RESPONSIBILITIES

I.        Junior (C1) Rotation

General Information:

Pediatric radiology rotations at the Seattle Children’s Hospital (SCH) are designed to provide residents with a wide range of experience in pediatric radiology, to familiarize residents with pediatric imaging procedures, and to provide the necessary information and expertise to successfully pass the Pediatric Radiology section of the Written and Oral Examinations of the American Board of Radiology.  Plain film interpretation and fluoroscopic examination are central to this success.

The major emphasis of the first eight weeks of training at SCH is designed to provide a solid basis of understanding of plain film radiographic findings and fluoroscopic techniques and interpretation essential to pediatric radiology.  These areas receive major emphasis on the Board Examination and are essential to the training of any radiologist. We also include an exposure to Nuclear Medicine and, secondarily, CT during this rotation.

There will usually be one to three residents at this level.  The first eight weeks will usually be divided among fluoroscopy (3 weeks) plain film interpretation (3 weeks) and nuclear medicine (2 weeks).

A.      Plain Film Radiography - Outpatient/Emergency Department

General Goals:

During this three-week rotation, you will learn to interpret Emergency Department and outpatient plain film examinations, provide quality control advice for performance of examinations, and suggest appropriate additional services.

Medical Knowledge and Technical Skills Objectives:

1.      Recognize normal pediatric anatomy and anatomic variations in all body parts.

2.      Identify common fractures and child abuse.

3.      Recognize airway obstruction, chest infections, and pleural abnormalities.

4.      Recognize intestinal obstruction, bowel wall abnormalities, and signs of intussusception.

Resident responsibilities:

1.   Emergency radiology exam review - in the early AM review and report prior nights ED exams and report errors to the Emergency Department.

2.   Review and report outpatient plain films (studies from the clinics of Orthopedics, Cardiology, Pulmonary, Birth Defects, Endocrine and General Medicine, and other medical and surgical specialties).  These studies will include films from the previous day’s clinics that were taken to clinic un-read, and occasional “on-line” reading of the current day’s clinic films that are going to be taken to clinic.  Read these later studies as expeditiously as possible to prevent unnecessary patient care delay. Communicate any “on-line” study results to referring physicians.

3.   Field calls from referring physicians regarding studies and advice.

4.   Provide consultation to clinicians seeking assistance.

5.   Review all studies with the staff radiologist and dictate the interpretations.  After they are transcribed onto PowerScribe, promptly (by days end) review, edit, and sign your reports.

B.      Fluoroscopy

General Goals:

The resident learns and becomes proficient in performing and interpreting procedures. You will learn indications, techniques, methods and interpretation.  Staff supervision is close and supportive.  Emphasis is hands-on experience and development of independent diagnostic techniques.

Medical Knowledge and Technical Skills Objectives:

During this time, skill should be achieved in most areas of pediatric fluoroscopy, including:

•      Airway fluoroscopy.
•      Barium swallow/esophagram.
•      Upper gastrointestinal series with/without small bowel follow through.
•      Dedicated small bowel follow through.
•      Contrast enema.
•      Air enema for intussusception reduction.
•      Ostomy study.
•      Feeding tube placements.
•      Voiding cysto-urethrogram.
•      Fistulogram/sinogram.
•      Vascular line patency study.

Resident responsibilities:

1.   Review the daily schedule for appropriateness and type of examination. Review all prior relevant studies. Direct questions to referring physicians as indicated.

2.   Learn to perform common fluoroscopic studies efficiently and with the lowest reasonable radiation dose.

3.   After studies are reviewed with the staff radiologist, dictate the interpretations on PowerScribe.  Edit, review, and sign your reports by days end.

4.   Call the referring physician or house staff with positive results and when requested to do so.

5.   During quiet or light case load times when fluoroscopy is not being performed or interpreted, preview out-patient radiographic exams, review and dictate these with the attending staff. This includes “stat” readings generated in Room 1.

C.      Nuclear Medicine

General Goals:

This rotation emphasizes the indications, techniques, and interpretation of pediatric nuclear medicine procedures and is usually two (frequently divided) weeks in length.

Medical Knowledge and Technical Skills Objectives:

Techniques and interpretation of many of the following studies will be learned:

COMMON                                                                 LESS COMMON

Lasix Renogram                                                       Cardiac

Nuclear cystography                                                 Renal cortical labeling exams

Total body bone scan                                                Liver/Spleen Scan

Ventricular shunt studies                                           Hepatobiliary scan

MIBG scans                                                             Gated blood pool imaging

                                                                              Coronary perfusion scans

                                                                              Ventilation/perfusion lung scans

                                                                              Cerebral Blood Flow studies

Resident Responsibilities:

1.      Review the daily schedule for appropriateness and type of examination. Review all prior relevant studies. Direct questions to referring physicians as indicated.

2.   The technologists would appreciate you answering the phone when they are in the room and notifying them when you leave for lunch or       conference to allow them to prepare for coverage if needed.

3.      After studies are reviewed with the staff radiologist, write results in the Nuclear Medicine case log book.  Dictate the interpretations on PowerScribe; edit, review, and sign your reports by days end.