Wednesday, September 10, 2014

A Day in the Life: Radiology

I'm spending my first year of residency rotating through 12 different specialities in 4-week blocks (really I have 13 blocks -- I rotate through general internal medicine twice). Right now I'm in the middle of my radiology rotation, which is a particularly interesting one since it's a speciality I never rotated through as a medical student. Here's what a typical day looks like:
nice and dim
0800 - 0900 h: rounds
Rounds are meetings attended by physicians from five different specialties (often videoconferencing in from other sites), nurses, and sometimes other staff involved in patient care. Generally five to fifteen challenging patient cases are presented and discussion ensues. Rounds are great -- they promote collegiality, guide patient management, and educate at the same time.

0900 - 0930 h: teaching with radiologist
I'm assigned to work with a different radiologist each morning. After rounds I check in with them for some teaching or to shadow them for a bit on what they are working on that particular day (it varies between x-ray, ultrasound, CT, MR, mammography, nuclear medicine, and biopsies). They generally give me a list of cases to look at on my own, a paper to read, or a module to work through.

0930 - 1200 h: independent cases
I spend a few hours in the residents' office, looking over the cases. With the help of an anatomy book and a few other resources (see below) I try to interpret each patient's imaging. It's pretty fun work; each case is its own little puzzle. In going through them by myself I come up with lots of questions -- which fortunately the radiologists are patient enough to answer!

1200 - 1300 h: review cases with radiologist or lunchtime rounds
At the end of the morning I check in with the radiologist again to review the cases and learn about all the stuff that I'd missed or misinterpreted (yes, it's a lot...but getting something wrong and being corrected is probably the best way to help me to remember it the next time!).

1300 - 1400 h: watching procedures
Throughout the day I usually spend some time watching what the radiologist I'm assigned to is doing. This may be biopsies (always interesting to see -- especially the stereotactic ones) or may be spending time with the imaging techs to see how images on MR, PET, or mammogram are acquired.

1400 - 1630 h: independent cases
In the afternoon I'm assigned to a different radiologist and usually spend a few more hours working through cases.

1630 - 1700 h: review cases with radiologist or rounds
At the end of the afternoon I meet up with the radiologist to review the cases, go over any other interesting ones they may have seen, and do some teaching. Often I also go to afternoon rounds.
vestige of another time
Radiology has been a great rotation so far. I was worried that the days would feel long with so much independent case/study time, but I feel that I'm using this self-directed time efficiently and using resources well to learn as much as possible. It's great that I have the flexibility to choose what I'd like to focus on -- and the radiologists are wonderful and always willing to teach or answer questions (even though I feel like I'm always pestering them while they're dictating!). I don't have any clinical responsibilities on this rotation; I'm so grateful to be paid to learn.
anatomy scribbles

Here are the resources that I've found most helpful:
  1. Atlas of Human Anatomy (Netter) -- My main goal in this rotation is to learn anatomy. It's so important in radiology to know what you're looking at!
    good old Netter's
  2. Cross-Sectional Human Anatomy (Dean & Herbener) -- An older atlas, but one with an excellent layout of gross anatomy next to CT cross sections, all labelled with numbers (perfect for quizzing yourself).
    Cross-Sectional Human Anatomy (Dean & Herbener)
  3. TNM Atlas (Wittekind et al.) -- A simple handbook listing the TNM staging for every type of cancer. I love it for the clear line drawings showing each stage and the common patterns of metastatic spread.
    TNM Atlas -- superb diagrams!
  4. Radiopaedia -- A huge wiki-based collaborative collection of cases and learning resources. Great at all levels!
  5. W-Radiology -- Has some nice labelled CT and MRI cross sections -- good for figuring out what's what on imaging.
  6. Loyola University Chicago -- This site is packed with great resources, including a CXR atlas, bronchopulmonary segments CT module, and cross-sectional labelling modules (gross and CT), among other things. I love how simple the interface is -- no bells and whistles, just function. It's set up so that you can quiz yourself (click to view answers).
    Loyola University Chicago -- CXR atlas
    Loyola University Chicago -- bronchopulmonary segments on CT
    Loyola University Chicago -- cross sections
  7. UBC Radiology Modules -- These modules are designed for first-year medical students and are a good place to start reviewing anatomy and basic imaging.
    UBC Radiology Modules
  8. UBC Neuroanatomy Atlas (gross & MRI) -- A great collection set up for self quizzing.
UBC Neuroanatomy Atlas -- gross sections
UBC Neuroanatomy Atlas -- MRI

Have you done a radiology rotation? What resources did you use to study?

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