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everybody. Welcome to the minor bleeds new weapon on radiology. So this is a finance savories basically covering what's junior doctors and the healthcare professionals need to know about radiology in the UK So this is our first episode. It's the introduce for radiology is like It's a specialty, introducing yourselves different types of scans on help to putting requests on discuss with radiology because cannot then be a source of anxiety for new doctors under the health care professionals. So delivering this first session is a doctor. And listen is one of the ST ones in Sheffield at the moment that she's going to be telling you about what radiology is like, how to request scans, help to talk to radiologist so and how to get most from that specialty. So this is the first part in this series. So after in the next coming weeks and months, we also will be covering chest X rays, mskube, plain films, abdominal and pelvic X rays and CT heads. CT abdomen does, and CT pelvis is a swell. So I will hand over to Lizzie. That's okay. Yeah, I said I am. Was the honesty one in radiology? So our then you've been doing this for just over a month. Uh, so too far up the advantage in the only a few months panels on the other side of stings. And I was a Well, I'm having to bring radiology and wondering why the house with me almost gone And why don't you get Scott and things like that? But now, being on the other side, I understand they eventually need to know why they need to know it on disses kind of the basis of this talk on. Just introduce you to the different types of stuns so that later in the Siris, when you are introduced, Teo interpreting them, you can kind of understand the indications a bit more. So today's talk I'll just go over the radiology department itself, who you might find there on the role of the radiologist within the radiology department. Like said, I'll go through the different types of scans briefly, Um, what they had Bunches and disadvantages of each gun type is and where we might use different skeletons on for different indications. There's a lot of indications with the skin, so it's not time to cover it. Also, just be just be the main bits and then finishing up will go through the kind of things that we're looking for on the scan request. The information is important to include the radio. Just, you know, knows we looking for a nose touch. Gotta Teo. To get so in the radiology department, you'll find a mix of healthcare professionals, like anywhere in the hospital, on you got the registrar's and consultants on the zero dog offers. Doing the scams got reporting radiographers in a lot of hospitals on missing Aquaphor's. Who did the ultrasound stunning on then the nursing on, um, assistance stuff as well. It's important to know who's in your radiology department and what they do, because sometimes the query that you have conveyed directed to another member of the team. And if you have what she's about scan prep, for example, or timings of scans on, sometimes you can get that information. But even in the Redox was also doctors themselves on day Consol appointments and things. So you know, always having to bring the radiologist and to do everything within the department that Israel just themselves. They will be getting rid, forcing stuns, saying in the dark room that kind of stereotypical radiology job on, but they're also doing a lot more. So there's the dynamic imaging, um, in in the department, so they'll be doing office on lists. Fluoroscopy lists, um, and doing image guided procedures and interventions. This world, um, they'll be participating and eat. Eat a lot of the time. I'm sure, if you're golden MG t, usually you have seen there's often a radiologist that president giving their advice on scans have been hard on. Then the radiology juniors will do duty, which is when they'll be so that I'm handling the more urgent queries on getting more urgency guns from from the ward's and doing any urgent procedures if there's a Class C for it. Also, just to be aware, there is a large range of subspecialties with in radiology. Um, and where this my effects of a junior doctor is depend. Well, you're a District General hospital or a larger teaching hospital. Um, sometimes during subnormal work and I was you queries about scams on betting some of the more specialists guns, my directed towards a particular sort specialty, every geologist. So it's just to be aware there is that large range of some specialties and sometimes, you know you might acidotic your queries to You know, for example, your head scan queries might be best directed Teo a neuro. So that was something that up. What if everyone sure the duty radiologist compartment the direction of that kind of thing? So that actually is just to be aware that some hospitals might have more of a subspecialist settle. So it's kind of it, really. For the radiology department, though, the kind of people you'll sign And if you want it down, that on there, the kind of things that can help you out with. And so I'll move on now two different types of scans. Um, it'll just be kind of a brief of new accent advantages. Disadvantages on the general indications the first of X ray, which is probably on the one that's done the most often and what you'll be most familiar with, Um, on the warts, uh, the main reasons for exploration of the I think it's not bone. It's solid. Geez, problem was fractures any hot kind of pathology on be checking that things like and G tube help. It climbs all those kind of lying placements we use X rays as well, and the advantages of exercises that they are quick and easy to perform even when people are acutely. Um, well, he still get some kind of imaging, Uh, your X ray, a celebrity. A shin does competitive feel the imaging techniques that will go through it in a bit. It's good when you want to image, um, areas where there's quite a large difference in the density of the tissues. So that's why, for example, energy bonus of a how density gets his good images in an X ray on things like, you know, Aaron the lungs against, you know, the heart border or the ribs, for example, because there's such a difference from my densities. So that's when it's good to be using, um, the next way the disadvantages of an X ray that we do get limited information from it so we can see kind of growth pathology. You know, we can see a lesion, for example, in a just sex right. We'll see that white difference in the tetanus city, but actually characterizing what it is sometimes isn't so easy on the chest X ray. That's often why follow up energy will be needed, actually characterizing what we've seen. And I said as well, because it's all about being quite a significant difference in those densities. Seeing so little things could be quite difficult and maybe missed on did. It's not good for imaging. Kind of like, uh, in in the body cavity organs and things because they're all kind of similar. Don't stay. We don't get that definition there. And that's where we can only really use X ray for the for the bony and the cardio pulmonary stuff that we do but also just be. Well, like I said, within the radiology department store, Oscopy may be happening, which is, um, but really Time X ray doing on that could be used things like, um, barium. Swallow those and swallowing difficulty. You can use it for things that help ease or g two placements. Things like that, really, they can image that everybody in real time and see the line all happy going in. So that's that's another indication for X ray and just a saseidx. No abdominal X rays. Consult times Be that the tricky 11 requesting we'll go into more detail book General abdominal X rays. You thinkings off obstruction, uh, like a toxic mega colon off foreign bodies. So again, very kind of gross pathologies there. You can't see most little things like inflammatory changes, that kind of thing, particularly on a another, um, Alexis, right? And that could be why sometimes you, my request for it. And I get some projected by the department. So just understanding why that that's that's gone hasn't happened is just this'll kind of techniques. It's just isn't good for that. So just on the next reading, I've got a couple of images that optical tricky ones have included in this presentation cause you'll get much more interpretations. Death in your future future elected in the Siris on. But it's just, uh, just start with a little kind of a little guy. Really. Um, so, like I said, just six rays actually films really good for things like candy upon Rheumatology's where you've got that different in density on. But if anyone wants to, um, just pop in the trap what this one is I'm sure you should have probably seen it. What kind of what we have to tell me. What? Your sex. I actually see the chop because I'm struggling to see the chart. I'll just give you a few seconds to look and then I'll just say what it is. Um, so this one's the right level of consolidation and keeping with blackly infection. Example. And that's what that's a very common indication. For next, right is query infection requiring chest infection when this one of the rats, if you just want to have a few, uh, a minute to have a look. Um, just say what you think this one is again, Like I said, actually is really good for bone bony things. Essentially, um, so you can see whether stuck you can see the whole outline of all the bony structures that in this foot on That's one of the really good indications for X rays, his friends and joints. Um, so this one is quite a for the cost. Is uncle of Got So you can see the future because you can see some soft tissue swelling here, just looking out and then just on the edges here, there's little erosions on gets off osteophytes around the's of marginal areas. We've got the road that's like common X ray of counts, for example, which is a good indication for X rays bonus stuff. So ultrasound of high frequency soundwaves that we used to view tissues on, and I think it may be slightly be utilized. Imaging Model T. Really, it's advantages are that it's low cost. There is no radiation. Uh, this put few contraindications, But be honest. I can't really think that's a contraindication to having an ultrasound is just a bit of jelly and the pro on, but you could give you a lot of orange Balkans with it that you can use Doppler to see flow on. It can also be used for doing image guided procedures. So just strains ascetic drains. Um, just anything like that and it drained in a collection. I do biopsies, that kind of thing. You can use ultrasound for, and it's an example. It in real time imaging. So you're obviously get to see that organ that flow whatever you look at in real time as it moves on. But it's really useful and it's portable is well, which is an advantage over the other types. You get muscle X rays, but the others, not so much and in terms of disadvantages, is very operated department actually got 11 person operating machine to get up that scan on on. There are patient factors that can make ultrasound quite difficult. So large body habitus. If the patients got off bowel gas, we really won't see much at all. Um, it's have not been prepped correctly. And so my last one about being where patient breath when you put in a request and in terms of ultrasound, if important in a request, anything sort of a biliary tree gallbladder related, that kind of thing. The patient really needed to fast and all the gold bladder just completely collectors. And you won't see anything coming to look something up. Everything king, for example, an old son que you be very common request was like an ache. And I it's really best that you get a patient to fill the bladder so you get good look at the bladder wall on because there's nothing in there that's caused an obstructive reason for their okay, I So just when you're requesting just seeing that if you sure what, the practice for the patient that you ask. So the nursing staff will be aware and so that you know that scan was not wasted until we get the answer that you wanted when you requested it. And then anything in with the ultrasound is if the patient really acutely well, it comes difficult to come in because they often have Teo turn on the side to see, like the all comes on the left or right on. You have to press squats, Um, and the the protests someone's got very tender, tense up turn it off. Sometimes difficult modality to use. So is just being where name disadvantage reduction and maybe these patients doctors. But limit this complexity that you're that, um, old sanitary indications it's got a very wide range. Indications head to toe. Um, you're completing what finally used for the ultrasound. And after that, if it intraabdominal pathology is s. So we'll see. We can commute a liver, the gold bladder, but the kidneys. So things like liver lesions cause it's tightest. Goldstone's, uh, renal calculi hydronephrosis a lot of the intraabdominal things. If you look this all been isolated organ physiology. It could be really good for that. And things like soft tissues. Well, it means characterizing them understands very good for that, um, little notes that kind of thing. Um, and it's got my body. Uses an M S K because you can see those soft tissue structures with ultrasound on. But it's fine. I think it's, but it's kind of oscal uses, um, excluding DVT's. Looking at court. It's, um, part of aging from both cysts. And so, yeah, it's got salt. It's intraabdominal. It's quite it's procedural use and it's got It's vastly bust you use in men more superficial structures of the soft tissue swelling. Okay, so, um so this is a pathology, which is, uh, quite well there's your last on ultrasound again. If you feel brave enough to pop in the chart what you think is going on I mean, it's labeled, so it's showing me too tricky. Uh uh. On this old sound you can see here, Miss outlines, doctor looked. You hear the goal. But, er lot of these little white things that you call stones. And then here where this is very wide. It's all here. This is over, Deba. Then the goal about a wall. So I got a stick world gold bladder with multiple gall stones and then you track it down from the bottom and here you've got what's a dilated CVD? So this here would be a typical ultrasound images to diagnosis on acute cholecystitis. Not something that ultrasound is good at diagnosing. Uh, but just within an issue conceit just above the goal of this, uh, like this, like, gray structure here. This is the liver. And you can get a good view of itself. Texture that. And if there was any little round lesions or anything like that, you see that A swell in the liver. I'm just where the CBD is here, just underneath. You'll get total day and you could put the doctor on and check that PSA low as well. So, um, there's a lot of things you can see on an ultrasound scan, and it's worth considering. Sometimes in patients, the same thing that radiation does just another quick one. This is what a normal kidney looks like. I'm not just found. Um, Is this structure around here? We got the call attacks and these dark bits is a little renal pyramids. Um, and it's just to show you here, a very common request that you don't that will get filter sounds is like a baby's on where the patients go on a k I you Here we have this sort of the next, potentially a policy. You got very dilated, renal pelvis. This is hard, you know? Versus And then when we followed it out the ultrasound. You have to believe me. This is ah, ureter with the stone in it. So here, this is the ureteric. Calculi wasn't hydronephrosis on, you know, without exposing this patient to radiation things we've got the answer really is to their okay either. So it's another good indication. Older some. Yeah. So the next one a CT? Um, So, again, this is obviously very commonly request this gun. And to be honest, is a junior doctor found that this was probably this done that I was having to ring radiologist about the most to try and get this These kind of scan set it, um, two ct. Good. For when you're looking at a solid gee within a body cavity that you can't get two particularly well since officially Or, for example, if you've got a cute little more patient on emergency, that's a medical situation where you need a quick scum to get the whole set off picture of it in one. And if you remember the ultrasound, we can see the intraabdominal structures. But they're a little bit off in isolation from each other that you're kind of looking around all of it. You can get the CT. You have to get all the slices in the body on that were really good. In acute situations you can. We can also enhance that. The CT images With contrast, uh, so the bunch of CT like, say, it's past that position, which is why it is commonly used. Informa's an acute situations. Um, acute Abdomen's things like that will use a CT and get good organ contrast on and and we can see multiple structural on the CT. Know all the vessels have thinks in city that there's a bunch is the big disadvantage, really with CT? Is the radiation exposure on whenever was thinking about the CT? That is amazing where we have to really think carefully when this patient industry take it because of the radiation exposure. Uh, to put it into perspective, a chest X ray gives you about 10 days of background radiation or equivalent to ah, a CT scan of your Celebrex instead of a chest X ray would give you about two years with about around radiation. So a CT is a lot more radiation. But, um, on X ray, for example, spots that we have to bear in mind with it azelas that if we do give contrast, there is the risks of contrast, which could be some of anaphylaxis allergic reactions. Um, and it could also cause an effort. It's a nephrotoxic. So, um, one big thing the CT is when you're requesting CT. Have to buy the patient's renal function in mind. Uh, on, uh, it may very soft trust trust, but where I recommend if Egypt five is less than 30 you're left me after ring radiology to discuss that request. Um, and I would advise, you know, if you put in a request and you pay, she's got me. Jeff are less than 30 that make plans in advance in terms of bringing the renal came, for example, plan for IV fluids so that when you run the duty radiologists, you considered to thumb that you know, the age of four hours, but I was rushing hold. But you're gonna do explains that and that the patient is aware of the risks. Um, any balance stop and still want to proceed with this guy. So that's a big thing throughout the CT is the and they control that you've You've addressed that If that's an issue for your patient on the same city is that it's not good for some soft tissue, More official structures. Uh, like sometimes of indications, the CT its biggest one of probably an acute situations, acute surgical things, for example. Um ct pas, I think wearing a p on and, uh, you can look for someone could balance allergies. Cholitis bolus Kenya. Any points is bleeding. Uh, any postoperative complications generally is a CT to look for a swell number one you're talking about the different things you can. You see. T four is just ensuring that, you know, you weigh the risk of radiation versus the benefit. What you need that scum toe answer basically intend to seat it. This's would be a pretty common indication for a CT again. I could give you a few seconds if anyone wants to pop in the chat. What we're looking at here. Um, but if you can see here, this is dilated bowel that it's a mild fall and here, where it kind of collapses, This is a transition point. It's it the terminal ileum eso This is kind of ah, a textbook kind of image of bowel obstruction with an obvious a transition point, which is where the obstruction will be located. Just that. So that's very common indication for a CT, like said and make you abdomen kind of situation and then this one again I said that But, um, off a textbook case, is that the images and listen to tricky to this scan here is a CT pa. She can see that by does, uh, contrast in the Palm realities, which is just instructor here on here. This filling defects that that's a saddle embolism to that civic Central pa thought patient. Okay, Um all right, Um, hum All right. Usually, if you're requesting an MRI, the patients probably hot some other imaging before hum and the MRI of being used Teo pain with details images because the but it gives you more detailed than just particularly soft tissue structures on just often used in off neuro on looking art strokes on a mess, that sort of thing to get a detail on it. It's often using unless k things. Uh, because you can see the, uh, ligaments the muscles a lot better than you can really see on CT. Um, so any thoughts of muscular injuries and you'll see it used, um, it's used end of gastro purposes for things that, um are CPIs when you look for stones on. But it's used to characterize things that little Asians, you could get a number. I'll liver to that to characterize anything that you've seen on another imaging modality on so you'll be on will tend to find it. It's something where you have seen something on another scam and you want better detail. Um, see if you get an MRI. Um, if you requested an MRI, just need to be aware. The usually doesn't MRI safety question. I'll that needs to be filled out. Seeing patient, which just go suits off the metal work. Previous surgery things like that that the patient might have had if they've had things like pacemakers. If there's got factful anything like that on that, we contraindications to the MRI. So the advantages of MRI I said it doesn't have everyday shin dose like the CT and just sex, right when you do get good soft tissue contract with Tamara. Um, the disadvantages is that it takes a while to get the MRI images is a lot of sequences often, and so it can often take any between half a mile a tune. Our So it's quite lengthy, stun, and often it could be poorly tolerated. And I know when I was ah, junior doctor from the Lord, I had a couple patients that just couldn't tolerate the scam, so I couldn't lay still about long. So it's something to buy. Remind on, depending on your patient, you've gone from you Often. People can get claustrophobic in the MRI scanner because they are there for so long. And you know, it's a very noisy, noisy tunnel and and and arise often less readily available. Um, so you might find out about was we comes things like that. It may be more difficult to get an MRI, and particularly it can be a bit more, especially starting to get reported. So you might find along the time to get your bolus. Well, um, it does give you just give me a good, detailed scan um so in terms of this is the situation went out of hours. You would still get the MRI on. Do you should still get some of the provisional report off the MRI Because this is the one of the emergency situation you could get. You could be asked to request an MRI. Ondo, this is just a cold recliner. Can just see all 45 this bold here. Just a cold or a flu. Um, Mrs uh, I well, I work at the moment. The reason So all of them, like a hip fracture protocol. Where if And you know, the patient has a next ray, for example on there's no obvious fracture, but there's still a strong suspicion that there is a fracture there when the new can order of the orthopedic clean can request on MRI s So you can see on this MRI here, you can follow the control ground. There's no obvious off use Cincy. When you would say that, that would be so. The fracture on then, If you look on this MRI, this is of the same hip yet. Just hear you got from contrary fracture that, um which he just couldn't see it'll only on the X ray. So that's what I mean by you. Get good, selfish in. You could see all the soft tissue around it really well. That's why I've been quite with in this case, stuff as last imaging modality is nuclear gym, which I'll just briefly my cheeks. It's not, um, it's not something you probably you won't be requesting. Felt acutely on your own calls for that sort of thing on bits. Not usually something you know you have to rush in. Bring the dude radiologist Teo that or anything like that on, but it's quite a specialist. A scam. So this is when you use small amounts of radioactive traces to highlight highly metabolic areas. Um, it's probably use most frequently in the oncology setting. Eso will be used to look often for metastatic disease, for example, and it is good. It's good. It's not finding that that early stage disease on dc'ing help a lot with the management funding and is disadvantages is that sometimes you might seasoning on the scan that just blows right. But that doesn't necessarily tell you definitely what it is, um, in the context of malignancy, usually you can say that it's in the fastest book on. You know, if it's a scan for some other reason and something glowing brightly, it could be any higher on the folic thing. That's that. I've been my reactions. Um, my doctor Tracy. Uh um on it is quite a long process. So they often have to have the radioactive trace, uh, sit around for a couple of hours, because if you think about it, the tracer gets taken up by highly. Well, that's for the carriers. So we want you to be basically us I know about was possible that it is not metabolizing watch when you go through this gun. So it come take. I was to get this done. Um, still just show you, uh, an example. So this was a scan. I was not on. I'll be honest on the first scan through Miss this. Um, so if this is just a CT of the afternoon here, structure that deliver this is on a liver window. Eso it just makes it easier to see a little Asians basically, um and then when you see the that's kind of the same image. See here this really bright hilum. It's public area on, you know, is that if the him retrospect, you can see it when you compare it to the other one. But it's much more subtle the Nazi on this pet scan, we can see that this is a highly metabolic area in the liver. And this is the liver metastasis here on here. Again, this is for the same. This is the same stuff. Uh, you don't have got a CT of the abdomen here, but could he got they all to hear and just see you next in a little toe? This structure shouldn't be so big. This is a pie. Ah, tick, lymph node. And again you could, you know, you could argue it's quite difficult to see that typically when you sort of scrolling up down to the CT and there's lots of it's coming I/O of you on. But when you see it on the pet here go. It's really glowing there, and you can't solve mistake. That s so that's a plus system a little, uh so it is really good. It's so it's looking at that sort of the static disease in the oncology system. So, uh, now we'll move on and talk about requesting scans, which is probably excited The bit that you be doing the most is junior doctors. But I think having that background of knowing roughly what the stands will come on, what the good for is useful when you come to request in this comes themselves. So you've got these all the steps to requesting this gun, and we'll just kind of look at here when you're feeling in the request for my kind of information. When you discuss it with radio, just kind of information that I wanna want from you. This won't. So when you put in the request, you need to put concise clinical details. Just need to know the key information for, you know, the patient on. Ultimately, what this comes down to is that you've got the patient that in front of you, you know, you've taken the history, don't examination. You've got all the investigations in front of you on all of these bits and lead you to think I want this time to rule out this pathology all because we think they got this pathology. What we need from your request is for you to so soon rise that for us that we could get to that same point because we don't have the patient there. We don't have the investigations right there. So you need to think about what bits of this patient's history examination our investigations led us to think this is what's going on. And that's where you can kind of pull out the key bits through in a moment. Kind of important information cloth get missed. So when you put in the request, you need to think a big bone. What is your clinical question? Your request needs to have a clinical question. You know, clerical start is very picky. Clear the infection. You need to put what you asking was to find in that scum. What you're thinking is going on That helps us pick the right side. Um, but also it helps when we're interpreting this kind of reporting this gun. If we know what your thinking, you know, we compared particular attention or something that my locked drawer bit tribunal. If we know you're looking for something, there might become more significant. Need to know if there's any differentials is again that impacts whether we go straight for a focused like a ultrasound of one thing. But whether we think, oh, you're thinking about two Or maybe you need a bit of a lot of scum ultimately need to think about how it is going to change management. Uh, because we don't expose patients to radiation uh, go through this gun on It meant nothing for the management of the same thing is gonna happen after a zit did before. It needs to impact the management somehow. Really, once you've kind of gone through that, what she question watch differentials have gonna change management. Just have a thing to yourself before you put that request in what would be the best time to answer my question so that you can try and pick the most appropriate modality as often, um, people may just get told like when you disagree with this, but it's worth talking a minute. Just think it's not the most part. Pit Scott full of patients onto the question. So hopefully you have a junior doctor. He'll be the one reading to try and get this guy. If you're not sure you know why I asked In the span of what the question is, I don't refer to ask you seniors, Um, because if you don't know and then you regained and this come gets rejected your own apartment to go back on anyway. And so you know, they don't want to do this come because of exercise that So if you don't feel it, just ask the senior is what you're looking for in this gum so that, you know, a very old treated now. And so, um, I consider the patient Celexa before because there are certain things, you know, contraindications to certain scans. If the age of farmers too low for the CT if it's, ah, female child bearing age. You thought about the possibility of pregnancy If you're going to request CT to consider patient factors when you're requesting this comes well on diffuse. Unsure If you kind of thought that everything I think I'm not sure what's comes. Best transplants question. You come to school, she's cardiology. They'll be rolling. Happy to um, you know, I've been on do two this morning and have several calls just saying, you know, this is a situation. This is the patient we think in this. What? What do you think your best? Do you think it'll sound, think CT scan over that filter to help them get the best kind of scum. So important information to previous malignancies Really important? It's important to note if we see all the bits. But on the scans, for example, it's really want to know if you have presidency on where it waas, if that had any treatment for it. And that kind of thing. No recurrence in people that that person isn't c is obsolete had more common. So it's important to know if that's something that patients had. Typically, it is something in quitting again, Uh, and then a slight of similar but previous related disease. A previous actions of the same disease. Uh, it's important for student it up because again, it's like but But you know, they'll have this again and you've got a bit more of an argument then. So, you know, we think this study's needed because they have this sets months ago. Well, you know, you know, they got this sample times on do usually, you know, they have this gun, and we we get the answer. Really, surgeries is very important, particularly if you're gonna be if it's the surgeries in the area that we're gonna be energy. And I had a scan recently That was first of the query obstruction and the patient and had multiple surgeries on had metastatic disease. But in the request, it didn't say, Well, the mattress facet disease waas It didn't say what surgery that hard. And we didn't have previous surgical notes of previous images hospital and it really hard trying to get that scam and try and interpret whether there's been progression of disease. Um, we're trying to solve track with the bowel, and the patients have parts removed. It makes it really hard if we don't know. Um, what this patients scum. Well, what that and you should be like with all we will cut it previously imaging. So if you never had recently had a scan and it found something to different just include in the details um, nice that we use it for us to swell which side this is often a something that people they overlooked. If you in their writing that just putting in the request card, just say which side the pain's on which side. The swelling gone, for example on because it doesn't make a difference too, when were taped in the scum. Like I say, sometimes something might look minor tribulus unless we know that that's very interesting. That small little detail might be what's causing that pain. But if you don't mention which side is, it makes it hard for us. And then if it's rather than mentioning if it needs needed urgently, a few patients really cute? Um, well, Or if they're scheduled for theatre on, for example, if they may go to Vo based on the scan, just mention it because ultimately you know things. Afternoon there was over 200 lbs. We integrated the hospital at one of your sight. So if you're standing to push into the top of the pile, just make it now on. But if it is something urgent, that is a situation where you should bring back through to the radiologist. Let them know that it's that it's an urgent scan that's needed, and I percent really impact if it's going to change the management that it's important to know. For example, you need the CT scan, Um, for, you know, uh, query appendicitis, a four surgical planning that will happen, You know, this afternoon so knowing that there is going to be an imminent change to the management based on it. In this gum is really important to know in the information. And if you have discussed with if it's out of your regular specialty on discuss with Dustin, it's something that they have requested. It's further investigations, and to help their diagnosis is is useful to know it does carry a little bit of weight. You know, if you've got patient really waiting, got a clean abdomen, the obstruction and you discussed with the surgeons and they requested a CT scan. It just causes a bit more way to, um, you know, several people have seen the patient, you know, greater Cuban. Well, we need to This is just a little box about if you're putting in a request for a procedure and that you need today books, including the clotting clotting Simbolon quoting platelets. Um, I want to know if there are any anticoagulants need to know. You need to discuss how long that means holding Well, if if you told him on, just be aware that if it's a very allergic regarded procedure on a special needs, consenting, usually before they come for the procedure. But again, that's something that you can ask when you ask for the procedure to say again, your patient consenting because it's much easier than But you should get into the department and then not being contention that he'd send it back. So we're going to discuss with right now. So the reason we need to discuss with the cardiologist really is if you start needs betting urgently, um, you know, if it needs doing that day and Oh, for example, if you're unsure about this gun that you want If you don't show what the best modality is and you want us, we can ask at the do toujeo. Just usually, that's usually how it works. Just have a little think. I guess I mean again. You can pop it in the chart if you want. Um, we'll just I'll just give you a couple of minutes, but just think about it. You're on the world and you gotta stand and he's batting. Uh, because, uh, Cuban well needs doing today. Um, think about kind of information. You have the for your in that church radiologist on, and you'll be surprised how often people don't prepare anything before in in the Radiologist, and I'll see him surprised that we're askin certain questions. It's useful to know in this context what will be asking you because it's a lot of people don't realize that we're gonna need to know that information. Oh, history, obviously. So we need to know, you know, essentially. Like I said before, it's concise information. We don't know everything about the background and nothing that's ever going on medication, you know, specifically, you know, the events of this admission all any previous related admissions, the events that so that led you to think patient has query X. You know, what investigations did they have, what sounds? Symptoms that they got? It was like you to think that patient has a pathology that needs this scan. So that's all we need to get just the relative. It's that make you think this patient requires this comes, sucks. Had blood so important. You know, I left and asking, What's the most upstate loads enough to get a woman, it but the computer. But it is involved. It's important for Egypt fall, like I mentioned before the CT, Um, but it's also important, for example, if you'll You're saying I want to see ti for a query collection in the ambulance. Well, then I need to really other inflammatory markers raised for the white cell count raise. Um, is that the amounts go along with books that wants to something else or if you're querying, um, you know, call a stye to saw something like that. You know, what's a little function like, we're gonna want to know these things consulting real world doctors on. We need to kind of get on the same page is due. So we kind of me to take him through. What made you think this patient had x apology? Um, announced You're telling girls all the things going through the same thing that you listed in with and right? Okay, the He's a deranged. It could be this all this. So that would be this stuff, all this stuff and also get through it. Kind of trying to get to the same point is you on and also, you know, have discussions both ways have settle. Do you think it could be this? And then I said I always thought about that. Well, actually, you know, no, because of this this and this. So it's really important. We know the investigations this well. So how's that prepared? One. Have the bloods and have any investigations else cancer had before to have it ready to start my day just about. But when was it that I almost styles and ask, You know, holiday clinically. What's the robes? I don't know if it helps this off prioritizing this. Come on. Just no Haman. Well, patient is it doesn't make a difference. If you're saying now. I think this patient's really well with some infection. I say all the pyrexia well. Oh, no. They've been a correction of the whole mission. Doesn't make a difference. So I think having there's obscenity, it doesn't take too much effort to just have to be up, you know, drops work. All right, push it home. Stay below unstable. The patient is examination findings. And again, I have been asked, what did you find? Examination. I know it can be difficult. Like get the on call, doctor. And maybe someone else examined them. But maybe just do with if you haven't got the time from someone yourself, which is an ideal, um, but what was found? What the, uh, the the consult. No, I haven't found on examination that led them to walk a scam. Um, just says that, you know, if you're saying clearly obstruction, but you don't know what their abdomen is like on this combination makes a difference. But if you can say, you know, it's, you know, diffusely tender this back thing is no bowel sounds. You go the rocking and then that wanting the scum, um, examination findings did make a big difference. So it's with either, You know, I did it upset somebody yourself, um, are least getting the most of today. It's a mission from a senior who uses questions. Come up from what? The mind from plainest you know, often also a Okay, My only know this happened, You know, they got this Whenever you thinking this, Um, what you're going to do with the scan results? You know what you're treating him for? The movement. It just makes a difference to the where things are going and how the skyline pocket patient more than boys happened through it. Uh, just make sure we get the right modality board radiation work possible. There's different types. Its contrast in non contrast, Conse I'm not going boy with it. Um, I'm just about getting my head around some of it myself. But for example, if you request the CT head, there's about 30 different ways that we convert CT head, so it just makes a big difference. We got a good history and, you know, it's got all the positive findings, you know, um, so we can get the right stuff for your patient. So we ultimately answer the clinical question on because that's kind of what we'll want effects. But it was intact in your britches. A swell. If we know the story properly, help prioritize as well. Like that. You know, there's hundreds of scans being requested in the hospital. On on diffuse. You just push you to the top of the pile. It's important that, you know, you make the story clear, make it clear home till while patient is give a good history makes you prepared all the details so that the radiologist has got all the information they need to be on the same page is you and think, right? Yeah. Iraq. You patients not Well. Um, let's get them. This guy just seems uncle request so you can kind of see where this is. Information a missing. Well, then request could have been improved. So go Female cancer, pain, vomiting, previous cysts. Nothing out there pelvis for a very in and flush of dominance. Allergy. So when I saw the sequester kind of thought don't absolutely love it big, I thought, it looks like it's possible. Besides this book, I don't quite know how um, uh, the patient is and they are well enough for it to be like an acute from scientists. Are they thinking about taken surgery? No. Sure. A very solid Gee, that's actually better seen with a transvaginal ultrasound scan. And no, actually that well, visualized on a seating. So already on thinking I don't really have enough here to constantly about this come. It's like said things were kind of things was thinking. Is that the best model for very um, soldier? What is the main thing that I think it had been a bit big, however clinically. Like I said, I don't know how most precious are they thinking something else? Oh, I was that put in what? You know, that's where they're at the minute. So also speak into the will obtain themselves and saying, You know, I don't have enough information on the request. I should consider it a really severe pain. White cell count and CRP were very racist there on a antibiotics, depending scientists. And they're considering surgery for a few months. Scientists. Now, if the request have been adjusted for this, you know, stay through females today. Right now. Your faucet pain, vomiting, previous list rays last count. See? Okay on antibiotics. Tremendous antis. You know, ct after provisc worry about the scientists. Um, surgical planning. You know something? Not not. That's not better. I can see what you're asking me. See why you're asking it? And I agree. Yeah, I know. That sounds like good. Be appendicitis. See, it's very short baths. Mom lets on tamoxifen. Your option of ointment. Okay? Yeah. Consigns. Yeah. All those three things relevant, You know, it's good to know yet. Short of breath. Corruption requirement 16 to pa. Uh, normal practice yet? Good to know that you know you saw is infection. You don't think it is? Could have a bit more information out, have the logistics rate. Is it normal? Often if you want see TV a should get just lateral first rule. Anything obvious that could call short of breath, Shortness of breath. Well, anything else thinking could this patient and this is a donation? It could cope. It has, uh, been considered a small possibility of trauma with your ex, you know, need to think about it. And impulsive well features. You should probably mention, you know, circle previous malignancy. Previous from both this. Any risk factors as well as the well Scott features would be good to know. And how that central promises, Really? The toxicologic increased respiratory, right? They needed a lot of oxygen. And if you start them on treatment, we see TPI check it out out of I wasn't some hospitals. They may say that you need to start the treatment on those little marker a heparin and get the CT pa. So within working hours on often, if you say you know premeds been started full, full pa. Um, you know, then it it gives us the insurance. Actually, you know, you do seem so I think this patient might suffer, Pete. Obviously not every patient could go straight onto that for, you know, central bleeding risks. But if you have started. It's good for him. So again, spoken to the clinical tea. So they have improved a consolidation. A chest X ray did that already completed the antibiotics. The daytime is raised. The toxic product. Second, make good. It's all of those things. Enough. And now you've said it, you know roses will trade rest outright gross D dimer posted wells features. Um, you've already thought about infection. It looks like it's probably not that it's like getting better. I'm adjusting. Uh, so if you don't get those informations into requests, you can see how that picture now makes you don't just think, Well, you some technical BP, as opposed to just stop brief One way you think now it could be a few things. And so this one is a background of UC and doctor colitis committed with change in bowel habits. Dark stools on their own to that pressure scope of room by the radio for about this one on day said it was for an abdominal X ray request. And what did I think? My fish that waas well, it's gonna go brush in. Why did they won't be something election? What what they wanted us to look for because I set that there was limitations term normal X ray. There are only a handful of thing. Really, we can we can look out on that Based on that, I don't have a clue. So something You have to bring the clinical team back and say We need to know what they're looking for all on them. That's right. Because we've got good background there. If you know, you know, all related sees some sense of the change in bowel habits. Boat. I really don't know what they won't really back to patient number for the bowels on the number of days Uh, on there were saying query obstruction because if news they don't pay pretty relevance doesn't need it to be in the request. This one again. I was called by the radio Prefer for an abdominal X ray Request what I think fathers die remounting the current positive right? Lower quadrant pain, tenderness guarding a slight tape record this we can't see things like inflammatory colitis is on the electric. If it was query to medical queery obstruction, that's different. So I have to say to read on between you doing with Uncle team back and ask them if there's anything else that they're looking for or if it's just collectors. And it probably is discussing for an alternative modality. If the urine and obstruction or something there enough on, then we can do the the X ray, you know, not trying to be particularly obstructive. It's just that for that clinical question that was with the program a doctor on this one as the last one. So it was a CT for accepting pelvis was from or generally one fevers, abdominal pain and a cough. Gracie Happy might still come. It's a good flow of a background information there. Query. Basil, pneumonia. Although just mythology inquiry call cystitis. There isn't a murder would think you're taking for rocks. It seems like a lot of radiation for something that is, um, it previously discussed could be seeing quite well on a chest X values muscle. Have their periods cause the statues, and that pulled up because, having gone through the history of the patient on the system that have had a recent previous cold started would have been useful to know, because again it puts more weight on me saying is it called abdominal pain. Is it in the area would expect for closest artists, Or is it injuring? You know the left also, where is it? What about these? So you think that that would kind of went through with a little concern? The scans and the indications? Basically, um, only we can see on a chest X ray, which isn't watch first radiation does to the patient school societies. We saw a nice example of that on the ultrasound. So if those the two main things thinking there's other modalities and community, there's less radiation does for the patient and still wants the clinical question. Okay, so that's a bit of a whistle stopped all through touch the scans. Just, I guess by going to the types of Scotland's sort of things you need to be thinking about when you put it in your request, um, solve information you need to be put it in. It's quite tricky to pin down exactly what we need to put in the request, cause it's quest to submit to the situation, and the patient glands front of you ultimately is making sure that in a concise way, you get old pieces of information to the radiologist make you think you use the clinical team. Think this with ology and that's what we need. This if you're unsure, discuss it. Ideology. And And if you're going to discuss with radiology to make sure you have all of that clinical information gathered with a lot because you know they'll be accu of people wanted to speak to the radiology. Just have the information that you turned, Um, and I'll be a much easier discussion between myself on the radiologist. Um, and you just went to my productive. If you call that stuff, they're already on to the, you know, together you can call to consent to some. What's the best thing for the patient? Thanks very much. Let's see that. I'm sure audience found that really helpful as an insurance help interact with radiology as a department on. So this is our first episode. So this one was in the intro. So next week on the 10th of November, we will be doing a session on how to have a stricture approach doing CT heads of injecting CT head scans on calling pitfalls that you may fall into. So if you want to attend that one you can go through either Facebook on our crew page in the minor bleed patient. Find it there. If you came through that way, it came through by a metal blink. Then, um, he should be able to see it linked to this event. If you can't, then let one of us know we'll give it a minute or so just to see if any questions pop up. Um, it's really forcing to give feedback because that's how you'll get your certificates. So as soon as you get feedback, you should hopefully get a link that'll go out in the next 10 minutes or so on. But you feel your feedback. Then you should get a certificate email back to you that you can put your port for years. I don't think they're any questions with anything you explained. Open. All right, thanks for your time this evening and quickly see you'll next week on. But they get sleep. The feedback thanks very much.