"Xiao Fang! There you are. After Fang Xian arrived, Professor Zhou shouted Xiao Fang. At the same time, he stood up and looked sideways at Yang Yifeng.

"Let's start first, the level certification of skills, the time is not short, strive to be able to determine the level of basic skills one by one during this National Day holiday, don't make jokes again." After Yang Yifeng saw Fang Xian coming, he also began to do things.

Zhou Cheng looked at Fang Xian and said, "Xiao Fang, skill level certification is not child's play, this is not only the recognition of your ability by the medical association, but also the responsibility entrusted to you." Therefore, it is important not to play tricks or be clever and rush to deal with it. ”

"As a result, there will be irreversible damage in future clinical work!"

Fang Xian naturally nodded: "Professor Zhou, I know the seriousness of the matter, but I can't completely judge it myself, so I'm sending you a message, I hope Professor Zhou, you can help me rehearse it in advance......"

In the skills assessment of the medical association, it can be a show, but in the real clinical work, it is impossible to show again.

Medicine is not allowed to show off skills, only competitions can.

Fang Xian knew the seriousness of the matter, especially after understanding the cruelty of the reality of destroying the disease, Fang Xian now felt more and more that he had to be cautious.

"Then let's start with the MRI reading technique, let's ...... little by little."

After Zhou Cheng finished speaking, he pointed in front of the MRI trainer.

Fang Xian had known about it before, so it was natural for him to come to the skill trainer.

The skill training room on the 33rd floor covers a large area, and the types of skill trainers in it are also extraordinarily rich, and the natural number is quite large, so Professor Yang and Professor Zhou have preset 5 skill trainers in advance, which correspond to different levels of skills, which can avoid the time of resetting the transfer.

Fang Xian seriously recalled the assessment content related to the level 5 of MRI reading.

MRI reading is not a therapeutic skill, but it is only a diagnostic auxiliary skill, but it is quite useful.

From level 1 to level 5, each has a different definition -

In the first stage, it is just an ordinary reading process, and you only need to fill in the key diagnoses correctly.

This one is not difficult, and it is even a little simple. As long as you have a certain amount of in-depth study of MRI reading, you can do it. For doctors who have now reached the level of wishful thinking for MRI reading, it is as simple as eating and drinking.

The first level of MRI reading is actually to read the location of the lesion and roughly qualitatively do it.

For example, what is the damage in what location......

Fang Xian walked back and forth on the panel twice, filled out the diagnosis of all twenty MRI plain films, and finally clicked submit!

The skill trainer is in the background and automatically reviews and scores the answers.

[Overall score: 97 points.] 】

It's not a hundred, there may still be some particularly subtle details that are not particularly comprehensive!

But that's not a problem, it's innocuous diagnoses that can't escape the machine's settings. It's just that in the clinic, it's not very useful.

For example, there is a little synovial fold around the tendon injury, and there is a little bit of undetectable fat thickening next to the bone cyst......

The level assessment of medical skills is to be a good doctor, not an absolute candidate, but the focus cannot be shifted.

The level 1 assessment of MRI reading ended without any waves.

The second stage of the assessment is the level 2 of the MRI reading technique, and the difficulty soars instantly.

Because of the form of assessment, there has been a change.

The level 2 of MRI reading is a test for more accurate positioning and qualitative of lesions!

Through the reading of 50 MRI films, according to the text prompts given, find out the deficiencies and display errors in the MRI.

That is to say, at this stage, the text prompt given is absolutely correct, but the page displayed by the MRI may be wrong in the correspondence with the text, and you must find out, such an assessment system is very conducive to the clinician's work process, more accurate positioning.

Also, don't be misled by reports or other people's diagnoses, and keep your sanity sufficiently.

And as for the first film, it made Fang Xian feel that it was difficult, not the kind of person who could directly give the answer after watching the film during the Level 1 assessment......

The text prompt reads, "Ruptured anterior cruciate ligament in the left knee and ruptured lateral collateral ligament." ”

I looked at the display in the MRI again—

The left and right knees, this is indeed the left knee joint! The positioning of the general direction must not be wrong, this is wrong, this is the problem of attitude, the problem of character.

Then look at the anterior fork ligament, it is indeed ruptured, and the lateral collateral ligament is also ruptured.

At first glance!

Is this all right?

Could it be that the exam process is playing tricks on me? In the assessment of the level 2 MRI reading technique that I encountered, I took a corresponding correct MRI on the first plain film to make me make a mistake on purpose?

Yes, in addition to the corresponding errors, there are also corresponding completely correct assessments, and if you correct them, you will be making something out of nothing!

It stands to reason that there are only one or two out of fifty at most for such a correct correspondence.

One or two is fine.

With a chance of less than four percent, it is impossible to be hit by yourself so directly.

Fang Xian narrowed his eyes and recalled the criteria for the Level 2 skill assessment again-

"Oh!" Fang Xian suddenly realized.

At this stage the text is absolutely correct, then there are some places where the display is different from the text.

Either the MRI shows more than the written diagnosis, or the MRI shows pathological changes that are less similar to the literal diagnosis.

You need to use text to correct the content in the MRI display, and the excess should be cut off, and the insufficient place should be supplemented with a text explanation. It's not just about finding a diagnosis, it's also about finding a diagnosis that corresponds to the text or is redundant or missing.

Fang Xian's ability to read the MRI must not be fake, but it still takes time to slowly grind this film-

He looked at the posterior cruciate ligament, meniscus, medial collateral ligament, and synovial folds inside the knee joint, all of which were absent.

Then look at the muscles, the muscles around the knee joint are perfectly shaped, and there are no signs of fracture or tearing.

Because he may be inexperienced, Fang Xian also looked at the shape of the blood vessels and nerves, all of which were complete and had no defects.

Ahh

Did you really come across an MRI that corresponds correctly to the text?

Oh yes.

TM, this is a low patella!

Yes, the lengthy lesions of this patient show, not traumatic, but naturally structural.

What is natural structure, to put it in layman's terms, is innate, and has nothing to do with trauma.

As we all know, anterior cruciate ligament injuries are definitely violent injuries, and anterior cruciate ligament, medial collateral ligament and medial meniscus injuries are common injuries and are called medial triads.

In this patient, there are abnormal signs such as anterior cruciate ligament rupture and lateral collateral ligament rupture, and the redundant diagnosis has nothing to do with violence......

It's really hard to think that if you don't pay attention, you may step on a pit.

After checking it carefully, Fang Xian typed out the error shown by the MRI: "Low patella." It does not match the text diagnosis, please remove! ”

After writing, Fang Xian, in order to be more cautious, looked at the patient to see if there was a congenital disease such as patellar varus.

After a final look, this point is currently impossible to judge on the MRI, and needs to be determined through physical examination.

Then ignore it!

The assessment of MRI reading is to prepare for becoming a doctor and is a key element in the diagnosis of some diseases, so it is absolutely impossible for you to have the opportunity to pick up the leaks.

Fang Xian came to the second MRI again.

The written diagnosis was: "There was no obvious abnormality in the reading of the right shoulder joint." ”

However, when reading the film, it was indeed shown in front of Fang Xian: patchy abnormal signal shadow was seen under the articular surface of the humerus on the left side, and T2W was a slightly higher signal. There is a fracture line within the humerus.

The long head tendon of the biceps brachii is ruptured, and the effusion is measured. Left shoulder capsule effusion, T1W1 is slightly hyperintense, T2W1 is hyperintense. Supraspinatus tendon sheath and subscapularis tendon signaling were not abnormal. Slightly increased signal in the bordering brachii and biceps brachyceps tendons......

supraspinatus rupture, partial tear of the subscapularis muscle, rotator cuff injury, acromioclavicular joint dislocation......

Even the hand that the MRI showed was wrong.

So, these have to be eliminated.

Although it is only necessary to correspond to the content and text content of the MRI, you must also be able to read the plain film before you can know what is right, what is wrong, where it needs to be repaired, and where it is the correct correspondence.

You can't fake it!

If the text is normal, then you need to find all the anomalies and write a similar correction to correct them.

Fang Xian sniffed, feeling that the setting of these exam questions was simply digging a pit for candidates, sometimes digging a pit is not enough, but more pits have to be dug.

It's just that such strict standards are designed to make doctors less prone to errors when working in the clinic.

Diagnosing errors, what are the consequences?

Fang Xian also encountered it, when he had surgery with Professor Xu Fengnian before, there was a patient who could not be diagnosed with arterial damage and was not prevented in time, but fortunately, Fang Xian's hemostasis at that time could also be directly ordered to level 5, otherwise, it is estimated that the patient would be more than lucky.

"The wrong direction of the affected limb is applied. There are injuries such as the long cast tendon of the biceps brachii, and the possibility of the patient's mismatch with his life and the wrong MRI display cannot be ruled out. The diagnosis should be corrected or eliminated. ”

After filling it out, Fang Xian went back to check it again, and suddenly realized it at that time, and added another sentence: "The MRI shows that there is acromial impingement syndrome and type III acromion, which should be corrected together." ”

It's also a natural structural diagnosis!

However, it was hidden in so many damages, and Fang Xian's current strength was almost ignored.

Ordinary doctors come to test such difficult questions?

Direction silently observed a few minutes of silence for the radiologist.

If suturing is the foundation of hand surgery, then MRI is the absolute head and highlight of the radiologist, and others rely on this skill to eat......

……

When Fang Xian slowly pushed back, although he felt struggling, he was still able to deduce the relatively correct answer after trying all kinds of methods.

The second level of MRI reading is to look at the lesion and locate it accurately.

Basically, the routine is pretty much the same, either the diagnosis is lengthy or the diagnosis is short.

But in the process of advancing the assessment to the 22nd MRI reading, Fang Xian encountered a very tangled case-

The text reads: "Posterior angle injury of the medial meniscus of the left knee." ”

When Fang Xian was reading the film, his symptoms were also exactly: "T-shaped tear in the posterior horn of the medial meniscus of the left knee joint." ”

The reason why this difference makes Fang Xian tangled is that in the professional field of orthopedics, there are various different diagnostic methods.

For example, in a broad range, T-shaped, transverse, and longitudinal tears at the back angle are all included in the scope of the back angle damage.

In this way, it is not easy for Fang Xian to determine whether this tear and injury should be particularly clarified.

However, for the sake of prudence, or to believe more in his professionalism, Fang Xian still wrote a non-corrective suggestion: "T-type injury belongs to the category of injury, but it cannot replace all injuries." ”

"The description is too broad and not rigorous enough. Injuries include, but are not limited to, ruptures, lacerations, edema, etc. Please amend it. ”

The definition of injury is too large, and if it is a tear, it cannot completely replace the injury, but can represent the definition of injury with a non-tearing performance.

The text describes a living being, and then the answer is an image of a person.

People must be living beings, but if the word biology is the standard, then it must not be mutually tolerant, and it is not easy to correct.

In a plain film, there is generally only one category of injury, and not all of them.

This question requires the theoretical knowledge of orthopedics to be able to answer it......

After writing like this, Fang Xian moved on to the next picture.

It was only Fang Xian who flipped it, and the assessment instrument in front of him seemed to vibrate, as if it was reminding him that Fang Xian's answer was wrong.

But Fang Xian didn't pay attention to it.

Wrong is wrong!

The assessment of level 2 skills does not require a complete 100% accuracy rate, and an error of about 5% is allowed, after all, this is a test-taking assessment, if it is too strict, it needs 100% accuracy, which is contrary to the original intention.

Seeing Fang Xian calmly facing the vibration of the instrument, unaffected in the slightest, Zhou Cheng and Professor Yang Yifeng glanced at each other, and they both read the stunned from each other's eyes......

How could Fang Xian not be affected?

But Fang Xian was not affected.

It's just that Fang Xian's reading speed has slowed down a lot.

Another half an hour passed, and Fang Xian arrived in front of the thirty-sixth MRI plain film.

Rubbed his eyes a little harder.

The eyes are indeed a little tired, not just visually tired.

Watching a plain film is no less than seeing a patient and making a diagnosis.

In less than an hour and a half, plus more than 20 MRI plain films for the Level 1 skill assessment, I watched more than 50 films in total, and the workload is indeed not small, and the accuracy must be ensured, not just like watching TV.

"Do you need a break?" Seeing that Fang Xian had a small move, Professor Zhou still asked with concern.

The assessment and certification of level 5 skills is not a simple triviality, nor can it be completed in a short period of time.

Fang Xian shook his head, pursed his lips and smiled, and continued to stare at the skill training instrument-

With the previous experience of taking the exam, Fang Xian finally found an actual correspondence in the thirty-sixth plain film, and there was no normal report and normal image of the pit.

Fang Xian waved his hand and wrote down the correct words.

Then I came to the thirty-seventh MRI image.

However, when Fang Xian arrived, he found that something was wrong.

Because on the text report, the obvious content is: "Left ankle lateral ligament injury, suspected obturator lesion, lumbar disc herniation." ”

This is the absolute standard of writing.

However, on the MRI, the content shown is only at the level of the ankle joint!

Fang Xian slid up and down the various levels of NMR, and finally determined this!

The thirty-seventh plain film, the content of the diagnosis and report, shows that the bull's head is not in the horse's mouth.

Imaging of the ankle joint, the diagnosis is obturator lesion, lumbar disc herniation.

Where is this?

Flipping left and right, Fang Xian found that in this plain film set, there was no MRI plane at the lumbar spine and pelvis.

"Is this topic so simple? Just need to make up the pelvic cavity and lumbar spine MRI? Fang Xian hesitated.

This is the first time Fang Xian has faced such a situation!

Most of the misplaced positions that have occurred before are the wrong left and right feet!

I didn't even make a mistake in the correspondence between the ankle joint and the knee joint, but now, it is directly from the ankle joint to the pelvis, which is a bit big!

According to reason, if it is not a bad pen, it will not make a mistake, such an obvious mistake, do you have to re-make up two MRI images by yourself?

This, Fang Xian didn't dare to be too sure.

Because finding out what is wrong and finding out the defects does not mean that it is a virtual fake, imagining, and then repeating the content of the text.

If you just need to fill it out, please complete the MRI images of the pelvis and lumbar spine!

Then such an assessment is too simple. This doesn't quite match the difficulty of the previous question.

So?

This film is too weird!

Grind it again-

Lateral ankle ligament injury, that's fine.

First positioning, the ankle joint, and the left ankle joint, on the MRI to identify several ligaments on the outside of the ankle joint, this is the basic skill, orthopedic sports medicine doctors and even orthopedic surgeons, can do.

There is no continuous fracture and the anatomy is normal, but there is a more intense signal of edema.

If you look closely, you can see that the fibrous structure with ligaments is broken!

That's right.

But this is the assessment content of the level 3 MRI reading.

Level 2 MRI reading, will not appear beyond the level of content in level 3 reading?

The diagnosis of injury can definitely be given, but at this time, it only represents a slight injury, not a wide range of meaning, including fracture and so on......

So how difficult is this?

Why exactly?

(End of chapter)