UW MSK Residents' Manual

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====== Rotation 2 ======



During the second through third year of radiology residency at UW (R3-4), all residents rotate through Musculoskeletal Radiology at Roosevelt. 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.


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

  * Demonstrate learning of knowledge based objectives and mastery of technical objectives for the second rotation
  * Continue to build and improve on skills developed during the first rotation
  * Develop skills in protocoling and monitoring CT and MR examinations
  * Demonstrate an understanding of the ACR Appropriateness Criteria and ACR Practice Guidelines and Technical Standards for musculoskeletal imaging 
  * Participate in the education of junior residents, interns, and medical students
  * Perform image guided procedures


===== Objectives =====
==== Knowledge-Based ====
 

  * Recognize and describe the radiographic presentation of Paget disease
  * Demonstrate learning of a systematic approach to arthritis
  * Demonstrate a systematic assessment of a solitary lesion of bone and be able to categorize the lesion as aggressive or nonaggressive
  * Recognize and describe common locations of and radiologic manifestations of osteonecrosis
  * Demonstrate knowledge of MRI safety issues including contraindication to scanning and use of contrast
  * Demonstrate learning of the use of various pulse sequences and planes of imaging used in MRI of musculoskeletal disorders
  * Demonstrate learning of joint anatomy and pathology on MRI

 

==== Technical ====
 

  * Build and improve on skills acquired during first rotation
  * Demonstrate the ability to gather essential and accurate patient information (electronic, personal communication) to appropriately prescribe MRI protocols (PC, ICS)
  * Provide effective and timely feedback and education to CT and MRI technologists regarding quality of examinations (ICS, SBP)
  * Demonstrate ability to monitor CT and MRI examinations to ensure the patient is adequately evaluated (MK, PC)
  * Provide technical and educational guidance to junior residents and students (ICS)
  * Safely perform fluroscopically guided joint injections and aspirations with faculty supervision (PC)
  * Demonstrate an understanding of indications, contraindications, radiation risks, and post procedural management of fluroscopically guided procedures including management of complications (MK, PC)
  * Demonstrate an ability to counsel a patient and obtain informed consent before performing a procedure, including a description of the procedure, risks, benefits, and alternatives; and solicit and respond to patient questions without discrimination based on religious, ethnic, sexual, economic, or educational differences (ICS, PC, P)
  * Maintain a log of all procedures performed including complications (PBL)

[[See Abbreviations]]
==== Performance ====
==== Performance ====


  * Report plain, and cross sectional studies from the __**MSK UNREAD WORKLIST**__
  * __//**Report STAT ER cases within a 30 minute window in preliminary format and call the ER with the results**//__
  * Successfully perform **SHOULDER** arthrograms under supervision by attendings or fellows: Review arthrogram videos which are available on MSK website prior to procedures. A link to our awesome online video [[http://uwmsk.org/arthrography|arthrography tutorials]].
  * Observe all arthrograms
  * Protocol CT, and MRI exams using the **MSK CT & MRI protocol reference book** when fellows are not available
  * Observe US exams
  * Complete required readings: Books are available at MSK reading room
  * Attend required conferences
  * Complete rotation evaluation 
  * **Present MSK noon conference**: 
    - Time : on last Wednesday at HMC 
    - Content : interesting MRI cases during the rotation

===== Required reading =====

  - [[http://uwmsk.org|UW MSK website]] providing essential knowledge of Musculoskeletal radiology 
  - [[http://www.amazon.com/Musculoskeletal-MRI-Clyde-Helms-MD/dp/1416055347/ref=sr_1_1?ie=UTF8&s=books&qid=1278969893&sr=8-1|Musculoskeletal MRI]] by Helms, Major et al.
  - [[http://www.amazon.com/Musculoskeletal-Imaging-Teaching-File-LWW/dp/0781757541/ref=sr_1_1?ie=UTF8&s=books&qid=1278969963&sr=1-1|MSK Imaging:  A Teaching File]] by Chew and Roberts

===== Cognitive exam =====
 

  * Week 1 - MRI of knee
  * Week 2 - MRI of shoulder
  * Week 3 - MRI of wrist and elbow
  * Week 4 - MRI of foot and ankle

The cognitive exams are multiple choice tests with images and feedback. They are accessed through the Catalyst website (www.catalyst.washington.edu). Each resident has his or her own unique catalyst homepage on which direct links to these exams should appear.

==== R4 practical exam ====





===== Conferences =====
==== A. Mandatory ====

  * Morning conference at UWMC (Everyday)
  * Thursday resident lecture at UWMC (Every Thursday)
  * Rehabilitation – MSK radiology conference at ROS (Every fourth Tuesday, 7:30AM)
  * Friday Online MSK Case Conference (with UC Davis & others) at Roos & HMC (Every Friday @ Noon)
  * Radiology – Rheumatology conference at ROS (Every other Friday 8:30 AM)
==== B. Optional ====

  * Orthopedic Radiology correlation conference at UWMC (Every third Wednesday, 6:30 AM)
 

===== Exit interview =====
 

At the end of each MSK rotation (core or elective), each resident will meet with Director of residency education of MSK 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.
UW MSK Residents' Manual

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