x-treme Posted July 30, 2007 Report Share Posted July 30, 2007 Hello everyone, Does anyone have any interactive websites that explains X-Rays and EKG's and how to properly interupt them and treat. I would like detailed websites, with many examples if possible. I have yet to find any good material. Thank you Link to comment Share on other sites More sharing options...
Superking25 Posted August 1, 2007 Report Share Posted August 1, 2007 The best way to interrupt an EKG or X-ray is to turn off the machine mid-way through taking a measurement. If you're good, you might just interrupt it so bad that the machine screws up and won't restart properly! Link to comment Share on other sites More sharing options...
pinkdoc Posted August 1, 2007 Report Share Posted August 1, 2007 Superking25: That made me laugh so hard out loud in my very quiet office... I'm sure I've interrupted an EKG machine before and not been able to turn it back on! Link to comment Share on other sites More sharing options...
janieK Posted August 1, 2007 Report Share Posted August 1, 2007 Hello everyone, Does anyone have any interactive websites that explains X-Rays and EKG's and how to properly interupt them and treat. I would like detailed websites, with many examples if possible. I have yet to find any good material. Thank you I didn't understand this the first time I read it. After the lightbulb went on, I'm guessing x-treme means "interpret". Link to comment Share on other sites More sharing options...
Superking25 Posted August 1, 2007 Report Share Posted August 1, 2007 Superking25: That made me laugh so hard out loud in my very quiet office... I'm sure I've interrupted an EKG machine before and not been able to turn it back on! Haha Booyah Link to comment Share on other sites More sharing options...
leviathan Posted August 3, 2007 Report Share Posted August 3, 2007 Hello everyone, Does anyone have any interactive websites that explains X-Rays and EKG's and how to properly interupt them and treat. I would like detailed websites, with many examples if possible. I have yet to find any good material. Thank you Dubin's EKG book is pretty gold....despite his shady history. Garcia's is a bit more in depth but I liked the different sections from beginner -> intermediate -> advanced so you can read up to the level you want to be familiar with. Don't know much about radiology though, sorry... Link to comment Share on other sites More sharing options...
Vitum Medicinus Posted August 3, 2007 Report Share Posted August 3, 2007 Best source I know of for interrupting an X-ray is a radiology residency. Even though we're learning basic tips of radiology through the first bit of med school, we're often told, "Remember, it takes five years to train a radiologist. You can't learn it all. Consult a radiologist when you need to." Link to comment Share on other sites More sharing options...
leviathan Posted August 4, 2007 Report Share Posted August 4, 2007 Best source I know of for interrupting an X-ray is a radiology residency. Even though we're learning basic tips of radiology through the first bit of med school, we're often told, "Remember, it takes five years to train a radiologist. You can't learn it all. Consult a radiologist when you need to." Kinda off topic, but is interpreting imaging studies something that you need a natural talent for? I suck at reading x-rays, and don't know how radiologists do it (along with every other type of imaging). I had an RT show me an intubation film the other day, and he was pointing out the carina, and for the life of me I couldn't see it. Link to comment Share on other sites More sharing options...
Ian Wong Posted August 4, 2007 Report Share Posted August 4, 2007 Kinda off topic, but is interpreting imaging studies something that you need a natural talent for? Interpreting imaging is all about experience, and (sorry to say it), knowledge level. Your eye will only see what it is looking for, and what it knows about. It's for this reason that PGY-2 radiology residents are usually pretty useless to the clinical workflow for a few months, because they are busy trying to file in their brains and eyes, what a "normal" looking chest x-ray, head CT, or right upper quadrant ultrasound should look like. Many of my attendings have told me that figuring out the range of normal appearances is the central foundation of radiology, one that takes a lifetime to master. Once they have a "search pattern" as to how to look at each kind of study systematically, (such as a chest x-ray) they can really start putting to use all that book knowledge as to what lesions could potentially occur, and then adapt their search pattern to include that possibility. As you see more and more abnormal CXR's, your search pattern gets longer and longer, but you become more comfortable going through it more rapidly. Soon, you get to the point where scanning through a chest x-ray takes a few seconds, and yet you can feel confident that you've looked for all lines and tubes, looked at the ribs, clavicles, thoracic spine, looked for airspace opacities, pleural effusions, pneumothorax, airway deviation, subdiaphragmatic tubes, clips, or pathology, and assessed the heart size and vasculature. A PGY-2 radiology resident might take 15+ minutes to do all of the above the first few days you put them on the chest rotation, and they are finally dictating radiographs and given full responsibility for the study. A PGY-5 resident will have the study read and dictated in a few seconds. It's all about familiarity with where pathology lives, and training your eye to look for it. As an example, the first time you go through a chest x-ray, it's a little complicated, as you start to get the anatomy down. In Med 1 and 2, we would get tested in anatomy on the various fissures, tracheobronchial tree, and different lobes. You struggle to find the pneumothorax or even how to count the ribs. Then, you feel pretty cocky as a third and fourth year med student, because you've seen some pathology, and finally can recognize a pneumothorax or pleural effusion. As a PGY-1 resident, you are pretty good at also looking for lines and tubes, because you are putting in central lines on various services, and are looking at your own studies to confirm line placement and excluding a post-procedural pneumothorax. However, as a PGY-2 resident, your mind gets blown away, as you realize all the stuff you've been subconsciously missing the entire time. These are things the average clinician doesn't look for, and which we see fairly commonly in the radiology reading room, because we are actively looking for it. Things like: - Correct patient, correct date - Upright vs supine radiograph, and whether it is a PA or AP study - All sub-diaphragmatic pathology - Subpulmonic pneumothoraces (in a patient lying down, the pneumothorax doesn't necessarily go to the lung apex) - Bone metastases - Fractures - Mediastinal masses - Most pulmonary nodules - Subcutaneous emphysema - Prior mastectomy (one breast is absent) - Pleural thickening or calicification, particularly at the apex - Airway lesions - How the degree of patient rotation or penetration might affect the study. - Cardiac valve calcifications - Vertebral body compression fractures, kyphosis, scoliosis, presence of osteopenia - Atypical lines and tubes, or rare entities, like aortic-balloon pump positioning. - Positioning of ICD or pacemaker leads - Congenital vascular anomalies, ie: right-sided aortic arch. Every single imaging study (whether it is an acute abdominal series, or a head CT, or a knee MRI) has a similar set of characteristics. There are the obvious findings that most everyone should get, and then there are the subtle findings that you wouldn't notice unless you are actively looking for them. How does the average radiology resident pick up on these nuances? Usually, it occurs because he/she missed one of them at some point, their attending subsequently pointed it out, and now he/she makes an active effort to look for that lesion on every subsequent study. This is how we get trained to look at the "four corners" of every study, because once you start to see how much stuff you were missing before, it's really scary! I don't think it takes natural ability to become a good radiologist, but you do need to have the drive to want to improve and learn. Radiology is a very, very visually-intensive specialty, which integrates knowledge across all specialties in medicine, along with a healthy dose of anatomy and pathology. One thing that a radiology attending once pointed out, was that if you were the kind of kid that loved playing "Where's Waldo?" (or in my case, "where's Goldbug?"), or liked those games where you had to find the 7 differences between the two pictures, that doing radiology would pretty much be like playing the adult versions of those games, for money. Now, even if you weren't one of these kids, that doesn't mean you can't learn to read studies. The quality of your interpretations will be directly proportional to how many of them you do, and also very importantly, the quality of the feedback you get. It's entirely possible read tons of studies, while continuing to do a crummy job of interpreting studies, but unless you are getting feedback that you are over-calling or under-calling lesions, or worse yet, flat out are missing things that are plainly obvious in retrospect, you won't improve your skills. Feedback is essential in refining your search pattern, which is a continuously ongoing process. Every day I see stuff that either I've not seen before, or not quite seen manifest the same way. Figuring out what it is, and making sure that I don't miss it again in the future is part of the fun. I think Radiology is a wonderful specialty, and it is central in the decision-making of most complicated patients. It's well worth the time to visit some of the below websites to practice seeing cases, and improving your interpretation skills. EKG's I'll leave to someone else, seeing as I look at maybe 1 of them a year now! Here's a few good online resources for learning radiology. http://www.learningradiology.com http://www.auntminnie.com http://www.med-ed.virginia.edu/courses/rad/ http://www.learningradiology.com has lots of tutorials and powerpoints, in addition to cases. http://www.auntminnie.com is probably the most popular internet website for radiology residents, with forums and a case of the day, which you take as an "unknown case", and as you answer their questions, reveals more and more about the case. Auntminnie's cases of the day go back to March 2002, so there's literally 5 years worth of daily cases to quiz yourself on. The Virginia website has a list of tutorials regarding common radiology scenarios (such as reading cervical spine radiographs, ICU chest x-rays, head CT's, etc), and is also well worth visiting. http://www.radiologyeducation.com/ http://www.radiologyeducation.com/ is a big web portal with all sorts of radiology links, in case the above collection isn't enough. Ian Link to comment Share on other sites More sharing options...
leviathan Posted October 18, 2007 Report Share Posted October 18, 2007 Holy crap...I just saw your reply now. Thanks for all of that info, Ian. Link to comment Share on other sites More sharing options...
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