Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

all right. Looks like we're live. I'll just give it a few seconds to let everyone join. Um, All right, um, without further ado, let's get started. Hello, everyone. Thank you for joining. And welcome to a talk by IR Juniors about radiology for F ones. Apologies For the slightly late start. We have some technical difficulties, but hopefully it will be okay during the talk. My name is Aryan. I'm currently F one at ST Marys Hospital in London on I'm joined by Turn, who is currently on F one at Birmingham City Hospital. And Satun, who's ST one radiology trainee at the Royal Free Hospital in London is Well, um, next slide. So we're just wanting to have a talk about radiology for F ones. But before we do, I thought I'd say a few words about IR juniors. So I, our juniors, is a national organization run by junior doctors and medical students. Um, we are mainly focused on promoting radiology as a career on interventional radiology as well. We run very seven throughout the year, such as teaching events and webinars. We run journal clubs we give teaching on different application process is so we get candidates who have scored highly in applications and ask them to be speakers for any advice and tips. Um, we run various research initiatives. We're planning on doing a conference data this year. So we do a lot of stuff to promote IR juniors to promote radiology and interventional radiology is a career. So if you haven't heard of IR juniors already, definitely check out our website. Check out our social media, make sure you're following it to, ah, be oxidate with the latest information and up to date with our latest events. Next slide next life. So Grady ology for F one. So we thought we'd give this talk to help prepare mainly incoming F ones for common radio lot of radiology scenarios. You'll come across things like requesting scans, communicating with the radiology department and common issues you might come across. So issues with contrast induced on the property issues with contrast, allergy and towards the end, we'll have some cases and we'll have a talk about interventional radiology as well. Um, this is not gonna be a talk about how to interpret chest X rays or abdomen X rays. Um, I'm going to assume that people watching this already know how to do. Those kinds of things were mainly going to be focusing on your day to day jobs as an F one on common kind of scenario, to come across the type of things that you might not have learned while at medical school. Uh, next slide. So this is like a very common timeline off what happens when you request the scan so you usually start off by taking history and examining a patient, or they'll already be on the ward and they'll be Clark through any, and there's usually a discussion with a senior on. There will be some kind off outcome like we need this patient, have a scan on do. The scan will need to be vetted, which means talking to a radiologist on. Then it will need to be added to the list, which means talking to a radiographers on. Then finally, the scandal will take place and you'll have to chase the report on but just going to talk through this process and common common things, you might come across next slide. So the first thing we really want to emphasize is when you're talking about requesting a scan, it's really important. You understand exactly what kind of scan request you want on. Do exactly the clinical question that you want to be answered and what you want the radiologist to be looking for. So if you look at this screen shot, this is an example of what you'll see if you type in CT into the search box. There's so many different types of CT scans that impossible. So it's really important. You know exactly what kind of see two you want with it, whether it's a contrast or claim on the type of clinical question that you want to be answered on. If you're ever unsure, I would always advise just double checking with your senior. Um, there's lots of reasons for this. First of all, it changes theatre ginseng of the scan. So, for example, a CTPE A for a query. Pulmonary embolism is obviously going to be a lot more urgent than an ultrasound for a benign asymptomatic lump. Um, it changes the way the scans are actually performed. So if you give contrast the sky and can be done in an arterial, venous and nephrogenic face, so perhaps it doesn't matter from your from your perspective, but actually for the radiologist percent perspective to obtain the most ideal images, it's actually really important to know what kind of phase they wanted. That depends on the Commericals question. It also affects the kind of radiation exposure the patient receives on Dalser. When you're getting the scan, it's really important The radiologist has an idea of why you want the scans happen as well. Um, next slide. So this is an example off what the request looks like a least in my hospital. Onda. Um, if you look in the clinical details box on the right hand side, that is the most important box. So that's where you're going to be writing some back like a line on the background of the patient. What's wrong with them? And then you want to write what you want the radiologist to look forward, what you're concerned about having said that there are there are other boxes which is very important as well on. I definitely did not appreciate them while I before I became an F form. So things like are they a diabetic or do they have CKD? Those are all risk factors for contrast, induce nephropathy whether there's any infection precaution. So if they're covert positive or if they have MRSA or if they're if they have c diff those or make a really big difference in real life because the RADIOGRAPHERS will actually need to communal the quit mint afterwards scan will take longer to do so. These are all things that you need to know beforehand, which perhaps you don't appreciate until you become an F one next slide. So these are some common scan request that you'll be doing a zone F one. So 75 year old man admitted with a history of cough and fever um, standard to request the chest X ray for something like that and just write no productive cough, either. Rising infection markers, query consolidation, query, infection, clear pleural effusion. Um, and then, you know, during admission, they test positive for covert Onda. Couple days later, they deteriorate, requiring high flow oxygen. So obviously you're concerned about pulmonary embolism, so you'd want to write something along the lines off new oxygen requirement in keeping with not in keeping with the chest X ray West wing, shortness of breath. You know they've got risk factors for a thromboembolic event um, query. Pulmonary embolism. Next slide. I are in just a time in here. I just wanted to help, like the importance of putting in relevant clinical information on the written request form. Um, just because when people reporting as well, that's usually the information that they have to refer to. And so the more information you give during that written request, the more information they have in their reporting scan. So it's really, really helpful. A swell. It happens much detail in that Yeah, thanks action. And like he like, he said, the radiologist doesn't know your patient. The only thing they see is the clinical detail section. So if you write what you want the radiologist to look for, they'll specifically write a comment in the report. You know, commenting about that they can't comment about something that you haven't written about. S 08 year old lady admitted with Abdul pain, constipation and vomiting. You might want to write in your abdomen X ray request bowels no, open for a few days after pain. Distention absolute constipation, query, obstruction, perforation, query, fecal loading. Um, and you know, if someone's being involved in the high speed road traffic accident. Something like a trauma low GCS query, intracranial bleed, query, abnormality, query, fracture. Um, next slide. So there will be times when patient will be too unwell or too unstable to actually go to the radiology department on day. Instead, off the patient going to the department, the department needs to come to the patient. Usually that's in the context of someone who's acutely unwell on the ward. Or they're in any recess or and I see you. Or they just had a non operation on the in recovery on. Usually this is a portable chest X ray, although there are two other times when scan will be need to be done. Portable is well so. For example, if they have certain infections like covert positive, they'll usually do, at least in my trust, a portable ultrasound on the ward. Rather than going to the radiology department on D, infecting everyone there, it's a lot safer for a non call radiologist to go into a cubicle and perform a bedside ultrasound. It does mean that the ultrasound will take longer. In my hospital. There's only one radiologist on call who does portable ultrasounds, and they've got a long list pretty much all day. So it the scans do take longer sometimes, and that's something to bear in mind. Next slide. So what does vetting a scan actually mean? And this is something which I wasn't actually too sure about until I started F one. So vetting a scan is basically a process to ensure that the image requests that you've made is appropriate for that patient and appropriate for the clinical question. You want to be answered? Um, so obviously we can't do CTS and MRI's on everyone. We have a limited amount of resource is certain scans have radiation exposure scans, with contrast, could be nephrotoxic. So it's basically just the safety safety process to go through to make sure the scan is appropriate. So that's basically when you better scan that, that basically means you're discussing your scan request with the radiologist on call to basically try and explain to them why they need to scan and to get their approval for it. Basically, um, next slide. So when you're talking to better scan, it's really important beforehand. You familiarize yourself with the patient on, but, um, you know, obviously when you're talking to someone else is really helpful to use, like an s bar format. So who you are, what team you're under, who the patient is, why they came in, what scanned you want. What, what's the indication for it on day? It'll make it refused to. If you if you say it in that order, it makes it really easy for the radiologist to understand exactly what kind of scan the one. And what you'll find is that for inpatients, the vast majority of scans can be kind of grouped into three categories in terms of the reason for doing them that cyber infection, malignancy or trauma on D. So if you can make it really clear to the radiologist why you want the scan, that's usually one of those three reasons that makes it a lot easier from their perspective to bet the scam, um, next life. So it's so when you are talking to the radiology department, try and avoid using phrases like Can I order a scan? Radiologists and radiographers don't like being ordered around. It's much more professional on, much more appropriate to say something like, Are you available to discuss the standard quest? We're concerned about accent. We think this scan is going to help identify this. Um, and I think the rate the radiologist really appreciate that kind of language and terminology when you're talking to them. If, for whatever reason, the radiologist doesn't think the scans indicated it's really important, you ask exactly what the reason is for that s o saying phrases like, Can you give me advice on what the best game would be or for my learning? Or, you know, those kinds of phrases They're really helpful, and it makes it really in just makes communicating a lot easier if you understand exactly why the scan hasn't been accepted. When you go back to your seniors to explain why they'll appreciate that information a lot better. There have been far too many times when I've seen F ones, no better scan, and then they go back to their seniors to say, Oh, the radiologist been better, And then when they're asked why, they don't know, and it just gets it can be quite frustrating because then you have to call the radiologist back, and then they may need further investigations, or they may want further history from the patient. And then you know, you may have to do the investigation and then call the radiologist back. It becomes a whole fast, basically, and actually setting it out from the start. Exactly what information the radiologist needs makes things so much easier. There are quite a few types of scans which don't need to be vetted. So things like chest X rays and Abdo X rays. The radiographers themselves will vet outpatient scans. At least in my hospital. The radiologist will bet themselves looking at the request. You don't need to call them ultrasound. The sonography hours will often take your request and show it to irregular consultant and build better in the ultrasound department. Um, and at least in my trust, CT heads as well don't need to be vetted. Um, next slide. Just start in there as well. Aria, Um, I think as you said, they're definitely certain things you can do to make your life easier when talking to the rate radiologist trying to protocol scan. So I think just basic things like introducing yourself so that they know which team your firm on been being from the start. Just saying what? What? The single calling him about it. So according to protocol, a CT scan say that early on. So then they know exactly where you're heading with the patient story on then for me personally, when I take all those that I like to hear the MRN or the hospital number off the patient early on, just that, then I can get up there profile on the screen, and it makes a lot easier, whereas if you're listening to the story without that information in front of you can make it a bit more difficult to just a few basic things. When you're starting off speaking to the radiologist, introduce yourself. Tell them what the thing you're asking them for, what scan it is or what you're asking to, particularly on on also the hospital number of the patient. And then you can go into the patient story. That's what I find really useful when speaking to people can't thanks so common reasons. Scans are declined, so one radiologist isn't convinced by the indication. For example, requesting a CT just after pelvis is part of a septic screen in so of a simple chest X ray. Um, perhaps an alternative imaging modality is more appropriate. For example, if you have a pediatric patient requesting an ultrasound for query. Appendicitis is usually much more favorable than a CT, which has ionizing radiation patient doctors. Maybe they have poor renal function or they have an allergy to contrast. Or maybe this guy is. Actually the scanner itself is actually contraindicated. Maybe they have a non MRI compatible pacemaker or they have cochlear implants or they've previously being in a in a war, and they have shrapnel in their eyes. In those kind of scenarios, an MRI probably isn't possible. Perhaps the patient's already had imaging at a different trust, and you didn't realize Perhaps the radiologist does is aware of that, and that saves the patient from being exposed to more radiation. Or perhaps this guy in itself isn't as urgent as it as you thought it was. Perhaps it could be done as an outpatient rather than in the new cute setting, uh, next light. But the main thing is, what happened? The reason is really important. You understand exactly what the reason is from personal experience. It's usually a lack of information in terms of the patient history. A lot of people will simply request a scan because my consultant said. So on day won't specify and enough detail what the patient history is and what you're concerned about. Um, that's just from my experience, what the most common reason is. Um, you know, if this guy, like I said before, if the scan has not being accepted, it's really important to understand exactly why I say you can communicate that back with your team. Uh, next slide out of hours. Obviously, they're going to be fewer staff. Know everything is going to be available. The time things like ultrasound. There's usually, at least in my hospital. One uncle radiologist who does ultrasounds out of ours. Nuclear Medicine Scan I've never heard of anyone getting on outside of hours. Um, usually, there's only one person in the radiology department actually taking scan requests on reporting scans. Sometimes there's two, but the radiologist after hours can be quite stretched sometimes. So if it's a non urgent scan, often the report itself will not come back until the following day. If you do need a report to be to be done urgently, it's best just to call the radiologist and ask her available report rather than trying to wait for one. Um next slide. So let's say you've requested your scan. The radiologist is happy with it. They felt it, Um, you still need to add it to the list. And this is something I didn't appreciate until I started F one. But actually, there's a whole bunch of questions that still need to be answered before the Radiographers are happy to add it to their list. Any oxygen requirements, they'll double check their renal function, especially if the scan involves contrast. That picture on the top right hand corner is an example of someone with neurology fr of nine and a really high creatinine. They basically have Stage five CKD. Doing a contrast scan for them is not really possible. And the infection precautions recess status. So, believe it or not, patients can have cardiac arrests in the scanner. So it's really important for the radiologists. No, if that DNA all or not, does the patient actually have a candy low if they need a contrast scan? One phrase I've found really useful is to say by the time they go for best time, they'll have one. If if they don't have one already, how can the patient travel again? This is something I really did not appreciate before I started F one. But actually, if the patient needs to be in their bed whilst they're travelling, it takes It can take so much longer for their scan until actually happened, because the radiology department or your nursing team needs to request one or two porters to actually come to the ward and take the patient down. Whereas if they're like a baby, their parents can simply carry the parents come simply carry their baby down to the radiology department. And everything just happens so much faster. Um, so things like that if trying to clarify if the patient can actually go down in like a wheelchair rather than a bed, it does actually make a really big difference. Uh, next slide. So going back to our timeline. So the scan has been better, has been added to the list, and the scans happened, so you can either look at the images for a weight. The formal report. But that's not the end of the story. So the next step is to think about what to do next. So does the scan actually shows something that you need to act on Maybe there's consolidation and you need to start antibiotics. Maybe the scan report itself actually recommends a different kind of scan or biopsy. Or maybe the scan report recommends the images be disgusting and mg t. These are all things that you need to have in the back of your mind whenever you read an image report to see what you can act on on what you could be proactive about, um, next life vessel access. So obviously, if you're going to be given contrast, you need vascular access on there. Such a stands where, um, it's important to have a large cannula. Obviously, the bigger the better. Um, for example, for a CT pa. Ideally, you want it least a pink cannula because they're going to give a large bolus of contrasts on you want really adequate pacification off the pulmonary trunks for a CT coronary angiogram? Ideally, you want that least a green cannula again because they're going to be giving bolus is a contrast on gum. They want to make sure that what the imaging is appropriate and they need the heart rate to be low. So often that means giving beat of blockers beforehand to slow down the heart rate to reduce any motion artifacts that can happen. And if you want to be the perfect F one and you want to be really, really keen, actually, having a cannula in the right arm is better than in the left arm for a CT coronary angiogram. Because if you have it in the left arm, the contrast has to cross the midline. It has to cross the heart before it gets to the superior vena cava, and that just causes more artifacts, whereas if it's coming from the right hand side, it doesn't cross the heart. Um, sometimes patients have really difficult IV access, and they will have a midline or central line. Some trusts can give contrast through these lines, but the trust I work out, you can't. That's because the Lumen off the line maybe too narrow or too long so they can't give the bolus of contrast that's necessary to do an adequate sky. If that is the case, then you may need to ask a senior or kindly asking in the statistics to do an ultrasound guided cannula instead. Um, next slide, um, MRI safety. So anyone who has an MRI scan we need to do a safety questionnaire. Often, patients are able to do this themselves, but there will be times when the patient isn't able to, for example, if they have a low GCS or if they have dementia. Onda. You might need to complete one of these safety questionnaires, and this is an example of what one looks like from my trust. Um, I know it doesn't sound like a lot, but when you're on call and you're really busy on, do you have to do something like this where you actually have to go onto your Internet print off? The safety questionnaire filled out. You might not know all the answers, so you have to go through the patient's notes or call a family member. Then you have to upload it back onto the system and then call the MRI Deogracias again. It can be a really annoying process when you've got unwell patients and you have to do something like this. So just something to be aware off next life contrast induced Nephropathy is a really big issue and a really hot topic, Um, so people who have contrast at risk off having a deterioration in their renal function. There are certain risk factors, like CKD, diabetes, dehydration or being very elderly, which make contrast inducing a frothy as a risk, much higher. Asar. As I'm aware, there aren't any clear cut guidelines on exactly what to do. But if the patient does have risk factors, for example, if there gee, if I was less than 60 and certainly if edgy a far is less than 40 we often give pre and post hydration. And that normally means giving a liter of IV fluids as maintenance before and after that scan. And also it's important to to schedule to consider whether they have any nephrotoxic medication and consider with holding these around the time of the scans. Well, um, next slide contrast Allergy profile Axis is another thing. I've come across as an F one, so sometimes patients will need to scan, but they'll have an allergy to contrast agents. It's not an absolute contraindication to actually having a scan again. There's no clear guidelines as far as I'm aware on what can be done, but it's very, very common to give pre medication. This is an example off a type of protocol that seems very reasonable that I've done before, Um, which involves giving steroids on an antihistamine at a certain dose in certain time before the scan, depending on how urgently it needs to be done. And another thing I've come across as an F one is actually, if the patient does have a contrast, allergy from medical legal reasons, the Radiographers will actually ask a doctor from the requesting team to administer the contrast. So you may find yourself like I found myself actually having to go down to the scanner room myself, and I'll have, like, an EpiPen in one hand behind my back. And I'll have the contrast in my other hand, and I'll be giving this patient a bolus and basically just praying that they don't have an anaphylactic reaction in front of me. Um, next slide. So CT actual colonoscopy is another thing. You may come across as an F one, especially if you do something like gastroenterology. So it's basically a technique where you take a CT scan off someone's abdomen and pelvis on D. The use, um, software to create a three D reconstruction of the inside of the colon. Onda, you're looking for things like masses, polyps and malignancy on. But it's a very useful alternative to having a colonoscopy. For example, if the patient is not able to tolerate one, for example, if there frail, um or perhaps, um, they just don't want one for personal preferences. Another thing about CT about your colonoscopy is that not only doesn't image the colon, but it also images or the other abdominal organs. So if you're concerned about something that's extra Luminal, it may be useful to do a CT ventricle and oscopy rather than just the colonoscopy itself. Um, one off. The other advantages of a CT much colonoscopy is that it's less radiation than the standard CT scan on you could, or a contrast instead of IV um, next line. So this is an example off a kind of bowel prep that you might give to someone having a CT virtual colonoscopy. As you can see, um, Gastrograph in, which is the contrast agent given already know only does it highlights the inside of the bowel more clearly, but it also are. It also acts as a mild laxative on the laxatives that you need to give for a CT. Virtual colonoscopy are less than for a colonoscopy itself, so it's a lot more tolerable for the patient as well. From a laxative point of view, uh, next life eso packs. So packs is the software used by hospitals to store and provide images off scans. It's it's very common for patients to have scans from different trusts and so that there needs to be a way off trusts. Communicating with each other and packs is one of the ways we do that, Um, one of, for example, rather than having to repeat a scan and expose the patient again to radiation, there's a lot more easy. It's a lot easier simply for images to be transferred from one trust the other. Another really key benefits off, that is, it allows radiologists to compare a current scan to a previous one, so that's a really big advantage as well. Next slide. All right, so now, which is going to move on to some cases? So I'm going to hand over to my colleague turn who's just going to talk you through some of these off. This is before you like that. So that's cool, but you're off, or thank goodness for that high 10 10 so I think we're having a bit of trouble hearing your your butt to speak with. Close to the micro. Bit louder, maybe. Okay. Yes. Oh, yeah. Yeah. It's a bit better for me. Um, okay. All right. It's a little tender on 88 off off with three off. You know anything about four? I'm sure. Office Yes. And 14 for confusion on damnation. War. Best remark that for think. Still having a bit of trouble? Anything else? Any other ideas we've got for? Have you got Michael had friends or anything? Oh, if you if you want, I can carry on the presentation for, like, the interventional radiology bit on. But whilst we give a bit of time to turn to sort of sort out his medical headphone issues without the better. Yep. We can try that. Yeah. So turn. If you want to skip forward a few slides after the cases, All right? So, yeah, that's fine. Yes. So, um, one thing you'll find is that a swell as radiology, you also be coming in contact a lot of the time with the interventional radiology department. Onda um, when term gets back on, he'll talk a bit more about that. But it's basically, um they're basically they're basically a bit more practical in a bit more surgeon. Like rather than diagnostic radiologists on they they they worked across many, many different specialties. One of the main ones being vascular surgery, which is something I did is enough one. And I thought it might be really useful just to talk about that for a bit. So in terms of interventional radiology procedures in vascular surgery, the three main ones are angiogram and your plasty in stent angiogram. The way I've seen talked to learner is angiogram. Sounds like instagram. So that's to do with taking pictures. And your plasty sounds like you're having a party. So that's to do with balloons. So you're ballooning up blood vessels on the stent is a stent. Uh, next slide? Uh, if you can hear me next life, please. Thank you. So angiogram. Uh, an angiogram is basically a way of obtaining images off the blood vessels in someone, so you obtain access by puncturing. Usually they're common femoral artery on you insert a catheter and you're injected, dye or contrast into their blood vessels, and your used fluoroscopy and digital subtraction and geography to image the contrast as it flows through the blood vessels. This'll image on the right hand side is just a Nexium sample of what an angiogram looks like. So at the top, you have the aorta and branching off it at the level of L4 are the common iliac arteries, and then branching off of those are the internal and external iliac arteries. Um, one of the things you might come across, especially if you do vascular surgery, is that everyone who has an angiogram will need a post and your review. So the most common causes for pseudo aneurysm is either trauma, for example, needle or infection. So everyone who has an angiogram, they'll need a post and your review afterwards, where you're really need to palpate the puncture site to look for any masses or hemotomas, you'll need to assess the vascular status off their limb. So, you know, is it warm and, well, perfused? What's the cap refill? Do they have pulses? Um, usually there's no problem with the procedures, but things can go wrong. Uh, next slide. So, Andrew class the sounds like you're having a party that's to do with balloons. So you're ballooning up a blood vessel. Usually you perform an angioplasty when someone has a short segment stenosis on the runoff. Distal to that is very good. Eso patients are often awake or under like sedation on your past. The catheter to the level of the snow's is, and then you'll blow up a balloon to open up the blood vessel, and you can balloon it a few times. One of the main complications of an angioplasty, especially if you balloon it too many times or if you inflate the balloon too much, is that the vessel can rupture or tear on. In that case, that's quite a serious thing, and the stent or a stent needs to be placed. Or they need to have an open operation quite urgently to patch the tear. Uh, next life. So this's an example off before and after an angioplasty. So you have the popliteal artery coming down on branching off. Firstly, is the anterior tibial artery. Onda, a Z conceive in the proximal anterior tibial artery, is quite a significant stenosis, but the runoff afterwards is quite good, and then going down after that branch is the tibia parent, your trunk and then that branches off into the paraneal and posterior tibial arteries. Um, if you look at the right image, which is the after angioplasty image, you can see the proximal stenosis in the anterior tibial artery has opened up quite a lot. It's not perfect. It's not gone back to normal. But the stenosis has definitely been improved on the run off to that limb. It looks so much better in the left hand picture. You can see quite a lot of collateral arteries distal to that stenosis, whereas afterwards you can see the runoff into that foot is really good. Uh, next slide, uh, stenting. So a stent is basically a small metallic mesh that supports the vessel. Long term, it's usually used in conjunction with angioplasty. Um, so usually you plasty the blood vessels open up a bit and then you'll insert your stent on overtime. The arterial wall will grow into the stats on basically Axis, a permanent permanent device that can keep the blood vessel open. One of the drawbacks of a stent is that the patient will need long term, um, anti platelets or anticoagulants next slide. So this is an example off before and after a stent. So if you look at the left hand picture at the talk is the common femoral artery branching office, the profunda. And then, um, following on from the common femoral is the superficial femoral artery, and I hope you can appreciate. There's basically a little small tapering off the superficial femoral artery near the top of the Midge just after the profunda has branched off. And if you look at the middle image once a stent has been inserted, you can see well, it's just one image, so you can't fully see the runoff afterwards. But you'll have to take my word for it that the runoff afterwards is so much better. And if you look at the image on the far right hand side, you can see where the stent has been placed. So you can compare the right far right image to the far left to see exactly where that stenosis is and how that's the nurses has open how the stent is opened up that stenosis basically, uh, next light. Okay, so that was about vascular surgery turned. Do you want to try and come back on with your see if you're Mike is working a bit better along now. Any better? Maybe, Like a little bit. If you keep talking, we'll let you know. Okay? Yes, Well, off this book is another. So for about three days, Very well, that's 10 80. You are seeing anything, baby with with school at the base of use is enough to remember anything. Yes, before this is this is on the market with all this stuff so well, like this established my spine, said CT. Head out for any for you, if any, if you can. Or any evidence for focus or so they fuck it or it's it is office doctor. Yes, Usually, in fact, it's, however, it is any sort of any or I'll find it very difficult. Long. Yeah, exactly. I've seen before. They also over one of us on your life. I feel it dismissing back to see a sports should get done. Look, let's go back. Let's say we head office. No. Well, four a while. The navelbine the best report before. Oh, before you won't We walked up. What allowed any before I'm like this is obviously off or before that? Well, all this by that awful alli alli bit more sleep, You know, it's on. Oh, your headline. That is wonderful over this factor for before something. What? Yeah. Oh, 10. Can you speak a little louder again? I think I have it difficulty again. Well, yeah, It's exactly like this. I want one for me and getting some people like to say I want I want some people off. Yeah, on the roof. But I was off once a day office, they or before you go to the next case or but seven year old, this is next case is a reading. Oh, What? It's a 47 old admitted. Oh, and they often you know that more. This is the fourth five populated Well for the public or six you most. Yeah, well, but really, if you this is oh, five, about four. Be practiced. It is almost done I before almost every day it is. Well, school is any suspicion. It was Oh, no. Well, my right one. Oh, you'll be Is it gone or both here the best or or or a little part here off? You don't have to test before. It's very predictable if you for people this off this five. Oh, I guess maybe, or this dumb off. But there is the constipation pregnancy or that's it. Or beside point to it, or what Anything is Once it's can set it on. It's probably next patient, you know. Or if patients off work until only for life. But well, last week awful. It isn't because, but perfect. It's more off the medication. So it's a 44 or sudden, You know, That's what I've been with this off. They are all right over this is people with Ms Expert or for the policy. What? What? What? What is it? Yeah, it's awful. I'm good. Over, over away. This this or only office. Oh, this is more Well, the final one. But we'll have to Well, and why? Yeah, or what it is. It is if Oh, yeah, if possible. Or let's say now you are now about over to get it, That they're like being more active, argue with people or you didn't know about this on off on off, they were like you like you want to know what? Why? Oh, why? Why is that example? Oh, initiative. You say that here. What? Anything. When you're getting oh, well, was standing you'll see here? Yeah. So? But that was like, I'm sorry to Can you hear me? Just sorry to interrupt. I think just your mic still is a bit fuzzy, so I'm at least for me. I can't hear you that Well. I don't know what it's like for other people. Do you mind if I just talk about the slicer? Because I'm really struggling to hear you. Is that okay? Yeah. Can you hear me? Fine. Yes. All right. Um, so I felt we just finished off by talking a bit about some interventional radiology. You might come across as an F one, so I r is the fasting and one of the most interesting areas off of modern medicine. So interventional radiologist sees image guided techniques like ultrasound fluoroscope, your CT to perform minimally invasive procedures. There's a whole host of patients who may not be able to have an open operation, but actually, they may be eligible for a minimally invasive interventional radiology procedure. So there's a whole host of patients, um, who previously were not able to have surgery who now can undergo a procedure. And that's thanks, toe. I r. Um, interventional radiologists work across multiple body sites with various different specialties. On the most common technique used in interventional radiology is the seldinger technique, which is way it was. The technique is technique used to obtain access to some was arteries. So you puncture artery with a needle, and then you insert a guidewire. You would draw your needle, and then you insert like a sheath over it, and then you take out your guide wire on. That's how you obtained access. And then you can travel to the area of interest with your catheter sheath. Perform your procedure next light. So there's a whole host of different specialties I R comes across. Vascular surgery is one of the most common, and that's rotation that I did as an F one. But there's a whole host of other things. Obstetrics and gynecology for fibroid embolization, for example, is another common one next slide. So I think we've gone through these slides if you just go to the next one. So top I our referral tips. So the same way when you're getting a scan when you talk to interventional radiology really important to familiarize yourself with the patient's background, any previous imaging, they've hard is really useful to have up to date blood. So routine bloods, including a clotting is all is almost always a must when doing, I are procedures on. One thing I would say is that I R is a rapidly growing specialty, So don't be afraid to ask questions. Don't be afraid to ask someone if you're not sure about a certain procedure, whether or not they need to be on anti coagulation things like that, whether they need to have it under general anesthetic or if it could be under sedation, a local anesthetic, all the IR registrars will be able to answer those questions for you. Um, and I would encourage people to go to theater and see interventional radiology procedures is really fascinating to see, especially if you have an interest in the area next life. So how you'll be interacting with the I R department. So, you know, ultrasound guided biopsies, drains, especially ultrasound or CT guided drains that I've come across have usually being in draining parts of the abdomen. So, for example, of someone's had a perforated bowel or perforated appendicectomy, they may have an operation, but then POSTOP. They still have raised in clumps markers, and they're spiking temperatures on when you repeat a CT scan. They've actually got collections everywhere in their abdomen, and you need intervention radiologists to do another ultrasound or CT guided aspiration off those collections and those collections condemned be cultured for sensitivities. And you can give the patient the optimal antibiotics for those types of things. Maybe you need help with the Skelaxin S, in which case, um, Hickman line or pick line may be necessary. G I leads trying to do like a lesson. Tear it artery Embolization is another operation for another procedure that could be offered, Um, so there's lots of lots of different seizures that could be done. Um, and you know, I r is a rapidly growing field, so it's really interesting on out. Strongly recommend is a career option if you haven't been thinking about it already. Next slide. So in conclusion, we've talked about how to request scans how to communicate with the radiology department really want to emphasize the importance of knowing exactly what some type of scan you want to do on what the clinical question is and what the clinical indication is like, sections said Put time into your requests. The radiologists don't know your patients. Sometimes the only thing they see is that clinical details box, which is only one or two sentences long. And if you want them to comment on something, you really have to make sure you put it in your in your request. Otherwise, the radiologist is not going to know what what to write about for you basically make sure you familiarize yourself with the patient before hand on DA. Try and go see some IR procedures in theater. If you haven't already. Um next light on, That's it. If you want to hear more talks from IR juniors, that's our social media pages. Follow us on Facebook. Go to the ER genius website. We run loads of events throughout the year, lows of teaching webinars, those webinars about different kinds of application processes. So definitely sign up on gravel like a website and check up track us out on social media. Um, that's I think that's it. Thanks for listening. If anyone has any questions, I think the three of us are more than happy to try and answer them. I saw there were some questions as we were going through the slides? Yeah, I think there were a couple Orian just about. Can you do a portable abdominal X ray? Um, so that is possible. You can do it. I think the only thing to mention is that the utility off, um, abdominal radiographs, I think has definitely decreased in the last few years. I think. Now, um, when you think about what they could be used for A. I guess the main thing is, if someone's in obstructional perforation there, the main kind of things that you would use an abdominal radiograph for. But nowadays, I think a lot of the time people go straight for CT if you're clearing obstruction or a perforation because it gives you a lot more information on it. For surgeons, it's a lot more helpful to know where they're obstructed. Is it a single loop obstruction, or is it closely construction and or or where the perforation has occurred on what the mechanism is? So I think CT is usually the more useful form for abdominal imaging rather than a radiograph. But in theory, yeah, you can do a portable abdominal radiograph on. I think that was one of the question Yeah, I think there was one question about CT coronary angiograms. Um, I really don't think this is something that's not important, But if it was a cannula in the right arm, that's better than a cannula in the left. The cannula in the right arm does not have to cross the midline, as in it doesn't need to cross the heart, so it causes less artifacts. If if there are any other questions, please posting brew in the next few minutes just to quickly highlight this last slide. So, in terms off other resources that might be useful for you guys. As you start off one, I think for radiology specifically and s one related radiology. I know that mind the bleep have been doing a radiology Siris. Think it's a nine part Siris covering interpretation of different types of radiology such as X rays, abdominal radiographs and what not. So that's definitely worth checking out on YouTube. If if you're interested in learning a bit more radiology, I'm wanting to prepare yourself. Radiology is enough one and then other More general resources are the are a genius website which we've got us aren't already said lots of careers advice and applications. Advice for the future Radiology cafes. A great source of information as well on the society for radiologists and training. So there's a few extra resource is just Teo help you guys if you want to do a bit more further reading. We just learned a bit more about radiology. But if there are any other questions, please feel free to post them through or drop us. An email to the eye. Are geniuses email account? Yeah. Thank you. Everyone for listening. I hope everyone learns something on the bridges again for the technical difficulties. Yeah, really sorry about that, guys. But I hope I hope everyone learns something on. But I wish everyone the best for the start of their F one. Yeah. Good luck, guys. Yeah. If there are any other questions that we should, um I think we should close everything on DA wish. Everyone the best with starting F one. Best of luck. Great. Thanks for much. See you guys later. Thank you so much. Everyone