Radiology Curriculum

Radiology Curriculum

Radiology Egyptian Fellowship Board


Preface

T he Egyptian Fellowship and the radiology scientific council worked collaboratively to

make this curriculum available for trainees’ and trainers’ guidance and support.

Postgraduate medical education world wide are now governed by sets of academic stan-

dards that describe the qualities and abilities of graduates. In addition, there are standards

for The training processes , trainers’ selection and methods of assessment. standards en-

sure transparency and clarify expectations.

The Egyptian fellowship has already defined and published its standards for the general

and professional competencies expected from our graduates in different specialties upon

successful completion of training. These expectations have been clearly reflected in the

radiology curriculum.

The curriculum describes what trainees will know and be able to do upon completion

of training. In additions, methods of teaching and learning needed to deliver the curriculum

are outlined. The curriculum also describes expectations from trainees during their rota-

tions in “The training rules and regulations section”. Methods of assessment and examina-

tion regulations are also available in the last section of the curriculum.

All topics covered during practical and theoretical study are outlined. This will help

trainees to guide their readings and their choice of learning activities. In addition, all re-

quired procedures and interventional techniques are listed together with expected perform-

ance at various stages of training

To help our trainers, supervisors and maximize benefits, we provided a list of required

lectures at various rotations and what obligatory courses are requested. The Egyptian Fel-

lowship will work closely with radiology scientific council to ensure proper organization

and implementation of the curriculum at various training stages.

We hope that all our trainees, trainers and educational supervisors will cooperate with The

Egyptian Fellowship and radiology scientific council so that our shared vision for graduation

of outstanding radiology practitioners becomes a reality . Esmat Ahmed Sheba Secretary General

Higher Committee of Medical Specialties



Acknowledgement

The radiology curriculum has been created through collaboration between The Radi-

ology Scientific Council and The Egyptian Fellowship Curriculum Committee. The

Fellowship Board and the Radiology Scientific Council would like to acknowledge

the efforts and the substantial contribution of Professor Dr Mammdouh Mahfouz ,

Professor of Radiology , Cairo University to the curriculum development.

The fellowship curriculum committee and the radiology scientific council con-

sulted international and national curricula in radiology. The external refer-

ences for the development of this curriculum are:

1. The Royal College of Radiologists Curriculum and Assessment blue print

2007

2. The Accreditation Council for Graduate Medical Education (diagnostic

radiology program requirements )

3. Previous Egyptian Fellowship radiology curriculum

4. Postgraduate Medical Education and Training Board UK (Guidelines for

curriculum development 2006)


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6

الىظيفخ أسن الطجيت هيئخ الوكتت م

أشعخ ثطت المبهرح. أ دريخ صبلخ السيذ سبلن.د.أ رئيس الوجلس 1

جبهعخ لنبح السىيس ليلً هذوذ المبضً. د.أ عضى 2

جبهعخ السلبزيك أدوذ عثوبى أثى العس. د.أ عضى 3

جبهعخ الونصىرح طبرق عجذ الونعن الذيسطً. د.أ عضى 4

األشعخ جبهعخ المبهرح. أ هذرم أدوذ الجذوي. د.أ عضى 5

ثوعهذ األورام المىهً ثبلمبهرح. أ إكرام دبهذ هذوىد. د.أ عضى 6

جبهعخ المبهرح. أ إيوبى هذوذ ركً. د.أ عضى 7

األشعخ ثكليخ طت المبهرح. أ سبهخ عجذ العسيس زكً. د.أ عضى 8

األشعخ ثطت المبهرح. أ هذوذ الطىخً. د.أ عضى 9

األشعخ ثطت المبهرح. أ هوذوح هذفىظ. د.أ عضى 10

إستشبري ثهيئخ الوستشفيبد التعليويخ سلين وديع. د.أ عضى 11

األشعخ ثطت المبهرح. أ أشرف صالح هذوذ سلين. د.أ عضى 12

األشعخ ثطت عيي شوس. أ وديذ طنطبوي. د.أ عضى 13

األشعخ ثطت المبهرح. أ دبتن دسنً درويش سالم. د.أ عضى 14

رئيس لسن األشعخ ثبلونيب أسبهخ عجذ الىدود. د.أ عضى 15

رئيس لسن األشعخ ثبألزهر سيذ أدوذ سيذ عنين. د.أ عضى 16

أستبر ورئيس لسن األشعخ ثطت ثنهب تبهر أدوذ كوبل. د.أ عضى 17

رئيس لسن األشعخ ثبألسكنذريخ. أ إيهبة سبهً رضب. د.أ عضى 18

الوجلس العلوً لالشعخ التشخيصيخ


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The overall aims of radiology training………………………………………………………..11 Training rules and regulations…………………………………………………………………....11 Radiology training curriculum……………………………………………………………………..15

Breast radiology……………………………………………………………………………………………………………………………….16 Cardiac radiology…………………………………………………………………………………………………………………………….17 Gastrointestinal radiology……………………………………………………………………………………………………………..18 Head and neck /ENT/Dental radiology…………………………………………………………………………………...20 Musculoskeletal radiology…………………………………………………………………………………………………………….22 Neuroradiology……………………………………………………………………………………………………………………………….23 Obstetric and Gynecological radiology…………………………………………………………………………………...25 Oncological radiology…………………………………………………………………………………………………………………..26 Pediatric radiology………………………………………………………………………………………………………………………….27 Thoracic radiology…………………………………………………………………………………………………………………………..29 Uroradiology…………………………………………………………………………………………………………………………………….30 Vascular and vascular intervention radiology………………………………………………………………………...32 Radionuclide radiology………………………………………………………………………………………………………………….34

Program Structure and topics...…….……………………………………………………………..35 First year…………………………………………………………………………………………………………………………………………….35 Second and third year…………………………………………………………………………………………………………………..38 Fourth year……………………………………………………………………………………………………………………………………..42

Training methodology………………………………………………………………………………..44 Methods of trainees’ evaluation………………………………………………………………….44 Methods of assessment……………………………………………………………………………….45


The overall aims of radiology training………………………………………………………..11 Training rules and regulations…………………………………………………………………....11 Radiology training curriculum……………………………………………………………………..15

Breast radiology……………………………………………………………………………………………………………………………….16 Cardiac radiology…………………………………………………………………………………………………………………………….17 Gastrointestinal radiology……………………………………………………………………………………………………………..18 Head and neck /ENT/Dental radiology…………………………………………………………………………………...20 Musculoskeletal radiology…………………………………………………………………………………………………………….22 Neuroradiology……………………………………………………………………………………………………………………………….23 Obstetric and Gynecological radiology…………………………………………………………………………………...25 Oncological radiology…………………………………………………………………………………………………………………..26 Pediatric radiology………………………………………………………………………………………………………………………….27 Thoracic radiology…………………………………………………………………………………………………………………………..29 Uroradiology…………………………………………………………………………………………………………………………………….30 Vascular and vascular intervention radiology………………………………………………………………………...32 Radionuclide radiology………………………………………………………………………………………………………………….34

Program Structure and topics...…….……………………………………………………………..35 First year…………………………………………………………………………………………………………………………………………….35 Second and third year…………………………………………………………………………………………………………………..38 Fourth year……………………………………………………………………………………………………………………………………..42

Training methodology………………………………………………………………………………..44 Methods of trainees’ evaluation………………………………………………………………….44 Methods of assessment……………………………………………………………………………….45

Table of Contents ……………..


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10


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To promote and support the qualification of specialized radiologists by the end of 4 years training, who are:

Aware of the current and advanced diagnostic imaging modalities and their applications for diagnosis and treatment.

Able to run a radio- diagnostic unit providing the basic and com-mon diagnostic procedures .

Able to write a comprehensive report on radiological study with clinico- radiological interpretation and to deduce the correct

diagnosis or the possible differential diagnoses.

Able to conduct a research work and get benefit of the published scientific researches, and to present a short talk on an assigned topic.

Able to communicate and keep pace with radiologists abroad.

Prepared to acquire and apply the new developments in Radiology whenever available.

Having a sufficient preliminary knowledge about the use of computers and computer sciences in radiological diagnosis and management.

This is a four years structural residency training program aimed at training the medical graduate as a radiologist to a level of specialist in radio diag-nosis. The training will be conducted in the centers recognized by the Scientific Council of Radiology. The chosen centers will be announced and circulated annually by the Scientific Council of Radiology.

Requirements Of The Training Program:

The trainee

Supervisor/ Trainer

The overall aims of radiology training

Training rules and regulations


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Basic Requirements:

The trainee should be a holder of a diploma in human medicine, M.B.B.ch. or its equivalent from a recognized medical school of any Arab country or from a medical school in any foreign country provided that this medical school is accredited by its country of origin and the accredi-tation is affirmed by the Egyptian local regulations

The trainee should have completed a 12 months period of internship.

The trainee should be licensed to practice medicine by the appropriate licensing authority.

The trainee is supposed to be a citizen of an Arab country and/or be able to read, write and speak the Arabic language.

The trainee should successfully pass the entry selection examination and interview when applicable.

The trainee shall duly complete and sign the registration form and affirm it by the appropriate authority.

The trainee shall comply with any other requirements which may be recommended by the Scientific Council of Radiology in the future.

General Requirement:

The training is conducted only in the approved centre/centers

The trainee should work on a full time basis through-out the whole period of the training.

The trainee should participate actively in all academic and clinical activi-ties of the department of Radiology in particular and the hospital in gen-eral.

The trainee shall assume increasing responsibilities according to the level of training and attained competence.

The trainee should maintain proper professional standards in relations with patients, their relatives, the medical nursing and administrative staff.

The trainee should maintain the confidentiality and ethics of the profession.

The trainee


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Specific Requirements: The trainee is responsible for any patient examined in the Radiology Depart-ment in regard to the following points:

Check the patient’s file for the clinical data, provisional diagnosis, labora-tory investigations,..

Ascertain that full clinical history including all the radiologically relevant data are available in the request form prior to any step in patients exami-nation.

Assess the requested radiological study to provide the suitable prepara-tion procedure.

Supervise, assist, or perform the required radiological study including contrast media injection and patient’s after care

Inspect all radiological studies performed before the patient leaves the radiology department to ensure adequate and complete study

Provide (or prepare) the emergency and preliminary reports to be checked by the trainer.

Mandatory Requirements:

The trainee has to attend and participate in the cyclic academic and clinical activities of the radiology department. Attendance and participa-tion should not be less than 80% of the total number of activities at any training rotation/period.

The trainee has to keep a Log Book wherein record of all activities per-formed and learned during the training program are registered. The activities should be dated and categorized as to whether been per-formed by the trainee him/herself or as an assistant or participant. Each activity registered in the Log Book should be counter signed by the trainer and finally the completed Log Book shall be signed by the

Educational supervisor when deemed complete.


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Educational supervisor Qualification and quality

A highly qualified Radiologist being a holder of MD, American Board, FRCR or equivalent.

Titled as a Consultant Radiologist.

Has an experience of at least 6 years after the high qualification.

Should have a recognizable experience in teaching and postgraduate training.

Responsibilities Monitoring of the training program.

Organization of the annual assessment examinations.

Receive , assess and approve the periodic evaluation reports from the trainers

Ensure the provision and regularity of the scientific training activities.

Participate and monitor all training activities.

Participate in The arrangements of the training courses and preparatory courses for the examinations.

Inspect and monitor the trainee’s Log Book.

Be accountable for the actual performance of the trainees.

Look after the trainees and give them the requirements of the training including technical experience with increasing responsibilities according to the trainee’s abilities and progress.

Organization and provision of the scientific activities in his affiliated training center with help from trainers and trainees.

Provide periodic evaluation reports of the trainee to The Egyptian fellow-ship board.

Trainer Qualification

Achieved a high qualification In Radiology such as M.D, American Board, or equivalent.

Has an experience of at least 3 years after the high qualification . Train-ers having only the master degree of Radio-diagnosis should have an experience of at least 6 years in the field of diagnostic Radiology.

Will be an employee of a Consultant or Senior Registrar status.

Is employed on a full time basis , in the selected training hospital Responsibilities and Duties of the Trainer

Shall be responsible for the actual performance of the trainee.

Shall be able to look after the trainee and give him/her the require-ments of the training including technical experience with increasing responsibilities according to the trainee’s abilities and progress.

Will be responsible for approval of the holidays and leaves.

Will be responsible for arranging the rotations for the trainees.

Will be responsible for appointment of the trainee to the different levels of training.

Will be responsible for the preliminary approval of the trainee admit-tance to examinations.

Organization and delivery of The training and educational activities in collaboration with The educational supervisor

Supervisors and Trainers


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Radiology training curriculum

by the end of training, trainees should have adequate knowledge and deep understanding of: 1. The basic radiation physics and radiation safety 2. The concepts and terminology of diagnostic and interventional radiology 3. The role and usefulness of the various diagnostic and interventional techniques in all age groups 4. The responsibilities of a radiologist to the patient, including the legal framework and necessity for informed consent 5. The various types of contrast media, drugs (including intravenous sedation) and monitoring used in day to day radiological practice 6. The indications, contraindications, doses (adult and pediatric) and the management of reactions and complications of contrast media and sedation drugs 7. The principles of radiation protection and the legal framework for protection against ionizing radiation 8. The safety requirements for radionuclide imaging 9. The basic radiological and radiographic procedures 10. The practice of clinical audit and risk management 11. The principles of medical research including research design and the interpret of research data 12. The principles and practice of evidence based medicine as it applies to the radiology discipline by the end of training, Egyptian Fellowship trainees should be able to: 1. Demonstrate safe radiological practice 2. Interpret and formally report all core radiological procedures and Techniques performed during routine work 3. Perform all routine radiological procedures 4. Perform and report on call investigations appropriate to the level of training and to the level of provided supervision 5. Attend and conduct clinico-radiological conferences and multidisciplinary meetings 6. Participate in regular critical film review 7. Critically read and appraise published material using appropriate libraries 8. Use information technology within the library services and the Web to search for radiological literature 9. Perform basic word-processing, and access computerized medical databases, electronic mail systems and the internet

Core knowledge

Core Skills


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Core attitudes and behaviors

by the end of training Egyptian Fellowship trainees should: 1. Appreciate the legal and ethical framework within which radiology and general healthcare provision operate 2. Keep abreast of developments in information management relevant to radiology departments 3. Communicate effectively with patients and colleagues 4. Keep abreast of current trends and recent advances in clinical radiology 5. Strive for best practice in patient record keeping and the transfer of clinical data and images

by the end of training, trainees should have adequate knowledge and deep understanding of: 1. The breast anatomy and clinical conditions relevant to clinical radiology 2. The radiographic techniques employed in diagnostic mammography 3. The principles of current practice in breast imaging and breast cancer screening 4. The proper application of other imaging techniques to this specialty (e.g. ultrasound, CT scan, magnetic resonance imaging and radionuclide imaging) 1. Report and interpret mammograms demonstrating common breast disease 2. Participate in mammographic report sessions (screening and regular) 3. Perform ultrasound of the breast 4. Participate in multidisciplinary breast meetings 1. The anatomy and physiology of the breast 2. The pathology of benign and malignant breast conditions 3. The epidemiology of breast cancer 4. The principles of population screening for breast cancer 5. The principles of mammographic technique and factors affecting quality 6. The technique of breast ultrasound and factors affecting quality 7. The technique of scintimammography and sentinel node imaging 8. Magnetic resonance imaging of the breast 9. Digital imaging of the breast and factors affecting image quality 10.The indications, contraindications and complications of each imaging method 11.The role of multidisciplinary meetings in the management of breast disease 12.Local, national and international imaging guidelines

Breast radiology

Core knowledge

Core skills

Advanced knowledge


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Advanced skills

1.Use ultrasound in diagnosing breast diseases 2.Use of radionuclide imaging in diagnosing and staging breast diseases 3.Use of magnetic resonance imaging in evaluation of breast diseases 4.Perform the following procedures 1.Cyst aspiration 2.Ultrasound guided fine needle aspiration cytology, localization and core biopsy 3.Stereotactic fine needle aspiration cytology, localization and core biopsy 4.Mammographic guided localization for biopsy and treatment 5.Ultrasound guided localization for biopsy and treatment 6.Mammographic surgical specimen localization

By the end of training, trainees should have adequate knowledge and deep understanding of: 1.The cardiac anatomy and clinical practice relevant to clinical radiology 2.The manifestations of cardiac disease demonstrated by conventional radiography 3.The application of the following techniques in the field of diagnostic cardiology:

Echocardiography (including trans-esophageal)

Radionuclide investigations

Computed tomography

Magnetic resonance imaging

Angiography, including coronary angiography 1.Interpret and Report plain radiographs performed to show cardiac disease and postoperative appearances 2.Interpret and Report common and relevant cardiac conditions demonstrated by ultrasound, computed tomography and magnetic resonance imaging

Cardiac radiology

Core knowledge

Core skills


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Advanced knowledge 1.The anatomy, normal variants and physiology of the cardiovascular system 2.The epidemiology of cardiac diseases 3.The pathological processes of benign and malignant conditions involving The cardiovascular system 4.The techniques of cardiac imaging using: Plain films Ultrasound/echocardiography CT and CT angiography MR and MR angiography Radionuclide radiology 5. The indications, contraindications and complications of each imaging Method Conduct, supervise and interpret the following imaging techniques to a high professional standard: 1.Plain radiography 2.Cardiac ultrasound and echocardiography 3.Computed tomography 4.Magnetic resonance imaging

By the end of training trainees should Demonstrate adequate knowledge of: 1.The gastrointestinal and biliary anatomy and related clinical practice relevant to clinical radiology 2.The radiological manifestations of disease within the abdomen demonstrated by: conventional radiography, contrast studies (including Barium studies and ERCP), ultrasound, computed tomography, magnetic resonance imaging, radionuclide investigations and angiography 3.The applications, contraindications and complications of relevant interventional procedures

Advanced skills

Gastrointestinal radiology

Core knowledge


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19

Core skills

1.Interpret and Report plain radiographs performed to show gastrointestinal disease 2.Perform and report the following contrast examinations: - swallow and meal examinations - small bowel studies - enema examinations 3.Perform and report transabdominal ultrasound of the gastrointestinal System and abdominal viscera 4.Supervise and report computed tomography of the abdomen , CT Colonography and virtual studies 5.Supervise and report MRI investigations of the abdomen 6.Perform the Ultrasound-or CT guided biopsy and drainage procedures 7.Appropriatly use the following techniques: 1.Sinogram 2.Sialogram 3.GI motility studies 8.Recognize the current application of radionuclide investigations in the following areas: 1.Liver 2.Biliary system 3.Gastrointestinal bleeding 4.Abscess localization 5.Assessment of inflammatory bowel disease 9.Identify the application of angiography and vascular interventional techniques to GI subspecialty 10.idenity the relevant applications of percutaneous biliary procedures 1.The anatomy, normal variants and pathophysiology relevant to GI and hepatobiliary function 2.The pathology of benign and malignant conditions of : 1.the gastrointestinal tract 2.the hepatobiliary system 3.the pancreas 3.The epidemiology of GI, hepatobiliary and pancreatic diseases 4.The principles of population screening for colorectal cancer 5.The techniques of GI, hepatobiliary and pancreatic imaging using:

Plain films

Contrast studies

Ultrasound

CT

MR

Radionuclide imaging 6.The indications, contraindications and complications of each imaging method

Advanced knowledge


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20

Advanced skills

1.Conduct, supervise and interpret professionally the following imaging techniques: 1.plain radiography and fluoroscopic contrast studies 2.ultrasound 3.CT 4.MRI 2.Accuratly localize and take biopsy of abdominal and pelvic masses including lymph node biopsy 3.Practice of safe and effective interventional techniques including the drainage of: 1.hepatobiliary collections 2.intra-abdominal collections 3.pelvic collections 4.Recognize the uses of radionuclide radiology in diagnosis of: 1.GI bleeding 2.tumours and metastases 5.RecognizeThe role and limitations of ultrasound, CT, MRI and radionuclide radiology in the following conditions: 1.The staging of GI and hepatobiliary cancers 2.The investigation of abdominal trauma 3.Identification of oesophageal, gastric, small bowel, and large bowel abnormalities 5.Identification and categorization of peritoneal and mesenteric pathology

By the end of training trainees should have adequate knowledge of: 1.The head and neck anatomy and clinical practice relevant to clinical radiology 2.The manifestations of ENT/dental diseases as demonstrated by conventional radiography, relevant contrast examinations, ultrasound, CT and MRI 3.The application of ultrasound as a tool of diagnosis to the thyroid, salivary glands and other neck structures 4.The application of radionuclide investigations in the diagnosis of the thyroid and parathyroid glands disorders

Head and Neck/ENT/Dental radiology

Core knowledge


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21

Core skills

By the end of training, Trainees should be able to: 1.Report plain radiography performed to show ENT/dental disease 2.Perform and report relevant contrast examinations (e.g. barium studies including video swallows) 3.Perform and report ultrasound of the neck (including the thyroid, Parathyroid and salivary glands) 4.Supervise and report computed tomography of the head and neck for ENT problems 5.Supervise and report computed tomography for orbital problems 6.Supervise and report magnetic resonance imaging of the head and neck problems 7.Interpret radionuclide thyroid investigations 1.The anatomy, normal variants and pathophysiology relevant to head and neck radiology 2.The pathological processes of both benign and malignant disease in the head and neck region. The techniques of head and neck imaging using: 1.Plain films 2.Ultrasound 3.CT 4.MRI 5.Contrast studies 6.Radionuclide imaging 3.The indications, contraindications and complications of each imaging Method, the principles of informed consent 1.Professionaly conduct, supervise and interpret the following imaging techniques a. plain radiography b. sialography c. dacryocystography d. ultrasonography including Doppler studies e. CT including: the primary diagnosis of benign and malignant lesions, staging of head and neck tumors, detection of skull base and neck tumors f. MRI including: the primary diagnosis of benign and malignant lesions, staging of head and neck tumors, detection of skull base lesions, demonstration of cranial nerve anatomy and pathology g. upper GI contrast studies including: barium swallow, Video fluorography, radionuclide imaging 2.Accuratly localize and biopsy neck masses and lymph nodes using ultra sound or CT scan 3. Use the ultrasound or CT as a guide for drainage of head and neck collec-tions 4. Cannulate and dilate salivary gland ducts 5. Cannulate and dilate lacrimal ducts

Advanced knowledge

Advanced skills


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22

Musculoskeletal radiology

Core knowledge By the end of training, trainees should demonstrate adequate knowledge of: 1. Musculoskeletal anatomy and current clinical practice relevant to clinical radiology 2. Normal variants of normal anatomy, which may mimic disease 3. The manifestations of musculoskeletal diseases as demonstrated by conventional radiography, CT, MRI contrast examinations, radionuclide investigations and ultrasound 1. Report plain radiographs relevant to the diagnosis of disorders of the musculoskeletal system including trauma 2. Interpret radionuclide investigations of the musculoskeletal system, 3. Supervise and report computed tomography of the musculoskeletal system 4. Supervise and report magnetic resonance imaging of the musculoskeletal system 5. Conduct ultrasound of the musculoskeletal system 6. Supervise CT of trauma patients 7. Supervise MRI of trauma patients 8. Use appropriately relevant contrast examinations (e.g. CT and MR arthrography) 1. The anatomy, normal variants and pathophysiology relevant to musculoskeletal radiology 2. The pathological processes of both benign and malignant disease in the musculoskeletal system 3. The techniques of musculoskeletal imaging using plain film radiography, ultrasonography, computed tomography, magnetic resonance imaging, radionuclide imaging and fluoroscopic procedures including arthrography 4. The indications, contraindications and complications of each imaging method

Core skills

Advanced knowledge


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23

Advanced skills

1. Conduct, supervise and interpret competently, the following imaging techniques:

Plain radiography including primary care examinations, trauma cases, rheumatological disorders, general and pediatric orthopedic disorders

Ultrasonography of the joints and soft tissues including doppler studies

Computed tomography including the use of CT for the primary diagnosis of benign and malignant pathology, the staging of Bone tumors, the detection of direct extension and metastatic spread .

The use of MRI for the primary diagnosis of benign and malignant musculoskeletal pathology, the staging of tumors including the detec-tion of their direct extension and metastatic spread

MRI and CT for the demonstration of spinal anatomy and pathology, joint anatomy and pathology, the investigation of rheumatological disorders and the investigation of trauma and sports injuries

Radionuclide imaging

Fluoroscopic procedures including CT an MR arthrography 2. Using imaging techniques, trainees should be able to accurately localize and biopsy the following:

Soft tissue masses

Bone masses

By the end of training, trainees should Demonstrate adequate knowledge of: 1. Neuroanatomy and clinical practice relevant to neuroradiology 2. The manifestations of central nervous system disease as demonstrated on conventional radiography, CT, MRI and angiography 3. The applications, contraindications and complications of invasive neuro radiological procedures 4. The application of radionuclide investigations in neuroradiology 5. The application of CT and MR angiography in neuroradiology

By the end of training, trainees should be able to: 1. Report plain radiographs in the investigation of neurological disorders 2. Supervise and report cranial and spinal computed tomography 3. Supervise and report cranial and spinal magnetic resonance imaging 4. Observe and report cerebral angiograms 5. Observe cranial and carotid ultrasound including Doppler 6. Observe and report imaging of the cerebrovascular system by MR angiography and CT angiography

Neuroradiology

Core knowledge

Core skills


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1. The anatomy, normal variants and physiology of the central and peripheral nervous systems, spine and spinal cord in adults and children 2. The pathological correlation of diseases and variations of the CNS, including the spine and cranium. The application and interpretation of the various imaging modalities 3. The physical principles and technical background for the performance of all imaging modalities for diagnostic imaging of the following:

The skull and its contents

The spine and its contents

Maxillofacial area 4. The full range of currently used diagnostic and therapeutic techniques including conventional radiography, CT, MRI including MR spectroscopy, functional imaging, angiography, ultrasound, myelography and nuclear medicine including SPECT and PET 5. The currently used interventional techniques, their indications, contraindications, complications and protocols for use 6. Patient safety and protection 7. Fundamentals of quality assurance in neuroradiology 1. Perform and report cerebral angiogram 2. Observe CT perfusion techniques 3. Perform and report myelograms 4. Perform and report carotid ultrasound including doppler 5. Observe and interpret transcranial pediatric ultrasound 6. Observe interventional neuro radiological procedures 7. Observe MR functional brain imaging techniques

Advanced knowledge

Advanced skills


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25

Obstetric and Gynecological radiology

Core knowledge

By the end of training, trainees should demonstrate adequate knowledge of: 1. Obstetric and gynecological anatomy and clinical practice relevant to clinical radiology 2. The physiological changes affecting imaging of the female reproductive organs 3. The changes in maternal and fetal anatomy during gestation 4. The applications of angiography and vascular interventional techniques 5. The applications of magnetic resonance imaging in gynecological disorders and obstetrics By the end of training , trainees should be able to: 1. Report plain radiographs performed to show gynecological disorders 2. Perform and report ultrasound examinations in gynecological disorders, including possible complications of early pregnancy (e.g. Ectopic) using both transabdominal and endovaginal techniques 3. Supervise and report computed tomography in gynecological disorder 4. Supervise and report magnetic resonance imaging in gynecological disorders 5. Observe fetal MRI 6. Observe angiography and interventional techniques in gynecological Diseases 1. The anatomy, normal variants and pathophysiology relevant to the female genitourinary system 2. The pathological processes of both benign and malignant diseases in the female genitourinary system 3. The epidemiology of gynecological diseases 4. The techniques of gynecological imaging including: plain film radiogra-phy, ultrasonography, contrast studies and fluoroscopic examinations of the genitourinary tract, computed tomography, magnetic resonance and ra-dionuclide imaging 5. The indications, contraindications and complications of each imaging method 6. The principles of informed consent 7. The role of multidisciplinary meetings in the management of Gynecological disease 8. The medico-legal aspects of obstetric and gynecological practice

Core skills

Advanced knowledge


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1. Conduct, supervise and interpret the following imaging techniques: Ultrasound studies of the abdomen and pelvis including: transvaginal techniques, Doppler studies, contrast studies of the genitourinary tract, fluoroscopic studies of the genitourinary tract, CT and MRI for gynecological disease 2. Accurately localize and take biopsy from pelvic and abdominal masses 3. Use different imaging modalities for Drainage of abdominal-pelvic abscesses/collections

By the end of training, trainees should Demonstrate adequate knowledge of 1. The clinical oncological practice relevant to radiology 2. The tumor nomenclature and staging 3. The application of ultrasound, radionuclide investigations, computed tomography, and magnetic resonance imaging, angiography and Interventional techniques in oncological imaging and staging, as well as monitoring the response of tumors to therapy 4. The radiological manifestations of complications which may occur in tumor management 1. Report plain radiographs performed to assess tumors 2. Perform and report investigations in oncological staging and monitoring the response of tumors to therapy including ultrasound, Computed tomography, magnetic resonance imaging and radionuclide investigations 3. Perform image-guided biopsy of masses using ultrasound or CT guidance 1. The anatomy, normal variants and pathophysiology of the major tumor

bearing organs 2. The oncologic staging systems 3. The Lymph node notation, routes of lymphatic drainage and anatomical routes of spread of common tumors 4. The methods used to analyze tumor response to treatment 5. The techniques of oncological imaging using plain film radiography, ultrasonography, computed tomography, magnetic resonance, Radionuclide imaging and fluoroscopic procedures 6. The indications, contraindications and complications of each imaging method

Advanced skills

Oncological radiology

Core knowledge

Core skills

Advanced knowledge


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1. Conduct, supervise and interpret imaging techniques for the accurate diagnosis and staging of common tumors and their metastatic spread using: plain radiography, ultrasonography, computed tomography, magnetic resonance, radionuclide imaging and fluoroscopic procedures 2. Accurately localize and take biopsy from soft tissue masses and bone using ultrasound, or CT bone 3. Recognize The role of plain radiography, MRI, CT and nuclear medicine in the evaluation of an equivocal diagnosis of malignant lesions 4. Identify The indications and use of functional imaging 5. Observe The use of tumor specific agents and their application to cancer management 6. Observe The use of PET and CT PCT in cancer diagnosis and management 7. Recognize The value of imaging in therapy planning

By the end of training, trainees should Demonstrate adequate knowledge of 1. Pediatric anatomy relevant to clinical radiology 2. Disease entities specific to the pediatric age group and their clinical manifestations relevant to radiology 3. Disease entities specific to the pediatric age group and their manifestations as demonstrated on conventional radiography, ultrasound, contrast studies, CT, MRI and radionuclide investigations 4. The management recognition of features of child abuse 1. Report plain radiographs performed in the investigation of pediatric disorders including trauma 2. Perform and report ultrasound studies in the pediatric age group 3. Supervise and report cranial computed tomography studies, particularly in the setting of acute trauma 4. Perform and report routine fluoroscopic procedures in the pediatric age group, particularly urinary tract and gastrointestinal systems 5. Supervise and report computed tomography ,magnetic resonance imaging and radionuclide investigations in the pediatric age

Advanced skills

Pediatric radiology

Core knowledge

Core skills


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1.The embryology, anatomy, normal variants, developmental abnormalities and relevant physiology of children 2.The pathological processes of both benign and malignant diseases in the pediatric age group 3.The techniques of imaging used in the wide variety of pathological processes occurring in the pediatric age group including digital radiography, ultrasonography, computed tomography, magnetic resonance, radionuclide imaging and fluoroscopic procedures 4.The indications, contraindications and complications of each imaging method 5.The principles and use of radiation dose reduction and radiation protection techniques 6.The drug dose regimes used in diagnostic procedures 7.The medico-legal aspects of pediatric practice 1.Conduct, supervise and interpret all imaging techniques used in the investigation of pediatric diseases including

● Plain radiography

● Ultrasonography and Doppler studies

● Computed tomography

● Magnetic resonance

● GI studies including identification of GI bleeding site

● Fluoroscopic procedures including: routine genitourinary investigations, routine gastrointestinal investigations

● Management of intussusception

● Disorders of swallowing 2. Biopsy procedures

● Insertion of percutaneous nephrostomies

● Per-cutaneous aspiration and drainage techniques

Advanced knowledge

Advanced skills


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29

Thoracic radiology

By the end of training, trainees should Demonstrate adequate knowledge of 1. Thoracic anatomy and clinical practice relevant to clinical radiology 2. The manifestations of thoracic disease as demonstrated by conventional radiography and CT 3. The application of radionuclide investigations to thoracic pathology with particular reference to lung scintigrams 4. The applications, risks and contraindications of the technique of image guided biopsy of thoracic lesions 1. Report of plain radiographs performed to show thoracic diseases 2. Supervise and interpret radionuclide lung scans 3. Supervise and report the following computed tomography examinations:

● CT of the thorax

● CT pulmonary angiography

● Drainage of encysted pleural space collections under image guidance 4. Observe image-guided biopsies of lesions within the thorax 1. The anatomy, normal variants and pathophysiology relevant to respiratory function 2. The pathological processes of both benign and malignant disease involving the thorax 3. The epidemiology of lung diseases 4. The principles of population screening for lung cancer 5. The surgical techniques used in the staging and treatment of lung cancer 6. The techniques involved in all imaging and procedures used in evaluating and treating thoracic diseases including digital radiography, ultrasonography, computed tomography, magnetic resonance, Radionuclide imaging and fluoroscopic procedures 7. The indications, contraindications and complications of each imaging method

Core knowledge

Core skills

Advanced knowledge


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1. Conduct, supervise and accurately interpret the following imaging techniques

● Plain radiography specially for thoracic trauma

● Ultrasonography including demonstration of thoracic wall lesions and pleural effusions

● Computed tomography including identification and categorization of focal and diffuse lung disease

● CT pulmonary angiography

● Computed tomography of pleural lesions, thoracic wall and mediastinal lesions

● Magnetic resonance imaging

● Radionuclide radiology including ventilation/perfusion lung scan 2. localize and take biopsy of the following:

● Thoracic wall lesions

● Pleural lesions

● Pulmonary lesions

● Mediastinal lesions

By the end of training, trainees should Demonstrate adequate knowledge of 1. Urinary tract anatomy and clinical practice relevant to clinical radiology 2. The manifestations of urological disease as demonstrated on conventional radiography, ultrasound, CT and MRI 3. The current application of radionuclide investigations for imaging of renal function and vesico-ureteric reflux 4. The application of angiography and vascular interventional techniques

Advanced skills

Uroradiology

Core knowledge


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1. Report plain radiographs performed to show urinary tract disease 2. Perform and report the following contrast studies:

● Intravenous urogram

● Retrograde pyeloureterography

● Nephrostogram

● Ascending and micturating cystourethrogram 3. Perform and report transabdominal ultrasound of urinary tract pathology 4. Supervise and report computed tomography of the urinary tract including CT angiography 5. Report radionuclide investigations of the urinary tract in the following areas:

● kidneys

● Vesico-ureteric reflux 6. Observe the performance and evaluation nephrostomies 7. Observe Drainage of renal abscesses and peri-renal collections 9. Observe endorectal ultrasound 10.Perform image-guided renal biopsy under US or CT guidance 11.Observe and participate in the interpretation of Magnetic resonance imaging applied to the urinary tract 12.Observe vascular interventional techniques 1.The embryology, anatomy, normal variants and pathophysiology relevant To urogenital system 2.The pathology and pathophysiology of benign and malignant conditions involving the urogenital system 3.The epidemiology of urogenital diseases 4.The techniques involved in all imaging and procedures used in evaluating and treating urogenital diseases including:

● Plain radiography

● Ultrasonography

● Contrast studies including genitogram

● Computed tomography

● Magnetic resonance imaging

● Radionuclide imaging

● Fluoroscopic procedures

● Interventional techniques 5.The indications, contraindications and complications of each imaging method

Core skills

Advanced knowledge


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1. Conduct, supervise and accurately interpret of the following imaging techniques:

● Digital radiography including intravenous urography, retrograde and antegrade pyelography, and cystourethrography

● Ultrasonography including Doppler studies

● Computed tomography of the urinary tract and pelvis including: unenhanced CT for detection urinary calculi, the staging of renal and vesical tumors

● CT-urography

● CT-angiography

● Magnetic resonance imaging of the urinary tract and pelvic organs

● Urodynamic imaging

● Imaging of renal transplant 2. Perform safely and effectively the following interventional techniques:

● Biopsy of renal and retroperitoneal masses

● Drainage of collections

● Percutaneous nephrostomy 3. Observe Antegrade pyelography, Renal cyst aspiration and ablation, Nephrolithotomy, Suprapubic vesical access and Transrectal Prostate biopsy 4.Staging of pelvic malignancy 5.Identification of pelvic floor disorders 6.Identification of renal and adrenal abnormalities 7. Perform percutaneous nephrostomy

By the end of training, trainees should Demonstrate adequate knowledge of 1. Vascular anatomy and clinical practice relevant to clinical radiology 2. The indications, contraindications, pre-procedure preparation including informed consent), sedation and anesthetic regimens, patient monitoring during procedures and post-procedure patient care 3. Procedure and post-procedure complications and their management 4. The appropriate applications of the following techniques:

● Ultrasound including Doppler vascular studies

● Computed tomography and CT angiography

● Magnetic resonance imaging and MR angiography

● Intra-arterial angioplasty and embolization techniques

Advanced skills

Vascular and vascular intervention radiology

Core knowledge


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33

Core skills

1. Report plain film radiographs relevant to major vascular disease 2. Supervise and report CT examinations of the vascular system (CTA) including image manipulation 3. Supervise and report MRI examinations of the vascular system (MRA) including image manipulation 4. Perform and report : venous and arterial color Doppler 1. The anatomy, normal variants and physiology of the appropriate vascular systems 2. The current interventional equipments used including percutaneous Access needles and kits, catheters and guide wires, other devices, stents and embolization materials 3. The full range of the currently used diagnostic and therapeutic techniques 4. The indications, contraindications and complications of each method 1. Perform under supervision the following procedures

● Diagnostic arteriography

● Percutaneous peripheral angioplasty

● Percutaneous central venous access

● Thrombolysis

● IVC filter insertion

● Embolization

● Vascular stent insertion

● Alternative arterial access (e.g. Axilla)

● GI vascular dilatations and stent applications

● Transjugular liver biopsy

Advanced knowledge

Advanced skills


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34

Radionuclide radiology

Advanced knowledge

By the end of training, trainees should have adequate knowledge and deep understanding of: 1.Computing, image processing, tracer principles and techniques, radiation biology and protection, radiopharmacy and radiochemistry in relation to the applications of nuclear medicine data acquisition image processing and display 2.Appropriate mathematics and physics applied to radionuclide tracer theory, modeling of tracer kinetics and quantitative imaging 3.The kinetics of radioactive tracers used in nuclear medicine 5.The physiological principles of tracer techniques 6.Errors associated with quantitative measurements 7.The theory of biological effects of high and low-level radiation from unsealed sources 8.The calculation of the effective (ED) radiation dose from radiopharmaceuticals 9.The necessary precautions for the safe handling of radiopharmaceuticals 10.The diagnosis and treatment of radiation induced disorders 11.The management of radiation accidents 13.The properties of commonly used diagnostic radionuclides 14.The physiochemical and biological properties of different radiopharmaceuticals in routine clinical practice, clinical trials and under development 15.The principles of localization of radiopharmaceuticals 16.Different formulations used in nuclear medicine 17.Cell labeling techniques 18.Quality control 19.Protocols for study performance and analysis 20.Preparation of patients, precautions and complications 22.The full range of radionuclide diagnostic techniques available including the indications, contra-indications and complications 23.The factors affecting the choice of radiopharmaceuticals 24.The effects and side effects of these agents 25.The legal and regulatory requirements for the practice of radionuclide Radiology Conduct, supervise and interpret all radionuclide diagnostic imaging and common non-imaging procedures in the following areas:

● Breast ● chest/thorax ● cardiac ● gastrointestinal ● Cerebral ● head and neck ● musculoskeletal

Advanced skills

● Oncology ● pediatric imaging ● urogenital radiology ● endocrine diseases


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35

The trainee will spend a period of 12 months in one of the selected training centers/hospitals being employed. During this period the candidate is ex-posed to the basic radiological information essential to establish his career as a radiologist. Data are obtained mainly through lectures which should cover the following aspects:

1. Physics. 2. Radiological Anatomy. 3. Radiological Techniques and Positioning. 4. Dark Room principles. 5. Emergency and intensive care Radiology. 6. Radiobiology, radiation Protection and dosimetry.

The physical principles of Conventional Radiology. Ultrasound, Computed Tomography (CT) , Magnetic Resonance Imaging (MRI) and Nuclear Medi-cine Imaging are included with integration of these principles on the quality of the generated images and the resultant diagnostic data.

Conventional Radiology -Basic concepts:

Introduction to medical Imaging

Radiation and the atom

Interaction of radiation with matter

Computers in medical Imaging -Diagnostic radiology:

X- ray production, tubes, generators

Screen- film radiography

Film processing -Fluoroscopy [Suites, equipments, modes of operation, image quality, radia-tion dose].

-Image quality [Contrast, Resolution, Noise, Operating curves]. -Digital Radiography [Implementation, CR devices, Image processing, patient’s dose, contrast versus resolution in digital imaging].

Nuclear medicine -Radioactivity and nuclear transformation -Radionuclide production and Radiopharmaceuticals -Radiation detection and measurements [Types of detectors, counting statistics]. -Nuclear imaging [Scintillation cameras, computers,..] -Emission Tomography

SPECT

PET

Program Structure

First year

1-Radiology physics


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36

Computerized Tomography Basic principles

Geometry and Historical Development

Detectors and Detector Arrays

Details of Acquisition

Tomographic Reconstruction

Digital Image Display

Radiation Dose

Image Quality

Artifacts

Ultrasonography Characteristics of Sound

Interaction of Ultrasound with Matter

Transducers

Beam Properties

Image Data Acquisition

Two- Dimensional Display and Storage

Image Quality and Artifacts

Doppler Ultrasound

System Performance and Quality Assurance

Acoustic Power and Bioeffects

Magnetic Resonance Imaging Magnetization Properties

Generation, Detection and localization of MR Signal

Pulse Sequences, Spin Echo, Inversion Recovery, Gradient Recalled Echo

Signal from Flow and MR angiography

Perfusion and Diffusion Contrast

Magnetization Transfer Contrast

K- space Data acquisition and image reconstruction

Three- Dimensional Fourier transform image acquisition

Image characteristics

Artifacts

Instrumentation

Safety and Bioeffects

Mammography X- ray Tube design

X- ray Generator and phototimer system

Compression, scattered Radiation, and magnification

Screen- film cassettes and film processing

Ancillary procedures [Stereotactic breast biopsy, Digital mammography]

Radiation Dosimetry

Regulatory requirements [Accreditation, Quality assurance]

Radiography of different anatomic regions in the human body (Skull, Spine, Chest, Abdomen and pelvis, Upper and Lower limbs,...) is outlined with fair knowledge of the exposure factors and accurate positions of each anatomic part.

2– Radiological positioning and techniques


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The current radiological techniques for conventional radiology and imaging including patient preparation, examination technique, con-trast material used, patient after care and the possible complications of each technique as well as management of these complications.

Contrast media: Types (positive, negative), chemical components, indi-cations and contraindications for use, Reactions to certain types and management of these reactions

Anatomy as demonstrated on the radiological and imaging procedures in-cluding conventional radiography, contrast studies, CT and MRI. The anat-omic regions of interest should cover:

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 mus-cles

The heart and great vessels

The chest including lungs, mediastinum and chest wall

The gastrointestinal system including solid organs [liver, spleen, pan-creas,..]

The genitourinary system [Kidneys, ureters, urinary bladder, prostate, seminal vesicles, uterus and adnexa]

The peripheral vessels and lymphatics of the upper and lower limbs

The breast

Ultrasonography of the abdomen and pelvis, basic principles of doppler and color doppler sonography are also included.

Dark room construction, the radiographic film, the film cassette ,intensifying screens & film screen combination, the processing machines and tech-niques, film criticism, and common faults in film processing, Film copy and subtraction techniques.

Radiation Protection

Sources of exposure to ionizing radiation

Radiation Detection equipment in radiation safety Radiation protection and exposure control

Personnel Dosimetry

Regulatory agencies and radiation exposure limits Radiation Dosimetry of the patient

X- ray Dosimetry

Radiopharmaceutical Dosimetry: The MIRD method [Medical Internal Radiation Dosimetry]

3-Radiological anatomy

5-Dark room principles

4-Ultrasonography

6-Radiobilogy (Radiation protection, Dosimetry and biology)


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38

Radiation Biology

Interaction of radiation with Tissue

Cellular Radiobiology

Response of organ systems to radiation

Acute radiation syndrome

Radiation- induced Carcinogenesis

Hereditary effects of radiation exposure

Radiation effects in utero

Recommended Books for first year topics: Imaging Atlas of Human Anatomy By Jarrie Weir, Petter Abrahams MD

The essential physics of medical imaging 2nd

Edition By Bushberg JT MD

The Principles of Dark Room Techniques By Nabil Khattar MD

A practical guide to special Techniques in Diagnostic Radiology By Nabil Khattar MD

Radiologic Science: Physics, Biology and protection By Stewart C..Bushong MD

Clark’s positioning in Radiology By Louis Kreel MD

Basic Radiology (Theoretical &Practical) -Neuroradiology - Radiology of the face and neck - Musculoskeletal Radiology - Radiology of the chest and heart - Gastrointestinal Radiology - Genitourinary Radiology -Vascular and Interventional Imaging Basic Radiology including Radiological and imaging procedures currently used for, diagnosis of diseases affecting each particular system of the body including conventional X- rays, tomography, contrast studies, ultrasound & Doppler, CT, MRI and nuclear imaging.

Imaging modalities in neuroradiology

Physical principles of MR imaging

Normal brain anatomy CT, MRI

Diagnosis of cerebrovascular stroke

Imaging of brain tumors

Intracranial infections

Posterior fossa lesions

Intracranial vascular malformation

Intracranial cysts and calcifications

White matter diseases

Intracranial traumatic lesions

Advanced diagnostic techniques, MDCT, MRA,MR

Diffusion and perfusion studies

Diagnostic value of neuro-MR spectroscopy

Congenital brain lesions, [hydrocephalus, neuronal migration disorders]

Transcranial US

Second and third year

1 )Neuro-radiology


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39

Interventional neuroradiology

Nuclear neuroradiology

Normal anatomy of the spine by CT, MRI

Imaging of degenerative spinal diseases

Postoperative spine

Diagnosis of spinal inflammatory disease

Imaging of Spinal neoplasms

Traumatic lesions of the spine

Spinal dysraphism

Spinal interventions

Spinal congenital anomalies

Imaging modalities

physical principles of MRI in head and neck imaging

Head and neck ultrasound

Imaging of maxillofacial trauma, CT Head and neck inflammatory diseases, CT, MRI

Imaging of orbital pathology , CT, MRI

Imaging anatomy and pathology of the petrous bones, CT, MRI

Imaging of the parapharyngeal spaces CT, MRI

Imaging of the tongue and mouth flour lesions CT, MRI

Imaging of salivary glands, CT, MRI

Imaging of mandibular pathology, CT, MRI

Imaging of sinonasal pathology CT, MRI

Imaging of larynx CT, MRI

Imaging anatomy and pathology of the cervical lymph node diseases

Thyroid and parathyroid anatomy and pathology

Head and neck nuclear imaging

Head and neck interventional techniques

Imaging modalities in musculoskeletal pathology

Physical principles of musculoskeletal MRI

Diagnosis of skeletal trauma

Bone and joint infections X ray, CT, MRI

Imaging of bone tumors X ray, CT, MRI

Diagnosis of metabolic and endocrinal bone disease

Hematological bone disease X ray, MRI

Imaging of polyarthropathies

Musculoskeletal ultrasound

Musculoskeletal nuclear imaging

3-A-Major joint MR imaging

Knee joint Normal anatomy, examination protocols Ligamentous pathology, meniscal lesions Synovial lesions, miscellaneous lesions

2) Face and Neck

3) Musculoskeletal Radiology


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40

Shoulder joint Normal anatomy, examination techniques Rotator cuff lesion, labral pathology SLAP injuries, impingement syndrome. Ankle joint Normal anatomy, examination techniques Tendon pathology, ligamentous injuries Bone marrow lesions and avascular necrosis. Wrist joint Normal anatomy, examination techniques Ligamentous pathology and TFCC injuries Carpal and ulnar tunnel syndromes. Hip joint Normal anatomy, examination techniques Avascular necrosis and migratory osteoporosis Fractures and slipped epiphysis, labral injuries. Elbow joint Normal anatomy, examination techniques Ligamentous injury and nerve entrapment syndrome.

Pulmonary radiology (Anatomic and functional imaging of congenital disor-ders, pulmonary neoplasms, acute respiratory failure, drug induced chest dis-orders, imaging of transplanted lung,...)

How to interpret chest X rays, normal and pathology

Normal CT anatomy of the chest

Diagnosis of focal lung disease, X ray and CT

Diagnosis of diffuse lung disease, X ray and HRCT

Imaging of the pleural and chest wall pathology

Diagnosis of pulmonary vascular diseases

Imaging diagnosis and staging of lung cancer

Diagnostic value of MRI in chest diseases

Imaging of the mediastinum, anatomy and pathology

Intensive care Radiology

Imaging of pulmonary TB

Interventional chest Radiology

Chest scintigraphy

Chest trauma

Imaging of Air way disease

Imaging of pulmonary Circulation

Diagnostic modalities for cardiac imaging

Principles and diagnostic values of echocardiography

Basics of MDCT coronary angiography

Principles of cardiac MRI

Nuclear cardiac imaging

Imaging of congenital heart diseases

Diagnosis of acquired heart diseases

Imaging of ischemic heart disease

Pericardial lesions and cardiomyopathies

4) Chest and Heart Radiology


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41

Imaging modalities in gastrointestinal pathology

Diagnosis of hypo pharynx and esophageal pathology

Imaging of stomach and duodenum

Diagnosis of small intestinal pathology

Diseases of the colon

Abdominal ultrasound techniques, diagnostic value

Hepatic imaging CT, MRI

Biliary and pancreatic imaging

Imaging of splenic pathology

Imaging of acute abdomen

Abdominal injuries

Imaging of peritoneum and mesenteric pathology

Abdominal nuclear medicine (liver, adrenal,…)

Abdominal interventional techniques

Diagnostic modalities in uroradiology

MR urography diagnostic value and physical principles

Imaging of renal physiology and kinetics of contrast agents

Imaging of renal pathology :

Congenital lesions

Stones

Infection and Inflammatory diseases

Cystic renal disease

Renal neoplasms

Diagnosis of ureteric pathology

Imaging diagnosis and staging of urinary bladder neoplasms

Imaging of the urethra

Imaging of the prostate CT, MRI

Transrectal US

Imaging diagnosis of male infertility and impotence

Imaging of the testis and scrotum

Urinary tract nuclear scintigraphy

Renal trauma

Interventional uroradiology

Role of Imaging in renal transplantation

Imaging of the adrenal glands anatomy and pathology

Introduction to vascular imaging, modalities and techniques

Head and neck vascular pathology

Imaging of aortic lesions

Pulmonary and bronchial arterial pathology

Imaging of mesenteric vascular diseases

Peripheral arterial and venous diseases

Vascular aspects of male infertility

Basics of vascular interventional radiology

5) Gastrointestinal & Abdominal Imaging

6) Genitourinary Radiology

7) Vascular and Interventional Imaging


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42

HSG Technique – indications – findings

CT pelvis, anatomy and pathology

Obstetric US

Gynecology US

MR female pelvis and pelvic floor dynamics

Mammographic Techniques

Benign and malignant Breast lesions

Diagnostic Pitfalls in mammography

Breast ultrasound normal, pathology

MR breast technique

Osteoporosis pathophysiology

DXA in evaluation of osteoporosis

Introduction to pediatric imaging

Pediatric neuroradiology -Normal brain and spine anatomy - Imaging of hydrocephalus - Neuronal migration disorders - Imaging of intracranial infection - Pediatric Brain tumors - Spinal dysraphism

Pediatric chest radiology

Pediatric abdominal imaging - Normal CT anatomy

- Acute abdomen - Abdominal masses - Genitourinary imaging

Pediatric musculoskeletal imaging - Musculoskeletal infection - Bone tumors - Skeletal dysplasia - Metabolic bone diseases

A) Intensive Care Radiology

Portable radiographic techniques

Congestive heart failure and adult respiratory distress syndrome

Radiologic evaluation of patients after cardiac surgery

Non cardiac thoracic surgical procedures, post-operative radiology

Abdominal imaging in sepsis of unknown origin

Imaging in immune suppressed patients

Diagnosis of chest complications in critical care units

Interventional procedures in ICU patients (venous line placement, trans-pleural biopsies, drainage procedures, intervention for variceal bleeding, veno-occlusive disease and massive pulmonary embolism,...)

Fourth year

1) Women’s imaging

2) Pediatric Radiology

3) Radiology of Specific Entities


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B) Emergency Radiology

Imaging of acute cerebro -vascular diseases

Diagnosis of maxillofacial injuries

Spinal and paravertebral posttraumatic pathology

Imaging of non aortic thoracic injuries

Traumatic aortic injuries and emergent aortic syndromes (rupture, dis-section, intramural hematoma, ulcer,...)

Imaging of abdominal trauma

Acute non traumatic abdominal imaging

Urinary tract emergencies (stones, urine retention, infections,...)

Emergency MRI

Pediatric emergency imaging (Abdominal pain, respiratory infection, skeletal trauma,...)

The use of teleradiology in medicine. C) Oncologic Imaging

Staging and classifications of tumors

Imaging strategies for oncologic diagnosis

Oral cavity, tongue and mouth floor neoplasms

Hodgkin’s and non Hodgkin’s lymphomas

Soft tissue tumors of the appendicular skeleton

C.T radiation therapy treatment planning

Radiosurgery

interventional radiology for cancer diagnosis and management

Recommended text books: -Text book of Radiology and Imaging by David Sutton -Diagnostic Radiology by R.G.Grainger &D.J. Allison -Radiology by Juan M. Taveras

International periodicals recommended: -The Radiological Clinics of North America - Radiographics - Pediatric Radiology - Clinical Radiology - European Radiology -Am. J. Roentgenology [AJR] -Seminars in Ultrasound, CT and MRI.


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44

Training methodology

The following methods are going to be used to ensure the delivery of the curriculum topics and help trainees to attain the program intended learning outcomes:

1- lectures 2- group discussion and tutorials 3- Problem solving and Case presentation 4- Video – Films 5- Simulator Labs for interventional techniques 6- Practical hands on [ultrasound] 7- On he job training and apprenticeship

Methods of trainees’ evaluation

Trainees' progress is going to be assessed using several methods 1. Attendance Trainees must attend At least 80% of all face to face instructions and scientific activities. Prove of attendance is going to be the counter signature of the trainer or the educational supervisor 2. Active participation during group discussion and case presentation 3. Logbook assessment The log book is going to be assessed regularly by the trainer and educational supervisor. Completion of activities as related to any stage of training is a pre-requisite for signature and for promotion from one year of training to another. The educational supervisor and trainer are Co responsible about the validity of their signatures. They must report every month to the Egyptian Fellowship Board about the progress of their trainees.

4. Practical evaluation On the job training represents an invaluable opportunity for mentoring and feedback for trainees on their performance during routine work 5. Annual promotion Examination o This examination is held at the end of the 2ed and 3 years of training,

success in this examination is a mandatory prerequisite for the following year upgrade o The examination is held in October

o The examinations consists of 120 multiple choice Questions (M.C.Q)

covering the radiological subjects in the curriculum of the same year o Candidates who fail to pass this examination may have two other trials

during the next two successive months [November and December] o Upon success, candidates are allowed to pass to the next year of

training program. Those who fail to pass the three trials should repeat the whole year training. 6. Final summative examinations. These examinations are the first and final exams. All of them must be passed successfully by trainee in order to get the Egyptian Fellowship certificate. Details and regulations are presented below.


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45

Methods of assessment

The general rules and regulations of assessment approved by the Egyptian fellowship board and published at the training handbook and also at the board web site applies for the radiology specialty. In addition to the successful completion of the training program, all candidates must successfully pass three exams in order to get the fellowship certificate.

•The trainee shall have completed the first year of radiology training in an accredited center by The Scientific Council of Radiology (Egyptian Board for Medical Specialties). •The trainee should have completed the Log Book requirements of the first year of training and approved by the director of the examination committee •The trainee shall have submitted the official exam application form and exam subscription fee before the announced closing date as determined by the Egyptian Fellowship Board. •Trainee who fail to pass the examination may apply for two additional per missions •The 2nd and 3 examination trials are allowed 6 and 12 months after date of the 1 examination respectively •The trainee may not be permitted admission to the First Part Examination more than three times except in rare unusual circumstances approved by The secretary general of The higher Committee of medical specialties

Regulations

Pre-requisites for entering the first part exam

Trainees should pass the following courses in order to be eligible for the first part exam

1. Local TOEFEL with a score of at least 500 2. Computer courses in word processing, power point and internet


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46

The final exam

This is the final certifying exam in Egyptian Board Training Program in Radiology. The examination consists of The written, practical and oral exams.

Trainees are allowed to sit for the second part exam after passing success-fully the first part and after completion of the training period (four years). In addition, each candidate must submit his log book for final assessment. The trainee’s application should have been approved by the training and accreditation committee of the Scientific Council upon receiving the follow-ing documents.

Duly completed and approved application form for admission to the final exam

Duly completed and approved Log Book fulfilling all the requirements of the training program.

A confidential evaluation report from The educational supervisor in the training centre recommending the trainee to sit for the final exam.

Duly paid examination fees as announced. Each candidate has three chances to pass the exam and one more additional chance may be granted in special approved circumstances.

The third part exam is a practical and oral exam. Candidates who pass successfully the second part are allowed to sit for the third part. Again each candidate has three chances to pass the practical exam and an additional fourth chance may be granted in special approved circumstances. If the trainee failed, he will be required to ask the council for ONE complete year training after which he/she shall apply to sit for the Final Written Exam again. When successful, the trainee shall be required to appear and pass the practical and Oral Exam in not more than TWO attempts in the following years.

Candidates qualified with Diploma or Master Degree in Radio diagnosis from one of the recognized universities in Egypt or its equivalent are exempted from the first and second year training program as well as the first part examination. Candidates who get their master or diploma in radiology since five years or more must resite for the first part examination.

Written exam

Practical exam (3rd part)

Diploma or master degree holders


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47

The structure of the examination

First part exam

The Practical/oral exam

The written final exam

The exam is composed of two papers. One of them is MCQ and the other is short assay questions. Both papers test trainees knowledge and problem solving skills in the following domains:

Radiation physics

Radiological anatomy

radiological positions and Techniques

dark room principles

nuclear medicine, radiobiology and radiation protection Part two exam is composed of four papers (two MCQ and two short assay) covering all the theoretical topics of the second, third and fourth years of training. Each paper is two hours in duration and the exam is covered in two days. The Practical Exam The date and place of this examination will be announced by the Examina-tion Committee. Only successful candidates who pass the Final Written Exam of Egyptian Board of Radiology will be permitted to appear for the practical and oral Examinations. The exam consists of two sessions:

• The long Case session includes 3 sets of radiological films, each set corre-sponds to a single case that is fully investigated radiologically. The trainee has to give a full radiological report on each set of films ended by the possi-ble diagnosis or differential diagnosis. The time allowed for each set is 15 minutes

• The Short Case session where the trainee is exposed to 10 cases, each case is represented by one radiological film showing one or more pathologic en-tities. The trainee has to spot the pathology shown in each film. The time allowed is 5 minutes for each set. Oral Exam

This examination will follow the practical exam and consists of two parts, each of 30 minutes duration.

Each session will be conducted by one pair of Examiners, l5 minutes for each examiner.

Radiology Curriculum

Documents