Electives/Sub-Internships
Course Title: Surgery-Radiology-Pathology Elective
Course Number: RAD509
Prerequisite: RADO 502 or 503; Surgical Clerkship
Department: Surgery, Radiology, and Pathology
Department URL: http://geiselmed.dartmouth.edu/radiology/
Type: Elective
Faculty:
Principal supervisor – Petra Lewis MB.BS
Co-supervisors – Andrew Crockett MD, MPH
Carol Liu MD
Location: Operating Rooms, Pathology, Radiology
Duration: 4 weeks
Credits: 4
When Offered: Cannot run concurrently with RADO502 and PATH501;
Not in July or August
Visiting Students: No
Contact Information
Coordinator: (FOR NOW). Bailey Johnston
Coordinator E-mail: Bailey.M.Johnston@hitchcock.org
Coordinator Phone: 603 650 6309
Course Description:
This will be a 4 week elective with time spent in pathology, the operating
room, and in radiology. Students will explore a full breadth of disease
processes by correlating gross resections from surgical procedures and
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image-guided biopsies, confirmatory evidence by pathology, and pertinent
imaging findings that aid diagnosis and treatment. This elective requires
significant independence, motivation and organization on the part of the
student.
Objectives & Goals:
Students will have a chance to approach the surgery-radiology-pathology
correlation from different angles. There are 3 areas of study/application.
Note that although a broad structure is suggested here, it can be focused
more closely for students with specific interests (for example women’s
health focusing on breast biopsies and surgeries).
1. RADIOLOGY
Learning objectives:
Upon completion of this elective, the student will be able to:

Describe how radiology interfaces with surgery and pathology

Correlate the imaging appearance of common pathological entities
with the gross and microscopic pathologic appearance of a specimen

Compare and contrast the various techniques used to obtain biopsy
samples using imaging guidance, including CT, US and MRI imaging
guidance.

Compare the differences/advantages/disadvantages between
aspirates, core biopsies, and excised surgical specimens
Structure and Tasks:
Student will be orientated to the various areas in radiology where biopsies
are acquired on Day 1. During the first and 3rd weeks of the elective,
students will follow patients that are receiving biopsies for suspicious
lesions (breast, liver, lung, etc) using different methods (US, CT, IR,
stereotactic). Patients will be identified by review of the procedure lists in
VIR, CT and breast imaging. One day will be spent in Breast Imaging. They
will be expected to review EDH patient records prior to biopsy acquisition,
introduce themselves to the patient, witness the procedure, and follow up
with pathology in the next 24-48 hours to observe how samples are
processed and evaluated. The final diagnosis should be reported to, and
discussed with the procedural radiologist. As far as possible, students will
continue to follow any patients who will undergo surgical management in
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the subsequent weeks. They will be expected to review pertinent imaging
with a radiologist prior to the procedure. They will then attend as much of
the procedure as possible and follow up with pathology, correlating the
findings.
During weeks 2 and 4, students will review the radiology for the cases that
they will be following to surgery.
2. SURGERY
Learning objectives:
Upon completion of this elective, the student will be able to:

Describe how surgery interfaces with radiology and pathology and be
able to describe examples of the importance of clear communication
between the departments

Correlate the surgical appearance with the pathologic appearance of
specimens

Describe how samples are collected by surgery

Compare the differences/advantages/disadvantages between
aspirates, core biopsies, and surgical specimens
Structure and Tasks:
In weeks 2 and 4, Students will obtain the OR schedule and identify cases
they wish to attend over the last three weeks of the rotation. They will
select 2 surgical areas of interest, which may include but are not limited to
oncological surgery, colorectal, ENT, neurosurgery urology, breast surgery.
The list should be reviewed with the elective supervisor and the patient
cases conveyed to pathology in preparation for the slide review sessions.
Students will review pertinent imaging prior to the surgery, consulting with
a radiologist as necessary. Students can interview the patient
preoperatively. Students will scrub in for as much of the procedure as
possible, with agreement of surgical staff. They will follow specimens to the
surgical pathology lab and watch the pathologist make the initial
diagnosis. Students will subsequently follow up in several days after the
final stains are made. Finally, students should correlate pre-operative
imaging with the pathological findings.
3. PATHOLOGY
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Learning objectives
Upon completion of this elective, the student will be able to:

Describe how Pathology interfaces with radiology and surgery

Correlate how the surgical/radiologic appearance relates to the
pathologic appearance of common entities

Describe how samples are processed by pathology

Compare the differences/advantages/disadvantages between
aspirates, core biopsies, and surgical specimens
Assignments and Tasks:
Follow specimens (aspirates, cores, surgical specimens) to the Pathology
laboratory after image-guided assisted aspirate procedures, core biopsies
procedures or surgery and observe the process of preparing the specimens
(in Cytopathology for aspirates or the Gross room for surgical specimens)
by the cytotechnologists or pathology assistants. Review the microscopic
slides with a specialist pathology attending on a dedicated day during that
week or the following week if not processed at that time. Correlate the
pathological findings to the initial imaging and gross appearance of the
specimens.
4. CORRELATION/INTEGRATION
There are several activities that will help solidify the concept of correlating
the three major areas of study above. The first is attending interdisciplinary
conferences that incorporate the findings of each major area to devise
effective treatment strategies. Appropriate conferences might include the
following depending on the student schedule. Attendance at at least one
of the conferences identified with a * is required.
 CTOP (Tuesday 8am, Radiology Large Conference Room)
 *Head and Neck Tumor Board (Thursday 7am)
 *Liver Tumor Clinic (Tues 12p)
 Lymphoma tumor board (Tues 4:30p)
 Brain cutting
 *Breast Biopsy-Pathology conference (first thurs month 7a, Borwell
4th floor pathology)
 *Breast Tumor Board (wed 12p, Aud F)
 *GI Tumor Board (mon 7a,)
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Finally, the student will decide an area of interest to present findings that
correlate a major disease process with imaging, surgery, and pathology.
Some insight could be provided on potential imaging modalities that could
best describe the process, bringing in current research findings in the area.
For example, findings from breast node resection could be presented with
their initial imaging studies, incorporating new diagnostic screening
methods and guidelines as potential discussion points. This will be
presented at a weekly resident conference or as part of a lunch conference.
Instruction: No formal lectures but one-on-one with course supervisors and
others for feedback regarding cases
Evaluation:
Radiology
Students will be evaluated by radiology staff based on their preparedness
for cases, professionalism, enthusiasm, and follow-up. Additionally students
will be evaluated during their presentation of a topic of interest at the end
of the rotation (see integration below). Students will be responsible for the
distribution and collection of evaluation forms.
Surgery
Surgical faculty will contribute to the evaluation based on student
preparedness for cases, professionalism, and follow-up. The student will
incorporate interesting cases into their presentation (described in the
integration below). Students will be responsible for the distribution and
collection of evaluation forms.
Pathology
Pathology faculty will contribute to the evaluation of the student based on
preparedness and professionalism. The student will incorporate interesting
cases into their presentation (described in the integration below). Students
will be responsible for the distribution and collection of evaluation forms.
APPROVAL
Directions: Please print form and have Department Chair and Sponsor sign.
(Clinical Education will submit to Associate Dean of Clinical Education for
signature)
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Jocelyn Chertoff MD
________________________________
________________________
Department Chair
Signature
______________________________
Date
Petra Lewis MB.BS
________________________________
Elective Sponsor
________________________
Signature
May 9, 2015
______________________________
Date
________________________________
Associate Dean for Clinical Education
______________________________
Date
Return signed copy to:
Office of Clinical Education
HB 7015
2/5/2016
________________________
Signature
Electives/Sub-Internships
AND Please send electronic copy to:
Clinical.Education@dartmouth.edu
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