I have to admit though, I am pleasantly surprised. It's amazing how much more enjoyable radiology can be when you're taught how to actually read them and how to notice any abnormalities. Now, that's not to say that I'm a master at reading radiographs after a month of classes, definitely not. I still have my fair share of radiographs where I can stare at them for half an hour, my professor is telling me "This is a perfect example of this disease" and I'm not seeing it. It's just not happening. It's not there. Sometimes I wonder if staring at radiographs for too long can make you start hallucinating and seeing fuzzy shapes and blurry marginations that aren't actually there.
But then there are things I can see, even if it did take me a while, and I am so happy that I'm finally understanding SOMETHING that I'm really not to worried about the rest right now. A month into classes and I can pretty reliably find the cranial and caudal arteries and veins on every radiograph (barring those with an alveolar pattern where it is so opaque you can't see any vessels at all), I can see bronchi, I can evaluate the trachea and heart for any abnormalities, and I can evaluate different lung patterns. Coming off of anatomy where all I could do was look at bones and it took me forever to try and determine abdominal organs within a haze of white, I think I'm doing pretty good.
Now, can I tell you what all of those morphologic changes actually means? Not yet. But after Friday I will, because I have to learn it all by then. But one step at a time. And the more difficult part is sometimes all you can see is an enlarged vein, and that might be your only clue of venous congestion. And in some diseases only the arteries are enlarged, in some it's only the veins, and in some it's both. I'm confident that those are logical changes occurring from the disease process so I'm not as worried about learning that, I'm just happy I can see what an enlarged or small vessels looks like now, since before I couldn't tell and all I had to go off of was "the vessels should not be larger than the minimum diameter of the 4th rib." Because that was really helpful when I couldn't even see the vessels.
Here are two radiographs from a normal thorax. The heart and diaphragm are obvious in white, and all the black is lungs. In radiographs, "we see what we see in the chest because of air in the lungs", which provides enough contrast to be able to see vessels and masses. So in this image, all the black between the hear and ribs is lung field, and those white squiggly lines are different vessels. The issue comes when you have some kind of pulmonary disease that causes there to be less air in the lungs, because then you lose your contrast and the vessels can't be seen as well. That's one of the areas I'm still working on.
In this lateral view, the trachea is the slightly thick black line coming down over the heart. A more opaque (whiter) thick line can be seen crossing the trachea from the top of the heart, which is the descending aorta. The shadow, known as summation, caused by the overlapping trachea and aorta can tell you if those two structures are in the correct position. The thicker white line leaving from the back of the heart and heading to the diaphragm is the caudal vena cava. I can also see the cranial lob artery and vein in the cranial portion of the heart. The artery and vein are white and parallel, and the cranial bronchi is the blacker line between them. And this heart shape is pretty good. To look for disease in this view, you would look for increased sternal contact or how it meets the diaphragm.
Overall, I'm surprised at how much I'm actually enjoying learning how to read radiographs, but I guess things are always more enjoyable when you actually know what you're doing. And now that I've got reading the normal radiographs down pretty well, it's time to work on the ones I'll actually be seeing in my career. The non-normal, messed up ones.
