Internship & Residency
Reading Films
 |
|
Dr. Karl Newman
|
Correctly interpreted, imaging studies
can reveal a wealth of useful and otherwise unobtainable clinical data.
For the earnest house officer, there are few endeavors in
the academic curriculum more rewarding
than learning to properly read x-rays.
This month, Q Fever!’s I&R correspondent, Dr.
Karl Newman, waxes philosophic on his tips and tricks of: Reading
Films.
Yo! Welcome back!
Boy, are you a sight for sore eyes! And can I just say, you
are lookin’ FINE! Plus,
you’re just in time for one of my favorite subjects
- Radiology!
Now I know what you’re muttering.
You’re like, “Dr. Karl, why’zit I gotta learn me ta read da films,
when I got da radiologist gonna read dem fo’ me?”
Okay, first of all, quit talking
like that! What are you, a moron? Enunciate!
Second, consider this. Say
you’re on call. It’s 3:30 in the afternoon. You’ve got a
patient in the ER with a possible pneumonia.
You order up a chest x-ray. So far, so good, right? But now what? You’re
gonna show the radiologist? Dude, it’s 3:30 in the afternoon! They’re
gone for the day! So what now, Sherlock?
So you see what I mean? You’ve got
to be prepared for these situations, cuz’ they’ll happen a lot. Now
listen closely:
1) Get A Wet Read.
This is a good way to get a preliminary
report on those urgent studies that just can’t wait till 10 the next
morning when the radiologist shows up.
The procedure is simple. Bring the
film (or the computer monitor, if your center uses digital imaging)
over to the foot-operated sink and rinse thoroughly. Eventually you’ll
want to have the entire image submerged in at least eight inches of
water. It helps to use antibacterial soap, but be sure not to get fooled
by
that
godawful
hand conditioner they sneak in there sometimes.
Oh, for optimal results, you should
be wet too. Use the safety shower - that’s what it’s there for!
Now, and this is the important
part,
once both you and the film (or computer) are fully soaked, read the
film
right-to-left, as if you were reading a book in Hebrew or
Japanese.
[Note: it may help at this time to become fluent
in both Hebrew and Japanese so that you you know what I’m talking
about.]
Voila! The
Wet Read!
One caveat: while convenient
and downright pleasurable, these “wet readings” won’t
hold up in court. Take it from me, Bud.
2) Get The Right Gear.
This tip is more for those of you
have multiple films you have to review. For example, you’re an intern
with 20 patients on your census; when you’re down in the file room,
you may have to look at fifteen or more films on those patients. Obviously,
getting wet reads on all of them would be logistically difficfult,
not to mention potentially dangerous. But can you afford to spend half
an hour looking at all these studies?
Here’s the secret: Get a good pair
of X-Ray Goggles. I suggest the ones made by Acme
- they’re available from any comic book worth its salt. Most people
don’t
know
this, but
wearing these goggles
will allow you not only to see through clothing and walls, but
also to read a whole stack of films, all at once! Just think of
the time savings. Kinda boggles the mind, eh? But don’t thank me yet
... read on!
3) Look Da Part.
OK, you’re down in Radiology with
the team, and it’s time to put up or shut up. The
attending just put you on the spot. He’s all like, “Karl, what do you think
of this film?” And you’re thinking to yourself, “Oh shoot. Damn. Mudda.
No way. Nope,
no clue. Aw, fer Crissakes.”
Look, it happens.
You can’t be expected to know everything. But that doesn’t mean you
can’t make a good show of it. As Vince Lombardi said, “Just showing
up is 65% of winning, which isn’t everything. It’s the only thing.”
So do what I do: Tilt your head a
little. Get up a little closer to the film, look intent, then back
away from it. Get like ten feet back and tilt your head the other
way.
Then run back up, rip the film off the viewer, and scan it
with the brightlight. Make sure you maneuver the foot pedal
up and down a
few times
as
if you’re
seeing
something important. Put on the X-ray specs if you've got ‘em.
Slap the film back up onto the viewer and go “Hmmmph.”
Then, and only then, say:
“Normal.
This film is normal.”
Now you’re gonna want to distract
the attention of your team. Try the joke about getting a CAT scan on
your dog and a PET scan on your cat. While they’re
laughing uncontrollably, it’ll give you just enough time to make
your getaway! By the time you meet up with them later, they’ll have
moved on to more significant things than this one little x-ray reading.
After all, there are so many other more important things in
life.
Whooaaaa! Well,
that’s all for this month.
Give me a call one of these days, will ya? We’ll head out for GI cocktails.
Till then, ...
“Just
tell ‘em Dr. Karl sent ya!”
