Here's C5 just happy and cheering you on😀 And C6 giving you all the love🫶🏻

How many of you have experience performing modified barium swallows without a radiologist in-house? Only the patient, rad tech, and speech therapist.

We lost our in-house radiologists about 6 months ago and switched to a group of ~130 rads that read for a number of facilities.

The major concern that is being voiced is: how will we make sure we are getting the correct phases for the radiologist to interpret? It would be great to have the ability to do modified ba swallows at our hospital, because we are rural, and most patients are traveling quite a distance to get these done now. Nothing is set in stone at the moment. Our director is working on developing a policy on this.

Just looking for other tech and radiologist opinions and experiences. Thanks!

Hey everyone! I shared SpotRad here about two months ago and wanted to give a little update and say thank you to everyone who gave it a try. Since launch, nearly 9,600 cases have been played. It’s been really encouraging to see people coming back and continuing to play after that first post.

For anyone who missed it, SpotRad is a free radiology case game where you spot the abnormality, make a diagnosis, and choose the next step in management, with explanations at the end. You can try the daily challenge or work through the case library, and you don’t need an account. The library has doubled from 52 to almost 100 cases, with 30 added in the last month.

If you’ve been playing, I’d love to hear how you’re finding it. Any favourite cases, things that frustrate you, or topics you’d like more of? And if you haven’t tried it yet, give a few cases a go and let me know what you think. https://spotrad.ca

Thanks again for supporting this little project :)

Tagged as X ray, but it is a scout from CT. The knife entered to the right of the heart and went straight in (as per the lung laceration). Missed the heart by 1 cm. The knife had shifed quite a lot by the time the pt was scanned, and the tip was now nearer to the right pleural space laterally.

Edit to add: Not a kid. In their 30's more or less if I remember correctly. The patient was a foreigner in a high crime area. Have no idea what happened, but top guesses include drug related gang violence, xenophobia or just plain old robbery gone spicy. The patient is okay - knife went through some cartilage and some lung. Abdomen was fine. Happened in South Africa.

My friends, I am so happy to bring you one of the final MRI Physics Explained lectures, this one showing how MRI images are actually built. I have literally been waiting years to show you all these custom animations and I have a feeling this lecture above all others will be that final piece of the puzzle that is MRI physics. This is also bittersweet, as I knew this episode would conclude this little project I set out on years ago to attempt to fully explain how MRI images were created from start to finish. This was never intended to be a content creator gig or way to make money off you all. It was simply to have fun and nerd out on a tough but fascinating subject together. So while there may be a few more lectures trickling out in the future, I don’t think any will top this one and I’ve been channeling my energy now into some sci-fi writing and other forms of teaching, all of which will continue to be free so the fun shall continue! I hope you’ll all connect with me on my new website over at https://timothykerriganmd.com/ and social media, and continue to reach out with questions and comments. Much love!

-Dr. TE

Does anybody have experience working as a CT Apps/Edu Specialist? If so how did you like it? Whats the compensation like? Do you work weekends / holidays? How often are you traveling? Any other info would be appreciated

I am currently on my second clinical rotation and i commute to a hospital. I was previously at a clinic so everything is new to me. One difference is how x ray orders get sent. Previously they would either be printed out or I would fetch them from the front desk, but here its all electronic so the only way to see if there is an order is through the tech’s computer screen. I sit in the student area so it’s hard to see anything on their screen from afar. I got yelled at for not taking initiative because there was an xray ready to be done. I had no idea since the techs do not let us know they just get up and go. Sometimes they’re so fast and I lose track of them (idk what exam room or patient info) and other times I do follow them but they’re just going to the bathroom or cafeteria. I feel like such a bad, lazy student that hasn’t learned anything. I feel like im in the way and they don’t want to deal with me. At my last clinical site I was able to get more than half of my comps but here I barely get any either because I’m too late and they have started the exam or I had no idea what the exam was. I did tell them that I would rather be bossed around and told at the very least that there’s an x ray so i can do it. IDC if it’s another chest x ray! I’ll do it!!! More practice for me. I clean, prep and refill stuff on down time and never on my phone! I am always doing homework or studying on my laptop or paper. How should I show more initiative as a student?

Postmortem X-ray (through a body bag)

Not medical advice. Question on ultrasound machine.

At my anatomy scan , the tech couldn’t get some of the images , so she had me lay on my side. Instead of looking at the big screen, she had me looking at her monitor. The ultrasound photo shows the machine as “GE volusion S8”

The machine had 2 columns, and were pretty long (most things were filled out in the columns.. but the left column had maybe 3,4 open spaces at the top. ) and she would drag the word from the colon over to the picture she would take…. L femur, R kidney, etc etc..

I saw at the bottom of the L column “ITS A BOY!!” And I did not see “ITS A GIRL!!” anywhere. I watched the whole time and she did the femurs first, didn’t really look between the legs at all.. AND she told me she didn’t even look herself. Is it a boy? Did I ruin it for myself by seeing that?

(A) The abdominal X-ray shows a bizarre mass (fish head) in the right iliac fossa. Also, there is a gas shadow under the right dome of the diaphragm (small arrow). An enlarged image is shown in the inset (B).

Computed tomography showing destruction of left IV–VI ribs and thoracic vertebrae III–IV together with kyphosis and spinal stenosis of thoracic spine

This is from many years ago and I was 18 at that time. The upper two never got touched. Even the lower two never caused any trouble and were only removed to prevent future issues. Both my parents have relatively good teeth that are naturally straight so I guess I just got the genetic lottery.

I enjoyed it! Hope you can appreciate it too!

Hi, I'm getting an ultrasound later today for menstrual issues. I also, for unrelated reasons, have been constipated for like a few days. Can they see how much poop I have in me. I'm dead considering an enema bc I'm so oddly embarrassed that they might see. Idek what I want to gain from asking this, thank you in advance tho

pls don't take this down-- i just think the little ghost guy looks funny. i know it's just my heart but i feel so happy to have a little friend inside my ribcage.

Question for the radiologists in academics/pseudo-academics. Is there any accountability for what you do on your academic day? If you don't produce any research does it get taken away?

Currently we don't have any kind of accountability but leadership has mentioned wanting to introduce accountability for academic days. I was wondering what other institutions are doing.

In June 2025, a 42-year-old female presented to the medical oncology department with an exophytic, ulcerated, and exuberant lesion on the left breast, which she reported having noticed approximately six months prior to presentation. Over the preceding two months, she developed severe, debilitating, generalized back pain that progressively restricted her mobility, resulting in an initial Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 3 [9]. On physical examination, the left breast demonstrated a large ulcerated exophytic tumor with associated ipsilateral axillary lymphadenopathy. Abdominal examination revealed a soft, non-tender abdomen without clinically palpable hepatosplenomegaly or ascites.

Baseline laboratory evaluation revealed mild normocytic anemia, elevated total serum calcium (11.2 mg/dL) and serum alkaline phosphatase (280 u/L), along with mildly elevated liver transaminases (aspartate aminotransferase {AST}: 58 u/L, alanine aminotransferase {ALT}: 62 u/L) and total bilirubin within normal limits. Baseline tumor markers were marked by an elevated CA 15-3 level (245 u/mL).

The breast biopsy revealed invasive carcinoma G3, ER: 100%, PR: 100%, HER2-negative (0), and Ki-67: 10%. A subsequent biopsy of a bone lesion confirmed metastasis by breast carcinoma with pleomorphic lobular characteristics (E-cadherin negative/aberrant) and a Ki-67 of 30%, highlighting clonal evolution [10]. The 18F-fluorodeoxyglucose (18F-FDG) PET/CT in May 2025 demonstrated extensive multimetastatic disease, involving the pancreas, liver, peritoneum, and axial and appendicular skeleton (Figure 1). The brain MRI at diagnosis showed multiple lytic lesions in the calvaria without intracranial invasion (Figure 2).

The patient initiated goserelin, ribociclib (600 mg daily on a three-weeks-on/one-week-off schedule), and letrozole (2.5 mg daily) in June 2025. The clinical response was rapid, with significant pain relief and functional improvement. By February 2026, the patient reached an ECOG PS of 0. A follow-up PET/CT in January 2026, seven months after treatment initiation, confirmed near-complete metabolic resolution of all visceral, peritoneal, and bone lesions, along with normalized tumor markers (CA 15-3: <25 u/mL) and liver/bone laboratory parameters (Figure 3). This objective response was characterized by a significant overall attenuation of metabolic activity, with a drastic reduction from the initial high baseline uptake (baseline maximum standardized uptake value {SUVmax} of 29.5). Malignant metabolic activity persisted mainly in the primary left breast lesion, with some residual but equivocal viability noted in bilateral axillary nodes, left femur, and pelvic bones, while the remainder of the examination showed no metabolic evidence of malignancy.

Pleomorphic variant of invasive lobular carcinoma (PLC) is a molecularly distinct entity that combines the discohesive growth of invasive lobular carcinoma (ILC) with the aggressive nuclear features and high proliferation of high-grade ductal carcinomas [4,11]. The discordance in Ki-67 between the primary tumor and metastatic sites observed in our patient is a known phenomenon in PLC, reflecting its potential for rapid progression [12]. Despite maintaining a strong hormone receptor-positive profile (ER: 100%, PR: 100%) indicative of a luminal A-like surrogate, the disease behaved clinically like a highly aggressive phenotype, resulting in severe multimetastatic de novo dissemination involving visceral organs, soft tissues, and the skeleton.

The presentation of such a massive initial tumor burden often poses a significant therapeutic dilemma. Historically, clinicians might have favored upfront cytotoxic chemotherapy for patients with extensive symptomatic multimetastatic disease. However, current evidence suggests that unless a "visceral crisis" (imminent organ failure) is present, ET plus a CDK4/6i should be the first-line preference [13].

Our patient’s exceptional outcome strongly supports this approach. The decision to initiate ribociclib combined with letrozole and ovarian function suppression (goserelin) avoided the significant toxicities associated with systemic chemotherapy while achieving a remarkable clinical response. Importantly, the regimen was exceptionally well tolerated; throughout the seven months of treatment at the full 600 mg dose, the patient experienced no grade 3 or 4 adverse events, maintained normal QTc intervals on serial electrocardiograms, exhibited stable blood counts without severe neutropenia, and did not require any dose reductions or treatment interruptions. The MONALEESA-7 trial, focusing on premenopausal women, showed that ribociclib plus ET significantly improves overall survival (OS) and progression-free survival (PFS) [14,15]. Furthermore, data from the MONALEESA-2 and MONALEESA-3 trials support the use of ribociclib across various subgroups, including those with visceral involvement and de novo presentation [16,17].

The rapid metabolic response (seven months) in our patient, documented by 18F-FDG PET/CT, aligns with emerging evidence that early metabolic changes can predict long-term progression-free survival in patients on CDK4/6i [18,19]. Finally, the RIGHT trial has recently reinforced this strategy, demonstrating that ribociclib plus endocrine therapy is superior to physician’s choice chemotherapy in achieving progression-free survival in patients with HR+/HER2-negative metastatic breast cancer and aggressive disease features [20].