THE AGA KHAN UNIVERSITY...
61
THE AGA KHAN UNIVERSITY HOSPITAL RESIDENCY MANUAL ACADEMIC YEAR 2007/2008 RADIOLOGY DEPARTMENT
Transcript of THE AGA KHAN UNIVERSITY...
THE AGA KHAN UNIVERSITY
HOSPITAL
RESIDENCY MANUAL
ACADEMIC YEAR 2007/2008
RADIOLOGY DEPARTMENT
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Prepared By: Residency Training Co-coordinator
Issued By: Director Residency Training
Approved By: Chairman Radiology Department
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PART A
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Postgraduate Training in Diagnostic Radiology is intended to be an interactive
learning process. The self-actuated, thoughtful, and motivated student will find AKU
to be an environment, which is rich in learning resources. These include the faculty,
patients, libraries, computers and electronic media, as well as peers and other students
etc. You are expected to utilize all these to advance your education.
To help you make the transition from undergraduate to postgraduate, the
department’s Residency Training Committee has produced this manual, to provide a
framework for your orientation and continuation in the program. In addition to
providing useful practical information, this manual also introduces you to the system
of evaluation and assessment, which is pivotal in guiding you through your years of
productive and hopefully enjoyable learning.
Good Luck!
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TABLE OF CONTENTS
Part A
• List of Residents
• Chief Resident / Elected representative
• Radiology Faculty
• Department Residency Committee
• General Objectives
Part B
• Specific Rotation Objectives
• Monthly Teaching Schedule
• Annual Rotation Calendar
• Radiation Physics Tutorials
Part C
• PGME Core Lectures
• Residency Level / Rotations
• On call objectives
• Leave Policy for Residents
• Code of conduct and disciplinary policy
• Residents Appreciation
• Resident/Faculty Assessment
• Resident’s Evaluation
• Guidelines for Case Presentations
• OSCE Pattern
• Evaluation of Resident’s Rotations
• Resident’s Appraisal of Faculty
• Case Presentation sheet
• Journal club sheet
• Written Test Schedule
• List of Recommended Books
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LIST OF RESIDENTS RADIOLOGY DEPARTMENT
THE AGA KHAN UNIVERSITY HOSPITAL (Nov. 2006 – Oct. 2007)
R1s:
Dr. M. Zeeshan Mobin-ul-Haq Dr. Qazi Saad Bin Khalid Dr. Fahd Haroon Haji Haroon Dr. Shayan Sirat Maheen Anwar Dr. Darakhshan Kanwal Shaikh Dr. Sumaira Parvez Siddiqui
R2s:
Dr. Amanullah Beg
Dr. Nadir khan
Dr. Mahwash Rehan
Dr. Kiran Hilal
Dr. Muhammad Idris
Dr.Zainab hussain
R3s:
Dr. Munazza Salim
Dr. Saima Hafeez
Dr. Imad-Ur-Rehman
Dr. Shahbaz
R4s:
Dr. Abdul Ghafoor
Dr. Farah Iqbal
Dr. Muhammad Farhan Rizvi
Dr. Madiha Batool
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CHIEF RESIDENT
TERMS OF REFERENCE
• Member of Departmental Residency Committee (DRC), appointed on recommendation of DRC to department Chair.
• Prepares the minutes of DRC meetings.
• Under direction of Program Director / coordinator, organizes on-call duties rota, annual duty rota and
earned leaves.
• Under directions from Program Director / coordinator, deputizes residents extra duty for participation in disciplinary action and organizes clinical meetings.
• Monitors as liaison, attendance of department’s academic rounds.
• Acts between faculty and resident body.
• Reports to Program Director and DRC.
• Organizes and Chairs general meeting of resident body (at least 6 meetings annually).
• Serves for 1 year.
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RESIDENT REPRESENTATIVE
TERMS OF REFERENCE
• Elected by General meeting of all residents (R1, R2, R3), after an election supervised by Faculty.
• Elected from 2nd / 3rd year residents.
• Reports to resident body, all pertinent issues arising from DRC.
• Represents the general opinion of resident body at DRC.
• Co-ordinates with Chief Resident in all issues concerning Residents.
• Acts as recording secretary during general meetings of resident body.
• Serves for 1 year.
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RADIOLOGY FACULTY
Chairman Radiology
Associate & Assistant
Professors
Senior Instructors/Instructor
Physicist Part Time Radiologists
Syed Mansoor Naqvi BSc. (Hon) Karachi MSc. Karachi
Muhammad Nadeem Ahmad M.B.B.S., Karachi M.C.P.S., Pakistan F.C.P.S., Pakistan
Yousuf M.B.B.S., Karachi M.C.P.S.,F.C.P.S., F.R.C.R., U.K Zafar Sajjad M.B.B.S., Karachi M.R.C.P.(UK), F.R.C.R., U.K Tanveer-ul-Haq M.B.B.S., Karachi M.C.P.S.,F.C.P.S., F.R.C.R., U.K Humera Ahsan M.B.B.S., Karachi M.C.P.S.,F.C.P.S., M. Azeemuddin M.B.B.S., Karachi M.C.P.S.,F.C.P.S., Imrana Masroor M.B.B.S., Karachi M.C.P.S.,F.C.P.S., Vaqar Bari M.B.B.S., Punjab D.M.R.D., Punjab M.C.P.S.,F.C.P.S., Zishan Haider M.B.B.S., Lahore M.C.P.S.,F.C.P.S., Dawar B.A. Khan M.B.B.S., Karachi M.C.P.S.,F.C.P.S., Wasim Ahmed Memon M.B.B.S., Karachi M.C.P.S.,F.C.P.S., Naila Nadeem M.B.B.S., Karachi M.C.P.S.,F.C.P.S., Ishtiaq Ahmed Chishty M.B.B.S., Karachi M.C.P.S., Pakistan F.C.P.S., Pakistan
Gulnaz Shafqat MB.B.S., Karachi M.C.P.S., Pakistan F.C.P.S., Pakistan Shaista Afzal M.B.B.S., Karachi F.C.P.S., Pakistan S. M. Faisal (KENYA) Mosharraf M.B.B.S., Karachi M.C.P.S., Pakistan F.C.P.S., Pakistan Syed Zafar Ali (KENYA) M.B.B.S., Karachi M.C.P.S., Pakistan F.C.P.S., Pakistan Waseem Akhtar Mirza M.B.B.S. Karachi, F.C.P.S Pakistan Basit Salam M.B.B.S., Karachi F.C.P.S., Pakistan Farhan Ahmad M.B.B.S., Karachi M.C.P.S., Pakistan F.C.P.S., Pakistan F.R.C.R., U.K Fozia Ajmal M.B.B.S., Karachi MBA(HM); PG Diploma Epidemiology (UK) Dr. Gul-e-Khanda M.B.B.S. Karachi FCPS Dr. Fatima Mubarak M.B.B.S IMM Dr. Muhammad Talha M.B.B.S IMM
VIR Fellow Dr Misbah Tahir MBBS Karachi M.C.P.S., Pakistan F.C.P.S., Pakistan
Masood Afzal M.B.B.S., Karachi D.M.R.D., Canada Samina Siddiq Khanani M.B.B.S., Karachi M.C.P.S., Pakistan F.C.P.S., Pakistan Maseeh-uz-Zaman M.B.B.S., Karachi F.C.P.S Pakistan MS. (NM), Pakistan Dr. Kamran Kamal M.B.B.S. Karachi D.A.B.R (USA) Riffat Parveen Hussain M.B.B.S., Karachi MS. (NM)Pakistan Kulsoom Fatima M.B.B.S., Karachi F.C.P.S., Pakistan Part time Radiologist Nevine Haider M.B.B.S., Karachi M.C.P.S., Pakistan Quratulain haider M.B.B.S., M.C.P.S., F.C.P.S., Pakistan Dr. Ejaz Memon M.B.B.S, Karachi D.M.R.D. Punjab M.C.P.S. Pakistan
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DEPARTMENTAL RESIDENCY COMMITTEE
Dr. Zafar Sajjad Associate Professor & Director Residency Training Program
Dr. Imrana Masroor Assistant Professor & Coordinator
Residency Training Program
Dr. Muhammad Farhan Rizvi Resident - IV
Chief Resident
Dr. Nadir Khan Resident – II
Resident Representative
MEMBERS:
Dr. Zafar Sajjad Associate Professor & Director Residency Program
Dr Tanveer ul Haq
Associate Professor
Dr. Imrana Masroor Assistant Professor & Residency coordinator
Dr. Wasim Memon
Assistant Professor
Dr. Dawar Burhan Assistant Professor
INVITEE:
Dr.Nadeem Ahmed Dr.Farhan Ahmed
Dr.Fozia Ajmal
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General Objectives
1. To produce clinical Radiologists who are competent and compassionate;
The graduating resident is expected to be fit to perform all / most of the routine procedures in clinical radiology. Interpretation skills should be developed to the level of an independent specialist / consultant. He/she is expected to aspire to the highest ethical standards, putting the absolute welfare of the individual patient above all other interests.
2. To produce leaders; who have the spirit of enquiry, critical appraisal, continued self-
assessment, team approach, and the habit of life-long learning.
He/she is expected to understand that leadership enables through change and that change is brought about through education, application of new knowledge and research.
3. To encourage students to achieve their full potential; through an engaging,
communicative, environment of peers and mentors. Students are expected to understand the value of an interactive style of learning, including a process of appraisal/evaluation, whilst recognizing their responsibilities to the program, the department, the patients and their colleagues.
All students are expected to obtain certification, at fellowship level, in Radiology at the College of Physicians & Surgeons Pakistan. They are not discouraged from the pursuit of other certificates in different jurisdictions e.g. FRCR, provided that it does not interfere with their responsibilities and commitment to the program.
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Residents Rotation
5 Year Plan (FROM BATCH 2006)
Rotations R1 R2 R3 R4 R5 Total IVP+NM
1 ½ months 1 - -1 - 3 1/2
FL 2 2 2 1 1 8 US 1 ½ months+
GR In 2nd Half 2 2 2 2 9 ½
PAEDS - 1 2 - - 3 MAMMO +GR
1 1 - - 1 3
CT 1 2 2 2 2 9 MRI 1 2 2 1 2 8 VIR - - 1 2 1 4 CLINICAL ER/MED/ SURG
2 - - - - 2
* - - - 1 1 2 GEN REP
1 1 1 1 1 5
ELECTIVE - - - 1 1 2 ORIENTATION 1 - - - - 1
TOTAL 12 12 12 12 12 60 � FIRST 6 WEEKS OF N/M ROTATION IS NOT COMBINED WITH IVU. � ROTATION IN IVU WILL BE COVERED DURING GR OR FL
ROTATION.
GS: General Surgery IM: Internal Medicine ER: Emergency
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ROTATION PLAN FOR 2007-2008
Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct R1 M. Zeeshan A1 O FL ER US MRI Mam GR FL IVP GS/M IVP/
US CT
Qazi Saad B1 O IVP/ US
Mam GS/M US MRI IVP GR FL FL CT ER
Fahd HaroonC1 O GS/MD
US US/ IVP
FL ER Mam MRI GR CT FL IVP
Shayan SiratD1 O US GR MRI Mam FL GS/M
IVP CT ER US/ IVP
FL
Darakhshan KanwalE1
O US/ IVP
IVP FL GS/M CT FL ER Mam MRI GR US
Sumaira Parvez F1
O CT FL IVP/US
IVP US MRI FL GS/M Mam ER GR
R2 Amanullah Beg
A2
IVP
CT MRI FL GR
CT FL US MRI Mam US PAED
Nadir khan B2 FL Mam CT GR
US FL US CT PAED MRI IVP
MRI
Mahwash Rehan C2
CT MRI GR
MRI FL US CT FL US PAED Mam IVP
Kiran Hilal D2 MRI GR
FL CT CT IVP
MRI Mam FL US PAED US
Muhammad Idris E2
Mam FL US US FL PAED
GR MRI CT IVP MRI CT
Zainab hussain F2
US US IVP GR MRI MRI Mam PAED FL CT CT FL
R3 Saima Hafeez A3
VIR VIR MRI CT PAED
CT FL PAED FL US US MRI
Imad Ur Rehman B3
CT MRI PAED
VIR VIR FL PAED
US MRI FL CT US
Munazza salim C3
PAED
CT US PAED
FL MRI VIR VIR US MRI FL CT
Shahbaz D4 US PAED
CT MRI MRI PAED US FL CT VIR VIR FL
R4
Abdul Ghafoor
A4
MRI US FL * ELEC US MRI * VIR ELEC CT CT
Farah Iqbal B4 ELEC FL US ELEC MRI CT US CT * * MRI VIR
Muhammad Farhan Rizvi C4
* MRI MRI FL US VIR CT US ELEC CT ELEC *
Madiha Batool D4
FL ELEC VIR US CT * ELEC
MRI CT US * MR
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RESIDENT’S PLACEMENT IN VARIOUS IMAGING AREAS Nov Dec Jan Feb Mar Apr May June Jul Aug Sep Oct
IVP/NM A2* B1,E1 E1,F2 C1,F1 * F1 D2 * B1 D1 * A1 * E2 * A1 D1
B2 *
C1 C2 *
FL B2,D4 A1E2B4 F1D2A4 E1A2C4 C1C2C3
E2
D1B2B3 E1A2A3
B1F1C2
D3
B1D2F2
A3
B1B3
C1C3 D1F2D3
US
F2D3 B1D1E1
F2A4
C1E2C3
B4
A1C1E2
F1D4
B1B2C4
F1C2A4 B2D3B4 C2C3 D2A3D4 A1D1A2
A3
E1D2B3
CT
C2B3 F1A2C3 B2D3 D2A3 D2D4 E1A2A3
B4
C2C4 B2B4 D1E2D3
D4
C1E2C4 B1F2B3
A4
A1E2C3
A4
MRI
D2A4 C2B3C4 A2 D1C2D3 A1F2D3
B4
B1F2C3 F1D2A4 C1E2D4 A2B3 E1B2C3 E2B4 B2A3D4
PAEDS
C3 D3 B3 C3 A3 E2D3 B3 F2A3 B2 C2 D2 A2
Mammo
E2 B2 B1 * D1 A1 C1 F2 D2 E1 F1 A2 C2 *
VIR
A3 A3 D4 B3 B3 C4 C3 C3 A4 D3 D3 B4
ELEC
B4 D4 B4 A4 D4 C4 A4 C4
*
C4 A4 D4 A4 B4 B4 D4 C4
ER A1 F1 E1 D1 F1 B1
CLIN GS /M C1 BI E1 D1 F1 A1
• This duty is assigned only to R IV **IVP/US stands for 2 weeks rotation each in the respective areas, in the same order
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First Month Orientation Plan for New Residents Classes on Saturdays are between 8-9 AM
November ROTATIONS Facilitator
MORNING SESSION
After noon
sessions Topics 03:00-04:30p.m Days Date
Thurs 1 Dept Round CR Friday 2 Dept Briefing/
Policies Briefing Zafar Sajjad/ Imrana Masroor
Saturday 3 Upper/Lower Limb Radiological Anatomy
Munazza Saleem
Sunday Monday 5
CR System Kashif Mirza
Tuesday 6 Wednesday 7
Thursday 8 File Room & Reception working
Mirza Rehan B. Wasif Siddiqui
Friday 9 Nuclear Medicine Masih Uz Zaman Saturday 10
X-Ray Chest Rad Anat.
Imaad-ur-Rehman
Sunday Monday 12 Radiation Safety Mansoor Naqvi Tuesday 13 Quality Standards Capt Habib Wednesday 14 Past Present and
Future Capt Habib
Thursday 15 Mammography Imrana Masroor Friday 16 Plain X-Ray
Abdomen Anatomy Saima Hafeez
Saturday 17
Plain X-Rays Spine Anatomy
M.Shahbaz Alam
Sunday Monday 19 Tuesday 20 Wednesday 21 Thursday 22 Friday 23
Common Radiography Positioning
Mr Tasneem & Ms. Zareen Khan
Saturday 24 Sunday
Monday 26 Contrast Media Farah Iqbal Tuesday 27 Cross sectional
Anatomy Thorax Madiha Batool
Wednesday 28 Abdomen Cross Sectional Anatomy
M.Farhan Rizvi
Thursday 29
Brain Cross sectional Anatomy
A.Ghafoor
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PART B
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Objectives
Of
Rotations
During all rotations contribution of teaching films to the department library is essential.
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GENERAL REPORTING: Year 1:
- Each day reports general radiology films assigned to under supervision. - Develops basic understanding of anatomy, normal variations, and interpretations
of common pathologies. - Reads any basic radiological anatomy text book as well as an atlas of anatomy
and normal variations. - Has to report at least 20-25 x-rays per day. - Contributes interesting cases to department library. - Has to expose at least 50 XRAYS during one month rotation and get it signed by
QC supervisor. Year 2:
- Reports all assigned general radiology films under supervision. - Reads the cases which are seen during daily reporting. - Has to report at least 30-35 x-rays per day. - Contributes interesting cases to the department library. - Has to expose at least 50 XRAYS during one month rotation and get it signed
by QC supervisor Year 3:
- Reports plain films, assists & monitors junior. - Seeks help with difficult cases. - Has to report 40-45 x-rays per day. - Contributes interesting cases to the department library.
Year 4:
- Works independently. - Supervises juniors as required. - Has to report 40-45 x-rays per day. - Seeks help from seniors, as necessary. - Contributes interesting cases to the department library.
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IVU Year 1:
- Familiarize with all aspects of I.V.U. examination including technical aspects and various protocols and is able to perform “TAILORED” examinations, under supervision.
- Knows indications & contra indications / Types of IVU and intravascular contrast agents.
- Knows all contrast media sensitivity reactions and its management. - History taking and preliminary preparation (e.g. steroid prep.) / Lab. test
assessment (e.g. Creatinine) if necessary. - Contrast media administration along with informed consent for procedure. - Normal Anatomy / variations and reporting of routine IVU’s. - Clear knowledge of Radiation protection. - Reports under close supervision. - At least reports 15 plain films per day under supervision. - Contributes interesting cases to department library.
Year 2:
� All of above + o Recognition of common GU abnormalities. o Reports under supervision. o Report 20-25 X-rays per day under supervision. o Contributes interesting cases to department library.
Year 4: (* rotation) - Conducts / supervises all examinations. - Reports all examinations under supervision. - Seeks help as necessary. - Monitors and trains junior residents. - Contributes interesting cases to department library.
.
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Fluoroscopy 1ST year (1st rotation): Knowledge Based Objectives: At the end of the rotation the resident should be able to:
1. Discuss the proper clinical and radiological indications for the following studies: a. Barium Swallow b. Upper GI Series c. Single Contrast Barium Enema d. Air Contrast Barium Enema e. Small Bowel Follow Through f. Enteroclysis g. Fistulograms h. Intravenous Urogram i. Cystogram j. Loopogram k. HSG
2. State the physiologic properties, proper concentrations and proper indications for the use of the following contrast material:
a. Barium b. Water soluble contrast media (oral Hypaque or Gastrografin) c. Ionic and Non-Ionic intravenous contrast media.
3. Understands the uses of Glucagon / Buscopan / other drugs including proper dosage, physiologic effects, side effects and contraindications used in fluoroscopy. 4. List the risk factors for allergic reaction to IV contrast media. 5. States the proper assessment and treatment of allergic reactions to contrast media. 6. Recognize the normal radiographic appearance of structures of the GI/GU tract. 7. Knows radiation safety procedures in the area
Technical Skills: At the end of the rotation, the resident should be able to:
1. Demonstrate basic knowledge of the equipment to be used during fluoroscopy,Including proper kV techniques for the various procedures, radiation safety features of the equipment, and proper radiation safety techniques. 2. Demonstrate fluoroscopic techniques for performance of the following procedures:
a. Barium Swallow including rapid sequence images of the hypo pharynx and cervical esophagus. b. Upper GI series c. Single Contrast Barium Enema d. Air Contrast Barium Enema
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3. Gain experience when possible with other GI procedures such as:
a. Fistulogram b. Loopogram c. Feeding tube placements d. Enteroclysis e. HSG / MCUG
4. Demonstrate Initial development of fluoroscopic skills by identifying the more common abnormalities during the performance of exams.
1ST year (2nd rotation)
- All of the above, plus - Perform following procedures under supervision.
� GI Ba studies (e.g. Ba swallow and Ba enema) � Fistulo/Sinogram. � Urethrogram � HSG
- Reporting under supervision. - Reports at least 5-10 plain films per day under supervision. - Teaching Files contribution.
2nd year (3rd rotation)
- In addition to above duties, detection of abnormalities / variations on Fluoro and on film.
- Reporting of all procedures. - Performs small bowel enemas under supervision. - Present in supervision in ERCP / Esoph. Dilatation etc… - Reports at least 5-10 plain films per day under supervision.
2nd year (4th rotation)
- In addition to afore mentioned duties, performs small bowel enemas. - Monitors & assists juniors working in this area. - Performs micturating cystourethrogram - Reports all examinations under supervision. - Reports at least 10-15 plain films per day under supervision.
3rd year (5th and 6th rotation)
- Performs almost all fluoroscopic procedures. - Reports all examinations under supervision. - Consults with referring clinicians. - Assists & monitors juniors. - Does general reporting 15-20 cases per day
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4th year (7th rotation)
- Works almost independently. - Assists & monitors juniors. - Seeks help as necessary. - Does general reporting.
ULTRASOUND
1st year:
- Acquires knowledge of physics in development of optimal image quality and
artifacts. - Correlates radiological knowledge with sonographic anatomy. - At end of 1st rotation, is familiar with simple/routine abdominal & pelvic
examinations. - At the end of 2nd rotation, is able to perform abdominal, pelvic and obstetric
examinations and should have done at least 50 Obst. And 100 abdominal ultrasounds.
- Reports under direct supervision. - Contributes interesting cases to department library. - Assist in doing the routine US guided interventional procedure.
2nd year:
- Develops increasing proficiency in all examinations including Obstetrics. Observes/assists in Doppler examinations and guided interventional procedures.
- Reports under direct supervision. - Attends patients from ER along with senior residents. - Perform at least 50 Obs, 100 abdominal US. - Perform at least Doppler studies. - Every resident should at least do 5 Biophysical profile examinations. - Assists and performs 30 U/S guided interventional procedures.
3rd year:
- Has increasing degree of responsibility. - Reports normal examinations with indirect supervision. - Consults with referring clinicians. - Assists 1st & 2nd year residents in learning activities. - The Required no. of US are 50 Obstetrics, 100 abdominal and 30 Doppler
examinations under supervision - Performs routine interventional procedures under direct / indirect supervision.
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4th year - Functions as an independent specialist. - Seeks help when necessary. - Responsibility to teach the junior residents. - 30 Doppler examinations under supervision. - Will do routine and special procedures in intervention under indirect supervision.
CT SCAN 1st year: (1st and 2nd rotation)
- Acquires knowledge of physics to development of optimal image quality and image artifacts.
- Knowledge of sectional anatomy of head, paranasal sinuses, chest and abdomen. - Indications & contra indications of various CT procedures learns and helps in
patient preparation. - Know the following about the contrast media. - Composition, types, dosage, contrast reactions, risk factors, preparation of the at
risk patients, indications, contraindications and management of complications. - Be able to give a routine protocol for the following types of the examinations
Head, Neck, Para nasal sinuses, temporal bone, spine different protocol of the abdominal CTs
- Know the difference between conventional, spiral and Multidetector CT, with respect to the basic physics, radiation dose artifacts, time of scan, advantages and disadvantages and reformation.
- Attend the reporting rounds, and at least appreciate the normal and abnormal scans.
- Pathologies like role of CT in trauma head. - Difference between infarct and hemorrhage. CT appearances of abscess and
neoplastic lesions. Types of hydrocephalus. Types of different types of intracranial herniations, difference between sutures and fractures.
- CT appearances of Sino-nasal diseases. - Types of facial fractures. - Importance of Unenhanced KUB/FACT. - Radiological signs of Urolithiasis and appendicitis. - Contributes interesting cases to department library. WORKING TASK: During the First rotation the resident should do at least one audit in consultation with the section head:
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2nd year: 3rd Rotation 4th Rotation
All of the objectives of first year rotation. Sectional anatomy of Chest and Abdomen. Know the commonly presenting pathologies. like CHEST: CT Appearances of lung cancer, Mediatinal masses. Difference between lymphadenopathy and Vascular enlargement. Locations of Mediastinal lymph Nodes CT Features of Lung Metastases/Lymphoma. How to describe the lesions in the lungs. Approach in the diagnosis of Chest pathologies. Abdomen: CT densities OF Fat. Fluid. Hematoma, Soft tissues etc. Anatomy of retropreitoneum. Sizes of abdominal lymph nodes. CT criteria for lymphadenopathy. CT appearances of abscess v/s neoplastic lesion. Importance of contrast Enhanced/Biphasic/Triphasic scans with implications according to the pathologies. Difference between effusion and ascites. CT Appearances of Liver neoplastic lesions. Segments of liver. Role of CT in abdominal; trauma. With effects on the viscera’s according to the grading. CT features of pancreatitis. CT features of diverticulitis. . REPORTING: 50 Brains. 25 CT PNS/KUB.
- Contributes interesting cases to dept library.
After completion of previous objectives the 4th Rotation specific objectives are: Enhance knowledge of Ct appearances of more pathology related to Chest and abdomen. Working Task; 100 CT Brain. 50 CT PNS 50 CT KUB. 30. CT CHEST & ABDOMEN. *Contributes interesting cases to dept library.
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3rd year (5th rotation)
- All of the previous objectives. - Basics of HRCT. - Anatomy of neck and temporal bone. - Basic pattern on HRCT. - Consults with referring clinicians. - Assists & monitors junior residents. - Assist / perform CT guided procedures in direct / indirect supervision.
� WORKING TASK:
- Brain+PNS+CT KUB/FACT.
- 50 CT Abdomen.
- 50 CT chest.
- Comparative Scans of CT NECK.
- Contributes interesting cases to dept library.
4th year :( 6th and 7th rotation)
- Performs all the routine as well as specialized CT exams. - Performs CT guided biopsies under direct / indirect supervision. - Assists & monitors junior residents. - Contributes interesting cases to dept library.
MRI SCANNING
1st year:
- Learns basic physics of MRI. - Knowledge of MRI spectroscopy and Diffusion perfusion imaging. - Understands indications, contraindications of various MRI procedures and MRI
safety issues. - Applies knowledge of sectional anatomy to multiplanar images of MRI esp. brain
and spine. - Functional anatomy of Brain. - Takes patients history. - Attends reporting sessions and neuroradiology meeting. - Understands MRI protocols and indications for contrast study. - Contributes teaching cases to MRI library.
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2nd year:
- In addition to objectives of 1st year.
2nd Rotation 3rd Rotation Normal appearances of brain and spine. Normal variations / artifacts recognition and correction. MRI features of major pathology e.g. Infarcts, hemorrhage and tumors. Able to differentiate infection vs. tumors. Disc abnormalities. Reporting of 30 Normal brains and 20 spine Scans. Contributes interesting cases to dept library.
Objectives of second rotation. Reporting of pathologies related to brain and spine (50). At least cover three chapters from Neurorequisites (Vascular, degenerative and tumors). Anatomy of Knee, shoulder and hip. MR appearances of abdominal organs. Contributes interesting cases to dept library.
3rd year
- In addition to objectives of first two years. - Supervises assists & monitors junior residents.
4th Rotation 5th Rotation
Objectives of second rotation. Reporting of routine MR stuff. Reporting of Knee MRI pathologies and other normal musculoskeletal MRI. At least three chapters from Neurorequisites (Infections, White matter disorders and Spine). Monitor and assist juniors. Recognition of abdominal / pelvic / MRCP pathologies, as well as Renal, carotid and other MRA’s. Presents cases in Neuroradiology meeting.
- Contributes interesting
cases to dept library.
All previous objectives. Reporting of routine MRI cases. Reporting of Knee, shoulder and knee cases. Cover completely the Neurorequisites remaining chapters. MRI Features of Knee Ligamentous tears from Stroller. Features of common Bone Tumors. Consults with referring clinician. Presents cases in Neuroradiology meeting.
- Contributes interesting
cases to dept library.
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4th year
- In addition to objectives of first three years.
6th Rotation 7th Rotation Able to interpret and report specialized MRI of various musculoskeletal injuries and tumors. Teach and assist juniors. Present interesting cases
- Contributes interesting cases to dept library.
Report all cases under supervision. Read the common musculoskeletal abnormalities from Stroller. Monitor and transfer the Knowledge to juniors. Learn the administrative skills.
- Contributes interesting cases to dept library.
MAMMOGRAPHY
1st year: - Applies principles of physics, radiation safety, and knowledge of anatomy,
principles of screening in clinical mammography. - Review positioning and technical aspects of mammography - Observe/Understand mammography positioning and technique and take patient’s
history. - Introduction to the components and purpose of MQSA (Mammographic Quality
Standards Act). - Understand purpose of BIRADS - Review breast anatomy (gross and microscopic). - Identify basic mammographic abnormalities and determine appropriate work-up. - Using established criteria, distinguish between benign and malignant. - Observe breast ultrasound - Attends all reporting sessions, and do reporting under strict supervision. - Also need to do general reporting (10 X-rays in morning and 10 X-rays in
evening per day). - Contributes teaching cases to dept. library.
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2nd year (2nd Rotation) - Take patient’s history - Review requirements of MQSA and BIRADS - Work with technologist on daily, weekly and monthly QC requirements - Review examinations initially independently making preliminary conclusion and
recommendation, followed by review with attending radiologist. - Perform breast ultrasound (review findings under attending supervision). - Perform / observe cyst aspirations, FNAs, core biopsy and localizations with the
assistance and direct supervision of the attending radiologist. - Be able to discuss differential diagnosis and decide appropriate
recommendations. - Also need to do general reporting (10 X-rays in morning and 20 X-rays in
evening per day). - Be able to consult with referring clinicians and surgical staff - Be able to interview and discuss findings and recommendations with patients
4th year :(* Rotation) - Reports mammograms under supervision.
- Seeks help as necessary. - Reports and performs / observes interventional procedures under supervision. - Perform breast ultrasound under supervision. Every Rotating Resident from R1 to R4 will do one Audit during their rotation
NUCLEAR MEDICINE
1st year:
- 6 weeks rotation. - Basic nuclear physics and instrumentation. - Radiation safety and protection. - Indications, patient preparation of nuclear medicine / DXA procedures. - Residents are to interview and examine (as appropriate) all patients seen in the
Nuclear Medicine department and gather all data (history, physical exam, laboratory tests, x-ray reports and x-ray films when available) prior to the attending physician readout session. It is resident’s job to obtain all existing correlative x-rays when available) prior to the attending physician readout session.
- The radiology resident should be able to understand radiopharmaceutical Preparation, gamma camera quality control, data acquisition and processing by the end of the rotation.
- Attends reporting session. - Dictate all the studies read using the organized format and previously used
transcribed reports. - Contributes interesting cases to the department film library.
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- At the end of this rotation the student is expected to have a good working knowledge of the basics of radioisotope scanning and able to interpret and supervise the examinations.
4th year (2nd Rotation) - a revisit of all the objectives covered under the 1st year rotation - should at this time have a good working knowledge of elution of generators,
pharmaceutical preparation, injection to the patients for various procedures, patient positioning and gamma camera acquisition techniques
- should be well versed with the gamma camera quality control measures - issues related to radiation protection within the section and their control measures - should have sound knowledge of issues regarding patient education and
counseling for the various procedures as well as issues related to radiation protection (particularly I-131 therapy patients)
- patient positioning and data processing technicalities of DXA scans - should be able to report, under supervision, Nuclear and DXA scans - contribute at least 1 interesting case to department film library
Reading Recommendations: Requisites of Nuclear Medicine – James H Thrall.
INTERVENTIONAL RADIOLOGY: The Vascular & Interventional Radiology residency training at the Aga khan University Hospital. Designed to provide the diagnostic radiology residents with a knowledgebase and practical experience in both vascular and non-vascular diagnostic and interventional radiology sufficient to support their needs as general diagnostic radiologists upon graduation from the residency training program. The residency graduate should be capable of performing / assisting a Variety of routine diagnostic studies such as routine peripheral and visceral angiography with acceptable complication rates. They should possess full interpretive skills for these procedures and should be fully cognizant of the indications and contraindications of these procedures, the disease processes involved, alternative non-invasive imaging means for evaluating the patient requiring such studies, and the various surgical and radiologic interventions which may be considered for therapy. They should be competent at providing the appropriate pre- and post-procedural care measures and at recognizing and appropriately dealing with specific complications, which may occur as a consequence of these studies.
It is important that the resident realize that vascular and interventional radiology is a rapidly changing field, which blends the interpretation of diagnostic images with minimally invasive clinical procedures. The analyses of the radiologic findings, recognition of the patient’s path physiologic condition, reporting the examination results, are equally as important as the performance of the interventional procedure. In addition, the peri-procedural aspects of the patient care and clinical decision-making concerning patient management are just as important as the interventional procedures being performed.
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Key lesson in all rotation of VIR.
Has to be fully involved in patient’s counseling, consenting, initial work-up, assessment and post-procedural care. Learn commonly used and emergency medications (Indication, Dosage and complications) in VIR.
3rd year: First Rotation: 2nd Rotation:
Knowledge Based Objectives:
GI vascular anatomy in detail. Lower extremity vascular disease patterns and collateral pathways. Path physiology and manifestation of thoracic aortic arterial disease. Understanding the indications for and risks of diagnostic angiography and venography. Basic understanding of the risks of and indications for the range of vascular interventional procedures. Methodology of access to the urinary tract and biliary tract by percutaneous methods with primary and alternate approaches. Understanding of pathophysiology of biliary obstructive disease. Basic knowledge of methods and limitations of CTA and MRA. Technical Skills: Catheterization of the femoral artery and vein. Selective catheterization of major first order vascular branches with assistance. Selection of injection and filming rates in angiography. Performing catheter and wire exchanges. Fluoroscopically and sonographically guided puncture technique. Knows the different views to be taken during interventional procedures. Interpretive Skills: Have knowledge of normal vascular
. Basic arterial anatomy of the aorta and major branches, the brachiocephalic vessels and the upper and lower extremities. Basic venous anatomy of the upper and lower extremities, the superior and inferior vena cava and the renal and hepatic veins. Knowledge of the segmental anatomy of the liver. Basic understanding of the pathophysiology of peripheral vascular disease. Mastery of principles of radiation protection for patient and operator. Path physiology of Reno vascular hypertension. Basic understanding of the indications for and risks of GU and biliary system nonvascular interventional procedures Basic knowledge of cardiovascular pathophysiology including plain films signs of cardiac disease. Know the different views to be taken during Vascular interventional procedure. Technical Skills: Routine catheterization of the femoral artery and vein using the Seldinger technique with Standard needle puncture and micro puncture techniques. Obtaining homeostasis following arterial and venous invasive diagnostic and interventional
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anatomy and variants. Able to differentiate normal from abnormal vessels. Evaluation of normal / abnormal CTA and MRA imaging studies. Cumulative Experience Goals: Assist at least 10 arterial or venous catheterizations. Assist at least 05 IVC filter insertion. Insert an inferior vena cava filter as primary operator. Assist with at least 10 percutaneous GU or biliary interventional procedures (PTC, PTC with stenting, PCN, DJ stent, PCNL)
Procedures. Performing and maintenance of procedural sterility and use of special procedures table Supplies and equipment. Assisting with catheter and wire exchanges. Safe handling of catheters within patients: e.g., flushing, injecting, connections for power Injections. Application of principles of radiation protection for patient and operator. Interpretive Skills: Basic arteriogram images, with recognition of normal anatomic structures. Basic venogram images, recognition of normal anatomic structures. Identification and evaluation of vascular stenoses. Experience Goals: Perform at least 05 Femoral puncture. Perform at least 05 arterial catheterizations. Under assistance will able to perform at least 5 PCN and 5 biliary interventions, 05 PICC line and other percutaneous interventions. Assist approx. 10 interventional vascular procedures. Log book of interventional procedures should be maintained. Assist and then able to perform GU, biliary and venous access interventions. Reporting of cases should be routine.
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- Develops fundamental skills in the area, including indications: contra indications of procedures and interpretation of images.
- Learns to consult with referring clinicians. - Is supervised throughout the rotation. - Contributes interesting cases to dept library. - Learns patient care including pre & post procedure. - Is not expecting to develop independent skills in procedure performance. - During this rotation resident is given one of the following assignment (writing a
research paper, do a clinical audit or a presentation) 4th year
• Knowledge Based Objectives: • In-depth knowledge of vascular manifestations of systemic and organ
disease processes. • Understanding and ability to describe the indications, risks, capabilities and
limitations of the range of vascular interventional procedures: thrombolytic therapy, foreign body retrieval, embolization, stent placement and TIPS.
• Methodology for percutaneous gastrostomy and gastrojejeunostomy. • GI vascular disease patterns and collateral pathways. • Renal vascular disease patterns and differential diagnoses. • Hepatic vascular disease patterns and differential diagnoses. • Brachiocephalic vascular disease patterns and collateral pathways. • Patterns of disease in vasculitis. • Indications for and risks of GU and biliary interventions, with options for
treatment and expected success rates. • Methodology for various GU and biliary interventions. • Basic knowledge of coronary artery anatomy.
• Technical Skills
• Central venous catheter (Joe Cath) insertion and catheter placement;
sonographically guided puncture techniques. • Performance of routine aortography and venography procedures with
assistance. • Independent operation of the fluoroscopy equipment and table with
technologist assistance. • Difficult femoral arterial punctures, Antegrade approach and brachial
approach. • Performance of routine aortography and extremity arteriography from the
aorta under supervision. • Performance of selective catheterization as needed for routine extremity
arteriography. • Works under supervision.
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Cumulative Experience Goals
• Participate in approximately 20 arteriogram and venous procedures. • Participate in approximately 15 non-vascular interventional procedures. • Participate in 05 balloon angioplasty / stenting procedures. • Assist 05 inferior vena cava filters.
OBJECTIVES OF EXTERNAL ROTATIONS EMERGENCY ROOM ROTATION: ( 4 weeks rotation)
Observe the initial resuscitation and management of the common medical and surgical emergencies including: Trauma: blunt and penetrating
Medical emergencies: MI, Pulmonary edema, acute asthma, respiratory failure, haemoptysis, sepsis, stroke, seizures etc Surgical emergencies: Bowel Obstruction, GI Hemorrhage, Pancreatitis, urinary colic and obstruction, haematuria, etc
Be familiar with the management pathways of acute patients with a particular emphasis on the role of imaging. Be able to perform the initial assessment of emergency patients for the purposes of triage. Be able to take a brief relevant history and perform an initial examination. MEDICINE ROTATION: (2 week rotation)
1. Able to take appropriate medical history. 2. Be able to arrive at appropriate diagnosis of common medical problems. 3. Be able to order appropriate investigations for common medical problems. 4. Be familiar with management of common medical problems. 5. Be familiar with management of medical emergencies. 6. Be familiar with patient counseling/ and confidentiality issues in medicine. 7. Observe assessment and resuscitation of acute medical emergencies
GENERAL SURGERY ROTATION: ( 2 weeks rotation)
1. Observe assessment and resuscitation of acute surgical emergencies. 2. Be familiar with the indications and appropriate use of IV Fluids and antibiotics. 3. Be competent in taking a surgical history. 4. Be able to suggest appropriate investigations for various situations 5. Be familiar with the management of surgical emergencies. 6. Be familiar with the surgical issues in the management of elective patients. 7. Be aware of the clinical issues in critical care.
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Electives 4th year
- 2 months rotation. - Resident spends this time to learn/enhance the skills in imaging in a
Particular area within AKU / SIUT / Shaukat Khanum Hospital /KARACHI XRAYS.
*(Star) Rotation:
The Resident on the star rotation is supposed to supervise or do general reporting, IVU and Mammogram Reporting and any other area where there is need.
PEDIATRICS ROTATION 2nd Year (1st Rotation)
- Basic understanding of routine pediatric plain radiography and fluoroscopic studies.
- Anatomy of plain radiographs, Contrast studies, CT and MRI Procedures. - Prepare at least one presentation from Pediatric Case. - Knowledge of radiation protection / safety issues in pediatric radiology. - Should take detail history of pediatric CT and MRI patients and give
appropriate protocol with consultation. - Resident should be capable of performing routine GI, GU examinations at the
end of rotation. - A good understanding of the following procedures should also be a goal: - Air / Barium enema for intussusceptions reduction and complex enemas for
neonatal obstruction - Recognition of the following would be considered a minimum: - Chest Radiographs- - Typical pediatric pneumonia, Hyaline membrane disease, TTN, reactive airway
disease/ bronchiolitis /asthma, pleural effusion and empyema; pneumothoraces in different ages
- Common congenital heart disease - Extremity Radiographs - Typical pediatric fractures, including buckle and bending fractures, common
bone tumors, battered child syndrome, osteomyelitis and recognition of ossification centers.
- Abdominal Radiographs
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- Obstruction in neonates and older children, appendicitis and other surgical entities, common calcifications and masses
- Skull, Facial, And Spine Radiographs - Fractures, sinus disease, Craniosynostosis, diskitis
- Upper GI series - Vascular rings and pulmonary sling, malrotation, pyloric stenosis, gastro
esophageal reflux, inflammatory bowel disease - VCUG - Vesicoureteral reflux with grading, posterior and anterior urethral valves, bladder
diverticula’s, ureterocele and duplication anomalies - Barium enema - Polyps, Hirsch sprung disease, intussusception, inflammatory bowel disease
- IVU - Calculus disease, duplication anomalies. - Ultrasound - Resident should do every pediatric ultrasound. - Should understand the normal size / appearances of pediatric abdominal organs
according to different ages. - Able to perform and interpret Neonatal Brain ultrasound and should be able to
diagnose various grades of IVH.
Experience goals - Plain radiographs - Residents should take every opportunity to review as many plain films as
possible ensuring a mix of ER, inpatient, and outpatient films. When necessary emphasis should be placed on emergency films and outpatient studies.
- Does 15-20 plain films under supervision. - Upper GI series - A minimum of 20 exams / month should be attainable. - VCUG - A minimum of 20 exams / month should be attainable. - Barium Enema - A minimum of 10 should be the goal. - The resident should attempt to be a part of every intussusception reduction study. - IVU - Residents should attempt to be involved in every IVP as they are not commonly
done. - Ultrasound - At least 10 neonatal brain ultrasound under supervision.
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3rd Year
- In addition to objectives of first rotation - Should strictly follow and guide radiographers about the radiation protection /
safety issues in pediatric patients. - Resident should be involved in step-by-step decisions making process for each
imaging procedure, including the choice of scanning technique, discussion of the procedure with parents / guardians, decisions to administer and monitoring, sedation and contrast, image checking for quality and completeness, image interpretation and reporting to referring physicians.
- The resident should attend clinical conferences and participate in interdisciplinary consultations regarding Neuroimaging procedures.
2nd Rotation 3rd Rotation
Will gain more experience / knowledge of routine Pediatric general Radiology and fluoroscopy. Knowledge of radiological features of normal variations and commonly presenting Congenital / acquired abnormalities on plain X-rays. Further improve the knowledge of CT and MRI anatomy. Know the Myelination process and the diseases which affect this process. Normal Variation and congenital abnormalities of brain and spine. Knowledge of Hypoxic injury / infections / and radiological features of pediatric brain and spine tumors. Able to perform routine ultrasound more proficiently. Understand the normal anatomy and technique to perform the Hip sonography.
Able to perform pediatric fluoroscopic procedures under indirect supervision. Able to perform Abdominal and Neonatal Brain and Hip US in indirect supervision. Report the Plain Films, CT and MRI under supervision. Further enhance the knowledge of pediatric pathologies. Contributes teaching films to library.
PHYSICS TUTORIAL CLASSES
- Every week two classes of one-hour duration are arranged for the first and second year residents for understanding the basic concept of radiological physics and its clinical application.
- These tutorial classes are for the period of two years and are taken by a qualified physics teacher.
- The residents will be assessed by periodical tests, the results of which will be part of their annual evaluation
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LOG BOOK
- A log book has to be maintained by each resident. - The procedures done daily should be entered in it and should be signed daily by
the supervising faculty. - Extra papers can be pasted in the log books to record the activities. - Record of Radiation Dosage monitoring should also be maintained. - All Data of Case presentation / Journal clubs / clinico-radiological meeting
participation / articles / case reports / PGME – CPSP – Other workshops should be maintained.
RESEARCH ACTIVITES
- Every resident should be assigned to write at least 2-3 case reports and 1-2
articles during their tenure of residency. - Each resident should be assigned to a Faculty member for a year and this should
be the responsibility of both faculty and resident to complete this task. - Each resident is expected to do at least one presentation in international / national
radiological / other conference and at least three posters in his / her tenure of residency.
- A resident is supposed to do / attach with at least one Audit during his residency. - The research activity should be followed by the Assigned Faculty / Coordinator /
Director on half yearly basis or more frequently if required. - This activity should play an important role in annual resident evaluation /
promotion.
MISCELLANEOUS ACTIVITIES - Maintain log book as discussed. - Submit all his / her presentation cases teaching films in the secretary office. - Also submit other Interesting / teaching cases in routine rotations in the secretary
office / Respective section incharge. - Record his/her presentation immediately and send it to respective person for
record and further critique. - Should complete / submit and preferably get approved his / her synopsis in first
year and dissertation in 3rd year. - Also should pass his intermediate module in 3rd year.
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PART C
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Clinico-Radiology Meetings: Following are the clinical meetings which should be attended by the residents as mentioned. The Attendance is Mandatory . Neuroradiology. Thursday 8-9
am Faculty/MRI Resident
Neuroradiology. Wednesday 1-2 pm
Faculty/MRI Resident
GI Every Friday 8-9 am
Faculty/All Residents
Pediatric Thursday 12-1 pm
Faculty/Paeds Resident
Mammo. Breast tumor board
Wednesday 9.30-10.30 am 1.30-2.30 pm
Faculty/Mammo Resident
General surgery. Friday 10.00-12.00 am
Faculty+ R 1V Resident according to Rota.
Uroradiology. Tuesday 8.00-9.00am
Faculty/ IVU or GR resident.
Tumor Board Friday 9.00-10 am
Faculty/CT resident
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MONTHLY TEACHING ACTIVITY SCHEDULE
Monday Tuesday Wednesday Thursday Friday 1st Week Journal club
8-9 A.M. Interesting
Case 8–9 A.M.
Film viewing Session
4:30 -5 :15 P.M.
Case Presentation
8-9 A.M. Film viewing
Session 4 :30-5:15
P.M.
Film viewing Session
8-9 A.M. Film viewing
Session 4:30-5:15
P.M.
GIMeeting 8-9 A.M.
2nd Week Film viewing Session
8-9 A.M.
MRI Film Session
8-9 A.M. Film viewing
Session 4:30 -5 :15
P.M.
Case Presentation
8-9 A.M. Film viewing
Session 4:30 -5 :15
P.M.
Film viewing Session 8-9
A.M. Film viewing
Session 4:30 -5 :15
P.M.
G.I. Meeting 8-9 A.M.
3rd Week Journal Club 8-9 A.M.
Research Methodology
8-9 A.M. Film viewing
Session 4:30 -5 :15
P.M.
Case Presentation
8-9 A.M. Film viewing
Session 4:30 -5 :15
P.M.
Intervention Film Session
8-9 A.M. Film viewing
Session 4:30 -5 :15
P.M.
GIMeeting 8-9 A.M.
4th Week Residents Test
8-9 A.M.
Film viewing Session
8-9 A.M. Film viewing
Session 4:30 -5 :15
P.M.
Case Presentation
8-9 A.M. Film viewing
Session 4:30 -5 :15
P.M.
Nuclear Medicine Session 8-9 A.M
Film viewing Session
4:30 -5 :15 P.M.
G.I. Meeting 8-9 A.M.
� The session topics can change. � Didactic lectures on Saturday Mornings.
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CALL RESPONSIBILITIES
1ST YEAR RESIDENT • Take the histories in CT / MRI. • Obtain informed consent in CT/MRI or in any other interventional procedure. • Work in close coordination with immediate seniors. • Attend the physician request of CT / MRI / U/S first and then coordinate with the senior
residents. • If not involved in those areas then try to do U/S in presence of senior residents. 2nd YEAR RESIDENT
• R2’s will have more responsibilities in call hours regarding all the above described work. • Patient care is utmost priority. • He / she do the U/S and then ask the senior to check the findings. • Should show the administrative skills to manage the work in the dept. and guide / supervises
the radiographers and junior residents and taking guidance from senior residents as necessary.
• During the last 3 months of R2 training, on call R2 will further act as an independent resident and will be under cover of a senior resident preferably R 4. He / she will do the most of the work firstly including opinion on complex CT / MRI and then get those findings checked by immediate seniors at the same moment.
• Should try to follow preferably all radiological opinions / reports of on call hours patient or at least follow positive cases.
R 3 / R 4
• As they are the senior residents they will have the primary responsibility of work load management / patient care.
• Also have the responsibility of guidance / monitoring of junior on call residents to complete the floor work in a very professional way.
• Senior resident will be the in charge of the radiology dept. in on call hours and his / her professional approach should reflect in working style.
• Monitor very strictly the work of junior residents and R3 should be involved in U/S, CT, MRI and general reporting along with junior.
• Give opinion on X-rays, CT, and MRI etc. to the other dept. colleagues when they asked for it and seek help from faculty directly when necessary.
• Perform U/S guided interventional procedures under direct / indirect supervision. • Remain in close consultation with the faculty. • At least make preliminary remarks on the ER MR cases.
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GENERAL COMMENTS ABOUT THE CALL HOURS
• Call starts from 5:15 pm in week days till 9:00 am of next day.
• RESPONDING TO BEEPERS IS ABSOLUTELY ESSENTIAL, FAILING WHICH
CAN PROVOKE ADMINISTRATIVE ACTION.
• Working on call include,
o Do U/S
o Give opinion on Plain X-rays
o Give opinion on CT
o Give opinion on MRI etc
o Preliminary evaluation of VIR patients to be done in call hours and inform the on
call VIR faculty accordingly.
o Post procedural care of VIR patients in recovery area and follow –up in case the
patient is admitted.
o Manage the dept. work smoothly and effectively.
o Every patient’s safety and care in radiology is directly / indirectly is resident’s
responsibility.
(R1 & R2 residents should take consult form senior residents before giving any
opinion on CT, MRI, Ultrasound and Plain x-rays)
• Close consultation with on call faculty.
• Ask and involve on call faculty in case of query, emergency or interventional procedure
without hesitation.
• Professional attitude is essential.
• History taking, informed consent, reporting of ER plain X-rays, CT, MRI are the
responsibilities of on call residents.
• Attend calls in ICU, CCU, ER or other wards when asked to.
• Observe proper dress code during on call hours.
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• Senior residents (R3 / R4) will take post call off on next days at 1:00 pm subject to the
completion of their rotation work and signing of all reports of on call procedures keeping in
mind that patient care should not suffer.
• All reports should be signed and review cases should be finalized before leaving the dept.
otherwise the resident will have to stay to complete the work.
• Arrange the resident in place of post call off resident in consultation with chief resident.
• If a resident is on unplanned leave or for any good reason he is not doing his / her call than
he / she should substitute call with other resident of his/her level and inform this to chief
resident.
• Sunday’s and Holiday’s/Eid Rota will be separately devised.
• The change in duty Rota will only be made after approval from Chief Resident.
• No one is allowed to leave the hospital during working hours or on call hours unless there is
an emergency and after getting permission from the on call senior resident and faculty.
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ON CALL ROTA November and December Calls will be designed according to the combination of R2+R3, R2+R4, & R3+R4. R1’s will do only short calls in this period (from 05-9:30pm) AFTER 2 MONTHS The call system will be according to the routine call system. 1 resident on short call and 2 residents on full call. From December 2007 onwards there will be three residents on full call on Saturdays and Sundays. ON CALL SCHEDULE The aim of on-call duty is to provide effective radiologic coverage for the management of emergencies after
working hours in the ER or the wards. The second important aim is the exposure of residents to emergency
radiologic problems and their independent handling.
There are three types of on-call duties assigned to residents:
Short Call (R I)
RI will do short call from first day of Residency every fourth or fifth day for two months.
Observe the senior residents when they are performing various on call procedures.
They are expected to remain in the department during this period.
Actively involve In the History Taking/ Taking the Contrast Injection Consent and other activities on the
Call Hours.
Full Call
From 3rd month of 1st year onwards residents are put on full call during which they function as a radiologist
to help out the clinicians from ER or the wards regarding the emergency management of patients. The
resident is expected to remain within the hospital premises and be available on pager.
For the first two years they are accompanied by R III or R IV.
Short Call (R 1 till R IV) From 5 p.m. to 9 p.m.
All on call residents will seek help from faculty member whenever considered necessary.
Will take full responsibility in completing work so as to reduce the workload on the full call resident.
.
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LEAVE POLICY FOR RESIDENTS These points are in addition to the leave policy for the employees of AKU as mentioned in the personal polices.
• Maximum number of residents on leave at one time will not be more than three.
• Only one resident is allowed to go for leave from same year at one time.
• Applications for leave in the coming month should be submitted till 15th of the ongoing month.
• Leave planner for residents. Leave planner to be displayed in secretary’s office and on the
notice board.
• Documentation of all leaves (sick, casual and earned leaves). When a resident goes on leave he/she signs a leave register maintained by the secretary at the time of going on leave and resuming duty
. • Disciplinary action for all uninformed, unplanned and unapproved leaves, e.g. an extra night
call.
• There is no casual leave for the resident.
• All leaves to be informed to (coordinator/chief resident/physician in charge and secretary in that order) before 10 a.m. otherwise it would be treated as unpaid leave
• Maximum duration of leaves for residents is two calendar weeks at one time.
• Certificate (medical) to be provided with the leave application for SICK LEAVE on same day. Resident has to come and show up in CHC .Failing to do so will have to do an extra full night call.
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Code of conduct and Disciplinary Policy For Disciplinary Issues: 1. Verbal counseling will be given. A file note of each verbal session will be kept. 2. If the offences continue , a written reprimand will be issued and one of the following further
sanctions will be added:
Extra duties.
Withholding of salary.
3. After written Reprimand the following extra sanctions will be added
Suspension from training.
4. The period of suspension will have to be made up after 4 years of residency and will not be paid.
5. For serious offenses – Residency may be terminated.
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Resident’s Appreciation Resident of the Year
Three Residents will be Nominated based on the attendance Record, Monthly Evaluations and Test
Scores attained during the Year.
The Nominee will be voted on by the Faculty and selected member of staff of the department.
Resident securing the most votes will be awarded the best Resident of the year.
Research Excellence Award: Yearly Award will be given to the resident with most Published case Reports or Original articles
in one year.
Award for Maximum Morning Session Attendance .
Awarded to resident having maximum attendance in the morning sessions.
Award for Maximum Attendance in the Department
Given to resident having maximum attendance in the department, with least number of unplanned
leaves.
Best Case Presentation of year Award
Given to resident on best case presentation/ Journal club during the year.
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RESIDENTS ASSESSMENT 1. In training evaluation report. (Copy attached)
- Monthly on rotation basis. - Report is completed by rotation preceptor. - Discussed with resident and signed. - Comments added by Co-coordinator. - Accumulated reports reviewed twice a year.
2. Written examination.
- Monthly Written test which comprises MCQ’s and short Essay questions. - After the completion of section OSCE and VIVA of the particular section. - Periodical Physics Tests (MCQ/Essay Type) - Accumulated results reviewed twice a year.
3. Viva Voce examinations.
- After The completion of the Section Usually Once in two Month. - Accumulated results reviewed twice a year.
4. Performance at Department Academic Rounds
- Punctuality. - Behavior and attitude towards work/patient care. - Working co-operation with the colleagues and staff. - Quantity of presentation
� Style � Content
- Performance review will be discussed with resident twice yearly based on thresholds.
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THRESHOLD FOR PASSING THE SIX MONTHLY/YEARLY EVALUATION Test overall Physics test (R-I + R-II) 60% marks Attendance (morning) 80% Overall attendance (without approval / unplanned 95% �
��physics class attendance 90% Monthly evaluations (average) should not be less than 2.75 in an evaluation period Attitude / Behavior 360 degree evaluation (yearly) Journal club / Case Presentation should not be less than 70% (25- 36) satisfactory Comments The DRC will assess the resident based on the above threshold values in addition to overall performance and attitude
����
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LIST OF PRECEPTORS FOR RESIDENT EVALUATION
• Drs. M. Nadeem Ahmad/Humera Ahsan MRI
• Dr. Yousuf Pediatrics
• Dr. Tanveer ul Haq Vascular Intervention
• Drs. Wasim Memon/Dr Azeemuddin. CT
• Dr. Imrana Masroor Ultrasound/Mammography
• Dr. Riffat Parveen / Dr Masih Nuclear Medicine.
• Dr Vaqar Bari. FL/IVP/Gen.
(Each monthly rotation will be followed by a written assessment based on objectives of rotations in addition to filling of monthly evaluation form. The preceptors will be responsible for taking the written assessment).
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DEPARTMENT OF RADIOLOGY
RESIDENT EVALUATION: MONTH: ----------
Department: ------------- Name: ____________________________________ Date: __________________
Residency Level: ___________________________
Evaluating Faculty/s: ____________________________________________________
CRITERIA 1 2 3 4 RADIOLOGY SKILLS
Theoretical Knowledge with clinical application.
Punctuality/Presence in the procedure and reporting
rounds.
Timely reporting
History taking and pre-reporting workup.
Patient Care/Time Management.
Completion of assignments. Attitude towards work.
Contribution to department.
Interest in research activities.
The Objectives of the rotation is achieved or not according
to the Manual.
PERSONAL QUALITIES
Administrative and leadership qualities
Maturity and independent thinking
Performance under stress
Ability to undertake responsibility
Verbal communication skills
Relationship with Medical Staff
Relation with other staff
Demonstrate personal honesty & caring attitude
Maintain proper decorum & demeanor
COMMENTS:
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General Professional Plan & Goals. FINAL RATING: 4 3 2 1 RECOMMENDATIONS: SIGNATURE PROGRAM DIRECTOR RESIDENT Discussed with resident and copy handed over. 4. Excellent: Exceptional, superior, far exceeds reasonable expectations, only a
few Resident can earn this. 3. Good: Unusually strong, often exceeds reasonable expectations but it is
really not Outstanding. 2. Average: Equals to the majority of residents at this level of training, occasionally Exceeds reasonable
expectations (most rank here) 1. Poor: Not acceptable for a resident at this level of training. Recommendations for remedial work. NOTE: This completed form must be referred to the Residency Co-coordinator for His/her written comments and any further discussion with the concerned Resident. CO-ORDINATOR’S COMMENTS:
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GUIDELINES FOR CASE PRESENTATION IN MORNING SESSIONS 1. 1 case/session (1 hour session 0800 – 0900 hours} 2. The Cases should be initially approved from the director residency at least 2 weeks prior .The
case should also be shown to supervising faculty at least 1-2 days before presentation.
3. Each case MUST:
a) Provide short history and physical findings. b) Consist of several diagnostic imaging modalities. c) Have an outcome: Clinical/Preferably Pathological. The presenting student will provide history and physical examination findings and also the films 10 minutes prior to presentation.
4. The recipient student will be expected to describe:
a) Description of findings on each examination, as they were performed in chronological order. b) Differential diagnosis plus any other pertinent comments e.g. appropriateness of investigations
performed. c) Preferred diagnosis.
5. Comments from presenting student including:
a) Comments on recipient’s presentation. b) The diagnosis. c) BRIEF descriptive overview of the disease/entity.
6. Cases, including all documentation to be catalogued into the departmental
Museum. (Should be handed over to the residents Secretary). 7. All Cases should be recorded and send to ISD In charge DR Kashif Mirza. 8. In case of mandatory workshop/leave /external rotation of a resident the
presentations/journal club should be mutually exchanged.
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PROVISIONAL LIST OF DIDACTIC LECTURE SERIES MODIFIED ACCORDING TO NEEDS/SUGGESTIONS
1. BASIC CHEST INTERPRETATION (VB) 2. BASIC CT OF HEAD (DB) 3. BASIC CT OF CHEST (ZH) 4. BASIC CT OF ABDOMEN (WM) 5. BASIC PLAIN FILMS MUSCULOSKELETAL (AZ) 6. BASIC OBSTETRIC + PELVIC U/S (IM) 7. BASIC ABDOMEN U/S (ZH) 8. BASIC DOPPLER U/S (IM) 9. BASIC U/S SMALL PARTS (DB) 10. BASIC MR BRAIN (MNA) 11. BASIC MR SPINE (HA) 12. BASIC MR PELVIS (HA) 13. BASIC MUSCULOSKELETAL MRI (MNA) 14. BASIC GUIDANCE TECH & PROCEDURE (TUH) 15. BASIC GI CONTRAST STUDIES (ZS) 16. CONTRAST MEDIA (VB) 17. DRUGS IN RADIOLOGY (IC) 18. IMAGING ALGORITHIM IN TRAUMA (ZS) 19. IMAGING ALGORITHIM IN STROKE (HA) 20. IMAGING ALGORITHIM IN ABDOMEN PAIN (WM) 21. IMAGING ALGORITHIM IN ONCOLOGY (ZS) 22. PRINCIPLES OF NUCLEAR MEDICINE (RP) 23. ISSUES IN PAEDS RADIOLOGY (Y)
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Test Schedule
S.NO SECTION / TOPICS
1 Contrast media / Drugs in radiology
2
Radiographic positioning / Quality Control
3
Radiological techniques
4
G I Contrast media
5
Paeds Radiology
6
Female Imaging
7
GIT / Hepatobiliary
8
Chest
9
Cardiovascular system
10
Skeletal system and soft tissue
11
Genitourinary system
12
Eye, ENT, Head & Neck
13
Neuro radiology
14
Nuclear Medicine
15
Interventional Radiology
TEST FORMAT: Separate tests for topics like contrast media, positioning, techniques etc Each system is divided in to two sections and is assessed by two written tests and an OSCE and VIVA WRITTEN TEST FORMAT: Written test is composed of three short essay question and thirty single best MCQS. Faculty must give key of SEQS and MCQS with references so that pool can be developed.
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OSCE FORMAT : Comprises of 10 cases related to topic.
Format of OSCE sheet: � Name of Resident � Name of Radiological Exam
� Technique used � Findings � Diagnosis/differential Diagnosis
� Any further radiological investigation.
VIVA FORMAT: Comprises of two panels, each with three set of films ( Different set for R1/R2 and R3/R4).
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THE AGA KHAN UNIVERSITY DEPARTMENT OF RADIOLOGY
Resident’s Appraisal of Faculty Name of Faculty _____________________________________ Period of Evaluation _____________________________________ Level of Residency (Mandatory)_________________________________ Please rate the following categories by checking the appropriate column. Comments ***
Poor Fair
** Good
Very Good
*Excellent
Demonstrate ability to communicate ideas effectively
Is able to answer questions clearly
Is able to challenge Resident’s thinking Successfully uses teaching films and aids (such as videos, charts, demonstrations etc)
Is able to provide useful feedback
Demonstrates positive attitude towards teaching
Observes and objectively comments on Resident’s professional skills
Provides a good professional role model
Overall effectiveness as teacher
Comments: --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- * EXCELLENT: Faculty member consistently provides lectures, tutorials or clinical sessions Regarded as enjoyable, helpful learning experiences. The student looks forward to his/her teaching sessions. Only a small fraction of the faculty would fall in this category. ** GOOD: Faculty member provides well organized learning opportunities from which the student benefits most of the time. Most faculties will fall in this category. *** POOR: Faculty member consistently provides confusing or unhelpful teaching sessions from which the student learns very little. The student is tempted to skip his/her sessions. Only a small fraction of the faculty may be expected in this category.
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List of Residents and faculty for the
Research activities for the year 2007-2008
S.NO Faculty Name Residents Name 1 Dr Nadeem Dr.Madiha 2 Dr Tanveer
DR.Farah
3 Dr Yousuf
Dr.Abdul Ghafoor
4 Dr Humera
Dr.Farhan/Dr. Zainab
5 Dr Zafar Sajjad
Dr.Saima
6 Dr Imrana
Dr.Nadir
7 Dr V.Bari
Dr.Aman
8 Dr Azeem
Dr.Muhammad Idrees
9 Dr W.Memon
Dr.Mahvash
10 Dr Dawer
Dr.Kiran
11 Dr Zeeshan
Drs.Fahad/Shayan
12 Dr Naila
Dr.Munazza
13 Dr Ishtiaq
Drs.Qazi
14 Dr Farhan
Drs.Zeeshan
15 Dr Gulnaz
Dr.Imad
16 Dr Shaista Dr.Shahbaz
17 Dr Waseem Akhtar Darakshan
18 Dr Basit Sumera
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Resident’s Case presentation Assessment
Date------------------- Presenter-------------------------- Level of Residency------------ Evaluator---------------- S.no Criteria. 1 2 3 4
A. CONTENT: 1. Introduces & summarizes topic in an
interesting way.
2. Cover the topic adequately and appropriately.
3. well researched and referenced content. B. Methodology
4. Get the point of view across the audience.
5. Involve the audience. 6 Keep up to time limits.
C. Communication: 7. Use audible language fluently and
coherently.
8. Uses Appropriate gestures, body language and eye contact.
9. Confidently handles questions.
D.Visual Aids: 10. Use Clear Visual aids relevant to
spoken words.
11. Spelling Mistakes (No spelling Mistakes is 4)
12. Describe the Images rightly and
confidently.
Comments: __________________________________________________ ________________________________________ Signature Evaluator -------------------- Presenters ------------------- Evaluation counting: Total Marks-48. 1. Poor. (Total Score=1-12) 2. Unsatisfactory. (Total Score=13-24) 3. Satisfactory. (Total Score=25-36) 4. Outstanding. (Total Score=37-48)
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Residents Journal Club Activity
Presenter: -------------------------------Evaluator: ------------------------------- Date: -------------------------------------Level of Residency: ----------------
Points on which scoring will be made. 1 2 3 4 1 Selection of article. 2. Understanding of topic and statistics. 3. Get the point of view across the audience. 4. Use Of tables and charts 5. Effectively concising and Keep up to the
time limits.
6. Language fluent and coherent. 7. Use appropriate gestures, body language
and eye contact.
8. Use clear visual aids relevant to the spoken words.
9. Searched other articles other than the selected article on same topic.
10. Ability to defend or critique the selected
article.
11. Confidently handle the questions. 12. Practical Application of article. Comments: ______________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Signature: Evaluator__________________________ Presenter Signature_________________ Evaluation counting: Total Marks-48. 1-12.Poor. 13-24 Unsatisfactory. 25-36.Satisfactory. 37-48.Outstanding.
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RECOMMENDED BOOKS FOR INTERMEDIATE MODULE AND FINAL EXAMINATION OF FCPS IN DIAGNOSTIC RADIOLOGY
1. Anatomy for Diagnostic Imaging.
S.P. Ryan, M.M.J. McNicholas. Saunders; ISBN: 0702014478
2. Christensen's Physics of Diagnostic Radiology
Thomas Curry, James Dowdey, Robert Murry Jr. Lea & Febiger; ISBN: 0812113101
3. Guide to Radiological Procedures
Chapman. W B SAUNDERS COMPANY; ISBN: 0702025658
4. Fundamentals of Body CT
W.Richard Webb, etc. W.B.Saunders; ISBN: 0721668623
5. MRI: the Basics Ray Hashemi MD PhD, William G. Bradley Jr MD PhD FACR. Lippincott Williams and Wilkins; ISBN: 0683182404
6. MCQs
7. Textbook of Radiology and Imaging Dr. David Sutton MD FRCP FRCR. Churchill Livingstone; ISBN: 0443053685
8. Grainger and Allison's Diagnostic Radiology
Ronald G. Grainger, David J. Allison, Andreas Adam, Adrian K. Dixon. Churchill Livingstone; ISBN: 0443064326.
9. Aids to Radiological Differential Diagnosis
Stephen Chapman, Richard Nakielny (Editor). Bailliere; ISBN: 0702018953.
10. Neuroradiology; The Requisites, Second Edition Robert I. Grossman, MD / David M. Yousem M.D; ISBN:0-8016-6492-6
11. MRI & CT Imaging of Head and Neck and Spine, 3rd Edition Richard E. Lat Chaw; ISBN 0-8151-5330-9
