PEDIATRIC RADIOLOGY - CHILDREN’S HOSPITAL SAN DIEGO

GOALS AND OBJECTIVES – 1st YEAR RESIDENTS

 

I.          Knowledge:     At the end of the rotation the radiology resident should be able to:

A.        CHEST

1.          Identify normal from abnormal airways and recognize air trapping  on chest radiographs of infants and young children.

2.         Recognize common hiding places of pneumonia in infants and children and recognize common normal pitfalls that are frequently mistaken for pathology.

3.         Identify foreign bodies in the lower airway of children.

B.         BONE

1.          Identify common and uncommon fractures in children.

2.          Differentiate accidental from non-accidental trauma.

3.          Establish bone age on the basis of radiographs and understand the different methods.

4.         Recognize and measure different types of scoliosis

5.          Recognize normal variants commonly mistaken for pathology.

C.         GENITOURINARY

1.          Identify abnormalities on VCUG’s and IVP’s versus normal  variants.

D.         G.I.

1.          Identify and formulate a differentiate diagnosis of neonatal intestinal obstruction in the neonate.

2.          Recognize malrotation on an UGI in the neonate, infant and child.

3.          Recognize radiographic abnormalities of the child with an acute  abdomen.

4.         Identify and witness or perform with supervision treatment of intussusception

5.             Identify swallowing disorders in children.

6.          Formulate a differential diagnosis in the child with GI bleeding.

E.          HEAD, NECK AND SPINE

1.          Identify normal vs. abnormal findings on skull and spine  radiographs.

II.         Decision Making/Technical Skills:  At the end of the rotation the resident should  be able to:

1.          Make preliminary decisions on film interpretation and consultation.

2.          Recognize and obtain assistance in situations, which require immediate input from the staff radiologist.

3.          Understand the importance of film quality, technique and radiation doses.

4.             Learn to perform fluoroscopic exams on neonates, infants and children; anticipating possible complications.

5.          Review pediatric inpatient and outpatient radiographs and dictate results  after work has been checked with staff radiologist.

6.          Make decisions on quality of films, ultrasound exams, etc. prior to  discharge of patient on outpatient studies.

7.          Recognize limitations of skills and always ensures all work is checked by staff radiologist prior to final dictation.

8.          Learn how to become more efficient and budget his or her time to accurately get through a large volume of work.


GOALS AND OBJECTIVES – 2nd /3RD/4TH YEAR RESIDENTS

I. Knowledge: At the end of the rotation the radiology resident should be able to:

A. CHEST

1. Identify normal from abnormal airways and recognize air trapping on chest radiographs of infants and young children.

2. Recognize common hiding places of pneumonia in infants and children and recognize common normal pitfalls that are frequently mistaken for pathology.

3. Identify foreign bodies in the lower airway of children.

4. Recognize abnormalities associated with congenital heart disease on chest radiographs.   

5. Explain pathophysiology and recognize patterns of the more common congenital heart lesions.

B.    BONE

1.     Identify common and uncommon fractures in children.

2.     Differentiate accidental from non-accidental trauma.

3.    Recognize and either diagnose or give a reasonable differential diagnosis of primary bone malignant and benign tumors and tumor-like lesions in children.

4. Identify causes of limping in a child.

5.     Understand and interpret hip ultrasound in the evaluation of hip dysplasia.

6.     Identify septic arthritis and/or osteomyelitis on radionuclide bone scans.

7.     Establish bone age on the basis of radiographs and understand the different methods.

8. Recognize and measure different types of scoliosis

9. Recognize normal variants commonly mistaken for pathology.

C.    GENITOURINARY

1.     Identify abnormalities on VCUG’s and IVP’s versus normal variants.

2.     Have a complete understanding of urinary tract infections in children and the role of various imaging modalities.

3. Recognize congenital abnormalities of the GU tract.

4. Recognize abnormalities on renal ultrasound in children.

5. Recognize abnormalities on radionuclide renal scans.

6. Identify testicular torsion, tumors and anatomic abnormalities by scrotal ultrasound.

D.    G.I.

1.     Identify and formulate a differentiate diagnosis of neonatal intestinal obstruction in the neonate.

2.     Recognize malrotation on an UGI in the neonate, infant and child.

3.     Recognize radiographic abnormalities of the child with an acute abdomen.

4. Identify and witness or perform with supervision treatment of intussusception

5.    Identify swallowing disorders in children.

6.     Formulate a differential diagnosis in the child with GI bleeding.

7. Understand the role of various imaging modalities in the child with an abdominal mass and formulate a differential diagnosis.

E.     HEAD, NECK AND SPINE

1.     Identify normal vs. abnormal findings on skull and spine radiographs including trauma, infections, neoplasms and congenital anomalies.

2.     Recognize abnormalities on skull films and CT in the evaluation of craniosynostosis.

3.     Identify common abnormalities on CT of the head and MRI of  the brain in neonates, infants and children.

4.     To identify normal and abnormal findings on cranial ultrasound.

5.     To identify abnormalities on MRI and ultrasound of the spine.

II.    Decision Making/Technical Skills: At the end of the rotation the resident should be able to:

1.     Make preliminary decisions on film interpretation and consultation.

2.     Recognize and obtain assistance in situations, which require immediate  input from the staff radiologist.

3.     Understand the importance of film quality, technique and radiation doses.

4.    Perform fluoroscopic exams on neonates, infants and children; anticipating possible complications.

5.     Review pediatric inpatient and outpatient radiographs and dictate results  after work has been checked with staff radiologist.

6.     Assist the technologist/nurse in preparation of the patient for fluoroscopic  examination (i.e. barium enema, bladder catheterization).

7.      Supervise and teach medical students and pediatric residents on elective  in radiology.

8.     Prepare and present cases at weekly conferences.

9.     Make decisions on quality of films, ultrasound exams, etc. prior to  discharge of patient on outpatient studies.

10.  Recognize limitations of skills and always ensures all work is checked by  staff radiologist prior to final dictation.

11.  Learn how to become more efficient and budget his or her time to accurately get through a large volume of work.


SUGGESTED STUDY/READING LIST:

1.    Children’s Hospital San Diego Radiology Teaching File. Using Dr. Senac’s file library then random additional cases in TF

2.     ACR Pediatric Radiology Syllabi - #’s 6, 19, 35.

3.     Emergency Radiology of the Acutely Ill or Injured Child, by Swischuk,

 Leonard. Williams & Wilkins, 4th ed, 2000.

4.     Practical Pediatric Radiology by Hilton, S. Edwards, D. Saunders,

 2nd ed, 1994.

5.     Practical Pediatric Imaging by Kirks, DR. Lippincott-Raven, 3rd ed, 1998.

6.     Caffey’s Pediatric X-Ray Diagnosis by Silverman, F and Kuhn, JP.

 Mosby, 9th ed, 1993.

7. Pediatric Neuroimaging by Barkovich, J. Raven, 3rd ed, 2000.


CONFERENCE SCHEDULE

MONDAY

Ortho/Rad 730-830

Neuro CT/MR I 800-830

Surgery/Rad 1230-1330 (1st Monday)

TUESDAY

Body/Neuro CT/MRI 800-830

Rad Ops 1200-1330 (1st Tuesday)

Rad M/M 1200-1330 (3rd Tuesday)

WEDNESDAY

Neuro CT/MRI 800-830

ER/Rad 1200-1330 (1st Wednesday)

Tumor Board 1230-1330 (2nd & 4th Wednesday)

Neuro Tumor Board 1230-1330 (3rd Wednesday)

THURSDAY

Body/Neuro CT/MRI 800-830

FRIDAY

Urology/Rad 730-830 (1st & 3rd Friday)

ICU M/M 730-830 (2nd Friday)

Trauma M/M 730-830 (3rd Friday)

ENT/Rad 730-830 (4th Friday)

Neuro CT/MRI 800-830

UCSD/Peds 1230-1330 (2nd Friday)

DAILY WORK SCHEDULE

8 AM Preview ER board

8 AMCT/MRI Conference

8 AM Fluoro schedule begins

830-done Read out ER board

830-done Wet reads

0830 NICU rounds

0900 PICU rounds

1030 House staff inpatients and ER rounds

1230-1330Lunch/Conferences (approx.)

1330-1700 US, Nuclear Medicine board, staff out, AM fluoro cases


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