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Thoracic Imaging

Elective Number: (Oasis E74u) 2908

Rotation Supervisor: Dr. Juliana Bueno

Coordinator: Linda (Lin) Moore; linmoore@virginia.edu; phone: 924-9484

Duration: 2 weeks

Available: 3, 4a, 6, 7, 8, 9, 10b, 11, 12, 13, 14

Time to Report: 8:00 am

Place to Report: Residency/Student Elective Office - Room 1832

Typical day: 8:00 am - 4:00 pm

Attendance: Attendance at elective activities is mandatory.

Preparatory Reading:

  1. A Diagnostic Approach to Mediastinal Abnormalities Camilla R. Whitten, Sameer Khan, Graham J. Munneke, Sisa Grubnic RaqiQGraghics, 2007, Vo1.27: 657-671, 10.1148/rg.273065136
  2. Lines and Stripes: Where Did They Go? -From Conventional Radiography to CT Jerry M Gibbs, Chitra A. Chandrasekhar, Emma C. Ferguson, Sandra A. Oldham RadioGraghics, 2007, Vo1.27: 33-48, 10.1148/rg.271065073

Number of students per rotation: 2

Course Description: In addition to the regular lectures in the basics of chest radiology provided during the first years of the Medical School, the Thoracic imaging Section offers a 2 and 4-week elective rotation to fourth-year medical students.

The general learning objectives of this rotation are:

• Enhance learning and understanding of human anatomy, physiology, and thoracic pathology through imaging;
• Prepare the physician in training to efficiently use the resources of radiology in patient care
• Identify what the next best study is for specific thoracic pathologies
• Distinguish common pathologic states with different imaging modalities in thoracic imaging;
• Identify the different imaging methods and state-of-the-art technology used in thoracic imaging
• Identify the risks of radiation exposure and identify the knowledge on alternative imaging methods that do not utilize ionizing radiation
• Define basic thoracic radiologic anatomy in both conventional radiography and cross sectional imaging of the chest.
• Enhance exposure of the student to image guided procedures frequently performed

As a whole, the rotation must provide the students a basic but sufficient and solid knowledge on the fundaments of thoracic imaging, in order to serve as a foundation to their internship and forthcoming specialty training.

Students will attend the lectures and tutorials given by radiology faculty, fellows, and residents and any conferences within thoracic imaging. Additional time will be devoted to self-study of images, slide-and webbased interactive learning modules, which have been prepared as teaching materials.

Students are encouraged to add cases to the teaching files. All students are encouraged to participate in department activities including
numerous case-based and didactic conferences, seminars, and ground rounds.

Specific objectives of the Thoracic imaging rotation:

Conventional Radiography:
• Identify the basic radiographic projections in conventional radiology
of the chest (AP, PA, lateral, oblique views, lordotic view) and their
main indications.
• Name basic radiologic anatomic landmarks on a chest radiograph
(mediastinal and cardiac contours, right and left lungs lobes,
pleural spaces, thoracic cage)
• Identify the most common emergent pathologies in a chest radiograph:
• Pneumothorax and Tension Pneumothorax
• Lobar/Complete lung atelectasis
• Pleural effusion
• Pneumonia
• Overt pulmonary edema – signs of fluid overload
• Malposition of lines and tubes
Esophageal intubation
Bronchial intubation
Malposition of venous catheters
Malposition of chest tubes
Migration of esophageal stents
Cross-sectional imaging (CT/MRI):
• Identify the usefulness and limitations of non-contrast and contrast CT and MRI of the chest
• Identify the basic anatomy of thoracic organs in cross-sectional images (vascular and non-vascular structures of the mediastinum, lungs, pleura, thoracic cage)
• Identify the differences and main indications between standard chest CT protocols and High Resolution Computed Tomography (HRCT).
• Name basic radiologic terminology used in the description of infiltrates and common lesions in the lungs:
Ground glass opacity
Cyst versus cavity
Nodule versus mass
Atelectasis (discoid, segmental, lobar)

• By the end of the rotation, the student will be able to apply asystematic approach and analysis in the interpretation of a chest radiograph.
• The student will be able to recognize a technically limited chest radiograph and chest CT, as well as the implications of technique over interpretation, understanding the importance of image quality.
• The student must recognize the aforementioned emergent thoracic pathologies as seen by conventional radiography and understand the importance of prompt communication of findings to
the treating team.
• The student will be able to define, recognize and differentiate common parenchymal opacities seen by CT:
Ground glass opacity
Cyst versus cavity
Nodule versus mass
Atelectasis (discoid, segmental, lobar)

Image-guided procedures:
The students will have the opportunity to observe image guided procedures performed as part of the diagnostic and therapeutic work-up for neoplastic and non-neoplastic diseases of the chest (including mediastinal, pulmonary, pleural and chest wall pathologies).

Specific objectives of this component of the rotation are:

Distinguish the advantages of imaging methods such as ultrasound and computed tomography as a guide for percutaneous biopsies and pleural drainages.
Identify the potential complications of image-guided percutaneous procedures.
Name the main indications and contraindications of percutaneous image guided procedures in the thorax.

When participating in a procedure, the student must acknowledge the relevant clinical history of the patient, the clinical indication for the procedure and be aware of comorbidities and risk factors that may contraindicate the procedure.
Students will not be able to actively perform or participate in procedures; although they will be present along the entire process, including analysis of the images, planning, observation of the procedure and interpretation of follow-up images.

An enthusiastic participation is expected from the students during the rotation.
The student will participate in the read-out of radiology residents.
Knowledge of main clinical history of patients with interesting radiologic findings is encouraged, as association of clinical and radiologic findings will facilitate the understanding of the pathology.
Avoiding disruptive behavior such as constant chatting with peers while the resident or attending interprets studies as well as cell phone use in the reading room is expected.


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