ࡱ> []VWXYZ xbjbj]q]q a??88    8E z$}}!!!@!o!o!"!!e'4e'e'e'!,e'!e'e'{Lc,J &ǑZɘT"J0z!Be'ce'cJ!!!8 :   Rotation: Cardiovascular imaging (CVI)Rotation Duration: 4 weeksMonth(s): 2 Institution: StanfordCall Responsibility: noneNight(s): covered by night floatResponsible Faculty Member(s): Dominik Fleischmann, MD Section Chief Frandics Chan, M. D., Ph.D. Bruce Daniel, M.D. Robert Herfkens, M.D. Margaret Lin, M.D.Location: CVI reading room, H-1301Phone Numbers: Reading rooms: 6-2424, 6-2423Technologists/Technical Staff: Michelle Thomas: CT chief technologist Teresa Nelson and Claudia Cooper: MR supervisors Training Level: Years 2 and 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. Cardiovascular Imaging-rotation 1- Second Year Rotation This rotation involves interpretation of chest radiographs, CT angiograms (including but not limited to pulmonary embolism studies, abdominal angiograms, lower extremity runoffs, and upper extremity angiograms), CT venograms, MRI angiograms, MRI venograms, mesenteric ischemia protocols, as well as cardiac CT and MR. Devote particular focus to learning key applications for upcoming senior call, including all vascular trauma, acute aortic syndromes, pulmonary embolism, and deep venous thrombosis. 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: Learn the basic principles of computed tomographic (CT) angiographic acquisition, including scanner settings and contrast medium delivery. Learn the basic principles of magnetic resonance (MR) angiographic acquisition, including scanner settings and contrast medium delivery. Learn the basic principles of 3D workstation operation (TeraRecon) for volumetric navigation through CT and MR cardiovascular imaging studies. Describe indications and basic principles of cardiac CT and MRI. Demonstrate knowledge of CT parameters contributing to patient radiation exposure and techniques that can be used to limit radiation exposure. Understand the use of beta-blockers in cardiac CT. Understand the role of CT and MR angiography relative to invasive angiography and standard abdominal and thoracic CT and MR procedures for characterizing vascular abnormalities. Develop an understanding of key surgical and interventional radiological procedures and understand how imaging is used to triage to specific therapies and to plan those therapies. Recognize the findings of life-threatening conditions and respond urgently. Discuss the classification, symptoms, and signs of contrast reactions and the clinical management including appropriate use of pharmacologic agents and their mode of administration and doses. Understand the pre-medication regimen for contrast-sensitive patients including drugs, doses, and dose scheduling. Skill Objectives: Practice 3D rendering and navigation using the AquariusNet (TeraRecon) system in the reading room and using GE Advantage Windows and Vital Images Vitrea in the 3D laboratory. Master the interpretation of plain radiographs of post-operative cardiac and vascular surgery patients. Protocol pulmonary embolism CTs and CT angiograms, with minimal fellow assistance, cognizant of contraindications. Time permitting, actively participate in cardiac CT supervision, protocoling, post processing, and interpretation. Time permitting, actively participate on the cardiac MR service, including protocoling, post processing, and interpretation. Provide concise, accurate reports. Provide emergency treatment for adverse reactions to intravenous contrast material. Become facile with PACS and utilize available technical and written information sources to manage patient information. Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. Assess and manage quality control of pulmonary embolism CTs and CT angiograms. 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. Work closely with assigned faculty member to complete the daily workload of CTs of the chest, abdomen and pelvis. 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: Discuss CT technology, physics and its application, including dosimetery. Identify complex vascular anatomy and pathology on CT and MR angiographic studies. Synthesize cogent differential diagnoses for arterial and venous lesions. Identify life-support devices and postoperative findings on cardiac and vascular surgery patients. Understand the anatomy of the chest as seen on chest radiographs. Understand the anatomy of the chest as seen on a chest CT angiograms, specifically the pulmonary arteries and veins, heart and aorta, coronary arteries, and great vessels. Recognize the appearance of pulmonary embolism on CT, cognizant of pitfalls. Understand coronary artery anatomy, including congenital abnormalities. Understand the appearance of pathology on cardiac MRI, including, but not limited to, myocardial infarction, hypertrophic obstructive cardiomyopathy (HOCM), and arrhythmogenic right ventricular dysplasia (ARVD). Understand vascular anatomy of the upper and lower extremities. Understand the pathophysiology and imaging findings of aortic dissection, traumatic aortic injury, intramural hematoma, and penetrating ulcer. Understand the principles of prospective and retrospective cardiac gating. Understand abdominal angiographic anatomy, as well as the pathophysiology and imaging manifestations of ischemia. Understand the pathophysiology, management, and appearance of abdominal aneurysms and pseudo-aneurysms. Obtain mastery of at least half of the diagnoses listed in the appendix. Skill Objectives: Accurately identify and interpret findings of acquired and congenital heart disease on chest radiographs, cardiac CT and CMRI. Accurately interpret postoperative chest radiographs and chest CTs. Accurately interpret pulmonary embolism CTs and CT angiograms of the aorta, abdominal vessels, and extremities. Perform and interpret basic post-processing (3D) images using TeraRecon and other available software. Refine skills in interpretation of chest radiographs and chest CT scans. Correlate pathologic and clinical data with radiographic and chest CT findings. 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 and MR images for quality and suggest methods of improvement. Understand the role of CT in the evaluation of specific diseases and among varied patient populations. Skill Objectives: Incorporate on-line just-in-time learning at the workstation on a daily basis. For example ARRS Goldminer; MyPACS.net; StatDx. 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. Prepare four teaching cases: two MR and two non-MR cases. Behavior and Attitude Objectives: Incorporate formative feedback into daily practice, positively responding to constructive criticism. Follow-up interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. 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. 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 cost effective use of time and support personnel. 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. 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. 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. 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: Produce concise and accurate reports on most examinations. Communicate effectively with physicians, other health professionals. Present at monthly cardiac imaging conference. Behavior and Attitude Objectives: Work effectively as a member of the patient care team. Cardiovascular Imaging-rotation 2- Third Year Rotation This rotation involves interpretation of chest radiographs, CT angiograms (including but not limited to pulmonary embolism studies, abdominal angiograms, lower extremity runoffs, and upper extremity angiograms), CT venograms, MRI angiograms, MRI venograms, mesenteric ischemia protocols, as well as cardiac CT and MRI. Devote particular focus to learning key applications for vascular trauma, acute aortic syndromes, pulmonary embolism, and deep venous thrombosis. 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: Continue to build on the knowledge objectives achieved in the 1st rotation. Learn advanced principles of CT scanning protocols and contrast media usage. Recognize the findings of life-threatening conditions and respond urgently. Discuss the classification, symptoms, and signs of contrast reactions and the clinical management including appropriate use of pharmacologic agents and their mode of administration and doses. Understand the pre-medication regimen for contrast-sensitive patients including drugs, doses, and dose scheduling. Expand expertise in performance and interpretation of extremity CT and MR angiography Develop improved skills in protocoling, monitoring, and interpreting chest MR studies, including cardiovascular MRI. Describe indications for and intermediate principles of cardiac CT and MRI. Demonstrate advanced knowledge of CT parameters contributing to patient radiation exposure and techniques that can be used to limit radiation exposure. Skill Objectives: Continue to build on the skills objectives achieved in the 1st rotation. Gain intermediate level expertise with volumetric navigation through 4D CT and MR cardiac data sets and use of advanced algorithms for characterizing cardiac and vascular function. Provide accurate and timely reports on all cases. Coordinate activities in the reading room, including providing direction for the technologists, consultation for other clinicians, and answering the phone. Become facile with PACs and utilize available information technology to manage patient information. Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation. Actively participate on the cardiac MR service, including protocoling, post processing, and interpretation. Provide emergency treatment for adverse reactions to intravenous contrast material. 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. Apply ACR communication guidelines and notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation. Consult with increasing confidence, with referring physicians in regard to CT imaging procedures. Work closely with assigned faculty member to complete the daily workload of CTs. 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: Continue to build on the knowledge objectives achieved in the 1st rotation. Discuss CT technology, physics and its application, including dosimetery. Learn intermediate complexity CT physics and pertinent concepts for image interpretation of common and uncommon studies. Identify the majority of normal and abnormal anatomic structures and their variants on CT angiographic images of the extremities, chest, abdomen and pelvis. Demonstrate knowledge of all of the diagnoses listed in the appendix. Skill Objectives: Continue to build on the skills objectives achieved the 1st rotation. Perform and interpret more complex post-processing (3D) images. Refine skills in interpretation of chest radiographs and chest CT scans. Correlate pathologic and clinical data with radiographic and chest CT findings. Accurately identify and interpret findings of acquired and congenital heart disease on chest radiographs, cardiac CT and CMRI. 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. 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. Behavior and Attitude Objectives: Incorporate formative feedback into daily practice, positively responding to constructive criticism. Follow-up interesting or difficult cases without prompting and share this information with appropriate faculty and fellow residents. 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. Skill Objectives: Provide accurate and timely interpretations to decrease length of hospital and emergency department stay, with the supervision of faculty. 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. 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. 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. 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. 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: Produce concise and accurate reports on most examinations. Communicate effectively with physicians, other health professionals. Obtain informed consent with the utmost professionalism. Behavior and Attitude Objectives: Work effectively as a member of the patient care team. Workflow: The workday begins at approximately 8:30, immediately following morning conference. Readouts occur throughout the morning and afternoon. The resident should preview cases before readout and gather clinical information regarding the patients history, current status and indications for the angio study prior to readout. Readouts will occur both morning and afternoon. The resident may pre-dictate cases that he/she performed or checked. They can be made preliminary (status 70) once they have been reviewed with the attending. The resident should promptly review and sign dictated reports. The resident should field requests for emergency add-on studies and should elicit enough clinical history to insure that the correct study is performed for the condition suspected. He/she should also find out whom to contact with the results, and where any outpatient should be sent when the study is completed. When an IV nurse is not available, the resident should be available to place IVs and monitor contrast injections for CT scans. The resident should participate in protocoling cases for the upcoming days studies as there is a great deal to be learned from this process. This should be performed in conjunction with the fellow, who is ultimately responsible. All protocols are done in the Centricity RIS. For the proper protocol to be performed, it is important to check EPIC for information regarding the patients clinical history, indication and prior studies, if any. If the clinical question or reason for the exam is unclear, then the ordering physician should be contacted to clarify and ensure that the proper examination is performed. This should be done at least a day prior to the scheduled exam (if not more) and not while the patient is lying on the exam table, waiting to be scanned! IV Issues: For most routine cases, one of our IV nurses will place the IV and monitor the injection. For CT angio and bi-phasic studies, a 20 gauge IV will be necessary. If the nurse cannot achieve IV access, the resident or fellow will be asked to attempt to place the IV. PICC lines are not to be used for contrast injection, unless they are certified as a "power PICC." Contrast Issues: We use non-ionic iodinated contrast as a rule in all patients. Prior to injection, the patient should be questioned concerning prior reaction to iodinated IV contrast. The protocol for managing contrast reactions is posted online in the resident website, and is available as well as on the pocket phone card. If the history of reaction is mild such as local pain, nausea or mild urticaria (1-2 hives), a contrast examination can be performed. However, if the prior reaction is severe including symptoms such as bronchospasm or laryngeal edema, then an alternative exam should be considered and discussed with the ordering physician. If it is decided that CT is still the desired exam, then the patient must be pre-medicated. Our pre-medication regimen consists of 50mg prednisone PO at 13 hours, 7 hours and 1 hour prior to contrast administration. Additionally, 50mg benadryl PO is administered 1 hour before the exam. Duties: Preparing studies: Studies are primarily reviewed on PACS. Many studies, including aortic and coronary exams, should also be sent to AquariusNet (AQNET2) prior to readout to facilitate evaluation on the 3D workstation. The resident should note whether there are prior comparison studies. If there are prior studies, the resident should make sure they are available online for viewing, or fetch them if necessary. The resident should note whether there are any outside cases to be reviewed. If so, these should be digitized by the film library staff for review on the PACS workstation. Time allowing, the resident may pre-dictate studies using the Nuance voice recognition software. The studies will then enter status 60, or "dictated." They will no longer be visible on the work list. What to do during readout: During readout, the resident should articulate the indication for the examination and be able to provide brief patient history, which may require review of notes from EPIC. While the attending reviews the images, the resident should state what his/her impression was of the findings for any cases they have checked or scanned. During the readout, the resident should take note of the findings to be included in the dictation. The resident should be sure he/she understands what the "bottom line" is for the study, so that the report will convey the significance of the findings. Questions are welcome during readout. Pit-falls in ordering/reporting information: It is the responsibility of the radiologist (resident or fellow) to determine and advise the ordering physician of the correct exam linked to each specific clinical setting. All significant findings should be conveyed to the ordering physician in a timely fashion this may be by phone or fax. This is not just a courtesy; it is our legal obligation! Please request a readback for any of the critical results designated "S9." Be sure to document communication (who, when and what results) in the report. Conference Schedule/Format: TitleDayTimeLocationCV imaging Resident conferenceFridayNoonLucasMethod of Assessment of Performance: Written evaluation of resident by responsible faculty member monthly. Verbal feedback to resident by faculty. ACR In-Training Service Exam annually. Recommended Reading and References: The fastest resource to get acquainted with the typical spectrum of diseases assessed on the CVI rotation is to review the CVI lectures early during the rotation, or even before the rotation. The two (of 16) most relevant topics are: Acute aortic syndromes, and Pre-postoperative aorta [Cardiovascularimaging.stanford.edu/education/] Rubin and Rofsky; CT and MR angiography. Schoepf, CT of the Heart. Fishman and Jeffrey, MDCT Principles, Techniques and Clinical Applications, Chapters 1, 6, 8, 22-24. Fleischmann D and Rubin GD. Delayed bolus propagation in patients with peripheral arterial occlusive disease: implications for CT angiography. Radiology 2005; 236:1076-1082. Chan FP and Rubin GD. MDCT Angiography of pediatric vascular diseases of the abdomen, pelvis, and extremities. Pediatric Radiology 2005; 35:40-53. Veith FJ, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002 May; 35(5): 1029-35. Hiatt MD, Rubin GD. Surveillance for endoleaks: how to detect all of them. Semin Vasc Surg 2004; 17:268-278. Stat DX RadPrimer As a suggestion, you should do selected readings nightly on topics which have come up on cases seen during the day. This is much more effective than reading texts cover-to-cover and, in general, results in better retention of material because you will be able to associate what youve read with a real case that youve recently seen.  Appendix: Congenital1Coarctation of Aorta2Double Aortic Arch3Right Aortic Arch4Pulmonary Sling5L-Transposition6Truncus Arteriosus7Total Anomalous Pulmonary Venous Return8Scimitar Syndrome9D-Transposition10Septal Defects11Heterotaxia Syndromes12Patent Ductus Arteriosus13Ebstein Anomaly14Partial Anomalous Pulmonary Venous Return15Cor Triatriatum16Endocardial Cushion Defect17Tetralogy of FallotValvular18Aortic Stenosis19Aortic Regurgitation20Bicuspid Aortic Valve21Mitral Stenosis22Mitral Valve Prolapse23Mitral Regurgitation24Mitral Annular Calcification25Pulmonary Stenosis26Tricuspid Regurgitation27Infective Endocarditis (IE)28Carcinoid Syndrome29Rheumatic Heart Disease30LV Apical Aortic ConduitPericardial31Infectious Pericarditis32Neoplastic Pericarditis33Constrictive Pericarditis34Pericardial Cyst35Absent Pericardium36Pericardial Effusion37Pericardial TamponadeNeoplastic38Atrial Myxoma39Cardiac Lipoma40Ventricular Thrombus41Cardiac Sarcoma42Cardiac Metastases43Papillary Fibroelastoma44Fibroma45Lipomatous Hypertrophy, Interatrial Septum46LymphomaCardiomyopathy47Hypertrophic Cardiomyopathy48Dilated Cardiomyopathy49Restrictive Cardiomyopathy50Myocarditis51Arrhythmogenic RV Dysplasia52Hypereosinophilic Syndrome53Cardiac Sarcoidosis54Cardiac Amyloidosis55LV Non-Compaction56Hemochromatosis57Takotsubo CardiomyopathyCoronary Artery58Anomalous Left Coronary Artery, Malignant59Anomalous Left Coronary Artery, Benign60Anomalous LCX61Anomalous Origin RCA Benign/Malignant62Bland-White-Garland Syndrome63Coronary Artery Aneurysm64Coronary Calcification65Coronary Thrombosis66Coronary Artery Stenosis67Coronary Artery Dissection68Acute Myocardial Infarction69Chronic Myocardial Infarction70Infarction LAD Distribution71Papillary Muscle Rupture72Non-Atherosclerosis MI73Ischemic Cardiomyopathy74Non-Transmural Myocardial Infarction75Post Infarction LV Aneurysm76Post Infarction LV Pseudoaneurysm77Left Ventricular Free Wall Rupture78Ventricular Septal Rupture79Left Ventricular Thrombus80Post-Stent Restenosis81Post CABG Thrombosis82Myocardial Bridge83Coronary FistulaHeart Failure84Right Heart Failure85Left Heart FailureHypertension86Left Ventricular Hypertrophy87Right Ventricular Hypertrophy88Pulmonary Arterial Hypertension89Branch Pulmonary StenosisElectrophysiology90Pulmonary Vein Stenosis91Pacemakers/ICDs92Left Atrial Thrombus Thorax21Thoracic Aortic Aneurysm22Mycotic Aneurysm23Post-Traumatic Pseudoaneurysm24Aortic Ulceration25Aortic Dissection26Takayasu Arteritis27Marfan Syndrome28Giant Cell Arteritis29Pseudo-Coarctation30Traumatic Aortic Laceration31Ductus Diverticulum32Bronchial Artery Pathology33Pulmonary Artery Aneurysm34Acute Pulmonary Embolism36Chronic Pulmonary Embolism37Hereditary Hemorrhagic Telangiectasia38Superior Vena Cava SyndromeAbdominalAorta39Abdominal Aortic Aneurysm40AAA with Rupture41Endoleak Post AAA Repair42Aortic Enteric Fistula43Infected Aortic Graft44Abdominal Aortic Occlusion45Abdominal Aortic Dissection46Abdominal Aortic TraumaVisceral Arteries47Superior Mesenteric Artery Embolus48Chronic Mesenteric Ischemia49Celiac Artery Compression Syndrome50Upper GI Bleeding51Lower GI Bleeding52Hepatic Artery Trauma53Hepatic Neoplasm54Splenic Trauma55Splenic Artery AneurysmVenous59IVC Anomalies60IVC Occlusion61Varicocele62Pelvic Congestion Syndrome63May Thurner Syndrome64Nutcracker SyndromeRenal65Renal Artery Atherosclerosis66Fibromuscular Dysplasia, Renal67Segmental Arterial Mediolysis68Polyarteritis Nodosa69Renal Artery Aneurysm70Renal Trauma71Renal Tumor72Renal Arteriovenous Fistula73Renal Transplant DysfunctionExtremitiesUpper Extremities74Subclavian Artery Stenosis/Occlusion75Raynaud Phenomenon76Collagen Vascular Diseases77Hypothenar Hammer Syndrome78Subclavian Vein Thrombosis79Thoracic Outlet Syndrome, Venous80Catheter Induced Venous Occlusion81Dialysis AVF82Dialysis AV GraftPelvis83Iliac Artery Occlusive Disease84Iliac Artery Aneurysmal Disease85Pelvic Trauma86Uterine Artery Embolization87High-Flow PriapismLower Extremities88Lower Extremity Aneurysms89Acute Lower Extremity Ischemia90Lower Extremity Arterial Trauma91Femoropopliteal Artery Occlusive Disease92Fibromuscular Dysplasia, Extremity93Popliteal Entrapment94Cystic Adventitial Disease95Buerger Disease96Persistent Sciatic Artery97Arteriovenous Malformation, Extremity98Klippel-Trenaunay Syndrome99Arteriovenous Fistula100Deep Vein Thrombosis101Varicose Veins/Incompetent PerforatorsHeart 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, Tumor     STANFORD UNIVERSITY MEDICAL CENTER Residency Training Program Rotation Description  DATE \@ "M/d/yyyy" 10/16/2011  (:DQR_g}  . 0 C D M N g h i y   ! 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