Monash Health Prevocational Term Description
Title of post
Monash Imaging
Site
Monash Medical Centre, Clayton
Important
Contacts
Name:
Review Date:
Contact:
Program
Director
A/Prof Richard King
richard.king@monashhealth.org
Unit Head:
Prof Stephen Stuckey
stephen.stuckey@monashhealth.org
Intern
supervisor
Dr Steven Alatakis
steve.alatakis@gmail.com
HMO
supervisor
N/A
NUM:
Winnie Chee
winnie.chee@monashhealth.org
Administration:
Dot Dunn
dot.dunn@monashhealth.org
December, 2015
Overview of Unit:
Monash Imaging is the collective name given to the radiology department which provides radiology services
to Monash Health. It is the largest public hospital radiology department in Australia, and incorporates all
radiological imaging modalities including general radiography, CT, ultrasound, MRI, fluoroscopy,
mammography, nuclear medicine and interventional radiology. Monash Imaging is one of the few
departments which can perform every aspect of modern radiological imaging, including adult, paediatric,
women’s and cardiac imaging.
Monash Imaging provides radiological services at Monash Medical Centre Clayton, Dandenong Hospital,
Casey Hospital, Monash Medical Centre Moorabbin and the Kingston Centre. The department plays an
important role in providing radiological education and teaching to specialty radiology trainees, other junior
doctors, medical students and allied health staff. The department also engages in extensive research
activities across multiple modalities and sites, including at the Monash Biomedical Institute, and publishes
more papers in peer reviewed journals than any other department in Victoria.
Orientation:
The orientation week in Monash Imaging is conducted at Monash Medical Centre. The intern should get to
know the radiology registrars quickly, and will shadow the registrars whenever they obtain informed consent
or perform a procedure. The registrars will give the intern tasks to complete, which should be completed as
efficiently as possible. The intern should only perform tasks which they are comfortable performing, and if the
intern is unsure about anything, they should ask for clarification from the registrar or consultant.
During the week before the intern commences working in Monash Imaging, they should phone Dr Steven
Alatakis, the Monash Imaging Intern Supervisor, on 0402147187, for an informal discussion about the roles
and responsibilities of the Monash Imaging intern. The phone call can be made at any time, including after
hours. If the intern supervisor is unable to take the phone call then he will make arrangements for the phone
conversation to be held at another time in the same week.
[Updated, July 15, 2015]
Monash Health Prevocational Term Description
On the intern’s first day, the intern will do the following:
1. The intern will come to the main reporting room, located within Monash Imaging at Monash Medical
Centre, at 8:30 am to introduce themselves to any of the registrars who are present.
2. At 9:00 am the intern supervising radiologist will meet the intern and will take them on a tour of the
department. The intern should try to learn their way around the department as quickly as possible.
3. In each area of the department, the intern should introduce themselves as the new Monash Imaging
intern, with instructions for staff to page them for any IV cannulations.
4. After the tour of the department the intern will see the Departmental Secretary and Executive
Assistant to the Head of the Department, Ms Dot Dunn, in her office, in order to complete paperwork
and obtain their pager. They will also make an appointment to see the Head or Deputy Head of
Radiology, for a brief meeting about their rotation.
5. After completing any paperwork, the intern will go back to the main reporting room and introduce
themselves to the registrars and radiologists who are there.
6. As the registrars are called to perform certain tasks they will take the intern with them as an observer.
The intern’s aim is to learn how to perform these tasks as quickly as possible. The intern will also be
asked to perform various tasks by the registrars and radiologists, and is encouraged to ask questions
whenever they can.
Roster:
The Monash Imaging intern roster is based on the following principles:

The intern works a total of 76 hours per fortnight, which includes a 14 hour shift on alternating
weekends.

The intern needs to work at both the Clayton and Dandenong campuses, in order to obtain more
diverse exposure and to provide assistance at both campuses.

The intern needs to attend one of the weekly intern education lectures, which is held at 1:00 pm, at
the Dandenong campus on Wednesdays or at the Clayton campus on Thursdays.
The roster works over a two week cycle, as follows:
WEEK 1
DAY
SITE
HOURS
TOTAL HOURS
Monday
Day Off
-
-
Tuesday
Dandenong Campus
09:00 – 16:00
7 Hours
Wednesday
Dandenong Campus
09:00 – 16:00
7 Hours
Thursday
Clayton Campus
09:00 – 16:00
7 Hours
Friday
Clayton Campus
09:00 – 15:00
6 Hours
Saturday
Clayton Campus
08:00 – 22:00
14 Hours
Sunday
Day Off
-
-
Total hours worked in week 1 is 41 hours.
[Updated, July 15, 2015]
Monash Health Prevocational Term Description
WEEK 2
DAY
SITE
HOURS
TOTAL HOURS
Monday
Clayton Campus
09:00 - 16:00
7 Hours
Tuesday
Dandenong Campus
09:00 - 16:00
7 Hours
Wednesday
Dandenong Campus
09:00 - 16:00
7 Hours
Thursday
Clayton Campus
09:00 - 16:00
7 Hours
Friday
Clayton Campus
09:00 - 16:00
7 Hours
Saturday
Day Off
-
-
Sunday
Day Off
-
-
Total hours worked in week 2 is 35 hours.
Total hours worked per fortnight is 76 hours.
In addition, some rosters will be modified to allow the intern to attend subspecialist activities, such as nuclear
medicine PET imaging and neuro-interventional activities.
Education Opportunities:
All Monash Health interns are required to attend the weekly intern education sessions. The education
sessions are held at Monash Medical Centre and Dandenong Hospital, on the following days:
You will always be rostered at one of these sites on one of these days, in order for you to attend the
meetings. Attendance at these meetings is mandatory.
Intern Teaching (mandatory & protected)
Thursday
1.00 – 2.00pm
Lecture Theatre 3 MMC
Intern Teaching (mandatory & protected)
Thursday
1.00 – 2.00pm
Lecture Theatre 3 DH
Radiology Registrar Tutorials
Radiology registrars attend regular teaching sessions in the
department, and the intern is welcome to attend these meetings.
The intern should liaise with the registrars they are working with
each day to find out the time and location of these meetings
Learning Objectives
At the end of this rotation, the intern, under supervision, will be able to demonstrate:

Proficiency in obtaining consent for radiological procedures:
o In the beginning the intern will observe radiology registrars and consultants obtaining informed
consent from patients for radiological procedures.
o As the intern becomes more experienced they will be able to obtain informed consent themselves,
with a registrar or radiologist present, and eventually consent will be obtained independently.
o A document containing an explanation of how common radiological procedures are performed,
together with the potential complications, is available and will be made available to the intern
before they commence working in Monash Imaging. The information discussed in the document
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Monash Health Prevocational Term Description




will be used in conjunction with information obtained by direct observation, when the intern
obtains informed consent.
Competency in basic medical procedures:
o The most common procedure which will be performed by the intern will be IV cannulations. Less
common procedures which will be performed by the intern include pleural taps, ascitic taps and
lumbar punctures.
Competency in basic radiological procedures:
o The most common basic radiological procedure which will be performed by the intern will be
ultrasound guided cannulation, followed by radiological PICC insertion, which requires the use of
both ultrasound and fluoroscopy.
Knowledge of major radiological modalities:
o The intern will be exposed to all of the major radiological modalities, including x-ray imaging, CT,
ultrasound, fluoroscopy, angiography and general interventional radiology, nuclear medicine and
MRI.
o The exposure to the major radiological modalities will occur at both a radiologist and radiographer
level, so that the intern fully understands how imaging is performed and subsequently
interpreted.
Knowledge of radiological subspecialties:
o The intern will spend a short period of time being exposed to more subspecialized areas of
radiology, including paediatric radiology and interventional neuroradiology.
Other information
Log book:
The intern will keep an electronic logbook, which can be on an excel spreadsheet or as a word document.
The log book requires a front page which will include the intern’s name, Monash Health employee number
and dates of their rotation. Please note that this will be treated as a legal document, and any documentation
which is found to be fraudulent will be reported to Monash Health administration.
For each day, the intern will document the following information:








Date.
Site worked (Clayton or Dandenong campus).
Consenting for procedures: each consent needs to be documented, including the patient UR
number, type of procedure and if the consent was observed or taken by the intern.
IV cannulations: the total number of unguided IV cannulations should be documented, although UR
numbers do not need to be documented.
Procedures: all other procedures must be documented, including patient UR number, type of
procedure, whether any complications occurred, how much of the procedure was performed by the
intern, and who the supervising registrar or consultant was.
Procedures observed: the types of procedures observed should be documented, with no need to
record the UR number or supervising radiologist.
Interaction with radiographers & sonographers: any time spent with radiographers & sonographers
should be documented, with mention of the modality involved. Patient and radiographer details do
not need to be recorded.
Radiology meetings attended.
This information should be collated each day, and the weekly log book emailed to me at the end of the week
or at the beginning of the following week.
Monash Imaging Radiology Conferences and Multidisciplinary Meetings:
Every day multiple radiology meetings are held throughout Monash Imaging, with most meetings held at the
Clayton and Dandenong campuses. The intern should attend some of these meetings, taking into account
other activities. If possible, the intern should attend at least one meeting regularly, such as the general
medical meeting at the Clayton campus on Thursdays. The intern does not have to attend a meeting in its
entirety, and can attend part of a meeting, in between taking part in other departmental work.
[Updated, July 15, 2015]
Monash Health Prevocational Term Description
A list of meetings will be emailed to the Monash Imaging intern before they commence their rotation.
Overview of Daily Tasks and Activities of Monash Imaging Intern:
The following is a description of a typical day for the Monash Imaging intern. Apart from the morning
departmental round, the order of when the other activities are performed is variable.
Morning departmental round:
The intern commences work at 09:00. Their first task is to go to each part of the department and let the
radiologists, radiology registrars, nursing staff and radiographers know that they are rostered to that site for
the day, and that they should page the intern when required. The areas where the intern should go to include
the nursing station, recovery ward, each CT room, MRI, ultrasound, fluoroscopy, interventional rooms and
main reporting rooms.
Checking blood results:
Patients who are having procedures may have had preoperative blood tests, depending on the type of
procedure they are having. The types of blood tests will depend on the type of procedure the patient is
having. The intern needs to check the blood tests and let the relevant registrar know what the results are. If
the blood tests have been performed at Monash Health then the results can be obtained through the Monash
Health Pathology Department website. If the blood tests have been performed elsewhere then the intern will
need to contact the relevant pathology institution. If no blood tests have been performed then the intern will
need to order the blood tests and follow up the results, which may require taking the blood sample
themselves.
Intravenous cannulation:
The intern will be asked to perform IV cannulation by registrars, radiographers and nurses. Since many staff
members are capable of performing IV cannulation, some of the patients who will require cannulation by the
intern will be relatively difficult to cannulate, and will require ultrasound guided IV cannulation.
Ultrasound guided IV cannulation is an important skill which must be developed by the intern. This skill will
be taught by registrars. Once this skill has been mastered, the intern will be able to perform ultrasound
guided IV cannulation in patients who are inpatients, but only if the interns or resident medical officers on the
wards are unable to cannulate the patient.
Fluid and drug orders:
The intern will learn the protocols which exist for the administration of IV fluids for the purpose of prehydration, in patients with renal impairment who require IV iodine based contrast. Other protocols also exist
for the administration of medications such as midazolam and buscopan.
Reviewing of patients prior to discharge:
Patients who have had radiological procedures require assessment before they are discharged from the
department. The intern will review patients with a registrar and subsequently independently, looking for
procedural complications and safety to be discharged.
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Monash Health Prevocational Term Description
Completion of procedural notes:
The intern will write procedural notes for procedures that they have observed, assisted with or performed.
They will be taught by the supervising registrar how to write procedural notes, and will be able to do this
independently once competent.
Obtaining consent for procedures:
The intern will initially observe registrars and radiologists obtaining consent for radiological procedures.
Eventually, after the intern develops enough experience, they will be able to obtain consent themselves,
initially in the presence of a registrar or radiologist, and eventually independently.
Performance of procedures:
The intern will be taught how to perform certain procedures, initially through direct observation, then by
supervision by registrars and radiologists, and finally will be able to perform procedures independently. The
intern will only perform procedures when they are competent to do so. There is no expectation that the intern
will be able to perform every type of common radiological procedure, at a competent level, by the end of their
rotation.
The most common procedures that the intern will be exposed to are the insertion of PICCs, unblocking
PICCs which have been inserted previously, ascitic taps, pleural taps, joint aspirations and lumbar
punctures.
Minor activities:
The intern will be expected to liaise with other medical units, contact inpatient wards, talk to patients and
family members, and to perform other relatively minor tasks. Although these activities are simple, the
performance of these activities leads to an increase in efficiency and work throughput.
Medical meetings:
The intern will be provided with a list of medical multidisciplinary meetings before they commence their
rotation. If the intern has no other tasks which require completion, they should attend a few meetings each
week. The general medical meeting at the Monash campus should be attended on a regular basis.
Radiographer contact and education:
When the intern has no other tasks requiring completion, they should spend time with the radiographers and
sonographers in the department. The intern needs to spend time with radiographers who are taking x-rays
and performing CT scans, ultrasound examinations, MRI scans, fluoroscopic procedures, nuclear medicine
studies and angiographic procedures. This should be done on a regular basis, so that the intern is
comfortable with how the different imaging modalities are undertaken.
Log book maintenance:
The intern needs to keep a list of their procedures, consents and other activities, as listed in the “log book”
section of this document. Since the intern will take part in many tasks during the day, the intern needs to
keep a contemporaneous record of their activities.
The log book needs to be emailed to the supervising radiologist at the end of each week or at the beginning
of the following week.
Departmental education program:
The Monash Imaging registrars receive regular education sessions. The intern should liaise with their
supervising registrars each day to find out if any teaching sessions are scheduled for that day. The intern is
encouraged to attend these education sessions.
Monash Health intern teaching program:
All Monash Health interns must attend an intern teaching session each week. This is held at 13:00 at the
Dandenong campus every Wednesday, and at the Clayton campus every Thursday. The intern must attend
one of these meetings each week, and can leave the department to attend the meeting irrespective of the
tasks they need to complete in the department.
[Updated, July 15, 2015]
Monash Health Prevocational Term Description
Observing reporting radiologists:
The intern will sometimes sit in with registrars, fellows and radiologists while they interpret and report
different types of imaging, in particular plain films. The intern will not be expected to know how to interpret
imaging, but rather to learn a few basic points which may help them in the future.
Subspecialist rotations:
The intern will be rostered to participate in certain subspecialist radiologist activities during their rotation. This
will include obstetric and gynecological ultrasound, paediatric radiology, nuclear medicine including PET
imaging, and neuro-interventional radiology. When the intern is rostered in these subspecialist areas they will
not be expected to perform other duties in the department.
Monash Imaging Intern Feedback:
An informal feedback session is held at the end of the intern’s fifth week, at which time a feedback document
is completed, the supervising radiologist gives feedback to the intern, the intern provides feedback to the
supervising radiologist, and any issues are discussed. A formal feedback session is held at the end of the
intern’s tenth week, where the process is repeated. After both feedback sessions, the feedback documents
are sent to the Junior Medical Workforce unit.
The Monash Imaging intern has contact with multiple registrars and radiologists throughout their rotation,
and are encouraged to ask questions and both give and receive feedback during their rotation. The
supervising radiologist has regular contact with the intern, and the intern is encouraged to contact the
supervising radiologist at any time, either in person, via email (on steve.alatakis@gmail.com), or via mobile
phone (on 0402147187) at any time, including out of hours.
Reading List:
The intern is expected to read a basic radiology textbook during the first few weeks of their radiology
rotation. The textbook, called “Felson’s Principles of Chest Roentgenology”, is a basic textbook which
teaches the reader how to look at chest x-rays. The textbook takes approximately 10 hours to read, and will
be emailed to the intern before they commence their rotation.
After the intern reads this basic textbook, a further basic textbook which describes how to look at CT scans
will be made available. Further basic textbooks and radiology journal articles are available on request.
Attitude and performance:
The Monash Imaging intern position is a rewarding rotation which allows the intern to develop valuable skills,
to participate in the workload of a busy radiology department, and to determine whether the intern is suited to
becoming a radiologist. The position differs to other intern positions in that the intern works with a large
number of registrars and radiologists, unlike other rotations where they work with a small number of doctors.
This allows the intern to increase their exposure to radiological knowledge and procedures. The drawback
with working with so many doctors is that it is possible for an intern to avoid performing their tasks, since the
intern is supervised by different doctors at different times.
It is extremely important that the intern is punctual, works hard, attempts to learn quickly, develops
radiological knowledge and skills, answers their pager quickly, responds to work related emails, maintains an
accurate log book, and demonstrates a positive attitude to their work. An intern who decides to reduce their
commitment to their work will eventually be discovered and appropriate disciplinary measures will be taken.
This document was completed by Monash Imaging intern supervisor Dr Steven Alatakis. Please contact me
at any time if you require further information.
[Updated, July 15, 2015]