Body CT GI/GU
HSC Body Imaging PGY3
(The Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional CanMEDS Objectives follow the HSC Body Objectives in PGY5 below)
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 responsibilites
-One day a week (for a total of 4 days) of flouro on the day that has the most bookings
-If once flouro is taken care of, resident can attempt reading of CTC, CTE, MRE
-Resident should check in with MRI and CT techs to see when these exams are performed and then schedule readout time with staff.
The submission of Daily Encounter Cards (Daily ITERs) are required for this rotation.
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.
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.
To expand on those listed as a PGY2.
Continue to build on interpretative skills.
Effectively identify life threatening findings and notify appropriate staff.
Be able to direct and protocol choice of test and change if necessary.
Be able to consent patients and participate in image guided procedures.
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.
Please read the corresponding RSNA Physics module, as outlined in the Physics curriculum
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
Expand on those listed as a PGY2.
Be able to identify:
- Abscess – liver, pancreatic, renal, bowel
- Carcinomatosis
- Cholangiocarcinoma
- Budd-Chiari Syndrome
- Closed loop obstruction
- FNH, HCC, adenoma of liver
- Pancreatic Islet cell tumours
- Cystic Pancreatic neoplasms
- VHL and MEN syndromes
- Pseudoanuerysms
- Retroperitoneal fibrosis
- Bowel ischemia and pneumatosis intestinalis
- Carcinoid and carcinoid syndrome
- Polysplenia syndromes and findings
- Congenital anomalies
- CT urography and enterography
Know the anatomy of the peritoneum and retroperitoneum along with the included organs and fascial planes.
Adequately assess and interpret CT images of the intra-abdominal and pelvic organs in the setting of trauma.
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
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 )
- CT urogram
- Adrenal washout study
- CT aortic protocol (for assessment of dissection, anueyrsm leak/rupture)
Become familiar with assessment of the aorta for complications when the patient has had an endovascular aortic repair.
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.
PGY 3 BODY IMAGING (SC)
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 and MRI.
Residents will review all CT/MRI requisitions with the responsible staff radiologist when able and record the examination plan on the requisition.
The resident will review each CT/MRI 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:
- Triple phase CT of the liver/kidneys,
- Gallbladder/biliary tree, and pancreatic imaging ( for workup of cholangiocarcinoma or pancreatic tumor )
- CT urogram
- 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 intra-abdominal and pelvic organs in the setting of trauma.
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.
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.