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2013 CuRe Preclerkship Presentation Jeffrey Mottola, M.D. Diagnostic Imaging Health Science Centre, University of Manitoba Outline • Background • Overall objectives • Suggested systems • Investigation and interpretation (ex) • Where radiology fits in? Background • Currently • DI contributes 15h of preclerkship modular based teaching • Respiratory (2h), Gastrointestinal (2h), Neurosciences (2h), Musculoskeletal (4h), Genitourinary (1h), and ITC (4h) • 40% didactic 60% PBL 0% e-learning • Currently no multidisciplinary sessions • No dedicated sessions for radiology anatomy, techniques, appropriateness criteria, or radiation protection Overall Goals • Ensure undergrads are equipped with the knowledge and interpretation skills to practice safely and effectively during clinical rotations • To demonstrate familiarity with: • Anatomy and physiology pertaining to radiology • Imaging physics and radiation protection • Radiology requisition and DI expectations • The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) • The clinical role of imaging techniques • The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Overall Goals • To ensure undergraduates are equipped with the knowledge and interpretation skills they require to practice safely and effectively on clinical rotations • To demonstrate familiarity with: • Anatomy and physiology pertaining to radiology • Imaging physics and radiation protection • Radiology requisition and DI expectations • The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) • The clinical role of imaging techniques • The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Overall Goals • To ensure undergraduates are equipped with the knowledge and interpretation skills they require to practice safely and effectively on clinical rotations • To demonstrate familiarity with: • Anatomy and physiology pertaining to radiology • Imaging physics and radiation protection • Radiology requisition and DI expectations • The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) • The clinical role of imaging techniques • The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Overall Goals • To ensure undergraduates are equipped with the knowledge and interpretation skills they require to practice safely and effectively on clinical rotations • To demonstrate familiarity with: • Anatomy and physiology pertaining to radiology • Imaging physics and radiation protection • Radiology requisition and DI expectations • The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) • The clinical role of imaging techniques • The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Overall Goals • To ensure undergraduates are equipped with the knowledge and interpretation skills they require to practice safely and effectively on clinical rotations • To demonstrate familiarity with: • Anatomy and physiology pertaining to radiology • Imaging physics and radiation protection • Radiology requisition and DI expectations • The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) • The clinical role of imaging techniques • The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Overall Goals • To ensure undergraduates are equipped with the knowledge and interpretation skills they require to practice safely and effectively on clinical rotations • To demonstrate familiarity with: • • • • Anatomy and physiology pertaining to radiology Imaging physics and radiation protection Radiology requisition and DI expectations The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) • The clinical role of imaging techniques • The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Overall Goals • To ensure undergraduates are equipped with the knowledge and interpretation skills they require to practice safely and effectively on clinical rotations • To demonstrate familiarity with: • • • • • Anatomy and physiology pertaining to radiology Imaging physics and radiation protection Radiology requisition and DI expectations The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) The clinical role of imaging techniques • The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Overall Goals • To ensure undergraduates are equipped with the knowledge and interpretation skills they require to practice safely and effectively on clinical rotations • To demonstrate familiarity with: • • • • • • Anatomy and physiology pertaining to radiology Imaging physics and radiation protection Radiology requisition and DI expectations The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) The clinical role of imaging techniques The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Overall Goals • To ensure undergraduates are equipped with the knowledge and interpretation skills they require to practice safely and effectively on clinical rotations • To demonstrate familiarity with: • Anatomy and physiology pertaining to radiology • Imaging physics and radiation protection • Radiology requisition and DI expectations • The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) • The clinical role of imaging techniques • The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Overall Goals • To ensure undergraduates are equipped with the knowledge and interpretation skills they require to practice safely and effectively on clinical rotations • To demonstrate familiarity with: • Anatomy and physiology pertaining to radiology • Imaging physics and radiation protection • Radiology requisition and DI expectations • The characteristics of Imaging techniques (Xray, US, Nuc, CT, MR, IR) • The clinical role of imaging techniques • The use of appropriateness criteria (ACR) • Appropriate investigation and interpretation in common medical conditions • To support undergraduate learning across the remainder of the clinical curriculum by exploiting imaging to elucidate normal anatomy and pathology (Themes and longitudinal courses) • To raise the profile of radiology as a career choice for undergraduates Suggested Systems • • • • • • • • • • • • Gastrointestinal Repiratory Cardiovascular Genitourinary Musculoskeletal Endocrine – Thyroid/Adrenal Neurobiology Obstetrics and Gynecology Oncology – including breast Infectious diseases Pediatrics ENT • • • • • • • • • • • • Dr. J Mottola Dr. R Kreml Dr. I Kirkpatrick Dr. M Vivian Dr. J Koenig Dr. J Mottola Dr. V. Wadhwa Dr. N Milo Dr. J Reynolds Dr. B Memauri Dr. H Moffatt Dr. A Sam Breatnach et al. ESR 2011 Investigation and Interpretation • The Chest Radiograph Approach • • • • Positioning and film quality Views (PA, AP, lateral, Lat – decubitus, supine …) Patient demographics Normal anatomy • Musculoskeletal (bones and soft tissues) • Upper abdomen (Gastric bubble etc) • Mediastinum (interfaces, lines, and stripes) • Lungs (lobar and bronchial) • Pleura EXAMPLE Investigation and Interpretation • The Chest Radiograph • • • • • • • • • • • Cardiac enlargement Cardiac failure and pulmonary edema Pleural effusion Collapse and consolidation Misplaced ETT and Catheters Pneumothorax Pneumomediastinum and subcutaneous emphysema Hyperinflation of lungs Free gas beneath the diaphragm Pulmonary and mediastinal mass detection Acute vascular dissection and traumatic aortic injury EXAMPLE Investigation and Interpretation • Radiology in management of disease (multimodality) • • • • • • • • • • Chest and cardiac emergencies Airway disease: asthma and COPD Aneurysm and vascular dissection Pleural effusion Pneumonia Embolic disease Pulmonary neoplasms Hemoptysis Congenital heart disease Pediatric respiratory disease EXAMPLE Where we fit in? MO (WGS) Introduction to Diagnostic Imaging - General Overview - Characteristics and role of various imaging techniques - Technique related physics and safety (*) Where we fit in? M1(WGS and SGS) System based: - Anatomy and physiology in radiology - Approach to interpretation of normal images - Multidisciplinary sessions (Anatomy) Where we fit in? M2(WGS and SGS) System based: - Investigation and interpretation in common medical conditions (Rads) - Radiology incorporated into multidisciplinary sessions Where we fit in? M3 and/or M4 TTC (WGS and SGS) - Case based sessions (Investigation and interpretation – as in ITC) -Appropriateness criteria (ACR) -Radiology requisitions and expectations Where we fit in? CS/CR (WGS and SGS) - CS - Ultrasound (+/- Interpretation) - CR - Multidisciplinary sessions - Longitudinal e-learning curriculum