SYLLABUS for 3Rd YEAR MEDICAL STUDENTS

SYLLABUS FOR 3rd YEAR MEDICAL STUDENTS

RADIOLOGY ELECTIVE

Course Title: MSIII Radiology Elective

Department: Department of Radiology

Course Director: Eduardo C. Gonzales Toledo, MD

Course Co-Director: Carlos Previgliano, MD

Faculty:

Scott Adams, MD

Office: 1-320A Ext. 56208

Beeper: 0057

Chaitanya Ahuja, MD

Office: 1-349A Ext. 56118

Beeper: 2629

Alberto I. Carbo, MD

Office: 1-324F Ext. 55387

Beeper: 2526

Meghna Chadha, MD

Office: 1-349A Ext. 56119

Beeper: 2628

Horacio D’Agostino, MD

Office: 1-320B Ext. 56247

Cell: 318-470-7013

Thomas R. Gates, MD

Office: 1-324I Ext. 56235

Beeper: 1477

Eduardo C. Gonzales Toledo, MD

Office: 1-324L Ext. 56280

Beeper: 1920

Anne Hollister, MD

Ext. 56185

Beeper: 1752

Mardjohan Hardjasudarma, MD

Office: 1-324A Ext. 56232

Stacy Lee, MD

Office: 1-349A Ext.31322

Beeper: 2776

Nelson D. Luraguiz, MD

Office: 1-324B Ext. 56278

Beeper: 2400

Linda Nall, MD

Office: 1-324H Ext: 56234

Beeper: 1329

Carlos Previgliano, MD

Office: 1-351 Ext. 57196

Beeper: 2838

Guillermo P. Sangster, MD

Office: 1-324G Ext. 57619

Beeper: 4567

Alberto I. Simoncini, MD

Office: 1-324K Ext. 56223

Beeper: 2834

Romulo G. Vea, MD

Office: Interventional Suite

Ext. 54789

Beeper: 2946

Jane Yang, MD

Ext 56214

Beeper: 1480

Beeper: 0418

Course Description:

During the third year of the MD curriculum at LSU Health Shreveport, a two-week elective clerkship in the Department of Radiology is offered. The following are the clerkship's overarching objectives as well as learning objectives for each of nine areas of focus (described in depth at end of syllabus). This syllabus must be read in full before reporting for the first day of the clerkship. Also, the student is responsible for printing out and bringing the checklist on Moodle each day of the clerkship. Upon completion of the MSIII Radiology Clerkship, students will:

A. Demonstrate basic skills in the interpretation of images of the chest, breast, abdomen, neurological, and musculoskeletal systems, and appreciate the importance of history and clinical data in the proper interpretation of imaging exams.

B. Use radiographic findings to develop a differential diagnosis and outline subsequent diagnostic work-up for common medical problems such as bone trauma, chest pain, shortness of breath, abdominal pain, and masses.

C. Describe the clinical indications and contraindications for specific imaging studies and explain the clinical impact of different imaging modalities (e.g. radiation exposure, contrast reaction); explain the limitations of different imaging studies.

D. Demonstrate the proper methods of ordering common imaging studies, and explain the cost of commonly utilized imaging procedures.

E. Explain the underlying principles of physics relevant to commonly used imaging modalities plain film radiography, ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET).

F. Describe the basic principles of safety and radiation protection for patients and health care practitioners.

COURSE COMPOSITION AND SCHEDULE:

Lectures:

Lectures given by the faculty appropriate to the content area for each day are available on Moodle. The lectures will serve as an introduction to that specific area as well as an overview of concepts important for evaluation of imaging studies by both radiologists and those in other specialties. The lectures should be reviewed prior to beginning a given content area. For instance, before beginning the MSK portion, students should watch the MSK podcast, and so on. If the lecture is in PowerPoint format, play it in slideshow mode in order to hear the audio recorded by the faculty.

Additional radiology conferences are held daily. The conference schedule is available online at http://www.lsuhscshreveport.edu/Radiology/Radiologyschedule.aspx . If you are unable to access the conference schedule online, please email Angie White at and she will e-mail you a copy. Students on the MSIII elective are encouraged to attend as many of the conferences as possible.

Clinical Experience:

Both of the students in the rotation will follow the same schedule. During the elective days, students will follow faculty in an area of their choice, which may or may not also be one of the designated content areas. Students do not have to choose the same elective and may follow different faculty during elective days. In the event of a holiday, the elective day will be eliminated and the student should move on to the next content area in order to cover all required content areas. The Interventional Radiology elective for the clerkship involves observing three interventional procedures throughout the clerkship. The student must talk to Angie White or contact Dr. D’Agostino if she is not available on the first day of the rotation to find out the interventional schedule and appropriate times to observe procedures.

In the event of a faculty meeting or conference that the radiology faculty must attend, the student is required to attend as well.

Attire:

Students should wear appropriate hospital scrubs and white coat throughout the rotation.

Evaluation Method (Grading Criteria):

Courseevaluationwillbeonresidentandfacultyfeedbackanddailyparticipation on the radiology service. Students’ scores will be calculated according to the following criteria:

Objective / Subjective
Multiple Choice Exam / 60% / Performance Evaluations / 40%

The exam will consist of 50 questions that will be representative of important radiological concepts that are emphasized in the daily lectures. It will count for the objective portion of the clerkship grade. Students should report to Dr. Gonzalez Toledo’s office at 1pm on the last day of the clerkship to take the exam on Moodle.

The areas of clinical/performance evaluation include the following topics:

1.  Clinical Knowledge

2.  Participation

3.  Work Ethic

4.  Professionalism – including attendance

Additionally, for each area of focus the student must identify unknown imaging studies/pathologies as posed by the physician.

Subject / Main Contact/
Lecturer / Contingency
1 / Contingency 2 / Contingency
3
Monday / 1. MSK / Dr. Simoncini (typically reads in ER reading room, 1st floor hospital, room D1-4) / Dr. Gonzalez Toledo / Dr. Hollister / Report to attending
Tuesday / 2. MSK / Dr. Simoncini / Dr. Gonzalez Toledo / Dr. Hollister / Report to attending
Wednesday / 3. Elective (skip if 1 day is lost for a Holiday) / Choose according to topic of interest
Thursday / 4. Abdominopelvic / Dr. Sangster (typically reads in FWCC, 1st floor) / Dr. Carbo / Report to attending
Friday / 5. Abdominopelvic / Dr. Carbo (typically reads in ACC radiology clinic [1st floor]) / Dr. Sangster / Report to attending
Monday / 6. Cardio
thoracic / Dr. Previgliano (typically reads in general reading room, 2nd floor hospital, code 3322) / Dr. Carbo / Report to attending
Tuesday / 7.Cardio thoracic / Dr. Previgliano / Dr. Carbo / Report to attending
Wednesday / 8. Neuro / Dr. Gonzales Toledo (typically reads in neuro reading room, hospital 2nd floor) / Dr. Hardjasudarma / Dr. Simoncini / Report to attending
Thursday / 9. Breast
(and test only on Thanksgiving week) / Dr. Luraguiz (typically reads in ACC radiology clinic [1st floor]) / Dr. Stacey Lee (typically reads in FWCC, 3rd floor) / Report to attending
Friday / 10. Test/ Elective / Test administered by Dr. Gonzales Toledo / Choose elective according to topic of interest

There is a standard web-based format for student performance evaluation in the third year that all clerkships and electives use on MyEvaluations.com. Faculty will complete a MyEvaluation survey at the end of the clerkship.

Grades:

Above 89.5 A

79.5 to 89.49 B

69.5 to 79.49 C

<69.5 F; Fail at the discretion and consideration of the clerkship director.

Attendance:

Attendance and participation in clinical activities and related discussion is required for optimal student benefit. Absences may be excused or granted in the case of serious illness or direct family emergency. The clinical preceptor must be notified of the absence as soon as possible through email, phone, or other method of personal communication established by the preceptor.

All days missed during the rotation must be made up at the preceptor’s discretion in order to successfully complete the rotation. Unexcused absences of two days during the rotation will result in the loss of a letter grade. More than two days of unexcused absence will result in a failing grade for the rotation.

Students are to arrange both electives (Day 3 and Day 10) with the faculty according to their topic of interest.

Students should contact their preceptors 2 to 3 days in advance to see where/when you should meet him. If no response, arrive at 8am and talk to Angie White in room 1-320D to contact the preceptor for the day.

If Mrs. White is unavailable, contact Dr. D’Agostino for assistance (Office: 1-320A). If both are unavailable, use the faculty contact list provided on Moodle to page your preceptor directly.

In the event that none of the preceptors are available on a certain day, go to the attending or main contact of the next day.

The reading room schedule is online at http://www.lsuhscshreveport.edu/Radiology/Radiologyschedule.aspx and will always list if a faculty member is away. Students are encouraged to check this schedule on a regular basis.

ED2 Requirements:

Students will be required to present ED2 documentation (download the file named “checklist” from Moodle) each day to be signed by the faculty. This will denote attendance. The student must witness/complete each of the disease processes or objectives on the ED2 checklist either in the lecture or while with the faculty with verification by the faculty. If there are no cases that fulfill the ED2 objective, it is the student’s responsibility to ask the faculty member to produce an archived case.

Areas of Focus:

A.  Musculoskeletal Imaging (REQUIRED)

a.  Key Concepts

i.  By attending lectures/seminars, and attending radiologic interpretation in reading rooms, the student will understand:

1.  The basics of ordering and interpreting musculoskeletal imaging studies in acute musculoskeletal trauma

2.  Appropriate use of MRI for musculoskeletal imaging in painful joints

b.  Learning Objectives

i.  By the end of the Musculoskeletal imaging segment, the student will be able to:

1.  Recognize radiographic soft tissue clues for fractures of the wrist and elbow

2.  Describe basic concepts of MRI imaging for cartilage injury, fracture, and edema

3.  Distinguish anterior from posterior dislocation of the hip on a pelvic radiograph

4.  Describe the radiographic findings seen in AVN of the hip

5.  Define a burst fracture of the spine and recognize it on AP and lateral films of the thoracic spine

6.  Describe standard views used to image the shoulder in trauma

7.  Identify the lines used to evaluate the cervical spine in acute trauma setting

8.  Explain the role of radiographs, CT, radionuclide bone scans, and MRI in evaluating patients with musculoskeletal problems

B. Cardiothoracic Imaging (REQUIRED)

a. Key Concepts

i. By attending lectures/seminars and attending radiologic interpretation in reading rooms, students will understand:

1. The basics of ordering and interpretation of cardiothoracic imaging studies in acute chest pain as well as the value of imaging in diagnosis of acute chest pain related to cardiovascular disease

2. The anatomy and basic interpretive principles of chest radiology

3. Tubes and lines, including placement, complications, and imaging of devices in the chest

4. Interpretation of abnormal air collections in the thorax and how to recognize pneumothorax

5. Imaging of pneumonia, TB, and atelectasis

b. Learning Objectives:

i. By the end of the Cardiothoracic-imaging segment, the student will be able to:

1. Identify and list diagnoses for and/or state significance of: pneumothorax on an upright chest radiograph and on a supine chest radiograph; pneumomediastinum on a chest radiograph; collapse of the lung; lobar consolidation on a chest radiograph and CT scan; left heart failure on a chest radiograph; silhouette sign and the air bronchogram sign on a chest radiograph; abnormal mediastinum on a frontal chest radiograph

2. Differentiate complete opacification of a hemithorax as pleural effusion, lung collapse or lung consolidation/mass based on the position of the mediastinum

3. Recognize the development of an enlarging pleural fluid collection on a chest radiograph of a patient with pneumonia and suggest the diagnosis of empyema and role of chest CT scanning

4. Identify a malpositioned chest tube, feeding/nasogastric tube, endotracheal tube, pacemaker leads, pulmonary artery catheter and central venous catheter on a chest radiograph, and state the desired location for each

5. For cardiac MRI, be able to identify appropriate indications for cardiac MRI and to describe differential diagnosis of abnormal delayed myocardial contrast enhancement

6. For cardiac CT, be able to identify appropriate indications for cardiac CT and thoracic Ct angiography as well as review radiation doses and their implications with cardiac CT

C.  Abdominopelvic Imaging (REQUIRED)

a.  Key Concepts

i.  By attending lectures/seminars and attending radiologic interpretation in reading rooms, the student will understand:

1.  Appropriate imaging workup for acute abdominal pain

2.  Anatomy, interpretive principles, and pathology in both radiographs and CT images of the abdomen

3.  Decision-making in abdominal imaging

b.  Learning Objectives

i.  By the end of the Abdominopelvic imaging segment, the student will be able to:

1.  Identify the following anatomic structures on a plain film and/or CT of the abdomen/ pelvis: psoas muscle, spleen, stomach, colon, liver, small bowel, bladder, kidneys, rectum, adrenal glands (CT), pancreas (CT), vessels - superior mesenteric artery and vein, splenic vein, portal vein, aorta, IVC, iliac artery and vein (CT), duodenum (CT), urinary bladder (CT), ureters (CT)

2.  Recognize on the plain abdominal films: intestinal obstruction, pneumoperitoneum, ileus, toxic megacolon and sigmoid volvulus

3.  Understand the indications and common imaging patterns of gastrointestinal contrast exams

4.  Recognize ERCP and MRCP images and indications

5.  Describe the imaging workup of acute abdominal pain.

a.  Review current imaging tools for the evaluation of patients with acute abdominal pain

b.  Discuss guidelines for appropriate imaging modality selection

c.  Recognize the most common diseases producing an acute abdominal pain: small bowel obstruction, obstructive uropathy, appendicitis, pneumoperitoneum, splenomegaly, acute cholecystitis, pancreatitis, colonic diverticulitis, ischemic bowel and intestinal perforation