Rotational Goals, Curriculum & Objectives

Musculoskeletal Radiology Rotation 1

Goals

1. Demonstrate learning of the knowledge based objectives
2. Accurately dictate skeletal plain film studies
3. Communicate effectively with referring clinicians
   1. Including obtaining relevant history for study interpretation
   2. Regarding important findings on studies performed
4. Demonstrate learning of the clinical indications for ordering and using radiological examinations including advanced musculoskeletal imaging
5. Demonstrate responsible work ethic.
   This would include being present at the musculoskeletal station at 8A.M, and throughout the work day, completion of dictation of all reviewed studies in a timely manner, attendance at all departmental teaching conferences, and grand rounds presentations.
6. Facilitate the learning of medical students, peers, other professionals participating in the musculoskeletal service including nurse practitioners, physical therapy students
7. Build confidence in reading ER and STAT musculoskeletal studies.
8. Contribute at least 2 cases per month to the Radiology Department Teaching File
9. Start Reviewing the ACR teaching file for musculoskeletal radiology

The above rotational goals incorporate the core competencies as follows:

Medical Knowledge - Goals 1 and 4
Interpersonal and Communication Skills - Goals 2 and 3
Practice Based Learning and Improvement - Goal 6
Professionalism - Goal 5
Patient Care - Goals 3 and 4

Assessment tools utilized —

Global ratings by faculty including rotation evaluation sheet
Conference attendance logs
In-service examination

Plan —

Develop 360 degree evaluations

Individuals to be included - technologists on day shift in radiology core, technology supervisor for radiology core, students involved in the rotation

Knowledge Based Objectives Rotation 1

1. I. Aspects of Basic Science Related to Bone
   1. Histogenesis of developing bone including intramembranous and enchondral ossification
   2. Bone Anatomy
      1. Cellular constituents - osteoblasts, osteoclasts, chondroblasts, chondrocytes
      2. Non-cellular constituents - organic matrix, inorganic matrix
      3. Structure of cortical and cancellous bone
   3. Bone Physiology
      1. Bone mineralization
      2. Regulation of calcium homeostasis
      3. Regulation of bone formation and resorption
         1. Humoral - PTH, Calcitonin, Vitamin D
         2. Paraneoplastic - PTH like protein
2. Techniques Related to Musculoskeletal Radiology
   1. Radiography
      1. Understand the standard views obtained and patient positioning for plain film examinations of the
         1. Spine - cervical, thoracic, and lumbosacral
         2. Ribs
         3. Pelvis
         4. Extremities
         5. Joints - shoulder, elbow, wrist, hip, knee, ankle
   2. Conventional Tomography
      1. Methodology, indications, interpretation
   3. Fluoroscopic procedures
3. Normal Features and Variants
   1. Sequence of ossification at joints (e.g. elbow)
   2. Physiologic radiolucencies
   3. Bone island
   4. Vascular channels, nutrient canals
   5. Epiphyseal / apophyseal ossification centers - normal, multiple (e.g. bipartite patella
4. Trauma
   1. General principles
      1. Biomechanics of fractures
      2. Relationship of force and deformation
      3. Relevant anatomy and terminology
   2. Fracture description - closed, open, comminuted, segmental
      1. Description of distal fragment position vs. fracture / apex
   3. Subluxations / Dislocations
      1. Definition, description
   4. Stress Injuries
   5. Evaluation of healing
      1. Malunion
      2. Nonunion
      3. Delayed healing
5. Infection
   1. Basic Concepts
   2. Routes of Spread
   3. Sites of localization - neonates, infants, children, adults
   4. Septic arthritis
   5. Osteomyelitis
6. Joint Disorders
   1. Normal anatomy
      1. Types of joints - fibrous, cartilaginous, synovial
      2. Intervertebral discs
   2. Features to be evaluated for each disorder
      1. Bone density
      2. Soft tissue changes
      3. Bone sclerosis, production, osteophyte formation / appearance
      4. Bone erosions
      5. Joint space
      6. Alignment / deformity
      7. Distribution
   3. Specific arthropathies
      1. Osteoarthritis
         1. Primary
         2. Secondary
         3. Erosive
      2. Inflammatory
         1. Rheumatoid
         2. Psoriatic
         3. Reiter's
         4. Ankylosing spondylitis
7. Neoplasms
   1. Radiographic features

      Single vs. multiple
      Lytic, blastic, mixed
      Zone of transition
      Cortical destruction
      Matrix
      Periosteal response
      Soft tissue mass

8. Skeletal Dysplasias
   1. Paget's
      1. Radiographic features
      2. Appearance on bone scans
      3. Common sites of involvement
      4. Associated laboratory findings
9. Differential Diagnosis
   1. Understand and know the differential diagnosis of imaging findings as they include many of the pathologic processes listed in the previous sections III. Normal Features and Variants through VIII. Skeletal Dysplasias.

Musculoskeletal Radiology Rotation 2

Goals

1. Demonstrate learning of the knowledge based objectives for rotation 1 and 2.
2. Accurately dictate skeletal plain film studies.
3. Demonstrate ability to protocol CT studies to optimize examination to address clinical question posed. Demonstrate ability to critically analyze reconstructed images for proper technique and plane of reconstruction.
4. Demonstrate understanding of most frequently utilized pulse sequences for musculoskeletal MR imaging.
5. Begin to develop ability to protocol MR examinations.
6. Communicate effectively with referring clinicians
   1. Including obtaining relevant history for study interpretation
   2. Regarding important findings on studies performed
7. Begin to develop familiarity and skill in performing specific procedures, i.e. joint aspiration and arthrography.
8. Demonstrate responsible work ethic.
   This would include being present at the musculoskeletal station at 8A.M, and throughout the work day, completion of dictation of all reviewed studies in a timely manner, attendance at all departmental teaching conferences, and grand rounds presentations.
9. Facilitate the learning of medical students, peers, other professionals participating in the musculoskeletal service including nurse practitioners, and physical therapy students.
10. Participate in bi-weekly inter-departmental teaching conference with rheumatology fellows, and weekly orthopedic department conference.
11. Build confidence in reading all musculoskeletal studies.
12. Contribute at least 2 cases per month to the Radiology Department Teaching File
13. Continue reviewing the ACR teaching file for musculoskeletal radiology

The above rotational goals incorporate the core competencies as follows:

Medical Knowledge - Goals 1,3,4,5,7, and 9
Interpersonal and Communication Skills - Goals 2, 6, 8, and 9
Practice Based Learning and Improvement - Goals 6 , 7, and 9
Professionalism - Goal 5
Patient Care - Goals 3,5, and 6
Systems Based Practice - Goal 9

Assessment tools utilized—

Global ratings by faculty
Conference attendance logs
Multi-disciplinary conference attendance logs
In-service examination

Plan —

Develop 360 degree evaluations
Individuals to be included - technologists on day shift in radiology

Knowledge Based Objectives Rotation 2

1. All knowledge based objectives from rotation 1
   1. Infection
      1. Concepts continued
      2. Septic arthritis
      3. Osteomyelitis
      4. Terminology- sequestrum, involucrum, cloaca, Brodie's abscess
      5. Acute vs. Subacute
      6. Chronic
         1. Sclerosing osteomyelitis of Garre
      7. Organisms
         1. bacterial
         2. tuberculous
         3. fungal
   2. Joint Disorders
      1. Normal anatomy
      2. Types of joints - fibrous, cartilaginous, synovial
      3. Intervertebral discs
      4. Features to be evaluated for each disorder
         1. Bone density
         2. Soft tissue changes
         3. Bone sclerosis, production, osteophyte formation / appearance
         4. Bone erosions
         5. Joint space
         6. Alignment / deformity
         7. Distribution
      5. Specific arthropathies
         1. Osteoarthritis
            1. Primary
            2. Secondary
            3. Erosive
         2. Inflammatory
            1. Rheumatoid
            2. Psoriatic
            3. Reiter's
            4. Ankylosing spondylitis
            5. Enteropathic
            6. Juvenile chronic
         3. Connective tissue
            1. SLE
            2. Scleroderma
         4. Depositional
   3. Neoplasms
      1. Radiographic features
         1. Single vs. multiple
         2. Lytic, blastic, mixed
         3. Zone of transition
         4. Cortical destruction
         5. Matrix
         6. Periosteal response
         7. Soft tissue mass
      2. Features on advanced imaging modalities - Nuclear studies, CT, US, MRI
      3. Osseous lesions
      4. Chondroid lesions
      5. Fibrous lesions
      6. Vascular lesions
      7. Associated syndromes
      8. Primary vs. secondary lesions
2. Metabolic / Hematologic Disorders
3. Skeletal Dysplasias
4. Syndromes

Musculoskeletal Radiology Rotation 3

Goals

1. Demonstrate learning of the knowledge based objectives for rotation 1, 2, and 3.
2. Demonstrate increasing proficiency in ability to protocol CT studies to optimize examination to address clinical question posed.
3. Demonstrate ability to critically analyze reconstructed images for proper technique and plane of reconstruction.
4. Demonstrate initiative in correcting problems encountered in CT and MR imaging. (e.g. resident assesses whether all pulse sequences performed are filmed and intervenes prior to film review with attending so all performed studies can be reviewed. e.g. resident identifies improper technique for CT reconstructions and interacts with CT technologist to correct problem prior to film review with attending.
5. Demonstrate unders1anding of most frequently utilized pulse sequences for musculoskeletal MR imaging and utility of each.
6. Demonstrate ability to protocol and monitor MR examinations.
7. Demonstrate increased proficiency in the interpretation of musculoskeletal MR studies.
8. Demonstrate ability to evaluate patients for interventional procedures and obtain consent. Knowledge required includes appropriate indications, contraindications, objectives, alternatives, and possible complications. Pre- procedure assessment requires review of all prior imaging studies. Post- procedure assessment requires knowledge of proper treatment for all possible procedural complications.
9. Communicate effectively with referring clinicians
   1. Including obtaining relevant history for study interpretation or for assessment for interventional procedure.
   2. Regarding important findings on studies performed
10. Demonstrate responsible work ethic.
    This would include:
    1. Being present at the musculoskeletal station at 8A.M, and throughout the work day,
    2. Completion of dictation of all reviewed studies in a timely manner.
    3. Demonstration of awareness of any scheduled interventional procedures for the musculoskeletal radiology service.
    4. Attendance at all departmental teaching conferences, and grand rounds presentations.
11. Facilitate the learning of medical students, peers, other professionals participating in the musculoskeletal service including nurse practitioners, and physical therapy students.
12. Participate in bi-weekly inter-departmental teaching conference with Rheumatology fellows, and weekly orthopedic department conference.
13. Contribute at least 2 cases per month to the Radiology Department Teaching File.
14. Finish reviewing the ACR teaching file for musculoskeletal radiology

The above rotational goals incorporate the core competencies as follows:

Patient Care - Goals 3, 7, 8
Medical Knowledge - Goals 1,2,3,4,5,6,7
Interpersonal and Communication Skills - Goals 7, 8, 10
Professionalism - 8,9
Practice Based Learning and Improvement - Goals 8, and 9, 10, 11
Systems Based Practice - Goal 7, 11

Assessment tools:

Global faculty evaluations
Departmental and inter-departmental conference attendance logs
360 degree evaluations
Procedure logs
ACR in-service examination

Knowledge Based Objectives Rotation 3

All knowledge based objectives from rotations 1 and 2 to a greater depth.

Musculoskeletal Radiology Rotation 4 - Elective

In addition to all the goals of rotations 1,2 and 3 the following goals apply to the elective:

Have a thorough understanding of all aspects of Musculoskeletal radiology
Act as a consultant for referring physicians
Perform all musculoskeletal procedures
Correlate pathologic and clinical data