1. Kadom and Fasih PALET: A tool for making an engaging teaching event

2. Disclosures None

3. “PALET” tool Preparation Link Attention Engagement Transfer

4. Professor E.D. Ott Case presentation Abdominal Imaging fellows

5. Mag view 45 y.o. F, family history colon cancer Acute abdominal pain during annual colonoscopy Plain film signs free air: 1.Air under diaphragm 2.Falciform ligament sign 3.Air both sides of bowel (Rigler sign) Pearls: Best erect or l lat decub CT more sensitive Most common cause perforated ulcer 1 in 400-500 colonoscopies, rectosigmoid site most common

6. Washington DC Abdominal Imaging CEDP course Quiz case April 13 th, 2013

7. History withheld

8. What is going on? Supine Mag view

9. Quiz 1-Use I respond software Q. Which segment of the bowel is most likely to have perforated and why? A. Rectosigmoid

10. Quiz 2 Q. What are the two most common causes of pneumo-retroperitoneum? A. Perforated diverticulitis b. Perforated duodenal ulcer

11. Quiz 3 What is the rate of perforation in: A: Optical Colonoscopy? 1 in 400-500 B: CT Colonography? 1 in 3000

12. Coronal Axial

13. Supine Coronal

14. Pearls CT is the most sensitive modality to detect complications of endoscopy. Rectosigmoid junction is the most frequent site of perforation. Most cases are managed conservatively.

15. Methods of Engagement Multiple choice Q and A, touch pads, show of hands Quiz, games, case Questions, answers, discussion – dialogue! Visuals (slides, videos, white board drawing) Handouts (tables, articles, resources etc) Demonstration, simulation, role play

16. Thank you

17. Audience #2 High school students

18. Scenario 45 year old woman visits the family doctor for annual health exam. Anxiety regarding personal health. Parents had cancer of the large intestine. Family doctor refers for a camera test of the large intestine called Colonoscopy(Colon=large bowel, Scope=direct visualization)

19. Course of events Patient develops severe belly pain during the camera examination. An x –ray of the belly is requested and performed in the Radiology department.

20. Normal structures ( Anatomy) A B Normal X-RAY Patient’s X-RAY

21. X ray of the Belly Patient lying down Patient lying down: enlarged view

22. Specialist doctor performing the camera test (Gastroenterologist) requests a CAT scan.

23. CAT scanner (Computerized Axial Tomography)

24. X ray of the Belly Image from a CAT scan optimized to show free air

25. Take home points Camera examination of the bowel is used to detect cancers in the large intestine. Rarely, this may produce a hole in the intestinal wall resulting in air and other contents to leak out into the belly. This is an emergency…

26. Questions?