Chest Imaging: An Algorithmic Approach to Learning

166 Pages·2012·8.85 MB·English

by  Les R. Folio (auth.)

Chest Imaging

Les R. Folio
Chest Imaging
An Algorithmic Approach to Learning
Les R. Folio, DO, MPH, FAOCR
Col (ret), USAF, MC, SFS
Clinical Associate Professor of Radiology
Philadelphia College of Osteopathic
Medicine
Philadelphia, PA
USA
[email protected]
ISBN 978-1-4614-1316-5 e-ISBN 978-1-4614-1317-2
DOI 10.1007/978-1-4614-1317-2
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011937481
© Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. 2012
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To the medical students, residents
and fellows I have taught chest imaging
over the years.

Foreword
I was distinctly honored when Col (ret) Folio asked me to write this foreword, as he
taught chest imaging throughout my student tenure at the Uniformed Services
University (USU) in Bethesda, MD. He led the second year radiology lecture series
for our class, to include the memorable CXR fi nal oral exam event, and ran the
fourth year radiology elective for several years, providing all the chest imaging
presentations for hundreds of students. My fellow students and I found his peda-
gogical teaching techniques and course materials, such as RoboChest, useful in that
he taught in a way one remembers, from fi ndings to differential. This book refl ects
his teachings by breaking the chest x-ray into manageable components that the stu-
dent of radiology can reasonably master in a short period of time.
The following text presents a unique approach to the CXR that includes mne-
monics on most everything from the search pattern and diagnostic approach to dis-
ease processes that are retained for years. By reading this book, one can understand
the complexity of interstitial disease (for example) with clever algorithms built in
Excel ® that provide a general understanding of an otherwise daunting and seem-
ingly unlimited differential. And who could possibly forget the fi ndings of hydro-
pneumothorax with his balloon and milk in the glass analogy? Or the tram tracks in
bronchiectasis from his straw in the sponge model? This text allows these teaching
pearls to be shared for years to come.
The online directory structure of lung patterns on his www.robochest.com is
unparalleled. When looking for the information needed, this website naturally
guides the student of radiology in an interactive outline format that expands when
more detail is desired. One always knows where they are on the pathway with bread-
crumb trails, and can backtrack in a methodical fashion to get to a differential diag-
nosis. This basic launching platform to chest imaging is timeless and especially
useful for many of us that will deploy with minimal resources in austere environ-
ments such as combat. This book contains everything RoboChest has, with many
improvements, including clearer descriptions, annotations, and relations to the anal-
ogous models.
I am confi dent I will be reading this book several times over in the next few
years, and I expect that when I deploy, it will be packed safely in my gear bag to take
with me to help provide good medicine in combat situations. I believe I can speak
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viii Foreword
for our entire graduating class: that no other teacher comes to mind when reading a
CXR; he is a legend in our book. I hope you fi nd this text and his teaching methods
as useful as we did, and are fortunate enough to benefi t from his inspiring lectures
in the future.
– Captain “JD” Hoskins, President,
USU School of Medicine Class of 2011
Preface
This book is written for the “student of radiology” which historically has included
medical students and radiology residents. Due to recent increased diversity in the
medical team, I consider nurse practitioners, physician’s assistants, nurses, medi-
cal students and radiology technicians to be included as students of radiology. The
audience also includes residents and fellows of all clinical disciplines, especially
ICU staff. The morning CXR review and rounds that follow (ICU, surgery, ID,
etc.) are the pulse of any hospital. Even in combat hospitals the day starts with the
CXR rounds, followed by ICU and other specialty rounds (surgery, infectious dis-
ease, etc.).
I am often asked how I came up with the RoboChest title for the fi rst edition and
the online content. It is very simple; the program we used to make the online version
is called RoboHelp by Adobe® . With Adobe’s® permission, I borrowed the “Robo”
and added chest. It was designed to be help pages for a larger project that is still
under development. These are the familiar help boxes that accompany popular pro-
grams that are organized in folders that can be opened for more detail.
In this edition, I have distilled the content of the search pattern to a very easy to
remember mnemonic (ABCDS) × 2 covering all aspects of the CXR.
The second mnemonic that helps guide the student of radiology through the diag-
nostic process is ID CD, or Identify, Defi ne, Categorize, Differential. Using these
and several other mnemonics introduced throughout the book, a beginner can build
confi dence reading CXRs.
The prior two versions of RoboChest book were meant as a guide to the launching
website www.robochest.com. Although this book follows the same methodical pat-
tern-driven approach to the chest x-ray, it is meant as a stand-alone introduction to
chest imaging, while being augmented by the RoboChest website as a teaching tool.
I hope you fi nd this book as a valuable guide through the world of chest x-rays.
L es R. Folio, DO, MPH, FAOCR
Col (ret), USAF, MC, SFS
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