Download Cardiothoracic Radiology

Louisiana State University Health Sciences Center – Shreveport
Radiology Residency Program
Cardiothoracic Curriculum, Goals and Objectives
The goal is for each resident to achieve independent competency and acquire tools with which
to continue self-education and life-long learning. The level of practice should be consistent
with national community standards as outlined in the American College of Radiology (ACR)
Practice Guidelines.
Emphasis throughout the four-year residency program is on understanding the
pathophysiology of diseases and disorders, and its appearance across all different imaging
modalities.
Patient Care
FIRST YEAR RESIDENTS (PGY-2):
1. Demonstrate knowledge of the basics of radiation safety. Understand radiation dose from
chest radiographs and chest CT.
2. Demonstrate knowledge of and ability to use electronic patient information systems,
including the radiology information system and appropriate use of electronic systems to
obtain patient laboratory data, etc., to integrate with imaging findings to assist in an
accurate diagnosis.
3. Understand the indications for each imaging examination performed and the specific
indications for any examination performed on an individual patient. Ability to protocol CT
examinations appropriately according to indication, and with attention to reducing patient
risk from radiation and contrast exposure.
4. Demonstrate the ability to use the internet as a tool for teaching and learning, including
access to information to improve knowledge in patient care situations.
SECOND YEAR RESIDENTS (PGY-3):
1. All of the objectives listed for first year should be attained with increased mastery.
2. Organized and efficient approach to thoracic procedures, including planning the procedure,
informed consent, performing the procedure, immediate post-procedure care, followup of
patients with tubes in place, and communication with clinicians. Followup on procedures to
obtain results of biopsies.
THIRD YEAR RESIDENTS (PGY-4):
1. All of the objectives listed for first and second years should be attained with increased
mastery.
2. Teaching of the above objectives to medical students and junior residents.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for earlier years should be attained with increased mastery.
Medical Knowledge
FIRST YEAR RESIDENTS (PGY-2):
During the first year, residents are expected to learn indications for common radiologic procedures, the
technique for performing these procedures, and normal findings. These include:
1. Residents should become familiar with interpretations of standard chest radiographic
studies and chest CT, including CT angiography for aortic and pulmonary vascular disease.
2. Normal anatomy on CXR and CT should be understood.
3. Basic familiarity with the most common pathologies should be demonstrated: edema,
pneumonia, pulmonary embolism, cardiac chamber enlargement, aortic vascular disease,
lung cancer, lung nodules, .
4. The principles of use of radiographic contrast material should be understood. This includes
indications for application of contrast, contraindications to use of contrast, considerations in
choice of particular contrast material, and recognition and treatment of adverse reactions to
contrast material.
5. The principles of performing image-guided thoracic procedures should be understood.
6. Specific knowledge objectives appended.
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SECOND YEAR RESIDENTS (PGY-3):
1. All of the objectives listed for earlier years should be attained with increased mastery.
2. Specific knowledge objectives appended.
THIRD YEAR RESIDENTS (PGY-4):
1. All of the objectives listed for first and second year residents should be reviewed with
increased mastery.
2. Demonstration of the knowledge associated with first and second year objectives should be
demonstrated with teaching to medical students and junior residents.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. Teaching of the above objectives to medical students and junior residents should be
increasingly emphasized.
Interpersonal and Communication Skills
FIRST YEAR RESIDENTS (PGY-2):
1. Work to structure written reports of imaging studies to accurately and effectively transmit
results and recommendations to referring clinicians.
2. Demonstrate appropriate phone communication skills.
3. Begin to develop skills in obtaining informed consent, focusing on effective communication
skills with patients, including discussion of alternatives and possible complications of
procedures.
4. Effective and appropriate communication with technologists and other staff.
SECOND YEAR RESIDENTS (PGY-3):
1. Demonstrate increasing skill in clearly and concisely communicating via the radiology
written report.
2. Demonstrate ability to discuss cases with clinicians.
3. Demonstrate refinement in skills related to obtaining informed consent, including use of
interpreters when language barriers exist.
4. Demonstrate leadership role in communications/interactions with technical personnel and
patients, including explanation of delays related to emergencies.
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THIRD YEAR RESIDENTS (PGY-4):
1. All of the objectives listed for first and second year residents should be reviewed with
increased mastery.
2. Improved ability to discuss cases with clinicians
3. Demonstration of the knowledge associated with first and second year objectives (in this
document and rotation specific objectives) should be demonstrated with teaching to
medical students and junior residents.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. Demonstrate increased ability to communicate effectively with providers at all levels of the
health care system as well as those in outside agencies.
3. The senior resident should model by action as well as directly teach the above objectives to
medical students and junior residents.
Professionalism
FIRST YEAR RESIDENTS (PGY-2):
1. Demonstrate understanding of broad principles of medical ethics.
2. Demonstrate understanding of the principles of patient confidentiality by compliance with the
HIPAA Privacy Rule.
3. Demonstrate completion of medical records, including review/signoff of radiology reports,
according to departmental/hospital guidelines.
4. Demonstrate positive work habits, including punctuality and professional appearance.
5. Demonstrate honesty with patients and all members of the health care team.
6. Enthusiastic participation as a member of the patient-care team.
SECOND YEAR RESIDENTS (PGY-3):
1. All of the objectives listed for first year residents should be reviewed with increased
mastery.
2. Demonstrate altruism (putting the interests of patients and others above own self-interest).
3. Demonstrate organized and efficient approach to managing workload.
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THIRD YEAR RESIDENTS (PGY-4):
1. All of the objectives listed for first and second year residents should be reviewed with
increased mastery.
2. The resident should teach the above objectives to medical students and junior residents
directly as well as by modeling behavior consistent with these objectives.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. The senior resident should increasingly supervise and mentor medical students and junior
residents in achieving these objectives.
Practice-Based Learning and Improvement
FIRST YEAR RESIDENTS (PGY-2):
1.
Analyze practice experience and perform practice-based improvement in cognitive
knowledge, observational skills, formulating a synthesis and impression, and
procedural skills. Demonstrate this by active review and performance modification
related to on-call discrepancies and active participation in morbidity and mortality/
misses conferences.
2.
Demonstrate use of multiple sources, including information technology, to optimize
life long learning and support patient care decisions.
3. Familiarity with internet resources, including PubMed, chestxray.com, etc.
SECOND YEAR RESIDENTS (PGY-3):
1. All of the objectives listed for first year residents should be reviewed with increased
mastery.
2. Demonstrate increasingly critical assessment of the scientific literature in journal clubs as
well as other clinical and conference environments.
3. Review recent key papers supplied by thoracic faculty
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THIRD YEAR RESIDENTS (PGY-4):
1. All of the objectives listed for first and second year residents should be reviewed with
increased mastery.
2. Familiarity with thoracic radiology material recently published in Radiology, Radiographics
and AJR.
FOURTH YEAR RESIDENTS (PGY-5):
1. All of the objectives listed for first, second, and third year residents should be reviewed with
increased mastery.
2. Demonstrate awareness of resources available to practicing radiologists for lifelong learning,
including print, CD-ROM, and internet products of the ACR.
3. Demonstrate knowledge of the above objectives by supervision of medical students and
junior residents as well as by directly teaching these objectives.
Systems-Based Practice
FIRST YEAR RESIDENTS (PGY-2):
1. Begin to acquire knowledge regarding the costs of imaging studies and impact of costs on
appropriate choices for clinical use.
2. Demonstrate knowledge of the examination system of the American Board of Radiology and
importance of board certification.
SECOND, THIRD AND FOURTH ROTATIONS (PGY 3-5):
1. All of the objectives listed for first year residents should be reviewed with increased
mastery.
2. Demonstrate the ability to design cost-effective imaging strategies/care plans based on
knowledge of best practices.
3. Demonstrate knowledge of how decisions about timing/availability of imaging studies may
affect hospital length of stay, referral patterns for specific examinations and use of
diagnostic studies outside the Department of Radiology.
4. Demonstrate knowledge of hospital-based systems that affect physician practice, including
physician code of ethics, medical staff bylaws, quality assurance committees, and
credentialing processes. This includes knowledge of how these processes may affect the
scope of practice of any one physician and competition among practitioners.
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Year 1 (first 4-week rotation)
Goals: After completion of the first thoracic radiology rotation, the resident will be able to:
1. demonstrate learning of the knowledge-based objectives (1/4 of the total topics).
2. understand standard patient positioning in thoracic radiology.
3. obtain pertinent patient information relative to radiologic examinations.
4. accurately and concisely dictate a chest radiograph report.
5. communicate effectively with referring clinicians and supervisory staff.
6. demonstrate knowledge of the clinical indications for obtaining chest radiographs and
when a chest CT or MR may be necessary.
7. know basics of the IV contrast agents
8. be familiar with CT anatomy of the respiratory and cardiovascular tract.
9. perform basic image-guided procedures of the chest.
10. prepare the resident to be able to safely practice while on call by the end of the first
year.
Knowledge Based Objectives:
1. Review the thoracic anatomy including: chest wall, lungs, pleura and mediastinal organs.
2. Understand the normal imaging appearance of thoracic organs including cardiovascular and
respiratory tracts using plain film radiography, computed tomography (CT).
3. Identify and describe cardiothoracic diseases on plain films.
Technical Skills:
1. Be familiar with fluoroscopic techniques and safe operation of the fluoroscopic unit.
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2. Interview patients prior to radiographic contrast injection.
3. Compose a concise dictated a plain film report report.
4. Begin to function as a consultant to referring physicians and patients.
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References for 1 Year:
1
Felson's Principles of Chest Roentgenology
2
Chest radiology: plain film patterns and differential diagnoses. James C. Reed.
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Fraser and Pare's Diagnosis of Diseases of the Chest
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Fundamentals of Body CT (Webb, Helms, Brant)
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ACR Contrast Manual
Year 2
Goal: After completion of the second thoracic radiology rotation, and in addition to those goals
listed for Year 1, the resident will:
1. demonstrate advances of the knowledge-based learning objectives (½ of the topics) .
2. continue to build on chest radiograph interpretive skills.
3. Develop detailed knowledge of contrast agents and allergic reactions.
a. Be prepared to answer patient and staff questions concerning when contrast
media should or should not be utilized and how to treat contrast reactions.
4. develop skills in protocoling, monitoring, and interpreting chest CT scans.
5. demonstrate an ability to generate and interpret basic multiplanar reconstructions
(MPR) and volume-rendereing images of CT.
6. understand normal MRI findings related to the respiratory and cardiovascular tracts.
7. Acquire more confidence during calls.
8. Perform simple image-guided biopsies and drainage procedures with instruction and
under the direct supervision of the Interventional radiology Faculty.
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Knowledge Based Objectives:
Contrast Material:
1. Understand the physical properties and composition of standard contrast agents and
the physiologic mechanisms of contrast media excretion.
2. Learn to screen patients who are at risk from injection of intravascular radiographic
contrast material. Understand the classification, symptoms, and signs of contrast reactions
and clinical management including appropriate use of pharmacologic agents and their mode
of administration and doses after appropriate patient assessment.
3. Understand the indications for premedication and the appropriate regimen to
premedicate contrast sensitive patients including dosages, and dose scheduling.
1. Refine comprehension of physics as it applies to patient medical radiation dose, and
radiation safety.
2. Expand understanding of the causes and effects of Cardiothoracic and respiratory tract
diseases.
3. Understand diagnosis, classification, and management of trauma.
4. Attend department case conferences and didactic presentations, including
interdepartmental conferences, grand rounds, guest lecturers, etc.
References for 2nd year:
1. ACR Practice Guidelines for the Use of Intravascular Contrast Media, Version 5.0
2. CT and MR of the Chest (Naidich, Webb, Muller)
3. High Resolution CT of the Lung (Webb, Muller, Naidich)
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Year 3:
Goal: Add to general knowledge acquired in the first two years and learn
more advanced and less common techniques and disorders.
Objectives:
1. Increase awareness of the CT and MR manifestations of cardiothoracic disease:
a. Learn about the different types of thoracic traumatic injuries and their
classification as well as recommended non-surgical and surgical
management and injury prognosis.
b. Understand of inflammatory diseases as seen on CT and MR and their
clinical management.
c. Learn staging of thoracic neoplasms
2. Use the independent workstation for more advanced applications and image
reconstruction on CT.
3. develop skills in protocoling, monitoring, and interpreting chest MR studies, including
cardiovascular MRI.
4. demonstrate an ability to generate and interpret multiplanar reformatted (MPR) or
three-dimensional images MRI studies as appropriate.
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Reference for 3 year: See 1st and 2nd years
Year 4
Goal: Review all the knowledge and skills you have accumulated in the
first three years and fill the gaps in your knowledge.
1. demonstrate learning of the knowledge-based objectives.
2. refine skills in interpretation of radiographs, CT and MRI scans.
3. correlate pathologic and clinical data with radiographic, CT and MRI findings.
4. become a more autonomous consultant and teacher.
5. get as much case management experience as possible.
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Knowledge Based Objectives:
1
Review cases in the ACR teaching file and peer reviewed teaching files available on the
internet. The best sites should present as unknown cases, asking for you to make a diagnosis
and suggest recommended imaging and clinical management, summarizing the correct
diagnosis and management at the end.
2
Attend available department case conferences or other didactic presentations, including
interdepartmental conferences, grand rounds, guest lecturers, etc. Emphasize independent
thinking before seeking direct staff supervised patient management.
3
Understand the basic principles of radiofrequency ablation, thermocoagulation, and
other minimally invasive procedures, along with the appropriate imaging guidance and post
treatment surveillance.
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Reference for 4 year: See 1st and 2nd years
Assessment/Evaluation of Residents
1)
Electronic evaluation by attending faculty each month after the rotation and Written evaluation
every 6 Months with the Program Director
2)
ACR in-training examination
3)
OSCE evaluation twice per year
4)
Written ABR exam
5)
Oral ABR exam
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List of didactic lectures:

Thoracic anatomy

CXR: Basic interpretation and findings

Signs in thoracic radiology

Interstitial lung disease

Alveolar lung disease

Atelectasis, airways, and obstructive lung disease

Pulmonary infection

Mediastinal masses

Solitary pulmonary nodules

Benign and malignant neoplasms of the lung

Congenital lung disease

Thoracic vascular trauma

Thoracic non vascular trauma

Non traumatic aortic emergencias

Pulmonary embolism

Congenital heart disease

Ischemic heart disease

Myocardial disease

Cardiac valvular disease

Pericardial disease
References:
University of Colorado (uchsc.edu)
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