Pediatric Radiology **All Goals and Objectives for this rotation are identical across all PL years** Primary Goals for this Rotation Competencies GOAL I: Normal vs. Abnormal (Radiology). Differentiate normal from abnormal features on radiographs. 1. Examine radiographs in a systematic manner. K 2. Interpret radiographs accurately, recognizing the characteristic patterns by K which physiologic and morphologic alterations are demonstrated. 3. Differentiate common normal variants and developmental features from K pathologic conditions on plain radiographs. GOAL II: Interpreting Common Radiographs (Radiology). Order and interpret radiographic studies in common and emergency conditions. 1. Request the radiographic study needed to clarify a clinical problem. K, PC 2. Communicate key patient information related to the radiographic study to the K, PC, IPC radiologist. 3. Manage patients effectively using radiographic information. K, PC 4. Interpret common findings on radiographs accurately. For example, identify the following features on commonly obtained radiographs:

a) Abdominal radiographs: abdominal masses, fecaliths, free intraperitoneal air, ileus, congenital and acquired intestinal obstruction, pneumatosis intestinalis, intraperitoneal and retroperitoneal calcifications b) Chest radiographs: atelectasis, airspace and interstitial pulmonary disease, cardiomegaly, foreign bodies, abnormalities of lung volume pneumothorax, pleural fluid, tumors, abnormal pulmonary vascularity, vascular anomalies c) Extremity radiographs: benign and malignant bone tumors, cysts, bone destruction, common fractures [Salter-Harris classification], common dislocations, osteomyelitis, arthritis, soft tissue swelling, foreign body K d) Lateral neck radiographs: adenoidal and tonsillar hypertrophy, epiglottic and glottic edema, foreign body, retropharyngeal abscess, subglottic narrowing--congenital and acquired, cervical spine abnormalities e) Sinus radiographs: mucosal thickening, masses, air-fluid levels, bone destruction f) Spine radiographs: vertebral dislocation and fracture, vertebral destruction, collapsed vertebra, disc space disease, segmentation anomalies, scoliosis g) Recognize the correct and incorrect location of tubes and intravascular lines h) Recognize common conditions such as infantile respiratory distress syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis.

5. Develop a basic level of proficiency in identifying common abnormalities in these radiographic studies that pediatricians order in emergent or urgent situations: K

1. Skeletal survey for suspected non-accidental trauma 2. Computer tomography of the head

GOAL III: Advanced Imaging (Radiology). Use appropriate imaging modalities in the diagnosis and management of pediatric patients. 1. Counsel families and patients regarding the basic indications for and risks and costs associated with specialized imaging such as the following:

a) Computed tomography (CT) b) Contrast imaging: cystourethrography, barium esophagram, upper K, PC, IPC, P, gastrointestinal series, small bowel follow through, contrast enema, SBP angiogram, c) Ultrasound d) Nuclear medicine : Bone Scan, Positron emission tomography (PET) e) Magnetic resonance imaging (MRI)

2. Use radiology consultation effectively for design of workup and diagnosis; K, PC, IPC provide key patient information to the radiologist and follow up as needed. 3. Consult the radiologist for interventional procedures where appropriate, such as:

a) Vascular intervention (angioplasty, thrombolysis, embolotherapy) b) Venous intervention (central venous lines, peripherally inserted central lines, peripheral and central ports) c) Abscess drainage K, PC, IPC d) Percutaneous biopsies e) Gastrostomy, gastrojejunostomy and cecostomy f) Tracheal and esophageal intervention (esophageal dilatation, tracheobronchial stents) g) Renal and hepatobiliary intervention (drainage catheters, stents)

4. Recognize the most suitable imaging study for evaluation of various disease K, PC conditions (e.g., bone scan vs. skeletal survey in suspected intentional trauma). 5. Conduct timely and appropriate follow-up of fetal ultrasonographic K, PC abnormalities. 6. Be familiar with the online availability of the American College of Radiology’s K, PC Appropriateness Criteria for Pediatric Imaging Studies at www.acr.org. GOAL IV: Diagnostic and screening procedures. Describe the following tests or procedures, including how they work and when they should be used; competently perform those commonly used by the pediatrician in practice. Radiologic interpretation: abdominal ultrasound K, PC Radiologic interpretation: abdominal X-ray K, PC Radiologic interpretation: cervical spine X-ray K, PC Radiologic interpretation: chest X-ray K, PC Radiologic interpretation: cranial US K, PC Radiologic interpretation: CT of head K, PC Radiologic interpretation: extremity X-ray K, PC Radiologic interpretation: GI contrast study K, PC Radiologic interpretation: lateral neck X-ray K, PC Radiologic interpretation: MRI of head K, PC Radiologic interpretation: nuclear medicine GI scanning K, PC Radiologic interpretation: renal ultrasound K, PC Radiologic interpretation: renogram K, PC Radiologic interpretation: skeletal X-ray (incl. abuse) K, PC Radiologic interpretation: sinus films K, PC Radiologic interpretation: voiding cystourethrogram K, PC Core Competencies: K - Medical Knowledge PC - Patient Care and Procedural Skills IPC - Interpersonal and Communication Skills P - Professionalism PBLI - Practice-Based Learning and Improvement SBP - Systems-Based Practice

Performance Expectations by Level of Training Beginning Developing Accomplished Competent Description of Description of identifiable Description of Description of identifiable identifiable performance identifiable performance performance characteristics reflecting performance characteristics reflecting characteristics development and characteristics the highest level of reflecting a movement toward reflecting near performance. beginning level of mastery of performance. mastery of performance. performance. Medical PL1 PL1, PL2 PL2, PL3 PL3 Knowledge Patient Care and PL1 PL1, PL2 PL2, PL3 PL3 Procedural Skills Interpersonal and PL1 PL1, PL2 PL2, PL3 PL3 Communication Skills Professionalism PL1 PL2, PL3 PL3 Practice-Based PL1 PL1, PL2 PL2, PL3 PL3 Learning and Improvement Systems-Based PL1 PL1, PL2 PL2, PL3 PL3 Practice

Milestones assessed on this rotation are:

Patient Care 1: History Level 1 Level 2 Level 3 Level 4 Level 5 Gathers information Adapts template to Filters, prioritizes, Filters, prioritizes, Recognizes and strictly following a filter and prioritize and synthesizes the and synthesizes the probes subtle clues template pertinent positives history to develop a history to develop a from patients and and negatives based differential differential families; on broad diagnostic diagnosis in real- diagnosis in real distinguishes categories or time for time for complicated nuances among possible diagnoses uncomplicated or or atypical diagnoses to typical presentations presentations efficiently drive further information gathering Patient Care 4: Clinical Reasoning Level 1 Level 2 Level 3 Level 4 Level 5 Presents clinical Generates an Organizes clinical Integrates clinical Role models and facts (e.g., history, unfocused facts to compare and facts into a unifying coaches the exam, tests, differential diagnosis contrast diagnoses diagnosis(es); organization of consultations) in the based on the clinical being considered, reappraises in real clinical facts to order they were facts resulting in a time to avoid develop a prioritized elicited prioritized diagnostic differential differential diagnosis diagnosis, including life threatening diagnoses, atypical presentations, and complex clinical presentations

Practice-Based Learning and Improvement 1: Evidence-Based and Informed Practice Level 1 Level 2 Level 3 Level 4 Level 5 Develops an Independently Locates and applies Critically appraises Coaches others to answerable clinical articulates clinical the evidence, and applies critically appraise question and question and integrated with evidence, even in and apply evidence demonstrates how to accesses available patient preference, the face of for complex patients access available evidence to the care of uncertainty and evidence, with patients conflicting evidence guidance to guide care tailored to the individual patient

Professionalism 1: Professional Behavior Level 1 Level 2 Level 3 Level 4 Level 5 Identifies expected Demonstrates Maintains Recognizes Models professional professional professional professional situations that may behavior and behaviors and behavior with behavior in trigger coaches others when potential triggers for occasional lapses increasingly professionalism their behavior fails lapses complex or stressful lapses and to meet professional situations intervenes to prevent expectations lapses in self and others

Identifies the value Demonstrates Extends the role of and role of accountability for Fully engages in Exhibits a sense of the pediatrician pediatrics as a patient care as a patient care and duty to patient care beyond the care of vocation/career pediatrician, with holds oneself and professional patients by engaging guidance accountable responsibilities with the community, specialty, and medical profession as a whole