As mentioned yesterday, this chest x-ray is from a 67-year old woman with chest pain:
Did you notice the broken right clavicle (aka “collarbone”)?
The lesson: Look at the corners and edges of the films. In fact, look at them first before you look at the stuff in the middle. The eye is naturally drawn towards the structures in the middle of the image, so good radiologists cultivate the habit of looking at those structures last.
Otherwise, it’s too easy to get “tunnel vision” concentrating on various abnormalities in the middle of the image, then forget to go back and look at items in the image periphery.
More broadly, it’s important to develop a standard “search pattern” for each type of radiology study. For a chest x-ray, I look at the bones (shoulders, ribs), the upper abdomen, the mediastinum (the white cluster in the middle with the heart, the aorta, the airway, etc.), then finally the lungs.
For other kinds of scans (CT scan of the abdomen, MRI of the knee, etc.), I have a different but standardized visual search pattern. As in much of life, 90% of success in radiology (and medicine in general) comes from cultivating good habits!
