Chest x-ray (CXR) is one of the most requested imaging modalities in hospitals and often the starting point for the diagnosis and management of cardiopulmonary diseases. It is usually performed on patients from the emergency room, critical care unit, following the placement of various medical devices or prior to major surgical procedures.1
Traditionally, radiologists are responsible for interpreting and reporting CXR and research indicates that they offer a better quality and accuracy of reporting compared to other physicians.2
However, the increasing demand for medical imaging services can lead to a delayed report and a growing reliance on physicians from different specialties, to interpret these images. This can in some cases lead to overlooked diagnosis, incorrect treatment, postponed discharge and increased financial costs, especially if images are interpreted by junior trainees.3,4,5
The Department of Radiology at Aalborg University Hospital organized a basic course in CXR and CT, addressed to residents from various specialties, where the primary goal was to help them acquire the necessary competences to interpret CXR and CT, especially during shifts when the on call radiologist can be unavailable due to other issues with higher priority.
Our course was based on cases from our department and included following topics:
- Chest anatomy on CXR and CT
- Technical factors and assessment of image quality
- Importance of both views (postero-anterior and lateral), the challenges of the supine antero-posterior view and the role of previous imaging
- Systematic approach
- Introduction to the most common radiological signs seen on CXR, correlated with CT findings
- Mediastinum: anatomy and common abnormalities (CT classification of mediastinal compartments, prevascular, visceral and paravertebral lesions)
- Lungs: anatomy and common abnormalities (difference between atelectasis and consolidations, explaining radiological features of pneumonia, nodules, tumors and interstitial pathology)
- Pleura: anatomy and common abnormalities (pneumothorax, pleural effusion, pleural plaques)
- Medical devices in the thorax (normal location and criteria)
The course programme can be viewed in Figure 1.
Tutors were represented by radiology residents from our department, trained and supervised by senior chest imaging specialist. The organizing team consisted of the residency program director from our department, chest imaging specialists and radiology residents.
At the end of the course, the participants were asked to take part in a multiple-choice quiz consisting of 13 cases, with brief clinical information. The most likely diagnosis had to be chosen, each question with a duration of approximately 2 minutes. After each question, the correct answer was explained in detail. In Figure 2 we present an example of a case from the quiz.
After the course, each participant received a feedback survey, which focused on the curriculum and its structure, relevance, difficulty level, expectations, degree of satisfaction, and possible missing topics. Furthermore, each presentation was separately evaluated.