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RESIDENT SURVIVAL GUIDE This section is currently being edited. More will be added in the future.
Adapted from Brant WE & Helms CA., Fundamentals of Diagnostic Radiology, 3rd ed.
Recommended Reading This is one of the busiest rotations. There will be many ICU and CCU films waiting for you to read in the morning, plus any early morning in house films. Most if not all are follow up exams, so use priors and comparisons to your advantage. Better, worse, or the same? Call the clinician for pneumothorax and malpositioned lines. Nurses will ask you if a line is okay to use. Radiologists do not "okay" the use of PICC lines or feeding tubes; we report whether the position appears appropriate, nothing more. Recommended Reading Check the fluoro schedule in the morning and review the studies you will be performing today. While on this rotation, you are responsible for all abdominal plain films, ERCP, HSG, and all fluoroscopic studies. Ask for help if you need it. Outlines of how to do the most common procedures are below:
Recommended Reading You will be reading all the chest, abdomen, and pelvic CTs and MRIs. The bone resident will read all trauma CTs. Please check for comparisons/prior; some are not in PACS. At 3pm each day, go over the schedule for tomorrow's scans. You are responsible for all scans done before 4:30 pm. Outpatient scans must be looked at before your leave to rule out acute processes, but can be dictated and staffed in the morning. Any outpatient studies done during call hours will have a preliminary read by the on-call resident but will need to be staffed and dictated by the Body resident.
Recommended Reading Every morning, an MRI schedule will be placed at the Neuro Reading Room workstation. All your requisitions will be brought to you and placed in the bin. You are responsible for all MRI and MRA brains, necks, and spines, all CT and CTA brains, soft-tissue neck, spines, sinuses, and temporal bones. All CT heads from the ER require a call back, negative or positive (x4590). Document name, time, and date of call.
Recommended Reading You are responsible for all plain films of the extremities, hips, spine, and skull, MRI of the joints, and all chest, abdomen, and pelvic trauma CTs. Trauma dictations must include in the Impressions, unless otherwise, "no acute osseous abnormalities of the thoracic and lumbar spine", as well as "results discussed with trauma team at [time/date]".
You'll get lots of reading done during this rotation. Chest and bone are the majority of cases seen during this month. Remember, Friday night call person reads the Friday afternoon clinics with staff Saturday morning, unless there is a first year. Light Board: In the morning, films should be aleardy hung with a pile of requisitions, ready for you to start. For dictation, use PowerScribe and enter the assession number into the MRN box. The patient's film should pop up into the que, ready for you to dictate. To go to the next study, press Ctrl+N. When finished with the first board, call Jen to setup the next board. Boys Town stone studies: These are pre-op lithotripsy studies. Dictation is through the Boys Town phone dictation. Military Base Teleradiology: Various studies, plain films, ultrasounds, and CTs come through the telerad station. Requisites will be waiting for you in the black bins. Dictate through PowerScribe just as you would light box clinic films, with the assession number.
Complete the year appropriate modules from the Childrens Hospital Clevland Clinic Online Learning Curriculum Recommended Reading
Gender: [x] Chronological age: [x] years, [x] months ([x] months) (calculate this) Skeletal Age: [x] years, [x] months ([x] months) (look this up according to gender) Expect Mean Skeletal Age: [x] months (from Brush Foundation Scale) Standard Deviation: [x] months (from Brush Foundation Scale)
Interpretation (choose 1, compare to any priors if available):
Recommended Reading Check the schedule for the day and note the procedures. Let your attending know what and when procedures are scheduled. The ultrasound technicians are a great learning resource and will teach you a lot. Be nice to them and they will be nice to you, making your job much easier. To dictate, scan the bar code on the requisition to make the patient appear on PowerScribe.
Recommended Reading Recommended Reading “Shellfish or ‘iodine allergy’ is not a contraindication to use of IV contrast and does not mandate a pretreatment regimen” ~ eMedicine. Pre-medicate for non-emergent studies Emergent studies, administer the following meds and wait 15 minutes.
From the U.S. Food and Drug Administration: Physicians should consider the risks and benefits of using GBCAs in patients with acute or chronic severe renal insufficiency (glomerular filtration rate <30 mL/min/1.73m2); renal dysfunction of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period. In these patients, GBCA should be avoided unless the diagnostic information is essential and not available with non-contrast enhanced MRI. Additional risk factors that may increase the risk are repeated or higher than recommended doses of a GBCA and the degree of renal impairment at the time of exposure. For patients already receiving hemodialysis, physicians may consider the prompt initiation of hemodialysis following the administration of a GBCA in order to enhance the contrast agent's elimination. However, the usefulness of hemodialysis in the prevention of NSF is unknown. Physicians should also report all cases of NSF to the FDA’s MedWatch at http://www.fda.gov/medwatch/
Hold metformin prior and 2 days after. Hold diuretics 1 day prior. Cr below 1.4, full dose contrast Cr 1.5 - 2.0, hydrate with IV NS; Mucomyst 1200 mg IV prior to CT or 600 mg PO BID before and after scan. Alternatively, give Bicarb 3ml/kg/hr 1 hour prior and 1ml/kg/hr 6 hours after (mix 3 amps in 1L of D5 water, bolus 500cc prior to CT, then 100cc/hr until it's gone). Cr above 2.0, consider alternative study
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This is an informational website only. We will not discuss specific medical conditions and/or dispense medical advice. We urge you to seek such advice from your local medical professional. This site last updated: 2/24/08 |