Radiopaedia Blog

This week a radiologist's campaign to become a US senator was thrown into controversy by reportedly 'gruesome' x-rays he posted on Facebook. In a filmed interview, journalist Tim Carpenter confronted Milton Wolf with x-rays and comments he posted on Facebook several years ago. Despite claiming the x-rays were shared for educational purposes, it seems clear that the images, including one of a gunshot decapitation, were mainly intended as entertainment. 

I'll leave you to judge the specifics of Wolf's actions for yourself (some aspects I personally don't condone), but my interest in this issue is more broad.

As a website built upon collaborative contributions, Radiopaedia.org contains many 'entertaining', 'confronting', 'gruesome' and downright 'WTF' medical images that serve little educational purpose. And yet these images contain no patient identifiers and abide by HIPAA guidelines. I myself have contributed medical images of such nature to this site and as social media editor i have overseen the sharing of some of these images across our social media network - and yes, they usually prove very popular! 

Just yesterday, journalist Caleb Garling published a piece about Radiopaedia in the San Francisco Chronicle, clearly inspired by the 'bizarre' nature of some of our images. With the Radiopaedia site and social media network rapidly expanding, I expect mainstream media exposure like this will only increase, placing the site's content more and more in the realm of the general public. 

And so for a site that primarily aims to educate health professionals, is the publication of occasional images of 'questionable' clinical value appropriate? Is it just a little harmless fun? Is it right for the public to be shown or have access to these images? Or should we as radiologists and other health professionals enforce upon ourselves a degree of professionalism beyond that of simply maintaining patient confidentiality? 

I'd be very interested to hear your thoughts on the issue. My personal philosophy has always been that as long as what I am sharing or saying brings no harm, then exposing others to the quirkier or squirmier sides of radiology is not a terrible thing. But perhaps with the new popularity of Radiopaedia, a more considered approach is required on my part. 

Related...

• Patient privacy and cases on Radiopaedia.org
• Radiopaedia.org privacy policy
• Radiopaedia.org case publishing guidelines 

Dr Andrew Dixon is a Radiologist at the Alfred Hospital in Melbourne, Australia. He is social media editor for Radiopaedia.org, and among other things, has founded the successful Radiology Signs project on Facebook, Tumblr and Twitter and the Radiology Channel on YouTube.  

NB: Opinions expressed are those of the author alone, and are not those of his employer, or of Radiopaedia.org. 

Every month or two we will collate some of the feedback we get from our users and post it on this blog. It is always rewarding to hear that what we are building is important and appreciated. If you have feedback or a story of how Radiopaedia.org helps you, please send it to [email protected]

"The best site for rapid revision . excellent pictures , nice description and analysis." Dr KH

"Great clinical resource for clinicians in almost any speciality" @DrJoshuaTepper via Twiiter

"I'm on my last year (last month, actually!) as a Radiology resident in Mexico City. The reason for contacting you is that I have been using radiopaedia.org since another resident talked to me about it, about two years ago. What you are doing is an outstanding labor, I feel really fortunate to have tools like radiopaedia, because it has undoubtedly helped me throughout the residency, and I know I will still use it for reference after graduation."  Dr W. L. Mexico City

"One of the best site in radiology. Nice and crisp explanation." Anonymous 

"Thank you for consistently providing such valuable & high yeild information at the tip of our fingers. Best of luck for everyone behind this marvelous page & again thank you." MM via Facebook

"The best radiology site ever" Ahmed

"Thanks so much for that great work. It's very helpful for us." Dr RI

"Hello, I am taking medicine lessons, in France, and I just wanted to tell you and all of the crew of your website, how useful your website is ! Moreover, the huge X-rays images you provide is an excellent idea, and allows me (and I guess, many other students) to have a different and interesting sight on sketches surgeons draw us. So, thank you !!!"  MT, France

"Wonderful website, I use it all the time!  Thank you so much." KS M.D, South Carolina, USA

"I am a Radiology Senior Registrar in Nigeria. Thanks for the great job you're doing. This service is of inestimable value." Dr MI, Nigeria

"The best & the most widely used radiology website ever" Dr DI, Egypt

Going on-call for the first time is a daunting experience for many radiology trainees. That's why we are creating a series of tutorials focussed on teaching core conditions across emergency radiology.

The tutorial series utilizes Radiopaedia.org's Playlist feature and each tutorial set has pre-reading articles and cases as well as a series of cases to be given as an interactive tutorial. Topics covered include:

• body trauma
• neuroradiology core conditions including MRI emergencies
• head and neck emergencies
• chest and abdominal emergencies
• vascular and interventional imaging
• common and "not-to-miss" musculoskeletal conditions
• obstetric and gynecological emergencies
• pediatric core conditions

Firstly we would like to collect some information on what teaching trainees are currently getting (promise, it's a very short questionnaire) and then you can access the free preview and give us some feedback. To access just click here.

Thyroid cancer incidence has almost tripled since 1975 and yet mortality has remained stable, according to a new analysis reported in JAMA Otolaryngology - Head & Neck Surgery. The authors have suggested there exists an 'epidemic of diagnosis' rather than disease. And it would appear that detection of small, indolent, papillary thyroid cancers is probably to blame.

This latest research adds further weight to calls for improved reporting of incidental thyroid nodules on CT and MRI by radiologists. It is hoped that new guidelines, such as the Duke 3-Tiered System recently blogged about by Dr Jenny Hoang, can help ensure that radiologists take an evidence based approach to thyroid nodules.

Related post: Reporting of incidental thyroid nodules on CT and MRI

Cheating is one of the most important skills a radiology trainee needs to master. Not only can a good cheat hide your incompetence, but sometimes it may even bring glory!

1. The Crystal Ball 

There are times when you're reporting a chest x-ray that the patient has already gone on to have a CT. When this occurs, you'd be crazy not to use it! If the CT shows a mass then you should report that sucker on your film with all the confidence of a hero. If the CT is normal then spit out a standard report and move on. 

Key features: hero potential, zero risk to patient 

2. Ultimate balling 

This is a more advanced version of crystal balling that involves the use of future cervical spine or abdominal CT to find apical or basal chest lesions. One of the great benefits of ulti-balling is that there is little chance of anyone ever calling you out on the cheat. Recently it has become popular for radiologists to tally their ulti-ball successes as a form of competitive cheating among co-workers. 

Key features: extreme hero potential, an emerging competitive sport

3. The Status Quo

If the film you're reporting looks the same as the previous one, and that one was reported by someone far more experienced than you, then just say the same thing as them. The chance of you genuinely spotting something that they missed is very low, but the chance of you creating a fake abnormality is high. 

The status quo cheat also comes with free indemnity cover. If it is discovered in the future that you missed something on the film, the fact that someone more experienced also missed it will mean that they cop the major blame instead of you.

Key features: commonly applicable, free indemnity

4. The Sneaky Show

If there's no previous or subsequent imaging for you to cheat off, then it may be time for a sneaky show. Find a colleague more experienced than you and make up some excuse to get them to look at your screen. "How do I invert the contrast again?". A radiologist's natural instinct will be to point out any abnormality they see, to which you will simply reply "Yes, I know that". If they say nothing then be careful; this cheat is prone to false negatives. 

Key features: sneaky epinephrine rush, competence protected   

5. Rolling the Temp

A nice little fallback option for those chest radiographs you're not quite sure about. Find an experienced but unsuspecting radiologist who is only working temporarily within your department and pounce. Show them the case, ask them directly for their thoughts and then pass those off as your own. It doesn't matter if they end up thinking you are incompetent; temps are largely insignificant in the ultimate landscape of your radiology career. 

If it is later discovered that you missed something on the film then you have yourself the perfect scapegoat.  "Yes, I thought at the time that was a rib metastasis but I showed it to the short radiologist with bad teeth when he worked here and he assured me it was normal. I should've backed my own interpretation." 

Key features: controlled exposure of your incompetence, scapegoaty goodness

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• Top 5 Tips: How to survive first year of radiology training
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