Radiology is a four-year medical residency with common fellowships after. It is a basic element of medical care and frequently results in patient admission or diagnosis. The document outlines basic radiology concepts - one view is insufficient so use multiple views, patterns provide clues to diagnosis, ensure thorough image review, know what you're looking for, and understand test limitations. It provides examples of using pattern recognition and multiple views to correctly diagnose conditions like pneumonia subtypes, pneumothorax, pneumomediastinum, and fractures. It stresses using decision trees and understanding when secondary tests are needed based on initial findings and patient history.

1. Radiology – The Basics
Laurie Lomasney, MD
Department of Radiology

2. Radiology
 Four year residency
 Fellowships common
 Basic element of medical care
 Frequently the test that results in
patient admission/diagnosis

3. Basic Concepts
 One view is no view – use it all!
 Patterns are your clue
 Be sure you are looking
 Know what you’re looking for
 Know the limits of your test

4. Basic Concepts
 One view is no view – use it all!
 Patterns are your clue
 Be sure you are looking
 Know what you are looking for
 Know the limits of your test

5. One View is No View
Posterior sulcus nodule = Cancer

6. One View is No View
RML collapse

7. One View is No View
Pectus excavatum, not
pneumonia

9. Basic Concepts
 One view is no view – use it all!
 Patterns are your clue
 Be sure you are looking
 Know what you’re looking for
 Know the limits of your test

10. Patterns are Your Clue
PCP Pneumonia
CHF
Interstitial Lung Disease - Acute

11. Patterns are Your Clue
Pneumonia Alveolar edema
Air Space Consolidation

12. Patterns are Your Clue

13. Patterns are Your Clue
SB > 3cm
Continuous valvulae
Paucity colonic gas
Multiple non-colonic A/F levels

15. Basic Concepts
 One view is no view – use it all!
 Patterns are your clue
 Be sure you are looking
 Know what you’re looking for
 Know the limits of your test

16. Be Sure You are Looking
RT
Kartegener’s Syndrome

17. Be Sure You are Looking

18. Be Sure You are Looking
“Rule out pneumonia”
Marked free
intraperitoneal air

20. Basic Concepts
 One view is no view – use it all!
 Patterns are your clue
 Be sure you are looking
 Know what you’re looking for
 Know the limits of your test

21. Know What You’re Looking
For
PNEUMOTHORAX
Skin fold – no intervention Failed line placement, SOB:
Gray edge with peripheral Thin line without peripheral lung
markings markings = pneumothorax

22. Know What You’re Looking
For
Pneumothorax + mediastinal
shift
=
Tension Pneumothorax

23. Know What You’re Looking
For
PNEUMOMEDIASTINUM
Air paralleling trachea,
bronchi, left heart border

24. Know What You’re Looking
For
1. Trauma Board
2. Wide mediastinum
3. NG deviation
4. Tracheal deviation
5. Left apical cap

25. Know What You’re Looking
For
Aortic Transection X 2

26. Know What You’re Looking
For
35 year old with Lymphoma 65 year old with Pulmonary
Arterial Hypertension

27. Know What You’re Looking
For
PNEUMOPERITONEU
M
Upright –
Nondependent point

28. Know What You’re Looking
For
PNEUMOPERITONEU
M
Supine – Double Bowel Wall Sign Outlining of liver/GB

29. Know What You’re Looking
For
35 year old with recurrent
abdominal pain:
Extensive pancreatic
calcification = recurrent
pancreatitis

30. Know What You’re Looking
For
35 year old with bloody
diarrhea
Thumb-printing transverse
colon = Colitis

31. Know What You’re Looking
For
Bowel dilatation acidosis
60 year old with
and no bowel sounds,
Pneumatosis
suspect dead bowel
Portal venous gas

32. June 3, 1965

33. Basic Concepts
 One view is no view – use it all!
 Patterns are your clue
 Be sure you are looking
 Know what you’re looking for
 Know the limits of your test

34. Know the Limits of Your Test
• Screening tests come first
• Secondary tests come second
• Basic decision trees work for most, but
not all, patients

35. Know the Limits of Your Test
35 year old on BCP with acute Shortness of breath

36. Know the Limits of Your Test
40 year old with confusion after skull fracture
Subdural hematoma

37. Know the Limits of Your Test
80 year old fell in bath tub this AM,
unable to bear weight = Femoral
neck fracture

38. Know the Limits of Your Test

39. Take time to consider your
test first, and review the
results after
You’ll be the star of your team!

40. Dust and gas in the constellation of Sagittarius