Monday, 9 December 2024

The Generative AI Odyssey: A year of navigating new frontiers - APMEC 2025 conference symposium

Symposium Title 

The Generative AI Odyssey: A year of navigating new frontiers


Symposium Description

In January 2024, during a pre-conference workshop on AI at APMEC 2024, we embarked on an exploratory journey into the new world of artificial intelligence (AI), focusing particularly on generative AI. Our workshop introduced the latest innovations, sparking discussions on the ethical, technical, and societal implications of these technologies. As the year unfolded, the technologies not only evolved at an unprecedented pace but also began reshaping the landscapes of medicine, education, art, and beyond.

Recognizing the need for continuous dialogue and reflection, we are proud to announce this symposium which aims to serve as a critical one-year checkpoint, offering a panoramic view of the advancements, setbacks, and emergent questions that have characterised the last months in generative AI. We will explore how and where AI is embedded in how we practice and the tools and platforms we use, including when we do online search, take advantage of autocomplete and chatbot options, AI tools and extensions within work productivity software, and standalone AI platforms and mobile Apps. We will finish discussing open access AI, share lessons learnt, discuss current and future applications of AI in HPE.


Individual Presentation Title

Overview of Basics of AI in HPE

Poh-Sun Goh

Individual Presentation Description

This presentation will review basic ideas, principles and practices of AI in HPE, and set the stage for subsequent presentations and discussions.


Individual Presentation Title

Current Applications of AI in HPE

Elisabeth Schlegel

Individual Presentation Description

This presentation will review current applications of AI in HPE, in assisting faculty and students to build knowledge and skills in HPE


Individual Presentation Title

AI with a conscience: envisioning a sustainable and ethical roadmap 

Mildred Lopez

Individual Presentation Description

This presentation will review lessons learnt applying AI in HPE, and look out to predict and prepare for the next wave of innovations, with a focus on sustainable and ethical development.


Key Objectives:

- Examine milestones reached and lessons learned in the application and development of generative AI across various aspects of HPE.

- Openly discuss the challenges, ethical dilemmas, and unresolved issues that have emerged, fostering a community that learns from its trials and errors.

- Engage in forward-thinking discussions to predict and prepare for the next wave of innovations, with a focus on sustainable and ethical development.


Who Should Attend:

This symposium is designed for researchers, educators, and policymakers who are at the forefront of integrating AI into their work. We welcome attendees who are both seasoned AI experts and those new to the field, aiming to foster a multidisciplinary dialogue that bridges gaps between theory and practice.

https://medicine.nus.edu.sg/cenmed/sites/apmec2025/programs.html#mainConf2 

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Google search

Gupta, P., Ding, B., Guan, C. & Ding, D. (2024). Generative AI: a systematic review using topic modelling techniques. Data and Information Management, 8(2), 100066‑. https://dx.doi.org/10.1016/j.dim.2024.100066

National Academy of Medicine; The Learning Health System Series; Whicher D, Ahmed M, Israni ST, et al., editors. Artificial Intelligence in Health Care: The Hope, the Hype, the Promise, the Peril. Washington (DC): National Academies Press (US); 2023 Aug 2. 2, OVERVIEW OF CURRENT ARTIFICIAL INTELLIGENCE. Available from: https://www.ncbi.nlm.nih.gov/books/NBK605942/

Yu H. (2024). The application and challenges of ChatGPT in educational transformation: New demands for teachers' roles. Heliyon, 10(2), e24289. https://doi.org/10.1016/j.heliyon.2024.e24289

https://www.nafsa.org/ie-magazine/2024/1/10/generative-ai-and-global-education

https://www.lombardodier.com/insights/2024/october/the-ai-health-revolution-future.html?gad_source=1&gclid=EAIaIQobChMIqNapsc2oigMV4DODAx2y-BUcEAAYBCAAEgLcZvD_BwE

Cultivating Holistic Healthcare Practitioners for a Sustainable Future - APMEC 2025 pre-conference workshop

W1A3

Wednesday 15 Jan 2025, 8.00am – 12noon

Venue: TBC

CULTIVATING HOLISTIC HEALTHCARE PRACTITIONERS FOR A SUSTAINABLE FUTURE

1Poh-Sun Goh and 2Eilsabeth Schlegel

1Singapore and 2Bahamas


Workshop Description

This workshop is dedicated to empowering educators and healthcare professionals to develop holistic healthcare practitioners through innovative educational strategies and practical applications. To do so we will focus on the integration of traditional and alternative medical practices, emphasising preventive care and promoting environmental consciousness in medical practice. Participants will explore how to design curricula that reflect these values, assess their effectiveness, and engage in faculty development activities that promote these goals. Through interactive sessions and group discussions that include Social Sustainability to enhance the quality of life, improving well-being, and promoting equity within a population, participants will design actionable strategies to foster environments that facilitate connections and enable access to health. This highly interactive workshop will include short faculty presentations exploring background, key ideas, current and innovative curricular practices, assessment strategies and role of faculty development. Participants will leave with a comprehensive understanding on how to foster environments that facilitate connections, enable access, and enhance overall health, and be inspired to be ready to implement changes that lead to more sustainable and equitable healthcare practices.


Workshop Objective

At the end of the workshop participants will gain insights into how innovative curricular and assessment strategies, and faculty development methods can together forge a roadmap for implementing sustainable healthcare practices centered on patient needs. Attendees will leave equipped with a toolkit of actionable strategies to implement sustainable education that is ready to push change that improves standards of care, champions social justice, and focuses on long-term sustainability of the health systems we serve.


Who Should Attend

This workshop is designed for health professions educators, curriculum developers, clinical trainers, healthcare administrators and other stakeholders who are committed to advancing sustainable, holistic healthcare education. It is particularly designed for professionals looking to integrate innovative curricular and assessment strategies, engage in meaningful faculty development, and apply step-by-step strategies to foster a socially sustainable program. Attendees who are passionate about enhancing the well-being and equity of their communities through medical education will find this workshop valuable.

https://medicine.nus.edu.sg/cenmed/sites/apmec2025/program_details.html#W1A3

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Google Search

https://globalforum.diaglobal.org/issue/october-2022/the-changing-face-of-medicine-shaping-an-adaptable-sustainable-future-for-patient-care/

Berry, L. L., Yadav, M. S., & Hole, M. K. (2024). Reclaiming Healthcare’s Healing Mission for a Sustainable Future. Journal of Service Research, 27(1), 6-27. https://doi.org/10.1177/10946705231198024

Argus-Calvo, B., Clegg, D. J., Francis, M. D., Dwivedi, A. K., Carrola, P. A., & Leiner, M. (2024). A holistic approach to sustain and support lifelong practices of wellness among healthcare professionals: generating preliminary solid steps towards a culture of wellness. BMC medical education, 24(1), 1364. https://doi.org/10.1186/s12909-024-06353-7

Seetharaman, M., Krishnan, G., & Schneider, R. H. (2021). The Future of Medicine: Frontiers in Integrative Health and Medicine. Medicina (Kaunas, Lithuania), 57(12), 1303. https://doi.org/10.3390/medicina57121303

https://www.heallist.com/resources/blog/sustainable-practices-in-holistic-health-trends-for-eco-friendly-healing

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Session Google Doc

https://chatgpt.com/

ChatGPT and PerplexityAI Prompt - “Cultivating Holistic Healthcare Practitioners for a Sustainable Future how to design medical curriculum to teach and assess”

Designing a medical curriculum that cultivates holistic healthcare practitioners for a sustainable future involves integrating traditional medical knowledge with a broader, more inclusive approach to health, wellness, and community care. This curriculum should emphasize not only the treatment of disease but also prevention, mental health, social determinants of health, environmental factors, and patient-centered care. 

Here’s a step-by-step guide for designing such a curriculum:

### **1. Curriculum Foundation: Core Principles**

- **Holistic Health Philosophy**: The foundation of the curriculum should rest on the concept of treating the whole person—body, mind, and spirit—rather than focusing solely on the disease. This includes understanding the interconnectedness of physical, emotional, mental, and social well-being.
  
- **Sustainability**: Given the global environmental and healthcare challenges, sustainability should be embedded in every part of the curriculum, encouraging practitioners to think about long-term solutions, both in patient care and in broader public health policy. This includes sustainable medical practices, reducing the ecological footprint of healthcare, and fostering health equity.

- **Cultural Competence**: Teaching how to interact with diverse populations, understanding cultural beliefs about health and healing, and promoting health equity is central to preparing a practitioner who can work in a global, interconnected world.

- **Interdisciplinary Approach**: Encourage collaboration across disciplines like nursing, psychology, public health, and complementary therapies. Holistic care benefits from a multi-disciplinary perspective and teamwork in addressing patients’ needs from multiple angles.

- **Community-Centered Care**: Focus on how practitioners can serve their communities, understanding local health challenges, and providing care that reflects the values and needs of those communities.

### **2. Content Areas to Include**

- **Foundations of Holistic Medicine**:  
  *History, philosophy, and principles of holistic health*. Introduce integrative and complementary medicine (e.g., acupuncture, nutrition, herbalism, mindfulness, and alternative therapies) alongside conventional medicine.

- **Patient-Centered Care**:  
  Teach the art of deep listening, empathy, and effective communication. This involves patient education, shared decision-making, and forming a therapeutic relationship.

- **Chronic Disease Management & Prevention**:  
  Equip students with the skills to manage long-term health conditions with an emphasis on prevention, lifestyle medicine, and community-based interventions.

- **Mental and Emotional Health**:  
  Focus on psychological well-being, stress management, resilience, and how mental health impacts physical health.

- **Social Determinants of Health**:  
  Examine how factors like socioeconomic status, education, environment, and access to healthcare affect overall health outcomes. Teach strategies for advocating for vulnerable populations and addressing health disparities.

- **Global Health and Sustainability**:  
  Cover the environmental factors that influence health (e.g., climate change, pollution, food security) and sustainability practices in healthcare delivery, such as waste reduction, energy-efficient facilities, and resource conservation.

- **Ethical and Legal Issues in Holistic Medicine**:  
  Discuss the ethical dilemmas practitioners might face when integrating conventional and alternative treatments, patient autonomy, and respect for diverse values and beliefs.

- **Technology in Healthcare**:  
  Address the role of technology in holistic healthcare, including telemedicine, electronic health records, AI in diagnostics, and digital tools for self-management.

### **3. Teaching and Learning Approaches**

- **Active Learning & Case-Based Learning**:  
  Use real-life case studies where students must apply holistic principles in treating diverse patients. This could involve a variety of scenarios—chronic illness, mental health issues, social challenges, and cultural contexts. 

- **Simulation and Role-Playing**:  
  Simulations and role-playing exercises allow students to practice patient communication skills, decision-making, and team collaboration. These can be used to help students navigate difficult patient-provider relationships or sensitive cultural issues.

- **Interprofessional Education (IPE)**:  
  Foster collaboration between students from different healthcare disciplines. Through joint problem-solving and shared learning experiences, students can develop a more well-rounded approach to care.

- **Community-Based Learning**:  
  Partner with local clinics, non-profits, or community health organizations where students can work directly with underserved populations and apply holistic care principles in real-world settings.

- **Mind-Body Connection Training**:  
  Teach stress-reduction techniques, mindfulness, yoga, or tai chi, not just as practices to recommend to patients but as tools for self-care and well-being for healthcare professionals themselves.

- **Reflective Practice**:  
  Encourage students to engage in reflective journaling, group discussions, or mentoring to assess their own biases, emotional responses, and growth in understanding holistic care.

### **4. Assessment Methods**

To assess whether students are effectively learning holistic principles and integrating them into practice, consider a variety of assessment methods:

- **Formative Assessments**:  
  Quizzes, group discussions, written reflections, and role-playing assessments to gauge understanding of theoretical knowledge and practical skills.
  
- **Objective Structured Clinical Examinations (OSCEs)**:  
  OSCEs with stations designed to test students’ communication, cultural competence, and holistic care skills (e.g., counseling a patient on managing chronic disease while considering their social circumstances).

- **Portfolios**:  
  Students can document their learning journey, integrating experiences from community service, internships, case studies, and reflections on how they applied holistic principles in their clinical practice.

- **360-Degree Feedback**:  
  Collect feedback from peers, instructors, and patients (if possible) on the student’s ability to practice holistic, patient-centered care.

- **Practical Projects**:  
  Assign projects where students create and implement community health interventions that address both local healthcare challenges and sustainability.

- **Capstone Projects**:  
  A final project in which students develop and present a holistic healthcare model or intervention for a specific community or population, considering all the factors that influence health (e.g., medical, environmental, social, economic).

### **5. Continuous Improvement**

- **Ongoing Faculty Development**:  
  Faculty should receive training in holistic teaching methods, sustainability, and interdisciplinary collaboration to model the behaviors and values they want to instill in their students.

- **Student and Community Feedback**:  
  Regular feedback from students and the communities they serve can help refine and update the curriculum to keep it relevant and effective.

- **Adapting to New Research and Trends**:  
  Holistic healthcare is a dynamic field, with new practices, philosophies, and sustainability models emerging. Regularly review and integrate new evidence-based practices and innovations.

### **6. Sustainability in the Curriculum**

- **Focus on Sustainable Practices in Healthcare**:  
  Educate students on minimizing waste, reducing energy use, and promoting eco-friendly policies in healthcare systems.

- **Health and Climate Change**:  
  Integrate lessons on how environmental health impacts individual and population health, emphasizing sustainable practices both in clinical settings and broader public health frameworks.

By fostering a holistic approach to healthcare education, practitioners will be better equipped to meet the diverse and evolving needs of patients, communities, and the planet, ensuring a sustainable future for both healthcare systems and society as a whole.



## Designing a Medical Curriculum for Holistic Healthcare Practitioners

To cultivate holistic healthcare practitioners equipped for a sustainable future, medical curricula must integrate comprehensive educational frameworks that emphasize systems thinking, interdisciplinary collaboration, and holistic assessment methodologies. Here’s how to design and assess such a curriculum effectively.

### **1. Integrating Systems Thinking**

A robust curriculum should frame health education as a **complex adaptive system**. This involves recognizing the interconnections between personal, programmatic, and practical elements of healthcare education. The **3P-6Cs toolkit** provides a framework to achieve this by linking:

- **Personal**: Individual learner experiences and backgrounds.
- **Program**: The structured educational components.
- **Practice**: Real-world applications in healthcare settings.

By applying this systems thinking approach, educators can create integrated designs that capture students' developmental journeys and prepare them for evolving healthcare models[1].

### **2. Emphasizing Interdisciplinary Learning**

Given the complexity of health challenges, curricula should promote **interdisciplinary education**. This can be achieved through:

- **Modified Course Designs**: Implementing models that allow students to explore connections between different health disciplines.
- **Integrated Assessments**: Using assessments that require students to demonstrate their ability to work across disciplines and apply knowledge in collaborative settings.

Such an approach not only enhances knowledge but also fosters essential skills for teamwork in healthcare environments[4].

### **3. Holistic Health Assessments**

Curricula must include training on **holistic health assessments**, which focus on understanding the whole patient rather than just their immediate medical issues. Key components of holistic assessments include:

- Comprehensive evaluations of physical, mental, social, and environmental factors.
- Collaborative goal-setting with patients to empower them in their care processes.

This person-centered approach ensures that future practitioners are adept at considering all aspects of a patient's well-being[2][5].

### **4. Incorporating Sustainability Education**

With the increasing importance of sustainability in healthcare, curricula should embed principles of **sustainable healthcare practices**. This includes:

- Teaching about the impact of environmental factors on health outcomes.
- Integrating sustainability into existing modules across all specialties.

Such integration can be facilitated through participatory learning methods and real-world problem-solving scenarios that highlight the relevance of sustainability in clinical practice[3].

### **5. Assessment Strategies**

Evaluating student competencies in holistic and sustainable healthcare requires innovative assessment methods beyond traditional examinations. Suggested strategies include:

- **Portfolio Assessments**: Allowing students to document their engagement with holistic practices and sustainability concepts.
- **Reflective Writing**: Encouraging students to reflect on their learning experiences and how they apply holistic principles in practice.
- **Creative Outreach Activities**: Involving students in community projects that promote health education and sustainability awareness[3][6].

### Conclusion

Designing a medical curriculum that cultivates holistic healthcare practitioners involves a multifaceted approach integrating systems thinking, interdisciplinary learning, holistic assessments, sustainability education, and innovative assessment strategies. By doing so, educational institutions can prepare future healthcare providers to meet the complex demands of modern healthcare while promoting a sustainable future for the profession.

Citations:
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC7789213/
[2] https://academicpartnerships.uta.edu/healthcare-nursing-online-programs/rn-to-bsn/holistic-health-assessment/
[3] https://www.medschools.ac.uk/media/2949/education-for-sustainable-healthcare_a-curriculum-for-the-uk_20220506.pdf
[4] https://pubmed.ncbi.nlm.nih.gov/39130680/
[5] https://www.aiam.edu/alternative-medicine/holistic-assessment-nursing/
[6] https://pmc.ncbi.nlm.nih.gov/articles/PMC11590568/
[7] https://corp.nhg.com.sg/College/Pages/Highlights/nhgcollegearticle202206.aspx
[8] https://onlinedegrees.umhb.edu/online-programs/healthcare/rn-to-bsn/holistic-health-assessments/

Sunday, 1 December 2024

M3 Tutorial on 6 December 2024 @ 1pm

   


                   


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⬇️
Dear Phase III Surgery CG 14-25 Students,
For the Radiology session  “Acute Abdomen”, this will be a one and a half hour scheduled live interactive teaching session (on Zoom) this coming Friday, 6 December at 1pm on Zoom, including time for self-study during the session of the presented and reference-further reading online content (see below). Please refer to Entrada and visit the blog for the open access online content curated by A/Prof Goh Poh Sun at this URL - https://medicaleducationelearning.blogspot.com/2024/12/m3-tutorial-on-6-december-2024-1pm.html

Remarks : Please review the session outline and content before the tutorial. During the live session, I will highlight relevance of material, share ideas of how to make full use of this material, and for those students who have reviewed material beforehand, engage in interactive Q and A. Other students will have around 30 minutes or more within the allocated curricular time to do self-study of this material.

We will be covering 7 major clinical conditions (below) 

Radiology Bowel Perforation
Radiology Bowel Obstruction
Radiology Acute Appendicitis
Radiology Acute Cholecystitis
Radiology Acute Diverticulitis
Radiology Acute Pancreatitis
Radiology Colon Cancer

Best regards
Poh Sun

(This tutorial process has been iteratively refined over the last year, during the COVID-19 pandemic.
Learning takes place essentially as a process of self study, in each of you individually. Following by active discussion and use of this material in clinical practice. For this session, we will review and discuss your understanding during the live session this Friday. My role is to present compact, usable content, that you can both review and use, and come back to, as and when you require in the future. For those of you who are interested in how this tutorial process has been refined with previous tutorial groups please click to tap on this link - https://medicaleducationelearning.blogspot.com/2024/07/m3-tutorial-on-monday-8-july-2024-1pm.html

⬇️
Start here with background info and learning tips
⬇️

Some tips to increase your learning and training effectiveness and efficiency:
Poh-Sun Goh

1. Reflect on the purpose of your medical education and expected outcomes of your undergraduate education and clinical training process.
2. Your current clinical exposure to case based learning in the emergency department, wards, and clinics-outpatient settings builds on a foundation of pre-clinical basic sciences in year 1 and 2 of the medical program (with anatomy and pathology particularly applicable to the interpretation of radiology / imaging studies of your patients).
3. For the abdomen, think about what anatomical structures lie within the area of interest/clinical presentation, or may present with the clinical symptoms and signs exhibited by your patients. Ask yourself what radiological investigation you might request or review in order to make a diagnosis - to rule in, or rule out potential clinical diagnosis. Radiology helps you to "see living anatomy and pathology" in your patients. Thus confirm or exclude diagnosis. Keep in mind that early disease may have very subtle of "negative" imaging during the early stages of clinically symptomatic disease.
4. Review the Radiology studies for your patients. Ask yourself why certain investigations were performed. And in what order.
5. Correlate imaging findings with your clinical observations. Do they make sense, correlate with clinical findings, or do you have to entertain alternative diagnostic possibilities?
6. Use textbooks and a wide variety of online resources to improve your diagnostic and interpretative skills. Practice, practice, practice with reflection and feedback, using a range of resources, to increase your exposure to the variety and spectrum of clinical and imaging findings, both normal and abnormal, from typical, to less common and atypical (as you progress to increase your experience and mastery of clinical practice, and improve your knowledge and skills from undergraduate, through postgraduate to continuing professional development and lifelong learning settings).
7. Compare and contrast is one of the simplest and most effective methods to learn to recognise and differentiate between normal and abnormal XRs and scans. Review a series of normal XRs and scans, and then do side by side comparison between examples of normal, normal and abnormal, and examples of abnormal XRs and scans. 

https://effectiviology.com/interleaving/ (mixed practice or interleaving superior to blocked practice)

and



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Below section is guided learning path (Option 1)
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Session guide (one learning path) - start with 'Tips' section above, then explore material section below, all on open access websites. One path is to start with 'a curriculum', then explore an approach to the AXR, both normal, and abnormal. Followed by review of common pathology presenting as an acute abdomen on CT scans. Start with bowel perforation on erect CXR, and AXR, unknown cases, for example here, focusing on appearance of free air, and 'Rigler's sign' on AXR. Then move on to examples of acute appendicitisacute cholecystitisacute diverticulitis (focusing on the similarities between these three pathologies, and taking note of differences between normal and abnormal structures, paying attention to the wall of the structure, and the adjacent fat in particular). Then review bowel obstruction, on the AXR, and CT scan, paying attention to the strengths and weaknesses of the AXR, and added value of a CT scan - pay attention to visibility of bowel segment which is dilated proximal to obstructing point, and cause of obstruction shown on CT).

⬇️
Below section is alternative exploratory path (Option 2)
Starting with background information, and "curriculum"
⬇️



⬇️
Below section for Google images search for thematic cases (for practice review, and click through for additional information for selected cases)
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Radiology Colon Cancer


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Section below for self-directed learning



👁
Google and Entrada analytics for current tutorial
👀
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Thursday, 10 October 2024

Imaging of Respiratory Tract Disorders - Respiratory System Block for Self-Directed Learning - 28 November 2024

There are three sections to this open access website clearly marked below - Section 1: including link and screenshot of professionally produced segmented e-Lecture; Section 2: including lecture slides with full accompanying transcript; and Section 3: links to curated open access interactive self-study materials related to topic. The pedagogical approach, main ideas and clinical relevance are sequentially outlined in step-wise manner below.

---

Dear Phase 2 Students

The lecture will be a self-directed learning lecture.

Link to self-directed e-Lecture is within open access webpage link below.


the link to Entrada (with my pre-recorded video uploaded) below (and screenshot)





with link to e-Lecture (screenshot below)




---

alternative modular self-study pathways, curated online content, and links to my individual slides are accessible on following link, from last year's session

https://medicaleducationelearning.blogspot.com/2024/10/imaging-of-respiratory-tract-disorders.html

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Warmest regards,

Poh-Sun 

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_______________________


(e)Lecture Outline

Section 1: Introduction 
and
Pre-lecture reflection questions / recall and review if necessary Y1 material

Section 2: Learning objectives

Section 3: Pre-test

Section 4: Lecture proper

Part 1 - review of basic principles of CXR production and tissue characterization

Part 2 - review of the CXR findings in six major diseases

Section 5: Post-test

___________________________


Section 1: Introduction 


Lets start by revising what we have covered last year.  This exercise to recall what you know follows recommendations from the educational literature on how to promote learning. By first revisiting, reviewing and recalling what has been learnt previously. The process of recalling information provides the foundation for new learning.  Learning something new is built on a foundation of prior knowledge. Repetition, review and recall promotes learning.



Please reflect on each of the following questions, pause after each question, write down your answer, and reflect upon your answer. 


1. What is the relevance of diagnostic imaging/radiology in your future clinical practice?

2. How are CXRs and CT scans of the chest produced?

3. How do different tissues appear on CXRs and CT scans? Why does bone appear white? Air black? Soft tissues varying shades of grey?

4. Can you identify normal anatomy on a CXR? CT scan of the chest?

5. Do you know where to find the lecture material on this topic presented in Year 1?

If you are unsure of the answer to any of these questions, please revisit and review the relevant sections in the Y1 lecture and interactive eLecture on the websites below.






Section 2 : Learning objectives of this (e)Lecture



Recall that radiology allows you (as future doctors), to see "living" anatomy, and "in vivo" pathology.

This ability to visualise what is going on in the patient in front of you, in both health and disease will be a useful diagnostic tool for you as doctors.

The easiest way to make sense of what you see on a radiology examination is to recall what you have been exposed to and learnt recently in gross pathology.

We will focus on the Chest Radiograph in this lecture. This is the most commonly requested radiology investigation. While this lecture won't show you every possible abnormality visible on CXRs, it is the start of a learning and skill development process. We will spend time on typical presentations of several common and important clinical conditions, and use these to illustrate the basics of CXR interpretation. As you develop experience over the next few years, you will gradually become more familiar with more subtle or gross presentations of disease, with more atypical features.

As you no doubt realise, an XR or scan is a snapshot of a point in time of a developing disease process. Early on, the manifestations of a disease on an XR or scan might be small, ill defined, or difficult to visualise. Later in the disease process, an abnormal feature might be large, and also difficult to define (for example a small, moderate size or large pleural effusion). It may be initially difficult for you to determine with a completely opaque hemithorax whether you are dealing with pneumonia, a large effusion or complete collapse of the lung.




For those of you who are focused on more immediate concerns, the assessment items on radiology that you will be faced with will evaluate your ability to recognise major examples of pathology on common radiological examinations. For example on the chest radiograph or CXR.




To review again the learning objectives of the undergraduate radiology program in the medical curriculum, you can see how radiology translates what you have learnt in Y1 anatomy, to give you the ability to see "in vivo" living anatomy in your future patients.

And visualise in vivo pathology in your patients. 


Section 3 : Pre-test



Lets do an assessment exercise now to not only show you what potential future examination assessment items might be, but also to illustrate how radiology (on the following CXRs) allows you to visualise gross pathology in your patient.



Google image search "lung gross pathology lung cancer"
Google image search "patient with lung cancer"

Google image search for "lung gross pathology pneumothorax"
Google image search "patient with pneumothorax"
Google image search "patient with tension pneumothorax"

Google image search for "lung gross pathology pneumonia"
Google image search "patient with pneumonia"

Google image search for "lung gross pathology pleural effusion"
Google image search "patient with pleural effusion"

Google image search "lung gross pathology cardiac failure pulmonary odema"
Google image search "patient with pulmonary oedema"

Google image search "lung gross pathology cardiac failure alveolar pulmonary odema"

Google image search "lung gross pathology cardiac failure interstitial pulmonary oedema"

Google image search for "gross pathology rib fractures"
Google image search for "patient with rib fractures"

Google image search for "cadaver rib fractures"



Please try and match the five diagnoses (A to E) with the CXRs provided (1 to 6). There are two examples on the CXRs provided of one of the five diagnoses.

This exercise begins the process to introducing you to the typical appearance of common and important clinical problems that your patient may present with.



Section 4: (e)Lecture proper

We will focus on two major areas. Firstly review basic principles of CXR production and interpretation. And then review the key features of six major clinical problems on CXRs.






We first very briefly review basic principles behind the production of a CXR, and why different tissues have different densities on XRs (white, shades of grey, and black).





Recall that XRs are produced by placing you patient between an XR source, and a recording medium; which may be an XR film, or digital recording plate.  The XR is therefore a record of the absorption of XRs as they pass through different organs and tissues in your patient.




By convention, on a XR, black represents areas of greatest XR absorption, and white the least absorption of XRs. On this normal CXR, you can see the radiographic densities of five categories of tissue. Air being blackest, with gradually lighter shades of grey with fat, soft tissue/blood/muscle, bone and metal. You will appreciate how fat being less dense than soft tissue will absorb less XRs, and appear a darker shade of grey than soft tissues or muscle.






This difference in XR absorption between different tissues and organs allows you to distinguish the edge or surface between different tissue layers and organs. Because XRs travel in straight lines through your patient, the interface between different tissues is highlighted and visible at tissue interfaces tangential to the path of the XR beam. This is referred to as the "silhouette sign". A simple analogy help you visualize this is to recall the what the silhouette of an object looks like when placed between a candle or light source and a background surface. The edge of the projected "shadow" is the silhouette making the edge between absorbed and transmitted light.





We use the silhouette phenomenon on a CXR to detect the edge between the normal left heart border, and adjacent aerated normal lung which contains air. We also use this to see the normal lung markings, due to difference in XR absorption between the blood within the pulmonary vessels and the adjacent normal lung. In disease, when the alveoli or air spaces in the lung are filled with fluid, blood or pus, we lose the ability of see these edges, allowing us to infer that the air spaces in the lung are not aerated or air filled.





Finally, an appreciation of the geometry of the XR beam passing through you patient allows you to understand how the heart, which you recall lies anteriorly on the front of the chest cavity is less magnified on a PA (posterior anterior) CXR, where the beam passes from back to front of the patient, compared to an AP (anterior posterior) CXR. Because patients have different chest front to back thicknesses, an AP film does not give you a good estimate of the transverse width of the heart, compared with the internal side to side chest diameter. The ratio of the widest side to side width of the heart divided by internal chest diameter (widest at that level) should be less than 50% in patients who do not have cardiomegaly; and is more reliably assessed on PA rather than AP CXRs, since we are not able to appreciate the front to back diameter of patients on CXRs; and cannot correct for this magnification factor when viewing AP CXRs.





We will now focus on the key radiological features of a few major disease categories on the CXR.

These 6 diseases are not only common, but need to be recognised quickly, accurately and confidently by you as future doctors in the EMD, wards and clinics; as you patient may require urgent treatment.

This is also why testing your ability to recognise these diseases on radiological examinations will take place not only in the radiology section of the examination, but radiology images will also be shown to you as part of the work up and assessment of your patients.



see segmented video of e-Lecture



Pneumothorax (mp4)



Pleural Effusion (mp4)



Rib Fractures (mp4)



Pneumonia is described as an area of consolidation, or air space shadowing on a CXR. This appearance may be due to pus (pneumonia), fluid (pulmonary oedema), or blood (for example lung contusion or a pulmonary infarct). A definitive diagnosis is made by correlating the radiological appearance on the CXR with the clinical setting, or clinical findings.

Pneumonia (mp4)


see segmented video of e-Lecture


Lung Mass (mp4)






Cardiac Failure (mp4)



In this second major section of the (e)Lecture, we will review six major diseases and their CXR findings. Please review the description of the key features of each disease, and then a typical CXR of each disease.




Pneumothorax (mp4)
                         
https://www.dropbox.com/s/g7800b1qivoqqrm/Y2pneumothorax.mp4?dl=0








Pleural Effusion (mp4)







Rib Fractures (mp4)







Pneumonia (mp4)







see segmented video of e-Lecture


Lung Mass (mp4)






Cardiac Failure (mp4)








Section 5 : Answers to the pre-test

We conclude this (e)Lecture by revisiting the quiz presented to you at the beginning of this lecture. The answers should be quite obvious to you after this presentation, and are given on the single slide below. Please review the content of this lecture again, focusing on any area you might be unsure about. Please ask any questions you might have now, or post any questions on Entrada immediately after the lecture. I will address these questions both live during the lecture, as well as after the lecture on Entrada.


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Further Reading


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Phase 1 Lecture (2024)

https://medicaleducationelearning.blogspot.com/2024/10/imaging-of-chest-and-lungs-respiratory.html