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Curriculum

Our residents spend approximately 60- to 70% of their time at UC Irvine Medical Center and 30- to 40% of their time at VA Long Beach Medical Center.

Pediatric months are spent at Children's Hospital of Los Angeles and at UC Irvine Medical Center. Approximate tallies of rotations are provided below.

During the first six months of the PGY-2 year, residents rotate through general diagnostic divisions with no call of any kind. Starting from January of PGY-2 year, residents begin taking home IR and VA call. As per ACGME guidelines, in-house ER rotations will begin in July of PGY-3 year. IR, fluoroscopy, musculoskeletal and ultrasound rotations provide many opportunities for hands-on learning of imaging guided procedures.
 

Advanced rotations

During advanced imaging rotations, senior residents learn state-of-the-art modalities, which include coronary CT angiography and CT-intravenous pyelography (CT-IVP), among others. Program faculty and a network of volunteer private practice radiologists provide extensive senior reviews to residents prior to oral board examination.

Our program provides daily conferences, which consist of didactic sessions and "hot seat" reviews.

Conference sessions

At UC Irvine, noon and 4 p.m. teaching sessions are held on Mondays, Tuesdays and Thursdays. A noon teaching session is also held on Fridays.

At the VA Long Beach Medical Center, we have daily noon conferences on Mondays, Tuesdays, Thursdays and Fridays. Physics lectures are offered once or twice a week by several full-time physics teaching faculty to prepare junior residents for ABR physics examination.

Apart from residents on ER, IR and CHLA rotations, everyone attends Wednesday afternoon didactic sessions at UC Irvine Medical Center.

PGY-4 and PGY-5 residents attend AFIP course in Washington, D.C.

Approximate Rotation Tallies

UCI
Months
Body CT 2-3
Ultrasound 2-3
Neuroradiology 2
Fluoroscopy 2-3
Chest 2-3
Bone 2-3
MRI 2-3
Nuclear Med. 2-3
ER 4-5
Research 1
IR 2-3
Adv. Imaging 1
Elective 2
Mammography 3
OB-US 1
LBVA
Rotation Months
CT 2
General Dx 4-5
US 2-3
MRI 2
NM 2-3
Advanced CT 1
General Diagnostic / GI-GU »
Description:

The rotation in abdominal radiology encompasses the spectrum of gastrointestinal and genitourinary radiology. The techniques of fluoroscopy are taught, including single and triphasic upper GI examinations, all types of small bowel examinations and single and double contrast barium enemas. Intravenous urography is also taught, along with fluoroscopic genitourinary radiology procedures. The day begins promptly at 7:30 a.m. with a review of abdominal radiographs. Residents then perform and interpret the fluoroscopic examinations and the intravenous urograms during the course of the day under the close supervision of the faculty. Each case is discussed in detail and the educational activities of the section are supplemented by assigned reading of appropriate texts and journal articles. Faculty and residents also attend an interdisciplinary gastroenterology conference once a month. 

General Goals:
  • Develop proficiency in the performance of gastrointestinal fluoroscopic examinations, including but not limited to, single and triphasic upper GI examinations, the small bowel follow-through and single and double contrast barium enemas.
  • Discuss the use of barium versus water-soluble contrast agents and the indications and contraindications for each.
  • Discuss the role of glucagon in fluoroscopic barium studies and its intended effect, side effects and contraindications.
  • Develop proficiency in the supervision of intravenous pyelography and in the performance of fluoroscopic genitourinary radiological studies, including but not limited to, voiding cystography and retrograde urethrography.
  • Discuss the use of ionic vs. low osmolar contrast and the indications and contraindications for each.
  • State the proper assessment and treatment of allergic reactions to contrast material.
  • Describe the most common indications for fluoroscopic contrast examinations and discuss the advantages and limitations in these and other clinical presentations. Discuss alternative imaging modalities when the role of fluoroscopy is limited.
  • Develop a method of performing an examination given a specific clinical indication. Aim to maximize information and minimize radiation, time and cost.
  • Develop a viewing pattern and a dictating style that answers the clinical question posed and that presents the relevant findings in a cogent, logical and easily understandable fashion.
  • Recognize the normal radiographic appearance of the structures of the gastrointestinal and genitourinary tract.
  • Recognize common pathologic entities and provide a diagnosis or a differential diagnosis, as appropriate.

Specific Goals:
  • State the findings on an abdominal radiograph that may be seen in patients with a small bowel obstruction. Compare and contrast this with the findings in an adynamic ileus.
  • Describe the findings in reflux esophagitis that may be seen on a barium study of the esophagus and discuss the progression to Barrett's esophagus.
  • Enumerate the findings that may help differentiate a benign gastric ulcer from a malignant one.
  • Identify the findings in appendicitis and diverticulitis. Compare and contrast the role of a barium enema to computerized tomography in these entities.
  • Discuss the role of the barium enema in the screening for colon carcinoma. Describe the appearance of pre-malignant and malignant lesions of the colon.
  • Identify signs of renal obstruction on intravenous pyelography.
  • Grade the level of vesicoureteral reflux, if any, identified during a voiding cystourethrogram.

Reading List:

Gastrointestinal Radiology 

  • Jones and Braver. Essentials of G.I. Radiology
  • Margulis and Burhenne. Alimentary Tract Radiology
  • Laufer and Levine. Double Contrast Gastrointestinal Radiology
  • Jones and Donner. Normal and Abnormal Swallowing
  • Johnson. Alimentary Tract Imaging-A Teaching File
Genitourinary Radiology 

  • Kutcher, R. Genitourinary Radiology
  • Amis, S. Essentials of Uroradiology
  • Dunnick, R. Textbook of Uroradiology
  • Barbaric, Z. Principles of Genitourinary Radiology
Angiography & Interventional Radiology »
Description:

The vascular and interventional radiology rotation hopes to teach the resident basic angiography and image guided techniques, as well as interpretation of the imaging involved.


General Goals:
  • To become familiar with the indications, contraindications, technique and expected benefits of interventional diagnostic and therapeutic procedures.
  • To develop a level of technical proficiency.
  • To learn to avoid complications, by technique modification, caution, common sense, etc.  Learn the management of complications when they occur.
  • To develop an appropriate, professional communication style when dealing with patients and families.
  • To learn and practice radiation safety (ALARA principle) while operating the appropriate imaging equipment for interventional procedures.
  • To communicate well, develop a descriptive ability that is concise and function as a true consultant when dealing with colleagues and referring physicians.
  • To master vascular anatomy, normal, variant and pathological, as well as the pertinent imaging techniques and findings on all modalities used in IR including the principles, applicability and limitations of MRA and CTA.
  • To realize and master the periprocedure aspects of IR cases, especially, the pre-procedure consultation, procedure planning and goals, the procedure performance and interpretation, and the post-procedure care and management of the patient.

Specific Goals:

To have performed (under supervision) basic interventional procedures.
  • Basic angiography - femoral arterial and venous puncture, master the safe handling of catheters, flushing, injecting, connecting, power injection, manipulation and exchanging including the obtaining of hemostasis following arterial and venous procedures, and supervision of image acquisition.
  • Image guided (Fluoro, US, CT) procedures; including a) biopsy techniques, including coaxial access systems and other specific biopsy devices, b) drainage of abnormal fluid collections.
  • Percutaneous access to the biliary and renal systems.
  • To become familiar and competent at conscious sedation and patient monitoring.

Responsibilities:
  1. Starting time is 7:45 a.m. sharp.
  2. Prior to the day's procedures, scan the day's cases and discuss with the fellow or attending physician the most suitable schedule and use of rooms/facilities, etc.
  3. The resident should evaluate the patient, which includes reviewing the history, indications for the procedure, pertinent labs, previous relevant imaging, interviewing the patient and obtaining full informed consent.
  4. The patient evaluation together with a directed physical examination and informed consent has to be included in a clear and legible pre-procedural note.
  5. The resident must maintain their personal procedure log, the IR procedure log (angio reading room), a log of the services' "active" inpatients that need continued follow-up and any IR department research related data collection sheets that need completion and dictate the cases he/she is involved with following review with the relevant attending.
  6. The resident must ensure that all relevant pre-procedure medications have been requested and administered (e.g., many procedures require antibiotics prior to commencement; therefore, anti-infective orders need to be written).
  7. There are a number of conferences which the IR team attends and presents at, including Surgical M+M (Thursday mornings) and Vascular Conference (Wednesday afternoons).  The resident should coordinate the imaging of the patients to be presented and gain valuable experience in presenting the interesting cases.
  8. With respect to both on-call and daytime cases, the resident must obtain the relevant information, discuss the request with an attending, relate the decision to the requesting service and coordinate the case staffing.
Above all, the resident is not on service purely for the purpose of paperwork and consenting patients. At the end of the rotation the resident should have gained useful knowledge and experience from their hard work and, hopefully, have enjoyed their time in the angio/interventional section. The interventional radiology service is a team effort, and both the fellow and attendings will always share and help with the service's tasks and aid the resident at all times.


Reading List:

Textbooks:
  • Cope C, Burke DR, Meranze C:  Atlas of Interventional Radiology.  JP Lippincott, New York, 1990.
  • Kadir S, Diagnostic Angiography.  WB Saunders Co, Philadelphia.
  • The SCVIR Syllabus Series
    • Peripheral Vascular Interventions
    • Visceral and Thoracic Arteriography and Interventions
    • Portal Hypertension
    • Venous Interventions
    • Biliary Interventions
  • For reference: Abrams Angiography 4th ed. Little Brown and Co.
Journals:
  • Journal of Vascular and Interventional Radiology
  • Cardiovascular and Interventional Radiology
  • American Journal of Roentgenology
  • Radiology
Multimedia:
  • SCVIR Interactive Videodisc Training Programs
    • Peripheral Vascular Disease
    • Peripheral Vascular Interventions
    • Portal Hypertension
    • Venous Interventions
    • Biliary Interventions
Body CT »
Description:

The body CT service interprets computerized tomographic studies of the chest, abdomen and pelvis performed for a variety of indications. The resident on the service is responsible for formulating a preliminary interpretation on all of the studies reviewed during the day, either individually or in conjunction with the fellow. The resident should expect to arrive at 7:30 a.m. to begin reviewing the cases. The resident and fellow will work together to ensure that valid indications are provided for all studies, that all contrast injections are performed in a timely fashion and that all studies are checked prior to discharge of the patient from the department. Residents and fellows will also organize the cases prior to final interpretation by an attending. This may include hanging the current and relevant prior studies and/or pulling the reports of prior studies. After the attending has reviewed the cases with you, remain at the alternators to dictate the cases and serve as a consultant to the referring physicians as they review their films. Ensure that trauma cases are incorporated into the daily work and that they are interpreted as soon as they are filmed.

Once a week, an Adult Tumor Board is held, which the radiologists on the body CT service attend. Depending on their level of experience and comfort, residents are encouraged to present the cases at this conference. The body CT service may also present cases at the Gynecological Oncology Tumor Board.


General Goals:
  • Identify normal anatomy of the chest, abdomen and pelvis.
  • Describe the most common indications for body computerized tomography, and discuss its advantages and limitations in these and other clinical presentations. Discuss alternative imaging modalities when the role of body computerized tomography is limited.
  • Prescribe a method of performing an examination given a specific clinical indication. Aim to maximize information and minimize radiation, time and cost.
  • Develop a viewing pattern and a dictating style that answers the clinical question posed and that presents the relevant findings in a cogent, logical and easily understandable fashion.
  • Recognize common pathologic entities and provide a diagnosis or a differential diagnosis, as appropriate.

Specific Goals:
  • Evaluate trauma patients for the presence or absence of pneumothorax, pneumoperitoneum, free fluid, visceral laceration, osseous injury and a sentinel clot.
  • Describe the features of benign vs. malignant liver lesions, such as cysts, hemangiomas, hepatomas and metastases.
  • Identify signs of nonresectability in patients with pancreatic cancer.
  • Stage patients with common chest, abdominal and pelvic malignancies such as carcinomas of the lung, breast, esophagus, stomach, pancreas, kidney, colon, cervix and ovary.
  • Describe the different patterns of metastatic disease due to cervical, ovarian and endometrial cancer.
  • Identify the findings in appendicitis and diverticulitis. Compare and contrast the role of computerized tomography to a barium enema in these entities.
  • Enumerate the findings in acute renal obstruction.
  • Describe the work-up of the incidentally discovered renal or adrenal mass.

Reading List:
  • Webb, Brant and Helms. Fundamentals of Body CT
  • Lee, Sagel, and Stanley. Computed Body Tomography with MRI Correlation
  • Mueller and Webb. High Resolution CT of the Chest
  • Myers. Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy
  • Zerhouni and Naidich. CT of the Thorax and MRI Correlation
Neuroradiology and Head & Neck Radiology »

Description:


Residents are allocated portions of several months on the Neuroradiology and Head and Neck Radiology boards. A portion of the training is incorporated with the vascular/interventional rotation and the MRI rotation. Dedicated neuroradiology on the Neuro CT board totals two months at UC Irvine Medical Center.

The residents are expected to protocol all the patients in order to fully determine the clinical indications for each examination. Following adequate clinical information, a decision needs to be made regarding appropriate imaging planes, the slice thickness and slice intervals.

Goals:
  • To develop an understanding of neuroimaging of the brain, head and neck, and spine.
  • To be able to develop indications for CT vs. MRI studies (see attached Imaging Guidelines: Neuroradiology and MRI).
  • To be able to interpret the studies appropriately.

Responsibilities:
  1. Reporting of the neuro/CT and the head and neck radiology cases, within one day after the cases are performed.
  2. Being available from 7:30 a.m. to protocol forms that have been received since the previous day. At the end of each day, Monday-Friday, the next day's exams are previewed and protocoled as needed.
  3. The resident is to be available promptly for all contrast injections, if needed. This includes the first case of each morning.
  4. The resident is expected to work closely with the non-radiology housestaff and attending staff to communicate patient needs.
  5. The following protocols apply for deciding the correct examination:
    1. The routine brain study is done in the "EMI" plane (20? to the infraborbital-meatal line - Reid's base line).
    2. Refer to previous examinations when available. Comparison studies should be performed in a similar fashion regarding positioning and contrast material use.
    3. Elderly patients, patients with airway problems, patients with rigid spines, sedated children and others may have to be scanned in a plane closer to the axial plane because of mechanical or other reasons.
    4. Be specific in categorizing various studies properly. Physicians will then learn to request them precisely. Examples:
      • Orbital CT - should be done in axial and coronal planes.
      • Skull base or facial CT - preferably in two planes.
      • Neck CT - axial.
      • Spinal CT - usually regional of cervical, thoracic or lumbar areas in axial plane.
      • CT myelography - usually regional and with nonionic contrast medium.
    5. Overlapping sections. Examples:
      • Whenever necessary, to compensate for the partial volume effect of scan voxel thickness. (Is the abnormality real?).
      • For all orbital studies (usually 2 mm of overlapping through orbital center with EMI or 2.5-5 mm through orbital center with G.E.). In the coronal plane, 5 mm of overlap should suffice.
  6. The following guidelines are suggested for deciding about ionic contrast material:
    1. A history to suggest possible risk of contrast material injection should always be obtained in each patient.
    2. Contrast material should probably not be injected without special deliberation and/or consent in the following patients:
      • Anaphyllactoid reaction to contrast material in the past.
      • Obviously dehydrated patients (poor skin turgor, sunken eyes, and impaired oral intake).
      • Multiple myeloma.
      • Gout or uric acidemia.
      • Renal failure.
      • Insulin dependent, poorly controlled or long-standing diabetes (especially when possibly dehydrated).
      • Congestive heart failure.
    3. Dosage in children should best be kept to 1 cc per pound of body weight. (In small adults it is also best to adhere to this dosage).
    4. Contrast scans should not be done on the same day as other contrasted radiographic exams - IVU, angiography, etc.
    5. A decision for contrast injection should be made more readily in patients who have been administered general anesthesia in order to avoid having to repeat the anesthetic to complete the study.
    6. Contrast injection may be eliminated in the following examination:
      • The first study following head trauma if performed within five days of the event.
      • Studies to follow ventricular size in unshunted patients.
      • Studies to follow ventricular size in shunted patients where the shunt is felt to be functioning satisfactorily.
      • Contrast material should be used in shunted hydrocephalus where the shunting system is suspected to be impaired (may show ventriculitis, meningitis).
Reading List
  • Connors III JJ and Wojak JC. Interventional Radiology: Strategies and Practical Techniques. Philadelphia: WB Saunders Co., 1999.
  • Greenberg JO. Neuroimaging. A Comparison to Adams and Victor's Principles of Neurology. New York: McGraw-Hill, Inc., 1995.
  • JR, da Costa Leite C. Neurodiagnostic Imaging. Pattern Analysis and Differential Diagnosis. Philadelphia: Lippincott-Raven, 1998.
  • Newton TH, Hasso AN and Dillon WP. Computed Tomography of the Head and Neck., Volume III. New York: Raven Press, 1988.
  • Orrison Jr WW, Lewine JD, Sanders JA, Hartshorne MF. Functional Brain Imaging. St. Louis: C.V. Mosby Co., 1995.
  • Phelps PD and Lloyd GAS. Radiology of the Ear. Boston: Blackly Scientific Publications, 1983.
  • Ramsey RG. Neuroradiology with Computed Tomography. Philadelphia: W.B. Saunders Co., 1981.
  • Som PM and Bergeron RT. Head and Neck Imaging. St. Louis, Mosby Year Book, 2nd ed., 1991.
  • Weinberg PE, et al. Neuroradiology Test and Syllabus, Part 1. ACR, 1990.
  • Weinberg PE, et al. Neuroradiology Test and Syllabus, Part 2. ACR, 1990.
  • Williams AL and Haughton VM. Cranial Computed Tomography. St. Louis: CV Mosby Co.,Inc., 1985.



Neuroradiology and MRI

Anton N. Hasso, M.D., F.A.C.R.

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Head and Brain

Computed Tomography (CT)
CT without contrast is the best way to evaluate acute trauma and suspected acute hemorrhage or hemorrhagic infarction within the first 12 to 24 hours. Bone artifacts diminish accuracy in the posterior fossa.

Indications:
  • Acute head trauma with suspected intracranial bleeding.
  • Suspected subarachnoid hemorrhage.
  • Suspected hemorrhagic cerebral infarction.
  • Contraindications to MRI (aneurysm clips, pacemakers, neurostimulators, cochlear implants, pregnancy).

Magnetic Resonance Imaging (MRI)
MRI is the best way to evaluate the brain when acute hemorrhage is not an issue and if MRI is available and not contraindicated.  CT should be obtained in all other circumstances.

Excellent Indications:
  • Suspected, but undiagnosed hemorrhage in posterior fossa or brain stem.
  • Suspected, non-hemorrhagic cerebral infarction
    • dementia, suspected from multiple infarcts.
  • Suspected intracerebral aneurysms or arteriovenous malformations.
  • Suspected dural sinus thrombosis.
  • Suspected brain tumor, including particularly:
    • meningiomas
    • posterior fossa tumors
    • acoustic neuromas
  • Suspected intracerebral metastases
    • bulky tumors
    • tumor seeding of meninges or any intradural locus
  • Suspected lymphoma
  • Suspected pituitary tumor or lesion
  • Suspected intraorbital or visual pathway lesions
  • Suspected intracranial infections such as cerebritis, meningitis, when lumbar puncture is not diagnostic, particularly:
    • brain abscess
    • toxoplasmosis
  • Suspected multiple sclerosis. (MRI of the brain is the first choice over evoked responses).
  • Suspected multifocal leukoencephalopathy
Poor Indications:
  • Headaches
  • Tension headaches
  • Migraine
  • Cluster headaches
  • Dizziness
  • Vertigo

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Head and Neck (Cranial and Extracranial)

Computed Tomography (CT)


CT is the best way to evaluate cortical bone, such as the bony calvarium. It is best for the middle ear, ossicles and cholesteatoma. CT is vastly superior to plain radiographs for the evaluation of large air spaces such as sinuses, mastoids and adjacent bone.

Indications:
  • Evaluation of osseous structures.
  • Suspected middle ear disorders.
  • Suspected disorders of paranasal sinuses or mastoids. (Please note: limited coronal sections are most cost-effective).
  • Evaluation of masses of the hypopharynx and larynx.
  • Indications for MRI when MRI is contraindicated.

MRI
MRI is the best way to identify and evaluate soft tissue masses with respect to their source of origin, their precise location and extension, and for temporomandibular joint if imaging is necessary.

Indications:
  • Staging of head and neck malignancies.
  • Evaluation of the extent of thyroid malignancies.
  • Evaluation of thyroid or parathyroid masses if neither nuclide scans nor ultrasound is used.
  • Evaluation of masses of nasopharynx, parotid or submandibular glands.
  • Evaluation of ocular and orbital lesions.
  • Evaluation of temporomandibular joint dysfunction.

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Contraindications:

Aneurysm clips, pacemakers, neurostimulators, cochlear implants, pregnancy
(Relative contraindication: An uncooperative patient - anesthesia may be required)

Computed Tomography (CT)
CT is useful for the assessment of the spine when MRI is contraindicated or unavailable but is only rarely superior, such as in the evaluation of fractures.

Indications:
  • Suspected spinal fracture.
  • Suspected spinal stenosis when low back pain is progressive and heaviness after exercise is relieved by rest.
  • Indications for MRI when MRI is contraindicated.

MRI
MRI is best for the evaluation of known or possible tumors, including primary bone tumors, skeletal metastases and intradural masses. It can provide a non-invasive, non-radiating serial evaluation of the response to anti-cancer treatment. It is best to show infection such as spondylitis, osteomyelitis, discitis and abscesses. It is best to show the demyelination of multiple sclerosis is the spinal cord in involved and MRI of the brain is negative. It is best to diagnose spinal disc degeneration, distinguish it from facet or spur problems, and to diagnose spinal cord diseases. It eliminates the need for myelography to diagnose metastases and may make it unnecessary prior to disc surgery. It is best for all levels of the spine.

Indications:
  • Suspected vertebral, paraspinal or intraspinal metastases or infections.
  • Suspected primary bone tumors.
  • Suspected multiple sclerosis or spinal cord disease.
  • Suspected disc herniation, based on progressive and persistent symptoms of back and leg pain, lasting four to eight weeks without improvement despite treatment including bed rest and medication.
  • Radiculopathy of unknown cause.
  • Suspected spinal stenosis when low back pain is progressive and heaviness after exercise is relieved by rest.
  • Follow-up of treatment for malignancy or infection.
  • Evaluation of recurrent symptoms after spinal surgery.

MRI DANGERS - Screening for Patient Safety (Absolute & Relative Contraindications)

The following militate against patient eligibility for MRI (things to ask your patients about before requesting MRI):
  • Cardiac pacemakers and other implantable or surface electronic devices (includes pain stimulators and insulin infusors).
  • Artificial heart valves (some but not all).
  • Cerebral aneurysm clips and other metal vascular clips on the brain.
  • Cochlear implants and metal middle ear drainage devices.
  • Bullets, shrapnel or metal fragments in the body (depending on location and presence of fibrosis).
  • Metal orthopaedic prostheses in the body region under MRI investigation.
  • Metal workers, including grinding and welding (may require X-ray of orbital region to exclude intraorbital metallic foreign bodies).
  • History of eye injury from metal fragments (may require X-ray of orbital region to exclude intraorbital metallic foreign bodies).
  • Pregnancy.
Magnetic Resonance Imaging »
Description

Residents are allocated up to six months of rotation on the magnetic resonance imaging service during residency. During the rotation, the resident is expected to learn basic information regarding the safety and efficacy of magnetic resonance imaging and the interpretation of the diagnostic images. Familiarity with physical parameters will be stressed in both practical experience and didactic lectures.

The residents are expected to interface with the patients in order to fully determine the clinical indications for each examination and the safety constraints which must be met in each individual case, in order to integrate these factors in forming a decision regarding appropriate pulse sequences and imaging planes.


Goals:
  • To gain an understanding of the physical parameters involved in magnetic resonance sciences (MRI, MRA, MRS).
  • To develop a good understanding of image interpretation.
  • To integrate patient clinical information and safety needs in a way that will allow the most optimal imaging parameters to be chosen.
  • To develop familiarity with the possible imaging parameters available and the indications for their use.
  • To develop appropriate reporting skills.
  • To provide high-quality patient care compatible with the goals of UC Irvine Medical Center and the School of Medicine.

Responsibilities:
  1. The starting time for full-time involvement each day is at 7:30 a.m., Monday-Friday. The resident of the day is expected to be available by beeper or by telephone during the working day.
  2. Neuroradiology and MRI resident teaching conferences are held intermittently within the regular resident conference schedule. In addition, the radiologic clinical correlative Neuroradiology-Neurology-Neurosurgery joint conference is held from 7:30 a.m. to 9:00 a.m. each Wednesday in Building 3, Room 101.
  3. Attend and participate in the daily film reading sessions.
  4. Make every effort to maximize patient throughput while providing exceptionally user-friendly service to the patients and the referring physicians.
  5. Work with and respect the expertise of the technologists and ancillary personnel. They are very experienced and have much to teach.
  6. Coordinate all away time with the MR fellow in order to ensure smooth and continuous coverage.
  7. Obtain more detailed policy and procedure information from the departmental secretary.

Reading List:
  • Barkovich AJ. Pediatric Neuroimaging, 2nd ed. Philadelphia: Lippincott-Raven, 1995.
  • Bradley Jr WG and Bydder G. MRI Atlas of the Brain. London: Martin Dunitz, 1990.
  • Bradley Jr WG, Adey WR and Hasso AN. Magnetic Resonance Imaging of the Brain, Head and Neck: A Text Atlas. Maryland: Aspen Systems Corp., 1985.
  • Brandt-Zawadski M and Norman D. Magnetic Resonance Imaging of the Central Nervous System. New York: Raven Press, 1987.
  • Bushong SC. Magnetic Resonance Imaging: Physical and Biological Principles. St. Louis: CV Mosby Co. Inc., 1988.
  • Cohen MD an Edwards MK. Magnetic Resonance Imaging of Children. Philadelphia: BC Decker Inc., 1990.
  • Higgins C and Hricak H. Magnetic Resonance Imaging of the Body. New York: Raven Press, 1987.
  • Manacuso A and Hanafee W. Computed Tomography in Magnetic Resonance Imaging of the Head and Neck, 2nd ed. Baltimore: The Williams and Wilkins Co., 1985.
  • Mink, et al. Magnetic Resonance Imaging of the Knee. New York: Raven Press, 1987.
  • Orrison Jr WW, Lewine JD, Sanders JA, and Hartshorne MF. Functional Brain Imaging. St. Louis: CV Mosby Co. Inc., 1995.
  • Reeder MM, Bradley Jr WG. Gamuts in RadiologyComprehensive Lists of Roentgen Differential Diagnosis, 3rd ed. New York: Springer-Verlag, 1993.
  • Stark D and Bradley W. Magnetic Resonance Imaging, 3rd ed. St. Louis: CV Mosby Co., Inc., 1999.
  • Stoller DW. Magnetic Resonance Imaging in Orthopaedics and Sports Medicine. Philadelphia: JB Lippincott Co. Inc., 1993.
  • Valk J and van der Knaap MS. Magnetic Resonance of Myelin, Myelination, and Myelin Disorders. New York: Springer-Verlag, 1989.
Mammography »
Description:

Radiology residents rotate through the mammography section for a total of two months (two rotations).

Knowledge-Based Objectives:

After completion of the mammography rotation, the resident should be able to:
  • List the major risk factors for breast cancer.
  • Differentiate between indications for screening and diagnostic mammograms.
  • Identify the different histological types of breast cancer.
  • Recognize the mammographic projections and how they are obtained.
  • Evaluate normal vs. abnormal structures on the mammogram.
  • Determine benign characteristics of masses and calcifications on mammography.
  • Determine malignant characteristics of masses and calcifications on mammography.
  • Detect architectural distortion on the mammogram.
  • Work up diagnostic problems with additional views, ultrasonography, and clinical correlation.
  • Utilize the BI-RADS classification in determining a final mammographic interpretation.
  • Establish a follow-up plan from probably benign lesions.
  • Comply with MQSA and accreditation laws, including quality control measures.

Technical Skills:

At the end of the rotation, the resident should be able to:
  • Interpret and dictate mammograms after review by the attending radiologist.
  • Assist with and perform mammographic needle localizations of breast lesions.
  • Select lesions appropriate for stereotactic core biopsy. Assist with the performance of same.

Decision-Making and Value-Judgment Skills:

At the end of the rotation, the resident should be able to:

  • Recognize limitations in personal skill and knowledge, always making sure decisions, dictations and consultations are checked by the attending radiologist.
Musculoskeletal Radiology »
Description:

The section of musculoskeletal radiology encompasses all radiographic imaging services and interventional procedures related to musculoskeletal radiology. These include: interpretation of plain radiographs, computed tomography and MRI studies of the bones and joints. Also included are procedures such as arthrography, therapeutic joint injections including facet joint and appendicular skeleton joint injections, soft tissue and bone biopsy. This section provides urgent consultations to orthopaedics, rheumatology, emergency medicine and others. Our residents are encouraged to attend Thursday morning Orthopaedic Grand Rounds and once a month, Radiology-Rheumatology Conference.


General Goals:
  • Identify normal anatomy of the bones and joints.
  • Describe the most common indications for plain radiograph, CT and MRI for different bones and joints.
  • Identify the modality of choice for the best and least expensive evaluation of a disease process in an anatomical site.
  • Discuss alternative imaging modalities.
  • Review the radiological and technical steps in setting a protocol for doing tomograms, CT and MRI studies.
  • Discuss the indications and procedural steps for performing arthrograms and other procedures in this section.
  • Develop a viewing pattern and dictating style that answers the clinical questions and presents relevant findings.
  • Discuss common pathologic entities and provide a diagnosis or a differential diagnosis for one or a combination of radiologic findings.

Specific Goals:
  • Discuss radiological reporting of skeletal trauma.  Report the proper description of fractures, position and alignments.
  • Evaluate signs of osteomyelitis and septic joint, spondylodiscitis, tuberculosis, sarcoid and Paget's disease.
  • Review the differential diagnoses for chondrocalcinosis, bone infarcts, epiphyseal, metaphyseal and diaphyseal lesions of bone.
  • Recognize different bone matrices such as osteoid, fibrous and chondroid matrices.
  • Discuss the differential diagnosis of common osteolytic and osteosclerotic lesions of bone and understand the origin of metastasis from other organ systems to bone.
  • Evaluate differential diagnosis of expansile bone lesions, permeative lesions, punched-out lytic lesions, endocortical erosion, etc.
  • Discuss the differential diagnosis of periosteal new bone formation and differentiate aggressive from benign reactions.
  • Discuss the target joints for different arthritides.
  • Evaluate common bone dysplasias.
  • Understand and recognize common metabolic bone disorders.

Guidelines:

The following are guidelines which radiology residents should follow to ensure a comprehensive educational experience in this section.

The key to a successful rotation is awareness, being prepared and knowing what to expect.

How to Preview:
  1. Start reviewing cases at 7:30 a.m.
  2. Knowing the patient is important. Getting information from requisition, looking at patient's computerized medical record and prior radiological studies, or calling the physician or the nurse for information and history.
  3. Making certain prior radiology examinations have been loaded into current status on the PACS system.
  4. Making certain the CT or MRI related to an arthrogram is transmitted and loaded onto the PACS system.
  5. Load the bone or PET scan (if available) of patients being evaluated for skeletal metastasis.
  6. If a case is incomplete for any reason, such as missing images or requisitions, call and inform the film library. (Do not try to interpret an incomplete exam).
  7. Read about the cases from books and journals.  Know the disease process and the mechanism.
How to Review:
  1. When a resident is reviewing the cases with attending, he/she is assumed to know the cases and the findings.
  2. Residents are encouraged to analyze the findings and ask questions.
  3. Be prepared to show your knowledge about the disease process. Quote a book or an article you have read about the subject.
  4. Register the interesting cases in the Bone Book.
  5. Show those interesting cases in Rheumatology Conference with review of recent literature.
  6. Review and be prepared to discuss one recent article every day (preferably Radiology, AJR, Skeletal Radiology).
Dictation:
  1. Start with history, then X-ray findings and, at the end, conclusion. Be descriptive and to the point. Answer those pertinent clinical questions. Do not describe too many negative findings unless they are pertinent to the clinical concern.
  2. Sign out your reports on the RIS (Radiology Information System) twice every day (early morning and late afternoon).
Procedures:
  1. Read about the procedure on the night before the procedure is scheduled, and be mentally prepared.
  2. Arthrograms are scheduled in the afternoon, usually at 1, 2, and 3 p.m.
  3. In obtaining the consent form from the patient, get allergy history (especially to contrast agents and Xylocaine). Inform the patient about the risks of bleeding, infection and allergic reactions. Describe the details of the procedure to the patient to be prepared.
  4. Get the follow-up on the patient after surgery or during the clinical course.

Suggested Readings:
  • Arthritis - Black and White.  By Ann Brower
  • Summarized Version of Resnick's Book (one volume)
  • Keats Book of Normal Variants
  • Meschan Book of Normal Radiological Anatomy
  • Pitt MJ, Speer DP. Radiologic reporting of skeletal traumaRadiologic Clinics of North America, Vol. 28(2), March 1990
  • Bone Radiology, Felix Chew
  • Orthopaedic Radiology - A Practical Approach. Author: Adam Greenspan
Molecular Imaging »
Description:

Molecular Imaging encompasses all diagnostic and therapeutic in vivo procedures using unsealed radioactive materials. Most of these procedures are imaging procedures.  The clinical rotations take place at UC Irvine Medical Center, at the VA Long Beach Medical Center and at Long Beach Memorial Medical Center. At UC Irvine Medical Center, the day usually begins around 8 a.m. The resident is responsible for obtaining relevant patient data prior to or at the time of dosing a patient. This data may be from the referring physician, the chart, the patient or from our radiology files. This data may modify the requested study. The resident must understand the clinical indication for the study and what it is expected to demonstrate. The resident is responsible for ensuring studies are complete prior to the patient leaving the department and that all possible information has been obtained from the study. The resident on the service is responsible for formulating a preliminary interpretation on all of the studies reviewed during the day. The resident dictates the cases after review with the attending physician. This need not happen at a fixed time; optimally each scan is dictated as the patient is leaving the department. Dictation might be delayed to obtain correlation with prior studies or additional information from the referring physician. After the attending has reviewed the cases with you, remain in the nuclear medicine reading room to dictate the cases and to serve as a consultant to the referring physicians as they review their films. The resident in nuclear medicine is often asked to present cases at Tumor Boards, Morbidity and Mortality Conferences and Clinical Pathologic Conferences, even when these cases do not involve nuclear medicine studies.


General Goals:
  • Describe the most common indications for nuclear medicine studies and discuss the advantages and limitations in these and other clinical presentations. Discuss alternative imaging modalities when the role of nuclear medicine is limited.
  • Prescribe a method of performing an examination given a specific clinical indication. Aim to maximize information and minimize time and cost.
  • Develop a viewing pattern and a dictating style that answers the clinical question posed and that presents the relevant findings in a cogent, logical and easily understandable fashion.
  • Recognize common pathologic entities and provide a diagnosis or a differential diagnosis, as appropriate.
  • Know the physical and biological characteristics of common radiopharmaceuticals used in clinical nuclear medicine studies.
  • List the quality control procedures involved in the preparation and administration of radiopharmaceuticals.
  • Describe the quality control procedures employed and the frequency with which they must be done to ensure optimal performance of the equipment and compliance with government regulations.

Specific Goals:

At the end of their rotations, each resident should be familiar with the indications for the following sorts of studies, the diagnostic criteria and the radiopharmaceuticals used in each:
  • First Year
    1. Skeletal scintigraphy: Use of 2 and 3-phase scans, diagnosis of osteomyelitis, patterns of metastatic involvement, RSD, stress injuries, and arthritides.  Therapy for metastatic bone pain using Sr-89 or Sm-153.
    2. Lung scintigraphy: Criteria for pulmonary embolus, different ventilatory agents, differential diagnosis of abnormal scans.
    3. Gastrointestinal scintigraphy: Hepatobiliary scans and the pharmacological interventions possible, liver spleen scanning, GI bleeding studies, Meckel's scan, functional studies.
  • Second Year
    1. Genitourinary scintigraphy: Various renal radiopharmaceuticals, the pharmacological interventions used, renal transplant evaluation, testicular scans, GU functional studies.
    2. Tumor and Inflammatory scintigraphy: Gallium-67, labeled WBC's, MIBG, Octreoscan and some familiarity with monoclonal antibodies and 18-FDG.
  • Third Year
    1. CNS scintigraphy: Brain perfusion scans and the indications, brain death studies, cisternography.
    2. Endocrine scintigraphy: Thyroid and parathyroid scans, hyperthyroid therapy, management of thyroid carcinoma.
  • Fourth Year
    1. Cardiovascular scintigraphy: myocardial perfusion scans, the stress agents used, gated SPECT, parametric images (bullseye), use of attenuation correlation. Gated blood pool scans, including phase analysis and other quantitation and some familiarity with infarct scans.
    2. Quality Control and Artifacts: radiopharmaceutical preparation, camera QC and processing to include SPECT and its artifacts (especially in cardiac scans).

Reading List:

For Nuclear Medicine Physics:
  • Chandra, R. Introductory Physics of Nuclear Medicine
  • 2. Saha, G. Physics and Radiobiology of Nuclear Medicine
For Radiation Biology:
  • Hall, Eric Radiobiology for the Radiologist
For Clinical Nuclear Medicine:
  • Thrall JH and Ziessman HA. Nuclear Medicine: The Requisites
  • As a lesser choice:
  • Mettler F and Guiberteau M. Essentials of Nuclear Medicine Imaging

As References:
  • Wagner H, Szabo Z and Buchanan J. Principles of Nuclear Medicine
  • Herbert JG, Eckelman WC and Neuman RD. Nuclear MedicineDiagnosis and Therapy
  • Fogelman I and Maisey M. An Atlas of Clinical Nuclear Medicine
  • Journal of Nuclear Medicine
  • Seminars in Nuclear Medicine
Ultrasound »
Description:

The ultrasound service performs and interprets a wide range of sonographic studies requested for a variety of clinical indications. Using high frequency sound waves, tomographic images are obtained to yield diagnostic information for guide diagnostic or therapeutic interventions. The ultrasound resident should arrive by 7:30 a.m. to begin reviewing the cases from the preceding evening. Optimally, this should be done with the resident who interpreted these studies on-call. The resident on the service is responsible for formulating a preliminary interpretation on all of the studies reviewed during the day, either individually or in conjunction with the fellow. The resident and fellow will work together to ensure that valid indications are provided for all studies and that all studies are checked prior to discharge of the patient from the department. Residents and fellows will also organize the cases prior to final interpretation by an attending. This may include hanging the current and relevant prior studies and/or pulling the reports of prior studies. Due to the rapid pace of the service and the constant influx of examinations formal read-out sessions are difficult; most studies are interpreted and dictated as quickly as possible after they have been performed. The resident is expected to assist in the dictation of cases, especially those cases which the resident performed or observed. Whenever possible, the resident should schedule vacation time when the fellow is to be present on the service, rather than leaving the service without the benefit of a resident or fellow.


General Goals:
  • Describe the most common indications for ultrasound, and discuss its advantages and limitations in these and other clinical presentations. Discuss alternative imaging modalities when the role of ultrasound is limited.
  • Prescribe a method of performing an examination given a specific clinical indication. Aim to maximize information and minimize time and cost.
  • Develop proficiency in the hands-on scanning and interpretation of basic examinations. In particular, by the time the resident has completed one month on the service, he or she must be able to personally scan and interpret the following examinations:
    • Abdomen: liver, gallbladder, biliary system, pancreas and spleen.
    • Retroperitoneum: kidneys and aorta.
    • Pelvis: uterus and ovaries, including transabdominal and endovaginal techniques.
    • Pregnancy: gestational sac determination, measurement of gestational age using fetal biometry and verification of fetal heart motion.
    • Neonatal brain: germinal matrix, lateral ventricles, midline structures.
    • Scrotum: testes, including Doppler insonation.
    • Duplex Doppler studies of the extremities.
    • Duplex Doppler studies of hepatic and renal transplants.
    • An ultrasound proficiency sheet must be completed at the end of the first rotation through ultrasound demonstrating the above.
  • Develop a dictating style that answers the clinical question posed and that presents the relevant findings in a cogent, logical and easily understandable fashion.
  • Recognize common pathologic entities and provide a diagnosis or a differential diagnosis, as appropriate.
  • Recite the basic physical principles involved in sonography, including Doppler imaging.
  • Gain some experience with ultrasound guided interventional procedures such as aspirations, drainages and biopsies.

Specific Goals:
  • Diagnose biliary tract pathology, such as gallbladder calculi, gallbladder wall thickening, pericholecystic fluid and intrahepatic and extrahepatic biliary ductal dilatation.
  • Identify the sonographic characteristics of a simple cyst.
  • Recognize hydronephrosis and differentiate it from parapelvic cysts.
  • Evaluate the aorta for aneurysms.
  • Diagnose fibroids and characterize ovarian masses.
  • Verify an early intrauterine pregnancy, using one or more of the following criteria: double decidual sac sign, yolk sac, fetal pole. Correlate sac size with first appearance of these signs. Obtain a M-mode tracing of the fetal heart rate.
  • Grade intracranial hemorrhage in neonates.
  • Document blood flow to both testes using Doppler techniques.
  • Evaluate the deep venous system of the extremities for the presence or absence of deep venous thrombosis using graded compression and Duplex Doppler techniques.
  • Document and analyze the arterial and venous waveforms in patients' status post hepatic and/or renal transplantation.
  • Describe the sonographic signs in acute appendicitis.

Reading List:
  • Kurtz and Middleton. Ultrasound: The Requisites
  • Callen P. Ultrasonography in Obstetrics and Gynecology
  • Polak J. Peripheral Vascular Sonography: A Practical Guide
Radiological Physics »
Description:

The course in radiological physics is a series of lectures and review sessions covering the physics of all diagnostic imaging modalities and the related disciplines. Specifically the course covers:
  • Basic concepts, which sets the foundation of radiation physics and computers in medical imaging.
  • Diagnostic radiology, that includes all of the major imaging modalities along with image quality assurance.
  • Nuclear medicine, including radionuclide decay, production, radiopharmaceuticals, radiation detection and imaging.
  • Radiation protection, including X-ray dosimetry, nuclear dosimetry and radiation biology.

General Goals:
  • To provide the residents with a comprehensive understanding of the basic sciences of medical imaging.
  • To convey to the resident the important role that a basic understanding of physical principles can play in the practice of radiology.

Specific Goals:
  • A record of attendance for at least 80 percent of the physics lectures is required of all residents who have not yet passed the written physics examination of the American Board of Radiology.
  • Achieve a passing score on each of the physics quizzes at least once.
  • Achieve a passing score on the written physics examination of the American Board of Radiology.

Reading List:
  • Bushberg JT. The Essential Physics of Medical Imaging
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