Body Systems Syllabus

Home , Acrania, Bifid rib, Caroli disease, Keratocyst, Sesamoiditis, Wandering spleen

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

• 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, angioplasty and stenting. Interpret the examination accurately and safely • Communicating effectively with patients and clinicians regarding the benefits and risks associated with • Recognise the normal abdominal anatomy, and variants. different diagnostic modalities and procedures. • Conduct a thorough and systematic review of the imaging examination and perceive relevant abnormalities. • Correctly describe the likely cause of abnormalities in broad context (e.g. neoplastic, traumatic, inflammatory) • Integrate knowledge of pathology, clinical information and imaging appearance to form an appropriate differential diagnosis. • Evaluate the imaging study in light of differential diagnoses to identify clinically relevant findings.

• Colonic interposition (Chilaiditi • Phrenic ampulla • “Feline” oesophagus Syndrome) • Intramural pseudodiverticulosis • Brunner gland hyperplasia • Mobile caecum • Functional megacolon and ogilvie • Ectopic pancreatic rest • Duodenal diverticulum syndrome • Prominent lymphoid follicles • Primary colonic pneumatosis • Gastric diverticulum • Cathartic colon 2. Hepatopancreatobiliary System

• Reidel’s lobe • Milk of calcium bile • Congenital absence of hepatic • Focal fatty infiltration • Agenesis of dorsal pancreas segments • Replaced right hepatic artery • Annular pancreas • Variant hepatic venous drainage • Variant left hepatic supply • Pancreas divisum • Biliary hamartoma 3. Renal and Urinary Tract

• Junctional zone • Accessory renal arteries • Dromedullary hump • Retroaortic renal vein • Column of bertin • Parapelvic cysts BODY SYSTEMS BODY • Persistent fetal lobulation • Retrocaval ureter • Renal ectopia • Congenital megacalices • Horseshoe kidney • Ureteritis cystica • Ureteral duplication • Urachal remnant • Bladder diverticulum 4. Male Reproductive System

• Ectasia of rete testis • Scrotal pearl • Epidermoid cyst of testis • Congenital prostatic cyst 5. Spleen / Haematological / Bone Marrow

• Spenuculi • Splenosis • Wandering spleen

6. Retroperitoneum

• Duplicated IVC • Pelvic lipomatosis

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 165 Abdominal Imaging – Adult Clinical Conditions (For Paediatric Conditions, See Paediatric Syllabus) Category 1 Category 2 Category 3 1. Gastrointestinal System

Oesophagus

• Carcinoma • Pharyngeal pouch • Leiomyoma • Trauma (tear and rupture) • Oesophageal web • Spontaneous intramural • Reflux esophagitis and hiatus • Oesophageal varices haemorrhage hernia • Cricopharyngeal spasm • Scleroderma • Motility disorders • Duplication cyst • Achalasia • Other esophagitis (infective, corrosive, radiation and auto- immune) • Diverticula • Schatzki ring Stomach

• Carcinoma • Acute gastric dilation • Gastric diverticulum • Peptic ulcer • GIST tumours • Leiomyoma / leiomyosarcoma • Lymphoma • Post surgical appearances and • Menetrier’s disease • Gastritis, acute and chronic complications • Corrosive injury • Hyperplastic and inflammatory • Gastric volvulus colon Organoaxial polyps colon Mesenteroaxial • Gastric outlet obstruction Small Bowel

• Crohn’s disease • Coeliac disease • Small bowel infections / • Small bowel obstruction • Metastatic disease infestations • Ischaemia • Lymphoma • Whipple’s disease / Amyloid and • Intussusception • Primary small bowel tumour mastocytosis • Small bowel trauma (adenocarcinoma and / or • Polyps & polyposis syndromes • Haemorrhage carcinoid) • Eosinophilic gastroenteritis • Post surgical appearances and • Yersinia complications • GIST tumours • Meckel’s diverticulum • Jejunal diverticulosis • Gallstone ileus • Radiation enteritis • TB

• Carcinoma • Polyps • Radiation Colitis • Diverticular disease • Angiodysplasia • Metastases • Appendicitis • Infective Colitis • Lymphoma • Inflammatory bowel disease • Carcinoid tumour • Pneumatosis intestinalis • Obstruction and • Perianal sepsis pseudoobstruction • Pseudo-obstruction • Ischaemic colitis • Post surgical appearances and • Volvulus complications • Toxic megacolon • Epiploic appendagitis • Haemorrhage • Mesenteric panniculiti Peritoneum / mesentery / abdominal wall

• Ascites • Rectus sheath haematoma • Mesenteric cyst • Hernias • Pseudomyxoma peritonei • Desmoid tumour • Peritonitis • TB peritonitis • Mesothelioma, other tumours • Metastases • Sclerosing peritonitis • Pneumoperitoneum 2. Hepatopancreatobiliary system

Diffuse Liver Disease

• Fatty infiltration and fatty sparing • Acute & chronic hepatitis • Primary biliary cirrhosis SYSTEMS BODY • Cirrhosis • Sclerosing cholangitis • Wilson disease • Portal hypertension • Haemochromatosis • a 1 anti-trypsin deficiency • Glycogen storage disorder • Post transplant appearances and complications • Caroli’s disease Focal Liver Disease

• Cyst • Hydatid disease • Biliary hamartomas • Cavernous haemangioma • Cholangiocarcinoma • Biliary cystadenoma • Metastatic disease • Abscess • Hepatocellular carcinoma • Focal nodular hyperplasia • Hepatocellular adenoma Trauma / Vascular

• Trauma • Budd-Chiari syndrome • Liver infarction • Portal vein thrombosis • Peliosis hepatis • Veno-occlusive disease Biliary

• Cholelithiasis • Adenomyosis • Biliary infestation (including • Acute Cholecystitis • Gallbladder polyps oriental cholangiohepatitis) • Obstruction • Gallbladder carcinoma • Choledochal cyst • Cholangiocarcinoma • Cholangitis • Chronic cholecystitis / Porcelain gallbladder

• Acute pancreatitis • Chronic pancreatitis • Annular pancreas • Pancreatic carcinoma • Pseudocyst • Ectopic pancreas • Trauma • Ampullary tumour • Pancreas divisum • Islet tumours • Intraductal neoplasia • Cystic pancreatic tumours 3. Renal and urinary tract

Renal Congenital / Developmental

• Congenital / Developmental:- • Medullary sponge kidney • Calyceal diverticulum • Horseshoe / Pancake / duplex • Adult polycystic kidney disease kidney • Crossed fused ectopia • Vesicoureteric reflux Renal Neoplasia

• Renal cell carcinoma • Oncocytoma • Multilocular cystic nephroma • Transitional cell carcinoma • Angiomyolipoma Renal Inflammation / Infection

• Renal abscess / carbuncle • Tuberculosis • Schistosomiasis • Acute pyelonephritis • Xanthogranulomatous pyleonephritis Renal Vascular Conditions

• Renal infarction • Renal AV fistula • Polyarteritis nodosa • Renal artery stenosis • Fibromuscular dysplasia • Renal vein thrombosis • Renal artery aneurysm Miscellaneous Renal Conditions

• Obstruction • Acute tubular necrosis • Acute cortical necrosis (including PUJ) • Papillary necrosis • Acquired cystic disease of the • Renal trauma • Analgesic nephropathy kidney • Renal calculi • Renal atrophy • Amyloidosis • Simple renal cysts • Renal transplant complications • Diabetic nephropathy • Contrast media nephrotoxicity • Nephrocalcinosis • Sickle cell nephropathy • Glomerulonephritis (acute and • Gouty nephropathy chronic but not specific subtypes • SLE excepting Goodpastures) • Acute and chronic renal failure

• Cystitis (acute and chronic) • Neurogenic bladder • Other tumours • Transitional cell carcinoma • Diverticula • Ureteropyelitis cystica • Trauma • Schistosomiasis • Urethral strictures • Tuberculosis • Ureterocoele • Malacoplakia • Urachal remnants Adrenals

• Adrenal metastasis • Cushings syndrome • Addison’s disease and syndrome • Adrenal adenoma (functioning and • Multiple endocrine neoplasia • Adrenal hyperplasia non functioning) • Paragangliomas • Myelolipoma • Phaeochromocytoma • Spontaneous adrenal • Adrenal carcinoma haemorrhage 4. Male reproductive system

• Benign prostatic hyperplasia • Epididymal cysts • Testicular cysts • Prostatic carcinoma • Spermatocoele • Prostatitis (acute and chronic) • Epididymo-orchitis • Varicocele • Other epididimal / paraepididymal • Testicular torsion • Spermatic granuloma abnormalities: TB / adenomatoid • Testicular tumours including • Testicular microlithiasis tumor lymphoma / leukemia • Testicular trauma

• Urethral trauma SYSTEMS BODY 5. Splenunculi / Haematological / Bone Marrow

• Lymphoma • Myeloma / plasmacytoma • Sickle cell anaemia • Trauma • Myeloproliferative / • Spherocytosis • Spontaneous and delayed rupture myelodysplastic disorders • Thorotrast • Infarction • Leukemia • Metastases • Haemoglobinopathies • Abscess (e.g. thalassemia) • Splenic cyst • Haemangioma • Langerhans cell histiocytosis • ITP • DIC • Splenic Infection (e.g. mononucleosis) • Immunosuppression & Opportunistic infection 6. Retroperitoneum

• Lymphoma • Retroperitoneal fibrosis • Inflammatory aortitis • Lymph node enlargement, metastases • Sarcoma • Aortic aneurysm

• AXR • Barium meal • Intravenous (CT) cholangiography • IV Pyelogram • Barium enema • MRI of the pelvis • Barium swallow • Small bowel follow through • PTC • ERCP • Enteroclysis • Biliary stents • CT abdomen & pelvis • MRCP • Ureteric stents • US abdomen & pelvis • MRI of the liver • Cholecystostomy • US of urinary tract • CT colonography • Gastrostomy • US of appendix • Biopsy • TIPS • Drainage • Duodenal intubation • Abdominal angiography

Page 170 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Cardiothoracic Imaging Learning • Limitations of Plain X-ray /Fluoroscopic Procedures Competencies • X-ray image Quality Assessment in Chest Imaging Equipment and Technique The competent (trainee) radiologist will be able to:

• PA and lateral chest views • Demonstrate a clinical, pathological and radiological • Inspiratory and expiratory views and indications understanding of cardiothoracic disease. • Portable chest views • Interpret common and important clinical presentations • Lordotic view in cardiothoracic imaging practice for example; • Decubitus view

¡ Cough Skills ¡ Shortness of breath

¡ Chest pain • Be able to perform and interpret - ¡ Chest trauma

¡ Haemoptysis Diaphragm screening ¡ Fever

¡ Part of multi-system disorder presentations • Aspirated foreign body ¡ Anatomical variants CT CORE KNOWLEDGE

Knowledge Explain the strengths, weaknesses and risks (radiation BODY SYSTEMS BODY related and other) of the imaging modalities currently • Safety / Preparation / Contrast Use (IV/ Oral) / Radiation used in diagnosing and evaluating chest abnormalities. Safety /Dosimetry/Common methods of dose Reduction Know the radiation doses of imaging modalities that /Technical Factors of improving spatial and temporal utilize ionizing radiation and understand the common resolution dose reduction methods. • Indications/contraindications for CT/specific protocols/ CT-guided procedures Understand the risk of radiation in pregnancy and alternative imaging pathways in pregnancy. Equipment and technique Describe/direct assessment or work-up of a clinical problem or imaging finding using imaging methods as • Common CT artifacts appropriate. • Limitations of CT Procedures • CT image Quality Assessment in Chest Imaging Be able to recommend follow-up imaging at later time interval when appropriate. Equipment and Technique Recognize the radiologically guided diagnostic and interventional procedures, their indications, • CT/HRCT/Cardiac CT techniques for common clinical contraindications and basic procedural details. situations • Contrast media – intravenous: indications, benefits, risks Plain X-rays/Fluoroscopy • IV contrast allergy – prevention • IV contrast allergy – treatment of an acute reaction Knowledge • Contrast induced nephropathy and its prevention

• Safety / Preparation / Contrast Use (IV/ Oral) / Radiation Safety Dosimetry and Dose Reduction /Technical Factors/ conventional vs digitial plain radiography/use of grid • Indications/contraindications for Plain X-ray/specific protocols

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 171 Ultrasound • Equipment and technique • Pulmonary embolism assessment Knowledge • PET and its role • NMCT Image Quality Assessment Safety Non Imaging Investigations • Ultrasound of pleural effusion – diagnosis and treatment planning • Demonstrate knowledge of the role and process of other • Equipment and technique non-imaging investigations (e.g. bronchoscopy) used in • Limitations of ultrasound in chest imaging this area. • US image Quality Assessment in Chest Imaging • Recognise and describe cardiac imaging techniques and findings Angiography • Knowledge in these topics is optional, and may be examinable Knowledge During Phase 1 • Safety/Preparation/Contrast Use/Radiation/Technical • Factors/Indications/Contraindications Topics to include: • Identify the strengths and weaknesses of angiography in chest and vascular disease • Acquisition techniques- i.e. difference between a • Equipment and technique routine CT angiogram and a CT angiogram targeting the • Use of angiography in interventional procedures coronary arteries, to include knowledge regarding: • Limitations • Contrast: Volume, Rate, Mix, dual v three phase • Image quality assessment • Limitations of CT unit with clinical impact i.e. how low does heart rate need to be, does the heart rate need to MRI in chest disease be regular • Expected radiation dose exposure for routine Coronary Knowledge CT with the variation expected with the different CT units • Safety / Preparation / Contrast Use (IV/ Oral) / Technical • Acquisition technique variation: Factors ¡ RV/LV • Indications/contraindications for MRI/specific protocols ¡ Pulmonary arteries • Identifies the strengths and weaknesses of MRI in chest/ ¡ Triple rule out cardiac disease and conducts examinations accordingly. • Anatomy: ¡ Cardiac chamber structure Equipment and technique ¡ Trabeculations, bands, papillary muscles ¡ Venous anatomy and variation • MR sequences for chest use ¡ Arterial anatomy and variation • Limitations of MRI Procedures • Valvular structure • MR image Quality Assessment in Chest Imaging ¡ AV – variation and implications ¡ MV- variation and implications Nuclear medicine in chest disease • Function: ¡ Left Ventricle Knowledge ¡ Radiation dose variation with CT unit ¡ Data / image manipulation for post processing • Safety / Radiopharmaceutical Use / Radiation Safety ¡ Validation of technique Dosimetry and Dose Reduction ¡ Right Ventricle • Identifies the strengths and weaknesses of nuclear ¡ Radiation dose variation with CT unit medicine in chest/cardiac disease and conducts ¡ Data / Image manipulation for post processing examinations accordingly ¡ Validation of technique

Page 172 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 • Cardiac Magnetic Resonance Imaging surgical consultation, biopsy). • Brief introductory knowledge • Technique, sequences, Conditions which are optimally Radiological Interventions assessed • Myocardial structure, function • Demonstrate knowledge of chest interventional • Valvular structure, function procedures including the role of procedures, associated complications and their management. Phase 2 • Basic principles and indications for chest biopsy or • Advanced study units – reporting credentialing, level A drainage:

• Fellowship (post 5th year) – full credentialing to ¡ Fine needle aspiration

supervisor level, level B ¡ Core biopsy

¡ Embolization for haemoptysis and AVM

KEY SKILLS ¡ Tumour embolization and radio-frequency ablation • Localisation techniques – CT, ultrasound and • Interpret the examination accurately and safely fluoroscopy. • Causes of sampling error • Recognise the normal chest anatomy, range of variants • Potential complications and their detection and and changing appearance with age and physiological management states, including recognising normal imaging studies or • Specimen handling requiring limited work-up to arrive at this conclusion. • Communicating effectively with patients and clinicians • Conduct a thorough and systematic review of the regarding the benefits and risks associated with

imaging examination and perceive and describe relevant different diagnostic modalities and procedures. SYSTEMS BODY abnormalities. Judge likely category of abnormality, eg air space disease, interstitial disease, mediastinal mass. • Within limits of information available, integrate broader knowledge of pathology, epidemiology, gross morphology, ancillary tests, clinical presentations and imaging appearances to form an appropriate differential diagnosis. • Evaluate the imaging study in light of differential diagnoses to identify clinically relevant findings.

Acts safely

• Recognise and act appropriately upon imaging signs of a chest emergency in conditions such as: • Tension pneumothorax; • Acute aortic dissection or traumatic aortic rupture. • Pulmonary embolism • Myocardial infarct • Cardiac tamponade

Convey findings

• Communicates relevant findings including diagnoses, treatment plans, complications and follow up to the referring clinician, patient and or family/carers and other health care team members and assists in formulating an imaging and management plan as necessary (e.g.

• Technical limitations- Physics and • Asymptomatic variations of aortic • Superior accessory fissure Position (Inspiration, Rotation….) arch branching, including: • Inferior accessory fissure • Azygos lobe fissure • Right arch with aberrant left • Inferior pulmonary ligament • Cardiophrenic fat pads subclavian artery • Tracheal cartilage calcification • Aberrant right subclavian artery • Aortic diverticulum of • Variations of segmental and • Eventration- partial / total Kommerell subsegmental branches of • Pectus excavatum • Aortic nipple / left superior bronchopulmonary tree • Pectus carinatum intercostal vein • Absence of the left pericardium • Rhomboid fossa • Common origin of brachiocephalic • Normal thymus and left common carotid arteries • Tracheal buckling (“bovine arch”) • Bifid rib • Separate origin of vertebral artery • Cervical rib from arch • Congenital variations of coronary anatomy, including: • Independent ositum of MRC and conus branch • Circumflex from RCA • Circumflex from RC Sinus • LCA from RC Sinus • Poland’s syndrome

Chest Imaging – Adult Clinical Conditions (For Paediatric Conditions, See Paediatric Syllabus)

Category 1 Category 2 Category 3 1. Air Space/Ground-glass

• Diffuse alveolar damage / ARDS • Eosinophilic lung disease • Alveolar microlithiasis • Diffuse alveolar haemorrhage • Pulmonary alveolar proteinosis • Amyloidosis • Aspiration pneumonia • Toxic inhalation • Lymphoma • Atelectasis & patterns of collapse • Pulmonary sequestration • Hydatid disease • Adenocarcinoma in lepidic • Cryptogenic organizing originPulmonary oedema pneumonitis (cardiogenic and other) • Acute hypersensitivity pneumonitis • Pneumonia (viral, bacterial & • Adenocarcinoma in-situ/minimally fungal) & complications (e.g. invasive adenocarcinoma abscess) • Mycobacterial infection • AIDS & other forms of Immunocompromised host infection

• Bronchiectasis • Tracheal Stenosis • Tracheobronchomegaly • Cystic Fibrosis • Bronchiolar Disease • Kartageners syndrome • Chronic Obstructive Airways • Tracheobronchomalacia • Tracheopathia osteoplastica Disease • Relapsing polychondritis • Allergic bronchopulmonary aspergillosis 3. Interstitial

• Sarcoidosis • Diffuse interstitial pneumonias • Asbestosis • Langerhan’s Cell Histiocytosis • Lymphangitis carcinomatosa • Hypersensitivity pneumonitis • Pulmonary fibrosis • Drug reactions • Connective tissue disorders • Pneumoconiosis, coal, silica (lung manifestations) • Lymphangiomyomatosis • Smoking related interstitial lung diseases 4. Mediastinum

• Lymphoma • Thymoma • Sympathetic ganglion tumours • Superior Vena Cava Obstruction • Ectopic parathyroid • Fibrosing mediastinitis • Pneumomediastinum • Ectopic thyroid • Neurenteric cyst

• Diaphragmatic hernias • Germ cell tumours SYSTEMS BODY • Goitre • Bronchogenic cyst • Metastatic lymph node • Extramedullary haematopoiesis involvement • Nerve sheath tumours • Oesophageal cancer & other diseases 5. Carcinoma & Nodules

• Bronchogenic carcinoma and • Wegener’s Granulomatosis staging • Pulmonary hamartoma • Lung (tumour) Biopsy and • Pulmonary carcinoid complications • Rheumatoid nodule • Solitary pulmonary nodule: ¡ causes and management (solid vs ground-glass nodule) • Metastasis (lung) • Radiation changes 6. Pleura

• Pleural effusion • Actinomycosis • Fibrous tumour of pleura • Asbestos related pleural disease • Malignant mesothelioma • Pneumothorax • Haemothorax • Pleural metastasis • Pleural thickening • Empyema

• Emphysema • Alpha 1 antitrypsin deficiency • Lymphangioleiomyomatosis • Langerhans cell histiocytosis • Neurofibromatosis • Tuberous sclerosis 8. Heart & Pericardium

• Cardiac size & contour • Cardiac mass • Pericardial tumours, • Pericardial effusion / • Pacemaker & defibrillator • Coronary AV fistula haemopericardium / placement and artificial valves • Right ventricular dysplasia pneumopericardium • Coronary artery atheromatous • Takotsubo cardiomyopathy • Valvular heart disease disease • Valsalva sinus aneurysm • Pericardial calcifications • Cardiac aneurysm • Valvular heart disease • Cardiomyopathy • Left to right shunt (septal defects and patent ductus arteriosus) 9. Vessels

• Pulmonary embolism & venous • Pulmonary arterial hypertension • Marfan’s / Ehlers-Danlos thromboembolism • AV malformation / angioma • Scimitar syndrome • Embolism (septic, air, fat & other) • Congenital variants of arteries • Pulmonary varix • Aneurysm and veins in chest, including • Dissection transposition of arteries, • Cor pulmonale anomalous venous drainage • Atheromatous disease, including • Marfan’s / Ehlers-Danlos coronary arteries • Coarctation / pseudocoarctation • Anomalous origin of coronary arteries • Management of acute hemoptysis 10. Chest Wall

• Pectus and Kyphoscoliosis • Haematopoietic disease (e.g. • Poland’s Syndrome • Rib lesions Sickle cell disease, Thalassaemia) • Rib notching • Rib expansion • Multiple myeloma

• Diaphragmatic rupture • Chest wall trauma • Tracheobronchial rupture • Rib/sterna/clavicular/thoracic spine fractures & Complications • Median sternotomy • Endotracheal, intercostal tube, chest drainage tube and catheter assessment • Thoracotomy and complications • Pacemaker wire position • Central line malpositioning • Oesophageal rupture/Boerhaave’s syndrome • Inhaled and swallowed foreign bodies 12. Techniques & Applications (Adult Chest)

• CXR • Ultrasound of the chest • MRI of mediastinum/certain • CT/HRCT • Diaphragmatic fluoroscopy parenchymal disease/heart • CT Pulmonary Angiography • Venography of central veins • MR venography of the chest

• CT aortography, including its use • Angiography • Bronchial angiography SYSTEMS BODY for TAVI • CT-guided lung biopsy • Pulmonary angiography • CT coronary angiography • Embolization • CT of pulmonary masses • Tumour ablation • Chest CT in trauma and vascular diseases

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 177 Extracranial Head and Neck Ultrasound Imaging Learning Competencies Knowledge Safety The competent (trainee) radiologist will be able to:

•Indications/contraindications for Extracranial Head & Demonstrate a clinical, pathological and radiological Neck Imaging Ultrasound/specific protocols understanding of extracranial head and neck disease • Ultrasound Image Quality Assessment Interpret common clinical presentations in head and neck • Limitations of Ultrasound in Extracranial Head & Neck imaging practice. Imaging CORE KNOWLEDGE CT Scanning

• Explain the strengths, weaknesses and risks (radiation Knowledge related and other) and roles of the imaging modalities currently used in diagnosing and evaluating head • Safety / Scan Preparation / Contrast Use (IV/ Oral) and neck abnormalities (e.g. ultrasound: thyroid, / Radiation Safety Dosimetry and Dose Reduction / parathyroids, neck nodes and salivary glands; CT: Technical Factors sinuses (pre FESS), neck (staging of SCC), salivary glands • Indications/contraindications for Extracranial Head & and thyroid, basic temporal-bone pathology; MRI: IAM’s, Neck Imaging CT / Specific Protocols common skull base lesions, sinonasal malignancy, large / critically placed carcinoma in H & N (e.g. nasopharynx, Equipment and technique tongue base). • Describe/direct assessment or work-up of a clinical • CT Image Quality Assessment problem or imaging finding using imaging methods as • Limitations of CT in Extracranial Head & Neck Imaging appropriate. • Recognise and act upon an inadequate examination. Equipment and Technique • Be able to recommend follow-up imaging at later time interval when appropriate. • Cone Beam CT, its advantages and limitations in Head Plain X-ray / Fluoroscopy and Neck, ENT and Dental imaging. MRI Scanning Knowledge

Knowledge • Safety / Preparation / Contrast Use (IV/ Oral) / Radiation Safety Dosimetry and Dose Reduction / Technical Factors • Safety / Scan Preparation / Contrast Use / MRI General • Indications/contraindications for Extracranial Head & Safety / Technical Factors Neck Imaging/specific protocols. • Indications/contraindications for Extracranial Head & • Limitations of Plain X-ray /Fluoroscopic Procedures Neck MRI / Specific Protocols • X-ray image Quality Assessment in Extracranial Head & Neck Imaging Equipment and technique

Equipment and Techniques • MRI Image Quality Assessment • Limitations of MRI in Extracranial Head & Neck Imaging • The Orthopantomogram (OPG), Indications, Artefacts and limitations.

Page 178 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Nuclear Medicine • Evaluate the imaging study in light of differential diagnoses to identify clinically relevant findings. Knowledge Acts Safely • Safety / Radiopharmaceutical Use (Labelled RBC /DTPA MAG III DMSA) / Radiation Safety Dosimetry and Dose • Recognise imaging signs suspicious of conditions Reduction with significant patient implications (eg malignant or • Dosimetry and Dose Reduction infective lesions). Equipment and technique • Safely assign a benign diagnosis and discriminate such cases from those that require further assessment. • Demonstrate knowledge of the principles/ limitations/ • Correctly categorise indeterminate findings and guide indications of MIBG / Octreotide Scanning/ PET Scans in further investigation appropriately. Extracranial Head & Neck Imaging. • NMCT Image Quality Assessment Convey findings • Limitations of NMCT in Extracranial Head & Neck Imaging • Communicates relevant findings including diagnoses, • Role of PET and PET/CT in Head and Neck Cancer treatment plans, complications and follow up to the imaging and its limitations. referring clinician, patient and or family/carers and other health care team members and assists in formulating Skills an imaging and management plan (e.g. surgical consultation, biopsy). • Be able to interpret - • Conduct appropriate notifications in relation to

¡ infectious diseases and other notifiable conditions. Nuclear Medicine GIT Bleeding Studies SYSTEMS BODY

¡ Meckels Scans

¡ DTPA / DMSA / MAG III Radiological Interventions

Non Imaging Investigations • Describe the techniques of imaging guided fine needle aspirate cytology (e.g. thyroid nodules and neck nodes) • Demonstrate knowledge of the role and process of other and core biopsy. non-imaging investigations (e.g. nasendoscopy) used in • Communicate effectively with patients regarding the this topic. benefits and risks associated with different diagnostic modalities and procedures. KEY SKILLS

• Interpret the examination accurately and safely • Recognise the normal head and neck anatomy, range of clinically significant variants and changing appearance with age and physiological states, including recognising normal imaging studies. May require limited work-up to arrive at this conclusion. • Conduct a thorough and systematic review of the imaging examination and perceive relevant abnormalities. • Correctly describe likely category of abnormalities on imaging examination (eg. solid mass, lymphadenopathy, cyst). • Within limits of information available, integrate broader knowledge of pathology (e.g. epidemiology, gross morphology, ancillary tests), clinical presentations and imaging appearances to form an appropriate differential diagnosis. © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 179 Neuro/ENT Imaging – Normal Variants Category 1 Category 2 Category 3 1. Brain

• Large Virchow-Robin spaces • Normal appearance of brain at • Normal appearance of brain in • Asymmetry of hemispheres and different ages in adulthood paediatrics ventricles • Vermian pseudotumour • Persistent cavum septum • Calcarine pseudotumour pellucidum • Choroid plexus pseudotumour • Cavum vergae • “Low hanging” cerebellar tonsils • Basal ganglia calcification • Mega-cisterna magna • Dentate nucleus calcification • Empty sella 2. Skull

• Frontal hyperostosis • Normal vault thinning • Parietal foramina • Arachnoid granulations • Large external occipital protruberance • Arachnoid granulations • Pseudofractures

¡ Accessory sutures

¡ Superficial temporal artery

¡ Occipitomastoid suture

¡ Spheno-occipital synchondrosis 3. ENT

• Neck and pharynx • Neck and pharynx: • Calcified stylohyoid ligament

¡ Asymmetry of internal jugular ¡ Pyramidal lobe of thyroid

veins ¡ Median thyroid vein

¡ Persistent adenoids ¡ Temporal bone:

• Paranasal sinuses ¡ High jugular bulb

¡ Low cribriform plate ¡ Variation in mastoid ¡ Dehiscent lamina papyracea development

¡ Onodi cell • Aberrant retropharyngeal course

¡ Carotid dehiscence into of carotid artery sphenoid sinus • Paranasal sinus developmental • Temporal bone and pneumotisation variants and drainage patterns ¡ Dehiscent internal carotid artery

¡ Dehiscent internal jugular vein

• Circle of Willis normal variants • Azygos anterior cerebral artery • Duplicated cerebral arteries • Vertebral artery asymmetry & • Persistent fetal cerebral arteries

dominance ¡ Hypoglossal

• Common carotid artery origin ¡ Trigeminal variations • Asymmetric internal jugular veins • Jugular bulb variations Extracranial Head & Neck Imaging – Clinical Conditions Category 1 Category 2 Category 3 1. Imaging Techniques & Applications

• Facial x-rays • MR of neck • Special x-ray views of temporal • Routine views are • MR of paranasal sinuses bones

¡ Lateral view • Angiography of external carotid • Sialography

¡ Caldwell view branches • Dacryocystography

¡ Water’s view • OPG • Laryngography • PET/CT • Pharyngography ¡ Basal view • Lateral airway x-rays • Image guided procedures • Videofluoroscopy of swallowing • CT face & sinuses • Cone Beam CT of temporal bones, • CT temporal bones sinus and dental pathology SYSTEMS BODY • CT & MR of skull base • CT & MR of nasopharynx • CT of neck • US of Thyroid and Parathyroid • US of salivary glands • US of Neck 2. Nose and sinuses; facial bones

Congenital / Developmental

• Frontoethmoidal / anterior skull • Choanal atresia base encephalocoele • Anterior neuropore abnormalities Trauma / Fractures

• Zygomaticomaxillary fractures • Nasal fractures

¡ Isolated fracture of the zygoma ¡ Nasal bone fractures

and zygomatic arch ¡ Fractures of the nasal septum

¡ Tripod fracture ¡ Fractures of the nasal spine

• Maxillary fractures ¡ Nasoorbitalethmoidal fractures ¡ Isolated antral fractures

¡ Alveolar ridge fractures • Mid-face fractures

¡ LeFort types I To III

¡ Bilateral mid-face fractures

• RhinoSinusitis, acute • Sinonasal polyposis • Invasive fungal infection • RhinoSinusitis, chronic • Fungal sinusitis • Planning CT for functional • Mucocoele endoscopic sinus surgery • Wegener’s granulomatosis Benign Tumours & Tumour-like Conditions

• Sinus osteoma • Juvenile angiofibroma • Mandibular and Maxillary Tori • Fibrous dysplasia • Inverting papilloma • Ossifying Fibroma • Stafne Cyst Malignant Tumours

• Metastases • Adenocarcinoma • Melanoma • Squamous cell carcinoma • Esthesioneuroblastoma • Lymphoma • Chrondo-Sarcoma • Osteo-Sarcoma • Rhabdomyosarcoma 3. Orbit

Congenital / Developmental

• Dermoid, epidermoid • Vascular malformation (Cavernous • Coloboma • High myopia changes in globe haemangioma) • Lymphangioma • Neurofibromatosis type 1 Trauma / Fractures

• Orbital fractures • Ocular Injuries

¡ Orbital rim fractures ¡ Ruptured globe

¡ Blow-out fractures ¡ Dislocated lens

¡ Blow-in fractures ¡ Retinal detachment

¡ Orbital emphysema ¡ Phthisis bulbi • Foreign body Inflammatory / Infection

• Idiopathic orbital inflammatory • Optic neuritis • Dacroadenitis disease (pseudotumour) • Phthisis bulbi • Sjogren Syndrome • Subperiosteal abscess • Orbital cellulitis Benign Tumours & Tumour-like Conditions

• Capillary haemangioma • Benign mixed lacrimal tumour • Optic nerve sheath meningioma Malignant Tumours

• Retinoblastoma • Lymphoma • Lacrimal gland malignantcies • Ocular melanoma • Rhabdomyosarcoma • Optic pathway glioma

• Thyroid orbitopathy (Graves) • Venous varix of orbit (primary and secondary) • Carotid-cavernous fistula 4. Temporal Bone and Cerebellopontine angle; Skull base

External auditory canal

• Atresia • Necrotising external otitis • Exostoses • EAC cholesteatoma • Keratosis obturans • Squamous cell carcinoma Middle ear, mastoid

• Acute mastoiditis + abscess • Dehiscent jugular bulb • Cholesterol granuloma • Aberrant internal carotid artery • Cholesteatoma, congenital • Rhabdomyosarcoma • Cholesteatoma, acquired • Chronic mastoiditis • Post-operative ear • Glomus tympanicum paraganglioma Inner ear; petrous apex

• Apical petrositis • Labyrinthitis ossificans • Congenital labyrinthine

• Cochlear implants abnormalities SYSTEMS BODY • Otosclerosis • Cochlear dysplasia • Cholesterol granuloma petrous • Chondrosarcoma petrous apex apex • Labyrinthitis ossificans • Large endolympatic sac (LEDS) • Otosclerosis • Petrous apex pseudolesion Cerebellopontine angle and internal auditory canal

• Acoustic schwannoma • Epidermoid cyst • Aneurysm • Meningioma • Arachnoid cyst • Metastases • Viral labyrinthitis • Neurofibromatosis 2 • Ramsay-Hunt syndrome • Superficial siderosis General temporal bone lesions

• Temporal bone fractures • Fibrous dysplasia • CSF leak • Paget’s disease Skull base

• Glomus jugulare paraganglioma • Chordoma of clivus • Jugular foramen schwannoma • Dural sinus thrombosis • Skull base meningioma • Chondroid series tumour • Metastasis • Post radiation treatment appearances and complications

• SCC hypopharynx • Vocal cord paresis • Laryngocele • SCC larynx • Laryngeal trauma • Chondroid lesions • Epiglottitis • Tracheal and Laryngeal infection/ inflammation • Inhaled foreign bodies 6. Oral cavity, Pharyngeal mucosal Space

Congenital

• Thornwaldt’s cyst • Lingual thyroid • Dermoid of floor of mouth Inflammatory / Infective

• Tonsillar abscess • Simple ranula • Ludwig’s angina: infection • Plunging ranula extending into sublingual and • Sialocoele submandibular spaces • Retention cyst of pharynx Benign Tumours

• Benign mixed tumour of submandibular gland Malignant Tumours

• SCC of oral cavity • Adenoid cystic carcinoma, minor • SCC of oropharynx / tonsil salivary glands • SCC of nasopharynx / NPC • Lymphoma Miscellaneous

• Zenker’s diverticulum

7. Submandibular Space

Congenital / Developmental

• Dermoid/Epidermoid cyst • Lymphatic malformation Infection / Inflammatory

• Obstruction / calculus • Acute infection • Chronic infection Benign Tumours

• Pleomorphic adenoma • Reactive lymphadenopathy

• Salivary gland origin • Metastatic lymphadenopathy • Lymphoma 8. Parotid Space

Congenital / Developmental

• 1st branchial cleft cyst, sinus or fistula Infection / Inflammatory

• Acute parotitis • Sjogren’s syndrome • Lymphoepithelial cysts of HIV Benign Tumours

• Benign mixed tumour • Warthin’s tumour • Haemangioma (children) (pleomorphic adenoma) Malignant Tumours

• Mucoepidermoid carcinoma • Intraparotid node metastases • Adenoid cystic carcinoma • Lymphoma SYSTEMS BODY Miscellaneous

• Perineural spread via CN 5 • Benign masticator muscle • Denervation atrophy of trigeminal hypertrophy nerve territories 9. Carotid Space

Congenital / Developmental

Infective / Inflammatory

• Lymphadenopathy • Caseating necrosis due to • Node abscess granulomatosis infection Vascular Lesions

• Internal jugular vein thrombosis • Carotid arterial dissection • Carotid artery pseudoaneurysm Benign Tumours

• Paraganglioma • Nerve Sheath Tumours • Castleman’s disease (e.g. carotid body tumour and glomus vagale) • Reactive lymphadenopathy

• Metastatic lymphadenopathy • Lymphoma 10. Masticator Space

Infective / Inflammatory

• Masticator space abscess / cellulitis Malignant Tumours

• Spread of SCC • Perineural spread via trigeminal nerve • Sarcoma • Lymphoma Miscellaneous

• Benign masseteric hypertrophy • Schwannoma of trigeminal nerve

11. Retropharyngeal Space (RPS) and Prevertebral Spaces

Normal Variants & Pseudolesions

• Retropharyngeal effusion • Levator scapulae hypertrophy

Infective / Inflammatory

• Suppurative adenopathy or RPS • Longus colli tendonitis abscess (calcific HADD) • Prevertebral space infection Malignant Tumours

• Nodal metastases in RPS • Lymphoma in RPS nodes

Degenerative

• Osteophytes and calcification in the anterior longitudinal ligament 12. Visceral Space Organs

Thyroid

• Multinodular goitre • Hashimoto’s Thyroiditis • Follicular carcinoma • Grave’s Disease • Anaplastic carcinoma • Thyroid adenoma • Papillary carcinoma • Assessment of solitary nodule (e.g. colloid nodule, follicular lesion) • Sonographic Assessment of thyroid nodules

• Imaging in hyperparathyroidism • Developmental cysts – parathyroid or thymic origin 13. Neck – general

Congenital lesions

• 2nd branchial cleft cyst • Slow Flow Malformations: • Dermoid cyst • Thyroglossal duct cyst Venous, Lymphatic, Mixed Venous- • Thyroglossal duct fistula Lymphatic • 1st, 3rd and 4th Branchial • High Flow Vascular malformations: Anomalies AVM or AVF • Infantile Hemangiomas (true neoplasms) Lymph nodes of the neck

• Knowledge of common patterns of • Reactive lymphadenopathy • Castleman’s disease lymph node and lymphatic spread • Suppurative lympadenitis • Lymph node groups in the Head and Neck, their nomenclature and definition • Metastases in neck nodes

(especially SCC and papillary SYSTEMS BODY thyroid Ca) • Lymphoma 14. Maxillofacial / Dental

Basic Dental Disease

• Caries • Impacted teeth • In maxilla, associated with antral • Periodontal disease • Know common dental disease • Periapical sepsis nomenclature for teeth Odontogenic Lesions

• Periapical granuloma • Dentigerous cyst • Common / important odontogenic • Periapical cyst cysts and tumours • Periapical abscess • Ameloblastoma • Odontogenic Keratocyst (OKC) Trauma

• Mandibular fractures • TMJ dysfunction

¡ Body and angle • TMJ dislocation

¡ Symphyseal and parasymphyseal

¡ Condylar

¡ Ramus and coronoid process

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 187 Neuroradiology Learning Catheter angiography Competencies Knowledge • Basics of catheter angiography in neuroradiological The competent (trainee) radiologist will be able to: practice • Safety / Preparation / IV Contrast Use / Radiation • Demonstrate a clinical, pathological and radiological Safety, Dosimetry and Dose Reduction / Technical Factors understanding of neurological imaging practice • Indications/contraindications for Neuroradiological • Interpret common and important clinical presentations Imaging/specific protocols. in neurological imaging practice for example; • Equipment and Techniques: / standard projections • Basic knowledge of therapeutic options e.g. • Headache embolisation, aneurysm treatment • Suspected stroke/collapse • Cranial and Spinal Trauma Ultrasound • Focal neurological deficit • Radicular/cranial nerve symptoms Knowledge • Myelopathy

Safety CORE KNOWLEDGE

• Indications/contraindications for Neuroradiology • Explain strengths, weaknesses and risks (radiation Imaging Ultrasound/specific protocols related and other) and roles of the imaging modalities currently used in diagnosing and evaluating Equipment and Technique neurological abnormalities. (eg use of IV contrast agents in CT and MRI, MRI sequence options, ultrasound in the • Basic knowledge of the role of trans cranial doppler neonate). ultrasound • Describe/direct assessment or work-up of a clinical • Ultrasound Image Quality Assessment problem or imaging finding using imaging methods as • Limitations of Ultrasound in Neuroradiology Imaging appropriate. • Recognise and act upon an inadequate examination. CT • Recommend follow-up imaging when appropriate.

Knowledge Plain X-ray / Fluoroscopy

• Safety / Scan Preparation / IV Contrast Use / Radiation Knowledge Safety, Dosimetry and Dose Reduction / Technical Factors • Indications/contraindications for Neuroradiological CT • Safety / Preparation / IV Contrast Use / Radiation Imaging / Specific Protocols Safety, Dosimetry and Dose Reduction / Technical Factors • The use of CT angiography, CT venography and CT • Indications/contraindications for Neuroradiological perfusion in neurological practice Imaging/specific protocols • CT Image Quality Assessment • Limitations of CT in Neuroradiology Imaging Equipment and Techniques MRI • Limitations of Plain X-ray /Fluoroscopic Procedures • X-ray image Quality Assessment in Neuroradiology Knowledge Imaging

• Safety / Scan Preparation / IV Contrast Use / MRI General Safety / Technical Factors • Indications/contraindications for Neuroradiological Imaging MRI / Specific Protocols

Page 188 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 • MR angiographic techniques and imaging appearances to form an appropriate • MR Venography differential diagnosis • The basic principals and utility of MR perfusion, MR • Evaluate the imaging study in light of differential diffusion diagnoses to identify clinically relevant findings

Equipment and Technique Acts Safely

• MRI Image Quality Assessment • Recognise imaging signs suspicious of conditions with • Limitations of MRI in Neuroradiology Imaging significant patient implications (e.g.: subarachnoid haemorrhage, isodense subdural haematoma, cord Nuclear Medicine compression, coning) • Safely assign a benign diagnosis and discriminate such Knowledge cases from those that require further assessment • Correctly categorise indeterminate findings and guide • Safety / Radiopharmaceutical Use / Radiation Safety subsequent investigation appropriately Dosimetry and Dose Reduction • Demonstrate knowledge of the principles/ limitations/ Convey findings indications of SPECT and PET Scans in Neuroradiology Imaging • Communicates relevant findings including diagnoses, • Knowledge of tracer options for neuro imaging (eg FDG, treatment plans, complications and follow up to the DOTA) referring clinician, patient and or family/carers and other health care team members and assists in formulating

Equipment and Technique: Basics only an imaging and management plan as necessary (eg: SYSTEMS BODY surgical consultation, biopsy) • NMCT Image Quality Assessment • Limitations of NMCT in Neuroradiology Imaging Interventions and techniques • Non Imaging Investigations • Demonstrate competence in lumbar puncture and Knowledge of the role of non-imaging investigations (e.g.: myelography. Possess basic knowledge about EEG, nerve conduction studies, CSF examination). interventional techniques used during management of aneurysms, dural AV fistulae, arteriovenous KEY SKILL malformations and arterial and venous thrombosis (thrombolysis) Interpret the examination accurately and safely • Demonstrate knowledge of more advanced imaging methods including perfusion imaging, and basic • Recognise normal neurological anatomy, common knowledge of MR spectroscopy and functional MRI normal variants, expected changes with age and • Communicate effectively with patients regarding the physiological stages, including recognising normal benefits and risks associated with different diagnostic imaging studies or requires limited work-up to arrive at modalities and procedures this conclusion • Conduct a thorough and systematic review of the imaging examination and perceives relevant abnormalities • Correctly describe likely category of abnormalities on imaging examination (e.g.: stroke, brain tumour, extra- axial mass effect) • Within limits of the information available, integrate broader knowledge of pathology (e.g.: epidemiology, gross morphology, ancillary tests), clinical presentations

Category 1 Category 2 Category 3 1. Brain and intracranial structures

Congenital malformations (see Paeds Syllabus)

• Chiari malformations 1 & 2 • Dandy Walker spectrum • Septo-optic dysplasia • Agenesis of corpus callosum • Holoprosencephaly • Hemimegalencephaly • Heterotopic grey matter • Microcephaly • Lissencephaly • Chiari malformation 3 • Schizencephaly • Pachygyria-polymicrogyria Infection

• Meningitis • Neurocysticercosis • Rickettsial infections • Cerebral abscess • Tuberculosis • Lyme disease • Empyema • Fungal infections • Herpes encephalitis • HIV / AIDS and the CNS • Ventriculitis Tumours

• Intra-axial metastases • Other brain tumours • Even More Brain Tumours

• Leptomeningeal metastases • Ependymoma ¡ Central neurocytoma

• Meningioma • Choroid plexus papilloma ¡ Ganglioglioma

• Astrocytoma • Choroid plexus carcinoma ¡ Gliosarcoma

• Glioblastoma multiforme • Medulloblastoma ¡ Pineoblastoma

• Brainstem glioma • Haemangioblastoma ¡ Pineocytoma

• Teratoma • Germinoma ¡ Subependymoma

• Primary CNS lymphoma • DNET ¡ Astroblastoma

• Supratentorial PNET ¡ Dysplastic cerebellar • Pilocytic astrocytoma gangliocytoma

• Oligodendroglioma ¡ Desmoplastic infantile • Subependymal giant cell ganglioglioma

astrocytoma ¡ Atypical teratoid-rhabdoid • Pleomorphic xanthoastrocytoma tumour

• Gliomatosis cerebri ¡ Angiocentric lymphoma

• Atypical meningioma ¡ Embryonal carcinoma

• Leukemia ¡ Haemangiopericytoma

¡ Malignant meningioma Non-neoplastic cysts

• Arachnoid cyst • Dermoid cyst • Neuroglial cyst • Colloid cyst • Epidermoid cyst • Pineal cyst • Choroid plexus cyst • Ependymal cyst • Porencephalic cyst

• Extradural haematoma • Carotico-cavernous fistula • Subdural haematoma • Traumatic subdural CSF hygroma • Traumatic subarachnoid haemorrhage • Cerebral contusion • Diffuse axonal injury • Non-accidental injury • Intracranial herniation syndromes Demyelination; dementias

• Multiple sclerosis • Alzheimer’s disease • Subacute sclerosing • Tumefactive demyelination • Parkinson’s disease panencephalitis • Multi-infarct dementia • ADEM Vascular lesions

• Thromboembolic infarction • Fibromuscular hyperplasia of the • Superficial siderosis • Carotid and vertebral dissection carotids • CADASIL • Subarachnoid haemorrhage, • Cavernous malformation • Capillary telangiectasia aneurysmal • Arteriovenous malformation • Subarachnoid haemorrhage, • Pseudoaneurysm

perimesencephalic (venous) • Cerebral amyloid disease SYSTEMS BODY • Aneurysm • Vasculitis • Spontaneous intracerebral • Cranial dural AV fistula haemorrhage • Vascular loop compression (e.g. • Hypotensive infarction trigeminal neuralgia, hemifacial • Diffuse hypoxic injury spasm) • Venous infarction • Developmental venous anomaly • Intracranial venous thrombosis Toxic, metabolic, or degenerative disorders

• Acute hypertensive encephalopathy • Osmotic demyelination syndrome • Effects of drug abuse (PRES) • Status epilepticus • Fahr’s disease • Mesial temporal sclerosis • Carbon monoxide poisoning • Idiopathic (benign) intracranial • Alcoholic encephalopathy hypertension • Hepatic encephalopathyEffects of therapeutic radiation • Effects of chemotherapeutic drugs Miscellaneous

• Brain death • Normal pressure hydrocephalus • Hypertrophic pachymeningitis • Obstructive hydrocephalus • Neurosarcoidosis – communicating and non- • Intracranial hypotension communicating • Aqueduct stenosis • Complications of CSF shunts

• Pituitary microadenoma • Pituitary stalk anomalies • Hamartoma of tuber cinereum • Pituitary macroadenoma • Rathke’s cleft cyst • Pituicytoma • Pituitary apoplexy • Lymphocytic hypophysitis • Craniopharyngioma • Empty sella 3. Skull

• Skull fractures & complications • Haemangioma • Myeloma • Metastases • Fibrous dysplasia • Paget’s disease • Frontal hyperostosis 4. Spinal cord and related structures; peripheral nerves

• Ependymoma • Syringomyelia • Astrocytoma • Transverse myelitis • Meningioma • Cord demyelination • Epidural haemorrhage • Arachnoid cyst • Epidural abscess • Dorsal / ventral dural defect • Spinal / epidural metastases • Spinal vascular malformations • Intrathecal metastases • Spinal dural AV fistula • Traumatic cord injury • Meningitis • Spinal cord infarction • Disc prolapse • Neurofibroma • Transverse myelitis • Arachnoiditis • Postoperative epidural fibrosis / scarring 5. Neurocutaneous syndromes

• Neurofibromatosis 1 • Von Hippel Lindau • Basal cell naevus syndrome • Neurofibromatosis 2 • Tuberous Sclerosis • Cowden syndrome 6. Cranial Nerve

• Optic neuritis • Vestibular neuritis • Schwannoma • Bell palsy • Vascular compression syndrome • Perineural spread (trigeminal neuralgia) Imaging Techniques and Applications (Adult Neuro & Spine)

• Skull x-ray for trauma • Myelography & CT myelography • Spinal interventions – bone, disc • CT skull and brain and facet joints (principles) • MRI of brain • MRI of pituitary • CT of spine • MRI of spine

The competent (trainee) radiologist will be able to: Safety

• Demonstrate a clinical, pathological and radiological • Indications/contraindications for MSK Imaging understanding of MSK imaging Ultrasound/specific protocols • Interpret common clinical presentations in MSK imaging practice. Equipment and Technique ¡ Interpret clinical emergencies where intervention e.g. surgical or oncological, is required. E.g. • Ultrasound Image Quality Assessment fracture dislocation of spine, pathological or • Limitations of Ultrasound in MSK Imaging complicated peripheral joints fractures with potential neurovascular harm or alignment CT Scanning problem e.g. stress fracture, infection.

¡ Acquire further relevant clinical information from Knowledge referring clinician which may affect radiological diagnosis or differential diagnosis. • Safety / Scan Preparation / Contrast Use (IV/ Oral) / Radiation Safety Dosimetry and Dose Reduction / CORE KNOWLEDGE Technical Factors • Indications/contraindications for MSK Imaging CT / • Explain the strengths, weaknesses and risks (radiation

Specific Protocols SYSTEMS BODY related and other) of the imaging modalities currently used in diagnosing and evaluating MSK abnormalities. Equipment and Technique • Recognise and act upon an inadequate examination. • Describe/direct assessment or work-up of a clinical • CT Image Quality Assessment problem or imaging finding using imaging methods as • Limitations of CT in MSK Imaging appropriate. • Recognise and act upon an inadequate examination. MRI Scanning • Be able to recommend follow-up imaging at later time interval when appropriate. Knowledge Plain X-ray / Fluoroscopy •Safety / Scan Preparation / Contrast Use / MRI General Safety / Technical Factors Knowledge • Indications/contraindications for MSK Imaging MRI / Specific Protocols • Safety / Preparation / Contrast Use (IV/ Oral) / Radiation Safety Dosimetry and Dose Reduction / Technical Factors Equipment and Technique • Indications/contraindications for MSK Imaging/specific protocols. • MRI Image Quality Assessment • Limitations of MRI in MSK Imaging Equipment and Techniques Nuclear Medicine • Limitations of Plain X-ray /Fluoroscopic Procedures • X-ray image Quality Assessment in MSK Imaging Knowledge

• Safety / Radiopharmaceutical Use / Radiation Safety Dosimetry and Dose Reduction • Octreotide Scanning/ PET Scans in MSK Imaging

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 193 Equipment and Technique: Basics only an imaging and management plan as necessary plan (e.g. surgical consultation, and non-primary bone or soft • NMCT Image Quality Assessment tissue sarcoma biopsy) with referring physician team. • Limitations of NMCT in MSK Imaging Radiological Interventions KEY SKILLS • Describe the imaging guided techniques and planning • Interpret the examination accurately and safely of joint aspiration, diagnostic and therapeutic injections • Recognise the normal MSK anatomy, range of variants and biopsy (excluding primary sarcoma of bone and and changing appearance with age and physiological soft tissue) in the MSK system, including strengths and states, including recognising normal imaging studies or weaknesses of different procedures. requires limited work-up to arrive at this conclusion. • In relation to potential primary sarcoma of bone and • Conduct a thorough and systematic review of soft tissue biopsy, be able to refer to an orthopaedic the imaging examination and perceives relevant oncology and radiology service in a designated specialty abnormalities. unit. • Correctly describe perceived abnormalities in terms of • Assess the adequacy of a biopsy specimen in relation location, appearance and possible differential diagnosis. to pathology requirements and be aware of common • Within limits of information available, integrate broader problems associated with biopsy adequacy. knowledge of pathology (eg epidemiology, gross • Communicate effectively with patients regarding the morphology, ancillary tests), clinical presentations and benefits and risks associated with different diagnostic imaging appearances to form an appropriate differential modalities and procedures. diagnosis. • Interact effectively with other health care team • Evaluate the imaging study in light of differential members such as surgeons, rheumatologists, oncologists diagnoses to identify clinically relevant findings. and pathologists during management of MSK conditions. Acts Safely

• Recognise imaging signs which would lead to a change in management, such as infection, fracture/dislocation, tumor. • Safely diagnose other lesions or normal anatomy without excessive investigation or patient risk. • Correctly categorise indeterminate findings and guide investigation appropriately including knowing when to refer for MSK subspecialist or multidisciplinary team opinion particularly with respect to potentially significant tumour or tumour-like bone or soft tissue conditions. This is especially related to potentially primary bone or soft tissue sarcoma, which requires dedicated specialised team/unit referral. Have awareness of anatomical compartment contamination and effect on management and prognosis for the individual patient.

Convey findings

• Superimposed hair braid • Superimposed soft tissue 2. Technique / Artifact

• Mach effect • Projectional variants (e.g. lucency greater tuberosity humerus, tuberosity radius simulating bone lesion, epiphysis proximal humerus simulating fracture) 3. In relation to Musculoskeletal System

• Accessory Ossicles that may • Hyperostosis frontalis interna simulate fracture • Variants of pneumatisation of • Sutural variants that may simulate paranasal sinuses fracture • Intracranial calcifications • Vascular channels • Pseudosubluxation of C2/3 BODY SYSTEMS BODY • Nutrient foramina • Accessory ribs • Bone island • Variations in pedicle size • Anomalies of segmentation • Notochordal remnants • Transitional spine • Scoliosis of sacrum • Variants of epiphyseal fusion • Fibrous cortical defect • Variants of ossification (bone, • Coccygeal angulation epiphysis, apophysis, ossicles, • Physeal scar sutures, synchondroses, ligaments) • Metaphyseal density • Vacuum phenomenon • Bipartite patella / other bones • Growth arrest lines • Especially with MRI, awareness • Fusion of carpal / other bones of normal red and white marrow • Variants in bone marrow fat pattern in growth and ageing content • Variants of glenoid labrum (e.g. • Potentially symptomatic / painful Buford complex) normal variants (awareness • Variants of acetabular labrum required for patient care) • Eg. fusion: Tarsal coalition • Awareness that some previous • Eg. Ossicles / ossification centres: “normal variants” have been Os tibial externum further investigated and are pathologic eg. many “os acetabulum” are infact stress fractures related to FAI. Spinal Variants

• Limbus vertebra • Craniovertebral junction variants • Filum terminale fibrolipoma • Conjoined nerve roots • Ventriculus terminalis • Bone island • Lumbar segmentation & numbering anomalies

• Tarsal coalition • Ossicles around the ankle & foot • Accessory muscles of the hindfoot • Low soleal musculotendinous junction • Accessory soleus

References: Atlas of Normal Variants that May Simulate Disease. Theodore E. Keats, Mark W. Anderson. Mosby-Year Book Inc 2007. ISBN: 10 0-323-04300-3, ISBN: 13 978-0323-04300-7

Musculoskeletal Imaging – Clinical Conditions (For Paediatric Conditions, See Paediatric Syllabus) Category 1 Category 2 Category 3 1. Shoulder and Clavicle

Normal appearances

• Plain film findings • Arthrography • Ultrasound findings • MR findings • CT findings • MR arthrography Imaging Techniques & Applications

• Standard plain film views of the • Additional special x-ray views: • Westpoint view for instability

shoulder joint ¡ True AP and lateral views of • Arthrography and joint aspiration ¡ AP external rotation the scapula • MR arthrography

¡ AP internal rotation ¡ Scapular neck • CT arthrography

¡ True anatomical AP for GH ¡ Scapular spine • Non-rotator cuff ultrasound

joint space ¡ Suprascapular notch

¡ Axial view ¡ Coracoid and acromion

¡ Outlet view for impingement ¡ Scapulothoracic

• Standard projections for the ¡ Bicipital groove

clavicle ¡ Acromioclavicular joint

¡ Sternoclavicular joint • MRI of shoulder • Ultrasound of rotator cuff • CT of shoulder & scapula Impingement

• Plain film signs of subacromial • Ultrasound findings in • Internal impingement syndrome impingement subacromial impingement • Coracoid impingement syndrome • MRI signs of subacromial impingement

• Common fractures • Less common fractures (Greater tuberosity, Humeral (Coracoid process, scapular spine) neck, Neck and body of scapula, Acromion) • Clavicular fractures & related complications • Sternoclavicular joint dislocation and subluxation Joint Trauma

• Loss of alignment and congruity • Glenoid hypoplasia at the GHJ (dislocation and • Bony Bankart lesion subluxation) • Reverse Hill-Sachs defect • Hill-Sachs defects • Posterior glenoid rim fracture • AC joint subluxation Arthritis and Bursitis

• Osteoarthritis • Atypical infective arthritis • Other arthritides • Rheumatoid arthritis • Psoriatic arthritis (Gout, amyloid) • Septic arthritis, bacterial • Osteochondromatosis • Other bursitis

• Osteomyelitis • Calcium pyrophosphate • Sternoclavicular hyperostosis SYSTEMS BODY arthropathy (CPPD) Glenohumeral Capsule & Ligament Injuries

• Bankart injuries • Adhesive capsulitis, including • TUBS (Traumatic Unilateral with treatment options Bankart lesion, usually requiring • SLAP injuries in general surgery) • AMBRI (Atraumatic, Multidirectional, Bilateral, Rehabilitation, rarely needs an Inferior capsular shift) • SLAP lesions – types I to IV • GLAD lesion • HAGL lesion • Inferior instability • IGL lesion • Microinstability (superior instability) • Perthes and ALPSA lesions • Labral cysts • Rotator interval injuries and synovitis

• Calcific tendinopathy (HADD) • Pectoralis major tears / avulsion • Long head of biceps instability • Rotator cuff tendinopathy / tears • Long head of biceps dislocation • Other tendon injuries or avulsions • Long head of biceps tendinopathy (e.g., coracobrachialis, short head / tears of biceps, etc.) • Subscapularis tear / avulsion • Infraspinatus tear / avulsion Miscellaneous Disorders

•AVN & bone infarcts • Traumatic osteolysis of the outer • Osteochondral lesion OCD clavicle • Acromial apophysitis • Suprascapular nerve palsy • Scapulothoracic bursitis • Post-op changes & complications • Axillary nerve palsy in humeral head prosthesis • Quadrilateral space syndrome • Parsonage-Turner Syndrome 2. Elbow and Forearm

Normal appearances

• Plain film findings • MR findings • Ultrasound findings • Elbow ossification centres • CT findings • Arthrography Imaging Techniques & Applications

• Essential elbow views: • Additional views • CT of the elbow

¡ AP, lateral • Axial • MR of the elbow

¡ Oblique • Radial head-capitellar • US of the elbow • AP and lateral forearm views in • ‘Cubital tunnel’ • US & MR of elbow / forearm zero rotation • Stress for MCL instability nerves Bony Trauma

• Common elbow fractures • Less common elbow fractures • Stress fracture of olecranon (Epicondylar, lateral condylar, (Coronoid, olecranon) • Essex-Lopesti fracture/subluxation capitellar, radial head & neck, • Coronoid process fracture ulnar) • Plastic bowing of the forearm • Supracondylar fractures & related bones complications • Fracture-Dislocations (Monteggia, Galeazzi) • Nightstick fracture • Greenstick fractures Joint Injuries & Overuse syndromes

• Soft tissue signs of intra-articular • Loose bodies and os • Radiocapitellar overload syndrome fracture supratrochleare • Capitellar OCD

¡ Supinator sign • Synovial osteochondromatosis • Valgus extension overload

¡ Fat fad displacement

• Osteoarthritis • Psoriatic arthritis • Bicipital radial bursitis • Rheumatoid arthritis • CPPD • Other arthritides • Gout (Amyloid) • Septic arthritis • Osteomyelitis • Olecranon bursitis Tendinopathy & Tendon Injuries

• Posterior dislocation of elbow • Brachialis injuries • Collateral ligament injuries • Hyperextension injuries • Lateral epicondylitis • Medial epicondylitis • Biceps tendinopathy and rupture • Triceps tendinopathy and rupture Neuropathies & Nerve Injuries

• Ulnar neuropathy • Radial (posterior interosseus) • Median neuropathy neuropathy • Anconeus epitrochlearis • Synovial fringe syndrome 3. Hand and Wrist BODY SYSTEMS BODY Imaging Techniques & Applications

• Essential views • MRI • Additional views

• PA • Bone scan ¡ Pisotriquetral view

¡ Oblique • Additional views ¡ Carpal boss view

¡ Lateral ¡ Hook of hamate view ¡ Anterior ridge of trapezium ¡ Scaphoid view ¡ Functional views for carpal instability (including stress, ulnar deviation, clenched fist)

¡ DRUJ instability views Bony Trauma

• Common carpal fractures • Phalangeal fractures • AVN/OCD of capitate

¡ Scaphoid • Stress views for thumb MCPJ, & • Less common carpal fractures

¡ Triquetral indications • Anterior ridge of the trapezium

¡ Scaphoid AVN • Lunatomalacia • Pisiform • Nonunion & repair of scaphoid • Capitate ¡ Thumb fractures ¡ MCP joint (UCL and RCL) • Fractures at base MC1 • Stress fracture • Volar plate injuries • Hook of hamate • MCP fracture/dislocations • Pisiform • CMC joint injuries, esp. 5th • Distal radial growth plate

• Scapholunate dissociation • SLAC & SNAC wrist • Soft tissue signs of intra-articular • DISI & VISI fracture • Lunate & perilunate dislocations

¡ Pronator quadratus fat plane • TFCC Injuries displacement • DRUJ instability

¡ Scaphoid fat pad displacement Arthritis & Inflammation

• Osteoarthritis • Soft tissue abscess • Ulnar impingement syndrome • Rheumatoid arthritis • Septic tenosynovitis • Hamato-lunate impingement • Psoriatic arthritis • Gout • Scleroderma • CPPD • Haemochromatosis • SLE • Septic arthritis and osteomyelitis • Reflex sympathetic dystrophy • Acromegaly • Other arthritides (e.g. amyloid) Tendons

• Extensor tendinopathies • Tendon injuries • Proximal and distal intersection

(de Quervain’s and ECU) ¡ FDP rupture – 3 types syndrome

• Flexor tendinopathies ¡ Bowstringing

¡ Extensor tendon injuries

¡ Extensor hood injuries Miscellaneous

• Ganglia • Carpal boss syndrome • Hypothenar hammer syndrome • Carpal tunnel syndrome • Guyon’s canal syndrome 4. Pelvis, Hip and Thigh

Imaging Techniques & Applications

• XR AP pelvis • MRI of pelvis & hips • US of groin NB. int rotation of hips • US of hip joints • Additional views

• Lateral views of the hip • Bone scan of pelvis & hips ¡ Judet

¡ Frog leg ¡ Prone symphysis

¡ Cross-table ¡ Obturator

• Sacroiliac joint views ¡ Flamingo

• CT of pelvic fractures ¡ ASIS

¡ Lesser trochanter Bony Trauma

• Disruption of the pelvic ring • Apophyseal avulsions • Stress reaction and fractures

• Anterior and posterior column ¡ ASIS, PSIS ¡ Apophysitis

injury ¡ Ischial tuberosity ¡ Femoral shaft

• Pubic rami fractures ¡ Lesser trochanter ¡ Thigh splints • Sacral stress fracture ¡ Tensor fascia lata ¡ Groin strain – osteitis pubis

¡ Iliac crest

• Dislocations of the hip • Transient osteoporosis • Loose hip fragment • Regional migratory osteoporosis • Acetabular fractures • Nontraumatic avascular necrosis • Femoral neck fractures

¡ Subcapital

¡ Stress / incomplete

¡ Intertrochanteric including classification

¡ Complications e.g, avascular necrosis (AVN) Arthritis and Inflammation

• Osteoarthritis • Synovial chondromatosis • Ankylosing spondylitis • Rheumatoid arthritis • Other hip conditions • Acromegaly

• Septic arthritis ¡ Labral tears / cysts • DISH-related (diffuse idiopathic

• Sacroilitis ¡ Transient osteoporosis skeletal hyperostosis)

¡ Idiopathic chondrolysis • Ankylosis, joint changes in paraplegia & quadriplegia ¡ AVN of the femoral head

¡ Snapping hip syndromes • Iliopsoas bursitis, infection • Other septic bursitis BODY SYSTEMS BODY Nerve & Muscle Pathology

• Muscle and tendon tears • Intramuscular and intermuscular • Inflammatory myopathies

¡ Adductor hematoma ¡ Polymyositis

¡ Quadriceps • Peripheral nerve sheath tumours ¡ Dermatomyositis

¡ Hamstrings • Course & injuries to femoral nerve • Nerve entrapments • Necrotising fasciitis ¡ Gluteus ¡ Obturator neuropathy • Intramuscular abscess • Muscle wasting ¡ Sciatic nerve entrapment • Diabetic myonecrosis • Myositis ossificans ¡ Meralgia paraesthetica

(Heterotopic ossification) ¡ Pudental nerve entrapment

• Cellulitis ¡ Groin hernias (“sports hernia”) Post-Treatment Changes

• Hip joint prosthesis & • Arthrodesis of hip • Femoral rods, nails, plates & complications • Pelvic fracture fixation complications • Radiation necrosis 5. Knee and Leg

Imaging Techniques & Applications

• AP, Lateral views • Flexed weight-bearing view • XR & CT arthrography • Intercondylar view (Rosenberg • MRI of knee • MR arthrography view) • CT of knee • US of knee • Patellofemoral skyline view • Leg length assessment (CT, X-ray) • Knee alignment by CT

• Fracture healing • Bone scan findings in fractures • Plastic bowing of the fibula • Long bone fractures • Fibular head fracture • Transient osteoporosis of the knee • Growth plate fractures • Stress fractures of the growth • Patellar fractures plates • Bone bruising (MR) • Evaluation of orthopaedic • Salter-Harris type I fractures prostheses and fixation • Stress fractures of femur, patella, • Spontaneous osteonecrosis of the tibia and fibula knee (SONK) • Osteochrondritis dissecans Knee Injuries

• Common avulsion injuries • Less common avulsions • Uncommon avulsions ¡ ACL, PCL, MCL, LCL ¡ Segond and reverse Segond ¡ Gerdy’s tubercle avulsion • Osteochondral fractures fracture ¡ Capsular avulsion ¡ Tibial condyle ¡ Medial retinacular avulsion ¡ Arcuate avulsion ¡ Femoral condyle from patella ¡ Biceps femoris avulsion ¡ Patella ¡ Apophysis of tibial tuberosity • Vertical patellar fractures ¡ Tibial plateau fracture ¡ Quadriceps avulsion • Uncommon meniscal findings • Soft tissue abnormalities on plain ¡ Patellar sleeve fractures ¡ Meniscal ossicle films • Abnormal ossicles around the ¡ Parameniscal cyst ¡ Joint effusion knee ¡ Meniscocapsular separation ¡ Lipohaemarthrosis • Less common meniscal conditions • Thickening of ligamentum ¡ Chondrocalcinosis ¡ Discoid meniscus mucosum ¡ MCL soft tissue swelling ¡ Meniscal cyst • Other patellar conditions ¡ Osteochondral loose bodies ¡ Post-operative meniscal ¡ Fong’s syndrome • Dislocations & related change ¡ Excessive lateral pressure complications ¡ Less common tendon syndrome (ELPS) ¡ Internal derangement pathologies ¡ Hoffa’s disease ¡ Meniscal tears (all types) ¡ Popliteus tendon injury ¡ Patellar position & tracking ¡ Ligament tears ¡ Iliotibial band tendinopathy abnormalities ¡ Posterolateral corner injury and rupture ¡ Plica syndrome • Patellar tendinopathy and rupture ¡ Quadriceps tendinopathy and • Patellar conditions rupture • Ganglia – periarticular, intraosseous and cruciate ligament Leg Trauma

• Ruptured popliteal cyst • Proximal tibiofibular joint • Proximal tibiofibular joint • Gastrocnemius tear ¡ Fractures and dislocations ¡ Instability due to hypoplastic (tennis leg) facets • Other muscle tears Arthritis / Synovitis / Bursitis

• Osteoarthritis • Pigmented villonodular synovitis • Lipoma arborescens, knee • Rheumatoid arthritis • Synovial osteochondromatosis • Reflex sympathetic dystrophy, • Chondrocalcinosis, including CPPD • Bursal pathology knee • Popliteal (Baker) cysts ¡ Prepatellar bursitis • Haemophillia ¡ Infrapatellar bursitis • Gout ¡ Pes anserine bursitis

• For vascular pathology, see VIR • Proximal tibiofibular joint syllabus ganglion causing peroneal nerve entrapment 6. Ankle and Foot

Normal Appearances & Functional Asoects

• Anatomy of ankle ligaments ¡ Lateral ligament complex ¡ Deltoid ligament ¡ Distal tibiofibular syndesmosis • Biomechanics of a diastasis injury Imaging Techniques & Applications

• AP, Lateral views • MRI of foot & ankle • Additional Ankle views • Mortise view • US of the Achilles tendon ¡ Impingement • Views of toes • US of foot and ankle ¡ Weight bearing • Oblique views ¡ Stress • CT for complex fractures ¡ Proximal fibular shaft for • Bone scan Maisonneuve fracture • Additional foot views

¡ Axial heel SYSTEMS BODY ¡ Weightbearing ¡ Navicular ¡ Harris-Beath ¡ Plantodorsal midfoot ¡ Os tibiale externum ¡ Skyline sesamoids

• Common Ankle Fractures • Midfoot injuries • Ankle impingement

¡ Weber classification • Lisfranc fracture-dislocation ¡ Anterolateral

¡ Dupuytrens fracture • Osteochondritis dissecans OCD ¡ Anteromedial

¡ Maissoneuve fracture talar dome • Posterolateral Ankle arthrofibrosis

¡ Posterior lip of distal tibia • AVN of the talus • Classification of talar dome

¡ Medial malleolus • Stress Fractures fractures • Commonly missed hindfoot ¡ Distal fibula • Lauge-Hansen classification of fractures ¡ Distal tibia ankle injuries

¡ Talar dome ¡ Talar neck and lateral process

¡ Tibial plafond ¡ Distal tibial growth plate

¡ Anterior process of calcaneum ¡ Other ankle ligament injuries

¡ Posterior process of talus ¡ Anterior talofibular ligament

¡ Lateral process of talus (ATFL)

¡ Talar neck • Calcaneal fracture classification & analysis • Subtalar dislocation • Avulsion fractures & ligament injuries

¡ LCL complex

¡ Deltoid ligament

¡ Distal tibiofibular syndesmosis Foot & Ankle Tendon Injuries & Tendinopathies

• Achilles tendinosis & tear • Haglund syndrome (retrocalcaneal bursitis) • Tibialis posterior tendon injuries & tenosynovitis • Plantar fasciitis • Other heel conditions

¡ Plantar fibromatosis • Painful os tibiale externum • Other tendinopathy & tenosynovitis

¡ FDL

¡ FHL

¡ Peroneal

¡ Tibialis anterior

• Forefoot fractures & dislocations • Other Hindfoot conditions • Mueller-Weiss syndrome

¡ Base of fifth metatarsal ¡ Tarsal coalition (spontaneous atraumatic

¡ Fractures of tarsal bones ¡ Sinus tarsi syndrome osteonecrosis of the tarsal

¡ Midtarsal fractures & ¡ Tarsal tunnel syndrome navicular) • Other conditions of the forefoot dislocations ¡ Other tarsal stress fractures ¡ Bunionette formation ¡ Metatarsal fractures (acute & ¡ 2nd MT base stress fracture ¡ Painful os intermetatarseum stress) ¡ Special 5th MT fractures ¡ Morton’s neuroma • Fractures & dislocations of toes ¡ Spiral distal shaft

¡ Jones fracture

¡ Fracture of the tubercle • Other forefoot injuries

¡ Turf toe

¡ Plantar plate rupture

¡ Toe deformities

¡ Sesamoid stress fractures, sesamoiditis

¡ Hallux valgus and metatarsus primus varus

¡ Hallux rigidus

¡ Freiberg’s infraction

Arthropathy and Infection SYSTEMS BODY

• Osteoarthritis • Midfoot ganglia • Acromegaly • Post-traumatic arthritis • Neuropathic (Charcot) foot • Hemochromatosis • Rheumatoid arthritis • Diabetic foot • Septic arthritis and osteomyelitis • Reiter’s syndrome • Reflex sympathetic dystrophy 7. The Spine (For Spinal Cord & Nerves, See Neuro Syllabus)

Congenital and Developmental Disorders (Also see Paediatric Syllabus)

• Chiari I malformation • Failure of vertebral formation • Meningocoeles • Neurofibromatosis Type 1 • Partial vertebral duplication • Dural dysplasia • Neurofibromatosis Type 2 • Vertebral segmentation failure • Mucopolysaccharidoses • Idiopathic scoliosis • Klippel-Feil spectrum • Sickle cell disease • Congenital scoliosis and kyphosis • Congenital spinal stenosis • Osteopetrosis • Schmorl node • Neuromuscular scoliosis • Ochronosis • Scheuermann Disease • Idiopathic kyphosis • Caudal Regression Syndrome • Tethered cord • Connective tissue disorders • Neurenteric cyst • Diastematomyelia • Achondroplasia • Osteogenesis imperfecta • Posterior element incomplete fusion • Sacrococcygeal teratoma

Infections • Discitis (pyogenic, TB) • Granulomatous osteomyelitis • Echinococcus • Epidural abscess • HIV • Schistosomiasis • Subdural abscess • Spinal meningitis • Cysticercosis • Paraspinal abscess • Septic facet joint arthritis • Osteomyelitis • Pseudoinflammatory: pseudoarthrosis of ankylosing spondylitis Spine Post-procedural Imaging

Post-operative Imaging and Complications • Recurrent vertebral disc herniation • Pseudomeningocoele • Post-operative infection • Bone graft complications • Peridural fibrosis • Hardware failure Cervical Spine

• Routine Non-trauma Views • Additional non-trauma views

¡ Neutral lateral ¡ Flexion and extension

¡ AP from C3 toT1 ¡ Additional trauma views

¡ AP atlantoaxial region ¡ “Swimmer’s view”

¡ AP obliques ¡ Other Injuries

¡ Acute trauma Views ¡ Rotary atlantoaxial subluxation

¡ Cross-table lateral ¡ Radicular symptoms following

¡ With clinical neuropathy – cervical spine injury CT or MRI • Neurocentral joint degeneration

¡ AP views after lateral view • Rheumatoid arthritis, esp. atlanto- cleared axial subluxation

¡ Flexion and extension with patient UNAIDED!!

¡ Spinal alignment signs

¡ Prevertebral soft tissue swelling • Hyperflexion injuries

¡ Wedge compression fracture

¡ “Clay shoveler’s” fracture

¡ Flexion teardrop fracture

¡ Unilateral or bilateral facet dislocation / fracture dislocation

¡ Acute disc protrusion • Hyperextension injuries

¡ Fracture of the posterior arch of the atlas

¡ Extension sprain injuries

¡ Extension teardrop fracture

¡ Hangman’s fractures • Odontoid process fracture • Jefferson fracture

• Routine views • Additional views • AP ± weight bearing • Lateral centred on the • Lateral (long exposure) thoracolumbar junction • Acute trauma • Cross-table lateral if unable to • Wedge compression fractures stand • Age of fractures • Other injuries • Burst fractures • Thoracic disc protrusion • Fractures and dislocations Lumbar Spine

• Routine views • Bone scan, including SPECT

¡ AP • Stress fractures of the spinous

¡ Lateral process

¡ Coned lumbosacral junction • Interspinous bursopathy • Other conditions ¡ 30° angled sacroiliac joints ¡ Limbus vertebra ¡ Additional views ¡ Schmorl’s nodes ¡ Oblique views ¡ Scheuermann’s disease ¡ Acute trauma ¡ Lumbosacral pseudarthrosis ¡ Wedge compression

¡ Burst fracture

¡ Transverse process BODY SYSTEMS BODY ¡ Chance injuries

¡ Injury to ring apophysis • Vertebral osteonecrosis • Bone stress and stress fractures of the pars • Sacroiliitis • Discitis & vertebral osteomyelitis Degenerative Spinal Conditions & Arthritides

• Degenerative disc disease • OPLL • Neurogenic (Charcot) arthropathy nomenclature • Degenerative scoliosis • Septic arthritis facet joint • Degenerative disc disease • Facet joint synovial cyst • Ossification of ligamentum flavum

¡ Bulge • Ankylosing spondylitis

¡ Disc annular tear • GIT-related spondylitides

¡ Disc herniation, cervical • Septic arthritis sacroiliac joint

¡ Foraminal disc extrusion

¡ Degenerative endplate changes • Spondylolisthesis • Instability • Spondylosis • Acquired spinal stenosis • DISH • Facet arthropathy • Rheumatoid arthritis • Epidural lipomatosis

• Multiple Hereditary • Ollier disease • Mucopolysaccharidoses Osteochondromas (diaphyseal • Maffucci syndrome • Spondyloepiphyseal dysplasias aclasis) • Achondroplasia • Neurofibromatosis • Osteogenesis imperfecta • Meleorrhostosis • Osteopoikilosis • Trevors disease 9. Bone Marrow & Metabolic Diseases

• Osteoporosis • Hemochromatosis • Osteopenia / osteoporosis related • Osteomalacia • Hemosiderosis to primary bone tumour • Renal osteodystrophy • Myelofibrosis • Gaucher’s Disease • Patchy red marrow • Extramedullary hemopoiesis • Leukemia • Hyperparathyroidism • Radiation changes • Immune suppression states • Treatment-related benign reactive changes Haemoglobinopathies • Thalassaemia • Sickle cell anaemia 10. Peripheral Nerve Conditions

• Muscle denervation • Brachial plexus pathology • Idiopathic brachial plexus neuritis

• Thoracic Outlet Syndrome ¡ Trauma • Hypertrophic neuropathy

• Common nerve entrapments ¡ Traumatic neuroma • Peripheral neurolymphomatosis

– Median nerve ¡ Radiation plexopathy • Leprosy

¡ Superior sulcus syndrome

¡ Other entrapment neuropathies

¡ Supracapsular n.

¡ Posterior interosseus n.

¡ Radial n.

¡ Ulnar n.

¡ Femoral n.

¡ Posterior tibial n.

¡ Common peroneal n. 11. Bone Tumours

Imaging Methods • X-Ray • MRI • Biopsy methods (appropriate • CT surgical consultation first!) • Nuclear imaging Secondary Malignancy • Metastases, lytic • Metastases, blastic • Multiple myeloma

Page 208 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Primary Osteoblastic • Osteoma • Osteoblastoma • Osteoid osteoma • Osteosarcoma Primary Cartilaginous • Enchondroma • Chondromyxoid fibroma • Osteochondroma • Chondroblastoma • Chondrosarcoma Primary Fibrous • Fibrous dysplasia • Fibrosarcoma • Fibroxanthoma • Nonossifying Fibroma • Fibrous cortical defect • Malignant fibrous histiocytoma Miscellaneous • Giant cell tumour • Ewing sarcoma • Adamantinoma • Intraosseous haemangioma • Lymphoma • Aneurysmal bone cyst • Plasmacytoma • Multiple myeloma • Chordoma Tumour-Like Lesions

• Unicameral bone cyst • Brown tumour • Thoracic elastofibroma SYSTEMS BODY • Intraosseous lipoma • Bone infarct • Heterotopic ossification • Paget disease 12. Soft Tissue Tumours

Imaging Methods • X-Ray • CT • Ultrasound (cyst vs. solid) • MRI • Nuclear imaging • Biopsy methods (appropriate surgical consultation first!) Secondary Malignancy • Lymph node metastases • Metastases, muscle • Metastases, fat Primary Fatty • Lipoma • Liposarcoma Primary Fibrous • Fibromatosis / desmoid • Fibrosarcoma, soft tissue • Malignant fibrous histiocytoma Other Primary Soft Tissue Tumours • Synovial sarcoma • Soft tissue chondroma • Soft tissue chondrosarcoma • Leiomyosarcoma • Rhabdomyosarcoma

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 209 Peripheral Nerve Tumours • Benign peripheral nerve sheath • Malignant peripheral nerve sheath tumour tumour • Neurofibroma, solitary • Neurofibroma, plexiform Primary Vascular • Capillary haemangioma • Angiosarcoma • Lymphangioma • Capillary malformation (e.g. Sturge Weber syndrome) • Venous malformation • Arteriovenous malformation Miscellaneous Tumours and Tumour-Like Lesions • Pigmented villonodular synovitis • Giant cell tumour of the tendon • Elastofibroma of the chest • Synovial osteochondromatosis sheath • Myositis ossificans • Aneurysm • Tumoral calcinosis • Venous varix • Soft tissue ganglion • Unrecognised muscle tear • Apophyseal avulsions

Page 210 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Paediatric Imaging Learning • Indications/contraindications for Paediatric Imaging/ Competencies specific protocols. Equipment and Techniques The competent (trainee) radiologist will be able to:

• Limitations of Plain X-ray /Fluoroscopic Procedures • Demonstrate a clinical, pathological and radiological • X-ray image Quality Assessment in Paediatric Imaging understanding of paediatric disease • Interpret common and important clinical presentations Ultrasound in Paediatric Imaging • Demonstrate knowledge of the special conditions Knowledge related to the paediatric imaging examination including increased patient sensitivity to radiation, often limited Safety co-operation and comprehension, potential emotional stress and possible need for sedation. There is also a • Indications/contraindications for Paediatric Imaging need to empathise with anxious parents. Ultrasound/specific protocols • Identify the likely paediatric abnormalities that may be encountered and assessed in a general practice. Equipment and Technique

CORE KNOWLEDGE • Ultrasound Image Quality Assessment • Limitations of Ultrasound in Paediatric Imaging • Interacts effectively with other health care team members such as medical imaging staff, the child’s CT Scanning SYSTEMS BODY parents/carers, paediatric clinicians, GPs and relevant statutory authorities during management of paediatric Knowledge conditions. • Explain the strengths, weaknesses, risks and roles of • Safety / Scan Preparation / Contrast Use (IV/ Oral) / the imaging modalities, currently used in diagnosing Radiation Safety Dosimetry (ALARA principle) and Dose and evaluating paediatric abnormalities (to the parents/ Reduction / Technical Factors carers and sometimes to the child). The trainee needs • Indications/contraindications for Paediatric Imaging CT / to demonstrate knowledge of the different range of Specific Protocols pathology depending on the child’s age and clinical features on the interpretation of investigations. (E.g. a Equipment and Technique vascular renal mass in a neonate vs. a child of 4 years with a supra renal mass and elevated urinary VMA etc). • CT Image Quality Assessment • Describe and direct assessment or work-up of a clinical • Limitations of CT in Paediatric Imaging finding using imaging methods as appropriate. • Recognise when referral to a tertiary centre is necessary. MRI Scanning • Acts effectively in the paediatric setting in order to maximise the likelihood of a successful diagnostic study. Knowledge • Recognise and act upon an inadequate examination and suggest further investigations or referral to a paediatric • Safety / Scan Preparation / Contrast Use / MRI General centre’s. Safety / Technical Factors • Indications/contraindications for Paediatric Imaging MRI Plain X-ray / Fluoroscopy / Specific Protocols

Knowledge Equipment and Technique

• Safety / Preparation / Contrast Use (IV/ Oral) / Radiation • MRI Image Quality Assessment Safety Dosimetry and Dose Reduction / Technical Factors • Limitations of MRI in Paediatric Imaging

Knowledge • Correctly assign the class of diagnosis based on the imaging appearances when this is possible, (E.g. benign/ • Safety / Radiopharmaceutical Use (Labeled RBC /DTPA normal variant/ inflammatory processes/neoplasm), MAG III DMSA) / Radiation Safety Dosimetry and Dose suggesting appropriate diagnoses for age and to direct Reduction further assessment where required. • Nuclear Medicine GIT Bleeding Studies • Recognise and act appropriately upon imaging signs of • Meckels Scans a paediatric emergency. • DTPA / DMSA / MAG III) • Correctly categorise indeterminate findings and to • Demonstrate knowledge of the principles/ limitations/ guide investigation appropriately and this also includes indications of MIBG / / PET Scans in Paediatric Imaging referral to a paediatric radiology centre. • Appreciate the age of consent and the need for full Equipment and Technique: Basics only disclosure of the benefit and risk of a particular examination and procedure. Consent is required • NMCT Image Quality Assessment (either verbally or in writing) before an examination or • Limitations of NMCT in Paediatric Imaging procedure is to be performed. • Recognise the radiological findings of child abuse and KEY SKILLS suggest relevant further investigations.

• Interpret the examination accurately and safely Convey findings • Recognise normal paediatric anatomy, range of variants and changing appearances with age and physiological • Communicates relevant findings including diagnoses, states; including recognising normal imaging findings treatment plans, complications and follow up to the or those that require limited work-up to arrive at the referring clinician, parents/carers and other health care diagnosis. team members and assists in formulating an imaging • Conduct a thorough and systematic review of the and management plan as necessary. imaging examination and to recognise relevant abnormalities. Radiological Interventions & Paediatric procedures • Correctly describe the likely site of abnormalities on imaging examination. (e.g. diaphyseal destructive • Describe, perform with systematic approach to imaging lesion, suprarenal mass). Within the limits of clinical and recognition of pathology and correctly evaluate: information available, to integrate broader knowledge ¡ A micturating cystourethrogram – recognise vesico- of pathology (e.g. epidemiology, gross morphology, ureteric reflux, duplex system, trabeculated bladder and possible ancillary tests), clinical presentations and and posterior urethral valves imaging appearances to form an appropriate differential ¡ An airways and chest screening – for diaphragmatic diagnosis. movement and tracheomalacia. • Evaluate the imaging study in light of differential ¡ A barium swallow for vascular ring/sling and gastro- diagnoses to identify clinically relevant findings. oesophageal reflux Activities may include eliciting clinically relevant ¡ A non-ionic contrast / barium meal – recognise to findings or appropriate further investigative pathways assess malrotation or volvulus including talking to and examining the patient. Discuss ¡ US renal tract the case with the referring clinicians, the parents/ ¡ US cranial carers, reviewing previous imaging, reviewing relevant ¡ US hip for DDH and joint effusion literature and providing suggestions for further imaging ¡ US pylorus which may include biopsy or other interventional ¡ US intussusception procedure. • Describe the technique for, risks of and contraindications to contrast media enema studies in the evaluation of common paediatric distal small bowel

Page 212 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 and large bowel pathologies, including hirschsprung’s disease, Microcolon, colonic and ileal atresia and meconium ileus. • Reference for Paediatric Imaging Radiation Dose • The Image Gently Campaign (lower radiation dose in the imaging of children) http://www.imagegently.org/

Paediatric Normal Variants

There are numerous normal variants in children and adolescents in virtually all body systems.

Atlas of Normal Variants that May Simulate Disease. Theodore E. Keats, Mark W. Anderson. (most upto date version available) BODY SYSTEMS BODY

Note there is extensive overlap with the adult syllabus in the various body systems. Some of the required paediatric syllabus is included in the adult syllabus.

Category 1 Category 2 Category 3 NEONATES & FIRST 3 MONTHS

1. Head and spine

• Aqueduct Stenosis • Common Orbital lesions • Hydranencephaly • Arachnoid cyst • Dandy Walker spectrum • Septo-optic dysplasia • Callosal dysgenesis • EncephalocoeleHoloprosencephaly • Hemimeganencephaly • Chiari malformations spectrum • Choanal atresia • Neuronal migrational • Hydrocephalus abnormalities • Infections – meningitis and • Porencephaly encephalitis • TORCH Infections • Intracranial haemorrhage • Vein of Galen Aneurysm • Neonatal encephalopathy (Hypoxic Ischemic Injury) • Neoplasms – supra and infra tentorial tumours • Abusive Head Trauma • Periventricular Leukomalacia • Trauma 2. Neck

• Congenital abnormalities e.g. • Lingual thyroid / / Thyroid

¡ Branchial abnormalities agenesis

¡ Thyroglossal duct cyst • Torticollis • Fibromatosis colli • Vascular Malformations e.g. • Lymphadenitis lymphangioma • Neoplasm’s – e.g. haemangioma, neuroblastoma, rhabdomyosarcoma • Prevertebral abscess • Trauma e.g. Cervical spine fractures and normal variants simulating fractures

• Assessment of Intravascular lines • Aortic Co-arctation • Ebstein’s anomaly and ET tubes • Bronchopulmonary foregut • Neonatal VSD /ASD / TAPVD • Chronic Lung Disease of malformations e.g. Bronchial • Pericardial defects Prematurity Atresia, Congenital lobar • Pleuropericardial cyst • Diaphragmatic Hernia overinflation, CPAM, Pulmonary • Pulmonary Haemorrhage • Hyaline membrane disease Sequestration • Pulmonary Hypoplasia/congenital • Infections including bronchiolitis, • Dextrocardia and anomalies of venolobar syndrome pneumonia, abscesses and situs • Truncus Arteriosus aspiration • Persistent Pulmonary Hypertension • Meconium Aspiration • Tetralogy of Fallot • Neonatal mediastinal masses • Transposition of the Great vessels (Normal thymus / masses benign • Variants of aortic arch and major and malignant) branch anomalies • Neonatal Pneumonia and • Vascular rings/slings Aspiration • Oesophageal atresia and tracheo- oesophageal fistula • Patent Ductus Arteriosis • Pulmonary Interstitial Emphysema • Pneumothorax/ Pneumomediastinum

• Transient tachypnoea of the SYSTEMS BODY Newborn 4. Abdomen & Pelvis

Stomach & Duodenum, Spleen • Duodenal Atresia and Web • Duplication Cysts • Gastroesophageal reflux • Gastroschisis • Malrotation with or without small • Omphalocoele bowel volvulus • Trauma • Pyloric Stenosis Small and Large Bowel • Hirschsprung’s disease • Anal atresia • Colonic atresia • Ileal Atresia & Stenosis • Colonic Duplication • Meconium Ileus • Meconium peritonitis • Meconium Plug Syndrome/small left colon • Microcolon • Necrotising Enterocolitis Pancreas & Retroperitoneum • Adrenal haemorrhage • Annular pancreas • Neuroblastoma • Pancreatitis Hepatobiliary • Neonatal hepatitis / Biliary atresia • Choledochal cyst • Bile plug syndrome • Hepatoblastomas • Liver tumours – non • Liver Transplantation • Haemangioma/ hepatoblastoma • Spontaneous bile duct perforation haemangioendothelioma • Vascular Malformations

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 215 Kidneys & Urinary Tract • Nephroblastomatosis • Anomalies of renal / position • HUS • Non-obstructive/non-refluxing and fusion: Including Horseshoe/ • Neurogenic bladder (primary) megaureter Ectopia/ Duplex/ Crossed Fused • Renal vascular accident • Posterior urethral valves Ectopia • Sacrococcygeal teratoma • PUJ/ VUJ obstruction • Autosomal dominant and recessive • Pyelonephritis Polycystic Kidney Disease • Urachal anomalies • Mesoblastic Nephroma • Ureterocoele • Multicystic dysplastic Kidney • Vesicoureteric Reflux • Nephrocalcinosis • Wilms Tumour Genital Systems (Some overlap with O&G, Abdomen curricula) • Hernias • Abnormalities of uterine fusion • Foreign bodies / development and uterine obstruction • Cryptorchidism • Epididymitis • Hydrocoele • Testicular/ovarian neoplasm • Testicular trauma • Torsion of the testicular appendix • Torsion testis/ovary • Varicocoele Vascular • Haemangiomas • AVM • Vascular tumours • Vascular malformation e.g. (other than haemangioma) Lymphatic Malformation/ Venous Malformation 5. Neonatal Imaging Techniques and Applications

• CXR • CT brain, skull & spine • AXR • US of spine • Skeletal XR & survey • MRI of brain & pituitary • Skull x-ray • MRI of spine • IVP • MCU • US of abdomen & pelvis • US of brain • Barium swallow • Barium meal • Barium enema

THE BABY, TODDLER, CHILD AND ADOLESCENT

1. Head, Neck & Spine

Normal – refer to adult syllabus • Sutures on x-ray and CT • Normal appearances of the cerebrum at different ages & normal myelination

Page 216 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Developmental (Some overlap with Neuro Syllabus) • Benign macrocrania of infancy • Arachnoid cyst • Fibrous dysplasia (increased subarachnoid fluid • Branchial cleft cyst • Rathke’s cleft cyst space of infancy) • Colloid cyst • Craniosynostosis • Malformations of cortical • Dermoid, epidermoid cyst development

¡ Heterotopic grey matter

¡ Lissencephaly

¡ Schizencephaly

¡ Pachygyria - polymicrogyria Neurocutaneous / Phakomatoses • Neurofibromatosis 1 • Tuberous sclerosis • Neurofibromatosis 2 • Von Hippel Lindau Neoplastic and Hamartomatous (Some overlap with Neuro syllabus; NB. Different categories for Adult vs. Children) • Choroid Plexus Papilloma/ • Haemangioblastoma • Hamartoma of the tuber cinereum carcinoma • Langerhans cell histiocytosis • Craniopharyngioma • Oligodendroglioma • Ependymoma • Rhabdomyosarcoma • Gliomas (including brain stem and optic nerve)

• Medulloblastoma SYSTEMS BODY • Pilocytic Astrocytoma • Pineal tumours • Pituitary tumours • Retinoblastoma Vascular • Vascular malformations • Moya moya • Venous thrombosis • Sturge-Weber Syndrome Infective • Meningitis / Cerebral abscess • ADEM • Retropharyngeal abscess • Transverse myelitis • Sinusitis, tonsillitis and enlarged adenoids Trauma • Intra cranial haemorrhage • Shearing injuries • NAI – abusive head trauma • Skull fractures and complications Miscellaneous • Dysmyelination syndromes MELAS • Leigh’s disease Spine • Scheuermann’s condition • Inflammatory Spinal diseases • Scoliosis – idiopathic/ congenital • Sacrococcygeal Teratomas • Spinal dysraphism • Spinal Bone Tumours • Spinal Cord Tumours • Tethered cord

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 217 Imaging Techniques and Applications (Paediatric Neuro, H&N, Spine) • Skull x-rays • Angiography • Spinal x-rays • MR angiography • Airway x-rays • Myelography • CT skull and brain • Lumbar puncture • MRI of brain • MRI of pituitary • CT of spine • MRI of spine 2. Chest (Incl. Heart)

Normal – see adult chest syllabus • Thymus

Developmental • Bronchogenic cyst • Agenesis/aplasia • Dextrocardia/Situs inversus • Kartagener and immotile cilia • Diaphragmatic Hernia syndrome • Laryngomalacia • Neurogenic and oesophageal • Tracheomalacia duplication cysts • Swyer-James syndrome Traumatic • Pneumatocoele

Neoplastic and hamartomatous • Mediastinal lymphoma • Dermoids • Mediastinal germ cell tumour • Lymphangioma • Thoracic neuroblastoma Infective • Bronchiolitis • Croup • Epiglottitis • Non-resolving pneumonia including tuberculosis / chronic aspiration / bronchiectasis/ foreign body/ abscess & empyema • Typical and atypical pneumonias Miscellaneous • Foreign body • Histiocytosis • Asthma • Tuberous sclerosis • Cystic fibrosis Vascular • ASD/ VSD/ PDA and left to right • Partial anomalous Pulmonary shunts Venous drainage • Acute pulmonary oedema/ fluid • Reduced pulmonary vasculature overload • Tetralogy of Fallot

Normal – see adult MSK syllabus Developmental & Nutritional • DDH • Osteochondroses • Congenital Pseudarthrosis of the • Fibrous dysplasia • Rickets tibia • Osgood-Schlatter’s • Talipes Equinovarus • Heavy metal Poisoning • Perthes Disease • Tarsal Coalition • Scurvy • Slipped capital femoral epiphysis • Vertebral Segmentation anomaly, • Vertical Talus • Thalassemia including Klippel-Feil Syndrome • VACTERL Deformity • Discoid meniscus Inherited • Achondroplasia • Cleidocranial dysostosis • Haemophilia • MPS • Osteogenesis Imperfecta • Osteopetrosis • Osteopoikilosis • Sickle cell disease Traumatic BODY SYSTEMS BODY • Fractures

¡ Greenstick

¡ Plastic bowing

¡ Salter harris

¡ Torus • Fracture – Dislocation – monteggia • Epiphyseal/apophyseal avulsion • Injury to the physis • Non-Accidental injury • Stress and toddler’s fractures • Bone Infarction / osteonecrosis Infective & Inflammatory • Brodies abscess • Juvenile inflammatory arthritis • Osteomyelitis / Discitis • Septic Arthritis • Transient Synovitis

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 219 Neoplastic, hamartomatous and related conditions • Aneurysmal Bone Cyst • Chondroblastoma • Adamantinoma • Ewing’s Sarcoma • Fibromatoses • Chondromyxoid fibroma • Cartilage tumours • Metastases

¡ Enchondroma

¡ Olliers • Fibrous dysplasia • Langerhans Cell Histiocytosis • Osteosarcoma • Osteochondroma • Non-Ossifying Fibroma/ Fibrous cortical defect • Osteoid Osteoma/ Osteoblastoma • Unicameral Bone Cyst • Vascular tumours Imaging Techniques and Applications (Paediatric MSK) • X-rays • CT scan • US of other joints • Skeletal survey • MRI scan • US of hip joint • Bone scan 4. Abdomen & Pelvis

Normal Developmental • Duplex kidney and complications • Biliary atresia • Mesenteric cyst • Multicystic dysplastic kidney • Meckel’s diverticulum • Urachal rest • PUJ obstruction • Choledochal cyst Traumatic • Assessment of major blunt trauma • Testicular trauma and visceral perforation • Torsion testis/ovarian Neoplastic and hamartomatous • Liver Haemangioma • Hepatoblastoma • Nephroblastomatosis • Fibrolamellar hepatoma • Neuroblastoma and • Multilocular cystic nephroma ganglioneuroma • Ovarian teratoma • Wilm’s tumour Infective / inflammatory • Appendicitis & mesenteric adenitis • Epididymitis • Cholecystitis and cholelithiasis • Bladder and upper tract urinary infection including: Pyelonephritis and renal abscess • Inflammatory bowel disease • Hydronephrosis • Reflux nephropathy

Page 220 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Vascular • Henoch-Schonlein Purpura • Liver transplant • Kawasaki’s disease • Renal transplant Miscellaneous • Intussusception • Coeliac disease • Ingested foreign bodies and • Reflux oesophagitis and hiatus • Hydrometrocolpos bezoar hernia • Caroli disease Imaging Techniques and Applications (Paediatric Abdomen, Pelvis) • AXR • Enteroclysis • ERCP • IV Pyelogram • Renal scintigraphy • MRCP • MCU • Intussusception reduction • MRI of the liver • Barium swallow • MRI of the pelvis • Barium meal • Abdominal angiography • Small bowel follow through • Barium enema • CT abdomen & pelvis • US abdomen & pelvis • US of urinary tract • US of appendix 5. Other Systemic Conditions

Chromosomal BODY SYSTEMS BODY • Down’s syndrome • Marfan syndrome • Noonan syndrome • Turner’s syndrome Other • Leukaemia and Lymphoma • Mastocytosis

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 221 Breast Imaging Learning • Distinction between screening and diagnostic mammography Competencies • Role of Ultrasound Screening in dense breasts • Role of MRI screening in high risk women The competent (trainee) radiologist will be able to: CORE KNOWLEDGE • Demonstrate a clinical, pathological and radiological understanding of breast disease. • Explain the strengths, weaknesses and risks (radiation • Interpret common and important clinical presentations related and other) of the imaging modalities in breast imaging practice for example currently used in diagnosis and assessment of breast abnormalities. • Breast lump • Describe/direct assessment or work-up of a clinical • Breast pain problem or imaging finding using imaging methods as • Nipple discharge appropriate. • Recognise and act upon an inadequate examination. • Describe the pathology of breast disease • Be able to recommend follow-up imaging at later time interval when appropriate. •Incidence of carcinoma of the breast Risk factors: Mammography ¡ racial

¡ genetic Knowledge ¡ hormonal

¡ dietary • Basic physics of mammography including exposure ¡ Other factors • Basic knowledge of film-screen mammography units • Local spread • Comparison of film/screen vs digital mammography • Patterns of metastatic disease in breast carcinoma • Comparison between CR vs full field Digital (DR) • Staging of breast carcinoma • Standard mammography positioning techniques • Survival rates • Rationale for compression and magnification • Other types of breast disease as listed in the level 2 • Image quality assessment criteria document • Mammography quality control procedures • Special mammography positions and techniques • Explain basic principles and issues of screening related • Imaging of breasts with implants to breast cancer in Australia and New Zealand • Radiation related mammography risk

• Aim of Screening Ultrasound •Target group •Differences between opportunistic and population Knowledge screening • Screening intervals including “at risk” screening • Indications/contraindications for use of breast • Randomised controlled trials methodology ultrasound • False negative rates • Ultrasound equipment and technique • Interval cancer rates • Ultrasound image quality assessment • Screening artefacts: • Limitations of breast ultrasound ¡ Lead-time bias

¡ Length bias • Screening controversies • Cost effective screening • Genetic factors including BRCA-1 and BRCA-2 genes and gene testing.

Page 222 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 MRI • Distinction between malignant and benign (invasive and non invasive) mammographic features Knowledge • Lesion localisation techniques (Clock face vs quadrants) • Unusual mammographic patterns of malignant breast • Indications/contraindications for use of breast MRI pathology • Standard MRI breast sequences • Unusual mammographic patterns of benign breast • Special sequences for assessment of breast implants pathology • MRI image quality assessment • Imaging the post-operative breast • Limitations of breast MRI • Commonly missed lesions on mammography • Mammographic artefacts CT • Implant mammography • Normal ultrasound breast anatomy Knowledge • Ultrasound differentiation between benign and malignant disease • Use of CT in breast cancer staging • Ultrasound features of cysts • Common CT appearances of metastatic disease in • Breast implant ultrasound breast carcinoma • Normal MRI breast anatomy • Accuracy of CT compared with other modalities • MRI differentiation between benign and malignant • Role of CT in detection of incidental breast lesions disease • MRI features of cysts Nuclear Medicine • Breast implant MRI

Knowledge KEY SKILLS SYSTEMS BODY

• Imaging findings in benign and malignant breast • Interpret the examination accurately and safely disease using Tc-sestamibi or Tc-tetrofosmin • Recognise the normal breast anatomy, range of variants scintimammography and changing appearance with age and physiological • Indications/contraindications for Nuclear Medicine bone states; recognise normal imaging studies. scanning in breast cancer staging • Recognise breast pathology: benign, in-situ and invasive • Indications/contraindications for PET or PET/CT in breast lesions. cancer imaging • Conduct a thorough and systematic review of the • Accuracy of PET or PET/CT compared with other imaging examination and perceive relevant findings, modalities positive and negative. • Describe assessment or work-up of a clinical problem • Within limits of information available, form an or mammographic finding using imaging methods as appropriate differential diagnosis by integrating appropriate imaging findings with broader knowledge of clinical • Recognise and describe imaging findings in the presentation, epidemiology, pathology, and ancillary breast tests. •Evaluate the imaging study in light of differential • Normal mammographic anatomy and development; diagnoses to identify clinically relevant findings. patterns and variations with age • Mammographic features of breast pathology: Acts Safely

¡ asymmetric density

¡ circumscribed mass • Recognise imaging signs suspicious of malignant breast

¡ stellate lesion disease.

¡ architectural distortion • Safely assign a benign diagnosis and discriminate such

¡ micro-calcifications cases from those that require further assessment.

¡ macro- calcifications • Correctly categorise indeterminate findings and guide further investigation if required.

• Explain the importance of the triple test, i.e. concordance between imaging, clinical and pathological findings in formulating a management plan.

Convey findings

Radiological Interventions

• Demonstrate knowledge of breast interventional procedures including the role of procedures, associated complications and their management. • Principles, indications and technique of: • Fine needle aspiration • Core biopsy • Methods of stereotactic and vacuum assisted biopsy • Ultrasound guided biopsy • MRI guided biopsy • Causes of biopsy sampling error • Management of potential complications • Specimen handling and radiography • Localization techniques:

¡ Hook wire

¡ Carbon tracing

¡ Sentinel node mapping

¡ Clinical trials of isotope seeds for localising lesions • Principles and indications of Ductography • Communicating effectively with patients and clinicians regarding the benefits and risks associated with different diagnostic modalities and procedures.

• Extraneous to breast • Accessory nipples • Poland’s syndrome • Cassette artefacts • Variations of lymphatic drainage

• Deodorant artefact ¡ Sentinel node(s)

• Normal lymph nodes & lymphatic ¡ Axillary

drainage ¡ Internal mammary • Skin lesions ¡ Infraclavicular • Sternalis ¡ Contralateral • Normal breast • Normal asymmetry • Accessory glandular tissue • Variation in appearance over time / hormonal state • Normal chest wall Breast Imaging Clinical Conditions Category 1 Category 2 Category 3 1. Breast Cancer Screening BODY SYSTEMS BODY • Principles of mammographic • Indications for ultrasound and • Alternative breast screening screening MRI in breast screening methods • Evidence for population screening • Computer aided diagnosis • Population vs. sporadic screening • Categorisation in breast screening 2. Malignant Disease

• Invasive breast cancer • Inflammatory carcinoma • Sarcomas of the breast • Ductal • Papillary carcinoma • Metastatic disease to the breast • Lobular • Intracystic carcinoma • Lymphoma of the breast • Subtypes (medullary, tubular, • Atypical ductal hyperplasia • Male breast cancer mucinous) • Columnar cell change • Paget’s disease of the breast • DCIS • Phylloides tumour • Investigation of axillary lymphadenopathy

• Fibroadenoma • Post operative appearances • Management of breast pain • Breast cysts e.g. seroma, scarring, breast • Cosmetic oil and gel injections • Simple reconstruction, reduction • Diabetic mastopathy • Complex mammoplasty • Multiple papillomatosis • Breast abscess • Giant fibroadenoma • Granulomatous mastitis • Hamartoma and lipoma • LCIS • Chronic breast abscess • Benign breast calcifications • Radial scar • Breast hematoma • Ductal papilloma • Fat necrosis • Usual ductal hyperplasia • Sclerosing adenosis and fibrocystic • Lymphoedema of the breast change • Gynaecomastia

• Breast abscess and mastitis ¡ Breast implants – Types & Complications Techniques & Applications for Breast Imaging • Mammography, analogue • Vacuum-assisted biopsy • Features of cancer on breast MRI • Mammography, CR & digital • Hook wire localisation • Causes of false positives on breast • Common mammographic artifacts • Indications for breast MRI MRI • Mammography-ultrasound lesion • Principles of BI-RADS correlation • Ultrasound of the breast • Triple-test principle • Fine-needle biopsy • Core biopsy

Imaging Learning Competencies • Ultrasound Image Quality Assessment • Limitations of Ultrasound in O&G Imaging The competent (trainee) radiologist will be able to: CT Scanning • Demonstrate a clinical, pathological and radiological understanding of O&G disease. Knowledge • Interpret common and important clinical presentations in O & G imaging • Safety / Scan Preparation / Contrast Use (IV/ Oral) • Explain the basic principles of routine screening for / Radiation Safety Dosimetry and Dose Reduction / obstetric abnormality in first and second trimester Technical Factors • Indications/contraindications for O&G / Specific CORE KNOWLEDGE Protocols

• Explain the strengths, weaknesses and risks and roles of Equipment and Technique the imaging modalities currently used in diagnosing and evaluating obstetric and gynaecological abnormalities. • CT Image Quality Assessment Explain the role and process of other non-imaging • Limitations of CT in O&G Imaging investigations e.g the use of blood tests in First Trimester Screening, Second Trimester Screening, the MRI Scanning implication of BRCA positivity etc • Describe/direct assessment or work-up of a clinical Knowledge SYSTEMS BODY problem or finding using imaging methods as appropriate. • Safety / Scan Preparation / Contrast Use / MRI General • Recognise and act upon an inadequate examination. Safety / Technical Factors • Indications/contraindications for O&G Imaging MRI / Plain X-ray / Fluoroscopy Specific Protocols

Knowledge Equipment and Technique

• Safety / Preparation / Contrast Use (IV/ Oral) / Radiation • MRI Image Quality Assessment Safety Dosimetry and Dose Reduction / Technical Factors • Limitations of MRI in O&G Imaging • Indications/contraindications for O&G Imaging/specific protocols. Nuclear Medicine

Equipment and Techniques Knowledge

• Limitations of Plain X-ray /Fluoroscopic Procedures • Safety / Radiopharmaceutical Use (Labelled RBC /DTPA • X-ray image Quality Assessment in O&G Imaging MAG III DMSA) / Radiation Safety Dosimetry and Dose Reduction Ultrasound • Demonstrate knowledge of the principles/ limitations/ indications of Nuclear Medicine Scanning/ PET Scans in Knowledge O&G Imaging

Safety Equipment and Technique: Basics only

• Indications/contraindications for O&G Imaging • NMCT Image Quality Assessment Ultrasound/specific protocols • Limitations of NMCT in O&G Imaging

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 227 KEY SKILLS to ensure the communication with the patient is appropriate; meaning timely, using terms that the • Interpret the examination accurately and safely patient can readily comprehend, with an appreciation of • Appreciate the normal anatomy, range of variants and their social support and social network, with empathy changing appearance with age and physiological states, for the content, and acceptance of the possible need for including recognising normal imaging studies or those repeat explanations. that require limited work-up to arrive at this conclusion. • Conduct a thorough and systematic review of Radiological interventions the imaging examination and perceive relevant abnormalities. • Describe the techniques of both routine and ultrasonic • Judge the likely site of abnormalities on imaging hystero-salpingography, HyCoSi (hysteron salpingo examination. (eg. endometrial vs. myometrial / contrast sonography), amniocentesis and CVS, myometrial vs. adnexal) and appropriate category of appreciating their place in investigation and their abnormality (eg ovarian mass lesion / fetal abdominal complications. wall defect), in order to determine a differential • Communicate effectively with patients regarding the diagnosis benefits and risks associated with different diagnostic • Within limits of information available, integrate a modalities and procedures, appreciating their cultural broader knowledge of clinical presentations, imaging circumstances, social support and social network. appearances and pathology (eg epidemiology, gross • Interact effectively with other health care team morphology, ancillary tests), to form an appropriate members such as medical imaging staff, obstetricians, differential diagnosis. gynaecologists, neonatologists, midwives, nurses, GPs • Re-evaluate the imaging study in light of differential and pathologists during management of obstetric and diagnoses to identify clinically relevant findings. gynaecological conditions. Activities may include eliciting clinically relevant findings, or appropriate further investigative pathways including talking to and examining the patient, reviewing previous imaging, reviewing relevant literature, or obtaining a second opinion, follow up, biopsy, or further imaging.

Act safely

• Recognise imaging signs suspicious of conditions with significant patient implications (e.g. fetal abnormality / ectopic pregnancy/ abnormal placental site). • Safely assign class of diagnosis (benign / normal variant/ probable malignancy / significant fetal abnormality) and direct further assessment where required. • Correctly categorise indeterminate findings and guide further investigation appropriately.

Convey findings

• Appropriately communicate relevant findings including diagnoses, their implications and assists in formulating an applicable imaging and management plan. (e.g. urgent obstetric or emergency service referral, amniocentesis, IV cannulation and possible laparoscopy). Particularly in this setting, where the diagnoses may be distressing, care should be taken

• Variations of uterine version • Physiological ovarian follicle • Arcuate uterus 2. Obstetrics

• Braxton-Hicks contraction • Physiological pericardial fluid • Circumvallate placenta • Placental lakes • Brachycephaly • Debris/vernix in amniotic fluid • Decreased end diastolic velocity • Normal gut herniation before 12 in umbilical artery due to fetal weeks respiration or movement • Transient rotated foot position • Placental shelf • Dolichocephaly • Corpus luteum with increased circumferential vascularity in first trimester (vs ectopic) • Succenturiate lobe Obstetric & Gynaecological Imaging – Clinical Conditions BODY SYSTEMS BODY Category 1 Category 2 Category 3 GYNAECOLOGICAL IMAGING

1. Ovarian Lesions

Physiological • Physiological cysts & their complications including haemorrhagic cysts ie corpus luteal, follicular • Corpus Luteum of pregnancy • Ruptured follicle midcycle Developmental • Pre / postmenopausal appearance • Absent / streak ovaries

Idiopathic • Endometriosis • Polycystic ovary syndrome Neoplastic • Surface epithelial-stromal; Serous, • Other surface epithelial-stromal • Struma Ovarii mucinous & endometrioid tumors • Ovarian carcinoid • Germ cell tumors • Secondary neoplasms • Sex cord stromal tumors

Miscellaneous

• Ovarian Torsion • Ovarian Stimulation • Luteomas of Pregnancy • Ovarian Hyper stimulation • Meig’s Syndrome syndrome • Theca lutein cysts 2. Adenexal Non-ovarian lesions

Physiological / Developmental • Broad ligament cysts • Wolffian duct remnants • Paraovarian & fimbrial Inflammatory • PID & hydrosalpinx • Tubal occlusions • Tuberculosis Salpingitis • tubovarian abscess • Salpingitis Isthmica Nodosa Neoplastic • Carcinoma of the fallopian tube • Tubal metastases • Tubal leiomyoma Idiopathic • Tubal Endometriosis

Vascular • Adenexal varices

3. Non-pregnant Uterus and Cervix

Physiological Changes related to age • Age related physiological alterations Congenital / developmental anomalies • Mullerian Duct Uterine Anomalies • Absent uterus • Intersex states (Subseptate / bicornuate etc.) • Nabothian cysts Benign tumours / hyperplastic lesions • Leiomyoma • Adenomyosis • Cervical polyp Malignant neoplasms / dysplasia • SCC of the cervix • Leiomyosarcoma Inflammatory / Post surgical / Iatrogenic • IUD placement & complications • Asherrman’s syndrome • Endometrial adhesions

4. Endometrial Lesions

Physiological • Changes related to age and the normal and abnormal menstrual cycle Neoplastic / dysplastic • Atypical endometrial hyperplasia • Gestational Trophoblastic Disease • Malignant mixed müllerian tumors and endometrial carcinoma • Stromal tumors • Endometrial polyps Infective • Endometritis

Hyperplastic / proliferative • Simple endometrial hyperplasia • Adenomyosis • Endometrial polyps • Endometrial cysts 5. Vagina & Labia BODY SYSTEMS BODY Malignant neoplasms / dysplasia: • SCC of vagina • Adenocarcinoma • Rhabdomyosarcoma (Pediatric) • Paget’s disease • Vulval carcinoma • Vaginal Leimyoma Infective/Inflammmatory • Bartholin’s Cyst • Bartholonitis • Vaginal Foreign Body • Vaginal Fistula Congenital/developmental anomalies • Mullerian Duct Fusion Anomalies • Gartner duct cysts • Imperforate Hymen (Hematometra/ colpos) • Labial adhesions • Vaginal Atresia • Ambiguous genitalia Techniques & Applications (Gynaecological) • Transabdominal ultrasound • Pelvic MRI • Pelvic angiography & embolisation • Transvaginal ultrasound • Sonohysterogram • Pelvic venography & embolisation • Pelvic CT • HyCoSi • Hysterosalpingography

1. First Trimester

• Miscarriage • Cervical incompetence • Heterotopic pregnancy • Ectopic pregnancy • Chorio-amniotic separation • Abdominal Ectopic • Gestational trophoblastic disease • Perisac haematoma • Physiological (e.g., extrusion of the gut into the cord, mineralisation of the skull vault) Nuchal Scan • Scanning and interpretation of • BOO • Ienencephaly combined first trimester screening • Limb defects • Encephalocele • Cystic Hygroma • Acrania anencephaly spectrum • Hydrocephalus • Cystic hygroma / hydrops • Gastroschisis • 2VC • Omphalocele 2. Second Trimester Morphology Scan

ASUM Guidelines For the Mid Trimester Obstetric Scan June 1991, Reaffirmed May 1996, Revised October 1999, July 2005 CHECKLIST OF STRUCTURES TO BE SCANNED Head • Falx • Cavum Septum Pellucidum • Skull Bones • Lateral Ventricles • Choroid Plexus • Cerebellum/Vermis • Nuchal thickness • Cisterna Magna Face • Orbits • Nasal Bone • Jaw • Lips • Profile Diaphragm • Right • Left Heart • FHMD • Position • Axis • 4 Chambers • Intraventricular Septum • Foramen Ovale • Mitral Valve • Tricuspid Valve

Page 232 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Great Vessels • Left Ventricular Outflow Tract • Right Ventricular Outflow Tract • Aortic arch • Ductal Arch Abdomen • Stomach / Situs • Kidneys • Bladder • Abdominal Wall Spine • Ossification Centres • Skin Line Extremities • 12 Long bones • Hands/Fingers • Feet/Toes • Position of joints Umbilical Cord • Insertion

• 3 Vessels SYSTEMS BODY Other • Cervical incompetence

Abnormal Second Trimester Scan

Sonographic Markers of Aneuploidy • Nuchal thickening • Echogenic gut • Choroid Plexus cysts • Echogenic intracardiac foci • Single vessel cord • Short humerus • Short femur • Absent nasal bone Neural Axis • Anencephaly • ACC • Hydranencephaly • Hydrocephalus • Holoprosencephaly spectrum • Encepholocele • Choroid plexus cyst • Arachnoid Cysts • Chiari II • Dandy Walker Spectrum • Spina Bifida • Mega cisterna magna • Vein of Galen • Intracranial Tumours • Sacral Agenesis • SCT • Cerebellar hypoplasia

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 233 Face and neck • Absent nasal bone • Cystig Hygroma • Cleft lip palate • Micrognathia Chest cardiac • CDH • Pleural Effusion • CHAOS • CPAM • Cardiac defects • Teratoma • Pericardial Effusion • Pentralogy of Cantrell • Arrythmias Abdomen and Renal Tract • Omphalocoele • Bowel atresias including Duodenal • Bladder extrophy • Gastroschisis atresia • Cloaca • Renal Pelvis dilatation • Abdominal cysts • Adrenal masses • BOO, posterior urethral valves • Ascites • Renal masses • Renal agenesis • Abdominal calcifications • Hepatic masses • MCDK • Echogenic kidneys • Horseshoe kidney • Ectopic kidney MSk • Club foot • Abnormalities of the hand / feet • Skeletal dysplasias • Polydactyly • Arthrogryposis • Radial ray • Focal femoral deficiency • Scoliosis, segmental spine anomalies Other • Fetal Hydrops • Eetal infection • Heterotaxy syndrome

3. Third Trimester

• Routine Assessment of fetal • Fetal dopplers growth and wellbeing • Fetal anaemia • IUGR • macrosomia • Placental assessment • Umbilical Artery dopplers 4. Placenta Membranes and Cord Abnormalities

• Placenta Praevia • Placenta increta/percreta/acreta • Chorioangioma • Placental Haemorrhage & • Doppler studies relating to • Cord cysts Abruption IUGR and placental insufficiency • Umbilical Vein Varix • Anomalies of placental form, including umbilical, • Amniotic band syndrome thickness or cord insertion (e.g. • Circumvallate Placenta succinturate lobe / marginal cord • Velamentous cord insertion insertion etc.) • Chrioamnion separation • Placental insufficiency & IUGR • Vasa praevia • Retained products of conception • SUA

• Assessment and evaluation of normal and abnormal liquor volumes • Oligohydramnios • Polyhydramnios 6. Multiple Pregnancies

• First trimester determination of • TTTS, staging • TRAPS (twin reverse arterial chorionicity and amnionicity, ie: • Discordant twin growth perfusion) DCDA, MCDA, MCMA • Conjoined twins • Recognition of twin peak sign • Fetus-in-fetu • Acardia 7. Post partum complications

• Endometritis • Ovarian Vein Thrombosis • RPOC • LSCS complcations eg collections 8. Aneuploidy

• Trisomy 21 • Trisomy 13 • Turner’s syndrome • Trisomy 18 • Triploidy BODY SYSTEMS BODY

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 235 Vascular Imaging and Ultrasound Interventional Radiology Knowledge Learning Competencies Safety The competent (trainee) radiologist will be able to • Indications/contraindications for Vascular Imaging & • Demonstrate a clinical, pathological and radiological Interventional Radiology Ultrasound/specific protocols understanding of vascular disease. • Interpret common and important clinical presentations Equipment and Technique in vascular imaging and interventional radiology • Construct management plans for common clinical • Ultrasound Image Quality Assessment presentations in vascular imaging and interventional • Limitations of Ultrasound in Vascular Imaging & radiology. Interventional Radiology

CORE KNOWLEDGE CT Scanning

• Explain the strengths, weaknesses and risks (radiation Knowledge related and other) and roles of the imaging modalities and procedures currently used in vascular imaging and • Safety / Scan Preparation / Contrast Use (IV/ Oral) interventional radiology. / Radiation Safety Dosimetry and Dose Reduction / • Demonstrate knowledge of the indications, Technical Factors contraindications and complications of interventional • Indications/contraindications for Vascular Imaging & procedures as well as their relative efficacy compared Interventional Radiology CT / Specific Protocols with other treatment options (including no treatment). • Where appropriate participates in the clinical Equipment and Technique assessment and counselling of a patient prior to the performance of an interventional radiology procedure. • CT Image Quality Assessment • Describe / direct assessment or work-up of a vascular • Limitations of CT in Vascular Imaging & Interventional or interventional radiology problem using imaging Radiology methods as appropriate. • Explain the preparation, techniques and protocols for an MRI Scanning investigation or procedure. • Recognises and act upon an inadequate examination or Knowledge procedure. • Safety / Scan Preparation / Contrast Use / MRI General Plain X-ray / Fluoroscopy Safety / Technical Factors • Indications/contraindications for Vascular Imaging & Knowledge Interventional Radiology MRI / Specific Protocols

• Safety / Preparation / Contrast Use (IV/ Oral) / Radiation Equipment and Technique Safety Dosimetry and Dose Reduction / Technical Factors • Indications/contraindications for Vascular Imaging & • MRI Image Quality Assessment Interventional Radiology/specific protocols • Limitations of MRI in Vascular Imaging & Interventional Radiology Equipment and Techniques

• Limitations of Plain X-ray /Fluoroscopic Procedures • X-ray image Quality Assessment in Vascular Imaging & Interventional Radiology

Page 236 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Nuclear Medicine health care team members and assists in formulating an imaging and management plan as necessary. Knowledge Radiological interventions • Safety / Radiopharmaceutical Use (Labelled RBC /DTPA MAG III DMSA) / Radiation Safety Dosimetry and Dose • Competent in the techniques of basic diagnostic Reduction angiography. Familiar with common vascular • Nuclear Medicine GIT Bleeding Studies interventional procedures such as angioplasty and • Meckels Scans stenting. • DTPA / DMSA / MAG III) • Competent at basic biopsy and image guided drainage • Demonstrate knowledge of the principles/ limitations/ procedures. Familiar with the steps involved in indications of MIBG / Octreotide Scanning/ PET Scans in percutaneous nephrostomy insertion. Vascular Imaging & Interventional Radiology • Assess the adequacy of interventional procedures, recognise and manage complications and Equipment and Technique: Basics only demonstrate knowledge and application of the follow- up of procedures. • NMCT Image Quality Assessment • Competent in the knowledge, clinical presentations, • Limitations of NMCT in Vascular Imaging & assessment and management of interventional Interventional Radiology radiological procedures. • QA for procedural radiology. KEY SKILLS • Communicating effectively with patients and clinicians regarding the benefits and risks associated with

• Interpret the examination accurately and safely different diagnostic modalities and procedures. SYSTEMS BODY • Recognise the normal anatomy, range of variants and changing appearance with age and physiological states. • Conducts a thorough and systematic review of the imaging examination and perceive the relevant abnormalities. • Within the limits of information available, integrates broader knowledge of pathology (eg. Epidemiology, gross morphology, ancillary tests), clinical presentations and imaging appearances to form an appropriate differential diagnosis. • Evaluates the imaging study in light of differential diagnoses to identify clinically relevant findings.

Acts Safely

• Recognises imaging signs suspicious of conditions with significant patient implications (eg. traumatic aortic injury, aortic dissection, embolism, aneurysm leak). • Safely assign a class of diagnosis. • Correctly categorises indeterminate findings and guides investigation appropriately.

Convey findings

• Communicates relevant findings including diagnoses, treatment plans, complications and follow up to the referring clinician, patient and or family/carers and other

Vascular and Interventional Imaging – Normal Variants Category 1 Category 2 Category 3 1. General and peripheral vascular

• Carotid tonsillar loops • Persistent sciatic artery • Popliteal entrapments 2. Thoracic vascular

• Aortic arch variants • Double SVC • Left SVC • Co arctation • Thoracic outlet syndrome • Azygous continuation IVC 3. Abdominal vascular

• Double IVC • Left IVC • Hepatic arterial variants • Accessory renal arteries • Coeliac / mesenteric arterial • Renal vein variants variants 4. Urointervention

• Horseshoe kidney • Ureteric variants • Urachal variants • Pelvic kidney • Exrarenal pelvis • Parapelvic cysts 5. Gastrointestinal and hepatobiliary

• Chyladites • Billiary tree variants

Page 238 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Vascular and Interventional Radiology – Clinical Conditions Category 1 Category 2 Category 3 VASCULAR DIAGNOSTIC CONDITIONS

1. General Vascular – combine with peripheral vascular

• Aneurysms • Fibromuscular hyperplasia • Granulomatosis with polyangitis • Atherosclerosis (Wegener’s Granulomatosis) • Fibromuscular hyperplasia • Takayasu’s Arteritis • Arteriovenous malformation • Giant Cell Arteritis • Embolism • Vasculitis – other • Patterns of vascular trauma / • Polyarteritis Nodosa injury • Hereditary Haemorrhagic Telangectasia 2. Peripheral Vascular – combine with general vascular

• Vascular grafts and complications • Iatrogenic femoral • Buerger disease (Thromboangitis • Deep venous thrombosis Pseudoaneurysm and AV fistula obliterans) • Raynaud phenomenon • Popliteal artery entrapment syndrome • Adventitial cystic disease of

popliteal artery SYSTEMS BODY • Klippel-Trenauny-Weber Syndrome • May Turner syndrome 3. Chest and Neck Vascular

• Common congenital variants of • Subclavian steal syndrome • Thoracic outlet syndrome thoracic aorta • Superior vena cava syndrome • Paget-Schroetter (effort) syndrome • Spontaneous aortic dissection • Aortitis • Traumatic aortic injuries • Haemoptysis • Carotid artery stenosis • Pulmonary AVM • Carotid artery dissection • Pulmonary embolism 4. Cardiac

• Principles of cardiac CT • Principles of cardiac MRI • Cardiac catheterisation • Principles of echocardiography • Indications for coronary • Transoesophageal • Coronary artery anatomy and angiography echocardiography variations • Principles of cardiac nuclear • Coronary artery ischemic disease imaging 5. Abdominal Vascular

• Abdominal aortic aneurysm • Splenic and other visceral artery • Coeliac artery compression • Mesenteric ischemia aneuryms syndrome • GI haemorhage • Aortic endoleak • Budd Chiari syndrome • Blunt abdominal and pelvic • Vascular complications of • Aortoenteric fistula trauma pancreatitis • Mesenteric vein thrombosis • Retroperitoneal and rectus sheath • Portal hypertension / varicies haematoma • Renal artery stenosis

1. Principles of Interventional Procedures

• Principles of conscious sedation, • Principles of patient aftercare and analgesia and anticoagulation followup • Correct site / correct procedure • Role of multidisciplinary care • Pre-procedure blood tests • Sterile and aseptic practice • Taking consent • Risks of various common interventions 2. Vascular Intervention

• Diagnostic arteriography • Percutaneous angioplasty • Complex arterial and venous • Dialysis fistulography • Vascular stent insertion access • Percutaneous venous access • Embolisation • IVC filter retrieval • Central and PICC line insertion • IVC filter insertion • Foreign body retrieval • Lumbar sympathectomy • Thrombolysis / thrombectomy • Aortic stent grafts 3. Uroradiology Intervention

• Nephrostomy • Antegrade stent insertion / • Varicocele / ovarian vein • Renal biopsy ureteric dilatation embolisation • Transrectal prostate biopsy • Uterine fibroid embolisation • Fallopian tube recanalisation 4. Gastrointestinal & Hepatobiliary Intervention

• GI tract dilatations and stenting • Transjugular liver biopsy • Hepatic chemoembolisation • Liver biopsy principles and • Percutaneous transhepatic • Hepatic radioembolisation techniques cholangiogram and drainage • Percutaneous local ablative • Other abdominal organ biopsy • Biliary stenting therapies (principles) • Percutaneous abscess drainage • Percutaneous gastrostomy • Transjugular intrahepatic portosystemic shunt (principles)