Minci-ken Series

(Picture Via College of Medicine : University of Florida)

Rotation in Radiology
by Minci Yazumin

Acknowledgement I would like to thank Patience, Hope and Dark Room in aiding the production of this mini-publication. “After all, if an x-ray is poor, there is a chance that injuries could go undetected or diseases could go undiagnosed” -Charles W. PickeringIntroduction During our final years in medical school, we get to choose any specialty we'd like spend extra time in with an aim to polish up your skills. Radiology was one of my choices and I was to attend a 4 weeks rotation with the team. This little booklet is not meant to be a crash course book. I'd say it'll serve merely as a guide as to how you are to get around in the Radiology Department should you choose to accept it. A further reminder, this booklet is produced based on the views of a medical student. Therefore, I apologize in advance for any inaccuracies or weak interpretations of events that may have been picked up by the more experienced others. 1. Why I chose Radiology? I was aiming to benefit from the variety it provides. Life was not all sitting in the dark room all day. Radiologists do scans, interventions, interact with fellow physicians etc. I wanted to know what the job description was and most importantly I wanted to feel confident in interpreting at least the chest X-Ray. Role of radiologist: From what I've gathered, they; ● Interpret the film or scan ● Design the investigation requested by other clinicians – how much exposure, what settings to use to highlight the desired problem, use what sort of contrast. ● Perform some interventional procedures especially if it's radiology based. As far as training is concerned, full insight can be found here : Radiology - sBMJ 2.Activities in Radiology Department

Here is roughly what my initial 4 week timetable looks like;

Later on, additional personal teaching sessions were added. Looking back, I wished I could have improved on certain things to properly benefit from my rotation. 1. Take proper histories from patients who underwent procedures 2. Brush up my anatomy, pathology and physiology on the common clinical conditions. 3. When obesrving a procedure, think about how its done, the indications and contraindications to procedure, the intended benefit including the risk and complication. Also explore the effects of local and general anaesthetic in mind as I watch the procedure.

A special note about MDT; MDT stands for Multi-Disciplinary Team and the meeting done every week by certain groups of physicians has great benefit to the patient's care. Instead of the GP having to be the focal point of referral, a patient can be referred rapidly between specialties and save up precious times. The patient wouldn't have to wait for 2 weeks or so before being called into the system and get referred all over again. Most medical students think that MDT meetings are boring and a waste of time. However,I believe that if we could put that time to good use, then..'there is no day in which you learn something is a complete loss'. Here are my personal tips in attending a meeting. 1. Know the patients – Your department is obviously involved. Check the list of patients and understand their condition that led their case to be presented to the MDT. If this is not possible, sit in the MDT with your ears open. LISTEN carefully to the presenting complaints , what investigations have been done and make sure at the end of it, you know what the next plans are. 2. Identify key specialists involved – This is a great time for you to seek out other learning opportunites. If you introduce yourself as a medical student from this and this department and said that you want to observe a particular procedure being done because the patient was presented in the MDT, I'm sure the consultant would allow it. It is like 'follow-up' right? 3. Active listening - sit with good view. Being attached to the radiology department, you'd see a film or a scan differently. It's not a matter of only saying that the lesion looks benign etc. you'd have to give 2 or 3 reasons as to why it is benign. Hence it is vital for you to hear your consultant describe the lesion on the film as he/she presents it. For instance, identify the key features as to why something is called asbestosis and others just a benign peural disease. 4. Bring some brain food – Some MDT meetings are ususally done during lunchtime. If you see other people bringing in food /drinks.. might as well do the same. The meeting might take a long time.

3. Resources: These are not complete. Just bits and pieces of material I used over the rotation. a.Books 1. Complete Self-assessment for medical students – Patel & Patel 2. Abdominal X-Rays Made Easy – James Begg b.Internet Resources 1. Anatomy by Diagnostic Imaging – has accessible lecture slides. 2. Undergrad Radiology Teaching File, University of Toronto. 3. Human Anatomy, DarthMouth Medical School. 4. http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Procedures/Proc edures_f.htm – anatomy shown in the form of scans or on xray film. 5. Student BMJ – Imaging. 6. LearningRadiology.Com. 7. Introduction to Chest Radiology. 8. Radiopaedia.Org. 9. E-Radiography

4.Personal Safety “When I entered the field in July 1958 I believed what they told me about radiation risks. I spent much effort reducing the dose to patients in radiology” -John Cameron-

Other 1. 2. 3.

than ensuring the patient's safety, it is vital that we take care of ourselves too. Make sure you are not pregnant Radiation – use lead coverings for the body and thyroid Interpreting an Xray may require a dark room but it doesn't mean you'd have to read books in the dark as well. 4. If the scanning department is at the basement or something, do walk in well-lit areas. 5. Make sure no radioactive spills come on you as you hang out in the nuclear medicine department. If in doubt, request for a check using one of those ghostbuster like radioactive machines.

I end this booklet with the Pearls of Wisdom in the Radiology Department.These are the exact words of some of my consultants and doctors within the team.

“We've got to die of something” “Life without contrast is boring” “You're not paid for what you do for the patients. You're paid for what you know” “EDUCATION is what you've got left, after what you've been taught and forgotten” “What is good in practice, must be good in theory” “You can't see what you dont' know” “Q: Is it a concern for you that you will be in a speciality with not much patient contact? A: So far, nobody has stopped me from seeing me the patients and taking a history of them. If I want to see patients, I can always see them at the wards” “Radiology is one of the ROADs to happiness” “Patients have no idea what we are willing to do in providing them with the best care” (with reference to himself being a subject to try out the new scans)

Have Fun,

Minci Yazumin © 2007

Any questions/comments or suggestions can be forwarded to my email.