ULTRASOUND ROTATION (including FAU)



1670050233045DIAGNOSTIC RADIOLOGYGOALS & OBJECTIVESULTRASOUND ROTATION (including FAU)00DIAGNOSTIC RADIOLOGYGOALS & OBJECTIVESULTRASOUND ROTATION (including FAU)3429057467500ROTATION GOALS:To provide theoretical and practical information, concepts and experience that will enable the resident to be a competent practitioner in Diagnostic Ultrasound and to pass the written and oral exams of the Royal College of Physicians and Surgeons.The areas to be studied include general abdomen, gynecology, obstetrics, neonatal brain, superficial anatomy sonography, Doppler ultrasound assessment of leg veins, carotid arteries, intraabdominal blood vessels, fetaluterine blood vessels, endovaginal sonography, endovaginal sonohysterograms, endorectal prostatic sonography.ROTATION OBJECTIVES:MEDICAL EXPERTThe resident should demonstrate competence in the performance and supervision of ultrasound examinations, demonstrating acquisition of the following:An understanding of the physics of ultrasound and the basic principles of machine design operationNormal anatomy, common artifacts and normal variantsDetailed knowledge of emergency indications for ultrasoundThorough knowledge of the ultrasound findings in common pathologiesAwareness of the nature and major manifestations of uncommon and rare pathologiesAble to perform a basic ultrasound examinationAble to supervise and advise technologistsThorough knowledge of what constitutes a complete examination including: required views, important measurements, and important anatomical relationships.Correlate US findings with clinical information, other imaging tests and lab data, etc.ABDOMEN/PELVIS/GENERAL ULTRASOUND: Liver/Biliary/Spleen (eg. biliary obstruction, tumours, portal hypertension, cirrhosis)Gallbladder disease (cholecystitis, cholelithiasis, neoplasms)Pancreatic inflammatory and neoplastic diseasesVenous Doppler studies & carotid ultrasoundRenal (acute and chronic conditions)Peritoneal (diffuse and focal processes)Retroperitoneal (diffuse and focal conditions)Abdominal Wall (hernias, hematomas, inflammatory processes, neoplastic processes)Uterine abnormalities (myometrial and endometrial; premenopausal and postmenopausal)Ovarian (neoplastic, physiologic, torsion)PEDIATRIC: (topics also addressed during the Sick Kids rotation)GI: Pyloric stenosis, appendicitis, herniasGU: Common anomalies, UPJ, PUV, infection, cystic diseases, Wilm’s tumour, neuroblastomaMSK: Basic principles of hip USOB/GYN:Assessment of early gestation and first trimester complicationsFeatures and assessment of ectopic pregnancyNormal obstetrical ultrasound: measurements, appearancesCommon complications of multifetal pregnancySecond and third trimester complicationsPostpartum complications, including gestational trophoblastic diseaseFeatures of common fetal anomalies, for example: trisomies, holoprosencephaly, agenesis of the corpus callosum, hydranencephaly, Dandy-Walker, Neural tube defects, Cystic hygroma, diaphragmatic hernias, gastroschisis, and more.Fetal Assessment Unit: the resident will review cases with the radiologist, or gynecologist, covering the service at mutually agreeable times during the week. NEONATAL:Normal cranial ultrasoundFeatures of intracranial hemorrhageFeatures of acute ischemia and sequelae, VentriculomegalyCongential malformationsCOMMUNICATOR:To dictate well-organized reports, describing relevant findings, diagnosis and recommendations.To demonstrate effective communication skills when dealing with patients, families, staff and referring clinical services.COLLABORATOR:To demonstrate effective consulting skills when interacting with other physicians & health team members.To interact appropriately with other ultrasound department staff, demonstrating a team approach to patient care.MANAGER:To demonstrate awareness of the indications for various ultrasound examinations.Consider advantages and disadvantages of ultrasound vs. other imaging modalities in emergency care and routine practice.Prioritizes and manages cases appropriatelyHEALTH ADVOCATE:Recognize and consider consent issues, patient comfort and other patient-related issues, when participating or performing ultrasound examinations.PROFESSIONAL:Punctual and available for assigned duties To demonstrate integrity, honesty and compassion.To practice understanding ethical and medical-legal requirements of s.To demonstrate awareness of own limitations.SCHOLAR:To set personal learning goals & objectives during rotation.To take a leadership role in the learning of others, with teaching/supervision of junior residents on rotation, elective students, off-service residents.METHODS: 6+ blocksFOD/PGY 1 (mornings at KGH and afternoons at HDH (see below))FOD/PGY 2 (KGH)COD/PGY 3 (HDH)COD/PGY 3 (FAU) (see below)COD/PGY 4 (KGH/FAU (see below)TTP/PGY 5 (HDH)TTP/PGY 5 (MSK US/JS) (see below)The resident will gradually assume the role of junior staff wherein the sonographer performing the scan will check all scans with the resident. If there is any question at all regarding any aspect of the scan, or clinical situation, the resident will consult with the attending radiologist. The resident will dictate some reports in this phase, as time permits. The resident, depending on their scanning skills to date, will notify the attending radiologist if they desire more experience in scanning to be coordinated during the week.Re: FOD/PGY1 – 1st blockThe resident will spend the mornings at KGH and the afternoons at HDH for the entire block. The resident should arrive at KGH at 7:30 am so that they can be involved with the overnight add-on studies which are typically “on-call” type cases (query appendicitis, query ectopic, etc.).? Week 1Residents should attempt to familiarize themselves with studies that will be important on-call (see guidelines below)accompany sonographer during scanrotate through different U/S roomsaccompany sonographer to check scans with the radiologist learn how to start machine and set up various controls to start examlearn variables used to optimize image during examslearn role of various transducers for machinelearn how input imaging onto digital archiving system Week 2 Assume role of sonographer with direct supervision by sonographer (perform at least two scans per day)interface with patientpreparation of patientscan under sonographer's supervisioncheck scan results with radiologist Weeks 3 and 4 Assume role of sonographer without direct supervision in some circumstancesscan patient until exam complete or until difficulty, then consult sonographerscanning must be done within constraints of timetable. Sonographer will have authority to alter and change routine.Re: COD/PGY3 – FAU blocks - See also FAU Goals and ObjectivesResidents are to contact IT (Liz Benoit) prior to the start of the rotation for their login and password to the Viewpoint software which will allow them the ability to review any FAU reportResidents will have access to the teaching file of cases within Viewpoint The FAU resident will be expected to add four interesting cases to the Viewpoint database during the rotation Once per month, the Friday morning US round will be assigned as a “Fetal Imaging” round either assigned to Dr. Davies, or the radiologist assigned to FAU The FAU resident, in consultation with the assigned staff, will be expected to present interesting cases at the Fetal Imaging rounds (as above). The FAU resident will be assigned to the roundsThe Viewpoint software has been installed on the KGH conference room computer for case presentation at the Fetal Imaging rounds and academic half-dayDr. Davies will be reminded when a radiology resident is on the FAU rotationThe radiology resident will be reminded to introduce themselves to Dr. Davies at the beginning on the rotationDr. Davies has asked that the residents review the information on this website prior to the start of the rotation: : PGY4 – KGH/FAU block – See also FAU Goals and ObjectivesDuring this block, the resident will be scheduled at KGH reviewing and reporting the general US cases, but on the days a radiologist is assigned to the FAU, they will be expected to review the FAU cases and discuss them with the radiologist during sign off/reporting, or at a mutually agreeable time. Re: TTP/PGY5 - MSK US/JS Block at HDHOne of the JS blocks will be scheduled at HDH were the resident will be expected to scan and report all the musculoskeletal ultrasound studies (6-8 studies per day), to be reviewed with assigned MSK radiologist.Ultrasound Scanning Skills – Applies to all BlocksThere will be protected times during the week that residents will be expected to primarily scan patientsKGH - Tuesday and Thursday morningsHDH - Monday and Thursday afternoon (to include MSK)Residents will be expected to review and report all the cases which they have scanned during the protected timesResident will not be expected to review or report any other cases during the protected timesThe resident will meet with the charge tech on the days they are scanning to decide which room(s) they will be usingThe resident will be given ~15 minutes per patient to scan a specific body part. They will then be joined by the US technologist to complete the exam. The resident will review his/her images with the US technologist before they proceed with the remainder of the examDepending on the level of training, and proficiency in scanning, the resident will have the option of increasing the amount of scanning per patient and/or completing the study.ROUNDS (Abdominal and Obstetrical Rounds alternate)Friday – 07:45 RECOMMENDED READING:1.Diagnostic Ultrasound, (4th edition), Rumack C, Wilson S, Charbonneau W (2016) Mosby 2.Ultrasonography in Obstetrics and Gynecology, (6th edition), Callen PW (2016) W.B. SaundersCompany. 3.The Requisites, Ultrasound, (3rd edition), Middleton WD, Kurtz AB, Hertzberg BS (2015) Mosby 4.Diagnostic Imaging, Gynecology, (1st edition), Hricak H, et al. (2007) AMIRSYS.5.Clinical Doppler Ultrasound: Expert Consult, (3rd edition), Allan PL, et al (2013) Churchill Livingstone Elsevier.GUIDELINES FOR AFTER HOURS SCANSGOALSTo identify the types of US scans that are useful on-call. Residents should gain scanning experience in these cases. The bolded items are the most important.Female Pelvis (transabdominal and endovaginal scans)Assess for early intrauterine pregnancy.Assess for causes of “threatened abortion”.Ectopic pregnancy.Ovarian torsion.Pelvic inflammatory disease. Mimics of gynecologic pathology including appendicitis and acute diverticulitis.Adult AbdomenAssess for causes of upper abdominal painAssess for causes of lower abdominal pain.Assess for evidence of traumatic injury (especially liver, spleen and kidneys).Cholelithiasis.Acute cholecystitis.Biliary obstruction.Ureteric obstruction.Urinary calculiAscites.Intra abdominal abscess.Portal thrombosis, hepatic vein obstruction, and hepatic artery thrombosis. Complications of abdominal aortic aneurysm.Acute pancreatic processes including pseudocyst and abscess formation.Acute appendicitis.Acute diverticulitis.Obstetric UltrasoundAssess for fetal life.Be aware of discriminatory levels that are useful for interpreting the significance of ultrasound findings in early pregnancy.Assess for number of fetuses and chorionicity and amnionicity of twins.Assess causes of vaginal bleeding, including placenta previa and placental abruption.Superficial ScansAssess causes of acute scrotal pain.Testicular torsion.Acute epidydimitis.Acute orchitis.Simple and complex hydrocelesTesticular traumaAssess for femoral artery pseudoaneurysm and arterio-venous fistula.Assess for acute DVT (arms & legs).Renal Transplant AssessmentHydronephrosis.Perinephric fluid collections.Allograft blood flow, including resistive indices of interlobar arteries and blood flow in the main renal vein(s) and artery(ies).Renal size and echogenicity.Technologist to perform scan, resident to interpret with assistance of the on-call radiologist.PediatricIntussusceptionHPS (Hypertrophic Pyloric Stenosis).Testicular torsion and torsion of testicular appendage.Intracranial hemorrhage and ischemia in neonates. ................
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