Radiology – The Basics

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 Gray edge with peripheral markings Failed line placement, SOB: Thin line without peripheral lung 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 65 year old with Pulmonary Arterial Hypertension 35 year old with Lymphoma

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

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

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