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Transition to the Wards

Donna Magid M.D., M.Ed.

Welcome to Transition to the Wards, the bridge from the classroom to the wards. Part of that successful transition will include appropriate comprehension and utilization of diagnostic imaging. Radiology is a central clinical hub through which virtually all spokes of the patient care wheel will run. The vast majority of your patients, be they emergent, routine, or anywhere in between, are likely to have had or to be having some sort of imaging procedure in their diagnostic assessment, treatment planning and therapy, and follow-up. In line with urgent new national imperatives to provide high-value care in every subspecialty and every situation, we are hoping to help you evolve as intelligent, informed, patient-centric 'consumers', who understand how to consult with Radiology and Radiologists, how to weigh the cost/benefit ratio of any imaging decisions, research and understand which studies may or may not be appropriate in individual circumstances, how/when/where to refer, when more information is needed, and to have some insight into the increasingly urgent issues of dose and cost.


The articles in this section provide an introduction to clinical radiology and highlight important concepts that you will encounter during your time on the wards.

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Basic Principles and Introduction to Chest Radiographs

Basic Radiology Module
Transition to the Wards 2011, revised 2016 D. Magid MD M.Ed

Kopal Kulkarni MS IV and Donna Magid MD, M.Ed

Requesting an imaging study

While giving a brilliant patient presentation on rounds, you mention that your patient would benefit from getting diagnostic imaging. The resident says, “Great, go for it.” Now what?

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Requesting Imaging Studies

Donna Magid, MD, M.Ed

One does not ‘order’ an exam, one requests a consultation from a Radiologist. The actual process of inputting a request, either on-line through Physician Order Entry (POE), Epic, or via the fax forms on the floor, is subject to constant change; therefore showing you the actual mechanics will be left up to the individual floors and services. In the same vein, many studies—especially after 5 PM or on weekends—must be approved in direct discussion with the relevant Radiologist. Again, the array of timetables and phone numbers—where to call until 5 PM, where to call nights and weekends, which subspecialty service, who is on call—is confusing and in constant flux.

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Contrast Agents in Imaging

Donna Magid MD, M.ED

Imaging is based on the assumption that, whatever the form of energy or physics used to peer beneath the skin and into the body, different tissues and substances will produce different visual representations, usually along the grey scale (black-->greys-->white). This is dependent on the desired information, or useful visual signal, exceeding the disruptive or confounding information, or noise. The goal is always to maximize detail and definition, and to minimize anything interfering with or degrading these characteristics.

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Kiddy Physics

July 2012 - Donna Magid MD, M.Ed

Opinions are mine alone, and do not reflect the Dept., Institution, or American Board of Radiology.  Potential errors also mine alone, accuracy not guaranteed. For orientation/introductory purposes only, do not disseminate or quote.

Brief History

  • Nov. 1895: Roentgen publishes description of ‘x-rays’, capable of penetrating tissue and creating an image on photographic plates.
  • 1896: 1st 1000 articles (some of dubious medical value) follow (Lancet 1897 described locating a baker’s ring in a freshly baked cake).  (Over the next few years, an x-ray crazy public would start exchanging hand images instead of photographs—although the first report of radiation burn to the hand also appeared this year, in “Deutsche medicinische Wochenschrift”-- or other tokens, and would be offered irrelevant and dangerous products and services such as a 15 minute x-ray exposure ‘guaranteed to cure headaches”, similar ‘x-ray headache tablets,' x-ray-associated shoe polishes, stove cleaners, golf balls [more bounce?], and - perhaps most horrifying—radioactive “disease-preventing prophylactics,” aka condoms).
  • 1897: Osler proposes acquiring a ‘Roentgen Ray Apparatus” (RRA) which does not arrive until 1901, with Drs.Baetjer and Cushing.
  • 1901: Roentgen awarded first Physics Nobel prize.  Exposure times at this point ranged from the shortest - 5 minutes - up to 20 minutes.
  • 1902: 1st skin neoplasm reported
  • 1910: 1st published report of Roentgen ray ‘poisoning’
  • 1928: 1st Committee on Protection and Mortality.  Established measurement units, little else.
  • 1929: Committee advised ‘Skiagraphers’ to wear ‘kid gloves”
  • 1936: “X-Ray Martyrs” published; a monument to ‘radium martyrs’ inscribed with the names of those dying of radiation-associated disease was also erected in Hamburg, Germany. Dr. Baetjer had died, age 59, in 1933 of radiation-related disease. Extensive over-exposure of his hands in particular had led to decades of non-healing ulcerations and lesions, over 100 surgical procedures and progressive amputations,  and death from radiation-induced neoplasms.
  • 1976: First mandated room shielding. NOW: Radiation protection, monitoring and usage rules at national, state and Institutional levels; mandated protection of individuals and adjacent rooms; mandated monitoring, inspection, licensing, quality assessment, performance reviews......We’ve come a long way!
  • 2006: ‘SENTINEL EVENT’: First time that medical/dental/human-generated exposure dose per capita on planet exceed natural/background radiation levels. Biggest contributor to this 600% increase over 25 preceding years:  CT.
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Introduction to the ACR Appropriateness Criteria

Donna Magid, MD, M.Ed

"What to Order When”

The American College of Radiology (ACR) supports an Appropriateness Criteria (AC) site, which is a valuable reference for students endeavoring to fathom what imaging study might be desirable under which clinical circumstances, and why. This site ranks possible imaging alternatives (plain film aka radiography; CT, US, MRI, etc.) from 9 (best choice) to 1 (least appropriate) for a number of constantly reviewed and updated clinical scenarios.   Site is at www.acr.org