Radiopaedia Blog

The Royal Melbourne Hospital Neuroradiology and Neuropathology Departments will be publishing the cases presented at our monthly multidisciplinary meetings online as Radiopaedia Playlists, so that everyone can benefit from these cases. These will be uploaded approximately monthly, and will contain a selection of unusual cases or particularly nice examples of more common pathology. In almost all instances each case will have both imaging and histology. 

Click here to view current cases (March 2014)

Past meetings:

• #1 August 2013
• #2 September 2013
• #3 October 2013
• #4 November 2013
• #5 February 2014
• #6 March 2014

As a consultant radiologist at a teaching hospital, I find myself repeating the same advice over and over again over each year, to each new group of radiology trainees. So, for the sake of saving my vocal cords and hopefully reducing my tedium-quotient, I thought I would try to capture some of my advice in a series of blog posts.

The first thing to stress is that this is just my advice based on what worked for me when I studied as well as capturing some of the ideas that have emerged over they years during many hours of conversation about study technique with colleagues and trainees. Part of your journey through training and exams is working out what works for you and what doesn't. As such I will not accept blame or hate mail when you drop an oral exam, ok? I will, however, gladly accept the responsibility for you passing everything on the first go :)

The second point is that these posts will be in no particular order, and for the sake of expediency, will be a little rough around the edges. Hopefully one day I can go back and pound them into some sort of cohesive whole, but for now it’s this or nothing.

As I go, I will update this first post with the various posts as they become available.

So without further ado here are the posts so far:

1. How to effectively practice for oral radiology exams, and not waste time
2. Practice for your oral technique in the shower
3. Islands of knowledge or puddles of ignorance
4. The secret art of relevant negatives
5. Never surprise your examiner

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. 

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.