MRI

PGY5 MRI

Supervisor:               Dr. Paul Jeon, Health Sciences Centre

The following is an outline of the goals and objectives of the MRI rotation during PGY 3 and 5, incorporated into CanMEDS format.

The assessment tools utilized during the rotation include 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 couldrender the rotation incomplete, and the rotation will be completed at a later date. 

 

Duties and Responsibilities:

At the beginning of the rotation, the MR resident will inform the MR operating staff at the Janeway and HSC of his/her daily responsibility to help initiate, organize, protocol and report appropriate MR imaging tests.

It is the duty of the resident to function at all times in a professional, mature and responsible manner, whether dealing with patients, colleagues, or health care workers.

The MR resident must review all MR abdominal exams with attending staff in a timely fashion, and in an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same. The junior MR resident is responsible only for the abdominal MR exams during his/her month.

The senior MR resident should review selected MR MSK exams with attending staff in a timely fashion, and in an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same.

The senior MR resident may review selected MR CNS exams with attending staff in a timely fashion, and in an urgent/emergent fashion, should the patient’s condition (or attending physician) dictate the same.

The MR resident will be responsible to prepare 2 MR cases, on PowerPoint (in ICR format) from a provided list, to the MR supervisor by the end of the rotation.

The MR resident is responsible to review and read vigorously from the suggested reading list.

An end of rotation exam will be given during the last week of the rotation to assess knowledge and where applicable, skills (i.e. CAN MEDS) obtained during the month. A pass mark of 70 % is set as the benchmark.

 

Specific Daily Duties

Residents are expected to start work at 0800h. Any circumstances that may prevent the resident doing so can be communicated to Ms Margie Chafe or Rhonda Marshall as soon as possible.

Any holiday time taken during this rotation must have appropriate approval and follow the protocol outlined in the Radiology Resident Manual.

The MR Resident will review at least  10 (total number) of Abdominal and/or MSK PF per day with the staff designated in either of the ER PF or MR slots contained in the Work Rota. When there is no staff designated in the ER PF slot, then the review can occur with the staff designated in the standard Plain Film slot.

The MR resident will check the daily MR patient list at both sites (Janeway and HSC) to ensure proper protocols are in place and to deal with any safety/contrast questions that may arise.

The MR resident will present cases to staff in a prepared, organized fashion and subsequently dictate a timely concise, accurate report.

A verbal report must be provided to the responsible attending physician for urgent findings that are detected; the details of this communication must be then acknowledged subsequently at the end of the generated report (i.e. time and date of verbal report and the physician’s name receiving the verbal report).

 

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.

Practical  Guide to Abdominal and Pelvic MRI:

John Leyendecker, Jeffrey Brown

MSK MRI:

Clyde Helms, Nancy Major

 

Recommended reading list:

Body MRI : Evan Seigelman

 

Resource List :

MRI Normal Variants and Pitfalls:

Laura Bancroft, Mellena Bridges

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

 

  1. Medical Expert
  2. Determine indications for appropriate MR examinations in relation to the specific organ system, after reviewing pertinent background clinical information, and preceding diagnostic examinations.

OBJECTIVES PGY 3 :

After completing this rotation, the resident should be able to:

  1. Identify and describe the basic MR anatomy of the abdomen/pelvis, Musculoskeletal and CNS systems.

 

  1. Articulate the basic physics of MRI.

 

  1. Describe and identify pertinent MR safety issues.

 

 

  1. Outline and discuss current MR imaging procedures/protocols after studying the accompanying MR Protocol Document and content structure/suggested readings:
  2. Describe the major elements in the MR organ based medical knowledge objectives (curriculum) specifically in the Abdominal, MSK and CNS systems.

 

  1. Outline and discuss indications and contraindications of Gadolinium contrast agents as well as the following:

a)         Consider the physical properties of Gadolinium and the physiologic mechanisms of contrast media excretion.

b)         Identify patients who are at risk from injection of intravascular radiographic contrast material. Comprehend the classification, symptoms, and signs of contrast reactions and clinical management including appropriate use of pharmacologic agents and their mode of administration and doses after appropriate patient assessment.

i)          Consult the ACR Manual for Contrast Media.

ii)         Be prepared to answer patient and staff questions concerning when contrast media should or should not be utilized and how to treat contrast reactions.

c)         Understand the indications for premedication and the appropriate regimen to premedicate contrast sensitive patients including dosages, and dose scheduling

 

  1. Dictate accurate, concise and timely reports on MR cases reviewed with staff.
  2. Effectively communicate simple instructions to technologists and significant findings to the referring physician staff and house staff.

 

   

  1. Organize MR diagnostic imaging requests that are generated by the ordering clinicians.

 

OBJECTIVES PGY 5 :

After completing this rotation, the resident should be able to:

  1. Demonstrate a thorough understanding of the basic MR anatomy of the abdomen/pelvis , Musculoskeletal and CNS systems .(PGY 5)

 

  1. Display a sound working knowledge of the physics of MRI.

 

  1. Describe, identify and deal with pertinent MR safety issues.

 

  1. Determine indications for, and implement appropriate MR examinations in relation to the specific organ system, after reviewing pertinent background clinical information, and preceding diagnostic examinations.
  2. Outline and discuss and implementcurrent MR imaging procedures/protocols after studying the accompanying MR Protocol Document and content structure/suggested readings:  

 

 

  1. Demonstrate a sound understanding of the indications and contraindications of Gadolinium contrast agents as well as the following:

a)         Consider the physical properties of Gadolinium and the physiologic mechanisms of contrast media excretion.

b)         Identify patients who are at risk from injection of intravascular radiographic contrast material. Comprehend the classification, symptoms, and signs of contrast reactions and clinical management including appropriate use of pharmacologic agents and their mode of administration and doses after appropriate patient assessment.

i)          Consult the ACR Manual for Contrast Media.

ii)         Be prepared to answer patient and staff questions concerning when contrast media should or should not be utilized and how to treat contrast reactions.

c)         Understand the indications for premedication and the appropriate regimen to premedicate contrast sensitive patients including dosages, and dose scheduling

  1. Describe the major elements in the MR organ based medical knowledge objectives (curriculum) specifically in the Abdominal, MSK and CNS systems.
  2. Dictate accurate, concise and timely reports on MR cases reviewed with staff.

 

 

  1. Effectively communicate instructions to technologists and significant findings to the referring physician staff and house staff.
  2. Communicator

    

  1. Initiate, organize/coordinate and screen/triage MR diagnostic imaging requests that are generated by ordering clinicians.

a)         Develop lifelong learning skills to augment knowledge of medicine and Diagnostic Radiology (recognition of imaging abnormalities with synthesis of clinical and radiological information to arrive at the correct diagnosis or differential diagnosis)

b)         Progressive increase in radiological knowledge base and continuous learning in MR Radiology during rotations and case based study.

c)         Acquire knowledge of principles of MR Physics 

d)         Demonstrate the ability to use all relevant Resource Materials (Refer to Appendix - Core Reference List of texts, references, websites, sources for lifelong self-learning)

e)         Knowledge of principles of research design and implementation.

f)          Demonstrates knowledge of MR imaging produces diagnostic information and their advantages and limitations.

g)         Have film reading ability of plain film ( abdominal/MSK) examinations.

h)         Be able to recommend an appropriate MR imaging study in an emergent situation. 

 

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.

Skills:

a)         Provide an accurate clear and informative radiologic report with a precise diagnosis when possible or a relevant differential diagnosis with recommendations for follow up or further imaging as appropriate

b)         Directly communicate urgent and unexpected findings with the referring physician or their representative. Document the communication in the report.

 

c)         Demonstrate effective face to face skills with patients and their families, other physicians, nurses, technologists and support staff

d)         Demonstrate appropriate telephone and digital communication skills

e)         Demonstrate skills in obtained written and verbal informed consent

f)          Participate in multidisciplinary conferences and radiologic case presentations.

 

  1. Collaborator
  2. Manager

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.

 

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.

 

  1. Health Advocate
  2. Scholar

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.

Skills:

a)         Gather essential and accurate information about patients

 

b)         Gather information from the patient folder, faculty, literature, digital textbooks and internet

c)         Develop an imaging plan based on the clinical presentation and available information

d)         Perform the appropriate examination with skill and knowledge.

f)          Demonstrate knowledge regarding the indications and contra-indications of MR imaging.

g)         Ascertain that the correct procedure is performed on the correct patient

h)         Explain the procedure and obtain consent if required.

           

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.

Identify strengths, deficiencies, and limits in their knowledge and expertise; set learning and improvement goals; use multiple sources, including information technology to optimize life-long learning and support patient care decisions.

Incorporate formative evaluation feedback into daily practice.

 

 

 

  1. Professional

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.

Demonstrate confidentiality with all information transmitted during a patient encounter.

Demonstrate an understanding of broad principles of biomedical ethics.

Demonstrate positive work habits including punctuality and a professional appearance.

Demonstrate knowledge of issues of impairment (i.e. physical, mental and alcohol and substance abuse) obligations for impaired physician reporting, and resources and options for care of self-impairment or impaired colleagues.