Body CT
PGY2 Body CT Imaging HSC
For this rotation, there ARE flouro responsibilities. These are discussed under the PGY2 GI/GU rotation objectives
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Body Objectives in PGY5 below)
Supervisor: Dr. Wesley Chan, Health Sciences Centre
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
It is very important to note that the listed Goals and Objectives for all residents be achieved while maintaining professionalism, adequate communication and interpersonal skills. Residents must be able to establish a therapeutic relationship with patients and communicate well with patients, families and medical staff (including technologists, house staff and clinicians) while providing clear and thorough explanations of diagnosis and management.
The submission of Daily Encounter Cards (Daily ITERs) are required for this rotation.
Duties and Responsibilities
Participate in and/or protocol all CT requisitions the day prior to the patient’s appointment.
Aid technologists when needed and troubleshoot protocols when needed.
Interpret daily body CT’s and review with staff in a timely manner.
Dictate and sign off reports to staff in a timely manner.
Provide verbal reports to attending clinicians when needed and to the emergency department.
Be able to aid on emergency CT when required and ensure they are performed timely.
Participate in Image guided procedures.
Understand the basic physics of CT including pitch, slice thickness, mA and kV, scanner types.
Learn principles and effects of contrast enhancement, timing and its applications.
Learn to appropriately protocol and oversee studies.
Learn appropriate form of dictation.
Be able to recognize and effectively treat all forms of adverse contrast reactions.
Be able to interpret basic CT pathology.
Be studied in CT anatomy.
Understand the importance of radiation dose & when it is appropriate (or Not) to use CT as a diagnostic tool.
Be able to effectively carry out these goals while maintaining professionalism.
Required Reading List:
Please Read the corresponding RSNA PHYSICS MODULE as outlined in the Physics curriculum
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT. Webb WR, Brant WE, Helms CA. W.B.Saunders Co. 2005
Spiral CT principles, Techniques and Clinical applications. Fishman EK, Jeffrey RB Jr. Lippincott-Raven
Computed Body Tomography with MRI Correlation. Vol.2. Lee and Sagel. Lippincott-Raven
Helical (Spiral) Computed Tomography. A practical Approach to Clinical Protocols. Silverman PM. Lippincott-Raven.
- Medical Expert
- Medical Expert
Be able to identify the CT appearances of:
- Obstructive uropathy secondary to ureteric calculus
- Renal cystic disease
- Renal cell carcinoma
- Adrenal masses and adenoma
- Liver cirrhosis
- Hepatic hemangioma
- Liver cancer – primary and metastatic
- Biliary obstruction, gallstones
- Pancreatitis and complications
- Pancreatic cancer
- Bowel and gastric cancer
- Bowel obstruction
- Visceral Perforation – free air
- Lymphoma
- Ovarian cancer
- Cervical, uterine cancer
- Prostate cancer
- Omental disease
- Aortic aneurysm and dissection
- Ascites
- Trauma – liver, spleen, kidney, bowel , bladder, arterial injury
- Appendicitis
- Bladder carcinoma, TCC, CT urography
- Inflammatory bowel disease and its complications
- Pseudomembranous and other forms of colitis
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial planes.
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Triple phase CT of the liver/kidneys,
- Gallbladder/biliary tree, and pancreatic imaging ( for workup of cholangiocarcinoma or pancreatic tumor )
- Adrenal washout study
- CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies.
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree
- Fatty Infiltration of the liver
- Biliary duct dilatation
- Cirrhosis/Portal hypertension
- Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
- Ascites
- Gallbladder wall thickening
- Solitary and multiple splenic masses
- Splenomegaly
- Pancreatic mass
- Pancreatitis
- Adrenal mass, hypertrophy and hemorrhage
- Renal mass including both benign and malignant causes
- Masses of the renal collecting system and bladder
- Hydronephrosis
- Nephrolithiasis/Nephrocalcinosis
- Omental caking/Peritoneal disease
- Pseuodomyxoma peritoneum
- Lymph node enlargement
- Bowel wall thickening, including infectious and inflammatory causes such as IBD
- Bowel obstruction, diagnosis and determination of etiology
- Pneumoperitoneum
- Mesenteric masses, including such tumors as Carcinoid
- Aortic aneurysm/dissection
- Pelvic mass (including uterine/adnexal masses)
- Prostatic carcinoma and hypertrophy
- Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Know the anatomy and pathology related to the abdomen and pelvis including focal and diffuse liver disease, masses of the kidneys, adrenal glands, pancreas and spleen, retroperitoneal masses, mesenteric masses and masses affecting the uterus and ovaries.
Be able to describe and identify couinaud segments of the liver.
Be able to protocol CT/MRI studies of the abdomen and liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers
PGY2 BODY CT (ST. CLARE'S)
Supervisor: Dr. Angus Hartery, St. Clare’s Mercy
The following is an outline of the goals and objectives of the Body Imaging rotation, incorporated into CanMEDS format.
The assessment tools utilized during the rotation include global faculty ratings including the ITER rotation evaluation sheet. An examination assessing knowledge obtained at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation.
Duties and Responsibilities
Become competent in the interpretation and technical aspects of Computerized Tomographic Axial Imaging.
Residents will review all CT requisitions with the responsible staff radiologist when able and record the examination plan on the requisition.
The resident will review each CT examination, present it to the staff radiologist for discussion, and dictate the report.
The resident will also be responsible for performing procedures such as biopsies and abscess drainage under CT guidance. If there is no resident on the Chest rotation, the resident may become involved in CT guided lung biopsies.
The resident will also present cases at scheduled rounds, with the help of the staff as needed.
Required Reading List
It is recommended that a junior resident read at least two hours a night whereas a senior resident should plan to read four to six hours per night.
Fundamentals of Body CT, Webb WR, Brant WE, Helms CA; Chapters 8-18
Know the indications, limitations/complications and be able to plan, interpret, and report the following CT studies:
- Multi phase CT of the liver/kidneys,
- Gallbladder/biliary tree, and pancreatic imaging ( for workup of cholangiocarcinoma or pancreatic tumor )
- Adrenal washout study
- CT aortic protocol (for assessment of dissection, aneurysm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
Adequately assess and interpret CT images of the chest/abdomen/pelvis in oncology patients, which in turn will help the resident become familiar with the staging of each organ tumors.
Know the indications, limitations and complications and be able to plan, interpret and report body MRI studies. (Senior residents as time permits)
Be able to recognize, give the differential diagnosis and management plan of at least the following:
- Solitary and multiple hepatic lesion(s), including those of the biliary tree
- Biliary duct dilatation
- Cirrhosis/Portal hypertension
- Hepatic nodules in the setting of cirrhosis (regenerating/dysplastic/HCC)
- Gallbladder wall thickening
- Solitary and multiple splenic masses
- Splenomegaly
- Pancreatic mass
- Pancreatitis & secondary complicaitons
- Adrenal mass, hypertrophy and hemorrhage
- Renal mass including both benign and malignant causes, ureteric and bladder mass (ureterolithiasis, TCC)
- Omental caking/Peritoneal disease
- Pseuodomyxoma peritoneum
- Lymph node enlargement
- Bowel wall thickening, including infectious and inflammatory causes such as IBD
- Bowel obstruction, diagnosis and determination of etiology
- Pneumoperitoneum
- Signs of ischemic bowel
- Mesenteric masses, including such tumors as Carcinoid
- Aortic aneurysm/dissection
- Pelvic mass (including uterine/adnexal masses)
- Prostatic carcinoma and hypertrophy
- Abscess
Be able to perform CT guided biopsies, aspirations and drainages.
Be able to describe and identify couinaud segments of the liver.
Know the pathology involving the aorta including aneurysms, dissections and penetrating ulcers.
Gain knowledge of the anatomy of the peritoneum and retroperitoneum including fascial planes.
- Communicator
- Collaborator
Communicate effectively with patients/families, referring physicians, and co-workers.
Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.
Establish good relationships with peers and other health professionals while effectively providing and receiving information.
Produce succinct reports that describe findings, most likely diagnosis, and where appropriate, recommend further investigation or management.
Become an effective consultant of radiology.
Interact effectively with health professionals by recognizing their roles and expertise.
Collaborate effectively and constructively with other members of the health care team.
Interact with house staff and referring physicians as “first contact”.
Be active participants in inter and intra discipline rounds.
- Manager
- Health Advocate
Understand the effective use of allocation and utilization of health care resources with specific attention to radiology.
Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology.
Make cost effective use of health care resources based on sound judgment.
Set realistic priorities and use time effectively in order to optimize professional performance.
Understand the principles of practice management.
Understand the fundamentals of quality assurance.
Promote health of the population through the application of radiology.
Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs.
Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
Understand the issues regarding screening.
Recognize the burden of illness upon the patients served by Radiology.
Be able to correlate findings seen on different modalities (CT, MR, Ultrasound) and be able to choose the most appropriate investigation.
- Scholar
- Professional
Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community.
Demonstrate an understanding and a commitment to the need for continuous learning.
Develop and implement an ongoing and effective personal learning strategy.
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design. Critical appraisal skills will be enhanced through Journal Club but these skills should not, of course, be limited to this.
Demonstrate an ability to be an effective teacher of radiology.
See as many cases as possible during the days with follow-up reading performed at night.
Residents are required to present and teach to other residents, medical students and house staff.
Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior.
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate reliability and conscientiousness.
Understand the principles of ethics and apply these in critical situations.
Demonstrate an awareness of personal limitations, seeking advice when necessary.
Accept advice graciously.