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Body Systems Syllabus

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Body Systems Syllabus Body Systems Syllabus This syllabus defines the learning competencies, the clinical conditions and normal variants for each body system that trainees are expected to know and demonstrate proficiency in by the end of their training. The clinical conditions and normal variants are categorised into levels of knowledge as defined below. Contents • Definitions 161 ¡ Learning Competencies 162 ¡ Normal Variants 162 ¡ Condition Categories 162 • Abdominal Imaging 162 ¡ Normal Variants 165 ¡ Adult Clinical Conditions 166 • Cardiothoracic Imaging 171 ¡ Learning Competencies 171 ¡ Normal Variants 174 SYSTEMS BODY ¡ Adult Clinical Conditions 174 • Extracranial Head & Neck Imaging 178 ¡ Learning Competencies 178 ¡ Neuro/ENT imaging Normal Variants 180 ¡ Extracranial Head & Neck Imaging Clinical Conditions 181 • Neuroradiology 188 ¡ Learning Competencies 188 ¡ Adult Clinical Conditions 190 • Musculoskeletal Imaging 193 ¡ Learning Competencies 193 ¡ Normal Variants 195 ¡ Adult Clinical Conditions 196 • Paediatric Imaging 211 ¡ Learning Competencies 211 ¡ Paediatric Clinical Conditions 214 • Breast Imaging 222 ¡ Learning Competencies 222 ¡ Breast Normal Variants 225 ¡ Breast Clinical Conditions 225 • Obstetric & Gynaecological Imaging 227 ¡ Learning Competencies 227 ¡ O&G Normal Variants 229 ¡ Clinical Conditions 229 • Vascular Imaging & Interventional Radiology 236 ¡ Learning Competencies 236 ¡ VIR Normal Variants 238 ¡ Adult Clinical Conditions 239 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 161 Learning Competencies diagnosed in timely fashion. They may not be as common as Category 1.2 conditions. Required skills and learning competencies are defined for each body system. 1.3) Less common conditions in which the radiological appearance has an important role in diagnosis Normal Variants — Definition These include rarer conditions with specific or characteristic appearances where the patient & clinician Best practice necessitates particular emphasis on would be significantly assisted by their inclusion in a situations which may compromise patient care. report. The vast majority of truly rare conditions are not Unrecognised normal variants may be misinterpreted as included in this category, but a few rare pathologies (e.g., possible pathology causing unnecessary clinical concern Osteogenic sarcoma) are included because of their clinical and costly investigation. For this reason, an indicative importance and characteristic imaging findings. list of normal variants has been developed for each of the body systems with the exception of Paediatrics. The Category 2 following textbook is required reading for Paediatric Normal Variants: Conditions which are clinically relevant but of lesser importance due to: Atlas of Normal Variants that May Simulate Disease. Theodore E. Keats, Mark W. Anderson. Mosby-Year Book • Less urgency in their diagnosis Inc 2007. ISBN: 10 0-323-04300-3, ISBN: 13 978-0323- • Less frequency in their occurrence 04300-7 The passing candidate should able to be to suggest the It should be noted that the Part 1 Anatomy examination correct disease type and /or diagnosis, however a lesser now has a specific focus on clinically relevant normal level of knowledge is still acceptable. Findings should NOT variants. This examination may contain questions that be diagnosed incorrectly as other unrelated conditions. are related to the specific normal variants listed in the sections below. Please see the Anatomy syllabus for Category 3 further comments on normal variants and their place in Anatomy learning and assessment. Conditions which are rare, but which should be known to prevent a more serious diagnosis being considered e.g. Condition Categories – Definition mesoblastic nephroma is the most common renal mass in a neonate (rather than Wilm’s tumour). For most Category Condition Categories are defined as follows: 3 conditions the candidate need only know a few facts. It is not an exhaustive list. Conditions given in Category 3 Category 1 should have clinical relevance in a practical setting, and it is fully accepted that many rare conditions will not be 1.1) Common Conditions included. Those that would be encountered in a differential Abdominal Imaging Learning diagnosis several times a year in a clinical practice. Ignorance of these conditions would seriously affect Competencies the radiologist’s status as a peer or useful member of a The competent (trainee) radiologist will be able to: multidisciplinary team. Demonstrate a clinical, pathological and radiological 1.2) Conditions in which the radiology has a major impact understanding of gastrointestinal disease. on patient management Interpret common and important clinical presentations in abdominal imaging practice for example; These are conditions that either could be potentially fatal, or could have major clinical consequences if not Page 162 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 • Abdominal Trauma Ultrasound • Appendicitis • Suspected bowel obstruction Knowledge • Suspected abdominal collection • Jaundice Safety • Renal Colic • GIT Haemorrhage • Indications/contraindications for Abdominal Ultrasound/ • Upper abdominal Pain (e.g. pancreatitis) specific protocols • Lower abdominal Pain (e.g. diverticulitis) • Limitations of Ultrasound in Abdominal Imaging CORE KNOWLEDGE Equipment and Technique Explain the strengths, weaknesses and risks (radiation • Ultrasound Assessment of Abdominal and Pelvic Viscera related and other) of the imaging modalities currently abdominal wall used in diagnosis and assessment of abdominal • Ultrasound / Doppler Assessment of Abdominal abnormalities. Vasculature • Contrast enhanced Ultrasound Describe/direct assessment or work-up of a clinical • Endoluminal Ultrasound (Principles / Indications Only) problem or imaging finding using imaging methods as • Ultrasound Image Quality Assessment appropriate. CT Scanning Be able to recommend follow-up imaging at later time interval when appropriate. Knowledge BODY SYSTEMS BODY Plain X-ray / Fluoroscopy • Safety / Scan Preparation / Contrast Use (IV/ Oral) / Radiation Safety Dosimetry and Dose Reduction / Knowledge Technical Factors • Indications/contraindications for Abdominal CT / Specific • Safety / Preparation / Contrast Use (IV/ Oral) / Radiation Protocols Safety Dosimetry and Dose Reduction / Technical Factors • Indications/ contraindications for Plain X-ray/ specific Equipment and Technique protocols • Limitations of Plain X-ray /Fluoroscopic Procedures • Limitations of CT in Abdominal Imaging Equipment and Techniques Skills • AP Supine +/- Erect/ Decubitus /Erect chest for free gas / Be able to perform and interpret - Renal area (Insp/ Exp: re calculi) / Lateral • CT Assessment of Abdominal and Pelvic Viscera • CT Assessment of Abdominal Vasculature Skills • CT Assessment of the Retroperitoneum • CT colonography, CT IVC and CT IVP • Be able to perform and interpret - • CT Image Quality Assessment • Contrast and Fluoroscopic Contrast Study • Barium Swallow MRI Scanning • Barium Meal • Barium Follow Through / Enteroclysis • Safety / Scan Preparation / Contrast Use / MRI General • Barium Enema Safety / Technical Factors • Urethrogram • Indications/contraindications for Abdominal MRI / • MCU Specific Protocols • Cystogram • Limitations of MRI in Abdominal Imaging • X-ray image Quality Assessment in Abdominal Imaging © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 163 Skills Acts safely • Be able to perform and interpret - • Recognise imaging signs related to acute emergency • MRI Assessment of Abdominal and Pelvic Viscera abdominal conditions (e.g. pneumoperitoneum, acute including liver specific contrast studies colitis, toxic megacolon, ischaemic gut, aortic rupture). • MRI Assessment of Abdominal Vasculature • Safely assign a class of diagnosis (benign / normal • MRCP variant / probable malignancy) and direct further • MRI Image Quality Assessment assessment where required. • Correctly categorise indeterminate findings and guide Nuclear Medicine further investigation if required (e.g. renal cyst / haemangioma of liver). Knowledge Convey findings • Safety / Radiopharmaceutical Use (Labelled RBC /DTPA MAG III DMSA) / Radiation Safety Dosimetry and Dose • Communicates relevant findings including diagnoses, Reduction treament plans, complications and follow up to the • Nuclear Medicine GIT Bleeding Studies referring clinician, patient and or family/carers and other • Meckels Scans health care team members and assists in formulating • DTPA / DMSA / MAG III an imaging and management plan as necessary (e.g. • Demonstrate knowledge of the principles/ limitations/ surgical consultation, biopsy). indications of MIBG / Octreotide Scanning/ PET Scans in the abdomen. Radiological Interventions • Equipment and Technique: Basics only • NMCT Image Quality Assessment • Demonstrate knowledge of abdominal interventional • Limitations of NMCT in Abdominal Imaging procedures including the role of procedures, indications associated complications and their management. Non Imaging Investigations • Examples include: • Percutaneous fine needle biopsy / core biopsy / abscess • Demonstrate knowledge of the role and process of drainage; other non-imaging investigations (e.g. endoscopy / • Biliary and urological interventions such as colonoscopy / capsular endoscopy / manometry). percutaneous transhepatic cholangiography /biliary drainage/nephrostomy; KEY SKILLS • Abdominal arterial interventions including embolisation, chemoembolisation,
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