Posts in category: Radiology

Estimated reading time: 3 minutes

Radiology residency may be tedious yet incredibly rewarding. Therefore, it requires strategic learning, self-discipline, and, most crucially, a clear understanding of core concepts. Numerous residents experience certain common mistakes that actually hinder their studies and performance.

Therefore, here are a few mistakes you should be aware of and avoid during your radiology residency:

1. Neglecting the Basics

Too many residents get right into complicated cases without first acquiring the basics of anatomy, physics, and fundamentals of imaging modalities. 

• Unless you have a solid foundation, reading advanced cases is a fight. Make sure you spend enough time learning the basics before handling complicated cases.

2. Trusting Only in Reporting Without Appreciating the Clinical Context

A radiologist’s work is more than reporting imaging results. Knowledge of clinical correlation is key to proper diagnosis and good communication with referring physicians. 

• Always bear in mind the patient’s history, symptoms, and laboratory data while interpreting.

3. Failure to Actively Participate in Case Discussions

One of the optimal methods to learn as a resident is by debating cases with colleagues and teachers. Passive learning via reading only is not adequate. 

• Attend tumor board meetings, interdepartmental discussions, and case presentations to improve your diagnostic process.

4. Neglecting Emerging Technologies and AI in Radiology

Radiology is quick to change, with AI and new imaging modalities increasingly becoming the cornerstones of the specialty. Residents who fail to remain current with technological developments risk falling behind. 

• Try to keep yourself updated with information on AI-based applications, newer modalities, and changing imaging protocols.

5. Not Reporting Enough Hands-on

Radiology residency is not about reading books, hands-on exposure is essential. The more you report, the better you will be. 

• Attempt to interpret as many cases as you can and take feedback from senior radiologists to enhance your skills.

6. Underestimating the Role of Physics

Most residents take radiology physics lightly, perceiving it as secondary to image interpretation. 

• But a good knowledge of imaging principles, artifacts, and radiation safety is crucial in producing quality reports and patient safety.

7. Inability to Formulate a Systematic Approach to Interpretation

A frequent error is reporting images randomly without any systematic method. 

• Creating a stepwise method—like examining imaging planes in an orderly fashion and always looking for incidental findings—is a guarantee against inconsistency and error.

8. Failure to Use Online Learning Material

Textbooks are necessary but should be followed by high-yield digital learning material. 

• Some websites, such as Conceptual Radiology, present high-yield, structured learning material specifically crafted for radiology residents.

9. Ineffective Time Management and Burnout

Residency in Radiology can prove to be extremely demanding, and ineffective time management may result in burnout. 

• Plan a sound study schedule, take breaks where needed, and ensure a balance between work and life to stay energized and motivated during residency.

10. Refusal of Feedback and Failing to Learn from Errors

All residents commit errors—it comes with learning. The important thing is to embrace mistakes, obtain constructive criticism, and learn from each case. 

• Being open to feedback from the faculty and mentors will assist in sharpening your diagnostic skills and decision-making.

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Estimated reading time: 3 minutes

Appendix is a small, blind-ended tubular structure from the cecum, and its inflammation, appendicitis, is a frequent cause of acute abdomen needing surgery. Imaging is important in the diagnosis of appendicitis and in the differentiation from mimics. This blog discusses the imaging modalities to evaluate the appendix and their utility in diagnosis.

Role of Imaging in Appendicitis

The main function of radiology in appendicitis is to exclude the removal of a normal appendix. This calls for proper localization of the appendix and identification of signs of inflammation. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) all have a role to play in assessing appendicitis, each having its own strength and weakness.

Imaging Modalities

1. Ultrasound (US)

• Initial imaging modality, particularly in children and pregnant women.
• Uses a graded compression method to outline the appendix by pushing aside overlying bowel loops.

• US features of appendicitis:
  • Blind-ending tubular structure with origin from the cecum.
  • Non-compressible, aperistaltic, with a gut signature (hyperechoic mucosa, hypoechoic muscularis, hyperechoic serosa).
  • Diameter >6 mm indicates inflammation.
  • Hyperemia and stranding of periappendiceal fat, and free fluid.
  • Probe tenderness, which is parallel to peritoneal inflammation.
• Tips for finding the appendix on US:
  • Begin with a curvilinear probe for survey.
  • Begin with identification of the ileocecal junction.
  • Look 2–3 cm caudal to the ileocecal junction for the appendix.
  • Use a high-resolution linear probe for clear imaging.
  • Left lateral decubitus positioning may be considered if the appendix is not seen initially.

2. Computed Tomography (CT)

• Senti and specificest modality for the diagnosis of appendicitis (>95% sensitivity).
• Usually done as a contrast-enhanced CT (CCT) abdomen in India.

• In a few facilities (e.g., in the U.S.), a limited appendicitis CT (from subhepatic region to pelvis) can be done.
• CT Features of Appendicitis:
  • Dilated appendix (>6 mm in diameter).
  • Wall thickening and enhancement.
  • Stranding of periappendiceal fat.
  • Appendicolith (in certain cases).
  • Abscess or perforation in complicated cases.
• No oral contrast required; there is no reduction in accuracy with or without oral contrast.

3. Magnetic Resonance Imaging (MRI)

• Used almost exclusively for pregnant patients in whom radiation exposure cannot be tolerated.
• Routine sequences are T1, T2, and diffusion-weighted imaging (DWI).
• Findings are the same as on CT but have longer acquisition times.

Clinical Considerations

• Mantrell Score: A clinical scoring system that is utilized to determine the probability of appendicitis. A score of ≥7 indicates a high likelihood of appendicitis.
• Common Positions of the Appendix:
  • Retrocecal (most common, easy to visualize).
  • Pelvic, paracecal, pre-ileal, and post-ileal (potentially more difficult to visualize).
• Mimics of Appendicitis:
  • Mesenteric adenitis, Crohn’s disease, ovarian pathologies, and diverticulitis.

Key Takeaways

• Ultrasound should be the initial imaging in pediatric and pregnant patients.
• CT is the most reliable modality and must be utilized when ultrasound is not conclusive.
• MRI is reserved for situations in which radiation exposure is a problem.
• Radiologists need to be familiar with false negatives and positives, identify complications, and include alternative diagnoses in the report if appendicitis is not suspected.

For further in-depth discussion of imaging in practice, subscribe to Conceptual Radiology and get ahead on your radiology education!