Welcome to your Chest Rotation. Dr. Dominique DaBreo, Dr. Rob Dhillon, and Dr. Justin Flood are your friendly Cardiothoracic Radiologists found in the Cardiothoracic Reporting Room 22.1.166.
Knowledge Objectives Block 1
CANMED Goals block 1
1. Develop an approach and be able to concisely dictate a chest radiograph report.
2. Develop an approach to acute CT chest pathologie
3. Communicate effectively with referring clinicians and supervisory staff
4. Obtain pertinent patient information relative to radiologic examinations and protocolling.
5. Demonstrate knowledge of the clinical indications for obtaining chest radiographs and when a chest CT or MR may be necessary.
Day work flow Block 1
1. Be on time, please arrive by 800 AM to Cardiothoracic reporting room. Please look ahead to Radiologists schedule to see which work station will be available.
2. Morning CT protocolling to be done by the resident, grey Chest folder in CT room. Please reference Chest CT protocols.
3. Protocol CT Chest inpatients throughout the day as brought by CT technologists and booking. Please reference Chest CT protocols.
4. Please leave Cardiac and Lung Biopsy protocolling to the Attending.
5. Answer phone calls in Cardiothoracic Reporting room. Take consultation as far as you can and ask Attending as necessary.
6. Provide consultation for Physicians who visit the Cardiothoracic Reporting room. Take consultation as far as you can and ask Attending as necessary.
7. Dictate 20 xrays and any overnight STAT CTs in AM, then any outpatient CT cases.
8. Dictate STAT CT first and outpatient CT cases in PM.
9. Lung Biopsies are performed in the AM by Attending and Senior Residents.
10. Thoracic Tumour Boards every Wednesday 12:30-1:30pm, attend if it does not conflict with noon rounds.
11. Interstitial Lung Disease Rounds Friday 12-1pm (4 times a year), optional to attend if does not conflict with noon rounds.
Please ensure for Dr. Rob Dhillon and Dr. Dominique DaBreo to use our templates for Chest reporting. Please reference within Dr. Rob Dhillon’s macro in advance for list for CT Chest, CT Chest and Abdomen templates. Please clone templates into your macros in advance to rotation.
Chest xray reports must be concise 1- 3 lines. First report supportive lines/tubes, then any pertinent lung, cardiomedastinal, pleural or bony abnormality. Always answer clinical question provided on requisition. Also reference Dr. Dhillion’s macros in advance to the start of the rotation.
FINDINGS: Support devices are unchanged. No focal consolidation, pleural effusion, pulmonary edema or pneumothorax. The cardiomediastinal borders are unchanged.
SUGGESTED READING/TUTORIALS PRIOR TO START OF ROTATION
Felson's Principles of Chest Roentgenology, a Programmed Text by Lawrence R. Goodman
http://eradiology.bidmc.harvard.edu/interactivetutorials/ Chest tutorials
Definition, Identification, and Significance of Signs and Finding Nomenclature in Thoracic Radiology. Knowledge should include diseases for which these signs are classic, potential alternative diagnoses, or pitfalls [Hansell et al. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2008;246:697-722]
Cardiothoracic CT protocols
1. CHEST (with or without IV contrast). Majority of cases clinical question can be adequately assessed without contrast.
2. CHEST LOW-DOSE (LDT): noncontrast study for nodule follow up and lung cancer screening. DO NOT used for cancer follow up typically.
3. CHEST & ABDOMEN: usually give IV contrast (unless poor renal function), no oral contrast for majority cases.
4. ILD new pt (includes expiratory study).
5. ILD follow up (no expiratory study).
6. ASCENDING AORTA (can be done with or without IV contrast and gated or non-gated).
7. PULMONARY VEIN (done as with and without IV contrast).
8. DISSECTION: LDT and contrast enhanced chest arterial phase. If positive study for Type B should extend study to include abdomen +/- pelvis. If high pretest probability for Type A, perform study gated.
9. CT PULMONARY ANGIOGRAM (CTPA).
10. DOUBLE RULE OUT: Specific protocol designed for optimal enhancement of both the pulmonary arteries and thoracic aorta. Rule out PE and aortic dissection. We DO NOT perform triple rule protocols.
Reading General Chest Books
Please see Cardiothoracic Teaching Folder on the V drive for reference articles. We encourage you to use online resources including StatDx, Radiopaedia, or online Radiographics articles for chest nomenclature, staging, and help guide your differential diagnosis.
Reference ABR core study guide articles for Thoracic Imaging http://pubs.rsna.org/page/radiographics/abr-core-exam-study-guide.