YEREVAN STATE MEDICAL UNIVERSITY

(DEPARTMENT OF RADIOLOGY)

FOUR YEAR EDUCATIONAL RESIDENCY PROGRAM OF DIAGNOSTIC RADIOLOGY

The four-year diagnostic radiology residency program is designed to provide residents with direct clinical involvement at graduated levels of responsibility. Imaging has a great impact on disease diagnosis in all medical fields and new advents on different imaging tools have significantly changed the quality of medical diagnostic approaches. Interventional Radiology, or better to say “Image-Guided Microsurgical Procedures” have opened a new world for either diagnose or treat many of diseases in a safer, faster, and more effective way. Considering advances in medical knowledge, modern radiology has a great position. The specialists should acquire enough knowledge and expertise to answer diagnostic and therapeutic needs of patients in all fields and be capable for other colleagues to handle diagnostic and therapeutic procedures and use technology in this way. Obviously, the quality of radiology ward depends on residency programs. In regards to above needs, educational goals of diagnostic radiology are listed as below:

A) General goals

B) Specific goals:

1) Thorax 2) Musculoskeletal System 3) Digestive System (GI) 4) Genitourinary System (GU) 5) Nervous System 6) Head & Neck 7) Pediatrics 8) Breast 9) Interventional Radiology 10) Nuclear Medicine 11) Physics

GENERAL GOALS: Residents initially interpret radiographic studies, which are subsequently reviewed by a faculty attending. Additionally, during most interventional procedures, residents are primary operators under direct supervision of attending physicians. All residents participate in a mentoring program in which they select a faculty member to provide guidance during the training process and to act as a resource for individual needs. Periodic reviews provide a forum to encourage educational progress and professional development. At the end of radiology residency program, the residents should achieve the following goals: 1) Acquiring enough knowledge in radiology as a specialist. 2) Ability to supervise over applied radiological methods and to present a proper report. 3) Ability to make decision in using other necessary radiological interventions to gain more precise results and treatment guidance. 4) Ability to diagnose and treat diseases and give consultation services to their colleagues of same field or other fields. 5) Ability to teach related sciences of radiology. 6) Acquaintance with preventive methods to keep them safe from the risks of ionizing radiation and use these methods for patients and personnel as well. 7) Ability to establish proper relationship with other residents to improve education. SPECIFIC GOALS:

A) THORAX

Radiology residents should have following capabilities about thorax upon completion of residency program: 1) Having necessary knowledge about anatomy and radiological anatomy of thorax (Including: Lungs, Parenchyma, Air Passages, Mediastinum, Cardiovascular and Thoracic wall) and having good ability to detect above parts and explain their relations through plain or contrast radiographies, fluoroscopy, sonography, , angiography and sectional surveys. 2) Having good knowledge about thorax embryology and being able to express it. 3) Having proper knowledge about thorax physiology and pathophysiology of its diseases and being able to present and interpret radiological findings in details. 4) Being able to create radiographs in proper conditions (KVP, MAS and protection methods). 5) Being able to perform and interpret plain , fluoroscopy and ultrasound (gray scale and Doppler) of thorax. 6) Considering the early changes in thoracic images, they must be able to prepare daily reports of radiographies in the ward. 7) Supervising over administration of CT scan, HRCT and MRI of thorax and suggesting a proper protocol whenever it is necessary and interpreting the results. 8) Being acquainted with pulmonary imaging and familiar with thoracic diagnostic tests such as blood gas analysis , pulmonary function and exercise tests, invasive monitoring and nuclear medicine of thorax. 9) Being able to carry out some interventional procedures when needed, according to physician’s requests. 10) Being able to coordinate with other wards to carry out patient's files and biopsies and follow up the results. 11) Having knowledge of CT-guided or fluoroscopy-guided biopsies. 12) Having proper knowledge about special use of contrast media and its complications and adverse reactions and being able to diagnose and treat these reactions. 13) Being able to explain the presence of following items in thorax images : - Implants and Devices used in thorax - Heart valves - Pacemakers - Cardiac defibrillators - Esophagus, air passages and coronary stents - Orthopedic devices 14) Being able to prepare all radiological methods, interpretational reports and differential diagnoses of thorax, independently. 15) Having good knowledge of thoracic diseases, radiological indications and the best radiological method in different thoracic diseases. 16) Ability to present interesting cases in coordination with other wards in periodical conferences as Case Reporting. 17) Capability of managing educational programs about thoracic imaging. B) MUSCULOSKELETAL SYSTEM Radiology residents should have following capabilities regarding Musculoskeletal System upon completion of residency program: 1) Having necessary knowledge about anatomy and radiological anatomy of Musculoskeletal System and vessels of extremities and having good ability to detect them and explain their relations through plain or contrast- radiography, fluoroscopy, bone densitometry, sonography, tomography, angiography and sectional surveys. 2) Having knowledge of Musculoskeletal System's embryology and being able to express it. 3) Having proper knowledge of Musculoskeletal System physiology and pathophysiology of its diseases and being able to present and interpret radiological findings in details. 4) Being able to create radiographs in proper conditions (KVP, MAS and protection methods). 5) Having ability to properly perform common plain and contrast radiographic methods, and interpret the results. 6) Having good knowledge of different Bone Densitometery methods and ability to interpret the results. 7) Supervising over administration of CT scan and MRI of Musculoskeletal System and suggesting a proper protocol whenever it is necessary and interpreting the results. 8) Being familiar with interventional procedures of Musculoskeletal System. 9) Having proper knowledge of special use and indications of contrast material use, its complications and adverse reactions and being able to diagnose and treat these reactions. 10) Being able to prepare all radiological methods, interpretational report and differential diagnoses of Musculoskeletal System, independently. 11) Having good knowledge of Musculoskeletal System diseases, radiological indications and the best radiological method in different Musculoskeletal diseases. 12) Having proper knowledge about Nuclear Medicine findings of Musculoskeletal System. 13) Being able to manage educational programs on Musculoskeletal imaging. C) DIGESTIVE SYSTEM (GI) Radiology residents should have following capabilities about Digestive System upon completion of the residency program: 1) Having necessary knowledge about anatomy and radiological anatomy of Digestive System and related organs ( salivary glands, liver, pancreas, spleen …), and having good ability to detect them and explain their relations through plain or contrast-radiography, fluoroscopy, ultrasound, tomography, angiography and sectional surveys. 2) Having good knowledge of Digestive System embryology and being able to express it. 3) Having proper knowledge about Digestive System physiology and pathophysiology of related diseases and being able to describe the relationships of Digestive System disorders (such as abnormal peristalsis and icterus) and radiological findings. 4) Being able to create radiographs in proper conditions (KVP, MAS and protection methods). 5) Being able to perform and interpret plain radiography, all methods of contrast or double-contrast radiography, and ultrasound studies of Digestive System, including abdominal (Gray scale, Doppler) or endosonography. 6) Supervising on administration of CT scan and MRI of digestive system and suggesting a proper protocol whenever it is necessary and interpreting the results. 7) Being familiar with interventional procedures of Digestive System. 8) Having good knowledge of special applications of contrast media and their complications and adverse reactions and being able to diagnose and treat these reactions and complications. 9) Being able to prepare all radiological methods, interpretational reports and differential diagnoses of Digestive System, independently. 10) Having good knowledge of Digestive System diseases, radiological indications and the best radiological method in different Digestive System diseases. 11) Having good knowledge of suitable radiographic tools or other experiments in each case and being able to describe their applications. 12) Having proper knowledge of Nuclear Medicine findings of Digestive System. 13) Being able to manage educational programs on Digestive System imaging.

D) URINARY AND REPRODUCTIVE SYSTEM

Radiology residents should have following capabilities about Urinary and Reproductive system upon completion of the residency program: 1) Having necessary knowledge about anatomy and radiological anatomy of Urinary and Reproductive system (Male and Female) and having good ability to detect them and explain their relations through plain or contrast- radiography, fluoroscopy, ultrasound, tomography, angiography and sectional surveys. 2) Having good knowledge of GU system embryology and being able to express it. 3) Having proper knowledge of GU system physiology and pathophysiology of related disorders and being able to present and interpret radiological findings. 4) Being able to create GU system radiographs in proper conditions (KVP, MAS and protection methods). 5) Having good knowledge of different radiologic methods of GU system (Plain and Contrast - radiography, fluoroscopy, sonography, CT scan, MRI, angiography …) and being able to perform and interpret plain and contrast-radiography and fluoroscopy of GU system. 6) Being able to do and interpret sonography (Plain and Doppler) of GU system. 7) Supervising over administration of CT scan and MRI of GU system and suggesting a proper protocol whenever it is necessary and interpreting the results. 8) Being familiar with interventional procedures of GU system. 9) Having proper knowledge of special applications of contrast media and their complications and adverse reactions and being able to diagnose and treat these reactions. 10) Being able to prepare all radiological methods, interpretational report and differential diagnosis of GU system, independently. 11) Having good knowledge of GU diseases, radiological indications and the best radiological method in different GU diseases. 12) Having proper knowledge of Nuclear Medicine findings of GU system. 13) Being able to manage educational programs on GU imaging. Note: All above training programs are also applied for adrenal glands.

E) NERVOUS SYSTEM

Radiology residents should have following capabilities on Nervous System imaging upon completion of the residency program: 1) Having necessary knowledge of anatomy and radiological anatomy of Nervous System and having good ability to detect them and explain their relations through plain or contrast radiography, fluoroscopy, ultrasound, tomography, angiography and sectional surveys. 2) Having knowledge of Nervous System embryology and being able to express it. 3) Having proper knowledge about Nervous System physiology and pathophysiology of related disorders and being able to present and interpret the radiological findings in details. 4) Being able to create radiographs in proper conditions (KVP, MAS and protection methods). 5) Being able to perform and interpret ultrasound study (Gray scale and Doppler) and different methods of plain and contrast-radiography of Nervous System. 6) Supervising on administration of CT scan and MRI of Nervous System and suggesting a proper protocol whenever it is necessary and interpreting the results. 7) Being familiar with interventional procedures of Nervous System. 8) Having proper knowledge of special applications of contrast media and their adverse reaction and complications and being able to diagnose and treat these reactions. 9) Having good knowledge of Nervous System diseases, radiological indications and the best radiological method in different Nervous System diseases and having good ability to describe them. 10) Being able to prepare all radiological methods, interpretational report and differential diagnosis of Nervous System, independently. 11) Having proper knowledge of nuclear medicine findings of Nervous System. 12) Being able to manage educational programs on Nervous System imaging.

F) HEAD AND NECK

Radiology residents should have following capabilities about Head and Neck upon completion of the residency program:

1) Having necessary knowledge of anatomy and radiological anatomy of Head and Neck (Including orbits, Para nasal sinuses, facial bones, suprahyoid and infrahyoid and neck spaces) and having good ability to detect them and explain their relations through plain or contrast-radiography, fluoroscopy, ultrasound, tomography, angiography and sectional surveys.

2) Having knowledge of Head and Neck embryology and being able to explain the origin of problems due to abnormal development of embryonic structures.

3) Having proper knowledge of Head and Neck physiology and pathophysiology of related disorders and being able to present and interpret radiological findings.

4) Being able to create radiographs in proper conditions (KVP, MAS and protection methods).

5) Being able to perform and interpret plain radiography, fluoroscopy and ultrasound (Gray scale and Doppler) of Head and Neck.

6) Supervising on administration of CT scan and MRI of Head and Neck and suggesting a proper protocol whenever it is necessary and interpreting the results.

7) Being familiar with interventional procedures of Head and Neck.

8) Having proper knowledge of special applications of contrast and its adverse reactions and complications and being able to diagnose and treat these reactions.

9) Being able to prepare all radiological methods, interpretational report and differential diagnosis of Head and Neck, independently.

10) Having good knowledge of Head and Neck diseases, radiological indications and the best radiological method in different Head and Neck diseases.

11) Having good knowledge of suitable radiological tools or other experiments in each case and being able to describe their applications.

12) Having good knowledge of Nuclear Medicine findings of Head and Neck.

13) Being able to manage educational programs about Head and Neck imaging.

G) PEDIATRICS

Radiology residents should have following capabilities about pediatrics upon completion of the residency program:

1) Having necessary knowledge of embryology and normal development of different organs in childhood.

2) Having good knowledge of radiological manifestations of congenital anomalies in different body organs.

3) Having proper knowledge of principles of cardiovascular resuscitation and having necessary skills of intubation in pediatrics.

4) Being familiar with catheterization of pediatrics in different ages and sexes.

5) Having good knowledge of interpretation and performing fluoroscopic methods (such as Barium Enema, VCUG, UGI …).

6) Knowing radiological manifestations of different pediatric diseases and being able to interpret them, specially perform and interpret these cases: a. Intussusceptions (causes, radiological diagnosis and treatments) b. Hirschprung's disease c. Common diseases of chest and airways d. Genitourinary infections e. Bowel obstruction f. Abdominal mass g. Bone traumas

7) Being able to give primary consultation service in pediatrics radiology to physicians.

H) BREAST

Radiology residents should have following capabilities about breast upon completion of the residency program:

A) Having good knowledge of mammography (as listed below) and being able to perform them:

1) General principles:

-Anatomy and radiological anatomy -History of mammography and zeromammography -Techniques of mammography - Lesion localization techniques in mammography -Applications of mammography -Clinical classification -High risk groups -Screening mammography -Physical examination of breast -Classical methods of interpreting and reporting of mammography -Equipments of mammography -Zeromammography

2) Malignant diseases of breast:

-Comparison between histological findings and radiological findings -Minimal breast cancer -Diagnosis of different kinds of common breast masses -Diagnosis of different kinds of uncommon breast masses -Indirect signs and symptoms of malignancy and breast lesions -Breast cancer in adolescent

3) Benign lesions of breast:

-Comparison between histological findings and mammographic findings -Diagnosis of benign lesions of breast -Benign breast calcification -Diagnosis of uncommon benign breast diseases

4) Breast study in pregnancy

5) Importance of skin lesions in mammographic diagnosis

6) Importance of lymph nodes in mammography diagnosis

7) Breast prosthesis in mammography

8) Breast and its malignancies in men

B) Having good knowledge of breast ultrasound (as listed below) and being able to perform:

1) Different methods of breast ultrasound. 2) Sonographic anatomy and anatomy of breast and axillary region and morphologic changes regarding age and hormonal status. 3) Indications of breast ultrasound and semeiology of its diseases including:

-Fibrocystic changes of breast -Cysts and tumors inside the cyst -Abscesses -Solid benign tumors -Malignant tumors -Differential diagnosis and diagnostic errors of benign and malignant lesions -Scars -Breast prosthesis

4) Performing breast ultrasound and interpretation of results:

-Third year residents: under observation of faculty members and fourth year residents -Fourth year residents: independently, exception of complications (under faculty member's guidance)

C) Having good knowledge of breast MRI (as listed below) and being able to perform it:

-At the end of residency program, residents should have good knowledge about appropriate MRI methods of breast study and be able to describe its indications and contraindications, also be able to recommend the best method of MRI if necessary.

I) INTERVENTIONAL RADIOLOGY

Radiology residents should have following capabilities on interventional radiology upon completion of the residency program:

1)Having knowledge of interventional procedures (as listed below) and their indications, contraindications, complications, preventions, diagnosis and referring their complications: a. Angiography of limbs, and gastro-intestinal vessels b. Angiography of brain and spinal cord c. Venography of limbs. d. Splenoportography e. PTC (Percutaneous Transhepatic Cholangiography) f. Percutaneous Nephrostomy - Pyelography g. Draining of abscesses and liquid collections in cavity or plural spaces h. Biopsy and FNA of body's different masses (such as lung, liver, kidney, thyroid and breast) i. Arthrography of knee j. Image-guided Drainage or treatment of thyroid, breast, kidney, ovary and liver cysts. 2) Having knowledge of interventional procedures (as listed below) and their indications, contraindications, complications, preventions, diagnosis and referring their complications: a. Digital angiography b. Angioplasty, Embolization and intra-arterial stenting c. IVC and SVC gram, IVC filtering d. Interventional treatment of tumors including: -Local trans-arterial chemotherapy -Laser therapy -Radiotherapy e. Gastrostomy f. Transcutaneous bile drainage g. General principles of interventional methods in pediatrics h. Caverno-sonography and interventional radiology applications for impotency treatment i. Placental biopsy or amniotic fluid aspiration j. Mediastinal biopsy k. Bone biopsy including: vertebrae l. Ablation therapy for Osteoid Osteoma, transcutaneous laser therapy of disks, transcutaneous treatment of nerve root association pain (PRT) and other interventional methods in bone and etc. m. Interventional treatment of pain by blocking nerves such as Celiac-plexus block, Sphenopalatine block n. Other joints Arthrography 3) Having knowledge of different devices’ characteristics in interventional radiology and ability to explain them. 4) Knowing medications and devices in interventional radiology and ability to explain their applications, indications, contraindications and complications. 5) Having good knowledge and explanation ability of preparation methods, requesting patients samples and necessary media to transmit them to laboratory. 6) Being familliar with interventional radiology risks in special cases (Infectious diseases such as acquired immune deficiency syndrome (AIDS), coagulopathies, Diabetes, allergy and ...) and having ability to provide required preparation and changes in patients in interventional procedures, before and after the procedures. J) NUCLEAR MEDICINE Radiology residents should have following capabilities about nuclear medicine upon completion of the residency program: 1) Knowing Nuclear Medicine devices. 2) Having knowledge of principles of Nuclear Medicine In Vivo and In Vitro: 1) In Vivo methods including: - Neurological System - Endocrine glands - Respiratory System - Digestive System - Musculoskeletal system - Urogenital System - Cardiovascular and lymphatic Systems - Breast tumors 2) In Vitro methods including: usage of Radio-immunoassay in evaluation of hormonal levels and other biologic substances. 3) Having good knowledge of therapeutic methods of Nuclear Medicine. 1) Treatment of Hyperthyroidism 2) Treatment of thyroid differentiated cancers 3) Other treatments 4) Knowing Nuclear Medicine methods in Oncology: a) Having good knowledge of Radio-drugs applications in tumors diagnosis: SPECT and PET b) Having good knowledge of Immuno-scintigraphy applications and its therapeutic method. K) PHYSICS Radiology residents should have following knowledge and capabilities about physics upon completion of first year: 1) General principles: - Electromagnetic waves characteristics and definition ( wave and molecular) - Electromagnetic waves spectrum specially X-ray - Atom structures and electron and nucleus energy levels - Radioactivity and unstable nucleus - Atom stimulation and ionization - Linear energy transfer - Interaction and reaction between ray and materials - Electromagnetic attenuation (Linear and Mass attenuation, HVL) - Units in radiation 2) Computer in imaging: - Computer Basics - Digital DATA transferring - Digital to Analog DATA exchange and reverse procedures - Computer structures and components - Receiving, processing, saving and displaying of digital images 3) Protections against ray : - Natural and unnatural radiation resources - General population and imaging center's personnel radiation tolerance doses -Genetically important radiation dose - Individual Dosimetry and imaging centers Dosimetry - Protection and exposure control ( Time, Distance and shielding ) - Decreasing of exposure techniques - Protection in Nuclear Medicine and radiotherapy centers - Dosimetry after exposure 4) Radiobiology - Biologic effects classification - Interaction of radiation and live tissues - Cellular Radiobiology ( Effects on DNA, Sensitive maker factors to ray, …) - Tissues response to radiation - Acute radiation syndrome - Carcinogenesis - Danger estimation models - Congenital effects of radiation ( genetic effects of radiation to fetus ) 5) Production and control of X-ray: - X-ray production (Bremmstrahlung Production process ) - Dedicated spectrum of X-ray - X-ray tube - Filtration - Collimators - X-ray generator and its different parts - Kinds of generators - Exposure timers - Effective factors on X-ray radiation - Rating chart of tube and measurement units of tube temperature - Cooling tube charts and its covers 6) Quality of Images: - Contrast ; Including: Object contrast, Recorder ( Detector and film ) - Noise (Quantum noise and other reasons) - Spatial dissociation power and its factors - Fourier Transform - Sampling and Aliasing 7) Radiography: - Radiography with film and screen - Cassette (Structures, Resonator sheets and their characteristics) - Radiology film (Kinds and their characteristics) - Density and gradient of films - Radiography with sensitive phosphor (Thermoluminescence and Photoluminescence) - Digital radiography - Scattered radiation and methods of its reducing (Grades) 8) Fluoroscopy: - Fluoroscopy devices, Picture boosters( Changing factor, contrast ratio, FOV…) - Images artifacts - Booster complex and optical coupling - Kinds of video camera, methods, automatic control of image brightness - Photospot systems ( Camera, Digital methods, Video recorder devices) 9) Collateral methods in radiology - Stereo-radiography ( Binocular, Monocular ) - Observation methods of 3D images - Rebuilding 3D images by tomographic Data - Common tomography - Subtraction methods ( including: DSA) 10) Mammography - Suitable X-ray tube for Mammography - Suitable X-ray generator for Mammography - Compression, grades and magnification - Suitable screen and film for Mammography - Film development and fixation - Dosimetry in Mammography Radiology residents should have following knowledge and capabilities about physics upon completion of the second year: 1) Computed tomography (CT scan ) - Gathering Data - Image rebuilding - CT and Hounsfield unit - Different generations and their differences, Helical CT - Sections thickness, projections and radiuses - SN ratio and spatial dissociation power - Radiation dose - Bone Densitometry - Methods of images rebuilding - Artifacts - Images displaying 2) MRI - Atom's nucleus characteristics such as spin - Performing and receiving of MR signal - Resonance - FID signal - Return to stability - T1 and T2 times - Pulse sequences (GRE, IR, SE) - Images displaying ( Gradients coils) - 2D Fourier Transform in spin-echo and GE imaging - 3D Fourier Transform in imaging - Contrast and spatial dissociation power - SN ratio - Running materials signal and MRA - MRI Artifacts (Machine , patient and signal processing) - MRI machine structures - Biological effects 3) Ultrasound - Sound characteristics - Mechanical energy development - Wave length, frequency and speed of sound – Pressure, intensity and scales of decibel - Production of sonic waves ( Transducer) - Fresnel zone, Fraunhaufer zone, Side lobes - Ultrasonic waves changes in materials ( Reflection , Deflection and Annotation) - Data gathering - Transducer actions - A mode, B mode and M mode scans - Kinds of Transducers - Image quality – Longitudinal and Latitudinal dissociation power, Contrast and Noise - Artifacts - Doppler method, Frequency shift - Continuous and pulsed waves in Doppler - Duplex scan and running materials imaging - Biologic effects 4) Quality control in radiology - Radiological devices control (Tube, bed, grades …) - Control of CT scan machine - Control in other imaging methods 5) Radioactivity and nucleus changes - Radioactivity - Decomposition constant and half-life - a, b,g ,b + decays and Electron Capture Decay (ECD) - Other forms of radioactivity 6) Production of radionuclide and radioisotopes: - Cyclotron - Nuclear Reactors - Generators - Characteristics, usages and quality control in Radiomedicine and Radiopharmacy 7) Measurement and detecting of radiation - Kinds of detectors - Spectroscopy 8) Imaging in Nuclear Medicine - Anger scintillation camera - Detectors and Collimators - Principles of image creation - Efficiency of methods and high quality image gathering - Computer in Nuclear Medicine - Image processing - Tomography methods in Nuclear Medicine - Focal plane tomography - SPECT - Structures - Image creation - Collimators - Efficiency - Quality control - PET - Annihilation coincidence detection - Machine structures and imaging methods Radiology residents should be able to do protection methods in different surveys for patients, personnel and themselves upon completion of program.

Specific educational goals in each residency year are as below: First year: 1) Having good knowledge of embryology and physiology of thorax, GI, GU, musculoskeletal system, nervous system, head and neck, pediatrics and breast, and pathophysiology of related disorders. 2) Learning anatomy and radiological anatomy of thorax, musculoskeletal system, GI, GU, nervous system, head and neck, pediatrics and breast and being able to show the anatomy on radiographic images. 3) Having knowledge of pulmonary imaging and thoracic diagnostic tests (such as blood gas analysis, pulmonary function and exercise tests, invasive monitoring). 4) Having proper knowledge of contrast materials, their indications for imaging in each of above organs, adverse reactions, complications and their handling, and having good ability to express them and change them per cases. 5) Being able to carry out plain, contrast-radiography and fluoroscopy of thorax, musculoskeletal system, GI, GU, nervous system, head and neck, pediatrics and breast under proper conditions (MAS, KVP and protective methods). 6) Ability to explain and detect radiographic findings in musculoskeletal system, especially in trauma and fractures of extremities and spine. 7) Being able to explain the presence of following items in thoracic images: - Implants and devices used in the thorax - Heart valves - Pacemakers - Cardiac defibrillators - Esophagus, air ways and coronary stents - Orthopedic devices 8) Having proper understanding of radiological findings in disorders of thorax, GI, GU, head and neck, pediatric and breast, and being able to show them in plain radiographic images, contrast-radiography and fluoroscopy. 9) Having good knowledge about radiologic findings of Nervous System diseases and ability to show them on plain radiography and . 10) Being able to prepare primary reports of plain, contrast-radiography and myelography of Nervous System and ability to present to faculty members. 11) Being able to prepare primary reports of plain radiographic images of musculoskeletal system, plain and contrast-radiographic images of thorax, , GI, GU, head and neck, pediatrics, breast, and thoracic, GI and GU fluoroscopy and ability to present to faculty members. 12) Being able to establish a good relationship with other residents of this field or other fields and faculty members due to educational purposes. 13) Having enough information of these points and good ability to describe them: (A)Radiology of skull including: paranasal sinuses, mastoid, petrous bone and hypophysis grave and etc. - Normal and abnormal calcifications - Skull in newborn and child - Congenital skull abnormalities such as craniosinostosis, basilar compression, etc. - Skull changes in benign and malignant tumors, vascular injuries, infections and metabolic abnormalities. - Skull trauma (B) Anatomy and radiological anatomy of central nervous system including: - Spinal and vertebral malformations including: dysraphism, segmentation. - Vertebral localized abnormalities - Vertebral trauma 14) Having good knowledge of radiological findings of Nervous System diseases and ability to show them on plain radiography and myelography. 15) Being able to prepare primary reports of plain, contrast-radiography and myelography of Nervous System and ability to present to faculty members. 16) Knowing about basics of interventional radiology. Second year: Beside the expertise acquired during the first year, second year residents should have following capabilities: 1) Having proper knowledge about radiological findings of different thoracic, musculoskeletal, GI, GU, nervous system, head and neck, pediatrics and breast diseases and ability to explain and show them on contrast- radiographic images. 2) Having proper knowledge about ultrasound findings of different thoracic, musculoskeletal, GI, GU, nervous system, head and neck, pediatrics and breast diseases and good ability to explain them. 3) Being able to carry out plain and Doppler ultrasound of thorax and describe the findings. 4) Being able to prepare a primary report of thorax, GI, GU, head and neck ultrasound and presenting it for faculty members. 5) Being able to teach plain and contrast-radiography and fluoroscopy of thoracic, GI, GU, musculoskeletal, head and neck diseases, and plain, contrast-enhanced and myelographic images of nervous system diseases to first year residents and guide them. 6) Being familliar with angiographic methods in diseases of thorax, GI, GU, musculoskeletal, extremities, head and neck and nervous system, and describing its indications and methods. 7) Being familliar with nuclear medicine findings in thorax, GI, GU, head and neck and musculoskeletal system, and having good ability to interpret the latter. 8) Having proper knowledge of indications, complication and methods of ultrasound and contrast-radiography such as US-guided removal of abscess, arthrography and fistulography in different organs under supervision of senior residents. 9) Being able to prepare primary reports of thoracic, musculoskeletal, GI, GU, nervous system, head and neck, pediatric and breast contrast-radiographs to present to faculty members. 10) Being able to determine applications of interventional radiology in each rotational wards in their program such as GI system, GU system, etc. 11) Being able to carry out patients history, physical examination, preparation, profile review, request review and necessary laboratories test (such as: Blood Pressure, CBC, PT, …) before interventional procedures.

Third year: Third year residents should have following capabilities beside acquired expertise during the previous years: 1) Having proper knowledge about CT and HRCT findings and knowing how to run angiography for different diseases of thorax and proper ability to express them. 2) Having proper knowledge about CT scan and angiography findings in different disease of GI, GU, and ability to express them. 3) Knowing different protocols of abdominal and upper GI CT scan and ability to describe them. 4) Being able to prepare primary report of thoracic, musculoskeletal, head and neck, GI and GU systems CT scans and present to faculty members in order to gain necessary expertise for final interpretations of CT scan. 5) Being able to teach thoracic, GI and GU, head and neck and musculoskeletal ultrasound to second year residents and help them to do musculoskeletal ultrasound and contrast radiographies. 6) Being able to perform thoracic, musculoskeletal, head and neck angiography independently and knowing how to interpret the results. 7) Knowing different protocols of thoracic HRCT and thoracic, abdominal and UGI, GU, musculoskeletal and head and neck CT scans and ability to describe them. 8) Being able to supervise over thoracic, GI, GU, head and neck and musculoskeletal system CT scans and thoracic HRCT and suggest proper protocol if needed. 9) Being able to prepare primary report of thoracic HRCT and CT scan and present to the faculty members in order to gain necessary expertise for final interpretations of CT and HRCT. 10) Being able to perform and make reports on ultrasound-guided abscess removal, arthrography and fistulography independently. 11) Having good knowledge about findings of CT scan and angiography of musculoskeletal system, head and neck and ability to describe them. 12) Being able to perform Doppler ultrasound and angiography of upper and lower extremities independently and ability to explain the results. 13) Having knowledge of indications, contraindications, methods and complications of interventional radiology and being able to act as aid in interventional procedures.

Fourth year:

Fourth year residents should have following capabilities beside the acquired experiences and knowledge during the previous years: 1) Knowing MRI findings of different thoracic, GI, GU, head and neck, breast and musculoskeletal system diseases and having good ability to express them. 2) Knowing different MRI and CT protocols in thorax, GI, GU, head and neck, musculoskeletal and nervous system and being able to express them. 3) Being able to supervise over administration of thoracic, GI, GU, head and neck, musculoskeletal and nervous system CT and MRI and suggest a proper protocol, whenever necessary. 4) Being able to prepare primary report of thoracic, GI, GU, head and neck, musculoskeletal and nervous system’s CT and MRI and present to faculty members to be experienced enough to administrate final interpretations of CT and MRI imaging. 5) Being able to prepare primary report of Nervous System MRI and CT scan of skull and spinal cord and presenting to faculty members.

6) Being able to perform radiologic diagnostic methods of orbit (such as ultrasound study of orbit) and prepare its primary report in order to acquire the ability to interpret them independently.

7) Being able to teach sectional imaging of thorax, GI, GU, head and neck, musculoskeletal and nervous system to third year residents. 8) Being acquainted with different methods of Bone Densitometry and having enough ability to interpret the results. 9) Being able to manage inter-ward conferences and journal clubs of thorax, GI, GU, head and neck, musculoskeletal and nervous system. 10) Being able to manage conferences programs in relation to other wards. 11) Having enough information about CT scan and MRI findings of following items of nervous system and ability to describe them: a) Tumoral and cystic lesions b) Skull trauma and Nervous System traumatic lesions c) Vascular and Ischemic abnormalities of brain and spine d) Infections and inflammatory lesions e) Degenerative lesions of brain and spinal cord f) Congenital anomalies in brain and spinal cord g) Temporal bone lesions h) Orbit and globe lesions i ) Spinal demyelinating diseases j) Degenerative and inflammatory lesions of inter-vertebral discs 12) All residents in fourth year of residency program should have a good knowledge of interventional radiology and ability to act as first aid in interventional prrocedures