Resident Orientation by lkl36201

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									Resident Orientation

Pediatric Radiology Section




            Pediatric Radiology Section


                                          RCM/MIR
Pediatric Radiology Resident Orientation

   •   Goals & Objectives
   •   Resident Assignments
   •   Learning Materials
   •   Critical Event Reporting
   •   Fuji PACS Tips & Tricks




                                      RCM/MIR
Pediatric Radiology Resident Rotation
          Goals & Objectives
The Six Core Competencies
• Patient Care
• Medical Knowledge
• Interpersonal and Communication Skills
• Professionalism
• Practice-Based Learning and Improvement
• Systems-Based Practice



                                            RCM/MIR
Pediatric Radiology Resident Rotation
              Week 1-4
• Patient Care
  – Utilize Clinical Desktop for gathering
    pertinent patient information
  – Interview and examine patients when
    appropriate for accurate interpretation of
    radiological studies




                                                 RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 1-4
• Medical Knowledge
  – Identify normal/abnormal radiographs of the chest, heart,
    abdomen and skeleton including variable appearances at
    different ages
  – Evaluate chest radiographs of infants and children in intensive
    care units including
     •   neonatal respiratory distress and its complications
     •   congenital heart disease
     •   radiographic findings associated with sickle cell disease
     •   the normal appearance of various catheters and devices including
         endotracheal tubes, central venous lines, chest tubes and extra-corporeal
         membrane oxygenation devices

                                                                           RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 1-4
• Medical Knowledge (Continued)
  – Evaluate the abdominal films of infants and children in intensive
    care units, to recognize:
     • pneumoperitoneum
     • small bowel obstruction
     • necrotizing enterocolitis
  – Identify pediatric orthopedic problems and their management,
    including:
     •   fractures
     •   scoliosis
     •   developmental dysplasia of the hips
     •   Legg-Calve Perthes
     •   hip effusions/septic hip
                                                               RCM/MIR
  Pediatric Radiology Resident Rotation
                Week 1-4
• Medical Knowledge (Continued)
  – Establish radiographic bone age
  – Become familiar with the plain radiographic findings in
    common pediatric conditions of ambulatory patients on
    chest, abdominal, and skeletal radiographs




                                                     RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 1-4
• Interpersonal & Communication Skills
  – Provide direct communication to the referring physician or
    appropriate clinical personnel when interpretation of a study
    reveals an urgent or unexpected finding, and document this
    communication in the radiological report using specific date and
    time.
  – Make preliminary review of inpatient, outpatient, NICU and PICU
    films, and discuss findings with the Staff Radiologist, dictate, and
    confer with pediatric residents.
  – Participate in daily presentation of radiographic findings of NICU
    and/or PICU patients to clinical teams, and relay any radiologic
    recommendations
                                                                 RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 1-4
• Professionalism
  – Recognize limitations in personal knowledge and skills
    so as not to make decisions beyond the level of
    competence
  – Demonstrate altruism and compassion towards patients




                                                    RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 1-4
• Practice-Based Learning and Improvement
  – Learn to present cases at daily morning teaching
    conference
  – Prepare an end-of-rotation follow-up conference




                                                       RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 1-4
• Systems-Based Practice
  – Become aware of the basic necessities for coding and
    billing, including:
    • Ensuring there is a requisition from the doctor’s office
    • Providing accurate and sufficient information within the
      radiological report to support appropriate ICD-9 coding




                                                                 RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 5-8
• Patient Care
  – Demonstrate knowledge of the levels of ionizing
    radiation related to specific imaging procedures and
    employ measures to minimize radiation dose to the
    patient.
  – Perform radiological examinations appropriately and
    safely, assuring that the correct examination is ordered
    and performed


                                                       RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 5-8
• Medical Knowledge
  – With assistance from a Staff Radiologist, perform and
    evaluate fluoroscopic images of the gastrointestinal
    and genitourinary tract.
  – With assistance from a Staff Radiologist or Staff
    Sonographer, perform and evaluate:
    •   cranial sonogram
    •   renal sonogram
    •   abdominal and pelvic sonograms
    •   hip sonogram to evaluate for effusion
                                                     RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 5-8
• Medical Knowledge (Continued)
  – Evaluate computerized tomographic images of the
    chest, abdomen, pelvis and extremities.
  – Increase knowledge of pediatric plain radiographs
    and/or sonographic findings of children with emergent
    conditions including:
    •   pneumonia, pneumothorax
    •   congestive heart failure
    •   appendicitis, intussusception
    •   nonaccidental trauma, fractures
    •   hip effusions
                                                     RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 5-8
• Interpersonal & Communication Skills
  – Same as weeks 1-4 and add
  – Review plain radiographs and be able to make
    recommendations for further evaluation with sonogram,
    contrast studies or CT with pediatric house officers




                                                   RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 5-8
• Professionalism
  – Same as weeks 1-4 and add
  – Recognize limitations in personal skill and knowledge
    in order to consult with senior residents and staff when
    needed
  – Be capable of making independent decisions on routine
    issues to become prepared for night call



                                                      RCM/MIR
   Pediatric Radiology Resident Rotation
                 Week 5-8
• Practice-Based Learning and Improvement
  – Same as weeks 1-4
• Systems-Based Practice
  – Same as weeks 1-4




                                            RCM/MIR
   Pediatric Radiology Resident Rotation
                Week 9-12
• Patient Care
  – Same as weeks 1-8




                                           RCM/MIR
    Pediatric Radiology Resident Rotation
                 Week 9-12
• Medical Knowledge
  – Perform all fluoroscopic examinations except when
    complications are anticipated, with the consultation of
    the Staff Radiologist
  – Increase knowledge base regarding both common and
    uncommon pediatric conditions by plain radiograph,
    contrast studies and imaging, including some familiarity
    with the findings of pediatric body MR imaging
  – By the end of the rotation, have knowledge sufficient to
    pass the American Board of Radiology examination
                                                        RCM/MIR
    Pediatric Radiology Resident Rotation
                 Week 9-12
• Interpersonal & Communication Skills
  – Same as weeks 5-8
• Professionalism
  – Same as weeks 5-8
  – Be capable of making independent decisions
• Practice-Based Learning and Improvement
  – Same as weeks 5-8
• Systems-Based Practice
  – Same as weeks 1-8
                                                 RCM/MIR
Pediatric Radiology Resident Orientation

   •   Goals & Objectives
   •   Resident Assignments
   •   Learning Materials
   •   Critical Event Reporting
   •   Fuji PACS Tips & Tricks




                                      RCM/MIR
         Resident Assignments
•   PICU
•   NICU
•   Fluoroscopy
•   MR/Reading Room
•   Ultrasound
•   CT (CT/MR)
•   Saturday and Holiday Coverage
•   Dictation System
•   Conferences


                                    RCM/MIR
                  PICU
• Organize, review and dictate all PICU and
  7E/7W radiography studies
• Review studies with Reading Room Staff
• PICU Team Rounds at ~10:30am
• After PICU dictations are completed,
  responsibilities include
  – 8E/8W/9E/9W/12W board,
  – outpatient and emergency room films
  – orthopedic clinic films
                                              RCM/MIR
                  NICU
• Organize, review and preview all NICU
  radiography studies
• Review studies with CT/MR/US Staff
• NICU Team Rounds at ~10:30am
• After NICU dictations are completed,
  responsibilities include
  – 8E/8W/9E/9W/12W board,
  – outpatient and emergency room films
  – orthopedic clinic films
                                          RCM/MIR
             Fluoroscopy
• Review the available information, confirm
  histories and plan specialized studies with the
  Staff Radiologist
• Perform, review and dictate the studies
• Read ESSE pediatric offices studies
• After the flouro schedule is complete, the
  resident should come to the main reading
  room to help with other studies including the
  boards, out patients and orthopedic films
                                             RCM/MIR
         MR/Reading Room

• When there are five residents/fellows
  – responsibility for the inpatient studies
  – orthopedic clinic films
  – outpatient films
  – emergency unit films
  – PICU/NICU films as needed.
  – assistance in fluoroscopy, sonography and CT
    when needed

                                               RCM/MIR
              Ultrasound

• Coordinate the schedule with the staff
  radiologist and sonographers
• Participate in selected ultrasounds
• Review and dictate the studies
• After the ultrasound schedule is complete, the
  resident should assist the main reading room
  with other studies including the boards, out
  patients and orthopedic films
                                            RCM/MIR
               CT(CT/MR)
             (5 or 4 trainees)
• Review old and outside exams
• Review history with the parents
• Protocol for the scan
• Perform, review and dictate the studies
• After the CT/MR schedule is complete, the resident
  should assist the main reading room with other
  studies including the boards, out patients and
  orthopedic films
• First responder for contrast teactions
                                                 RCM/MIR
 Saturday and Holiday Coverage
• Junior Residents
  – Begin at or before 7:30am
  – End sometime after 1:00pm
• Senior residents
  – Begin at or before 7:30am
  – Stay until 5 PM. They will sign out to the night float
• Senior residents may not switch with a 1st Year
  resident for Saturday Coverage
• Monday Holiday Coverage
  – residents assigned to Monday holiday coverage are
    expected to read all in patient boards
  – service begins at 7:30 a.m and ends when the work is done

                                                             RCM/MIR
                PowerScribe
• Use Voice Recognition on
  – US
  – CT/MR
  – NICU
  – EU
  – GI/Fluoro
  – Ortho



                              RCM/MIR
              PowerScribe Errors
- History: Refusing to 8, weight loss and vomiting
- Lobes the first 2006
- I used to 5 catheter

• SLCH transcription is getting complaints about our reports.
• The issue is escalating within SLCH and MIR.

We must do a few things immediately:
• The residents must proofread reports carefully before sending them to
  your IDX queue; the history field as especially prone to errors.
• Staff will proofread the reports before signing
   – print out the erroneous reports
   – highlight the errors and give them to the residents.



                                                                    RCM/MIR
      BUSCON Dictation System

•   Enter your five number code
•   Scan Acc#1
•   Scan Acc#2, ….
•   Scan DOB
•   Dictate
•   Press End


                                  RCM/MIR
 Addenda (Options for Dictation)
1. BEST METHOD
   Enter a “C” before the A# to be addended.
  •   C9541234 instead of A9541234
2. ALTERNATE METHOD
   Enter the A# without the leading “A”
  •   9541234 instead of A9541234
3. ACCEPTABLE
   Generate addendum with the BUSCON system


                                               RCM/MIR
                           7:30 Conferences

               Monday                Tuesday            Wednesday             Thursday                Friday



Week1    Resident Orientation   Resident Case Conf   Resident Case Conf   Resident Case Conf      US Knobology
                                                                                                   /Technique
                                                                                                     Hip Tap


Week 2     No Conference        Resident Case Ccnf   Resident Case Conf   Resident Case Conf    Followup I

Week 3     No Conference        Resident Case Conf   Resident Case Conf    MRI Conference      Head Ultrasound

Week 4     No Conference        Resident Case Conf    EU Conference       Resident Case Conf   Followup II
                                                                                               Conference/
                                                                                               Exit Interview




                                                                                                       RCM/MIR
                    Conferences
• Pediatric Radiology Teaching Conference
   – Tuesday – Friday 7:30-8:30
   – The resident assigned chooses Teaching File Cases to be shown
     as unknowns to the other residents
• Pediatric Radiology Follow-up Conferences
   – Second and last Friday of the Rotation 7:30-8:30
   – Each diagnostic radiology resident is responsible for presenting at
     least two cases
   – Definitive clinical and/or pathologic follow-up
• Noon Conference
   – With very rare exception, all diagnostic radiology residents will be
     able attend.
   – The resident should know the history, physical findings, clinical
     course, correlative radiological and pathological findings.
                                                                        RCM/MIR
             Conferences
• EU Conference
  – Last Wednesday of the rotation
  – EU picks cases and prepares history
  – We present the images
  – We all join in the discussion
• MR Conference
• Ultrasound Knobology


                                          RCM/MIR
Pediatric Radiology Resident Orientation

   •   Goals & Objectives
   •   Resident Assignments
   •   Learning Materials
   •   Critical Event Reporting
   •   Fuji PACS Tips & Tricks




                                      RCM/MIR
                           Text Books
    GENERAL TEXTS
•   Pediatric Imaging (The Core Curriculum) by Marilyn J. Siegel and Brian
    D. Coley, M.D. (2006)
•   Fundamentals of Pediatric Radiology by Lane F. Donnelly M.D. (2001)
•   Practical Pediatric Imaging: Diagnostic Radiology of Infants and Children
    by Donald R., M.D. Kirks and N. Thorne Griscom, M.D. (1998)
•   Imaging of the Newborn, Infant, and Young Child by Leonard E.
    Swischuk (1997)
•   Caffey's Pediatric Diagnostic Imaging (2 Vol. Set) by Jerald P. Kuhn,
    Thomas L. Slovis, and Jack O. Haller (2003)

  SPECIALTY TEXTS
• Pediatric Sonography by Marilyn J. Siegel (2001)
• Pediatric Body CT by Marilyn J. Siegel (Editor) (1999)


                                                                            RCM/MIR
     Online Learning Materials

• Prior Resident Follow-Up Conferences
 M:\Pediatric Radiology Section Info\Pediatric Radiology Follow Up

• Cleveland Clinic Pediatric Radiology
  https://www.cchs.net/pediatricradiology/




                                                                     RCM/MIR
Pediatric Radiology Resident Orientation

   •   Goals & Objectives
   •   Resident Assignments
   •   Learning Materials
   •   Critical Event Reporting
   •   Fuji PACS Tips & Tricks




                                      RCM/MIR
             Critical Event Reporting

PURPOSE:

Prompt transmission of accurate critical test results to the
physician or nurse, with primary responsibility for the patient, is
essential in ensuring timely diagnosis and treatment of patients
served by the Radiology Department at Children’s Hospital of St.
Louis.




                                                                  RCM/MIR
                Critical Event Reporting
                       Definitions
Critical Test Result:

A diagnostic test finding (i.e., “result”) that is significantly beyond
the established normal variation as defined by each diagnostic
testing service and as approved by the medical director. Critical
results require prompt notification to the licensed care provider.




                                                                      RCM/MIR
               Critical Event Reporting
                      Definitions
Read back:

The process of confirming the accuracy of verbally or telephonically
transmitted information or orders by writing down what was heard,
then reading it back to the person who provided the information.
Numbers are called out individually (e.g., “one, five” for fifteen,
which could be heard as “fifty”).




                                                                RCM/MIR
               Critical Event Reporting
                      Definitions

Licensed Care Provider:

The person authorized to act or intervene on behalf of the patient,
usually a MD or APN. It may also be a RN or Pharmacist, acting
on the basis of a medical staff-approved protocol or other written
orders.




                                                                 RCM/MIR
             Critical Event Reporting
Critical Events in the SLCH Radiology Department:

* Hazardous line placement (e.g. CVL, ETT, GI catheters)
* Child abuse
* Evidence of increased intracranial pressure/impending herniation
* New or enlarging hemorrhage and/or extra-axial fluid collections
* Portal venous gas
* Pneumothorax, substantial or under pressure
* Pneumoperitoneum/bowel perforation


       This is the minimum list of events. Use discretion.
                                                               RCM/MIR
               Critical Event Reporting
                      Definitions
Documentation:

Following notification, the Critical Test Results will be documented for
    the following items

Date and Time of notification
Name and title of person(s) notified

The documentation will be recorded on the x-ray report by the
   reporting radiologists or the designated reporting staff.


                                                                  RCM/MIR
Pediatric Radiology Resident Orientation

   •   Goals & Objectives
   •   Resident Assignments
   •   Learning Materials
   •   Critical Event Reporting
   •   Fuji PACS Tips & Tricks




                                      RCM/MIR
Synapse Worklist Navigation




                              RCM/MIR
                Search
The Best Synapse Feature You’ve Never Used




                                             RCM/MIR
                Search
The Best Synapse Feature You’ve Never Used




                                             RCM/MIR
Synapse Tool Bar Icons




                         RCM/MIR
Synapse Power Jacket




                       RCM/MIR
Synapse Power Jacket Shortcuts




                                 RCM/MIR
Working with Comparisons




                           RCM/MIR
       Synapse
Window/Level – Pan/Zoom




                          RCM/MIR
Right Mouse Click Options




                       RCM/MIR
Accessing Tools


            Right Mouse Click
            To Access the
            Tools SubMenu




                            RCM/MIR
Tools Menu

  •   Label Images (C1, T1, L2…)
  •   Remove text from images
  •   Remove patient name
  •   ROI measurements




                             RCM/MIR
Synapse Navigation Tools




                           RCM/MIR
Synapse Image Manipulation Shortcuts




                                  RCM/MIR
Synapse Keyboard Shortcuts




                             RCM/MIR
Synapse Hotkey Shortcuts




                           RCM/MIR
            Save Changes???




Yes to save annotations, window/level setting etc.
No to exit without saving
                                                     RCM/MIR
Making PowerPoint Teaching File




                                  RCM/MIR
             Closing Points

• VoiceMic is $500
  – Don’t drop them
  – Don’t spill on them
• Be mindful of food around the computers




                                            RCM/MIR
Thanks for your help!




                        RCM/MIR
         Contrast Reactions

• Check with Christi in CT
• Protocol is taped in the scanner room
• Needs more detail




                                          RCM/MIR
                          F8

• After you dictate a case
  – Leave the case open in Synapse
  – Hit the F8 button on in the function key row of the
    key board to change its status in Synapse worklist
    to “Dictated”




                                                          RCM/MIR

								
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