ࡱ>  dfYZ[\]^_`abc bjbj]q]q aX??F8<`00-0-0-0+2+2+2=`?`?`?`?`?`?`b$e?`+2 2 2"+2/2?`@-0-0T`F@@@32* -0-0_@+2=`@@lBz]?  |I`H` 2 e@eT@+2+2+2 q:   Rotation: Chest/Chest CT Rotation Duration: 4 wksMonth(s): 4.6 (1 at VA)Institution: Stanford/VACall Responsibility: noneNight(s): noneResponsible Faculty Member(s): Ann Leung, MD Section Head Dominik Fleischmann, MD Frandics Chan, MD Margaret Lin, MD Gabriela Gayer MD (Visiting) Location: Ballroom at Stanford, chest reading room at VAPhone Numbers: Stanford Hospital: Reading room: 3-6587, 3-1346, 5-8132 VA hospital: 650-493-5000 (plus extension) front desk: 65959 reading room:6-3853, 6-7300, 6-3814, 6-0415Technologists/Technical Staff: Janis Troeger RT Day Shift Technical Supervisor Elinor Tung RT Technical Coordinator Training Level: Years 1-3Goals & Objectives- A note about goals and objectives- The goals and objectives outlined in this document are based upon the six core competencies as defined by the ACGME. As residents gain experience and demonstrate growth in their ability to care for patients, they assume roles that permit them to exercise those skills with greater independence. This conceptgraded and progressive responsibilityis one of the core tenets of American graduate medical education. This document should provide you a framework for the stepwise progression of your knowledge and skills. Rotation 1-STANFORD HOSPITAL chest x-ray This rotation primarily involves interpretation of digital chest radiographs, mostly from inpatients and the ICU, but also chest CT as needed to support the clinical workflow. Patient Care Goal Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to: Knowledge Objectives: Demonstrate knowledge of patient positioning and indications for posteroanterior (PA), anteroposterior (AP), lateral decubitus, and lordotic chest radiographs. Demonstrate knowledge of exam specific radiation doses. Demonstrate knowledge of indications for chest radiographs studies of pregnant patients. Recognize the findings of life-threatening conditions and notify referring clinician without being prompted. Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary. Actively participate with faculty in interpretation and workup of patients. Participate in radiation safety lectures. Skill Objectives: Become facile with Radwhere voice recognition, Centricity PACs and RIS, and EPIC. Utilize available information technology to manage patient information. Gather clinical and radiologic data on patients with thoracic pathology. Develop diagnostic plan based upon clinical presentation and imaging findings. Accurately and concisely dictate a chest radiograph report using nomenclature recommended by the Fleischner Society. Provide accurate and timely reports. Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. Conduct ICU rounds with the ICU team Monday through Friday from 11:30 AM to 12 PM. Behavior and Attitude Objectives: Work with the health care team in a professional manner to provide patient-centered care. Notify referring clinician for urgent, emergent, or unexpected findings, and document time, date, and the person spoken to in the dictation. Utilize appropriate summary codes. Medical Knowledge Goal Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to: Knowledge Objectives: Describe key points of each of the diagnoses. Describe basic digital and conventional x-ray physics in the chest. Identify relevant anatomic structures on radiographic and CT images of the chest. Be familiar with the more common pathologic conditions in the upper abdomen and understanding their pathophysiology. Learn indications and contraindications for lung biopsies. Demonstrate learning of pathophysiology and imaging appearance of at least one quarter of the diagnoses listed in the appendix. Demonstrate learning of at least one-quarter of the knowledge based objectives for chest plain films listed below: Chest Plain Film: Understand standard positioning in thoracic radiology. Identify normal anatomy and landmarks on frontal and lateral chest radiographs. Know the expected course and possible complications of lines, tubes, and other devices. Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum. Recognize patterns of lobar atelectasis. Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse coalescent, multifocal ill-defined, fine or coarse reticular, and fine nodular opacities; multiple nodules and masses; solitary pulmonary nodule. Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis. Describe the divisions of the mediastinum and common pathologies affecting each division. Recognize and give differential for hilar masses. Recognize and give differential for pleural effusions, thickening, and calcifications. Recognize and give differential for chest wall lesions. Skill Objectives: Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses Demonstrate a clinically appropriate diagnostic workup plan Demonstrate the ability to use all relevant information resources to acquire evidence based data Accurately and concisely dictate chest radiograph reports. Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT or MR may be necessary. Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in thoracic radiology described in the detailed thoracic curriculum. List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and linear) of interstitial lung disease. Separate pulmonary from pleural or extrapleural processes. Behavior and Attitude Objectives: Recognize limitations of personal competency and ask for guidance when appropriate. Practice-Based Learning and Improvement Goal Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to: Knowledge Objectives: Assess chest x-ray images for quality and suggest methods of improvement. Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. Skill Objectives: Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. Facilitate the learning of students and other health care professionals. Participation in case conferences. Participation in the clinical activities of Thoracic Imaging Section. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. Behavior and Attitude Objectives: Incorporate formative feedback into daily practice, positively responding to constructive criticism. Follow up on interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. Help in teaching of technologists, medical students, housestaff, and other health care professionals. Systems Based Practice Goal Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to: Knowledge Objectives: Understand how their image interpretation affects patient care. Demonstrate ability to design cost-effective care plans. Demonstrate knowledge of funding sources. Demonstrate knowledge of reimbursement methods. Demonstrate knowledge of regulatory environment. Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision, and management of staff. Skill Objectives: Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. Practice using cost effective use of time and support personnel. Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness Criteria. Participate in local and national radiological societies. Participate in discussions with faculty regarding operational challenges and potential systems solutions regarding all aspects of radiologic service and patient care. Attend and participate in multi-disciplinary conference. Interact and learn from department administrators. Behavior and Attitude Objectives: Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Knowledge Objectives: Understanding of the need for respect for patient privacy and autonomy. Demonstrate principles of confidentiality with all information transmitted during a patient encounter. Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning to the reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. If the resident will be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate faculty and/or fellow. Demonstrate knowledge of issues of impairment. Discussion of above issues during daily clinical work. Training programs and/or videotapes on harassment and discrimination. Didactic presentations on the impaired physician. Participation in hospital-based educational activities and independent learning. Skill Objectives: Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. Behavior and Attitude Objectives: Demonstrate respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout ones career. Demonstrate honesty with patients, support staff, and colleagues. Demonstrate positive work habits, including punctuality, professional appearance and demeanor. When assisting referring clinicians with imaging interpretation and patient management, decide when it is appropriate to obtain help from supervisory faculty. Interpersonal and Communication Skills Goal Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to: Knowledge Objectives: Know the importance of accurate, timely, and professional communication. Skill Objectives: Provide a clear, succinct report using nomenclature recommended by Fleischner Society. Communicate effectively with physicians, other health professionals. In cases of serious or unanticipated findings, document that communication in report. Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible complications. Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to families, support personnel, and physicians. Participate in daily ICU and weekly BMT work conferences. Participate in Thoracic Tumor Board and Joint Chest conference. Behavior and Attitude Objectives: Work effectively as a member of the patient care team. Rotation 2-VA Hospital chest x-ray and chest CT This rotation involves interpretation of digital chest radiographs, chest CT, and medical knowledge component of guided lung biopsies. Lung biopsies will be performed in the interventional rotation. Continue to build on skills developed in the first rotation, including the core competencies described above. Patient Care Goal Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to: Knowledge Objectives: Demonstrate knowledge of patient positioning and indications for posteroanterior (PA), anteroposterior (AP), lateral decubitus, and lordotic chest radiographs. Demonstrate knowledge of exam specific radiation doses. Demonstrate knowledge of indications for chest radiographs and thoracic CT studies of pregnant patients. Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary. Appropriately protocol all requests for chest CT to include thin-section images, high resolution images, expiratory images, or prone images when appropriate, and use of intravenous contrast, given the patients history. Demonstrate knowledge of CT parameters contribution to patient radiation exposure and techniques that can be used to limit radiation exposure. Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT examination. Recognize the radiographic findings of life-threatening conditions and notify referring clinician without being prompted. Actively participate with faculty in interpretation and workup of patients. Participate in radiation safety lectures. Skill Objectives: Provide accurate and timely reports on all cases with the supervision of faculty. Accurately and concisely dictate chest radiograph and chest CT reports using nomenclature recommended by the Fleischner Society. Gather clinical and radiologic data on patients with thoracic pathology. Develop diagnostic plan based upon clinical presentation and imaging findings. Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation. Behavior and Attitude Objectives: Work with the health care team in a professional manner to provide patient-centered care. Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. Medical Knowledge Goal Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to: Knowledge Objectives: List key points of level appropriate diagnoses. Describe intermediate level digital and conventional x-ray physics in the chest. Identify relevant anatomic structures on CT images of the chest. Be familiar with the more common pathologic conditions in the upper abdomen and understanding their pathophysiology. Learn indications and contraindications for lung biopsies. Demonstrate understanding of the pathophysiology and imaging appearance of at least one half of the diagnoses listed in the appendix. Demonstrate learning of at least one-half of the knowledge based objectives below: Chest Plain Film: Understand standard positioning in thoracic radiology. Identify normal anatomy and landmarks on frontal and lateral chest radiographs. Know the expected course and possible complications of lines, tubes, and other devices. Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum. Recognize patterns of lobar atelectasis. Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse coalescent, multifocal ill-defined, fine or coarse reticular, and fine nodular opacities; multiple nodules and masses; solitary pulmonary nodule. Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis. Describe the divisions of the mediastinum and common pathologies affecting each division. Recognize and give differential for hilar masses. Recognize and give differential for pleural effusions, thickening, and calcifications. Recognize and give differential for chest wall lesions. Chest CT: Understand standard CT protocols in thoracic radiology including the indications for intravenous contrast, low dose, HRCT, and airway protocols. Identify normal cross-sectional anatomy of the thorax on CT, including mediastinal lymph node designations and bronchial anatomy. The resident should gain an understanding of: Mediastinal masses with differential based on location, morphology, and patient demographics. The evaluation of the solitary pulmonary nodule. The major histologic types of primary lung cancer and the new 7th UICC/AJCC staging system published in 2009. Diffuse lung diseases that may demonstrate: linear or reticular opacities, including interlobular septal or intralobular interstitial thickening; nodular opacities in a centrilobular, perilymphatic, or random distribution; ground glass; consolidation; cysts or emphysema. The CT appearance of a variety of pulmonary infections, including those specific to the immunocompromised host. The non-infectious complications of immunocompromised patients, including those of solid organ and bone marrow transplant recipients. Diseases of the small and large airways. Pulmonary hypertension and pulmonary vascular diseases. Diseases of the pleura and chest wall. Skill Objectives: Continue to build on chest radiograph interpretive skills. Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses. Demonstrate a clinically appropriate diagnostic workup plan. Demonstrate the ability to use all relevant information resources to acquire evidence based data Accurately and concisely dictate chest radiograph reports. Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT or MR may be necessary. Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in thoracic radiology described in the detailed thoracic curriculum. List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and linear) of interstitial lung disease. Separate pulmonary from pleural or extrapleural processes. Correlate radiographic and chest CT findings. Perform and interpret more complex post-processing (3D) images. Behavior and Attitude Objectives: Recognize limitations of personal competency and ask for guidance when appropriate. Practice-Based Learning and Improvement Goal Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to: Knowledge Objectives: Assess CT images for quality and suggest methods of improvement. Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. Skill Objectives: Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. Facilitate the learning of students and other health care professionals. Participation in case conferences. Participation in the clinical activities of Thoracic Imaging Section. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. Behavior and Attitude Objectives: Incorporate formative feedback into daily practice, positively responding to constructive criticism. Follow up on interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. Help in teaching of technologists, medical students, housestaff, and other health care professionals Systems Based Practice Goal Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to: Knowledge Objectives: Understand how their image interpretation affects patient care. Demonstrate ability to design cost-effective care plans. Demonstrate knowledge of funding sources. Demonstrate knowledge of reimbursement methods. Demonstrate knowledge of regulatory environment. Demonstrate knowledge of intermediate level management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision, and management of staff. Skill Objectives: Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. Practice using cost effective use of time and support personnel. Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness Criteria. Participate in local and national radiological societies. Participate in discussions with faculty regarding operational challenges and potential systems solutions regarding all aspects of radiologic service and patient care. Attend and participate in multi-disciplinary conference. Interact and learn from department administrators. Behavior and Attitude Objectives: Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Knowledge Objectives: Understanding of the need for respect for patient privacy and autonomy. Demonstrate principles of confidentiality with all information transmitted during a patient encounter. Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning to the reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. If the resident will be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate faculty and/or fellow. Knowledge of issues of impairment. Discussion of above issues during daily clinical work. Training programs and/or videotapes on harassment and discrimination. Didactic presentations on the impaired physician. Participation in hospital-based educational activities and independent learning. Skill Objectives: Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. Behavior and Attitude Objectives: Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout ones career. Demonstrate honesty with patients, support staff, and colleagues. Demonstrate positive work habits, including punctuality, professional appearance and demeanor. When assisting referring clinicians with imaging interpretation and patient management, decide when it is appropriate to obtain help from supervisory faculty. Interpersonal and Communication Skills Goal Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to: Knowledge Objectives: Know the importance of accurate, timely, and professional communication. Skill Objectives: Provide a clear, succinct report using nomenclature recommended by Fleischner Society. Communicate effectively with physicians, other health professionals. In cases of serious or unanticipated findings, document that communication in report. Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible complications. Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to families, support personnel, and physicians. Participate in daily ICU and weekly BMT work conferences. Participate in Thoracic Tumor Board and Joint Chest conference. Behavior and Attitude Objectives: Work effectively as a member of the patient care team. Rotations 3 and 4-Stanford Hospital chest CT-2nd and 3rd year This rotation involves interpretation of chest CT, and also chest x-rays when needed to support the workflow. Continue to integrate and refine skills from the first two rotations, developing more autonomy. Patient Care Goal Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to: Knowledge Objectives: Appropriately protocol all requests for chest CT to include thin-section images, high resolution images, expiratory images, or prone images when appropriate, and use of intravenous contrast, given the patients history. Demonstrate knowledge of CT parameters contribution to patient radiation exposure and techniques that can be used to limit radiation exposure. Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT examination. Recognize the radiographic findings of life-threatening conditions and notify referring clinician without being prompted. Demonstrate knowledge of patient positioning and indications for posteroanterior (PA), anteroposterior (AP), lateral decubitus, and lordotic chest radiographs. Demonstrate knowledge of exam specific radiation doses. Demonstrate knowledge of indications for chest radiographs and thoracic CT studies of pregnant patients. Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary. Active participation with faculty in interpretation and workup of patients. Participation in radiation safety lectures Skill Objectives: Provide accurate and timely reports on all cases with the supervision of faculty. Accurately and concisely dictate chest radiograph and chest CT reports using nomenclature recommended by the Fleischner Society. Gather clinical and radiologic data on patients with thoracic pathology. Develop diagnostic plan based upon clinical presentation and imaging findings. Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation. Behavior and Attitude Objectives: Work with the health care team in a professional manner to provide patient-centered care. Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. Medical Knowledge Goal Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to: Knowledge Objectives: List key points of level appropriate diagnoses. Describe advanced level digital and conventional x-ray physics in the chest. Identify relevant anatomic structures on CT images of the chest. Be familiar with the more common pathologic conditions in the upper abdomen and understanding their pathophysiology. Learn indications and contraindications for lung biopsies. Demonstrate understanding of the pathophysiology and imaging appearance of at least three quarters of the diagnoses listed in the appendix. Demonstrate learning of at least three-quarters of the knowledge based objectives below. Chest Plain Film: Understand standard positioning in thoracic radiology. Identify normal anatomy and landmarks on frontal and lateral chest radiographs. Know the expected course and possible complications of lines, tubes, and other devices. Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum. Recognize patterns of lobar atelectasis. Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse coalescent, multifocal ill-defined, fine or coarse reticular, and fine nodular opacities; multiple nodules and masses; solitary pulmonary nodule. Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis. Describe the divisions of the mediastinum and common pathologies affecting each division. Recognize and give differential for hilar masses. Recognize and give differential for pleural effusions, thickening, and calcifications. Recognize and give differential for chest wall lesions. Chest CT: Understand standard CT protocols in thoracic radiology including the indications for intravenous contrast, low dose, HRCT, and airway protocols. Identify normal cross-sectional anatomy of the thorax on CT, including mediastinal lymph node designations and bronchial anatomy. The resident should gain an understanding of: Mediastinal masses with differential based on location, morphology, and patient demographics. The evaluation of the solitary pulmonary nodule. The major histologic types of primary lung cancer and the new 7th UICC/AJCC staging system published in 2009. Diffuse lung diseases that may demonstrate: linear or reticular opacities, including interlobular septal or intralobular interstitial thickening; nodular opacities in a centrilobular, perilymphatic, or random distribution; ground glass; consolidation; cysts or emphysema. The CT appearance of a variety of pulmonary infections, including those specific to the immunocompromised host. The non-infectious complications of immunocompromised patients, including those of solid organ and bone marrow transplant recipients. Diseases of the small and large airways. Pulmonary hypertension and pulmonary vascular diseases. Diseases of the pleura and chest wall. Skill Objectives: Continue to build on chest radiograph interpretive skills. Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses. Demonstrate a clinically appropriate diagnostic workup plan. Demonstrate the ability to use all relevant information resources to acquire evidence-based data. Accurately and concisely dictate chest radiograph reports. Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT or MR may be necessary. Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in thoracic radiology described in the detailed thoracic curriculum. List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and linear) of interstitial lung disease. Separate pulmonary from pleural or extrapleural processes. Correlate radiographic and chest CT findings. Perform and interpret more complex post-processing (3D) images. Behavior and Attitude Objectives: Recognize limitations of personal competency and ask for guidance when appropriate. Practice-Based Learning and Improvement Goal Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to: Knowledge Objectives: Assess CT images for quality and suggest methods of improvement. Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. Skill Objectives: Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. Facilitate the learning of students and other health care professionals. Participate in case conferences. Participate in the clinical activities of Thoracic Imaging Section. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. Behavior and Attitude Objectives: Incorporate formative feedback into daily practice, positively responding to constructive criticism. Follow up on interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. Help in teaching of technologists, medical students, housestaff, and other health care professionals. Systems Based Practice Goal Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to: Knowledge Objectives: Understand how their image interpretation affects patient care. Demonstrate ability to design cost-effective care plans. Demonstrate knowledge of funding sources. Demonstrate knowledge of reimbursement methods. Demonstrate knowledge of regulatory environment. Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision, and management of staff. Skill Objectives: Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. Practice using cost effective use of time and support personnel. Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness Criteria. Membership and participation in local and national radiological societies. Participate in discussions with faculty regarding operational challenges and potential systems solutions regarding all aspects of radiologic service and patient care. Attendance and participation in multi-disciplinary conference. Interact and learn from department administrators. Behavior and Attitude Objectives: Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Knowledge Objectives: Understanding of the need for respect for patient privacy and autonomy. Principles of confidentiality with all information transmitted during a patient encounter. Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning to the reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. If the resident will be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate faculty and/or fellow. Knowledge of issues of impairment. Discussion of above issues during daily clinical work. Training programs and/or videotapes on harassment and discrimination. Didactic presentations on the impaired physician. Participation in hospital-based educational activities and independent learning. Skill Objectives: Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. Behavior and Attitude Objectives: Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout ones career. Demonstrate honesty with patients, support staff, and colleagues. Demonstrate positive work habits, including punctuality, professional appearance and demeanor. When assisting referring clinicians with imaging interpretation and patient management, decide when it is appropriate to obtain help from supervisory faculty. Interpersonal and Communication Skills Goal Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to: Knowledge Objectives: Know the importance of accurate, timely, and professional communication. Skill Objectives: Provide a clear, succinct report using nomenclature recommended by Fleischner Society. Communicate effectively with physicians, other health professionals. In cases of serious or unanticipated findings, document that communication in report. Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible complications. Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to families, support personnel, and physicians. Participate in daily ICU and weekly BMT work conferences. Participate in Thoracic Tumor Board and Joint Chest conference. Behavior and Attitude Objectives: Work effectively as a member of the patient care team. Rotation 5-Stanford chest x-ray-third-year This rotation involves interpretation of digital chest radiographs, chest CT, and medical knowledge component of guided lung biopsies. Lung biopsies will be performed in the interventional rotation. Residents should focus on the integration of all previous chest rotations to concentrate on becoming an effective, independent consultant and teacher. Patient Care Goal Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to: Knowledge Objectives: Appropriately protocol all requests for chest CT to include thin-section images, high resolution images, expiratory images, or prone images when appropriate, and use of intravenous contrast, given the patients history. Demonstrate knowledge of CT parameters contribution to patient radiation exposure and techniques that can be used to limit radiation exposure. Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT examination. Recognize the radiographic findings of life-threatening conditions and notify referring clinician without being prompted. Demonstrate knowledge of patient positioning and indications for posteroanterior (PA), anteroposterior (AP), lateral decubitus, and lordotic chest radiographs. Demonstrate knowledge of exam specific radiation doses. Demonstrate knowledge of indications for chest radiographs and thoracic CT studies of pregnant patients. Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary. Actively participate with faculty in interpretation and workup of patients. Participate in radiation safety lectures. Skill Objectives: Provide accurate and timely reports on all cases with the supervision of faculty. Accurately and concisely dictate chest radiograph and chest CT reports using nomenclature recommended by the Fleischner Society. Gather clinical and radiologic data on patients with thoracic pathology. Develop diagnostic plan based upon clinical presentation and imaging findings. Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation. Behavior and Attitude Objectives: Work with the health care team in a professional manner to provide patient-centered care. Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. Medical Knowledge Goal Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to: Knowledge Objectives: List key points of level appropriate diagnoses. Describe advanced level digital and conventional x-ray physics in the chest. Identify relevant anatomic structures on CT images of the chest. Be familiar with the more common pathologic conditions in the upper abdomen and understanding their pathophysiology. Learn indications and contraindications for lung biopsies. Demonstrate understanding of the pathophysiology and imaging appearance of all of the diagnoses listed in the appendix. Demonstrate learning of all of the knowledge based objectives below. Chest Plain Film: Understand standard positioning in thoracic radiology. Identify normal anatomy and landmarks on frontal and lateral chest radiographs. Know the expected course and possible complications of lines, tubes, and other devices. Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum. Recognize patterns of lobar atelectasis. Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse coalescent, multifocal ill-defined, fine or coarse reticular, and fine nodular opacities; multiple nodules and masses; solitary pulmonary nodule. Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis. Describe the divisions of the mediastinum and common pathologies affecting each division. Recognize and give differential for hilar masses. Recognize and give differential for pleural effusions, thickening, and calcifications. Recognize and give differential for chest wall lesions. Chest CT: Understand standard CT protocols in thoracic radiology including the indications for intravenous contrast, low dose, HRCT, and airway protocols. Identify normal cross-sectional anatomy of the thorax on CT, including mediastinal lymph node designations and bronchial anatomy. The resident should gain an understanding of: Mediastinal masses with differential based on location, morphology, and patient demographics. The evaluation of the solitary pulmonary nodule. The major histologic types of primary lung cancer and the new 7th UICC/AJCC staging system published in 2009. Diffuse lung diseases that may demonstrate: linear or reticular opacities, including interlobular septal or intralobular interstitial thickening; nodular opacities in a centrilobular, perilymphatic, or random distribution; ground glass; consolidation; cysts or emphysema. The CT appearance of a variety of pulmonary infections, including those specific to the immunocompromised host. The non-infectious complications of immunocompromised patients, including those of solid organ and bone marrow transplant recipients. Diseases of the small and large airways. Pulmonary hypertension and pulmonary vascular diseases. Diseases of the pleura and chest wall. Skill Objectives: Continue to build on chest radiograph interpretive skills. Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful differential diagnoses. Demonstrate a clinically appropriate diagnostic workup plan. Demonstrate the ability to use all relevant information resources to acquire evidence based data Accurately and concisely dictate chest radiograph reports. Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT or MR may be necessary. Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in thoracic radiology described in the detailed thoracic curriculum. List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and linear) of interstitial lung disease. Separate pulmonary from pleural or extrapleural processes. Correlate radiographic and chest CT findings Perform and interpret more complex post-processing (3D) images. Behavior and Attitude Objectives: Recognize limitations of personal competency and ask for guidance when appropriate. Practice-Based Learning and Improvement Goal Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning. Residents are expected to develop skills and habits to be able to: Knowledge Objectives: Assess CT images for quality and suggest methods of improvement. Analyze and develop improvement plans in the clinical practice, including knowledge, observation, and procedural skills. Skill Objectives: Demonstrate independent self-study using various resources including texts, journals, teaching files, and other resources on the internet. Facilitate the learning of students and other health care professionals. Participate in case conferences. Participate in the clinical activities of Thoracic Imaging Section. Demonstrate critical assessment of the scientific literature. Demonstrate knowledge of and apply the principles of evidence-based medicine in practice. Behavior and Attitude Objectives: Incorporate formative feedback into daily practice, positively responding to constructive criticism. Follow up on interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. Help in teaching of technologists, medical students, housestaff, and other health care professionals. Systems Based Practice Goal Residents must demonstrate an awareness of, and responsiveness to, the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to: Knowledge Objectives: Understand how their image interpretation affects patient care. Demonstrate ability to design cost-effective care plans. Demonstrate knowledge of funding sources. Demonstrate knowledge of reimbursement methods. Demonstrate knowledge of regulatory environment. Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical records, and the recruitment, hiring, supervision, and management of staff. Skill Objectives: Provide accurate and timely interpretations to decrease length of hospital and emergency department stay. Appropriately notify the referring clinician if there are urgent or unexpected findings and document such without being prompted. Practice using cost effective use of time and support personnel. Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness Criteria. Participate in local and national radiological societies. Participate in discussions with faculty regarding operational challenges and potential systems solutions regarding all aspects of radiologic service and patient care. Attend and participate in multi-disciplinary conference. Interact and learn from department administrators. Behavior and Attitude Objectives: Advocate for quality patient care in a professional manner, particularly concerning imaging utilization issues. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Knowledge Objectives: Understanding of the need for respect for patient privacy and autonomy. Principles of confidentiality with all information transmitted during a patient encounter. Understanding of their responsibility for the patient and the service, including arriving in the reading room promptly each day, promptly returning to the reading room after conferences, completing the work in a timely fashion, and not leaving at the end of the day until all work is complete. If the resident will be away from a service (for time off, meeting, board review, etc.), this must be arranged in advance with the appropriate faculty and/or fellow. Knowledge of issues of impairment. Discussion of above issues during daily clinical work. Training programs and/or videotapes on harassment and discrimination. Didactic presentations on the impaired physician. Participation in hospital-based educational activities and independent learning. Skill Objectives: Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. Behavior and Attitude Objectives: Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest. Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout ones career. Demonstrate honesty with patients, support staff, and colleagues. Demonstrate positive work habits, including punctuality, professional appearance and demeanor. When assisting referring clinicians with imaging interpretation and patient management, decide when it is appropriate to obtain help from supervisory faculty. Interpersonal and Communication Skills Goal Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to: Knowledge Objectives: Know the importance of accurate, timely, and professional communication. Skill Objectives: Provide a clear, succinct report using nomenclature recommended by Fleischner Society Communicate effectively with physicians, other health professionals. In cases of serious or unanticipated findings, document that communication in report. Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible complications. Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to families, support personnel, and physicians. Participate in daily ICU and weekly BMT work conferences. Participate in Thoracic Tumor Board and Joint Chest conference. Behavior and Attitude Objectives: Work effectively as a member of the patient care team.  Workflow and Duties: During each rotation, a resident is expected to: Wear hospital identification Arrive by 8:30 am for work on the chest service May leave after ICU conference for noon conference Return by 1:15 pm from conference Notify section head or attending of day for scheduled absences on rotation Preview studies to be read during the morning read-out Participate in the weekly Thoracic Tumor Board Participate in the monthly ILD conference Participate in the monthly Joint Chest Conference Dictate all radiographic and CT studies of inpatients and SMIC/SMOC outpatients before the end of the day Conference Schedule/FormatTitleDayTimeLocationResident conferences Chest-CVIFridays12:00Lucas ICU conferenceDaily11:30BallroomThoracic tumor boardTuesdays2:00Cancer center, clinic AInterstitial Lung DiseaseFridaysMonthly at 4:00Cancer Center, clinic AJoint chest conferenceWednesdaysMonthlyPulmonary divisionMethod of Assessment of Performance: Written evaluation of resident by responsible faculty member monthly Verbal feedback to resident by faculty ACR In-Training Service Exam annuallyRecommended Reading First Rotation Reed. Chest Radiology: Plain Film Patterns and Differential Diagnoses Collins and Stern. Chest Radiology: The Essentials. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2008; 246(3): 697 722. Second Rotation Kazerooni & Gross, Cardiopulmonary Imaging Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2008; 246(3): 697 722. Third and Fourth Rotations Naidich et al. Computed Tomography and Magnetic Resonance Imaging of the Thorax Webb et al. High Resolution CT of the Lung.  APPENDIX : LungAirspaceCongenital1Hamartoma, Airway2Cystic Adenomatoid MalformationInfectiouis3Pneumonia Bacterial4Pneumonia, Community Acquired5Immunocompromised Pneumonia6Pneumonia, Staphylococcus7Pneumonia, Mycobacterial8Abscess, Lung9Fungal, Histoplasmosis10Fungal, Aspergillosis11Fungal, Blastomycosis12Fungal, CoccidioidomycosisVascular13Cardiogenic Pulmonary Edema14Noncardiac Pulmonary Edema15Embolism, Fat Pulmonary16Diffuse Alveolar Hemorrhage17Churg-Strauss SyndromeInflammatory - Degenerative18Eosinophilic PneumoniaToxic - Metabolic19Metastatic Pulmonary Calcification20Alveolar Microlithiasis21Lipoid Pneumonia22Pulmonary Alveolar Proteinosis23Desquamative Interstitial Pneumonia24Illicit Drug Use, Pulmonary Manifestations25Cryptogenic Organizing Pneumonia26Smoke Inhalation27Emphysema, ParaseptalNeoplastic28Bronchioloalveolar Cell CarcinomaInterstitiumInfectious29Pneumonia, Viral30Pneumonia, PneumocystisInflammatory - Degenerative31Sarcoidosis, Lymphadenopathy32Idiopathic Pulmonary Fibrosis33Hypersensitivity Pneumonitis34Rheumatoid Arthritis35Scleroderma36Polymyositis - Dermatomyositis37Nonspecific Interstitial PneumoniaToxic - Metabolic38Asbestosis39Silicosis - Coal Worker Pneumoconiosis40Hard Metal PneumoconiosisNeoplastic41Lymphangitic Carcinomatosis42Lymphangiomatosis43Lymphocytic Interstitial PneumoniaCongenitalAirwaysCongenital44Cystic Fibrosis45Tracheobronchomegaly46Immotile Cilia Syndrome47Bronchial Atresia48Alpha-1 Antiprotease Deficiency49Paratracheal Air Cyst50Williams-Campbell SyndromeInfectiouis51Bronchitis, Chronic52Chronic Obstructive Pulmonary Disease53Bronchiectasis54Laryngeal Papillomatosis55Mycobacterial Avium Complex56BronchiolitisInflammatory - Degenerative57Allergic Bronchopulmonary Aspergillosis58Emphysema, Panlobular59Tracheobronchomalacia60Relapsing Polychondritis61Middle Lobe Syndrome62Saber-Sheath Trachea63Bronchiolitis Obliterans64Asthma65PneumatocelesToxic - Metabolic66Langerhans Cell Histiocytosis, Pulmonary67Bronchiolitis, Respiratory68Emphysema, Centrilobular69AmyloidosisNeoplastic70Tracheopathia Osteochondroplastica71Carcinoid72Kaposi Sarcoma73Tracheal Neoplasms74Endobronchial TumorMediastinumMediastinumCongenital75Bronchogenic Cyst76Meningocele, Lateral77Pulmonary Bronchogenic CystInfectious78Mediastinal Abscess79MediastinitisInflammatory - Degenerative80Mediastinal Fibrosis81Achalasia82Esophageal Diverticuli83Hernias, Hiatal and ParaesophagealNeoplastic84Goiter, Mediastinum85Lymphoma, Hodgkin, Pulmonary86Lymphoma, Non-Hodgkin87Thymoma88Germ Cell Tumors89Lipomatosis90Castleman Disease91Nerve Sheath Tumors92Sympathetic Ganglion Tumors, Mediastinum93Extramedullary HematopoiesisVascular94VaricesAorta and Great VesselsCongenital95Right Aortic Arch96Aberrant Subclavian97Aortic Coarctation98Intralobar Sequestration99Left Superior Vena Cava100Azygos Continuation of IVC101Azygos FissureInfammatory - Degenerative102Ductus Diverticulum103Aortic Atherosclerosis104Marfan Syndrome105Aortic Dissection106Aortic Aneurysm107Takayasu Arteritis108SVC SyndromeHeart and PericardiumCongenital109Partial Absence Pericardium110Heterotaxy Syndrome111Pericardial CystInflammatory - Degenerative112Coronary Artery Calcification113Left Atrial Calcification114Ventricular Calcification115Valve and Annular Calcification116Aortic Valve Dysfunction117Mitral Valve Dysfunction118Constrictive PericarditisToxic - MetabolicNeoplastic119Left Atrial Myxoma120Metastases, PericardiumPulmonary VasculatureCongenital121Arteriovenous Malformation, Pulmonary122Partial Anomalous Venous Return123Scimitar Syndrome124Idiopathic Pulmonary Artery Dilatation125Congenital Interruption Pulmonary ArteryInfectious126Septic Emboli, PulmonaryInflammatory - Degenerative127Vasculitis, Pulmonary128Wegener Granulomatosis, Airway129Veno-Occlusive DiseaseToxic - Metabolic130Talcosis, Pulmonary Manifestations131Illicit Drug Abuse132Silo-Filler's DiseaseVascular133Pulmonary Emboli134Neurogenic Pulmonary Edema135Pulmonary Artery Hypertension136Aneurysm, Pulmonary Artery137High Altitude Pulmonary EdemaNeoplastic138Pulmonary Artery Sarcoma139Embolism, TumorRemovePleura - Chest Wall - DiaphragmPleuraCongenitalInflammatory - Degenerative140Pleural Effusion, Exudative141Apical Cap142Systemic Lupus ErythematosusInfectious143Empyema144Bronchopleural FistulaNeoplastic145Metastasis, Pleural146Malignant Mesothelioma147Pancoast Tumor148Localized Fibrous Tumor of the Pleura149Pneumothorax, CatamenialVascular150Transudative Pleural EffusionToxic - Metabolic151Asbestos Related Pleural DiseaseChest WallCongenital152Pectus Deformity153Kyphoscoliosis154Poland SyndromeInfectious155Empyema NecessitatisInflammatory - Degenerative156Ankylosing SpondylitisNeoplastic157Lipoma, Chest Wall158Lymphoma, Chest Wall159Askin TumorDiaphragmCongenital160Eventration of Diaphragm161Hernias, Bochdalek and MorgagniInflammatory - Degenerative162Phrenic Nerve ParalysisSpecial TopicsAtelectasis163Atelectasis, Lobar164Atelectasis, Subsegmental165Atelectasis, RoundTrauma166Pneumomediastinum167Pneumothorax, Traumatic168Tracheobronchial Tear169Lung Contusion170Aortic Transection171Rib Fractures and Flail Chest172Spinal Fracture, Thoracic173Diaphragmatic Rupture174Sternal Fracture175Esophageal Rupture176Splenosis, Thoracic177Hemothorax, TraumaticLung Cancer178Lung Cancer, Non-Small Cell179Lung Cancer, Small Cell180Lung Cancer, Staging181Lung Cancer, Regional Lymph Node Classification182Solitary Pulmonary Nodule183Lung Cancer, MissedPortable ICUNon-Surgical184Tubes and Catheters, Abnormal185Tubes and Catheters, Normal186Cardiac Pacemakers187PleurodesisSurgical188Median Sternotomy189Pneumonectomy, Extrapleural190Post-Transplant Lymphoproliferative Disease (PTLD)191Lung Transplantation192Transplantation, LungPhysiology193AspirationSpecial Patients194Metastases, Lung195Drug Reaction, Intrathoracic196Radiation-Induced Lung Disease197Immunosuppressed (Not AIDS)198HIV/AIDSAdded in Connection with DI2Overview199Wegener Granulomatosis, Pulmonary200Silhouette201Hilum Overlay202Hilum Convergence203S-Sign of Golden204Cervicothoracic Sign205Incomplete Border206Pad Sign207Luftsichel Sign208Air Crescent Sign209CT Angiogram Sign210CT Halo Sign211Reverse Halo Sign212Atelectasis, Cicatricial213Atelectasis, Right Upper Lobe214Atelectasis, Middle Lobe215Atelectasis, Right Lower Lobe216Atelectasis, Complete Lung217Atelectasis, Left Upper Lobe218Atelectasis, Left Lower LobeVolume LossDevelopmental Abnormalities219Congenital Lobar Emphysema220Congenital Pulmonary Airway Malformation221Isomerism222Extralobar Sequestration223Double Aortic Arch224Atrial Septal Defect225Ventricular Septal Defect226Pulmonary Varix227Bicuspid Aortic Valve228Anomalous Pulmonary Venous Return229Morgagni Hernia230Bochdalek Hernia231Congenital Diaphragmatic Hernia232LymphangioleiomyomatosisAirway Diseases233Squamous Cell Carcinoma, Airways234Adenoid Cystic Carcinoma235Mucoepidermoid Carcinoma236Metastasis, Airways237Tracheal Stenosis238Broncholithiasis239Swyer-James-McLeod240Bronchiolitis, Constrictive241Amyloidosis, Airways242Primary Ciliary Dyskinesia243Mounier-Kuhn SyndromeInfections244Pneumonia, Pneumococcal245MRSA246Pneumonia, Legionella247Nocardiosis248Tuberculosis, Post-Primary249Nontuberculous Mycobacterial Infection250Mycoplasma Pneumonia251Community Acquired Pneumonia252Influenza Pneumonia253Cytomegalovirus Pneumonia254Cryptococcosis255Pneumocystis, Jirovecii PneumoniaPulmonary Neoplasms256Preinvasive Adenocarcinoma257Invasive Adenocarcinoma258Squamous Cell Carcinoma259Hamartoma, Pulmonary260Neuroendocrine Carcinoma261Nodular Lymphoid Hyperplasia262Lung Cancer, Resectable263Lung Cancer, Unresectable264Bronchiolitis, FollicularInterstitial, Diffuse, and Inhalational Lung Disease265Acute Eosinophilic Pneumonia266Chronic Eosinophilic Pneumonia267Neurofibromatosis268Sarcoidosis269Farmer's LungConnective Tissue Disorders, Immunological Diseases, and Vasculitis270Mixed Connective Tissue Disease271Sjogren Syndrome272Inflammatory Bowel DiseasePulmonary Edema, Hemorrhage, and Vasculitis273Behcet Syndrome274Granulomatosis, Lymphomatoid275Granulomatosis, Necrotizing SarcoidMediastinal Abnormalities276Thymic Malignancy277Thymolipoma278Teratoma279Seminoma, Mediastinal280Nonseminomatous Malignant Germ Cell Neoplasm281Esophageal Duplication Cyst282Thymic Cyst283Coronary Artery Aneurysm284Lymphangioma, Mediastinal285Hemangioma, Mediastinal286Metastatic Disease, Lymphadenopathy287Lymphoma, Hodgkin, Mediastinal288Lymphoma, Non-Hodgkin, Mediastinal289Mediastinal FibrosisCardiovascular Disorders290Pulmonary Thromboembolic Disease, Acute291Pulmonary Thromboembolic Disease, Chronic292Cardiac Myxoma293Sarcoma, Cardiac294Pericardial EffusionTrauma295Trauma, Lung296Traumatic Aortic Injury297AspirationPost-Treatment Chest298Lobectomy299Pneumonectomy300Amiodarone Toxicity301Ablation ProceduresPleural Diseases302Chylothorax303Hemothorax304Pleural Plaques305Pleural Fibrosis and 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