MUSCULOSKELETAL ROTATION



1695450154305DIAGNOSTIC RADIOLOGYGOALS & OBJECTIVESMUSCULOSKELETAL ROTATION00DIAGNOSTIC RADIOLOGYGOALS & OBJECTIVESMUSCULOSKELETAL ROTATION3429057467500ROTATION GOALS:To train residents to be competent consultants in musculoskeletal imaging to the level of a general diagnostic radiologist;To competently assess routine plain films and CT scans; to have some experience with MR and US imaging of the musculoskeletal system;To learn the basic anatomy and pathology of the musculoskeletal system and understand the imaging characteristics of this pathology (including normal variants, trauma, congenital, neoplastic, inflammatory, idiopathic, metabolic and iatrogenic processes)To learn the radiology of common orthopaedic procedures, as well as some of the common complications, which may arise.ROTATION OBJECTIVES:MEDICAL EXPERT:To acquire and demonstrate knowledge of radiological anatomy of peripheral and axial skeleton, including the relevant soft tissues.To acquire and demonstrate knowledge of common anatomic variants, including accessory ossicles, growth centers, normal variants, etc.To demonstrate familiarity with standard views and projections, indication and method for stress views.To recognize, name and describe common fractures and dislocations, to be familiar with all the eponyms) as well as other forms of common musculoskeletal trauma.To develop an approach to joint disorders, including knowledge of clinical and imaging features differentiating various forms of arthritis.To recognize and describe features of metabolic bone disease: Renal osteodystrophy, rickets, scurvy, osteomalacia, osteoporosis, hyperparathyroidism, congenital syphilis.To describe the major features of the more common skeletal dysplasias: osteogenesis imperfecta, mucopolysaccharide disorders, Down’s syndrome, achondroplasia, epiphyseal and metaphyseal dysplasias.To develop an approach to assessment and diagnosis of tumours and tumour-like conditions, in particular the radiographic features discriminating non-aggressive from aggressive bone lesions.To describe features of the common bone tumours: metastases, multiple myeloma, lymphoma, osteosarcoma, Ewing’s sarcoma, osteiod osteoma, giant cell tumours, chondroid lesions, etc.To recognize and describe features of common tumour-like conditions of bone, for example Paget’s disease, fibrous dyspasia, etc.To develop an understanding of infection and how it affects the musculoskeletal system (osteomyelitis, septic arthritis, diskitis).COMMUNICATOR:To dictate well-organized reports, describing relevant findings, diagnosis and recommendations.To demonstrate effective communication skills when dealing with patients, during consent or procedures, as well as with consulting clinicians.To communicate effectively with patients and their families and have a compassionate interest in them.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 develop an understanding of indication for plain film assessment, nuclear medicine, CT and MRI, considering advantages and disadvantages of available imaging modalities.To become familiar with indications, patient preparation and potential complications of MSK interventional procedures.To consider available imaging resources when planning and recommending patient care, using them effectively and efficiently.HEALTH ADVOCATE:Recognize and consider radiation doses when recommending, approving and protocoling cases.Recommend and guide appropriate imaging strategies, depending on the clinical scenario, and to advise on the use and misuse of radiological tests.PROFESSIONAL:To be punctual and available for the assigned duties.To demonstrate integrity, honesty and compassion.To exhibit appropriate personal and interpersonal professional behaviors.To accurately assess one’s own performance, strengths and weaknesses.SCHOLAR:To set personal learning goals and reading plan during rotation.To contribute to the learning of others, with teaching/supervision of junior residents on rotation, elective students, off-service residents.METHODS:During the 4 dedicated blocks of training in musculoskeletal radiology (see below), the resident will experience a graduated exposure to musculoskeletal imaging. This will include plain films, CT scan, MRI and fluoroscopy. All blocks will be at KGH.The resident will also be exposed, in graduated steps, to all the musculoskeletal interventional procedures including arthrograms, diagnostic and therapeutic injections, and biopsies.Two blocks of equivalent musculoskeletal training will occur as follows: - 6 weeks during the 4 blocks of Nuclear Medicine rotations- 2 weeks during the 2 blocks of HDH ultrasound in PGY3 and PGY5, is when the resident is expected to scan and review the HDH MSK ultrasound studies with the assigned staff (6-8 per day)PGY 2 - Block 1 The residents will learn the basics of bone and trauma radiology. As the resident progresses through the rotation, more complicated studies and procedures will be introduced, and MSK CTs will be also seen, stimulating the correlation of findings between different modalities and better understanding of cross sectional anatomy. The resident is also required to learn to perform the most frequent arthrograms and diagnostic injections (mostly shoulders and hips). They will supplement this experience with reading around trauma, orthopaedic procedures and the most common rheumatologic and metabolic disorders. Residents will be encouraged to review the ER/STAT cases done overnight for improved exposure to MSK CT while on their MSK rotation. The resident should review at least 15-20 plain films per day, and 1 CTs, MRI or US. The resident should be reading a general textbook on musculoskeletal radiology, such as Stoller, or the Resnick synopsis, and the Brant and Helms MSK sections.PGY 3 - Block 2 The resident will be progressively more exposed to routine cases and CTs of extremities and joints. Reading should then be progressively focused around arthritides, bone and soft tissue tumors and metabolic bone disorders. The resident should review at least 20-25 plain films per day, and at least one or two CTs and MRIs, along with any MSK US studies. The resident at this point may be handling routine arthrography and other MSK interventional procedures independently, depending upon the exposure in Block 1.PGY 4 - Block 3 The block will be more dedicated to cross section imaging, particularly MRIs, including the technique, protocoling and interpretation. Plain film reading skills will continue throughout the rotation, helping to further correlate the findings. The resident should review at least 30-35 plain films per day, and 2-4 MRIs, as well as all MSK CTs and US studies. The resident should by now have mastered a sensible approach to arthritis, trauma, neoplasia, and metabolic bone disease.PGY 5 - Block 4 This block should be a consolidating block and by the end the resident should function as a junior consultant. The resident is expected to read plain films, perform the required procedures and supplement this with MRIs and CTs. The resident should review at least 40-50 plain films per day and all available cross-sectional imaging. The resident should now confidently handle routine musculoskeletal interventional procedures, and be performing with supervision, less routine procedures.RECOMMENDED READING:Fundamentals of Skeletal Radiology; Helms CA, W.B.Saunders.Orthopedic Imaging: A practical Approach; Greenspan, Lippincott, Williams and Wilkins, 4th ed. 2004 (must read)Musculoskeletal MRI; Phoebe Kaplan , Robert Dussault, Clyde Helms Musculoskeletal MRI; Clyde Helms, Nancy Major; A Saunders; 2nd ed. 2008.Bone and Joint Imaging; Donald Resnick; A Saunders; 3rd ed. 2004.Arthritis in Black and White; Brower A, W.B.Saunders Co.Musculoskeletal Imaging: The requisites; B.J Manaster, David May; 3rded, 2006.Arthrography; Freiberger RH, and Kaye JJ, Appleton-Century-Crofts, 1979 Symposium on Arthrography; Anderson TM, RCNA Vol 19 No 2, June 1981Imaging of Joints; Kaye JJ, RCNA Vol 28 No 5, Sept 1990Normal Roentgen Variants That May Simulate Disease; Keats TE, A Mosby, 2006.An Atlas of Normal Developmental Roentgen Anatomy; Keats TE, andSmith TH, YBMP, 1977Atlas of Roentgenographic Measurement; Keats TE., YBMP, 2001.Radiologic Clinics of North America editions. ................
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