Chest
PGY5 Pulmonary and Cardiovascular Radiology
Co -Supervisors: Dr. Rick Bhatia, Health Sciences Centre
- Scott Harris, Health Sciences Centre
- Medical Expert
Supervisor: Dr. Melanie Stenback, St. Clare’s
The following is an outline of the goals and objectives of the Pulmonary and Cardiovascular rotation during PGY5, 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 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 could render the rotation incomplete, and the rotation will be completed at a later date.
The submission of Daily Encounter Cards (Daily ITERs) are required for this rotation.
Duties and Responsibilities
Gain knowledge and understanding regarding imaging of the Pulmonary and Cardiovascular system with particular attention to plain film studies.
Interpret and report plain film examinations of the chest of both in-patients and outpatients including preoperative films and daily ICU/CCU/CVICU patients.
In conjunction with Body CT/MRI, resident reviews chest CT and MRI examinations including cardiac studies.
To perform, interpret and report lung biopsy and pleural drainage procedures (resident may share this duty with resident on ultrasound duty).
To attend Chest Oncology rounds.
To supervise Chest Radiology rounds when scheduled.
Specific Daily Duties
Report - Chest CT’s
- Pre-op chest radiographs
Perform lung biopsies and chest drains (time permitting).
Report at least 20 Chest plain films per day.
Report Cardiac CT and MRI’s on Tuesdays.*
Report consults
All duties listed above, with the caveat of self directed learning to focus on knowledge gaps and prepare for exams. Exact goals and duties will be discussed with the resident at the start of the rotation.
* On Tuesdays, the resident is responsible for Cardiac work only. Staff will do ICU and Chest CT’s from HSC. Janeway chest CT’s can be incorporated into Wednesday’s work.
Please note there is a graded responsibility within Pulmonary Radiology implying residents will progress from having all their procedures closely supervised and all examination study reports checked, to being able to perform procedures with little or no supervision and to report independently.
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.
A binder of mandatory reading is provided to each resident, organized with weekly reading assignments.
All needed texts and articles are provided and scaled to the resident’s level.
Cardiac Imaging - the requisites
The Royal College also provides the following reading list:
“Diagnosis of Diseases of the Chest” by Fraser, Pare and Genereaux (Reference Text)
“The Lung: Radiological and Pathological Correlation” by Heintzman, 2nd Edition (Must Read)
“Chest Radiology” by Felson (Must Read)
“Imaging of Diseases of the Chest” by Armstrong (Must Read)
“High Resolution CT Scanning” by Műller (Additional Text)
Please read corresponding RSNA physics module, as outlined in the physics curriculum
Know the anatomy of the chest and the normal variations which can be seen on chest imaging.
Know the anatomy of the heart and coronary arteries.
Integrate the physiology of the cardiovascular and pulmonary systems with the radiographic image and clinical history.
Become proficient in the interpretation of critical care chest imaging.
Be able to perform a lung biopsy and pleural drainage and manage the potential complications.
Understand the physics of how a chest image is created.
Know the staging of lung cancer and the factors which determine the operability of a lesion.
Interpret the post-operative chest and the post traumatic chest.
Protocol and interpret cardiac CT/MRI studies.
Know principles and indications for coronary CT angiography.
Protocol and interpret pulmonary CT/MRI studies including high resolution CT.
Recognize and give the differential diagnosis of at least the following:
- Lobar collapse
- Solitary pulmonary nodule
- Multiple pulmonary nodules
- Interstitial lung disease
- Airspace disease
- Mediastinal mass
- Pleural fluid
- Pleural mass
- Chest wall mass
- Pulmonary vascular disease
- Cardiac disease: valvular, congenital, myocardial, pericardial
- Anomalies/abnormalities of the aorta
- Elevation of the diaphragm
- Thymic mass
Know the radiology, pathology, and clinical aspects including presentation, manifestations and management of at least the following chest and cardiac conditions:
- Pneumonia (including viral, bacterial, mycobacterial and fungal infections)
- Lymphoma
- Lung cancer
- Metastatic disease to the chest including lymphagitic carcinomatosa
- Carcinoid
- Extrinsic allergic alveolitis
- Occupational lung disease (including silicosis and asbestosis)
- Idiopathic pulmonary fibrosis
- Rheumatoid arthritis, scleroderma, ankylosing spondyloarthritis, lupus
- Sarcoidosis
- Alveolar proteinosis
- Pulmonary hemorrhage syndromes
- Wegener’s granulomatosis
- Eosinophillic pneumonia
- BOOP
- Pulmonary edema
- Pulmonary hypertension
- Pulmonary embolism
- Pneumothorax
- Mitral stenosis/regurgitation
- Aortic stenosis/regurgitation
- Aortic aneurysm
- Aortic dissection
- Right-sided aortic arch
- Congestive heart failure
- Thymoma
- Superior vena cava obstruction
- Pulmonary hematoma
- Pulmonary sequestration
- Bronchogenic cyst
- Pericardial effusion
- Mesothelioma
- Benign pleural fibroma
- Anomalous coronary artery
- Bicuspid aortic valve
- Ascending thoracic aortic aneurysm
- Myocarditis
- Hypertrophic cardiomyopathy
- ARVD
- Partial Anomalous pulmonary venous return
- Atrial septal defect
- Myocardial Infarction
- 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 (i.e. lung cancer and cardiac calcification).
Recognize the burden of illness upon the patients served by Radiology.
- 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.