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Pediatric Radiology II

PEDIATRIC RADIOLOGY ROTATIONS (Peds I, Peds II and Peds Senior)

GENERAL OBJECTIVES:

 These rotations are designed to give radiology residents the skills to interpret diagnostic imaging studies by one-on-one teaching with the Pediatric Radiologists, attendance at teaching rounds and self-directed study.  This rotation though based in fluoroscopy, CT, ultrasound, MRI and plain radiography involves correlation with other diagnostic imaging modalities.  The rotation supplement pediatric radiology teaching provided during the Cardiac radiology rotation, the Nuclear medicine rotation, and the angiography/interventional radiology rotation at the University hospital/Stollery Children’s hospital and the pediatric radiology rotation and ultrasound (cranial sonography) at the Royal Alexandra hospital.  The curriculum listed below encompasses the expectations for pediatric expertise from all of these rotations.
The Pediatric I rotation is most appropriate for residents in the PGY-3 or PGY-4 year, and is best done in an 8-week bloc.  The Pediatric II rotation is to be done after completion of Pediatric I.  The Pediatric Senior rotation is designed for a PGY5 resident.
On completion of the pediatric radiology rotations the resident will be competent to function as a consultant radiologist to referring clinicians in the area of pediatric radiology.  The resident will demonstrate ability to supervise and perform imaging procedures as well as advise referring physicians as to the appropriate investigations for the patient.   These skills will be developed to a level appropriate for Royal College Certification.
 
 

SPECIFIC OBJECTIVES:

 
 
At the completion of training, the Resident will have acquired the following competencies and will  function effectively as:
 
 

Medical expert:

 
Peds I:
·         Demonstrate knowledge of pediatric anatomy as seen by conventional radiography and fluoroscopy  .
·         Demonstrate knowledge of clinical radiology and pathology as it pertains to pediatric radiology.
·         Develop a rapport with the pediatric referring service for correlation of pediatric imaging with clinical scenarios/surgical findings.
·         Develop a working knowledge of radiographic procedures associated with pediatric radiology such as:  voiding cysto-urethrograms, pediatric upper and lower GI exams.
·         Tailor exams as necessary to derive the maximum benefit with the least amount of intervention, with special consideration to the pediatric patient population.  This would include monitoring radiation
 
PedsII:
·         The senior resident will focus more upon their role as a consultative pediatric radiologist taking a more independent role in patient care.
·         Develop a working knowledge of CT and ultrasound imaging as it pertains to pediatrics, including a thorough understanding of common pediatric diseases and their imaging features and differential diagnoses.
·         Perform basic ultrasound guided interventional procedures.
·         The senior resident will take on more responsibility in a graded fashion with regard to on-call pediatric cases, as well as day-to-day planning, protocol, and evaluation of day cases.
·         The senior resident will be adept at tailoring a pediatric patient’s imaging needs with regard to their clinical condition.
 
Peds Senior:
·         The resident will be expected to expand on the skills obtained in the Peds I and II rotations.  In addition, the will focus on pediatric MRI.  This will include knowledge of imaging sequences, MRI interpretation and safety issues.
 
*Please see appendix for specific knowledge requirements
 

 
Communicator:
 
Specific Requirements:
·         Residents will demonstrate a concise, and appropriate reporting style with use of appropriate lexicon regarding pediatric conditions.
·         Appropriate, and pertinent differential diagnoses will be generated by the residents.  The differential list should be inclusive without being exhaustive.
·         Imaging findings requiring emergent intervention (ie: small bowel volvulus, pneumothorax, pneumoperitoneum, and intracranial hemorrhage)  will be readily identified by the resident, and communicated to the referring service immediately.
 
Collaborator
 
Specific Requirements:
·                     Have the ability to function as a member of a multi-disciplinary health care team.
·                     Consult effectively with pediatric clinicians and other health care professionals.
 
Manager:
 
Specific Requirements:
·                     Demonstrate competence in conducting and supervising pediatric radiologic procedures.
·         Understand the unique circumstances of pediatric radiology.  Understand that imaging of pediatric patients is simply not imaging “small adults”.
 
Health Advocate:
 
Specific Requirements:
·         Understand the risks and complications related to all pediatric imaging, and interventional procedures.
·         Develop effective imaging algorithms in evaluating pediatric patients, so as to maximize patient care, while minimizing cost, and possible morbidity/mortality to the patient
·         Understand the ALARA concept and issues pertaining to radiation safety, particularly in the pediatric population.
 
Scholar

Specific Requirements:
·                     Critically appraise appropriate sources of medical/imaging literature
·                     Demonstrate ability to develop a personal continuing medical education strategy.
·                     Demonstrate teaching ability to disseminate knowledge to other residents, faculty, and other health professionals.
·                     Contribute cases to the pediatric teaching files.
·                     Develop strategies/plans to initiate/participate in research activities in pediatric radiology.
 
Professional
 
Specific requirements:
·         Have insight to one’s strength’s and weakness.  Have a realistic impression of one’s limitations, and know when to consult others.
·         Exhibit high personal and professional attitudes.
·         Deliver high quality care, in a professional and timely fashion.
·         Develop a congenial and professional working relationship with all associated health professionals and patients (and family members).
 
 

RESIDENT DUTIES
 
PEDS-I Resident: 
·         review conventional radiographs including examinations from the pediatric emergency room.  Dictate cases after review with staff radiologist.
·         Learn to perform standard fluoroscopic procedures used in pediatric radiology
·         Review films from PICU and NICU with staff and dictate cases.
 
PEDS-II Resident:
·         protocol CT cases for the day
·         check ultrasound examinations and review with staff radiologist and report
·         supervise and review pediatric CT examinations and dictate cases after review with staff radiologist
·         Perform basic ultrasound guided interventions such as liver biopsies and drainages
·         All cases that are to be reviewed with staff should have first been be reviewed by the resident, as well as review of any prior imaging.  Contributory clinical information should also be assembled by the resident whenever possible. 
·         Teaching information to be disseminated to residents, clinical housestaff, and other health professionals when appropriate.
·         2 teaching file cases to be submitted at the end of each rotation.
 
PEDS Senior:
·         -Perform the duties of the Peds I and Peds II rotations when on the rotations
·         -Protocol and supervise pediatric MRI studies
·         -interpret, review and report pediatric MRI
 
 
Required Reading:
 Practical Pediatric Imaging – Kirks
 Pediatric Radiology – The Requisites – Blickman
Emergency Imaging of the acutely ill / injured child – Swischuk
Imaging of the newborn, infant, and young child – Swischuk