SAINT VINCENT HOSPITALDEPARTMENT OF RADIOLOGY

WORCESTER, MASSACHUSETTSPOLICY AND PROCEDURE MANUAL

SUBJECT: HOUSE OFFICER COMPETENCIES

POLICY:Prior to becoming authorized to independently perform certain radiological procedures, radiology residents must demonstrate competence of such procedures.

PURPOSE: To assure the safe and effective performance of radiological procedures by radiology residents at Worcester Medical Center.

DEFINITIONS:

Radiology Resident:A graduate physician enrolled in the radiology residency program at St. Vincent Hospital at Worcester Medical Center.

Competence:Performance of a radiology procedure at a level compatible with a standard of practice for that procedure.

Radiological Procedure:A diagnostic or therapeutic act or procedure performed upon a patient which subjects the patient to theoretical (such as fluoroscopy) or definable risk (such as angiographic and interventional procedures).

IMPLEMENTATION:

  1. The Department of Radiology authorizes radiology residents to perform certain

procedures independently. This policy will describe administrative processes and practices used to assure resident competence.

2. A. Radiology procedures to be governed by this policy.

  1. Diagnostic angiography.

This applies to all diagnostic angiographic procedures with the exception of cardiac catheterization. This includes, but is not limited to, all abdominal,

pelvic, peripheral vascular, carotid, and cerebral angiography. Access may be via femoral, brachial, axillary, translumbar, or other approach.

  1. Angiography with therapeutic intervention includes angiography with

balloon angioplasty, stent placement, intra-arterial thrombolytic therapy, embolization or any other angiographic intervention.

3. Venography, diagnostic and interventional.

Same definition as 2A.1 and 2A.2 with access at the venous system

  1. Placement of central venous catheters.

This includes, but is not limited to, PICC lines, passports, dialysis catheters.

  1. All image guided biopsy procedures.

This includes, but is not limited to, ultrasound, fluoroscopy, and CT guided biopsy of any organ or structure.

DATE ISSUED:3/16/01SUPERCEDES DATE:NonePAGE:1 of 3

SAINT VINCENT HOSPITALDEPARTMENT OF RADIOLOGY

WORCESTER, MASSACHUSETTSPOLICY AND PROCEDURE MANUAL

SUBJECT: HOUSE OFFICER COMPETENCIES

  1. All image guided drainage procedures.

This includes, but is not limited to, aspiration and/or catheter drainage placement of any fluid collection.

  1. All image guided interventional diagnostic procedures.

This includes, but is not limited to, myelograms, arthrograms, nuclear cisternograms, nephrostograms and cholangiograms.

  1. All Nuclear Medicine therapies.

These include, but are not limited to, I-131, Samarium and Strontium.

  1. General use of fluoroscopy.

This includes, but is not limited to, general use of fluoroscopic equipment.

  1. Performance of GI contrast studies.

This includes use of barium, or water soluble contrast agent, for performance of studies of the esophagus, stomach, small bowel and large bowel.

  1. Tube studies.

Contrast injection through indwelling tubes for evaluation of patency and/or position. This includes, but is not limited to, evaluation of central lines, nasogastric tubes, feeding tubes, drainage catheters, T-tubes and fistulograms.

  1. Criteria used to determine competence:
  1. Diagnostic Angiography – always requires attending supervision.
  2. Angiography with therapeutic intervention – always requires attending supervision.
  3. Venography, diagnostic and interventional – always requires attending supervision.
  4. Placement of central venous catheters – always requires attending supervision.
  5. All image guided biopsy procedures – always requires attending supervision.
  6. All image guided drainage procedures – always requires attending supervision.
  7. All image guided interventional diagnostic procedures – always requires attending supervision.
  8. Nuclear Medicine therapies – always requires attending supervision.
  9. General use of fluoroscopy – completion of one month of radiology residency training plus ten supervised episodes completed satisfactorily.
  10. Performance of GI contrast studies – completion of one month of radiology residency training and ten supervised cases completed satisfactorily.

11.Tube Studies – completion of one month of radiology residency training and ten

supervised episodes completed satisfactorily.

DATE ISSUED:3/16/01SUPERCEDES DATE:NonePAGE: 2 of 3

SAINT VINCENT HOSPITALDEPARTMENT OF RADIOLOGY

WORCESTER, MASSACHUSETTSPOLICY AND PROCEDURE MANUAL

SUBJECT: HOUSE OFFICER COMPETENCIES

  1. Competence may be determined through completion of supervised cases by an attending radiologist or house officer already authorized to perform that procedure independently.
  1. Documentation needed to confirm competence:

All beginning radiology residents will maintain a log of fluoroscopic, GI and tube studies until approval for independent performance is signed off by the Radiology Residency Program Director or Chief, Department of Radiology. At that time, all lead radiology technologists will be notified.

Issued by: ______Date: ______

David A. Bader, M.D., Program Director

Approved by: ______Date: ______

Chair, Department of Radiology

Approved by: ______Date: ______

Director, Medical Education Committee

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