Hey, everybody, it's Rishi Agrawal.
And in this video, I'm going to be taking a look at some clips from the TV
show Chicago Med to see how accurate their radiology is.
All right, let's start.
Trying to figure out where I went wrong.
Guy showed up this morning, I ran these,
discharged and two hours later, he's wheeled in with a massive MI.
How did I miss it?
What was the lesion?
Right, coronary.
I know, what
I'm looking for, and I don't see any abnormalities.
I got the guy back, but it's not good.
It's not.
OK, so what's wrong with that?
Well, he's pointed to the chest x ray when the Asian guy
asked him where the lesion was and he said, right coronary.
Obviously on a chest X-ray, you can't diagnose a myocardial infarction.
So that might be where he went wrong.
So it is not it's not uncommon.
It's pretty common actually for in the workup of an MI
to get a chest x ray because sometimes you can see things on a chest x ray
that can cause chest pain that might mimic a myocardial infarction
or a heart attack. Like if the patient, for example,
had a pneumothorax that might cause chest pain.
But if a patient doesn't have any of those things and actually has an MI
you probably won't see anything on a chest x ray.
Or if they have a big enough MI, then maybe they have heart failure
and it's causing pulmonary edema.
That might be the only thing that you can see on a chest x ray.
So the fact that they put that in there
when talking about an MI is really weird, because this show is supposed to be,
really good when it comes to medical accuracy.
All right, let's take a look at another clip.
three.
All right.
Can you tell me your name?
Russell.
We were going to, but.
Get me a set of vitals.
Someone draw gas and get a chest X-ray.
Do you know him? Since I was a kid.
Russell, can you move your fingers and toes?
Where did this happen?
At the store?
Claire,?
That's 90 heart rate. 124.
Alright everybody, quiet. Russell, take it.
OK, it looks like this guy has a gigantic
glass sculpture
penetrating through his chest,
so it's going to be really hard to get a chest x ray.
Let's see how they do it.
Take a deep breath for me.
I don't hear much on the left side.
We're going to need a chest x ray.
It's not optimal, but we're going to do it from here.
Russell, listen to me.
No, you are not.
All right.
I'm going to hold the plate from here.
You just you shoot as head on as possible, OK?
Here we go. Russell.
Listen to me. You're doing great, buddy.
I just need you to keep it still as possible, please.
X-ray. Everyone clear.
Clear. OK.
That that's not going to show anything, I mean, you have this humongous
glass sculpture like right on top of this dude's chest,
like I get irritated sometimes when I get X-rays of a patient's chest
and there's too many EKG leads overlying the chest.
So here we've got this humongous glass sculpture.
That's going to be a really, really bad chest X-ray.
The other weird thing is that whenever the X-ray tech
said, everybody clear, everyone went like this.
Like, that's not
like when you're shocking a patient, as in
defibrillating a patient when you have to re synchronize their heart.
OK, so touching the patient isn't going to somehow shock you.
OK, so it's kind of weird that they all went like this.
Now you are supposed to back away.
You want to be at least like six feet away from the X-ray source,
especially if you're a health care worker
Like over time, like one, X-ray is not going to make a difference.
But if you are near X-ray sources all the time,
you want to at least wear protective equipment like this guy is wearing.
He's wearing lead or back away from the patient.
So all of those people,
if they weren't wearing lead should have been out of the room.
But I'm very skeptical as to how this X-ray is going to look
because like he's got this humongous thing over lying his chest.
Big hemopneumothorax with some shift.
OK, so that's a very good chest x ray
for the amount of stuff that he has on his chest, like all I see really
is this one kind of cone shaped thing in his left upper chest.
I don't see this whole thing at all.
So that's really
weird.
Now, he said, big hemopneumothorax.
There is some haziness in the left chest and he is supine.
So that means he probably has blood
in the back of his chest, like in the plural space -- hemothorax.
And because there's probably also air in there,
he probably has a deep sulcus sign, which they're not showing here.
But I would guess that he has a hemopneumothorax too.
So I agree with that diagnosis.
All right.
Let's see what else we got.
Incredible.
Wait until you get the headset on.
It's like I'm moving around inside of his body.
All right, so tell me how this thing works.
It combines images from the CT angiogram and creates
a three dimensional model of the patient's anatomy.
With the HTC Vive, you get virtual reality.
It allows us to better tailor our operation.
Are you having some concerns?
Oh, no, no. Just just curious.
Oh, by the way, Dr.
Rhodes, I met your father today. OK.
That was a little weird.
I mean, the way they said with the HTC Vive, like it's a clearly
a sponsored little partnership that they had.
The way that they were using VR here,
it seemed kind of superfluous and, not necessary.
Most of the time in radiology, when we're making
a diagnosis, we're using just the regular old axial images.
But I could see
how 3-D recons can be used to kind of get
a better visualization of the patient's total like anatomy or pathology.
The addition of VR, I'm not sure if it helps that much,
but I could see how in the future, maybe VR could be used to do things
that are not possible today, for example, like with robotic surgery.
So you could have potentially a patient who is remote from the practitioner
so you can have a robot being controlled through a VR system
by a practitioner who's miles away, for example.
That might be one application.
I think there's a lot of potential for VR to change medicine,
but the way they're using it here is kind of superfluous, and
it just seems like it was stuck in as an ad for HTC.
So I'm not a big fan of what they did here.
Let's take a look at another clip.
Ashley's problem is right there,
superior mesenteric artery the fat pad
that supports it has shrunk and is now constricting the duodenum
so fluid passing through her stomach it gets stuck in this pressure point.
You're right, it is physical.
You still could've told me you were going to give her a placebo.
So that was legit.
And actually they used the right image, too.
So this is a patient who has SMA syndrome where you can see that
the duodenum is being compressed between the abdominal aorta and the SMA.
And you can see actually in this CT image that they chose that the proximal
part of the duodenum is dilated right before the SMA.
So that was that was spot on.
Good.
All right.
Let's get a look at his chest.
X-ray, clear.
Hemopneumothorax. Dr.
Choi, get a chest tube in on the right. You got it.
OK, here we have another hemopneumothorax.
So, yeah, I think that the picture that they used for this is...
Let's let's take another look.
X-ray clear.
Yeah, the picture that they used is pretty good,
so you could see that there's haziness throughout the right hemithorax.
And there's this very subtle, lucency at the edge of the lungs.
So this is a hemopneumothorax in a patient who's supine.
Now, the one criticism I have here is that.
The people in the room,
not everybody was leaded up. So,
you know, for health care practitioners who are exposed to X-rays frequently,
either you should get out of the room or you should wear lead
like the person who is at the head of the table here.
Well, first we need to discuss the results of a chest x ray.
We discovered a mass
approximately two centimeters in diameter in the left lobe of your lung.
Now a finding like that in conjunction with coughing
blood, I'm concerned.
We need a CT scan and then a possible biopsy.
Don't bother.
We really should determine-- It's cancer.
You know, that's not bad.
Let's take a look at that chest x ray again.
Centimeters in diameter.
Yeah.
So what they're showing here is enlargement of the left hilum,
and you can see that there is a spiculated lesion in the left hilum here.
And it looks pretty good.
So in a patient with that history of hemoptysis,
I'm not sure if they mentioned if he was a smoker or not, but hemoptysis
and something that looks like that in the lung,
I certainly would be concerned about lung cancer also.
Now it doesn't always have to be lung cancer.
You could have some infections that cause hemoptysis,
or you can have a patient with pulmonary embolism that causes hemoptysis,
although it usually wouldn't look like this.
But with this history and with that chest X-ray,
I would certainly be concerned about lung cancer also.
So pretty good.
Now, in general,
I think that Chicago Med does a pretty good job of the images
that they do choose to show because they do look like their actual pathology.
But I think that the way they explain them and the context
that they put them in is sometimes not completely right.
And it seems like although a lot of their medical stuff
is pretty accurate, when it comes to the radiology,
there's still some that is to be desired there.
So I'm going to be looking at some more episodes.
This was season 1 of Chicago Med, and I'll see if they improve in future
episodes. All right, so this was a lot of fun.
If you have any shows with radiologists and you want to get my reaction,
let me know and I'll be happy to take a look. Thanks.