STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Rotation: Chest/Chest CT
Rotation Duration: 4 wks
Month(s): 4.6 (1 at VA)
Institution:
Call Responsibility: none
Night(s):
Stanford/VA
none
Responsible Faculty Member(s):
Ann Leung, MD – Section Head
Dominik Fleischmann, MD
Frandics Chan, MD
Margaret Lin, MD
Gabriela Gayer MD (Visiting)
Location: Ballroom at Stanford, chest
reading room at VA
Technologists/Technical Staff:
Janis Troeger RT – Day Shift Technical Supervisor
Elinor Tung RT – Technical Coordinator
Training Level:
Phone Numbers:
Stanford Hospital:
Reading room: 3-6587, 3-1346, 5-8132
VA hospital:
650-493-5000 (plus extension)
front desk: 65959
reading room:6-3853, 6-7300, 6-3814, 60415
Years 1-3
Goals & ObjectivesA 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 concept—graded and progressive responsibility—is 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.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Rotation 1-STANFORD HOSPITAL chest x-ray
This rotation primarily involves interpretation of digital chest radiographs, mostly from inpatients
and the ICU, but also chest CT as needed to support the clinical workflow.
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:
(1) Demonstrate knowledge of patient positioning and indications for posteroanterior (PA),
anteroposterior (AP), lateral decubitus, and lordotic chest radiographs.
(2) Demonstrate knowledge of exam specific radiation doses.
(3) Demonstrate knowledge of indications for chest radiographs studies of pregnant patients.
(4) Recognize the findings of life-threatening conditions and notify referring clinician without being
prompted.
(5) Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest
CT or MR may be necessary.
(6) Actively participate with faculty in interpretation and workup of patients.
(7) Participate in radiation safety lectures.
Skill Objectives:
(1) Become facile with Radwhere voice recognition, Centricity PACs and RIS, and EPIC. Utilize
available information technology to manage patient information.
(2) Gather clinical and radiologic data on patients with thoracic pathology.
(3) Develop diagnostic plan based upon clinical presentation and imaging findings.
(4) Accurately and concisely dictate a chest radiograph report using nomenclature recommended by the
Fleischner Society.
(5) Provide accurate and timely reports.
(6) Coordinate activities in the reading room, including providing direction for the technologists,
consultation for other clinicians, and answering the phone.
(7) Conduct ICU rounds with the ICU team Monday through Friday from 11:30 AM to 12 PM.
Behavior and Attitude Objectives:
(1) Work with the health care team in a professional manner to provide patient-centered care.
(2) Notify referring clinician for urgent, emergent, or unexpected findings, and document time, date, and
the person spoken to in the dictation. Utilize appropriate summary codes.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
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:
(1)
(2)
(3)
(4)
Describe key points of each of the diagnoses.
Describe basic digital and conventional x-ray physics in the chest.
Identify relevant anatomic structures on radiographic and CT images of the chest.
Be familiar with the more common pathologic conditions in the upper abdomen and understanding
their pathophysiology.
(5) Learn indications and contraindications for lung biopsies.
(6) Demonstrate learning of pathophysiology and imaging appearance of at least one quarter of the
diagnoses listed in the appendix.
(7) Demonstrate learning of at least one-quarter of the knowledge based objectives for chest plain films
listed below:
Chest Plain Film:
(1)
(2)
(3)
(4)
(5)
(6)
Understand standard positioning in thoracic radiology.
Identify normal anatomy and landmarks on frontal and lateral chest radiographs.
Know the expected course and possible complications of lines, tubes, and other devices.
Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum.
Recognize patterns of lobar atelectasis.
Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse
coalescent, multifocal ill-defined, fine or coarse reticular, and fine nodular opacities; multiple nodules
and masses; solitary pulmonary nodule.
(7) Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis.
(8) Describe the divisions of the mediastinum and common pathologies affecting each division.
(9) Recognize and give differential for hilar masses.
(10) Recognize and give differential for pleural effusions, thickening, and calcifications.
(11) Recognize and give differential for chest wall lesions.
Skill Objectives:
(1) Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful
differential diagnoses
(2) Demonstrate a clinically appropriate diagnostic workup plan
(3) Demonstrate the ability to use all relevant information resources to acquire evidence based data
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
(4) Accurately and concisely dictate chest radiograph reports.
(5) Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT
or MR may be necessary.
(6) Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in
thoracic radiology described in the detailed thoracic curriculum.
(7) List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and
linear) of interstitial lung disease.
(8) Separate pulmonary from pleural or extrapleural processes.
Behavior and Attitude Objectives:
(1) 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:
(1) Assess chest x-ray images for quality and suggest methods of improvement.
(2) Analyze and develop improvement plans in the clinical practice, including knowledge, observation,
and procedural skills.
Skill Objectives:
(1) Demonstrate independent self-study using various resources including texts, journals, teaching files,
and other resources on the internet.
(2) Facilitate the learning of students and other health care professionals.
(3) Participation in case conferences.
(4) Participation in the clinical activities of Thoracic Imaging Section.
(5) Demonstrate critical assessment of the scientific literature.
(6) Demonstrate knowledge of and apply the principles of evidence-based medicine in practice.
Behavior and Attitude Objectives:
(1) Incorporate formative feedback into daily practice, positively responding to constructive criticism.
(2) Follow up on interesting or difficult cases without prompting and share this information with
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
appropriate faculty and fellow residents.
(3) Help in teaching of technologists, medical students, housestaff, and other health care professionals.
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:
(1)
(2)
(3)
(4)
(5)
(6)
Understand how their image interpretation affects patient care.
Demonstrate ability to design cost-effective care plans.
Demonstrate knowledge of funding sources.
Demonstrate knowledge of reimbursement methods.
Demonstrate knowledge of regulatory environment.
Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical
records, and the recruitment, hiring, supervision, and management of staff.
Skill Objectives:
(1) Provide accurate and timely interpretations to decrease length of hospital and emergency department
stay.
(2) Appropriately notify the referring clinician if there are urgent or unexpected findings and document
such without being prompted.
(3) Practice using cost effective use of time and support personnel.
(4) Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness
Criteria.
(5) Participate in local and national radiological societies.
(6) Participate in discussions with faculty regarding operational challenges and potential systems
solutions regarding all aspects of radiologic service and patient care.
(7) Attend and participate in multi-disciplinary conference.
(8) Interact and learn from department administrators.
Behavior and Attitude Objectives:
(1) Advocate for quality patient care in a professional manner, particularly concerning imaging
utilization issues.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
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:
(1) Understanding of the need for respect for patient privacy and autonomy. Demonstrate principles of
confidentiality with all information transmitted during a patient encounter.
(2) 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.
(3) Demonstrate knowledge of issues of impairment.
(4) Discussion of above issues during daily clinical work.
(5) Training programs and/or videotapes on harassment and discrimination.
(6) Didactic presentations on “the impaired physician.”
(7) Participation in hospital-based educational activities and independent learning.
Skill Objectives:
(1) 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:
(1) Demonstrate respect, compassion, integrity, and responsiveness to patient care needs that supersede
self-interest.
(2) Demonstrate excellence: perform responsibilities at the highest level and continue active learning
throughout one’s career.
(3) Demonstrate honesty with patients, support staff, and colleagues.
(4) Demonstrate positive work habits, including punctuality, professional appearance and demeanor.
(5) When assisting referring clinicians with imaging interpretation and patient management, decide when
it is appropriate to obtain help from supervisory faculty.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
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:
(1) Know the importance of accurate, timely, and professional communication.
Skill Objectives:
(1) Provide a clear, succinct report using nomenclature recommended by Fleischner Society.
(2) Communicate effectively with physicians, other health professionals. In cases of serious or
unanticipated findings, document that communication in report.
(3) Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible
complications.
(4) Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to
families, support personnel, and physicians.
(5) Participate in daily ICU and weekly BMT work conferences.
(6) Participate in Thoracic Tumor Board and Joint Chest conference.
Behavior and Attitude Objectives:
(1) Work effectively as a member of the patient care team.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Rotation 2-VA Hospital chest x-ray and chest CT
This rotation involves interpretation of digital chest radiographs, chest CT, and medical knowledge
component of guided lung biopsies. Lung biopsies will be performed in the interventional rotation.
Continue to build on skills developed in the first rotation, including the core competencies described
above.
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:
(1) Demonstrate knowledge of patient positioning and indications for posteroanterior (PA),
anteroposterior (AP), lateral decubitus, and lordotic chest radiographs.
(2) Demonstrate knowledge of exam specific radiation doses.
(3) Demonstrate knowledge of indications for chest radiographs and thoracic CT studies of pregnant
patients.
(4) Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest
CT or MR may be necessary.
(5) Appropriately protocol all requests for chest CT to include thin-section images, high resolution
images, expiratory images, or prone images when appropriate, and use of intravenous contrast, given
the patients history.
(6) Demonstrate knowledge of CT parameters contribution to patient radiation exposure and techniques
that can be used to limit radiation exposure.
(7) Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT
examination.
(8) Recognize the radiographic findings of life-threatening conditions and notify referring clinician
without being prompted.
(9) Actively participate with faculty in interpretation and workup of patients.
(10) Participate in radiation safety lectures.
Skill Objectives:
(1) Provide accurate and timely reports on all cases with the supervision of faculty.
(2) Accurately and concisely dictate chest radiograph and chest CT reports using nomenclature
recommended by the Fleischner Society.
(3) Gather clinical and radiologic data on patients with thoracic pathology.
(4) Develop diagnostic plan based upon clinical presentation and imaging findings.
(5) Coordinate activities in the reading room, including providing direction for the technologists,
consultation for other clinicians, and answering the phone.
(6) Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Behavior and Attitude Objectives:
(1) Work with the health care team in a professional manner to provide patient-centered care.
(2) Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation.
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:
(1) List key points of level appropriate diagnoses.
(2) Describe intermediate level digital and conventional x-ray physics in the chest.
(3) Identify relevant anatomic structures on CT images of the chest.
(4) Be familiar with the more common pathologic conditions in the upper abdomen and understanding
their pathophysiology.
(5) Learn indications and contraindications for lung biopsies.
(6) Demonstrate understanding of the pathophysiology and imaging appearance of at least one half of the
diagnoses listed in the appendix.
(7) Demonstrate learning of at least one-half of the knowledge based objectives below:
Chest Plain Film:
(1) Understand standard positioning in thoracic radiology.
(2) Identify normal anatomy and landmarks on frontal and lateral chest radiographs.
(3) Know the expected course and possible complications of lines, tubes, and other devices.
(4) Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum.
(5) Recognize patterns of lobar atelectasis.
(6) Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse
coalescent, multifocal ill-defined, fine or coarse reticular, and fine nodular opacities; multiple
nodules and masses; solitary pulmonary nodule.
(7) Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis.
(8) Describe the divisions of the mediastinum and common pathologies affecting each division.
(9) Recognize and give differential for hilar masses.
(10) Recognize and give differential for pleural effusions, thickening, and calcifications.
(11) Recognize and give differential for chest wall lesions.
Chest CT:
Understand standard CT protocols in thoracic radiology including the indications for intravenous contrast,
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
low dose, HRCT, and airway protocols. Identify normal cross-sectional anatomy of the thorax on CT,
including mediastinal lymph node designations and bronchial anatomy.
The resident should gain an understanding of:
(1) Mediastinal masses with differential based on location, morphology, and patient demographics.
(2) The evaluation of the solitary pulmonary nodule.
(3) The major histologic types of primary lung cancer and the new 7th UICC/AJCC staging system
published in 2009.
(4) Diffuse lung diseases that may demonstrate: linear or reticular opacities, including interlobular
septal or intralobular interstitial thickening; nodular opacities in a centrilobular, perilymphatic, or
random distribution; ground glass; consolidation; cysts or emphysema.
(5) The CT appearance of a variety of pulmonary infections, including those specific to the
immunocompromised host.
(6) The non-infectious complications of immunocompromised patients, including those of solid organ
and bone marrow transplant recipients.
(7) Diseases of the small and large airways.
(8) Pulmonary hypertension and pulmonary vascular diseases.
(9) Diseases of the pleura and chest wall.
Skill Objectives:
(1) Continue to build on chest radiograph interpretive skills.
(2) Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful
differential diagnoses.
(3) Demonstrate a clinically appropriate diagnostic workup plan.
(4) Demonstrate the ability to use all relevant information resources to acquire evidence based data
(5) Accurately and concisely dictate chest radiograph reports.
(6) Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT
or MR may be necessary.
(7) Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in
thoracic radiology described in the detailed thoracic curriculum.
(8) List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and
linear) of interstitial lung disease.
(9) Separate pulmonary from pleural or extrapleural processes.
(10) Correlate radiographic and chest CT findings.
(11) Perform and interpret more complex post-processing (3D) images.
Behavior and Attitude Objectives:
(1) Recognize limitations of personal competency and ask for guidance when appropriate.
Practice-Based Learning and Improvement
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
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:
(1) Assess CT images for quality and suggest methods of improvement.
(2) Analyze and develop improvement plans in the clinical practice, including knowledge, observation,
and procedural skills.
Skill Objectives:
(1) Demonstrate independent self-study using various resources including texts, journals, teaching files,
and other resources on the internet.
(2) Facilitate the learning of students and other health care professionals.
(3) Participation in case conferences.
(4) Participation in the clinical activities of Thoracic Imaging Section.
(5) Demonstrate critical assessment of the scientific literature.
(6) Demonstrate knowledge of and apply the principles of evidence-based medicine in practice.
Behavior and Attitude Objectives:
(1) Incorporate formative feedback into daily practice, positively responding to constructive criticism.
(2) Follow up on interesting or difficult cases without prompting and share this information with
appropriate faculty and fellow residents.
(3) Help in teaching of technologists, medical students, housestaff, and other health care professionals
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:
(1) Understand how their image interpretation affects patient care.
(2) Demonstrate ability to design cost-effective care plans.
(3) Demonstrate knowledge of funding sources.
(4) Demonstrate knowledge of reimbursement methods.
(5) Demonstrate knowledge of regulatory environment.
(6) Demonstrate knowledge of intermediate level management principles such as budgeting, record
keeping, medical records, and the recruitment, hiring, supervision, and management of staff.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Skill Objectives:
(1) Provide accurate and timely interpretations to decrease length of hospital and emergency department
stay.
(2) Appropriately notify the referring clinician if there are urgent or unexpected findings and document
such without being prompted.
(3) Practice using cost effective use of time and support personnel.
(4) Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness
Criteria.
(5) Participate in local and national radiological societies.
(6) Participate in discussions with faculty regarding operational challenges and potential systems
solutions regarding all aspects of radiologic service and patient care.
(7) Attend and participate in multi-disciplinary conference.
(8) Interact and learn from department administrators.
Behavior and Attitude Objectives:
(1) 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:
(1) Understanding of the need for respect for patient privacy and autonomy. Demonstrate principles of
confidentiality with all information transmitted during a patient encounter.
(2) 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.
(3) Knowledge of issues of impairment.
(4) Discussion of above issues during daily clinical work.
(5) Training programs and/or videotapes on harassment and discrimination.
(6) Didactic presentations on “the impaired physician.”
(7) Participation in hospital-based educational activities and independent learning.
Skill Objectives:
(1) Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity
in gender, age, culture, race, religion, disabilities, and sexual orientation.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Behavior and Attitude Objectives:
(1) Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest.
(2) Demonstrate excellence: perform responsibilities at the highest level and continue active learning
throughout one’s career.
(3) Demonstrate honesty with patients, support staff, and colleagues.
(4) Demonstrate positive work habits, including punctuality, professional appearance and demeanor.
(5) When assisting referring clinicians with imaging interpretation and patient management, decide when
it is appropriate to obtain help from supervisory faculty.
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:
(1) Know the importance of accurate, timely, and professional communication.
Skill Objectives:
(1) Provide a clear, succinct report using nomenclature recommended by Fleischner Society.
(2) Communicate effectively with physicians, other health professionals. In cases of serious or
unanticipated findings, document that communication in report.
(3) Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible
complications.
(4) Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to
families, support personnel, and physicians.
(5) Participate in daily ICU and weekly BMT work conferences.
(6) Participate in Thoracic Tumor Board and Joint Chest conference.
Behavior and Attitude Objectives:
(1) Work effectively as a member of the patient care team.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Rotations 3 and 4-Stanford Hospital chest CT-2nd and 3rd year
This rotation involves interpretation of chest CT, and also chest x-rays when needed to support the
workflow. Continue to integrate and refine skills from the first two rotations, developing more
autonomy.
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:
(1) Appropriately protocol all requests for chest CT to include thin-section images, high resolution
images, expiratory images, or prone images when appropriate, and use of intravenous contrast, given
the patients history.
(2) Demonstrate knowledge of CT parameters contribution to patient radiation exposure and techniques
that can be used to limit radiation exposure.
(3) Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT
examination.
(4) Recognize the radiographic findings of life-threatening conditions and notify referring clinician
without being prompted.
(5) Demonstrate knowledge of patient positioning and indications for posteroanterior (PA),
anteroposterior (AP), lateral decubitus, and lordotic chest radiographs.
(6) Demonstrate knowledge of exam specific radiation doses.
(7) Demonstrate knowledge of indications for chest radiographs and thoracic CT studies of pregnant
patients.
(8) Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest
CT or MR may be necessary.
(9) Active participation with faculty in interpretation and workup of patients.
(10) Participation in radiation safety lectures
Skill Objectives:
(1) Provide accurate and timely reports on all cases with the supervision of faculty.
(2) Accurately and concisely dictate chest radiograph and chest CT reports using nomenclature
recommended by the Fleischner Society.
(3) Gather clinical and radiologic data on patients with thoracic pathology.
(4) Develop diagnostic plan based upon clinical presentation and imaging findings.
(5) Coordinate activities in the reading room, including providing direction for the technologists,
consultation for other clinicians, and answering the phone.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
(6) Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation.
Behavior and Attitude Objectives:
(1) Work with the health care team in a professional manner to provide patient-centered care.
(2) Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation.
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:
(1)
(2)
(3)
(4)
List key points of level appropriate diagnoses.
Describe advanced level digital and conventional x-ray physics in the chest.
Identify relevant anatomic structures on CT images of the chest.
Be familiar with the more common pathologic conditions in the upper abdomen and understanding
their pathophysiology.
(5) Learn indications and contraindications for lung biopsies.
(6) Demonstrate understanding of the pathophysiology and imaging appearance of at least three quarters
of the diagnoses listed in the appendix.
(7) Demonstrate learning of at least three-quarters of the knowledge based objectives below.
(8)
Chest Plain Film:
(1)
(2)
(3)
(4)
(5)
(6)
Understand standard positioning in thoracic radiology.
Identify normal anatomy and landmarks on frontal and lateral chest radiographs.
Know the expected course and possible complications of lines, tubes, and other devices.
Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum.
Recognize patterns of lobar atelectasis.
Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse
coalescent, multifocal ill-defined, fine or coarse reticular, and fine nodular opacities; multiple
nodules and masses; solitary pulmonary nodule.
(7) Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis.
(8) Describe the divisions of the mediastinum and common pathologies affecting each division.
(9) Recognize and give differential for hilar masses.
(10) Recognize and give differential for pleural effusions, thickening, and calcifications.
(11) Recognize and give differential for chest wall lesions.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Chest CT:
Understand standard CT protocols in thoracic radiology including the indications for intravenous contrast,
low dose, HRCT, and airway protocols. Identify normal cross-sectional anatomy of the thorax on CT,
including mediastinal lymph node designations and bronchial anatomy.
The resident should gain an understanding of:
(1) Mediastinal masses with differential based on location, morphology, and patient demographics.
(2) The evaluation of the solitary pulmonary nodule.
(3) The major histologic types of primary lung cancer and the new 7th UICC/AJCC staging system
published in 2009.
(4) Diffuse lung diseases that may demonstrate: linear or reticular opacities, including interlobular septal
or intralobular interstitial thickening; nodular opacities in a centrilobular, perilymphatic, or random
distribution; ground glass; consolidation; cysts or emphysema.
(5) The CT appearance of a variety of pulmonary infections, including those specific to the
immunocompromised host.
(6) The non-infectious complications of immunocompromised patients, including those of solid organ
and bone marrow transplant recipients.
(7) Diseases of the small and large airways.
(8) Pulmonary hypertension and pulmonary vascular diseases.
(9) Diseases of the pleura and chest wall.
Skill Objectives:
(1) Continue to build on chest radiograph interpretive skills.
(2) Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful
differential diagnoses.
(3) Demonstrate a clinically appropriate diagnostic workup plan.
(4) Demonstrate the ability to use all relevant information resources to acquire evidence-based data.
(5) Accurately and concisely dictate chest radiograph reports.
(6) Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT or
MR may be necessary.
(7) Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in
thoracic radiology described in the detailed thoracic curriculum.
(8) List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and
linear) of interstitial lung disease.
(9) Separate pulmonary from pleural or extrapleural processes.
(10) Correlate radiographic and chest CT findings.
(11) Perform and interpret more complex post-processing (3D) images.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Behavior and Attitude Objectives:
(1) 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:
(1) Assess CT images for quality and suggest methods of improvement.
(2) Analyze and develop improvement plans in the clinical practice, including knowledge, observation,
and procedural skills.
Skill Objectives:
(1) Demonstrate independent self-study using various resources including texts, journals, teaching files,
and other resources on the internet.
(2) Facilitate the learning of students and other health care professionals.
(3) Participate in case conferences.
(4) Participate in the clinical activities of Thoracic Imaging Section.
(5) Demonstrate critical assessment of the scientific literature.
(6) Demonstrate knowledge of and apply the principles of evidence-based medicine in practice.
Behavior and Attitude Objectives:
(1) Incorporate formative feedback into daily practice, positively responding to constructive criticism.
(2) Follow up on interesting or difficult cases without prompting and share this information with
appropriate faculty and fellow residents.
(3) Help in teaching of technologists, medical students, housestaff, and other health care professionals.
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:
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Knowledge Objectives:
(1) Understand how their image interpretation affects patient care.
(2) Demonstrate ability to design cost-effective care plans.
(3) Demonstrate knowledge of funding sources.
(4) Demonstrate knowledge of reimbursement methods.
(5) Demonstrate knowledge of regulatory environment.
(6) Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical
records, and the recruitment, hiring, supervision, and management of staff.
Skill Objectives:
(1) Provide accurate and timely interpretations to decrease length of hospital and emergency department
stay.
(2) Appropriately notify the referring clinician if there are urgent or unexpected findings and document
such without being prompted.
(3) Practice using cost effective use of time and support personnel.
(4) Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness
Criteria.
(5) Membership and participation in local and national radiological societies.
(6) Participate in discussions with faculty regarding operational challenges and potential systems solutions
regarding all aspects of radiologic service and patient care.
(7) Attendance and participation in multi-disciplinary conference.
(8) Interact and learn from department administrators.
Behavior and Attitude Objectives:
(1) 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:
(1) Understanding of the need for respect for patient privacy and autonomy.
(2) Principles of confidentiality with all information transmitted during a patient encounter.
(3) 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.
(4) Knowledge of issues of impairment.
(5) Discussion of above issues during daily clinical work.
(6) Training programs and/or videotapes on harassment and discrimination.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
(7) Didactic presentations on “the impaired physician.”
(8) Participation in hospital-based educational activities and independent learning.
Skill Objectives:
(1) 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:
(1) Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest.
(2) Demonstrate excellence: perform responsibilities at the highest level and continue active learning
throughout one’s career.
(3) Demonstrate honesty with patients, support staff, and colleagues.
(4) Demonstrate positive work habits, including punctuality, professional appearance and demeanor.
(5) When assisting referring clinicians with imaging interpretation and patient management, decide when
it is appropriate to obtain help from supervisory faculty.
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:
(1) Know the importance of accurate, timely, and professional communication.
Skill Objectives:
(1) Provide a clear, succinct report using nomenclature recommended by Fleischner Society.
(2) Communicate effectively with physicians, other health professionals. In cases of serious or
unanticipated findings, document that communication in report.
(3) Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible
complications.
(4) Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to
families, support personnel, and physicians.
(5) Participate in daily ICU and weekly BMT work conferences.
(6) Participate in Thoracic Tumor Board and Joint Chest conference.
Behavior and Attitude Objectives:
(1) Work effectively as a member of the patient care team.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Rotation 5-Stanford chest x-ray-third-year
This rotation involves interpretation of digital chest radiographs, chest CT, and medical knowledge
component of guided lung biopsies. Lung biopsies will be performed in the interventional rotation.
Residents should focus on the integration of all previous chest rotations to concentrate on becoming an
effective, independent consultant and teacher.
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:
(1) Appropriately protocol all requests for chest CT to include thin-section images, high resolution
images, expiratory images, or prone images when appropriate, and use of intravenous contrast, given
the patients history.
(2) Demonstrate knowledge of CT parameters contribution to patient radiation exposure and techniques
that can be used to limit radiation exposure.
(3) Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT
examination.
(4) Recognize the radiographic findings of life-threatening conditions and notify referring clinician
without being prompted.
(5) Demonstrate knowledge of patient positioning and indications for posteroanterior (PA),
anteroposterior (AP), lateral decubitus, and lordotic chest radiographs.
(6) Demonstrate knowledge of exam specific radiation doses.
(7) Demonstrate knowledge of indications for chest radiographs and thoracic CT studies of pregnant
patients.
(8) Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest
CT or MR may be necessary.
(9) Actively participate with faculty in interpretation and workup of patients.
(10) Participate in radiation safety lectures.
Skill Objectives:
(1) Provide accurate and timely reports on all cases with the supervision of faculty.
(2) Accurately and concisely dictate chest radiograph and chest CT reports using nomenclature
recommended by the Fleischner Society.
(3) Gather clinical and radiologic data on patients with thoracic pathology.
(4) Develop diagnostic plan based upon clinical presentation and imaging findings.
(5) Coordinate activities in the reading room, including providing direction for the technologists,
consultation for other clinicians, and answering the phone.
(6) Actively participate in cardiac CT supervision, protocoling, post processing, and interpretation.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Behavior and Attitude Objectives:
(1) Work with the health care team in a professional manner to provide patient-centered care.
(2) Notify referring clinician for urgent, emergent, or unexpected findings, and document in dictation.
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:
(1)
(2)
(3)
(4)
List key points of level appropriate diagnoses.
Describe advanced level digital and conventional x-ray physics in the chest.
Identify relevant anatomic structures on CT images of the chest.
Be familiar with the more common pathologic conditions in the upper abdomen and understanding
their pathophysiology.
(5) Learn indications and contraindications for lung biopsies.
(6) Demonstrate understanding of the pathophysiology and imaging appearance of all of the diagnoses
listed in the appendix.
(7) Demonstrate learning of all of the knowledge based objectives below.
Chest Plain Film:
(1)
(2)
(3)
(4)
(5)
(6)
Understand standard positioning in thoracic radiology.
Identify normal anatomy and landmarks on frontal and lateral chest radiographs.
Know the expected course and possible complications of lines, tubes, and other devices.
Recognize the presence of air in the pleura, mediastinum, pericardium, and peritoneum.
Recognize patterns of lobar atelectasis.
Recognize and give differential for the following plain film patterns: segmental or lobar, diffuse
coalescent, multifocal ill-defined, fine or coarse reticular, and fine nodular opacities; multiple
nodules and masses; solitary pulmonary nodule.
(7) Recognize and give differential for cystic or cavitary lesions of the lungs, including bronchiectasis.
(8) Describe the divisions of the mediastinum and common pathologies affecting each division.
(9) Recognize and give differential for hilar masses.
(10) Recognize and give differential for pleural effusions, thickening, and calcifications.
(11) Recognize and give differential for chest wall lesions.
Chest CT:
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Understand standard CT protocols in thoracic radiology including the indications for intravenous contrast,
low dose, HRCT, and airway protocols. Identify normal cross-sectional anatomy of the thorax on CT,
including mediastinal lymph node designations and bronchial anatomy.
The resident should gain an understanding of:
(1) Mediastinal masses with differential based on location, morphology, and patient demographics.
(2) The evaluation of the solitary pulmonary nodule.
(3) The major histologic types of primary lung cancer and the new 7th UICC/AJCC staging system
published in 2009.
(4) Diffuse lung diseases that may demonstrate: linear or reticular opacities, including interlobular septal
or intralobular interstitial thickening; nodular opacities in a centrilobular, perilymphatic, or random
distribution; ground glass; consolidation; cysts or emphysema.
(5) The CT appearance of a variety of pulmonary infections, including those specific to the
immunocompromised host.
(6) The non-infectious complications of immunocompromised patients, including those of solid organ
and bone marrow transplant recipients.
(7) Diseases of the small and large airways.
(8) Pulmonary hypertension and pulmonary vascular diseases.
(9) Diseases of the pleura and chest wall.
Skill Objectives:
(1) Continue to build on chest radiograph interpretive skills.
(2) Demonstrate sufficient knowledge of medicine and its proper application to generate meaningful
differential diagnoses.
(3) Demonstrate a clinically appropriate diagnostic workup plan.
(4) Demonstrate the ability to use all relevant information resources to acquire evidence based data
(5) Accurately and concisely dictate chest radiograph reports.
(6) Demonstrate knowledge of the clinical indications for obtaining a chest x-ray and when a chest CT
or MR may be necessary.
(7) Identify normal radiographic pulmonary anatomy and be able to define and identify various signs in
thoracic radiology described in the detailed thoracic curriculum.
(8) List and identify on a chest radiograph and CT four patterns (nodular, reticular, reticulonodular, and
linear) of interstitial lung disease.
(9) Separate pulmonary from pleural or extrapleural processes.
(10) Correlate radiographic and chest CT findings
(11) Perform and interpret more complex post-processing (3D) images.
Behavior and Attitude Objectives:
(1) Recognize limitations of personal competency and ask for guidance when appropriate.
Practice-Based Learning and Improvement
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
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:
(1) Assess CT images for quality and suggest methods of improvement.
(2) Analyze and develop improvement plans in the clinical practice, including knowledge, observation,
and procedural skills.
Skill Objectives:
(1) Demonstrate independent self-study using various resources including texts, journals, teaching files,
and other resources on the internet.
(2) Facilitate the learning of students and other health care professionals.
(3) Participate in case conferences.
(4) Participate in the clinical activities of Thoracic Imaging Section.
(5) Demonstrate critical assessment of the scientific literature.
(6) Demonstrate knowledge of and apply the principles of evidence-based medicine in practice.
Behavior and Attitude Objectives:
(1) Incorporate formative feedback into daily practice, positively responding to constructive criticism.
(2) Follow up on interesting or difficult cases without prompting and share this information with
appropriate faculty and fellow residents.
(3) Help in teaching of technologists, medical students, housestaff, and other health care professionals.
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:
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
(1)
(2)
(3)
(4)
(5)
(6)
Understand how their image interpretation affects patient care.
Demonstrate ability to design cost-effective care plans.
Demonstrate knowledge of funding sources.
Demonstrate knowledge of reimbursement methods.
Demonstrate knowledge of regulatory environment.
Demonstrate knowledge of basic management principles such as budgeting, record keeping, medical
records, and the recruitment, hiring, supervision, and management of staff.
Skill Objectives:
(1) Provide accurate and timely interpretations to decrease length of hospital and emergency department
stay.
(2) Appropriately notify the referring clinician if there are urgent or unexpected findings and document
such without being prompted.
(3) Practice using cost effective use of time and support personnel.
(4) Demonstrate ability to review and utilize the medical literature, including ACR Appropriateness
Criteria.
(5) Participate in local and national radiological societies.
(6) Participate in discussions with faculty regarding operational challenges and potential systems
solutions regarding all aspects of radiologic service and patient care.
(7) Attend and participate in multi-disciplinary conference.
(8) Interact and learn from department administrators.
Behavior and Attitude Objectives:
(1) 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:
(1) Understanding of the need for respect for patient privacy and autonomy.
(2) Principles of confidentiality with all information transmitted during a patient encounter.
(3) 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
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
(4)
(5)
(6)
(7)
(8)
in advance with the appropriate faculty and/or fellow.
Knowledge of issues of impairment.
Discussion of above issues during daily clinical work.
Training programs and/or videotapes on harassment and discrimination.
Didactic presentations on “the impaired physician.”
Participation in hospital-based educational activities and independent learning.
Skill Objectives:
(1) 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:
(1) Respect, compassion, integrity, and responsiveness to patient care needs that supersede self-interest.
(2) Demonstrate excellence: perform responsibilities at the highest level and continue active learning
throughout one’s career.
(3) Demonstrate honesty with patients, support staff, and colleagues.
(4) Demonstrate positive work habits, including punctuality, professional appearance and demeanor.
(5) When assisting referring clinicians with imaging interpretation and patient management, decide when
it is appropriate to obtain help from supervisory faculty.
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:
(1) Know the importance of accurate, timely, and professional communication.
Skill Objectives:
(1) Provide a clear, succinct report using nomenclature recommended by Fleischner Society
(2) Communicate effectively with physicians, other health professionals. In cases of serious or
unanticipated findings, document that communication in report.
(3) Demonstrate skills in effective communication to patients of the procedure, alternatives, and possible
complications.
(4) Demonstrate the verbal and non-verbal skills necessary for face-to-face listening and speaking to
families, support personnel, and physicians.
(5) Participate in daily ICU and weekly BMT work conferences.
(6) Participate in Thoracic Tumor Board and Joint Chest conference.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Behavior and Attitude Objectives:
(1) Work effectively as a member of the patient care team.
Workflow and Duties:
During each rotation, a resident is expected to:
 Wear hospital identification
 Arrive by 8:30 am for work on the chest service
 May leave after ICU conference for noon conference
 Return by 1:15 pm from conference
 Notify section head or attending of day for scheduled absences on rotation
 Preview studies to be read during the morning read-out
 Participate in the weekly Thoracic Tumor Board
 Participate in the monthly ILD conference
 Participate in the monthly Joint Chest Conference
 Dictate all radiographic and CT studies of inpatients and SMIC/SMOC outpatients before the end of
the day
Conference Schedule/Format
Title
Day
Time
Location
Resident conferences
Chest-CVI
Fridays
12:00
Lucas
ICU conference
Daily
11:30
Ballroom
Thoracic tumor board
Tuesdays
2:00
Cancer center, clinic A
Interstitial Lung
Disease
Fridays
Monthly at 4:00
Cancer Center, clinic A
Joint chest conference
Wednesdays
Monthly
Pulmonary division
Method of Assessment of Performance:
 Written evaluation of resident by responsible faculty member monthly
 Verbal feedback to resident by faculty
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description

ACR In-Training Service Exam annually
Recommended Reading
First Rotation
 Reed. Chest Radiology: Plain Film Patterns and Differential Diagnoses
 Collins and Stern. Chest Radiology: The Essentials.
 Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2008; 246(3): 697 – 722.
Second Rotation
 Kazerooni & Gross, Cardiopulmonary Imaging
 Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2008; 246(3): 697 – 722.
Third and Fourth Rotations
 Naidich et al. Computed Tomography and Magnetic Resonance Imaging of the Thorax
 Webb et al. High Resolution CT of the Lung.
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
APPENDIX :
Lung
Airspace
Congenital
1 Hamartoma, Airway
2 Cystic Adenomatoid Malformation
Infectiouis
3
4
5
6
7
8
9
10
11
12
Pneumonia Bacterial
Pneumonia, Community Acquired
Immunocompromised Pneumonia
Pneumonia, Staphylococcus
Pneumonia, Mycobacterial
Abscess, Lung
Fungal, Histoplasmosis
Fungal, Aspergillosis
Fungal, Blastomycosis
Fungal, Coccidioidomycosis
13
14
15
16
17
Cardiogenic Pulmonary Edema
Noncardiac Pulmonary Edema
Embolism, Fat Pulmonary
Diffuse Alveolar Hemorrhage
Churg-Strauss Syndrome
Vascular
Inflammatory - Degenerative
18 Eosinophilic Pneumonia
Toxic - Metabolic
19
20
21
22
23
24
25
26
27
Metastatic Pulmonary Calcification
Alveolar Microlithiasis
Lipoid Pneumonia
Pulmonary Alveolar Proteinosis
Desquamative Interstitial Pneumonia
Illicit Drug Use, Pulmonary Manifestations
Cryptogenic Organizing Pneumonia
Smoke Inhalation
Emphysema, Paraseptal
Neoplastic
28 Bronchioloalveolar Cell Carcinoma
Interstitium
Infectious
29 Pneumonia, Viral
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
30 Pneumonia, Pneumocystis
Inflammatory - Degenerative
31
32
33
34
35
36
37
Sarcoidosis, Lymphadenopathy
Idiopathic Pulmonary Fibrosis
Hypersensitivity Pneumonitis
Rheumatoid Arthritis
Scleroderma
Polymyositis - Dermatomyositis
Nonspecific Interstitial Pneumonia
Toxic - Metabolic
38 Asbestosis
39 Silicosis - Coal Worker Pneumoconiosis
40 Hard Metal Pneumoconiosis
Neoplastic
41 Lymphangitic Carcinomatosis
42 Lymphangiomatosis
43 Lymphocytic Interstitial Pneumonia
Congenital
Airways
Congenital
44
45
46
47
48
49
50
Cystic Fibrosis
Tracheobronchomegaly
Immotile Cilia Syndrome
Bronchial Atresia
Alpha-1 Antiprotease Deficiency
Paratracheal Air Cyst
Williams-Campbell Syndrome
51
52
53
54
55
56
Bronchitis, Chronic
Chronic Obstructive Pulmonary Disease
Bronchiectasis
Laryngeal Papillomatosis
Mycobacterial Avium Complex
Bronchiolitis
Infectiouis
Inflammatory - Degenerative
57
58
59
60
61
62
63
Allergic Bronchopulmonary Aspergillosis
Emphysema, Panlobular
Tracheobronchomalacia
Relapsing Polychondritis
Middle Lobe Syndrome
Saber-Sheath Trachea
Bronchiolitis Obliterans
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
64 Asthma
65 Pneumatoceles
Toxic - Metabolic
66
67
68
69
Langerhans Cell Histiocytosis, Pulmonary
Bronchiolitis, Respiratory
Emphysema, Centrilobular
Amyloidosis
70
71
72
73
74
Tracheopathia Osteochondroplastica
Carcinoid
Kaposi Sarcoma
Tracheal Neoplasms
Endobronchial Tumor
Neoplastic
Mediastinum
Mediastinum
Congenital
75 Bronchogenic Cyst
76 Meningocele, Lateral
77 Pulmonary Bronchogenic Cyst
Infectious
78 Mediastinal Abscess
79 Mediastinitis
Inflammatory - Degenerative
80
81
82
83
Mediastinal Fibrosis
Achalasia
Esophageal Diverticuli
Hernias, Hiatal and Paraesophageal
84
85
86
87
88
89
90
91
92
93
Goiter, Mediastinum
Lymphoma, Hodgkin, Pulmonary
Lymphoma, Non-Hodgkin
Thymoma
Germ Cell Tumors
Lipomatosis
Castleman Disease
Nerve Sheath Tumors
Sympathetic Ganglion Tumors, Mediastinum
Extramedullary Hematopoiesis
Neoplastic
Vascular
94 Varices
Aorta and Great Vessels
Congenital
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
95
96
97
98
99
100
101
Right Aortic Arch
Aberrant Subclavian
Aortic Coarctation
Intralobar Sequestration
Left Superior Vena Cava
Azygos Continuation of IVC
Azygos Fissure
Infammatory - Degenerative
102
103
104
105
106
107
108
Ductus Diverticulum
Aortic Atherosclerosis
Marfan Syndrome
Aortic Dissection
Aortic Aneurysm
Takayasu Arteritis
SVC Syndrome
Heart and Pericardium
Congenital
109 Partial Absence Pericardium
110 Heterotaxy Syndrome
111 Pericardial Cyst
Inflammatory - Degenerative
112
113
114
115
116
117
118
Coronary Artery Calcification
Left Atrial Calcification
Ventricular Calcification
Valve and Annular Calcification
Aortic Valve Dysfunction
Mitral Valve Dysfunction
Constrictive Pericarditis
Toxic - Metabolic
Neoplastic
119 Left Atrial Myxoma
120 Metastases, Pericardium
Pulmonary Vasculature
Congenital
121
122
123
124
125
Arteriovenous Malformation, Pulmonary
Partial Anomalous Venous Return
Scimitar Syndrome
Idiopathic Pulmonary Artery Dilatation
Congenital Interruption Pulmonary Artery
Infectious
126 Septic Emboli, Pulmonary
Inflammatory - Degenerative
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
127 Vasculitis, Pulmonary
128 Wegener Granulomatosis, Airway
129 Veno-Occlusive Disease
Toxic - Metabolic
130 Talcosis, Pulmonary Manifestations
131 Illicit Drug Abuse
132 Silo-Filler's Disease
Vascular
133
134
135
136
137
Pulmonary Emboli
Neurogenic Pulmonary Edema
Pulmonary Artery Hypertension
Aneurysm, Pulmonary Artery
High Altitude Pulmonary Edema
Neoplastic
138 Pulmonary Artery Sarcoma
139 Embolism, Tumor
Remove
Pleura - Chest Wall - Diaphragm
Pleura
Congenital
Inflammatory - Degenerative
140 Pleural Effusion, Exudative
141 Apical Cap
142 Systemic Lupus Erythematosus
Infectious
143 Empyema
144 Bronchopleural Fistula
Neoplastic
145
146
147
148
149
Metastasis, Pleural
Malignant Mesothelioma
Pancoast Tumor
Localized Fibrous Tumor of the Pleura
Pneumothorax, Catamenial
Vascular
150 Transudative Pleural Effusion
Toxic - Metabolic
151 Asbestos Related Pleural Disease
Chest Wall
Congenital
152 Pectus Deformity
153 Kyphoscoliosis
154 Poland Syndrome
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
Infectious
155 Empyema Necessitatis
Inflammatory - Degenerative
156 Ankylosing Spondylitis
Neoplastic
157 Lipoma, Chest Wall
158 Lymphoma, Chest Wall
159 Askin Tumor
Diaphragm
Congenital
160 Eventration of Diaphragm
161 Hernias, Bochdalek and Morgagni
Inflammatory - Degenerative
162 Phrenic Nerve Paralysis
Special Topics
Atelectasis
163 Atelectasis, Lobar
164 Atelectasis, Subsegmental
165 Atelectasis, Round
Trauma
166
167
168
169
170
171
172
173
174
175
176
177
Pneumomediastinum
Pneumothorax, Traumatic
Tracheobronchial Tear
Lung Contusion
Aortic Transection
Rib Fractures and Flail Chest
Spinal Fracture, Thoracic
Diaphragmatic Rupture
Sternal Fracture
Esophageal Rupture
Splenosis, Thoracic
Hemothorax, Traumatic
178
179
180
181
182
183
Lung Cancer, Non-Small Cell
Lung Cancer, Small Cell
Lung Cancer, Staging
Lung Cancer, Regional Lymph Node Classification
Solitary Pulmonary Nodule
Lung Cancer, Missed
Lung Cancer
Portable ICU
Non-Surgical
184 Tubes and Catheters, Abnormal
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
185 Tubes and Catheters, Normal
186 Cardiac Pacemakers
187 Pleurodesis
Surgical
188 Median Sternotomy
189 Pneumonectomy, Extrapleural
Post-Transplant Lymphoproliferative Disease
190 (PTLD)
191 Lung Transplantation
192 Transplantation, Lung
Physiology
193 Aspiration
Special Patients
194
195
196
197
198
Metastases, Lung
Drug Reaction, Intrathoracic
Radiation-Induced Lung Disease
Immunosuppressed (Not AIDS)
HIV/AIDS
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
Wegener Granulomatosis, Pulmonary
Silhouette
Hilum Overlay
Hilum Convergence
S-Sign of Golden
Cervicothoracic Sign
Incomplete Border
Pad Sign
Luftsichel Sign
Air Crescent Sign
CT Angiogram Sign
CT Halo Sign
Reverse Halo Sign
Atelectasis, Cicatricial
Atelectasis, Right Upper Lobe
Atelectasis, Middle Lobe
Atelectasis, Right Lower Lobe
Atelectasis, Complete Lung
Atelectasis, Left Upper Lobe
Atelectasis, Left Lower Lobe
Added in Connection with DI2
Overview
Volume Loss
Developmental Abnormalities
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
219
220
221
222
223
224
225
226
227
228
229
230
231
232
Congenital Lobar Emphysema
Congenital Pulmonary Airway Malformation
Isomerism
Extralobar Sequestration
Double Aortic Arch
Atrial Septal Defect
Ventricular Septal Defect
Pulmonary Varix
Bicuspid Aortic Valve
Anomalous Pulmonary Venous Return
Morgagni Hernia
Bochdalek Hernia
Congenital Diaphragmatic Hernia
Lymphangioleiomyomatosis
233
234
235
236
237
238
239
240
241
242
243
Squamous Cell Carcinoma, Airways
Adenoid Cystic Carcinoma
Mucoepidermoid Carcinoma
Metastasis, Airways
Tracheal Stenosis
Broncholithiasis
Swyer-James-McLeod
Bronchiolitis, Constrictive
Amyloidosis, Airways
Primary Ciliary Dyskinesia
Mounier-Kuhn Syndrome
244
245
246
247
248
249
250
251
252
253
254
255
Pneumonia, Pneumococcal
MRSA
Pneumonia, Legionella
Nocardiosis
Tuberculosis, Post-Primary
Nontuberculous Mycobacterial Infection
Mycoplasma Pneumonia
Community Acquired Pneumonia
Influenza Pneumonia
Cytomegalovirus Pneumonia
Cryptococcosis
Pneumocystis, Jirovecii Pneumonia
Airway Diseases
Infections
Pulmonary Neoplasms
256 Preinvasive Adenocarcinoma
257 Invasive Adenocarcinoma
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
258
259
260
261
262
263
264
Squamous Cell Carcinoma
Hamartoma, Pulmonary
Neuroendocrine Carcinoma
Nodular Lymphoid Hyperplasia
Lung Cancer, Resectable
Lung Cancer, Unresectable
Bronchiolitis, Follicular
Interstitial, Diffuse, and Inhalational Lung Disease
265
266
267
268
269
Acute Eosinophilic Pneumonia
Chronic Eosinophilic Pneumonia
Neurofibromatosis
Sarcoidosis
Farmer's Lung
Connective Tissue Disorders, Immunological Diseases, and Vasculitis
270 Mixed Connective Tissue Disease
271 Sjogren Syndrome
272 Inflammatory Bowel Disease
Pulmonary Edema, Hemorrhage, and Vasculitis
273 Behcet Syndrome
274 Granulomatosis, Lymphomatoid
275 Granulomatosis, Necrotizing Sarcoid
Mediastinal Abnormalities
276
277
278
279
280
281
282
283
284
285
286
287
288
289
Thymic Malignancy
Thymolipoma
Teratoma
Seminoma, Mediastinal
Nonseminomatous Malignant Germ Cell
Neoplasm
Esophageal Duplication Cyst
Thymic Cyst
Coronary Artery Aneurysm
Lymphangioma, Mediastinal
Hemangioma, Mediastinal
Metastatic Disease, Lymphadenopathy
Lymphoma, Hodgkin, Mediastinal
Lymphoma, Non-Hodgkin, Mediastinal
Mediastinal Fibrosis
290
291
292
293
Pulmonary Thromboembolic Disease, Acute
Pulmonary Thromboembolic Disease, Chronic
Cardiac Myxoma
Sarcoma, Cardiac
Cardiovascular Disorders
2/18/2016
STANFORD UNIVERSITY MEDICAL CENTER
Residency Training Program
Rotation Description
294 Pericardial Effusion
Trauma
295 Trauma, Lung
296 Traumatic Aortic Injury
297 Aspiration
Post-Treatment Chest
298
299
300
301
Lobectomy
Pneumonectomy
Amiodarone Toxicity
Ablation Procedures
302
303
304
305
306
307
308
309
Chylothorax
Hemothorax
Pleural Plaques
Pleural Fibrosis and Fibrothorax
Malignant Pleural Effusion
Iatrogenic Pneumothorax
Pneumothorax, Primary Spontaneous
Pneumothorax, Secondary Spontaneous
Pleural Diseases
Chest Wall and Diaphragm
310
311
312
313
Diaphragmatic Paralysis
Chest Wall Metastases
Chondrosarcoma, Chest Wall
Plasmacytoma and Multiple Myeloma
2/18/2016