Experiential Training Requirements

EXPERIENTIAL TRAINING REQUIREMENTS

Introduction

Trainees are expected to meet the minimum requirements specified for each of the experiential training requirements. Training sites/networks are expected to make every effort to ensure that trainee rosters accommodate experiential training requirements.

Logbook Requirements: Please note that the requirements for the specific logbooks (Angiographic and Interventional, Obstetrics & Gynaecological Ultrasound and Paediatrics and Neonate Ultrasound), must be completed in addition to meeting the experiential training number requirements.

Submission in TIMS

We have tried to simplify the recording of the number of examinations/procedures. Trainees do not need to upload their RIS/ PACS printout into TIMS.

The trainee needs to enter the number of the specific experiential training examinations/procedures completed at least once every year so their progress can be tracked. The trainee must press save each time they enter a number. The next time they wish to update TIMS, they need to add to the number already displaying so there is an updated total number. When the trainee has reached the minimum number required they can press submit and the assessment instance will show as ‘Pending 1st Reviewer Approval’.

For example, the requirement for General X-ray in Years 1-3 is 7000 plain films, which are to be read by the end of Year 3. At the end of Year 1, the trainee must update TIMS with how many they have read by simply entering the number into the ’EXP: Gen Rad Years 1-3 completed to date’ field for this TIMS assessment.

The Director of Training (DoT) will then be auto-notified and will need to approve this assessment. Approving it indicates that each experiential training requirement has been checked by the DoT who has witnessed the RIS/PACS system reports or trainee log book.

Contents

• General X-Ray Experiential Training Requirements 62 • Breast Imaging Experiential Training Requirements 64 • Interventional Radiology Experiential Training Requirements 66 • Magnetic Resonance Imaging Experiential Training Requirements 68 • Nuclear Medicine Experiential Training Requirements 70 EXPERIENTIAL REQ • Obstetric & Gynecology Experiential Training Requirements 73 • Paediatric & Neonatal Experiential Training Requirements 75 • Bone Mineral Densitometry 77 • CT Coronary Angiography 78 • CT Colonography 79

Type of Examinations to • Chest be studied • Abdominal • Extremity • Emergency Department and ICU Imaging

Number of • Observe 5 of each type of examination within the initial 5 day attachment examinations to be • Perform 1 of each type of examination within the initial 5 day attachment under studied by type supervision • 7,000 plain films are to be reported by the end of year 3 of training o Assuming 40 weeks are worked each year: equates to 58 X-rays per week in the first 3 years of training • 10,000 plain films minimum are to be reported by the end of training o Assuming 40 weeks are worked each year: equates to 38 X-rays per week in the last 2 years of training

Total: 10,000

Note: The plain films can include images prepared and presented in clinical meetings, MDMs, seen in training sessions, or double read reports. Trainees should keep a record of all images they wish to count for purposes of future audits. The responsibility is placed on the trainees (as adult learners) to get a good mix of cases.

Expected level of • By the end of phase 1 trainees should be able to report plain films, interventional knowledge and degree procedures and fluoroscopic studies independently under the supervision of a of independence to be consultant obtained • Please refer to the Curriculum for Category conditions and Key conditions • Refer to Guidelines on Supervision of Registrars in Training Departments for information on degree of independence

Duration of attachment: 5 days attached to a radiographer within the first three months of training then ongoing experience in fluoroscopic and general radiology.

Learning Outcome Suggested Content

Observe the role of • Appropriateness of positioning and views (e.g. erect abdominal, lateral chest the radiographer X-ray) and understand the • Fluoroscopic studies interaction and roles • Barium studies of radiographer and • Intravenous Urogram (IVU) radiologist • Tubograms • Spinal access

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each • Radiographic anatomy examination • Surface anatomy with relevance to positioning

Identify and discuss • Pregnancy status the radiation safety • Last menstrual period (LMP) requirements for each • Radiation protection requirement examination • Paediatric vs. Adult patients • Organ sensitivity • Pulsed fluoroscopy • Digital vs. analogue • Screening time • Screening vs. images • Please refer to the Curriculum for the AIT Syllabus

Identify and discuss • Patient mobility and spinal injury patient conditions • Patients from Culturally and Linguistically Diverse Backgrounds (CALD) that may impact on • ICU-artefacts the safety and or effectiveness of the examination EXPERIENTIAL REQ

Type of Examinations to • Mammogram-standard views, extra views (diagnostic and screening) be studied • Special Views – o Extended CC o Lateral o Cleopatra o Spot Compression o Magnification • Biopsy (ultrasound, stereotactic and MRI guidance) • US • MRI (diagnostic and screening)

Number of • 100 Diagnostic mammograms, to be reported with appropriate supervision and examinations to be feedback (equates to 20 per year over five years) studied by type • 500 screening mammograms, to be examined, not reported (assuming 40 weeks worked each year: equates to 2.5 per week over five years – observed) • 100 ultrasounds to be reported, must be present at examinations (equates to 20 per year over five years) • 20 MRI, to be examined, ideally live but can be archived cases, or cases presented in clinical meetings, MDMs or seen in training sessions (equates to 4 per year over five years: to be seen not reported – ideally are “live”, but can be archived teaching cases) • 10 Biopsies, to be performed, including cyst aspiration and biopsies under US guidance, stereotactic biopsies (equates to 2 per year over five years)

Total: 730

Expected level of Breast imaging is an important part of both public hospital and private practice knowledge and degree radiology. Trainees, by the end of their training, need to be competent in diagnostic of independence to be breast imaging, including mammography and ultrasound, and to have been exposed obtained to breast MRI, as well as the investigation and staging of metastatic breast cancer. This also includes basic interventional techniques and an ability to adequately investigate suspected breast pathology. The trainee needs to be able to safely interpret screening examinations, particularly mammography. A knowledge of benign and malignant breast pathology and epidemiology is essential.

• Please refer to the Curriculum for Category conditions and Key conditions • Refer to Guidelines on Supervision of Registrars in Training Departments for information on degree of independence • By the end of their experiential training requirements in Breast Imaging, trainees should be able to meet the requirements of Breast Screen Australia for screening mammogram reading. Trainees may achieve this level well before the end of their training, depending on jurisdictional permission and the local training environment.

Duration of attachment: Minimum 8 weeks in a breast screen and assessment unit, and / or diagnostic department. This needs to include attendance at multidisciplinary meetings (does not have to be consecutive)

Learning Outcome Suggested Content

Observe the role of • Patient positioning the radiographer • Family history and past history and understand the • Radiology exam and double read interaction and roles • Patient care of radiographer and • Importance of previous images radiologist

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each • Surface imaging anatomy examination • Anatomy of the breast and axilla at different ages • Anatomy following treatment (therapeutic and or cosmetic)

Identify and discuss • Radiation induced breast cancers, including those induced by mammography and the radiation safety other medical imaging requirements for each • Surveillance – frequency screening vs. diagnostic examination • Please refer to the Curriculum for the AIT Syllabus

Identify and discuss • Patient mobility issues patient conditions • Implants that may impact on • Dense breasts the safety and or • Cyclic and age related hormonal effects effectiveness of the • Patients from Culturally and Linguistically Diverse Backgrounds (CALD) examination EXPERIENTIAL REQ

Type of examinations to • Ultrasound, Fluoroscopy and Computerised Tomography guided procedures be studied • Vascular access – Arterial and Venous • Drainage – Effusions / Ascites / Abscess / Nephrostomy / Biliary • Biopsy and FNA targeted and general • Musculoskeletal biopsy and intervention • Angioplasty and stent (Understand principles and method and assist) • Embolisation (Understand principles and method and assist)

Number of • 50 biopsy / drainage / musculoskeletal interventions (e.g. joint injection) – to be examinations to be performed and reported studied by type • 50 vascular procedures including a minimum of 10 arterial punctures – to be performed and reported

Total: 100*

* The procedures are required to be recorded in the Angiographic and Interventional Radiology Procedures Logbook and uploaded into TIMS for verification on completion.

Expected Level of • Able to undertake procedures and report on all Category 1 conditions, Key knowledge and degree conditions and identify all Category 2 conditions of independence to be • Please refer to the Curriculum for Category conditions and Key conditions obtained • Refer to Guidelines on Supervision of Registrars in Training Departments for information on degree of independence

Duration of attachment: 3 months minimum / 6 months recommended over duration of training program. (does not have to be consecutive)

Learning Outcome Suggested Content

• Observe the • Patient focus conduct of • Provision of information on procedure procedures • Choice of procedure – risk / benefit / alternative by Consultant • Patient comprehension Radiologists • Risk / Complication (ensure patient • Informed consent consent is • Awareness of own limitations and knowing when to seek help obtained)

• Carry out interventional procedures under supervision of a Consultant Radiologist

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each • Surface imaging anatomy examination • Arterial and Venous anatomy • Peritoneal anatomy • Urinary tract anatomy • Biliary anatomy • Spinal anatomy

Identify and discuss • Screening time the radiation safety • Please refer to the Curriculum for the AIT Syllabus requirements for each examination

Identify and discuss • Allergy patient conditions • Coagulopathy that may impact on • Renal dysfunction the safety and or • Contrast reactions effectiveness of the • Anxiety examination • Analgesia and sedation • Body mass EXPERIENTIAL REQ

Type of examinations to • Brain be studied • Spine • Head and Neck • Musculoskeletal • Body • Cardiovascular • Breast

Number of 750 – Of these, 500 are to be reported, 150 in phase 1 of training and 350 in phase examinations to be 2 of training. Reporting includes input into protocolling of studies. 250 may be studied examined in clinical meetings, MDMs or training sessions, or may be archived cases

Total: 750

Expected level of • Be able to competently protocol MRI studies, problem solve sequences and knowledge and degree artefacts of independence to be • Please refer to the Curriculum for Category conditions and Key conditions obtained • Refer to Guidelines on Supervision of Registrars in Training Departments for information on degree of independence

Duration of attachment: Recommended period is 6 months (may also include term(s) of System-Focused Rotations) (does not have to be consecutive)

Learning Outcome Suggested Content

Observe the role of • MRI sequence protocolling the radiographer • Pre Screening Questionnaires and understand the • Use of sequences interaction and roles • Safety of radiographer and • Use and placement of coils radiologist • Contrast safety

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each • Radiographic anatomy examination

Identify and discuss the • Implants and other Contra-Indications (CI) safety requirements for • Heating each examination • Specific Absorption Rate (SAR) • Contrast Safety - Nephrogenic Systemic Fibrosis (NSF) • Projectiles • Pregnancy • Please refer to the Curriculum for the AIT Syllabus

Identify and discuss As above patient conditions that may impact on the safety and or effectiveness of the examination

Suggested types of • Brain 200 studies and numbers • Spine 200 • Head and Neck 50 • Musculoskeletal 200 • Body including pelvis 50 • Cardiovascular 30 • Breast 20 EXPERIENTIAL REQ

Recommended types • Bone of examinations to be • Thyroid studied • Parathyroid (Sestamibi imaging) • Ventilation / Perfusion • VQ • GI Bleed scan • Renal: DTPA / MAG 3 • Renal: DMSA • Liver colloid • Liver Haemangioma • MIBG / OCTREOTIDE • Cardiac (including performing exercise and pharmacological stress tests under supervision – also expect correlation of at least 2 cases with an anatomical modality such as CTCA or Catheter Angiography) • Sentinel lymph node mapping • White Cell / Gallium • CT/PET – NSCLC, Colorectal Cancer, Lymphoma, head and neck tumours • Paediatric Nuclear Medicine, ESP Renal, (obstruction, infection, reflux) bone, (fracture, non-accidental injury, infection) Liver,-biliary atresia versus neonatal hepatitis • Therapy-Iodine 131 for thyrotoxicosis or thyroid cancer • Strontium for palliation of bony metastases

Number of 250 includes 50 CT/PET (studies can be observed +/- reported) * examinations to be studied Total: 250

* It is recommended that the Nuclear Medicine and CT/PET requirements should be recorded by trainees for auditing purposes in a log book. A logbook has been created for trainees should they wish to utilize this. It is not mandatory, nor is there a breakdown for the total number of specific scans required.

Trainees should be aware that Nuclear medicine and CT/PET is an examinable content and trainees should ensure they obtain a broad range of scans and experiences.

Expected level of • Review and correlate with other standard imaging modalities (e.g. Plain film, CT knowledge and degree etc.) of independence to be • Be involved with the primary interview of the patients (e.g. asking a patient for a obtained bone scan about previous surgery, tumour or symptoms) • Appreciate radiation dose and precautions in common clinical situations e.g. lactating mother, young female for I131 therapy for thyrotoxicosis. • Bone scan: infection, fracture, primary and secondary tumour, stress fracture, RSD, prosthetic complications • Thyroid: thyrotoxicosis: Graves and autonomous nodule, cold nodule vs hot nodule Therapy for thyrotoxicosis and radiation precautions for patients • Parathyroid: adenoma, • V/Q: PE, reverse mismatch indicative of parenchymal process • GI Bleed • DTPA: renal function / obstruction • DMSA: Scarring • Liver Colloid: Focal nodular hyperplasia • Liver Blood pool: Haemangioma • MIBG / Octreotide: Neuroblastoma, Phaeochromocytoma and carcinoid tumour. • WBC / Gallium: infection, lymphoma, sarcoidosis, inflammatory bowel disease, PUO

Expected level of • Cardiac: Risk stratification Ischemia / infarction / hibernation / viability knowledge and degree • PET: NSCLC, Colorectal malignancy, lymphoma, head and neck of independence to be • Please refer to the Curriculum for Category conditions and Key conditions obtained continued • Refer to Guidelines on Supervision of Registrars in Training Departments for information on degree of independence

Duration of attachment: 4 weeks (does not have to be consecutive)

Learning Outcome Suggested Content

Observe the role of • The aim should be to be familiar with the basics of image acquisition and the radiographer comprehend the principles of interpretation in diagnosing common conditions. and understand the • Tumour interaction and roles • Nuclear medicine therapies-with I131 (thyroid), Strontium (bone pain palliation) of radiographer and - risks, benefits and radiation precautions radiologist

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each • Radiopharmaceutical distribution, dose examination

Identify and discuss • Half life EXPERIENTIAL REQ the radiation safety • Excretion requirements for each • Pregnancy examination • Relationship R to L Shunts • Please refer to the Curriculum for the AIT Syllabus

Identify and discuss As above patient conditions that may impact on the safety and or effectiveness of the examination

Type of examinations to • Pelvic Scans (transabdominal (TA) and transvaginal (TV)) be studied • Early pregnancy and complication scans • Nuchal Translucency scans • Obstetric Morphology scans • Obstetric Growth Scans • Relevant MRI (foetal, placental, ovarian and uterine) • Body CT

Number of • 1st Rotation: Minimum-perform 50 US scans under supervision per rotation as examinations to be a junior registrar, with an emphasis on first trimester scans and pelvic scans performed (including TV scans) as these would constitute most of the emergency situations that trainees should have to deal with on call and during working hours. The trainee is expected to spend most of their time with the Sonographers learning scanning techniques, and report / review their scans with the supervising Radiologist.* • Subsequent Rotation: Minimum-perform 50 scans under supervision with an emphasis on reporting and interpreting findings. • Obstetrics and Gynaecology MRI exposure as part of MRI rotation is desirable.

Total: 100 ultrasounds

* Trainees commencing from December 2013 (New Zealand) and from January 2014 (Australia and Singapore) will be required to record these scans in the Obstetrics and Gynaecology Ultrasound Logbook and upload it into TIMS for verification on completion. These 50 ultrasound scans are in addition to the 1st year training requirement that trainees are required to perform 50 undifferentiated ultrasound scans.

Expected Level of • Perform and interpret early pregnancy / pelvic scans knowledge and degree • 2nd and 3rd trimester scans- perform basic biometry, document presentation of of independence to be foetus and placental position obtained • Perform and interpret female pelvic scans – TA and TV analysis. • Interpret CT scanning gynaecological pathology • Interpret MR scanning gynaecological pathology • Understand appropriate use of placental and foetal MRI • Please refer to the Curriculum for Category conditions and Key conditions • Refer to Guidelines on Supervision of Registrars in Training Departments for information on degree of independence • Understand appropriate use of placental and foetal MRI • Please refer to the Curriculum for Category conditions and Key conditions • Refer to Guidelines on Supervision of Registrars in Training Departments for information on degree of independence EXPERIENTIAL REQ Duration of attachment: • Recommended: 2 rotations each of 4 weeks • Minimum: 8 weeks or equivalent

Learning Outcome Suggested Content

Observe the role • 1st Rotation: By the end of their first rotation, ideally by the end of their 2nd of the sonographer year, trainees are expected to be able to perform and interpret pelvic and early and understand the pregnancy scans competently, have performed at least 50 scans (supervised – interaction and roles and recorded in a logbook) and be able to interpret 2nd and 3rd trimester scans of sonographer and (i.e. morphology, growth etc.). radiologist • 2nd Rotation: There should be greater emphasis on 2nd and 3rd trimester scanning, performing fetal biometry, interpreting and reporting scan findings. • Should be able to scan and interpret uterine, ovarian and pelvic studies and identify common pathology.

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each • Normal developmental anatomy examination

Identify and discuss the • Please refer to the Curriculum for the AIT syllabus safety requirements for each examination

Identify and discuss • Contraindications of transvaginal scans patient conditions • Cultural significance of TV scans that may impact on • Relevant family history the safety and or effectiveness of the examination

Type of examinations to • CXR be studied • AXR • Extremity XRs • Abdominal US • Neonatal head US • Hip US • Barium Swallow and meal • TPT placement under fluoroscopy • Contrast enema • IVU • MCU • Fluoroscopy for line checks • Brain CT • Skeletal survey for NAI • MR brain and spine

Number of • 20 Screening procedures to be performed and reported examinations to be • 50 supervised ultrasounds to be performed and reported (includes abdominal studied and hips)* • 10 Neonatal heads to be observed and reported • 300 Paediatric plain films to be reported

Total: 380

* Trainees commencing from December 2013 (New Zealand) and from January 2014 (Australia and Singapore) will be required to record these scans in the Paediatric and Neonatal Ultrasound Logbook and upload it into TIMS for verification on completion. These 50 ultrasound scans are in addition to the 1st year training requirement that trainees are required to perform 50 undifferentiated ultrasound scans.

Duration of attachment: 3 months minimum or equivalent in paediatric Radiology training. This can be taken as a single block of a minimum of 4 weeks and 12 weeks at a paediatric hospital radiology department. The remainder of paediatric training can be completed through training in community paediatric radiology, either within an adult hospital, or in other suitable and appropriate training settings as determined by training jurisdictions. Appropriate paediatric case-mix and supervision must be readily available in order for non-paediatric hospital training to be recognised.

Learning Outcome Suggested Content

Expected level of • Able to undertake procedures and report on all Category 1 conditions, Key knowledge and degree conditions and identify all Category 2 and 3 conditions of independence to be • Please refer to the Curriculum for Category conditions and Key conditions EXPERIENTIAL REQ obtained • Refer to Guidelines on Supervision of Registrars in Training Departments for information on degree of independence

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each • Normal developmental anatomy examination

Identify and discuss • Please refer to the Curriculum for the AIT syllabus the radiation safety • Paediatric Dose Reduction requirements for each examination

Identify and discuss • Increased patient sensitivity to radiation patient conditions • Often limited co-operation and comprehension that may impact on • Potential emotional stress and possible need for sedation the safety and or • Need to empathise with anxious parents effectiveness of the examination

Type of examinations to • BMD be studied

Number of • 50 BMD scans to be seen, not reported. Ideally all live cases, but can be archived examinations to be teaching cases (equates to 10 per year over the five years of training). studied

Expected level of • Understand the pathophysiology of osteoporosis, as well as the principles knowledge and degree and practice of bone density, body composition measurement and aspects of of independence to be advanced bone measurement techniques. obtained • The trainee should reach a standard that allows them to appropriately report BMD studies. • Please refer to the Curriculum for Category conditions and Key conditions • Refer to Guidelines on Supervision of Registrars in Training Departments for information on degree of independence

Learning Outcome Suggested Content

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each examination

Identify and discuss • Please refer to the Curriculum for the AIT syllabus the radiation safety requirements for each examination

Identify and discuss • Understand artefacts that may impact on imaging patient conditions that may impact on the safety and or effectiveness of the examination EXPERIENTIAL REQ

Type of examinations to • CTCA be studied

Number of • 50 CTCA scans, to be seen, not reported but supervised by a CTCA qualified examinations to be specialist. Ideally at least 10 live cases and no more than 40 archived teaching studied cases (equates to 10 per year over the five years of training). • For supervision purposes, a qualified radiologist is credentialed to Level 1.

Expected level of • Be able to problem solve sequences and artefacts knowledge and degree • Please refer to the Curriculum for Category conditions and Key conditions of independence to be • Refer to Guidelines on Supervision of Registrars in Training Departments for obtained information on degree of independence

Learning Outcome Suggested Content

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each • Coronary artery anatomy examination

Identify and discuss • Please refer to the Curriculum for the AIT syllabus the radiation safety requirements for each examination

Type of examinations to • CTC be studied

Number of • 20 CTC scans, to be seen, not reported, and supervised by a qualified examinations to be Radiologist. Ideally at least 10 live cases and no more than 10 archived teaching studied cases (equates to 4 per year over the five years of training). For supervision purposes, a qualified radiologist is credentialed in CT Colonography

Learning Outcome Suggested Content

Identify the anatomy • Please refer to the Curriculum for the Anatomy syllabus that is relevant to each examination

Identify and discuss • Please refer to the Curriculum for the AIT syllabus the radiation safety requirements for each examination

Identify and discuss • Allergy patient conditions • Coagulopathy that may impact on • Buscopan the safety and or • Anxiety effectiveness of the • Analgesia and sedation examination • Body mass EXPERIENTIAL REQ