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 Murphy’s 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



2.
Faculty evaluations
Mock orals
ACR in-service examination results
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




3.
Faculty evaluations
360 evaluations
Mock orals
Semi-annual review of procedure log
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




4.
Faculty evaluations
Learning portfolios (learning plan)
Mock orals
ACR in-service examination
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



5.
Faculty evaluations
360 evaluations
Formal evaluation of resident dictations documented in resident learning portfolios
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



6.
Faculty evaluations
360 evaluations
semi-annual review of conference attendance
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



2.
Faculty evaluations
Mock orals
ACR in-service
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



3.
Faculty evaluations
360 evaluations
Semi-annual review of procedure log
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




4.
Faculty evaluations
Learning portfolios (learning plan)
Mock orals
ACR in-service examination
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



5.
Faculty evaluations
Direct observation by the faculty
Formal evaluation of resident dictations documented in resident learning portfolios
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



6.
Faculty evaluations
360 evaluations
Semi-annual review of conference attendance
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



2.
Faculty evaluations
Mock orals
ABR written examination results
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



3.
Faculty evaluations
360 evaluations
Semi-annual review of procedure log
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



4.
Faculty evaluations
Learning portfolios (learning plan)
Mock orals
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



6.
Faculty evaluations
360 evaluations
Semi-annual review of conference attendance
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.
Assessment method

Faculty evaluations
Suggested References:


The Case Review Series: GI and GU
On-line teaching files