Welcome To Your Thoracic Imaging Rotation
In radiology you will find that learning is optimized by responsibility. Becoming a good chest radiologist requires a skill with perception which can only develop with experience. In order to direct your learning experience with us, the following expectations and learning objectives are provided to help integrate you to our service. They have been tailored to your level of experience and will be adjusted to challenge you as you progress through your chest rotations. We want you to feel comfortable and confident with chest imaging and are open to your feedback!
Attached is a list of suggested texts covering both general and specialized topics in thoracic imaging. Please take time in the library or bookstore to decide which books you prefer. All the books are excellent, although each radiologist in the section and yourself indeed may have different preferences. Find out what works for you best.
The thoracic radiology Requisites is a popular resident choice and a valuable resource though this should really be seen as a starting point for your reading rather than the endpoint. At different times in your training other texts may offer you additional information to su pp lement your understanding. For example in your early interpretation of CXRs the first few chapters of Felson's 1972 Chest Roentgenology are not only still very informative but also very enjoyable rapid reading. Few books have been written in a similar style! In later rotations more in depth reviews such as DP Naidich's or P Armstrong's reference texts are sources for more in depth review and reading up of interesting topics. For challenging cases you should also do literature reviews and present your findings to your attendings and resident colleagues for their collective continued learning. By the end of your chest rotations in chest you must be familiar with the concepts in Webb, Muller and Naidich's HRCT book. Nearer the boards most will also read the Case Review books or the ACR Self-evaluation series as final reviews.
A monthly schedule is available at the start of each block providing conference times, dates and locations. All residents on thoracic imaging rotations are expected at ALL the chest conferences during their rotations.
The thoracic section ascribes to the year by year detailed curriculum for thoracic imaging as detailed by the Society of Thoracic Radiology. This is can also be located here.
The Rotations
1. First Year Residents, Early Year: Bellevue Hospital Chest
Please arrive at Bellevue Chest CT area by 8:00 am.
Start by reviewing the MICU unread films, writing notes to yourself about the cases. On Mondays and on Tuesdays following a Monday holiday the chest service is additionally responsible for the unread CCU, MICU and SICU films from the prior days. Please contact clinical housestaff for any relevant findings such as misplaced lines or pneumothoraces. If you feel comfortable doing so, or if your attending has instructed you, pre-dictate the cases. If you finish, join the senior resident or chest fellow in reviewing the chest CTs. If there is no senior resident or chest fellow on the CT rotation, triage the unread CTs and review the emergency cases. Please recall any old prior examinations from the PACS archive to allow later comparison. Generally, this is the most recent examination although for nodule comparison cases the oldest examination is also useful. Please contact the PACS administration office if examination recall presents technical difficulties. As workflow allows (this is variable and cannot be helped) you may dictate cases later in the day.
Learning objectives: This is your first introduction to chest and because you are preparing for ER call at Bellevue in January, your main focus should be developing a consistent method for assessing and reporting on plain films, becoming fluent with the PACS and educating yourself to the role you will play in patient care, particularly with respect to typical urgent and emergent cases. Gaining CT skills is encouraged to this end. Committing yourself to your observations and interpretations, even if reviewing cases independently, by writing notes, will add immensely to the speed with which you progress.
*If there are more than 2 residents with you on this rotation, on some days you may be asked to go to Tisch Hospital .**
2. First Year Residents, Late Year: Tisch Hospital Chest
Please arrive at Tisch Hospital Chest area by 8:00 am . Start by reviewing any leftover ER films from the night before, and triage and look over the CT scans, writing notes to yourself about the cases. If you feel comfortable doing so, or if your attending has instructed you, pre-dictate some of the cases. During the day you may need to communicate emergent findings to clinical staff or under supervision protocol inpatient CT cases.
If there is no nurse available to do injections in the ED you may occasionally be called upon to perform injections.
Learning objectives: As this is your second chest rotation, and by now you will have started call, this rotation is the time to work on fine tuning your plain film skills and to focus on developing similar skills with CT scans, how to assess the study and report findings. Things should be “clicking” together now and you should begin to feel comfortable working without direct supervision towards the end of the month.
3. Second Year Residents: Bellevue Hospital Chest CT
Please arrive at Bellevue Chest CT area by 8:00 am . Begin by protocolling the upcoming cases for the day, to be further discussed with the attending as needed. Triage, review and if time allows, pre-dictate unread CTs (This can be shared with the chest fellow if present. Please recall any old prior examinations from the PACS archive to allow later comparison. Generally, this is the most recent examination although for nodule comparison cases the oldest examination is also useful. Please contact the PACS administration office if examination recall presents technical difficulties. You will take all scheduling phone calls, and protocol the upcoming cases. Your responsibilities include keeping track of the cases that are to arrive, and providing preliminary interpretations to clinicians who might be with the patient at the scanner. Occasionally if there is no nurse available to do injections in the ED you may be called upon to perform injections
Learning objectives: This is your opportunity to take charge and run a service. Indeed, as the chest attendings may be different in the morning and afternoon we rely on you to keep track of the workflow. When clearing cases off the scanners, try to come to a preliminary diagnosis, and decide whether you need to expand the imaging beyond what was planned, for instance to include thin sections or expiratory images. Contact clinical services with any emergent findings you make, noting the name, time and service of the person with whom you spoke. At the end of this rotation you should feel well prepared for performing chest cases on body call, including traumas and pulmonary embolism cases.
4. Fourth Year Residents: Outpatient Chest
Please report to the Tisch CT reading area. Please arrive at your morning location by 8:00 am . If the Bellevue service is incompletely staffed due to post-call residents or illness your attending may instruct you to go to Bellevue instead. Please begin by start reviewing unread CTs. During the day you will read the Chest CT examinations from Tisch and Rivergate with the attendings present. You will be responsible for keeping track of the cases that are to arrive, and providing preliminary interpretations to clinicians who might be with the patient at the scanner. If time permits you should try and pre-dictate unread CTs.
5. Fourth Year Residents: VA Chest
Please report to the Tisch CT reading area. Please arrive at your morning location by 8:00 am . During the day it is still presently required for you to sign in at the VA hospital or document participating in the remote reading of VA cases by completing and submitting the appropriate forms. If the Bellevue service is incompletely staffed due to post-call residents or illness your attending may instruct you to go to Bellevue instead. Please begin by start reviewing unread CTs. During the day you will reading the Chest CT examinations from Tisch and Rivergate with the attendings present. You will be responsible for keeping track of the cases that are to arrive, and providing preliminary interpretations to clinicians who might be with the patient at the scanner. If time permits you should try and pre-dictate unread CTs.
Fourth Year Learning objectives:
You should use this final o pp ortunity on dedicated Chest rotations to hone those skills that you think you will require for your future practice as a radiologist. You should feel comfortable by now with dealing with on-call type cases and should be thinking increasingly about how you will report these and outpatient cases once you are reporting alone. To this end it is useful to pre-dictate as many cases as possible. Committing your impressions and management recommendations to text will help you determine your level of understanding of pulmonary conditions and direct your questions and reading. You should be becoming increasingly comfortable with interpreting high-resolution CT.
Additional Information:
As per the Vice Chair of Education you are dismissed for 30 mins on either end of the daily noon conferences and additional physics conferences as a pp licable.
- Absences from the rotation must be reported to the section chief, Dr Leitman (263-5226 or email), and Mary Arosemena (263-6373).
- At the beginning of the rotation please inform Dr Leitman of upcoming ‘post-call' days so covering attendings will know not to expect you.
- The Chest section secretary is Shanese Williams (263-5229)
- The faculty point person for the rotation is Johnny Vlahos or section chief Dr. Leitman.
