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Hi, everyone. Thank you for joining. My name is Adil. I'm the I RJ Medical Student Education Lead. Um, and I let everyone introduce themselves, but before I do that, I just want to say from next week, there's two sessions left. So next week and the week after they will be hosted on Microsoft teams and not med all. And the reason behind that is because med all they're not supporting, um like they're not letting us make new events anymore for some reason. Um So we'll be moving to Microsoft Teams uh from next week. Yeah, that's that, that's it for me. Um Yeah, if you'd like to introduce yourself. Hi, everyone. I'm Babo, treasurer of University of Nottingham's Radiology Society. Uh Hello. I'm, I'm one of the radiologist twos at Nottingham. Ok, so lovely. Shall I just, shall I just go ahead? Um So thank you for coming. Um I don't think there's many of us so please feel free to just, just shout out, ask questions, interrupt me at any time. Um I won't be able to see the chat. So, um we will kindly read out the questions. Um I'll share my screen now just see if you can see it. One sec sharing window, one moment, share this window. Lovely. Can you see this now? Yes, we can see it. Lovely. Excellent. So I can't see anything except for my slide. So just stop me any moment. We've got 10 questions to go through. So I'll, I'll give about five minutes per, per section. I'll give you a minute to read each questions, but we're gonna go through 10 just SBA style questions and I'll give us hopefully um you know, some talking points uh to take forward to you in life. None of this. Um I was speaking a bit further than like um either just before none of this is essential information. So I wouldn't stress if you're not getting it correct. Just just for, you know, progression day to day life. Don't worry, I don't expect any real knowledge here. So safe space, say whatever you like. Um So question one, I'll let you read it yourself. I'll give you just a couple of minutes and then we'll, I'll start talking. OK. Mm And on your screens is this is, this is the thing big enough is the picture big enough the the picture is clear on the screen. OK. Lovely. Did anyone say in the chat or shout out loud? How do you wanna do this? Nothing on the chart. Am I have I stopped sharing? Sorry. That's, that's not my bad. Yeah. You stopped sharing. Uh Sorry. OK. OK. OK. Um I'm gonna go ahead. Does wanna say what they think. No one said anything in chat yet. OK. Nothing. Just say, just, just say the letter in the chart. So I would say anything that you think is a abnormal, this is the easiest one today. No, you know up your knee, someone just said ee OK. Right. Lower lobe. Fine. Let's go through it. So the right answer is the um, the middle lobe. So the middle lobe, um you haven't got a right middle lobe just because there's only one middle lobe. Um but I think that's a bit lobe, I mean, but it's the right middle lobe. And the way you know this is can you see my mouse is that, is that projecting at all? Yes, we can see the maps lovely. Excellent. So you can see this right heart border and you can see this bit of consolidation and you can't really make this right heart border out so clearly anymore. So you know that it's located in the right middle lobe. That's just how you know um this right hemidiaphragm is clear. You can't see this, you can see this edge. So it's not in the right lobe, there's nothing right touching it. You can so you can localize it in the right middle lobe. So right middle lobe consolidation, what you you could also say right lower zone. And if you can localize it this area of the heart, you just say right, lower zone consolidation ordinarily, this doesn't matter, right? So this, this sign in radiology in general for plain films, um it's called the silhouette sign. And the idea is if there's air and soft tissue next to each other, you should be able to see a line. If you can't see a line, it means there's like similar densities next to each other. So it's, it's more the loss of the silhouette sign, the loss of that right heart border. There. Number three, there shows the right middle lobe which is just next to it is where the where the pathology is where the consolidation is, consolidation isn't just pneumonia. It can be anything, it can be, blood can be cells, it can be pus, et cetera. So um don't just think it's infection be all those little things. So it's just consolidation. Another example of right middle lobe consolidation. Can you see the right middle, right heart border there? It's just ob obliterated can still see the right hemidiaphragm. So this this can localize the right middle lobe consolidation up here a little bit harder, it's a little bit higher. So this this would actually be the right upper lobe. So it's just this bit that counts as right middle lobe ordinarily as I say none of this matters. Now, the reason I put these two slides up here is to just to show you two masses. So on the, on the right here, you can see this thyroid mass here. It's just a supra, superior mediastinum, anterior mediastinum um mass uh over here as well. And I can tell you why it's an, it's like over here, you can see this sort of lobulated appearance of something there, right? Um But you can see the aorta separator over here, you can see the aorta separator, the aorta is a posterior metastin structure. So this must be an anterior metasin mass because you can make it separate. So this turns out to be a lymphoma um because there's and the differentials matter from masses in the anterior posterior mediastinum. Does that make sense? So, anterior mediastinum, the classic forties, terrible lymphoma, thymoma, teratoma, thyroid mass, posterior mediastinum. We'll come onto that here. You can't make out the aorta separately to this mouse. Therefore, it's a posterior musin lesion. These are different, different differentials. This is like stuff like um nerve sheath, tumor, extra hematopoiesis, these sorts of things, that's why it used to matter. It didn't matter, it doesn't matter anymore because we have CT um but this is the sort of thing we'll get in our exams. So you don't need to generally worry about this. People stress about this a lot about localizing. Exactly. It doesn't matter too much. I promise you can just say zone and say this consolidation. That's just generally. But this is hopefully a good illustration of the silhouette sign. Does that all make sense? Those whistle stops, tore through the silhouette sign and why it used to matter in plain films in the past, why now we use CT S for the localization. Um But you can still be accurate, you can still make an accurate, useful set of differentials um that you, you know it, when you have just a chance to X ray, you can start off with the correct differentials and then the correct investigations following that. Hopefully that makes sense. Anybody wants me to ask before I move on anything at all. Nothing. There's nothing into that lovely question. Two, I'll give you a minute. Just give me one second. Just keep looking. You'll see the pathology, I promise side. OK. Everyone stay in the chat. What it is. No one has said anything yet, say something. Otherwise we will move on. Say 11 person say anything, just get me wrong. It's fine. Anything. Yes. Um We have multiple answers in chat. Lovely there. Someone said D and then the 33 people guessed. Ee yes. So E is correct. D um we'll go through them. So a hiatus. So the, the abnormality we're looking at is this line here. Can you see this triangle of stuff here? Can you see that that heart is really dense? Yeah. And then you've got this double density, right? And you've got this, this border and then another linear border, right? You shouldn't have this border, this bit shouldn't be so dense and it's so uniform and linear that's why you call it a collapse and we'll go through it in a second.