Radiology And Medical Imaging Specialty Curriculum

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The Arab LeagueCouncil of Arab Health MinistersThe Arab Board of Health SpecializationsRadiology And Medical Imaging SpecialtyCurriculum- 1-

1. Introduction:The specialty of radiology has grown enormously over the last few decades, helped with theadvent and the introduction of new diagnostic modalities, and also, with the development ofsub-specialties. The Radiologists are expected to be trained both academically and practicallyand must understand research methodology and participate in research as well.By ensuring full training and high standards, the Arab Board of Radiology & MedicalImaging will not only graduate competent radiologists capable of attending to the variousdiagnostic, therapeutic and research aspects of radiology practice, but also ensure that themanpower needs of the Arab countries are served within the cultural, ethnic and socioeconomic frame of the Region.The completion of recognized training and success at passing all parts of the exam will resultin the award of the following qualification: The Diploma of the Arab Board of Radiology andMedical Imaging2. Objectives of Training2.1 - DEFINITIONDiagnostic Radiology is a branch of medical sciences concerned with the use of radiologicaland imaging techniques in the diagnosis and treatment of diseases.2.2 - GENERAL OBJECTIVESBy completion of the educational program, the graduate physician will be competent tofunction as a specialist in Diagnostic Radiology. The physician will be able to advise on,supervise, and perform the imaging procedures to such a level of competence, and across abroad range of radiological practice, as to function as a consultant to referring generalphysicians and specialists.Knowledge, technical skills, and communication skills are the three pillars on which aradiological career is built, and are all linked to an attitude to the practice of medicine whichrecognizes both the need to establish a habit of promoting a team approach to the provision ofimaging services and continuous learning .The radiologist is first and foremost a physician and is expected to uphold the professionalethical standards, maintain confidentiality and develop understanding of issues such as qualityassurance, clinical governance and risk management as well as be aware of the local infectioncontrol requirement2.3 - SPECIFIC OBJECTIVES2.3.1 The trainee should: Understand the nature of formation of all types of radiological images, including- 2-

physical and technical aspects, patient positioning and contrast media used.Know the theoretical, practical and legal aspects of radiation protection, and possibleharmful effects of radiation.Understands and applies regulations of radiation protection that are relevant to hiscountry of practice as well as the general internationally accepted principles such asALARAKnow human anatomy with emphasis on radiological applications both conventionaland cross- sectional.Understand the multiple applications and uses of clinical radiology, includingappropriate application of imaging to patients, importance of informed consent,complications of radiological procedures including reaction to contrast media andfactors affecting film interpretation and differential diagnosis.Understand the fundamentals of quality assurance in radiologyUnderstand the fundamentals of epidemiology, biostatistics and decision analysis.Show competence in technical and interpretative skills.Demonstrate the ability to manage the patient independently during a procedure, inclose collaboration with a specialist or the referring physician. The radiologist shouldknow when to discontinue the procedure, or when to refer the patient to anotherphysicianUnderstand the likely outcomes of radiological investigations in both the normalsituation and where pathology is demonstrated and have the ability to recognizeunexpected findings and manage complications effectively.Understand the appropriate follow-up care of patients who have receivedinvestigations and/or interventional therapy.Develop and demonstrate a sound and systematic style of reporting.Show competence in effective consultation, conduction of clinico-radiologicalconferences, and the ability to present scholarly material and lead case discussions.Show evidence of scholarly activity through documentation of participation inresearch and attendance of scientific meetings2.3.2 Training RegulationsThis is a four years structured residency training program aimed at training the medicalgraduate to the level of specialist in radiology and medical imaging. The training will beconducted in centres recognized by the Arab Board of Radiology & Medical Imaging.2.3.3 The TraineeA. Basic Requirements: The trainee should be a holder of a diploma in human medicine, M.D/M.B.Bch. orequivalent from a recognized medical school of any Arab country or from a medicalschool in any foreign country provided that this medical school is accredited by itscountry of origin and the accreditation is affirmed by the Arab Board regulations- 3-

The trainee should have completed a minimum period of 12 months of internship.The trainee should be licensed to practice medicine by the appropriate licensingauthority.The trainee is supposed to be a citizen of an Arab country and/or be able to read, writeand speak the Arabic language.The trainee should be enrolled in an approved training program.The trainee shall duly complete and sign the registration form and affirm it by theappropriate authority.The trainee shall comply with any other requirements which may be introduced by theArab Board of Radiology & Medical Imaging in the future.B. General Requirements: The training is conducted only in the approved centres/hospitalsThe trainee shall work on a full time basis throughout the period of training. Incompelling circumstances waiving this requirement and subsequent adjustment of thetraining period will be decided on a case-by- case basisThe trainee shall participate in all academic and clinical activities of the department ofRadiology in particular and make the effort to attend other relevant activities in thetraining centre.The trainee shall assume increasing responsibilities according to the level of trainingand attained competence.The trainee shall maintain proper professional standards in relations with patients,colleagues & technical, nursing and administrative staff.The trainees shall adhere to the standards of confidentiality and ethical practicerequired in their workplace.C. Specific Requirements:The trainee is responsible for any patient examined in the Radiology Department with regardsto the following points: Check the patient’s file for clinical data, provisional diagnosis, laboratoryinvestigations etc. Ascertain that full clinical history including all the radiological relevant data areavailable in the request form prior to any step in patients examination. Assess the requested radiological study to recommend the suitable preparationprocedure. Supervise, assist, or perform the required radiological study including contrast mediainjection and patient’s after care Inspect all radiological studies performed before the patient leaves the radiologydepartment to ensure adequate and complete study Provide emergency reporting and prepare preliminary reports to be checked by thetrainer.- 4-

D. Mandatory Requirements: The trainee has to attend and participate in the cyclic academic and clinical activitiesof the radiology department. Attendance and participation must not be less than 80%of the total number of activities at any training rotation/period.The trainee has to keep a Log Book ( electronic ) record of all activities performedand learned during the training programme. Activities such as reporting may beentered in terms of sessional commitment. For practical procedures the activity shouldbe dated and categorized as to whether it has been performed by the traineehim/herself or as an assistant or participant. The Log Book should be counter signedby the trainer at the end of each rotation and finally the completed Log Book shall besigned by the educational supervisor at the end of each academic year and at the end ofthe training.3. Educational Supervisor3.1 - Qualifications Radiologist with a higher qualification in Radiology being a holder of AmericanBoard, FRCR, ABRMI or equivalent.Of the rank of Consultant Radiologist.Has an experience of at least 5 years after the higher qualification.Should have a recognizable experience in teaching and postgraduate training.3.2 - Responsibilities Monitoring of the training program and the trainees.Receive , assess and approve the periodic evaluation reports from the trainersEnsure the provision and regularity of the scientific training activities.Participate in and monitor training activities.Participate in the arrangements of the training courses and preparatory courses for theexaminations.Inspect and approve the trainee’s Log Book.Be accountable for the actual performance of the traineesProvide periodic evaluation reports of the trainee at the end of each academic year.Identify potential problems in trainee performance and perform counseling / take thenecessary corrective steps4. Trainer:4.1 - Qualifications Achieved a high qualification In Radiology such as American Board, ABRMI orequivalent.Has an experience of at least 3 years after the higher qualification.Of the rank of Consultant Radiologist.Is employed on a full time basis , in the selected training hospital/ center- 5-

4.2 - Responsibilities and Duties of the Trainer Responsible for the actual performance of the trainee.Look after the trainee and give him/her the requirements of the training includingtechnical experience with increasing responsibilities according to the trainee’s abilitiesand progress.Responsible for approval of the holidays and leaves.Responsible for arranging the rotations for the trainees.Responsible for the preliminary approval of the trainee admittance to examinations.Organization and delivery of the training and educational activities in collaborationwith the educational supervisor5. Radiology training curriculumBy the end of training, trainees should have skills to apply practical knowledge and deepunderstanding of: The basic radiation physics and radiation safety The concepts and terminology of diagnostic and interventional radiology The role and usefulness of the various diagnostic and interventional techniques in allage groups The responsibilities of a radiologist to the patient, including the legal framework andnecessity for informed consent The various types of contrast media, drugs (including intravenous sedation) andmonitoring used in day to day radiological practice The indications, contraindications, doses (adult and pediatric) and the management ofreactions and complications of contrast media and sedation drugs The principles of radiation protection and the legal framework for protection againstionizing radiation The safety requirements for radionuclide imaging The basic radiological and radiographic procedures The practice of clinical audit and risk management The principles of medical research The principles and practice of evidence based medicine as it applies to the radiologydiscipline6. SkillsBy the end of training trainees should be able to: Demonstrate safe radiological practice Interpret and formally report all core radiological procedures and Techniquesperformed during routine work Perform all routine radiological procedures Perform and report on call investigations appropriate to the level of training and to thelevel of provided supervision Attend and conduct clinico-radiological conferences and multidisciplinary meetings Participate in regular critical film review- 6-

Use information technology within the library services and the Web to search forradiological literaturePerform basic word-processing, and access computerized medical databases,electronic mail systems and the internet7. Program StructureThe training combines theoretical and practical aspects in the form of didactic lectures,seminars, tutorials and one-to-one teaching & hands on training. For convenience, thecurriculum will be divided into two “parts” however in practice the two “parts” will befollowed in parallelFIRST PART(First year)During this period the trainee is exposed to the basic radiological information essential toestablish his career as a radiologist obtained mainly through lectures which should cover thefollowing aspects: Physics. Radiological Anatomy. Radiological Techniques and Positioning. Image processing principles. Emergency and intensive care Radiology. Radiobiology, radiation Protection and dosimetry.I.Radiology physicsThe physical principles of Conventional Radiology. Ultrasound, Computed Tomography(CT), Magnetic Resonance Imaging (MRI) and Nuclear Medicine Imaging are included withemphasis on the effect of these principles on the quality of the generated images and theresultant diagnostic data.a. Conventional Radiology- Basic concepts:- Introduction to medical Imaging Radiation and the atom Interaction of radiation with matter Computers in medical ImagingDiagnostic radiology:- X- ray production, tubes, generators Screen- film radiography Film processingFluoroscopy [Suites, equipment, modes of operation, image quality, radiation dose].Image quality [Contrast, resolution, noise, operating curves].Digital Radiography [Implementation, CR devices, image processing, patient’s dose,- 7-

contrast versus resolution in digital imaging].b. Image processing principles:The radiographic film, the film cassette,intensifying screens & film screen combination, theprocessing machines and techniques, Digital processing, film criticism, and common faultsand film artefactsc. Nuclear Medicine Radioactivity and nuclear transformationRadionuclide production and RadiopharmaceuticalsRadiation detection and measurements [Types of detectors, counting statistics].Nuclear imaging [Scintillation cameras, computers,.]Emission TomographySPECTPETd. Computerized Tomography Basic principlesGeometry and Historical DevelopmentDetectors and Detector ArraysDetails of AcquisitionTomographic ReconstructionDigital Image DisplayRadiation DoseImage QualityArtifactse. Ultrasonography Characteristics of SoundInteraction of Ultrasound with MatterTransducersBeam PropertiesImage Data AcquisitionTwo- Dimensional Display and StorageImage Quality and ArtifactsDoppler Ultrasound & color DopplerSystem Performance and Quality AssuranceAcoustic Power and Bioeffectsf. Magnetic Resonance Imaging Magnetization PropertiesGeneration, Detection and localization of MR SignalPulse Sequences, Spin Echo, Inversion Recovery, Gradient Recalled Echo- 8-

Signal from Flow and MR angiographyPerfusion and Diffusion ContrastMagnetization Transfer ContrastK- space Data acquisition and image reconstructionThree- Dimensional Fourier transform image acquisitionImage characteristicsArtifactsInstrumentationSafety and Bioeffectsg. Mammography II.III.X- ray Tube designX- ray Generator and phototimer systemCompression, scattered Radiation, and magnificationScreen- film cassettes and digital mammographyAncillary procedures [Stereotactic breast biopsy & localization]Radiation DosimetryRegulatory requirements [Accreditation, Quality assurance]Radiological positioning and techniques Radiography of different anatomic regions in the human body (Skull, Spine,Chest, Abdomen and pelvis, Upper and Lower limbs,.) is outlined with detailof the exposure factors and accurate positions of each anatomic part The current radiological techniques for conventional radiology and imagingincluding patient preparation, examination technique, and contrast materialused, patient after care and the possible complications of each technique aswell as management of these complications. Contrast media: Types (positive, negative), chemical components, indicationsand contraindications for use, reactions to certain types and management ofthese reactionsRadiological AnatomyAnatomy as demonstrated on the radiological and imaging procedures including conventionalradiography, contrast studies, US, CT and MRI. The anatomic regions of interest shouldcover: The skull and its contents including the brain and cerebral vessels, skull base,pharynx and temporal bones The face and facial bones, orbits , sinuses , jaws & salivary glands The neck, thyroid, larynx & extra cranial vessels The spine, spinal cord and meninges The musculoskeletal system including bones ,joints, ligaments and muscles The heart and great vessels The chest including lungs, mediastinum and chest wall The gastrointestinal system including solid organs [liver, spleen, pancreas] as- 9-

IV.well as the oesophagus , stomach , bowel and biliary treeThe genitourinary system [Kidneys, ureters, urinary bladder, prostate, seminalvesicles, uterus and adnexa]The peripheral vessels and lymphatics of the upper and lower limbsThe breastRadiobiology (Radiation protection, dosimetry and biology) Radiation Protection-Sources of exposure to ionizing radiationRadiation detection equipment in radiation safetyRadiation protection and exposure controlPersonnel DosimetryRegulatory agencies and radiation exposure limits Radiation Dosimetry of the Patient-X- ray DosimetryRadiopharmaceutical dosimetry: The MIRD method [Medical InternalRadiation Dosimetry] Radiation Biology-Interaction of radiation with tissueCellular radiobiologyResponse of organ systems to radiationAcute radiation syndromeRadiation- induced carcinogenesisHereditary effects of radiation exposureRadiation effects in-uteroBasic Radiology (Theoretical & Didactic)FIRST PARTi.Physics :Approved physics course to be introduced to cover physics,radiobiology and radioisotopes1) General X-Ray: A basic knowledge of physicsFundamentals of nuclear physics and general properties of radiationProduction of X-Ray and their propertiesInteraction of X-Ray & Gamma Ray with matterMeasurement of X-Ray & Gamma Ray quantity, scintillation counterandthermoluminescence dosimeter and absorbed dose-10-

X-Ray equipment construction (filter,grid,etc.)Physical aspect of radiography, fluoroscopy, image intensifiertelevision, flat detectorsTypes of medical filmsTypes of intensifying screensImage artifactsComputers in radiology (P A C S)2) Nuclear Medicine: Basic principles Radiopharmacology Dose Calibrator Equipment Emission Tomography Data display.3) Computerized Tomography: Basic principles Equipment Image reconstruction and display4) Ultrasonography: Basic principles Interaction of ultrasound with matter Transducers Pulse echo system Gray-scale system Doppler system5) Magnetic Resonance Imaging: Basic principles Imaging sequences Artifactsii.Radiobiology : General effect of irradiation Effect of irradiation on intrauterine development Pre-implantation period Period of major organogenesis Fetal period Protection of the patient in diagnostic radiology Health effects of ionizing radiation Radiation dose from diagnostic radiology Absorbed dose in body tissues-11-

X-Ray examination of womenALARA principle & avoidance of unnecessary doseQuality controliii.Radio-isotopes in diagnosis : Preparation of radioactive tracer Patient preparation - Data acquisition Body systems:bone,renal, cardiac, endocrine .etc.iv.Radiological Anatomy :(16 hours ) Musculo-skeletal (4hours) Mediastinum, lung(2hours) Gastrointestinal tract Nervous system Urogenital tract Cardio vascular system Soft tissues (e.g. Thyroid, breast, etc) Obstetrics & Gynecologyv.(2 hours)(3 hours)(1 hour)(1 hour)(2 hours)(1 hour)Radiographic Positioning &Technique : ( 6 hours ) Radiographic positions of different body parts Appropriate selection of X-Ray equipment and suitable photographicmethods vi.Exposure factorsContrast Media:(2 hours)Types, administration, contra indicat

Achieved a high qualification In Radiology such as American Board, ABRMI or equivalent. Has an experience of at least 3 years after the higher qualification. Of the rank of Consultant Radiologist. Is employed on a full time basis , in the selected training hospital/ center -6-4.2 - Responsibilities and Duties of the Trainer Responsible for the actual performance of the trainee. Look after the .

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