ࡱ>  =bjbj 45,,ooooobdddddd$1dooooobb&ڂm?2d.dN0o`, 5: Clinical Rotations Body Imaging and GI/GU Competency-Based Goals and Objectives by level of training (Pediatric abdominal imaging G&O are included in the pediatric rotations) Rotation One 1. Medical Knowledge Instrumentation and Protocols Basic CT and MRI instrumentation Common CT and MRI artifacts Become familiar with on-line protocols Types of oral and intravenous contrast Contra-indications to contrast administration, pre-treatment regimens for at-risk patients, nephrogenic systemic fibrosis, and treatment regimens for contrast reaction Abdomen Liver: normal size, diffuse disease, (fatty infiltration, acute and chronic hepatitis, cirrhosis, edema), focal masses, metastases, granuloma Gallbladder: normal appearance, acute cholecystitis (calculous/acalculous), sonographic Murphys sign, other etiologies of wall thickening Bile ducts: normal intra- and extrahepatic bile duct diameters and dilatation Pancreas: normal anatomy, pancreatic duct, mass Spleen: normal size, focal masses, lymphoma, abscess, infarction, granuloma Peritoneal cavity: ascites Trauma: hemoperitoneum, pneumothorax, vascular injury, solid organ injury, mesenteric/bowel injury, active bleeding Kidneys, urinary bladder and prostate Normal renal anatomy, simple renal cyst Ureters: hydronephrosis, pyonephrosis, hydroureter, stone Urinary bladder: calculi, wall thickening Abscess/pyelonephritis, perinephric fluid Post-renal transplant collections: hematoma, urinoma, abscess, lymphocele Complex renal cyst, adult polycystic disease and acquired renal cystic disease, renal cell carcinoma, angiomyolipoma Urinary bladder: mass, infection, hemorrhage, wall thickening, bladder outlet obstruction, diverticula, ureterocele Trauma Bowel Inflammatory conditions including appendicitis, diverticulitis, inflammatory bowel disease, epiploic appendagitis Infectious colitis Ischemic bowel Bowel perforation Bowel obstructions and underlying etiology Intussusception, volvulus, closed loop obstruction, incarcerated hernias, strangulation Gynecology Ovarian neoplasm: cystic/solid adnexal masses, cystadenoma/carcinoma, dermoid, fibroma, germ cell tumor, Doppler evaluation Ovarian torsion appearance on CT Pelvic inflammatory disease, tubo-ovarian abscess Vascular Abdominal aorta: normal appearance and measurement, aneurysm Inferior vena cava: normal appearance, thrombosis Lower extremity deep vein thrombosis Hematoma Pseudoaneurysm Liver transplants, including hepatic artery stenosis or thrombosis, portal vein thrombosis, post-biopsy complications Pancreas transplant: vasculature, fluid collections Hemodynamics of cirrhosis, portal hypertension and varices, portal vein thrombosis Assessment Methods Faculty evaluations Mock orals ACR in-service examination results 2. Patient Care Gather essential and accurate clinical information about patients relevant to the interpretation of the examination including correlation with prior radiological studies. Communicate effectively and demonstrate caring, respectful behavior when interacting with patients and their families, answering their questions and helping them to understand the image-guided procedure as well as its clinical significance. Use information technology to support patient care decisions. Perform basic procedures such as thoracentesis and paracentesis with faculty guidance. Start a procedure log for image-guided procedures Protocol GI and GU examinations including CT and MRI with faculty guidance. Determine if additional imaging is needed before the patient examination is complete Recognize CT findings of appendicitis, diverticulitis, cholecystitis, hydronephrosis, ureteral obstruction, bowel obstruction, volvulus, ischemic bowel, pneumoperitoneum, common traumatic injuries of the chest/abdomen, active extravasation, emphysematous inflammatory processes, bronchogenic carcinoma, pneumothorax, pulmonary embolus, aortic dissection, aortic rupture, traumatic vascular injury and common neoplasms. Assessment Methods Faculty evaluations 360 evaluations Mock orals Semi-annual review of procedure log 3. Practice-Based Learning and Improvement Participate in self-directed learning including outside reading on anatomy and common pathology supplemented with information on emergency/trauma processes. Participate in QA/QI activities. Use information technology to access on-line medical information, and to facilitate self-directed learning. Assessment Methods Faculty evaluations Learning portfolios (learning plan) Mock orals ACR in-service examination 4. Interpersonal and Communication Skills Dictate prompt, accurate and concise radiological reports for basic studies. Develop effective communication skills with patients, patients families, physicians and other members of the health care team. Obtain informed consent for procedures with faculty guidance. Promptly communicate urgent, critical or unexpected findings to residents, referring physicians or clinicians and document the communication in the radiological report. Assessment Methods Faculty evaluations 360 evaluations Formal evaluation of resident dictations documented in resident learning portfolios 5. Professionalism Demonstrate integrity, respect and compassion to patients, physicians, staff and other health care professionals. Demonstrate positive work habits, including punctuality and professional appearance. Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information. Demonstrate a commitment to continuous professional development and lifelong learning through consistent conference attendance and participation. Assessment Methods Faculty evaluations 360 evaluations semi-annual review of conference attendance 6. Systems-Based Practice Understand how medical decisions affect patient care within the larger system. Demonstrate knowledge of and apply appropriateness criteria and other cost-effective healthcare principles to professional practice. Assessment Method Faculty evaluations Suggested References Fundamentals of Body CT by Richard Webb The Requisites in GI, GU Rotation Two 1. Medical Knowledge Abdomen Liver: post-liver transplantation collections: hematoma, biloma, abscess Gallbladder: inflammatory conditions, carcinoma Bile ducts: bile duct stones, inflammatory disease, cholangitis, pneumobilia, neoplasm Pancreas: neoplasm, cysts Pancreatitis complications: abscess, pseudocyst and pseudoaneurysm, chronic pancreatitis Peritoneal cavity: abscess, hemorrhage, omental mass, metastasis, carcinomatosis Spleen: varices Gastrointestinal tract: neoplasm, inflammatory conditions Abdominal wall hernia, inguinal hernia Kidneys, urinary bladder and prostate Kidneys: xanthogranulomatous pyelonephritis, emphysematous pyelonephritis, congenital anomalies, pelvic kidney (see pediatrics section), medullary nephrocalcinosis Adrenal glands: mass Retroperitoneum: adenopathy, mass Ureters: ureteral stone Urinary bladder: ectopic ureterocele Renal artery stenosis, renal vein thrombosis (see vascular section section) Staging renal cell carcinoma Gynecology Cervix: mass, stenosis, endometrial obstruction Fallopian tube: hydrosalpinx, pyosalpinx Post-hysterectomy Peritoneal inclusion cyst Ovarian, cervical and endometrial cancer staging Scrotal Staging for testicular neoplasm Vascular Renal vein thrombosis Mesenteric ischemia Arterial stenosis and thrombosis Assessment Methods Faculty evaluations Mock orals ACR in-service 2. Patient Care Screen and supervise more complex studies Pre-procedural evaluation: coagulation laboratory studies, anticoagulation medication Stratification of risk for percutaneous procedures Techniques for image-guided invasive procedures: understanding important landmarks and pitfalls of percutaneous procedures, including recognition of critical structures to be avoided Biopsy of soft tissue masses Aspiration of fluid collections, cysts and catheter placement for abscess and fluid drainage Post-procedural evaluation: radiographic studies, patient monitoring, management of complications Maintain a procedure log Fine needle biopsy versus core biopsy in specific application, such as focal liver mass, renal mass, thyroid/parathyroid mass, retroperitoneal lymphadenopathy Determine the appropriate patient protocol/study and interact with the technologist on a regular basis. Assessment Methods Faculty evaluations 360 evaluations Semi-annual review of procedure log 3. Practice-Based Learning and Improvement Participate in self-directed learning with outside reading from Webb and the Case Review Series. Demonstrate knowledge and the application of the principles of evidence-based medicine in practice. Participate in QA/QI activities. Facilitate the teaching of medical students. Assessment Methods Faculty evaluations Learning portfolios (learning plan) Mock orals ACR in-service examination 4. Interpersonal and Communication Skills Interact with residents and attending physicians in consultation to enhance clinical radiological correlation. Dictate accurate and concise radiological reports for more complex studies with concise impression including diagnosis and/or differential diagnoses Assessment Methods Faculty evaluations Direct observation by the faculty Formal evaluation of resident dictations documented in resident learning portfolios 5. Professionalism Demonstrate responsiveness to the needs of patients that supercedes self-interest (altruism). Demonstrate a commitment to continuous professional development and lifelong learning through consistent conference attendance and participation. Assessment methods Faculty evaluations 360 evaluations Semi-annual review of conference attendance 6. Systems-Based Practice Effectively prioritize patients requiring cross-sectional imaging studies. Participate in discussions with faculty regarding system challenges and potential solutions regarding radiological service and patient care. Assessment Method Faculty evaluations Suggested References: Fundamentals of Body CT by Richard Webb Case Review Series for GI, GU Rotation Three (and > months) 1. Medical Knowledge Features that distinguish different types of benign and malignant hepatic masses on CT and MRI imaging Features that distinguish different types of benign and malignant renal masses on CT and MRI imaging Features that distinguish different types of benign and malignant pancreatic masses on CT and MRI imaging Features that distinguish different types of benign and malignant adrenal masses on CT and MRI imaging Biliary abnormalities on MRCP imaging Expected post-operative findings with more complex bowel surgery Assessment Methods Faculty evaluations Mock orals ABR written examination results 2. Patient Care Perform more complex image-guided procedures with faculty oversight Screen and supervise, with increasing level of responsibility, most cross-sectional imaging studies. Consistently provide safe patient care by minimizing the radiation dose when determining protocols for CT. Recognize the MRI findings of common abdominal/pelvic neoplasms and causes of biliary obstruction, as well as the CT findings of less common thoracic/abdominal disease processes Assessment Methods Faculty evaluations 360 evaluations Semi-annual review of procedure log 3. Practice-Based Learning and Improvement Outside reading. Review radiology education web sites and teaching files including ACR CD-ROM. Facilitate the teaching of medical students and more junior level residents. Participate in QA/QI activities. Assessment Methods Faculty evaluations Learning portfolios (learning plan) Mock orals 4. Interpersonal and Communication Skills Dictate accurate and concise reports for the most complex studies with concise impression including diagnosis and/or differential diagnoses as well as recommendations for further imaging and/or management, when appropriate. Consult effectively with medical staff and attending physicians. Assessment Methods Faculty evaluations Direct observation by the faculty Formal evaluation of resident dictations documented in resident learning portfolios. 5. Professionalism Demonstrate accountability to patients, society and the profession. Demonstrate a commitment to continuous professional development and lifelong learning through consistent conference attendance and participation. Assessment Methods Faculty evaluations 360 evaluations Semi-annual review of conference attendance 6. Systems-Based Practice Understand indications for and cost-effectiveness of varying cross-sectional imaging modalities (Ultrasound versus CT versus MRI). Practice cost-effective evaluation of patients requiring imaging studies that does not compromise the quality of care through the utilization of the ACR Appropriateness Criteria. 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