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CHEST RADIOLOGY ROTATIONSGENERAL FORMATPersonnel on service: One (1) attending radiologist and two (2) residentsHours of coverage: 8:00 a.m.-5:00 p.m., Monday-Friday, except holidaysDaily Schedule:8:00-9:00 • Lower level Residents review films in front Chest Reading Room with attending radiologist and dictate reports.9:00-1:00 • Upper level resident covers Medical Rounding Room and TCV/OP - 4W boards all of the 2nd room. Each resident reviews and reports films in their designated room after checkout with the attending radiologist. • Residents present Demonstration Rounds in their assigned room with supervision of the attending radiologist. • Attending radiologist circulates among the 3 Chest rooms performing resident checkouts, giving early readings, and consultations and attending Demonstration Rounds. • Residents provide early readings and consultations.1:00-2:00 • Residents go to Residents’ Conference (Moss Amphitheater) • Attending radiologist covers for early readings and consultations2:00-5:00 • Review and read films in all three Chest rooms • On Mondays, prepare for Thoracic Tumor Board, on Tuesday and on every other Monday prepare and present Pulmonology Conference at 4:30 PM (MOSS) • At end of day, check films recently hung for obvious abnormalities that need a phone call to clinical physician (i.e. misplaced line, large pneumothorax, acute edema, pulmonary embolus, etc.)CONFERENCESMedical-Surgical Chest Conference • Get film jackets, pull films for presentation, and mount them on rollerscope in Moss on the prior afternoon or evening (i.e., Monday).
• Both residents and the attending radiologist on the Chest service will participate in the conference. Medical students on the Chest rotation are to be encouraged (required?) to attend, also. • More senior resident will present the cases. Attending radiologist will be consultant.Thoracic Oncology Conference • Held on Tuesdays at 12:30 p.m. (until ~2:00 p.m.) in Cancer Center Conference Room. Lunch provided. • Residents and attending radiologist get film jackets and pull films for presentation on the prior afternoon or evening (i.e., Monday). • Instruct Film Room to deliver the films to the Cancer Center Conference Room prior to 12:00 noon on Tuesday. • Attending Radiologist and both residents will attend the Thoracic Oncology Conference • Upper level resident and attending MD present cases • Attending on procedures covers for early readsRECOMMENDED READINGFirst Rotation Muller, Fraser, Coleman, Pare: Radiologic Diagnosis of Diseases of the Chest, Chapter 1, The Normal Chest; Chapter 3, Radiologic Signs of Chest DiseaseSubsequent Rotations Armstrong P, Wilson AG, Dee P, Hansell DM: Imaging of Diseases of the Chest, 3rd Edition. St. Louis, Mosby, 2000 McLoud, Theresa C: Thoracic Radiology: The Requisites. St. Louis, Mosby, 1998 Muller, Fraser, Coleman, Pare: Radiologic Diagnosis of Diseases of the Chest, Chapters 5& 6, 9, 14, & 15, 19, 21-22
OBJECTIVES AND ASSESSMENT OF PERFORMANCEIntroduction. The Department of Radiology has developed objectives to guide the residentthrough clinical rotations. Clinical rotations enable the resident to accumulate knowledge,develop technical skills, and establish decision-making processes. These objectives are to beused as general guidelines in regard to the residents progression through the residency. Knowingthat residents attain knowledge and skills at different competency levels and that fluctuation ofpatient loads impact upon the residents experiences, it would not be reasonable to expect eachresident to fully accomplish each objective during any rotation. The objectives, therefore, are tobe used as a relative measure of progress, either as a formal measurement administered by theclinical faculty at the end of the rotation or as a personal evaluation by the resident. Objectivesnot completed on a first rotation to a clinical area may be carried over until the next rotation atthat site.Rotation 1Knowledge Based Objectives: At the end of the rotation, the resident should be able to:1. Identify normal anatomy of the chest as it is seen on the chest radiograph2. Identify and/or describe common variants of normal3. Demonstrate a basic knowledge of the radiographic findings of common medical conditions such as pneumonia and congestive heart failure.4. Demonstrate an understanding of pathologic terminology related to the chestTechnical Skills: At the end of the rotation, the resident should be able to:1. Distinguish normal from abnormal structures on a chest radiograph2. Dictate a report that is brief and understandable3. Communicate verbally with referring physicians and house staff about radiographic findings4. Recognize cephalization and pneumothorax both in upright and supine patientsDecision-Making and Value Judgment Skills: At the end of the rotation, the residentshould be able to:1. Make decisions about when to alert house staff to the immediacy of a condition that is apparent on the radiograph2. Determine when to request that a repeat examination is needed because of technical inadequacyRotation 2Knowledge Based Objectives: At the end of the rotation, the resident should be able to:1. Discuss various common diseases and the altered lung patterns they produce2. Describe the characteristics of common abnormal cardiac shadows and chamber enlargement3. Discuss the various indications for ordering a chest CT4. Discuss the progression of ARDS seen on ICU radiographs5. Recognize normal and abnormal position of lines and tubes on ICU radiographsTechnical Skills: At the end of the rotation, the resident should be able to:1. Recognize and differentiate the following pathologic anatomy in the lungs: − air space processes − lobular processes − interstitial processes2. Given an appropriate radiograph, recognize cardiac enlargement.
3. Identify anatomy and significant pathology as seen on ICU chest films.Decision-Making and Value Judgment Skills: At the end of the rotation, the residentshould be able to:1. Determine which cases can be interpreted and dictated independently and which cases require the assistance of a faculty radiologist.Rotation 3Knowledge Based Objectives: At the end of the rotation, the resident should be able to:1. Name and describe characteristics of chest pathologies that are seen infrequently in routine work but have distinctive radiographic and/or clinicopathological signs.2. Correlate pathological and clinical data with radiographic findings on the chest film.Technical Skills: At the end of the rotation, the resident should be able to:1. Read routine chest films with a high level of accuracy and efficiency.2. Prepare and present the radiographic components of the radiology/pathology in chest conferences.3. Supervise the performance of a chest CT examination.Decision-Making and Value Judgment Skills: At the end of the rotation, the residentshould be able to:1. Accuracy in interpreting and dictating cases, identifying consistently those cases with which assistance is needed.2. Consult with primary care physicians and surgeons in regard to chest imaging procedures.Rotation 4Knowledge Based Objectives: At the end of the rotation, the resident should be able to:1. Identify and describe characteristics of all chest pathologies2. Correlate pathological and clinical data with radiographic findings on the chest filmTechnical Skills: At the end of the rotation, the resident should be able to:1. Efficiently and accurately read chest films – volume is important2. Prepare and present the radiographic components of the radiology/pathology in chest conferences3. Supervise and instruct junior residents, technologists and medical studentsDecision-Making and Value Judgment Skills: At the end of the rotation, the residentshould be able to:1. Accurately interpret and dictate cases2. Confidently provide consultation for referring physicians