LouisianaStateUniversityHealthSciencesCenter – Shreveport

Radiology Residency Program

Abdominal Curriculum, Goals and Objectives

Compiled by Drs. Guillermo Sangster and Alberto Carbo

BODY ROTATION GOALS/OBJECTIVES

Patient Care

FIRST YEAR RESIDENTS (PGY-2):

1.Demonstrate knowledge of and ability to use electronic patient information systems, including the radiology information system and appropriate use of electronic systems to obtain patient laboratory data, etc., to integrate with imaging findings to assist in an accurate diagnosis.

2.Understand the indications for each imaging examination performed and the specific indications for any examination performed on an individual patient.

3. Learn indications and contraindications for each form of CT contrast (oral, rectal, IV) and MR contrast. Learn how to treat contrast reactions.

  1. Learn to triage CT/MR patients appropriately. Remember, not all ED cases are extremely emergent and some in-house patients require your immediate attention.

5. Technical aspects of computed tomographic and MR examinations of the chest, abdomen, and pelvis should be understood and the ability to design a specific protocol to address the clinical question at hand should be mastered. This includes knowledge of when and how much oral and/or rectal contrast to administer, when and how much intravenous contrast material to administer, and appropriate patient positioning and image acquisition parameters for each examination. Check the CT protocol book that is located in the control room.

6.Demonstrate the ability to use the internet as a tool for teaching and learning, including access to information to improve knowledge in patient care situations.

SECOND AND THIRD YEAR RESIDENTS (PGY-3 and 4):

  1. All of the objectives listed for first year residents should be reviewed with increased mastery.
  1. Demonstrate knowledge of the levels of ionizing radiation related to specific imaging procedures. With knowledge of levels of ionizing radiation related to specific imaging procedures, employ measures to minimize radiation dose to the patient.
  1. Demonstrate ability to integrate laboratory findings and other clinical parameters in recommending appropriate patient specific imaging strategies for diagnostic purposes.
  1. You should be able to run the Body service with less direction from attending staff.
  1. Increased ability to apply the tomographic technique to other areas of the body should be gained. This includes knowledge of performance and interpretation of tomographic examinations of the neck, extremities, and thin section examinations of the chest for interstitial lung disease.
  1. The resident should become a resource to medical students and junior residents in achieving the above objectives.

FOURTH YEAR RESIDENTS (PGY-5):

  1. All of the objectives listed for first, second, and third year residents should be reviewed with increased mastery.

2.Increased emphasis should be placed on integration of CT with other clinical, imaging (MRI, Ultrasound, etc.) and laboratory findings in arriving at as specific a diagnosis as possible.

3. The resident should be able to run the Body service largely independently.

  1. Teaching of the above objectives to medical students and junior residents should be increasingly emphasized.

Medical Knowledge

FIRST YEAR RESIDENTS (PGY-2):

1.Residents should become familiar with the techniques of performing the basic computed tomography and MR studies of the chest, abdomen and pelvis.

2.The principles of use of radiographic contrast material, including but not limited to intravascular use of iodinated contrast material and gadolinium, should be understood. This includes indications for application of contrast, contraindications to use of contrast, considerations in choice of particular contrast material, and recognition and treatment of adverse reactions to contrast material.

3. A primary goal of the rotation should be to develop a basic understanding of normal cross-sectional anatomy of the chest, abdomen and pelvis and alterations in that anatomy with common pathologies that will be encountered on call (especially trauma, abdominal abscess, appendicitis, diverticulitis, pancreatitis, urinary infection/stone disease, and CT of pulmonary embolism).

SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

  1. All of the objectives listed for first year residents should be reviewed with increased mastery, especially imaging findings related to trauma.
  1. Increased ability to evaluate pathologic alterations in normal anatomy of the chest, abdomen, and pelvis should be demonstrated. This includes alterations as a result of malignancy, and understanding of the computed tomographic and magnetic resonance staging of malignancies in the chest, abdomen and pelvis. The effects of common and rare infectious diseases should also be demonstrated. The resident should be capable of generating a differential diagnosis associated with common alterations in anatomy of each of the thoracic, abdominal, and pelvic organs.

3.Demonstration of the knowledge associated with these objectives should be demonstrated with teaching to referring clinicians, medical students, and junior residents.

FOURTH YEAR RESIDENTS (PGY-5):

  1. All of the objectives listed for first, second, and third year residents should be reviewed with increased mastery.
  2. Teaching of the knowledge associated with the above objectives to referring clinicians, technical personnel, medical students, and junior residents should be increasingly emphasized.

Interpersonal and Communication Skills

FIRST YEAR RESIDENTS (PGY-2):

1.Work to structure written reports of imaging studies to accurately and effectively transmit results and recommendations to referring clinicians, including urgent or unexpected findings.

2.Work with attending staff to develop techniques for effective oral communication with patients, referring clinicians, and support personnel in radiology.

3.Demonstrate appropriate phone communication skills.

SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

  1. All of the objectives listed for first year residents should be reviewed with increased mastery.
  1. Demonstrate increasing skill in clearly and concisely communicating via the radiology written report.
  1. Demonstrate leadership role in communications/interactions with technical personnel and patients, including explanation of delays related to emergencies.

4. Demonstration of the knowledge associated with these objectives should be demonstrated with teaching to medical students and junior residents.

FOURTH YEAR RESIDENTS (PGY-5):

  1. All of the objectives listed for first, second, and third year residents should be reviewed with increased mastery.
  1. Demonstrate increased ability to communicate effectively with providers at all levels of the health care system as well as those in outside agencies, etc.
  1. The senior resident should model by action as well as directly teach the above objectives to medical students and junior residents.

Professionalism

FIRST YEAR RESIDENTS (PGY-2):

  1. Demonstrate compassion, honesty and ability to provide care/interact with others without regard to religion, ethnic, sexual, or educational differences and without employing sexual or other types of harassment.
  1. Demonstrate understanding of the principles of patient confidentiality by compliance with the HIPAA Privacy Rule.

3.Demonstrate completion of medical records, including review/signoff of radiology reports, according to departmental/hospital guidelines.

4.Demonstrate positive work habits, including punctuality and professional appearance.

5. Demonstrate honesty with patients and all members of the health care team.

SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

  1. All of the objectives listed for first year residents should be reviewed with increased mastery.
  1. Demonstrate altruism (putting the interests of patients and others above own self-interest).

3.The resident should teach the above objectives to medical students and junior residents directly as well as by modeling behavior consistent with these objectives.

FOURTH YEAR RESIDENTS (PGY-5):

  1. All of the objectives listed for first, second, and third year residents should be reviewed with increased mastery.

2.The senior resident should increasingly supervise and mentor medical students and junior residents in achieving these objectives.

Practice-Based Learning and Improvement

FIRST YEAR RESIDENTS (PGY-2):

1.Analyze practice experience and perform practice-based improvement in cognitive knowledge, observational skills, formulating a synthesis and impression, and procedural skills. Demonstrate this by active review and performance modification related to on-call discrepancies and active participation in morbidity and mortality/ misses conferences.

  1. Demonstrate use of multiple sources, including information technology, to optimize life long learning and support patient care decisions.

SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

  1. All of the objectives listed for first year residents should be reviewed with increased mastery.

2. Residents should demonstrate that they are reading the current literature, particularly the Radiology and the American Journal of Roentgenology, by being familiar with material recently published in those journals. A life-long pattern of reading these journals should be begun.

FOURTH YEAR RESIDENTS (PGY-5):

  1. All of the objectives listed for first, second, and third year residents should be reviewed with increased mastery.
  1. Demonstrate awareness of resources available to practicing radiologists for lifelong learning, including print, CD-ROM, and internet products of the ACR.
  1. Demonstrate knowledge of the above objectives by supervision of medical students and junior residents as well as by directly teaching these objectives.

Systems-Based Practice

FIRST YEAR RESIDENTS (PGY-2):

1.Begin to acquire knowledge regarding the costs of imaging studies and impact of costs on appropriate choices for clinical use.

SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):

  1. All of the objectives listed for first year residents should be reviewed with increased mastery.
  1. Demonstrate the ability to design cost-effective imaging strategies/care plans based on knowledge of best practices.
  1. Demonstrate knowledge of hospital-based systems that effect physician practice, including physician code of ethics, medical staff bylaws, quality assurance committees, and credentialing processes. This includes knowledge of how these processes may affect the scope of practice of any one physician and competition among practitioners.

FOURTH YEAR RESIDENTS (PGY-5):

  1. All of the objectives listed for first, second, and third year residents should be reviewed with increased mastery.

2. Demonstrate knowledge of how decisions about timing/availability of imaging studies may affect hospital length of stay, referral patterns for specific examinations and use of diagnostic studies outside the Department of Radiology.

Table of Contents

Assessment/Evaluation of Residents

Guidelines for Evaluation of Competency

Benchmarks by Year of Training

Knowledge of Technologies and Skills for Competency

ASSESSMENT/EVALUATIONS OF RESIDENTS

  1. Electronic evaluation by attending faculty each month after the rotation and Written evaluation every 6 Months with the Program Director
  2. ACR in-training examination
  3. OSCE evaluation twice per year
  4. Written ABR exams

GUIDELINES FOR EVALUATION OF COMPETENCY
PATIENT CARE

a) Technical skills

b) Imaging and medical management

c) Compassionate and effective communication with patients

d) Timely effective communication with referring health care providers

MEDICAL KNOWLEDGE

a)Diagnostic Radiology Fund of Knowledge

  1. recognition of imaging abnormalities
  2. synthesis of clinical and radiological information
  3. derivation of diagnosis or differential diagnosis

b) Knowledge of principles of Radiation Physics and Dosimetry

c) Use of Resource Materials; texts, references, websites, and other sources for life

PRACTICE BASED LEARNING AND IMPROVEMENT

a) Principles of Quality Improvement and participation in QI programs

b) Self assessment programs and lifelong learning

INTERPERSONAL AND COMMUNICATION SKILLS

a) Communication, Consultation in Radiologic Practice

b) Record Keeping, Radiologic Reports, Case Presentation

c) Knowledge of HIPAA regulations

d) Understanding verbal and written Informed Consent

e)Teaching effectively residents, medical students and other health care professionals

PROFESSIONALISM

a)Professional Conduct, Medical Ethics, and Integrity

SYSTEM BASED PRACTICE

a) Understand cost effectiveness in selection of imaging studies

b) Understand the efficient selection of studies in sequence to maximize diagnostic yield

while minimizing cost and patient risk

c) Learn to use evidence based medicine for clinical decision-making

d) Optimize patient care by consultation with other health care

providers

BENCHMARKS BY YEAR OF TRAINING

The goal is for each resident to achieve independent competency and acquire tools with which to continue self-education and life-long learning. The level of practice should be consistent with national community standards as outlined in the AmericanCollege of Radiology (ACR) Practice Guidelines.

Emphasis throughout the four-year residency program is on understanding the pathophysiology of diseases and disorders, and its appearance across all appropriate imaging modalities.

Year 1

Goal: To prepare the resident to be able to safely practice with supervision during the week days and independently while on call by the end of the first year.

Objectives:

Contrast Material:

1 Understand the physical properties and composition of standard contrast agents and the physiologic mechanisms of contrast media excretion.

2 Learn to screen patients who are at risk from injection of intravascular radiographic contrast material. Understand the classification, symptoms, and signs of contrast reactions and clinical management including appropriate use of pharmacologic agents and their mode of administration and doses after appropriate patient assessment.

a) Consult the ACR Manual for Contrast Media, Version 5.0).

b) Be prepared to answer patient and staff questions concerning when contrast media should or should not be utilized and how to treat contrast reactions.

3. Understand the indications for premedication and the appropriate regimen to premedicate contrast sensitive patients including dosages, and dose scheduling.

Knowledge Based Objectives:

1Review the anatomy of the gastrointestinal and genitourinary systems.

2Understand the normal appearance of gastrointestinal and genitourinary organs on basic imaging modalities using plain film radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI).

3. Learn conventional imaging protocols.

4. Interpret, identify and/or manage diseases of the abdominal contents and multisystem processes that involve abdominal viscera.

5. Understand contrast administration and pathophysiology of gastrointestinal and genitourinary diseases/conditions.

Technical Skills:

1 Interview patients prior to radiographic contrast injection.

2 Be familiar with fluoroscopic techniques and safe operation of the fluoroscopic unit.

3Compose a concise dictated report. Begin to function as a consultant to referring physicians and patients.

Required Reading :

1 ACR Practice Guidelines for the Use of Intravascular Contrast Media, Version 5.0

3GI resident Handbook

References for 1st Year:

1Genitourinary Radiology: The Requisites (Requisites Series). Zagoria, Tung

2Textbook of GastrointestinalRadiology. Gore RM, Levine MS, Laufer I. Philadelphia: WB Saunders

Year 2

Goal: Add to disease and imaging modality knowledge while gaining more confidence.

Objectives:

  1. Review the general developmental anatomy of the GI and GU systems.
  2. Refine techniquesand comprehension of physics as it applies to patient medical radiation dose, and radiation safety.
  3. Expand understanding of the causes and effects of disease of abdominal organ systems.
  4. Understand diagnosis, classification, and management of trauma.
  5. Further refine dictation skills.
  6. Begin to use the independent workstation for image reformatting and reconstruction.
  7. Attend department case conferences and didactic presentations, including interdepartmental conferences, grand rounds, guest lecturers, etc.
  8. Perform simple image- guided biopsies and drainage procedures with instruction and under the direct supervision of the Interventional radiology Faculty.

References for 2nd Year:

  1. Dunnick, N.R., Sandler, C.M., Newhouse, J.N., Amis, Jr., E.S., Textbook of Uroradiology, 3rd ed., Philadelphia, PA: Lippincott Williams & Wilkins, 2000.
  2. Textbook of GastrointestinalRadiology. Gore RM, Levine MS, Laufer I. Philadelphia: WB Saunders

Year 3

Goal:
Add to general knowledge acquired in the first two years and learn
more advanced and less common techniques and disorders.

Objectives:

1 Learn about the different types of abdominal organ injuries and their classification as well as recommended non-surgical and surgical management and injury prognosis.

2Increase awareness of the CT and MR manifestations of gastrointestinal and genitourinary tract disease.

3Learn staging of neoplasms and review normal MRI findings of the adrenals, kidneys, bladder, prostate, and female pelvic organs

4Understand diagnosis of the multiple manifestations of inflammatory disease as seen on US, CT / CT Urography, MR/MR Urography and their clinical management.

5Use the independent workstation for more advanced applications and image reconstruction.

Reference for 3rd year:

Clinical Urography, 3rd Ed., Pollack, et al. u

RSNA Journals and AJR on line (Departmental subscriptions)

ACR teaching files and Departmental CD series

Year 4

Goal:

  1. Review all the knowledge and skills you have accumulated in the first three years and fill the gaps in your knowledge.

Focus on:

  1. Get as much case management experience as possible.
  2. Expand Obstetrical knowledge through elective rotation in Women’s Health.

Objectives:

  1. Understand congenital anomalies, inflammatory, and neoplastic conditions as they appear on hysterosalpingography.
  2. Review cases in the ACR teaching file and peer reviewed teaching files available on the internet. The best sites should present as unknown cases, asking for you to make a diagnosis and suggest recommended imaging and clinical management, summarizing the correct diagnosis and management at the end.
  3. Attend available department case conferences or other didactic presentations, including interdepartmental conferences, grand rounds, guest lecturers, etc. Emphasize independent thinking before seeking direct staff supervised patient management.
  4. Develop proficiency at image reconstruction and reformatting.
  5. Understand the basic principles of radiofrequency ablation, thermocoagulation, and other minimally invasive procedures, along with the appropriate imaging guidance and post treatment surveillance.
  6. Increasing utilization of Web-based references such as RSNA Journals and AJR on line (Departmental subscriptions) and review of ACR learning files on CD series.

List of didactic lectures:

GU

  1. Adrenal
  2. Renal Masses and Infection
  3. Infiltrative Renal diseases
  4. Primary Retroperitoneal tumors
  5. MDCT, staging and therapy of blunt renal injury
  6. Urinary calculus disease
  7. Benign Gyn
  8. Gynecologic Malignancies
  9. Scrotal pathology

GI

  1. The plain abdominal radiograph
  2. Stomach and duodenum -fluoroscopic technique, normal anatomy and pathology Intestinal obstruction and ileus
  3. Pharynx and esophagus- fluoroscopic technique, normal anatomy and pathology
  4. GI virtual studies – virtual gastroscopy
  5. Postoperative gastrointestinal anatomy
  6. Small intestine- fluoroscopic technique, normal anatomy and pathology
  7. Intestinal obstruction and ileus
  8. Appendix
  9. Colon and rectum- fluoroscopic technique, normal anatomy and pathology, virtual colonoscopydefecographycolonic transit time: technique, normal, constipation
  10. Hepatic masses-hypo and hypervascular
  11. Hepatic cirrhosis and its complications
  12. Biliary disease
  13. Pancreas- including neoplasm, inflammation, trauma and ERCP/MRCP
  1. Spleen

Multisystem