Updated October 6th, 2023

I learned a lot during my radiology residency, but I also made a lot of mistakes. However, I always tried to learn from my mistakes and use them to do better next time. This did not always work out as expected, but in the end, it worked. Or at least, I passed my board exam. Now that I spent some time teaching residents myself, I am thinking back now and then. I am thinking about what I could have done better (or earlier). In this article, I will therefore give my 7 best tips for radiology residents to make the best out of your residency.

Short disclaimer: These are my personal thoughts and selection. I am assuming that everybody will read books (or online radiology resources) and that you are working thoroughly. However, there are some other tips, I want to share and shortly elaborate on in the following paragraphs.

Further Reading:

• A Typical Workday in the Life of a Radiologist
• Pros and Cons of Being a Radiologist
• Best Lead Glasses for Radiology

In a Nutshell: The 7 Best Tips for Radiology Residents

For those in a hurry, these are the 7 most important tips I can give in a nutshell:

1. Read other reports
2. Ask colleagues or the whole reading room
3. Learn from the radiographers
4. Accept other opinions
5. Take the difficult cases
6. Follow up on your studies
7. Summarize your findings

In the following paragraphs, I will go into more detail:

1. Read Other Radiology Reports during Residency

Wheter you just started your residency or you started your rotation into a subspecialty. Read what others wrote. Especially, if the writer is an experienced radiologist, you can learn a lot. Sometimes more than reading a book chapter on the respective topic.

• Read the previous reports of your patient. It will help understand the current case.
• Read CT reports during your x-ray rotation to understand anatomy better.
• Read reports from similar techniques to get to know the report structure.
• Read reports from other pathologies to know what to look at.
• Read just a lot of reports. It will increase your vocabulary and enable different views.

This is helpful whether your institution uses free text or structured reporting. Reading what others wrote will help you to find your style and give you the power to express what you want to.

2. Ask Colleagues or the Reading Room for (Second) Opinions

I often observe, that residents are working on their own, trying to read through their cases. Of course, they come to discuss the case with a board-certified/attending radiologist. However, there are a lot of cases, where an open question into the reading room could help so much more. Of course, some people will be bothered if someone keeps asking questions non stop. But there are many situations where everyone will benefit if the question is asked openly.

• Did you forget a specific classification?
• See something you can’t name?
• Do you want to add some more differential diagnoses (DDx)?

Asking somebody (even if she or he is also a resident or started after you) will not only help you to get an answer. It will also deepen the knowledge of the person asked. Therefore, you are strengthening the whole team. If nobody knows, look it up in a radiology textbook or online and educate the rest of the team.

Naturally, this will only work if you are working together with others and if they are open to being asked. (You can ask first).

3. Talk to the Radiographers and Learn from Them

A trait in some young doctors is that they think they are something better. In radiology, this can lead these residents to believe that radiologic technologists are some sort of subordinates. As in many other fields, this very problematic for interpersonal relationships. Furthermore, it will limit your personal development and reduce the potential to learn and grow. Therefore, you should meet everyone at eye level.

Not only should you treat everyone you work with with respect. I also strongly advise you to talk to them, ask them for help/opinions, and watch what they do. During my residency, I learned more from some of the radiologic technologists than I did from some of the attending physicians.

What is kVp in Radiology? Most rad techs can explain it to you.

If you have time, watch how x-rays are taken (or help with patient positioning). It is also really helpful, if you know, how to operate your computed tomography system or your MRI. This helps you understand your images better and gives you the ability to optimize acquisitions or protocols. Later on, you will find it easier to perform more complex exams such as cardiac CT or MRI, on your own.

4. Accept Other Opinions and Admit if You Were Wrong

Of course, many doctors have their narcissistic traits (myself not excluded). Therefore, it may be difficult to accept that you are or were wrong. And by admitting you were wrong, I dont mean to shout around that you were wrong.

Lets say you missed something and somebody brought it to your attention. If you just nod through it, or just say “I’ll add it”, the case will be good, but you may be missing something. Instead, you can say “Dang, I missed that/misinterpreted that. Can you tell me, how to do better next time?“

Most of the more experienced radiologists I know will be happy to give some tips and share their experience. And that is the real value for your radiology training. Again, there may be some information, you will not find in any radiology book.

A similar situation is when someone comes in with a DDx to your report. You can stand by your first diagnosis. However, I strongly advise you to consider for a moment that the other opinion might be correct. Maybe there really IS a fracture. Maybe that lesion IS a metastasis. After evaluating the other option, you may still come back to your first opinion. However, there will be times when you will change your mind. As in the previous point, this is where you will learn and where your patients will benefit.

5. Take the Difficult Cases During Your Radiology Residency

Depending on the reading structure of your radiology department, you may have a list of studies that are many people working on. There were times, where I found myself only chosing the easier studies: The unremarkable non-contrast chest CT. The pre-OP chest x-ray. The abdominal low-dose CT. These studies may be very easy to dictate. But you will not learn too much from them.

I know that it can be overwhelming to open up a head/neck/chest/abdomen/pelvis staging CT, where the dynamic of a (very) metastatic disease is of great importance for the further workup of the patient. However, if you do not face these cases, you are missing an important chance to grow.

And later in your carreer, there will be times, where you need to read these cases. And then, you may not have as much backup as during your radiology residency. Therefore, sometimes also reach for the very complex cases and studies. At the end (maybe after some revisions) you will have written a report and you will have grown on this challenge.

6. Follow Up on Your Cases during Radiology Residency

Strictly speaking, this applies not only to radiology residency. Following up on your cases can be a game changer and an invaluable opportunity. But what do I mean by this.

As you read studies, you’ll find that you often can’t make a definitive diagnosis. Maybe you feel the same way I did, that you are a little unsatisfied when you submit the report. However, there is an easy fix for that. Follow up on your cases. Create a secure text document on your PC (best password protected) and write the names, date, and your diagnosis or question in this list.

• Was this lesion really a metastasis?
• What will MRI say to this pancreas structure or the liver lesion I saw on ultrasound?
• What did the CT reveal that I suggested for the suspected opacitiy on the chest x-ray?
• Will CT/MRI confirm my suspected undisplaced pelvic fracture?

From time by time, you can come back to your list. You can look up if the patient received another imaging, follow up, biopsy or surgery. That way, you will often receive an answer to your open questions. In addition, you will have confirmation of your thoughts – or you will have to rethink your thought process. This will help you grow with each case you follow up on, and significantly strengthen your diagnostic skills during radiology residency.

7. Try to Summarize the Findings of your Study into one Clear Conclusion

Depending on the structure of your residency or radiology training, you will discuss your reports with a more experienced colleague. If this is the case, think about your study as a whole before starting to discuss it. Try to think your impression through and best fit the relevant conclusion into one sentence.

This can be:

“This patient with known metastatic breast cancer has partial remission with size-regressed lung metastases and stable mediastinal lymph nodes on chemotherapy.“

I often have residents come to me and say something like: “This patient’s metastases are shrinking.” Then I have to look up the case or ask what the primary tumor is. Then we may have to look up if there was any therapy. Later we talk about the lymph nodes.

All of these steps are tedious, they take time and reduce the quality of the case discussion. However, if you prepare each case in your mind into one conclusion, you will significantly benefit from it. You will have a better case discussion with more room for other information. You will also learn to conclude cases, which will help you to easily communicate the findings to another physician or the patient.

Tips for Your Radiology Residents – The Conclusion

Naturally, this list is not exhaustive and there are several other things to keep in mind during radiology residency. You will still need to learn radiology and look up things online or in books. Be open minded, respectful and question things.

Radiology is such a wonderful and diverse specialty.

Happy reporting!