PROGRAM GOALS

I. Basic Goals

1. To provide superb training in all areas of clinical imaging by dint of having space, equipment, faculty, clinical material and a course of instruction. The defined areas of coverage are chest, gastrointestinal, genitourinary, musculoskeletal, neuroradiology, cardiovascular interventional radiology, nuclear medicine, ultrasound, computed tomography, pediatric radiology, breast imaging, and medical physics.
2. To give the residents an opportunity to participate in clinical and basic research.
3. To encourage additional training beyond the requirements of the Board in a focused area of interest, (neuroradiology, cardiovascular interventional radiology, pediatric radiology, nuclear medicine, cross-sectional imaging, chest, musculoskeletal, or abdominal imaging), initially during the latter part of the residency and subsequently in a one or two year fellowship.

II. Subspecialty Training Goals

1. Chest (Dr. Feigin's more detailed chest curriculum is also available in PDF format)

1st Rotation:

1. Demonstrate learning of knowledge based objectives
2. Accurately and concisely dictate a report
3. Communicate effectively with referring clinicians and supervisory staff
4. Understand standard positioning in chest radiology
5. Obtain pertinent patient information relative to radiologic examinations
6. Demonstrate the learning of the clinical indications for obtaining chest radiographs and when CT or MR may be necessary
7. Demonstrate a responsible work ethic

2nd Rotation:

1. Demonstrate learning of knowledge based learning objectives
2. Continue to build on chest radiograph interpretive skills.
3. Demonstrate an understanding of the ACR Appropriateness Criteria for chest radiography

3rd Rotation:

1. Demonstrate learning of all knowledge-based objectives
2. Refine skills in interpretation of radiographs and chest CT scans
3. Develop skills in protocoling, monitoring, and interpreting HRCT scans
4. Develop skills in protocoling, monitoring and interpreting chest MR studies
5. Become a more autonomous consultant and teacher
6. Correlate pathologic and clinical data with radiographic and chest CT findings

4th Rotation:

1. Demonstrate medical knowledge of all the material addressed in the thoracic radiology curriculum.
2. Demonstrate continuing improvement in clinical, academic, and administrative performance related to previously achieved goals and objectives.
3. Demonstrate ability to generate appropriate and complete differential diagnosis for abnormal findings on chest radiographs, chest CT, HRCT, and cardiothoracic MRI.
4. Demonstrate ability to dictate accurate chest radiographs, chest CT, HRCT, thoracic and cardiac MR reports with at least 95% accuracy and NO major interpretive errors.
5. Demonstrate ability to competently function in the role of consultant and teacher.
6. Demonstrate efficient interpretation of all ICU and inpatient chest radiographs and all cross sectional imaging studies of the chest.

2. Musculoskeletal

1st Year:

1. Development of working skills in conventional radiology of musculoskeletal conditions with an emphasis on recognition of traumatic injury.
2. Understanding of radiographic findings in common orthopedic and rheumatologic conditions and following common surgical procedures.
3. Recognition of complications of surgery on postoperative radiographs.
4. The resident must be prepared for the second year, when overnight coverage of the Emergency Department is required.

2nd Year:

1. Introduction to MRI, CT, Ultrasound and Nuclear Medicine as applied to the musculoskeletal system. An appreciation of when these techniques should be employed and a moderate degree of diagnostic skill in these areas is to be developed.
2. The resident must assume the responsibility of the night rotation in the Emergency Department.

3rd Year:

1. The resident should make an effort to obtain experience in procedures such as joint aspiration/injection and biopsies whenever possible.
2. Difficult findings should routinely be made and a polished differential diagnosis should be present for important entities.
3. Reporting style is expected to be concise and clinically pertinent.

4th Year:

1. Further study in any deficient areas as recognized by the resident or staff.
2. The resident should have enough knowledge of orthopedics and orthopedic imaging to function as a valuable consultant to the orthopedic surgeon.
3. The resident should be competent in all aspects of emergency radiology and triaging of imaging studies in this arena.

3. Abdominal Imaging

1st year:

1. Develop skills at interpreting basic imaging studies including CT, IVP, barium studies (upper GI series, barium enema, small bowel series).
2. Learn normal anatomy in the various imaging studies and begin to learn various pathologies.
3. Develop skills in exam selection for appropriate clinical problems.
4. Learn about how the various imaging technologies differ and the current state of each modality.

2nd Year:

1. Learn basic interpretation of body MRI studies.
2. Develop additional skills in CT, US and general radiology.
3. Classification of renal lesions/cysts as well as clinical impact of CT on staging tumors and on patient management.
4. Develop skills in patient and study triage as the primary ER resident.

3rd & 4th Year:

1. Performance of abdominal biopsies.
2. Learn and perform advanced CT techniques including CT angiography, 3D imaging and volume imaging.
3. Be able to triage patients to proper studies with increased understanding.
4. Increased ability to detect pathology on CT, MRI and US.

4. Breast Imaging

2nd Year:

1. Develop knowledge regarding the technical aspects of performing screening and diagnostic mammography.
2. Develop skills at interpreting screening and diagnostic mammograms in a systematic fashion and employing the standardized BIRADS lexicon in reporting. Must be able to distinguish benign from malignant disease. Must reliably detect abnormalities.
3. Develop skill with correct utilization of standardized mammography lesion descriptors and final assessment categories.
4. Develop skill with making appropriate and competent recommendations for follow-up and/or further intervention.
5. Develop and demonstrate compassionate and competent non-cognitive skills with respect to patient communication of results and recommendations following breast imaging and diagnostic procedures.
6. Acquire skills of interpreting post-operative and post-radiation therapy mammograms. Must be able to recognize post-surgical and post-therapy changes and to distinguish these from findings indicative of recurrent malignant disease.
7. Acquire knowledge of normal breast anatomy as seen in mammograms, breast sonography and breast MRI. Acquire knowledge of functional and metabolic information obtained from mammoscintigrams.
8. Performance of image-guided (mammographic or sonographic) pre-operative needle-wire localizations of breast lesions.
9. Performance of image-guided (stereotactic or sonographic) cyst aspiration procedures.

4th Year:

1. Further develop and refine compassionate and competent non-cognitive skills with respect to patient communication of results and recommendations following breast imaging and diagnostic procedures.
2. Performance and interpretation of galactograms.
3. Performance of stereotactic and sonographic image-guided breast biopsy using standard automated core biopsy devices and vacuum.
4. Refine knowledge and principles of the performance and interpretation of screening and diagnostic breast imaging examinations.
5. Become familiar with breast imaging quality-assurance and quality control procedures and documentation.
6. Acquire knowledge of national regulations pertaining to breast imaging (the MQSA law).

5. Neuroradiology

1st year:

1. Learn to interpret CT scans with particular emphasis on studies performed on individuals presenting with acute or emergent clinical abnormalities (infarction, spontaneous intracranial hemorrhage, aneurysmal subarachnoid hemorrhage, traumatic brain injury, infection, hydrocephalus, and brain herniation).
2. Become familiar with CT appearance of (a) traumatic (fractures and soft tissue injuries) of the orbit, skull base, face and petrous bones and (b) inflammatory (sinusitis, orbital cellulitis, otitis, mastoiditis, cervical adenitis and abscess) lesions.
3. Learn to identify airway compromise and obstruction.
4. Learn the appearance of traumatic lesions of the spine with emphasis on findings of spinal instability.
5. Become familiar with the CT and MRI findings of degenerative disease.

2nd year:

1. Learn the CT and MR findings of hyperacute infarction (including findings on diffusion weighted MRI).
2. Learn to identify and characterize focal lesions and diffuse brain processes and be able to provide a short differential diagnosis for the potential causes of these processes.
3. Be able to characterize facial fractures based on clinical classification systems (e.g. Le Fort fractures).
4. Learn to identify neoplastic masses arising in the orbit, skull base, petrous bone and soft tissues of the neck.
5. Be able to use standard anatomic classification schemes to accurately describe the location of mass lesions.
6. Learn the CT, MRI and myelographic findings of spinal cord compression.
7. Become familiar with findings on all three modalities that allow for accurate spatial localization of spinal lesions (extra-dural, intra-dural extra-medullary, and intra-medullary).
8. Be able to identify and differentiate discogenic and arthritic degenerative diseases.
9. Develop skills in fluoroscopically guided lumbar puncture, lumbar myelography, recognition and treatment of contrast reactions.
10. Develop skills in common carotid angiography, cervical myelography, and head and neck aspirations.

3rd & 4th Year:

1. Differentiate different types of focal intracranial lesions (neoplastic, inflammatory, vascular) based on anatomic location (e.g. intra- vs. extra-axial), contour, intensity and enhancement pattern.
2. Become familiar with the utility of MR diffusion- and perfusion-weighted sequences, functional MR, and MR spectroscopy.
3. Understand and be able to identify patterns of disease spread within and between areas of the head and neck (e.g. perineural and nodal spread).
4. Learn the imaging findings that allow for the differentiation of inflammatory and neoplastic lesions.
5. Learn the imaging features of intraspinal processes, including syringomyelia, arachnoiditis and spinal dysraphism.
6. Develop skills in internal carotid and vertebral angiography, spine biopsies, CT angiography, CT perfusion studies, and head and neck biopsies.

6. Nuclear Medicine

1st Year:

1. Understand the principles of radiotracer technique including radiopharmacology, biodistribution, physics and instrumentation.
2. Understand the principles of radiation biology, contamination and decontamination radiation protection of patients and personnel (ALARA, effects of distance, time and shielding, handling radioactive materials).
3. Understand the significance of clinical history in image interpretation.
4. Understand normal distribution of various radiopharmaceuticals.
5. Identify scans based on radiotracer distribution.

2nd Year:

Acquire skills for interpretation of the following studies:

1. Bone scan
2. Esophageal transport imaging
3. Gastric emptying studies
4. Hepatobiliary studies (acute cholecystitis, sphincter of Oddi dysfunction)
5. Renal scans (MAG3, DTPA, DMSA)
6. Scintimammography
7. Lymphoscintigraphy including sentinel node detection

3rd & 4th Year:

Acquire skills for interpretation of the following studies:

1. Monoclonal antibody imaging (anti CEA, ProstaScint)
2. CSF scans (VP and LP shunts, Ommaya reservoir, CSF leaks)
3. Brain SPECT (dementia, trauma, brain tumors)
4. Brain death imaging
5. Clinical PET (cancer diagnosis and staging, epilepsy, myocardial viability)
6. Gated blood pool imaging – planar and SPECT
7. Myocardial perfusion imaging with T1-201 and Tc-99m Sestamibi Planar, SPECT, gated SPECT

7. Ultrasound

1st Year:

1. Acquire a basic understanding of ultrasound physics principles and instrumentation.
2. Learn ultrasound cross-sectional and vascular anatomy.
3. Must be able to distinguish normal from abnormal in the abdomen, pelvis, superficial organs, pregnancies and vascular system.
4. Become familiar with endocavitary scanning techniques.
5. Learn to detect basic ultrasound emergencies.

2nd year:

1. Acquire knowledge about Doppler physics and duplex imaging.
2. Acquire hands-on scanning skills.
3. Interpret more complex obstetrical ultrasound cases, more complex vascular ultrasound cases (carotid, liver duplex, TIPPS) and specialized small parts ultrasound (prostate, complex scrotal cases).
4. Must reliably diagnose ultrasound emergencies such as ectopic pregnancy, ovarian and testicular torsion, acute cholecystitis, hydro/pyonephrosis and deep venous thrombosis.

3rd & 4th year:

1. Perform ultrasound- or CT-guided organ biopsies and fluid aspirations.
2. Interpret most complex abdominal, pelvic, vascular and obstetrical sonograms.

8. Pediatrics

1st Rotation:

1. Watch all fluoroscopy.
2. Perform UGI and VCUG exams on children older than 1 year with attending in the room.
3. Perform fluoro on teenagers without the attending if the resident has done adult fluoro.
4. Learn to recognize malrotation, GE reflux, VU reflux, pyloric stenosis.
5. Learn to recognize normal bone, chest and abdomen films at various ages, Salter-type fractures, pneumonia, reactive airways disease, bronchiolitis, sickle cell changes, croup.
6. Read Pediatric Radiology Case Base by Seibert & James.
7. View films in Teaching Modules.
8. Prepare a case for the Teaching File for each week of rotation.
9. Use the teaching file films for resident conferences.

2nd Rotation:

1. Perform familiar fluoro exams then shows films to the attending.
2. Watch, then perform enema exams and exams on patients less than one year with the attending in the room.
3. Learn to recognize colonic aganglionosis, inflammatory bowel disease, meconium ileus, intussusception, malrotation, swallowing dysfunction.
4. Learn to recognize ICU pathology: RDS, chronic lung disease, edema, meconium aspiration, tubes and catheters and their proper positions.
5. Cover injections and sedations in CT area.
6. Learn to recognize and characterize abdominal and mediastinal masses, trauma pathology.
7. Finish Teaching Modules and Case Base
8. Read one of the general texts in the Pediatric Radiology Library (e.g. Kirks, Hilton or Swischuk).
9. Prepare a case for the Teaching File for each week of rotation.
10. Use the teaching file to find films for resident conferences

3rd & Subsequent Rotations:

1. Perform all exams with or without attending in the room, depending on degree of familiarity.
2. Learn to recognize microcolon, tracheobronchomalacia, diaphragm paralysis.
3. Learn to recognize congenital cardiac disease, dwarfing syndromes, postoperative complications.
4. Learn to recognize bowel pathology, lung infiltration, abnormal fluid collections.
5. Learn to recognize intracranial pathology, abnormal bowel, congenital renal abnormalities, normal and abnormal appearance of the maturing pelvis, testicular torsion.
6. Continue reading one of the general texts in the Pediatric Radiology Library (e.g. Kirks, Hilton or Swischuk)
7. Use other speciality texts and journals available to read about interesting cases encountered.
8. Prepare a case for the Teaching File for each week of rotation.
9. Use the teaching file to find films for resident conferences and for Board review.

9. Cardiovascular/Interventional Radiology

1st Rotation (second year of residency):

1. Understand the process of scheduling patients for CVDL procedures.
2. Become familiar with the terminology and the inventory within the Angio suite.
3. Understand and be able to use the equipment in the Angio suite.
4. Be able to perform a history and physical exam.
5. Be able to write a consultation on a patient and obtain informed consent for the procedures.
6. Begin to feel comfortable performing basic procedures, and participate as first assistant to the fellow on advanced procedures.
7. Understand the principles of conscious sedation and how to use the proper medications during a procedure.
8. Finish reading one of the two required books (Cope or Rosen).

2nd Rotation (usually 3rd or 4th years):

1. Feel more comfortable with all the requirements of the first month rotation.
2. Become more actively involved in the more advanced procedures as first assistant. Graded responsibility will be given depending on the individual resident’s ability. Become primary operator on the more basic procedures.
3. Become more involved with the day to day running of the section.
4. Finish reading the other book not completed during the first rotation.

3rd & 4th Rotation (usually within the 3rd & 4th years):

1. Familiarize oneself and be comfortable with all the requirements of the first two rotations.
2. Be a full active member in the running of the section. Taking on more responsibility as the senior resident on the service. Primary operating on more advanced cases and first assisting the junior resident on more basic procedures.
3. Have the responsibility and be functioning in a "fellow-like" role.