Posts in category: Radiology

Starting your Radiology Residency is both exciting and overwhelming. You’ve cleared your exams, earned the white coat, and stepped into a world of CT scans, MRIs, and PACS. But no matter how much you’ve studied, the reality of clinical life during your first year residency can feel like a sharp uphill climb.

Here is a survival guide full of doable advice to ensure that you survive and even flourish in your first year internship in a radiology residency program.

1. Understand the First Year Is a Transition Period

Your first year of your residency program is less about theory and more about adjusting to the hospital environment. You will learn to:

• Communicate effectively with clinicians
• Prioritize urgent scans and patient care
• Manage workflow in a hectic reporting room
• Deal with on-call duties as junior resident doctor

2. Know Your Modalities Inside Out

All radiology residents are supposed to know the fundamentals of:

• X-rays – Begin interpreting them like a checklist
• CT and MRI protocols – Know indications and sequences
• Ultrasound scanning skills – Practice as much hands-on as you can

Being competent in modalities will make you an asset in any radiology residency program.

3. Build a System for Effective Reporting

Your initial few months will probably be slow, but that’s all right. Develop speed gradually. Utilize structured templates for frequent cases—this will conserve time as well as enhance clarity. Learn to:

• Prioritize emergencies
• Dictate clearly and briefly
• Double-check key findings

With time, your productivity as a residency doctor will increase remarkably.

4. Make a Study Plan That Suits Residency Life

During your internship, long hours and irregular shifts are par for the course. Don’t shoot for perfection—shoot for consistency. Try:

• Micro-studying: 20-30 minutes of reading each day after work
• Podcasts or videos on commutes
• Group discussions with other radiology residents
• This routine keeps you connected to academics while balancing clinical responsibilities.

5. Show Respect to Technicians and Seniors Too

The radiology department is a team. 

• Technicians can teach you more than you know about scanning techniques.
• Senior residents and consultants are your best guides for clinical decision-making. 
• Be humble, be curious, and always be respectful.

6. Get Comfortable With Being On-Call

On-calls can be daunting, particularly in your first-year internship. Here’s how to deal:

• Pre-review common emergency imaging cases beforehand
• Know who to call for help—never shy away
• Keep a logbook of challenging or interesting cases for future learning
• The more calls you encounter, the more proficient you’ll be at handling them.

7. Keep Your Body and Mind Well

Don’t make your 1st year student internship a burnout trap. Tips are:

• Sleep properly
• Eat and drink well
• Speak to friends, mentors, or therapists if you feel overwhelmed
• Your health is crucial to succeed in a stressful medical doctor residency

8. Document and Reflect

Keep a digital or hard copy logbook of cases. This has a dual purpose:

• Contributes to your portfolio for exams and presentations
• Assists in solidifying learning through reflection

This habit will pay off in time your radiology internship is over.

Conceptual Radiology: Your Partner in Residency Success

Leading your radiology residency is a whole lot simpler when you have the correct tools in your bucket. Conceptual Radiology is designed exactly for that purpose—it’s your academic and clinical companion during your radiology residency life as a junior resident doctor. Whether you are learning how to interpret images, learning protocols, or our high-yield videos, case discussions, and detailed lectures are designed for every phase of your residency program. 

Stay confident, stay updated, and ace your radiology internship with Conceptual Radiology by your side.

Final Thoughts

Surviving your first year as a junior resident doctor in a radiology residency is all about adaptation, consistency, and self-care. Whether you’re enrolled in a top-tier radiology residency program or working in a resource-limited setting, the key to success is simple: show up, stay curious, and keep learning.

Each day of your residency program is a new lesson. Have faith in the process—and in yourself.

Estimated reading time: 3 minutes

Appendix is a small, blind-ended tubular structure from the cecum, and its inflammation, appendicitis, is a frequent cause of acute abdomen needing surgery. Imaging is important in the diagnosis of appendicitis and in the differentiation from mimics. This blog discusses the imaging modalities to evaluate the appendix and their utility in diagnosis.

Role of Imaging in Appendicitis

The main function of radiology in appendicitis is to exclude the removal of a normal appendix. This calls for proper localization of the appendix and identification of signs of inflammation. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) all have a role to play in assessing appendicitis, each having its own strength and weakness.

Imaging Modalities

1. Ultrasound (US)

• Initial imaging modality, particularly in children and pregnant women.
• Uses a graded compression method to outline the appendix by pushing aside overlying bowel loops.

• US features of appendicitis:
  • Blind-ending tubular structure with origin from the cecum.
  • Non-compressible, aperistaltic, with a gut signature (hyperechoic mucosa, hypoechoic muscularis, hyperechoic serosa).
  • Diameter >6 mm indicates inflammation.
  • Hyperemia and stranding of periappendiceal fat, and free fluid.
  • Probe tenderness, which is parallel to peritoneal inflammation.
• Tips for finding the appendix on US:
  • Begin with a curvilinear probe for survey.
  • Begin with identification of the ileocecal junction.
  • Look 2–3 cm caudal to the ileocecal junction for the appendix.
  • Use a high-resolution linear probe for clear imaging.
  • Left lateral decubitus positioning may be considered if the appendix is not seen initially.

2. Computed Tomography (CT)

• Senti and specificest modality for the diagnosis of appendicitis (>95% sensitivity).
• Usually done as a contrast-enhanced CT (CCT) abdomen in India.

• In a few facilities (e.g., in the U.S.), a limited appendicitis CT (from subhepatic region to pelvis) can be done.
• CT Features of Appendicitis:
  • Dilated appendix (>6 mm in diameter).
  • Wall thickening and enhancement.
  • Stranding of periappendiceal fat.
  • Appendicolith (in certain cases).
  • Abscess or perforation in complicated cases.
• No oral contrast required; there is no reduction in accuracy with or without oral contrast.

3. Magnetic Resonance Imaging (MRI)

• Used almost exclusively for pregnant patients in whom radiation exposure cannot be tolerated.
• Routine sequences are T1, T2, and diffusion-weighted imaging (DWI).
• Findings are the same as on CT but have longer acquisition times.

Clinical Considerations

• Mantrell Score: A clinical scoring system that is utilized to determine the probability of appendicitis. A score of ≥7 indicates a high likelihood of appendicitis.
• Common Positions of the Appendix:
  • Retrocecal (most common, easy to visualize).
  • Pelvic, paracecal, pre-ileal, and post-ileal (potentially more difficult to visualize).
• Mimics of Appendicitis:
  • Mesenteric adenitis, Crohn’s disease, ovarian pathologies, and diverticulitis.

Key Takeaways

• Ultrasound should be the initial imaging in pediatric and pregnant patients.
• CT is the most reliable modality and must be utilized when ultrasound is not conclusive.
• MRI is reserved for situations in which radiation exposure is a problem.
• Radiologists need to be familiar with false negatives and positives, identify complications, and include alternative diagnoses in the report if appendicitis is not suspected.

For further in-depth discussion of imaging in practice, subscribe to Conceptual Radiology and get ahead on your radiology education!