Radiology
I.
Rationale
During the course of caring for patients, family physicians order many diagnostic and therapeutic tests.
Included among these are diagnostic and interventional imaging studies. It is necessary for the family
physician to know the indications for various tests, how to interpret the common ones, and when to consult
a radiologist for further information or testing. In addition, with the blossoming of medical technology, the
family physician must keep abreast of new innovations and know the most cost-effective way of utilizing
this technology.
This curriculum has two components: the focused rotation in radiology and the longitudinal component,
which takes place over time in the Family Practice Center and on other rotations where radiology related
topics may be covered.
II.
Competencies
Patient Care
Goal: Provide evidence based care to patients using radiologic support.
Objectives:
A. Discuss how to appropriately prep a patient for various diagnostic imaging studies.
B. Demonstrate the ability to read common radiographs including:
1. Chest X-rays
2. Sinus films
3. Abdominal films
4. Orthopedic radiographs
5. GI studies
6. IVP
7. CT/MRI of the head, chest, abdomen/pelvis
C. Recognize and manage reactions to iodinated radiograph contrast agents.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending
Evaluation
Program Dir
Review
Last Updated March 7, 2013
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision and
Feedback
Medical Knowledge
Goal: Develop a broad knowledge base of symptoms, physical exam, diagnoses and interventions
amenable to radiological diagnosis, intervention or intervention.
Objectives:
A. Discuss
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
the radiological indications for common problems including:
Headache
Cough
Acute mental status change
Sinus pain/ chronic sinusitis
Abdominal/pelvic pain
Low Back pain
Trauma/injury
Breast mass
Chest pain
Obstetrical complications (size/date discrepancy, bleeding fetal anomalies, etc)
B. Discuss
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
the indications for common diagnostic imaging tests including:
Chest X-rays
Sinus films (plain and CT)
Abdominal films (KUB, flat, up-right, decubitus)
Orthopedic radiographs
CT (head, abdominal)
Ultrasound (abdominal, pelvic, OB, cardiovascular)
MRI (head, spine, and extremities)
GI studies (UGI w/ SBFT, enteroclysis, ACBE)
Nuclear medicine (bone scans, liver/spleen scans, MUGA, HIDA)
Mammography
IVP
C. Review the indications for interventional radiology including:
1.
Lumbar puncture under fluoroscopy
2.
Percutaneous biopsy
3.
Drainage of collections of fluids
4.
Placement of stents and tubes
5.
Angiograms
6.
Embolization
Learning Activities
X Attending Rounds
X Multidisciplinary Rounds
Grand Rounds
X Sub-Specialty Conference
Morning Report
X Didactics
Other
Evaluation Methods
X Attending Evaluation
Program Dir
Last Updated March 7, 2013
X
X
X
X
x
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
Directly Supervised Procedures
In-Training Exam
X
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
X
Morning Report
Faculty Supervision
Review
360 ᵒ evaluation
Other
X
and Feedback
Quarterly Review
Videotape Review
Interpersonal /Communication Skills
Goal: Residents will develop and demonstrate effective information exchange and teaming with patients,
their families, and other health professionals.
Objectives:
A.
Be able to give the patient informed consent on any diagnostic or therapeutic procedures to be
performed in a manner understandable to the patient.
B. Be able to answer questions the patient and family may have concerning the diagnostic imaging
tests as well as address any concerns they may have about them.
C. Be able to interpret test results and communicate these results to the patient and her/his family in
terms understandable to them.
D. Learn to communicate efficiently and effectively with radiologic consultants.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
X
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
Program Dir
Review
X
360 ᵒ evaluation
Other
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Directly Supervised Procedures
In-Training Exam
X
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Videotape Review
Practice Based Learning and Improvement
Goal: Understand the need for and engage in continuing self-education about updates in diagnostic
imaging.
Objectives:
A.
B.
C.
D.
List indications for each of the common diagnostic imaging tests and common problems.
List indications for each of the interventional radiological procedures.
Describe the necessary preparation of patients for diagnostic testing, including the order of tests if
multiple tests are being performed.
Interpret normal and abnormal radiographs of patients seen in continuity clinic and while rotating
through radiology.
Last Updated March 7, 2013
E.
Describe the diagnosis and management of a patient undergoing a reaction to an iodinated
radiologic contrast agent.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Review
X
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
Directly Supervised Procedures
In-Training Exam
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Systems Based Practice
Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system
of health care and the ability to effectively call on system resources to provide care that is of optimal value.
Objectives:
A. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society and how these elements of
the system affect their own practice.
B. Know how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources.
C. Practice cost-effective health care and resource allocation that does not compromise quality of
care.
D. Advocate for quality patient care and assist patients in dealing with system complexities.
E. Know how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system
performance.
Learning Activities:
x
Attending Rounds
x
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Other
Evaluation Methods
x
Attending Evaluation
x
Program Director Review
Last Updated March 7, 2013
x
x
x
x
Research Conference
Ethics Committee Conf
Specialty Conference
Noon Conference
Faculty Supervision
Directly Supervised
Procedures
In-Training Exam
x
x
Outpatient Clinics
Direct Patient Care
Resident Seminar
Journal Club
Critical Appraised Topics
Morning Report
x
Faculty Supervision and
Feedback
Other
Professionalism
Goal: Residents will demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population.
Objectives:
A. Conduct informed consent with patients for radiologic procedures, in both the inpatient and
outpatient setting, in a manner understandable to the patient.
B. Address questions and concerns that a patient may have about radiologic testing.
C. Communicate test results to patients and family members.
D. Prepare a consultant referral form or radiology request form which contains a complete and succinct
summary of the patient's diagnosis, the question for the consultant, and other information pertinent
to the referral.
E. Summarize the cost of the radiologic workup of one patient on the inpatient service and present a
brief summary of the costs involved to the ward team.
F. List sources to which the resident physician may turn for more information or continuing education
on diagnostic imaging.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty Conference
X
Morning Report
Didactics
Other:
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Review
X
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
IV. Instructional Strategies (see above)
A.
B.
C.
D.
E.
F.
V.
Interpreting films in radiology
Interpreting films on patients in continuity clinic
Assigned readings
On-line computer learning
Ambulatory care conference
Associated rotations: orthopedics, sports medicine, internal medicine, OB/GYN, Emergency
medicine
Evaluation Strategies (see above)
A. Observation of resident by radiology preceptor
Last Updated March 7, 2013
B. Observation of resident by clinic preceptor
C. Attendance at conference series
D. Demonstrate competency in evaluating various CXR findings to include:
1. Normal
2. Pulmonary infiltrate
3. Pulmonary edema
4. Pneumothorax
5. Pneumomediastinum
6. Widened mediastinum (list the DDx)
E. Completing CXR competency test of which an 80% score minimum is required
F. End of rotation evaluation
VI.
Implementation Methods
A.
B.
C.
D.
E.
F.
G.
H.
I.
The radiology rotation will occur in conjuction with Sports Medicine and Family Practice
Clinic, and will consist of a 4-week block of practical instruction at Emory Dunwoody Medical
Center.
The resident will spend Monday afternoons (1 pm to 5 pm), Tuesday and Wednesday
mornings (0830 to 1230) in the radiology department. Wednesday afternoons will be
reserved for individual reading/study time. The resident will report on the first day of the
rotation to Dr. Martin Sheline, Director of Radiology, for orientation to the department.
The morning session will be spent reading films with one of several radiologists from the
hours of 0830 to 1230.
The afternoon session will be spent observing various diagnostic procedures commonly
done in the radiology department to include, nuclear medicine studies, cardiac
catheterizations, and echocardiograms. The times may vary, depending on procedures
scheduled
If no procedures are scheduled, then the resident will spend that time using the on-line
learning materials identified in the Radiology Teaching File.
Additional learning will occur during other rotations to include sports medicine, orthopedics,
OB/GYN, Internal medicine, Family Practice Clinic, Emergency Medicine and by using the
on-line resources identified in the Radiology Teaching File.
The resident will attend didactics on Thursday mornings, and will be assigned to the Family
Practice Clinic on Thursday afternoons and the entire day on Fridays.
Except for unusual circumstances, no leave is allowed during this rotation.
The resident is responsible for:
1. Contacting: Dr. Michael Terk,
Orthopedic & Spine Center @ Executive Park
59 Executive Park South, 4th Floor, Suite 4000
Atlanta, GA 30329
Assistant: Marvis Zanders
404-778-5834
404-778-6250
2.
3.
4.
5.
6.
7.
8.
the Director of Radiology, on the first day for orientation
Using the on-line teaching file for additional learning materials.
Documenting radiologic procedures observed.
Completion of the rotation evaluation.
Actively seeking feedback.
Perform FP Call.
Perform FP Clinic as assigned.
Last Updated March 7, 2013
9. Perform Sports Medicine Clinic as assigned.
http://www.aafp.org/online/en/home/policy/policies/r/radiology.html
VII.
BIBLIOGRAPHY/SUGGESTED READINGS
1. American College of Radiology. Appropriateness Criteria - Diagnostic Imaging. Available from
http://www.acr.org/Quality-Safety/Appropriateness-Criteria/Diagnostic. Accessed 12/8/2013.
Topics on
a. Breast Imaging Criteria
b. Cardiac Imaging Criteria
c. Gastrointestinal Imaging Criteria
d. Musculoskeletal Imaging Criteria
e. Pediatric Imaging Criteria
f. Thoracic Imaging Criteria
g. Urologic Imaging Criteria
h. Vascular Imaging Criteria
i. Women's Imaging Criteria
ACR, Appropriateness criteria on Interventional radiology. http://www.acr.org/QualitySafety/Appropriateness-Criteria/Interventional .
a. Abdominal Aortic Aneurysm: Interventional Planning and Follow-up
b. Radiologic Management of Benign and Malignant Biliary Obstruction (Revised)
c. Radiologic Management of Gastric Varices (New)
d. Radiologic Management of Hepatic Malignancy
e. Radiologic Management of Iliac Artery Occlusive Disease (Revised)
f. Radiologic Management of Infected Fluid Collections
g. Radiologic Management of Inferior Vena Cava Filters
h. Radiologic Management of Lower Gastrointestinal Tract Bleeding
i. Radiologic Management of Lower Extremity Venous Insufficiency
j. Radiologic Management of Mesenteric Ischemia
k. Radiologic Management of Thoracic Nodules and Masses
l. Radiologic Management of Upper Gastrointestinal Bleeding
m. Radiologic Management of Urinary Tract Obstruction
n. Radiologic Management of Uterine Leiomyomas (Revised)
o. Radiologic Management of Vertebral Compression Fractures
2. Radiologic Evaluation of Incidentally Discovered Adrenal Masses. Willat J, Francis I. Am Fam
Physician. 2010 Jun 1;81(11):1361-1366
3. Radiologic Evaluation of Suspected Renovascular Hypertension. Hartman R. Kawashima A. Am Fam
Physician. 2009 Aug 1;80(3):273-279.
4. Radiologic Imaging in the Management of Sinusitis. Okuyemi K, Tsue T. Radiologic Imaging in the
Management of Sinusitis
Last Updated March 7, 2013