Louisiana State University Health Sciences Center – Shreveport
Radiology Residency Program
Abdominal Curriculum, Goals and Objectives
Compiled by Drs. Guillermo Sangster and Alberto Carbo
BODY ROTATION GOALS/OBJECTIVES
Patient Care
FIRST YEAR RESIDENTS (PGY-2):
1.
Demonstrate knowledge of and ability to use electronic patient information systems,
including the radiology information system and appropriate use of electronic systems to
obtain patient laboratory data, etc., to integrate with imaging findings to assist in an
accurate diagnosis.
2.
Understand the indications for each imaging examination performed and the specific
indications for any examination performed on an individual patient.
3.
Learn indications and contraindications for each form of CT contrast (oral, rectal, IV) and
MR contrast. Learn how to treat contrast reactions.
4.
Learn to triage CT/MR patients appropriately. Remember, not all ED cases are
extremely emergent and some in-house patients require your immediate attention.
5.
Technical aspects of computed tomographic and MR examinations of the chest, abdomen,
and pelvis should be understood and the ability to design a specific protocol to address the
clinical question at hand should be mastered. This includes knowledge of when and how much
oral and/or rectal contrast to administer, when and how much intravenous contrast material to
administer, and appropriate patient positioning and image acquisition parameters for each
examination. Check the CT protocol book that is located in the control room.
6.
Demonstrate the ability to use the internet as a tool for teaching and learning, including
access to information to improve knowledge in patient care situations.
SECOND AND THIRD YEAR RESIDENTS (PGY-3 and 4):
1. All of the objectives listed for first year residents should be reviewed with increased
mastery.
2. Demonstrate knowledge of the levels of ionizing radiation related to specific imaging
procedures. With knowledge of levels of ionizing radiation related to specific imaging
procedures, employ measures to minimize radiation dose to the patient.
3. Demonstrate ability to integrate laboratory findings and other clinical parameters in
recommending appropriate patient specific imaging strategies for diagnostic purposes.
4. You should be able to run the Body service with less direction from attending staff.
5. Increased ability to apply the tomographic technique to other areas of the body should be
gained. This includes knowledge of performance and interpretation of tomographic
examinations of the neck, extremities, and thin section examinations of the chest for
interstitial lung disease.
6. The resident should become a resource to medical students and junior residents in
achieving the above objectives.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. Increased emphasis should be placed on integration of CT with other clinical, imaging (MRI,
Ultrasound, etc.) and laboratory findings in arriving at as specific a diagnosis as possible.
3. The resident should be able to run the Body service largely independently.
4. Teaching of the above objectives to medical students and junior residents should be
increasingly emphasized.
Medical Knowledge
FIRST YEAR RESIDENTS (PGY-2):
1.
Residents should become familiar with the techniques of performing the basic
computed tomography and MR studies of the chest, abdomen and pelvis.
2.
The principles of use of radiographic contrast material, including but not limited to
intravascular use of iodinated contrast material and gadolinium, should be understood.
This includes indications for application of contrast, contraindications to use of contrast,
considerations in choice of particular contrast material, and recognition and treatment
of adverse reactions to contrast material.
3.
A primary goal of the rotation should be to develop a basic understanding of normal
cross-sectional anatomy of the chest, abdomen and pelvis and alterations in that
anatomy with common pathologies that will be encountered on call (especially trauma,
abdominal abscess, appendicitis, diverticulitis, pancreatitis, urinary infection/stone
disease, and CT of pulmonary embolism).
SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):
1. All of the objectives listed for first year residents should be reviewed with increased
mastery, especially imaging findings related to trauma.
2.
Increased ability to evaluate pathologic alterations in normal anatomy of the chest,
abdomen, and pelvis should be demonstrated. This includes alterations as a result of
malignancy, and understanding of the computed tomographic and magnetic resonance
staging of malignancies in the chest, abdomen and pelvis. The effects of common and rare
infectious diseases should also be demonstrated. The resident should be capable of
generating a differential diagnosis associated with common alterations in anatomy of each
of the thoracic, abdominal, and pelvic organs.
3. Demonstration of the knowledge associated with these objectives should be demonstrated
with teaching to referring clinicians, medical students, and junior residents.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. Teaching of the knowledge associated with the above objectives to referring clinicians,
technical personnel, medical students, and junior residents should be increasingly
emphasized.
Interpersonal and Communication Skills
FIRST YEAR RESIDENTS (PGY-2):
1.
Work to structure written reports of imaging studies to accurately and effectively
transmit results and recommendations to referring clinicians, including urgent or
unexpected findings.
2.
Work with attending staff to develop techniques for effective oral communication with
patients, referring clinicians, and support personnel in radiology.
3.
Demonstrate appropriate phone communication skills.
SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):
1. All of the objectives listed for first year residents should be reviewed with increased
mastery.
2. Demonstrate increasing skill in clearly and concisely communicating via the radiology
written report.
3. Demonstrate leadership role in communications/interactions with technical personnel and
patients, including explanation of delays related to emergencies.
4. Demonstration of the knowledge associated with these objectives should be demonstrated
with teaching to medical students and junior residents.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. Demonstrate increased ability to communicate effectively with providers at all levels of the
health care system as well as those in outside agencies, etc.
3. The senior resident should model by action as well as directly teach the above objectives to
medical students and junior residents.
Professionalism
FIRST YEAR RESIDENTS (PGY-2):
1. Demonstrate compassion, honesty and ability to provide care/interact with others without
regard to religion, ethnic, sexual, or educational differences and without employing sexual
or other types of harassment.
2. Demonstrate understanding of the principles of patient confidentiality by compliance with
the HIPAA Privacy Rule.
3. Demonstrate completion of medical records, including review/signoff of radiology reports,
according to departmental/hospital guidelines.
4. Demonstrate positive work habits, including punctuality and professional appearance.
5. Demonstrate honesty with patients and all members of the health care team.
SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):
1. All of the objectives listed for first year residents should be reviewed with increased
mastery.
2. Demonstrate altruism (putting the interests of patients and others above own self-interest).
3. The resident should teach the above objectives to medical students and junior residents
directly as well as by modeling behavior consistent with these objectives.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. The senior resident should increasingly supervise and mentor medical students and junior
residents in achieving these objectives.
Practice-Based Learning and Improvement
FIRST YEAR RESIDENTS (PGY-2):
1.
Analyze practice experience and perform practice-based improvement in cognitive
knowledge, observational skills, formulating a synthesis and impression, and procedural
skills. Demonstrate this by active review and performance modification related to oncall discrepancies and active participation in morbidity and mortality/ misses
conferences.
2. Demonstrate use of multiple sources, including information technology, to optimize life long
learning and support patient care decisions.
SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):
1.
2.
All of the objectives listed for first year residents should be reviewed with increased
mastery.
Residents should demonstrate that they are reading the current literature, particularly
the Radiology and the American Journal of Roentgenology, by being familiar with
material recently published in those journals. A life-long pattern of reading these
journals should be begun.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. Demonstrate awareness of resources available to practicing radiologists for lifelong learning,
including print, CD-ROM, and internet products of the ACR.
3. Demonstrate knowledge of the above objectives by supervision of medical students and
junior residents as well as by directly teaching these objectives.
Systems-Based Practice
FIRST YEAR RESIDENTS (PGY-2):
1.
Begin to acquire knowledge regarding the costs of imaging studies and impact of costs
on appropriate choices for clinical use.
SECOND AND THIRD YEAR RESIDENTS (PGY-3 or 4):
1. All of the objectives listed for first year residents should be reviewed with increased
mastery.
2. Demonstrate the ability to design cost-effective imaging strategies/care plans based on
knowledge of best practices.
3. Demonstrate knowledge of hospital-based systems that effect physician practice, including
physician code of ethics, medical staff bylaws, quality assurance committees, and
credentialing processes. This includes knowledge of how these processes may affect the
scope of practice of any one physician and competition among practitioners.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. Demonstrate knowledge of how decisions about timing/availability of imaging studies may
affect hospital length of stay, referral patterns for specific examinations and use of diagnostic
studies outside the Department of Radiology.
Table of Contents
Assessment/Evaluation of Residents
Guidelines for Evaluation of Competency
Benchmarks by Year of Training
Knowledge of Technologies and Skills for Competency
ASSESSMENT/EVALUATIONS OF RESIDENTS
1) Electronic evaluation by attending faculty each month after the rotation and Written
evaluation every 6 Months with the Program Director
2) ACR in-training examination
3) OSCE evaluation twice per year
4) Written ABR exam
5)
Oral ABR exam
GUIDELINES FOR EVALUATION OF COMPETENCY
PATIENT CARE
a) Technical skills
b) Imaging and medical management
c) Compassionate and effective communication with patients
d) Timely effective communication with referring health care providers
MEDICAL KNOWLEDGE
a) Diagnostic Radiology Fund of Knowledge
a. recognition of imaging abnormalities
b. synthesis of clinical and radiological information
c. derivation of diagnosis or differential diagnosis
b) Knowledge of principles of Radiation Physics and Dosimetry
c) Use of Resource Materials; texts, references, websites, and other sources for life
PRACTICE BASED LEARNING AND IMPROVEMENT
a) Principles of Quality Improvement and participation in QI programs
b) Self assessment programs and lifelong learning
INTERPERSONAL AND COMMUNICATION SKILLS
a) Communication, Consultation in Radiologic Practice
b) Record Keeping, Radiologic Reports, Case Presentation
c) Knowledge of HIPAA regulations
d) Understanding verbal and written Informed Consent
e) Teaching effectively residents, medical students and other health care professionals
PROFESSIONALISM
a) Professional Conduct, Medical Ethics, and Integrity
SYSTEM BASED PRACTICE
a) Understand cost effectiveness in selection of imaging studies
b) Understand the efficient selection of studies in sequence to maximize diagnostic yield
while minimizing cost and patient risk
c) Learn to use evidence based medicine for clinical decision-making
d) Optimize patient care by consultation with other health care
providers
BENCHMARKS BY YEAR OF TRAINING
The goal is for each resident to achieve independent competency and acquire tools with
which to continue self-education and life-long learning. The level of practice should be
consistent with national community standards as outlined in the American College of Radiology
(ACR) Practice Guidelines.
Emphasis throughout the four-year residency program is on understanding the
pathophysiology of diseases and disorders, and its appearance across all appropriate imaging
modalities.
Year 1
Goal: To prepare the resident to be able to safely practice with supervision during the week days
and independently while on call by the end of the first year.
Objectives:
Contrast Material:
1
Understand the physical properties and composition of standard contrast agents and the
physiologic mechanisms of contrast media excretion.
2
Learn to screen patients who are at risk from injection of intravascular radiographic
contrast material. Understand the classification, symptoms, and signs of contrast reactions and
clinical management including appropriate use of pharmacologic agents and their mode of
administration and doses after appropriate patient assessment.
a) Consult the ACR Manual for Contrast Media, Version 5.0).
b) Be prepared to answer patient and staff questions concerning when contrast media
should or should not be utilized and how to treat contrast reactions.
3. Understand the indications for premedication and the appropriate regimen to
premedicate contrast sensitive patients including dosages, and dose scheduling.
Knowledge Based Objectives:
1
Review the anatomy of the gastrointestinal and genitourinary systems.
2
Understand the normal appearance of gastrointestinal and genitourinary organs on basic
imaging modalities using plain film radiography, ultrasound, computed tomography (CT), and
magnetic resonance imaging (MRI).
3.
Learn conventional imaging protocols.
4.
Interpret, identify and/or manage diseases of the abdominal contents and multisystem
processes that involve abdominal viscera.
5.
Understand contrast administration and pathophysiology of gastrointestinal and
genitourinary diseases/conditions.
Technical Skills:
1
Interview patients prior to radiographic contrast injection.
2
Be familiar with fluoroscopic techniques and safe operation of the fluoroscopic unit.
3
Compose a concise dictated report. Begin to function as a consultant to referring
physicians and patients.
Required Reading :
1
ACR Practice Guidelines for the Use of Intravascular Contrast Media, Version 5.0
3
GI resident Handbook
st
References for 1 Year:
1
2
Genitourinary Radiology: The Requisites (Requisites Series). Zagoria, Tung
Textbook of Gastrointestinal Radiology. Gore RM, Levine MS, Laufer I.
Philadelphia: WB Saunders
Year 2
Goal: Add to disease and imaging modality knowledge while gaining more confidence.
Objectives:
1
Review the general developmental anatomy of the GI and GU systems.
2
Refine techniques and comprehension of physics as it applies to patient medical
radiation dose, and radiation safety.
3
Expand understanding of the causes and effects of disease of abdominal organ systems.
4
Understand diagnosis, classification, and management of trauma.
5
Further refine dictation skills.
6
Begin to use the independent workstation for image reformatting and reconstruction.
7
Attend department case conferences and didactic presentations, including
interdepartmental conferences, grand rounds, guest lecturers, etc.
8
,Perform simple image- guided biopsies and drainage procedures with instruction and
under the direct supervision of the Interventional radiology Faculty.
nd
References for 2 Year:
1. Dunnick, N.R., Sandler, C.M., Newhouse, J.N., Amis, Jr., E.S., Textbook of
Uroradiology, 3rd ed., Philadelphia, PA: Lippincott Williams & Wilkins, 2000.
2. Textbook of Gastrointestinal Radiology. Gore RM, Levine MS, Laufer I.
Philadelphia: WB Saunders
Year 3
Goal:
Add to general knowledge acquired in the first two years and learn
more advanced and less common techniques and disorders.
Objectives:
1
Learn about the different types of abdominal organ injuries and their classification as
well as recommended non-surgical and surgical management and injury prognosis.
2
Increase awareness of the CT and MR manifestations of gastrointestinal and
genitourinary tract disease.
3
Learn staging of neoplasms and review normal MRI findings of the adrenals, kidneys,
bladder, prostate, and female pelvic organs
4
Understand diagnosis of the multiple manifestations of inflammatory disease as seen on
US, CT / CT Urography, MR/MR Urography and their clinical management.
5
Use the independent workstation for more advanced applications and image
reconstruction.
rd
Reference for 3 year:
rd
Clinical Urography, 3 Ed., Pollack, et al. u
RSNA Journals and AJR on line (Departmental subscriptions)
ACR teaching files and Departmental CD series
Year 4
Goal:
Review all the knowledge and skills you have accumulated in the
first three years and fill the gaps in your knowledge.
Focus on
getting as much case management experience as possible.
Expand Obstetrical knowledge through elective rotation in Women’s Health.
Objectives:
1
Understand congenital anomalies, inflammatory, and neoplastic conditions as they
appear on hysterosalpingography.
2
Review cases in the ACR teaching file and peer reviewed teaching files available on the
internet. The best sites should present as unknown cases, asking for you to make a diagnosis and
suggest recommended imaging and clinical management, summarizing the correct diagnosis and
management at the end.
3
Attend available department case conferences or other didactic presentations, including
interdepartmental conferences, grand rounds, guest lecturers, etc. Emphasize independent
thinking before seeking direct staff supervised patient management.
4
Develop proficiency at image reconstruction and reformatting..
5
Understand the basic principles of radiofrequency ablation, thermocoagulation, and other
minimally invasive procedures, along with the appropriate imaging guidance and post treatment
surveillance.
Increasing utilization of Web-based references such as RSNA Journals and AJR on line
(Departmental subscriptions) and review of ACR learning files on CD series.
List of didactic lectures:
GU
Adrenal
Renal Masses and Infection
Infiltrative Renal diseases
MDCT, staging and therapy of blunt renal injury
Urinary calculus disease
Bladder and prostate
Benign Gyn
Gynecologic Malignancies
Urethra and vagina
Scrotal pathology
GI
The plain abdominal radiograph
Stomach and duodenum -fluoroscopic technique, normal anatomy and pathology Intestinal
obstruction and ileus
Pharynx and esophagus- fluoroscopic technique, normal anatomy and pathology
GI virtual studies – virtual gastroscopy
POSTOPERATIVE gastrointestinal anatomy
SMALL INTESTINE- fluoroscopic technique, normal anatomy and pathology
Intestinal obstruction and ileus
Appendix
Colon and rectum- fluoroscopic technique, normal anatomy and pathology, virtual colonoscopy
defecography colonic transit time: technique, normal, constipation
Hepatic masses-hypo and hypervascular
Hepatic cirrhosis and its complications
Biliary disease
Pancreas- including neoplasm, inflammation, trauma and ERCP/MRCP
Spleen – non-traumatic
MDCT of splenic injury
Multisystem
CT on call
Retroperitoneal Anatomy and disease
Basics of abdominal and retroperitoneal biopsies
Diaphragm, body wall and peritoneal reflections
Omentum and mesentery
Hernias
Radiographic contrast media
Calcium
Fat
Blood
Gas
Foreign and Surgical
Aunt Minnie conference
Legal issues in Radiology
Quality Improvement and the Peer Review Process
Reference: University of Colorado, uchsc.edu body section