Internet Resources for Education in Radiology
Article Outline
The Internet has changed the practice of medicine in many ways, from enabling telemedicine to making the scientific literature easily accessible and searchable. Medical education also has changed and benefited a great deal from the Internet. Lectures, tutorials, and other educational materials readily available online to medical students, residents, and other physicians have increased the opportunities for self-study. Radiology, more than any other medical specialty, is extremely well suited to Web-based study. Just as a surgeon gains experience from performing surgery and an internist gains experience from caring for patients, a radiologist gains experience from examining many radiologic images. Although it is less helpful for teaching image-guided therapies, the Web lends itself to self-study of visual materials and provides an easily accessible resource for gaining experience in radiologic interpretation.
Sifting through the numerous radiologic Web sites for useful teaching tools, however, may require more time than a student or resident can spend. Many sites must be explored to find useful teaching material, because the quality of online educational resources is uneven. A student or resident interested in radiologic self-study may be deterred by these obstacles. We therefore have identified and reviewed a number of Web sites offering useful materials, listing them in three categories: those offering teaching files (Table 1), those offering tutorials (Table 2), and those sponsored by radiologic organizations offering a variety of educational resources (Table 3). Our purpose is to provide an easily accessible and understandable reference for residents and medical students who wish to explore Web-based self-study in radiology. The information outlined here should allow students to spend more time learning rather than surfing the Internet.
Table 1. World Wide Web Sites for Teaching Files
| Site Address | Comments |
|---|---|
| radquiz.com | Portal for radiology teaching resources; organ system–based, with many cases for each system from different Web sites; includes normal images to delineate anatomy and many teaching files; about 10–20 unknown cases per organ system, mostly from AJR: American Journal of Roentgenology; appropriate for medical students and residents; review materials for board examinations available for each organ system; teaching areas for radiologic physics and technology; link to the ACR teaching files, which require registration; quiz section with answers provided below the questions (user does not fill in); several long audio lectures playable through RealPlayer, appropriate for both medical students and residents |
| auntminnie.com/index.asp?sec=edu&d=1 | Commercial site; extensive teaching files organized by organ system; all cases as unknown diagnoses; teaching files searchable by ACR code, modality, and/or diagnosis; case of the day (archived) with questions and extensive discussion, board examination–style review questions (multiple choice), cases with radiologic-pathologic correlations; log-on necessary, but access is free |
| anatomiel.med.uni-erlangen.de/Ecomparetitlepage.htm | German site; well-organized teaching cases for plain radiography (thorax and abdomen), CT (brain, thorax, abdomen, pelvis), angiography, and contrast-enhanced studies; cases displayed as unknown diagnoses; no way to search for specific diagnosis; findings, diagnosis, and discussion can be viewed separately, with side-by-side comparison of normal and pathologic cases; normal anatomy and basic introduction provided for each section; quiz section with many unknown cases; diagnosis obtained by clicking a link |
| brighamrad.harvard.edu/education/online/tcd/tcd.html | Teaching file site sponsored by Brigham and Women's Hospital; well organized, with search options by anatomic area (multiple subdivisions), imaging modality, and/or key word; approximately 180 cases, which may be browsed as known or unknown diagnoses; resident level |
| rad.uab.edu:591/tf | Site for the University of Alabama at Birmingham; organized by body system and specialty; extensive files with good search options; cases can be searched by key word and viewed as known or unknown diagnoses; 452 GI, 204 genitourinary, 77 vascular, 50 US, 39 trauma, 32 chest, 18 neurologic, 16 head and neck, 9 nuclear medicine, 8 musculoskeletal, and 8 pediatric cases |
| rad.washington.edu/teachingfiles.html | Teaching files for the University of Washington; primarily musculoskeletal cases, also some mammography; online textbook, anatomy modules for musculoskeletal radiography; excellent mammography link with about 60 cases, mostly resident level; good information, well presented; cases can be viewed as known or unknown diagnoses; online teaching files: 46 musculoskeletal, 2 breast, 9 chest, 1 GI |
| eurorad.org | European Association of Radiology site with organ system–based teaching files; cases include breast, cardiac, chest, GI, genitourinary (male and female), head and neck, abdomen, interventional, musculoskeletal, neurologic, pediatric, uroradiologic, and vascular; access from pull-down menu; 758 total cases, mostly resident level; clinical history, images, discussion, diagnosis, references; search engine available; selected cases; no unknown diagnoses; choose from diagnoses |
| uchsc.edu/sm/neuroimaging/tflist.htm | University of Colorado neuroradiology site; 102 cases; brain, spine, and head and neck; mostly resident level; cases can be viewed as known or unknown diagnoses; good organization, but image files cannot be opened on separate screen |
| radiology.co.uk/srs-x/cases.htm | Scottish Radiological Society educational resource page; 96 resident-level cases organized by body system; cases can be viewed as unknown or known diagnoses with clinical history and images; tutorials (medical student level) are available on lobar collapse and head CT in trauma |
| ej.rsna.org/ej2/0071-98.fin/database.html | Study done by authors at UCLA Department of Radiology to organize teaching files found at the RSNA Launch Pad and various search engines; Web sites organized by total number of cases, cases per section of the oral board examinations, depth of discussion, whether cases were presented as known or unknown diagnoses, image size and type, and availability of continuing medical education credit; Web sites are well organized, but the listing has not been updated, and many links no longer work |
| sbu.ac.uk/~dirt/museum/im0.html | Educational radiology Web site of Central Middlesex Hospital (London); 324 cases organized by pathology or anatomy as known diagnoses, and by body system as unknown diagnoses; clinical information and discussion of each case with images; resident level; basic radiology introduction for medical students (introductory texts, reading a chest radiograph, technical aspects of radiology); images are of average or low quality |
| uhrad.com | Case Western Reserve University site; teaching files organized by specialty and body system: body, pediatric, women's imaging, neurologic, musculoskeletal, nuclear medicine, positron emission tomography, interventional; >200 cases; good-quality images; cases cannot be viewed as unknown diagnoses; diagnosis is given with image, along with discussion and references; mostly resident level |
| radiologyeducation.com | Digital library of radiology education resources; comprehensive portal to educational sites for all areas of radiology; no site-specific content; radiology textbooks, anatomy and embryology textbooks, radiology teaching files, radiology journals, continuing education, 3 basic sites for medical students |
| rad.usuhs.mil/synapse/radpix.html | MedPix medical image database and teaching files; searchable by body system; many cases, ranging from 12 for breast to 283 for GI; can be searched as unknown or known diagnoses and according to several categories; link to ACR teaching files; registration required to use all features, but good access without registration; case organization and display of images not easy to follow |
| kstr.radiology.or.kr/chest/weekly_case.htm | Korean Society of Thoracic Radiology site; weekly chest cases and archived cases (>230 total); cases can be searched as unknown diagnoses or according to disease categories; language pack must be installed to decipher Korean |
| harbor-ucla-radiology.org/TeachingFile.htm | Teaching file site for Harbor-UCLA Medical Center; organized by organ system and specialty; cases can be viewed as known or unknown diagnoses; only 25 cases (8 musculoskeletal, 5 neurologic, 4 pediatric, 4 chest, 1 each for US, genitourinary, GI, nuclear medicine); cases given with history, images, and brief discussion |
| octet.com/~mikety/unknowns.html | Private Web site for radiology education set up by Michael Tobin; not updated in several years; 14 chest, 18 bone, 6 GI cases, mostly at medical student level; can be viewed as unknown or known diagnoses; diagnosis and pertinent findings included |
| radweb.med-rz.uni-sb.de/static/en/index.htm | Virtual Radiological Case Collection; German site; 266 cases sorted and searchable by ACR code; cannot be viewed as unknown diagnoses; no discussion of cases, diagnosis, or associated findings |
| stpaulshosp.bc.ca/stpaulsstuff/NeatcasesbyText.html | Teaching file for St Paul's Hospital, Vancouver, British Columbia; 90 teaching files; cases interesting but not organized; cases cannot be viewed as unknown diagnoses; short discussions |
| radiologyweb.com | Commercial site, requires log-on; 28 teaching files searchable by ACR code; cases can be viewed as unknown diagnoses, but the ACR code is always visible; viewers can submit answers for case of the month; board review questions for residents |
| ibiblio.org/jksmith/UNC-Radiology-Webserver/UNCRadTeachingFile.html | University of North Carolina teaching files; cases organized by diagnosis, cannot be viewed as unknown diagnoses; clinical history, images, and discussion provided; images are of medium quality and are organized by specialty: chest (n = 7), cardiovascular or interventional (n = 3), GI (n = 22), genitourinary (n = 10), mammography (n = 9), musculoskeletal (n = 6), neurologic (n = 13), nuclear medicine (n = 9), pediatrics (n = 7), US (n = 13); links to other Web sites |
| uab.edu/pedradpath/index.html | Site for Children's Hospital of University of Alabama at Birmingham; 36 teaching files for pediatric radiology with pathologic correlation, including 14 on the central nervous system and head and neck, 12 GI or genitourinary, 6 musculoskeletal, and 4 chest; not searchable; cases may be viewed as known or unknown diagnoses, but even for unknowns, findings and diagnosis are given with clinical history and images; images not high quality |
| medicine.creighton.edu/radiology/caseofthemonth.htmlmedicine.creighton.edu/radiology/index.html | Case of the month from Creighton University; only 14 cases, 10 in pediatric radiology; site has not been updated; cases are presented as unknown diagnoses and are very easy to navigate and learn from; access to textbook-style information on basic radiology, practice questions, and advice for board examinations |
| med.wayne.edu/diagRadiology/TF/TeachingFile.html | Wayne State University teaching files; organized by organ system; cases chosen by diagnosis, no unknowns; 8 chest, 18 neurologic, 2 cardiovascular, 9 GI, 6 genitourinary, 12 musculoskeletal; each organ system has a section showing normal radiographic anatomy; cases and teaching are at the medical student and beginning resident level; slow server |
| rad.upenn.edu/resmac/weekcase/Archive.html | University of Pennsylvania site for residents' case of the month; organized by organ system; 76 cases, mostly GI and musculoskeletal; not updated since July 2001; cases not presented as unknown diagnoses; diagnoses given with images |
| rad.kumc.edu/nucmed/ | University of Kansas nuclear medicine site; 30 nuclear medicine and 20 positron emission tomography cases; resident level; acceptable images; cases presented as known diagnoses |
| radiology.ucsf.edu/academics/learning_ctr/rlccase.htm | University of California, San Francisco, sample radiology cases; 14 cases of abdominal radiology to introduce the use of imaging techniques for specific diagnoses; medical student level; multiple images, stepwise approach |
| ultrasound.ucsf.edu/USCases.html | Teaching files include 4 obstetric, 2 gynecologic, 2 renal, 1 pediatric, 1 penile, and 1 scrotal US; cases presented as unknown diagnoses with brief clinical history and moderate-quality images |
| uams.edu/radiology | University of Arkansas case of the month; general radiology cases, resident level; archived cases go back only to 2001; clinical history and findings given on the same page; viewers must click for diagnosis; no search ability or list of teaching files |
| radiology.uchc.edu | University of Connecticut site; 32 teaching cases organized alphabetically by diagnosis; cases cannot be viewed as unknown diagnoses or grouped by body system; archived case of the week that can be viewed as unknown; archive has about 10 additional cases |
Table 2. World Wide Web Sites for Radiology Tutorials
| Site Address | Comments |
|---|---|
| info.med.yale.edu/intmed/cardio/imaging/contents.html | Yale University cardiothoracic imaging site; comprehensive review and learning module for heart imaging; starts with extensive review of normal anatomy; each review supplemented by multimedia presentation of echocardiograms and angiograms; reviews cover echocardiography, other ways to image the heart, and important lung and cardiac findings, with extensive multimedia support; cases include bone, soft tissue, and mammography; multiple cases include diagnosis and cannot be viewed as unknown diagnoses; good resource for residents and medical students |
| hsc.virginia.edu/medicine/clinical/radiology/other/educational-software.html | University of Virginia site with interactive tutorials; tutorial covers cervical spine, intensive care unit chest radiography, introduction to head and emergency body CT, informed consent, and patient confidentiality; all interactive, with opportunity for self-assessment |
| brighamrad.harvard.edu/education/online/Cardiac/Cardiacframe.html | A tutorial on cardiac nuclear imaging through the Brigham and Women's Hospital site; text-based tutorials, slide shows, and teaching files; basics of cardiac imaging, viewing, and pathophysiology; interactive quiz for self-assessment; mostly resident-level information |
| chestx0ray.com/Education/Education.html | Tutorial site for reading chest radiographs; slide-based lectures along with tutorials on anatomy and physiology; multimedia used for tutorials; some interactivity; slow server speed; downloads can be slow |
| uroradiology.net | Web site on uroradiology created by Dr Robert Older of the University of Virginia; interactive slide presentations on reactions to contrast media, genitourinary US and radiologic imaging, and the pitfalls of CT diagnosis of renal masses; 5 interactive cases for uroradiology; program must be downloaded to view the uroradiology cases |
| sbu.ac.uk/~dirt/museum/topics.html | Educational radiology site from Central Middlesex Hospital (London, England); tutorial for reading chest radiographs, including viewing strategies, list of anatomic features, discussion of lung structure and function; all have text-based discussion with thumbnail images interspersed; introductory tutorial on basics of US, also text-based; no self-assessment |
| radiology.wisc.edu/Med_Students/neuroradiology/NeuroRad/NeuroRad.htm | Tutorial for neuroradiology; covers neuroanatomy, vascular anatomy, neurofunctional systems, MR imaging, and CT; video files run with Windows Media Player include anatomic images; not very user friendly |
| med.wayne.edu/diagRadiology/Anatomy_Modules/Page1.html | Radiography-based anatomy modules for brain, upper abdomen, thorax, and pelvis; anatomy is taught from plain radiographs and CT scans with text-based explanations; slow server; no opportunity for self-assessment |
| rad.washington.edu/anatomy | Musculoskeletal anatomy tutorials taught from radiographs; mostly text-based with images throughout to illustrate points; some interactivity; structures can be clicked on for more information; extremity CT and MR imaging can be viewed as QuickTime movies; no opportunity for self-assessment |
| everest.radiology.uiowa.edu/nlm/app/livertoc/liver/liver.html | University of Iowa Department of Surgery site for learning the segmental anatomy of the liver; text-based discussion with thumbnail images and some QuickTime movies to demonstrate segmental anatomy in 3 dimensions; emphasis is primarily surgical; mostly resident level |
| ob-ultrasound.net | Tutorial page for obstetric US; mostly text-based comprehensive review of the basics of obstetric US; linked to many different pictures, images, and teaching files of different diseases; equipment; anatomy; and basic US physics; some links are dead, but most still work; not interactive; no self-assessment |
| vh.org/Providers/Lectures/icmrad/Opening.html | Online textbook for introductory radiology; 4 sections: chest, nuclear medicine, and skeletal and abdominal radiography; clicking on a section brings up text-based lectures with clickable thumbnails for illustration; not very interactive; no self-assessment |
| radiology.co.uk/srs-x/tutorials.htm | Scottish Radiological Society educational resource page; text-based tutorials for lobar collapse, head CT in trauma and renal transplantation; most concepts are basic and explained well with diagrams; no interactivity |
| mritutor.org/mritutor | Tutorial on basics of MR imaging, one of very few on this subject; primarily text-based with some simple diagrams and thumbnail MR images; topics include instrumentations, pulse sequences, artifacts, safety, and contrast media; not interactive; no self-assessment |
Table 3. World Wide Web Sites of Organizations in Radiology with Teaching Materials
| Site Address | Comments |
|---|---|
| rsna.org/education/related.html | Extensive radiology education portal page from RSNA providing links for education in anatomy, radiology teaching files, health policy, medical ethics, physics, research, telemedicine, veterinary radiology, and much more; no links to tutorial sites |
| arrs.org/edu/caseofweek | Educational page sponsored by the American Roentgen Ray Society; offers an unknown case of the week and archived cases organized by body system (222 cases, generally resident level): 9 abdominal, 1 adrenal, 7 breast, 17 cardiac, 45 gastrointestinal, 34 genitourinary, 10 head and neck, 4 hepatobiliary, 28 musculoskeletal, 33 neurologic, 7 obstetric, 20 pediatric, and 7 vascular or interventional; some images are low quality; arrows point out findings; 4–5 possible diagnoses are given for each case; whether or not student chooses correctly, correct answer is immediately given with in-depth discussion on the disease entity, followed by questions for thought; no opportunity to search cases for specific diagnoses |
| snm.org/education/resident_techstudent_case_1.cfm?A=10029 | Educational page sponsored by the Society of Nuclear Medicine; 5 online teaching files: 1 pulmonary, 2 bone, 2 endocrine; cases are presented in Aunt Minnie style; with stepwise introduction and teaching and the opportunity for self-assessment (questions) throughout the discussion; case discussion is in-depth and informative, mostly resident level; oldest case was added on March 1, 2002 |
| apdr.org | Web site for the Association of Program Directors in Radiology; links to radiologyweb.com, auntminnie.com, and the RSNA education portal page; essays and residency information for medical students, and fellowship listings for residents; portal pages for other Web-based educational resources |
| rsna.org/education/etoc.html#pulldowns | Educational page sponsored by RSNA; interactive education, online journals, and continuing medical education articles; one must be an RSNA member or register and pay a fee to use these materials |
These site listings are snapshots in time. Web resources are truly moving targets. Soon after one describes the current status of resources on the Web, that status may change. Therefore, there is no possible guarantee of the future accuracy of these sites. The future likely holds more resources, perhaps of even higher quality.
One major asset of Web-based resources, however, is that they are available anywhere and at any time. These resources can also provide outreach to practitioners in underdeveloped countries who may be unable to afford printed materials or travel to continuing medical education courses. In addition, these resources can be updated according to current practice and are not bound by a printing date.
It is an ongoing challenge to keep abreast of the availability of current and new Web sites. Sites were reviewed for this article from the perspective of a 1st-year radiology resident or 4th-year medical student. The comments are meant to help users find sites that best fit their needs. Program directors are encouraged to bookmark useful sites on resident workstations, making the gateway available to any resident or medical student with a spare minute to find a site and learn. These resources can be incorporated into picture archiving and communication system workstations of the future, so that when the queue of pending cases is exhausted and e-mails are answered, a few cases or a structured teaching session can occupy the available minutes until more cases are ready.
The Radiological Society of North America (RSNA) has an extensive portal page for radiology education. We used this portal and popular Web search engines (eg, Google, Yahoo, MSN, and Excite) to compile a large list of sites to explore. The search terms that consistently produced the best results were “radiology” and “teaching.” Two types of education pages were sought: teaching files, to allow practice in radiographic diagnosis, and Web-based tutorials, to provide a more basic education in radiology. The teaching file Web sites were assessed according to several criteria, including the number of files, the ability to view the cases as both known and unknown diagnoses, the depth of case discussion, image quality, the presence of board review materials, server speed, and the site's general organization and ease of use.
Web-based tutorials also were explored and assessed for quality. Medical students and residents of other specialties may benefit more from a teaching module designed to introduce the novice to a certain subject in radiology. These tutorials were assessed for clarity, interactivity, ease of use, and opportunity for self-assessment.
Educational research publishing in radiology is already moving to the Web; the full text of Academic Radiology is now available via the Internet (1). AJR: American Journal of Roentgenology publishes occasional abstracts of peer-reviewed Web sites in its “AJR Web Review.” We looked for resources on the Web that would be beneficial to trainees and program directors in radiology. Other educators have looked to the Web for radiology teaching material and described their findings (2, 3, 4, 5, 6, 7). Unfortunately, one common feature of these lists is that some of the links are now dead; the Web is dynamic and has moved on. Several articles have categorized the sites as to type (teaching vs cases) (2), and there has been some effort to organize and confirm teaching cases that appear on the Web (3). Some educators have rated sites in terms of quality, organization, and speed of access (4). Three recent articles in the radiology literature suggest criteria for rating Web sites (5, 6, 7). The World Wide Web is maturing, and we are becoming more informed consumers of Web-based teaching materials.
We noted two main difficulties while compiling this list of Web sites in educational radiology. The listed sites were explored from the RSNA Web site and various commercial Web search engines, but many teaching sites located on a university Web page may not be registered with a search engine, making it even more difficult to ensure that high-quality educational sites are not missed. A second limitation was inconsistent upkeep of portal sites. There are numerous portal pages for education in radiology, many of which are well organized. The RSNA site, for example, has an extensive portal page with links to many sites for radiologic education (but with no ranking of sites to guide browsing). If such listings are not updated regularly, they will invariably begin to accumulate dead links that take up valuable space and shift the student's or resident's attention from education to Web browsing.
These problems are relatively easy to address. Physicians who create educational Web sites for their institutions should be educated about the benefits of registering these sites with major search engines. In addition, major portal pages, such as those on the Association of Program Directors in Radiology or RSNA sites, should have a Web master who is responsible for regular updates to the education portal page. This would be a small price to pay for having centralized pages from which radiology education is promoted. Centralized pages also could provide links to the Web sites of various teaching hospitals, helping to increase site traffic.
The educational Web site lists included in this article are posted, with direct links, at the Web site of the Association of Program Directors in Radiology (www.apdr.org/edu_portal.htm). The electronic lists will be updated frequently and should remain a valuable resource for radiology programs and directors.
References
- References
- . Academic Radiology on the World Wide Web. Acad Radiol. 2001;8:696–697
- . World Wide Web resources for radiology residents. Acad Radiol. 2000;7:559–561
- . Internet teaching files in radiology: a call to action. Acad Radiol. 2000;7:748–749
- . The value of the World Wide Web for tele-education in radiology. J Telemed Telecare. 2000;6:27–30
- . Radiology on Internet: advice in consulting websites and evaluating their quality. Eur Radiol. 2000;10:859–866
- . How to evaluate educational radiology sites on the Web. Diagn Imaging. 1999;21:75–81
- . Evaluating online radiology information resources. Acad Radiol. 1999;6:561–562
PII: S1076-6332(03)80156-3
doi:10.1016/S1076-6332(03)80156-3
© 2003 Acad Radiol. Published by Elsevier Inc. All rights reserved.
