Diagnostic Imaging Residency Program Course Work

Residents are required to attend an 8 month long course in physics which encompasses many aspects of imaging. This is a formal course given to MD radiology residents at the University of Massachusetts. This occurs as a 2-hour lecture, once weekly for 8 months. Less formal sessions (resident-driven) geared to prepare them for the qualifying portion of the ACVR examination will be given in CT and MRI, special procedures, radiation biology, pathophysiology, and anatomy.

Courses in Diagnostic Imaging – Physics

Course Outline

Physics of Radiology and Nuclear Medicine, Andrew Karellas, Ph.D. Associate Professor, Radiology, University of Massachusetts

  • Modern Physics concepts: Quantum nature of radiation, electromagnetic spectrum, units of measurement, nature and origin of electromagnetic radiation with emphasis on visible, UV, gamma-ray and x-ray part of the spectrum.
  • Production of ionizing radiation, x-ray tubes and circuits. X-ray generators (single phase, 3-phase, high frequency). X-ray beam filtration, X-ray spectra and energy. X-ray tube power ratings and practical limitations. X-ray focal spots and how they affect tube loading and geometric unsharpness. Extrafocal radiation (origin and effects). Beam restriction and collimation.
  • Interactions of radiation and matter (photoelectric, Compton, coherent scattering), exponential law of attenuation.
  • The radiographic image (concepts of contrast and resolution) Modulation Transfer Function (MTF), Wiener spectrum and noise. Some applications of Fourier analysis to radiographic systems. Geometry of radiographic image. Origin and nature of x-ray scatter. Effect of scatter on subject contrast. Antiscatter mechanisms, grids and air gaps, automatic exposure control devices. Radiation quantity and quality, radiation detectors.
  • Image receptors: Radiographic screens, radioluminescent materials, physical and photographic characteristics of x-ray film, photostimulable phosphor technology for digital radiography.
  • Image recording techniques (laser printing methods, physical requirements).
  • Fluoroscopy: Image intensification techniques (concepts, units and noise concerns). The physics and engineering of modern image intensifiers, video cameras and charge-coupled devices. Cineangiography, image viewing and recording. Bandwidth limitations. Television techniques and electronic x-ray imaging. Digital subtraction angiography.
  • Conventional tomography. Magnification radiography (advantages and limitations).
  • Mammography: Mamrnographic equipment and image receptors. Quantitative aspects of the mammography image. Future outlook of digital mammography.
  • Computed tomography: mechanisms of contrast, reconstruction, equipment requirements, spiral scanning techniques.
  • Computers and Teleradiology: Image data communication, archiving and display requirements and digital radiography.
  • Nuclear Medicine Imaging: Nuclear emissions and their applications, nuclear counting statistics. Gas, scintillation and solid state detectors, nuclear spectroscopy and gamma camera imaging spectroscopy, radionuclide generators, concepts of Single Photon Emission Tomography (SPECT) and Positron Emission Tomography (PET). Medical Internal Radiation Dosimetry (MID) calculations.
  • Radiation effects and radiation protection: Basic radiobiological aspects, Radiation protection measures, and practices, regulatory aspects. Radiation dose precautions in fluoroscopy. The concept of effective dose.
  • Ultrasound: Basic interactions, transducers and image acquisition techniques. Doppler effect, applications and imaging.
  • Basic principles of MRI and imaging techniques.

Courses in Diagnostic Imaging – CT and MRI

Resident Training MRI Lecture Outline

  • Instrumentation, Digital images, Resolution, Signal/Noise
  • Magnetism
  • Larmor frequency
  • Faraday’s Law
  • T1, T2, T2* relaxation
  • Spin echo techniques-T1, T2 and intermediate-weighted pulse sequences
  • Gradient echo, T2* weighted sequences
  • Inversion recovery-STIR, FLAIR images
  • Fat Saturation
  • MRA
  • Contrast enhancement- with T1-weighting and T2*-weighting
  • Clinical case presentations

Radiology Residents' CT Learning Objectives Checklist

  • Attend 2 hour physics lecture by AST
  • Read CT physics chapter in Christensen or other textbook (eg, Berland)
  • Be able to describe cause of these CT artifacts-beam hardening, partial volume averaging, blooming artifact, edge gradient artifact, noise or photon starvation
  • Be able to describe in own words the concept of windowing. Know approximate window settings for brain, lung, mediastinum, nasal cavity, bone
  • Complete physics practice exam (in binder) and return to AST
  • Learn CT scanner operation-be able to run a scan completely by yourself (on emergency basis if needed)
  • Attend all clinical CT scans on CT day
  • Learn terminology and orientation of animal vs. human images (use CD-ROM and binder notes)
  • Learn CT skull anatomy landmarks (test yourself using CD-ROM and binder notes)
  • Learn major brain divisions on gross specimens (use CD-ROM and binder notes)
  • Learn ventricular system-gross and CT (use CD-ROM and binder notes)
  • Learn cranial nerves (use CD-ROM)
  • Learn CT anatomy of entire head (use annotated hard copy of normal dog)
  • Know HU for major tissue types (binder notes)
  • Know terminology for types of hydrocephalus (see newsletter in binder)
  • Be able to explain in own words concept of contrast enhancement
  • Know the three factors which cause a lesion to be hyperdense on pre-contrast CT
  • Learn image characteristics for various lesions (see glossary in binder, Kornegay article, human texts)
  • Be able to dictate report with all the necessary ingredients (see memo)
  • Learn basic anatomy of spinal canal (with myelography) thorax and adrenal gland region
  • Practice CT biopsy with phantom (see articles)
  • Read all CT articles in resident reading list/files
  • Complete the self-exam in CD-ROM

Courses in Diagnostic Imaging – Radiation Biology

Radiology Rounds for Residents

Objective
To answer all ACVR board objectives related to radiation physics, biology, monitoring, protection and the regulatory aspects of radiobiology. Oncology and tumor biology will not be discussed.

Text
Radiobiology for the Radiologist 5th Ed by Eric Hall

Additional reading material

  • Essentials of Nuclear Medicine Physics by Powsner & Powsner
  • Radiation Protection in Medical Radiography by Mary Alice Statkiewicz-Sherer
  • Christensen’s Physics of Diagnostic Radiology by Curry
  • The Essential Physics of Medical Imaging by Bushberg
  • Small Animal Clinical Oncology by Withrow & MacEwen
  • Nuclear Medicine, Technology and Techniques edited by Bernier
  • Handbook of Veterinary Nuclear Medicine edited by Clifford Berry and Greg Daniel
  • Veterinary Clinics of North America Small Animal Practice: Radiation Oncology Jan 1997, 27:1 edited by Ronald Burk
  • Handouts from Dave Ruslander & Ken Rassnick
  • Radiation Physics, Burk, Chapter 1, Bernier, Chapter 2, Bushberg, Chapter 2
  • Radiation Physics, continued
  • Radiation Physics, continued
  • DNA damage and the cell cycle, Hall, Chapters 2&4
  • Cell survival curves, Hall, Chapter 3
  • Radiation damage repair, Hall, Chapter 5
  • OER, RBE and LET, Hall, Chapter 6&7
  • Total body irradiation syndromes and fetal effects of radiation, Hall, Chapter 8&12
  • Radioprotectors, stochastic/deterministic and early/late effects of radiation, Hall Chapter 9, Chapter 10 p144-145, Chapter 13 p198, Chapter 19 p339-344
  • Radiation protection, Hall Chapter 15
  • Cell, tissue and tumor kinetics, Hall Chapter 21
  • Radiation Protection: units and dose limits, Christensen Chapter 21, Statkiewicz-Sherer Chapters 3&4
  • Radiation protection: shielding and monitoring, Statkiewicz-Sherer Chapters 8&9
  • Catch up/review
  • Catch up/review