Paediatric Radiology Rapid Reporting for FRCR Part 2B Michael Paddock Amaka C. Offiah 123 Paediatric Radiology Rapid Reporting for FRCR Part 2B Michael Paddock • Amaka C. Offiah Paediatric Radiology Rapid Reporting for FRCR Part 2B Michael Paddock Amaka C. Offiah Sheffield Teaching Hospitals Academic Unit of Child Health Sheffield Department of Oncology and Metabolism UK University of Sheffield Sheffield UK ISBN 978-3-030-01964-8 ISBN 978-3-030-01965-5 (eBook) https://doi.org/10.1007/978-3-030-01965-5 Library of Congress Control Number: 2018967447 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To Vaughan—for your unwavering faith, support and unconditional love MP To my husband and children—you know why ACO Foreword I was delighted to be asked to prepare a foreword for this book written by my colleagues, Dr M Paddock and Dr AC Offiah. As the Training Programme Director for South Yorkshire, it is wonderful to see an enthusiastic radiology trainee produc- ing high-quality teaching material, supported by an established consultant expert in their field of interest. Passing down knowledge continues the important cycle of learning and teaching with benefit to future generations of radiologists. Reading this book is a must for any specialist trainee in radiology preparing for the final FRCR examination. Paediatric radiology is often an area that is neglected during revision when the RCR curriculum requires a very wide breadth of knowl- edge. Many trainees have limited exposure to paediatric radiology during their training, and there may have been an interval between a paediatric attachment and preparing for the FRCR 2B examination. Paediatric imaging does however form part of all FRCR examinations, and you will be assessed in this area. I have been an examiner at the Royal College of Radiologists for many years and there is a recog- nised reduced performance in questions related to paediatric imaging. This book consists of cases set out in the style of the FRCR 2B Rapid Reporting examination. The high-quality images and attached notes are beautifully presented in a format that is easy to read. Your knowledge will be enhanced with what I think you will find to be an enjoyable learning experience. The carefully selected cases are either commonly seen in daily practice or are important to be aware of. This book will help you prepare for all components of the FRCR 2B examination (not just the Rapid Reporting element) and your future career as an independent practitioner. Happy reading and good luck! Ruth Batty The Royal Hallamshire Hospital/Sheffield Children’s Hospital Sheffield, UK vii Preface Firstly, congratulations on passing the FRCR Part 2A—well done! Now to the FRCR 2B examination where the fun can really begin… All three components of the 2B examination may contain a significant proportion of paediatric imaging. Candidates ‘struggle with interpretation of paediatric imaging—even for common paediatric pathologies’ as identified in the Royal College of Radiologists Examiners’ report. Better preparation in this component will also help you when faced with paediatric cases in the long case reporting and viva sections, and you will definitely get some! The amount of paediatric radiology training up and down the country is variable, and some candidates may not feel adequately prepared to tackle paediatric imaging in the Rapid Reporting section of the examination. The reality is that the majority of radiologists will go on to work in District General Hospitals (DGHs) where paedi- atric imaging can feature prominently in the day-to-day workload of the depart- ment. Most children will initially present to and be imaged in DGHs, given that most do not live next to a dedicated paediatric tertiary centre. The examiners need to make sure that you are a safe radiologist and that you are able to provide a sound radiological opinion which may contribute to effective patient management and care. This is what the 2B examination is assessing—your ability to use your knowledge and skills effectively and your preparedness to prac- tise radiology safely as an independent practitioner. We felt that there was a lack of dedicated paediatric radiology revision resources for the 2B examination, and we wrote this book to address that need. All radio- graphs are from standard day-to-day practice and have been collected over a 3-year period by one of the authors: the images range from the obvious buckle fracture to the subtle metaphyseal fracture (specific to physical child abuse) which is easily missed. Following the answer key for each test, we have expanded on certain abnormal findings or normal variants to further enhance your learning. We have purposefully not used arrows or line diagrams to show you where or what the abnormality is— abnormal radiographs do not come with this in the examination or in real life. As clinical radiologists, we have described the abnormality, and where subtle, it has been magnified as you would do in the examination and in clinical practice. Being a text comprising of paediatric radiographs, the image quality is dependent on the limited dose used to acquire the images. Thus, the quality of some of the magnified ix x Preface images in the explanations may be degraded but still remain adequate to sufficiently demonstrate the pathology. Where relevant, we have included tips for the viva examination. The references also include excellent pictorial reviews and links to educational websites so that you can get the most out of your revision. We emphasise that the best practice for the Rapid Reporting section of the exam- ination is to report paediatric radiographs and get them checked by your local pae- diatric radiologists. This book can be used to supplement your learning during normal working hours. We are extremely grateful to Dr. Jonathan M. Smith and Dr. Robin Dale, spe- cialty trainees on the Sheffield radiology training scheme, for their insight and feed- back throughout the preparation of this book. Finally, we wish you the best of luck in all components of the examination and your future careers. We hope that you will use this book as a future reference text, even after the examination. We welcome any comments, suggestions or feedback, and if you have any queries, please email us on [email protected]. Good luck! Sheffield, UK Michael Paddock Amaka C. Offiah Testimonies I used this book in the run up to sitting the Final FRCR Part B examination in autumn 2018 and I believe it played an important role in obtaining a high score in the Rapid Reporting element. Most practice exam sets include a few paediatric radiographs, but no other resource on the market provides a concentrated bank of paediatric radiographs with which you can hone your skills. This makes it particu- larly useful for candidates like me, who had completed their paediatric rotation a long time before sitting the exam, or for those candidates who are not very confident in paediatric reporting. The explanations are thorough and provide some useful tips for the viva component of the exam, also. Dr. Jonathan M. Smith Unlike the online rapids packets I used, this book offers explanations which are really helpful for confidently identifying abnormalities and discounting normal find- ings unique to paediatric radiology. The discussions are also great for viva prepara- tion. It definitely helped me to pass the FRCR 2B examination. Dr. Robin Dale xi Contents 1 Test 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 1.3 Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 2 Test 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 2.1 Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 2.2 Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 2.3 Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 3 Test 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 3.1 Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 3.2 Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 3.3 Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 4 Test 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 4.1 Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 4.2 Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 4.3 Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 5 Test 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 5.1 Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 5.2 Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 5.3 Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 6 Test 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 6.1 Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 6.2 Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 6.3 Explanations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 xiii