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SYLLABUS FOR 3rd YEAR MEDICAL STUDENTS
RADIOLOGY ELECTIVE
Course Title: MSIII Radiology Elective
Department: Department of Radiology
Course Director: Eduardo C. Gonzales Toledo, MD
Course Co-Director: Carlos Previgliano, MD
Faculty:
Scott Adams, MD
[email protected]
Office: 1-320A
Ext. 56208
Beeper: 0057
Chaitanya Ahuja, MD
[email protected]
Office: 1-349A
Ext. 56118
Beeper: 2629
Alberto I. Carbo, MD
[email protected]
Office: 1-324F
Ext. 55387
Beeper: 2526
Meghna Chadha, MD
[email protected]
Office: 1-349A
Ext. 56119
Beeper: 2628
Horacio D’Agostino, MD
[email protected]
Office: 1-320B
Ext. 56247
Cell: 318-470-7013
Thomas R. Gates, MD
[email protected]
Office: 1-324I Ext. 56235
Beeper: 1477
Eduardo C. Gonzales Toledo, MD
[email protected]
Office: 1-324L
Ext. 56280
Beeper: 1920
Anne Hollister, MD
[email protected]
Ext. 56185
Beeper: 1752
Mardjohan Hardjasudarma, MD
[email protected]
Office: 1-324A
Ext. 56232
Beeper: 0418
Stacy Lee, MD
[email protected]
Office: 1-349A
Ext.31322
Beeper: 2776
Nelson D. Luraguiz, MD
[email protected]
Office: 1-324B
Ext. 56278
Beeper: 2400
Linda Nall, MD
[email protected]
Office: 1-324H
Ext: 56234
Beeper: 1329
Carlos Previgliano, MD
[email protected]
Office: 1-351
Ext. 57196
Beeper: 2838
Guillermo P. Sangster, MD
[email protected]
Office: 1-324G
Ext. 57619
Beeper: 4567
Alberto I. Simoncini, MD
[email protected]
Office: 1-324K
Ext. 56223
Beeper: 2834
Romulo G. Vea, MD
[email protected]
Office: Interventional Suite
Ext. 54789
Beeper: 2946
Jane Yang, MD
[email protected]
Ext 56214
Beeper: 1480
Course Description:
During the third year of the MD curriculum at LSU Health Shreveport, a two-week
elective clerkship in the Department of Radiology is offered. The following are the
clerkship's overarching objectives as well as learning objectives for each of nine areas of
focus (described in depth at end of syllabus). This syllabus must be read in full before
reporting for the first day of the clerkship. Also, the student is responsible for printing out
and bringing the checklist on Moodle each day of the clerkship. Upon completion of the
MSIII Radiology Clerkship, students will:
A. Demonstrate basic skills in the interpretation of images of the chest, breast, abdomen,
neurological, and musculoskeletal systems, and appreciate the importance of history and
clinical data in the proper interpretation of imaging exams.
B. Use radiographic findings to develop a differential diagnosis and outline subsequent
diagnostic work-up for common medical problems such as bone trauma, chest pain,
shortness of breath, abdominal pain, and masses.
C. Describe the clinical indications and contraindications for specific imaging studies and
explain the clinical impact of different imaging modalities (e.g. radiation exposure,
contrast reaction); explain the limitations of different imaging studies.
D. Demonstrate the proper methods of ordering common imaging studies, and explain the
cost of commonly utilized imaging procedures.
E. Explain the underlying principles of physics relevant to commonly used imaging
modalities plain film radiography, ultrasonography, computerized tomography (CT),
magnetic resonance imaging (MRI), and positron emission tomography (PET).
F. Describe the basic principles of safety and radiation protection for patients and health
care practitioners.
COURSE COMPOSITION AND SCHEDULE:
Lectures:
Lectures given by the faculty appropriate to the content area for each day are available on
Moodle. The lectures will serve as an introduction to that specific area as well as an
overview of concepts important for evaluation of imaging studies by both radiologists
and those in other specialties. The lectures should be reviewed prior to beginning a given
content area. For instance, before beginning the MSK portion, students should watch the
MSK podcast, and so on. If the lecture is in PowerPoint format, play it in slideshow mode
in order to hear the audio recorded by the faculty.
Additional radiology conferences are held daily. The conference schedule is available
online at http://www.lsuhscshreveport.edu/Radiology/Radiologyschedule.aspx . If you
are unable to access the conference schedule online, please email Angie White at
[email protected] and she will e-mail you a copy. Students on the MSIII elective are
encouraged to attend as many of the conferences as possible.
Clinical Experience:
Both of the students in the rotation will follow the same schedule. During the elective
days, students will follow faculty in an area of their choice, which may or may not also
be one of the designated content areas. Students do not have to choose the same elective
and may follow different faculty during elective days. In the event of a holiday, the
elective day will be eliminated and the student should move on to the next content area in
order to cover all required content areas. The Interventional Radiology elective for the
clerkship involves observing three interventional procedures throughout the clerkship.
The student must talk to Angie White or contact Dr. D’Agostino if she is not available on
the first day of the rotation to find out the interventional schedule and appropriate times
to observe procedures.
In the event of a faculty meeting or conference that the radiology faculty must attend, the
student is required to attend as well.
Attire:
Students should wear appropriate hospital scrubs and white coat throughout the rotation.
Evaluation Method (Grading Criteria):
Course evaluation will be on resident and faculty feedback and daily participation on the
radiology service. Students’ scores will be calculated according to the following criteria:
Objective
Multiple Choice Exam
Subjective
60% Performance Evaluations
40%
The exam will consist of 50 questions that will be representative of important
radiological concepts that are emphasized in the daily lectures. It will count for the
objective portion of the clerkship grade. Students should report to Dr. Gonzalez
Toledo’s office at 1pm on the last day of the clerkship to take the exam on Moodle.
The areas of clinical/performance evaluation include the following topics:
1.
2.
3.
4.
Clinical Knowledge
Participation
Work Ethic
Professionalism – including attendance
Additionally, for each area of focus the student must identify unknown imaging
studies/pathologies as posed by the physician.
Subject
Main Contact/
Lecturer
Contingency
1
Contingency
2
Monday
1. MSK
Tuesday
2. MSK
Contingency
3
Dr. Simoncini
(typically reads
in ER reading
room, 1st floor
hospital, room
D1-4)
Dr.
Gonzalez
Toledo
Dr. Hollister Report to
attending
Dr. Simoncini
Dr.
Gonzalez
Toledo
Dr. Hollister Report to
attending
Choose
Wednesday 3.
Elective according to
(skip if 1 topic of interest
day is
lost for a
Holiday)
Thursday
4.
Abdomi
nopelvic
Dr. Sangster
(typically reads
in FWCC, 1st
floor)
Dr. Carbo
Report to
attending
Friday
5.
Abdomi
nopelvic
Dr. Carbo
(typically reads
in ACC
radiology clinic
[1st floor])
Dr. Sangster
Report to
attending
Monday
6.
Cardio
thoracic
Dr. Previgliano
(typically reads
in general
reading room,
2nd floor
hospital, code
3322)
Dr. Carbo
Report to
attending
Tuesday
7.Cardio
thoracic
Dr. Previgliano
Dr. Carbo
Report to
attending
Wednesday 8. Neuro
Dr. Gonzales
Dr.
Toledo
Hardjasudar
(typically reads ma
in neuro reading
Dr.
Simoncini
Report to
attending
room, hospital
2nd floor)
Thursday
9. Breast
(and test
only on
Thanksg
iving
week)
Dr. Luraguiz
(typically reads
in ACC
radiology clinic
[1st floor])
Dr. Stacey
Lee
(typically
reads in
FWCC, 3rd
floor)
Friday
10. Test/
Elective
Test
administered by
Dr. Gonzales
Toledo
Choose
elective
according to
topic of
interest
Report to
attending
There is a standard web-based format for student performance evaluation in the third year
that all clerkships and electives use on MyEvaluations.com. Faculty will complete a
MyEvaluation survey at the end of the clerkship.
Grades:
Above 89.5
A
79.5 to 89.49
B
69.5 to 79.49
C
<69.5
F; Fail at the discretion and consideration of
the clerkship director.
Attendance:
Attendance and participation in clinical activities and related discussion is required for
optimal student benefit. Absences may be excused or granted in the case of serious illness
or direct family emergency. The clinical preceptor must be notified of the absence as
soon as possible through email, phone, or other method of personal communication
established by the preceptor.
All days missed during the rotation must be made up at the preceptor’s discretion in order
to successfully complete the rotation. Unexcused absences of two days during the
rotation will result in the loss of a letter grade. More than two days of unexcused absence
will result in a failing grade for the rotation.
Students are to arrange both electives (Day 3 and Day 10) with the faculty according to
their topic of interest.
Students should contact their preceptors 2 to 3 days in advance to see
where/when you should meet him. If no response, arrive at 8am and talk
to Angie White in room 1-320D to contact the preceptor for the day.
If Mrs. White is unavailable, contact Dr. D’Agostino for assistance
(Office: 1-320A). If both are unavailable, use the faculty contact list
provided on Moodle to page your preceptor directly.
In the event that none of the preceptors are available on a certain day, go to the
attending or main contact of the next day.
The reading room schedule is online at
http://www.lsuhscshreveport.edu/Radiology/Radiologyschedule.aspx and will always
list if a faculty member is away. Students are encouraged to check this schedule on a
regular basis.
ED2 Requirements:
Students will be required to present ED2 documentation (download the file named
“checklist” from Moodle) each day to be signed by the faculty. This will denote
attendance. The student must witness/complete each of the disease processes or
objectives on the ED2 checklist either in the lecture or while with the faculty with
verification by the faculty. If there are no cases that fulfill the ED2 objective, it is the
student’s responsibility to ask the faculty member to produce an archived case.
Areas of Focus:
A. Musculoskeletal Imaging (REQUIRED)
a. Key Concepts
i. By attending lectures/seminars, and attending radiologic
interpretation in reading rooms, the student will understand:
1. The basics of ordering and interpreting musculoskeletal
imaging studies in acute musculoskeletal trauma
2. Appropriate use of MRI for musculoskeletal imaging in
painful joints
b. Learning Objectives
i. By the end of the Musculoskeletal imaging segment, the student
will be able to:
1. Recognize radiographic soft tissue clues for fractures of the
wrist and elbow
2. Describe basic concepts of MRI imaging for cartilage
injury, fracture, and edema
3. Distinguish anterior from posterior dislocation of the hip on
a pelvic radiograph
4. Describe the radiographic findings seen in AVN of the hip
5. Define a burst fracture of the spine and recognize it on AP
and lateral films of the thoracic spine
6. Describe standard views used to image the shoulder in
trauma
7. Identify the lines used to evaluate the cervical spine in
acute trauma setting
8. Explain the role of radiographs, CT, radionuclide bone
scans, and MRI in evaluating patients with musculoskeletal
problems
B. Cardiothoracic Imaging (REQUIRED)
a. Key Concepts
i. By attending lectures/seminars and attending radiologic
interpretation in reading rooms, students will understand:
1. The basics of ordering and interpretation of cardiothoracic
imaging studies in acute chest pain as well as the value of
imaging in diagnosis of acute chest pain related to
cardiovascular disease
2. The anatomy and basic interpretive principles of chest
radiology
3. Tubes and lines, including placement, complications, and
imaging of devices in the chest
4. Interpretation of abnormal air collections in the thorax and
how to recognize pneumothorax
5. Imaging of pneumonia, TB, and atelectasis
b. Learning Objectives:
i. By the end of the Cardiothoracic-imaging segment, the student will
be able to:
1. Identify and list diagnoses for and/or state significance of:
pneumothorax on an upright chest radiograph and on a
supine chest radiograph; pneumomediastinum on a chest
radiograph; collapse of the lung; lobar consolidation on a
chest radiograph and CT scan; left heart failure on a chest
radiograph; silhouette sign and the air bronchogram sign on
a chest radiograph; abnormal mediastinum on a frontal chest
radiograph
2. Differentiate complete opacification of a hemithorax as
pleural effusion, lung collapse or lung consolidation/mass
based on the position of the mediastinum
3. Recognize the development of an enlarging pleural fluid
collection on a chest radiograph of a patient with pneumonia
and suggest the diagnosis of empyema and role of chest CT
scanning
4. Identify a malpositioned chest tube, feeding/nasogastric
tube, endotracheal tube, pacemaker leads, pulmonary artery
catheter and central venous catheter on a chest radiograph,
and state the desired location for each
5. For cardiac MRI, be able to identify appropriate indications
for cardiac MRI and to describe differential diagnosis of
abnormal delayed myocardial contrast enhancement
6. For cardiac CT, be able to identify appropriate indications
for cardiac CT and thoracic Ct angiography as well as
review radiation doses and their implications with cardiac
CT
C. Abdominopelvic Imaging (REQUIRED)
a. Key Concepts
i. By attending lectures/seminars and attending radiologic
interpretation in reading rooms, the student will understand:
1. Appropriate imaging workup for acute abdominal pain
2. Anatomy, interpretive principles, and pathology in both
radiographs and CT images of the abdomen
3. Decision-making in abdominal imaging
b. Learning Objectives
i. By the end of the Abdominopelvic imaging segment, the student
will be able to:
1. Identify the following anatomic structures on a plain film
and/or CT of the abdomen/ pelvis: psoas muscle, spleen,
stomach, colon, liver, small bowel, bladder, kidneys,
rectum, adrenal glands (CT), pancreas (CT), vessels superior mesenteric artery and vein, splenic vein, portal
vein, aorta, IVC, iliac artery and vein (CT), duodenum
(CT), urinary bladder (CT), ureters (CT)
2. Recognize on the plain abdominal films: intestinal
obstruction, pneumoperitoneum, ileus, toxic megacolon and
sigmoid volvulus
3. Understand the indications and common imaging patterns
of gastrointestinal contrast exams
4. Recognize ERCP and MRCP images and indications
5. Describe the imaging workup of acute abdominal pain.
a. Review current imaging tools for the evaluation of
patients with acute abdominal pain
b. Discuss guidelines for appropriate imaging
modality selection
c. Recognize the most common diseases producing an
acute abdominal pain: small bowel obstruction,
obstructive uropathy, appendicitis,
pneumoperitoneum, splenomegaly, acute
cholecystitis, pancreatitis, colonic diverticulitis,
ischemic bowel and intestinal perforation
D. Neuroradiology (REQUIRED)
a. Key Concepts
i. By attending lectures/seminars and attending imaging
interpretation in reading rooms, the student will understand:
1. The methods of reducing the risk of contrast nephropathy
2. The weaknesses and limitations of imaging in the
evaluation of patient’s with central neurologic symptoms
and diseases
b. Learning Objectives
i. By the end of the Neuroradiology segment, the student will have
an understanding of the indications for, limitations of, and basic
methods of selecting and interpreting neuroradiologic studies. The
student will be able to:
1. Define terms commonly used in radiology reports
including: lucency, opacity, attenuation, Hounsfield units
(HU), hyperechoic, hypoechoic, signal
2. Categorize different tissues from most to least opaque on xray including: bone, soft tissue, air, metal, and fat.
3. Describe the procedure for ordering a radiologic exam at
your institution
4. Summarize the categories of critical information that must
be included on an imaging exam requisition
5. State the difference between a preliminary or “wet” read
and the final radiologic report
6. Predict types of imaging findings that would reported
directly to the ordering physician versus those which would
appear only in the transcribed radiologic report
7. Distinguish between the different types of contrast used in
imaging exams and the potential diagnostic benefits of each
8. Discuss the potential complications of intravenous contrast
administration for CT and MR exams and identify
predisposing risk factors
9. Describe different methods for reducing the risk of contrast
nephropathy
10. Identify normal anatomic structures of the head and neck,
brain, and spine on imaging exams and compare the degree
of anatomic detail between CT and MR
11. Recognize normal age related changes in the brain at
imaging
12. Describe the strengths, weaknesses and limitations of CT
vs. MRI in the evaluation of patient’s with central
neurologic symptoms and diseases
13. List some indications for contrast enhanced MRI and CT
14. Recognize imaging signs of increased intracranial pressure
15. Discriminate between a subdural and epidural hematoma at
CT
16. Describe imaging signs of a subarachnoid hemorrhage
E. Breast Imaging (REQUIRED)
a. Key Concepts
i. By attending lectures/seminars and attending radiologic
interpretation in reading rooms, the student will understand:
1. Different methods to evaluate for breast cancer, including
mammography, ultrasound, and MRI.
b. Lecture Objectives
i. By the end of the Breast imaging segment, the student will be able
to:
1. Explain the basic principles of mammography, including
screening views, diagnostic views, compression, and
positioning
2. Be able to describe the four major mammographic
findings
3. Explain the differences between and indications for
screening and diagnostic mammography
4. Understand the indications for breast ultrasound and breast
MRI
5. Be able to describe the basic types of image-guided
procedures of the breast and when they are performed
6. Explain the use of the BI-RADS atlas and how it
standardizes terminology, assessment, and
recommendations
7. Distinguish what studies are appropriate in the work-up of
patients depending on their risk status and the presence of
symptoms
8. Differentiate the varying recommendations for screening
mammography by major professional organizations,
including the American College of Radiology (ACR),
National Cancer Institute (NCI), and American Cancer
Society (ACS), and US Preventative Services Task Force
(USPSTF) for mammography screening
F. Nuclear Imaging ELECTIVE
a. Key Concepts
i. By attending lecture/seminars and attending radiologic
interpretation in reading rooms, the student will understand:
1. Nuclear imaging in endocrine disease
2. Clinical positron emission tomography (PET), and how it is
used today in workup of malignancy
b. Learning Objectives
i. By the end of the Nuclear imaging elective segment, to
demonstrate learning the limitations and the basics of ordering and
interpretation of nuclear medicine studies, the student will be able
to:
1. Explain, generally, what PET scanning is and how it works
2. Identify some of the indications for a PET scan
3. Recognize the benefits of a PET/CT scan over a PET scan
ii. By the end of the Endocrine Nuclear Imaging elective segment, to
demonstrate the physiology and imaging techniques used in
Endocrine Nuclear Medicine in the common disorders, the student
will be able to:
1. Recognize major symptoms of thyrotoxicosis
2. Identify thyrotoxic etiology from the scan findings
3. Recognize the different thyrotoxic therapies available
4. Identify "cold nodules" and list a differential diagnosis
5. Recognize the role of therapeutic radioiodine in treatment
of thyroid cancer
6. Recognize molecular imaging concepts in neuroendocrine
imaging
7. Explain the relationship between bone mass and fracture
risk
8. Differentiate between accuracy and precision in
management of patients with osteoporosis undergoing
BMD measurement
G. Interventional Radiology ELECTIVE
a. Key Concepts
i. By attending lectures/seminars and attending radiologic
interpretation in reading rooms, the student will understand:
1. Principles of interventional radiology including abscess
drainage and biopsies
2. Types of, and indications for, the procedures performed in
Interventional Radiology
b. Learning Objectives
i. By the end of the Interventional Radiology elective segment, to
demonstrate learning the limitations and the basics of ordering and
interpretation of interventional radiology procedures, the student
will be able to:
1. Discuss indications for commonly performed interventional
procedures
2. Differentiate between the various procedures performed in
interventional radiology
3. Explain the benefits of interventional radiology procedures
H. Pediatric Radiology ELECTIVE
a. Key Concepts
i. By attending lectures/seminars, and attending radiologic
interpretation in reading rooms, the student will understand:
1. Differences and similarities between pediatric and adult
procedures
2. Indications for ordering imaging procedures on pediatric
patients
3. Special concerns in pediatric imaging regarding need for
sedation and limiting radiation exposure
b. Learning Objectives
i. By the end of the Pediatric Radiology elective segment, to
demonstrate learning the limitations and the basics of ordering and
interpreting pediatric radiology procedures, the student will be able
to:
1. Discuss indications for pediatric imaging exams
2. Compare the limitations and advantages of imaging
modalities as applied to pediatrics
3. Begin to synthesize a systematic approach to evaluating
pediatric patients of varying ages with imaging
4. Discuss challenges specific to imaging children and how
these may affect choice of imaging modality
5. Contrast normal anatomy on a chest x-ray of an infant
compared to an adult
6. Identify consolidation on CXR and formulate a differential
diagnosis for the appearance
7. Recognize growth plates as a normal finding
8. Explain the significance of physeal involvement of a
fracture
9. List types of injuries that should raise suspicion for nonaccidental trauma
10. Describe the process of and indications for performing a
voiding cystourethrogram (VCUG)
I. Abdominal and Pelvic Ultrasound ELECTIVE
a. Key Concepts
i. By attending lectures/seminars, and attending radiologic
interpretation in reading rooms, the student will understand:
1. The basic physics underlying ultrasound technology
2. The conventions of ultrasound image display
3. Fundamental advantages and disadvantages of ultrasound
versus other imaging modalities
b. Learning Objectives
i. By the end of the Abdominal & Pelvic Ultrasound elective
segment, to demonstrate learning the limitations and the basics of
ordering and interpreting ultrasound procedures, the student will be
able to:
1. Discuss several common indications for abdominal and
pelvic ultrasound examination
2. Discuss common, abnormal sonographic findings related to
gall bladder, ovarian, and obstetric pathology
3. Distinguish the pros and cons of obtaining an ultrasound
examination given specific clinical scenarios
4. Explain the advantages of transvaginal ultrasonography
compared to a transabdominal pelvic ultrasound
5. Schedule fetal ultrasounds at the appropriate diagnostic
intervals
6. Estimate the accuracy of ultrasound for pregnancy dating
7. Describe the limitations of ultrasound for prenatal
diagnosis
8. Construct the appropriate imaging algorithm for common
diagnostic scenarios including: First trimester vaginal
bleeding, post menopausal vaginal bleeding, female pelvic
pain, staging of gynecologic malignancies
Supplemental Materials:
Supplemental podcast learning modules for radiology:
https://itunes.apple.com/us/podcast/learningradiology-video-podcasts/id287873184
https://itunes.apple.com/us/podcast/radiologyinfo.org-your-radiologist/id420938062