Radiology Residency Training Program
Statement of goals, objectives, and methods
The residency in Diagnostic Radiology at the Louisiana State University Health Sciences Center in Shreveport is designed to offer a comprehensive educational experience to physicians in the field of diagnostic radiology including chest radiology, mammography, musculoskeletal radiology, gastrointestinal radiology, genitourinary radiology, Neuroradiology, pediatric radiology, cardiovascular and interventional radiology, nuclear medicine, ultrasound, and emergency radiology. The total experience in nuclear medicine shall be no less than 4 months.
Resident selection is a comprehensive process involving a Committee appointed by the Chairman of the Department of Radiology and the Program Director to include faculty members as well as the Chief Resident. Resident candidates are expected to have completed an internship after medical school prior to their entry into the diagnostic radiology residency at LSU. Factors such as their level of scholastic achievement, strength of letters of recommendation, and success during interviews are incorporated into the resident selection process.
The patient care facilities at the Louisiana State University Health Sciences Center in Shreveport consist of 432 active teaching beds. This, in concert with the outpatient clinics, generates approximately 170,000 diagnostic imaging procedures annually. The Health Sciences Center serves as a tertiary referral center for patients from the region known as the “Ark-La-Tex”. This region consists of southern Arkansas, northern Louisiana, and eastern Texas. Patients with a large variety of diseases are regularly seen, including a number of unusual or complicated conditions and, in particular, those presenting diagnostic problems.
The resident teaching services within the Department of Radiology are organized according to both organ-specific and Radiologic modality lines. Specific faculty members are responsible for the following areas, gastrointestinal radiology, genitourinary radiology, thoracic radiology, musculoskeletal radiology, Neuroradiology, pediatric radiology, nuclear medicine, vascular and interventional radiology, ultrasound, cross sectional body imaging, emergency radiology, and mammography. This facilitates the residents gaining an understanding of the multi-modality approach to diagnostic radiology in modern practice.
During their four-year residency, residents will go through one-month rotations. Only when they’re going to the AFIP, may a rotation be less than one month long. Also, the Interventional Radiology rotations are ½ month long.
FIRST YEAR
During their first year of Radiology training, the resident will rotate through all of the different sections of Radiology, except for Mammography and possibly Nuclear Medicine. The reading room rotation consists of plain film reading of chest, abdomen, and musculoskeletal studies. The resident will rotate through Vascular and Interventional Radiology, and take IR call with their attending IR staff always present during the entire rotation. At no time is a first year resident allowed to perform an angiographic or interventional procedure, unless in the presence and supervision of a faculty member. This exposure is complemented by a series of introductory didactic lectures integrated with the study of the program instruction of the American College of Radiology Learning File. An introduction to radiographic technique is also included during this time.
After observing the activities of the staff radiologists and senior residents in each section, the resident is assigned progressively more material to prepare before discussing it in detail with a faculty member. During the entire first year (and other years as well), all radiographic examinations are closely checked by a faculty member before a final transcribed interpretation is rendered. Reports dictated by residents are checked and edited by faculty before release. The resident is urged to make a decision as to whether an examination is completed or requires further study. However, the staff radiologist closely supervises each examination to prevent any patient from being dismissed before an adequate study is obtained. The residents are required to formulate a provisional interpretation before discussing each case with a senior staff radiologist during a formal reading session. After the staff radiologist has indicated the proper interpretation and the reasoning behind his/her conclusion, the resident dictates a formal report to convey this opinion to the referring clinician. Whenever significant new findings are noted, the resident should alert the referring physician to the situation and dictate this communication in the formal report.
Each resident is responsible for keeping a log that documents his/her participation in any interventional procedures, including angiography, guided biopsies, drainage procedures, non-coronary angioplasty, embolization and infusion procedures, percutaneous introduction techniques, and lumbar punctures/myelograms and arthrograms. This log is reviewed every six months by the Program Director (who maintains a copy) to make certain that the resident is receiving sufficient experience in interventional procedures. First year residents are required to be trained in basic or advanced cardiac life-support and are granted time to attend courses given several times each year at the Health Sciences Center.
Night and weekend individual call, except for IR call (with the IR staff always present), begins during their PGY 3 year (2nd year of Radiology). The entire first year of Radiology is to help prepare the resident for call during their PGY 3 year and to help the resident be able to cope with emergency situations until a faculty member, who is always assigned as backup for the resident, can be consulted.
The first year residents join all the other residents in participating in formal teaching and review sessions covering all aspects of radiology, which are offered by the faculty. These sessions (comprising approximately 8 to 10 hours of study per week) include both formal teaching conferences conducted in a didactic fashion as well as case presentations by the faculty and residents.
The first year residents receive three weeks of annual leave, and sick leave according to institutional regulations. Subject to approval, the first year resident is also allowed one week of paid special educational leave provided he/she presents a paper or exhibit at a particular conference.
SECOND YEAR
In the second year, the resident will spend three to four months in general diagnostic radiology (gastrointestinal, genitourinary, cardio-pulmonary, musculoskeletal), two months in nuclear medicine and vascular/interventional, and one month each in pediatric radiology, neuroradiology, body imaging, ultrasound, and emergency radiology. The resident is encouraged to take increasing responsibility in designing patient examinations and in providing preliminary interpretations in consultation with the referring clinical staff. However, Radiology faculty are required to be in attendance for all invasive procedures and must closely check each examination before a final interpretation is rendered. During the nuclear medicine rotation, the resident becomes acquainted with the principles of instrumentation and nuclear physics and the characteristics of available radiopharmaceuticals through an introductory course geared to the needs of this specific area. In pediatric radiology, the resident is exposed not only to the general clinical and hospital population, but also to neonatal radiology of patients in the pediatric Intensive Care Unit. During the neuroradiology rotation (which includes CT and MRI of the brain, spine and head and neck, as well as myelography), residents monitor images as they are generated and are encouraged to make suggestions for optimization of patient examinations. Second year residents continue to attend the progressive course in radiation physics, radiation protection, and radiation biology given on a weekly basis.
The second year resident receives four weeks annual leave, and sick leave according to institutional regulations. Subject to approval, the second year resident is also allowed one week of paid special educational leave provided he/she presents a paper or exhibit at a particular conference.
THIRD YEAR
In the third year, residents continue to be afforded increased responsibility for performing and interpreting procedures. While faculty consultation is always freely available, the resident is strongly encouraged to develop a diagnosis to its final form and thus acquire the independence necessary to become a successful practicing radiologist. Nevertheless, no formal report is rendered until the staff radiologist has approved the final interpretation and discussed the case in detail with the resident. To enable the resident to refine knowledge and judgment in the broad field of radiology imaging, rotations are provided in each of the major specialty areas.
Each resident has a 2-week or one-month cardiac radiology rotation in conjunction with the cardiology division of the Department of Medicine, which provides exposure to coronary angiography, cardiac catheterization, and echocardiography. During this year residents must attend the four-week course at the Armed Forces Institute of Pathology in Washington, D.C. (At times, scheduling conflicts and limited space at the AFIP may cause this rotation to be taken at the end of the second year or early in the fourth year.) The resident attends the course in radiation physics and radiation biology in preparation for the Board examination. The resident is also expected to progressively increase his availability to junior residents as a consultant in addition to Radiology faculty.
The third year resident receives the four weeks annual leave, and sick leave according to institutional regulations. Subject to approval, the third year resident is also allowed one week of paid special educational leave provided he/she presents a paper or exhibit at a particular conference.
FOURTH YEAR
It is in the fourth year of training that the resident is given the maximum responsibility for performing and interpreting procedures. The practice of close monitoring by Radiology faculty is continued, however, and is required before a final interpretation is rendered. In addition to rotations through the specialty areas, the resident spends two months serving as a “junior staff member” in the general reading area, acting as a consultant for junior residents and participating in the interpretation of as many examinations as possible in gastrointestinal, genitourinary, cardio-pulmonary, and musculoskeletal imaging. The fourth year resident receives two one-month rotations in mammography (the first rotation in mammography will be during the third year), exposure to ultrasound of high-risk pregnancies in conjunction with the Department of Obstetrics and Gynecology at LSU, and a month of elective time. Electives must be approved by the Program Director or Chairman of the Department of Radiology.
Fourth year residents are responsible for presenting cases at numerous hospital-wide conferences, including Medicine and Surgery Grand Rounds, Tumor Conference, Pulmonary Conference, and Radiology-Pathology Conferences.
Exposure to the pathologic basis of diseases and imaging findings is gained from the joint conferences with the Department of Pathology, other departments, the AFIP Course, structured courses given by pathologists, and the correlations offered by Pathology and other departments at conferences and presentations during the four years of resident training.
The fourth year resident receives four weeks annual leave, and sick leave according to institutional regulations.
During the entire four years, residents are encouraged to assist the faculty in the preparation of research papers for presentation at scientific meetings or for publication in scholarly journals. Many residents are motivated by example and choose to engage in though-provoking investigations that are strongly supported by the faculty. Residents who succeed in having papers or poster exhibits accepted at national or local meetings are granted additional educational leave and their travel expenses are paid. Every resident has to produce at least one paper to be presented and judged at the Annual Departmental Resident Research Day.
The residents are consistently urged to study the American College of Radiology Learning File (available on CD Rom, video disks as well as films) and the residents are required to participate in the upgrading and maintenance of the Department of Radiology Teaching File by collecting and writing up in detail at least one case per month.
Detailed delineation of the curriculum and educational goals, and objectives of the major rotations with respect to knowledge, skills, and other attributes of residents at each level of training, are listed in the Section Manuals of the Department of Radiology, copies of which are in the possession of each and every resident and faculty member.