PGY4 Breast Imaging Objectives

Supervisor:  Dr. Connie Hapgood, St. Clare’s

The assessment tools utilized include an end of rotation exam and ITER. A score of 70% must be achieved on the exam.  If not, the exam must be repeated until a score of 70% has been achieved. There will be a mid rotation progress discussion to help guide the resident as needed.

The resident is asked to contribute one interesting case per rotation to the Radiology Breast Imaging teaching file. Review such case with one of the breast Radiologists and then present the case at weekly interesting case rounds. The case is then to be emailed to Dr. Hapgood.
 
A minimum of 8 daily performance assessment (DPA) cards must be submitted to complete this rotation. This enhances feedback throughout the rotation and comments from the cards will be used on the final ITER for the rotation.
 
Suggested reading list;
YouTube link for a module on mammographic positioning.
https://youtu.be/XcC8GGBOHTs

ACR BI-RADS® Atlas Fifth Edition Quick Reference Guide. Available at: https://www.acr.org/-/media/ACR/Files/RADS/BI-RADS/BIRADS-Reference-Card.pdf
Fundamentals of Diagnostic Radiology by Brant and Helms (Breast chapter).
Clinical breast imaging by Gilda Cardenosa
Breast MRI Diagnosis and Intervention by Morris and Liberman
Breast Imaging: The requisites.
Breast Imaging: Case review series.

Goals and objectives:
PGY4 breast imaging rotation (2 months):

Medical Expert:

• Continue to expand and develop the skills and knowledge learned during the PGY3 rotation with regards to mammography and breast ultrasound.
• Understand Mammography Quality Assurance standards (MQSA). Know the requirements needed to maintain accreditation.
• Know the indications for breast MRI
• Develop a working knowledge of breast MRI imaging protocols and techniques needed to produce high quality breast MRI images; review methods for optimizing MRI in keeping with current recommended standards
• Review the image patterns of normal fibroglandular tissue on breast MRI and the effect of hormonal influences.
• Characterize breast lesions, interpret and report on breast MRI examinations in accordance with the ACR BI-RADS lexicon
• Have a working knowledge of Kuhls curves
• Use MRI guided breast biopsy tools effectively and safely, first observing then performing under the supervision of a radiologist.
• Develop an approach to the interpretation and follow up of the post-surgical breast on mammography, ultrasound and MRI. This would include such entities as breast reduction, post lumpectomy and implant evaluation.
• Recognize radiation changes on mammography, ultrasound and MRI.
• Recognize commonly encountered artifacts on breast MRI.

Continue to build on knowledge of physics related to breast imaging.

Communicator:
 
Develop an organized approach to dictating a breast MRI.
 
Continue to effectively dictate mammography and breast ultrasound studies.
 
Establish good relationships with other health professionals.
 
Continue to actively take part in and lead discussions at weekly Radiology Pathology rounds.
Establish good relationships with the patient and their families. Obtain informed consent for all interventional procedures. Address concerns of the patient and their family members.

Collaborator:
 
Be an effective consultant of radiology.
 
Work effectively with other members of the health care team. Interact with house staff, nurses, technologists, booking staff, and other physicians as “first contact” to streamline requests. Staff radiologist always available for consult.
 
When needed, discuss with booking staff and referring physician the need for additional studies/biopsy and corresponding booking dates.
 
Ensure patient centered care. Effectively involve the patient in the decision making process of their follow up care whether it be additional radiographic studies, biopsy or consultation with other health professional i.e. surgery.
 
Leader:
 
Set realistic priorities and use time effectively to optimize professional performance.
 
Understand the principles of practice management and quality assurance particularly in how it relates to breast imaging.
 
Demonstrate effective use, allocation and utilization of health care resources with specific attention to breast radiology.
 
Demonstrate competency in ensuring patient safety.
 
Health Advocate:
 
Understand the role of breast imaging in screening.
 
Recognize the radiologist’s role to ensure all patients receive the appropriate radiological investigation.
 
Understand and communicate the benefits and risks of radiological intervention and treatment, including screening.
 
Recognize the effect of over calling findings on the patient’s mental health.
 
Scholar:
 
Demonstrate an understanding and a commitment to the need for continuous learning.
 
Be aware of up to date literature concerning the current staging and Birads classification of breast carcinoma.
 
 Be up to date on current surgical and medical management techniques with regards to breast pathologies both benign and malignant.
 
Develop and implement an ongoing and effective personal learning strategy.
 
Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design with respect to breast radiology.
 
Demonstrate an ability to be an effective teacher of breast radiology. Actively contribute to weekly Rad Path rounds.
 
Contribute one interesting case per rotation to the Radiology Breast Imaging teaching file. Review such case with one of the breast Radiologists and then present the case at weekly interesting case rounds. Then email the case to Dr. Hapgood.
 
Professional:
 
Practice radiology in an ethical, honest and compassionate manner maintaining the highest quality of care and professionalism to all colleges and patients.
 
Demonstrate integrity, honesty, compassion and respect for diversity.
 
Demonstrate reliability and conscientiousness.
 
Demonstrate an awareness of personal limitations, seeking advice when necessary.
 
Be committed to the health and well-being of all patients, however also understand the importance of one’s own health and well-being.
 
Accept advice graciously.
 
Fulfill medical, legal and professional obligations of a diagnostic radiologist.