Radiology Frameworks

Module 1: Prologue

Chest X-Ray, CT, or MRI?

In this talk, we focus on choosing the most suitable chest imaging study among X-rays (CXR), CT scans, and MRIs. CXRs are fast, accessible, and useful for conditions like tube placement, pleural effusions, and fractures but may be insufficient in the setting of trauma, aortic dissections, or metastases as their ability to characterize anatomy is limited by their 2 dimensional nature. CT scans permit 3D visualization of anatomy but involve radiation exposure and are costlier. Different types of CTs cater to various needs, and choosing the right one depends on clinical circumstances. MRIs excel in soft tissue differentiation and don't use radiation, but have limitations with metal implants, certain organs, and take longer. Overall, each imaging modality has strengths and limitations, and understanding their utility is crucial for appropriate patient care.

Module 1: Prologue

Portable CXRs in Patients with Shortness of Breath

In this talk, we review the crucial role of portable chest X-rays (CXRs) in managing inpatients experiencing respiratory distress, and how CXRs are a valuable diagnostic tool for narrowing down the differential diagnosis. We emphasize how CXRs complement other diagnostic exams, outline their capabilities and limitations in the inpatient setting, and review key imaging features indicative of common causes of inpatient respiratory distress. Our talk concludes by highlighting additional diagnostic tests like EKG and ABG and outlining potential interventions based on the identified causes of respiratory distress.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD

Module 1: Prologue

The Reason behind Different Zonal Distributions of Lung Diseases

Armed with a basic understanding of pathophysiology and how well ventilation, blood perfusion, and lymphatic clearance work in different regions of the lungs, you can have a much better shot at remembering or making educated guesses about the geographic distributions of many lung diseases you’ll encounter.

Companion Anki Deck for this talk:
https://ankiweb.net/shared/info/1825406403

Module 2: CXR

Portable Chest X-Ray: Basic Technical Concepts

Learn the in’s and out’s of portable x-ray equipment and techniques, conventional and digital radiography technologies, and how a portable chest x-ray is performed at a patient's bedside.

Module 2: CXR

How to Assess CXR Image Quality & Adapt Your Read

In this discussion, we unravel the factors that influence chest x-ray image quality and provide helpful insights into quality assessment and adapting your CXR interpretation in the setting of suboptimal image quality.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD

Module 2: CXR

How to Read a Chest X-Ray: The Lungs

In this talk, we explore the approach for interpreting chest x-rays, specifically focusing on the lungs. You'll learn how to handle common abnormalities like consolidation, atelectasis, interstitial opacities, lung nodules, and pulmonary vascular congestion.

Module 2: CXR

How to Read a Chest X-Ray: Mediastinal Lines, Stripes & Interfaces

When interpreting frontal chest x-rays, mediastinal lines, stripes, and interfaces can serve as soft markers for an underlying disorder in the medial lung/pleura, mediastinum, or left atrium.

Module 2: CXR

How to Read a Lateral Chest X-Ray

The lateral chest radiograph is an imaging study that can be challenging to both the novice or seasoned radiologist. Learn the anatomy that lurks within the lateral chest radiograph, and tips on how to read them with aplomb.

Module 3: CT

How to approach Chest Radiology

There are many approaches to developing a practical working knowledge and approach to chest radiology in your first year of radiology residency. This first presentation is an introduction to a feature-based approach to understanding chest radiology and a simple approach to lung opacities.

Companion Anki Deck for this talk:
https://ankiweb.net/shared/info/1278543249

Module 3: CT

How to Read a Chest CT

When radiologists read a chest CT (computed tomography), we follow a systematic approach to evaluate the images and provide an accurate interpretation.

Module 3: CT

CT Imaging: Basic Technical Concepts

Computed tomography (CT) imaging utilizes various scanning and presentation parameters to generate detailed cross-sectional images of the body. Adjusting these parameters is a balance between image quality and radiation dose. Radiologists and technologists carefully optimize these parameters based on the clinical needs of each individual patient, aiming to achieve a balance between diagnostic image quality and minimizing radiation exposure.

Module 4: Atelectasis/Consolidation

Atelectasis

Atelectasis is a condition in which the lung or a part of it collapses and does not expand properly during breathing. There are several forms of atelectasis, each with its own set of causes, and its treatment may require addressing the underlying cause.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD
Companion Anki Deck for this talk:
https://ankiweb.net/shared/info/1049086273
Suggested CaseStacks.com cases:

Module 4: Atelectasis/Consolidation

Acute Consolidation

Although the differential diagnosis for acute focal and multifocal consolidation can be approximated with the traditional mantra of “blood, water, pus”, consider this more nuanced differential diagnosis that isn’t too much more tougher to remember.

Module 4: Atelectasis/Consolidation

Diffuse Consolidation

The differential diagnosis of symmetric diffuse lung consolidation is heavily weighted towards two diagnoses. Understand how this can improve your diagnostic accuracy, and learn when to look for other causes.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD
Suggested CaseStacks.com cases:
https://www.casestacks.com/chest/chest-ct/practice/case-13/
https://www.casestacks.com/chest/radiographs/lung/classic-case12/
https://www.casestacks.com/chest/radiographs/practice-cases/case30/

Module 4: Atelectasis/Consolidation

Chronic Consolidation

The differential diagnosis for chronic focal or multi-focal consolidation diverges from the traditional mantra of “blood, water, pus”. Learn the diagnoses you need to keep in mind.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD

Module 5: Nodules

Nonspecific Lung Nodules & Masses

The overwhelming majority of lung nodules and masses we encounter are non-specific, frequently requiring imaging follow-up and often other work-up. Learn how to approach and manage this common imaging finding on chest x-ray and chest CT.

Module 5: Nodules

Specific Lung Nodules & Masses

Sometimes the appearance of a lung nodule or mass is so specific, that there is no differential diagnosis. Learn about 9 diseases that can sometimes manifest as a specific lung nodule or mass, and how to interpret them on chest CT.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD
Suggested CaseStacks.com case:
- https://www.casestacks.com/chest/radiographs/practice-cases/case1/

Module 5: Nodules

Distinguish Malignant vs. Benign Lung Nodules

Distinguishing between malignant and benign lung nodules on CT imaging is a critical task in clinical practice. Although it requires expertise and careful evaluation, there are some key features and considerations that can help differentiate between the two.

Module 6: Interstitial/GGO

Reticular & Septal Interstitial Patterns

Learn how to approach interstitial opacities when they present in a reticular or septal pattern. Better understand your role in the diagnosis of idiopathic pulmonary fibrosis in the multidisciplinary setting.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD and Joseph Azok, MD
Suggested CaseStacks.com cases:
https://www.casestacks.com/chest/chest-ct/nontraumatic/case-14/
https://www.casestacks.com/chest/chest-ct/practice/case-1/
https://www.casestacks.com/chest/chest-ct/practice/case-11/
https://www.casestacks.com/chest/chest-ct/practice/case-29/
https://www.casestacks.com/chest/radiographs/lung/classic-case13/
https://www.casestacks.com/chest/radiographs/lung/classic-case22/
https://www.casestacks.com/chest/radiographs/pleura/classic-case9/
https://www.casestacks.com/chest/radiographs/practice-cases/case25/

Module 6: Interstitial/GGO

Nodular Interstitial Patterns

Nodular interstitial patterns, such as centrilobular, perilymphatic, random, tree-in-bud, and bronchovascular patterns, can be tricky to interpret. Understand their pathophysiology and learn a practical approach for how to approach them. Learn how the presence of calcification can help you reach a diagnosis even quicker.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD
Suggested CaseStacks.com cases:
https://www.casestacks.com/chest/chest-ct/nontraumatic/case-3/
https://www.casestacks.com/chest/chest-ct/nontraumatic/case-4/
https://www.casestacks.com/chest/chest-ct/practice/case-32/
https://www.casestacks.com/chest/chest-ct/practice/case-33/
https://www.casestacks.com/chest/radiographs/lung/classic-case20/

Module 6: Interstitial/GGO

Isolated Ground-Glass Opacities

The differential diagnosis for ground-glass lung opacities is extremely broad. However, when they occur in relative isolation, the differential diagnosis becomes more tractable. Learn the trick for diagnosing isolated ground-glass lung opacities with relative specificity.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD
Suggested CaseStacks.com cases:
https://www.casestacks.com/chest/chest-ct/trauma/case-1/
https://www.casestacks.com/chest/chest-ct/nontraumatic/case-14/
https://www.casestacks.com/chest/chest-ct/practice/case-1/
https://www.casestacks.com/chest/chest-ct/practice/case-9/

Module 7: Lung Infection

Pneumonia / Lung Infections

Review the different ways lung infections can present on imaging, a practical method for categorizing lung infections, and what the role of medical imaging is in their diagnosis.

Module 7: Lung Infection

Viral Respiratory Tract Infections

Delve into the world of respiratory tract infections with this comprehensive guide, tailored for medical professionals and curious minds alike. In this talk, we review the anatomy of the respiratory tract, unravel the diverse symptoms and signs of various respiratory tract infections, and delve deep into the imaging findings that aid in diagnosis.

With a special focus on viral respiratory tract infections, particularly viral pneumonias, we explore how these conditions manifest on imaging studies. From understanding their characteristic features to discussing the nuances of diagnosis and treatment, we leave no stone unturned in demystifying these common infections.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD.

Module 7: Lung Infection

Tuberculosis Basics

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. The disease primarily affects the lungs but can also affect other parts of the body. This talk provides an overview of how tuberculosis infections proceed and the role of chest radiographs in their diagnosis.

Suggested CaseStacks.com case:
https://www.casestacks.com/chest/chest-ct/nontraumatic/case-10/

Module 8: Lung Cancer

Lung Cancer Types

Review the differences between various primary lung cancers, in addition to metastatic cancers to the lung. Learn the practical impact of different lung cancer types and why they present the way they do. Understand the different imaging presentations of lung cancer.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD.

Module 8: Lung Cancer

Lung Cancer Staging

After a lung cancer is diagnosed, describing the extent of lung cancer spread (staging) is crucial to establishing prognosis and guiding treatment planning. Learn how lung cancers are staged with medical imaging, and what you can provide in your interpretation to make staging more accurate and efficient.

Module 8: Lung Cancer

Staging Lung Cancer using the IASLC Lymph Node Map

The International Association for the Study of Lung Cancer (IASLC) lymph node map is a standardized system used to describe the location of lymph nodes in the chest. It's widely used in the diagnosis, staging, and treatment of lung cancer.

Module 8: Lung Cancer

Lung Cancer Treatments: Surgery / Radiation

A comprehensive overview of the most common non-pharmacological therapies for lung cancer: pneumonectomy, lobectomy, segmentectomy, wedge resection, and radiation therapy. Learn what to expect on post-treatment imaging, and what to look out for.

Module 8: Lung Cancer

PET/CT Basics

Medical imaging studies can be divided into structural vs. functional modalities, with PET imaging being a common functional modality used in daily practice. PET imaging involves introducing positron-emitting radiotracers into the body and acquiring three-dimensional image maps of their distribution, which can help diagnose various conditions by highlighting abnormal metabolic processes. FDG-PET/CT imaging is particularly useful in oncology for detecting abnormal glucose uptake associated with cancer, although its effectiveness can vary across different cancer types and it may produce false positives or negatives due to various physiological and pathological factors.

Module 9: Airway Diseases

Tracheal Disorders & Bronchiectasis

A review of large airway disorders, focusing on bronchiectasis and tracheal strictures, tracheal tumors, diffuse tracheal disorders with and without associated wall thickening.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD
Suggested CaseStacks.com cases:
https://www.casestacks.com/chest/chest-ct/trauma/case-6/
https://www.casestacks.com/chest/chest-ct/nontraumatic/case-20/
https://www.casestacks.com/chest/chest-ct/practice/case-7/
https://www.casestacks.com/chest/chest-ct/practice/case-22/
https://www.casestacks.com/chest/chest-ct/practice/case-25/
https://www.casestacks.com/chest/chest-ct/practice/case-37/
https://www.casestacks.com/chest/radiographs/lung/classic-case23/
https://www.casestacks.com/chest/radiographs/practice-cases/case50/

Module 9: Airway Diseases

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a widespread lung disease closely tied to cigarette smoking and exhibits 5-year survival rates that are actually worse than many cancers. Understand how COPD develops, its phenotypes (chronic bronchitis, obstructive bronchiolitis, and emphysema), its relationship to asthma, and how it's managed. Review the imaging features of COPD and 5 disorders correlated with COPD.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD.

Module 9: Airway Diseases

Cystic & Other Hyperlucent Lung Disorders

Lung parenchyma may appear hyperlucent in the setting of emphysema, cystic lung disease (acquired or congenital), hyperinflation, or hypoperfusion. Learn a practical approach to organizing and diagnosing this presentation.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD.
Suggested CaseStacks.com cases:
https://www.casestacks.com/chest/chest-ct/nontraumatic/case-8/
https://www.casestacks.com/chest/chest-ct/nontraumatic/case-17/
https://www.casestacks.com/chest/chest-ct/practice/case-9/
https://www.casestacks.com/chest/chest-ct/practice/case-29/
https://www.casestacks.com/chest/chest-ct/practice/case-33/
https://www.casestacks.com/chest/chest-ct/practice/case-35/
https://www.casestacks.com/chest/radiographs/lung/classic-case19/

Module 10: Mediastinal/Hilar

Anterior Mediastinal Disorders

The differential diagnosis for anterior mediastinal masses are much more than the “four T’s”. Learn a practical strategy for interpreting anterior mediastinal masses, and how to manage their workup.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD.
Suggested CaseStacks.com cases:
https://www.casestacks.com/chest/chest-ct/trauma/case-7/
https://www.casestacks.com/chest/radiographs/practice-cases/case11/
https://www.casestacks.com/chest/radiographs/practice-cases/case46/

Module 10: Mediastinal/Hilar

Middle Mediastinal Disorders

A comprehensive overview of middle mediastinal disorders: central veins, pulmonary arteries, thoracic aorta, esophagus, lymph nodes, and bronchopulmonary foregut malformations.

Module 10: Mediastinal/Hilar

Posterior Mediastinal Disorders

The posterior mediastinum is the portion of the mediastinum posterior to the anterior spinal margin. Posterior mediastinal masses are generally either neurogenic or vertebral in origin. Learn how to approach their diagnosis.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD.

Module 10: Mediastinal/Hilar

Hilar Disorders

The hila consist of central pulmonary arteries, central pulmonary veins, central bronchi, and hilar lymph nodes. Learn how to approach abnormalities of hilar size and hilar location, in addition to both intravascular and endobronchial disorders of the hila.

Some of the case images in this talk appear courtesy of Ahmed El-Sherief, MD.
Suggested CaseStacks.com cases:
https://www.casestacks.com/chest/chest-ct/practice/case-32/
https://w ww.casestacks.com/chest/radiographs/mediastinum/classic-case10/
https://www.casestacks.com/chest/radiographs/practice-cases/case26/

Module 11: Extrapulmonary

Pleural Disorders

Pleural disorders can be conveniently organized by phase of matter: pneumothoraces, pleural effusions, and pleural thickening/mass. Familiarize yourself with the spectrum of their appearances on CXR and CT, in addition to possible associated disease states.

Module 11: Extrapulmonary

Chest Wall & Diaphragm Disorders

Familiarize yourself with congenital and acute disorders of the chest wall. Review soft tissue and bone tumors that may occur in the chest wall. Recognize various causes and appearances of diaphragmatic hernias and elevation.

Module 12: Best Practices

Diagnostic Errors in Radiology

Radiologists are trained medical professionals who specialize in interpreting medical images such as X-rays, CT scans, MRI scans, and ultrasounds to diagnose and treat medical conditions. Despite their expertise, radiologists can occasionally make errors when reading imaging studies due to a variety of reasons. It’s important for healthcare providers and radiologists to understand how these errors occur and what steps they can take to mitigate the risk of error.

Module 12: Best Practices

Create More Effective Radiology Reports

In this talk, we explore why and how radiology reports can sometimes be challenging to read and decipher. If you write radiology reports, we’ll help you become better acquainted with some practices that can make your reports easier for others to interpret. If you read radiology reports, we’ll help you develop a better understanding of the things going on behind the scenes that influence how radiology reports get written the way that they do.