How to approach 1st year in Radiology Residency- Dr Sumer Sethi

Radiology is a discipline which provides multi-faceted exposure to its pupils. Several post graduates all around the world opt for radiology for this. But it is often confusing for freshers in their initial stage of radiology residency. Students do not have a properly caved path to follow in order to excel in this field. And that is simply because there is not much preparation required to prepare for learning radiology. You must let this specialization take over you rather than trying to get ahead of it.

 

For a 1^st year residency student the primary thing one must grasp is the actual concept and function of radiology. Mastering it is a rather steep learning curve and everyone must start from the basics. As far as PG is concerned, the most common practice is to teach Diagnostic radiology. You will find intervention radiology in a handful of places. It is anyway better to restrict yourself to the diagnosis  part in the first year.

 

To be adept on this front is a whole other ball game. Many are of the opinion that diagnostics is mastered mostly by practical work. Others seem to think theoretical study is the way to go. I however believe that the key lies somewhere in between this ‘spectrum’. Therefore I recommend two methods to approach it-

 

i. Spot finding- For spot finding one has to look at  a report, form an image and eventually find a differential diagnosis. It is the skill of keen observation of anomalies. It is crucial to regularly observe various reports like MRI, CT scan, X-Ray, Doppler, Fluoroscopy etc. and find the discrepancies such as density and signal abnormalities, asymmetry etc. This is the practical aspect of it. But to perfect it I used to carry a handbook, Chapman’s differential diagnosis on my person. Whenever you find an anomaly, you can immediately refer this as  a ready reference. This will enhance your observation and diagnosis skills as well as build up on your knowledge base gradually.

 

ii. Describe the finding- You have spotted the abnormalities and studied about it from your reference. Now you need to learn the skill of writing a description of the spotting. The description should be vivid enough that any radiologist can understand the intricacies of your findings without having to consult the image or report. The exact attributes of the abnormality in terms of size, density, symmetry, globulated or smooth- everything should be described accurately and with the help of correct terminology. For this you have to be well versed in radiological vocabulary, which you will automatically learn once you keep studying about every report you work on.

 

The above two methods are the basics that you need to follow through out.  As you progress, 2-3 months in you should also be familiar with hands on work like the positioning of the patients for different angles. Even though down the line this may not be your role but it is definitely a handy skill to have in your arsenal. Also you will learn the operation of various machines which again is not supposed to be your expertise but in exams like the DNB there will be theory papers on radiation physics. Afterall radiology is the amalgamation of physics and the many faces of medicine.

 

Reference books-

i.                     Textbook of radiology and imaging- Sutton David

ii.                    Grainger and Allison’s Diagnostic radiology ( make sure you have the latest edition)

Gradually when you will have ultrasound posting the recommended is

i.                     Diagnostic Ultrasound- Carol M Rumack

Specialized books on neuroradiology

i.                     Osborn’s brain- Anna G. Osborn

For Musculo-skeletal-

i.                     Essential’s of Skeletal radiology- Terry R. Yochum

For HRCT chest radiology-

i.                     Webb, Müller and Naidich's High-Resolution CT of the Lung

ii.                   Felson's Principles of Chest Roentgenology

 

Every time you are on your rotations and have to study the reports, note your findings and then study about them that very day while it is fresh in your mind.

 

Summary

·         Spot finding

·         Description of findings

·         Referring handbooks while on rotation

·         Referring reference textbooks after rounds

·         Carry a radiology anatomy atlas

·         Learn machine operations and positioning techniques

·         Pay heed to radio physics

 

Parting words

Due to its wide applications and concept many people opt for this line. Exploit the modern technologies like reverse image search and learn more and more about your reports and images Attend conferences and present your posters. This will gradually help you understand the art of radiology.

Always remember, a good radiologist has to be well read.