Radiology

I.Rationale

During the course of caring for patients, family physicians order many diagnostic and therapeutic tests. Included among these are diagnostic and interventional imaging studies. It is necessary for the family physician to know the indications for various tests, how to interpret the common ones, and when to consult a radiologist for further information or testing. In addition, with the blossoming of medical technology, the family physician must keep abreast of new innovations and know the most cost-effective way of utilizing this technology.

This curriculum has two components: the focused rotation in radiology and the longitudinal component, which takes place over time in the Family Practice Center and on other rotations where radiology related topics may be covered.

II. Competencies

Patient Care

Goal: Provide evidence based care to patients using radiologic support.

Objectives:

  1. Discuss how to appropriately prep a patient for various diagnostic imaging studies.
  2. Demonstrate the ability to read common radiographs including:
  1. Chest X-rays
  2. Sinus films
  3. Abdominal films
  4. Orthopedic radiographs
  5. GI studies
  6. IVP
  7. CT/MRI of the head, chest, abdomen/pelvis
  1. Recognize and manage reactions to iodinated radiograph contrast agents.

Learning Activities
X / Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / Readings
Didactics / X / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / Morning Report
Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback

Medical Knowledge

Goal: Develop a broad knowledge base of symptoms, physical exam, diagnoses and interventions amenable to radiological diagnosis, intervention or intervention.

Objectives:

  1. Discuss the radiological indications for common problems including:
  1. Headache
  2. Cough
  3. Acute mental status change
  4. Sinus pain/ chronic sinusitis
  5. Abdominal/pelvic pain
  6. Low Back pain
  7. Trauma/injury
  8. Breast mass
  9. Chest pain
  10. Obstetrical complications (size/date discrepancy, bleeding fetal anomalies, etc)
  1. Discuss the indications for common diagnostic imaging tests including:
  1. Chest X-rays
  2. Sinus films (plain and CT)
  3. Abdominal films (KUB, flat, up-right, decubitus)
  4. Orthopedic radiographs
  5. CT (head, abdominal)
  6. Ultrasound (abdominal, pelvic, OB, cardiovascular)
  7. MRI (head, spine, and extremities)
  8. GI studies (UGI w/ SBFT, enteroclysis, ACBE)
  9. Nuclear medicine (bone scans, liver/spleen scans, MUGA, HIDA)
  10. Mammography
  11. IVP
  1. Review the indications for interventional radiology including:
  1. Lumbar puncture under fluoroscopy
  2. Percutaneous biopsy
  3. Drainage of collections of fluids
  4. Placement of stents and tubes
  5. Angiograms
  6. Embolization

Learning Activities
X / Attending Rounds / X / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / X / Specialty Conference / Resident Seminar
X / Sub-Specialty Conference / X / Noon Conference / X / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / x / Directly Supervised Procedures / Morning Report
Program Dir
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / Quarterly Review
Other

Interpersonal /Communication Skills

Goal: Residents will develop and demonstrate effective information exchange and teaming with patients, their families, and other health professionals.

Objectives:

  1. Be able to give the patient informed consent on any diagnostic or therapeutic procedures to beperformed in a manner understandable to the patient.
  2. Be able to answer questions the patient and family may have concerning the diagnostic imaging tests as well as address any concerns they may have about them.
  3. Be able to interpret test results and communicate these results to the patient and her/hisfamily in terms understandable to them.
  4. Learn to communicate efficiently and effectively with radiologic consultants.

Learning Activities
X / Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
X / Morning Report / X / Faculty Supervision / Readings
Didactics / X / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / X / Morning Report
Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / Quarterly Review
Other

Practice Based Learning and Improvement

Goal: Understand the need for and engage in continuing self-education about updates in diagnostic imaging.

Objectives:

  1. List indications for each of the common diagnostic imaging tests and common problems.
  2. List indications for each of the interventional radiological procedures.
  3. Describe the necessary preparation of patients for diagnostic testing, including the order of tests if multiple tests are being performed.
  4. Interpret normal and abnormal radiographs of patients seen in continuity clinic and while rotating through radiology.

E. Describe the diagnosis and management of a patient undergoing a reaction to an iodinated radiologic contrast agent.

Learning Activities
X / Attending Rounds / Research Conference / Outpatient Clinics
X / Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
X / Grand Rounds / X / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / Faculty Supervision / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / X / Morning Report
X / Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / Quarterly Review
Other

Systems Based Practice

Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Objectives:

  1. Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice.
  2. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.
  3. Practice cost-effective health care and resource allocation that does not compromise quality of care.
  4. Advocate for quality patient care and assist patients in dealing with system complexities.
  5. Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.

Learning Activities:
x / Attending Rounds / Research Conference / x / Outpatient Clinics
x / Multidisciplinary Rounds / Ethics Committee Conf / x / Direct Patient Care
Grand Rounds / x / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / x / Faculty Supervision / Critical Appraised Topics
Other
Evaluation Methods
x / Attending Evaluation / x / Directly Supervised Procedures / Morning Report
x / Program Director Review / x / In-Training Exam / x / Faculty Supervision and Feedback
Other

Professionalism

Goal:Residents will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Objectives:

A.Conduct informed consent with patients for radiologic procedures, in both the inpatient and outpatient setting, in a manner understandable to the patient.

B.Address questions and concerns that a patient may have about radiologic testing.

C.Communicate test results to patients and family members.

D.Prepare a consultant referral form or radiology request form which contains a complete and succinct summary of the patient's diagnosis, the question for the consultant, and other information pertinent to the referral.

E.Summarize the cost of the radiologic workup of one patient on the inpatient service andpresent a brief summary of the costs involved to the ward team.

F.List sources to which the resident physician may turn for more information or continuingeducation on diagnostic imaging.

Learning Activities
X / Attending Rounds / Research Conference / X / Outpatient Clinics
X / Multidisciplinary Rounds / X / Ethics/Comm Conference / X / Direct Patient care
X / Grand Rounds / X / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
X / Morning Report / Faculty Supervision / Readings
Didactics / Procedures
Other:
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / X / Morning Report
X / Program Dir
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

IV. Instructional Strategies (see above)

A. Interpreting films in radiology

B. Interpreting films on patients in continuity clinic

C. Assigned readings

D. On-line computer learning

E. Ambulatory care conference

F. Associated rotations: orthopedics, sports medicine, internal medicine, OB/GYN, Emergency medicine

V. Evaluation Strategies (see above)

A. Observation of resident by radiology preceptor

B. Observation of resident by clinic preceptor

C. Attendance at conference series

D. Demonstrate competency in evaluating various CXR findings to include:

1. Normal

2. Pulmonary infiltrate

3. Pulmonary edema

4. Pneumothorax

5. Pneumomediastinum

6. Widened mediastinum (list the DDx)

E. Completing CXR competency test of which an 80% score minimum is required

F. End of rotation evaluation

VI. Implementation Methods

A.The radiology rotation will occur in conjuction with Sports Medicine and Family Practice Clinic, andwill consist of a 4-week block of practical instruction at Emory Dunwoody Medical Center.

B.The resident will spend Monday afternoons (1 pm to 5 pm), Tuesday and Wednesday mornings (0830 to 1230) in the radiology department. Wednesday afternoons will be reserved for individual reading/study time. The resident will report on the first day of the rotation to Dr. Martin Sheline, Director of Radiology, for orientation to the department.

C.The morning session will be spent reading films with one of several radiologists from the hours of 0830 to 1230.

D.The afternoon session will be spent observing various diagnostic procedures commonly done in the radiology department to include, nuclear medicine studies, cardiac catheterizations, and echocardiograms. The times may vary, depending on procedures scheduled

E.If no procedures are scheduled, then the resident will spend that time using the on-line learning materials identified in the Radiology Teaching File.

F.Additional learning will occur during other rotations to include sports medicine, orthopedics, OB/GYN, Internal medicine, Family Practice Clinic, Emergency Medicine and by using the on-line resources identified in the Radiology Teaching File.

G.The resident will attend didactics on Thursday mornings, and will be assigned to the Family Practice Clinic on Thursday afternoons and the entire day on Fridays.

H.Except for unusual circumstances, no leave is allowed during this rotation.

I.The resident is responsible for:

  1. Contacting:Dr. Michael Terk,

Orthopedic & Spine Center @ Executive Park

59 Executive Park South, 4th Floor, Suite 4000

Atlanta, GA 30329

Assistant: Marvis Zanders

404-778-5834

404-778-6250

  1. the Director of Radiology, on the first day for orientation
  2. Using the on-line teaching file for additional learning materials.
  3. Documenting radiologic procedures observed.
  4. Completion of the rotation evaluation.
  5. Actively seeking feedback.
  6. Perform FP Call.
  7. Perform FP Clinic as assigned.
  8. Perform Sports Medicine Clinic as assigned.

VII.BIBLIOGRAPHY/SUGGESTED READINGS

  1. American College of Radiology. Appropriateness Criteria - Diagnostic Imaging. Available from Accessed 12/8/2013. Topics on
  2. Breast Imaging Criteria
  3. Cardiac Imaging Criteria
  4. Gastrointestinal Imaging Criteria
  5. Musculoskeletal Imaging Criteria
  6. Pediatric Imaging Criteria
  7. Thoracic Imaging Criteria
  8. Urologic Imaging Criteria
  9. Vascular Imaging Criteria
  10. Women's Imaging Criteria

ACR, Appropriateness criteria on Interventional radiology. .

  1. Abdominal Aortic Aneurysm: Interventional Planning and Follow-up
  2. Radiologic Management of Benign and Malignant Biliary Obstruction (Revised)
  3. Radiologic Management of Gastric Varices (New)
  4. Radiologic Management of Hepatic Malignancy
  5. Radiologic Management of Iliac Artery Occlusive Disease (Revised)
  6. Radiologic Management of Infected Fluid Collections
  7. Radiologic Management of Inferior Vena Cava Filters
  8. Radiologic Management of Lower Gastrointestinal Tract Bleeding
  9. Radiologic Management of Lower Extremity Venous Insufficiency
  10. Radiologic Management of Mesenteric Ischemia
  11. Radiologic Management of Thoracic Nodules and Masses
  12. Radiologic Management of Upper Gastrointestinal Bleeding
  13. Radiologic Management of Urinary Tract Obstruction
  14. Radiologic Management of Uterine Leiomyomas (Revised)
  15. Radiologic Management of Vertebral Compression Fractures
  1. Radiologic Evaluation of Incidentally Discovered Adrenal Masses. Willat J, Francis I. Am Fam Physician. 2010 Jun 1;81(11):1361-1366
  2. Radiologic Evaluation of Suspected Renovascular Hypertension. Hartman R. Kawashima A. Am Fam Physician. 2009 Aug 1;80(3):273-279.
  3. Radiologic Imaging in the Management of Sinusitis. Okuyemi K, Tsue T. Radiologic Imaging in the Management of Sinusitis

Last Updated March 7, 2013