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Chest Radiology RADIOLOGY RESIDENCY HANDBOOK FOR CHEST RADIOLOGY Section of Cardiothoracic Radiology Department of Diagnostic Radiology Beaumont Health – Farmington Hills Botsford Campus Reehan Ali, DO Section Chief Cardiothoracic Radiology Rocky Saenz, DO – Program Director Timothy McKnight, DO – Assistant Program Director Michael Schwartz, MD – Department Chairman Updated July 2015 to meet NAS Standards GOALS AND OBJECTIVES ROTATION 1 Competency-Based Goals & Objectives Medical Knowledge Understand the various factors that affect a quality radiograph Understand the technique and quality control for chest radiography from patient positioning to the images on PACS Learn a methodical approach to analyzing a chest radiograph. Develop skills in interpretation of chest radiography Correlate pathologic and clinical data with radiographic findings. Monitor chest exams and determine if additional images are necessary. Begin to develop skills in differential diagnosis Demonstrate ability to appropriately order follow-up imaging. State clinical indications for performing chest radiography. Dictate accurate, concise radiography reports. Patient Care Read and/or dictate images with the assistance/review of faculty radiologists. Make preliminary decisions on all matters of image interpretation and consultation, recognizing need for and obtaining assistance in situations that require expertise of faculty radiologist. Develop an understanding of ACR appropriateness criteria for chest radiology imaging. Demonstrate knowledge of parameters contributing to patient radiation exposure and techniques used to limit radiation exposure. Act as a consultant to referring clinicians and recommend appropriate use of imaging studies. Professionalism Recognize limitations in personal knowledge and skills, being careful to not make decisions beyond the level of personal competence. Demonstrate compassion (be understanding and respectful of patient, their families, and medical colleagues). Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout one's career. Demonstrate honesty with patients and staff. Demonstrate honor and integrity: avoid conflict of interests when accepting gifts from patients and vendors. Demonstrate positive work habits, including punctuality and professional appearance. Demonstrate the broad principles of biomedical ethics. Demonstrate principles of confidentiality with all information transmitted during a patient encounter. Demonstrate a responsible work ethic Interpersonal and Communication skills Provide a clear dictated chest imaging report Provide direct communication to referring physicians or their appropriate representative, and documenting communication in report for emergent or important unexpected findings Demonstrate the verbal and non-verbal skills necessary for face to face listening and speaking to physicians, families, and support personnel Participation as an active member of the radiology team by communicating with clinicians face to face, providing consults, answering phones, problem solving and decision-making Practical experience in dictating radiological reports Practice-based learning Review all cases and dictate a preliminary report. Then review your interpretation with faculty and then correct report as needed before sending it to the faculty members report queue Share good learning cases and missed diagnosis with others in the department Systems-based learning Review of literature related to imaging tests seen for this rotation, including ACR Appropriateness Criteria and ACR Practice Guidelines and Technical Standards Assessment End of rotation global assessment by faculty Direct observation and feedback Reading-out with faculty Completion of assigned online modules in cardiothoracic radiology ACR In-Service examination Study Materials: 1. American College of Radiology teaching file 2. Radiology of Thoracic Diseases: A teaching File, Stephen J. Swensen. MOSBY 1993 3. Critical Care Imaging 3rd Edition, Lawrence Goodman, Charles E. Putman, WB Saunders Chapters 1-16 4. Thoracic Radiology: The Requisites, Theresa Mc Laud, Elsevier Mosby 1998 5. Cardiac Imaging 2nd Edition: The Requisites. Stephen Wilmot Miller, Elsevier Mosby 2005 6. A Radiologic Approach to Diseases of the Chest 2nd Edition., Irwin M. Freundlich, David G. Bragg, Williams and Wilkins 1997 7. The Core Curriculum: Cardiopulmonary Imaginge: Ella Kazerooni, Barry Gross Philadelphia, Lippincott Milliams & Wilkins, 2003 Web Sites: 1. Introduction to Chest Radiology http://www.med-ed.virginia.edu/courses/rad/cxr/ 2. http://rad.usuhs.edu/medpix/medpix_home.html?mode=default 3. http://chorus.rad.mcw.edu/index/3.html 4. Lobar Collapse Tutorial http://www.radiology.co.uk/srs- x/tutors/collapse/tutorial.htm 5. http://www.chestx-ray.com/ 6. Cardiac CT - Video Lectures from the 2006 STR Meeting http://www.thoracicrad.org/education/index2.htm 7. Education, Research, and Practice in Thoracic Imaging www.chestx-ray.com 8. ICU Chest Radiology http://www.med-ed.virginia.edu/courses/rad/chest/index.html 9. Introduction to Chest Radiology http://www.vh.org/Providers/Lectures/icmrad/chest/chest.html 10. UAB Department of Radiology Teaching File http://www.rad.uab.edu:591/tf/ 11. Cardiac MRI-University of Minnesota http://www.med.umn.edu/radiology/cvrad/chd/index.html 12. BrighamRAD MedShare Anatomy Query http://brighamrad.harvard.edu/education/online/tcd/bwh-query-anatomy.html 13. Society for Cardiovascular Magnetic Resonance http://www.scmr.org/ - see education tab 14. Cardiac Radiology - South Bank University London http://www.sbu.ac.uk/~dirt/museum/heart.html 15. Armed Forces Institute of Pathology http://www.radpath.org (see AFIP subject reviews) 16. Introduction to Cardiothoracic Imaging, Yale University School of Medicine http://info.med.yale.edu/intmed/cardio/imaging/ 17. A Curriculum In Chest Radiology For Diagnostic Radiology Residency With Goals And Objectives http://www.thoracicrad.org/str99/rescurr/index.htm 18. 2006 Cardiac Imaging Symposium - Society of Thoracic Radiology (18 online lectures with video) http://www.thoracicrad.org/education/index2.htm 19. ACR Case in Point http://caseinpoint.acr.org ROTATION 2 Competency-Based Goals & Objectives Medical Knowledge Continue to build on chest radiographic interpretive skills Continue to build knowledge in differential diagnosis. Refine approach to analyzing a chest radiograph. Refine skills in interpretation of chest radiography Correlate pathologic and clinical data with radiographic findings. Monitor chest exams and determine if additional images are necessary. Refine ability to appropriately order follow-up imaging. State clinical indications for performing chest radiography. Dictate increasingly accurate, concise radiography reports. Patient Care Read and/or dictate images with the assistance/review of faculty radiologists. Make preliminary decisions on all matters of image interpretation and consultation, recognizing need for and obtaining assistance in situations that require expertise of faculty radiologist. Become a more autonomous consultant and teacher. Develop an understanding of ACR appropriateness criteria for chest radiology imaging. Demonstrate knowledge of parameters contributing to patient radiation exposure and techniques used to limit radiation exposure. Act as a consultant to referring clinicians and recommend appropriate use of imaging studies. Professionalism Recognize limitations in personal knowledge and skills, being careful to not make decisions beyond the level of personal competence. Demonstrate compassion (be understanding and respectful of patient, their families, and medical colleagues). Demonstrate excellence: perform responsibilities at the highest level and continue active learning throughout one's career. Demonstrate honesty with patients and staff. Demonstrate honor and integrity: avoid conflict of interests when accepting gifts from patients and vendors. Demonstrate positive work habits, including punctuality and professional appearance. Demonstrate the broad principles of biomedical ethics. Demonstrate principles of confidentiality with all information transmitted during a patient encounter. Demonstrate a responsible work ethic Interpersonal and Communication skills Continue to build Technical, Communication and Decision-Making Skills learned in rotation 1. Provide a clear dictated chest imaging report Provide direct communication to referring physicians or their appropriate representative, and documenting communication in report for emergent or important unexpected findings Refine the verbal and non-verbal skills necessary for face to face listening and speaking to physicians, families, and support personnel Participation as an active member of the radiology team by communicating with clinicians face to face, providing consults, answering phones, problem solving and decision-making Continue to gain experience in dictating radiological reports Practice-based learning Review all cases and dictate a preliminary report. Then review your interpretation with faculty and then correct report as needed before sending it to the faculty members report queue Share good learning cases and missed diagnosis with others in the department Systems-based learning Review of literature related to imaging tests seen for this rotation, including ACR Appropriateness Criteria and ACR Practice Guidelines and Technical Standards Assessment End of rotation global assessment by faculty
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