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Anatomy Syllabus a Note on Normal Variants

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Anatomy Syllabus a Note on Normal Variants Anatomy Syllabus A Note on Normal Variants Categorisation of Required Skills Understanding and recognizing normal variants is a crucial part of being a radiologist, so as to avoid and Knowledge for Anatomical potentially damaging confusion with serious pathology. Structures This is to be distinguished from congenital anomalies, although sometimes the distinction between these Knowledge of pathologically relevant anatomy needs categories is somewhat blurred. In general however, to be learned in the early stages of training to ensure normal variants are not the cause of significant disease trainees have a baseline of knowledge to undertake the but may mimic significant abnormalities such as fractures, Anatomy exam. tumours, dysplasias etc. As a result it is important for trainees to become very familiar with these variants early Application of anatomical knowledge to disease will be in their training, and consequently, these are examined learned throughout all stages of training. formally in the Part 1 examination. Anatomical tasks of a radiologist that provide the basis Lists of radiologically relevant Normal Variants as they for the categories: pertain to clinical practice and specific body systems are contained in the section on body systems. All Part 1 1. Identification of a structure in projectional modalities examination candidates should specifically refer to this list and in cross sectional modalities. This includes to learn some of the common normal variants, especially identification of the structure’s expected location and those listed in Category 1. relations and size even if not visible. Category 1 • Projectional modalities: radiography, fluoroscopy, angiography (including spin angiography), Critical anatomical structures planar nuclear medicine studies. The multitude of radiography and fluoroscopy specific adaptations Must recognise and interpret, must know and explain. (e.g. OPG, planar arthrography, contrast studies, etc) are all subsumed in this. These structures comprise core basic radiologic anatomy, and a deficiency of anatomical knowledge and skills • Cross sectional modalities: CT, MR, US, SPECT and for these structures will jeopardise a radiology trainee’s PET nuclear medicine studies; includes CT variants ability to perform to a satisfactory level during radiology such as angio-CT. training. 2. Identification of a structure as normal or abnormal. Projectional identification: identifies confidently on all This requires the knowledge of the range of normality and common projectional modalities, also of normal variants, particularly those that simulate recognises normal variants and knows range of normality, disease or are on the borderlands with disease. can identify and point out expected location, shape and size even if not visible, and the adjacent category 1 3. Coherent communication with referrers, colleagues, structures. patients and the entire health care team regarding a particular anatomical structure or structures (normal Cross sectional identification: identifies confidently or abnormal as the case may be) in a language that on all common cross-sectional modalities, in standard is anatomically correct, radiologically relevant, and radiological planes and any dedicated planes (straight meaningful to the intended audience. or curved) commonly used for that structure, recognises normal variants and knows range of normality, can trace This is anatomical competence required at a basic level of structure from plane to plane in an interactive stack; Part 1 exit standard. Knowledge of pathologically relevant can identify and point out expected location, shape anatomy is a competence to be developed during training and size even if not visible, and the adjacent category 1 and to be assessed at the level of Part 2 exam. ANATOMY © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 81 structures; can point out this expected location and size in functional anatomy. Knows and can concisely describe a interactive scrolling stack. clinically important anatomical variants, particularly those that endanger the structure or those that simulate Knowledge base: can give a structured coherent verbal disease. account (oral or written) of the anatomical structure in language applicable to radiology reporting and to inter- Category 3 specialty communication; this includes all common and important anatomical characteristics of the structure, for Useful radiologic anatomical structures example course, parts, relations, distribution, etc. Knows and can concisely describe normal anatomical variants, Good to recognise, good to know. particularly those that endanger the structure or other structures, and those that simulate disease. Can draw a Anatomical structures in this category must be known to basic diagram (artistic skills not required) to illustrate key category 2 level for satisfactory sub-specialist radiology morphology, internal composition and external relations performance. A radiology trainee at the end of radiology of the structure in a way applicable to radiology image training would not be expected to know these structures analysis and identification. to category 2 level, but is aware of their existence. A radiology trainee at the beginning of radiology training is Category 2 unlikely to know these structures. Important anatomical structures Projectional identification: with increasing training and experience able to identify on all common projectional Must recognise, must know. modalities on which it is visible, and distinguish normal structure from abnormality of either this or other Anatomical structures in this category must be known structures. for competent generalist radiologist performance. For radiology trainees at the beginning of radiology training, Cross sectional identification: with increasing training anatomical knowledge of these structures is needed to and experience able to identify on all common cross- permit the acquisition of skills and knowledge of imaging sectional modalities on which it is visible in key working manifestations of disease. standard planes (transverse and coronal), and distinguish normal structure from abnormality of either this or other Projectional identification: identifies confidently on all structures. common projectional modalities, recognises normal variants, can differentiate normal from abnormal Knowledge base: with increasing training and experience appearance, can describe and point out the nearest aware of the structure’s existence, name, and functional category 1 structures to which it relates when not visible. anatomy. SAME AS FOR CATEGORY 1 STRUCTURES. Cross sectional identification: identifies confidently on all common cross sectional modalities in key working standard planes (transverse and coronal), recognises normal variants, can differentiate normal from abnormal appearance, can describe and point out the nearest category 1 structures to which it relates when not visible. Knowledge base: can give a concise, coherent verbal account (oral or written) of the anatomical structure in language applicable to radiology reporting and to inter- speciality communication; this includes all the clinically important anatomical characteristics of the structure, for example course, area of supply, location of vulnerability, Page 82 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Anatomy of the Head & Face (Excluding CNS) Category 1 Category 2 Category 3 1. INTRACRANIAL CAVITY (EXTRA AXIAL) Anterior Cranial Fossa • Ethmoid bone • Meningeal coverings • Frontal bone & sinus • Crista galli • Sphenoid: Lesser wing • Olfactory bulb and tract Middle Cranial Fossa • Sphenoid body, greater wing • Meningeal coverings & sinus • Temporal bone & apex • Middle meningeal artery • Foramina of middle cranial fossa • Vidian canal & contents • Foramen spinosum ¡ Optic canal • Foramen lacerum ¡ Superior orbital fissure ¡ Foramen rotundum ¡ Foramen ovale ¡ Carotid canal Posterior Cranial Fossa • Temporal bone • Meningeal coverings • Occipital bone • Foramina of posterior cranial fossa • Ganglia of CN IX & X in jugular & contents foramen ¡ Internal auditory meatus with CN VII & VIII ¡ Jugular foramen & contents ¡ Hypoglossal canal & CN XII ¡ Foramen magnum 2. CRANIAL VAULT Bones • Layers of skull • Dural coverings • Bones including prominences, • Arachnoid granulations foramina and key vascular • Sutures markings: ¡ Frontal ¡ Parietal ¡ Sphenoid ¡ Temporal ¡ Occipital ANATOMY © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 83 Scalp • Galea • Frontalis muscle • Blood supply to scalp • Occipitalis muscle Nerves • Meningeal • Skull bones • Scalp 3. THE ORBIT Bony Orbit • Boundaries & walls, including • Lacrimal fossa/crest contributions from specific skull • Periorbita bones • Medial & lateral tubercles • Foramina & contents • Orbital septum • Optic canal • Superior orbital fissure • Inferior orbital fissure Preseptal Structures • Lacrimal sac & duct • Lids & tarsal plates • Lateral and medial check • Blood supply & venous drainage ligaments of the globe • Levator palpebrae superioris & nerve supply • Conjunctival sac boundaries • Lacrimal canaliculi Extraocular Muscle Cone • Intraconal fat • Tendon annulus • Extraocular muscles & their nerve supplies Extraconal Space • Lacrimal gland • Nerve & blood supply to the lacrimal gland • Extraconal fat Globe & Contents • Cornea & sclera • Canal of Schlemm • Choroid & retina • Macula position • Iris & lens • Short ciliary arteries • Nerve supply ¡ Short and long ciliary
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