Emergency Radiology

 Preamble:  This rotation is predominantly for junior residents (PGY2 and 3) in the program.  The rotation objective is to give the resident experience predominantly in interpretation of a variety of conventional radiographs encountered in emergency medicine.  In addition, experience in the supervision and interpretation of emergency CT examinations (predominantly chest, abdomen and pelvis examinations) is an objective for this rotation.  By the end of the rotation, the resident should have fulfilled the following objectives (based on the CanMEDS format):

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The resident should be able to accurately and completely interpret conventional radiographs of commonly seen disease processes presenting to the emergency room.  This includes understanding the various radiographic views, radiographic anatomy and relevant findings for all common pathologies such as (but not only) traumatic injuries, chest infections, pulmonary edema, pleural effusions, common neoplastic conditions, bowel obstruction, bowel perforation and inflammatory bowel disease.  The resident should understand the indications for conventional radiography, the limitations of radiography and the indications for use of other imaging modalities to clarify or refine a diagnosis.
 The resident should understand common CT protocols, and be confident in supervising and interpreting CT examinations for emergency room patients.  The resident should have a thorough knowledge of normal anatomy as displayed by conventional radiography and CT as well as the imaging findings for all common disease processes and be able to correlate the imaging findings with the relevant pathology. The resident should have a basic understanding of the management implications of the imaging findings.
The resident should be able to generate a complete, meaningful and concise written report of the imaging findings and their clinical implications, including an appropriate summary when required.  The clinical questions raised should be answered if possible.  The resident should be able to discuss cases with clinicians and offer appropriate interpretations and suggestions for further imaging if required.  The report should be verified in a timely manner.
The resident should be attentive to the quality of the examinations viewed and discuss cases of suboptimal quality with the technical and attending radiology staff.  The resident should understand principles of quality control in imaging and recognize common technical problems and artifacts. 
The resident should gain an understanding of the work flow issues in an emergency radiology area and develop an understanding of the roles of various clerical, technical and other staff in the department. 
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The resident should develop an understanding of the role of  imaging in the investigation of emergency room clinical problems and be able to take a lead in determining what the most appropriate imaging test or sequence of tests is for a particular clinical problem.  Recognition of emergent conditions requiring immediate verbal reports and appropriate frequency of repeat examinations should be clearly understood. 
A self directed study program to complete the required reading should be developed.  A minimum of two interesting cases should be submitted to the teaching library.  The resident should be able to add to the discussion of interesting cases or findings in clinical or radiology conferences.  The resident should be involved in teaching of service residents and medical students on the rotation when they are scheduled for emergency room radiology.
A professional and respectful attitude towards clinicians, colleagues and staff should be clearly demonstrated.   Honesty in dealings with clinicians and staff should be observed at all times.  Residents are expected to recognize any limitations in knowledge and request for help when needed.
The resident should be present in the emergency interpretation room at 8:00 AM on working days, unless resident morning rounds are scheduled, in which case the resident should be present immediately after the rounds conclude.   The resident should review conventional radiographs from the evening/night before for the first two to three hours, and be available to supervise any emergency CT examination.  Review of films with the staff radiologist covering the emergency room should happen by 11:00 AM with dictation of these cases to follow.  Review of films in the afternoon should be along similar lines.  The resident should aim to review at least 40 cases/ day.  Transcribed reports should be verified the following day.  Any urgent report should be called directly to the referring physician.
Required and Recommended Reading:
Radiology of Emergency Medicine:  Harris and Harris
Radiology Of Skeletal Trauma – Rogers
Fundamentals Of Diagnostic Radiology - Brant And Helms.
The Radiology of Acute Cervical Spinal Trauma - Harris.