GI/GU

PGY2 Gastrointestinal & Genitourinary (also PGY3, PGY4)

Supervisor:                        Dr. Sarah Jenkins (HSC) 

Supervisor:                        Dr. Cheryl Jefford (SC)

 

ASSESSMENT TOOLS:  ITER. End of Rotation examination assessing knowledge obtained at each stage of training will be given during the last week.  A pass mark is 70%.  The inability to pass the exam could render the rotation incomplete, and the rotation will be completed at a later date. 

Exposure to GI and GU fluoroscopic exams through out residency is a MUST to maintain skills. Flouroscopic skills will be introduced and maintained in the follow rotations:

The submission of Daily Encounter Cards (Daily ITERs) are required for this rotation.

Duties and Responsibilities

Protocol for CT colonography review:

-  Review Terarecon video instructions to ensure you know how to use the software
-  Independently review a CTC study and discuss results (colonic and extra colonic) with staff
-  Discrepancies in findings require further review (be sure to bookmark the images or record image numbers of polyps to
   be time efficient)
-  If no discrepancies, a report can be dicatated and sent to staff


PGY2 GI/GU FLOURO ROTATION RESPONSIBILITES

  • Resident rotates between sites to allow greater exposure to pathology and machinery at both sites
  • Resident is to maximize fluoroscopic experience at site assigned
  • Recording fluoroscopic procedures in online procedure log is mandatory
  • Communication of rotation supervisors, and technologists will help plan the week for maximum flouro exposure
  • Flouroscopic exams take precedence over all other radiologic studies.
  • If rarely, there are no flouro studies, inpatient film list is resident responsibility.
  • In the AM, contact the assigned staff and schedule read out times.
  • If once flouro and inpatient plain films are take care of, resident should attempt reading of CTC, CTE, MRE.
  • Resident should check in with MRI and CT techs for to see when these exams are performed and then schedule read out time with staff.
  • End rotation exam will cover all the above modalities (including CRADS). Studying around these modalities, even when they are in limited bookings is necessary, just like every other rotation.

 
        http://www.terarecon.com/support/iNtuitionVideo/iNtuitionVideo.html

         online video tutorials CTC software can be found in session 8 and 9
                                                                                                     

PGY2 BODY CT GI/GU
·         Occurs at whatever site the resident is assigned to

  • 1 day/week the resident is on flouro room and EXEMPT from CT responsibilities
  • This is the day with most flouro booked to ensure maximum exposure
  • Traditionally Tuesdays at HSC, and Wednesdays at SCH
  • If rarely, there are no flouro studies, inpatient film list is resident responsibility.
  • In the AM, contact the assigned staff and schedule read out times.

 

PGY3 BODY CT GI/GU (the rotation without MR)

-       Occurs at whatever site the resident is assigned to 1 day/week the resident is on flouro room and EXEMPT from
        CT responsibilities
-       One day a week (for a total of 4 days) of flouro on the day that has the most bookings 
-       If once flouro is take care of, resident can attempt reading of CTC, CTE, MRE
-       Resident should check in with MRI and CT techs for to see when these exams are performed and then schedule read out
        time with staff.

 
PGY4 BODY CT GI/GU (the rotation with last 2 weeks MR)

-       Occurs at whatever site the resident is assigned to 1 day/week the resident is on flouro room and EXEMPT from CT
        responsibilities
-       One day a week (for a total of 2 days) of flouro on the day that has the most booking       Traditionally Tuesdays at HSC,
        and Wednesdays at SCH
-        If once flouro is take care of, resident can attempt reading of CTC, CTE, MRE
-       Resident should check in with MRI and CT techs for to see when these exams are performed and then schedule readout
        time with staff


Other Duties and Responsibilities

The resident may be asked to perform other fluoroscopic studies when there is no other resident assigned to that specific procedure rotation.

N)

Required Reading List

Please read the corresponding RSNA physics module, as outlined in the Physics curriculum

-        Fundamentals of Diagnostic Radiology Text Readings, Chapter 26 - Pages 733- 755
The Perihepatic Space: Comprehensive Anatomy and CT Features of Pathologic Conditions
RadioGraphics 2007; 27:129–143 Published online

-      Anatomic CT Demonstration of the Peritoneal Spaces, Ligaments, and Mesenteries: Normal and Pathologic  RadioGraphics 1995; 15:755-770

 

  1. Medical Expert
  2. Double contrast upper gastrointestinal series including esophogram
  3. Small bowel follow-through with screening of terminal ileum
  4. Small bowel enema
  5. Single contrast barium enema
  6. Double contrast barium enema
  7. Gastrograffin swallow / upper GI and enema
  8. T-tube cholangiogram
  9. Sialogram
  10. Interpretation of ERCP

 

            Gain knowledge of the pharmacology as it relates to barium, gastrografin and glucagon.

            Perform, interpret and report upper and lower GI studies including small bowel studies.

 

Become competent in the interpretation and technical aspects with a focus of attention on plain film examinations and contrast studies. ONE

Know the indications, limitations and complications and be able to perform, interpret, and report the following studies:

 

            Know the indications and be able to interpret and report an abdominal series.

Know the anatomy and function of the GI tract from the mouth to the anus.

            Be able to recognize and give the differential diagnosis of at least the following:

  • Pneumoperitoneum, pneumoretroperitoneum
    •       Gas in the biliary tree, portal venous system and pneumotosis intestinalis
           •       Ascites
           •       Abdominal mass
           •       Abdominal calcification
           •       Esophageal, gastric, small and large bowel obstruction
           •       Ileus
           •       Mucosal thickening (i.e., “thumbprinting”)
           •       Strictures
           •       Fistulas and sinus tracts
           •       Abnormalities as seen on contrast studies outlined in Objectives #1 and #2
  • Peritoneal fluid

Know the radiology, pathology, and clinical aspects including presentation, manifestations and management of the following:

Benign masses/lesions of the GI tract including:
 

Inflammatory ulcers/lesions
Infectious ulcers/lesions
Spindle cell tumour
Polyps
Strictures
Malignant masses/lesions of the GI tract including:

Aden carcinoma, squamous and sarcomas of the GI tract
Carcinoid
Metastatic disease to and from the GI tract
Inflammatory bowel disease
Ischemic bowel disease
Motility disorders of the GI tract
Congenital anomalies of the GI tract
Diverticulae of the GI tract

Know and recognize the surgical procedures commonly performed on the GI tract, for example:
Bilroth I and II
Roux-en –Y
Whipple’s procedure
Esophagectomy with gastric pull through
Hemi and total colectomy, A-P resection

 

Outline and discuss the different imaging modalities available and their appropriate indications in the comprehensive evaluation of the abdomen.

Identify, describe, and discuss the following:

  1. Pneumoperitoneum
  2. Abdominal calcifications

 

Acquire a sound knowledge base in and accurately recognize, describe, and discuss the following:

  1. Acute Abdomen
  2. Small Bowel Obstruction
  1. Large Bowel Obstruction
  2. Bowel Ischemia and Infarction Abdominal Trauma
  1. Lymphadenopathy
  2. Abdominopelvic Tumors and Masses
  1. AIDS in the Abdomen R ONE
  2. Communicator

 

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.

Produce succinct reports that describe findings, most likely diagnosis and, where appropriate, recommend further investigation or management.

 

 

  1. Collaborator
  2. Manager

Interact with house staff and referring physicians as “first contact”.

 

Make cost effective use of health care resources based on sound judgment.

Understand the fundamentals of quality assurance.

 

 

 

  1. Health Advocate
  2. Scholar

Promote the health of the population through the application of radiology.

Recognize the Radiologist’s role to ensure appropriate Radiation dose and to act as an advocate for patients in terms of their diagnostic imaging needs.

 

See as many cases as possible during the days with follow-up reading performed at night.

 

 

  1. Professional

Be Punctual.

Demonstrate reliability and conscientiousness.

Understand the principles of ethics and applies these in critical situations.

Demonstrate an awareness of personal limitations, seeking advice when necessary.