Educational Goals of the

University of Washington Diagnostic Radiology Residency Training

in Emergency Radiology

Initial Rotation (Emergency Radiology Days Rotation)

(Year I):

During this rotation, there will be extensive oversight and training from the PAs, fellows and attendings on service. Follow up rotations will allow the resident to operate more independently to expand their skills in the areas introduced and taught during this first month.

Medical Knowledge and Technical Skills Objectives:

1. This four- week rotation is intended to provide an overview of the clinical environment and dilemmas for which Emergency Radiology functions. 

2. The important imaging considerations for major anatomic regions and mechanism of injury will be illustrated using case studies. 

3. Selected radiographic features of diagnostic importance and imaging pitfalls will be stressed. 

4. The resident will learn how to rapidly evaluate initial images on the CT console (when appropriate) to determine if additional imaging is indicated – such as CTA of the head or neck, delayed images through the abdomen and pelvis, etc.

5. The resident will learn to perform the basic emergency ultrasound study performed in the emergency department, specifically the FAST scan.

Practice-Based Learning and Improvement Objectives:

1. Epidemiology of trauma, prognostic significance of trauma severity scoring schemes and common patterns of injury will be presented. 

2. Alternative imaging strategies to important clinical questions will be outlined.

3. The resident will learn the protocols involved in appropriately imaging patients, to ensure that the appropriate imaging study is obtained, but that unnecessary or inappropriate studies are not obtained, as these contribute to delay in patient management, and increased radiation exposure and expense.

4. The resident will observe the xray technicians demonstrating how to obtain radiographs, and will observe numerous exams being performed, to better understand the challenges in imaging injured or uncooperative patients, and how to modify positioning or technique to improve image quality.

5. The resident will observe the CT technician image patients. They will observe the workflow in setting up the scanner, moving the patient onto and off the scanner, setting up for contrast injection, and obtaining, post processing and evaluating images for quality assurance, to better understand the steps involved, the options available for optimizing imaging, the options available for additional retrospective reconstructions, and the amount of time and effort it takes to accomplish these tasks.

Interpersonal and Communication Skills Objectives:

1. The resident will learn the workflow of the ED, interactions with other sections within radiology, interactions with our clinical colleagues, etc.

Advanced Rotation (Emergency Radiology Nights and Backup Rotations) (Years II, III):

These four-week rotations are intended for residents that have evidenced consultative skill and independence through successful completion of the initial curriculum and intra-departmental examinations.

This rotation allows the resident to be challenged in all topics addressed in the initial rotation, in what is frequently a busy and challenging environment. For many of the hours during their night rotation, no attending will be in the ED, allowing the resident to operate independently and without real-time oversight. (Note that an attending will always be on call and available for consultations and problems).

Medical Knowledge Based Objectives:

(1) Know the indications and contraindications for emergent/urgent imaging;

(2) Recognize imaging findings indicative or suggestive of specific injuries;

(3) Recognize "finger prints" indicative of particular mechanisms of injury, and know the commonly associated patterns of injury;

Practice-Based Learning and Improvement Objectives:

(1) Know the limitations of and alternatives to specific imaging modalities;

(2) Increase their expertise and confidence as an imaging consultant,

(3) Show understanding and appropriate use of standards for documentation, reporting, and security methods for patient privacy.

Curriculum

The Year I residents will be involved in daily sectional teaching consisting of a repeating sequence of 16 topics in a case-based format.   Additionally, they will present an hour-long follow-up conference of interesting cases at the end of the rotation.

These rotations are part of a broader didactic and case-study curriculum.  The curriculum is intended to: (1) Facilitate resident preparations for and passage of "the boards"; (2) Promote improved quality and cost-effective health care and, most importantly, (3) to underscore our important civic and cultural responsibilities to provide each patient, colleague, and our community with expert, timely and "user friendly" consultative, educational and interpretative services.

Bibliography

HMC Bone Rotation Handouts. Residents will be given this folder/notebook with notes related to orthopedic injuries, which residents find to be a useful reference source.

Trauma Radiology Companion. EJ Stern: Check out a copy from the library and read this first. If not available in library, ask our library staff to recall a copy for your use.

Emergency Radiology. Distributed by CMEInfo. Set of DVDs of our 2006 CME course, available in library. Review DVDs during rotation.

Other useful references, but usually too much to read in first months:

Imaging in Trauma and Critical Care.  Stuart E. Mirvis and Kathirkamanthan Shanmuganathan.

Radiology of Skeletal Trauma. Lee F. Rogers

The Radiology of Emergency Medicine. John H Harris and William H Harris