#AskRG
Hi Dr Amar
I’m currently a second year resident in radiology at a government hospital. We have heavy workload here. My first year was spent in just slogging for long hours with no time for reading at all. Now in second year I’m overwhelmed by the syllabus and don’t really know where to start reading from. Please guide me regarding the same. Thank you.


Dear Dr. XYZ

Thank you for your question.
Congratulations for making it through first year.
A heavy work load is a good thing. More cases you see more radiology you learn.
I am sure its hectic but it's good to in a government college with lots of cases rather than having very few cases.
Don't worry about reading the text part of it. Trust me you can cover it in the last year or even the last three months.
What you won't get is exposure to cases so spend as much time in the department as possible.
Read about what cases you see routinely during your practice
Try to find that one senior who is interested in teaching and learning.
Avoid reading online articles and spotters at this stage.
Start with basic books.
Rumack for ultrasound.
Sutton for general radiology.
Abrahms atlas for Anatomy
Have ebooks or diagnostic imaging series in your library so that you can refer to them whenever you get a case.
Reiterating again. Don't be bogled down by the work you are doing.

Everything you do in the department is going to help you to be a better radiologist which is the ultimate goal!

You are lucky to busy.
If you have any further question feel free to ask me.

Best of luck.

#AskRG

If anyone has more advice for this resident message me @amarudare

#AskRG

Good morning
My name is Dr. MNO

I'm a 2nd year resident studying in a private college with a fairly relaxed work load with not many cases and very minimal academics , and Yet I feel like I wasted my first year as I have not read much of the syllabus and basics. Now i feel like I'm never going to be able to cope up. And now we would be going for peripheral postings where I'm sure it would be academically demanding. I feel I would be lost in that scenario.
Kindly advise as to what I should do. Is is possible for me to be at par with others by the end of my pg course.
Eagerly waiting for your input


Dear Dr. MNO


It’s very good that you have realised this early.
Don’t worry about the past and abt the time you wasted

Private college with less workload is always a good one because I have been a part of it

Less work load -

So u get see few cases , hence I suggest u to read abt the case what u regularly see in ur postings
For example - a case of cholecystitis -
Read about anatomy of gall bladder , variants , anomalies , cholelithiasis , other diseased conditions and Carcinoma in a day or two

You are done if u have covered these when you encounter a case like this

Similar way apply these headings to all the cases what u see in your postings

One suggestion is read read read TEXTBOOKS not the journals

Journals lack the basics and approach

There is a lot of time you can put in
Schedule a timetable for yourself and interact with close frnd or colleague of yours which will retain better if you study together

Don’t worry abt the time
Just follow the simple method I have suggested above u will be a confident Radiologist at the end of ur course

All the best 👍@DrVenki_rad (Dr Venkatesh M)
Make sure you follow is his radiology channel 'Shades of Radiology' on YouTube for radiology case discussions.


#AskRG

If you have anything to add or your own question feel free to message @amarudare

#AskRG

Hello sir
I am a resident of DMRE in a good institution. I got my seat through merit quota,not management. My institute also has dnb seat. The dnb resident and i do the same work, read the same things, i am also better at some things than him, but there seems to be a lot of bias against dmre. Sir, is there any career scope for dmre or am i just wasting my time? Sometimes i get depressed. Kindly guide me if there is anything else i can do after i finish my course.

Dear Dr GHI

Glad that you asked this question. Answering your first question, there is lot of scope for DMRE and you are not definitely wasting your time. You have to understand your limitations and excel in those. The chances of you being hired as a cross sectional (CT/MRI) radiologist are low. But you can always practice conventional radiology and Ultrasound. Also it may be difficult to practice in Tier one ciities like Mumbai.

Ultrasound is the bread and butter for all radiologists practicing in India. I have DMRE colleagues who are doing amazing work and earn more than their MD / DNB counterparts. Owing to the large population there will always be a scarcity of doctors in India so do not worry. You will definitely do well.
Whle you are doing your course and even after you are done, try to excel in what you do. A degree is like a trailer to a movie. A good trailer may get people in the theaters but for people to stay throughout the movie needs to be worth it. If you do good work , clinicians will value you and you will excel in your field. Because the degree is not considered at par with MD and DNB you may have to face initial resistance and discrimination (as you are doing currnetly). But do not get disheartened by that. Put in hardwork and prove that you are worth it.

On a side note
There are a few radiology residents who are under the guilt of paid / management seat. It is definitely not fair for meritorious candidates but at the same time it is not your fault, the education system itself is flawed. Do not waste your time and energy in being guilty or depressed. Put in hardwork and make yourself worthy of your seat. Thats the best that you can do.

I see a lot of radiology residents and even senior radiologists criticizing colleagues with other degrees (like MD vs DNB , MD vs DMRD, DMRE vs MD). I would like to say that in the long run the only thing that matters is your work. As long as you are answering clinicans questions they will be happy with you irrespective of your degree. Also there is no point in critizing another person or his degree. You cannot rise up by pushing others down. In fact all this ill-mouthing is not going to lead to anything. Instead of that invest your valuable time and hardwork into being a better radiologist.

PS: DMRE is a diploma degree which is recognised in a few states in India. It stands for Diploma in Medical Radiology and Electrology

#AskRG
Feel free to share unedited
If you have any suggestions for the resident or have your own questions you can contact me @amarudare

#AskRG

“Hi sir
I have completed my MD recently
And I studied from a below par level college
Where cases were not much and there was less staff too
And now I got a offer from XYZ hospital for intervention radiology
But problem is there is very less chance for hands on

So shall I join intervention and later work in govt hospital for hands on ?
Sir please help me out”

Dear Dr PQR

There are multiple answers for your questions and to be honest all are correct.

The option you chose has to be based on your personal attributes, passion, financial and family condition.

Chose interventional Radiology, if you are really interested or passionate about it.

There are many diagnostic centres and Hospitals in North India esp Punjab & Haryana which offer good salary upto 4 Lacs per month😊. Joining a government medical college or a diagnostic centre with multiple radiologists can be a good option if you want to brighten up your confidence and reporting skills.

As said earlier, none of the options are incorrect. The decision is largely based on your concerns and family situation.

If you are interested you can also join some short term courses in fetal echo or musculoskeletal radiology, if they suit your interest.

Also you should seek opinion of your seniors and Radilologists from the centre which you are planning to join for intervention regarding the quality of training and ability to perform independent procedures at the end to the course. Aim should be to Gain adequate Competence as a practitioner. That depends much on your dedication and ability to grasp the concept and skills.😇

Answered by

Dr Satyendra Raghuwanshi😇. Make sure you follow his YouTube channel Prayas Radiology for radiology related videos.

My addition to the above.
Interventional radiology has a steep learning curve. It's similar to any other survival branch so you need to have that kind of interest.
You should also be ready to invest at least 2 to 3 years if you want to practice dedicated IR.
Also most interventional radiology centers are in tier one and two cities. In tier 2 cities you may have to hop from one hospital to another for cases.
Advantage is that there is a lot of patient contact. You play a crucial role in patient management so it is very satisfying as a clinician.

So there are pros and cons. Talk to senior Radiologists around you and a the Hospital and decide.

Hope that helps.

If you have anything to add to the answer or have your own question you can send it @amarudare
Access old answers by clicking the hashtag #AskRG

#AskRG

Dr. ABC: Hello sir
I am a first year DNB radiology resident.
No one is interested in teaching us at our institute. How do I tackle this?

Answer by Dr. Devpriyo Pal

How to deal with the disappointment of ending up in a bad department?

After that mind-numbing NEET-PG preparation phase where you literally felt
like your life was slowly being squeezed out from within you, you thought
you’d manage to deal with everything that comes next.

You had it figured out – if you can deal with THAT pressure, nothing much will
faze you anymore. In a way, you were right. Very few things will challenge you
the same way as NEET-PG but there’s more to life than being better than
others at solving Multiple Choice Questions.

Most of us are not prepared to deal with the profound disappointment that
waits for many of us during residency. Not everyone ends up with the short
stick but the truth is that many of us do. There are far too many busy
government hospitals for this to not be a common problem.

As doctors who managed to crack this exam, we end up having certain
expectations from our new professors and departments. We had our fill of
doing shitty pointless work during internship and we have all thankfully left
that crap behind. Now we want to feel fulfilled during our residency. We want
to feel good about this training that we are undergoing.

Except, there are some departments which don’t give a shit about you.
These departments are made of people who are not interested in how you feel
and what you learn unless it benefits them. They are happy as long as the
department keeps running and they can just keep doing whatever they want –
outside the department. It doesn’t take much imagination to understand what
I am talking about.

So, you have ended up in a place like this.
Everyone above you wants you to do your work. Look at patients, give your
rounds and in general, make their life easy. You’re a first year PGT. You don’t
need to have the luxury of feeling good about the work you do.
But they are wrong. Especially in Radiology, they are very wrong. You have
been separated from a big part of what you used to identify yourself as a
doctor – patient contact. You are already struggling to understand where
exactly you fit in. At this point of time, the last thing you need is complete
apathy from the people around you.
You need excitement. Encouragement. Challenges. Criticism. Discussion.

It is very important to love the subject because you are going to spend a lot of
time studying it – more so than others because your subject is bigger and
newer.

So, where do you look for comfort?
Find a friend who understands what you are going through and is looking for
similar solutions. You might be lucky if he or she is in the same department but
they don’t have to be. A problem such as this can be dealt easily if you have a
bunch of like-minded people with you. Even one is great but you really have to
look for them. The idea is not to have someone who you can discuss the
subject with (although that would be awesome), the idea is to surround
yourself with people who inspire you to do what it takes to learn more. I have
a psychiatry resident in my institute who shares my passion for learning. He
often just drops in during my MRI posting to look at brain images because he
like neurology.

Try to find a good senior. I know most residents complain that they have
terrible seniors who are more focussed on torturing them than nurturing them
but at least one of them has gone through what you have – you just don’t
know them. They will be more than happy to give you the help that they didn’t
have. I got lucky with my seniors and I try to do even more for my juniors.
Once again, you do not have to restrict yourself to your own department or
even college!

Social media becomes very helpful for problems like this. I have met some of
the best people who I talk radiology with online! Ours is a subject which is
almost entirely based on still images (Except Ultrasound, IR etc) and discussing it online is an excellent way to learn. These days, I divide my Insta and FB time equally between puppy videos and radiology posts and there are days where I
learn more on social media than I do at my actual job.

I met another radio resident based in Kidwai on Quora. We don’t even talk
about radiology all that much but I have still managed to learn so much from
him! We have literally been on video calls trying to explain stuff to one another.
Moreover, there are so many free resources online that most of us don’t even
know about. Look at Radiogyan for example. I found out about this only
because Dr. Amar Udare, the founder of @radiogyan , sent a message to me on
Quora – a QnA website where I used to write a lot.

Since then Radiogyan.com has been my go-to website not only because it contains a
lot of resources for residents but also because it guides you to other resources!
Social Media helped me find a treasure-trove of information that has been
carefully curated and shared by Dr. Udare!

The point of this rather long-drawn post is to make you understand that even
though you may have no control over the place where you land up in, you do
have a lot of control over what you do with the opportunities you get. You
have to be rational and smart and really focus on improving your
circumstances.

There are always things you can do to make your life better – you just need to
experiment and think outside the box. It is entirely possible that you think up
something and it doesn’t pan out the way you intended but that’s no excuse to
stop. In this line of work, you have to be resilient.

Remember, no one gave you this opportunity. You earned it with years of
blood and sweat (literally in most of our cases) and so it would truly be a
shame if you were to allow it to go to waste because someone else doesn’t
give a damn.


This is an excellent answer by Dr. Devpriyo Pal (You can follow him on Quora for more such answers and instagram for educative radiology posts. These are especially useful for NEET PG and first year residents : https://www.instagram.com/drdev_radiology/)
Hope that helps.

I would only like to add one thing is that if you think that radiology is a branch that does not suit you (not because of the institute but the branch per se) you always have the option of opting for something else. If you can get into radiology you can get into any other branch for sure!

If you have anything to add to the answer or have your own question you can send it @amarudare
If your question is unanswered please send a reminder and we shall try to answer it.
PS: Please DO NOT send messages to me in “secret chat” mode. All questions are answered and shared anonymously.

You can access the previous answers by clicking this hashtag #AskRG

#AskRG

Radiologist:

Hello sir, let me introduce my self.

I am XYZ , a radiology resident from indonesia

would you please to give me an explanation about how can we differentiate between localized pneumothorax and bulla on chest x ray?

Hi Dr. XYZ

Glad to know that the website is helping residents from other countries as well

Coming to your query. Thats a great question and a tough one to answer. Here are few points that can help:

👉 Bullae will usually be in the upper lobes while pneumothorax will be in the lower lobes.
👉 Bullae will have vascular markings projecting throug them while pneumothorax will have a visible visceral pleural line. This can be better visualised with the patient in expiration.
👉 The diagnosis is difficult on chest radiographs alone. In a pneumothorax, howeever the patient will be asymptomatic.
👉 These can co-exist making diagnosis even more difficult.
👉 Ultrasound can be used to distinguish the two.
👉 In normal patients, thoracic US shows both the pleural and visceral layers of pleura, and sliding of layers back and forth over each other during respiratory cycle known as the SLIDING SIGN. When pneumothorax occurs, air fills between these two layers, and the movement of layers could not be visualised by ultrasonography
CT would be the best modality.
👉B-line artefacts are an artefact described as discrete laser- like vertical hyperechoic reverberation artefacts that arise from the pleural line. This will be lost in pneumothorax while preserved in bullae.

@radiogyan
@radiogyandotcom
Why is important to distinguish Giant Bulla from Pneumothorax

💫 Important for treatment plan (bulla - no tube thoracostomy; pneumothorax - may need tube thoracostomy if large or symptomatic)

Here are some additional imaging pearls:

Giant bullous emphysema:
💫 Presence of giant bullae in one or both upper lobes, occupying at least one third of the hemithorax and compressing surrounding normal lung parenchyma.

💫 Multiple large bullae, ranging from 1 to 20 cm in diameter, usually 2-8 cm, without a single dominant giant bulla

💫 Pneumothorax in a ruptured bulla can be diagnosed using the Double wall sign. If you see air on either side of the bulla wall, it suggests pneumothorax.

💫 Seashore sign in M-mode, which detects motion over time, proves that the pleural line is sliding. It is beneficial in patients where sliding may be subtle, such as, in the elderly or in patients with poor pulmonary reserve, who are not taking large breaths. In normal lungs, pleural sliding seems like that resembles waves crashing in onto the sand and is therefore called the ‘seashore sign’ and is present in normal lung. In pneumothorax patients, the typical back and forth movement or shimmering of the pleural line will not be present and it seems like on M-Mode parallel horizontal lines. It is called ‘stratosphere’ sign

In the above case I would favour a loculated pneumothorax over bulla.

Hope that helps 🙂

You can ask your radiology questions @amarudare

Previous questions can be accessed here: #AskRG

#RGpearls @radiogyan @radiogyancom

Dear all!

Thank you for being part of the RadioGyan community.

Many residents and radiologists and residents message me with their queries. I try to answer all of them but please do understand that I am a working professional just like all of you. I have a deadlines to meet like all of you, especially being a fellow in a busy radiology department. There is routine work, research work and the website (with all its social media channels). At times it becomes difficult to answer all the queries and I have skipped a few of them. In the upcoming days I will try to answer all the ones that I have received so far. Apologies to those whose queries have not been answered so far.

If you have any question you would want to ask, please feel free to ask here: https://radiogyan.com/contact/
The questions here are organised and this would be the preferred way to contact me. The messages get lost on Telegram and WhatsApp so it is difficult to track them.

Alternatively you can ask it in our telegram group: https://t.me/radiogyan . There may be others who can answer your query, which will not only be quicker, but they may have a better answer than I have.

Check the previous queries and answers : #AskRG

Please keep in mind these things before you message: https://t.me/radiogyan/11640

#HappyToHelp

#AskRG

Dr. ABC: Hello sir, I am a first year radiology resident.
Sir I cannot understand where to start studying radiology, I know the books and sources...but I still don't know how and where to start
Kindly guide me sir .

Answer:

Hi.
Congratulations on getting into radiology.

👉 As a first step, please stay away from online resources (including articles, webinars etc.) at least for the first few months. Too much of information without contenxt can be confusing.

👉 Buy physical copy of comprehensive textbook such a Grainger or Core Radiology (can be a photocopy or a second hand copy). Try to read about a case that you saw during your posting. If it is not possible to do that, note down the cases and try to read at the end of the week.
If you are in ultrasound or radiograph rotation, get a physical copy of Rumack or Felson / Xray survival guide and do the same.

👉 You have cleared a very difficult exam to get a radiology seat. Use the same techniques that helped you prepare for that exam.

👉 Try to seek help from your immediate seniors. Make their work easier and they will make your learning easier.

👉 Be present and proactive at work. Enjoy the being present at work. Chat with your colleagues, other physicians and techs.

👉 Read this article : https://radiogyan.com/guides/first-year-radiology-residents/

Hope that helps!

Dr. Amar Udare.
RadioGyan.com