great presentation about a proper way to present radiological cases during meetings

1. RADIOLOGYRADIOLOGY
PRESENTATION SKILLSPRESENTATION SKILLS
(THIRD YEAR SURVIVAL)
Oral
Formal or Informal

2. I know it’s your
patient, but let’s see
what our 3rd
year
student thinks!

3. OMG ! I don’t know what to
say!

4. • I – IDENTIFY
• D – DESCRIBE
• E – EXPLAIN
• A - ACTION
But…Dr. Roentgen
has given me an
I.D.E.A

5. IDENTIFY
Who, 2 Why’s and a What
Who--- is the patient?
55 yo aaf with a history of heart disease.
ie-sex, age, ethnicity and pertinient history
Why--- Chief complaint
She comes to the ED with complaint of SOB.
What--- What image are you looking at?
This is a frontal projection of a chest xray.
Why--- Indication for the exam.
SOB

6. DESCRIBE
EXAM QUALITY FINDINGS
EXAM- Describe the exam and any details of how it was performed.
ie-- AP portable chest x-ray done today in the ICU
ie-- Multiple sections from a CT exam of the abdomen
available – IV contrast was administered.
Number of images
Single or multiple
Prior films for comparison
ie--There is an upright PA and Lateral chest x-ray done
yesterday for comparison.

7. DESCRIBE
EXAM - QUALITY- FINDINGS
(Inspiration, Position, Exposure)
Inspiration–Adequate or decreased.
Poor is not a good descriptive choice. Remember: The patient is sick,
the technologist gets the best film possible, and you weren’t there.

8. Position–Satisfactory positioning or note rotation by clavicle position
compared to the midline spinous process.
* If clavicles project higher than the ribs its lordotic angulation
* PA will have less magnification of the heart than an AP
* If it is a portable---it’s an AP
* If there is a lateral view ---it’s a PA
* If you can’t tell---say FRONTAL
DESCRIBE
EXAM- QUALITY- FINDINGS
(Inspiration, Position, Exposure)

9. Adequate or satisfactory are good terms to use.
Penetration- is also a term used to describe exposure. This is assessment
of overall whiteness or darkness of the image.
Underexposure-image is too white (not enough photons) This limits
evaluation in retrocardiac region and can simulate
CHF or interstitial disease.
Overexposure-image is too dark. This can limit evaluation in the
periphery of lung field especially for nodules and
pneumothorax. It can also simulate COPD.
DESCRIBE
EXAM - QUALITY - FINDINGS
(Inspiration, Position, Exposure)

10. DESCRIBE
EXAM - QUALITY- FINDINGS
Depending on Attending physician’s preference:
Formal recitation of reading the chest x-ray
or
Description of dominant positive findings
Some attendings prefer a specific format when reading a chest x-ray
Know: Formal or informal—Which is appropriate for the situation
You can obtain this info from observations of other students,
interns and residents.

11. A good habit is to start by describing post–op changes,
support catheters and devices.
*Note the distal location of the device / catheter
***MALPOSITION OF LINES AND CATHETERS IS OFTEN OVER LOOKED
DUE TO PATHOLOGY ON THE IMAGE.
Terms for catheter / device description:
examples…
… The ET tube is above the carina
… Central catheter enters on the left extending to the SVC
… Post-op changes from mediastinal surgery are seen
.
NOTE TO SELF!

12. DESCRIPTIVE TERMS
FOR
NORMAL CHEST EXAMS
CHEST WALL- There is no soft tissue abnormality / pathology.
SKELETAL - No traumatic or destructive lesions are seen.
(note-degenerative changes in spine)
HEART SIZE - The cardiac silhouette is within normal limits.
MEDIASTINIUM - There is no mass or abnormality.
HILA - There is no hilar mass or suspicious adenopathy.
PULMONARY VASCULARITY- Is not engorged.
LUNGS - Show symmetric ventilation without mass or consolidation.
PLEURA - Shows sharp costophrenic angles without effusion.

13. PATHOLOGY DESCRIPTION
Use this phrase and fill in the blanks
There _*_ a/an ______ of ________density located______ which is of _______size
And shows ______shape and ________margin.
*is
*are
Let’s choose is
There is an ______ of ________density located______ which is of _______size
And shows ______shape and ________margin.

14. There __ a/an _*__ of _______density located______ which is of _______size
and shows ______shape and ________margin.
*Area
*Region
*Zone
*Focus
*Nodule
Let’s choose area
There is an area of _______density located______ which is of _______size
and shows ______shape and ________margin.

15. *increased
*decreased
*mixed
*homogeneous
*heterogeneous
There __ a/an ___ of _*__density located______ which is of _______size
and shows ______shape and ________margin.
Let’s choose mixed
There is an area of mixed density located______ which is of _______size
and shows ______shape and ________margin.

16. There is a ______ of ________density located___*___ which is of _______size
and shows ______shape and ________margin.
*projecting over
*in the region of
*lateral / medial to
*extending from “X” to Y
There is an area of mixed density located in the region of the Lt. lower lobe
which is of _______size and shows ______shape and ________margin.
Let’s choose In the region of
&
Lt. lower lobe
*in the Rt. / Lt. chest
hemithorax
lung
lobe

17. *Large
*Moderate
*Small
*Approximately 3cm in diameter
or 3 to 4 cm in diameter
Note--rib width serves as a 1cm measurement
There is a ______ of ________density located______ which is of ___*____size
and shows ______shape and ________margin.
Let’s choose “moderate”
There is an area of mixed density located in the region of the Lt. lower lobe which is
of moderate size and shows ______shape and ________margin

18. There is a ______ of ________density located______ which is of _______size
and shows __*__shape and ________margin.
*round / rounded
*lobular
*oval
*triangular
*irregular
*wedge shaped
Curvilinear is a universal descriptor that fits about any shape other than straight
Let’s choose irregular
There is an area of mixed density located in the region of the Lt. lower lobe which is of
moderate size and shows irregular shape and ________margin

19. *sharply defined
* ill defined
There is a ______ of ________density located______ which is of _______size
and shows ____shape and ___*__margin.
Let’s choose sharply defined
There is an area of mixed density located in the region of the Lt. lower lobe which is
of moderate size and shows irregular shape and sharply defined margins.
Whew!

20. EXPLAIN
Compare
• Is there change from a previous exam.
• State your interpretation of the significance
of the findings.
• Discuss diagnosis and differential
Example
I would be concerned about ___
I think this is____
I would have to consider____
•Start by stating the most likely first.
•Mention the most significant that would be considered
with this history and exam.
•Think in terms of general pathologic topics.
Infection, Neoplasm, Cardiovascular, Trauma

21. What are you going to do?
• observe
• compare with old studies
• repeat / new studies
• interventions
• lab studies
• additional physical exam
Example: * Plan to discuss with radiology about performing a
percutaneous biopsy.
* Check to see if there are other previous exams.
ACTION

22. PEARLS
Best film is the previous film
Hazy, ill defined, cloudlike, fluffy-------air space disease
Linear, reticular,coarse,-----interstitial disease
? Nodule-----repeat chest with nipple markers
? Pleural effusion----Decubitus film
? Apical disease----Lordotic film
Portable film----Repeat in department asap
? Retrocardiac mass----barium study---hiatal hernia
Chest wall lesion----get rib detail film
? Pneumothorax---get expiration film
Trace tubes & lines with your finger if exact position is not clear,
tip is where problems arise.
Et tubes go distal into Rt. mainstem often. Practice finding carina.
Rib height = 1cm--- Vertebral body=3cm
If it is calcified, goes away or remains stable over time = benign
Make statements—don’t ask questions---Watch tone of voice!
Think simple, cheap, and safe as first step.
Be as general as you have to be and as specific as you can be.
X-ray / CT---------------------------density
Ultrasound----------------------echogencity / anechoic
Nuclear medicine------------intensity / activity
MR------------------------------------- intensity / signal