GOALS & OBJECTIVES - Home | Diagnostic Radiology | School ...



2157730165735DIAGNOSTIC RADIOLOGYGOALS & OBJECTIVESBREAST ROTATION00DIAGNOSTIC RADIOLOGYGOALS & OBJECTIVESBREAST ROTATION3429057467500ROTATION GOALS:The training period in mammography consists of four blocks scheduled in PGY2, 3, 4, and 5. With this amount of training, one will not become expert in this field; however, it should be enough time to achieve a strong level of basic competence in the investigation of breast disease from the imaging point of view, and to understand the quality control issues of breast imaging.The rotation aims to teach the resident, in a graduated fashion, the principles of breast cancer screening, management of breast imaging abnormalities and to gain familiarity with diagnostic breast interventional techniques. Modalities to be covered include mammography, ultrasound and MRI.ROTATION OBJECTIVES:MEDICAL EXPERT:To learn quality assurance, proper positioning and basic mammographic techniques.To identify normal and abnormal anatomical appearances on mammography.To discuss the technical and physical factors important for obtaining an optimal mammographic study.To make a preliminary assessment of mammogram image, advising the technologist on the need for additional views, as necessary.To identify features of malignant and benign disease.To develop an approach to the assessment of breast calcifications & breast masses.To establish a plan for management or follow-up of probably benign disease/lesions.To identify normal and abnormal breast anatomy on ultrasound.To learn needle localization techniques.To learn the indications and techniques for stereotactic biopsy, US-guided core biopsy, cyst aspiration.To learn the role of ultrasound in breast imaging.To learn the techniques and indications for galactography.To become familiar with the evaluation of the post-surgical breast (including complications, post-surgical and post-radiation appearances) and male breast.To participate in image-guided breast core biopsies and fine-needle aspiration biopsies and to dictate appropriate addendums to the image-guided biopsy reports, after the surgical pathology becomes availableTo learn the role of MR imaging in breast evaluation and participate in breast MR image MUNICATOR:To dictate well-organized reports, describing relevant findings, diagnoses/differentials and recommendationsTo adequately describe findings using the ACR BI-RADS municate effectively with patients and their families in a compassionate manner using dialogue that allows adequate understanding of the findings. Communicate effectively and professionally with the breast imaging technologistsCommunicate effectively with referring physicians and understand when results should be communicated urgently or directly.COLLABORATOR:To demonstrate good consulting skills when interacting with other physicians & health team members.To interact appropriately with other radiology department staff, demonstrating a team approach to patient care.LEADER:To demonstrate awareness of the indications for various breast imaging modalities.To consider appropriateness of requested examinations and patient referrals.To consider available imaging resources when planning and recommending patient care, using them effectively and efficiently.To ensure an appropriate balance between patient care and learning needs. Conduct and supervise quality assurance in mammography, breast ultrasound and MRI and to understand safety issues that may arise. HEALTH ADVOCATE:Demonstrate awareness and understanding of breast imaging recommendations, screening recommendations and optimal patient work-up for various breast problems.To educate and advise on the use and misuse of breast imaging.PROFESSIONAL:To be punctual and available for assigned duties.To demonstrate integrity, honesty and compassion.To exhibit appropriate ethical, personal and interpersonal behaviors.To demonstrate an awareness of one’s own performance, strengths and weaknesses.SCHOLAR:To set personal learning goals & objectives during rotation.To effectively teach medical imaging and intervention to medical students, residents, technologists and clinical colleagues.GENERAL DUTIES: Become familiar with positioning for mammographic, sonographic and MR breast imaging through interaction with radiologists and technologists.Become familiar with digital image production and portrayal through interaction with IT personnel, radiologists and technologists.Review and report screening mammograms daily, after consultations and review with the attending.Supervise, with the attending, ultrasound breast scans daily and scan as clinically indicated, in consultation with the attending.Participate in ultrasound-guided and stereotactically-guided breast biopsies daily.Participate in galactograms when booked.Participate in image-guided breast needle localizations when booked.In consultation with the attending, optimize work-up mammograms, review images with the attending and report the studies.BREAST MRI:The?review and reporting of Breast MRIs?will occur on Wednesday?mornings,?with the attending assigned to?HDH mammography. The review only applies to the PGY4 and PGY5s?mammography blocks.The resident will pull cases from the reporting queue list for the Wednesday morning review (suggested 4-6 cases). The resident will need to review the cases?before?the?Wednesday morning review with the attending (predicate and fill out BIRFs).The attending staff assigned to report the Breast MRIs (KGH or HDH) can report any and all cases left in the reporting queue.The resident will not be expected to fulfill all the other general duties on Wednesday mornings, but these will be expected for the Wednesday afternoons (ie. biopsies, etc.)EVALUATION METHODS: Daily contact with the attending and, as usual, an ongoing evaluation of interaction will be conducted as is conducted in any routine rotation in radiology training. Supervision and evaluation of all image-guided breast procedures, by the attending with case-by-case feedback.Resident rounds.Preliminary reports of screening mammograms, work-up mammograms, breast sonograms, and breast MRI scans.Performance of image-guided breast biopsies, needle localizations and galactograms.Participate in daily decisions, communication with patients, and other members of the Breast Assessment Team, referring physicians and their representatives.RECOMMENDED READING: Books:Diagnostic Imaging: Breast, 2nd ED - Berg WA et al. AMIRSYS, 2013.Breast Imaging, 3rd edition, by Daniel B. Kopans 2007, published by Lippincott-Raven.Specialty Imaging: Breast MRI, by Raza S, Birdwell RL, et al, 2010. AMIRYS publisher.BI-RADS (Breast Imaging Reporting and Data Systems), Atlas, Mammography, Ultrasound, MRI, Follow-up and Outcome Monitoring, Published by the American College of Radiology. () ................
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