attending with that one-word history. In a few minutes, you finish the dictation.

You walk back to the reading room and begin to go over the case with your attending. Subsequently, he opens the case, looks at your history/dictation, and begins to look at it as the surgical team walks by to get the radiologist’s interpretation. The surgeon asks, “What do you think?” The radiologist says, “With a history of pain, it looks like the gallbladder fills nicely without findings suggesting cholecystitis.” The surgeon responds curtly, “We just took out the gallbladder!!”

My words of advice:

Always take the time to get a great history. As a resident, you should take the time to gather all the information. Without a good history, trust me, you will get burned. So, avoid the inevitable, take your time, and always get all the necessary information!!!

Establish a search pattern for all modalities

The day’s attending sends you out of the room to read a new CT scan of the abdomen. The patient has right lower quadrant pain, and the emergency doctor wants you to rule out appendicitis. So you look through the CT scan quickly and ramble into the Dictaphone about the case. Your eyes move here and there without any specific pattern. Finally, you see some terminal ileum wall thickening and put in your impression- findings suspicious for terminal ileitis/inflammatory bowel disease. Happily, you trot back to your radiology attending to go over the case. Within 10 seconds, your attending says, “You missed the 4 mm obstructive stone in the right ureter!”

My words of advice:

Believe it or not, almost every experienced radiologist has a rigorous search pattern and mental checklist in every case. With this checklist, they don’t miss any findings that may be relevant to patient care. You might not know they have a search pattern/checklist because they have been doing it for so long. And, they rapidly read the cases. But, I can guarantee you will miss plenty of significant findings if you do not go through an organized approach to looking at a film. It happens all the time!!!

Always check for priors

The radiology attending just left the service for the day. You are now on call for the night. The emergency department continues to call the nuclear medicine department every 10 minutes to get the result. Annoying, isn’t it? It is time to give a STAT interpretation of a pulmonary V/Q scan. So, you look at the scan and the associated chest film. And, you see three large mismatches without corresponding findings on the chest film. You call the ER and tell them the scan is positive for pulmonary embolus. You feel good because you think you made the right call for sure.

The next morning at the readout, your attending starts to look at the case. He notices that you didn’t compare to the prior scan. It seems the same. His interpretation- no findings to suggest new pulmonary embolus. He says, “Call the ER right now to make sure the patient doesn’t get more anticoagulants.” You feel like an idiot for missing the correct diagnosis!

My words of advice:

I can’t emphasize enough how important it is to compare priors. Priors will bail you out many times. And, comparing with them makes the difference between shoddy and outstanding patient care. If you want to become a resident star, always make a concerted effort to check for prior studies!

Learn about things that can kill a patient or are common first. Zebras can usually stay at the zoo!

You are taking your first independent call and start to look at your first ultrasound of the evening. It is a 2-year-old pediatric patient with right lower quadrant pain. Looking through the ultrasound images, you see a target like structure in the right upper quadrant. You recently read a large text and saw a case of Henoch Schonlein Purpura affecting the bowel. It happened to look just like it. Your differential reads Bowel thickening from Henoch Schonlein Purpura before anything else. Ten minutes later, the pediatric surgery team trots up the stairs toward your workstation and says, “What are you talking about? We were looking for a large bowel intussusception!”

My words of advice:

Stick to the most common two or three items within the differential diagnosis. You will often be right more than not. As I said, zebras can usually stay at the zoo!!

Making A Good Impression

I’m sure almost all of you want to make your best impression on the staff that you are going to work with for four years. One or two mistakes toward the beginning of your stay can make your life very difficult for the rest of your radiology training. Unfortunately, it is effortless to leave the wrong impression on the staff, but it is harder to correct. To avoid these blunders, I highly recommend you follow these rules. Don’t be the brunt of your residency’s jokes!


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Can You Pass The Real Saint Barnabas Diagnostic Residency Precall Quiz?

Today you are in for a treat. Our first-year residents at Saint Barnabas have all passed my homemade Precall Quiz with flying colors. So I was thinking why not publish the same 10 cases with images/videos below so you can test yourselves? (Don’t forget to look at the links to the videos for questions 2,3,5,6,8, and 10 that are either after the images or are on their own!) I also gave each resident up to 5 minutes to come up with a final diagnosis and they had to get at least 80% correct to pass. Can you do the same? Check out the answers at the bottom of this page to see h0w you did. If you pass, you are ready to take call!!! Let’s begin!!!

One…

 

Two…

 

Case 2 movie

 

Three…

 

 

Case 3 movie

 

Four…

 

 

Five…

 

Case 5 movie

 

Six…

 

Case 6 movie

 

Seven…

 

 

Eight…

 

Case 8 movie

 

Nine..

 

April 4, 2016

 

 

April 4, 2015

 

 

April 4. 2015

 

Ten…

 

Case 10 movie

 

1. Free air and air tracking adjacent to the ascending colon.

2. Acute appendicitis

3. Type A Aortic Dissection- Call Vascular Surgery!!!

4. T10-11 Disc Herniation with acute cord compression and possible early cord edema.

5. Normal/ nonspecific mesenteric subcentimeter nodes- ? mesenteric adenitis

6. Right-sided UVJ stone with right-sided hydroureter and hydronephrosis.

7. Left MCA distribution acute infarct with MCA thrombus. Evolving right frontal infarct.

8. Bilateral pulmonary emboli and right pleural effusion/air space disease

9. Probable old trochanteric avulsion fracture- Key point- it is chronic (lesson- look at priors!!!)

10. Proximal sigmoid mass, probably subserosal with findings suggestive of large bowel obstruction. Additional mesenteric adenopathy.

 

 

 

 

 

 

 

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Best Professional Societies For The New Radiology Resident And New Residency Graduate

professional societies

Student debts are mounting rapidly or you are just starting out in radiology residency. You have limited funds to join professional societies. Is it worth it to join multiple professional organizations? Which ones should they be?

This article will address these issues since they usually arise around this time of year. First, I will discuss why it is crucial to join a few of the professional societies. And then, I will talk about which organizations are essential to participating in from both a junior radiology resident and senior resident/fellow perspective and which ones are not so necessary. Let’s start…

Importance of Joining Radiology Professional Societies

Why even bother signing up? Many professional societies offer benefits to the individual and the specialty of radiology. For the individual, you may gain access to journal articles, CME credits, discounts on annual meetings, access to scholarships, discounts on insurance rates, and more. As for the betterment of the specialty, some societies support the ingredients needed to maintain our livelihood. For instance, some organizations support political action in Washington, D.C, to prevent reimbursement cuts, radiology research activities, the creation of appropriateness criteria, radiology residency boards, and more. It is straightforward to justify joining at least a few of the societies. So, let’s talk about the meat of this article- which ones to join?

Which Professional Societies To Join?

American College of Radiology

New residents: This one is a no-brainer. It is free to join for new residents, and you can quickly become a card-carrying resident member of the ACR. And, you get all the benefits of joining the essential radiological society while supporting the specialty of radiology. Why wouldn’t you want to join?

Senior Residents/Fellows: You have to start shelling out some cash to join the organization. Is it still worth it? Well, the first year out, it is not much to join. At a rate of 70 dollars for the first year, it pays to join. Furthermore, you support your livelihood since the ACR is the leading organization that lobbies for our specialty. As a more senior radiologist, joining rates become steeper- as high as 900 dollars per year! Even so, this is the primary organization that “has our backs” when it comes to all the political stuff. It makes sense.

American Roentgen Ray Society

New residents: This is society is another freebie during radiology residency. You get the benefit of a reputable journal (AJR) and support academic radiology. What is there not to like? Go for it!

Senior Residents/Fellows: At a rate of 350 dollars per year for the online subscription for a senior radiologist, I have mixed feelings about joining this society. Although CME credit opportunities abound when you enter this society, other institutions such as the RSNA duplicate the same education component but more extensive resources. Given plenty of dues shelled out to other institutions, I am on the fence about joining this one. I did not renew my subscription for a while. But I may decide to do so at some point!

Radiological Society Of North America

New Residents: Again, no money for online subscription means go for it! I find this society to have the best resources for education. Specifically, residents get access to Radiographics. This society is a great education tool for learning radiology. Plus, you get free access to the RSNA meeting if you choose to go. Why not join?

Senior Residents/Fellows: Though this society is relatively expensive for annual dues (currently $525/year), it is the best for CME credits and educational activities. For the senior radiologist, you have the opportunity to participate in great online lectures and cases. Plus, you get access to Radiographics and the gray journal (Radiology). Although I begrudgingly pay the dues, it is a crucial society for most seasoned radiologists to join.

Specialty Societies

New residents: I believe that as soon as you know what fellowship you want to pursue, you should immediately join that specialty society. Most of the time, the rates for resident members are significantly discounted. Plus, you are supporting the academic mission and advocacy for your prospective organization. Some of these societies have invaluable career resources. And, you typically get discounts at the annual meeting. Sign up!

Senior Residents/Fellows: Although not cheap, if you are a specialist in a particular area (I pay $510/year to join the SNMMI), you should feel some obligation to support your specialty. And, most specialty organizations give CME credits and discounts to annual meetings. I think, in the long run, it usually pays to keep up membership in your specialty society.

American Medical Association

New residents: Think twice about continuing membership in this society. Many of the positions espoused by the organization are counter to the missions of the radiology societies politically and educationally. Plus, you need to spend money on membership (1st year- 45 dollars, 2nd year- 80 dollars, 3rd year 120 dollars, and 4th year- 160 dollars). It’s probably not worth your while!

Senior Residents/Fellows: I find it hard to justify membership in this society. In addition to lobbying for primary care specialties over radiology, there is little benefit to joining. The articles from the prominent journal JAMA are usually not relevant to the daily practice of radiology, and you can always read the abstracts online if need be. I let my AMA membership lapse many years ago!!!

Final Thoughts

Maintaining membership in societies as a resident in most radiology and radiology specialty societies is a no-brainer because it is free or extremely cheap. In addition, you get the benefits of joining the organizations. However, before becoming an attending, you need to think about which ones to participate in since the dues can be significant, and the benefits may or may not be worth the additional funds. Now that you have to start paying down your debts, every dollar counts. But for the most part, I think most of you starting in the real radiology world should at least join the ACR, RSNA, and your specialty society. It just makes sense…