Neuro
PGY2 Neuroradiology
Supervisor: Dr. Robert Heale, Health Sciences
The following is an outline of the goals and objectives of the Neuroradiology rotation during PGY2, incorporated into CANMEDS format. The medical expert expectations have been organized by year. The remaining CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency.
The assessment tools utilized during the rotation include the ITER rotation evaluation sheet. An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day. The examination will assess the acquisition of knowledge throughout the rotation. The exam questions are derived from the rotation objectives, and consist of multiple choice, fill-in-the-blank, and OSCE type format. A pass mark is 70%. The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date.
The submission of Daily Encounter Cards (Daily ITERs) are required for this rotation.
Duties and Responsibilities
To learn the anatomy, physiology and associated pathological conditions affecting the Central Nervous system and to be able to interpret and report associated imaging studies with an emphasis on Computed Tomography.
Review and report all CT scans of head and spine performed at HSC site.
Where time allows, review some MRI studies to become familiar with this modality in preparation for the PGY3 rotation.
In most cases the expectation is that the study should be reviewed with staff on the same day as acquired.
Understand indications, contra-indications as well as advantages and disadvantages of various imaging modalities in the investigation of CNS disorders.
Participate in the education of medical students, interns and residents.
Actively participate and gain increased understanding and proficiency in CNS interventional procedures such as lumbar puncture.
Review CT protocols for your CT list each day.
Submit (in power point format) 4 researched & prepared CNS cases as assigned by the end of the rotation.
Present 1 CNS case each Tuesday at ICR during your rotation.
Generate accurate and concise radiographic reports.
Communicate effectively with patients, referring clinicians, technologists and supervisory staff.
Obtain essential patient information pertinent to the radiologic examination.
Demonstrate knowledge of clinical indications for radiography and indications for urgent and emergent computed tomography (CT) and magnetic resonance (MR) examinations.
Demonstrate a responsible work ethic.
Required Reading List
- Please read the corresponding RSNA physics module, as outlined in the physics curriculum
- Neuroradiology: Anne Osborne
- Statdx: Appropriate sections.
- Medical Expert
- Communicator
Know the gross anatomy of the central nervous system and review the pertinent aspects of functional neuroanatomy.
Become exposed to the techniques of myelography and lumbar puncture. If numbers of cases allow, the resident should strive to obtain proficiency in these examinations.
Become familiar with the basic imaging sequences required in MRI scanning of the head and spine.
Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast.
Know the anatomy and pathology regarding the brain and spinal cord.
Be able to read the following films: CT, MRI and myelogram.
Perform myelogram/lumbar punctures.
Be able to protocol MRI/CT scan examinations.
Specific Learning Objectives:
Normal Variants: Brain: Aging Brain, Arachnoid Granulations, Cavum Septi Pellucidi (CSP), Cavum Velum Interpositum (CVI), Enlarged Perivascular Spaces. Spine: Conjoined Nerve Roots Spine, Incomplete Fusion of Posterior Element Spine, Limbus Vertebra Spine.
Congenital/Genetic in the Adult: Brain Aqueductal Stenosis, Chiari Malformation, Dandy Walker Continuum, Lipoma. Spine: Scheuermann Disease, Schmorl Node, Vertebral Segmentation Failure
Trauma: Brain Brain Death, Calvarium Fracture, Cerebral Contusion, Cerebral Edema, Diffuse Axonal Injury (DAI), Epidural Hematoma, Herniation Syndromes, Missile and Penetrating Injury, Pneumocephalus, Subarachnoid Hemorrhage, Subdural Hematoma. Spine: Plain radiograph and CT of spinal trauma is covered in MSK, but reinforced in Neuroradiology.
Vascular Disease: Arteriolosclerosis, Carotid Cavernous Fistula, Cerebral Infarction, Cerebral Venous Sinus Thrombosis, Hypertensive Hemorrhage, Small Vessel Ischemia, Spontaneous Intracranial Hemorrhage, Aneurysmal Subarachnoid Hemorrhage, Nonaneurysmal Perimesencephalic SAH
Vascular Disease, Malformations: Arteriovenous Malformation, Cavernous Malformation Brain, Developmental Venous Anomaly (DVA)
Infection: Brain: Abscess, Extra-Axial Empyema, Herpes Encephalitis, Meningitis. Spine: Epidural abscess.
Metabolic: Acute Hypertensive Encephalopathy (PRES), Hepatic Encephalopathy, Hypoglycemia, Osmotic Demyelination Syndrome
Degenerative: Brain: Alzheimer Dementia, Multi-Infarct Dementia, Normal Pressure Hydrocephalus, Obstructive Hydrocephalus, Porencephalic Cyst. Spine: Acquired Lumbar Canal Stenosis, Cervical Facet Arthropathy, Degenerative Disc Disease, Degenerative Endplate Changes, Disc Herniation, DISH, Spondylolisthesis, Spondylolysis, Synovial Cyst,
Toxic: Alcoholic Encephalopathy, CO Poisoning, Drug Abuse, Idiopathic Intracranial Hypertension,
Neoplasm, Benign: Brain Hemangioblastoma, Meningioma, Neurofibroma, Pilocytic Astrocytoma, Pituitary Adenoma, Schwannoma. Spine: Hemangioma,
Neoplasm, Malignant: Brain: Metastases: Astrocytoma, Low Grade, Glioblastoma Multiforme, Primary CNS Lymphoma, Oligodendroglioma. Spine: Metastatic Lesions, Multiple Myeloma,
Cysts, Non-neoplastic: Brain: Arachnoid Cyst, Colloid Cyst, Dermoid Cyst, Epidermoid Cyst. Pineal Cyst. Spine:Perineural Root Sleeve Cyst,
Treatment-Related Lesions: CSF Shunts and Complications
Idiopathic/Miscellaneous: Empty Sella, Paget Disease, Thick Skull
Dictate clear, detailed, and accurate reports.
Use appropriate nomenclature when reporting radiographic, CT, or MR findings of CNS disease.
Communicate all unexpected or significant findings to the ordering provider and document the call and the date and time of the discussion in the report.
Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider.
Establish a therapeutic relationship with patients and communicate well with family. Provide clear and thorough explanations of diagnosis and investigation.
Produce succinct reports that describe findings, most likely diagnosis, and, where appropriate, recommend further investigation or management.
- Collaborator
- Manager
Effectively provide feedback to radiology technologists regarding quality of examinations.
Recognize when it is appropriate to obtain help from senior residents or faculty when assisting referring clinicians.
Establish good relationships with peers and other health professionals. Effectively provide and receive information. Learn to deal with conflict situations.
The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition, residents will be required to be active participants in inter and intra discipline rounds.
Consult effectively with other physicians and health care professionals.
Contribute effectively to other interdisciplinary team activities.
Learn competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology.
Learn to set realistic priorities and use time effectively in order to optimize professional performance.
Understand the fundamentals of quality assurance.
Utilize resources effectively to balance patient care, learning needs, and outside activities.
- Health Advocate
- Scholar
Learn to recognize the Radiologist’s role in ensuring appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs.
Understands and communicates the benefits and risks of radiological investigation and treatment, including population screening and the risk of radiation exposure to the pediatric population.
To recognize the burden of illness upon the patients served by Radiology.
Benefits/risks of radiologic investigation. Consult CAR and ACR appropriateness guidelines.
Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care
Demonstrate an understanding and a commitment to the need for continuous learning. Develop and implement an ongoing and effective personal learning strategy.
Be able to critically appraise medical information and demonstrates basic knowledge in biostatistics and experimental design with respect to Radiology.
Demonstrate an ability to be an effective teacher of radiology.
Research & submit cases for the teaching file.
Identify potential research project with supervisors.
- Professional
Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality
Demonstrate integrity, honesty, compassion and respect for diversity.
Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.
Demonstrate timeliness, 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.