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The overall objective of the Diagnostic Radiology Residency Program at UAB is to produce well-rounded general radiologists who have balanced experience in all radiologic subspecialties. This education includes monthly rotations in each subspecialties according to a curriculum that is driven by educational need and not by departmental service needs. The curriculum includes daily intradepartmental teaching conferences, multiple weekly interdepartmental subspecialty conferences, and a core curriculum of radiation physics and biology.
During his or her training, each resident will:
Learn all radiographic modalities, including interpretation of conventional radiographs, performance and interpretation of fluoroscopic and angiographic examinations, interpretation of diagnostic ultrasound, MRI, and CT, and various interventional procedures. This occurs in an adequately supervised setting with gradually increasing clinical responsibility over time.
Provide patient care that is compassionate, appropriate, and effective. Residents will counsel patients in an effective and informed manner. They will safely perform various examinations, keeping in mind radiation exposure and contrast issues at all times.
Incorporate a broad range of medical knowledge into the evaluation of patients and demonstrate an understanding of appropriate imaging studies based upon the clinical setting and evidence-based data.
Be a consultant for referring physicians and demonstrate appropriate communication skills.
Become proficient in the use of picture archiving computer systems (PACS) and other computer based imaging modalities.
Provide clear, concise, and informative reports that are clinically relevant. Residents will notify referring clinicians of urgent and emergent findings in a timely fashion.
Demonstrate professional behavior at all times, adhering to ethical principles and demonstrating sensitivity. Residents will be cognizant and respectful of patient confidentiality.
Critically evaluate the scientific literature and apply it to daily practice and develop good habits of continuing medical education.
Play an active role in teaching of students, peers, and other members of the health care team.
Demonstrate an understanding of the overall healthcare system, including hospital administration, payer reimbursement, and medical-legal issues.
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Rotation-Specific Curriculum and Educational Goals
Diagnostic Radiology Residency Program
University of Alabama Medical Center
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AFIP (1.5 mo.) - A six-week course in Radiologic Pathology at the Armed Forces Institute of Pathology in Washington, DC. Addresses the ACGME requirement for training in radiologic-pathologic correlation. The lectures discuss the radiologic presentation of a broad range of diseases from all organ systems. All imaging modalities are discussed.
Goals:
At the end of this 6-week course, the resident will be able to:
(1) Apply the principles of radiologic pathologic correlation to the interpretation of radiologic studies,
(2) Apply an understanding of the clinical and pathologic implications of the radiologic appearances of image interpretation, and
(3) Refine differential diagnoses in various organ systems based on specific imaging features.
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Body CT (3 mo.) - CT studies of abdomen and pelvis in inpatients and outpatients, guided biopsies, 3-D reconstruction studies.
Goals:
By the end of the first rotation (first or second year radiology residents), the resident will be able to:
(1) Identify relevant anatomic structures on CT images of the chest and abdomen,
(2) Understand basic CT scanning protocols and contrast media usage well enough to direct CT studies in most patients,
(3) Become facile with PACs and utilize information technology (Horizon, CDA, efilm, etc.) to manage patient information,
(4) Provide emergency treatment for adverse reactions to intravenous contrast material,
(5) Recognize the signs of life-threatening conditions on abdomen and pelvic CTs and appropriately notify the referring clinician without being prompted,
(6) Produce concise and accurate reports on most examinations, and
By the end of the second rotation (second year radiology residents), the resident will be able to do the above plus:
(7) Accurately characterize radiologic findings in the majority of abdominal and pelvic studies,
(8) Understand basic aspects of CT angiograpy,
(9) Perform CT-guided biopsies with help from faculty or fellow,
(10) Produce clear and concise dictated reports on more complex CT examinations,
(11) Manage the Body CT reading room and provide effective consultations for referring clinical residents and faculty, and
By the end of the third rotation (second or third year radiology residents), the resident will be able to do the above plus:
(12) Protocol and interpret complex and postoperative abdominal and pelvic CT cases in most patients, and
(13) Perform most CT-guided biopsies with only hands-off supervision.
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Body MRI (1 mo.) - MRI examinations of the abdomen and pelvis.
Goals:
By the end of this rotation (third or fourth year radiology residents), the resident will be able to:
(1) Understand the department's standard MR scanning protocols for abdominal and pelvic studies,
(2) Describe MR angiography technique and MRCP technique, and
(3) Interpret and report straightforward pathological findings on abdominal and pelvic MR studies.
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Breast Imaging (3 mo.) - Mammography, breast ultrasonography, guided breast biopsies, and localizations.
Goals:
By the end of the first rotation (first or second year radiology residents), the resident will be able to:
(1) Interpret and report screening mammograms with help of R2 Image Checker,
(2) Perform breast ultrasound examinations with assistance,
(3) Assist with localizations, ultrasound and stereotactic-guided biopsies, and cyst aspirations, and
By the end of the second rotation (second or third year radiology residents), the resident will be able to do the above plus:
(4) Protocol mammograms with regard to the need for special and additional views,
(5) Evaluate and provide consultation for more complex breast cancer cases,
(6) Communicate effectively with patients and family, demonstrating compassion and respect,
(7) Obtain informed consent for all breast procedures,
(8) Perform all procedures with hands-off supervision,
(9) Perform breast ultrasound examinations without assistance, and
By the end of the third rotation (fourth year resident), the resident will be able to do the above at a higher skill level.
By means of either lectures, conferences, textbooks, syllabi, journal reprints, videotapes, teaching files, and other teaching materials the resident should become familiar with the following topics in breast disease:
Epidemiology
Risk factors and incidence
Staging and survival rates
Breast Anatomy, Pathology, and Physiology
Breast development
Normal breast anatomy and histology; alteration with age, pregnancy, menstrual cycle, and hormonal effects
Pathologic and mammographic appearance and clinical significance of benign breast conditions, such as fibroadenoma, cyst, papilloma, hamartoma, lipoma, ductal ectasia, radial scar and fat necrosis
Atypical ductal hyperplasia, lobular neoplasia, and other histologic risk factors
Pathologic and mammographic appearance, clinical features' significance, and prognosis of ductal carcinoma in situ (DCIS)
Pathologic and mammographic appearance; clinical features and prognosis of invasive carcinoma including invasive ductal carcinoma not otherwise specified (NOS); and mucinous, medullary, papillary, tubular subtypes; and invasive lobular carcinoma
Other manifestations of breast cancer, such as Paget's disease and inflammatory carcinoma
Histologic grading
Pathologic staging
Multifocal and multicentric carcinoma
Margin analysis for specimens containing DCIS
Mammographic Equipment and Technique
Features of mammographic equipment units including target, filtration, automatic exposure control, and grids
Equipment requirements for ACR accreditation and Mammography Quality Standards Act (MQSA) certification
Familiarity with ACR recommended specifications for new mammography equipment
Characteristics of mammographic film screen systems
Positioning technique for craniocaudial and mediolateral oblique (MLO) views
Viewbox criteria for assessment of positioning, compression, exposure, contrast, sharpness, and noise
Rationale for breast compression
Selection of technical factors, including effects of milliampere seconds (Mas), kilovolt peak (kVp), and density settings on image quality
Film processing
Factors affecting exposure contrast, noise, and sharpness
Need for dedicated high-intensity viewboxes, viewbox masking, and magnifying glass
Standardized labeling of images
Mammography Quality Control
Purpose and frequency of performance of those quality control tests performed by technologist including phantom images and processor sensitometry
Appearance and causes of artifacts, such as roller marks, grid lines, motion unsharpness, dust, poor screen-film contact, pickoff, and scratches
Requirements and standards for ACR mammography accreditation and Food and Drug Administration (FDA) MQSA certification
Familiarity with ACR Mammography Quality Control Manual
Mammographic Interpretation
Normal mammograhic anatomy and parenchymal patterns
Mammographic features of typically benign calcifications, such as those caused by sclerosing adenosis, fibroadenomas, fat necrosis, secretory disease, sebaceous gland calcification, and dystrophic calcification
Mammographic features of calcifications of intermediate concern and those having a higher probability of malignancy
Significance of distribution of calcifications
Mammographic features of benign masses and densities such as asymmetric breast tissue, radial scar, hematoma, abscess, cyst, fibroadenoma, intramammary lymph node, hormonal replacement therapy, phyllodes tumor, hamartoma, gnyecomastia, lipoma, fat necrosis, edema, ductal ectasia, intracystic papilloma, and Mondor's disease
Mammographic appearance of malignant masses, densities and architectural distortion caused by in situ and invasive ductal carcinoma, invasive lobular carcinoma, and metastases to the breast
Knowledge of ACR BI-RADs lexicon
Problem Solving Mammography
ACR Practice Standard for the Performance of Diagnostic Mammography
Technique, value, and indications for supplementary mammographic views, such as tangential, 90-degree mediolateral (ML), spot compression, exaggerated rotated craniocaudal cleavage; blind areas of the breast
Technique for documentation of clustered skin calcifications
Criteria and methods for distinguishing focal asymmetric densities, asymmetric breast tissue, and breast masses
Technique for evaluation of implants, breast parenchyma, and implant leakage
Masses: criteria and methods for assessment by mammography and sonography; likelihood of malignancy
Calcifications: criteria for mammographic assessment
Magnification mammography: advantages and disadvantages, technique, dose, and indications
Localization of lesions seen on only one view; triangulation
Criteria for biopsy and follow-up of masses, calcifications, and soft tissue densities
Ability to perform breast physical examination
Evaluation and management of a palpable mass with no mammographic findings
Breast Ultrasound
Equipment and physical principles
Technique
Hands-on experience
Indications
Normal sonographic anatomy
Features of cysts
Differential features of benign and malignant solid masses
Limitations: detection and differentiation of microcalcifications; screening
Need for correlation with mammography
Criteria and reliability for evaluation of implant rupture
ACR Standard for the Performance of Breast Ultrasound
Interventional Procedures
Principles, indications and contraindications, equipment, technique, advantages, disadvantages, accuracy, preparation, and follow up for the following:
Needle-wire localization
Stereotactic core biopsy and fine-needle aspiration (FNA)
Ultrasound-guided core biopsy FNA; importance of correlation of pathologic, mammographic, and sonographic findings and history in determining patient management (the resident does not necessarily need to know how to perform stereotactic or ultrasound-guided core biopsies)
Mammographic- and sonographic-guided cyst aspiration
Galactography
Specimen radiography, including paraffin block radiography
Pneumocystography
ACR Standard for the Performance of Stereotactically Guided Breast Interventional Procedures
ACR Standard for the Performance of Ultrasound-Guided Percutaneous Breast Interventional Procedures
ACR image-guided breast biopsy accreditation program
Mammographic Reporting and Medicolegal Aspects of Mammography
ACR BI-RADS terms for the following:
Mass shape, margins, and density
Typically benign, intermediate concern, and higher probability of malignancy calcifications
Distribution modifiers for calcifications
Associated findings
Lesion location
Categorization of breast composition
Final assessment categories
Medicolegal aspects of screening, problem-solving mammography, and interventional procedures
Screening Mammography
ACR practice standards for screening mammography
Knowledge of practical aspects of performance and interpretation of screening mammography
Mammography audit: definition and desirable goals for positive predictive value, percentage stage 0 or 1 tumors, percent minimal carcinomas, percent node positivity, prevalent and incident cancer rates, recall rates, sensitivity, specificity, and false-negative rate
Relative efficacy of physical examination, breast self-examination, and mammography
Screening theory: lead time bias, length bias, selection bias, survival rates, prevalence versus incidence screening, definition of lead time, and interval cancer rate
Value of double reading
Radiation risk versus screening benefit
Cost-effectiveness screening
Randomized clinical trials, case control studies, and follow-up studies: purpose, methods, and results
Controversies regarding screening women aged 40 to 49 years
Screening guidelines of ACR American Cancer Society, National Cancer Institute
Breast MR Imaging
Indications
Technique
Characteristics of benign and malignant breast masses
Implant rupture
Therapeutic Considerations
Role of breast imaging in selection and monitoring of breast cancer treatment and post-treatment follow-up
Basic understanding of breast cancer treatment options
ACR standard for Diagnosis and Management of Invasive Breast Carcinoma therapy
ACR Standard for Diagnosis and Management of DCIS
Patient Management Principles
Patient interaction and communications
Informed consent for invasive procedures
Follow-up procedures for positive findings
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Cardiac Radiology (1 mo.) - Cardiac radiographs, cardiac angiography and MRI.
Goals:
By the end of this rotation (third or fourth year radiology residents), the resident will be able to:
(1) Identify and interpret findings of acquired and congenital heart disease on chest radiographs:
1. Acquired cardiac disease
a. Describe the common acute and late complications of myocardial infarction and recognize radiographic findings that may indicate these complications.
b. State the most common benign and malignant primary cardiac tumors.
c. Distinguish cardiac tumor from thrombus on CT and MR.
d. State the advantages and disadvantages of echocardiography, CT, and MR in the evaluation of cardiomyopathy and cardiac tumors.
e. Identify and describe the following abnormalities on MR:
i. Aortic stenosis
ii. Aortic insufficiency
iii. Mitral stenosis
iv. Mitral insufficiency
v. Left ventricular aneurysm or focal wall motion abnormality
2. Congenital heart disease
a. Cyanotic admixture shunts - understand the radiographic and clinical presentation of truncus arteriosus, transposition of the great vessels, single ventricle, total anomalous venous connection, double outlet right ventricle.
b. Heart failure in the infant or child - give a differential diagnosis for pulmonary edema in the following situations: Newborn, 3 months of age, 6 months of age, 2 years of age, 6 years of age.
c. State the differential diagnosis of dextrocardia.
d. State the definition and describe the abnormalities associated with isomerism.
e. Know the commonly performed surgical corrections for congenital heart disease including procedures performed through thoracotomy vs. sternotomy.
f. Recognize devices in the postoperative patient with congenital heart disease including PDA ligation clip, pulmonary artery band, mesh closure of ASD, embolization of Blalock or aortopulmonary collateral, pulmonary conduit.
(2) Demonstrate knowledge of angiographic anatomy of the heart and great vessels.
(3) Identify anatomy and basic pathology on cardiac angiography in children and adults.
(4) Describe indications for cardiac MRI.
(5) Protocol and interpret basic cardiac MRI studies, including:
i. Thoracic aorta
ii. Pulmonary arteries
iii. Thoracic veins - SVC, brachiocephalic veins
iv. Pericardium
v. Cardiomyopathy and cardiac tumors
vi. Ischemic heart disease
vii. Valvular heart disease
viii. Congenital heart disease in an adult
(6) Understand principles of cardiac MR and limitations.
(7) Understand and be able to direct use of cardiac and respiratory gating.
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Chest (3 mo.) - General chest radiographs and digital chest images at University Hospital and Kirklin Clinic, ICU radiographs, chest CT, cardiac imaging, guided lung biopsies.
Goals: First Month Chest Rotation:
By the end of this rotation (first year radiology residents), the resident will be able to:
1. Dictate chest radiograph report accurately, concisely and in timely fashion.
2. Understand standard positions for chest examinations.
3. Understand basic digital and conventional x-ray physics in the chest.
4. Notify referring physicians of emergent or unexpected findings without prompting.
5. Understand basic chest radiographic patterns. Separate pulmonary from pleural or extrapleural processes.
6. Understand basic chest CT anatomy and protocols.
7. Use PACS, Horizon and other computer interfaces without difficulty.
Knowledge Based Objectives
1. Normal anatomy - identify the following structures on chest radiograph (CXR)
a. Fissures - major, minor, accessory, azygous
b. Mediastinal lines - anterior junction line, posterior junction line, right paratracheal stripe, paraspinal lines, azygoesophageal recess, aortopulmonary window, Raider triangle, retrosternal line
c. Define the following anatomic terms - secondary pulmonary lobule, acinus
d. Name all segments of both lungs
2. Signs in Chest Radiology - define, identify and state importance of:
a. Air bronchogram - air space disease
b. Deep sulcus sign - pneumothorax
c. Reverse S sign of Golden - RUL bronchogenic carcinoma
d. Silhouette sign - location of abnormality
e. Fat pad sign - pericardial effusion
f. Double-density sign - left atrial enlargement
g. Hilum overlay sign - hilar vs. non-hilar mass
3. Chest Computed Tomography (CT)
a. Define all normal anatomy listed above on CT
b. Recognize the following categories of abnormalities on CT: airspace disease, interstitial disease, mass or nodule, bronchiectasis.
c. Know frequency and treatment of contrast reactions
d. Know the following CT protocols and be able to direct the technologist in their performance. Be aware of indications and limitations of each.
i. Routine contrast CT
ii. Routine noncontrast CT
iii. CT angiography
iv. High resolution chest CT
4. Interstitial disease
a. Identify following interstitial patterns - reticular, nodular, honeycombing
b. Define, identify and understand significance of Kerley B lines.
5. Airspace disease
a. List five broad categories of airspace abnormality, acute or chronic.
b. Understand the anatomic basis for air bronchograms and air alveograms.
6. Atelectasis, airways, and obstructive lung disease
a. Recognize partial or complete atelectasis of all lobes of the lung.
b. Separate atelectasis from massive effusion in unilateral opacification on CXR.
c. State types of atelectasis; recognize their appearance on CXR. Know important of air bronchograms in atelectasis.
d. Recognize findings of emphysema on CXR.
7. Mediastinal masses and mediastinal and hilar adenopathy
a. Know anatomic boundaries of the anterior, middle, posterior and superior mediastinum.
b. Name the four most common causes of anterior mediastinal mass.
c. Name three most common causes of a middle mediastinal mass.
d. Name the most common cause of posterior mediastinal mass.
8. Solitary and multiple pulmonary nodules
a. State definition of solitary pulmonary nodule and pulmonary mass.
b. Name four causes of multiple pulmonary nodules.
c. Name major causes of cavitary pulmonary nodules.
9. Chest trauma
a. Identify widened mediastinum on trauma patient and state the differential diagnosis including traumatic and nontraumatic etiology.
b. Identify pneumothorax and pneumomediastinum on supine radiographs.
c. Identify signs of possible diaphragmatic rupture.
10. Chest wall, pleura, and diaphragm
a. Recognize and name four causes of a large unilateral pleural effusion.
b. Recognize pleural effusions on erect, supine, and decubitus films. Separate freely layering from loculated effusions.
c. Recognize and state the criteria of a subpulmonic effusion.
d. Identify pneumothorax on supine and erect films.
e. Recognize tension pneumothorax and understand acute clinical significance.
11. Infection
a. Define “Ranke complex” and “Ghon lesion”; recognize both on CXR and CT.
b. Recognize CXR appearance of bronchopneumonia; state four common causes.
c. Recognize CXR appearance of lobar pneumonia; state three common causes.
d. Recognize a miliary pattern and provide a differential diagnosis.
12. Vascular disease
a. Recognize enlarged pulmonary arteries on CXR; distinguish from adenopathy.
b. Recognize and state differential of pulmonary arterial hypertension on CXR.
c. Define “aneurysm” and “pseudoaneurysm.” Recognize aortic aneurysm on CXR and CT. Know normal dimension of the thoracic aorta.
13. Cardiac disease
a. Identify right heart failure and left heart failure on CXR and CT.
b. Know criteria for enlargement of each cardiac chamber on CXR.
c. Identify, know the most common causes, and understand the physiologic basis of the classic radiographic findings in the following valvular diseases: aortic stenosis, aortic insufficiency, mitral stenosis, mistral insufficiency, tricuspid insufficiency, pulmonary valvular stenosis.
14. Pericardial disease
a. Describe and identify two CXR signs of a pericardial effusion.
b. State five causes of a pericardial effusion.
15. Monitoring and support devices: “lines and tubes”
a. Be able to identify, state the preferred placement, list the complications associated with malposition, of each of the following on CXR: Endotracheal tube, central venous catheter, Swan-Ganz catheter, feeding tube, nasogastric tube, chest tube, intraaortic balloon pump, pacemaker leads, automatic implantable cardiac defibrillator.
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Required Reading List for First Month Chest Rotation
Freundlich Chapter 42 - Digital Chest Radiography
Grainger & Allison Chapter 12 - normal anatomy
Felson Chapter 15 - A review of over 30,000 normal chest Roentgenograms
Fraser & Pare pp. 77-104 Normal hilar anatomy
Fraser & Pare The Pleura -normal anatomy pp. 154-167
Lee, Sagel, Stanley Chapter 5 - Normal CT anatomy
Fraser & Pare Chapter 18 - Increased lung density
Freunclich Chapter 6 - Airspace disease
Freudlich Chapter 5 - atelectasis
Fraser & Pare Chapter 20 - Atelectasis
Fraser & Pare Chapter 21 - Pleural disease
Freundlich Chapter 33 - Mediastinal masses
Freundlich Chapter 7 - Pulmonary nodule
Freundlich Chapter 40 - TTNA
Paul & Juhl Chapter 23 - pneumonia
Freundlich Chapter 13 - pulmonary arterial hypertension
Freundlich Chapter 20 - heart failure
Meschan Chapter 22 - valvular disease, cardiac chamber enlargement
Freundlich Chapter 19 - ICU radiology, lines and tubes
For Fraser & Pare chapters, radiographic sections required. Other sections suggested as time permits.
Recommended Reading List for First Month Chest Rotation
Felson Chapter 3 pp. 92-124 - Atelectasis.
Felson Chapter 6 -The Lymph Nodes
Fraser & Pare Chapter 8 - Mediastinum
Fraser & Pare Chapter 7 - Lymphatics
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Goals: Second Month Chest Rotation:
By the end of this rotation (second or third year radiology residents), the resident will be able to:
1. Refine differential diagnosis based on the chest radiograph.
2. Demonstrate skills in the protocol, monitoring, and interpretation of chest CT.
3. Demonstrate understanding of American College of Radiology appropriateness criteria for chest radiology.
4. Demonstrate ability to perform transthoracic needle biopsy with supervision.
Knowledge Based Objectives
1. Signs in Chest Radiology - define, identify and state importance of:
a. Air crescent sign - lung cavity, often due to fungal infection.
b. Hampton hump - pulmonary infarct.
c. Tapered margins sign - lesion in chest wall, mediastinum or pleura has smooth margins with obtuse angles.
d. 1-2-3 sign - right paratracheal and bilateral hilar adenopathy in sarcoidosis.
2. Signs in CT - define, identify and state importance of:
a. CT angiogram sign - enhancing pulmonary vessels against a background of low-attenuation material in the lung.
b. Halo sign - suggesting invasive pulmonary aspergillosis.
c. Split-pleura sign - empyema.
3. Interstitial lung disease
a. Know five major differential categories in basilar reticular lung disease.
b. Know differential diagnosis associated with the following abnormalities:
i. Nodular interstitial pattern
ii. Upper lung predominance
iii. Pleural effusion or thickening
iv. Cardiomegaly
v. Hyperinflated lungs
vi. Adenopathy
c. Define and identify “asbestos-related pleural disease” and “asbestosis”.
d. Identify honeycombing on CXR and HRCT, state its importance, and list the common causes.
e. State the radiographic classification of sarcoidosis.
f. Recognize progressive massive fibrosis secondary to silicosis on CXR and CT.
g. Recognize irregular lung cysts in patient with Langerhans cell histiocytosis.
4. Airspace disease
a. Name three pulmonary-renal syndromes.
b. Differentiate radiographic findings of ARDS compared to cardiogenic edema.
c. List five common causes of ARDS. Know its potential complications.
5. Atelectasis, airways, and obstructive lung disease
a. Identify bronchiectasis on CXR and CT. Name 5 common causes.
b. Name five common causes of bronchiectasis.
c. Recognize the typical appearance of cystic fibrosis on CXR and CT.
d. Name 3 important things to exclude on CXR when clinical history is “asthma”.
6. Mediastinal mass and mediastinal or hilar lymph node enlargement
a. Identify and give differential of thoracic inlet masses.
b. List the four most common causes of “eggshell” calcified lymph nodes.
c. Recognize a cystic mediastinal mass; suggest its diagnosis and treatment.
7. Benign and malignant neoplasms of the lung and esophagus
a. Name the four major histologic types of bronchogenic carcinoma and state the difference between non-small cell and small cell lung cancer.
b. State the typical radiographic appearance for the following types of lung cancer: small cell, squamous cell, adenocarcinoma, large cell carcinoma, carcinoid. State which most commonly cavitates.
c. Name three most common causes of a solitary pulmonary nodule.
d. State indications for percutaneous needle biopsy of pulmonary nodule. Know frequency of complications and their management.
e. Name the most common extrathoracic sites for metastases of non-small cell and small cell lung cancer.
f. Describe CXR and CT findings in Kaposi sarcoma.
8. Chest Trauma
a. Identify the indirect and direct signs of aortic injury on CT.
b. Identify fractures of ribs, clavicle, spine and scapula on CXR and CT.
c. Identify and differentiate the pulmonary findings in: contusion, hematoma, and pulmonary laceration. Know the expected radiographic course.
d. Name the three most common causes of pneumomediastinum in trauma.
9. Chest wall, pleura and diaphragm
a. Recognize pleural calcification on CXR and CT. State differential diagnosis.
b. Recognize typical findings and spectrum of asbestos-related pleural disease.
c. Recognize diffuse pleural thickening in benign vs. malignant disease.
d. State and recognize the CXR and CT findings of malignant mesothelioma.
10. Infection
a. Name the radiographic findings of primary pulmonary tuberculosis.
b. Name the radiographic findings of post-primary pulmonary tuberculosis.
c. Name the expected infections in the following types of immunocompromised patients:
i. Sickle cell disease
ii. Multiple myeloma
iii. Granulomatous disease of childhood
iv. Breast cancer patient undergoing chemotherapy
v. HIV infection
vi. Solid-organ transplant patient (e.g. heart, kidney)
vii. Bone marrow transplant patient
d. Describe the radiographic appearance of CMV and PCP pneumonia.
e. Name the types of malignancies associated with HIV infection.
11. Vascular disease
a. Recognize lobar and segmental pulmonary emboli on chest CT and MR.
b. Define the role of V-Q scan, chest CT, chest MRI and angiography in the diagnosis of PTE. Explain the benefits and limitations of each.
c. Describe the classification of aortic dissection (DeBakey I, II, III; Stanford A, B) and implication for medical vs. surgical management.
d. State, recognize, and distinguish the following on CXR and CT:
i. Aortic aneurysm - routine and ruptured
ii. Aortic dissection
iii. Sinus of Valsalva Aneurysm
iv. Coarctation
v. Pseudocoarctation
e. Recognize right aortic arch and double aortic arch on CXR, CT and MR.
f. State types of right aortic arch; know association with congenital heart disease.
g. Recognize aberrant subclavian arteries on CT and chest radiographs.
h. Recognize and distinguish the following on CT: aortic intramural hematoma, penetrating atherosclerotic ulcer, ulcerated plaque.
12. Acquired cardiac disease
a. Recognize coronary arterial calcifcation on chest radiographs and CT.
b. Know basic coronary artery anatomy. Be able to identify the following on coronary angiogram and CT: right, left main, left anterior descending, and left circumflex coronary arteries.
c. Identify myocardial calcification on CXR; discuss the clinical ramifications.
d. State the difference between left ventricular aneurysm and pseudoaneurysm.
e. Define the types of cardiomyopathy (dilated, hypertrophic, restrictive) and list the common causes of each.
f. State the cardiac diseases associated with mitral annulus calcification.
13. Congenital cardiac disease
a. State the findings and be able to recognize the following vascularity patterns: normal, shunt, and oligemia.
b. Name the causes of left-to-right shunt and their diagnosis on CXR.
c. Name the causes of oligemia and right-to-left shunt and diagnosis on CXR.
14. Monitoring and support devices: “tubes and lines”
a. Be able to identify, state the preferred placement of, list the complications associated with malposition, and identify the location on CXR of:
i. Left ventricular assist device
ii. Pericardial drain
iii. Intraesophageal manometer, temperature probe, or pH probe
iv. Tracheal or bronchial stent
15. Postoperative chest
a. Identify normal postoperative findings and complications of the following:
i. Wedge resection of lung
ii. Lobectomy
iii. Pneumonectomy
iv. Video-assisted thoracoscopic surgery
v. Coronary artery bypass
vi. Cardiac valve replacement
vii. Lung transplantation- unilateral or bilateral
b. Identify prosthetic valves by position within the heart. Understand the difference between mechanical and tissue valves. Know the following valve types:
i. Starr-Edwards
ii. Carpentier-Edwards
iii. Bjork-Shiley
iv. Hancock
v. St. Jude
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Required Reading List for Second Month Chest Rotation
Freundlich Chapter 11 - Interstitial lung disease
Freundlich Chapter 34 - Vasculitis
Freundlich Chapter 29 - Lung cancer
Freundlich Chapter 32 - Lymphoma
Freundlich Chapter 10 - Immunocompromised patient
Freundlich Chapter 39 - HIV infection
Freundlich Chapter 22 - PTE
Freundlich Chapter 21 - Aortic Disease
Paul & Juhl Chapter 25 - Tuberculosis
Lee, Sage, Stanley CT Book
Chapter 2 - Medicastinum
Chapter 8 - Pleura
Chapter 7 - Lung disease
Elliott. X-Ray Diagnosis of Congenital Heart Disease. Basic introduction, charts.
Soto Chapter 15 - Congenital aortic anomalies
Soto Chapter 20 - Coronary artery disease
Soto Chapter 19 - Cardiomyopathy
Soto Chapter 6 - Cardiac Anatomy
Soto Chapter 17 - CXR in Adults with congenital heart disease
Soto Chapter 9 - ASD and VSD
Highly Recommended for Second Month Chest Rotation
Reed, James. Chest Radiology. Plain Film Patterns and Differential Diagnosis, 4th ed, 1997. Fraser and Fraser and Pare, 4th ed. Specific topics.
Recommended for Second Month Chest Rotation
Gamuts in Radiology
Lillington Chapters 8, 18, 20
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Goals: Third Month Chest Rotation:
By the end of this rotation (fourth year radiology residents), the resident will be able to:
1. Refine skills in interpretation of radiographs and chest CT scans.
2. Develop skills in the interpretation of high-resolution CT studies.
3. Develops skills in the protocol, monitoring, and interpretation of chest MR studies, including cardiovascular MR imaging.
4. Demonstrate knowledge of and diagnostic skills in congenital heart disease.
5. Correlate pathologic and clinical data with radiographic and chest CT findings.
Knowledge Based objectives
1. Signs in Chest Radiology - define, identify and state importance of:
a. Ring around the artery sign - pneumomediastinum
b. Gloved finger sign - bronchial impaction, can be seen in ABPA
c. Luftsichel sign - variant of left upper lobe collapse
d. Figure 3 sign - Coarctation
e. Scimitar sign - abnormal pulmonary vein in hypoplastic lung
2. Chest CT
a. Describe a chest CT protocol optimized for evaluation of:
i. Thoracic aorta and great vessels
ii. Suspected pulmonary embolism
iii. Tracheaobronchial tree - suspected tracheal stenosis or tumor
iv. Suspected bronchiectasis
v. Lung cancer staging
vi. Suspected pulmonary metastases
vii. Suspected pulmonary nodule on chest radiograph
viii. Dyspnea
ix. Hemoptysis
b. Prescribe medication, if necessary, to pt. with history of “contrast reaction”.
3. Interstitial lung disease
a. Define “B reader” with regard to the evaluation of pneumoconiosis
b. Recognize the varying forms of interstitial pneumonitis (UIP, NSIP, AIP, DIP) including their presentation, radiographic appearance, and prognosis
c. Recognize and state differential for ground glass densities on HRCT
d. Understand the varying appearance of sarcoidosis on HRCT
e. Identify and give differential diagnosis for septal thickening, perilymphatic nodules, “tree in bud” opacities, and cystic spaces on HRCT
f. List five causes for acute interstitial lung disease
4. Atelectasis, airways, and obstructive lung disease
a. Define tracheomegaly.
b. Recognize tracheal stenosis on CXR and CT; name the most common causes.
c. Name the three types of pulmonary emphysema; identify each type on CT.
d. Recognize alpha1-antitrypsin deficiency on CXR and CT.
e. Recognize Kartagener syndrome on CXR; name its three components.
f. Define the term “giant bulla” and differentiate from pneumothorax.
g. Know workup and findings for bullectomy or lung volume reduction surgery.
5. Benign and malignant neoplasms of the lung and airways
a. State role of FDG-18 PET in evaluation of a solitary nodule and lung cancer.
b. Recognize abnormal contralateral mediastinal shift in the postpneumonectomy radiograph; state five possible causes.
c. Name the most common location for adenoid cystic and carcinoid tumors; describe their most common radiographic presentation.
d. Recognize and know clinical course of radiation pneumonitis and fibrosis .
e. State the role of MR imaging in lung cancer staging.
f. Describe TNM classification for staging of esophageal carcinoma including the components of each stage. Understand which are potentially resectable. Be able to label all mediastinal nodes with ATS nodal classification system.
g. State the staging of small cell lung cancer.
h. Describe TNM classification for staging of esophageal carcinoma including the components of each stage. Understand which are potentially resectable.
i. State the classification of lymphoma and the role of imaging in its staging.
j. Define primary pulmonary lymphoma; state its radiographic manifestations.
6. Infection
a. Name and describe the four types of pulmonary Aspergillus disease.
b. Identify an intracavitary fungus ball on CXR and CT.
c. Name diagnostic considerations in recurrent or persistent pneumonia.
d. Name the endemic mycoses, their specific geographic regions, and their radiographic manifestations.
e. Describe findings of posttransplatation lymphoproliferative disorders.
7. Unilateral hyperlucent lung
a. Recognize unilateral hyperlucent lung on CXR or CT.
b. Identify the common causes of unilateral hyperlucent lung and recommend studies to separate bronchial from vascular or chest wall causes.
c. Describe the origin and anatomic abnormality in Swyer-James syndrome.
8. Congenital lung disease
a. Recognize hypoplastic lung with or without scimitar syndrome on CXR. Name the associated findings in hypoplastic lung.
b. Recognize lower lung mass as possible sequestration. Explain the differences between intralobar and extralobar sequestration.
9. Vascular disease
a. Recognize pulmonary AVM by CXR and CT. Describe its clinical associations and complications and its radiographic treatment.
b. Recognize the role of angiography and embolization in massive hemoptysis.
c. Identify the findings seen in Takayasu arteritis on MR and angiography.
d. State the advantages and disadvantages of CT, MR, and transesophageal echocardiography in the evaluation of the thoracic aorta.
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Required Reading for Third Month Chest Rotation
Freundlich Chapter 43 - Chest MR
Freundlich Chapter 27 - Pneumoconiosis
Freundlich Chapter 28 - Sarcoidosis
Freundlich Chapter 26 - Aspergillus
Paul & Juhl Chapter 26 - Endemic Mycosis
Lillington Chapter 14 - Unilateral hyperlucent lung
Soto Chapter 27 - Aortic disease
Soto Chapter 27 - Cardiac tumors
Soto Chapter 7 - Valvular disease
Soto Chapter 8 - Isomerism
Webb, Richard. High Resolution Chest CT
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Emergency Radiology (1 - 2 mo.) - Coverage of radiologic work in patients seen in the Emergency Department and inpatients.
Goals:
By the end of the first month in the ED (first or second year radiology residents), the resident will be able to:
(1) Become facile with PACs and utilize information technology (Horizon, CDA, Amicus, efilm, etc.) to manage patient information,
(2) Interpret chest, abdomen, spine and extremity radiographs performed for traumatic and non traumatic indications,
(3) Understand the imaging algorithm of the Level 1 trauma victim,
(4) Understand the common mechanisms of injury to the musculoskeletal system,
(5) Describe common fracture patterns,
(6) Recognize radiographic signs of most life-threatening conditions and appropriately notify the referring clinicians without being prompted,
(7) Understand the imaging algorithm of musculoskeletal emergencies such as occult hip fracture and osteomyelitis,
(8) Interpret and understand complex orthopedic radiology problems such as acetabular and pelvic ring fractures, and
By the end of the second month in the ED (second year radiology residents), the resident will be
able to:
(1) Perform the above.
(2) Run the reading room and provide timely, accurate preliminary reports.
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GI/GU (3 mo.) Conventional and digital abdominal radiographs, barium studies of upper and lower GI tract and small intestine, swallowing studies, GI examinations with water-soluble contrast media, ERCP interpretation, fistulograms, i.v. urograms, urethrograms, cystograms, hysterosalpingograms, feeding tube passage.
Goals:
By the end of the first rotation (first year radiology residents), the resident will be able to:
(1) Recognize the signs of life-threatening conditions on abdominal radiographs (extraluminal gas, bowel obstruction, gas-containing abscess) and appropriately notify the referring clinician without being prompted,
(2) Perform routine UGI, BE and esophagograms in outpatients and some inpatients,
(3) Recognize some major abnormalities on contrast studies of the GI and GU tracts,
(4) Select appropriate oral contrast agents (barium vs. water-soluble) for GI contrast examinations,
(5) Protocol and supervise the performance of intravenous urograms,
(6) Provide fluoroscopic and interpretive support for modified barium swallows,
(7) Place transnasal enteral feeding tubes with fluoroscopic guidance,
(8) Perform emergency procedures such as retrograde urethrograms and cystograms in trauma patients, and
By the end of the second rotation (first or second year radiology residents), the resident will be able to do the above plus:
(9) Detect and characterize radiographic abnormalities in most GI and GU contrast studies,
(10) Perform and interpret fistulograms and sinus tract injections,
(11) Perform and interpret T-tube cholangiograms,
(12) Accurately convey GI and GU radiologic findings in dictated reports and in direct consultations with referring physicians,
(13) Manage the GI/GU reading room and provide effective consultations for referring clinical residents and faculty, and
By the end of the third rotation (third or fourth year radiology residents), the resident will be able to do the above plus:
(14) Perform and interpret UGI, BE and barium swallows in almost all patients, including post-surgical cases,
(15) Correctly interpret most IVU examinations,
(16) Interpret radiologic findings on ERCP examinations, and
(17) Correctly interpret most lower tract studies including RUG, cystograms and VCU in trauma and other patients.
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Interventional Radiology (3 mo.) Diagnostic and therapeutic angiography and a variety of other interventional procedures.
Goals:
By the end of the first rotation (first or second year radiology residents), the resident will be able to:
(1) Assist with the performance of all procedures done on the service,
(2) Explain procedures and obtain informed consent from patients scheduled to undergo interventional radiologic procedures and demonstrate compassion and respect to these patients,
(3) Insert PICC lines and Permacaths without assistance,
(4) Learn to access vessels using the Seldinger technique,
(5) Learn basic approach to drainage procedures (GI, GU, and abscess)
(6) Treat adverse reactions to intravenous contrast material,
(7) Dictate accurate reports of interventional procedures after discussion of cases with faculty, and
By the end of the second rotation (second or third year radiology residents), the resident will be able to do the above plus:
(8) Perform arteriovenous access fistulagrams in hemodialysis patients without assistance,
(9) Perform declotting procedures in A-V fistula patients with assistance,
(10) Perform and interpret arteriograms in potential renal donors,
(11) Perform contrast venography and interpret with assistance,
(12) Perform arterial studies with supervision and assistance, and
By the end of the third rotation (third or fourth year radiology residents), the resident will be able to do the above plus:
(13) Interpret and perform with hands-off supervision many arteriographic studies, e.g., run-off studies in lower extremities,
(14) Percutaneously place inferior vena cava filters,
(15) Perform permcath placement with supervision,
(16) Perform biliary, nephrostomy, abscess drainage procedures with supervision, and
(17) Perform arterial interventional procedures with assistance.
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Neuroradiology (4 mo.) CT and MRI examinations of the head, neck, and spine, fluoroscopically-guided lumbar puncture, contrast myelography, neuroangiography.
Goals:
By the end of the CT rotation at University Hospital (first year radiology residents), the resident will be able to:
(1) Understand the principles of CT scanning,
(2) Understand the indications for neuro CT, and prescribe appropriate protocols,
(3) Understand normal anatomy on head, neck, and spine CT studies,
(4) Recognize urgent and emergent findings on CT studies of the head (intracranial hemorrhage, infarct, abscess, tumor) and appropriately contact the referring clinician without being prompted,
(5) Recognize spinal fractures on CT,
(6) Utilize information technology (Horizon, CDA, Amicus, efilm, etc.) to manage patient information,
(7) Dictate cohesive reports of CT examinations of the head and spine for review by faculty, and
By the end of the neuro MRI rotation at University Hospital (first or second year radiology residents), the resident will be able to:
(9) Understand normal anatomy of the head and spine on MRI studies,
(10) Identify and report emergent findings in neuro MR studies, including stroke, spinal cord compression and discitis, and appropriately contact the referring clinician without being prompted.
(11) Interpret basic head and spine MRI examinations,
(12) Describe the appropriate uses of contrast agents in neuro MRI, and
By the end of the neuroimaging rotation at the Kirklin Clinic (third or fourth year radiology residents), the resident will be able to:
(13) Interpret more complex CT examinations of the head and spine,
(14) Interpret CT studies of the soft tissues of the neck,
(15) Supervise and interpret CT angiograms of the head and neck,
(16) Interpret most MRI examinations in spine disease,
(17) Understand and describe protocols for MR scanning in various neurological conditions,
(18) Interpret MRI studies in brain-tumor patients,
(19) Demonstrate preliminary understanding of imaging anatomy of the paranasal sinuses and temporal bone,
(20) Dictate concise, accurate reports of complex neuro imaging cases, and
By the end of the neuroangiography rotation (third or fourth year radiology residents), the resident will be able to:
(21) Understand the indications and contraindications for most neuroangiographic procedures,
(22) Communicate effectively with patients and family, demonstrating compassion and respect,
(23) Obtain informed consent for all neuroangiographic procedures,
(24) Perform basic neuroangiographic procedures in a supervised setting,
(25) Understand and participate in some neuro interventional procedures,
(26) Interpret basic neuroangiographic studies, and
(27) Perform myelograms with assistance.
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Nuclear Radiology (3 or 4 mo.) Exposure to a wide range of radionuclide imaging studies, functional radionuclide studies, radiotherapy of thyroid and bone disease, SPECT, and PET.
Goals:
By the end of the first rotation (first or second year radiology residents), the resident will:
(1) Have completed one textbook from the mandatory reading list,
(2) Understand physical characteristics of commonly used radionuclides,
(3) Understand basic nuclear radiology equipment including quality control,
(4) Know organ localization, uses of common radiopharmaceuticals, and quality control of Technetium- 99m,
(5) Understand appropriate indications for commonly ordered studies.
(6) Be able to interpret the following types of nuclear radiology studies: bone, lung, hepatobiliary, GI bleeding, thyroid, parathyroid, and basic renal scans and be able to perform correlation with radiographs, and understand when additional imaging should be recommended,
(7) Describe basic concepts of radionuclide therapy for thyroid carcinoma and hyperthyroidism including patient consent and radiation safety issues,
(8) Obtain a passing score on a written quiz, and
By the end of the second rotation (second year radiology residents), the resident will be able to do the above plus:
(9) Complete a second textbook from the required reading list,
(10) Understand SPECT imaging including quality control, image acquisition and study interpretation,
(11) Understand quantitative studies including gall bladder ejection fraction, renal ERPF/GFR studies, Lasix renography, gastric emptying and brain perfusion,
(12) Understand pharmacologic interventions in nuclear radiology including morphine/cholecystikinin hepatobiliary imaging, ACE inhibitor (Captopril) renography, Diamox brain imaging, and Reglan gastric emptying,
(13) Interpret radionuclide scans related to infection and tumor such as: Octreoscan, CEA scan, leukocyte scan, Gallium scam, MIBG scan, Thallium brain scan and hemangioma studies,
(14) Obtain a passing score on second rotation quiz, and
By the end of the third rotation (second or third year radiology residents), the resident will have:
(15) Completed a third textbook from the reading list,
(16) Performed and logged the required number of radionuclide treatments for hyperthyroidism and for cancer,
(17) An understanding of the Nuclear Regulatory Commission (NRC) rules concerning radionuclide imaging and therapy,
(18) Have understanding of radionuclide therapy for controlling bone pain (Sr-89, Sm-153), and
(19) Have an understanding of the basic concepts in radiolabeled antibody imaging (CEA scan) and therapy (Zevalin).
Note: Three additional months training in Nuclear Radiology is comprised of:
* Three rotations in pediatric radiology, each of which includes experience in nuclear radiology (0.75 mo.)
* Four rotations in Float, including Nuclear Radiology and Pediatric Nuclear Radiology (0.25 mo.)
* One rotation devoted to Cardiac Nuclear Radiology and Cardiac Radiology (1 mo.)
* Eighteen noon teaching conferences annually for 4 years (72 hours)
* A Physics Review Course, including Nuclear Radiology (10 hours)
* Occasional on-call coverage of Nuclear Radiology cases for 2 years
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OB Ultrasonography (1 mo.) Obstetrical ultrasonography in the Department of Obstetrics and Gynecology.
Goals:
By the end of this rotation (second year radiology residents), residents will be able to:
(1) Perform and interpret Level I ultrasound evaluations in pregnant patients, and
(2) Have some understanding of Level II examinations.
(3) Give a case conference on OB ultrasonography within one month of completing the rotation.
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Outpatient Musculoskeletal Radiology (2 mo.) Outpatient muscoloskeletal radiographs, musculoskeletal MRI, arthrography, musculoskeletal CT and ultrasound studies.
Goals:
By the end of the first rotation (first year radiology residents), the resident will be able to:
(1) Understand the common imaging and clinical manifestations of arthritis,
(2) Recognize the classic radiologic appearances of common bone tumors,
(3) Describe common fracture patterns and the common mechanisms of injury to the musculoskeletal system,
(4) Understand the basic concepts of metabolic bone disease,
(5) Interpret routine outpatient musculoskeletal radiographs,
(6) Provide accurate and concise reports of these studies, and
By the end of the second rotation (second or third year radiology residents), the resident will be able to do the above plus:
(7) Protocol and interpret routine musculoskeletal MRI scans of the shoulder, hip, knee,
(8) Observe and perform arthrography of the shoulder and hip.
(9) Perform CT guided sacroiliac joint injections, and
(10) Recognize the MR and CT appearance of common musculoskeletal diseases including: osteonectosis, common abnormalities of the knee including meniscle and ligamentous tears, tumor and infection.
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Pediatric Radiology (3 mo.) Chest and bone radiographs in children and neonates, radionuclide imaging, GI and GU contrast studies, pediatric neuroradiolgy, CT, ultrasonography, MRI.
Goals: (First through fourth year radiology residents)
Each of the four months, the resident will demonstrate gradually progressing skills and will be able to:
(1) Perform fluoroscopic studies of the pediatric GI tract safely and with diagnostic image quality,
(2) Understand and employ examination methods for producing diagnostic image quality with minimal radiation dose, demonstaring an understand the ALARA concept,
(3) Interpret radiographs of the pediatric musculoskeletal system and chest,
(4) Understand basic principles of radionuclide imaging in pediatric patients,
(5) Perform and interpret diagnostic ultrasound studies in children,
(7) Prescribe and interpret CT examinations of the head and body in children,
(8) Understand the principles of safe sedation in children, and
(10) Prescribe and interpret MRI scans in children,
(11) Understand safety considerations for MRI in the pediatric setting, and
(12) Interpret most radionuclide examinations in children without assistance.
Each month, the resident will be given progressive responsibility.
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Ultrasonography (3 mo.) Sonography of the abdomen, pelvis, thyroid, scrotum, and first-trimester obstetrical cases, color and spectral Doppler studies of carotids, upper and lower extremity and abdominal vasculature, and ultrasound-guided biopsies.
Goals:
By the end of the first rotation (first or second year radiology residents), the resident will be able to:
(1) Identify normal anatomic structures on abdominal, renal and lower extremity ultrasounds,
(2) Use the KinetDx workstation,
(3) Produce concise and accurate reports of all sonographic examinations,
(4) Perform routine lower extremity sonogram,
(5) Communicate effectively with patients and family, demonstrating compassion and respect,
(6) Obtain informed consent for all sonographic procedures,
(7) Assist with US-guided biopsies, and
By the end of the second rotation (second year radiology residents), residents will be able to do the above plus:
(8) Perform routine abdominal, renal and lower extremity ultrasound examinations in patients with normal findings,
(9) Perform and interpret routine pelvic and first-trimester obstetrical ultrasound studies, and studies in cirrhotic patients,
(10) Interpret studies in liver and renal transplant patients,
(11) Manage the US reading room and provide effective consultations for referring clinical residents and faculty, and
By the end of the third rotation (third year radiology residents), residents will be able to do the above plus:
(12) Interpret and report ultrasound findings in carotid arteries and transplant patients,
(13) Interpret and report upper and lower extremity mapping and other specialized vascular studies, and
(14) Perform US-guided biopsies with hands-off faculty supervision.
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VA (8 mo.) GI and GU contrast studies, placement of enteral feeding tubes, bone radiographs, emergency radiology cases, chest films, occasional arthrograms, interventional radiology, neuroangiography, neuroimaging studies, and ultrasound.
Goals: The purpose of this rotation is similar to the general float rotation and that is to simulate a private practice environment by performing and interpreting many different types of examinations. In general, the resident will be able to:
(1) Explain procedures and obtain informed consent from patients scheduled to undergo interventional radiologic procedures and demonstrate compassion and respect,
(2) Assist with the performance of all procedures,
(3) Interpret body and neuroimaging studies of increasing complexity,
(4) Protocol and supervise intravenous urograms,
(5) Perform and interpret contrast studies of the GI and GU tracts safely and appropriately in almost all patients with intermittent faculty supervision,
(6) Accurately interpret radiographs of the chest and skeleton in the majority of cases, and
(7) Work with the sonographers to assure that the ultrasound images they produce are diagnostic and appropriate for the clinical situation at hand,
(8) Detect and characterize abnormalities on ultrasound images,
(9) Perform Doppler ultrasound studies of the deep veins of the lower extremities without assistance,
(10) Perform ultrasound examinations of the abdomen and pelvis with little or no help from attending radiologist or sonographer,
(11) Notify referring clinicians of emergent or unexpected findings, and
(12) Manage the general radiology reading room and provide effective consultations for referring clinical residents and faculty.
Each month, the resident will be given progressive responsibility.
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Float (4 mo.) - This is a general radiology rotation on which the float resident covers the service assignment of a resident who is off duty for the day following a night on call. It consists of coverage of all other radiology resident rotations (except AFIP) in roughly equal amounts.
Goals: With each successive float rotation, the resident is expected to demonstrate gradually increasing ability to function effectively in diverse clinical settings that change from day to day, simulating the practice arrangement in many private practice groups. The specific goals are those listed under the individual rotations.
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Elective Rotations
Goals for elective rotations vary depending on the subspecialty area and whether the elective is primarily clinical or research in nature. Residents sometimes request non-routine elective assignments designed to provide them with experience in a particular area of interest. Faculty mentors work with residents to define the goals for these rotations on an individual basis.
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