Department of Radiology » College of Medicine » University ...
Clinical Rotations
Body Imaging and GI/GU
Competency-Based Goals and Objectives
by level of training
(Pediatric abdominal imaging G&O are included in the pediatric rotations)
Rotation One
1. Medical Knowledge
Instrumentation and Protocols
• Basic CT and MRI instrumentation
• Common CT and MRI artifacts
• Become familiar with on-line protocols
• Types of oral and intravenous contrast
• Contra-indications to contrast administration, pre-treatment regimens for at-risk patients, nephrogenic systemic fibrosis, and treatment regimens for contrast reaction
Abdomen
• Liver: normal size, diffuse disease, (fatty infiltration, acute and chronic hepatitis, cirrhosis, edema), focal masses, metastases, granuloma
• Gallbladder: normal appearance, acute cholecystitis (calculous/acalculous), sonographic Murphy’s sign, other etiologies of wall thickening
• Bile ducts: normal intra- and extrahepatic bile duct diameters and dilatation
• Pancreas: normal anatomy, pancreatic duct, mass
• Spleen: normal size, focal masses, lymphoma, abscess, infarction, granuloma
• Peritoneal cavity: ascites
• Trauma: hemoperitoneum, pneumothorax, vascular injury, solid organ injury, mesenteric/bowel injury, active bleeding
Kidneys, urinary bladder and prostate
• Normal renal anatomy, simple renal cyst
• Ureters: hydronephrosis, pyonephrosis, hydroureter, stone
• Urinary bladder: calculi, wall thickening
• Abscess/pyelonephritis, perinephric fluid
• Post-renal transplant collections: hematoma, urinoma, abscess, lymphocele
• Complex renal cyst, adult polycystic disease and acquired renal cystic disease, renal cell carcinoma, angiomyolipoma
• Urinary bladder: mass, infection, hemorrhage, wall thickening, bladder outlet obstruction,
diverticula, ureterocele
• Trauma
Bowel
• Inflammatory conditions including appendicitis, diverticulitis, inflammatory bowel disease, epiploic appendagitis
• Infectious colitis
• Ischemic bowel
• Bowel perforation
• Bowel obstructions and underlying etiology
• Intussusception, volvulus, closed loop obstruction, incarcerated hernias, strangulation
Gynecology
• Ovarian neoplasm: cystic/solid adnexal masses, cystadenoma/carcinoma, dermoid, fibroma, germ cell tumor, Doppler evaluation
• Ovarian torsion appearance on CT
• Pelvic inflammatory disease, tubo-ovarian abscess
Vascular
• Abdominal aorta: normal appearance and measurement, aneurysm
• Inferior vena cava: normal appearance, thrombosis
• Lower extremity deep vein thrombosis
• Hematoma
• Pseudoaneurysm
• Liver transplants, including hepatic artery stenosis or thrombosis, portal vein thrombosis, post-biopsy complications
• Pancreas transplant: vasculature, fluid collections
• Hemodynamics of cirrhosis, portal hypertension and varices, portal vein thrombosis
Assessment Methods
• Faculty evaluations
• Mock orals
• ACR in-service examination results
2. Patient Care
• Gather essential and accurate clinical information about patients relevant to the interpretation of the examination including correlation with prior radiological studies.
• Communicate effectively and demonstrate caring, respectful behavior when interacting with patients and their families, answering their questions and helping them to understand the image-guided procedure as well as its clinical significance.
• Use information technology to support patient care decisions.
• Perform basic procedures such as thoracentesis and paracentesis with faculty guidance.
• Start a procedure log for image-guided procedures
• Protocol GI and GU examinations including CT and MRI with faculty guidance. Determine if additional imaging is needed before the patient examination is complete
• Recognize CT findings of appendicitis, diverticulitis, cholecystitis, hydronephrosis, ureteral obstruction, bowel obstruction, volvulus, ischemic bowel, pneumoperitoneum, common traumatic injuries of the chest/abdomen, active extravasation, emphysematous inflammatory processes, bronchogenic carcinoma, pneumothorax, pulmonary embolus, aortic dissection, aortic rupture, traumatic vascular injury and common neoplasms.
Assessment Methods
• Faculty evaluations
• 360 evaluations
• Mock orals
• Semi-annual review of procedure log
3. Practice-Based Learning and Improvement
• Participate in self-directed learning including outside reading on anatomy and common pathology supplemented with information on emergency/trauma processes.
• Participate in QA/QI activities.
• Use information technology to access on-line medical information, and to facilitate self-directed learning.
Assessment Methods
• Faculty evaluations
• Learning portfolios (learning plan)
• Mock orals
• ACR in-service examination
4. Interpersonal and Communication Skills
• Dictate prompt, accurate and concise radiological reports for basic studies.
• Develop effective communication skills with patients, patients’ families, physicians and other members of the health care team.
• Obtain informed consent for procedures with faculty guidance.
• Promptly communicate urgent, critical or unexpected findings to residents, referring physicians or clinicians and document the communication in the radiological report.
Assessment Methods
• Faculty evaluations
• 360 evaluations
• Formal evaluation of resident dictations documented in resident learning portfolios
5. Professionalism
• Demonstrate integrity, respect and compassion to patients, physicians, staff and other health care professionals.
• Demonstrate positive work habits, including punctuality and professional appearance.
• Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information.
• Demonstrate a commitment to continuous professional development and lifelong learning through consistent conference attendance and participation.
Assessment Methods
• Faculty evaluations
• 360 evaluations
• semi-annual review of conference attendance
6. Systems-Based Practice
• Understand how medical decisions affect patient care within the larger system.
• Demonstrate knowledge of and apply appropriateness criteria and other cost-effective healthcare principles to professional practice.
Assessment Method
• Faculty evaluations
Suggested References
• Fundamentals of Body CT by Richard Webb
• The Requisites in GI, GU
Rotation Two
1. Medical Knowledge
Abdomen
• Liver: post-liver transplantation collections: hematoma, biloma, abscess
• Gallbladder: inflammatory conditions, carcinoma
• Bile ducts: bile duct stones, inflammatory disease, cholangitis, pneumobilia, neoplasm
• Pancreas: neoplasm, cysts
• Pancreatitis complications: abscess, pseudocyst and pseudoaneurysm, chronic pancreatitis
• Peritoneal cavity: abscess, hemorrhage, omental mass, metastasis, carcinomatosis
• Spleen: varices
• Gastrointestinal tract: neoplasm, inflammatory conditions
• Abdominal wall hernia, inguinal hernia
Kidneys, urinary bladder and prostate
• Kidneys: xanthogranulomatous pyelonephritis, emphysematous pyelonephritis, congenital anomalies, pelvic kidney (see pediatrics section), medullary nephrocalcinosis
• Adrenal glands: mass
• Retroperitoneum: adenopathy, mass
• Ureters: ureteral stone
• Urinary bladder: ectopic ureterocele
• Renal artery stenosis, renal vein thrombosis (see vascular section section)
• Staging renal cell carcinoma
Gynecology
• Cervix: mass, stenosis, endometrial obstruction
• Fallopian tube: hydrosalpinx, pyosalpinx
• Post-hysterectomy
• Peritoneal inclusion cyst
• Ovarian, cervical and endometrial cancer staging
Scrotal
• Staging for testicular neoplasm
Vascular
• Renal vein thrombosis
• Mesenteric ischemia
• Arterial stenosis and thrombosis
Assessment Methods
• Faculty evaluations
• Mock orals
• ACR in-service
2. Patient Care
• Screen and supervise more complex studies
• Pre-procedural evaluation: coagulation laboratory studies, anticoagulation medication
• Stratification of risk for percutaneous procedures
• Techniques for image-guided invasive procedures: understanding important landmarks and pitfalls of percutaneous procedures, including recognition of critical structures to be avoided
• Biopsy of soft tissue masses
• Aspiration of fluid collections, cysts and catheter placement for abscess and fluid drainage
• Post-procedural evaluation: radiographic studies, patient monitoring, management of complications
• Maintain a procedure log
• Fine needle biopsy versus core biopsy in specific application, such as focal liver mass, renal mass, thyroid/parathyroid mass, retroperitoneal lymphadenopathy
• Determine the appropriate patient protocol/study and interact with the technologist on a regular basis.
Assessment Methods
• Faculty evaluations
• 360 evaluations
• Semi-annual review of procedure log
3. Practice-Based Learning and Improvement
• Participate in self-directed learning with outside reading from Webb and the Case Review Series.
• Demonstrate knowledge and the application of the principles of evidence-based medicine in practice.
• Participate in QA/QI activities.
• Facilitate the teaching of medical students.
Assessment Methods
• Faculty evaluations
• Learning portfolios (learning plan)
• Mock orals
• ACR in-service examination
4. Interpersonal and Communication Skills
• Interact with residents and attending physicians in consultation to enhance clinical radiological correlation.
• Dictate accurate and concise radiological reports for more complex studies with concise impression including diagnosis and/or differential diagnoses
Assessment Methods
• Faculty evaluations
• Direct observation by the faculty
• Formal evaluation of resident dictations documented in resident learning portfolios
5. Professionalism
• Demonstrate responsiveness to the needs of patients that supercedes self-interest (altruism).
• Demonstrate a commitment to continuous professional development and lifelong learning through consistent conference attendance and participation.
Assessment methods
• Faculty evaluations
• 360 evaluations
• Semi-annual review of conference attendance
6. Systems-Based Practice
• Effectively prioritize patients requiring cross-sectional imaging studies.
• Participate in discussions with faculty regarding system challenges and potential solutions regarding radiological service and patient care.
Assessment Method
• Faculty evaluations
Suggested References:
• Fundamentals of Body CT by Richard Webb
• Case Review Series for GI, GU
Rotation Three (and > months)
1. Medical Knowledge
• Features that distinguish different types of benign and malignant hepatic masses on CT and MRI imaging
• Features that distinguish different types of benign and malignant renal masses on CT and MRI imaging
• Features that distinguish different types of benign and malignant pancreatic masses on CT and MRI imaging
• Features that distinguish different types of benign and malignant adrenal masses on CT and MRI imaging
• Biliary abnormalities on MRCP imaging
• Expected post-operative findings with more complex bowel surgery
Assessment Methods
• Faculty evaluations
• Mock orals
• ABR written examination results
2. Patient Care
• Perform more complex image-guided procedures with faculty oversight
• Screen and supervise, with increasing level of responsibility, most cross-sectional imaging studies.
• Consistently provide safe patient care by minimizing the radiation dose when determining protocols for CT.
• Recognize the MRI findings of common abdominal/pelvic neoplasms and causes of biliary obstruction, as well as the CT findings of less common thoracic/abdominal disease processes
Assessment Methods
• Faculty evaluations
• 360 evaluations
• Semi-annual review of procedure log
3. Practice-Based Learning and Improvement
• Outside reading. Review radiology education web sites and teaching files including ACR CD-ROM.
• Facilitate the teaching of medical students and more junior level residents.
• Participate in QA/QI activities.
Assessment Methods
• Faculty evaluations
• Learning portfolios (learning plan)
• Mock orals
4. Interpersonal and Communication Skills
• Dictate accurate and concise reports for the most complex studies with concise impression including diagnosis and/or differential diagnoses as well as recommendations for further imaging and/or management, when appropriate.
• Consult effectively with medical staff and attending physicians.
Assessment Methods
• Faculty evaluations
• Direct observation by the faculty
• Formal evaluation of resident dictations documented in resident learning portfolios.
5. Professionalism
• Demonstrate accountability to patients, society and the profession.
• Demonstrate a commitment to continuous professional development and lifelong learning through consistent conference attendance and participation.
Assessment Methods
• Faculty evaluations
• 360 evaluations
• Semi-annual review of conference attendance
6. Systems-Based Practice
• Understand indications for and cost-effectiveness of varying cross-sectional imaging modalities (Ultrasound versus CT versus MRI).
• Practice cost-effective evaluation of patients requiring imaging studies that does not compromise the quality of care through the utilization of the ACR Appropriateness Criteria.
Assessment method
• Faculty evaluations
Suggested References:
• The Case Review Series: GI and GU
• On-line teaching files
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