II.       Senior (C2) Rotation

General Information:

This eight-week rotation usually comes during the R4 or R5 years, following the completion of the junior (initial) rotation.  There will be two or three residents at this level from the University of Washington, Madigan, Sacred Heart or Virginia Mason.  This rotation is usually divided among 1) inpatient/conference rotation (3 weeks), 2) computed tomography (3 weeks) and 3) ultrasound (2 weeks) rotations.  Staff attending closely supervises the work.  Single day rotations in general radiology and fluoroscopy may be needed when these services are uncovered because of resident absences.

A.      Inpatient

General Information:

Daily work rounds begin at 8:00am in the inpatient reading room on inpatient and ICU boards and provides an opportunity for exchange of clinical data and for presentation of radiographic information.  Medicine team rounds with three teams (15 minutes each) are from 10:00 to 10:45 AM Monday, Tuesday, Wednesday, and Friday.  In addition, there are NICU rounds daily (except Thursday) at 9a.m. in the Nursery.  This provides an opportunity for clinical and radiological correlation of multiple modality studies.

General Goals:

This rotation provides service to the intensive care unit and in-patient services.  Focus is on film interpretation and conference presentation with the housestaff and faculty.

Medical Knowledge and Technical Skills Objectives:

1.      Understand and recognize conditions unique to the newborn infant such as meconium inspiration, IRDS, necrotizing enterocolitis, and intestinal atresia.

2.      Understand surgical treatment of congenital heart disease.

3.      Understand basic orthopedic treatment of congenital and acquired musculoskeletal abnormalities.

4.      Understand and recognize infections unique to the immunocomprimised children.

Resident Responsibilities:

1.   Review the in-patient plain films and all prior relevant studies.

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

3.   Provide consultation to clinicians seeking assistance.

4.     Review all studies with the staff radiologist and dictate the interpretations.  After they are    transcribed onto PowerScribe, review, edit, and sign your reports by day’s end.

B.      Computed Tomography

General goals:

This three-week rotation concentrates on the indications, technique, method and interpretation of computed tomography (CT) in children.  Neuro and body imaging are included in this rotation.

Medical Knowledge and Technical Skills Objectives:

By the end of service you should be able to:

1.      Interpret standard CT exams of the head, neck, chest, abdomen, pelvis and extremities.

2.      Apply CT in evaluations of unique pediatric problems, such as childhood cancer, craniofacial anomalies, congenital abnormalities of chest or abdomen, and pediatric vascular disease.

3.      Understand practical physics of helical, multislice CT equipment.

4.      Select appropriate protocol to answer specific clinical problems and apply low radiation dose methods.

5.      Handle IV contrast reaction.

6.      Understand doses for pediatric sedation.

Resident Responsibilities:

1.     Review requisitions, past relevant imaging and determine appropriateness of requested studies.

2.     Review prior studies to ensure proper tailoring of exam.  Review this information with the attending radiologist.

3.     Monitor studies as they are performed.  Whenever contrast media is administered, the resident should be physically in the vicinity of the scanner in case of reaction or adverse effect.

4.     Determine when the study is complete, consult with the attending staff if needed, and discharge the patient.

5.     Dictate findings after review.  Include sedation (usually chloral hydrate, Nebutal and Versed), if used, and dose, and contrast (oral and IV) dose, type and concentration.  Note any complication of contrast administration (infiltration, reaction), sedation, etc.

C.      Ultrasound

General Goals:

This two-week rotation concentrates on the indications, techniques, methods and interpretations of ultrasound (US) in children.

Medical Knowledge and Technical Skills Objectives:

1.      Interpret renal, cranial and abdominal examinations.

2.      Understand the use of ultrasound pediatric conditions such as hypertrophic pyloric stenosis, congenital dysplasia of the hip, neural tube defects of the spine and appendicitis.

3.      Understand the use of Doppler techniques in pediatric vascular disorders, including liver and kidney transplantation.

4.      Recognize normal developmental variations in organs such as kidney and brain.

Resident responsibilities:

1.     Review requisitions for the day’s work, past relevant imaging and determine appropriateness of the study requested.

2.     Establish plans for the studies.

3.     Review prior studies to ensure proper tailoring of the exam and review this information with the attending radiologist or fellow.

4.     Monitor and observe several of each of the common exams e.g. renal, cranial, abdomen and most of the less common exams e.g. liver and renal transplant, pelvis and hip ultrasounds.

Emphasis is on interpretation, although some “hands-on” experience is possible.  Portable studies in the Newborn Intensive Care Unit and other ICUs are also frequently done.  The resident participates in these studies as available.  Prior studies are often available and a valuable resource for comparison.  Ultrasound-guided biopsies, fluid drainages and other special studies may be performed with staff or fellow supervision but are generally the province of the fellow and/or the interventional service.

D.      Outpatient/Emergency Room

Aid your fellow resident(s) with outpatient reading as time permits.