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  • 1. SMBD-JEWISH GENERAL HOSPITAL ANGIOGRAPHY AND INTERVENTIONAL RADIOLOGY ROTATION Minimum Training Requirements Rotation to consist of minimum of 12 weeks to be taken with a minimum of two consecutive periods (8 weeks). GOALS 1. MEDICAL EXPERT It is expected that residents who have completed the rotation will be able to do simple angiography on their own. Such procedures as simple femoral arteriograms, and straight forward abdominal aortograms with lower limb runoff. Simple selective angiography is not a minimum requirement. However, it is hoped that most residents will be capable of doing celiac, SMA and selective renal angiography. Residents should be capable of placing PICC lines independently and placing filters with minimal supervision. Residents should know contrast volumes and rates and in general, types of catheters and guide wires which are in common use. Residents should be familiar with the significant anatomy and be able to identify gross pathology. Residents should be thoroughly familiar with indications and contra-indications and should know what type of pre-medication, antibiotic or analgesic is needed and be comfortable administering conscious sedation with knowledge of treatment of oversedation. Relevant clinical information should be known and limiting factors should be recognized and measures taken to correct the limitations. (Such things as contrast reactions, impaired renal function, bleeding problems.) As far as interventional procedures, residents are not expected to be able to perform these procedures on their own. However, they should be thoroughly familiar with the types of procedures that are available so that they may consult with their clinical colleagues and be in a position to suggest which types of interventional procedures are appropriate. Residents should be in a position to obtain informed consent from all patients for all of the above procedures, being able to inform the patients of potential complications and benefits. They should also be familiar with follow-up procedures on these patients. 2. COMMUNICATOR  Residents are expected to develop a systematic, complete but concise reporting style, covering all potentially clinically significant data.  Residents must develop skills in discussing procedures with patients, understanding their concerns, and being sensitive to their right to information, balancing risks and benefits tailored to the individual patient needs.  Residents must recognize the importance of effective communication with technical staff, nurses and secretarial staff so that clear messages are delivered in order that the correct treatment and follow up be arranged.  Complications encountered during procedures must be immediately communicated to referring clinicians who should be aware of the problem and collaborate in decision-making to deal with the problem.
  • 2. 3. COLLABORATOR  Residents must demonstrate good consulting skills when interacting with other physicians and health team members.  Residents must learn to interact appropriately with other radiology staff, demonstrating the importance of the team approach to patient care.  Residents must learn and demonstrate the direct approach to teamwork in an emergency situation recognizing when direct immediate contact with relevant clinical colleagues is needed.  Residents should be prepared to participate in interdisciplinary teaching rounds and research projects involving other specialties. 4. MANAGER  Residents should demonstrate awareness of indications and contraindications to various angiographic and interventional procedures.  Residents should consider the necessity and appropriateness of using costly equipment over less costly equipment to accomplish the required goal.  Residents must consider available imaging resources when planning and recommending patient care, using them effectively and efficiently. 5. HEALTH ADVOCATE  Residents must recognize and consider consent, patient comfort and other patient related issues when performing interventional acts, taking into account individual patient status and needs, also considering radiation exposure risk. ▪ Residents can play a critical role in advising patients of the role of smoking in vascular disease. 6. PROFESSIONAL  Residents must demonstrate integrity, honesty, reliability and compassion.  Residents must understand and practice the ethical and medico-legal requirements of interventional radiology.
  • 3.  Residents must recognize their own limitations and always keep in mind that the patient is paramount. 7. SCHOLAR  Residents should set personal learning goals and objectives.  Residents should be capable of teaching others (junior residents, medical students, nurses and technicians).  Residents must learn the importance of reading texts and journals as well as online learning sites and realize the necessity of a lifelong commitment to learning.  Residents should be prepared to participate in any ongoing or new research projects. QUANTITATIVE EXPECTATIONS Procedures Arterial -Aortography (50) -Selective Arteriography (30) -Embolization, all types (20) Angioplasty/Stenting(10) Venous Procedures -PICC Lines (50) -IVC Filters (10) -Tunnelled Catheters (10) -Transvenous biopsies (10) Non-vascular Interventions -Nephrostomy tube (10) -Biliary Drainage (5) -Percutaneous Gastrostomy(5) Fluid drainages (abscess, catheter drainage or ascites, pleural fluid, cholecystostomy)(15)
  • 4. 8. ROTATION GUIDELINES Duties of Rotation 8A) Film Reading Residents are expected to review and report all angiograms done within the department whether they have performed these or not. When no procedures are booked and all outstanding reports have been completed, it is recommended that residents review teaching files. 8B) Conferences Residents are expected to attend all departmental conferences unless occupied doing procedures. Although angiography conference is generally given by staff, residents should be prepared to present certain topics as required. 8C) Teaching Files The resident is required to enter all interesting cases of teaching value into the angiogram teaching file together with all relevant clinical information and where possible, give references. The entire teaching file should be reviewed by the resident at all free moments and where he or she feels that corrections or additions are indicated, this should be done. 8D) Obtaining of Consents During the rotations, all consents for angiography and interventional procedures should be obtained by the angiography resident who will be performing the procedure. This means that a thorough knowledge of the procedure be known, as well as potential complications and all significant data be noted. 8E) Reading of Films before end of rotation Please ensure that all films in your reading box are read. If you are unable to complete reading them, be sure to return the unread films to the Filing Room BEFORE THE END OF YOUR ROTATION. 9. Reading list There is no one single text that is all inclusive. At least three interventional texts are available which are worthwhile. Interventional texts -Valji K., Vascular and Interventional Radiology. WB Saunders 2006. ISBN 0721606210 -Kaufman J., Vascular and Interventional Radiology: Requisite Series. Mosby 2003. ISBN 0815143699 -Baum S. Pentecost M. Abrams’ Angiography: Interventional Radiology 2nd edition, Lippincott William and Wilkins. 2006 ISBN 0781740894
  • 5. Angiographic Texts -Kadir S., Atlas of Normal and Variant Angiographic Anatomy W.B. Saunders 1991 ISBN: 072162894X -Kadir S., Diagnostic Angiography. WB Saunders 1986. ISBN 0721610552 (Must Read) -Baum S. Abrams’ Angiography 4th edition (3 volumes ). WB Saunders 1996. ISBN 0316082260 -Reuter S., Redman H., Cho K. et al. GastroIntestinal Angiography. WB Saunders 1986. ISBN 0721619479 Reference Text. On CD-ROM (acquired Feb. 1999) -Baum S. Abrams’ Angiography 4th edition on CD-ROM. Featuring the contents of Abrams’ Angiography. Includes “Interventional Radiology” (1st edition) by Dr. Stanley Baum and Dr. Michael Pentecost. ISBN 0781714796 -Dickey, KW et al. ACR Learning File “Vascular and Interventional” Dr. R. Satin & Dr. Constantin January 2008
  • 6. SMBD-JEWISH GENERAL HOSPITAL MUSCULOSKELETAL ROTATION 1. GOALS By the end of the musculoskeletal rotation, the resident should be competent in standard diagnostic and interventional skills including: 1. Plain film radiography 2. CT msk imaging 3. MRI of all joints 4. Basic arthrographic diagnostic and therapeutic techniques 2. RESPONSIBILITIES a) The rotation begins at 8:00 A.M. until the work is completed. The musculoskeletal rotation is a 4 week block. b) The bone resident is expected to read a high volume of Emergency Room, in-patient and out- patient musculoskeletal related plain films. In addition, all MSK CT scans and all MSK-related MRI’s should be read promptly and reviewed by the attending staff soon thereafter, preferably on the same day. The resident should also be involved in all arthrographic procedures. c) Teaching of elective medical students and/or off service residents 3. ROTATION OBJECTIVES A. MEDICAL EXPERT • Understanding of pathophysicology of soft tissue, joint and osseous abnormalities • Giving a reasonable interpretation of abnormalities demonstrated by all imaging modalities • Learn detailed anatomy of the musculoskeletal system • To formulate appropriate differential diagnosis • Adequately perform techniques under US, CT or fluoroscopic guidance to diagnose or treat musculoskeletal related pathologies • Able to appropriately protocol MRI and CT scans
  • 7. B. COMMUNICATOR  To dictate well-organized reports, describing relevant findings, diagnosis and recommendations.  To demonstrate effective communication skills when dealing with patients, staff and referring clinical services.  To communicate life-threatening findings directly to the referring physician in a timely fashion.  To document pertinent conversations with the clinician in the report. C. 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. D. MANAGER • To guide clinicians regarding which modality is more appropriate for work-up of any particular pathology • Efficient use of health care resources E. HEALTH ADVOCATE  Recognize and consider consent issues, patient comfort and other patient-related issues, when participating or recommending imaging procedures.  Recognize and consider radiation doses when recommending, approving and performing diagnostic or interventional cases  To demonstrate knowledge and awareness of radiation protection and well as appropriate handling of body fluids. F. PROFESSIONAL  Demonstrate integrity, honesty and compassion.  Ability to show sensitivity and care to the patient and the patient’s family.  Practice understanding of ethical and medical-legal requirements of radiologists Demonstrate awareness of one’s own limitations G. SCHOLAR  Set personal learning goals & objectives during rotation(s).  Take a leadership role in learning from others, with teaching/supervision of junior residents on rotation, elective students, off-service residents.  Create Teaching Files for use by future trainees. H. EVALUATION
  • 8.  Assessed on daily basis by Musculoskeletal staff radiologist assigned to reviewing cases (Plain film,CT, MR, US)  Assessment of quality and quantity of Teaching Files created during rotation RECOMMENDED TEXTS: 1. Bone and Joint Imaging: Resnick 2nd Rotation 2. Arthritis in Black and White: Brower 1st Rotation 3. Greenspan, Adam 1st Rotation 4. Orthopedic Radiology: Weissman and Sledge * Reference Text 5. Radiology of Skeletal Trauma: Rogers ** Reference Text 6. Musculoskeletal MRI: Kaplan, Dussault, Helms, Anderson, Major - *Reference Text Updated by Dr. Mandalenakis May 2008
  • 9. SMBD-JEWISH GENERAL HOSPITAL PROGRAM GOALS: By the end of their training, residents should be able to detect and diagnose most pathologies of the respiratory system. The residents are expected to be familiar with all the modalities used in the investigation of chest diseases, their indications and possible contraindications. ROTATION OBJECTIVES: MEDICAL EXPERT: -After completing one month of chest rotation, the resident should be able to recognize normal anatomy of the chest both on radiographs and CT scan. -Know the different modalities used in the investigation of chest disease. -Know the indications of different radiographic techniques (decubitus films shoot through lateral, etc.) -Know the indications of contrast chest, CT studies and high resolution CT. -Recognize and diagnose most commonly seen pathologies of the thorax. -Familiarize himself/herself with transthoracic needle biopsies and drainages and the indications, complications and management of these complications. COMMUNICATOR -The resident should be able to dictate organized reports describing the pertinent findings, the diagnosis and the recommendations. -Be able to communicate effectively with patients, technologists and referring physicians. COLLABORATOR -Should be able to function as a consultant when interacting with other physicians. CHEST ROTATION
  • 10. MANAGER -The resident should use effectively and efficiently available imaging resources and should be able to function as a team player and share these resources with his/her colleagues in radiology (cost effectiveness, etc.) HEALTH ADVOCATE -Be sensitive to patients’ needs and be able to interact and explain to patients different modalities and procedures. PROFESSIONAL -To demonstrate integrity, honesty and compassion. -To practice understanding ethical and medico-legal requirements of radiologists. SCHOLAR -To establish personal learning goals during rotation and to participate in the teaching of junior residents, medical students and non radiology residents. ROTATION RESPONSIBILITIES -In first 2 weeks, learn how to interpret plain radiographs of the chest on inpatients and outpatients and review cases with staff assigned to the rotation. -In the subsequent weeks, the residents’ responsibilities include: - review plain chest films and CT scans of the chest, - provide supervision to the technologists for cases requiring a modified CT protocol - report all cases supervised or reviewed by them with the assigned staff radiologist - Assist the staff radiologists in the transthoracic needle biopsies and eventually perform the biopsies under staff supervision. TEACHING AND ROUNDS -Involved in teaching of medical students and non radiology residents. -Involved in daily ward rounds in reviewing imaging studies with house staff under the supervision of staff radiologists. -Preparation and presentation of chest topics at radiology rounds or to chest staff radiologist. RESOURCES Recommended texts include: Synopsis of Fraser & Pare High resolution CT of the lung (W.R. Webb, N.L. Muller & D.P. Naiditch) Hospital Medical Library
  • 11. Internet Updated by Dr. A. Lisbona May 2008 SMBD-JEWISH GENERAL HOSPITAL CT SCAN ROTATION 1.GOALS: By the end of residency training, the resident should be competent in standard diagnostic and interventional CT skills including: 1) CT Neuro, ENT, Chest, abdomen, pelvis and MSK 2) Specialized techniques such as CTA, Virtual colonoscopy. 3) Drainage and biopsy techniques. 4) Advising and guiding the technologist regarding proper protocols or modifications as required. 2. DUTIES a)The resident should be available for CT from 9:00 A.M. until 5:00 P.M. except for conferences, lunch and reviewing cases with other staff. b) All abdominal and pelvic cases should be reviewed by the resident with a staff radiologist and must be reported by the resident the same day as performed, whenever possible. Cases which have not been reviewed on the same day as done, must be reported by the resident on the same day as reviewed with staff. c) Residents are expected to supervise CT scanning after the first CT rotation. d) The resident is expected to participate in most procedures in the CT room -- e.g. biopsies, drainages, etc. e)The resident should take every opportunity to do reconstructions including 3D reconstructions. f) The resident should make himself/herself thoroughly familiar with all the technical aspects of CT scanning and should be able to answer all questions from technicians, staff and other residents on these matters. g) The resident should be active in placing cases in the teaching file. h)The resident should read extensively (see reading list) the standard texts in CT. i) Emergency films done during the day must have an immediate report to be sent down to the ER. If a final report cannot be done immediately, a preliminary report must be sent.
  • 12. j)The resident is encouraged to bring interesting cases to rounds. k)The resident must ensure that all cases reserved by them have been completed. If unable to complete reading them, residents must return the cases to the worklist. l) Teaching/supervision of elective medical students and/or off-service residents along with assigned radiologist. m) Teaching of CT technologists. 3. ROTATION OBJECTIVES MEDICAL EXPERT  To learn the appropriate indications for a variety of CT examinations.  To demonstrate basic knowledge of protocols for all of the body systems mentioned above.  To learn the normal anatomy of the above-mentioned systems.  To develop basic image interpretation skills.  To demonstrate knowledge of common pathologies (including trauma) and their associated CT findings.  To learn formulation of appropriate differential diagnoses.  To correlate CT findings with other imaging modalities (Plain films ,Ultrasound, MRI etc.)  To learn the technique and gain experience performing CT-guided biopsy (FNA & core), paracentesis, including indications, contraindications as well as recognition and management of complications.  To learn the basic CT physics and instrumentation related to equipment operation, image optimization and radiation dose reduction.  To learn the indications as well as absolute and relative contra-indications of IV contrast.  To learn identification and management of contrast reactions.  To learn to prioritize studies based on their medical urgency. COMMUNICATOR  To dictate well-organized reports, describing relevant findings, diagnosis and recommendations.  To demonstrate effective communication skills when dealing with patients, staff and referring clinical services.  To communicate life-threatening findings directly to the referring physician in a timely fashion.  To document pertinent conversations with the clinician in the report. COLLABORATOR  To demonstrate good consulting skills when interacting with other physicians & health team members.
  • 13.  To interact appropriately with other radiology department staff, demonstrating a team approach to patient care. MANAGER  Consider advantages and disadvantages of CT vs. other imaging modalities.  To consider available imaging resources when planning and recommending patient care, using them effectively and efficiently. HEALTH ADVOCATE  Recognize and consider consent issues, patient comfort and other patient-related issues, when participating in or performing CT/CT-guided procedures.  Be cognizant of radiation dose issues regarding repeat studies, accounting for age, medical status and alternate imaging possibilities. PROFESSIONAL  To demonstrate integrity, honesty and compassion.  To practice understanding ethical and medical-legal requirements of radiologists.  To demonstrate awareness of own limitations. SCHOLAR  To set personal learning goals & objectives during rotation.  To take a leadership role in the teaching of others, with teaching/supervision of junior residents on rotation, elective students, off-service residents. PGY 5 year: 1) To be competent in objectives listed above. 2) To demonstrate skill in biopsy and procedural techniques, performing with minimal supervision and guidance. To function as a junior consultant in the CT department 4) EVALUATION Assessed on a daily basis by staff assigned to CT as well as by staff evaluating performance at daily rounds. Formal evaluation at end of 4 week rotation. 5) RECOMMENDED TEXTS 1) Webb WR, Brant WE, Helms CA. Fundamentals of Body CT 2) Lee JKT, Sagel SS, Stanley RJ, Heiken JP. Computed Body Tomography with MRI
  • 14. Correlation. 3) Federle, Jeffrey, Desser, 1st ed, Diagnostic Imaging**, Salt Lake City, Utah 2004 4) Case Review Series by Mosby a. Genitourinary Imaging b. Abdominal Imaging 5) CT and MRI of the abdomen and pelvis: A teaching file Abloros, Koenraad Mortele, Sylvester Lee, Vincent Pelsser ** Genitourinary Imaging- coming out shortly. Dr. R. Satin (REVISED APRIL 2008) SMBD-JEWISH GENERAL HOSPITAL ENT GUIDELINES Total: 1 period (usually senior resident) Rotation consists of 2 weeks at JGH, 2 weeks at MUHC. PROGRAM GOALS: By the end of residency training, the resident should be familiar with the indications for ENT plain radiographic, CT and MR imaging and be able to protocol, detect and diagnose common pathologies. Resident should also be capable of dealing with the standard imaging of ENT emergencies and their interpretation. ROTATION OBJECTIVES: Medical Expert/Clinical Decision Maker After completing one month of ENT imaging, the resident should be able to: Know the indication/contraindications to plain films, CT and MR imaging and know where to consult the source documents for questions that arise regarding potential contraindications.  Know the appropriate techniques of dealing with contrast reaction and patient resuscitation in the CT and MRI suite environments.  Be familiar with basic CT parameters and MRI pulse sequences and their clinical applications.  Be familiar with basic imaging artifacts and understand how they can be avoided.  Recognize normal anatomy in the various imaging planes using the bread and butter imaging protocols  Recognize pathology and be able to discuss the signal and enhancement characteristics of commonly seen pathologies of the above-mentioned systems.  Basic concepts of benign and malignant neck masses, head and neck cancer and patterns of tumor spread, infectious or inflammatory diseases of the neck  Know how to use reconstruction software for reading out CTA, MRA and MRV studies.  Become comfortable with reading plain film studies such as sinuses, facial bones, mastoids, orbits and soft tissues of the neck. Communicator  To dictate well organized reports describing relevant findings, diagnosis and recommendations.  To demonstrate effective communication skills when dealing with patients, staff and referring clinical services.
  • 15. 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. Manager  To demonstrate awareness of the indications for ENT imaging examinations.  Consider advantages and disadvantages of each imaging study.  To consider available imaging resources when planning and recommending patient care, using them effectively and efficiently. Health Advocate  Recognize and consider consent issues, patient comfort and other patient-related issues, when supervising ENT CT and MRI examinations. Professional  To demonstrate integrity, honesty and compassion.  To practice understanding ethical and medical-legal requirements of radiologists.  To demonstrate awareness of own limitations. Scholar  To set up personal learning goals and objectives during rotation.  To take a leadership role in the teaching of others, with teaching/supervision of junior residents on rotations, elective students and off-service residents. Rotation responsibilities: In the first week: Focus on learning the basic anatomy as well as understanding the most common indications and contraindications to plain films, CT and MR imaging. Can review cases with the staff assigned to the rotation. Subsequent week resident responsibilities include: a) As is appropriate, interview patient, review patient charts, lab data and previous imaging history, in order to provide appropriate information for the involved technologists and study interpretation. b) Provide supervision/guidance to the technologist for cases requiring a modified CT or MR scanning protocol. c) Report all cases he/she has been involved with (supervising or reviewing). All cases need to be read out in conjunction with the assigned staff radiologist. d) Administer or supervise sedatives to patients parenterally as needed. TEACHING: a) The resident is encouraged to bring interesting cases to resident rounds. b) Supervision/teaching of elective medical students or off-service residents, along with assigned radiologist. c) Teaching of CT and MR technologists and students, as appropriate
  • 16. ROUNDS: Bring interesting ENT cases to combined ENT-radiology rounds as well as to the weekly ENT rounds given by the ENT staff. Evaluation: Assessed on a daily basis by staff assigned to ENT, as well as during education rounds. Formal ITER at end of 4-week rotation. PLEASE ARRANGE A TIME FOR THIS WITH SUPERVISOR! Suggested resources: Temporal Bone Imaging of the Temporal Bone, Swartz & Harnsberger. CT/MRI  Head and Neck Imaging, Peter M. Som, Hugh D. Curtin Miscellaneous Handbook in Radiology: Head and Neck Imaging.2nd Edition, Harnsberger, Radiology Clinics of North America. Diagnostic and Surgical Imaging Anatomy. Harnsberger, Osborn, Macdonald and Ross. The Requisites 2nd Edition, Neuroradiology, Grossman, RI, Yousem, DM Additional resources: CT/MRI teaching file Internet including STATDX paid subscription for the residents Departmental/Hospital journals Procedural skills to learn: None Dr. M. Levental Updated April 2008
  • 17. SMBD-JEWISH GENERAL HOSPITAL GENITOURINARY GUIDELINES Goals and objectives 1. MEDICAL EXPERT Radiologic anatomy of the upper and lower urinary tracts, as well as male and female genitalia are learned, together with the physiology and physiopathology of these systems. In the senior phase, this material is reinforced and the resident should act as consultant to the clinician in selecting the imaging modality in a particular situation, as well as performing and interpreting specialized procedures. Residents will also be responsible for reporting abdominal plain films. The resident will make use of the huge GU teaching file at the JGH (Dr Hyams’ file) as independent study. A team of two senior residents would be best suited for this rotation, to maximize the use of the teaching file. It is recognized that much of GU radiology is incorporated into the rotations in CT, MR, US and nuclear medicine. This dedicated rotation should be heavily weighted on plain film teaching file for exposure to IVP. Modes of Imaging for Assessing the GU Tract . Plain film of the abdomen . Excretory urography and tomography . Ultrasound: Abdominal, transrectal prostate, scrotal . CT - plain, with contrast, dynamic . Special procedures: Cystourethrography - retrograde and voiding. Sinography, loopograms. Pyelography - retrograde and antegrade. Hysterossalpingography. . Nuclear renography . Interventional Procedures: Angiography, venography, renal cystography (rarely performed), percutaneous nephrostomy and stent insertion, percutaneous biopsy, abscess drainage, renal angioplasty and embolization. These modalities are usually taught during the interventional radiology rotation; however, if there is no resident on the interventional rotation, the GU radiology resident is encouraged to participate.
  • 18. . MRI The Scope of GU Abnormalities to be Encompassed includes . Congenital anomalies . Stone disease . Infection . Trauma . Vascular diseases . Medical diseases . Neoplasms . Adrenal diseases . Bladder and urethra . Scrotum & testes . Neurogenic problems . Transplantation . Drug induced conditions . Prostheses, diversions and reconstructive procedures . Contrast . Fat containing lesions . Gynecology What the resident should know after completing the GU rotations ) How to design, supervise and modify basic IVP to maximize the information gained from this procedure; ) How to perform and modify fluoroscopic procedures, such as: voiding cystography, urethrography and antegrade pylography to suit individual patient requirements; ) How to compose concise meaningful, accurate and clinically helpful reports on GU studies, recognizing the importance of direct communication to referring clinicians in appropriate circumstances; ) Be able to advise clinicians on the most appropriate imaging modality to assess particular disease processes relevant to all individual patients; ) Understand the predisposing factors, physiology and clinical manifestations of adverse reactions to contrast media and be able to deal with these reactions efficiently in emergency circumstances; ) How to understand and utilize new information in major journals and GU sections of radiology textbooks. 2. COMMUNICATOR Residents must develop the ability to dictate organized succinct reports detailing pertinent findings, both positive and negative with a differential diagnosis and recommendations on further imaging or course of action. Residents must develop communication skills to deal with patient and family, support staff and referring physicians. There must be an understanding of the need to directly communicate urgent results in a timely fashion. 3. COLLABORATOR  Residents must demonstrate good consulting skills when interacting with other physicians and health team members.
  • 19.  Residents must learn to interact appropriately with other radiology staff, demonstrating the importance of the team approach to patient care.  Residents must learn and demonstrate the direct approach to teamwork in an emergency situation recognizing when direct immediate contact with relevant clinical colleagues is needed.  Residents should be prepared to participate in interdisciplinary teaching rounds and research projects involving other specialties. 4. MANAGER  Residents should demonstrate awareness of indications and contraindications to various angiographic and interventional procedures.  Residents should consider the necessity and appropriateness of using costly equipment over less costly equipment to accomplish the required goal.  Residents must consider available imaging resources when planning and recommending patient care, using them effectively and efficiently. 5. HEALTH ADVOCATE  Residents must recognize and consider consent, patient comfort and other patient related issues when performing interventional acts, taking into account individual patient status and needs, also considering radiation exposure risk. Residents must take into account renal function and potential deterioration when administering contrast agents for CT scanning, excretory urography and MRI studies. 6. PROFESSIONAL  Residents must demonstrate integrity, honesty, reliability and compassion.  Residents must understand and practice the ethical and medico-legal requirements of genitourinary interventions.  Residents must recognize their own limitations and always keep in mind that the patient is paramount. 7. SCHOLAR Conferences in GU radiology are given weekly. Teaching files, relevant texts and journals are available. Research projects and collaborating on papers is encouraged. Visiting professors are invited to McGill and the University of Montreal.
  • 20. Residents should take a leadership role in teaching junior residents, medical students, off service residents and technical and nursing staff. The need for lifelong continuing education must be recognized and internalized, through journal and textbook reading, attending rounds, meetings and symposiums as well as continuing web based modules. Reading list Must read: Dunnick, Reed and McCallum - Textbook of Uroradiology. Reference: Pollack, H. - Clinical Urography (Saunders). Rumack, Wilson and Charbonneau - Diagnostic Ultrasound. Elkin - Urologic Radiology. Lalli - Tailored Urography (Yearbook Medical Publishers, Inc.). Davidson - Radiology of the Kidney (Saunders). McCallum & Colapinto - Urethrography. Rozin, Samuel - Uterosalpingography in Gynecology (Thomas). Reeder, M. & Felson, B. - Gamuts in Radiology (Audio Visual Radiology of Cincinnati Inc.). Encyclopedia 3-volume set encyclopedia entitled “Clinical Urography” 2nd Edition - in Health Sciences Library. A.C.R. GU learning file – CD ROM Available through Radiology secretarial office (Rm. C210.2). December 2009
  • 21. GUIDELINES FOR GI ROTATION 1. GOALS By the end of residency training, the resident should be familiar with the indications for all gastrointestinal imaging and be able to perform, and diagnose common pathologies of the esophagus, stomach, duodenum, small bowel and colon. 2. DUTIES The resident is expected to perform and report all GI, and BE studies when possible and other minor GI studies such as barium swallows and modified barium swallows as well as small bowel studies. 3. MEDICAL EXPERT After completing the GI rotation, the resident should be able to:  Know the indications and contraindications of GI tract imaging  Understand reasons for conrtast media choices  Learn, perform and interpret:  Double contrast techniques of: -The upper GI tract and the colon (single contrast as well) -Small bowel follow through -Swallowing study -Contrast study of the post-operative stomach (particularly s/p bariatric surgery) -Sinogram, fistulogram techniques ▪ Understand normal anatomy and be able to recognize abnormal anatomy such as malrotation of small and large bowel. ▪ Know the pathology of small bowel disease and recognize abnormal small bowel patterns and associated pathology ▪ Be thoroughly knowledgeable of all polyposis syndromes ▪ Be able to recognize colitides and be able to discuss differential diagnosis ▪ recognize all forms of neoplastic disease of the colon, small bowel and stomach and discuss differential diagnosis ▪ Be knowledgeable of the variety of inflammatory, traumatic and idiopathic diseases of the stomach and small bowel. ▪ Understand how to demonstrate post operative and spontaneous leaks of the esophagus, stomach, small bowel and colon.
  • 22. 4. COMMUNICATOR ▪ To dictate well organized reports describing relevant findings, diagnosis and recommendations. ▪To demonstrate effective communication skills when dealing with patients, staff and referring clinical services. ▪To recognize complications (such as perforation) and appropriately advise referring clinicians in a timely fashion 5. MANAGER ▪ To demonstrate awareness of the indications for all GI examinations. ▪Consider advantages and disadvantages of GI examinations versus other imaging or endoscopy modalities. ▪To consider available imaging resources when planning and recommending patient care, using them effectively and efficiently. ▪To organize an effective schedule in order to accommodate all necessary examinations. 6. HEALTH ADVOCATE ▪ Recognize and consider consent issues, patient comfort and other patient-related issues, when conducting GI examinations. 7. PROFESSIONAL  To demonstrate integrity, honesty and compassion.  To practice understanding ethical and medical-legal requirements of radiologists.  To demonstrate awareness of own limitations. 8. SCHOLAR  To set up personal learning goals and objectives during rotation.  To take a leadership role in the teaching of others, with teaching/supervision of junior residents on rotations, elective students and off-service residents. 9. TEACHING  The resident is encouraged to bring interesting cases to resident rounds.  Supervision/teaching of elective medical students or off-service residents, along with assigned radiologist.  Teaching of GI technologists and students, as appropriate The resident is expected to enter interesting cases with teaching value including those that he has not performed. The teaching files should be consulted whenever time permits The resident is expected to attend and gather interesting and suitable cases for GI conference.
  • 23. 10. ROUNDS Attend all rotation-specific rounds as well as all teaching conferences 11. EVALUATION Assessed on a daily basis by staff assigned to GI, as well as during teaching conferences and rounds. Formal ITER at end of 4-week rotation. PLEASE ARRANGE A TIME FOR THIS WITH SUPERVISOR! 12. READING LIST – Essentials In Health Sciences Library - JGH a) Margulis and Burhenne:- Alimentary Tract Radiology: A Synopsis (REF) WI 141 M33 1994 b) Laufer: - Double Contrast Gastrointestinal Radiology (air contrast) - 2nd Ed. 1992 WI 141 L3; 1992 c) Marshak - small intestine (1983) WI 500 M35r 1976 d) Eisenberg:- Gastrointestinal Radiology: A Pattern Approach (1983) WI 141 E8g 1983 e) Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy by Morton A. Meyers - 4th Edition. Springer-Verlag (REF) WI 900 M57d 1994 f) ACR teaching file Dr. R. Satin UPDATED APRIL 2008
  • 24. SMBD-JEWISH GENERAL HOSPITAL NEURORADIOLOGY GUIDELINES PROGRAM GOALS: The goals of the Neuroradiology rotation at the McGill are to provide resident trainees with adequate knowledge base and expertise in the interpretation of images with regards to normal Central Nervous System (CNS) anatomy and common CNS pathology. The resident must be able to advise the clinician and patient on the potential uses of Neurointerventional procedures. The trainee must acquire expertise in order to carry out diagnostic procedures such as myelograms and diagnostic lumbar punctures. In addition, the resident must feel comfortable consulting with Neurologists, Neurosurgeons and other clinicians. The resident is expected to complete four (4) core rotations in Adult Neuroradiology, in addition to the 4 weeks spent in Pediatric Neuroradiology while at the Montreal Children’s Hospital. Residents are expected to show proficiency in the supervision and interpretation of plain radiographs, CT, MRI, and infant neurosonography GENERAL OBJECTIVES: KNOWLEDGE: a) Knowledge of the anatomy of the central and peripheral nervous systems, organs of special senses, and spinal cord in both adults and children (with emphasis on radiological applications). b) Knowledge of all aspects of Neuroradiology, including an understanding of diseases that pertain to the CNS, and the appropriate imaging investigations. c) Understanding of the general principles with regards to Neuro-interventional procedures. Performance of basic lumbar puncture /myelogram with supervision and guidance SPECIFIC OBJECTIVES: MEDICAL EXPERT/CLINICAL DECISION-MAKER:  Knowledge of:  Neuroanatomy: brain and spinal cord, brachial plexus  Neurovascular anatomy  Neuropathology: brain and spinal cord -cerebral tumors, degenerative and vascular diseases, hydrocephalus, cranial nerve pathology, sellar and Posterior fossa pathology - congenital brain disorders -cord tumors, degenerative and vascular diseases, syringomyelia - congenital spinal diseases - Neurotrauma COMMUNICATOR:  Able to provide and organize succinct, but thorough, diagnostic reports.
  • 25.  Able to consult with referring physicians both before and after studies/procedures are performed, demonstrating effective communication skills.  Demonstrate effective communication skills when dealing with patients, during interview, consent and procedure.  Able to explain the procedure and findings in terms that the patient and family can understand.  Demonstrate effective skills when dealing with staff from referring clinical services. COLLABORATOR:  Demonstrate adequate consultation skills when interacting with other physicians & health team members  Interact appropriately with other radiology departmental staff (technologists, nurses), demonstrating a team-based approach to managing patients. MANAGER:  Consider advantages and disadvantages of various available imaging modalities, and advise consultants accordingly.  Demonstrate awareness of the indications for various interventional modalities  Consider advantages and disadvantages available of operative versus interventional techniques.  Consider available imaging resources when planning and recommending patient care, using them effectively and efficiently. HEALTH ADVOCATE:  Recognize and consider consent issues, patient comfort and other patient-related issues, when participating or recommending imaging procedures.  Recognize and consider radiation doses when recommending, approving and performing diagnostic or interventional cases  To demonstrate knowledge and awareness of radiation protection and well as appropriate handling of body fluids. PROFESSIONAL:  Demonstrate integrity, honesty and compassion.  Ability to show sensitivity and care to the patient and the patient’s family.  Practice understanding of ethical and medical-legal requirements of radiologists  Demonstrate awareness of one’s own limitations. SCHOLAR:  Set personal learning goals & objectives during rotation(s).  Take a leadership role in learning from others, with teaching/supervision of junior residents on rotation, elective students, off-service residents.  Create Teaching Files for use by future trainees.
  • 26. ROTATION RESPONSIBILITIES: CLINICAL: Procedures Resident is expected to be directly involved in and where possible, perform all neuroradiological procedures, under staff supervision, which would include: a) Myelography - Iohexol - Lumbar or - Thoracic or - Cervical b) CT cisternography c) Neuroangiography - Intravenous - Intraarterial d) MRI-MRA, - MRI of the brain and spine The resident himself/herself is responsible for obtaining patient's consent on all neuroradiologic special procedures. (Note: Resident should refer to the written instruction form on obtaining patient's consent). Resident is expected to interpret and report with staff supervision: a) All procedures in which he has been involved and some procedures in which he has not been involved. b) All related radiologic investigations on patients undergoing neuroradiologic study, especially CT scans. c) Plain films include skull x-rays, sinuses, temporal bone studies (including tomography), d) cervical, dorsal and lumbosacral spines, and any other studies of the head and neck. Conferences Resident is expected to: a) Attend all neuroradiology conferences and present clinical cases and associated radiological discussion on a regular basis. b) Attend neuropathology conferences as often as possible (excepting physics lectures, Visiting Professors, etc.) Teaching files The resident is expected to enter interesting cases of teaching value in which he/she may not have
  • 27. been directly involved, into the teaching file. It is strongly recommended that he/she review cases from the teaching file when time permits. TEACHING: 1) The resident is required to bring interesting cases to teaching rounds. 2) Supervision/teaching of elective medical students or off-service residents. 3) Teaching of technologists (if assigned). 4) Prepare cases for teaching files (electronic or hard copy) 5) Include all interventional procedures in personal data bank ROUNDS:  Depending on hospital site, may be required to prepare case show, short presentation, etc. EVALUATION:  Assessed on daily basis by Neuroradiology staff radiologist and Fellow assigned to reviewing cases (CT, MR, US) Reference Texts for Neuroradiology 1. Diagnostic Neuroradiology. Anne Osborn, 1994, Mosby. 2. Handbook of Neuroradiology. Anne Osborn, 1991, Mosby. 3. Introduction to Cerebral Angiography. Anne Osborn, 1991, Harper & Row. 4. Imaging of Head Trauma. Alisa Gean, 1994, Raven Press. 5. Magnetic Resonance Imaging of the Head and Spine. Scott W. Atlas, 1991, Raven Press. 6. Magnetic Resonance Imaging of the Spine. Michael Modic, 1994, Mosby. 7. Imaging of the Pediatric Head, Neck and Spine. M Castillo et al, 1996, Lippincott-Raven Press. 8. Pediatric Neuroimaging. AJ Barkovich, 1995, 2nd Edition Raven Press. 9. Neuroradiology in Infants and Children. Nash Harwood, CR. Fitz, 1976, Mosby. Dr. L. Rosenbloom Updated May 2008
  • 28. SMBD-JEWISH GENERAL HOSPITAL MAMMOGRAPHY GUIDELINES PROGRAM GOALS: The resident should interpret as many mammograms as possible during the rotation and make good use of available teaching files including the ACR teaching files. MEDICAL EXPERT: 1. Be familiar with the pathologic processes and various clinical manifestations associated with breast disease. 2. Gain experience in detecting abnormalities on mammography by seeing at least 25 cases a day. 3. Know how to further investigate a mammographic abnormality appropriately. (including those referred from outside institutions with partial work up). 4. Know how a mammogram is performed technically including technical pitfalls. 5. Understand the limitations of mammography. 6. Be able to perform ultrasound of the breast. 7. Be able to perform breast imaging guided procedures including fine needle aspiration, core biopsy, and needle localization. 8. Know the BIRADS classification COMMUNICATOR:  Produce concise and meaningful reports to referring physicians.  Be able to discuss mammographic findings with the surgeons in the breast clinic as well as suggest further imaging workup and integrate clinical findings.  Communicate some findings to patients and families.  Explain procedures to patients. COLLABORATOR:  To understand the roles of the other members of the health care team and interact appropriately with them. (clinicians, nurses, technicians, receptionist and filing staff) MANAGER  To be aware of available imaging resources and to use them efficiently when planning further work up.  To be efficient in time management.
  • 29. HEALTH ADVOCATE  Recognize the role of radiation dose when recommending further imaging.  Be familiar with the Quebec Breast Screen Program SCHOLAR  To have knowledge of the various breast pathologies and how they appear on breast imaging.  To set personal learning goals and objectives.  Understand the current controversies in breast screening.  To teach elective students (when appropriate) basic principles of breast imaging at their level. PROFESSIONAL  To demonstrate integrity honesty and compassion  To demonstrate awareness of own limitations  To demonstrate ethical behaviour when interacting with patients Responsibilities . To perform physical examination of the breasts and to correlate these findings with the radiologic findings; . To assess the technical adequacy of films and the need for repeat views; . To be familiar with the typical imaging appearance of in situ and invasive breast carcinoma, as well as unusual forms of carcinoma; together with non malignant breast conditions ( e.g. fibroadenoma, oil cyst, secretory disease etc). . To perform needle localizations and needle biopsies of non-palpable lesions; . To indicate what further studies may be necessary including additional views, follow-up examinations, ultrasound, MRI and biopsy. . To read mammograms and special views that are then reviewed with the attending radiologist. . To review and correlate pathology results with mammograms and/or ultrasounds. . To report mammo and ultrasound cases and assign BIRADS at the end of the report. . Review MRIs done with attending radiologist. . Bring interesting cases to conference. Evaluation Evaluations done by staff at end of 4 week rotation. Reading Material (all available in JGH Library) Breast Imaging, Kopans, Lippincott, 1998 must read Teaching Atlas of Mammography, Tabar and Dean. must read
  • 30. ACR Diseases of the Breast: Test & Syllabus, (Second series - No. 36) Feig, Kalisher, Libshitz,Et al CalL number WN 200P941993 ** (two copies in the library and two copies in our department library) Percutaneous Breast Biopsy Edited by Steve H. Parker, MD & Wm. E. Jobe, MD Raven Press, 1993 Departmental Library Film Screen Mammography: An Atlas of instructional Cases, Bassett, et al Breast Cancer - The art and Science of Early Detection with Mammography. Perception, Interpretation, Histopathologic Correlation. 2005 Georg Thieme Verlag. Laozlo Tabar, Tibor Tot, Peter B. Dean Dr. M. Pinsky Updated May 2008
  • 31. JEWISH GENERAL HOSPITAL DEPARTMENT OF DIAGNOSTIC RADIOLOGY MRI ROTATION OBJECTIVES Total: 2 periods PGY4/5: 4 weeks per period MR Rotation encompasses Abdominal, Pelvic, Neuro, Thoracic and MSK. PROGRAM GOALS: By the end of residency training, the resident should be familiar with the indications for Neuro, Thoracic, MSK, abdominal and pelvic MR imaging and be able to protocol, detect and diagnose common pathologies of the above systems. ROTATION OBJECTIVES: MEDICAL EXPERT:  Know the contraindications to MR imaging and know where to consult the source documents for questions that arise regarding potential contraindications.  Know the appropriate techniques of dealing with contrast reaction and patient resuscitation in the MRI suite environment.  Know the most frequent indications for standard MR imaging.  Be familiar with basic sequences and their clinical applications.  Be familiar with basic imaging artifacts and understand how they can be avoided.  Recognize normal anatomy in the various imaging planes using the various sequences.  Recognize pathology and be able to discuss the signal and enhancement characteristics of commonly seen pathologies of the above-mentioned systems.  Know how to use reconstruction software for reading out MRA and MRV studies. COMMUNICATOR:  To dictate well organized reports describing relevant findings, diagnosis and recommendations.  To demonstrate effective communication skills when dealing with patients, staff and referring clinical services. COLLABORATOR  To demonstrate good consulting skills when interacting with other physicians & health team members.
  • 32.  To interact appropriately with other radiology department staff, demonstrating a team approach to patient care. MANAGER  To demonstrate awareness of the indications for MR examinations.  Consider advantages and disadvantages of MRI versus other imaging modalities.  To consider available imaging resources when planning and recommending patient care, using them effectively and efficiently. HEALTH ADVOCATE:  Recognize and consider consent issues, patient comfort and other patient-related issues, when supervising body MR examinations. PROFESSIONAL:  To demonstrate integrity, honesty and compassion.  To practice understanding ethical and medical-legal requirements of radiologists.  To demonstrate awareness of own limitations. SCHOLAR  To set up personal learning goals and objectives during rotation.  To take a leadership role in the teaching of others, with teaching/supervision of junior residents on rotations, elective students and off-service residents.  Manage the cases and share them with residents doing subspecialty rotations (neuro, msk, etc) ROTATION RESPONSIBILITIES: In first 1-2 weeks: Focus on learning the basic sequences for MR imaging as well as understanding the most common indications and contraindications to MR imaging. Review cases with the staff assigned to the rotation on a daily basis and the staff to which a case is assigned. Subsequent weeks resident responsibilities include: a) Interview patient, review patient charts, lab data, previous imaging history, in order to provide appropriate information for the involved technologists and study interpretation. b) Provide supervision/guidance to the technologist for cases requiring a modified MR scanning protocol. c) Report all cases he/she has been involved with (supervising or reviewing). All cases need to be read out in conjunction with the assigned staff radiologist. d) Administer antispasmodics and sedatives to patients parenterally as needed. TEACHING: a) The resident is encouraged to bring interesting cases to resident rounds. b) Supervision/teaching of elective medical students or off-service residents, along with assigned radiologist. c) Teaching of MR technologists and students, as appropriate d) Add interesting cases to the neuro log book for future teaching purposes. EVALUATION:
  • 33. Assessed on a daily basis by staff assigned to MRI, as well as during education rounds. Formal ITER at end of 4-week rotation. Suggested resources: Recommended texts: Body MRI by Evan Siegelman MRI Principles by Donald Mitchell Magnetic Resonance Imaging of the Brain and Spine Atlas, Scott W. Diagnostic Neuroradiology by Anne G. Osborn, Julian Maack Magnetic Resonance Imaging in Orthopedics & Sports Medicine, Second Edition David Stoller, M.D. MRI, Arthroscopy and Surgical Anatomy of the Joints David Stoller, M.D. Additional resources: Internet Medical journals CT and MRI of the abdomen and pelvis: A teaching file Abloros, Koenraad Mortele, Sylvester Lee, Vincent Pelsser Procedural skills to learn: Arthrogram portion of MR arthrogram study Dr. V. Pelsser Updated May 2008
  • 34. II. CLINICAL SCIENCES SMBD-JEWISH GENERAL HOSPITAL NUCLEAR MEDICINE GUIDELINES There are two aspects of this rotation for residents to keep in perspective: I. BASIC SCIENCES 1. Nuclear Physics relevant to Nuclear Medicine 2. Radiation Safety 3. Radiation Biology 4. Radiopharmacy 5. Instrumentation: Dose calibrators, portable radiation detectors, probes, 6. gamma cameras, PET scanners, Bone mineral densitometers. 7. Quality Control 8. Basic Statistics 9. Computer Science 10. The concept of Molecular Imaging 11. Antibodies, Tracer Kinetics and basic principles of RIA. Residents’ responsibilities It is understood that these Basic Sciences are not esoteric. They are a critical aspect of day-to-day Nuclear Medicine practice and indeed are emphasized on qualifying examinations, particularly American Board of Radiology examinations. The Resident should achieve the following objectives in the clinical sciences. 1. To become a medical expert:  To be able to interpret scans.  Become adept at performing nuclear medicine procedures
  • 35.  To acquire an appreciation of the role of nuclear medicine in the diagnostic algorithm  To acquire in depth knowledge of the pathophysiological basis of the specialty,  To understand the clinical applications of the specialty.  To be able to perform radiotherapy with unsealed sources 2.To become an effective communicator with both the patient and the consulting physicians. 3. To become an effective collaborator with consulting physicians and other health care professionals.  To especially develop an expertise in correlative imaging. 4. To become a competent manager:  To utilize resources effectively to balance patient care, learning needs and outside activities.  To allocate the finite health care resources wisely  To work effectively and efficiently in a health care organization 5. To become a health advocate for the patient and the medical system in general. 6. To become a scholar:  To utilize the appropriate nuclear medicine texts, journals, audiovisual series, government publications (CNSC) and on-line resources in order to gain the appropriate knowledge needed to become a nuclear medicine specialist.  To implement a personal continuing education strategy  To critically appraise sources of medical infonnation  To contribute to teaching files  To teach junior residents, housestaff and medical students  To contribute to development of new knowledge 7. To become a true professional who delivers the highest quality care with integrity, honesty and compassion.  To display appropriate personal and interpersonal professional behaviour.  To practice medicine ethically.  To become aware of the medico-legal issues relevant to nuclear medicine practice. Dr. C. Rush & Dr. J. Stern
  • 36. Updated May 2008 SMBD-JEWISH GENERAL HOSPITAL ULTRASOUND GUIDELINES PROGRAM GOALS: By the end of residency training, the resident should be competent in ultrasound skills required for general ultrasound including: 1. Ultrasound of abdomen, pelvis, small parts, peripheral vascular system 2. Advise technologist regarding special views or parameters required for cases ROTATION OBJECTIVES: MEDICAL EXPERT/CLINICAL DECISION-MAKER:  To demonstrate ultrasound scanning technique for abdominal and pelvic imaging.  To develop skills in use of transvaginal ultrasound probe and image interpretation.  To learn the appropriate indications for variety of ultrasound examinations.  To learn the normal ultrasound anatomy of the abdomen, pelvis, peripheral vascular system, scrotum.  To demonstrate knowledge of common pathologies and their associated ultrasound findings:  Liver/biliary tree (obstruction, tumours, portal hypertension, cirrhosis)  Gallbladder disease (cholecystitis, cholelithiasis)  Pancreatic inflammatory and neoplastic disease  Metastatic disease (liver, spleen, omentum/peritoneum)  Female pelvis: assessment of uterus, ovaries, endometrium, adnexa  To correlate ultrasound findings with other imaging modalities (Plain films, CT, MRI etc)  To learn the basic ultrasound physics and instrumentation related to equipment operation, choice of probes, image optimization. COMMUNICATOR  To dictate well-organized reports, describing relevant findings, diagnosis and recommendations.  To demonstrate effective communication skills when dealing with patients, staff and referring clinical services.
  • 37. 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. MANAGER  To demonstrate awareness of the indications for various ultrasound examinations.  Consider advantages and disadvantages of ultrasound vs. other imaging modalities.  To consider available imaging resources when planning and recommending patient care, using them effectively and efficiently. HEALTH ADVOCATE  Recognize and consider consent issues, patient comfort and other patient-related issues, when participating or performing ultrasound/ultrasound guided procedures.  PROFESSIONAL:  To demonstrate integrity, honesty and compassion.  To practice understanding ethical and medical-legal requirements of radiologists.  To demonstrate awareness of own limitations. SCHOLAR  To set personal learning goals & objectives during rotation.  To take a leadership role in the teaching of others, with teaching/supervision of junior residents on rotation, elective students, off-service residents. Rotation responsibilities: In the first week: Focus on learning basic US scanning techniques. May review interesting cases that have occurred during the day with assigned radiologist. Subsequent weeks resident responsibilities include: 1. Review patient charts, lab data, previous imaging, in order to provide appropriate information for the involved technologist and study interpretation. 2. Scan as many patients as conditions allow. 3. Report all cases he/she has been involved with (scanning or reviewing). All cases to be reviewed by supervising radiologist. 4. To understand the basic physical principles of Ultrasound including colour and pulsed Doppler. 5. To become familiar with normal abdominal, pelvic, small parts, fetal and neonatal anatomy. 6. To learn to perform and interpret abdominal, pelvic, small parts, early obstetrical and neonatal cerebral and body scans. 7. To learn to perform and interpret emergency cases when on call. 8. To put interesting cases in the teaching file. 9. To prepare cases for showing at the radiology departmental resident conferences.
  • 38. Teaching: 1. The resident is encouraged to bring interesting cases to resident conferences. 2. Teaching of elective medical students or off-service residents, along with assigned radiologist. 3. Teaching of technologist and ultrasound students, as appropriate. Evaluation: Assessed by staff assigned to US, Formal rotation evaluation at end of 4-wk rotation. Suggested resources: Recommended texts: Rumack & Wilson: Diagnostic Ultrasound, 2nd ed., Vol. 1&2 (in ultrasound dept.) Requisites series: Ultrasound Sanders: Clinical Ultrasound Additional resources: ACR Teaching files on CD ROM, Journals- ( JUM, Radiology, Radiographics, AJR) Journal of Clinical Ultrasound (in ultrasound dept.) Journal of Ultrasound in Medicine (in ultrasound dept.) Reading list The reading list will be updated each year and made available in the Radiology Department. Dr. M. Pinsky & Dr. J. Cassoff Updated May 2008