Computer generated transcript

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

Oh, thinking about it. Mhm. Lovely. Hi, everybody. My name is Helen. I'm one of the doctors at um Nottingham University Hospital in England. Um, welcome back to anyone who attended chest x rays two weeks ago. Thank you for coming back and welcome to anyone joining for the first time. Um, so just about me, I'm one of the teaching fellow doctors for surgery at Nottingham. I have a keen interest in radiology and I was a radiographer before I came into medicine. So it's kind of the area I'm really interested in. So, er, for this little series of um, talks, we mostly um, looking at each of the different x-rays, plain films going through them. Uh, and it's a bit of a consolidation of knowledge you've already got, giving you time to practice, looking at lots of different pathologies and giving you a kind of structure for how to report an x-ray out loud. So it's got a bit of a skew towards kind of how to do it if you're presented an x-ray in an oy, but of course, it's also clinically relevant if you're on the wards. And um, one of the consultants says what do you think of this film? Um or even if you're just reading a report to understand the terminology that they use. Cos um radiology often uses different words and stuff to describe things which can take a little while to get used to so onwards with abdomen x rays. So the abdominal X ray is not used so much anymore as some of you are probably aware, it is being phased out because it just doesn't give you as much information as a CT. And there are very few pathologies where an Abdo X ray would rule out you needing act. So let's say, for instance, bowel obstruction, not, which is the kind of most common reason people think about to do a CT uh Abdo x-ray if you didn't see it, an outer bowel obstruction. So they're classical big dilated loops of bowels, even if you didn't see one on x-ray, it doesn't mean there isn't a bowel obstruction. It just means it didn't show up on the x-ray. Um, so invariably you're gonna ct them anyway. So cut out the middle man. So certainly at Nottingham, at the, um, our hospital, they are not used, um, when coming in the door for patients. It's very unusual to see one that being said in some smaller hospitals. The DJ A SDG HS like I worked in Chesterfield, they do still do them routinely. It's more a access to CT problem than anything else. But as a general rule you don't see them, they are being phased out. There are a lot of radiation for something which you're probably gonna see to anyway. But that being said still definitely used in SYS and they are still around. So it is useful to know what they're all about. So let's crack on. So, uh please let me know if the slides don't change for you guys. But hopefully the objectives of this session is to give you a nice structured framework to how to verbally report an x-ray. Um We'll work through an x-ray together talking about the framework. And then I've got lots of examples at the end of all the kind of common pathologies you might come across in an Abdo x-ray, which we can go through. Um I usually teach us with the assumption that you guys probably have a bit of a baseline knowledge. But if there's anything I say you don't understand, you want me to go through more, feel free to pop it into the chat, I can see the chat and II will stop and explain anything if I'm not being clear enough. Wonderful. So this is my kind of verbal reporting template which tends to be the one which most people use. I like to have these leading little sentences to kind of prompt yourself to know what to say. And also if you keep yourself in a structure, it means if you're presented with a film, you think, oh my gosh. I have no idea what's going on, fall back on your structure and just start saying it the first three things. Um three steps to this are all kind of technical bits you kind of and it gets you the marks because it shows you um that you, you know, you should be checking them. Um and it's, you know, easy to do easy marks. It can, and it gets you into a bit of a flow and then you can start doing the more difficult things. And also again, in real life for these top ones, although you might not say them out loud, they are actually think you do need to check. Are you looking at the right x-ray? Is it for the correct patient? Is it technically good enough for you to answer the question or do you need to ask for another x-ray? They are things you should be assessing. I always use this example and I'd have told you guys last time. Do please always check you have the most recent x-ray up. Um It's really useful to have a previous as well to check against cos some pathologies. It's useful to see if it, if it's got better, if it's got worse or if it was there all the time and it's actually normal for that patient, but just be wary about you're not looking at a previous II would have if you were here last, I might have said the same thing we sent a patient home thinking it was a normal chest X ray. And actually the x-ray was from a year ago and they had a new pneumothorax and you know, it became a big incident cos they were sent home with a pneumothorax. So it happens, it's easy to do when you're busy on a ward round, make sure you've got the right patient and it's the right date. And also obviously the ay it's a mark. Um They don't tend to be trying to be Trixy though. So the first one, so we're going for the, in our structure. This is when we're just describing exactly what x-ray we're looking at Abdo S are really easy. They're all taken the same way, Supine. They don't really do Erex anymore. It's a bit of a throwback to walk to before CT S were a thing. So, um if you look at this picture, I don't know how easy is to write on the chat. Do you know what? Oh, it says on the side, there's no point asking that question. The one on your left is a, on the left of the screen is a Supine one, the one on the right of the screen is ect and you can tell because it says it um if they're doing anything other than Supine, they should label it as such. Cos it's unusual. Um And the reason we used to do erect ones because as you can see this both shows a bowel obstruction. Um So it's the same pathology when you do erect, you suddenly get those what's called a. Um, I don't know if you can, you see my mouse out of curiosity. Um, you can see a fluid level, it was called an air fluid level. So it's a direct cut off in a line and that was a pathic for a bowel obstruction. But these days you just go straight to CT. so don't bother. Um So it's gonna pretty much always be. This is a Supine abdominal film. Can't see the mouse. Unfortunately, fine. I will just describe everything. Ok. Patient demographics if you know it and you can read it off the side of the thing. Great. This is a boon, a Supine abdominal film for whatever the correct date and stuff is and name if you don't know it or if it doesn't say it on the film, it is nice just to use a generic phrase. This is Supine abdominal X ray for a patient of unknown demographics. If you can tell if it's an adult versus a pediatric patient, I tend to use the line skeletally mature cos obviously, some patients, they might be can't the ossification centers and um stuff do fuse slightly differently for some people. So you might have a 16 year old with a skeletally mature. Uh x-ray cos they've um gone through puberty early and stuff. So I like to use the word scholle mature or skeletally immature, you can tell what gender it is because you can see bright shadows, great crack on sounds great. But at the bare minimum patient of unknown demographics and then technical quality, often less of an issue in abdominal films versus x-rays because x-rays chest x-rays, sorry, chest x-rays are really dependent on if they're a bit rotated and they're quite easy to rotate and it throws the anatomy off abdominal films. It's less of an issue. A bit of rotation doesn't really change um the reading of it so much and obviously they're lying flat. So as a general rule, they tend to be relatively good. But if you do want to look for rotation, the best place to look is in your obturator foramen. So down in the pelvis, you've got your two little eye looking bits, your obturator foramen, they should look perfectly even if in this film, you've got one which is slightly smaller than the other. It just means the patient's tilted and they usually tilt the side which is bigger as the side they're tilting towards. So this one would have some b right sided uh rotation, but it's so minimal. Is this being recorded by any chance PSA day after? Yeah, fair enough. Um I can provide the slides. Um I'll provide the slides and I've um annotated everything including all the um uh what am I trying to say? All the practice ones have all got the exact what you should be saying with learning points in the notes. So if it's not recorded, you won't need it. You should be able to read it from the notes and the thing and I'll provide those if you want them, I don't know how it can get around, but I'm sure we'll sort it out or by all means, record it if we know how to. Um so that is rotation. So don't stress too much about rotation in an abdominal film penetration. Again, if anything it's gonna be under penetrated, cos they're big, cos people these days are big and you still assess it the same way. Can you see the spinus processes ni uh nicely? Um But most of the time it, it's pretty good. I wouldn't worry too much about that is all the anatomy included as probably the bigger one. Technically, when you do an abdominal film, you should see as you see with this one all the way to the bottom of the pubic. Um not the ra way all the way to the bottom. I see all of the pelvis because that um that technically you can have hernias down to there as well. You can have stones going into that area as well. And you should technically see all of the hemidiaphragm, both diaphragms completely. That is technically a full abdomen. It is very rare that someone is small enough who's not a pediatric that you can get that all on 11 film. So you might end up with two x-rays, one covering the bottom and then one covering the top, you might end up with a jigsaw puzzle. Cos they're so fat, they've ended up doing like four and you've gotta piece it together. But as a general rule, we tend to aim for missing the diaphragms and getting on the bottom because if you're worried about anything up under the diaphragms, you do a chest X ray as well and there's overlap. So when I'm kind of doing this as part of my spiel uh in the osk, I'd usually say, for example, for this one, it's of adequate technical quality. There is mild right sided rotation, good penetration. I can't, uh most of the anatomy required is visualized. I can't see any of the hemidiaphragms. If I was concerned about a pathology in that area, I'd ask for further uh either a, a chest X ray or a completion abdo x-ray to include the diaphragms, something like that. The vast mo of the time.