Professional Documents
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Abr PDF
Abr PDF
So thats it in a nutshell. Nows your chance to actually learn more than youll ever
know again, so dig in and go for it.
Dr. Stephen Humes
Musculoskeletal
Cardiopulmonary
Gastrointestinal tract
Genitourinary tract
Neuroradiology
Vascular and interventional
Nuclear radiology
Ultrasound
Pediatric radiology
Breast radiology
The following is a list of suggested books that you should get familiar with as you
prepare for the exam. Please note that these are only suggestions. Keep current with the
new books as they come out and listen to others for what they recommend.
Note that you wont be able to read all these. Note also that you should take advantage of
the window between taking the written boards and the start of the oral exam reviews to
read aggressively if you havent read throughout residency.
Once the reviews start, you dont want to be reading through things for the first time. You
want the reviews to be just that -- reviews.
Musculoskeletal
Fundamentals of Skeletal Radiology by Helms, C., 2nd ed., Elsevier Science, St.
Louis, 1994. Note that the entire book is a part of Fundamentals of Diagnostic
Radiology by Brandt, W., Helms, C., 2nd ed., Lippincott, Williams & Wilkins,
Philadelphia, 1998.
Case Review: Musculoskeletal Imaging by Yu, J., Elsevier Science, St. Louis,
2001. Contains all the key cases you need to know.
Musculoskeletal Imaging: A Teaching File by Chew, F., Maldjian, C., Leffler, S.,
Lippincott, Williams & Wilkins, Philadelphia, 1999. Great first chapter on hand
radiographs.
Musculoskeletal MRI by Kaplan, P., Helms, C., et. al., Elsevier Science, St. Louis,
2001. Just buy it. Youll need it the rest of your career.
Arthritis in Black and White by Brower, A., 2nd ed., Elsevier Science, St. Louis,
1996. A great book on heavily tested boards material.
Orthopedic Radiology by Weissman, B., Sledge, C., Elsevier Science, St. Louis,
1986. Great for fractures.
Cardiopulmonary
Case Review: Thoracic Imaging by Boiselle, P., McLoud, T., Elsevier Science,
St. Louis, 2001. On par with the other titles in the Case Review series.
Imaging of the Chest: A Teaching File by Mergo, P., Lippincott, Williams &
Wilkins, Philadelphia, 2002. Perhaps the new classic. Written by an examiner.
Cardiovascular MRI & MRA by Higgins, C., de Roos, A., Lippincott, Williams &
Wilkins, Philadelphia, 2003. Great book for all the cases you will need to know.
Gastrointestinal
Alimentary Tract Imaging: A Teaching File by Johnson, C., Elsevier Science, St.
Louis, 1993. Yet another out-of-print classic for all the barium you will need.
Four of my ten cases in GI were barium.
Textbook of Gastrointestinal Radiology by Gore, R., Levine, M., 2nd ed., Elsevier
Science, St. Louis, 2000. A really big set of two books, but easy to read and
contains a great chapter on the key descriptors for barium studies (Chapter 5,
Pictorial Glossary of Double Contrast Radiology).
CT and MRI of the Abdomen and Pelvis: A Teaching File by Ros, P., Lee, S.,
Lippincott, Williams & Wilkins, Philadelphia, 1997. A great text to have -- all the
standard cases, good differentials. A must read.
The Abdominal Plain Film with Correlative Imaging by Baker, S., Cho, K., 2nd
ed., McGraw-Hill Professional, New York, 1999. A classic radiology text filled
with plain films. You will be shown a plain film, and asking for a CT will only
irritate the examiner.
Genitourinary
Textbook of Uroradiology by Dunnick, N., Sandler, C., Newhouse, J., Amis, Jr.,
E., 3rd ed., Lippincott, Williams & Wilkins, Philadelphia, 2001. This is probably
one of the best radiology texts. Its current, succinct, and has everything you need
for boards and for practice. Dr. Dunnick was at the oral exams in 2003.
CT and MRI of the Abdomen and Pelvis: A Teaching File by Ros, P., Lee, S.,
Lippincott, Williams & Wilkins, Philadelphia, 1997. The chapters on the kidneys
and retroperitoneum are good.
Case Review: Genitourinary Imaging by Tung, G., Mayo-Smith, W., Zagoria, R.,
Elsevier Science, St. Louis, 2000. Another in the Mosby series.
Neuroradiology
Diagnostic Neuroradiology by Osborn, A., Elsevier Science, St. Louis, 1994. The
queen of the Armed Forces Institute of Pathology. Buy this one if you want to
understand neuro. No longer being published, so get it while you can.
Neuroradiology: The Requisites by Grossman, R., Youssem, D., 3rd ed., Elsevier
Science, St. Louis, 2003. A favorite among residents and book thieves. Fun to
read.
Spine Imaging: Case Review by Bowen, B., Elsevier Science, St. Louis, 2001.
Buy one of your very own. A high-end text with all the most important cases.
Head and Neck Imaging: Case Review by Youssem, D., Elsevier Science, St.
Louis, 2001. Another in the Mosby series, with some good jokes along the way.
All the key cases and then some.
Brain Imaging: Case Review by Loevner, L., Elsevier Science, St. Louis, 2001.
Yet another in the Mosby series.
Interventional Radiology Essentials by Laberge, J., et. al., Lippincott, Williams &
Wilkins, Philadelphia, 2000. A short comprehensive text on the subject. Shows
you all the key pictures.
Nuclear radiology
Essentials of Nuclear Medicine Imaging by Mettler, F., et. al., 4th ed., Elsevier
Science, St. Louis, 1998. This is the one book on nukes you should buy. Short,
comprehensive. All the most important cases with images. All the protocols are
neatly tucked away in the back. The chapter on cardiac is among the best, and you
need to know the protocols and the artifacts and the significant findings -- all of
which Mettler shows you. Dated in terms of PET.
Nuclear Medicine: A Teaching File by Datz, F., et. al., Elsevier Science, St.
Louis, 1992. An abbreviated Habibian, but out-of-print. Short but sweet.
Ultrasound
Diagnostic Ultrasound by Rumack, C., Charboneau, J., Wilson, S., 2nd ed.,
Elsevier Science, St. Louis, 1998. One of two texts to have. You need both
volumes because the ABR wants you to know obstetrics ultrasound. You will be
shown several cases, so Volume II is important, too. An easy read, even though
the size is intimidating.
Ultrasound: The Core Curriculum by Brant, W., Lippincott, Williams & Wilkins,
Philadelphia, 2001. A nice new book thats a quick read/review. Good for firstyears through seniors.
Pediatric radiology
Breast radiology
Breast Imaging Companion by Cardeosa, G., 2nd ed., Lippincott, Williams &
Wilkins, Philadelphia, 2001. This book has it all -- screening, diagnostic, how to
do procedures, BI-RADS stuff.
Teaching Atlas of Mammography by Tabr, L., Dean, P., Tot, T., 3rd ed., Thieme,
New York, 1994. A nice quick read for those trying to catch up. Good for practice
of BI-RADS descriptors.
One note concerning mammo: This field likes to reference the literature rather than
textbooks. So, on the oral boards, you can describe the ultrasound however you want, but
if you say something such as, Stavros criteria for a malignant lesion include, it may
help to get you out of the section early.
Miscellaneous
IRAD: Interactive Radiology Review & Assessment by Chew, F., Kline, M.,
Whitman, G., Lippincott, Williams & Wilkins, Philadelphia, 2000. This CD-ROM
is a must do, some say just before the exam. Creative format allows a variety of
interaction methods. Closest experience to the real thing.
Radiology Recall by Gay, S., Woodcock, Jr., R., Lippincott, Williams & Wilkins,
Philadelphia, 2000. A simple little text that goes a long way toward getting you to
where you need to be. Handy for a quick read before morning conference at all
levels.
Anatomy in Diagnostic Imaging by Fleckenstein, P., 2nd ed., Elsevier Science, St.
Louis, 2001. A word of advice: before starting to study for any section, review the
anatomy first. This book contains it all.
Miscellaneous documents
The following are some documents that discuss general principles of boardsmanship
that you may or may not find helpful. Take them with a grain of salt. They include the
following:
A copy of the exam schedule to give you an idea of how the day is structured.
Review courses
The following is some information on a couple of review courses for the exam. It is your
decision whether or not to attend one of these types of courses. Most will tell you it
doesnt make you or break you.
The Duke Review
The most famous review course is the Duke review. It is very well organized, and you get
to hear some of the leaders in radiology speak for a couple of hours on boards-directed
topics. Is it worth $800? I think so. Do you have to attend the course? Not necessarily.
I found it most helpful in the lectures on ob/gyn, which I didnt get much exposure to
during residency. Also helpful were the evening case conferences. Tons of images are
presented over the course of the week. It is kind of an endurance experience, however. Its
biggest limitation is that you dont get to take cases yourself (they do provide the
opportunity, but most go to the big lecture hall because they are able to show more
cases).
Below is the contact information:
Debbie Sykes
919-684-7228
www.radweb.mc.duke.edu
If you do decide to go, register early and get a room in the hotel where the conference is
held. You dont have much free time to be driving back and forth between hotels. Theres
a great gym next door, and in 2003 you could buy a weeks pass for $25, which is time
and money well spent.
The reviews are reviews, not learning sessions. Going unprepared to a review
is not high-yield. Also, the reviews aren't intended to be learning sessions. For
every question that is asked, that is one less case the others will see.
Take advantage of the fellows who are hanging around. Their memory of the
oral boards is fresh in their mind, and they know what to emphasize.
During the last month, I enlisted anyone and everyone to practice with me, taking 10-12
cases in a row. This is key. It is what you will be doing in Louisville, and I highly
encourage it. Its important that you get practice at doing this, and get to where youre
doing cases fast.
One word of advice that a reviewer provided: be careful with recalls, as they may
prejudice you into seeing something thats not really there. This happened to me during
one of the early review sessions, and its a good lesson to learn. Its OK to have an idea
of what has been shown, but take each case on its own.
Approach:
Gunslinger?
Modality description
Terminology
History-directed discussion
Discussion:
Finding characterization
Appropriate associated findings
Positive / negative findings
Mention extra topics ? extra quizzing
Appropriate recommendation of other imaging
Differential:
Knowledge base:
Of #1 differential
Of differential
Overall:
Degree of confidence
Safe patient management
Boardsmanship
The following is a compilation of advice given by various board examiners and fellows
while doing the review sessions. Take it for what its worth. In retrospect, most of these
admonitions were right on the money:
Confine your discussion to the findings -- some cases you should respond to
quickly (ruptured AAA).
Base your ddx on the images before you. Listing everything it could be shows
memorization and insecurity rather than a focus on the case at-hand.
The whole idea is to recognize the findings, describe them, and synthesize them
into a reasonable ddx.
Speak Up!
Put the last case behind you. Concentrate on the case in front of you.
Get all you can from the plain films before requesting an additional study.
Think of the oral boards as a series of small speeches -- when you make a finding;
be prepared to give a little talk.
Avoid the tendency to shotgun, especially if youre doing well. Take each case on
its own merit according to your own game plan.
Say what you think the diagnosis is on the initial study. Then request a specific
study to confirm what you think the diagnosis is (i.e. sagittal knee T2 with kissing
contusions, then get PD image to evaluate ACL). If your finding is not confirmed
on the subsequent exam, go back to the original study to look again for additional
findings.
Be as descriptive as you can. Make all the findings before launching into your
ddx.
Say what you think it is first. What do you want to see? Make a directed request
for an additional study. Dont ask, Do you have any additional images? Ask for
the specific study you want to see and why you want to see it.
If you dont see a finding, describe as much as you can. Then you can say, At
this point, I would check clinical indication for exam and request additional
studies accordingly.
Ignore the obvious finding at first. Do a quick search for secondary signs which
may help you narrow the differential of the major finding (e.g., myxopapillary
ependymoma).
Know discriminators (if the patient has pain, think pseudotumor). Also refer to
Helms MSK book (Fundamentals of Skeletal Radiology by Helms, C., 2nd ed.,
Elsevier Science, St. Louis, 1994.).
Correlate anatomy with what you are studying. Some of the questions (your first
few images in ultrasound -- guaranteed) are nothing more than straight anatomy.
Know sagittal anatomy of brain.
Make a targeted differential diagnosis for a specific age group -- let the examiner
see why you are saying something (if this patient has a history of recent travel, I
would be concerned for schistosomiasis). Give information to justify the category
of disease you are considering.
The orals are mainly about pattern recognition, and less so on the
pathophysiology and details of a disease process.
When taking a nuclear case such as a bone scan, recommend plain film or clinical
correlation. Always have a cxr when looking at a VQ scan.
If you think youve got it, give the ddx, and stop talking.
Wilms tumor mets: The way to get a definitive diagnosis is percutaneous biopsy.
Show you can manage the patient and that you are already thinking about the
patient clinically. Recommend percutaneous biopsy, cystoscopy, etc.
If you use the category of neoplasm, how would you prove it? If it is not a
neoplasm, what else could it be? Usually go for neoplasm last, so as to not forget
about the other categories (e.g., vascular, inflammatory, etc.).
Words to avoid: dilatation (use dilation); serpentine (use serpiginous); IVP (use
IVU). Delete the phrases It appears and I guess from your vocabulary. It makes
you sound weak. The examiners are looking for (and will grade you on) your
confidence.
If a case comes up and you know what it is, be inwardly joyous but outwardly
humble. Walk through it logically, and score as much as you can.
You arent scoring points if youre not talking. If finished, wrap up, and look up.
You must offer management. You get extra points if you do so.
Start taking cases now and cultivate these habits, as anyone will tell you that the bad
habits you have will surface under the pressure of the oral exam. Get them out of your
system sooner rather than later. Do it in morning conference rather than in front of the
person who wrote the textbook.
Sit on the front half of the chair, feet flat on the floor, and sit forward.
When the first image comes up, repeat the section you are in to yourself.
Give yourself a full five seconds to evaluate the image before speaking.
Describe the study type, contrast used, part of the body, and projection.
Be as descriptive as possible.
Be systematic.
Do not act like a gunslinger, even if the answer is screaming out at you.
If you dont see a finding, start by examining the image and describing what you do
see.
Only make pertinent positive and negative statements that you may wish to expound
on.
Copyright 2004 AuntMinnie.com
Start your diagnostic diagnosis with the most likely diagnosis. Only give a few
possibilities.
Support each diagnosis with a confirmatory statement (i.e., If the patient has
an elevated white count, I would favor PID. If the Beta is positive, I cannot
exclude an ectopic).
If you would like to confirm or look for additional findings with another modality,
suggest what you would normally do and what you expect to see on that study. The
examiner may put up that study.
If you screw up a case, let it go. Concentrate on the case before you.
Examiners tend to start with an easier warm-up-type case and then move to harder
cases.
Many of the cases are the largest or worst case of X that you have ever seen -believe it. The ABR does not want this to be an eye test, so if it is the right
location, age group, and imaging appearance, go with your gut.
Practice the no-feedback rule. The cases will come down, and you wont
know whether or not youre right. It is unnerving but will prepare you for the
lack of positive or negative reinforcement you normally anticipate in boards.
If you are let out before the first bell, you have definitely passed. Examiners
are required to show you as many cases as possible if you are on the verge of
conditioning/failing.