Foreword

I was distinctly honored when Col (ret) Folio asked me to write this foreword, as he taught chest imaging throughout my student tenure at the Uniformed Services University (USU) in Bethesda, MD. He led the second year radiology lecture series for our class, to include the memorable CXR Þnal oral exam event, and ran the fourth year radiology elective for several years, providing all the chest imaging presentations for hundreds of students. My fellow students and I found his pedagogical teaching techniques and course materials, such as RoboChest, useful in that he taught in a way one remembers, from Þndings to differential. This book reßects his teachings by breaking the chest x-ray into manageable components that the student of radiology can reasonably master in a short period of time.

The following text presents a unique approach to the CXR that includes mnemonics on most everything from the search pattern and diagnostic approach to disease processes that are retained for years. By reading this book, one can understand the complexity of interstitial disease (for example) with clever algorithms built in Excel¨ that provide a general understanding of an otherwise daunting and seemingly unlimited differential. And who could possibly forget the Þndings of hydropneumothorax with his balloon and milk in the glass analogy? Or the tram tracks in bronchiectasis from his straw in the sponge model? This text allows these teaching pearls to be shared for years to come.

The online directory structure of lung patterns on his www.robochest.com is unparalleled. When looking for the information needed, this website naturally guides the student of radiology in an interactive outline format that expands when more detail is desired. One always knows where they are on the pathway with breadcrumb trails, and can backtrack in a methodical fashion to get to a differential diagnosis. This basic launching platform to chest imaging is timeless and especially useful for many of us that will deploy with minimal resources in austere environments such as combat. This book contains everything RoboChest has, with many improvements, including clearer descriptions, annotations, and relations to the analogous models.

I am conÞdent I will be reading this book several times over in the next few years, and I expect that when I deploy, it will be packed safely in my gear bag to take with me to help provide good medicine in combat situations. I believe I can speak

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Preface

This book is written for the Òstudent of radiologyÓ which historically has included medical students and radiology residents. Due to recent increased diversity in the medical team, I consider nurse practitioners, physicianÕs assistants, nurses, medical students and radiology technicians to be included as students of radiology. The audience also includes residents and fellows of all clinical disciplines, especially ICU staff. The morning CXR review and rounds that follow (ICU, surgery, ID, etc.) are the pulse of any hospital. Even in combat hospitals the day starts with the CXR rounds, followed by ICU and other specialty rounds (surgery, infectious disease, etc.).

I am often asked how I came up with the RoboChest title for the Þrst edition and the online content. It is very simple; the program we used to make the online version is called RoboHelp by Adobe¨. With AdobeÕs¨ permission, I borrowed the ÒRoboÓ and added chest. It was designed to be help pages for a larger project that is still under development. These are the familiar help boxes that accompany popular programs that are organized in folders that can be opened for more detail.

In this edition, I have distilled the content of the search pattern to a very easy to remember mnemonic (ABCDS) × 2 covering all aspects of the CXR.

The second mnemonic that helps guide the student of radiology through the diagnostic process is ID CD, or Identify, DeÞne, Categorize, Differential. Using these and several other mnemonics introduced throughout the book, a beginner can build conÞdence reading CXRs.

The prior two versions of RoboChest book were meant as a guide to the launching website www.robochest.com. Although this book follows the same methodical pat- tern-driven approach to the chest x-ray, it is meant as a stand-alone introduction to chest imaging, while being augmented by the RoboChest website as a teaching tool. I hope you Þnd this book as a valuable guide through the world of chest x-rays.

Les R. Folio, DO, MPH, FAOCR

Col (ret), USAF, MC, SFS

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