Test Yourself - Periodic Sets

On the 1st Monday of each month we will provide a Set of 30 different radiographs - ie skeletal and chest radiographs. As follows:

• These will be the plain radiographs of 30 different patients.
• Patients numbered as 1 - 30.
• The skeletal images will be mainly - but not solely - from patients who have sustained trauma.
• The CXR images will be from patients attending the Emergency Department, or referred from Out Patients or from General Practice. Some CXRs will be those of patients on ITU, or on the medical, surgical, or paediatric wards.
• BUT - no clinical information will be provided. None. This will seem, initially, to be very peculiar. But, the rationale is very specific: these sets are intended to test two important skills. Viz:
  1. Knowledge of the principles that underpin, and are fundamental to, the accurate assessment of plain radiographs of different skeletal images & similarly of, normal and abnormal, CXR images.
  2. Knowledge of, and familiarity with, the common normal anatomical appearances / variants that are regularly found on plain (skeletal and CXR) radiographs.

The approach to follow, as you test yourself on these sets:

• Assign to each of the 30 cases your opinion as to whether the image / images are normal or abnormal.
• If you assess an image as abnormal - state the abnormality.

On the 1st Monday of each month we will also provide / list the diagnosis in each of those 30 cases.

• This listing will either state "Normal" or will specify the precise abnormality.
• There will usually be relatively little additional explanation or information. There may be a helpful reference to a page in our CXR Survival Guide book or to a page in our A&E Survival Guide book (3rd Edition). Occasionally, reference might be made to other textbooks or articles that describe common anatomical variants.

What is the ratio of Abnormal : Normal images in each of these sets?

• The ratio will vary.
• In some sets the ratio will be (very) approximately:
  
  60% or 70% Abnormals : 40% or 30% Normals.
• In some sets those ratios could be reversed.
  
  (NB On occasion we might choose to provide a set of 100% abnormal radiographs - thus providing a really tough diagnostic challenge. On other occasions we might provide a set of 100% normal radiographs - a tough anatomical test).

How challenging are the radiographs in each set? Our view:

• Year two Radiology Registrars / Residents should score 90% - 100% correct answers.
• Those who read plain films (radiographs) on a regular basis (eg Reporting Radiographers) should score 90% - 100% correct answers.
• Career grade Emergency Department Physicians, and Emergency Nurse Practitioners (ENPs), should score 90% - 100% correct answers.
• Doctors commencing work in the Emergency Department (ED) for a 4 or 6 month attachment, without a background of ED experience, should achieve at least an 80% correct score rate . . . ie if properly prepared for the ED attachment.