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