Virtual elective: Abdominal CT

Introduction

During these unprecedented times, many students and trainees are looking for ways to supplement their education as radiology rotations have shifted off-site and clinical services may have lower than usual volumes due to many non-emergent examinations being deferred.

This page is for medical students, residents, and fellows who are looking to simulate an Abdominal CT elective rotation. The material is of varying difficulty and depth that will be applicable for all learners. Each day will have goals relevant for medical students, residents, and fellows divided into beginning and advanced learner groups. Day 5 is test day, with both beginner and advanced versions. Beware, the advanced test has many challenging cases, so bring your A-game!

Start with the pre-test to test your knowledge and identify potential weak areas!

A few techical comments: the DICOM viewer works best on Chrome or Safari (not Internet Explorer). If you have a tablet in addition to a laptop or multiple monitors, you may find it handy to use one to view the studies and the other to make notes on the checklists and reporting templates that I provide below.


Day 1: CT anatomy and search pattern

Everyone can benefit from anatomy and search pattern tune-ups. Up to 60-80% of radiologist's errors are perceptual - that is, when we don't see something that we should have, and understandinig basic anatomy forms the foundation for identifying important abnormalities. This lesson reviews an annotated abdominal CT search-pattern atlas that emphasizes the practical way that I review every abdominal CT scan that I read.

Syllabus:

Objectives for beginning learners:

  • Recognize abdominal CT anatomy in both axial and coronal planes. In particular, take your time reviewing this CT by going through the detailed anatomy checklist.
  • Understand the importance and basic structure of a search pattern and how that forms the basis for dictating a radiology report.
  • Understand the basic functions of a PACS workstation including organizing the images into different layouts, changing window/level settings, basic annotation, measuring ROI, and triangulation.

Objectives for advanced learners:

  • Review key abdominal CT anatomy in both axial and coronal planes. In particular, make sure you are comfortable identifying every structure on the detailed anatomy checklist.
  • Increase your understanding of anatomic relationships by reviewing all of the anatomy in the coronal plane - this will increase your brain's understanding of the 3-dimensional anatomy and is an important safety net for abnormal findings that are challenging to see in the axial plane.
  • Refine your own search pattern:
    • Do you follow the same search pattern for every case? Why or why not?
    • Are there any structures or areas that you frequently overlook that you need to "add back" to your serach pattern?

Day 2: Abdominal CT 101

Abdominal CT 101 is a collection of full DICOM cases of essential diagnoses for understanding abdominal CT. There is particular emphasis on acute abdomen in an emergency room setting. Read the instructions in detail on the linked page for how to use the DICOM viewer, and don't forget that each case is fully annotated and has detailed notes that can be accessed by clicking the "blue paper icon" in the upper right hand corner.

Syllabus:

Objectives for beginning learners:

  • Reinforce the key anatomy and search pattern basics that you learned on day 1 as you review each of the cases
  • Build your radiology vocabulary: practice speaking like a radiologist! Try describing what you see as if explaning the case to someone on the phone, and compare that with the descriptions that I provide for each case.
  • Understand the bigger picture: determine the best management plan for each patient before reading the study notes.

Objectives for advanced learners:

  • Build your radiology vocabulary by identifying and summarizing the key findings before reading the study notes as if dictating a radiology report
  • Improve the clarity and conciseness of your communication: The ED just called! Give a one-two sentence summary with (1) the diagnosis, (2) the key findings supporting that diagnosis, and (3) your recommendations for management - in that order and free from radiology jargon.
  • Expand your differential diagnoses: even if the case is classic, try to think of 1-2 other possible diagnoses or variations that might be considered. For example, for the case of interstitial pancreatitis, what imaging features would make you concerned about autoimmune (igG4-related) pancreatitis? How would you distinguish or rule out these possibilities?
  • Who are you going to call? Refine your recommendations by determining the best management plan for each patient before reading the study notes.

Day 3: Cancer

Cancer imaging is a core aspect of abdominal radiology, and considering the abundance of different organ systems, a lot of different cancers can happen! Theses cases emphasize new cancer diagnoses. Review the basic reporting template and consider using it (or a version of it) when working through these cases. As you work through the cases for the next two days, in addition to growing your diagnostic acumen you will also be working on developing your radiology vocabulary and reporting skills.

Cases will now be reviewed in Radiopaedia viewer, which presents them in a sequential fashion. Please note that there is a "Findings" tab on the image viewer which will detail the key findings, with a discussion to follow. Intermediate or advanced learners will benefit by taking these cases as unknowns and trying to determine the diagnosis before reviewing the findings and discussion.

Beginning learner's syllabus:

Objectives for beginning learners:

  • Continue to reinforce the key anatomy and search pattern basics that you learned on day 1 as you review the cases
  • Continue to practice speaking like a radiologist! How would you describe this to a colleague on the phone? Try putting what you see into words, and compare that with the descriptions that I provide for each case.
  • Understand the varied appearance of cancer in the abdomen and pelvis including masses, adenopathy, organ infiltration, and peritoneal disease.

Advanced learner's syllabus

Objectives for advanced learners:

  • Test your knowledge by taking each case as an unknown before reviewing the findings and discussion, and refine your radiology reporting by recording the following for each case (as on the reporting template):
    • Key findings
    • Favored diagnosis
    • Differential diagnosis
    • Recommendations for tissue sampling in order to reach a diagnosis
  • Improve the clarity and conciseness of your communication: The oncologist is on the phone! Practice giving a one-two sentence summary in standard medical language of (1) your favored diagnosis, (2) the key findings supporting that diagnosis, and (3) your recommendations.

Day 4: Trauma

Another essential aspect of abdominal radiology is trauma imaging. Radiologists play a key role in rapidly identifying injuries and determining next steps in management (surgery, vascular intervention, or observation).

Cases will now be reviewed in Radiopaedia viewer, which presents them in a sequential fashion. Please note that there is a "Findings" tab on the image viewer which will detail the key findings, with a discussion to follow. Intermediate or advanced learners will benefit by taking these cases as unknowns and trying to determine the diagnosis before reviewing the findings and discussion.

Beginning learner's syllabus:

Objectives for beginning learners:

  • Continue to reinforce the key anatomy and search pattern basics that you learned on day 1 as you review the cases
  • Continue to practice speaking like a radiologist! How would you describe this to a colleague on the phone? Try putting what you see into words, and compare that with the descriptions that I provide for each case.
  • Understand the bigger picture - do you think the patient need to go to surgery? Determine the most appropriate next steps in management for each case.

Advanced learner's syllabus

Objectives for advanced learners:

  • Test your knowledge by taking each case as an unknown before reviewing the findings and discussion, and refine your radiology reporting by recording the following for each case (as on the reporting template):
    • Key findings
    • Favored diagnosis
    • Differential diagnosis
    • Recommendations for tissue sampling in order to reach a diagnosis
  • Improve the clarity and conciseness of your communication: The trauma surgeon is on the phone - give a one-two sentence summary in standard medical language of the key injuries with pertinent postives and negatives with your recommendations.

Day 5: Test

This collection of beginner and advanced test cases are meant to apply and test your knowledge. These are separate tests with different cases for beginning and advanced learners, so feel free to take them both. The beginner's test will largely focus on diagnoses already covered, whereas the advanced test will include new diagnoses and will have several very challenging cases. The emphasis is on acute presentations to the ED with a variety of diagnoses covered. If you don't know the diagnosis for sure, don't worry! That is real life, and what matters most is your ability to make appropriate recommendations. For each case try to come up with a favored diagnosis, differential diagnosis, and recommendations for next steps for management.

Beginning learner's syllabus:

Objectives for beginning learners:

  • Continue to reinforce the consistent use of your search pattern by evaluating each case in the same, systematic way
  • Improve the organization of your thoughts and communication skills by creating a cohesive, straightforward impression that can be readily communicated with the ordering provider

Advanced learner's syllabus

Objectives for advanced learners:

  • Continue to reinforce the consistent use of your search pattern by evaluating each case in the same, systematic way
  • Improve the organization of your thoughts and communication skills by creating a cohesive, straightforward impression that can be readily communcated with the ordering provider

Congratulations!

You've completed the abdominal CT virtual elective!

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