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Fluoroscopy RAH

GENERAL OBJECTIVES:

On completion of the Fluoroscopy rotation, the resident will demonstrate competence in performance and interpretation of all standard fluoroscopic procedures.  The resident will have attained a knowledge base capable of functioning as a junior consultant radiologist. 
 

SPECIFIC OBJECTIVES

Medical expert/clinical decision-maker

Specific Requirements:
·         Demonstrate knowledge of gross anatomy of all body systems imaged with fluoroscopy.
·         Demonstrate knowledge of clinical radiology and pathology as it pertains to body systems imaged with fluoroscopy.
·         Correlate abnormal findings on imaging studies with surgery and pathology.
·         Develop proficiency in the performance of procedures:  upper GI studies, small bowel follow throughs, lower GI studies (single and double contrast studies), arthrography, joint aspiration, myelography, cysto-urethrography, intravenous pyelography, retrograde pyelogram interpretation, sinograms/fistulograms, tube checks,  drainage tube placement and sialography.
·         Correlation with surgery, gastroenterology, and pathology will be key to the resident’s understanding of radiographic abnormalities. 
·         The resident will become fluent in the utilization of different contrast medias for different clinical scenarios (water soluble vs. barium). The resident will learn to optimize exams utilizing single or double contrast. 
·         The resident will recognize and act upon emergent findings with appropriate staff supervision such as: pneumoperitoneum, toxic megacolon, obstruction, bowel ischemia, biliary obstruction placing the patient at risk for ascending cholangitis. 
·         Understand, and be able to intelligently discuss irradiation risks with all fluoroscopic procedures.  Be able to tailor exams to achieve the most clinical information, with the lowest dose of irradiation possible.
·         Be able to obtain informed consent from a patient, and discuss intelligently all possible complications from fluoroscopic procedures.
·         Be able to recognize, and effectively treat intravenous contrast reactions.
·         Be familiar with all available modalities for investigation of the GI tract including ultrasound, CT, MR, ERCP and cholangiography
·         Be familiar with abnormalities demonstrated at ERCP
 

Communicator

Specific Requirements:
·         Demonstrate a logical and concise reporting style.
·         Show ability to recognize emergent conditions, and report them promptly to the referring clinical service.  Examples include: perforation, aspiration, and adverse reactions to contrast media.
 

Collaborator

Specific Requirements:
·         Consult effectively with other physicians and health care professionals.
·         Be able to function and contribute in an effective fashion within a multidisciplinary health care team.
 

Manager

Specific Requirements:
·         Show competence in conducting all fluoroscopic procedures.
·         Understand safety and economic issues pertaining to fluoroscopic procedures.
 

Health Advocate

Specific Requirements:
·         Explain the benefits and risks of all fluoroscopic procedures.
·         Educate and advise on appropriate use of fluoroscopy.
 

Scholar

Specific Requirements:
·         Evaluate pertinent medical literature in an effective fashion.
·         Demonstrate ability and willingness to be a teacher of fluoroscopy.
 

Professional

Specific Requirements:
·         Deliver high quality health care in an effective professional fashion.
·         Develop a continuing medical education strategy.
·         Develop realistic guidelines regarding one’s strengths and weaknesses.
 
References:

Gastrointestinal Radiology – Laufer and Levine

Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy – Meyers
Gastrointestinal Radiology: A Pattern Approach – Eisenberg
Double Contrast Gastrointestinal Radiology – Laufer
Computed Tomography of the Body – Moss, Gamsu, Genant