Hi, I'm not a doctor, but your tutorial allowed me to go through and understand my friend's Pelvic CT scan and even identify his kidney stones and tumor that the doctor told us he had. Thank you!
Very disturbed: came to see how the radiologist and urologist SHOULD have identified the kidney stone they missed 4 months ago leading me to 4 months of pain and lack of diagnosis, unnecessary tests procedures and referrals. My stone was not visible in the axial view but was very clear in the front/back view. (exactly where I as the patient told them my symptoms were). You also ONLY looked at uretors via axial. So apparently you would also have missed a simple 1-2mm (in the image) of symptomatic kidney stone(s). In the end about 3 small fragments came out 3+ months after symptom onset, end even though I saw them, felt them, looked at them with a magnifying glass, I was not believed because of the CT reading. Only when I insisted on a final meeting with the urologist - me insisting that sones hadn’t been ruled out, and he pulled up the old scan again and looked at the front view did he see OBVIOUS Stone that even I could see.
This video is amazing Can please do like a series of playlists showing how to read various imaging studies? I am a second year Radiology Resident and your videos helped me tremendously If you can, do like a series mainly for on call, and it covers all imaging areas of Radiography, Ultrasound, and CT scan
Great comprehensive video which shows the nuts and bolts of a critical skill to have - reading ER body films - as a resident. I would like to see more body videos with common pathology, for example a triple phase liver ct for hemangioma, renal stone protocol etc.
+neurotik yea those are great ideas. those were things i wish i had wheni was starting, what is triple phase ct, what is pancreatic protocol, what is adrenal protocol, etc.
Fantastic Video Sarel! I'm an R1 and just started my body CT rotation and as i'm sure you know.. Overwhelmed is an understatement. Love the way you break things down in your videos and I look forward to viewing many of them. Call starts pretty early here! 1 month away. Congrats on your success and again thank you for doing this. an amazing resource.
thanks for the comment. yeah i have an idea for a 'how to start rads' type video. the short story is get a good intro book like "core radiology " or "crack the core" and try to split rads up into all the different specialties. also give it time. its a hell of a lot easier for me to learn how to read an ankle MRI now than it was 4 yrs ago. best, sg
Thank you for the effort you put forth in producing this video. I've looked through many, but unfortunately, some narrators have voices/tones that put me to sleep or are simply difficult to sit through. It's nearly 1:00 am here in Guam and I've managed to stay awake and engaged watching your video. Many thanks! Catherine Whitford, CT Technologist
+Catherine Folkman Whitford thank you for your kind comment and please let me know if there is any other way my site can be more helpful. i've tried to make my videos information rich and edit out the non-essential portions
thank you Dr. Sarel Gaur for uploading such amazing videos ..simple to understand for someone like me who is in med school .. inspired by your work ..once again thank you for your time and effort in producing such videos. god bless . n keep up the good work
Hello Dr. sarel! I am a new diagnostic radiology resident... your videos help me a lot please we need videos for brain I get lost reading brain ct & lymph nodal sites in cases like lymphomas.. sometimes I still miss where to look for nodes.. & finally what the first advice you give me to start with, I wanna make the best use of my time& my mind great thanks doctor!
hey i man i hear ya. brain ct and mr is hard. just keep opening up the cases and trying to make findings. it gets easier over time. sit with an attending that you like and ask questions. re. lymph node sites. its still hard to remember. i always pull up radiology assistant for the thoracic lymph node stations: www.radiologyassistant.nl/en/p4646f1278c26f/mediastinum-lymph-node-map.html it gets easier over time. i guarantee in 4 yrs, you will not be as worried. you will actively take on new challenges in radiology best, sg
actually, im in my ssecond year now and im yet to start my clinicals so im sure I'll get to understand it better,..by the way, I loved the lecture,, #thumbs up
Thank you for your informative video. I like the systamatic & practical approach. Will you be able to upload few pathlogical CT abdomen Pelvis views like which are common.
Dr. Guar, Thank You so much for this video. It was absolutely FANTASTIC. I teach advanced Spinal MRI interpretation for Medical Doctors in private practice (for CME credit through University at Buffalo school of Medicine), however I do not have any training in CT and I found this video of yours to be extremely helpful. If My imaging center cannot find the cause of my abdominal pain, would you be willing to read my CT for me? I have UNH, but if you do not take that insurance, I would be happy to pay you cash.
haha yes those are in the works. I also want to update this video. Thanks for watching. If you want to see a guide of how a mediport is placed (IR), watch How to place a chest port catheter (mediport insertion) 2014 HD
Thanks. Can you comment on the hyperdensities around the prostate, and what they represent in this CT. Further, at 5:58, would you say single uncomplicated sigmoid diverticula?
Thanks for your comment. Those punctate hyperdensities just lateral to the prostate and seminal vesicles are phleboliths, calcifications forming in small diameter slow moving pelvic veins. These are very common and benign. The calcification inside the prostate parenchyma itself is a prostatatic calcification, another common and usually benign finding. I disagree with you re. the possible diverticula. Those look like hastrual contractions to me with circumferential narrowing of the colonic lumen. Diverticula are small outpouchings usually seen more proximally in the sigmoid, very common in patients older than 50. These will look like little grape like clusters extending slightly beyond the normal margins of the colon, usually multiple. Please see radiopaedia.org/cases/colonic-diverticulosis
Hi Sarel! great video! tks..what is the name of this tool that you're using to highlight the images ? Is on Osirix or you need to dowloawed from anywhere ? tsk
Thanks a lot for this video. Please do continue to share your knowledge. And I have a question: is there a filling defect in sigmoid colon? I think it looks like an "apple core" sign. Can you share your thought about this? Thanks a lot again and all the best to you.
I think I see what you are referring to, at approx 5:56. If you also look, theres a similar appearing area more distal and also some similar areas in the transverse colon. These areas are almost certainly haustral contractions, areas where the colon is contracting for peristalsis and not an actual lesion. Colon carcinoma is an adenocarcinoma, meaning it begins at the mucosal level. The bowel wall is a laminate of mucosa, submucosa, muscle layers, and the serosa (covering). To fully evaluate for colon cancer, you need to get the mucosa on profile, with good internal distension, so the mucosa is thinned out and you can evaluate for subtle masses. Otherwise, you risk over calling cancers or bowel wall thickening on a standard ct abdomen pelvis scan where the colon is not usually well distended. Think of the difference in thickness of a baloon when and when not fully inflated. The CT colonography is being used in some centers to screen for colon cancer. In this method, they distend the colon with large amounts of air to thin out the mucosa and evaluate for subtle mucosal disease. This technique is more accurate for detecting colon cancers. Colonoscopy, where they can get a high resolution color video image of the mucosa, is a sensitive technique for detection of colon cancer. For patients referred to evaluate for metastatic disease in a setting of known colon cancer, even then it can be difficult to detect the original mass lesion on a standard abdominopelvic ct scan. In short, its good to see those findings and be suspicious. Part of radiology (which I'm learning) is to know the limits and capabilities of the modality and which diseases can be diagnosed confidently and which cannot. In this case, your finding is most compatible with a haustral contraction.
Is this how long it takes you to look at the average CT scan? Or are there cases which take up a lot more time? Don't get me wrong but I am just trying to find an explanation for how they missed my renal calculi twice on the Ultrasound and once on a CT scan in 2004. Thankfully the 3rd time around an ultrasound did pick them up. Afterwards, looking at CT images I located them exactly where the U-sound found them. They were like a sore spot - quite radiolucent, in fact difficult not to see (!) even for someone with very little training like myself. History seems to repeat myself as I have abdominal pain and a palpable mass in the upper abdomen, yet the CT scan was deemed "unremarkable". It took the radiologist less than 8 minutes to go through it. First they lost the CT request, after that they couldn't locate the actual scan. When they found it - it was Friday night and they were in a hurry.... This is how things are done in a Toronto ER BTW. I purchased it and now I have to attend radiology lectures and watch videos like yours if I am to stand a chance of finding what is wrong with me sooner than it kills me....
+TheHallucinati hey wow sorry saw this late. interesting story, i'm glad you were able to find out what was going on. on average 10-15 minutes to look at a scan, can range from 3 min to 1 hr depending on the complexity. unfortunately, all radiologists are human and miss important findings from time to time. i'm glad my video helped you diagnose your own problem. best- sg
Excellent! Thank you. Would you be willing to review a non-contrast exam as comparison, commenting on the limiting factors in specific parenchyma? I view nothing but non-contrast and find I'm spending way too much time attempting to evaluate the abd/pelvis. :-0
Thanks for your comment. I'm working on some more videos including a video on noncontrast CT ab/pel to evaluate for renal colic. In regards to your question, usually solid organs (liver, spleen, pancreas, kidneys, adrenals, and GU organs) are not well evaluated as the parenchyma is not enhanced (increased in density) due to lack of IV iodinated contrast. This makes it difficult to evaluate for focal abnormalities in these organs. Also inflammatory disorders are usually characterized by hyperemia/enhancement and these can be under evaluated without contrast.
hey great question, has to do with the number of 'post IV contrast' phases or scans are performed. I actually made a video about this here: th-cam.com/video/i9pVTMoRecA/w-d-xo.html i've read the books but trust me videos are better - sg
When having a CT Scan done of stomach and pelvis.Can a hiatal hernia be seen? Can they also see the lung,or is only seen for a chest CT?I had scan today.Not completely sure which area of focus,but do know ultrasound of stomach & pelvis was abnormal results and inconclusive.Regular X-ray of pelvic area showed something of concern that started these other test to be done.I guess my question is that one thing is for sure,something has been found,but they just want everything together,before speaking with me?
re. hiatal hernia- yes would be seen on CT abdomen+pelvis. Re. lungs- you always will see the lung bases on a Ct abdomen pelvis because its part of the upper aspect of the abdomen. you can't see the entire lung but you can definitely make some lung findings, just as in my video above. ultrasounds of abdomen and pelvis are helpful but usually somewhat inconclusive depending on what is being sought. Keep in mind a large fraction of what we find are considered "incidental findings" which are findings that are seen and are hard to ignore but are unlikely to cause serious harm. best - sg
My liver was the exact same size on ultrasound. All labs normal. Normal ct. why when i look up normal liver size it says more than 16 cm its “hepatomegaly”
depending on the complexity of the case it can take anywhere from 3 to 30 minutes, sometimes more, and depends on how much work you have to go thru. A private practice radiologist might read 50 CTs / day
Thanks for sharing this knowledge. I"m trying to evaluate my own CT scan but don't have training... so this video is where I'm starting. I was curious if you might be willing to look at mine if I mail you the CD? I'd be willing to pay. Online I only found places that charge a lot of money to offer such a 2nd opinion. But I know if I was a doctor I'd be happy to do this for free, in my free time. :)
Unfortunately, the advertisements and messages begging the viewer to subscribe greatly distracts from the video. Does the doctor really make any money from the advertisements. Even worse, the doctor flips too quickly back and forth through the CT slices. I can flip though my own CT scan. I found that I have a small gallstone that the radiologist missed in his report.
+Kent Rieske aite kent, the msgs are scrapped. why? cuz you wanted it scrapped. as for the ads: nothing free in this world. a skippable ad is a small price to pay for decent content. please seek out my competitors...but i have a feeling you will be back if i'm going too fast, let me know what parts you need focus on and maybe you'll see it in an upcoming vid- SGMD
your explanation is too fast for the average patient. you are the Dr I don't want. talk to the patient, not to another DR. this video is way fast. Thanks for nothing!
Please don’t ever stop making content, you’re an amazing teacher!
Hi, I'm not a doctor, but your tutorial allowed me to go through and understand my friend's Pelvic CT scan and even identify his kidney stones and tumor that the doctor told us he had. Thank you!
thats what its all about. helping you understand what goes down in the trenches. thanks for watching - sg
Very disturbed: came to see how the radiologist and urologist SHOULD have identified the kidney stone they missed 4 months ago leading me to 4 months of pain and lack of diagnosis, unnecessary tests procedures and referrals. My stone was not visible in the axial view but was very clear in the front/back view. (exactly where I as the patient told them my symptoms were). You also ONLY looked at uretors via axial. So apparently you would also have missed a simple 1-2mm (in the image) of symptomatic kidney stone(s). In the end about 3 small fragments came out 3+ months after symptom onset, end even though I saw them, felt them, looked at them with a magnifying glass, I was not believed because of the CT reading. Only when I insisted on a final meeting with the urologist - me insisting that sones hadn’t been ruled out, and he pulled up the old scan again and looked at the front view did he see OBVIOUS Stone that even I could see.
@@GreenMyrtle wow, incredible how incompetent these doctors are. We should read our own CTs as patients. That's gonna go well.
This video is amazing
Can please do like a series of playlists showing how to read various imaging studies?
I am a second year Radiology Resident and your videos helped me tremendously
If you can, do like a series mainly for on call, and it covers all imaging areas of Radiography, Ultrasound, and CT scan
I do really appreciate for the high-quality video. It is really informative.
Great comprehensive video which shows the nuts and bolts of a critical skill to have - reading ER body films - as a resident. I would like to see more body videos with common pathology, for example a triple phase liver ct for hemangioma, renal stone protocol etc.
+neurotik yea those are great ideas. those were things i wish i had wheni was starting, what is triple phase ct, what is pancreatic protocol, what is adrenal protocol, etc.
Legendary teaching, thank you for your time and effort in producing this video
Fantastic Video Sarel! I'm an R1 and just started my body CT rotation and as i'm sure you know.. Overwhelmed is an understatement. Love the way you break things down in your videos and I look forward to viewing many of them. Call starts pretty early here! 1 month away. Congrats on your success and again thank you for doing this. an amazing resource.
thanks for the comment. yeah i have an idea for a 'how to start rads' type video. the short story is get a good intro book like "core radiology " or "crack the core" and try to split rads up into all the different specialties. also give it time. its a hell of a lot easier for me to learn how to read an ankle MRI now than it was 4 yrs ago. best, sg
Thank you for the effort you put forth in producing this video. I've looked through many, but unfortunately, some narrators have voices/tones that put me to sleep or are simply difficult to sit through. It's nearly 1:00 am here in Guam and I've managed to stay awake and engaged watching your video.
Many thanks!
Catherine Whitford, CT Technologist
+Catherine Folkman Whitford thank you for your kind comment and please let me know if there is any other way my site can be more helpful. i've tried to make my videos information rich and edit out the non-essential portions
thank you Dr. Sarel Gaur for uploading such amazing videos ..simple to understand for someone like me who is in med school .. inspired by your work ..once again thank you for your time and effort in producing such videos. god bless . n keep up the good work
thanks for your comment, will do - sg
Hello Dr. sarel!
I am a new diagnostic radiology resident...
your videos help me a lot
please we need videos for brain I get lost reading brain ct
& lymph nodal sites in cases like lymphomas..
sometimes I still miss where to look for nodes..
& finally
what the first advice you give me to start with, I wanna make the best use of my time& my mind
great thanks doctor!
hey i man i hear ya. brain ct and mr is hard. just keep opening up the cases and trying to make findings. it gets easier over time. sit with an attending that you like and ask questions.
re. lymph node sites. its still hard to remember. i always pull up radiology assistant for the thoracic lymph node stations: www.radiologyassistant.nl/en/p4646f1278c26f/mediastinum-lymph-node-map.html
it gets easier over time. i guarantee in 4 yrs, you will not be as worried. you will actively take on new challenges in radiology
best,
sg
Hey what program are you using? I am looking for a program like this for practice
Thank you for sharing, very informative.
actually, im in my ssecond year now and im yet to start my clinicals so im sure I'll get to understand it better,..by the way, I loved the lecture,, #thumbs up
Thank you for your informative video. I like the systamatic & practical approach. Will you be able to upload few pathlogical CT abdomen Pelvis views like which are common.
+Rasanga Peiris Yes its in the plans. Any thing in particular you are interested in?
Dr. Guar,
Thank You so much for this video. It was absolutely FANTASTIC. I teach advanced Spinal MRI interpretation for Medical Doctors in private practice (for CME credit through University at Buffalo school of Medicine), however I do not have any training in CT and I found this video of yours to be extremely helpful. If My imaging center cannot find the cause of my abdominal pain, would you be willing to read my CT for me? I have UNH, but if you do not take that insurance, I would be happy to pay you cash.
Damn you can tell you know this stuff really well thanks man
can i download this program you use in your computer ?
what`s that program you use to see slides like that ?
do you have CT scans of how situs inversus looks like?
Hi! Thank for great tutorial. I want to ask how exactly do you narrow the window for liver and spleen?
Found this very useful. Good review.
I'll put a request in for CT head and Trauma C-spine... =)
haha yes those are in the works. I also want to update this video. Thanks for watching. If you want to see a guide of how a mediport is placed (IR), watch How to place a chest port catheter (mediport insertion) 2014 HD
Thanks. Can you comment on the hyperdensities around the prostate, and what they represent in this CT. Further, at 5:58, would you say single uncomplicated sigmoid diverticula?
Thanks for your comment.
Those punctate hyperdensities just lateral to the prostate and seminal vesicles are phleboliths, calcifications forming in small diameter slow moving pelvic veins. These are very common and benign. The calcification inside the prostate parenchyma itself is a prostatatic calcification, another common and usually benign finding.
I disagree with you re. the possible diverticula. Those look like hastrual contractions to me with circumferential narrowing of the colonic lumen. Diverticula are small outpouchings usually seen more proximally in the sigmoid, very common in patients older than 50. These will look like little grape like clusters extending slightly beyond the normal margins of the colon, usually multiple. Please see radiopaedia.org/cases/colonic-diverticulosis
Hi Sarel! great video! tks..what is the name of this tool that you're using to highlight the images ? Is on Osirix or you need to dowloawed from anywhere ? tsk
I'm using Osirix Mac as a Dicom viewer with camtasia Mac to screen record. The latter is what allows for me to zoom and highlight different areas
Very helpful! Thank you so much.
Thanks a lot for this video. Please do continue to share your knowledge. And I have a question: is there a filling defect in sigmoid colon? I think it looks like an "apple core" sign. Can you share your thought about this?
Thanks a lot again and all the best to you.
I think I see what you are referring to, at approx 5:56. If you also look, theres a similar appearing area more distal and also some similar areas in the transverse colon. These areas are almost certainly haustral contractions, areas where the colon is contracting for peristalsis and not an actual lesion.
Colon carcinoma is an adenocarcinoma, meaning it begins at the mucosal level. The bowel wall is a laminate of mucosa, submucosa, muscle layers, and the serosa (covering). To fully evaluate for colon cancer, you need to get the mucosa on profile, with good internal distension, so the mucosa is thinned out and you can evaluate for subtle masses. Otherwise, you risk over calling cancers or bowel wall thickening on a standard ct abdomen pelvis scan where the colon is not usually well distended. Think of the difference in thickness of a baloon when and when not fully inflated.
The CT colonography is being used in some centers to screen for colon cancer. In this method, they distend the colon with large amounts of air to thin out the mucosa and evaluate for subtle mucosal disease. This technique is more accurate for detecting colon cancers. Colonoscopy, where they can get a high resolution color video image of the mucosa, is a sensitive technique for detection of colon cancer.
For patients referred to evaluate for metastatic disease in a setting of known colon cancer, even then it can be difficult to detect the original mass lesion on a standard abdominopelvic ct scan.
In short, its good to see those findings and be suspicious. Part of radiology (which I'm learning) is to know the limits and capabilities of the modality and which diseases can be diagnosed confidently and which cannot. In this case, your finding is most compatible with a haustral contraction.
Is this how long it takes you to look at the average CT scan? Or are there cases which take up a lot more time?
Don't get me wrong but I am just trying to find an explanation for how they missed my renal calculi twice on the Ultrasound and once on a CT scan in 2004. Thankfully the 3rd time around an ultrasound did pick them up. Afterwards, looking at CT images I located them exactly where the U-sound found them. They were like a sore spot - quite radiolucent, in fact difficult not to see (!) even for someone with very little training like myself.
History seems to repeat myself as I have abdominal pain and a palpable mass in the upper abdomen, yet the CT scan was deemed "unremarkable". It took the radiologist less than 8 minutes to go through it. First they lost the CT request, after that they couldn't locate the actual scan. When they found it - it was Friday night and they were in a hurry.... This is how things are done in a Toronto ER BTW. I purchased it and now I have to attend radiology lectures and watch videos like yours if I am to stand a chance of finding what is wrong with me sooner than it kills me....
+TheHallucinati hey wow sorry saw this late. interesting story, i'm glad you were able to find out what was going on. on average 10-15 minutes to look at a scan, can range from 3 min to 1 hr depending on the complexity. unfortunately, all radiologists are human and miss important findings from time to time. i'm glad my video helped you diagnose your own problem. best- sg
+Sarel Gaur MD cool name as well
Hello
Sir
My mom has stage 4 recurrent cervical cancer..
Please help me..🙏
Excellent! Thank you. Would you be willing to review a non-contrast exam as comparison, commenting on the limiting factors in specific parenchyma? I view nothing but non-contrast and find I'm spending way too much time attempting to evaluate the abd/pelvis. :-0
Thanks for your comment. I'm working on some more videos including a video on noncontrast CT ab/pel to evaluate for renal colic.
In regards to your question, usually solid organs (liver, spleen, pancreas, kidneys, adrenals, and GU organs) are not well evaluated as the parenchyma is not enhanced (increased in density) due to lack of IV iodinated contrast. This makes it difficult to evaluate for focal abnormalities in these organs. Also inflammatory disorders are usually characterized by hyperemia/enhancement and these can be under evaluated without contrast.
hi there , can I send a copy of my ct scan CD to show me where exactly is my stomach cancer?
Dr. Sorry for my question whats the difference betwen triphasic CT and biphasic CT? do you recomend books for this purpose..?? thanks
hey great question, has to do with the number of 'post IV contrast' phases or scans are performed. I actually made a video about this here: th-cam.com/video/i9pVTMoRecA/w-d-xo.html
i've read the books but trust me videos are better - sg
ok ... but the noncontrast adquisition isnt considered as a phase?? thanks!
Thank you!
When having a CT Scan done of stomach and pelvis.Can a hiatal hernia be seen? Can they also see the lung,or is only seen for a chest CT?I had scan today.Not completely sure which area of focus,but do know ultrasound of stomach & pelvis was abnormal results and inconclusive.Regular X-ray of pelvic area showed something of concern that started these other test to be done.I guess my question is that one thing is for sure,something has been found,but they just want everything together,before speaking with me?
re. hiatal hernia- yes would be seen on CT abdomen+pelvis. Re. lungs- you always will see the lung bases on a Ct abdomen pelvis because its part of the upper aspect of the abdomen. you can't see the entire lung but you can definitely make some lung findings, just as in my video above. ultrasounds of abdomen and pelvis are helpful but usually somewhat inconclusive depending on what is being sought. Keep in mind a large fraction of what we find are considered "incidental findings" which are findings that are seen and are hard to ignore but are unlikely to cause serious harm. best - sg
dear sir thats great only request is to be a bit louder and repost please otherwisw very helpful
thanks for your comment. I will try to repost a louder version soon
My liver was the exact same size on ultrasound. All labs normal. Normal ct. why when i look up normal liver size it says more than 16 cm its “hepatomegaly”
awesome dada............ \m/
Does it really only take about 15 min. To go through all this reading?
depending on the complexity of the case it can take anywhere from 3 to 30 minutes, sometimes more, and depends on how much work you have to go thru. A private practice radiologist might read 50 CTs / day
where is the stomach?
Thanks for sharing this knowledge. I"m trying to evaluate my own CT scan but don't have training... so this video is where I'm starting. I was curious if you might be willing to look at mine if I mail you the CD? I'd be willing to pay. Online I only found places that charge a lot of money to offer such a 2nd opinion. But I know if I was a doctor I'd be happy to do this for free, in my free time. :)
thanks a ton
Pay him!!!
Unfortunately, the advertisements and messages begging the viewer to subscribe greatly distracts from the video. Does the doctor really make any money from the advertisements. Even worse, the doctor flips too quickly back and forth through the CT slices. I can flip though my own CT scan. I found that I have a small gallstone that the radiologist missed in his report.
+Kent Rieske
aite kent, the msgs are scrapped. why? cuz you wanted it scrapped.
as for the ads: nothing free in this world. a skippable ad is a small price to pay for decent content. please seek out my competitors...but i have a feeling you will be back
if i'm going too fast, let me know what parts you need focus on and maybe you'll see it in an upcoming vid- SGMD
+Sarel Gaur MD I had advertisements on some of my videos that never paid a penny, so I canceled them all.
keep at it. for me its not about the money but seeing the dollar value of my content so i can grow it
struggling a bit to understand, ,,
hey any specifics. its meant to be for a early yr resident level
your explanation is too fast for the average patient. you are the Dr I don't want. talk to the patient, not to another DR. this video is way fast. Thanks for nothing!
He gave a disclaimer that this shouldn't be used for medical use.