Radiopaedia Blog

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?

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 speciality” 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

Video clips has not formed a huge part of Radiopaedia.org to date, however in the setting of ultrasound, cardiac studies and some other dynamic studies, they are essential. 

Recently we upgraded our video support to improve loading times and to ensure that they project well in both view and quiz mode. More improvements are clearly possible, and will be carried out in due course :) 

We are looking forward to many more obstetric cases in the near future. 

As a taste, please have a look at some of Dr Cathy Culvers cases. 

Currently the video must be in MP4 format, H.264 encoded. If your video is not in that format already, then there are many utilities to convert them, including  Evom. 

Help page: Video

When reporting follow-up studies the usual practice is to compare to the most recent previous study. Although generally this is a safe thing to do, with increased frequency of follow up exams in many disciplines, one runs the risk of not detecting subtle growth. If this occurs repeatedly then a tumor that may have significantly increased over time will have a series of reports all of which state “no change”.

As an example (Fig 1) look at 4 studies in a patient with a partially excised low grade glioma. Each study (A to D) is approximately 6 months apart. Note how hard it is to discern a change between adjacent pairs.

We simply cannot reliably detect subtle change. How much is below our change threshold will depend on many factors, such as the size and shape of the lesion, scan parameters and partial volume effect, slice position and patient position etc… Regardless, there is an amount below which we simply won’t be convinced that any actual change has taken place. This is obvious if you consider what would happen if you were to scan a patient every day. Even the fasted growing mass would look unaltered on sequential scans.

So what is the solution?

Look at older scans and consider what you expect the biological behavior of the process you are looking at to be; the more indolent the process the longer interval you need between scan pairs to detect change.

In the same patient as before, see how easy it is to see that there has been change when comparing scans 2 years apart (Fig 2).

My practice when assessing gliomas for example, is to look at the most recent scan, and then at the oldest valid comparison; one which does not have intervening surgery, and is not in the  immediate postoperative period.

You are then left with three possible outcomes from such a comparison:

1. change is obvious even when just compared to the most recent scan
2. no change when compared to the recent scan but some change when compared to the oldest scan
3. no change when compared to both the recent and oldest scan

In the setting of obvious change, there is no problem, and in fact there is no need to look at older scans.

If there is, however, no change compared to the recent study but change is evident when compared to the older scan, I usually pull up a few of the intervening scans, to try and assess whether growth is gradual, or something has changed in the behavior of this tumor, suggesting dedifferentiation into a higher grade. After all a tumor that had been stable for years but suddenly starts to grow needs, at the very least, closer follow-up and probably also needs to be considered for a change in management. My conclusion then reflects this distinction; e.g. “Although there is little discernable change when compared to the most recent study, when compared to multiple previous studies dating back 4 years, slow steady growth is evident.”

Only if there is no change when compared to the most recent scan, and no change when compared to the oldest scan does my conclusion read “Stable”, and then I append the time period over which I am claiming no change to have occurred; e.g. “Stable, with no appreciable growth over the past 24 months”.

This approach is valid to all comparison studies, regardless of system or underlying pathology. I hope this approach is useful to you, and will stop you from merely concluding with “stable”.

We start the new year with a few small features / improvements, before we get stuck into some bigger feature sets. 

Ability to delete your own cases

Until now, users have been unable to delete thier own cases, which is crazy but was legacy of when we only had a few cases instead of over 16,000! 

Go to 'view mode' from 'quiz mode'

This is mostly one for editors. When viewing a case in quiz mode I often find myself wanting to pop into view mode, so that I can edit the case. Now you can. Just click the case ID at the bottom of the screen. 

Donation page added to footer

For those of you who want to help us out we have made our donation page available in the footer.