Reading Films

December 10, 2003

Dr. Karl

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!”

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