Program Curriculum

Program Curriculum

Rotation Information

Chest

The resident assigned to this rotation is responsible for plain films of the chest. Your daily routine starts with the morning ICU films, followed by a steady stream of inpatient, outpatient and ER radiographs. After reading a steady stream of mostly portable chest films, you will weep with joy to see some beautiful PA and lateral films. You are encouraged to look up comparison cross-sectional images to improve your understanding of the anatomy and pathophysiology.

You will be required to call the recovery room and PICC nurse for line placements and possible post-operative complications. Please review the emergent findings list and make all necessary phone calls in a timely fashion as indicated.

Traditionally, this is also the station that medicine teams visit during morning rounds, so you will be consulted to discuss all other imaging modalities with the clinical teams. This is your opportunity to learn more detailed clinical information to guide and tailor your reports and to correlate imaging and clinical findings.

Recommended Reading

Goodman, L.R. Felson's Principles of Chest Roentgenology: A Programmed Text, 3rd ed, W.B. Saunders, Philadelphia, PA, 2006.

Collins, Chest Radiology: The Essentials, 1999 1st ed. (get the 2nd Edition)

GI & GU

The resident assigned to the rotation is responsible for all studies performed utilizing plain radiography and fluoroscopy to evaluate the GI and GU systems. In the morning, review the daily schedule and clarifying order indications with the ordering physician prior to the commencement of the exam. Before meeting the patient, review the chart and any prior imaging studies then and familiarize yourself with the patient's post surgical anatomy if applicable.

The attending radiologist will review all images and video of the fluoroscopy study with the resident, and the resident will dictate the exam. All emergent results will be communicated with the ordering physician in a timely manner.

It is the responsibility of the resident to maintain good communication with the technologists to keep the schedule moving and to complete possible add-on cases before call starts.

Familiarize yourself with the different contrast agents, route of administration, excretion and potential side effects. Contrast reaction or extravasation treatment guidelines are available at the reading station. The attending radiologist is to be notified immediately of any contrast reactions or extravasations that occur in the radiology suite.

You are responsible to prepare the cases (CT or fluoroscopy) for the monthly GI - Surgery -Radiology Conference that takes place in the main surgery conference room every 4th Friday of the month at 1PM.

Recommended Reading

Fundamentals of Fluoroscopy - Houston

Webb, W.R., Brant, W.E., Helms, C.A., Fundamentals of Body CT, 2nd ed., W.B. Saunders, Philadelphia, PA, 1998.

Mayo Clinic Gastrointestinal Imaging Review (Paperback) by C Danie Joimson (Author), Grant D.. Schmit (Author)

Halpert, RD.,. Goodman, P., Gastrointestinal Radiology -- The Requisites, Mosby, St. Louis, MO, 2006, 2nd ed.

MSK

The resident on the MSK rotation will be responsible for interpreting and dictating all plain films and intraoperative fluoroscopies, CTs and MRIs of the musculoskeletal system, also including skull and sinus radiographs.

You will perform arthrograms and joint injection with the MSK attending.

The MSK resident is expected to run the trauma CT scanning and give out a preliminary verbal report to the Trauma Surgery team at the scanner about all trauma head, face, c-spine, and chest/abdomen/pelvis CT scans. The MSK resident will dictate the final report for the trauma chest/abdomen/pelvis CT, and the neuro resident will dictate the head, face and c-spine images.

The resident should initially aim to become familiar with normal musculoskeletal anatomy and anatomical variants and work towards understanding the pathology of the system and to become comfortable and proficient at interpreting MSK plain film, CT, and MRI. Particular topics include traumatic injury, degenerative changes, arthritides, benign and neoplastic lesions, and systemic disease as it affects the musculoskeletal system.

Recommended Reading

Fundamentals of skeletal radiology - Helms

Musculoskeletal MRI - Helms

Musculoskeletal Imaging: The Requisites - Manaster

Body

The body resident is responsible for the following studies:

  • Chest, abdomen, and pelvic CTs
  • Chest, abdomen and pelvic MRIs
  • Cardiac MRI
  • Chest portion of the cardiac CTs (cardiac will be read by Dr. Paknikar)

The MSK resident will read all trauma CTs and the IR residents will read the Abdomen/pelvis CTAs. Occasionally, clinical teams will request interpretation of outside CT scans. When performing this service, please ask for the outside report, if available. After you have assisted the team, make sure the disk is loaded onto PACS by the PACS coordinator.

Your daily routine starts with protocoling all CT scans. All departmental protocols are outlined in a binder in the CT control room. This will often require looking up comparison imaging and at times calling the ordering provider for clarification of the clinical question. Contact your staff for any CT or MRI protocol questions. Make all effort to find alternative imaging methods for pregnant or pediatric patients. Pregnant patients have to be consented before a CT scan.

During the day, the body resident is frequently called to the CT scanner to determine if delayed images are needed. Please always check for comparison imaging prior to getting a delayed scan, as that may answer the question in lieu of delayed images and decrease radiation dose.

All emergent or urgent findings require a call and documentation in the report. All ER scans require a call within 1 hour. The body resident is responsible for all scans done before 4:30 pm. Any outpatient studies done during call hours will have a preliminary read by the on-call resident but will need to be staffed and dictated by the Body resident the next morning if no emergent findings were made.

Recommended Reading

Webb, W.R., Brant, W.E., Helms, C.A., Fundamentals of Body CT, 3rd ed., W.B. Saunders, Philadelphia, PA, 2005.

Vasanawala, S.S., Value of Delayed Imaging in MDCT of the Abdomen and Pelvis:, AJR 2006: http://www.ajronline.org/content/187/1/154.full.pdf

Roth, C.G., Fundamentals of Body MRI, 1st ed., W.B. Saunders, 2011

Clinic

The clinics rotation is a mix of radiographs and ultrasounds from our affiliated clinics mostly in digital format. There are only a handful of radiographs that come as hard copy on film in the morning. Studies include chest, MSK, GI and GU imaging. If the clinic notes attached to the requisition do not comment on the image findings, please call all urgent and emergent findings to the appropriate clinic.

The clinic images delivered on Friday night are read by the first year resident on Saturday morning. If you have time in the afternoon, please help out at the other stations.

Recommended Reading

See Chest, MSK and GI/GU

Nuclear Medicine

The Nuclear Medicine Rotation is shared with the CUMC/UNMC Nuclear Medicine Resident. The resident will review all requests and tailor the exam to the clinical question. If the clinical information provided is not sufficient, or if a significant change in the requested study is appropriate, the resident will contact the NUC attending and the clinical team as indicated.

The technician will obtain relevant history in most cases, however the resident is to interview and examine the I123 and I131 patients. Reports will be dictated either by the Nuclear Medicine or Radiology Resident. Results of emergency studies, and unexpected or clinically significant abnormal results, will be reported directly to the requesting physician (please note date, time and whom you reported to in your dictation).

Use the downtime to familiarize yourself with the imaging protocols and interpretation outlined in the Mettler textbook.

Each residents is required to actively participate in a minimum of 3 low and high dose iodine treatments with appropriate documentation, and be familiar with the treatment related safety procedures. You are encouraged to shadow the technicians to understand the daily routine quality control methods for cameras, radiopharmaceutical delivery and storage regulations and radiation safety for patients and staff.

The NUCS residents is responsible to prepare the cases for the weekly tumor board conference.

Recommended Reading

Mettler,F.A., Guiberteau, M.J., Essentials of Nuclear Medicine Imaging, 5th ed., W.B. Saunders, Philadelphia, PA, 2006.

Thrall, J.H., Ziessman, H.A., Nuclear Medicine: The Requisites, Mosby, St. Louis, MO, 2006.

Ultrasound

The resident assigned to ultrasound is responsible for all studies and ultrasound guided biopsies performed in the ultrasound suite. Arrive by 8:00am and review the ultrasounds and ultrasound-guided biopsies scheduled for the day. Notify your staff about the scheduled procedures in the morning.

The resident is encouraged to spend time in the ultrasound room throughout the day, to gain hands-on experience with the ultrasound machine, and to watch and perform exams with the guidance of the technicians and staff. Attending radiologist will review all images with the resident, and the resident will dictate all exams. Emergent results will be communicated to the ordering physician in a timely manner.

All ultrasound guided biopsies and drainage procedures will be performed under the guidance of the staff assigned to ultrasound for the day. The residents responsibility is the preprocedure workup of the patient, including H&P, lab results, medication list, consent and pre- and post procedure orders.

Once a week, the resident assigned to ultrasound will rotate through the OB-GYN ultrasound suites. Report to Dr. Smith (OB-GYN Program director) at the beginning of your rotation. In the OB-Gyn dept. the resident will be assigned to the obstetrician dictating ultrasounds for the day. At the end of your ultrasound rotation you will be expected to have completed a certain amount of obstetric ultrasounds on which the attending ob-gyn will sign off on.

Recommended Reading

Kurtz, A., Middleton, W., Ultrasound: The Requisites, 2nd ed Mosby, St. Louis, MO, 2003.

Mammo

Every resident has to complete 3 full months of mammo rotation during the last two years of the residency.

The day starts at 8am in the Breast Center with review of the previous afternoons screening mammograms, followed by the daily screening and diagnostic exams. You are encouraged to watch the technicians perform the exams to develop understanding of the different techniques, positioning and limitations of the exam. You will perform diagnostic ultrasounds with the close guidance of Dr. Davey as indicated.

Through Davey's one on one training you will develop full understanding of the screening process, technical aspect of the studies, gradually learn biopsy techniques and MRI interpretation, and gain full understanding of the underlying histopathology.

Dr. Davey holds a turkey biopsy practice session once or twice each year to improve the residents biopsy skills and ultrasound scanning technique.

Recommended Reading

Clinical Breast Imaging - Cardenosa

BIRADS atlas

Breast Imaging Case Review Series

Pediatrics

The pediatric rotation is at Children's Hospital and Medical Center, Omaha

On your first day, Dr. Allbery (Pediatric Radiology Program Director) will give you an orientation and discuss the expectations and daily routine with you. You will get a tour of the department, a badge and a parking sticker for the covered parking. The badge gives you access to the doctor's lounge where you get breakfast and lunch every day.

The first readout starts at 8am, therefore you are expected to arrive on time to preview the cases. You will be assigned to one week long rotations of US/plain film, fluoro/plain film, or CT/MRI. You may return to CUMC for noon lecture, except on the days of scheduled pediatric lectures and journal club at Children's. You are also expected to attend the pediatric tumor board, pediatric neurological tumor board and pediatric surgery-pathology-radiology conferences highlighted on your lecture schedule (the fellow or staff will present the cases).

During each rotation, you will have to complete the assigned pediatric radiology lectures from Cleveland Clinic - tailored to the level of your training.

Recommended Reading

Fundamentals of Pediatric Radiology - Lane F. Donnelly

Imaging of the Newborns Infant, and Young Child, 4th ed - Swischuk, L.E.,

Fundamentals of Fluoroscopy - Houston

Interventional Radiology

The day of interventional radiology rotation starts at 7:30am and end when the last scheduled patient leaves the department, not sooner than 4:30pm. The resident is responsible for preprocedure workup of the patient, including H&P, lab results, consent, preprocedure routine orders, etc. (Not responsible for procedure note, or post procedure orders.)

PGY-2:

During the first year rotation the residents will learn about the most common interventional radiology procedures. Indications for basic IR procedures, the necessary lab tests and imaging pre and post procedures will be discussed and the main steps of the procedures explained. Common complications of the procedures will be discussed as well. Basic operation of image guidance used during the rotation (US, X-ray, CT) will be discussed. Educational goals for the PGY-2 residents are the understanding of disease processes and conditions patient presents with during the IR rotation. Basic understanding of procedures offered.

PGY-3:

Individually tailored manual training will be emphasized during the second year rotation. Procedures will be discussed and explained in more details, in a step by step fashion and potential problems will be emphasized at each step. (The resident should be able to describe the most common procedures step by step by the end of the rotation.) Resident will learn basic manual techniques, such as US guided access of IJV, brachial / basilica vein access, CT guided biopsy / drainage, etc. Some resident may be able to perform complete procedures alone (with guidance) like tunneled dialysis catheter placement, IVC filter or PICC line placement. Educational goals for the PGY-3 residents are thorough understanding of the procedures with its benefits and complications. Acquire basic manual skills to perform the basic procedures.

PGY-4:

The third year IR training will be centered on more complex clinical decision making. Each procedure offered by IR will be discussed in clinical context and compared to potential alternative. For example, in third year, the resident should be able to offer various treatment alternatives for a patient with lower extremity arterial disease based upon patient general condition, co-morbidities, distribution and severity of arterial stenosis. More complex manual training will be available for residents who consider IR fellowship in the future. Educational goals for the PGY-4 residents are to understand decision making in IR.

PGY-5:

The interventional radiology rotation during the 4th year will incorporate one on one training for board preparation besides the regular board reviews. Rarely seen conditions and complicated procedures will be discussed between the everyday cases. Equipment choices will be mentioned mainly for those who will continue with IR fellowship. The resident will have the opportunity to perform complex cases with immediate help available if needed. Educational goals for PGY-5 residents is board preparation.

Neuroradiology

The neuroradiology rotation involves non-invasive neuroimaging of the brain, spine, head, neck, orbits, sinuses, facial bones, temporal bones and emergency neuroradiology studies. Imaging modalities predominantly include CT, CT angiography, MR, and MR angiography. Radiographs of the spine and skull are read by the MSK resident.

Residents will rotate through neuroradiology during each of their four years of training for a full month. Over this time it is expected that residents will progressively develop their abilities to interpret imaging studies of the central nervous system. Residents will learn the relative value of each modality, enabling to them to choose the appropriate study and the appropriate protocol for each patient.The residents will learn to dictate concise and appropriate radiographic reports and to serve as consultants to referring physicians.

After hours and weekend MRIs will be given a preliminary read by the on call resident, that you will staff out and dictate during the regular work day hours with neuroradiology staff.

All radiology residents attend the monthly neurosurgery conference, but you do not have to present.

Recommended Reading

Brant & Helms, Neuroradiology section. Fundamentals of Diagnostic Radiology, 3rd ed 2006.

Osborn, A.G., Diagnostic Neuroradiology, Mosby, St. Louis, MO, 1994.

Grossman, RI., Youssem, D.M., Neuroradiology -- The Requisites, Mosby, St. Louis, MO, 1994.

Lectures

  • Daily noon lecture
  • Monthly journal club
  • Monthly pediatric lectures at Children's Hospital
  • Weekly tumor board conference
  • Physics lectures
  • Nebraska Radiology Society Meeting
  • American Institute of Radiologic Pathology - 4 weeks paid course and housing in Washington, DC
  • Board preparatory course - with allowance
  • Physics preparatory course - with allowance
  • Paid national meeting of your choice if you present