Radiology Portal

Chest (Thoracic) Rotation 

Faculty Representative:  Dr. Frank Luba 

Hours: 8 am to approximately 5:00 pm and until attending dismissal   

Location:   

• UTMB Main (Galveston) 
  • PACS Worklist:  CHEST unread last 30 days
  • Attending assignment: CHEST ATTENDING 
• UTMB clear lake (Ground Floor, Radiology reading room) 
  • PACS Worklist:  CHEST unread last 30 days
  • Attending assignment: CHEST ATTENDING 

Schedule:

R1 with teaching faculty/attending. 

Please see QGenda for attending schedules.

Conferences: 

Daily resident noon Conference. 

Multidisciplinary Conferences 

Thoracic oncology conference – Cardiothoracic surgery conference  

When: Every Wednesday at Noon 
Where: Skype Meeting 

Pertinent contacts information

Chest reading room 

Main: 67773 / 67774 
CLC: 832 632 xxxx 

Imaging Library 

Main    21110 / 21191 
VL        51756 

Protocols 

Specific imaging (Link to the CT and MRI protocols from under Protocol section) 

Contrast 

Iodninated contrast Administration(http://intranet.utmb.edu/policies_and_procedures/19373673) 
Care for allergic contrast (http://intranet.utmb.edu/policies_and_procedures/22591431) 
Contrast Extravasation Care(http://intranet.utmb.edu/policies_and_procedures/22591433)  

Curriculum (hyperlink)

Goals and Expectations  

R1 

After completion of the first thoracic radiology rotation, the resident will be able to: 

1. demonstrate learning of the knowledge-based objectives. 
2. accurately and concisely dictate a chest radiograph report. 
3. communicate effectively with referring clinicians and supervisory staff. 
4. understand standard patient positioning in thoracic radiology. 
5. obtain pertinent patient information relative to radiologic examinations. 
6. demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary. 
7. demonstrate a responsible work ethic. 
8. perform image-guided procedures of the chest. 
9. participate in quality improvement/quality assurance and other operational activities. 

II. Objectives 

A. Knowledge-based: At the end of the first thoracic radiology rotation, the resident will demonstrate learning of at least one-third of the knowledge-based objectives (see Addendum). 

B. Technical, communication, and decision-making skills 

At the end of the first thoracic radiology rotation, the resident will demonstrate the following technical, communication, and decision-making skills: 

1. Dictate accurate and concise chest radiograph reports that include patient name, patient medical record number, date of exam, date of comparison exam, type of exam, indication for exam, brief and concise description of the findings, and short impression. 
2. Communicate with ordering physicians about all significant or unexpected radiologic findings and document who was called and the date and time of the call in the dictated report. 
3. Obtain relevant patient history from electronic records, dictated reports, or by communicating with referring clinicians. 
4. Describe patient positioning and indications for posteroanterior (PA), anteroposterior (A), lateral decubitus, and lordotic chest radiographs. 
5. When assisting referring clinicians with imaging interpretation and patient management, decide when it is appropriate to obtain help from supervisory faculty. 
6. Arrive for the rotation assignment on time and prepared after reviewing recommended study materials. 
7. Participate in discussions with faculty regarding operational challenges and potential systems solutions regarding all aspects of radiologic service and patient care. 
8. Use appropriate chest radiograph, CT, and MRI nomenclature when dictating reports and consulting with health care professionals.

R2  

I. Goals 

After completion of the second thoracic radiology rotation, and in addition to those goals listed for Year 1, the resident will: 

1. demonstrate learning of the knowledge-based learning objectives. 
2. continue to build on chest radiograph interpretive skills. 
3. develop skills in the protocol, monitoring, and interpretation of chest CT scans. 
4. demonstrate an understanding of ACR Appropriateness Criteria and ACR Practice Standards and Technical Guidelines for thoracic radiology. 
5. demonstrate an ability to generate and interpret multiplanar reformatted (MPR) or three-dimensional images of CT or MRI studies as appropriate. 

II. Objectives 

A. The resident will demonstrate learning of at least two-thirds of the knowledge-based objectives listed for Year 1 (see Addendum), in addition to identifying the following structures on chest CT and chest MRI (MK). 

• Lungs—right, left, right upper, middle, and lower lobes, left upper lobe (anteroposterior, anterior and lingular segments), and left lower lobe 
• Pleura and extrapleural fat 
• Airway—trachea, main bronchi, carina, and lobar bronchi 
• Heart—left ventricle, right ventricle, moderator band, left atrium, left atrial appendage, right atrium, right atrial appendage, mitral valve, aortic valve, tricuspid valve, pulmonary valve, coronary arteries (left main, left anterior descending, left circumflex, right, posterior descending), coronary veins, coronary sinus 
• Pericardium—including pericardial recesses 
• Pulmonary arteries—main, right, left, interlobar, segmental 
• Aorta—ascending, sinuses of Valsalva, arch, descending 
• Arteries—brachiocephalic (innominate), common carotid, subclavian, axillary, vertebral, internal mammary, intercostal 
• Veins—pulmonary, superior vena cava, inferior vena cava, brachiocephalic, subclavian, axillary, internal jugular, external jugular, azygos, hemiazygos, left superior intercostal, internal mammary 
• Bones—ribs and costochondral cartilages, clavicles, scapulae, sternum, spine 
• Esophagus 
• Thymus 
• Thyroid gland 
• Muscles—sternocleidomastoid, anterior and middle scalene, infrahyoid, pectoralis major and minor, deltoid, trapezius, infraspinatus, supraspinatus, subscapularis, latissimus dorsi, serratus anterior 
• Aortopulmonary window 
• Azygoesophageal recess 
• Gastrohepatic ligament, celiac axis 
• Diaphragm 
• Identify the following additional structures on chest CT: 
• Lungs—all lobes and segments; secondary pulmonary lobules 
• Fissures—major, minor, azygos, accessory (superior and inferior) 
• Airway—lobar and segmental bronchi 
• Inferior pulmonary ligaments 

B. At the end of the second thoracic radiology rotation, the resident will demonstrate the following technical, communication, and decision-making skills, in addition to those listed for Year 1. 

1. Appropriately protocol all requests for chest CT to include thin-section images, high-resolution images, expiratory images, or prone images when appropriate, and use of intravenous contrast, given the patient history. 
2. Demonstrate the ability to effectively present thoracic radiology cases to other residents in a conference setting by appropriately selecting cases, interacting with residents, and presenting a brief discussion of the diagnosis for each case. 
3. Demonstrate the ability to manage an intravenous contrast reaction that occurs during a chest CT examination. 
4. Act as a consultant for referring clinicians and recommend the appropriate use of imaging studies. 
5. Describe the principles of chest fluoroscopy, including the assessment of the diaphragm. 
6. Demonstrate knowledge of CT parameters contributing to patient radiation exposure and techniques that can be used to limit radiation exposure. 

R3/R4 

I. Goals 

After completion of the third thoracic radiology rotation, and in addition to the goals listed for Years 1 and 2, the resident will: 

1. demonstrate learning of the knowledge-based objectives. 
2. refine skills in interpretation of radiographs and chest CT scans. 
3. develop skills in protocoling, monitoring, and interpreting chest MR studies, including cardiovascular MRI. 
4. become a more autonomous consultant and teacher. 
5. correlate pathologic and clinical data with radiographic and chest CT findings. 

II. Objectives 

A. At the end of the third thoracic radiology rotation or senior year of radiology residency, the resident will demonstrate knowledge of all of the knowledge-based objectives introduced in Years 1 and 2. 

B. Technical and communication skills 

After completion of the third thoracic radiology rotation, the resident will demonstrate the following technical, communication, and decision-making skills, in addition to those listed for Years 1 and 2. 

1. Dictate accurate, concise chest radiograph, CT scan, and MR reports with at least 90% accuracy; the reports will contain no major interpretive errors. 
2. State the clinical indications for performing chest CT and MRI. 
3. Describe a chest CT protocol optimized for evaluating each of the following. 

• thoracic aorta and great vessels 
• coronary calcium 
• pulmonary vein anatomy 
• suspected pulmonary embolism 
• tracheobronchial tree 
• suspected bronchiectasis 
• lung cancer staging 
• esophageal cancer staging 
• suspected pulmonary metastases 
• suspected pulmonary nodule on a radiograph 
• shortness of breath 
• hemoptysis 
• cardiac mass 
• coronary arteries 
• suspected pericardial disease 

4. Understand the technical principles of all chest MRI exams and describe a protocol optimized for evaluating each of the following: 

• thoracic aorta 
• pulmonary arteries 
• thoracic veins (superior vena cava, brachiocephalic veins) 
• pericardium 
• cardiomyopathy and cardiac and paracardiac masses, including tumors 
• ischemic heart disease, including function, viability and perfusion 
• valvular heart disease 
• right ventricular dysplasia 
• congenital heart disease in an adult 
• superior sulcus tumor 

5. In collaboration with a pathologist, present an interesting cardiothoracic imaging case, with a confirmed diagnosis, correlating clinical history with pathologic and radiologic findings, to residents and faculty. 

6. Work in the reading room independently, assisting clinicians with radiologic interpretation, and teaching other residents and medical students assigned to thoracic radiology. 

RESOURCES  

Books –  (Free access via Moody Library) 

R1 

Reading: Reed J: Chest Radiology: Plain Film Patterns And Differential Diagnosis Lange S: Radiology Of Chest Diseases. Good for the first years. Webb WR: High-Resolution CT of the Lung

R2 

Webb WR: Fundamentals of Body CT  

Higgins C: Chest and Cardiac Radiology  

R3 

In addition to the materials listed for the first two rotations, more detailed technical references supplemented by state of the art technical publications in radiology journals. 

Review articles (Free access via Moody Library) 

Website  

Articles  

Videos