Monday, 29 December 2014

The xray doctor's 2014 in review

It's that time of the year to look back - and looking back its been a great 12 months for me. Here are some of my highlights:

Monday, 22 December 2014

"xrayoftheweek" - my new effort for 2015

In the last couple of years I've seen a lot of people take on challenges such as "a photo a day for a year" where they attempt to photoblog their life for a year. I was thinking about my blogging and education efforts for 2015 and decided I would try to do something similar to the photo-a-day challenge but using radiology images. However, it will be difficult for me to do this every day, and even with being as organised as I can, I won't be able to keep this up when I am on holiday etc etc. So I'll aim for an image a week. Time will tell if I can succeed. I will try to append the image with some text, describing the modality and the findings. I will try to post images from a variety of modalities and pitch it all levels - from medical students to radiologists, and hopefully also understandable enough for non-medics.

I'll post the images each Wednesday on my website ( and on my various social media channels (Twitter, Facebook, Google Plus, Tsu and Pinterest), and any videos will be on my YouTube channel. I'll use #FOAMRad, #FOAMed and #xrayoftheweek with each post so you can search for older posts.

Please note that I prefer to keep my professional and personal social media channels together, and I post on lots of other topics besides radiology. Therefore if this is likely to upset/offend you, please either mute these hashtags, or unfollow me. I welcome your feedback and I hope I can get to the end of 2015 with the same enthusiasm as I have now!

Friday, 26 September 2014

What is the name of this imaging sign?

This coronal CT image is of a young person stabbed in the left lower abdomen. What is the name given to this imaging sign?

Wednesday, 24 September 2014

My big screen debut!

I recently recorded a video for University Hospital Leicester's #EverybodyCounts campaign, along with my pharmacy colleague Jane Chivers. We talked about a new pathway for patients to be able to collect their prescribed Gastrografin from any branch of Lloydspharmacy in Leicestershire - making it a much more convenient process for a lot of patients. 

Have you ever watched yourself on video - for most people, including myself, its cringeworthy! The video is below, and click on the "CT colonography" link in the menu bar above for more information on how I perform these exams.

Everybody Counts - Dr Vikas Shah & Jane Chivers - Radiology and Phamacy working together from Leicester's Hospitals on Vimeo.

Friday, 19 September 2014

Abdominal distension - do the xrays tell you why?

These chest and abdominal xrays are of a man who presents with abdominal distension - what can you see and what would you do next?

Monday, 15 September 2014

Revise Radiology : a fantastic new resource for the FRCR exams

I recently came across a new website called Revise Radiology. This is a resource aimed at providing revision cases for the anatomy component of the FRCR 1 and the rapid reporting component for the final FRCR (2b) exams. Currently, it is an image-only resource, with these exams being based on providing answers on individual images.

Screenshots from Revise Radiology running on an Android phone

Tuesday, 5 August 2014

A classic radiology case...

This is a routine CXR of a young man. What can you see? What is the diagnosis?

Tuesday, 29 July 2014

What's unusual about the anatomy in this picture?

This man was having a CT of the chest to follow up a small lung nodule. Have a look at this image:

What is unusual about the anatomy? 

Friday, 25 July 2014

An unusual bone scan

This is the bone scan of a middle aged man. I am withholding other clinical details. What do you think is going on, and what's the cause?

Monday, 21 July 2014

A man with back pain

This man has back pain and is generally unwell:

What do you think is wrong, and what would you do next?

Friday, 11 July 2014

My article in the Summer 2014 RCR newsletter

This is an article I was invited to write about my experiences of running an imaging course for the Royal College of Radiologists newsletter. I describe how the team (myself, Drs Adair and Barnes, and Ms Helen Lee), transformed the old course into a new all-digital course. This experience helped me to start a brand new on call radiology course which was held last month. I hope the picture also helps to convince people that Leicester really is the best place in the UK for Indian food!

Saturday, 12 April 2014

A young woman with shortness of breath

This is a CXR of a 30 year old woman with shortness of breath and a dry cough. What do you think?

Friday, 4 April 2014

Pelvic floor imaging part 6: what is anismus?

This is the latest post in my series about pelvic floor imaging, you can catch up with all the previous articles here. This post focusses on what is arguably the most difficult (and controversial) diagnosis to make: anismus or anorectal dyssynergy

Thursday, 27 March 2014

A big heart.

Can you spot anything abnormal on this CXR?

Sunday, 16 March 2014

Pelvic floor imaging part 5: what is an enterocoele?

It's been a few weeks but my pelvic floor imaging series is back! So far, the posts have covered whether you need a proctogram, what is involved in having a proctogram, and looking at two of the most common findings on a proctogram test: rectocoele and rectal prolapse. This link will take you to all of my pelvic floor articles. This post focusses on another finding occasionally seen, an enterocoele (or enterocele for North American readers).

An enterocoele (pronounced enter-o-seal) is a prolapse of the small bowel into the pelvis. The bowel is divided into small bowel, which is usually located in the centre of the abdomen, and the large bowel which is located around the edge of the abdomen and ending in the rectum or back passage. The small bowel can sometimes drop down into the pelvis and press on the bladder or rectum, and this is seen particularly after a hysterectomy. In order to see this, all women undergoing a proctogram in my clinic are given a barium drink before the test and this then shows up the small bowel during the test. Without the barium drink, enterocoeles are very difficult to detect. Only women get the drink because enterocoeles are extremely rare in men, due to differences in the pelvic anatomy.

This is an xray image from the end of a proctogram test, showing loops of small bowel containing barium lying directly on top of the rectum:

Saturday, 8 March 2014

International Women's Day: don't forget about women's health

Today, 8th March, is International Women's Day. This is a global celebration of everything that women have contributed to our society, but also highlights important inequalities in women's rights across the world. My particular interest in this day stems from my interest in pelvic floor imaging. 

Pelvic floor problems, and specifically pelvic organ prolapse (POP) and incontinence are major health issues for women, regardless of nationality. However, to a certain extent these are hidden issues. They are hidden away from the media limelight because they are not life threatening like cancer or heart disease. This also means that there is a lack of funding into research, diagnosis and management of these problems. However, any woman who has suffered with pelvic organ prolapse or incontinence will tell you that although not life threatening, it dramatically reduces quality of life, with important and damaging physical, mental and sexual health consequences.

There needs to be a greater emphasis of physician recognition of POP, with an improvement in education starting from medical school. Women need to empowered with information and knowledge on the symptoms of POP. I would like to see more research and collaboration across nations and continents with regards to standardising the investigation (tests) and management of POP. Organisations and websites such as APOPS, Prolapse Matters and Pelvic Guru are doing an amazing job in shifting awareness across the world.

I am doing my bit by blogging about pelvic floor imaging. I hope that the information in my posts can help you to understand the role of radiology and scanning in POP, and reduce the fear of having these tests done.

Dr Vikas Shah
Consultant Radiologist

Monday, 3 March 2014

My pledge for NHS Change Day

Today, 3.3.2014, is the second NHS Change Day. Change Day is about making changes that matter in our everyday practice and reminding ourselves of why we do what we do. Pledges can be big or small; it doesn't matter - the main thing is that each and every person who participates has a belief in the values of the NHS and great patient care, and is passionate about keeping it that way now and in the future. You'll see from the Change Day website that there is a wide range of participants; managers, doctors, nurses, allied health professionals, and patients. 

Today, I am pledging to "undergo the same preparation that my patients do for CT colonography so that I understand how it feels for them". 

So what does this mean?

Friday, 28 February 2014

Radiologists are perspicacious!

I found this great picture on The YUNiversity of Righteous Grammar website last week. It shows Benedict Cumberbatch in the role of Sherlock Holmes, the detective famous from the novels by Arthur Conan Doyle.

I happen to think that "perspicacious" is the perfect descriptor of radiologists (but then again, I am biased!). 

Just like the famous detective, radiologists are tasked with solving complex problems, picking up clues from imaging tests and putting together seemingly unrelated pieces of data to synthesise a unifying diagnosis. Observation skills and lateral thinking are key weapons in the radiologist's armoury, and being able to gaze through the mist of information and noise to identify a key single finding is what makes radiologists perspicacious.

So the next time I'm asked to use a word to describe myself, I think I'll use perspicacious!

Friday, 21 February 2014

Pelvic floor imaging part 4: what is a rectal prolapse?

So far in this series, I have covered what is involved in having a proctogram (variously known as defaecating, defecating, voiding or evacuating proctogram), and what a rectocoele looks like.

This post focusses on another important finding: a rectal prolapse.

A rectal prolapse is suspected when people complain of a feeling of a lump coming out of the back passage. The problem starts with the lining of the bowel becoming thicker and looser (rectal mucosal thickening) and starting to droop down. This is known as mucosal thickening and intussusception. This by itself will not cause a feeling of a lump coming out but commonly makes people feel a fullness in their back passage even when they don't need to go to the toilet. 
The intussusception - prolapse spectrum

Thursday, 20 February 2014

My new role with APOPS

I am absolutely delighted to announce that I am now a member of the Medical Advisory Board of APOPS: The Association For Pelvic Organ Prolapse Support. This is headed up by Sherrie Palm; she has shown immense enthusiasm and energy in raising awareness of pelvic organ prolapse (POP) and enabling a shift in attitudes amongst both the general public and the healthcare community. 

Monday, 17 February 2014

Why CT colonography is better than PillCam

Last week, a device named PillCam was approved by the U.S. FDA, to be used for looking at the colon. I've seen blog posts comparing this to the future as predicted in The Jetsons. The idea is that the PillCam is an alternative to a traditional colonoscopy. 

But what is not being widely mentioned is that this will still require people to have full bowel preparation (which means unpleasant diarrhoea and unsafe for people with cardiac and kidney problems) because otherwise the device will simply float through a lot of faecal matter in the colon. Infact, it requires more bowel preparation than a colonoscopy, which means that the most unpleasant part of the whole experience is magnified further.

So what if you need your colon investigating but don't fancy having a colonoscopy? Is there a test which is far more pleasant and proven to work?

Wednesday, 12 February 2014

My YouTube channel and playlists

Radiology is a very visual specialty, and a lot of my work and educational material is present in video format.

You can find all the videos featured on this website, and a lot more, on my YouTube channel.

I have also created playlists of videos related to CT colonography and proctograms.

Click the "Subscribe" button on the YouTube site to be notified about new videos.

The video below is an example; this is a 3D reconstruction of the data from a CT scan showing the bones (ribs, spine and pelvis) and the major blood vessels. The data from a CT scan can be manipulated in a number of ways to provide useful information for diagnosis and also to aid treatment such as planning complex surgery.

Dr Vikas Shah
Consultant Radiologist

Saturday, 1 February 2014

Pelvic floor imaging part 3: what is a rectocoele?

In the first two posts of this series, I covered the symptoms that might indicate you need a pelvic floor test called a proctogram, and what this test involves. In this post, I will describe what is seen on a proctogram when someone has a rectocoele (pronounced rek-tow-seal and spelt rectocele for North American readers). 

A rectocoele is bulge of the front wall of the back passage (the rectum) into the back wall of the vagina. The typical symptoms that this causes are:
  • feeling of a lump or fullness in the back of the vagina
  • needing to press from inside the vagina to empty bowels
  • feeling of stool being trapped and needing to go to the toilet repeatedly

The image above is typical for how a rectocoele looks at the end of a proctogram test. There is barium within the rectum but also in a pouch (seen to the left of the rectum).

Tuesday, 28 January 2014

Should non-radiologists be using ultrasound?

Cardiologists and obstetricians already use ultrasound (US) in their routine clinical practice, but should we be encouraging other specialties to grasp a transducer and start learning how to scan? This article in Aunt Minnie summarises the latest issue of the journal Global Heart, in which there are several articles about the use of point-of-care US.

Overall, I am an advocate for extending use of diagnostic techniques such as US into clinical areas where they can be a powerful adjunct to routine clinical examination. The use of bedside echocardiography, as cited in the article, is a great example. Immediate and timely decisions can be made by having the skillset to perform the US. I also feel that the old (artificial) divisions between clinical medicine and diagnostics need to be broken down. There is increasing crossover between these two entities, and we are now seeing a generation of medics emerging who are taught that using US to evaluate a pleural effusion or intraperitoneal fluid is an extension of the clinical examination, not simply a confirmation or refutation of a differential diagnosis.

Image of Signos RT portable scanner from

Saturday, 25 January 2014

A brand new on call radiology course for 2014

"Tell me and I forget. Teach me and I remember. Involve me and I learn." (Benjamin Franklin)

Education is a passion of mine, and one of the biggest challenges of 2014 for me will be a brand new course I am starting here in Leicester. This course is for radiology trainees preparing to start their on calls. The first Leicester on call radiology course will be on 7th and 8th June 2014 at the Leicester General Hospital. 

There are other on call preparation courses but I wanted to start a course that was more interactive and allowed maximum hands-on case reviews, rather than spending a lot of time sitting through lectures.

Saturday, 18 January 2014

Pelvic floor imaging part 2: what is a proctogram?

In the first post in this 8 part series, I discussed what the pelvic floor is, and how problems with the pelvic floor may present. In this post, I will explain how the main pelvic floor xray test is done.

The xray test is called a defaecating proctogram (defecating for North American readers), sometimes known as a voiding or evacuating proctogram. It is a dynamic test, meaning that an xray movie is created during the act of straining and opening the bowels. Using some sort of scan is the only way of knowing from the outside what is actually happening to the back passage during the act of opening one's bowels. 

To start with, in my practice all female patients take a small volume of barium to drink before the test to show up the small bowel. The small bowel lies in the centre of the abdomen but sometimes can drop down into the pelvis and press on the back passage. This is less the case in men so they don't drink any barium. Just before the test, barium paste is put into the back passage and this is what is expelled.  The barium paste is also what gives patients the urge to open their bowels for the test. The patient sits on a commode next to the xray machine, and the radiologist (me!) and the radiographer are behind a screen. Xrays are then taken at rest, and then during straining and opening of the bowels.

This is what the first image usually looks like with barium (white) in the back passage. The white in the top left is barium in the small bowel.

Tuesday, 14 January 2014

Does your doctor embrace or resist technology?

This is an interesting article published in the NY Times a couple of days ago. It describes a growing trend in the USA for the employment of "scribes" by doctors, to help them complete electronic health records when seeing patients. The article quotes a Dr Sinsky, who researches physician dissatisfaction, as saying "physicians who use scribes are more satisfied with their work and choice of careers.". She goes on to say that scribes offer a triple win: “The patients get undivided attention from the physicians, the scribes are continuously learning while making an important contribution, and the physician gets the satisfaction of doing the work they went into medicine for in the first place.”

Maybe I’ve misunderstood the North American system, but in the UK that’s what junior doctors are for! Consultants (attendings) see patients on the rounds, give their undivided attention to patients, while the juniors scribe and learn from the pearls of wisdom emanating from their seniors. There is no hospital set up in the UK where doctors see patients on their own, it is a team effort. The exception to the rule is in the emergency department, which is the area that the article seems to focus on.

However, there is one simple reason why this will never catch on in the UK: privacy and confidentiality. I believe that patients will simply refuse to have a typist (one without any medical qualifications or training) be present at their consultations.

Sunday, 12 January 2014

Pelvic floor imaging part 1: do I need a proctogram?

This is the first post of an 8 part series about imaging of the pelvic floor. Pelvic floor imaging is one of my main areas of clinical interest and expertise. Problems with the pelvic floor are not as widely discussed in the media as cancer or heart disease, but my experience of seeing hundreds of patients a year has shown me that it can be incredibly distressing and disabling. Whilst a proportion of women will suffer from pelvic floor problems due to previous trauma at childbirth, in most cases the cause is unknown. Men can also be affected.

In this post, I will discuss what the pelvic floor is, what problems you may suffer from if your pelvic floor fails, and how I can help with your treatment.

The pelvic floor is made up of muscles and connective tissue, and provides support to the organs in the pelvis. The pelvis is divided into three compartments: anterior (front) containing the bladder, middle containing the vagina and uterus in women, and posterior (back) containing the anal canal and rectum. This is shown in the following image: 

(image courtesy of

Wednesday, 1 January 2014

Welcome to 2014!

Have you all had a great start to 2014? One of my resolutions this year is to try to increase awareness of what it is that radiologists do. In this day and age, pretty much every time you suffer any kind of illness, you are likely to have a scan. But most people still don't know what we actually do, what their scan images look like, and why we do a certain type of scan.

Stay in touch with my website and all my social media channels listed below to learn about what we do. Luckily it is a very visual job, so during this year I will try to share lots of interesting images and videos with you, and I'll try to spare you any long lectures!