Radiopaedia Blog

 

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 focused 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

 

Disclaimer: This post is intended as entertainment only and should not be acted upon. Neither the author nor radiopaedia.org will be held responsible for any lawsuits, premature termination of employment, loss of income or ill-tempered temp related injuries resulting from the use of these cheats. 

 

Related posts...

Starting as a first year radiology trainee can be daunting: it’s a new job in a new department and possibly in a new hospital.

You will have previously been exposed to medical imaging during your medical training and first years as a doctor on the wards. However, now you get to experience radiology from a whole new perspective. You’ll be asked a new set of questions: what protocol should we use? what rate should we be injecting the contrast? can we still give contrast if their creatinine is...? are you happy with the images?

And then, you’ll be hit with the most important question of all: what the HELL is THAT and is it normal?  

Here are our top 5 tips to survive your first few months of radiology training:

 

The radiology department is a foreign land to new registrars. In a large department, there may be over 100 radiographers and they’ll be asking you questions in what will appear to be a foreign language. As it turns out, it is a foreign language, but one you’ll pick up with surprising ease! Don’t be afraid to ask the questions you need to ask to deliver safe patient care, and never be afraid to ask for supervision when you’re asked to do a procedure you haven’t done before, or feel unsure about.

Radiology isn’t just about sitting at a computer and reporting. There are a whole heap of things that happen in every radiology department:

  • never done (or even heard of) that procedure before - talk to your supervising consultant, roll your sleeves up, scrub in and get involved
  • overhear someone talking about a case that sounds interesting - go and have a look
  • don't understand what the sonographer is showing you - go and help scan the patient
  • don't understand what the clinician wants to know - get to a clinical-radiology meeting and speak to the clinicians

Don’t fall into the trap of becoming a stereotypical radiologist - get involved and engaged in your department and in the hospital as a whole.

The sheer volume of knowledge that needs to be attained in the first couple of months is huge - and that’s just to survive the day-to-day activities of being in the department, let alone studying for exams. The amount of learning you’ll need to do seems like an unattainable mountain to climb, but that’s why the radiology training programme is not just 1 year, it’s at least 5... and well really, you should never stop learning.

Put aside a bit of time to do some reading about what you’re not sure about from each day. It may be related to anatomy or physics, or about how to approach an imaging study or a specific pathology. Spending 5 minutes extra reporting a study so you can read up on Radiopaedia.org is worthwhile.

You may be the only registrar starting in your department or you might be part of a larger group. Make a concerted effort to get to know your colleagues and not just the other registrars. Consultants are surprisingly friendly in most radiology departments. Getting to know the radiographers, technologists and support staff will make your life enormously easier, especially when you start on-call.

Radiology has a reputation to outsiders as a “lifestyle specialty” and yes, the hours aren’t as long as many of the surgical specialties. However, night shifts spent reporting a myriad of polytrauma studies with neurosurgeons breathing down your neck can be challenging.

You’ll most likely find the first six months tough - getting used to a new job, a foreign language to learn and a lot of study. But it will go by in a flash and you will soon appreciate what a great specialty radiology is.

 

We’d love to hear what your most important tips for surviving first year are. Please leave your comments below.

Good luck! 

Sometimes you just don't have the time to finish a case straight away. You may be interrupted, or need to chase histology or you just run out of time. Now when you create a case it will start off in 'Draft Mode' which means you can take your time making it just right before publishing it (draft mode will be rolled out over the next week). 

When a case is in draft mode only you can see it, and it won't be pushed to the moderation cue until you publish it. You won't be able to add it to playlists or articles or share it until you publish it however. 

 

Your draft cases will be accessible to you from your user page and from the top of the header. 

 

To publish a case, just go back into edit mode and click "Save and Publish". 

So that we don't end up with a huge number of unfinished essentially 'private' cases, there will be a limit to the number of draft cases you can have at any one time. Currently this will be set to 25 per user, but we will monitor usage and may adjust this over time. 

We hope this will result in higher quality cases. 

As always please let us know what you think of this new feature and report any bugs you may find. 

Cheers, Frank

Blog Subscription

We will only send you an email when there are new posts.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.