STANFORD UNIVERSITY MEDICAL CENTER
|Rotation: Chest/Chest CT |Rotation Duration: 4 wks |Month(s): 4.6 (1 at VA) |
|Institution: Stanford/VA |Call Responsibility: none |Night(s): none |
|Responsible Faculty Member(s): |Location: Ballroom at Stanford, chest reading room at VA |
|Ann Leung, MD – Section Head | |
|Dominik Fleischmann, MD | |
|Frandics Chan, MD | |
|Margaret Lin, MD | |
|Gabriela Gayer MD (Visiting) | |
| |Phone Numbers: |
| |Stanford Hospital: |
| |Reading room: 3-6587, 3-1346, 5-8132 |
| |VA hospital: |
| |650-493-5000 (plus extension) |
| |front desk: 65959 |
| |reading room:6-3853, 6-7300, 6-3814, 6-0415 |
|Technologists/Technical Staff: |Training Level: |
|Janis Troeger RT – Day Shift Technical Supervisor |Years 1-3 |
|Elinor Tung RT – Technical Coordinator | |
|Goals & Objectives- |
|A note about goals and objectives- The goals and objectives outlined in this document are based upon the six core competencies as defined by the ACGME. As |
|residents gain experience and demonstrate growth in their ability to care for patients, they assume roles that permit them to exercise those skills with |
|greater independence. This concept—graded and progressive responsibility—is one of the core tenets of American graduate medical education. This document should|
|provide you a framework for the stepwise progression of your knowledge and skills. |
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|Rotation 1-STANFORD HOSPITAL chest x-ray |
|This rotation primarily involves interpretation of digital chest radiographs, mostly from inpatients and the ICU, but also chest CT as needed to support the |
|clinical workflow. |
| |
|Patient Care |
| |
|Goal |
| |
|Residents must be able to provide patient care that is compassionate, appropriate, and effective for the |
|treatment of health problems and the promotion of health. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Demonstrate knowledge of patient positioning and indications for posteroanterior (PA), anteroposterior (AP), lateral decubitus, and lordotic chest radiographs.|
|Demonstrate knowledge of exam specific radiation doses. |
|Demonstrate knowledge of indications for chest radiographs studies of pregnant patients. |
|Recognize the findings of life-threatening conditions and notify referring clinician without being prompted. |
|Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary. |
|Actively participate with faculty in interpretation and workup of patients. |
|Participate in radiation safety lectures. |
| |
|Skill Objectives: |
| |
|Become facile with Radwhere voice recognition, Centricity PACs and RIS, and EPIC. Utilize available information technology to manage patient information. |
|Gather clinical and radiologic data on patients with thoracic pathology. |
|Develop diagnostic plan based upon clinical presentation and imaging findings. |
|Accurately and concisely dictate a chest radiograph report using nomenclature recommended by the Fleischner Society. |
|Provide accurate and timely reports. |
|Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. |
|Conduct ICU rounds with the ICU team Monday through Friday from 11:30 AM to 12 PM. |
| |
|Behavior and Attitude Objectives: |
| |
|Work with the health care team in a professional manner to provide patient-centered care. |
|Notify referring clinician for urgent, emergent, or unexpected findings, and document time, date, and the person spoken to in the dictation. Utilize |
|appropriate summary codes. |
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| |
| |
|Medical Knowledge |
| |
|Goal |
| |
|Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the |
|application of this knowledge to patient care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Describe key points of each of the diagnoses. |
|Describe basic digital and conventional x-ray physics in the chest. |
|Identify relevant anatomic structures on radiographic and CT images of the chest. |
|Be familiar with the more common pathologic conditions in the upper abdomen and understanding their pathophysiology. |
|Learn indications and contraindications for lung biopsies. |
|Demonstrate learning of pathophysiology and imaging appearance of at least one quarter of the diagnoses listed in the appendix. |
|Demonstrate learning of at least one-quarter of the knowledge based objectives for chest plain films listed below: |
|Chest Plain Film: |
| |
|Understand standard positioning in thoracic radiology. |
|Identify normal anatomy and landmarks on frontal and lateral chest radiographs. |
|Know the expected course and possible complications of lines, tubes, and other devices. |
|Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum. |
|Recognize patterns of lobar atelectasis. |
|Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse coalescent, multifocal ill-defined, fine or coarse |
|reticular, and fine nodular opacities; multiple nodules and masses; solitary pulmonary nodule. |
|Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis. |
|Describe the divisions of the mediastinum and common pathologies affecting each division. |
|Recognize and give differential for hilar masses. |
|Recognize and give differential for pleural effusions, thickening, and calcifications. |
|Recognize and give differential for chest wall lesions. |
| |
|Skill Objectives: |
| |
|Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses |
|Demonstrate a clinically appropriate diagnostic workup plan |
|Demonstrate the ability to use all relevant information resources to acquire evidence based data |
|Accurately and concisely dictate chest radiograph reports. |
|Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT or MR may be necessary. |
|Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in thoracic radiology described in the detailed thoracic |
|curriculum. |
|List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and linear) of interstitial lung disease. |
|Separate pulmonary from pleural or extrapleural processes. |
| |
|Behavior and Attitude Objectives: |
| |
|Recognize limitations of personal competency and ask for guidance when appropriate. |
| |
| |
|Practice-Based Learning and Improvement |
| |
|Goal |
| |
|Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously |
|improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to: |
| |
|Knowledge Objectives: |
| |
|Assess chest x-ray images for quality and suggest methods of improvement. |
|Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. |
| |
|Skill Objectives: |
| |
|Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. |
|Facilitate the learning of students and other health care professionals. |
|Participation in case conferences. |
|Participation in the clinical activities of Thoracic Imaging Section. |
|Demonstrate critical assessment of the scientific literature. |
|Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. |
| |
|Behavior and Attitude Objectives: |
| |
|Incorporate formative feedback into daily practice, positively responding to constructive criticism. |
|Follow up on interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. |
|Help in teaching of technologists, medical students, housestaff, and other health care professionals. |
| |
| |
|Systems Based Practice |
| |
|Goal |
|Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call effectively on |
|other resources in the system to provide optimal health care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Understand how their image interpretation affects patient care. |
|Demonstrate ability to design cost-effective care plans. |
|Demonstrate knowledge of funding sources. |
|Demonstrate knowledge of reimbursement methods. |
|Demonstrate knowledge of regulatory environment. |
|Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision, and |
|management of staff. |
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|Skill Objectives: |
| |
|Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. |
|Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. |
|Practice using cost effective use of time and support personnel. |
|Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness |
|Criteria. |
|Participate in local and national radiological societies. |
|Participate in discussions with faculty regarding operational challenges and potential systems |
|solutions regarding all aspects of radiologic service and patient care. |
|Attend and participate in multi-disciplinary conference. |
|Interact and learn from department administrators. |
| |
|Behavior and Attitude Objectives: |
| |
|Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. |
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|Professionalism |
| |
|Goal |
| |
|Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to |
|demonstrate: |
| |
|Knowledge Objectives: |
| |
|Understanding of the need for respect for patient privacy and autonomy. Demonstrate principles of confidentiality with all information transmitted during a |
|patient encounter. |
|Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning to the |
|reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. If the resident will|
|be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate faculty and/or fellow. |
|Demonstrate knowledge of issues of impairment. |
|Discussion of above issues during daily clinical work. |
|Training programs and/or videotapes on harassment and discrimination. |
|Didactic presentations on “the impaired physician.” |
|Participation in hospital-based educational activities and independent learning. |
| |
|Skill Objectives: |
| |
|Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, |
|and sexual orientation. |
| |
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|Behavior and Attitude Objectives: |
| |
|Demonstrate respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. |
|Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout one’s career. |
|Demonstrate honesty with patients, support staff, and colleagues. |
|Demonstrate positive work habits, including punctuality, professional appearance and demeanor. |
|When assisting referring clinicians with imaging interpretation and patient management, decide when it is appropriate to obtain help from supervisory faculty. |
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| |
| |
| |
| |
| |
|Interpersonal and Communication Skills |
| |
|Goal |
| |
|Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their |
|families, and professional associates. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Know the importance of accurate, timely, and professional communication. |
| |
|Skill Objectives: |
| |
|Provide a clear, succinct report using nomenclature recommended by Fleischner Society. |
|Communicate effectively with physicians, other health professionals. In cases of serious or unanticipated findings, document that communication in report. |
|Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible complications. |
|Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to families, support personnel, and physicians. |
|Participate in daily ICU and weekly BMT work conferences. |
|Participate in Thoracic Tumor Board and Joint Chest conference. |
| |
|Behavior and Attitude Objectives: |
| |
|Work effectively as a member of the patient care team. |
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|Rotation 2-VA Hospital chest x-ray and chest CT |
|This rotation involves interpretation of digital chest radiographs, chest CT, and medical knowledge component of guided lung biopsies. Lung biopsies will be |
|performed in the interventional rotation. Continue to build on skills developed in the first rotation, including the core competencies described above. |
| |
|Patient Care |
| |
|Goal |
| |
|Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of |
|health. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Demonstrate knowledge of patient positioning and indications for posteroanterior (PA), anteroposterior (AP), lateral decubitus, and lordotic chest radiographs.|
|Demonstrate knowledge of exam specific radiation doses. |
|Demonstrate knowledge of indications for chest radiographs and thoracic CT studies of pregnant patients. |
|Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary. |
|Appropriately protocol all requests for chest CT to include thin-section images, high resolution images, expiratory images, or prone images when appropriate, |
|and use of intravenous contrast, given the patients history. |
|Demonstrate knowledge of CT parameters contribution to patient radiation exposure and techniques that can be used to limit radiation exposure. |
|Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT examination. |
|Recognize the radiographic findings of life-threatening conditions and notify referring clinician without being prompted. |
|Actively participate with faculty in interpretation and workup of patients. |
|Participate in radiation safety lectures. |
| |
|Skill Objectives: |
| |
|Provide accurate and timely reports on all cases with the supervision of faculty. |
|Accurately and concisely dictate chest radiograph and chest CT reports using nomenclature |
|recommended by the Fleischner Society. |
|Gather clinical and radiologic data on patients with thoracic pathology. |
|Develop diagnostic plan based upon clinical presentation and imaging findings. |
|Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. |
|Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation. |
| |
|Behavior and Attitude Objectives: |
|Work with the health care team in a professional manner to provide patient-centered care. |
|Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. |
| |
| |
| |
|Medical Knowledge |
| |
|Goal |
|Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the |
|application of this knowledge to patient care. Residents are expected to: |
| |
|Knowledge Objectives: |
|List key points of level appropriate diagnoses. |
|Describe intermediate level digital and conventional x-ray physics in the chest. |
|Identify relevant anatomic structures on CT images of the chest. |
|Be familiar with the more common pathologic conditions in the upper abdomen and understanding their pathophysiology. |
|Learn indications and contraindications for lung biopsies. |
|Demonstrate understanding of the pathophysiology and imaging appearance of at least one half of the |
|diagnoses listed in the appendix. |
|Demonstrate learning of at least one-half of the knowledge based objectives below: |
| |
|Chest Plain Film: |
|Understand standard positioning in thoracic radiology. |
|Identify normal anatomy and landmarks on frontal and lateral chest radiographs. |
|Know the expected course and possible complications of lines, tubes, and other devices. |
|Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum. |
|Recognize patterns of lobar atelectasis. |
|Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse coalescent, multifocal ill-defined, fine or coarse |
|reticular, and fine nodular opacities; multiple nodules and masses; solitary pulmonary nodule. |
|Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis. |
|Describe the divisions of the mediastinum and common pathologies affecting each division. |
|Recognize and give differential for hilar masses. |
|Recognize and give differential for pleural effusions, thickening, and calcifications. |
|Recognize and give differential for chest wall lesions. |
| |
|Chest CT: |
| |
|Understand standard CT protocols in thoracic radiology including the indications for intravenous contrast, low dose, HRCT, and airway protocols. Identify |
|normal cross-sectional anatomy of the thorax on CT, including mediastinal lymph node designations and bronchial anatomy. |
| |
|The resident should gain an understanding of: |
| |
|Mediastinal masses with differential based on location, morphology, and patient demographics. |
|The evaluation of the solitary pulmonary nodule. |
|The major histologic types of primary lung cancer and the new 7th UICC/AJCC staging system published in 2009. |
|Diffuse lung diseases that may demonstrate: linear or reticular opacities, including interlobular septal or intralobular interstitial thickening; nodular |
|opacities in a centrilobular, perilymphatic, or random distribution; ground glass; consolidation; cysts or emphysema. |
|The CT appearance of a variety of pulmonary infections, including those specific to the immunocompromised host. |
|The non-infectious complications of immunocompromised patients, including those of solid organ and bone marrow transplant recipients. |
|Diseases of the small and large airways. |
|Pulmonary hypertension and pulmonary vascular diseases. |
|Diseases of the pleura and chest wall. |
| |
|Skill Objectives: |
| |
|Continue to build on chest radiograph interpretive skills. |
|Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses. |
|Demonstrate a clinically appropriate diagnostic workup plan. |
|Demonstrate the ability to use all relevant information resources to acquire evidence based data |
|Accurately and concisely dictate chest radiograph reports. |
|Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT or MR may be necessary. |
|Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in thoracic radiology described in the detailed thoracic |
|curriculum. |
|List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and linear) of interstitial lung disease. |
|Separate pulmonary from pleural or extrapleural processes. |
|Correlate radiographic and chest CT findings. |
|Perform and interpret more complex post-processing (3D) images. |
| |
|Behavior and Attitude Objectives: |
| |
|Recognize limitations of personal competency and ask for guidance when appropriate. |
| |
| |
| |
|Practice-Based Learning and Improvement |
| |
|Goal |
|Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously |
|improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to: |
| |
| |
| |
|Knowledge Objectives: |
|Assess CT images for quality and suggest methods of improvement. |
|Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. |
| |
|Skill Objectives: |
|Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. |
|Facilitate the learning of students and other health care professionals. |
|Participation in case conferences. |
|Participation in the clinical activities of Thoracic Imaging Section. |
|Demonstrate critical assessment of the scientific literature. |
|Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. |
| |
|Behavior and Attitude Objectives: |
|Incorporate formative feedback into daily practice, positively responding to constructive criticism. |
|Follow up on interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. |
|Help in teaching of technologists, medical students, housestaff, and other health care professionals |
| |
| |
|Systems Based Practice |
| |
|Goal |
|Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call effectively on |
|other resources in the system to provide optimal health care. Residents are expected to: |
| |
|Knowledge Objectives: |
|Understand how their image interpretation affects patient care. |
|Demonstrate ability to design cost-effective care plans. |
|Demonstrate knowledge of funding sources. |
|Demonstrate knowledge of reimbursement methods. |
|Demonstrate knowledge of regulatory environment. |
|Demonstrate knowledge of intermediate level management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision,|
|and management of staff. |
| |
|Skill Objectives: |
|Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. |
|Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. |
|Practice using cost effective use of time and support personnel. |
|Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness |
|Criteria. |
|Participate in local and national radiological societies. |
|Participate in discussions with faculty regarding operational challenges and potential systems |
|solutions regarding all aspects of radiologic service and patient care. |
|Attend and participate in multi-disciplinary conference. |
|Interact and learn from department administrators. |
| |
| |
|Behavior and Attitude Objectives: |
|Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. |
| |
| |
|Professionalism |
| |
|Goal |
|Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to |
|demonstrate: |
| |
|Knowledge Objectives: |
|Understanding of the need for respect for patient privacy and autonomy. Demonstrate principles of confidentiality with all information transmitted during a |
|patient encounter. |
|Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning to the |
|reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. If the resident will|
|be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate faculty and/or fellow. |
|Knowledge of issues of impairment. |
|Discussion of above issues during daily clinical work. |
|Training programs and/or videotapes on harassment and discrimination. |
|Didactic presentations on “the impaired physician.” |
|Participation in hospital-based educational activities and independent learning. |
| |
|Skill Objectives: |
|Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, |
|and sexual orientation. |
| |
|Behavior and Attitude Objectives: |
|Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. |
|Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout one’s career. |
|Demonstrate honesty with patients, support staff, and colleagues. |
|Demonstrate positive work habits, including punctuality, professional appearance and demeanor. |
|When assisting referring clinicians with imaging interpretation and patient management, decide when it is appropriate to obtain help from supervisory faculty. |
| |
| |
|Interpersonal and Communication Skills |
| |
|Goal |
| |
|Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their |
|families, and professional associates. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Know the importance of accurate, timely, and professional communication. |
| |
|Skill Objectives: |
| |
|Provide a clear, succinct report using nomenclature recommended by Fleischner Society. |
|Communicate effectively with physicians, other health professionals. In cases of serious or unanticipated findings, document that communication in report. |
|Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible complications. |
|Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to families, support personnel, and physicians. |
|Participate in daily ICU and weekly BMT work conferences. |
|Participate in Thoracic Tumor Board and Joint Chest conference. |
| |
|Behavior and Attitude Objectives: |
| |
|Work effectively as a member of the patient care team. |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
|Rotations 3 and 4-Stanford Hospital chest CT-2nd and 3rd year |
|This rotation involves interpretation of chest CT, and also chest x-rays when needed to support the workflow. Continue to integrate and refine skills from the|
|first two rotations, developing more autonomy. |
| |
| |
|Patient Care |
| |
|Goal |
| |
|Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of |
|health. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Appropriately protocol all requests for chest CT to include thin-section images, high resolution images, expiratory images, or prone images when appropriate, |
|and use of intravenous contrast, given the patients history. |
|Demonstrate knowledge of CT parameters contribution to patient radiation exposure and techniques that can be used to limit radiation exposure. |
|Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT examination. |
|Recognize the radiographic findings of life-threatening conditions and notify referring clinician without being prompted. |
|Demonstrate knowledge of patient positioning and indications for posteroanterior (PA), anteroposterior (AP), lateral decubitus, and lordotic chest radiographs.|
|Demonstrate knowledge of exam specific radiation doses. |
|Demonstrate knowledge of indications for chest radiographs and thoracic CT studies of pregnant patients. |
|Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary. |
|Active participation with faculty in interpretation and workup of patients. |
|Participation in radiation safety lectures |
| |
|Skill Objectives: |
| |
|Provide accurate and timely reports on all cases with the supervision of faculty. |
|Accurately and concisely dictate chest radiograph and chest CT reports using nomenclature |
|recommended by the Fleischner Society. |
|Gather clinical and radiologic data on patients with thoracic pathology. |
|Develop diagnostic plan based upon clinical presentation and imaging findings. |
|Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. |
|Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation. |
| |
|Behavior and Attitude Objectives: |
| |
|Work with the health care team in a professional manner to provide patient-centered care. |
|Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. |
| |
| |
|Medical Knowledge |
| |
|Goal |
| |
|Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the |
|application of this knowledge to patient care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|List key points of level appropriate diagnoses. |
|Describe advanced level digital and conventional x-ray physics in the chest. |
|Identify relevant anatomic structures on CT images of the chest. |
|Be familiar with the more common pathologic conditions in the upper abdomen and understanding their pathophysiology. |
|Learn indications and contraindications for lung biopsies. |
|Demonstrate understanding of the pathophysiology and imaging appearance of at least three quarters of the diagnoses listed in the appendix. |
|Demonstrate learning of at least three-quarters of the knowledge based objectives below. |
| |
|Chest Plain Film: |
| |
|Understand standard positioning in thoracic radiology. |
|Identify normal anatomy and landmarks on frontal and lateral chest radiographs. |
|Know the expected course and possible complications of lines, tubes, and other devices. |
|Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum. |
|Recognize patterns of lobar atelectasis. |
|Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse coalescent, multifocal ill-defined, fine or coarse |
|reticular, and fine nodular opacities; multiple nodules and masses; solitary pulmonary nodule. |
|Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis. |
|Describe the divisions of the mediastinum and common pathologies affecting each division. |
|Recognize and give differential for hilar masses. |
|Recognize and give differential for pleural effusions, thickening, and calcifications. |
|Recognize and give differential for chest wall lesions. |
| |
|Chest CT: |
| |
|Understand standard CT protocols in thoracic radiology including the indications for intravenous contrast, low dose, HRCT, and airway protocols. Identify |
|normal cross-sectional anatomy of the thorax on CT, including mediastinal lymph node designations and bronchial anatomy. |
| |
|The resident should gain an understanding of: |
| |
|Mediastinal masses with differential based on location, morphology, and patient demographics. |
|The evaluation of the solitary pulmonary nodule. |
|The major histologic types of primary lung cancer and the new 7th UICC/AJCC staging system published in 2009. |
|Diffuse lung diseases that may demonstrate: linear or reticular opacities, including interlobular septal or intralobular interstitial thickening; nodular |
|opacities in a centrilobular, perilymphatic, or random distribution; ground glass; consolidation; cysts or emphysema. |
|The CT appearance of a variety of pulmonary infections, including those specific to the immunocompromised host. |
|The non-infectious complications of immunocompromised patients, including those of solid organ and bone marrow transplant recipients. |
|Diseases of the small and large airways. |
|Pulmonary hypertension and pulmonary vascular diseases. |
|Diseases of the pleura and chest wall. |
| |
|Skill Objectives: |
| |
|Continue to build on chest radiograph interpretive skills. |
|Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses. |
|Demonstrate a clinically appropriate diagnostic workup plan. |
|Demonstrate the ability to use all relevant information resources to acquire evidence-based data. |
|Accurately and concisely dictate chest radiograph reports. |
|Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT or MR may be necessary. |
|Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in thoracic radiology described in the detailed thoracic |
|curriculum. |
|List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and linear) of interstitial lung disease. |
|Separate pulmonary from pleural or extrapleural processes. |
|Correlate radiographic and chest CT findings. |
|Perform and interpret more complex post-processing (3D) images. |
| |
| |
| |
|Behavior and Attitude Objectives: |
| |
|Recognize limitations of personal competency and ask for guidance when appropriate. |
| |
| |
|Practice-Based Learning and Improvement |
| |
|Goal |
|Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously |
|improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to: |
| |
|Knowledge Objectives: |
|Assess CT images for quality and suggest methods of improvement. |
|Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. |
| |
|Skill Objectives: |
|Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. |
|Facilitate the learning of students and other health care professionals. |
|Participate in case conferences. |
|Participate in the clinical activities of Thoracic Imaging Section. |
|Demonstrate critical assessment of the scientific literature. |
|Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. |
| |
|Behavior and Attitude Objectives: |
|Incorporate formative feedback into daily practice, positively responding to constructive criticism. |
|Follow up on interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. |
|Help in teaching of technologists, medical students, housestaff, and other health care professionals. |
| |
| |
|Systems Based Practice |
| |
|Goal |
|Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call effectively on |
|other resources in the system to provide optimal health care. Residents are expected to: |
| |
| |
| |
| |
|Knowledge Objectives: |
|Understand how their image interpretation affects patient care. |
|Demonstrate ability to design cost-effective care plans. |
|Demonstrate knowledge of funding sources. |
|Demonstrate knowledge of reimbursement methods. |
|Demonstrate knowledge of regulatory environment. |
|Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision, and |
|management of staff. |
| |
|Skill Objectives: |
|Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. |
|Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. |
|Practice using cost effective use of time and support personnel. |
|Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness |
|Criteria. |
|Membership and participation in local and national radiological societies. |
|Participate in discussions with faculty regarding operational challenges and potential systems solutions regarding all aspects of radiologic service and |
|patient care. |
|Attendance and participation in multi-disciplinary conference. |
|Interact and learn from department administrators. |
| |
|Behavior and Attitude Objectives: |
|Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. |
| |
| |
|Professionalism |
| |
|Goal |
|Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to |
|demonstrate: |
| |
|Knowledge Objectives: |
|Understanding of the need for respect for patient privacy and autonomy. |
|Principles of confidentiality with all information transmitted during a patient encounter. |
|Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning to the |
|reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. If the resident will|
|be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate faculty and/or fellow. |
|Knowledge of issues of impairment. |
|Discussion of above issues during daily clinical work. |
|Training programs and/or videotapes on harassment and discrimination. |
|Didactic presentations on “the impaired physician.” |
|Participation in hospital-based educational activities and independent learning. |
| |
|Skill Objectives: |
|Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, |
|and sexual orientation. |
| |
|Behavior and Attitude Objectives: |
|Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. |
|Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout one’s career. |
|Demonstrate honesty with patients, support staff, and colleagues. |
|Demonstrate positive work habits, including punctuality, professional appearance and demeanor. |
|When assisting referring clinicians with imaging interpretation and patient management, decide when it is appropriate to obtain help from supervisory faculty. |
| |
| |
|Interpersonal and Communication Skills |
| |
|Goal |
|Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their |
|families, and professional associates. Residents are expected to: |
| |
|Knowledge Objectives: |
|Know the importance of accurate, timely, and professional communication. |
| |
|Skill Objectives: |
|Provide a clear, succinct report using nomenclature recommended by Fleischner Society. |
|Communicate effectively with physicians, other health professionals. In cases of serious or unanticipated findings, document that communication in report. |
|Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible complications. |
|Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to families, support personnel, and physicians. |
|Participate in daily ICU and weekly BMT work conferences. |
|Participate in Thoracic Tumor Board and Joint Chest conference. |
| |
|Behavior and Attitude Objectives: |
|Work effectively as a member of the patient care team. |
| |
| |
| |
| |
| |
| |
|Rotation 5-Stanford chest x-ray-third-year |
|This rotation involves interpretation of digital chest radiographs, chest CT, and medical knowledge component of guided lung biopsies. Lung biopsies will be |
|performed in the interventional rotation. |
|Residents should focus on the integration of all previous chest rotations to concentrate on becoming an effective, independent consultant and teacher. |
| |
| |
|Patient Care |
| |
|Goal |
|Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of |
|health. Residents are expected to: |
| |
|Knowledge Objectives: |
|Appropriately protocol all requests for chest CT to include thin-section images, high resolution images, expiratory images, or prone images when appropriate, |
|and use of intravenous contrast, given the patients history. |
|Demonstrate knowledge of CT parameters contribution to patient radiation exposure and techniques that can be used to limit radiation exposure. |
|Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT examination. |
|Recognize the radiographic findings of life-threatening conditions and notify referring clinician without being prompted. |
|Demonstrate knowledge of patient positioning and indications for posteroanterior (PA), anteroposterior (AP), lateral decubitus, and lordotic chest radiographs.|
|Demonstrate knowledge of exam specific radiation doses. |
|Demonstrate knowledge of indications for chest radiographs and thoracic CT studies of pregnant patients. |
|Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary. |
|Actively participate with faculty in interpretation and workup of patients. |
|Participate in radiation safety lectures. |
| |
|Skill Objectives: |
|Provide accurate and timely reports on all cases with the supervision of faculty. |
|Accurately and concisely dictate chest radiograph and chest CT reports using nomenclature |
|recommended by the Fleischner Society. |
|Gather clinical and radiologic data on patients with thoracic pathology. |
|Develop diagnostic plan based upon clinical presentation and imaging findings. |
|Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. |
|Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation. |
| |
| |
|Behavior and Attitude Objectives: |
|Work with the health care team in a professional manner to provide patient-centered care. |
|Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. |
| |
| |
|Medical Knowledge |
| |
|Goal |
| |
|Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the |
|application of this knowledge to patient care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|List key points of level appropriate diagnoses. |
|Describe advanced level digital and conventional x-ray physics in the chest. |
|Identify relevant anatomic structures on CT images of the chest. |
|Be familiar with the more common pathologic conditions in the upper abdomen and understanding their pathophysiology. |
|Learn indications and contraindications for lung biopsies. |
|Demonstrate understanding of the pathophysiology and imaging appearance of all of the diagnoses listed in the appendix. |
|Demonstrate learning of all of the knowledge based objectives below. |
| |
|Chest Plain Film: |
| |
|Understand standard positioning in thoracic radiology. |
|Identify normal anatomy and landmarks on frontal and lateral chest radiographs. |
|Know the expected course and possible complications of lines, tubes, and other devices. |
|Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum. |
|Recognize patterns of lobar atelectasis. |
|Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse coalescent, multifocal ill-defined, fine or coarse |
|reticular, and fine nodular opacities; multiple nodules and masses; solitary pulmonary nodule. |
|Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis. |
|Describe the divisions of the mediastinum and common pathologies affecting each division. |
|Recognize and give differential for hilar masses. |
|Recognize and give differential for pleural effusions, thickening, and calcifications. |
|Recognize and give differential for chest wall lesions. |
| |
|Chest CT: |
| |
|Understand standard CT protocols in thoracic radiology including the indications for intravenous contrast, low dose, HRCT, and airway protocols. Identify |
|normal cross-sectional anatomy of the thorax on CT, including mediastinal lymph node designations and bronchial anatomy. |
| |
|The resident should gain an understanding of: |
|Mediastinal masses with differential based on location, morphology, and patient demographics. |
|The evaluation of the solitary pulmonary nodule. |
|The major histologic types of primary lung cancer and the new 7th UICC/AJCC staging system published in 2009. |
|Diffuse lung diseases that may demonstrate: linear or reticular opacities, including interlobular septal or intralobular interstitial thickening; nodular |
|opacities in a centrilobular, perilymphatic, or random distribution; ground glass; consolidation; cysts or emphysema. |
|The CT appearance of a variety of pulmonary infections, including those specific to the immunocompromised host. |
|The non-infectious complications of immunocompromised patients, including those of solid organ and bone marrow transplant recipients. |
|Diseases of the small and large airways. |
|Pulmonary hypertension and pulmonary vascular diseases. |
|Diseases of the pleura and chest wall. |
| |
|Skill Objectives: |
| |
|Continue to build on chest radiograph interpretive skills. |
|Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses. |
|Demonstrate a clinically appropriate diagnostic workup plan. |
|Demonstrate the ability to use all relevant information resources to acquire evidence based data |
|Accurately and concisely dictate chest radiograph reports. |
|Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT or MR may be necessary. |
|Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in thoracic radiology described in the detailed thoracic |
|curriculum. |
|List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and linear) of interstitial lung disease. |
|Separate pulmonary from pleural or extrapleural processes. |
|Correlate radiographic and chest CT findings |
|Perform and interpret more complex post-processing (3D) images. |
| |
|Behavior and Attitude Objectives: |
| |
|Recognize limitations of personal competency and ask for guidance when appropriate. |
| |
| |
|Practice-Based Learning and Improvement |
| |
|Goal |
| |
|Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously |
|improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to: |
| |
| |
| |
|Knowledge Objectives: |
| |
|Assess CT images for quality and suggest methods of improvement. |
|Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. |
| |
|Skill Objectives: |
| |
|Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. |
|Facilitate the learning of students and other health care professionals. |
|Participate in case conferences. |
|Participate in the clinical activities of Thoracic Imaging Section. |
|Demonstrate critical assessment of the scientific literature. |
|Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. |
| |
|Behavior and Attitude Objectives: |
| |
|Incorporate formative feedback into daily practice, positively responding to constructive criticism. |
|Follow up on interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. |
|Help in teaching of technologists, medical students, housestaff, and other health care professionals. |
| |
| |
|Systems Based Practice |
| |
|Goal |
| |
|Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call effectively on |
|other resources in the system to provide optimal health care. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Understand how their image interpretation affects patient care. |
|Demonstrate ability to design cost-effective care plans. |
|Demonstrate knowledge of funding sources. |
|Demonstrate knowledge of reimbursement methods. |
|Demonstrate knowledge of regulatory environment. |
|Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision, and |
|management of staff. |
| |
|Skill Objectives: |
| |
|Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. |
|Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. |
|Practice using cost effective use of time and support personnel. |
|Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness |
|Criteria. |
|Participate in local and national radiological societies. |
|Participate in discussions with faculty regarding operational challenges and potential systems |
|solutions regarding all aspects of radiologic service and patient care. |
|Attend and participate in multi-disciplinary conference. |
|Interact and learn from department administrators. |
| |
|Behavior and Attitude Objectives: |
| |
|Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. |
| |
| |
|Professionalism |
| |
|Goal |
| |
|Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to |
|demonstrate: |
| |
|Knowledge Objectives: |
| |
|Understanding of the need for respect for patient privacy and autonomy. |
|Principles of confidentiality with all information transmitted during a patient encounter. |
|Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning to the |
|reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. If the resident will|
|be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate faculty and/or fellow. |
|Knowledge of issues of impairment. |
|Discussion of above issues during daily clinical work. |
|Training programs and/or videotapes on harassment and discrimination. |
|Didactic presentations on “the impaired physician.” |
|Participation in hospital-based educational activities and independent learning. |
| |
| |
| |
|Skill Objectives: |
| |
|Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, |
|and sexual orientation. |
| |
|Behavior and Attitude Objectives: |
| |
|Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. |
|Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout one’s career. |
|Demonstrate honesty with patients, support staff, and colleagues. |
|Demonstrate positive work habits, including punctuality, professional appearance and demeanor. |
|When assisting referring clinicians with imaging interpretation and patient management, decide when it is appropriate to obtain help from supervisory faculty. |
| |
|Interpersonal and Communication Skills |
| |
|Goal |
|Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their |
|families, and professional associates. Residents are expected to: |
| |
|Knowledge Objectives: |
| |
|Know the importance of accurate, timely, and professional communication. |
| |
|Skill Objectives: |
| |
|Provide a clear, succinct report using nomenclature recommended by Fleischner Society |
|Communicate effectively with physicians, other health professionals. In cases of serious or unanticipated findings, document that communication in report. |
|Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible complications. |
|Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to families, support personnel, and physicians. |
|Participate in daily ICU and weekly BMT work conferences. |
|Participate in Thoracic Tumor Board and Joint Chest conference. |
| |
|Behavior and Attitude Objectives: |
| |
|Work effectively as a member of the patient care team. |
| |
| |
|Workflow and Duties: |
| |
|During each rotation, a resident is expected to: |
|Wear hospital identification |
|Arrive by 8:30 am for work on the chest service |
|May leave after ICU conference for noon conference |
|Return by 1:15 pm from conference |
|Notify section head or attending of day for scheduled absences on rotation |
|Preview studies to be read during the morning read-out |
|Participate in the weekly Thoracic Tumor Board |
|Participate in the monthly ILD conference |
|Participate in the monthly Joint Chest Conference |
|Dictate all radiographic and CT studies of inpatients and SMIC/SMOC outpatients before the end of the day |
| |
| |
| |
|Conference Schedule/Format |
|Title |Day |Time |Location |
|Resident conferences |Fridays |12:00 |Lucas |
|Chest-CVI | | | |
|ICU conference |Daily |11:30 |Ballroom |
|Thoracic tumor board |Tuesdays |2:00 |Cancer center, clinic A |
|Interstitial Lung Disease |Fridays |Monthly at 4:00 |Cancer Center, clinic A |
|Joint chest conference |Wednesdays |Monthly |Pulmonary division |
|Method of Assessment of Performance: |
|Written evaluation of resident by responsible faculty member monthly |
|Verbal feedback to resident by faculty |
|ACR In-Training Service Exam annually |
|Recommended Reading |
|First Rotation |
|Reed. Chest Radiology: Plain Film Patterns and Differential Diagnoses |
|Collins and Stern. Chest Radiology: The Essentials. |
|Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2008; 246(3): 697 – 722. |
|Second Rotation |
|Kazerooni & Gross, Cardiopulmonary Imaging |
|Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2008; 246(3): 697 – 722. |
|Third and Fourth Rotations |
|Naidich et al. Computed Tomography and Magnetic Resonance Imaging of the Thorax |
|Webb et al. High Resolution CT of the Lung. |
APPENDIX :
|Lung | | | | |
| |Airspace | | | |
| | |Congenital | |
| | | |1 |Hamartoma, Airway |
| | | |2 |Cystic Adenomatoid Malformation |
| | |Infectiouis | |
| | | |3 |Pneumonia Bacterial |
| | | |4 |Pneumonia, Community Acquired |
| | | |5 |Immunocompromised Pneumonia |
| | | |6 |Pneumonia, Staphylococcus |
| | | |7 |Pneumonia, Mycobacterial |
| | | |8 |Abscess, Lung |
| | | |9 |Fungal, Histoplasmosis |
| | | |10 |Fungal, Aspergillosis |
| | | |11 |Fungal, Blastomycosis |
| | | |12 |Fungal, Coccidioidomycosis |
| | |Vascular | | |
| | | |13 |Cardiogenic Pulmonary Edema |
| | | |14 |Noncardiac Pulmonary Edema |
| | | |15 |Embolism, Fat Pulmonary |
| | | |16 |Diffuse Alveolar Hemorrhage |
| | | |17 |Churg-Strauss Syndrome |
| | |Inflammatory - Degenerative |
| | | |18 |Eosinophilic Pneumonia |
| | |Toxic - Metabolic | |
| | | |19 |Metastatic Pulmonary Calcification |
| | | |20 |Alveolar Microlithiasis |
| | | |21 |Lipoid Pneumonia |
| | | |22 |Pulmonary Alveolar Proteinosis |
| | | |23 |Desquamative Interstitial Pneumonia |
| | | |24 |Illicit Drug Use, Pulmonary Manifestations |
| | | |25 |Cryptogenic Organizing Pneumonia |
| | | |26 |Smoke Inhalation |
| | | |27 |Emphysema, Paraseptal |
| | |Neoplastic | |
| | | |28 |Bronchioloalveolar Cell Carcinoma |
| |Interstitium | | |
| | |Infectious | |
| | | |29 |Pneumonia, Viral |
| | | |30 |Pneumonia, Pneumocystis |
| | |Inflammatory - Degenerative |
| | | |31 |Sarcoidosis, Lymphadenopathy |
| | | |32 |Idiopathic Pulmonary Fibrosis |
| | | |33 |Hypersensitivity Pneumonitis |
| | | |34 |Rheumatoid Arthritis |
| | | |35 |Scleroderma |
| | | |36 |Polymyositis - Dermatomyositis |
| | | |37 |Nonspecific Interstitial Pneumonia |
| | |Toxic - Metabolic | |
| | | |38 |Asbestosis |
| | | |39 |Silicosis - Coal Worker Pneumoconiosis |
| | | |40 |Hard Metal Pneumoconiosis |
| | |Neoplastic | |
| | | |41 |Lymphangitic Carcinomatosis |
| | | |42 |Lymphangiomatosis |
| | | |43 |Lymphocytic Interstitial Pneumonia |
| | |Congenital | |
| |Airways | | | |
| | |Congenital | |
| | | |44 |Cystic Fibrosis |
| | | |45 |Tracheobronchomegaly |
| | | |46 |Immotile Cilia Syndrome |
| | | |47 |Bronchial Atresia |
| | | |48 |Alpha-1 Antiprotease Deficiency |
| | | |49 |Paratracheal Air Cyst |
| | | |50 |Williams-Campbell Syndrome |
| | |Infectiouis | |
| | | |51 |Bronchitis, Chronic |
| | | |52 |Chronic Obstructive Pulmonary Disease |
| | | |53 |Bronchiectasis |
| | | |54 |Laryngeal Papillomatosis |
| | | |55 |Mycobacterial Avium Complex |
| | | |56 |Bronchiolitis |
| | |Inflammatory - Degenerative |
| | | |57 |Allergic Bronchopulmonary Aspergillosis |
| | | |58 |Emphysema, Panlobular |
| | | |59 |Tracheobronchomalacia |
| | | |60 |Relapsing Polychondritis |
| | | |61 |Middle Lobe Syndrome |
| | | |62 |Saber-Sheath Trachea |
| | | |63 |Bronchiolitis Obliterans |
| | | |64 |Asthma |
| | | |65 |Pneumatoceles |
| | |Toxic - Metabolic | |
| | | |66 |Langerhans Cell Histiocytosis, Pulmonary |
| | | |67 |Bronchiolitis, Respiratory |
| | | |68 |Emphysema, Centrilobular |
| | | |69 |Amyloidosis |
| | |Neoplastic | |
| | | |70 |Tracheopathia Osteochondroplastica |
| | | |71 |Carcinoid |
| | | |72 |Kaposi Sarcoma |
| | | |73 |Tracheal Neoplasms |
| | | |74 |Endobronchial Tumor |
|Mediastinum | | | |
| |Mediastinum | | |
| | |Congenital | |
| | | |75 |Bronchogenic Cyst |
| | | |76 |Meningocele, Lateral |
| | | |77 |Pulmonary Bronchogenic Cyst |
| | |Infectious | |
| | | |78 |Mediastinal Abscess |
| | | |79 |Mediastinitis |
| | |Inflammatory - Degenerative |
| | | |80 |Mediastinal Fibrosis |
| | | |81 |Achalasia |
| | | |82 |Esophageal Diverticuli |
| | | |83 |Hernias, Hiatal and Paraesophageal |
| | |Neoplastic | |
| | | |84 |Goiter, Mediastinum |
| | | |85 |Lymphoma, Hodgkin, Pulmonary |
| | | |86 |Lymphoma, Non-Hodgkin |
| | | |87 |Thymoma |
| | | |88 |Germ Cell Tumors |
| | | |89 |Lipomatosis |
| | | |90 |Castleman Disease |
| | | |91 |Nerve Sheath Tumors |
| | | |92 |Sympathetic Ganglion Tumors, Mediastinum |
| | | |93 |Extramedullary Hematopoiesis |
| | |Vascular | | |
| | | |94 |Varices |
| |Aorta and Great Vessels | |
| | |Congenital | |
| | | |95 |Right Aortic Arch |
| | | |96 |Aberrant Subclavian |
| | | |97 |Aortic Coarctation |
| | | |98 |Intralobar Sequestration |
| | | |99 |Left Superior Vena Cava |
| | | |100 |Azygos Continuation of IVC |
| | | |101 |Azygos Fissure |
| | |Infammatory - Degenerative |
| | | |102 |Ductus Diverticulum |
| | | |103 |Aortic Atherosclerosis |
| | | |104 |Marfan Syndrome |
| | | |105 |Aortic Dissection |
| | | |106 |Aortic Aneurysm |
| | | |107 |Takayasu Arteritis |
| | | |108 |SVC Syndrome |
| |Heart and Pericardium | |
| | |Congenital | |
| | | |109 |Partial Absence Pericardium |
| | | |110 |Heterotaxy Syndrome |
| | | |111 |Pericardial Cyst |
| | |Inflammatory - Degenerative |
| | | |112 |Coronary Artery Calcification |
| | | |113 |Left Atrial Calcification |
| | | |114 |Ventricular Calcification |
| | | |115 |Valve and Annular Calcification |
| | | |116 |Aortic Valve Dysfunction |
| | | |117 |Mitral Valve Dysfunction |
| | | |118 |Constrictive Pericarditis |
| | |Toxic - Metabolic | |
| | |Neoplastic | |
| | | |119 |Left Atrial Myxoma |
| | | |120 |Metastases, Pericardium |
| |Pulmonary Vasculature | |
| | |Congenital | |
| | | |121 |Arteriovenous Malformation, Pulmonary |
| | | |122 |Partial Anomalous Venous Return |
| | | |123 |Scimitar Syndrome |
| | | |124 |Idiopathic Pulmonary Artery Dilatation |
| | | |125 |Congenital Interruption Pulmonary Artery |
| | |Infectious | |
| | | |126 |Septic Emboli, Pulmonary |
| | |Inflammatory - Degenerative |
| | | |127 |Vasculitis, Pulmonary |
| | | |128 |Wegener Granulomatosis, Airway |
| | | |129 |Veno-Occlusive Disease |
| | |Toxic - Metabolic | |
| | | |130 |Talcosis, Pulmonary Manifestations |
| | | |131 |Illicit Drug Abuse |
| | | |132 |Silo-Filler's Disease |
| | |Vascular | | |
| | | |133 |Pulmonary Emboli |
| | | |134 |Neurogenic Pulmonary Edema |
| | | |135 |Pulmonary Artery Hypertension |
| | | |136 |Aneurysm, Pulmonary Artery |
| | | |137 |High Altitude Pulmonary Edema |
| | |Neoplastic | |
| | | |138 |Pulmonary Artery Sarcoma |
| | | |139 |Embolism, Tumor |
| |Remove | | | |
|Pleura - Chest Wall - Diaphragm | |
| |Pleura | | | |
| | |Congenital | |
| | |Inflammatory - Degenerative |
| | | |140 |Pleural Effusion, Exudative |
| | | |141 |Apical Cap |
| | | |142 |Systemic Lupus Erythematosus |
| | |Infectious | |
| | | |143 |Empyema |
| | | |144 |Bronchopleural Fistula |
| | |Neoplastic | |
| | | |145 |Metastasis, Pleural |
| | | |146 |Malignant Mesothelioma |
| | | |147 |Pancoast Tumor |
| | | |148 |Localized Fibrous Tumor of the Pleura |
| | | |149 |Pneumothorax, Catamenial |
| | |Vascular | | |
| | | |150 |Transudative Pleural Effusion |
| | |Toxic - Metabolic | |
| | | |151 |Asbestos Related Pleural Disease |
| |Chest Wall | | |
| | |Congenital | |
| | | |152 |Pectus Deformity |
| | | |153 |Kyphoscoliosis |
| | | |154 |Poland Syndrome |
| | |Infectious | |
| | | |155 |Empyema Necessitatis |
| | |Inflammatory - Degenerative |
| | | |156 |Ankylosing Spondylitis |
| | |Neoplastic | |
| | | |157 |Lipoma, Chest Wall |
| | | |158 |Lymphoma, Chest Wall |
| | | |159 |Askin Tumor |
| |Diaphragm | | |
| | |Congenital | |
| | | |160 |Eventration of Diaphragm |
| | | |161 |Hernias, Bochdalek and Morgagni |
| | |Inflammatory - Degenerative |
| | | |162 |Phrenic Nerve Paralysis |
|Special Topics | | | |
| |Atelectasis | | |
| | | |163 |Atelectasis, Lobar |
| | | |164 |Atelectasis, Subsegmental |
| | | |165 |Atelectasis, Round |
| |Trauma | | | |
| | | |166 |Pneumomediastinum |
| | | |167 |Pneumothorax, Traumatic |
| | | |168 |Tracheobronchial Tear |
| | | |169 |Lung Contusion |
| | | |170 |Aortic Transection |
| | | |171 |Rib Fractures and Flail Chest |
| | | |172 |Spinal Fracture, Thoracic |
| | | |173 |Diaphragmatic Rupture |
| | | |174 |Sternal Fracture |
| | | |175 |Esophageal Rupture |
| | | |176 |Splenosis, Thoracic |
| | | |177 |Hemothorax, Traumatic |
| |Lung Cancer | | |
| | | |178 |Lung Cancer, Non-Small Cell |
| | | |179 |Lung Cancer, Small Cell |
| | | |180 |Lung Cancer, Staging |
| | | |181 |Lung Cancer, Regional Lymph Node Classification |
| | | |182 |Solitary Pulmonary Nodule |
| | | |183 |Lung Cancer, Missed |
| |Portable ICU | | |
| | |Non-Surgical | |
| | | |184 |Tubes and Catheters, Abnormal |
| | | |185 |Tubes and Catheters, Normal |
| | | |186 |Cardiac Pacemakers |
| | | |187 |Pleurodesis |
| | |Surgical | | |
| | | |188 |Median Sternotomy |
| | | |189 |Pneumonectomy, Extrapleural |
| | | |190 |Post-Transplant Lymphoproliferative Disease (PTLD) |
| | | |191 |Lung Transplantation |
| | | |192 |Transplantation, Lung |
| |Physiology | | |
| | | |193 |Aspiration |
| |Special Patients | | |
| | | |194 |Metastases, Lung |
| | | |195 |Drug Reaction, Intrathoracic |
| | | |196 |Radiation-Induced Lung Disease |
| | | |197 |Immunosuppressed (Not AIDS) |
| | | |198 |HIV/AIDS |
|Added in Connection with DI2 | |
| |Overview | | |
| | | |199 |Wegener Granulomatosis, Pulmonary |
| | | |200 |Silhouette |
| | | |201 |Hilum Overlay |
| | | |202 |Hilum Convergence |
| | | |203 |S-Sign of Golden |
| | | |204 |Cervicothoracic Sign |
| | | |205 |Incomplete Border |
| | | |206 |Pad Sign |
| | | |207 |Luftsichel Sign |
| | | |208 |Air Crescent Sign |
| | | |209 |CT Angiogram Sign |
| | | |210 |CT Halo Sign |
| | | |211 |Reverse Halo Sign |
| | | |212 |Atelectasis, Cicatricial |
| | | |213 |Atelectasis, Right Upper Lobe |
| | | |214 |Atelectasis, Middle Lobe |
| | | |215 |Atelectasis, Right Lower Lobe |
| | | |216 |Atelectasis, Complete Lung |
| | | |217 |Atelectasis, Left Upper Lobe |
| | | |218 |Atelectasis, Left Lower Lobe |
| |Volume Loss | | |
| |Developmental Abnormalities |
| | | |219 |Congenital Lobar Emphysema |
| | | |220 |Congenital Pulmonary Airway Malformation |
| | | |221 |Isomerism |
| | | |222 |Extralobar Sequestration |
| | | |223 |Double Aortic Arch |
| | | |224 |Atrial Septal Defect |
| | | |225 |Ventricular Septal Defect |
| | | |226 |Pulmonary Varix |
| | | |227 |Bicuspid Aortic Valve |
| | | |228 |Anomalous Pulmonary Venous Return |
| | | |229 |Morgagni Hernia |
| | | |230 |Bochdalek Hernia |
| | | |231 |Congenital Diaphragmatic Hernia |
| | | |232 |Lymphangioleiomyomatosis |
| |Airway Diseases | | |
| | | |233 |Squamous Cell Carcinoma, Airways |
| | | |234 |Adenoid Cystic Carcinoma |
| | | |235 |Mucoepidermoid Carcinoma |
| | | |236 |Metastasis, Airways |
| | | |237 |Tracheal Stenosis |
| | | |238 |Broncholithiasis |
| | | |239 |Swyer-James-McLeod |
| | | |240 |Bronchiolitis, Constrictive |
| | | |241 |Amyloidosis, Airways |
| | | |242 |Primary Ciliary Dyskinesia |
| | | |243 |Mounier-Kuhn Syndrome |
| |Infections | | |
| | | |244 |Pneumonia, Pneumococcal |
| | | |245 |MRSA |
| | | |246 |Pneumonia, Legionella |
| | | |247 |Nocardiosis |
| | | |248 |Tuberculosis, Post-Primary |
| | | |249 |Nontuberculous Mycobacterial Infection |
| | | |250 |Mycoplasma Pneumonia |
| | | |251 |Community Acquired Pneumonia |
| | | |252 |Influenza Pneumonia |
| | | |253 |Cytomegalovirus Pneumonia |
| | | |254 |Cryptococcosis |
| | | |255 |Pneumocystis, Jirovecii Pneumonia |
| |Pulmonary Neoplasms | |
| | | |256 |Preinvasive Adenocarcinoma |
| | | |257 |Invasive Adenocarcinoma |
| | | |258 |Squamous Cell Carcinoma |
| | | |259 |Hamartoma, Pulmonary |
| | | |260 |Neuroendocrine Carcinoma |
| | | |261 |Nodular Lymphoid Hyperplasia |
| | | |262 |Lung Cancer, Resectable |
| | | |263 |Lung Cancer, Unresectable |
| | | |264 |Bronchiolitis, Follicular |
| |Interstitial, Diffuse, and Inhalational Lung Disease |
| | | |265 |Acute Eosinophilic Pneumonia |
| | | |266 |Chronic Eosinophilic Pneumonia |
| | | |267 |Neurofibromatosis |
| | | |268 |Sarcoidosis |
| | | |269 |Farmer's Lung |
| |Connective Tissue Disorders, Immunological Diseases, and Vasculitis |
| | | |270 |Mixed Connective Tissue Disease |
| | | |271 |Sjogren Syndrome |
| | | |272 |Inflammatory Bowel Disease |
| |Pulmonary Edema, Hemorrhage, and Vasculitis |
| | | |273 |Behcet Syndrome |
| | | |274 |Granulomatosis, Lymphomatoid |
| | | |275 |Granulomatosis, Necrotizing Sarcoid |
| |Mediastinal Abnormalities | |
| | | |276 |Thymic Malignancy |
| | | |277 |Thymolipoma |
| | | |278 |Teratoma |
| | | |279 |Seminoma, Mediastinal |
| | | |280 |Nonseminomatous Malignant Germ Cell Neoplasm |
| | | |281 |Esophageal Duplication Cyst |
| | | |282 |Thymic Cyst |
| | | |283 |Coronary Artery Aneurysm |
| | | |284 |Lymphangioma, Mediastinal |
| | | |285 |Hemangioma, Mediastinal |
| | | |286 |Metastatic Disease, Lymphadenopathy |
| | | |287 |Lymphoma, Hodgkin, Mediastinal |
| | | |288 |Lymphoma, Non-Hodgkin, Mediastinal |
| | | |289 |Mediastinal Fibrosis |
| |Cardiovascular Disorders | |
| | | |290 |Pulmonary Thromboembolic Disease, Acute |
| | | |291 |Pulmonary Thromboembolic Disease, Chronic |
| | | |292 |Cardiac Myxoma |
| | | |293 |Sarcoma, Cardiac |
| | | |294 |Pericardial Effusion |
| |Trauma | | | |
| | | |295 |Trauma, Lung |
| | | |296 |Traumatic Aortic Injury |
| | | |297 |Aspiration |
| |Post-Treatment Chest | |
| | | |298 |Lobectomy |
| | | |299 |Pneumonectomy |
| | | |300 |Amiodarone Toxicity |
| | | |301 |Ablation Procedures |
| |Pleural Diseases | | |
| | | |302 |Chylothorax |
| | | |303 |Hemothorax |
| | | |304 |Pleural Plaques |
| | | |305 |Pleural Fibrosis and Fibrothorax |
| | | |306 |Malignant Pleural Effusion |
| | | |307 |Iatrogenic Pneumothorax |
| | | |308 |Pneumothorax, Primary Spontaneous |
| | | |309 |Pneumothorax, Secondary Spontaneous |
| |Chest Wall and Diaphragm | |
| | | |310 |Diaphragmatic Paralysis |
| | | |311 |Chest Wall Metastases |
| | | |312 |Chondrosarcoma, Chest Wall |
| | | |313 |Plasmacytoma and Multiple Myeloma |
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