Radiopaedia Blog

 

For this first post in my planned series on how to prepare for radiology oral exams: essential techniques, I wanted to make a golfing analogy (stifle groans please), but you can replace any sport of your choosing if it helps.

If you want to get good at golf you do not simply play round after round after round. Although you will certainly improve, it does not offer the opportunity of working on problem areas; after all in 18 holes you may only get to use a particular club a few times, or putt from a certain distance a few times. Playing a full round exists mainly identify the areas you need to work on.

So lets say you play 18 holes and you notice that you miss three 6-foot putts.  Your next task is to go to the practice green and hit hundreds of 6-foot putts. If that still doesn’t help, then you need to work out what you are doing wrong, and you may need to read some articles on putting, or get a pro to give you a hand etc…

The same applies to practicing for oral exams. Too many of the trainees I see do the vast majority of practice cases in a group, either in tutorials or in study sessions. In both situations the cases are looked at once in an 'exam style' before moving on to the next case. Moreover these sessions usually contain a relatively random assortment of conditions, at most restricted to a system. It is no surprise that I see these trainees make the same mistakes over and over again.

As a rule of thumb you should probably be doing 10 times more cases on your own than you do in a group. Furthermore when you do cases on your own, you don’t do them the same way as you do in a tutorial, but rather you practice them, until they are nice and polished.

This was my routine (for a ~40-60min study block):

  1. pick a topic (e.g. bronchiectasis on chest x-ray, including causes such as ABPA / CF / idiopathic bronchiectasis etc… )

  2. pick conditions that can look similar (pulmonary fibrosis, interstitial edema, sarcoidosis, asthma etc..)

  3. get a pile of films or create a playlist on Radiopaedia.org (e.g. here is one I created earlier)

  4. look at the first case and verbally present it as if you were doing it in an exam (you may want to record yourself)

  5. check the answer

  6. go back and do it again now knowing what the answer is and try and make your presentation as polished as possible, including relevant positives and relevant negatives. Really try and make the language you use tight and unambiguous.

  7. move to the next case

As you try and complete step 6 you will probably find that you uncover areas that you are not certain about (e.g. what is the distribution of bronchiectasis in ABPA). This is knowledge you need to know if your presentation is going to be perfect. Because you are on your own, you can then turn to your trusty textbook or favorite online resource (no prizes for guessing which one I would recommend) to find out the answer. Then you incorporate that into your presentation as you practice it once more. 

This might seem tedious, but by the time you have done a dozen cases in this manner, you will have perfected your approach to this whole group of conditions and be able to knock any similar case out of the park.

 

Next: Practice for your oral technique in the shower

 

Dr Frank Gaillard is a neuroradiologist at the Royal Melbourne Hospital, Melbourne, Australia, and is the Founder and Editor of Radiopaedia.org.

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

 

 

A recent article by Caleb Garling from the San Francisco Chronicle about Radiopaedia.org raised a few interesting questions, and it made me sit back and think about what exactly Radiopaedia.org is about, along with some of the areas we we will be focusing on in the coming years.

Radiopaedia.org started with a dual purpose. The first is to create a platform to enable radiologists from all over the world to share their cases and their collective expertise. The second is to create a resource available to all health professionals independent of their personal, institutional or regional wealth.

Almost a decade into this project we have come a very long way in achieving a degree of success on both fronts.

We have created a bespoke web app which can display radiology cases on any modern browser in a way that is intuitive to most radiologists, and have amassed almost 15,000 cases covering an enormous variety of conditions. Thousands of contributors have also collaborated in writing over 6,500 articles and slowly we are getting to the point that most conditions have at least some content, and in very many instances the articles are comprehensive with many illustrative cases. We have done this all without charging a single dollar to any user to access our site or any of our content (NB the cases featured in our various iOS apps are available for free on the site).

Currently (Feb 2014) we are visited by well over 1 million unique individuals each month, who read over 4.5 million pages each month. 

Caleb Garling in his article asked: “But Radiopaedia does invite more questions. The [cases] are crowdsourced — are the diagnoses accurate? Do people have to worry about their X-rays being posted online without their knowledge? And perhaps most importantly, is this actually useful for doctors?”

These are good questions.

I have tried as best I can to answer the middle question  in a separate blog post (patient privacy and cases on Radiopaedia.org), but what about the other two questions? 

 

Is radiopaedia.org useful?

As far as usefulness for our intended audience (radiologists and other health professionals) I can only go on anecdotal experience and the hundreds of feedback emails and comments we receive each year (recently we have started to publish these here - we love to hear from you, and if you want to let us know how you find Radiopaedia.org useful leave a comment or send us an email). I personally think we are useful, and over the years I have been approached by hundreds of residents/registrars, fellows and consultants, both in radiology or other specialties who have told me how much they rely on Radiopaedia.org for study and as a references. Not only that, but I find myself referring to the site frequently.

 

Accuracy and quality

That brings us to the big question, and the one what will be one of the main focuses of our attention over the coming years: accuracy / quality of new content as well as of the content we already have.

Being a collaborative resource, contributed to by thousands of individuals from a wide range of backgrounds and bringing to the project a wide range of knowledge, the cases contributed are unavoidably of variable quality, despite fairly explicit guidelines outlining what constitutes a good quality case. 

Although all new cases undergo moderation by our section editors there is still variation in quality not just of the images themselves, but also in how solidly the diagnosis has been established. To give contributors the option of holding on to a case until they are able to ‘polish it’ prior to publishing it, we have recently released draft mode for cases and it has resulted in an improvement in the overall quality of cases. Additionally, we will soon also be allowing moderators to push a sub-standard or incomplete published case back to draft mode, at which time the contributing authors will be asked to improve the case. Perhaps even more importantly for future case uploads, we will be improving the edit mode for cases and adding incentives to fully document how a diagnosis has been established.

The other focus is in creating better search tools, which can float the better cases to the top of the results. The challenge is in how to mechanically identify these cases as with the number of cases we have a manual approach is impractical. We have been thinking hard about this and have a number of avenues to explore. As with everything we do, we will take an iterative approach, gradually improving each feature.

All of this is however not going to be enough without the support of our amazing community of dedicated volunteers. A huge advantage we have over traditional resources, an advantage which I think eventually will be shown to be decisive, is that any error can be corrected immediately. With good referencing we can create content that is of excellent quality, trustworthy and up to date. Most importantly we can continue to make all this content available to every single individual on the planet for free. By doing so we can help them become better doctors and thus help patients.

I look forward to seeing Radiopaedia.org grow into an even more comprehensive and mature resource and I hope that you will help us in our endeavor. 

 

 

Dr Frank Gaillard is a neuroradiologist at the Royal Melbourne Hospital, Melbourne, Australia, and is the Founder and Editor of Radiopaedia.org.

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

A frequent question I am asked revolves around privacy issues for cases submitted to Radiopaedia.org. Understandably this issue is of concern to many both within the health industry and from the general public. The main worry, I think, is the possibility of a third party recognizing an individual from their images and thus become privy to information that would normally only be available to the patient and their treating physicians.

Before discussing Radiopaedia.org's approach, the first thing to mention is that every hospital and practice I have worked at has a privacy policy and it behooves each contributor to ensure that they contribute cases in line with their local guidelines. However, there is considerable variation when it comes to local policy and thus Radiopaedia.org has its own strict policy guidelines which are incorporated by reference into our terms of use. This policy is based on HIPAA (Health Insurance Portability and Accountability Act) which precludes any cases containing individually identifiable health information.

The US department of Health & Human services website on HIPPA defines it as follows:  

 

Individually identifiable health information” is information, including demographic data, that relates to:

  • the individual’s past, present or future physical or mental health or condition,
  • the provision of health care to the individual, or
  • the past, present, or future payment for the provision of health care to the individual,

and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.

 

What does that mean in practice? Well, our case publication guidelines go into a fair bit of detail but the key points are that:

A) cases should be devoid of all patient identifiers and preferably have no text overlay on the images whatsoever (this can be difficult to achieve in some instances).

B) the supporting text (e.g. presenting complaint, case discussion etc..) should not include any other information which could be used to specifically identify an individual to a third party. 

C) if a case is for one reason or another unique in a way that could lead to identification of an individual then it should also not be uploaded. This means that a case which is has been featured in the media is usually inappropriate. 

We take this very seriously, and failure to abide by these rules is a breach of our privacy policy and terms of use.  All our cases are moderated by our dedicated volunteer section editors and any case found to have patient information is immediately deleted and the contributor sent a warning email.

Should a user repeatedly upload cases with patient details their account will be suspended; this has not occurred. 

Should you find information which could identify a patient please write to us immediately at [email protected] and we will remove the content. 

At the end of the day we accept cases to help us build an amazing resource which is shared without charge with every health professional on the globe, in the hope that this will lead to better diagnosis, treatment and outcome for patients. 

Provided we do so with a sensible approach to privacy, I think this is something we can all be proud of. 

 

 

Dr Frank Gaillard is a neuroradiologist at the Royal Melbourne Hospital, Melbourne, Australia, and is the Founder and Editor of Radiopaedia.org.

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

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...

 

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 specialty" @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

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