【医学知识】你不知道的事：放射学的秘密（10）
《Radiology Secrets Plus》是由宾夕法尼亚大学E. Pretorius和Jeffrey Solomon博士主编的以问答形式深入浅出的介绍相关放射性与影像诊断学内容的图书。该书总结了影像诊断学在实践过程中需要注意的100个知识要点，本公众号将持续推送翻译介绍。上一期我们介绍了：儿科辅助影像、日常护理与急救时的影像指证和妇科影像。本期推送是《放射学的秘密》系列的最后一期，本期除了介绍了妇产科重要影像诊断和胆囊超声，还对放射学医生的职业责任和资格考试进行了诠释。
91. 如果孕妇出现阴道出血、盆腔疼痛和子宫触痛，必须首先考虑是否有胎盘早剥。
If a pregnant patientpresents with vaginal bleeding, pelvic pain, and uterine tenderness, placentalabruption must be excluded.
图为超声下胎盘早剥
92.羊水过少最严重的并发症是胎儿肺发育不全。
The most dreaded complication of oligohydramnios is pulmonary hypoplasia.
93.脐突出比腹裂预后更差，因为前者的原因是染色体异常而导致的结构异常，并且其他结构异常的发生率也比后者要大。
Omphalocele has a worse prognosis than gastroschisisbecause the former is associated with an increased incidence of chromosomalabnormalities leading to other structural abnormalities.
94.大多数中风是血栓造成的而不是颈动脉狭窄。因此，在检查颈动脉循环时，确定不规则的动脉粥样硬化表面是很重要的。
Most strokes are due to emboli rather than carotidstenosis. Therefore, it is important to identify irregular atheroscleroticsurfaces when examining the carotid circulation.
图为脑血栓CT
95.早期或不复杂急性胆囊炎的声像图表现可能包括胆结石（可能在胆囊颈或胆囊管中）、胆囊壁增厚、胆囊扩张。超声Murphy征（由超声换能器压迫胆囊时的局部压痛）也可引起。
Sonographicfindings in early or uncomplicated acute cholecystitis may include gallstones(which may be impacted in the gallbladder neck or cystic duct), gallbladderwall thickening, and gallbladder distention. A sonographic Murphy's sign (focaltenderness over the gallbladder when compressed by the US transducer) may alsobe elicited.
图为胆囊炎超声图像（GB为胆囊；RL为肝右叶；ST为胃；箭头所指的强回声影为结石）
96. 胆石症与超声Murphy征相结合，对急性胆囊炎的预测价值为92%，阴性预测值为95%。
The combination of gallstones and a sonographicMurphy's sign has a positive predictive value of 92% and a negative predictivevalue of 95% for acute cholecystitis.
97. 如果判决医生有过失，必须证明以下四件事：（1）注意义务的确立（即医患关系）；（2）不负护理责任或出现失误；（3）不良预后引起机体损伤或精神伤害；（4）过失结果之间的直接因果关系。
For a physician to be found liable for malpractice,the following four things must be demonstrated: (1) establishment of a duty ofcare (i.e., doctor-patient relationship); (2) breach of the duty of care, ornegligence; (3) adverse outcome with injury or harm; and (4) direct causalitybetween the negligence and outcome.
98.放射科医生被起诉的三个最常见的原因是：诊断失误、未能及时和恰当地沟通调查结果，以及未能提出下一个适当的程序。
The three most common reasons radiologists get suedare failure of diagnosis, failure to communicate findings in an appropriate andtimely manner, and failure to suggest the next appropriate procedure.
99.如果想得到放射学会的放射诊断的认证，你必须通过美国放射学委员会的书面和口语考试（www.theabr.org）。笔试由一个物理部分和一个临床部分组成。你可以在第二、三、四年的放射学训练中考察物理部分，临床笔试部分是第四年的秋天，第四年六月在路易斯维尔（肯塔基州）进行口语考试。
To become board-certified in diagnostic radiology, youmust pass the written and oral examinations of the American Board of Radiology(www.theabr.org). The written examination consists of a physics portion and aclinical portion. You may take the physics portion in your second, third, orfourth year of radiology training. The clinical written portion is taken in thefall of the fourth year, and the oral examination is taken in Louisville, Ky.,in June of the fourth year of residency.
100. 唯一比去路易斯维尔更糟糕的是，回到路易斯维尔。（译者认为这句话想要告诉问我们医学是一门学无止境的科学，我们的学习只能进步不能后退，努力往更高的方向进发，而不是固步自封甚至退步。）
The only thing worse thangoing to Louisville is going back to Louisville.