Flip it!

RSNA 2019

Flip it! FINAL.pdf

RSNA 2019

On this page, you will find examples of the different techniques and technological tools to create highly engaging, interacte cases for your educational conferences!

While it can be more work up front to learn the technology and prepare these cases, ultimately it is more relaxing and enjoyable for the presenter because it allows you to simulate workstation-style teaching in the conference setting. The images to speak for themselves, rather than emphasizing your selection and commentary on key images.

TIP: open the presentation in a separate tab by clicking the right hand corner icon, + to zoom.

PRESENTER-DRIVEN TOOLS

Flip it movie.mp4

Embedded video clips

Short video clips such as this one of polycystic liver and kidney disease can be embedded into a PowerPoint presentation, and simulate a PACS scrolling experience.

Video clips convey much more imaging features than a few fixed, key images.

Usually the progress bar can be manually dragged from right to left, which allows the presenter more control over how the case is displayed.

This example was created quickly by exporting a DICOM to movie file in Horos. Several PACS allow direct export to movie files, which may be more convenient for some users than manipulating DICOM files.

Flip it scrollable powerpoint.pptx

Scrollable PowerPoint Cases

This case will scroll similar to a PACS station with the middle scroll wheel when opened in PowerPoint (it will not work in the web viewer, but you can download the file on a personal computer for review).

I use this case in a medical student lecture. I scroll through the axial images on the left, and place a key static image in the coronal plane on the right for reference. Using the small links at the bottom (PREV/NEXT) I can quickly jump to the next slide.

On the following slide, I scroll through the coronal images and place annotated key, static image of the axial on the right.

While scrolling through the case, I can ask about key anatomy and findings in an interactive, engaging fashion.

Showing cases this way conveys a tremendous amount of information and provides many more opportunities to point out subtle nuances that would be difficult to show in single images. Try it out!

Radiopaedia Cases

Radiopaedia provides an excellent platform for web-based image review. You can present individual cases or create a playlist with several cases, and present these cases in a separate browser window during case conferences as "unknowns".

Radiopaedia cases allow you to scroll through a case, simulating a PACS/workstation teaching session, while supplementing the case with didactic teaching points. There is a great wealth of questions that can be asked when showing a full case.

Next level: The same cases can be shared with the attendees via weblink, QR code, or email before the conference. Each person can access and scroll through the case while you deliver the teaching points. This gives each member an opportunity to interact with the case and take their learning to the next level whether beginning or advanced (and closer to making independent diagnoses!).

Tip: You can hide the diagnoses of the case by selecting "Share" -> "Case/Playlist with hidden diagnosis".

Tip: Select "Share" -> "Full screen mode" to open a PACS-like image viewer.

Example case

Example playlist

LEARNER-DIRECTED TOOLS

HINT: Left click + Drag to scroll through the case // select different series by clicking the 4 boxes in the upper left

Pacsbin DICOM viewer

This is the most sophisticated, robust, and frankly my favorite educational tool that exists in radiology today.

Pacsbin is a web-based anonymized DICOM viewer that simulated a PACS environment and allows both the presenter (and more importantly) the attendee to access full, DICOM cases in the didactic setting. They can use laptops, tablets, or phones to review cases. The phone interface is fantastic and intuitive.

For the beginning learner, getting used to the core features of a PACS viewer is an essential step to understanding radiology and becoming a savvy orderer, reviewer, and presenter of radiology images. Nearly every speciality will have opportunities to present radiology images to their patients, and this gives them an opportunity to learn the basics early on.

On my website, I have built Abdominal CT 101 and the UW Radiology-Pathology archive using Pacsbin. Abdominal CT 101 contains a detailed explanation on how to use the viewer.

Example case 1

Example case 2

HINT: Left click + Drag to scroll through the case // select different series by clicking the 4 boxes in the upper left

How to use Pacsbin in the lecture setting

There are several ways to incorporate Pacsbin into lectures. One way that has been successful for me is in an introductory medical student course called Acute Care GI.

I post a list of sequentially challenging cases on my website and ask the students to access them with their personal devices (laptop, tablet, or phone). The phone interface is fantastic, and extremely intuitive to scroll and window/level with fingers. I give the students 2 minutes to review the cases and encourage them to help each other out.

After 2 minutes, I scroll through the case on the projector, asking them questions and providing appropriate explanation and teaching points along the way.

We start with "Find the normal appendix!", which is a fun and humbling beginning that helps the students to realize just how much there is to learn in radiology, as often only about half of the class can find it. Below is a listing of the cases that I post for the lecture. These could also be shared via QR code or email before or during the conference.

Radiopaedia cases/playlists

Radiopaedia cases and playlists can be shared in a similar fashion to that described for Pacsbin above. You may find it more conveninent to use Radiopaedia cases becasue you do not have much experience exporting, preparing, and uploading cases to Pacsbin or Radiopaedia. Therefore, you could leverage the existing enormous case archive of nearly 35,000 cases.

As an example, let's say you are giving a lecture on Peptic Ulcer Disease. A full-screen playlist could be shared with the lecture via weblink or QR code. The presenter can give the attendees 2 minutes to review the case, after which he or she scrolls through the case in front of the group, reviewing key teaching points. Each case could be supplemented with key teaching points provided on separate PowerPoint slides.

However, many presenters prefer to use their own material, and therefore learning how to export and upload cases would likely be a valuable long-term goal if you have interest in creating interactive didactic material.

I personally take a combined approach on my website. I enjoy posting cases on Radiopaedia because of the durable education value (it will forever be available and searchable) reaches an enormous global audience (15 millions people each year).

But I prefer to use Pacsbin in the lecture setting because of the robust and flexible DICOM viewer. You cannot zoom/pan, annotate, window level, or triangulate in Radiopaedia. Therefore, if there is a finding on liver window, you will need to make sure that is uplaoded as separate series, which can become cumbersome to prepare in advance.

How I do it - my personal preferences

Personally, I like to use the resources above with the following workflow:

  • Continually collect educational cases and build teaching library during the normal workday
  • Export anonymized cases from PACS in DICOM format
  • Organize DICOM case library with Horos (free, open source version of Osirix)
    • Horos is truly amazing free software that functions as a full PACS and also allows very flexible export of images for teaching purposes...I love it!
  • In Horos, I can create new series and adjust window level settings for export
    • Scrollable powerpoint - export to JPEG
    • Pacsbin - export to DICOM, then upload using Pacsbin's web interface
    • Radiopaedia - using the built-in uploader
  • Whenever possible, I prefer to incorporate interactive cases into lectures using Pacsbin, supplementing them with didactic material
    • Cases are posted on my website or made available via QR code in the lecture format