PGY3 NEURO/ENT Objectives

Supervisor:         Dr. Nicole Myers, St. Clare's Mercy Hospital

Goals and Objectives for CT in Neuro/ENT

Preamble:

Upon completion of this rotation, the resident is expected to be able to independently manage the daily activities of a CT section and MRI.

In addition to the standard Professional Objectives, after completion of all of the Neuro
CT rotations, a resident should show competence in the following CanMEDS fields:

Evaluation:
​Assessed on a daily basis by staff assigned to ENT, as well as during education rounds.
Formal ITER at end of 4-week rotation. PLEASE ARRANGE A TIME FOR THIS WITH SUPERVISOR! There is an end of rotation exam that will also contribute to assessment of the student.  Preparing for this exam will entail performing everyday ENT cases, reading the suggested readings, and utilizing the practice ENT questions available on D2L. There is an end of rotation exam that will also contribute to the assessment of the student.  Preparing for this exam will entail performing everyday ENT cases, reading the suggested readings, and utilizing the practice ENT questions available on D2L.

The ENT CT experience at Memorial mainly includes time at the St. Clare’s site. This is mainly considered part of Neuro Imaging and fulfills Royal College requirement for training in:
Neuroimaging
Vascular and Interventional Radiology


Medical Expert:

Understand the anatomy of the central and peripheral nervous system and know how the normal anatomy will appear on CT scans. Use of “bread and butter” imaging protocols.
Know the physics of multidetector CT (MDCT) scanning and be able to choose the scan appropriate for any given clinical question.
Know the effects of slice thickness, windowing and centering on image quality.
Be familiar with basis CT parameters and MRI pulse sequences and their clinical applications
Understand MDCT scanning and image reconstruction.
Understand the factors which influence image contrast and resolution in CT. Know the various protocols for imaging the brain, head and neck and spine. Understand the artifacts unique to CT and methods to reduce or eliminate them.
Know the iodinated contrast agents including pharmacology, dose, and how they work as a contrast agent.
Know the symptoms and signs, prevention and urgent treatment of contrast reaction.
Know the gross pathology of the central and peripheral nervous system and how the diseases will appear on CT.
Recognize pathology and be able to discuss the signal and enhancement characteristics of commonly seen pathologies of the above-mentioned systems
Basic concepts of benign and malignant neck masses, head and neck cancer and patterns of tumor spread, and staging, infectious or inflammatory diseases of the neck
Understand the differential diagnoses of the patterns of abnormal density on
CT.
Become comfortable with reading plain film studies such as sinuses, facial bones, mastoids, orbits and soft tissues of the neck.
Know the indications and contraindications for CT of the nervous system. Understand the advantages and disadvantages of CT when compared to other modalities such as MRI, angiography and plain films.
Know the indications, technical factors and limitations of CT angiography of the neck and circle of Willis.
Know the technique of CT guided spine biopsy and disc aspiration including the potential adverse effects, pain management and the importance of informed consent.
Understand the principles of CT perfusion.


Scholar:
Utilize critical appraisal of the literature to positively impact patient care and outcomes.
Demonstrate intellectual curiosity and enthusiasm with clinical cases and problem solving. Attendance at designated rounds is expected.
To set up personal learning goals and objectives during rotation.
To take a leadership role in the teaching of others, with teaching/supervision of junior residents on rotations, elective students and off-service residents.
Health Advocate
Understand the implications of resource limitations on patient care. Be familiar with the role of radiologists in advocating for appropriate diagnostic imaging equipment for their patients.
Recognize and consider consent issues, patient comfort and other patient-related issues, when supervising ENT CT and MRI examinations.

Professional:
Deal with patients and families in an appropriate and professional manner. Demonstrating integrity, honesty, and compassion
Demonstrate a collegial, professional attitude to other hospital, medical and teaching staff.
To practice understanding ethical and medical-legal requirements of radiologists.
To demonstrate awareness of own limitations.
Communicator
Be able to dictate concise radiological reports documenting methodology, findings, appropriate differential diagnosis and recommendations for further management in a timely fashion.
Understand and be able to obtain informed consent as it applies to CT related procedures.
Provide appropriate interpretations for referring clinicians.
Demonstrate effective communication skills when dealing with patients, staff and referring clinical services.
Collaborator
Interact appropriately with clinicians, technologists and other members of the health care team.
To demonstrate good consulting skills when interacting with other physicians & health team members.

Manager:
Understand the organization of the radiology department.
Have an appreciation of workflow issues in CT as they impact on patient care. Understand the concept of scarce medical resources and wait times.
Know the indications for neuro CT and MRI scans and appropriately protocol examinations.
Consider advantages and disadvantages of each imaging study
Have an appreciation for patient wait times and issues around prioritization for CT scanning


Resident Responsibilities:
a) As is appropriate, interview patient, review patient charts, lab data and previous imaging history, in order to provide appropriate information for the involved technologists and study interpretation.
b) Provide supervision/guidance to the technologist for cases requiring a modified CT or MR scanning protocol.
c) Report all cases he/she has been involved with (supervising or reviewing). All cases need to be read out in conjunction with the assigned staff radiologist.
d) Administer or supervise sedatives to patients parenterally as needed.
e) Prepare in PowerPoint, one ENT case per week for review with staff for teaching.
f) MRI ENT with Assigned Staff that week
g) ENT CT with staff assigned CT that day


TEACHING:
a) The resident is encouraged to bring interesting cases to resident rounds every Tuesday.
b) Supervision/teaching of elective medical students or off-service residents, along with assigned radiologist.
c) Teaching of CT and MR technologists and students, as appropriate

ROUNDS:
Bring interesting ENT cases to combined ENT-radiology rounds as well as to the weekly ENT rounds given by the ENT staff.


Suggested resources:
Temporal Bone
Imaging of the Temporal Bone, Swartz & Harnsberger.
CT/MRI
 Head and Neck Imaging, 5th ed., Peter M. Som, Hugh D. Curtin
 Head and Neck Imaging Cases, Osamu Sakai
Miscellaneous
Handbook in Radiology: Head and Neck Imaging.2nd Edition, Harnsberger, Radiology Clinics of North America.
Diagnostic and Surgical Imaging Anatomy. Harnsberger, Osborn, Macdonald and Ross.
The Requisites 2nd Edition, Neuroradiology, Grossman, RI, Yousem, DM
Additional resources: CT/MRI teaching file
Internet including STATDX paid subscription for the residents
Departmental/Hospital journals