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Hi, everyone. Can you hear us? Okay. And Oh, Okay. Great. Great. Grand. Um, can you see the slides as well? I think you should. Because I got up into screens. Um, and I can see them. So we've got a really complex set up because the laptop wasn't really working. Okay, Has it too? Yeah, I think they're changing. Right. If you at any point can't hear us or the slides cut out, just let us know. Okay. Grant? Thanks, Alex. Yeah, They are changing, actually. Um, so welcome, everyone to our we event. Um, we've got quite a few slides because you guys have a lot of radiology themed Diallo's, so we might run quite quickly through them. But this event is recorded, and you should receive the slides afterwards. We'll send them out to you. Um, but feel free to fire any questions into the chat if you have any, Um, and we can get started. So these are the learning outcomes. Just very brief. What we're gonna cover. Um, I have tried to base, um, this lecture on my own phase three notes and the lectures that could that I had in phase three and the Phase three I lows I had, um so it should match up with what you guys have. But if something seems completely new to you and it's a little bit strange, it might be because it's been removed from the course. So don't panic. However, everything included will eventually become relevant. This is stuff that I've been going over. I'm in fifth year. Um, so it should be fine. Uh, I didn't even introduce herself. And Laura, I'm in fifth year. I'm normal. Adam. Fourth year. Okay, great. We can get sort of thing. Um, so just a little page on exam tips. So the story behind an image is the key to getting the correct diagnosis in your exams. Um, So don't panic if you see, you know, a radiological image and you have no idea what it is. Um, make sure you read the stem question will give you a story, will give you signs. It'll give you symptoms. And sometimes we'll even describe the image for you. It will tell you what the image actually shows, and they're just showing you the image is like a wee bonus. And we have some cases in our power point where you would never be presented with this image and told to think of the diagnosis. Um, but you might get a question where they describe imaging findings and using, like, keywords like Buzzword. So we've highlighted them and told them in whites and to look out for them through out the lecture. And and yet there's very few images as a medical shoot in general, where the diagnosis should be immediately clear. Um, but there are a couple, and we've put this little dog spot because their spot diagnoses and these are things that you should really learn for exams and mainly osk ease. Um, where often you're just giving, like a chest X ray, and you're meant to go through it and see what it shows. So we're actually beginning with the chest X ray, Um, which is probably one of the most important investigations you guys need to know. Um, so to begin with, assessing image quality of a chest X ray. So I use the I remember pneumonic abbreviation. Right. Um, so rotation. So sorry. There's no point on this, by the way. But everything should be marked, so you can see that there should be equal distance between the medial aspects of the clavicles. You can see the clavicles are highlighted sort of red brackets, and then there's a spinous process in between, and there should be equal distance between those two, and there's not equal distance. That suggests that the patient has been sort of rotated while they're getting the chest X ray taken, and that can make it appears that there's pathology present when there's not. Inspiration is the other one, so you should count either over seven anterior ribs or over seven posterior ribs. So your anterior ribs remember the slant ear ones and posterior the straight ones. I personally prefer to start counting the anterior ones. You can do one or the other. You don't need to do both. Um, so the first into your rib is the sort of see shape highlighted blue. So try and see if you can spot it on the other side, and then you count down and you can see in the image. The sixth and the seventh into your ribs are marked, and that shows that the patient's taking a nice, big deep breath in and you can see enough. Um, next. P is picture. So AP versus Pa. We'll talk about that in the next slide. Supine versus Rex. Or have they been standing? Have they been sitting? Have they been lying down and make sure you can see all the lung fields? Nothing has been cropped out and then exposure. So that's how much sort of X rays have been given to the patient. And you should be able to just see the virtual bodies behind the heart so you can see one like one square outlined there, and you should just be able to see that and pa versus a P so posterior interior pee. That's your standard chest X ray. That's what you're going to be seeing most of the time. And so X rays enter the patient's back to front. You can see a picture of a patient being a PA x ray taken. Um, most chest X rays will be pa because they're sort of the superior film, and you can see the patient sort of hugs the detector and that moves the scapula out of the way so you can see in the Pee film you can't see the scapular border. But in the AP film, I've drawn a red line. And that's because the patient scapula haven't been moved out of the way, so you can see it on the other side. And that's a little bit of a tell whether film is PA or a P Look for that scapula border. So a P X rays enter the patient front to back the receivers at their back. This is often used. If they are sitting down, they can't get out of bed. And if you have a portable X ray machine that is wheeled onto the ward will normally be a p. Um, So, due to the way that actually sort of diverge, the heart will impure enlarged. And so you can't really comment on heart size on an AP film, Um, and again there often performed. The patient can't mobilize and look for that scapula border, and then a wrecked versus supine. So we've got, um, an example of a super an X ray usually will tell you you can see it's a supine on that film. Um, but you can kind of tell once you've seen enough chest X rays, whether there erect or not, and the supine films kind of just look a bit slouchy there bit collapsed. They don't really look that nice. Um, so they're really done. If it's a patient who can't set up, they can't stand up and maybe they're intubated. Um, and it kind of just causes things to look a bit abnormal when they're not. And so they're not really done. So you can see in this chest X ray that looks quite abnormal. It doesn't look nice, but actually, the patient's CT was fine. And so it just goes to show that supine X rays can be a bit misleading. And you also have to remember that the patient's lying down, then fluid or gas in the pleural space will look different because normally, if you're standing up, gravity sort of brings fluid down. But if patient's are lying down, then it'll kind of distribute evenly. Um, so you should be able to point out the normal structures on the chest X ray. Um, so just see if you can think about the the key structures here. Um, and I've got a label diagram I took from online, which is quite good and kind of shows most of the stuff that you guys should be able to point out, um, you won't be able to see everything sort of in every chest X ray. So you know, your fishers might not always be able to see them, but you should at least be able to know where they are. So if you do see them, you can name them next a little bit on silhouette sign, which came up in my like, Phase three I lows. And it's quite an important sign, and I don't think it's really emphasized that much in teaching. I mean, it may be emphasised now, but when we were taught it, it wasn't really taught very well. It's actually very important that you guys know about it. Um, so that's a definite definition of silhouettes. It's the cast or show a dark shape and outline against a brighter background. So just keep that mind as we're going through this. So there are four basic radiographic densities. There's gas, fat, soft tissue, which is water metal in which is sort of bone. And when you have two adjacent anatomical structures in direct contact and they have different densities, we see a sharp margin on X rays, so they're outlined very nicely If they have the same density, then there's no margin and you can't differentiate them from one another. So you can see in the left image you've got metal, which is, you know you can take. There's a bit of a bone at the bottom and you can see the outlines. And then you have three different fluids of different densities, and you can see where they come into contact. There's this nice, sharp line, and then I'll talk about that image on the right. So I think these three images demonstrate silhouettes sign quite well, So these pictures were taken by having two boxes. So there was a heart in the anterior box and then an aorta in the posterior box, and you can see an image. A. Both boxes were filled with air, so the heart comes into contact with air and the aorta comes into contact with air. They're both of different densities, so you can see the outline quite nicely in be half. The heart box has been filled with water. Now water is sort of equivalent to soft tissue density. So where the heart comes into contact with the water, there are the same densities and you cannot differentiate them on an X ray so you can see an image be. You can follow the heart border at the top, but then it disappears at the bottom. But the aorta is still surrounded by air, so you can see the outline all the way down, and then the same goes for see. But it's just sort of the opposite way around. You can see the heart border very nicely all the way around. But then the aorta sort of disappears because as soon as it comes into contact with water is the same density, and you cannot differentiate them. And you're probably wondering where this is all going. Um, but this is putting it into practice. So in this chest X ray on your left heart border, which is on the right side of the image, you've got healthy lung. That's air density. The heart is soft tissue density, their differing density. So you get that silhouette, you get a nice left heart border. You can follow the curve all the way around on the right heart border. It looks a lot different. You've got some sort of long pathology going on, which is of soft tissue density. The heart is also of soft tissue density, so they're the same density and the silhouette is lost, so you cannot see the right heart border. It doesn't look sharp. It doesn't look defined. And that's silhouette sign. So this is the definition of so the wet sign from the guy who coined it. You don't need to sort of learn this definition, but it kind of puts it into practice. So he's talking about an inter thoracic lesion, which is touching the border of the heart. Aorta or diaphragm will obliterate that border. If it's not anatomically contiguous with a border of one of these structures, then it will not obliterate that border. So Silhouette sign is very important because it indicates pathology, and it also helps us locate where that pathology is. So I've got some examples here of different borders that you should be able to see on a normal chest X ray, and if that border is missing, it indicates sort of where that pathology is. So you're right Paratracheal stripe, which is in blue, and that comes into contact with the right upper lobe so that stripe is lost. Then you think you would think that there's pathology in the right upper lobe. Same for the right heart. Border is right. Middle lobe or medial, right? Lower lobe. But most of the time and questions if there's loss of the right heart border, then it's right middle lobe, right Hemi die from is right. Lower lobe aortic knuckle, which is outlined in green. That's the left upper lobe. The left heart borders the lingula and left hemidiaphragm is the left lower lobe. So to put that into practice, um, this X ray has an example. Silhouette sign. So which anatomical area is affected? So think about the borders that you should be able to see and which one is seemingly missing. And I've got Paul sub. So, uh, I got this one. I don't think I put this one in, but have I think about it, and then let's see. So this is the lingua. So you've lost the left heart border? Um, so you would think that there's pathology in the lingula. This is actually an example of pneumonia in the lingula. But without more clinical context, you wouldn't have been able to make that call. Um, I just know that because I took it from a website and it told me it was pneumonia. Um, so if a question wanted you to say that was pneumonia in an exam, then they would give you a nice story to go along with it. They would say, this is a six year old man who comes in with fever, coughing up dirty spits, and and he's just generally unwell. And then you would be able to sort of infer from that that Oh, this could be Gunship. Goodbye. There we go. Are we back? Can you guys see the slides? So yeah, because it's changing. Okay. Can you guys hear us? If someone could just fire in the chat if the audios back Yeah, Okay. Okay. So we're gonna do a little bit of cardio specific now. Um, so is this the first laid? Yeah. Okay, so So this case, Um, so this patient is meted with decompensated heart failure. And if you look at this erect pee chest X ray, what signs of heart failure Do you see that are present? So I don't know if you guys have Yeah, OK. Sorry. This is, uh, a pool for this one. OK, there's a pool for this one. Yeah. Submitted. Okay, Yeah. Okay. Great. Hold on. Yeah. So have you guys heard about the little memory? And it's like a B C D. E. So this usually in the lectures and it goes over it quite nicely, but we'll go over it again. So the way to look at heart failure or to wait to sell it is like the first signs. Always like cardio Maglis. That's like the heart getting bigger. But we'll start off with a B C. D. So with a you've got alveolar edema. And that's basically like you're battling capacities because of your fluid going out and into your interstitial space. But we'll go over that later on. Carly, be lines is your horizontal lines and your preference like perpendicular lines. And we'll go over all this in more detail. The next lines. I'm just giving you an over right now. And then you've got cardiomegaly, which is when your heart border is more than half of the diameter of your diaphragm. And you've got your dilated upper low vessels, which often looks like staghorn. And you've got your pleural effusions, which gives you blunting of your costophrenic angles. And, um so this is a slide that I put in because actually, when I was making these slides, um, I was thinking about the pros, like, sort of the progression and and heart failure. Um, so from people with mild heart failure to sort of severe heart failure, if you wanna put it that way and then the radiology sightings that come first, So the first one is actually capitalization of vessels, which we'll talk about in a little bit. But that's when your upper lobe vessels look really chunky, and they shouldn't be. They should be a lot thinner than your lower lobe vessels, but we'll show you an example than a bit. It then leads to interstitial um, edema, which is your curly be lines and then alveolar or alveolar edema and plural effusions. And I kind of saw this about the path of physiology, and I thought it was quite interesting. So you get increased pressure on the left side of the heart, and that backs up into your pulmonary veins. So you get increased pressure there, and that causes increased capillary pressure in the lungs and fluid just kind of pushed out into the interstitial spaces and then as heart failure progresses and you get further increasing pressure and fluid leaks out from the interstitial interstitial to the alveolar spaces. So hopefully, if you can think of the path of physiology, it does actually make a lot sense. And then you can think back and think, You know, what findings would I expect in someone with heart failure? In which side would I see first? Okay, so if we start off with the first step, which is cardiomegaly so this is essentially just a big heart. And normally the size of the damn meter of the heart is less than half of the what does the diet from, if that makes sense. So that's noted down in the image on the right, and it's basically just the big line at the bottom. But if the heart's enlarged, then it's gonna be more than half of the diameter of the diaphragm. Okay? And so you can see in this image that the heart is a lot bigger than it was in the previous images, and you can also, and you can also compare so and when you guys start placement, everything everyone teach you like. Compare the current chest X ray to the patient's previous chest X ray. Compare the current E C G to the patient's previous e c G. So even if the heart gets slightly bigger, you should still compare that to a patient's previously um, chest X ray, because that could just be the patient's normal. But you just need to double check that just in case. Um, and also when you're when you're commenting on the size of the heart and the heart, borders and everything, you can only do that on a PA film, so make sure it's a PFL because the A P is not accurate. And so they're looking at daily Stoppila vessels as your staghorn sign. Um, so when the patient's direct, the gravity basically causes the blood to flow into like the base of your pulmonary vessels. So your lower loss. That's why your lower vessels should be much wider than your upper vessels. But when fluid builds up because of your heart disease, this causes the upper vessels to become a lot more dilated. And that's when the staghorn sign appears, and you can see all this branching out of your vessels and it just becomes a lot more apparent. And this is your curly be lines, and this is one I never could find. I would let you just say in an exam I'd be like a curly blonde, but I didn't even know what they were. Um, but you might be able to see it here. So we've marked a couple at on left here, and it's basically just straight perpendicular lines, and you can see some above it as well. And I don't actually know why. This is why. Cause yes, this is just a sign of interstitial oedema. So it's fluids leaking out of your capillaries and to where it shouldn't be. And, um, this sign was described by Sir Peter James Kerley, apparently, and you describe some other types of line A, B and C, which are all signs of interstitial edema. But I've never met anyone who knew what a a n c. Lines were or used them in clinical practice. You ever, for that matter to be fair. And so the main ones are curly, be lines as long as you know them. Forget a N C. But they are a good sign to look out for. And once you know what you're looking for, they are quite easy to spot. And they really impressed people on placement. If you can look at it and be like, Oh, Curly, be lines. Okay, so next we've got your Abiola edema, and this is just you're battling shadows. And this is just when the fluid leaks out of your interstitial spaces, enter Abiola and it gives you this big shadow, which you can see in the image. Here. It's just your Yeah, basically. Okay, so we've got a question for you guys. And so it's a 40 year old, 40 year old female presenting with shortness of breath and hemoptysis. She's collapsed and her d dimer xrayed is raised. So what do you guys think is the diagnosis and we'll put a pull up your helping over this here. Also, another check is also so like for exams, just even just knowing the patient's age and their gender actually tells you a lot about the question. Rather than like if you guys get confused about anything, just take a step back. Look at all the big images, like the big points, and then take it from there. This is also an example of one of those questions that you could probably answer without even looking at the imaging. And often exams will be like that. They'll give you something and you actually don't need to look at the image or need to interpret it. But it helps if you can interpret the image, but you don't actually need to. It's all in the story, you know? And yeah, that's right. So that's a PE, and that's in your pulmonary arteries, right? The pulmonary. Yeah. Pulmonary arteries right there. Um, so you can see the blue, um is your pulmonary trunk Your red is the actual side of PE that's lodged in there. Green is your aorta, which is your biggest vessel, and yellow is your spc. So you've got another question here. So that's a 20 year old male presenting to the any with sudden onset of pleuritic chest pain and shortness of breath. And he has no known long disease. What is the diagnosis here? So this one, you can't really tell as much. Well, you actually actually can. But looking at the image tells you a lot more. Okay, So, like I said, it was a 20 year old male. So one thing with pneumothorax is that it's often if it's a spontaneous one and a young male. It's always tall, then young boys. And it's because, like even like a slight trauma can cause them to have a pneumothorax. Um, so this is due to present gas in the pleural space, and it basically cause your lung to collapse, and it compresses on your mediastinal structures. So if if it's attention, you also actually, we'll see it passing on your trachea and you'll have to keep a deviation. And this is, um, that's what might also common like him, a dynamic like instability. Um, and it can risk cardiac arrest and death. Um, so pneumothorax. It can either be spontaneous or it can be secretary to underlying disease. Or it can be traumatic, like we just said. So like an spore or just blunt trauma and like a road traffic collision as well that commonly happens. And so can I just read around the scenario and they had the findings will see is the visceral pleura edge, which looks like a thin white line. So we marked it in blue on the left, which is the right side of the patient, and and there's no long markings and peripheral to this line. So if you see on the left side of the patient, you can see all like the the vessels, and you can tell the long, like the long, um, surfaces there, whereas on the right hand side of the patient, it's just black, and it's clear, and you can also see, like the shriveled up space in the center. And that's just the lung that's compressing in, um, and you can see, uh, mediastinal shift, which indicates the attention you Martha rights also like. Interestingly, this is a chest X ray that people will tell you should never see, because you should be able to diagnose a pneumothorax at least attention your Catholics of this size, um, on a patient without imaging, you know, if you tap on their back, it'll be hyper resident. They'll be really short of breath if not, um, or a day sort of dying in front of you. Um, so that's just like an interesting thing. It's something that people will tell you you should never see because they should have been treated before they got this far Yeah. So sudden onset of chest pain. Just think of him, Hemothorax. Sorry. Pneumothorax. It's a young male, and it's after sport or whatever. Just think of pneumothorax. Okay, so let's look at some collapse now. So this chest X ray shows all over collapse. So which lobe do you guys think has been collapsed here? And just remember, compare the both lungs carefully, even if you guys don't have any idea what's going on, just remember to think, Okay, what's normal and what looks abnormal. So just compare that over here. You beat that? Yeah. This one's quite subtle, to be fair. Um, but I think it is something that you should be aware of because it is something that could you could be shown in a Noski. Yeah. So this is the left upper lobe collapse, and this is a difficult one. So don't worry about if you guys struggle with this, but with the left upper lobe collapse is basically this bail like capacity that's over your lung, and you can see the left, the right lung. Okay, so when I say right long, I mean the right of the patient, I don't mean like the right of your screen. So yes, so the right side you can see that just looks like a normal long margins. You can see everything there just looks fine. Whereas on the left you can see it's like more opaque. And something doesn't seem right that a are technicals a lot thicker. Something is just not right. So even if you guys don't know what's going on, you can tell the right and left are not the same thing over here. So yeah, if that's basically just it's really big, really, Um, but yes, that's your left upper. A little collapse and your left lower lobe collapse is when you've basically got to densities of your heart. So if you see your heart's not going to be this one dense object, it's going to be almost like a like this object behind it. And that is your left lobar collapse so you can see here like you've drawn, drawn like a triangle on the right to like show you guys like where the collapses and this is your right upper lobe collapse and you can see it's opaque on the right side again, right upper lobe, and you can see this elevation of your horizontal fresher, and it's basically inflated up because your right lung is not there to give it that way anymore. So it's basically like a balloon, like it's so your middle lobe in your left lobe is in your bottom over, just like all right. Okay, well, we're going to inflate up against it, and you're right. Hilum elevates, and you're right. Hemidiaphragm also elevates if you compare your diaphragm on your left diaphragm to your right diaphragm and your rights a lot higher. And that's not normal. Like even though your liver is there like that's That's not normal. So, um yeah, and you can just see that there's increased density as well. And over here, this is your right middle lobe collapse, which is also to surveil in the left upper lobe collapse, not cover the whole left lung. Yes, it does. It does, and that's why you can tell there's something wrong. Um, so it is a very vague one. But even if you know that, um, something's not right, like you can just pick it up. So it's your right middle lobe, and you can see the silhouettes in here, which is your loss of your right hard border heart border, which we've outlined in the Blue Line. And this is it's quite difficult to tell on, like a Corona, that corona of you. But if you look at it on a lateral projection, you can see it over there like there's like a metal middle of collapse. Um, you'll notice that I've not put the spotty dog here because I think this one is very tough, and I don't think they give you this in an exam. But it's something that you should be aware of just for like, completeness of all the lobe collapses, especially cause I've I don't think lateral and chest X rays are done that much anymore. Um, but just to be aware of it and this is your right lower lobe collapse and you can see this carb on the right side of your lung and you can you can tell it's just it's just not It just shouldn't be there. So this is basically the loss of your right hemidiaphragm and you're right heart border. And, um, it's basically like this triangle capacity and your posterior medial right hemithorax hemithorax. So it's the same as it was in your left lower lobe. But because you've got your heart there, it's a lot more clear because there's two different densities or is on this one. There's still triangle, but there's it's a lot more difficult, but you can still kind of tell that something's not right. And there's this curve, which is your right lower lobe clap. Okay, so there's another pathology here for you guys. And this a 60 year old male acute onset of abdominal pain with guarding. So look at the diaphragm. And what does this abnormality suggest? And this could very well come up in and ask you, Come on. Yeah. So this is your new, more peritoneum. And for those of you that have no idea what this is, I've never seen this before. It's all right. Don't worry about it. I let you only figure this out after I went to placement and got told about it. And so this is basically just when they're here under your diaphragm and this is due to a perforation in your abdomen somewhere. And there's fear under the diagram so you can actually see. And the circle on the right that actually shows you how thin your diaphragm really is. So the air underneath it that shouldn't be there. That's not normal. And that's only they are, because there's a perforation of some vessel organ, whether that's your stomach, whether that's your colon bell. Like what else? Like anything literally, anything gallbladder? Um, um, yes, That's basically all you really need to know. For that. They're not really gonna ask you much more, but just know that that's your pneumoperitoneum. Okay, so your pneumonia. So that's a 70 year old male he's admitted to hospital without, um week that week. Yeah, a week history of coughing up green and brown sputum. He has a fever. He's confused, and he's hypertensive as well. So what is the most likely treatment for this man's condition? I just realized I like giving you the answer when I've seen you money at the top. But yeah, what's the treatment of the morning? I guess, But just think like if I hadn't given you the fact that it was pneumonia, would you have been able to sort of to reduce that from the presentation of this man? The story that they're giving you and then seeing that there's consolidation on the X ray. Yeah, so? So this is like very similar to order saying last time like so in a question like that, you don't actually really need the chest X ray to know what it is just because you know he's got fever, you know, he's coughing up sputum, and he's confused. It's probably got a bit of sense sense of it, like it's just it's like classic signs of infection. And so, yes, this is ineffectually in your lung. It's basically when you've got, like, this matter filling in your alveoli, and it presents a consolidation on your chest X ray. So you can see here that something's not right. So and your right lower lobe and it's just way more pink than the left lower lobe is Something's not right. It's too dense. You know something's there and that, paired with his symptoms. It kind of gives you an idea of what it could be. So always remember your carb 65 score scoring system that always comes up in exams. Um, and this is basically just your system used for assessing how severe the pneumonia is, Um, and and it basically just tells you whether you need to treat an outpatient, or you should patient should come in to the hospital and get, um, also treated. Yeah. So, um, so it's basically see, if you've got confusion, you're real more than seven. Respiratory rate, more than 30 breaths per minute. And your systolic BP below 90 and diastolic before below 60. And, Oh, and the age is over 65 years. Okay, so now we did an M S K. Um, So, first off, bone Tumor's, um, these for your M s k presentations. Um, quite a few of them. You might be given the images a little bonus, but I think often what they do have said is they use buzzwords. So this is an example of that. Um, So this is a 15 year old male with worsening pain below his knee. Next week shows a lesion is proximal fibula with sunburst periosteal reaction, and you can see it highlighted. Sunburst there. Um, so what's the most likely diagnosis? Um, sorry. One second off some managing screens on my own. Mm. Hello. Are we back? Are we back now? Yeah, OK. Sorry, guys. Now, I went to the toilet and took a hot spot like phone. We've got, like, one computer in the PBL room, which is connected to edge room, but it doesn't have a mic. And then we've got one laptop that's, like, barely hanging on anyway. So, as I was saying, bone tumor's, um, this is something that I don't think they give you the imaging for and expect you to. Yes, this is being recorded. This isn't something that I think they give you the imaging for and expect you to know the diagnosis instead. What I think they do is they give you buzz words in the stem question. Um, so I've highlighted some buzzwords there. Um, so osteosarcoma. Most common primary, malignant bone tumor, Children, adolescents typically femur, tibia. And that has that sunburst periosteal reaction that was in the MCQ. Um, so you can see an example of that in the top image. It's kind of sort of branching out. It looks like a sunburst. I had a picture of a sunburst on the other side. If you see it, it kind of looks like it's branching out. But again, I don't think they'd give you the image. I think they would tell you it has sunburst periosteal reaction, and that indicates aggressive disease. Um, and and then also Codman Triangle. And that's where the bone lesion sort of. Lift the periosteum off the bone, and you can see it's sort of flying off there in that image, then during sarcoma that's common in Children. And the buzz word for this one is onion skin reaction. And that's the bottom image. And it's thought that this is intermittent or just get discontinuous growth so they get, um, lesion grows quite quickly, and then it stops. And then the periosteum sort of lays down bone while it's resting. And so you get that sort of layers of bone or periosteum, and then chondrosarcoma is the other one, and that's more common in middle aged people. And that's a malignant tumor cartilage, and that's typically actual skeleton. But I do not have a buzz word for that one, and then some benign bone tumor's um, so I think the main one with a sort of buzzword is giant Hill. Tumor's a bone, and that's often describes a soap bubble appearance. Um, they're benign. Peak age 20 to 40. Um, other benign bone tumor's, um, Osteoid, osteoma and such as benign, bone forming neoplasm and osteochondroma. And that's when you get a benign protuberance that's surrounded by a layer of cartilage. And that's an adolescence. Now, this one, they could show you the image. And this is something you could get in an off ski. Um, maybe not third year. I'm not entirely sure, but definitely in later years. So this is a seven year old male presenting with a four month history of worsening the stiffness and pain he's now housebound due to his symptoms. So think about what the diagnosis could be. And what's the definitive management for this condition? I think we just got a question. Okay. Oh, no, we don't. I just think it like So this is osteoarthritis of the knee. Um, so findings. I use the acronym loss. So you get loss of joint space osteo fights and subchondral sclerosis and subchondral sis. So subchondral sclerosis is that sort of intense whitening just at the joint. Um, and then osteophytes you kind of get bony growths at the edge and then loss of joint space. That's because you have loss of cartilage. So the reason that you see a gap in joints and a nice sort of dark gap is because cartilage doesn't have sort of calcium in it, so it doesn't show up on X rays. So when you lose that cartilage and when it grinds down, you get bone sort of rubbing. It's bone and it looks like you know the joint space is gone, and then definitive management for that would be a total knee replacement. Yes, I always like, really, look at the wording of the question, because if it's asking for defensive management, I want you to know what's going to purely fix this rather than, like, just supportively manage it, Um, so this is a central female with chronic pain and stiffness in our fingers. And what's the diagnosis of this one? So this one is osteoarthritis again, so we go through our loss, and so you got lots of joint space. You can see some of the bone is rubbing against bone there, and you get Ostro fights, those bony lumps and spurs you can kind of see the bone at the edge is kind of carving round the joints, and it shouldn't be doing that. And then the whiting of the bone beneath the cartilage. So subchondral sclerosis and then subchondral sis And and then I've got we example of one there with a red arrow, and it just looks like a black hole and bone. Um, you can also tell from the clinical image that I've given you of the hands sort of this, um, enlargement of the D I P and the P I. P joints is very classical of osteoarthritis, Um, and also that sort of presentation of an older person who's got stiffness in their fingers. Um, gout is an interesting one. Um, go, I guess if they gave you it in a question, it would usually be, um, sort of your big toll. That's the classical one. And it would really be like multiple soul, enjoy, be more of like a single hot swollen. Yeah, they would usually give you a single one and look this up, because I'm not really sure, But I'm pretty. I think the way that they describe it is sort of. It looks like a rat bites in gout, and it looks like a rat is sort of taking bites out of the bone. It's quite interesting if you want to look it up and this is a little bit of Paget's disease again, I think they would be quite cruel if they were to give, um imaging and expect you to know what it was. But I have highlighted sort of buzz words they might use, or they might expect you to sort of might say what the radiological features of Paget's and expect you to say Osteo process circum scripta, which is a big, big word. This is a chronic bone disorder, and it's, um, excessive. Abnormal bone remodeling usually affects skulls, buying pelvis and lower extremity long bones. And so you can see I've got pelvic extra there and the right femur is normal. That's fine, but you can see the left femur, and I've got way in large image. You can see course trabeculations so those lines and they look, you know, you can see them very clearly, and if you look on the right hand side, you can't really see them that much at all. And and also the femoral head is expanded. But I think that's fairly subtle. Um, so I wouldn't worry if you didn't spot that, um, So the skull they get thickened vault and osteoporosis circum Scripta is sort of a well defined lucency, so that means sort of like darkening. And it's often the frontal bone so you can see in the arrows. There's sort of this line, um, and you can see sort of a darker part of the skull just where the frontal bone is, and then ankylosing spondylitis. So that's a seronegative spondyloarthropathy m, which means it's remote toyed factor negative. And it's often HLA b 27 associated. Um, so they get fusion, which is ankylosis of the spine and the sacroiliac joints again, I'm not entirely sure they would give you this, um, just as imaging. But they might ask you to name the radiological features and so they get sick, really a tous. They get vertebral body squaring and they get dagger spine. And I've got an example of that in the next slide and they get bamboo spine so you can see that spine. Um, it looks a bit funny, I guess. Like it doesn't That's not even if you're not. You know, spine and spinal radiographs aren't taken off, and you don't really see them that much emplacement. But just for your knowledge of anatomy, you should be able to figure out that spine doesn't look quite right. And that's, um, so do two bony spurs, um, connecting first brace. You can see that drawing down at the bottom, um, is an example. A bamboo spine is a phrase you guys should remember. So if the question says it's like a young boy coming in with back pain in the morning that last so many hours and text Sorry like X ray images show a bamboo spine. You know it's gonna be ankylosing spondylitis, and this is just an example of dagger spine. So that's due to calcification of your super spinous and interspinous ligament, so you can see them on the diagram there and marked out and and it calcify. So I've got a normal extra in the left. That's what spine should look like so you can come when you get the slides. Later. You can compare that to what the bamboo spine looks like, and you can see on the abnormal image. There's this dense, calcified or white line running down the middle if you can see the hours pointing to it, and that's what's known as dagger spine. We've got another hand case for you guys. And this is a 20 year old male with hand pain falling a fall onto his outstretched hands. And he's tender in the anatomical snuffbox. Um, so I've outlined the anatomical snuffbox, and they're on that image. You can feel it on yourself. And that sort of image is what a snuffbox is. Apparently, um, so there's a fracture present here. Um, so which bone has been fractured again? This is one of the one of these questions that they wouldn't even need to give you the imaging for, um, if they said that someone's, you know, fallen onto an outstretched hands and they're tender in the anatomical snuffbox. You should. That should sort of make you think of a specific bone. So this is a skateboard fracture. I've highlighted the sort of line there. Um, this is very important not to miss. And that's because the blood supply from skateboard comes in only one direction. So if you cut off that blood supply due to a fracture, then you can get a vascular necrosis in the rest of the bone, and that can be that can have pretty pure, um, long term outcomes for the patient. And the key thing to know is that skateboard fracture isn't always seen on an X ray. Sometimes it might be seen sort of. If you take an X ray a week or two weeks after the fall because of sort of the remodeling that's taking place, you might be able to see it then. But MRI's the gold standards and you can see on the MRI where the scaphoid is, it looks quite dark, and that's sort of a D mail because it's been fractured. Okay, so we'll do a bit of your Aleve. Mhm. Okay, so this is a 55 year old female presenting with a thunderclap headache and neck stiffness, and it's the noncontrast CT head. So what do you guys think is the diagnosis by looking at this image? This is also one that you can work out without looking at the imaging. But damaging really helps you. Uh, so this is your subarachnoid hemorrhage, and it's mainly due to a ruptured aneurysm. Uh, it can be due to trauma or just mascular my information, but usually it is like it is a ruptured aneurysm, which is often genetic, and but this is a thunderclap headache. So you feel this sudden onset the worst headache of your life, and it's like being hit with a back at the back of your head, and it's very, very similar to a meningitis headache. But the only difference is you don't get a fever with this headache, and it reaches its maximum sense intensity and like under a minute. So it's very sudden onset, very quick, very painful, and it's investigated with a CT head. But if the CT head is negative, you can do a lumbar puncture 12 hours after the onset and this and, um f and the if the lumbar puncture has xanthochromia in it, which is basically your belly ribbon, Um, and then you basically also bragged on hemorrhage clears a bleed. Um, so yes, your findings would be an acute. So acute blood draw. Fresh bleed is bright on a CT scan. It's white, and there's blood and the basal cell restaurants and sulk. I, um, So and after this, you would consider a CT angiogram to look for the aneurysm and to know when to do coiling and went to, um, basically bring all intervention then and locate the bleed so first you had a CT head. If that's negative, you would do a lumbar puncture. And if you've confirmed a bleed, then you would do a CT angiogram just to add, Um, interestingly, Nice recently changed their guidelines on this. I've gone with the old guidelines because they're sort of I think they would still be accepted exams. And it's sort of the gold standard by considered by, you know, neurology people in like any, um, but nice say now that if you have someone that comes in and you think it's a subarachnoid hemorrhage and u c t them within six hours and it's negative, then you do not have to do a lumbar puncture. Because CT is very good at picking up subarachnoid hemorrhage is as long as they present within six hours. Um, but a lot of people disagree with that. So I've gone with the old guidelines, which I think is what you will see on placement and you will see in any and I don't think they'll fault you for that. But just in case you see, or maybe you've seen on slide, so that's something different. Okay, so this is your hemotomas. So there's two types. You've got your epi slash your extradural hematoma, and you've got your subdural hematoma. And both of these have their own characteristics, basically, So your epidural hematoma is basically between your skull and your dura meter, and this is limited by your suture lines. And this is why you get a lens or a convict shape, and you can see it on an X ray because it's pushing against it against your brain, not an X ray. Sorry, CT. A CT scan is pushing against your brain, and this is always your arterial bleeds, because that's where your arteries run through. Um, and it's usually you're middle meningeal artery because you'll get probably a blunt trauma to your terry on. And that's the bone that your middle meningeal artery lies on. And this presents with a lucid intro, which is basically just a temporary improvement before deteriorating. So you feel a lot better. But then you'll suddenly deteriorate and you've got your subdural hematoma, which is basically your concave, crescent shaped bridging. And it's basically just like this. It kind of looks like a I don't know what you'd call. It's basically just this. If you look at the edge is basically like this white mush pushed against the skull rather than this nice lens shape. And and it's basically a venous bleed, so the main difference is epidural is an arterial bleed. Subdural is a venous bleed, and that's due to the bridging veins. And this is commonly seen in your elderly because as you get older, your brain gets smaller, and when your brain gets smaller, there's a lot more space for your brain to move about in your skull. And even a slight trauma can basically break your veins and cause a bleed. And that's when you get this subdural hematoma that you see. We have a case for you guys here. And this is a 70 year old female presenting with, uh, and our history of Hemi praises and a facial droop. It's suspected she has had a stroke, and you do a non contrast CT head and there's no acute abnormality detected. Does this mean stroke is ruled out? I've not really got a pool for this story. Um uh, yes, on the x light. Um, so short answer is no, because, um um, so CT is very quick, and it's successful and it can be formed in stroke presentations. However, the key thing to know is that it takes time for, um, sort of ischemic stroke changes to show up on a CT. So CTS, you know, it's generally good. 60% are seen in 3 to 6 hours, and virtually all of them are seen in 24 hours. Um, so a scheme excitotoxic cerebral edema, which is what you're looking for. That's that sign of an fortune. It looks hypodense. It looks dark, and you can see that specific. See, on the three months later in image. You can really see it there, and you can kind of see it happening on the one day later, But three hours after, um, it is present. But, you know, like most people probably call that normal because it looks it does look normal. And it would be very easy to mess on a CT. But if you really wanted to do a head imaging, you'd probably prefer to do an MRI. Uh huh. So ct and acute setting on when you're considering stroke. That's used to exclude intercranial hemorrhage and which can present with similar symptoms. And that, as we saw before, that looks like white blood. And and that would contraindicate thrombolysis in stroke. Um, it's also sometimes you might be able to see early features of ischemia, and it's to exclude other intracranial pathology. So, for instance, and a tumor So CT is always used for, uh, excluding excluding a bleed or excluding a space occupying lesion. Because one of your contraindications for the lumbar puncture is a space occupying lesion. Um, but you'll need to do with your CT is negative. Um, bleed. This is, um, one of the first signs to show up. And you should be familiar, at least with the name. So it's hyperdense Middle Cerebral artery signed. You might be able to spot it. You might not. I'm not sure if they would show you the image. Um, but you should at least be aware that it's something that you can look for and that's the archer appears bright and you can see in circles. It appears quite bright. And that's you to thrombo embolic material in there to your Lumen. So you've had a thrombus that's formed in your heart or your carotid arteries is then embolized and then included um, the M C a and you can see it. Um, so that's the first visible sign of an M C. A in fortune, and that's usually visible within 90 minutes, and you'll sometimes see it mentioned. So Normal is talking about MRI. So MRI is more sensitive and specific in the diagnosis diagnosis of acute ischemic stroke In the first few hours after onset. However, it is more time consuming, and it might not be readily available. You know, if someone's already in the scan, er, you can't just chuck them out. And not all hospitals have an MRI machine to begin with. Diffusion weighted imaging is a buzzword that you should know because that's the specific sort of MRI, um, sequence that's done for stroke, and it's quite complicated. You can look up exactly what it means if you want, um, but it's basically looking for, um, Adama kind of and due to ischemia and you can see appears quite bright. Um, so you can see that left image bottom left image That looks normal. Um, although there is very slight changes, but most people would call that normal, but you can see in the other images that's your diffusion weighted sequences and you can really see that there's been some pathology there, and that is an ischemic stroke, then just additional imaging that can be done in stroke. I've put the nice guidelines down at the bomb because there's so many, um, sort of. This is when you do this sort of imaging. This is when you do that and it changes all the time. But the main ones to know of are created imaging. So that's if you're thinking that there's carotid disease or carotid dissection, which can also present with similar symptoms a stroke. Or if you think that maybe the thrombus has come from the carotid arteries. Um, and if you perform protest imaging, then you can consider doing across it and our trip to me. And if they're very still nosed and and the patient has a stroke or TIA in crotan territory, But again, look through the nice guidelines if you want to know more in depth, um, CT or MRI angiography. So that's if you're considering from Beck communication. And so the location of the thrombus is very important, and the nice guidelines go through when you can perform thrombectomy and at what time after presentation and onset. You can form thrombectomy, and it depends whether it's anterior posterior circulation and then perfusion imaging. So when you have a stroke, you get, um, an area of tissue that dies very quickly and then around. That I think it's called The penumbra is an area that, um, is at risk but still salvageable. So if you have a patient that presents a bit late and you're not quite sure if it's worth treating them or not with thrombectomy or Thrombolysis, then perfusion imaging can be performed to see if there's anything actually left to save and diffusion weighted MRI, sometimes also used for that purpose. So this is gynecology. Um, I put we note here because I want to stress that this one and I don't think you'd be asked to interpret gynecology imaging most of its ultrasound scans. And as a medical student, um, we're not really asked to learn about ultrasound scans because it is quite tricky. Um, but you could very well received a question stem that describes imaging findings, and then they ask for diagnosis based on that, and it helps to know exactly what they mean when they're giving you these buzzwords. So this is ovarian pathology. This is a 30 year old female, and she's had a trans vaginal ultrasound scan of the left ovary. Um, she's a symptomatic, and it shows a left of very lesion. So that's the large black circle that you can see in the image. It's thin walls. There's no solid component and Doppler scans that looks for flow, and that shows no flow within the lesion. So what is this lesion most likely to be again? This might look a bit scary because ultrasound images are scary, But think about the stem, you know, young a symptomatic, and you might be able to come to the answer. Yeah, great. So this is a benign of your insist, um, so ovarian follicles and a very in Flickinger cyst are pretty much the same thing. It just depends on what size they are, Which name you call it. So ovarian follicles very common, and you get 10. Ovarian follicles grow, and then they develop during a normal menstrual cycle, and usually only one of them goes to become a dominant variant follicle. So in a very in Flickinger cyst is larger, and that's what the dominant ovarian follicle becomes and they're asymptomatic. They're commonly seen in pelvic ultrasounds, and they do not occur. Post menopause, where we see, um, sort of assist in an ovarian cyst in a post menopausal women. She shouldn't really be there. And that would be quite concerning for malignancy, so finding, so it looks like a cyst. That's what cyst looks like on ultrasound. It's just empty and dark inside. There's nothing much to it. It's thin walls, and there's not different bubbles and segments to it, and it's got no solid component component, and there's no colored fluid. Doppler management is, you know, most required, no follow up. If it was bigger, then you might consider more imaging and follow up just to see if it's growing larger. If it goes away. Another couple of benign ovarian cysts that you should be aware of. Um, so Corpus Luteum is just the remnants of the follicle after ovulation and that produces hormones. And if it fertilization does not occur, then it goes away and becomes the Corpus Alba cans, Um, and and the fertilization occurs, enlarges, and it secretes more hormones and then envelopes sort of midway through pregnancy, then a Corpus Luteum cyst is if it fails to regress, and it's the most common pelvic, mass and first trimester, and most will invalid by the end of the second trimester. And it has that buzzword ring of fire appearance on Doppler, some more variant pathology. So this is a 25 year old female, and she presents with sudden onset pelvic pain. Pelvic ultrasound shows a left ovarian cyst. Doppler shows no flow within the cyst. What complication has occurred? So look at this image. Um, I'm telling you, that's a cyst, But inside doesn't look quite cyst like Remember, I said they were empty and dark. And yet there's something going on here and think about you know, it's an ovarian cyst. What complications can sort of occur. So this is an example of hemorrhagic ovarian cyst, and you can see that there's stuff inside it that shouldn't be there. Um, and it's the most common cause, apparently of acute pelvic pain in a federal pre menopausal female. So the cyst no longer looks dark and empty as what's described as a lace like pattern and within the cyst, and I guess you can kind of see that looks lace like, um, it's just not dark and empty anymore is the main thing. Um, and as it's hemorrhage, it's kind of clotted up, so there shouldn't be any internal blood flow, and it's still thin walled. Usually these completely resolved. And often people will be given a follow up ultrasound just to make sure that it's going away again. It's postmenopausal. Then, um, should really have, um, sort of physiological cysts because they're not going through the menstrual cycle anymore. So you would want to further investigate that, um, an endometrioma so a k a chocolate cyst. And so that's a localized form of endometriosis and that form cysts containing dark degenerated blood products. And it's called chocolate because you can see in the surgical image. Kind of looks a bit like chocolate, I guess. Um, um, usually finding the ovary and they may present the signs and symptoms of endometriosis. Um, so findings. And it's usually unilocular, so there's only one component to it, and it's got ground glass internally, and there's no flow. And Doppler, um, there is a chance malignant transformation, so they're often cut out and followed up annually. Um, I just want to stress that I don't think they would give you the imaging findings for an endometrioma. Because, as you can tell, lots of the cyst sounds very similar, but it is something that you should be aware of. And it can come up in exams as sort of a, um, feature of endometriosis. Uh, so this is a fun one. This is a 30 year old female with an incidental finding on a McDonald X ray. And so you can see the arrow that's, um, white. It looks like the bone, so it's calcified and they've cut it out. And it revealed this benign lesion, um, that you can see there. So what's the diagnosis? Great. So this is a mature teratoma, um, so it's also known as a dermoid cyst. Um, it comes Teratoma comes in the words and meaning like monstrous tumor. And so it's common. It's benign, and it contains elements from multiple germ cell layers, typically young females, and it can be a symptomatic or can present with a variant or shin. It was quite large. Um, often contains calcification, even including teeth, and sometimes they're seeing an X ray, and then an ultrasound will show heterogeneous, which means it's made of lots of, like different components. It doesn't all look the same. It's cystic, and it's got no blood flow on Doppler, um, management. So they're usually slow growing. Uh, they can be monitored for growth, and if they're really big, then they can be cut out. It's kind of sort of patient preference, but they're really large. They are at risk of causing, or variant or shin. So a key thing to know is that immature Territo HMAS are slightly different. They're a lot less common and they're malignant. Um, as opposed to mature teratoma as, um, this 20. Mhm. Mhm. Mhm, Mhm. Mhm, Right? Can you guys rivers? Now? I'm using my phone for we've got three devices. Everything's everything's giving up. Yep. OK, grants. Thanks. Um, so this is an example of PCOS. Um, So you can see lots of the black circles. They look like tiny little is this, um, which is where the name comes from. And so that's the most common endocrine problem in reproductive age females. It's losing cause of infertility. It often presents with irregular menstruation, infertility, multiple small follicles with no dominant follicle. Um, and there's also entries severe. So management really depends on the symptoms have less of difficult of sort of treatments there, Um, but that's a whole other port power point, its own for management of PCOS. Um, so it's a 25 year old female with a known ovarian teratoma. She's presented to a and E with acute severe Donald pain, nausea and vomiting and all sounds. Cancer is a very large ovary with no venous blood flowing Doppler. So what is the most likely diagnosis? Sorry if I'm going quite quickly. I'm just trying to get like through it on time. So this is a very interaction that is, uh, sorted ovary. So it's commonly due to the very mass, so a teratoma. It's presentation, typically young or postmenopausal, and so either or severe abdominal pain, and can be constant or intermittent. Nausea and vomiting are common, and on ultrasounds. That's the investigation of choice. You getting a large ovary. There's poor blood flow on Doppler because it's all twisted. Blood can't get through, it can't get back out, and you get ovarian edema, and sometimes you can see every pelvic fluids. Another thing in the eye Lowe's was to know about the risk of malignancy index uh, ultra. Some features time times in See a 125, which is a tumor marker. And and it's just important to know some of the features of malignancy or very malignancy. You might see an ultrasound and be aware of what the scoring system sort of indicates. So if it's very high, that person's high risk and so referral CTS recommended. If it's sort of in between, then there intermediate risk. So consider an MRI for further characterization of lesion to kind of find out what you're dealing with, and it's less than 25 or low risk. And then you can can and consider ultrasound or MRI if you want reassurance. Okay, last part, guys. Okay, so I was going to fly through this stuff, So it's basically just abdominal X rays and your education. So indications basically, just be your emergency presentation with your vision material. Really quite good. So you got a toxic megacolon your bowel obstruction and ingestion of any foreign body, and even just monitoring your real pick your renal stones and yeah, so it's limited in pregnancy, and, um, it is less sensitive and specific than a lot of Dublin CT. But it's very good for any about preparation instructions or talked about color and stuff that you know you can use it for and positive. It's rapid. It's accessible. You know what's going on. So on left. Okay, it's basically just your last. Me, all of it. Um, so you guys can just look over that later, and so is your kidneys. Besides that, if you're females and the context fantastic abdominal pain was that amount. So how close? Look at both of the CT. Have the extra. Okay, so this is your contract practice, and you can see your classification of your pancreas over there. It's quite hard to make it, but it's there. Uh, it looks like a sausage on the city of, uh, in my opinion, I think it looks like a sausage. And that's your cultural females. You motivate Corddry pain. After is saying, Where is the mountain? What's going on? Mhm. And you can say that's allergic stones in the rec recording, as in your gold modish particles, these sort of images. Um, it's kind of one of these things that once you see them, you don't forget you don't forget them And you know where to look. Next time, your hand is a an abdominal X ray. Okay, there's another one. Patrolmen with Let's sit back. Pain and intermitted materia. So what's the diagnosis? I'm just looking at the, uh So that's what you call starting calculus. And it's basically the same as the interest actually did. But it's your, you know, pelvis and stone just forms and get okay, uh, and wanted. Okay. You guys may not compose this, but, um, here are is your old male presented with acute dongle, bloating and nausea not built as bells or passed any gas for 24 hours? Diagnose are a large bowel obstruction and the lung X ray shows copy. Been saying, what does this suggest? I haven't set up the pool, so just how do we think about it? I only with the chemicals this, uh, gonna start placing. Well, you guys need a minute. So this is your segment globulus and a second volume. Is your copy being sign? Where is your sick of all this is refer you to sign as that episode. And also, that's the sense symptoms of a larger obstruction and abdominal situation. It's not Yes. Sorry. That's the specials. Um, so this is just a conclusion. Thanks for making it to the end. Um, so imaging is hard, and that's what we have, radiologist. So make sure that you know the basics. You can recognize the spot diagnoses, which we've highlighted talk and make sure you have a good, systematic process. We're going through different types of imaging. And don't worry if you don't have a systematic process at the minute. That's more something that you learn. Once you get into placement and you'll get endless lectures and how to go through a chest X ray, remember to read the question. Stem carefully. The story is the key to understanding the imaging. Look for those blood work. Those words and exposure to imaging will have a lot. You're about to start placement, use packs that sort of like imaging portal and ask doctor to SRI scans. And these are resources that found really useful. I high recommends else's principles of chest Rohan's and I don't know how much is that, but I highly recommend this very good book, and you can work through it in a couple of nights, and it's like a workbook It's funny, but it's, like, really good. And I put the link here. That's how I accessed it. And it should be accessible for your university Glasgow. Log in. This is feedback and you can scan the QR code, but it should send out the link anyway, I think I can actually do it now, but thanks for coming. I hope that was helpful. We will be sharing the slides. It might take a couple of minutes. And for me just to go through it. Imagine, send them. And this has been recorded. It just takes a couple of hours to sort of process. And But you may or may not get a notification when that's done. Um, but check back later, if you would like to watch back. Um, but yeah. Thanks for coming. I hope that was useful. Um, any questions, people free to email me or message me on Facebook or something? Um, yeah. Great. Ok, thank you, guys. Thanks. Hey. Oh, that's good. That we did, uh, right. Uh,