US
PGY4 Ultrasound HSC
Supervisor: Dr. Eric Sala, Health Sciences Centre
The following is an outline of both the curriculum as well as the goals and objectives of the ultrasound rotation during PGY4 & 5, 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
- At this stage, the role of the resident is to act as attending staff, with the responsibility being to cover the entire working of the department during the day. This includes reviewing all cases, as well as obtaining informed consent for all ultrasound guided procedures.
- Assisting the attending staff as well as independently performing these procedures is expected.
- Continued weekly contribution to the interesting case rounds as well as the preparation of a case for the departmental teaching file is also expected.
Required Reading List
- The two volume set: Diagnostic Ultrasound, by Rumack and Wilson
Apart from early pregnancy, the chapters relevant to the rotations at the adult hospitals are contained within the first volume.
- 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
- 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.
- Parathyroid, paracarotid artery and Doppler
- Advanced Abdominal Doppler: (visceral organs and organ transplant)
- Peripheral Vessels
Ultrasound Physics
In addition to the knowledge acquired in prior ultrasound rotations:
- Doppler phenomenon, Doppler formula
- Beam formation and focusing
- Gray-scale, m-mode, pulse wave Doppler, color Doppler imaging, power Doppler imaging
- Beam width, side load, slice thickness artefacts
- Multiple reflection artefacts: mirror image/reverberation
- Refractive artefacts
- Doppler artefacts: pulse wave, color imaging including ileising
- Gray scale versus Doppler: (trade off of penetration and resolution)
- 3D volumetric imaging
- Thermal/nonthermal effects on tissues: (biological health risks)
- Image optimization
- Hermonic imaging
- Ultrasound contrast agents
- Equipment quality assurance: phantoms, special/contrast resolution
Clinical Applications
- Liver: trauma
- Bile ducts: neoplasm (cholangiocarcinoma)
- Spleen: trauma
- Chest: pericardial effusion, mass, atelectasis, pneumonia
- Organ transplants
- Gastrointestinal tract: normal gut signature, appendicitis, diverticulitis, crohn’s disease
- Peritoneal cavity: free air
- Abdominal wall hernia and inguinal hernia
Genitourinary System
- Kidneys: xanthogranulomatous pyelonephritis, emphysematous pyelonephritis, congenital anomalies, pelvic kidney, medullary nephrocalcinosis
- Adrenal glands: mass
- Retroperitoneum: adenopathy and mass
- Ureters: ureteral stone
- Bladder: ectopic ureterocele
- Renal artery stenosis, renal vein thrombosis
Gynecology
- Peritoneal inclusion cyst
- Ovarian cancer staging
- Early obstetrics: unusual ectopic pregnancy (interstitial, cervical, ovarian, rudimentary horn)
Thyroid/Neck
- Parathyroid mass
- Congenital cyst: brachial cleft cyst
- Lymph nodes: benign and malignant characterization
- Post thyroidectomy recurrence
- Submandibular and parotid glands: normal and abnormal
Vascular/Doppler
- Carotid artery: normal, atherosclerotic plaque, carotid artery stenosis and occlusion
- AV fistula
- Renal transplant: resistive index (rejection, acute tubular necrosis), transplant vein thrombosis, renal infarction, post biopsy complications, renal artery stenosis
- Liver transplants, including hepatic artery stenosis or thrombosis, portal vein thrombosis, post biopsy complications, IVC stenosis
- Pancreas transplant
- TIPS evaluation and complications
- Arterial bypass graft, hemodialysis graft/fistula
- Vertebral artery: subclavian steal syndrome
- Mesenteric ischemia
- Renal artery stenosis
Scrotum
- Hernia
- Non descended testes
- Fournier’s Gangrene
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.
PGY4 Ultrasound SCH
Supervisor: Dr. Cheryl Jefford, St. Clare’s
The following is an outline of the goals and objectives of the ultrasound rotation during PGY4 & 5, 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.
Duties and Responsibilities
At this stage, the role of the resident is to act as attending staff, with the responsibility being to cover the entire working of the department during the day. This includes reviewing all cases, as well as obtaining informed consent for all ultrasound guided procedures.
Assisting the attending staff as well as independently performing these procedures is expected.
Continued weekly contribution to the interesting case rounds as well as the preparation of a case for 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.
The chapters relevant 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.
- Parathyroid, paracarotid artery and Doppler
- Advanced Abdominal Doppler:(visceral organs and organ transplant)
- Peripheral Vessels
Ultrasound Physics
In addition to the knowledge acquired in prior ultrasound rotations:
- Doppler phenomenon, Doppler formula
- Beam formation and focusing
- Gray-scale, m-mode, pulse wave Doppler, color Doppler imaging, power Doppler imaging
- Beam width, side load, slice thickness artefacts
- Multiple reflection artefacts:mirror image/reverberation
- Refractive artefacts
- Doppler artefacts:pulse wave, color imaging including ileising
- Gray scale versus Doppler:(trade off of penetration and resolution)
- 3D volumetric imaging
- Thermal/nonthermal effects on tissues:(biological health risks)
- Image optimization
- Hermonic imaging
- Ultrasound contrast agents
- Equipment quality assurance:phantoms, special/contrast resolution
Clinical Applications
- Liver:trauma
- Bile ducts:neoplasm (cholangiocarcinoma)
- Spleen:trauma
- Chest:pericardial effusion, mass, atelectasis, pneumonia
- Gastrointestinal tract:normal gut signature, appendicitis, diverticulitis, crohn’s disease
- Peritoneal cavity:free air
- Abdominal wall hernia and inguinal hernia
Genitourinary System
- Kidneys:xanthogranulomatous pyelonephritis, emphysematous pyelonephritis, congenital anomalies, pelvic kidney, medullary nephrocalcinosis
- Adrenal glands:mass
- Retroperitoneum:adenopathy and mass
- Ureters:ureteral stone
- Bladder:ectopic ureterocele
- Renal artery stenosis, renal vein thrombosis
Gynecology
- Peritoneal inclusion cyst
- Ovarian cancer staging
- Early obstetrics:unusual ectopic pregnancy (interstitial, cervical, ovarian, rudimentary horn)
Thyroid/Neck
- Parathyroid mass
- Congenital cyst:brachial cleft cyst
- Lymph nodes:benign and malignant characterization
- Post thyroidectomy recurrence
- Submandibular and parotid glands:normal and abnormal
Vascular/Doppler
- Carotid artery: normal, atherosclerotic plaque, carotid artery stenosis and occlusion
- AV fistula
- Renal transplant:resistive index (rejection, acute tubular necrosis), transplant vein thrombosis, renal infarction, post biopsy complications, renal artery stenosis
- Liver transplants, including hepatic artery stenosis or thrombosis,portal vein thrombosis, post biopsy complications, IVC stenosis
- TIPS evaluation and complications
- Arterial bypass graft, hemodialysis graft/fistula
- Vertebral artery:subclavian steal syndrome
- Mesenteric ischemia
- Renal artery stenosis
Scrotum
- Hernia
- Non descended testes
- Fournier’s Gangrene
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.