Rotation 1

During the first year of radiology residency at UW (R2), all residents rotate through Musculoskeletal Radiology at Harborview. The resident is expected to run the musculoskeletal service, making sure that exams are dictated, future exams are protocoled, procedures are performed, and consultations are given.

After completing the first four-week rotation in musculoskeletal radiology, the resident will be able to:

• Generate accurate and concise radiographic reports
• Communicate effectively with patients, referring clinicians, technologists and supervisory staff
• Understand standard radiographic positioning and anatomy
• Obtain essential patient information pertinent to the radiologic examination
• Demonstrate knowledge of clinical indications for radiography and indications for urgent computed tomography (CT) and magnetic resonance (MR) examinations
• Demonstrate a responsible work ethic
• Participate in quality improvement/ quality assurance activities
• Participate in the education of students and interns

• Demonstrate learning of normal radiographic and CT anatomy of the axial and appendicular skeleton
• Recognize and accurately describe common fractures and dislocations of the appendicular skeleton
• Demonstrate learning of pathophysiology and radiology of fracture healing and complications of healing such as delayed union, malunion and nonunion
• Demonstrate learning of radiographic presentation and evaluation of osteomyelitis and septic arthritis
• Recognize and describe complications of orthopedic devices including fracture fixation and spine and arthroplasty hardware

• Dictate clear, detailed, and accurate reports that include all pertinent information as established in the American College of Radiology (ACR) Guidelines for Communication(PBL, ICS)
• Use appropriate nomenclature when reporting radiographic, CT, MR or ultrasound (US) findings of musculoskeletal disease (ICS)
• Communicate all unexpected or significant findings to the ordering provider and document whom was called and the date and time of the discussion in the report (ICS, PC, P)
• Obtain relevant patient history from electronic records, dictated reports, the patient, or by communication with referring provider (PC)
• Recognize and describe positioning and anatomy of standard radiographic examinations of the musculoskeletal system (MK)
• Effectively provide feedback to radiology technologists regarding quality of exposure and patient positioning (ICS, SBP)
• Recognize when it is appropriate to obtain help from senior residents or faculty when assisting referring clinicians (PC, P)
• Demonstrate responsible, ethical behavior; positive work habits; and professional appearance; and adhere to principles of patient confidentiality (P)
• Participate in discussions with faculty and staff regarding operational challenges and potential system solutions regarding all aspects of radiologic services and patient care (SBP)

See Abbreviations

• Dictate at least 10 cases per hour (if cases are available to report) from the ORTHO UNREAD WORKLIST
• Observe arthrograms
• Observe CT-guided biopsies
• Protocol CT and MRI exams using the MSK CT & MRI protocol reference book when fellows are not available
• Complete required readings: Books are available at MSK reading room
• Attend required MSK conferences

1. UW MSK website providing essential knowledge of Musculoskeletal radiology
2. “Skeletal Radiology: The Bare Bones” by Chew
3. Core Lectures in MSK Radiology (ISS and SSR)

• Week 1 - Anatomy
• Week 2 - Trauma
• Week 3 - Arthritis
• Week 4 - Infection

A. Mandatory

• Noon conferences at Harborview (Everyday); the dedicated musculoskeletal radiology case conference is every Wednesday at noon in the HMC Nelson Conference Room
• Thursday afternoon resident lectures at UWMC (Every Thursday)

B. Optional

• Intergalactic MSK Conference at HMC ; Every Friday noon

1. At the end of rotation, each resident will meet with the MSK attending on site for brief exit interview during the last week. Resident will receive feedback regarding his/her performance during the month and also have opportunity to voice ideas to improve the rotation. MSK rotation evaluation should be submitted after the exit interview before the actual last date of rotation.
2. Each resident will take an exit exam on the last day of rotation. The exam will be held at the stand alone station at HMC.