Opinions



Opinion The Who, Why and How of Radiology Teaching Files 1 Norman L. Martin, M.D. A variety of teaching files in diagnostic radiology is needed to serve a broad spectrum of purposes and students. A method of acquiring a simplified teaching file to be used for and by medical students, non-radiology house staff, first-year radiology residents and senior staff members is described. The medical student, as a learning experience, acts as the procurer of this file. INDEX TERMS:



Education, diagnostic radiology. Opinions. Radiology and radiologists

Radiology 119:489-490, May 1976

• One very effective way of rapidly accumulating a good student radiology teaching file is to use the medical student as the procurer of the file. This affords the student an excellent learning experience. Six to eight students a month rotate through our Diagnostic Radiology module. One of the requirements while the students are taking the module is to prepare cases for the student teaching file. The student rotates through the areas of general diagnostic radiology, neuroradiology, pediatrics, special procedures, nuclear medicine, GI radiology, GU radiology, ultrasound, thermography, mammography, and bone and joint radiology. He or she is asked to prepare, under the guidance of the senior radiology staff, a case each week that has come through the section in which he is rotating. Such a case must be a classic radiographic demonstration of normal anatomy and physiology or some disease process. Under the supervision of the attending senior staff in the area, the student pulls the diagnostic films from the patient's jacket and these films are copied. The copy films are placed in a separate jacket. The student is then required to write a brief summary on the front of the jacket of the patient's chief complaint and pertinent medical history, the positive physical findings, appropriate laboratory and other diagnostic studies which have been or should be performed, and a differential diagnosis. A brief discussion of the anatomy, physiology and pathological process involved and the roentgenographic findings seen in the particular case are also summarized. This material is then reviewed with the senior staff member for his approval before being placed in the student teaching file. This accomplishes a number of things: first, the student must read a number of texts and consult with the senior staff, regarding the disease process under discussion. It causes him to review not just the radiograph-

Diagnostic radiology has grown rapidly as a consultative service during the past few years. With this increasing expansion has come the awareness of the need for more formal education of medical students and non-radiology house staff in the proper use of this consultative service (2, 3, 4, 8, 10, 11). The ordering of proper examinations in the proper sequence; the time, expense, and patient preparation involved; the indications, contraindications, and limitations of procedures as well as patient experiences and reactions to various examinations have not been taught to our non-radiologist colleagues (6, 12). The recent radiological literature attests to the advisability and capabilities of radiologists being teachers of medical students and house staff in both the basic sciences and clinical medicine (5, 12, 13, 17). Numerous teaching techniques have proved efficacious (1, 7, 9, 14, 15, 16, 18). One significant problem that arises in teaching medical students, non-radiology house staff, and first year radiology residents is the acquisition of a student radiology teaching file. This file should have radiographs of normal anatomy and physiology and simple, straightforward, classic diseases with characteristic roentgenographic findings. The diagnostic radiology teaching file used by senior radiology staff and residents has many excellent cases, but many are diagnostically difficult, unusual or rare and esoteric. These films have been kept because of personal interests, findings that should be diagnosed by more senior radiology residents, or for use when reviewing for board examinations. Consequently, the very simple fracture or very large pneumothorax may not be found in an otherwise excellent senior staff radiology teaching file. This type of case, however, is very important for the beginning first-year radiology residents, medical students and non-radiology house staff.

1 From the Department of Diagnostic Radiology (N. L. M., Assistant Professor), University of Kansas Medical Center, Kansas City, Kansas. shan Accepted for publication in January 1976.

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being on the viewer's left. This is evident in the work of Ambrose (3), Baker (4), New (5), and Scott (6). In the body, the precedent has similarly been set by Schellinger (7) and Alfidi (8), wherein the images are viewed from above with the right on the viewer's right and the left on the viewer's left. If original precedents are sought, it can be shown that most cross-sectional texts of anatomy are depicted in the same fashion as described above. Standard textbooks of anatomy which display cross sections from above are Gray's Anatomy, Cunningham's Manual of Practical Anatomy, Eycleshymer and Shoemaker's A Cross-Section Anatomy, Pansky and House, Pernkopf's Atlas of Topographical and Applied Anatomy, Grant's Atlas of Human Anatomy as well as cross-sectional anatomy shown in Meschan's Atlas of Anatomy Basic to Radiology. A newly released body scanning unit is designed in a fashion which makes it necessary to view body sections from below. We are informed that this design was conceived so that CT images could be viewed in the same orientation as conventional radiographs. Although. this orientation is opposite to currently accepted central nervous system CT viewing, it does not lack proponents. With the advent of this latter orientation, a controversy is created. The problem is further complicated by the fact that several authors are currently preparing texts of CT anatomy. Until recently, it appeared unlikely that viewing of the central nervous system would change. If this were the case, it would certainly be incongruous to publish a text of anatomy with the central nervous system viewed from above and the remainder of the torso viewed from below. Very recently, however, certain members of the neuroradiological community have expressed a willingness to view the central nervous system from below (9). If this were generally accepted, it would necessitate switching virtually all existing CT units to the opposite orientation. Doubtless,a certain amount of confusion would be created. We naturally would prefer viewing from above. Regardless of the outcome of this controversy, we believe that all CT anatomy should be viewed in the same fashion, that is, the central nervous system and the torso be viewed from either above or below.

J.

MACiNTYRE

May 1976

CT RESOLUTION

Expression of CT resolution is probably best done in terms of modulation transfer function as cycles per centimeter. This expression presents a more complete and continuous description of the imaging characteristics than a step-function using finite-sized objects. Of greater interest than spatial resolution is perhaps the concept of "detectability" which would combine the characteristics of the smallest size object which can be identified along with the contrast necessary to visualize this object. There Will, no doubt, be an evolution of phantoms for CT use over the next several years. It is hoped that construction of a standard phantom will be accomplished so that a three-dimensional expression of spatial and contrast resolution can be accurately and efficiently determined in everyday clinical practice. Readers' comments on the opinions expressed here are invited. Department of Radiology Cleveland Clinic Cleveland, Ohio 44106

REFERENCES 1. Hounsfield GN: Computerized transverse axial scanning (tomography): part 1. Description of system. Br J Radiol 48: 10 16-1022, Dec 1973 2. Alfidi RJ, Macintyre WJ, Meaney TF, et al: Experimental studies to determine application of CAT scanning to the human body. Am J RoentgenoI124:199-207, Jun 1975 3. Ambrose J: Computerized transverse axial scanning (tomography): part 2. Clinical application. Br J Radiol 48:1023-1047, Dec 1973 4. Baker HL Jr, Campbell JK, Houser OW, et al: Computer assisted tomography of head. An early evaluation. Mayo Clin Proc 49:17-27, Jan 1974 5. New PFJ, Scott WR, Schnur JA, et al: Computerized axial tomography with the EMI scanner. Radiology 110:109-123, Jan 1974 6. Scott WR, New PFJ, Davis KR, et al: Computerized axial tomography of intracerebral and intraventricular hemorrhage. Radiology 112:73-80, Jul 1974 7. Schellinger D, Di Chiro G, Axelbaum SP, et al: Early clinical experience with the ACTA scanner. Radiology 114:257-261, Feb 1975 8. Alfidi RJ, Haaga J, Meaney TF, et al: Computed tomography of the thorax and abdomen; a preliminary report. Radiology 117: 257-264, Nov 1975 9. Kricheff I: Personal communication

The who, why and how of radiology teaching files.

A variety of teaching files in diagnostic radiology is needed to serve a broad spectrum of purposes and students. A method of acquiring a simplified t...
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