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Radiology Rotation

Clerkship Director: Jeanne Lammering, cell: (310) 780-6688

Clerkship Coordinator: Kathleen Witty

Instructors:
Kira Chow
Nick Ferguson
Bernadette Greenwood
Omid Jafari
Darice Liu
Nicole Kurzbard-Roach
Andrew Song


Goals and Objectives

Knowledge for Practice
  • Know critical and high priority imaging findings and diagnoses and understand basic interpretive techniques in each subspecialty area.
  • Know the indications for the most important imaging examinations in each of the radiology subspecialty areas.
  • Demonstrate knowledge of human anatomy by recognizing key structures on various imaging modalities in each of the radiology subspecialty content areas.
Patient Care (Problem Solving and Clinical Skills)
  • Regard the critical importance of useful clinical history in imaging interpretation.
  • Recognize the consequences of radiation in humans of different genders and ages.
  • Understand the effects of radiographic dye on patients with kidney disease.
Practice-Based Learning and Improvement
  • Describe the common imaging findings of at least one pathologic entity, present an imaging differential diagnosis of these findings, and demonstrate understanding of the appropriate imaging evaluation and involved pathophysiology.
Systems-Based Practice
  • Understand the role of the radiologist in the care of patients undergoing imaging evaluation and/or image guided procedures or for whom such evaluation or procedures are being considered.
  • Know the relative costs associated with radiologic testing.
  • Understand the role that false positive and false negative results from mammography have on recommendations for screening.
Interpersonal and Communication Skills
  • Effectively advise patients and colleagues on the risks, benefits, limitations and indications of each of the most common imaging examinations.
  • Demonstrate understanding of the important role of communication in radiology with specific emphasis on the radiology report, urgent or unexpected findings, recommendations for follow-up imaging or procedures, and doctor patient communication.
Professionalism
  • Demonstrate understanding of the principles of mutual respect, honesty, and discretion in the use of patient clinical and imaging data, during lecture, as a part of the clinical radiology team, and when interacting with referring clinicians and non-radiology colleagues and support staff.
Interprofessional Collaboration
  • Demonstrate the ability to engage in an Interprofessional team in a manner that optimizes safe, effective patient and population-centered care.
Personal and Professional Development
  • Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients.

Course Description and Schedule

Course Objectives
  • Understand the role of radiology (diagnostic and interventional) in medicine
  • Learn appropriate use of imaging
  • Learn anatomy through imaging
  • Learn technical aspects, strengths, and weaknesses of different imaging modalities: CT, US, MR, Radiography, Nuclear medicine, IR
  • Understand safety issues in pregnancy, contrast use, MRI, contrast allergy
  • Review basic imaging findings, differential diagnosis
Basis for Curriculum
  • Based on the data-driven book “Make It Stick”
  • Active recall: MCQ
  • Interleave (see MCQ section below)
  • Repetition: overlap in lectures
  • MCQ: not all MCQ content will be covered in lectures and will be included in:
    • prior clinical exposure (i.e. indications for treating PE)
    • Self Learning Modules
    • Non image-based topics related to Radiology (i.e. appropriate use of ordering exams)
    • a combination of Google, lectures, UpToDate, etc.
References
Notes
  • The course is relatively fast but also self-paced.
  • Spread out for optimal learning.
  • If you do not understand some terms used during lectures, recordings are available.
  • You are not expected to be comfortable with interpreting images.
  • If you fall asleep in the middle of an exam and it locks you out, you will not be granted a retake.
Schedule
Topic iLearn pre/post MCQ
Radiation Safety
Quiz (self-paced)
READ Core Radiology chapter- see link)
18
CXR (Ferguson)
LIVE case based session: Cases(slides) Cases(video)
Before LIVE lecture:
Watch Slides Video
Review online module University of Virginia CXR Module
18
Abdominal Radiology (Ferguson)
Attend PBL cases about appropriate ordering: PBL cases (LIVE session)
Before LIVE lecture:
Video (Technique: Fluoroscopy) (18 min)
Video (Technique: Cross-sectional Imaging) (21 min)
Video (Abnormal Fluoroscopic Findings) (3 min)
Video (Abnormal KUB Findings) (8 min)
Video (Abnormal US Findings) (5 min)
GU/US 8
GI 27
Interventional Radiology Part A (Liu)
LIVE case-based session: Cases(slides)  video
Before LIVE lecture:
Watch recorded lecture: Slides Video

 

28
Interventional Radiology Part B (Song)
LIVE case-based session: Cases
Before LIVE lecture:
Watch recorded lecture, Slides Video
20
MSK (Ferguson/Chow)
LIVE didactic lecture: Slides Video
No video to watch beforehand
19
Neuroradiology (Jafari/Lammerimg)
LIVE case-based session
Before LIVE lecture:
University of Virginia Neuro Module Slides
29
Nuclear Medicine
Watch recorded lecture
Read Chapter
Watch:
Video: PET-CT(22 min)
Video: Nuclear cardiology (20 min)
Video: Thyroid/parathyroid, part 1 (10 min), part 2 (20 min)
Video: GI/pulmonary (28 min)
Video: Bone/renal/ brain (24 min)
29
Contrast (Chang)
Watch recorded lecture: Slides Video
6
Indications for Imaging (Chang)
Watch recorded lecture: Slides Video
(no quiz)
Women Imaging (Roach-Kurzbard )
LIVE didactic lecture: Slides Video
13
Cardiac USMLE content (Lammering)
Watch recorded lecture: Video  Slides
19
Renal USMLE content (Lammering)
Watch recorded lecture: Video Slides
17
Chest/Respiratory USMLE content (Lammering)
Watch recorded lecture: Video Slides
35
GI Radiology USMLE content   (Lammering)
Watch recorded lecture: Video Slides
17
Prostate Radiology and Intervention (Greenwood)
Optional LIVE lecture, not used for attendance
No quiz
Clerkship exam (complete first day and last Thursday) 52
Score Breakdown
Pre-quizzes/exams, pre-AMSER, Radiology TEACHES pre-assessment 5
Post quizzes + exams (2)         (n=382 questions) 52
Post AMSER                             (n=109 questions) 14
Radiology TEACHES Case      (n=134 cases) 15
Med U Modules/Aquifer Cases (n=19 cases) 10
Class attendance / participation 5
Total 100
Grading
  • Grading is on a curve
  • Honors: Top 20% of the class
  • High pass: top 50% of the class
  • Pass: above 70% absolute score
Quizzes
  • Pre-quizzes complete before each lecture
  • Post quizzes after lecture; scores are used towards final quiz grade
Absence Policy
  • If you’re scheduled to be on an interview on the date of a lecture, email Kathleen the interview invitation email for an excused absence (sign-in on the sign-in page and enter in the notes section the information about the excused absence)
Webinars
  • Lectures by faculty on calendar.
  • Instructional videos as outlines above.
  • Sign in form and complete all questions on sign-in form.
Examinations
  • Mid-term exam (no pre; only one exam). Complete by Friday of second week.
  • American Medical Student Educators in Radiology (AMSER) exam: 108-question AMSER National Shelf Exam.
    •  Pre (first day) and post-test (last Thursday) | Time: two hours.
  • Clerkship midterm (post only) and final (pre and post), On iLearn.
    • Midterm: end of second week (no pre-test).
    • Final: Pre (first day) and post (last Wednesday).
  • Radiology- TEACHES Introduction Letter
    • Your account has been setup for access to Radiology-TEACHES.
    • Here is a link to the Radiology-TEACHES portal.  
    • The user will use their email and last name to log on.
    • The last name is in lower case letters. If their last name is less than six letters they will need to add 9’s afterwards up to a total of six characters (i.e., lee999).
    • Questions or want to talk to your peers about appropriate imaging?  Join the Student Forums on the Radiology-TEACHES forums page.
    • Modules, and number of multiple choice questions (MCQ).
Modules #MCQ
Radiology-TEACHES Pre-Assessment 29
Radiology-TEACHES Post-Assessment 25
Radiology-TEACHES Choosing Wisely Educational Topics 26
Radiology-TEACHES Simulation Cases 83
Aquifer / Med-U Core Modules  (www.med-u.org)
  • obtain access information from Kathleen Witty, clerkship coordinator
  • complete 19 online cases (self-paced)

Learning Activity Objectives

At the conclusion of the rotation, the student should have seen examples of and/or understand the following:

 Introduction to Chest Radiology
  • Describe the anatomy and basic interpretive principles of chest radiography.
  • Discuss the basics of ordering and interpreting cardiothoracic imaging studies in patients presenting with acute chest pain.
Infection and Aspiration
  • Localize pathology within the lungs based on the pattern and location of radiographic shadows.
  • Consider TB and aspiration in the appropriate context when evaluating patients with radiographic signs of infection.
  • Discuss the limitations of imaging for infection.
Vascular Catastrophes
  • Identify the direct and indirect signs of pulmonary embolism on radiographs and CT.
  • Identify the direct and indirect signs of pericardial effusion on radiographs and CT.
  • Identify the direct and indirect signs of an acute aortic emergency and acute traumatic aortic injury on radiographs and CT.
Air in the Wrong Place
  • List the radiographic signs of pneumothorax, pneumomediastinum, and pneumoperitoneum.
  • Describe signs of a tension pneumothorax.
  • Discuss the changes in the radiographic appearances of abnormal thoracic and abdominal gas collections caused by differences in examination technique.
Lung Cancer, Atelectasis, and Mediastinal Contours
  • Identify the direct and indirect signs of atelectasis on radiographs and CT.
  • Describe the approach to evaluating a solitary pulmonary nodule.
  • Differentiate the varied manifestations of lung cancer on chest radiographs and CT.
  • Identify the normal mediastinal contours and landmarks.
Lines and Tubes
  • Identify a malpositioned chest tube, feeding/nasogastric tube, endotracheal tube, and state the desired position for each.
  • Identify the most common complications encountered when imaging patients with indwelling lines and tube.
KUB
  • Identify the visible solid and hollow organs of the abdomen on a KUB and radiographic obstructive series.
  • Identify large and small bowel obstruction, sigmoid volvulus, and adynamic ileus on abdominal radiographs.
MSK Trauma
  • Describe the basic principles used in ordering and interpreting musculoskeletal imaging studies in acute musculoskeletal trauma.
  • List the standard views used to image the shoulder in patients who have sustained trauma.
Take a Look at the Heart
  • Identify the findings of congestive heart failure on a chest radiograph
MSK Imaging
  • Identify the appropriate imaging modality to evaluate common musculoskeletal complaints.
  • Identify the strengths and weakness of radiographs, radionuclide bone scan, CT, and MRI in musculoskeletal imaging.
  • Describe important soft tissue clues for fractures on extremity radiographs.
C-Spine and Pelvis Trauma
  • Identify the important radiographic landmarks used to evaluate the cervical spine in the setting of acute trauma.
Vascular and Interventional Principles and Practices
  • Discuss the basic principles of interventional radiology including abscess drainage and biopsies.
  • Describe the types of common procedures performed in interventional radiology.
  • Explain the benefit of interventional radiology procedures.
Nuclear Medicine: Molecular Imaging
  • Describe the basic principle of PET scanning and how it works.
  • Identify the most common indications for a PET scan.
  • List the advantages of PET/CT vs. PET.
  • Describe the mechanism that allows an evaluation of the adequacy of myocardial oxygenation by the performance of a cardiac nuclear stress test
Abdominal Imaging in Pediatric Patients
  • Compare imaging strategies and algorithms designed to avoid or reduce pediatric radiation doses during imaging evaluation.
  • Describe the differences and similarities between pediatric and adult fractures.
Abdominal Imaging Perspectives: CT and MRI
  • Describe the workup of abdominal pain, masses, and trauma with attention to gender, age, and position of the area of pain, mass, or trauma.
  • List the imaging options for the evaluation of common GI and urological diseases.
Breast Imaging and Health Literacy
  • Discuss the different modalities used to evaluate for breast cancer.
  • Discuss the signs of breast cancer on mammograms and ultrasound exams
  • Be aware of the existence of the BI-RADS atlas and how it standardizes terminology, assessment, and recommendations (https://breast-cancer.ca/bi-rads/).
Pediatric Imaging
  • Discuss the basic principles and limitations of ordering and interpreting pediatric radiology examinations and procedures.
  • Synthesize a systematic approach to evaluating pediatric patients of varying ages with imaging.