Diagnostic Radiology Rotation for Medical Students

Introduction for current medical students

Welcome to Diagnostic Radiology's educational program for OHSU Medical Students. This site is designed to prepare you with the basics about radiology and will help you understand the role of radiology in medicine for your future career, whether you plan on specializing in radiology or not. By the end of this rotation you should have been introduced to some of the basics of the four core areas of radiology (body, chest, musculoskeletal and neurologic imaging).  More importantly, you should begin to understand the value radiology can bring to your future clinical practice and the tools the radiologist has at their disposal to narrow and define your own differentials.

There is a list below of areas of study to reference throughout the rotation. These follow the organization pattern of Learning Radiology, third edition; a copy of this text will be loaned to you for the duration of the rotation.  In addition to the linked reading guide, complementary articles are listed to augment the introductory text for the interested learner.  Due to unpredictable clinical demands of the volunteer resident, fellow and attending lecturers, lecture material will not follow the textbook curriculum.

There is no formalized test at the conclusion of the rotation.  You will be assessed throughout the rotation by the residents, fellows and faculty you observe and necessary feedback will be relayed to the clerkship director.  Attendance is mandatory where described, is personally tracked and will comprise a large component of your pass/fail grade.  There is a large component of self-directed learning on this rotation.  This should be utilized to extend reading room observation, complete reading assignments, and study areas of interest in radiology outside of the scope of the basic curriculum.  If there is student interest in areas of radiology outside of the core curriculum, contact the clerkship director to look into individualized rotations during this time period.

Links are provided to a list of interdisciplinary conferences, suggested reading list for Learning Radiology, a blank attendance form for reference when needed and some helpful links for more information about Radiology in general.

Clerkship Director: Bryan Wolf, M.D.

Important links

OHSU: SOM student handbook | Mistreatment reporting link

Radiology Sites: American Board of Radiology | American College of Radiology

Radiology Journals: Radiographics | American Journal of Roentgenology | Radiology

Radiology focused visiting medical students

We receive many applications from students who want to come to OHSU for an elective in order to strengthen their application to residency. OHSU students are given first priority in being placed in elective slots. If slots remain, they are open to students from any US medical school.

This being said, we do not automatically interview all applicants who do a visiting elective. A visiting elective at any institution may serve to improved OR reduce your chances of receiving an interview, and this should be considered when applying for any away elective.  To reduce the chances of visiting students not receiving an interview, we will review the grade transcript and board scores (submitted as part of the OHSU School of Medicine visiting student application) of each applicant and we will only approve visiting electives for students who will be competitive in our match process.  Since it is impossible to predict the applicant pool before November, we will do our best to make this assessment, but even where a visiting elective is approved, this does not guarantee an interview during the residency match process.

We also recognize that some students want to take our electives for reasons other than bolstering a residency application. Please indicate in your application if that is the case, and you will be offered a slot on a first-come/ first-served basis.

Curriculum

Chest radiology focuses on the diagnosis and assessment of cardiac and pulmonary diseases. Radiography plays a major role in lung imaging, and its chest radiographs are one of the most common radiologic exams in modern medicine. CT is also being more commonly used in imaging the lungs and heart, especially with the recent interest in low dose CT scans for lung cancer screening. While MRI is not commonly used in imaging the lungs, its use in imaging of the heart is one of the burgeoning fields of radiology. In imaging the lung, thoracic radiologists work closely with intensivists, pulmonologists, cardiothoracic surgeons and pathologists. Thoracic radiologists work closely with cardiac surgeons and cardiologists in imaging the heart, and often co-interpret cardiac studies with cardiologists.

Goals and objectives

Goals and objectives for the Radiology 709A General Elective.  This is not an all-inclusive list of relevant topics to medical student education but will serve to outline what each medical student should strive to learn at a minimum.  Please defer to the assigned reading list to ensure a more complete radiology introduction.

  • Employ a systematic search pattern for interpreting chest Radiographs.
  • Recognize normal anatomic structures of the chest on imaging exams.
  • Identify the different chest radiographic views and describe when they are helpful, as well as the limitations of each.
  • List different types of morphologies that can are commonly seen on a chest radiograph.
  • Identify consolidation on chest radiograph and formulate a differential diagnosis for the appearance.
  • Discuss chest radiographic findings that may help characterize a lung opacity as atelectasis.
  • Recognize a pleural effusion at chest radiograph on supine, upright and decubitus exams.
  • Describe radiographic signs of a pneumothorax.
  • Differentiate between hydrostatic edema versus non-cardiogenic edema on a chest radiograph.
  • Discuss the criteria for diagnosis of enlarged cardiac silhouette on PA versus AP chest radiograph.
  • What are the 6 most common causes for obstructive pulmonary disease?
  • Define ‘ball under the carpet’. Where is a mass located if it looks like a ‘ball under the carpet’?
  • Recognize the correct and incorrect positioning of feeding tubes, venous lines and endotracheal tubes on radiographs.
  • What are 2 important imaging signs of an abnormal mediastinum?
  • What are the 3 most common reasons for a ‘wide mediastinum’?
  • What is the most common appearance of a pulmonary embolus on a chest radiograph.
  • What are the most common signs, symptoms and vital signs of a pulmonary embolus?
  • What factor is the most important determinant of distribution of disease within the lungs?

Weekly reading guide

The following is a suggested reading guide for the provided medical student text Learning Radiology. The book is targeted towards entry level learners, providing the necessary foundations for image interpretation. Each section includes concise, image rich information that will be relevant to most areas of future general practice. Students should be able to complete the book in its entirety given the amount of time reserved for self-directed learning. When time does not permit due to scheduling or if a guided format is desired, please ascribe to the following schedule to complete the most pertinent sections of the book prior to completion of the course. High-yield sections are bolded.

Monday - Introduction

  • Chapter 1:Recognizing Anything, pages 1-7
  • Chapter 2:Recognizing a Technically Adequate Chest Radiograph, no assigned reading

Tuesday - Recognizing Normals

  • Chapter 3:Recognizing Normal Pulmonary Anatomy, pages 14-22
  • Chapter 4:Recognizing Normal Cardiac Anatomy, pages 24-31 (exclude MRI cardiac anatomy)

Wednesday - Airspace disease, hemithorax opacification, atelectasis, pleural effusions and pneumonia

  • Chapter 5:Recognizing Airspace versus Interstitial Disease, pages 35-44
  • Chapter 6:Recognizing the Causes of an Opacified Hemithorax, pages 45-49 
  • Chapter 7:Recognizing Atelectasis, pages 50-57
  • Chapter 8:Recognizing a Pleural Effusion, pages 58-67
  • Chapter 9:Recognizing Pneumonia, pages 68-75

Thursday - Gas outside of the lung and line placements

  • Chapter 10:Recognizing PTX, Pneumomediastinum, Pneumopericardium and Subq. emphysema, pages 76-83
  • Chapter 11:Recognizing Correct Placement of Lines and Tubes and Their Potential Complications, pages 85-96

Friday - Chest and heart disease

  • Chapter 12:Recognizing Diseases of the Chest, pages 97-112
  • Chapter 13:Recognizing Adult Heart Disease, pages 114-127

Body imaging deals with the imaging, diagnosis and treatment of diseases of the abdomen and pelvis. Body radiologists perform a broad range of interventional procedures under CT or ultrasound-guidance, including solid organ biopsies and aspirations. Commonly associated diagnoses include hepatobiliary disease, trauma, malignancies, and organ transplantation. The body imaging subspecialty works closely with internal medicine, multiple surgical specialties, gynecology, and other clinical services.

Goals and objectives

Goals and objectives for the Radiology 709A General Elective.  This is not an all-inclusive list of relevant topics to medical student education but will serve to outline what each medical student should strive to learn at a minimum.  Please defer to the assigned reading list to ensure a more complete radiology introduction.

  • What are the 6 Important Things you should search for when interpreting an abdominal radiograph?
  • Recognize abdominal organs on cross sectional imaging studies.
  • Recognize the correct and incorrect positioning of feeding tubes.
  • Recognize free intra-abdominal air on plain film and describe how patient positioning may affect sensitivity for its detection.
  • What is ‘Rigler’s Sign’ on an abdominal radiograph?
  • Differentiate between dilated small bowel and large bowel on plain film.
  • Describe how gas may be used as a contrast with an abdominal radiograph.
  • Consider how imaging can be used, and abused, for common diagnostic scenarios including: renal colic, suspected appendicitis, hematuria, right upper quadrant pain, pancreatitis, suspected small bowel obstruction, suspected diverticulitis, pelvic pain in a woman.

Weekly reading guide

The following is a suggested reading guide for the provided medical student text Learning Radiology. The book is targeted towards entry level learners, providing the necessary foundations for image interpretation. Each section includes concise, image rich information that will be relevant to most areas of future general practice. Students should be able to complete the book in its entirety given the amount of time reserved for self-directed learning. When time does not permit due to scheduling or if a guided format is desired, please ascribe to the following schedule to complete the most pertinent sections of the book prior to completion of the course. High-yield sections are bolded.

Monday - Recognizing normals

  • Chapter 14:Recognizing the Normal Abdomen, pages 129-139
  • Chapter 15:Recognizing the Normal Abdomen and Pelvis on Computed Tomography, pages 140-145

Tuesday - Bowel obstructions and extraluminal gas

  • Chapter 16:Recognizing Bowel Obstruction and Ileus, pages 147-157
  • Chapter 17:Recognizing Extraluminal Gas in the Abdomen, pages 158-166

Wednesday - Trauma

  • Chapter 18:Recognizing Abnormal Calcifications and Their Causes, no assigned reading
  • Chapter 19:Recognizing the Imaging Findings of Trauma, pages 174-181

Thursday - Gastrointestinal, hepatic and urinary tract abnormalities

  • Chapter 20:Recognizing Gastrointestinal, Hepatic and Urinary Tract Abnormalities, pages 182-202

Friday - Ultrasonography

  • Chapter 21:Ultrasonography – Understanding the Principles and Recognizing Nml and Abnormal, pages 204-219

Musculoskeletal imaging is one of the oldest subspecialties within radiology, and also one of the areas most affected by newer imaging technologies. MSK radiologists utilize radiographs to assess the skeletal system, commonly assessing the bones for traumatic injuries, neoplasms, infections, rheumatologic disorders, and congenital abnormalities. Ultrasound is used within this subspecialty to assess muscles and tendons, while MRI has become indispensable in assessing the fine details of the joints of the body. MSK radiologists also specialize in multiple procedures such as joint injections and aspirations, bone biopsies, and percutaneous treatment of some osseous tumors.

Goals and objectives

Goals and objectives for the Radiology 709A General Elective.  This is not an all-inclusive list of relevant topics to medical student education but will serve to outline what each medical student should strive to learn at a minimum.  Please defer to the assigned reading list to ensure a more complete radiology introduction.

  • Identify and name the following bones on radiograph and identify important anatomic landmarks: Humerus, radius, ulna, carpal bones, metacarpals and phalanges, femur, fibula, tibia, tarsal bones, calcaneus, metatarsals, vertebrae, ribs, pelvis, clavicles and scapulae.
  • Differentiate between the metaphysis, diaphysis, and epiphysis of a long bone on radiograph
  • Use proper terminology when describing a fracture.
  • Explain the significance of intra-articular extension or physeal involvement of a fracture.
  • Recognize a non-displaced fracture on radiographs.
  • Explain the importance of multiple radiograph views in fracture diagnosis.
  • Identify an elbow joint effusion on radiographs.
  • Differentiate between anterior and posterior dislocations of the shoulder on radiographs.
  • What are the 4 major mechanisms of injury to the pelvis?
  • Discriminate between the general types of soft tissue & osseous injuries best evaluated by CT or MR.
  • Construct the appropriate imaging approach for common diagnostic scenarios including: chronic joint pain or suspected arthritis, chronic back pain, acute back pain, trauma, neck trauma, occult hip fracture, suspected osteomyelitis, screening for metastatic disease.

Weekly reading guide

The following is a suggested reading guide for the provided medical student text Learning Radiology. The book is targeted towards entry level learners, providing the necessary foundations for image interpretation. Each section includes concise, image rich information that will be relevant to most areas of future general practice. Students should be able to complete the book in its entirety given the amount of time reserved for self-directed learning. When time does not permit due to scheduling or if a guided format is desired, please ascribe to the following schedule to complete the most pertinent sections of the book prior to completion of the course. High-yield sections are bolded.

Monday - Basics of MRI

  • Chapter 22:MRI – Understanding the Principles and Recognizing the Basics, pages 220-227

Tuesday - Bone density issues

  • Chapter 23:Recognizing Abnormalities of Bone Density, pages 228-239

Wednesday - Fractures and dislocations

  • Chapter 24:Recognizing Fractures and Dislocations, pages 240-253

Thursday - Joint disease

  • Chapter 25:Recognizing Joint Disease – An Approach to Arthritis, pages 254-265

Friday - Infection and tumor

  • no reading

Neuroradiologists primarily study the nervous system, including the brain, cranial nerves, and spinal cord. They play a major role in the diagnosis and assessment of treatment response for head & neck, brain, and spinal cord tumors. CT plays a major role in this field, especially for the assessment of the brain and spine following trauma and as a first line imaging modality for non-traumatic abnormalities such as degenerative disease. MRI plays a major role in this subspecialty and is used to evaluate congenital and developmental abnormalities, demyelinating disorders, infections, neoplasms, and the fine detail of the spine in trauma and degenerative disc disease. Ultrasound plays a minor role in assessing congenital abnormalities such as myelomeningocele and tethered cord.

Goals and objectives

Goals and objectives for the Radiology 709A General Elective.  This is not an all-inclusive list of relevant topics to medical student education but will serve to outline what each medical student should strive to learn at a minimum.  Please defer to the assigned reading list to ensure a more complete radiology introduction.

  • Identify normal anatomic structures of the head and neck, brain, and spine on imaging exams and compare the degree of anatomic detail between CT and MR
  • When is MRI a more appropriate modality for spine imaging?
  • What is the difference between Vasogenic Edema and Cytotoxic edema? What are common causes for Both?
  • Recognize imaging signs of increased intracranial pressure and herniation. What does the 'Star' represent?
  • Discriminate between a subdural and epidural hematoma at CT.
  • Describe imaging signs of a subarachnoid hemorrhage.
  • What does it mean when the 'Smile' is gone?
  • Construct the appropriate imaging approach for common diagnostic scenarios including: suspected stroke, suspected subarachnoid hemorrhage, head trauma, spine trauma, facial trauma, metastatic disease to the CNS, seizures, dementia, brain tumor follow up, sinus disease

Weekly reading guide

The following is a suggested reading guide for the provided medical student text Learning Radiology. The book is targeted towards entry level learners, providing the necessary foundations for image interpretation. Each section includes concise, image rich information that will be relevant to most areas of future general practice. Students should be able to complete the book in its entirety given the amount of time reserved for self-directed learning. When time does not permit due to scheduling or if a guided format is desired, please ascribe to the following schedule to complete the most pertinent sections of the book prior to completion of the course. High-yield sections are bolded.

Monday - MRI

  • Chapter 22:MRI – Understanding the Principles and Recognizing the Basics, pages 220-227
  • Chapter 26:Recognizing Some Common Causes of Neck and Back Pain, no assigned reading

Tuesday - Intracranial pathology

  • Chapter 27:Recognizing Some Common Causes of Intracranial Pathology, pages 279-301
  • Chapter 28:Recognizing Pediatric Diseases, no assigned reading

Wednesday - Stroke

  • no assigned reading

Thursday - Infection

  • no assigned reading

Friday - Tumor

  • no assigned reading

Other Areas of Study

Emergency medicine focuses on the utilization of medical imaging for the diagnosis and treatment of acutely ill or injured patients.  It encompasses all modalities and subspecialties within radiology, but with a focus on the acute setting.  The broad scope of this field includes the use of radiographs (e.g. for diagnosis of fractures and pneumonias), CT imaging (e.g. for settings such as trauma or acute abdominopelvic diagnoses like infection), MRI (e.g. for stroke and other acute neurologic, musculoskeletal or abdominal processes), ultrasound (e.g. for pregnancy, abdominal diseases, and soft tissue abnormalities), and nuclear medicine (e.g. in assessing ventriculoperitoneal shunts, amongst many other things).

Goals and objectives

Goals and objectives for the Radiology 709A General Elective.  This is not an all-inclusive list of relevant topics to medical student education but will serve to outline what each medical student should strive to learn at a minimum.  Please defer to the assigned reading list to ensure a more complete radiology introduction.

  • Discuss the role of abdominal ultrasound in the assessment of an acute trauma patient.
  • What does acute blood look like on the FAST Exam?
  • Review criteria for performing CT in trauma patient.
  • When does one order a C-spine radiograph versus a CT scan for cervical spine trauma?
  • What are the risks of scanning a low pretest probability patient versus the risks of not scanning?

Goals and objectives

  • Discuss challenges specific to imaging children and how these may affect choice of imaging modality
  • Contrast normal anatomy on a chest x-ray of an infant compared to an adult
  • Recognize growth plates as a normal finding
  • Explain the significance of physeal involvement of a fracture. What are these fractures called?
  • List types of injuries that should raise suspicion for non-accidental trauma
  • What is a buckle fracture?
  • What is the significance of a toddler fracture?
  • Construct the appropriate imaging approach for common diagnostic scenarios including: Suspected pyloric stenosis, intussusception, vomiting, suspected testicular torsion, and joint pain or limping

Pediatric radiology primarily deals with the diagnosis and follow up of congenital and childhood diseases. Since the focus is on congenital and childhood diseases, and not on the body part or system, this subspecialty contains elements of all of the other radiologic subspecialties such as thoracic, abdominal, ultrasound, nuclear medicine, emergency, and musculoskeletal imaging. With our knowledge of the long term risks associated with exposure to ionizing radiation, particular attention is paid to the use of non- or low dose ionizing radiation in pediatric patients. Pediatric radiologists play a direct role in treatment through procedures such as the fluoroscopically guided reduction of intussusception.

Goals and objectives

  • Discuss challenges specific to imaging children and how these may affect choice of imaging modality
  • Contrast normal anatomy on a chest x-ray of an infant compared to an adult
  • Recognize growth plates as a normal finding
  • Explain the significance of physeal involvement of a fracture. What are these fractures called?
  • List types of injuries that should raise suspicion for non-accidental trauma
  • What is a buckle fracture?
  • What is the significance of a toddler fracture?
  • Construct the appropriate imaging approach for common diagnostic scenarios including: suspected pyloric stenosis, intussusception, vomiting, suspected testicular torsion, and joint pain or limping

Ultrasound utilizes non-ionizing radiation to image the soft tissues of the body. It is very commonly used to assess the organs of the abdomen, pelvis, heart, other soft tissue and the brain and spinal cord in pediatric patients. Because it is non-ionizing, it is often the preferred modality for image guided procedures such as thoracentesis, paracentesis, abscess drainage, and organ biopsy.

Goals and objectives

Goals and objectives for the Radiology 709A General Elective.  This is not an all-inclusive list of relevant topics to medical student education but will serve to outline what each medical student should strive to learn at a minimum.  Please defer to the assigned reading list to ensure a more complete radiology introduction.

  • Summarize the benefits and limitations of ultrasound as an imaging modality.
  • What body habitus is best suited for abdominal ultrasound? How does this differ with CT of the abdomen?
  • Explain why ultrasound is a good modality for assessing vascular structures.
  • Describe the role of ultrasound in the workup of the following symptoms: right upper quadrant pain, renal colic, suspected appendicitis, evaluation of a breast mass, first trimester vaginal bleeding, post-menopausal vaginal bleeding, female pelvic pain, testicular torsion.

Women’s imaging focuses on imaging of the breast, fetus, and women’s reproductive organs. Women’s imagers play a major role in screening for and diagnosing breast cancer, as well as assessing treatment response. They often directly interact with patients during ultrasounds and a variety of image guided procedures such as breast biopsies. Ultrasound is commonly used to assess the fetus due to its wide availability and lack of ionizing radiation. MRI has also become a commonly used tool in various breast diseases and the prepartum imaging of congenital diseases. Women’s imagers work closely with maternal fetal medicine, OB/Gyn and other primary care providers, breast surgeons, pathologists and oncologists.

Goals and objectives

  • List two imaging modalities with no proven risk to the fetus in a pregnant patient?
  • Explain how a mammogram is performed in terms a patient would understand
  • Compare the role of screening mammography versus diagnostic mammography
  • Summarize the risks of screening mammography versus the risks of not screening.
  • Discuss current recommendations for screening mammography based on NNT and US Task Force
  • Describe the utility of ultrasound in the work-up of a breast mass
  • Explain the advantages of transvaginal ultrasonography compared to a transabdominal pelvic ultrasound
  • Construct the appropriate imaging approach for common diagnostic scenarios including: first trimester vaginal bleeding, post menopausal vaginal bleeding, female pelvic pain, staging of gynecologic malignancies

Imaging physics is a broad field involving the mathematics, physics, computer science and engineering of creating medical images. Knowledge of the how the images are made can aid in the diagnosis of some diseases, and can also help physicians and radiologists learn what abnormalities on images are real, and which are artifactual. Imaging physics also explores the biological effects of the radiation used in medicine. Understanding which imaging modalities utilize ionizing radiation and learning about the effects of this radiation are essential for physicians.

Goals and objectives

Goals and objectives for the Radiology 709A General Elective.  This is not an all-inclusive list of relevant topics to medical student education but will serve to outline what each medical student should strive to learn at a minimum.  Please defer to the assigned reading list to ensure a more complete radiology introduction.

  • Categorize different tissues from most to least opaque on radiograph including: bone, soft tissue, air, metal, and fat.
  • Compare and contrast the benefits and limitations of different radiologic modalities including: Plain film, CT, Ultrasound, MR, Nuclear medicine.
  • List risks associated with radiation exposure.
  • Describe the impact of patient age on radiation sensitivity and how that effects each study ordered.
  • Distinguish between the different types of contrast used in imaging exams and the potential diagnostic benefits of each.
  • Discuss the potential complications of intravenous contrast administration for CT and MR exams and identify predisposing risk factors.
  • Describe different methods for reducing the risk of contrast nephropathy.
  • Summarize risks and contraindications unique to MR examinations.