US | Radiology | Memorial University of Newfoundland

PGY3 Ultrasound HSC

Supervisor: Dr. Eric Sala, Health Sciences

The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound rotation during PGY3, 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 global faculty ratings such as 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. 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. 360 degree evaluations by the ultrasound technologists will also be included in the ITER evaluation sheet. This will also include nursing staff.

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

Duties and Responsibilities

In addition to scanning and reviewing all emergency patients and inpatients, a reasonable volume of the routine outpatient list should also be reviewed. As a general guideline, approximately 75% of the daily ultrasound list is the responsibility of the resident. This is in addition to obtaining informed consent and assisting attending staff with all ultrasound guided procedures.
Weekly contribution to interesting case rounds with a case specifically pertaining to the role of sonography is expected. Also, a contribution of at least one case per rotation to the departmental teaching file is also expected.

Required Reading List

The two volume set: Diagnostic Ultrasound, by Rumack and Wilson
Supplementary reading with the case review series, and both the general ultrasound, as well as the obstetrical gynecological ultrasound volumes is recommended.

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

Apart from early pregnancy, the chapters relevant to the rotations at the adult hospitals are contained within the first volume.

Medical Expert
“Hands On” Scanning:

In addition to the acquisition of knowledge specific to ultrasound, there is an expectation that the resident will learn to scan during all rotations. In addition, a knowledge of physics specific to ultrasound is expected. In addition to hands on scanning, the acquisition of interventional skills using ultrasound guidance will also be assessed.

Know the anatomy and pathology related to the body parts being scanned including the musculoskeletal system, neck, pleural space, abdomen and pelvis.

Be able to scan and interpret an ultrasound study of the pleural space, abdomen, pelvis, neck, and musculoskeletal system.

Know the role of ultrasound in situations of trauma.

Recognize and give the differential diagnosis of a lesion based on its anatomical location and echogenicity.

Perform an ultrasound guided biopsy and ultrasound guided drainage.

By the end of each level of training, the resident should be able to scan most clinical scenarios listed below in each training category.

Pancreas:(pancreatitis and mass)
Biliary Tree:(common bile duct and ductal dilatation)
Abdominal Mass/Adenopathy
Kidney:(mass/cyst)
Basic Doppler:(portal vein, pseudoaneurysm and AV fistula)
Early Pregnancy: (failed pregnancy)
Adnexal Mass:(ovarian and non ovarian)
Testes:(pain and masses)
Thyroid Nodules
Continue to refine ultrasound guided procedural skills

Ultrasound Physics

Define ultrasound, including the relationship of sound waves using imaging.
Transducer choice: curvi-linear, linear, sector, vector
Generation and detection of ultrasound waves.
Frequency, sound speed, wave length, intensity, decibels, beam width, Frezno zone, Frown Hopper Zone.
Interaction of sound waves with tissues:reflection, attenuation, scattering, refraction, absorption, acoustic impudence pulse echo principles
Straight and narrow sound beams, suprareflection constant sound speed
Beam shape:linear, sector, curved ray.
Probes:transabdominal and endocavitary
Display:Gray-scale, m-mode, pulse wave Doppler, color and power Doppler.
Image orientation
Image optimization:power output, gain, time gain compensation
Acoustic properties of fluid, cysts, calcification, complex fluid and solid structures
Tissue characteristics:acoustic shadowing and enhancement
Focal zone

Clinical Applications

Liver:hematoma, biloma, abscess
Post liver transplantation/surgery collections:hematoma, biloma, abscess
Gallbladder:hyperplastic cholecystosis, carcinoma
Bile ducts:bile duct stones, inflammatory disease, cholangitis, pneumobilia
Pancreas:neoplasm, cysts
Pancreatitis complications:abscess, pseudocyst and pseudoaneurysm, chronic pancreatitis
Peritoneal cavity:abscess, hemorrhage, omental mass, metastases, carcinocmatosis
Spleen:varices

Genitourinary System

Abscess/pyelonephritis, perinephric fluid
Post renal transplant collections:hematoma, uronoma, abscess, lymphocele
Complex renal cyst, adult polycystic kidney disease, acquired kidney cystic disease, renal cell carcinoma, angiomyelolypoma
Bladder:mass, infection, hemorrhage, wall thickening, bladder outlet obstruction, diverticulae, urethrocele
Transabdominal prostate
Ureters:hydroureter

Gynecology

Uterus:congenital anomalies, endometrial polyp, endometrial hyperplasia, endometrial carcinoma, endometritis, pyelometrium, fibroid localization (submucosal, intramural and subsurrousal) adenomyosis
Ovarian cyst:hemorrhagic/ruptured cyst, endometrioma, polycystic ovarian disease, over and hyper stimulation syndrome
Ovarian neoplasm:cystic/solid adnexal masses, cystadenoma/carcinoma, dermoid, fibroma, germ cell tumor, Doppler evaluation
Ovarian torsion:pelvic inflammatory disease, tube ovarian abscess
Cervix:mass, stenosis, endometrial obstruction
Fallopian tube:hydrosalpinx, pyosalpinx
Posthysterectomy
Early obstetrics:spontaneous complete/incomplete abortion, ectopic pregnancy, blighted ovum, embryonic death, subcryonic hematoma, gestational tripoblastic disease

Thyroid/Neck

Thyroid nodule characterization:echotexture, calcifications including microcalcifications, margins, recommendations for aspiration biopsy
Hashimoto’s thyroiditis/Graves disease

Vascular/Doppler

Peripheral aneurysm, including iliac and popliteal arteries
Hepatic vasculature:post and color Doppler imaging of the portal veins, splenic vein, hepatic arteries and hepatic veins, including normal direction of flow
Hemodynamics of cirrhosis, portal hypertension and varices, portal vein
Thrombosis
Upper extremity DVT
Renal vein thrombosis

Scrotum

Epididymitis, orchitis
Testicular torsion
Testicular mass characterization:microlithiasis, germ cell tumor, lymphoma, metastases
Cystic ectasia of mediastinum testes
Extra testicular masses/cysts, stromatocele, adenoma type tumor, epididymal head cyst
Varicocele
Trauma

Musculoskeletal

Normal tendon appearance
Foreign body
Soft tissue gas
Joint fluid
Muscle tear
Rotator cuff tear

Interventional

Biopsy of soft tissue masses as well as focal solid visceral masses
Aspiration of fluid collections, cysts and catheter placement for abscess and fluid drainage
Postprocedural evaluation:radiographic studies, patient monitoring, management of complications
Fine needle biopsy versus core biopsy and specific applications, including focal, liver and renal masses, thyroid lesions and retroperitoneal adenopathy

Throughout all ultrasound rotations, the following CANMEDS competencies should be demonstrated:

Communicator
Collaborator

Dictate prompt, accurate and concise reports for ultrasound studies.

Develop effective communication skills with patients, patient families, physicians and other members of the health care team.

Promptly communicate urgent, critical or unexpected ultrasound findings to residents, referring physicians or clinicians while documenting the communication in the report.

Dictate accurate and concise radiological reports for more complex studies with concise impression and diagnosis and/or differential diagnosis, as well as recommendations for further imaging and/or management.

Communicate effectively and demonstrate caring, respectful behavior when interacting with patients and their families, answering their questions and helping them to understand the ultrasound procedure as well as its clinical significance and as well understand the importance of the physician/patient interaction during an ultrasound exam.

Interact with residents and attending physicians in consultation when clinical and radiologic correlation is necessary.

If there are medical students rotating through the department during electives, time spent by the medical student in ultrasound should be with the resident in reviewing cases and performing procedures.

Manager
Health Advocate

Use information technology to manage information, to access online medical information and for self learning.

Understand how medical decisions affect patient care within a larger system.

Know how types of ultrasound practice and delivery systems differ from one another.

Effectively prioritize patients requiring ultrasound studies.

Use information technology to support patient care decisions.

Participate in quality assurance programs for sonographers and physicians.

Be aware of equipment quality assurance programs.

Practice cost effective evaluation of patients requiring ultrasound studies that does not compromise the quality of care.

Understand the bio effect and safety issues in diagnostic ultrasound.

Scholar
Professional

Demonstrate knowledge of principles of research methods, statistical methods, study design and their implementation.

Demonstrate critical assessment of the scientific literature.

Demonstrate knowledge and application of the principles of evidence based medicine in practice.

Facilitate teaching of medical students, stenographers, other residents and other health care professionals.

Apply basic knowledge of study design and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.

Demonstrate honor, integrity, respect and compassion to patients, other physicians and other health care professionals.

Demonstrate positive work habits, including punctuality and professional appearance.

Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information.

Demonstrate responsiveness to the needs of patients that super cedes self interest (altruism).

Demonstrate accountability to the patients, society and the profession.

The work day begins at 8:00 and the resident is expected to be present on time.

In cases where the resident is unable to attend to patients in the department for any reason (including having to attend rounds/teaching sessions, or other duties), the resident is expected to communicate this with both the attending staff as well as the ultrasound technologist, in order to ensure no interruption in delivery of patient care.

PGY3 Ultrasound SCH

Supervisor: Dr. Cheryl Jefford, St. Clare’s

The following is an outline of the goals and objectives of the ultrasound rotation during PGY3, 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.