Chest Curriculum JHH

8/11/2019 Chest Curriculum JHH

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Chest Curriculum

David S. Feigin, MD

Department of Radiology

Johns Hopkins niversity

General

Chest rotations should begin early in the frst year o residency. They will vary in length rom one to our weeks, but should total 10to 12 weeks by the end o the ourth year. The ur ose o theserotations, in con!unction with con erences, is to educate the residentin the detection, descri tion, work"u , management, and diagnosiso lung, mediastinal, leural, chest wall, and dia hragmatic disease.

#uring the rotation residents will be re$uired to%

&e ort to the work s ace rom tly a ter the com letion ocon erences'nderstand standard atient ositioning in chest radiology&eview flms ()C'* in atient and out atient+, list fndings, and

ormulate an inter retation rior to sta review.&eview old studies, rior inter retations and ertinent cross"sectional imaging.-btain ertinent atient history, clinical and lab data rom clinicians

and a ro riate com uteri ed resources./rovide accurate concise grammatically correct radiological re ort ina timely ashion./artici ate in de artmental $uality assurance e orts. &ecogni e anddiscuss inade$uate e aminations with technologists.

ach day o the rotation will include, whenever ossible, review oteaching fle cases and other materials a ro riate to the level othe resident.

t the end o each rotation o two weeks or more, the residentshould antici ate a 3mock oral board4 $ui , usually administered bythe section head. The $ui will be discussed in detail with theresident, and it will be used as a method or !udging the resident5s

rogress in com leting this curriculum. )n addition, there will be adiscussion o the resident5s overall er ormance and rogress duringthe rotation.


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F!RS" R#"$"!#%

&oals

#emonstrate learning o knowledge based ob!ectivesccurately and concisely dictate a re ort

Communicate e ectively with re erring clinicians and su ervisorysta 'nderstand standard ositioning in chest radiology-btain ertinent atient in ormation relative to radiologice aminations#emonstrate the learning o the clinical indications or obtainingchest radiogra hs and when CT or 6& may be necessary

#emonstrate a res onsible work ethic

#'(ectives

)atient Care

The frst rotation will em hasi e lain flm chest studies, but willinclude an introduction to, and correlation with, chest 7&CT.&esidents must review old flms and old re orts to rovide o timal

atient care.&esidents must demonstrate a willingness and ability to obtainhistory, lab, and athological data in a ro riate clinical setting too timi e atient care.&esidents should be able to demonstrate ability to er orm chest8uorosco y.&esidents should inter ret and dictate 90 chest "rays er day withat least :;< accuracy and no ma!or errors.&esidents must clear their radiology re ort $ueue every day.

Medical *no+ledge

&esidents must demonstrate learning o at least one"third o theknowledge based ob!ectives listed at the end o this section. Theem hasis during the frst rotation will be on normal anatomy andrecognition o common and emergent chest disease. ter the frstrotation, residents must demonstrate the ability to recogni e andcorrectly inter ret the ollowing conditions%


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The normal chest flm=ormal CT o the chest)C' a liances and associated mal ositions and com lications/neumonia/ulmonary edema% cardiogenic and noncardiogenicCongestive heart ailure/leural e usionChest trauma including vascular in!ury, lung trauma, dia hragmaticin!ury, etc.

ortic dissection, aneurysms, intramural hematoma and enetratingulcer/neumomediastinum/neumothora and mimicsCauses o cardiac enlargement>ractures o s ine, shoulders and ribs

Causes and recognition o acute and chronic infltrative lung disease&esidents are e ected to demonstrate an increased knowledge odisease rocesses encountered while on the rotation or duringteaching fle sessions.?nowledge o learned material will be assessed with an orale amination at the end o the rotation.

)ractice -ased earning

&esidents are re$uired to read the ollowing%>elson, @. Chest &oentgenology, Aaunders, 1B:

Debb D& and 7iggins C@, "horacic !maging , Ei incott, 200F.

&esidents should also read selected sections o %

7ansell, rmstrong, et.al., !maging of Diseases of the Chest ,ourth edition, 6osby, 200;.

6cEoud T. and @oiselle /6, Thoracic &adiology% The &e$uisites.6osby, 200B.

&esidents are encouraged to use internet sources or re erences tos ecifc to ics o interest, but it must be ke t in mind that internet


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sources are not edited nor re ereed and are thus considerably lessreliable and authoritative than ublished te ts and articles.

&esidents may be re$uired to er orm literature searches on diseaseto ics encountered during the work day.

!nterpersonal Communication Skills

&esidents are re$uired to demonstrate res ect ul communicationwith sta , atients and technologists&esidents are re$uired to rovide concise, accurate summaries ofndings and conclusions during read"out sessions&esidents are re$uired to rovide concise summaries o fndings,di erential diagnosis and radiologic management o cases duringteaching fle review sessions.

&esidents are re$uired to contact clinical sta by tele honeimmediately with urgent or emergent results.&esidents must begin to demonstrate the ability to e ectively

resent chest radiology cases to other residents including briediscussion o the fndings, di erential diagnosis and radiologicmanagement.

)rofessionalism

&esidents are e ected to be in the work lace on time and to not

leave until their clinical res onsibilities are ade$uately com leted&esidents must conduct themselves with the highest ethicalstandards and a ro riate military bearing at EE times.&esidents must clear their radiology re ort $ueue every day.&eading and teaching fle assignments must be com leted on time.

Systems -ased )ractice

&esidents are e ected to be aware o the rinci les o coste ective, $uality health care by being aware o the C&

a ro riateness criteria or evaluating atients.&esidents are e ected to artici ate in de artmental $ualityassurance e orts including%/roviding eedback to technologists#ocumentation o incident re orts&esidents must be aware o de artmental standard o erating

rocedure


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S/C#%D R#"$"!#%

&oals

#emonstrate learning o knowledge based learning ob!ectivesContinue to build on chest radiogra h inter retive skills.#emonstrate an understanding o the C& ro riateness Criteria

or chest radiogra hy

#'(ectives

)atient Care

The resident will demonstrate an im rovement in atient care skillsin com arison to the frst rotation.&esidents will demonstrate an im roved ability to act as a radiologyconsultant.&esidents will be conversant with the rinci les and ractice ochest 8uorosco y including the assessment o dia hragmatic

disease The resident should be able to dictate at least ;0 chest radiogra hsand : 7&CT studies er day.)nter retation should have no ma!or discre ancies and should betotally accurate F0< o the time.

The resident should be able to rotocol and inter ret high resolutionchest CT.&esidents must be able to inter ret and dictate ;0 cases er daywith at least F0< accuracy and miss no ma!or fndings.6edical ?nowledge

The resident will demonstrate learning o at least two"thirds o the

knowledge based ob!ectives listed at the end o this section.&esidents must demonstrate knowledge in%Dork"u , staging and diagnosis o ulmonary neo lasm

valuation and diagnosis o mediastinal masses.


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&esidents are re$uired to use the ollowing%

7ansell, rmstrong, et.al., !maging of Diseases of the Chest ,ourth edition, 6osby, 200;.

&eed, .C. Chest Radiology0 )lain Film )atterns andDi1erential Diagnosis , f th edition, , 6osby, 200 .

6uller, et.al., Radiologic Diagnosis of Diseases of the Chest ,Aaunders, 2001.

Debb D& and 7iggins C@, "horacic !maging , Ei incott, 200F.

6cEoud T. and @oiselle /6, Thoracic &adiology% The &e$uisites.

6osby, 200B.

&esidents will be re$uired to er orm literature searches on diseaseto ics encountered during the work day.

&esidents are encouraged to use internet sources or re erences tos ecifc to ics o interest, but it must be ke t in mind that internetsources are not edited nor re ereed and are thus considerably lessreliable and authoritative than ublished te ts and articles.

!nterpersonal Communication Skills

&esidents are re$uired to demonstrate res ect ul communicationwith sta , atients and technologists&esidents are re$uired to rovide concise, accurate summaries ofndings and conclusions during read"out sessions&esidents are re$uired to rovide concise summaries o fndings,di erential diagnosis and radiologic management o cases during

teaching fle review sessions.&esidents are re$uired to contact clinical sta by tele honeimmediately with urgent or emergent results.&esidents are re$uired to submit two teaching fle cases to 6 #/)Hwith accurate and concise history, fndings, di erential diagnosis,discussion and ca tions.


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&esidents must begin to demonstrate the ability to e ectivelyresent chest radiology cases to other residents including brie

discussion o the fndings, di erential diagnosis and radiologicmanagement.

)rofessionalism

&esidents are e ected to be in the work lace on time and to notleave until their clinical res onsibilities are ade$uately com leted&esidents must conduct themselves with the highest ethicalstandards and a ro riate military bearing at EE times.&esidents must clear their radiology re ort $ueue every day.&eading and teaching fle assignments must be com leted on time.


&esidents are e ected to be aware o the rinci les o coste ective, $uality health care by being aware o the C&a ro riateness criteria or evaluating atients.&esidents are e ected to artici ate in de artmental $ualityassurance e orts including%/roviding eedback to technologists#ocumentation o incident re orts&esidents must be aware o de artmental standard o erating

rocedure

"H!RD R#"$"!#%

&oals

ter com letion o the third chest rotation, the resident will%

#emonstrate learning o all knowledge"based ob!ectives&efne skills in inter retation o radiogra hs and chest CT scans#evelo skills in rotocoling, monitoring, and inter reting 7&CTscans

#evelo skills in rotocoling, monitoring and inter reting chest 6&studies@ecome a more autonomous consultant and teacherCorrelate athologic and clinical data with radiogra hic and chestCT fndings


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#'(ectives

)atient Care

The resident will continue to im rove atient care skills introducedduring rotations one and two.

The resident should be able to dictate at least :0 chest radiogra hsand 10 7&CT studies er day.)nter retation should have no ma!or discre ancies and should betotally accurate B0< o the time.

The resident should be able to rotocol and inter ret high resolutionchest CT.

Medical *no+ledge

t the end o the third chest rotation or senior year o radiologyresidency, the resident will demonstrate knowledge o all o theknowledge"based ob!ectives introduced in Iear 1.

The resident should demonstrate knowledge o neumoconiosis andinterstitial lung disease.

The resident will be able to describe the indications or chest 6&.


The resident will demonstrate an increased knowledge o the currentliterature.

!nterpersonal and Communication skills

)n addition to im roving skills rom frst and second rotations,residents should also demonstrate ability to e ectively teach otherresidents and medical students.

)rofessionalism

Aame standards as frst two rotations



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Aame standards as frst two rotations

F# R"H $%D S -S/2 /%" R#"$"!#%S

&oals

The ourth rotation should be s ent reviewing and refning skillsalready learned on the frst three rotations. The resident is e ectedto er orm at the level o a !unior sta radiologist.

#'(ectives

The resident u on com letion o the ourth rotation must%

#emonstrate medical knowledge o all the material addressed in thethoracic radiology curriculum.#emonstrate continuing im rovement in clinical, academic, andadministrative er ormance related to reviously achieved goalsand ob!ectives.

#emonstrate ability to generate a ro riate and com letedi erential diagnosis or abnormal fndings on chest radiogra hs,chest CT, 7&CT, and cardiothoracic 6&).#emonstrate ability to dictate accurate chest radiogra hs, chest CT,7&CT, thoracic and cardiac 6& re orts with at least B;< accuracyand =- ma!or inter retive errors.#emonstrate ability to com etently unction in the role o consultantand teacher. #emonstrate eJcient inter retation o all )C' and in atient chestradiogra hs and all cross sectional imaging studies o the chest.


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*no+ledge -ased Criteria

%ormal $natomy

1. =ame and defne the three ones o the airways2. #efne a secondary ulmonary lobule

. #efne an acinus9. Eist the lobar and segmental bronchi o both lungs;. )denti y the ollowing structures on the osteroanterior (/ + chestradiogra h%"Eungs "right, le t, right u er, middle and lower lobes, le t u erand lower lobes, lingula">issures" minor, su erior accessory, in erior accessory, a ygous " irway "trachea, carina, main bronchi

"7eart "right atrium, le t atrial a endage, le t ventricle, location othe our cardiac valves"/ulmonary arteries "main, right, le t, interlobar " orta "ascending,arch, descending"Keins "su erior vena cava, a ygous, le t su erior intercostal (Laorticni leL+"@ones "s ine, ribs, clavicles, sca ulae, humerus"&ight aratracheal stri e" unction lines "anterior, osterior" orto ulmonary window" ygoeso hagealrecess "/aras inallines

"Ee t subclavian arteryM. )denti y the ollowing structures on the lateral chest radiogra h%"Eungs "right, le t, right u er, middle and lower lobes, le t u erand lower lobes, lingula">issures" ma!or, minor, su erior accessory" irway "trachea, u er lobe bronchi, osterior wall o bronchusintermedius"7eart "right ventricle, right ventricular out8ow stri e, le t atrium,le t ventricle, the location o the our cardiac valves /ulmonaryarteries "right, le t" orta" ascending, arch, descending

"Keins "AKC, )KC, le t brachioce halic (innominate+, ulmonary veincon8uences"@ones "s ine, ribs, sca ulae, humerus &etrosternalline"/osterior tracheal stri e"&ight and le t hemidia hragms"&aiderNs triangle


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"@rachioce halic (innominate+ artery

Aigns in Chest &adiology

1. @e able to defne, identi y and state the signifcance o theollowing on a radiogra h%

"air bronchogram "indicates a arenchymal rocess, including non"obstructive atelectasis, as distinguished rom leural or mediastinal

rocesses"air crescent sign "indicates a lung cavity, o ten due to ungalin ection"dee sulcus sign on a su ine radiogra h "indicates neumothora"continuous dia hragm sign "indicates neumomediastinum

"ring around the artery sign (around ulmonary artery on lateralchest radiogra h+ "indicates neumomediastinum" allen lung sign "indicates a ractured bronchus "8at waist sign"indicates le t lower lobe colla se"gloved fnger sign "indicates bronchial im action, which can beseen in allergic broncho ulmonary as ergillosis"Golden A sign "indicates lobar colla se with a central mass,suggesting an obstructing bronchogenic carcinoma in an adult"lu tsichel sign "indicates u er lobe colla se, otentially due to anobstructing bronchogenic carcinoma in an adult"7am tonNs hum "indicates a ulmonary in arct

"silhouette sign "loss o the contour o the heart or dia hragm usedto locali e a arenchymal rocess (e.g. a rocess involving themedial segment o the right middle lobe obscures the right heartborderO a lingula rocess obscures the le t heart borderO a basilarsegmental lower lobe rocess obscures the dia hragm+"cervicothoracic sign "a mediastinal o acity that ro!ects above theclavicles is retrotracheal and osteriorly situated while an o acitye aced along its su erior as ect and ro!ecting at or below theclavicles is situated anteriorly"ta ered margins sign "a lesion in the chest wall, mediastinum or

leura will have smooth ta ered borders and obtuse angles with the

chest wall or mediastinum while arenchymal lesions usually ormacute angles"fgure sign "abnormal contour o the descending aorta, indicatingcoarctation o the aorta" at ad sign a sandwich sign "indicates ericardial e usion onlateral chest radiogra h"scimitar sign "an abnormal ulmonary vein in venolobar syndrome


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"double"density sign "contour ro!ecting over the right side o theheart, indicating enlargement o the le t atrium"hilum overlay sign and hilum convergence sign "used to distinguisha hilar mass rom a non"hilar mass

2. @e able to defne, identi y and state the signifcance o theollowing on a chest CT%

"CT angiogram sign "enhancing ulmonary vessels against abackground o low attenuation material in the lung"halo sign "suggesting invasive ulmonary as ergillosis in aleukemic atients"s lit leura sign "a sign o em yema

)nterstitial lung disease

1. Eist and identi y on a chest radiogra h and chest CT our atternso interstitial lung disease ()E#+2. 6ake a s ecifc diagnosis o )E# when su ortive fndings are

resent in the history or on radiologic imaging (e.g. dilatedeso hagus and )E# in scleroderma, enlarged heart and a acemakeror defbrillator in a atient with rior sternotomy and )E# suggestingamiodarone drug to icity+

. )denti y ?erley and F lines on a chest radiogra h and e laintheir etiology9. &ecogni e the changes o congestive heart ailure on a chestradiogra h " enlarged cardiac silhouette, leural e usions, vascular

redistribution, interstitial and*or alveolar edema, ?erley lines;. #efne the terms Lasbestos"related leural diseaseL andLasbestosisOL identi y each on a chest radiogra h and chest CTM. #escribe what a L@L reader is as related to the evaluation o

neumoconiosis:. )denti y honeycombing on a radiogra h and high resolution chestCT (7&CT+, state the signifcance o this fnding (end"stage lungdisease+, and list the common causes o honeycomb lungF. Atate the radiogra hic classifcation o sarcoidosisB. &ecogni e rogressive massive fbrosis*conglomerate massessecondary to silicosis or coal workerNs neumoconiosis on

radiogra hy and chest CT10. &ecogni e the ty ical a earance o irregular lung cysts and*ornodules on chest CT o a atient with EangerhanNs cell histiocytosis11. Eist our causes o unilaterallE#12. Eist three causes o lower lobe redominant )E# 1 . Eist twocauses o u er lobe redominant )E# 19 .)denti y a secondary

ulmonary lobule on 7 &CT


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1;. )denti y )ym hangioleiomyomatosis on a chest radiogra h and7&CT1M. )denti y and give a ro riate di erential diagnoses when the

atterns o se tal thickening, erilym hatic nodules, bronchiolaro acities (Ltree"in" budL+, air tra ing, cysts, and ground glasso acities are seen on 7&CT

lveolar lung disease 1. Eist our broad categories o acute alveolar lung disease ( E#+ 2.Eist fve broad categories o chronic E# . =ame three ulmonary"renal syndromes9. Eist fve o the most common causes o adult res iratory distresssyndrome;. =ame our redis osing causes o bronchiolitis obliteransorgani ing neumonia (@--/+

M. Auggest a s ecifc diagnosis o E# when su ortive fndings areresent in the history or on the chest radiogra h (e.g. broken emurand E# in at emboli ation syndrome, E# and renal ailure in a

ulmonary"renal syndrome, E# treated with bronchoalveolarlavage in alveolar roteinosis+:. &ecogni e a attern o eri heral alveolar lung disease onradiogra hy or chest CT and give an a ro riate di erentialdiagnosis, including a single most )kely diagnosis when su orted byassociated radiologic fndings or clinical in ormation (e.g. eri herallung disease associated with aratracheal and bilateral hilaradeno athy in an asym tomatic atient with LalveolarN sarcoidosis,

eri heral lung disease associated with a markedly elevated bloodeosino hil count in a atient with eosino hilic neumonia,eri heral o acities associated with multi le rib ractures andneumothora in a atient with acute chest trauma and ulmonary

contusions +

telectasis, irways and -bstructive Eung #isease

1 .&ecogni e artial or com lete atelectasis o the ollowing on achest radiogra h%"right u er lobe

"right middle lobe "right lower lobe"right u er and middle lobe "right middle and lower lobe "le t u erlobe "le t lower lobe2. &ecogni e com lete colla se o the right or le t lung on a chestradiogra h and list an a ro riate di erential diagnosis or theetiology o the colla se


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. #istinguish lung colla se rom massive leural e usion on arontal chest radiogra h

9. =ame the 9 ty es o bronchiectasis and identi y each ty e on achest CT ;. =ame ; common causes o bronchiectasisM. &ecogni e the ty ical a earance o cystic fbrosis on aradiogra h and chest CT:. =ame the im ortant things to look or on a chest radiogra h whenthe atient history is LasthmaLNF. #efne tracheomegalyB. &ecogni e tracheal and bronchial stenosis on chest CT and namethe most common causes10. =ame the ty es o ulmonary em hysema and identi y eachty e on a chest CT11. &ecogni e al ha"1"antitry sin c fciency on a chest radiogra hand chest CT12. &ecogni e ?artagenerNs syndrome on a chest radiogra h and

name the com onents o the syndrome1 . #efne the term giant bulla, di erentiate giant bulla romulmonary em hysema and state the role o imaging in atient

selection or bullectomy19.Atate the imaging fndings used to identi y surgical candidates

or giant bullectomy and or lung volume reduction surgery

6ediastinal 6asses and 6ediastinal*7ilar Eym h =ode nlargement

1. Atate the anatomic boundaries o the anterior, middle, osteriorand su erior mediastinum2. =ame the our most common causes o an anterior mediastinalmass and locali e a mass to the anterior mediastinum on aradiogra h, chest CT and chest 6&)

. =ame the three most common causes o a middle mediastinalmass and locali e a mass in the middle mediastinum on aradiogra h, chest CT and chest 6&)9. =ame the most common cause o a osterior mediastinal massand locali e a mass in the osterior mediastinum on a radiogra h,

chest CT and chest 6&);. =ame two causes o amass that straddles the thoracic inlet andlocali e a mass to the thoracic inlet on a radiogra h, chest CT andchest 6&)M. )denti y normal vessels or vascular abnormality on chest CT andchest 6&) that may mimic a solid mass:. =ame fve etiologies o bilateral hilar lym h node enlargement


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F. Atate the three most common locations (GarlandNs triad+ orlym h node enlargement to occur in the chest o atients withsarcoidosisB. Eist the our most common etiologies o Legg"shellL calcifed,lym h nodes in the chest10. &ecogni e a cystic mass in the mediastinum and suggest the

ossible diagnosis o a bronchogenic, ericardial, thymic oreso hageal du lication cyst

Aolitary and 6ulti le /ulmonary =odules

1. Atate the defnition o a solitary ulmonary nodule and a

ulmonary mass 2. =ame the three most common causes o asolitary ulmonary nodule. =ame our im ortant considerations in the evaluation o a solitaryulmonary nodule

9. =ame si causes o cavitary ulmonary nodules;. =ame our causes o multi le ulmonary nodulesM. Atate the indications or ercutaneous bio sy o a solitary

ulmonary nodule:. Atate the indications or ercutaneous bio sy when there aremulti le ulmonary nodulesF. Atate the com lications and the re$uency with which

com lications occur due to ercutaneous lung bio sy using CT or8uorosco ic guidanceB. Atate the indications or chest tube lacement as a treatment or

neumothora related to ercutaneous lung bio sy10. Atate the role o ositron emission tomogra hy (/ T+ in theevaluation o a solitary ulmonary nodule

@enign and 6alignant =eo lasms o the Eung and so hagus

1. =ame the our ma!or histologic ty es o bronchogenic carcinoma,and state the di erence between non"small cell and small cell lungcancer2. =ame the ty e o non"small cell lung cancer that most commonlycavitates . =ame the ty es o bronchogenic carcinoma that areusually central


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9. #escribe the T=6 classifcation or staging non"small cell lungcancer, including the com onents o each stage (), )), 111, )K, andsubstages+, and the defnition o each com onent (T1"9, =-" , 6-"1+;. Atate the staging o small cell lung cancerM. =ame the our most common e trathoracic sites or non"small celllung cancer and small cell lung cancer to metastasi e:. Atate which stages o non"small cell lung cancer are otentiallyres ectableF. &ecogni e abnormal contralateral mediastinal shi t on a ost"

neumonectomy chest radiogra h and state fve ossible etiologiesor the abnormal shi t

B. =ame the most common location or adenoid cystic and carcinoidtumors to occur10. Auggest the ossibility o radiation change as a cause o newa ical o acifcation on a chest radiogra h o a atient with evidence

o mastectomy and*or a illary node dissection11. #escribe the acute and chronic radiogra hic and CT a earanceo radiation in!ury in the thora (lung, leura, ericardium,eso hagus+ and the tem oral relationshi to radiation thera y12.Atate the role o 6& in lung cancer staging (e.g. chest wallinvasion, su erior sulcus or /ancoast tumor+1 . Atate the role o ositron emission tomogra hy (/ T+ in lungcancer staging19. #escribe the T=6 classifcation or staging eso hagealcarcinoma, including the com onents o each stage (), )), 111, )K+and the defnition o each com onent (T, =and 6+

1;.Atate the role o imaging in the staging o eso hageal carcinoma1M.Atate which stages o eso hageal carcinoma are otentiallyres ectable1:. Atate the classifcation o lym homa, the role o imaging in thestaging o lym homa, and the ty ical and aty ical mani estations othoracic lym homa1F. #efne rimary ulmonary lym homa1B. #escribe the ty ical chest radiogra h and chest CT a earanceso ?a osi sarcoma

Chest Trauma

1. )denti y a widened mediastinum on a trauma radiogra h andstate the di erential diagnosis (including aortic*arterial in!ury,venous in!ury, racture o sternum or s ine+2. )denti y the indirect and direct signs o aortic in!ury on contrast"enhanced chest CT scan


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. )denti y and state the signifcance o chronic traumaticseudoaneurysm on a chest radiogra h, CT or 6&)

9. )denti y ractured ribs, clavicle, s ine and sca ula on a chestradiogra h or chest CT;. =ame fve common causes o abnormal lung o acity on a traumaradiogra h or CTM. )denti y an abnormally ositioned dia hragm or loss o defnitiono a dia hragm on a trauma chest radiogra h and suggest thediagnosis o a ru tured dia hragm:. )denti y a neumothora and neumomediastinum on a traumachest radiogra hF. )denti y the allen lung sign on a radiogra h or chest CT scan andsuggest the diagnosis o tracheobronchial tearB. )denti y a cavitary lesion on a ost"trauma radiogra h or chest CTand suggest the diagnosis o laceration with neumatocele

ormation, hematoma or abscess secondary to as iration

10. =ame the three most common causes o neumomediastinum inthe setting o trauma11. &ecogni e and distinguish between ulmonary contusion,laceration and as iration

Chest Dall, /leura and #ia hragm

1. &ecogni e and name our causes o a large unilateral leurale usion on a radiogra h or chest CT2. &ecogni e a neumothora on an u right and su ine chestradiogra h

. &ecogni e a leural based mass with bone destruction orinfltration o the chest wall on a radiogra h or Chest CT and nameour likely causes.

9. &ecogni e leural calcifcation on a radiogra h or chest CT andsuggest the diagnosis o asbestos e osure (bilateral involvement+or old T@ or trauma (unilateral involvement+;. &ecogni e the ty ical chest radiogra hic a earance o leurale usion accounting or atient ostioningM. &ecogni e a arent elevation o a hemidia hragm on a chestradiogra h and suggest a s ecifc etiology with su ortive historyand associated chest radiogra h fndings (e.g. subdia hragmatic

abscess a ter abdominal surgery, dia hragm ru ture a ter trauma,and hrenic nerve involvement with lung cancer+:. &ecogni e a tension neumothora and understand the acuteclinical indications.F. &ecogni e di use leural thickening, as seen in fbrothora ,malignant mesothelioma and leural metastases


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B. Atate and recogni e the radiogra hic and CT fndings omalignant mesothelioma.

)n ection ()mmunocom etent, )mmunocom romised and /ost"trans lant/atients+ 1. =ame the radiogra hic mani estations o rimary ulmonarytuberculosis2. =ame the three most common segmental sites o involvement orreactivation tuberculosis in the lung

. #efne &anke com le and Ghon lesionO recogni e both on aradiogra h and CT9. =ame and describe the our ty es o ulmonary s ergillus

disease;. )denti y an intracavitary ungus ball on chest radiogra hy andchest CT M. Atate the radiogra hic a earances o Cytomegalovirus

neumonia:. =ame the ma!or categories o disease causing chest radiogra hor chest CT abnormalities in the immunocom romised atientF. -ther than bacterial in ection, name 2 im ortant in ections and 2im ortant neo lasms to consider in atients with ) #A and chestradiogra h or chest CT abnormalitiesB. #escribe the chest radiogra h and chest CT a earances o/neumocystis carinii neumonia

10. =ame the 9 most im ortant etiologies o hilar and mediastinaladeno athy in atients with ) #A11. #escribe the time course and chest radiogra hic a earance oa blood trans usion reaction12. Atate the radiogra hic a earances o myco lasma neumonia1 . #escribe the radiogra hic and CT a earance o a miliary

attern and rovide a di erential diagnosis19. =ame the diagnostic considerations in a atient who resentswith recurrent or ersistent neumonias1;. =ame the endemic mycoses, the s ecifc geogra hic regionswhere they are ound, and their radiogra hic mani estations

1M.Atate the most common ulmonary in ections seen a ter solid"organ (i.e. liver, renal, cardiac+ trans lantation1:. #escribe the radiogra hic and CT fndings o ost"trans lant)ym ho roli erative disorders

'nilateral 7y erlucent Eung (or hemithora +


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1. &ecogni e a unilateral hy erlucent lung on a radiogra h or chestCT2. )denti y the common causes or unilateral hy erlucent lung on achest radiogra h

. Give an a ro riate di erential diagnosis when a hy erlucentlung is seen on a chest radiogra h, and suggest a s ecifc diagnosiswhen certain associated fndings are seen (i.e. absence o abreast ina atientN a ter mastectomy or breast cancer, absence o a

ectoralis muscle in a atient with /olandNs syndrome, unilateralbullous disease*em hysema, or air tra ing on e iration in a

atient with Awyer" ames syndrome or an endobronchial oreignbody+

6onitoring and su ort devices "Ltubes and linesL

1. @e able to identi y, state the re erred lacement o ,com lications associated with mal osition and identi y the locationon chest radiogra hy or each o the ollowing %"endotracheal tube"central venous catheter "Awan"Gan catheter " eeding tube

"nasogastric tube"chest tube . "intra"aortic balloon um" acemaker and acemaker leads"automatic im lantable cardiac defbrillator"le t ventricular assist device"atrial se tal de ect closure device (Lclamshell deviceL+" ericardial drain"e tracor orealli e su ort cannulae"intraeso hageal manometer, tem erature robe or 7 robe ,"tracheal or bronchial stent2. lain how an intra"aortic balloon um works

/ost"o erative chest

1. )denti y normal ost"o erative fndings and com lications o theollowing rocedures, on chest radiogra hy, CT and 6&)%

"wedge resection, lobectomy, neumonectomy


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"coronary artery by ass gra t surgery"cardiac valve re lacement"aortic gra t aortic stent"transhiatal eso hagectomy"lung and or lung trans lant"lung volume reduction surgery

/ulmonary Kascular #isease

1. &ecogni e enlarged ulmonary arteries on a chest radiogra h anddistinguish them rom enlarged hilar lym h nodes2. &ecogni e enlargement o the central ulmonary arteries withdiminution o the eri heral ulmonary arteries as ulmonaryarterial hy ertension and suggest the ossible diagnosis o rimary

ulmonary artery hy ertension. =ame fve o the most common causes o ulmonary artery

hy ertension9. &ecogni e lobar and segmental ulmonary emboli on chest CTand chest 6&) (including 6& angiogra hy+;. #efne the role o ventilation" er usion scintigra hy, chest CT,chest 6&)*6& and lower e tremity venous studies in the evaluationo a atient with sus ected venous thromboembolic disease,including the advantages and limitations o each modalityde ending on atient resentation.

/ericardial disease

1 .&ecogni e ericardial calcifcation on a radiogra h and chest CTand list the most common causes2. #escribe and identi y two chest radiogra hic signs o a ericardiale usion

. Atate fve causes o a ericardial e usion9. Atate and recogni e the fndings o a each o the ollowing onradiogra hy, CT and 6&%" ericardial cyst"constrictive ericarditis" ericardial hematoma

" ericardial metastases" artial absence o the ericardium" neumo ericardium

Congenital 7eart #isease in the dult


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1. &ecogni e increased vascularity, decreased vascularity and shuntvascularity on a chest radiogra h and state the common causes oeach2. &ecogni e the ollowing on imaging e aminations o the chest,including radiogra hs, CT and*or 6&)%7eart disease resenting during adulthood"Ee t"to"right shunts and isenmenger hysiology" trial se tal de ect"Kentricular se tal de ect"/artial anomalous ulmonary venous connection"/atent ductus arteriosus ."Coarctation o aorta"Tetralogy o >allot and ulmonary atresia with ventricular se talde ect"Congenitally corrected trans osition o the great arteries"/ersistent le t su erior vena cava

"Truncus arteriosus" bstein anomaly"Cardiac mal osition, including abnormal situs 7eart diseaseoriginally treated in childhood "Coarctation o the aorta"Tetralogy o >allot and /ulmonary atresia with ventricular se talde ect"Com lete trans osition o the great arteries"Congenitally corrected trans osition o the great arteries"Truncus arteriosus"Commonly er ormed surgical corrections or congenital heartdisease

. #efne the role o angiogra hy, echocardiogra hy, chest CT, andchest 6&) in the evaluation o an adult atient with congenital heartdisease, including the advantages and limitations o each modalityde ending on atient resentation

Cardiovascular Correlation *no+ledge(covered in /ediatrics, Kascular")ntervention and Cardiac &otations+

Congenital Eung #isease

1. =ame the com onents o the ulmonary venolobar syndrome


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2. &ecogni e venolobar syndrome on a rontal chest radiogra h,chest CT and chest 6&), and e lain the etiology o the retrosternalband o o acity seen on the lateral view

. &ecogni e a mass in the osterior segment o a lower lobe on achest radiogra h and chest, and suggest the ossible diagnosis o

ulmonary se$uestration9. lain the di erences between intralobar and e tralobarse$uestration;. &ecogni e bronchial atresia al a radiogra h and chest CT, andstate the most common lobes o the lungs in which it occurs

Thoracic orta and Great Kessels

1 .Atate the normal dimensions o the thoracic aorta2. #escribe the classifcations o aortic dssection (#e@akey 1,11,

111O Atan ord , @+, and im lications or classifcation on medicalversus surgical management. Atate and recogni e the fndings o , and distinguish between each

o the ollowing on CT and 6&%"aortic aneurysm"aortic dissection"aortic intramural hematoma" enetrating atherosclerotic ulcer.L "ulcerated la$ue L"ru tured aortic aneurysmO N "sinus o valsalva aneurysm"subclavian or brachioce halic artery aneurysm "aortic coarctation

"aortic seudocoarctation9. &ecogni e a right aortic arch and a double aortic arch on aradiogra h, chest CT and chest 6&;. Atate the signifcance o a right aortic arch with mirror imagebranching versus with an aberrant subclavian arteryM. &ecogni e a cervical aortic arch on a radiogra h and chest CT :.&ecogni e an aberrant subclavian artery on chest CTF. &ecogni e normal variants o aortic arch branching, includingcommon origin o brachioce halic and le t common carotid arteries(Lbovine archL+, se arate origin o vertebral artery rom archB. #efne the terms aneurysm and seudoaneurysm

10. Atate the common cardiac anomalies associated with aorticcoarctation 11.Atate and identi y the fndings seen in TakayasuNsarteritis on chest CTand chest 6&12.Atate the advantages and disadvantages o CT, 6&)*6& andtranseso hageal echocardiogra hy in the evaluation o the thoracicaorta


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)schemic 7eart #isease 1 .#escribe the anatomy o the coronary arteries and identi y the

ollowing on a coronary arteriogram and CT scan"right coronary artery"le t main coronary artery"le t anterior descending coronary artery "le t circum8e coronaryartery2. Atate the clinical signifcance o coronary arterial calcifcation ona chest radiogra h

. &ecogni e coronary arterial calcifcation on CT and state thecurrent role o coronary artery calcium scoring with helical orelectron beam CT9. Atate which coronary artery is usually diseased when there is

a illary muscle dys unction;. #escribe the common acute com lications o myocardialin arction, including le t ventricular ailure, myocardial ru ture and

a illary muscle ru ture, and recogni e radiologic fndings that mayindicate theseM. #escribe the common late com lications o myocardial in arction,including ischemic cardiomyo athy, le t ventricular aneurysm, le tventricular seudoaneurysm, coronary"cameral fstula, dyskinesisand akinesis and recogni e radiologic fndings that may indicatethese:. )denti y le t heart ailure on a radiogra h and chest CT F.

&ecogni e acute myocardial in arction on 6& imagingB. #efne e!ection raction and state the normal le t ventriculare!ection raction10.ldenti y myocardial calcifcation on CT and state the etiologyLand signifcance o this fnding11 .Atate the di erence between a le t ventricular aneurysm and

seudoaneurysm12. #efne and identi y myocardial bridging on 6&1 .#efne the role o angiogra hy, echocardiogra hy, stress

er usion scintigra hy, chest CT, and chest 6&) in the evaluation oa atient with sus ected ischemic heart disease, including the

advantages and limitations o each modality

6yocardial #isease 1. #efne the ty es o cardiomyo athy (dilated, hy ertro hic,restrictive+ and list the common causes o each2. #efne right ventricular dys lasia and identi y on 6&)


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. Atate the most common benign rimary cardiac tumors, includingmy oma, li oma, fbroma and rhabdomyoma9. Atate the most common malignant rimary cardiac tumors,including angiosarcoma, rhabdomyosarcoma, lym homa;. #istinguish cardiac tumor rom thrombus on CT and 6&)M. Atate the most common malignancies to metastasi e to the heart,and the a earance on a radiogra h, chest CT and chest 6&:. Atate the advantages and disadvantages o echocardiogra hy,CT, and 6&) or evaluation o cardiomyo athy and cardiac tumors

Cardiac Kalvular #isease 1. Atate the fndings that indicate each o the ollowing and identi yeach on chest radiogra hs%"enlarged right atrium

"enlarged le t atrium"enlarged right ventricle"enlarged le t ventricle2. &ecogni e an enlarged le t atrium, vascular redistribution, andmitral valve calcifcation on a chest radiogra h and suggest thediagnosis o mitral stenosis

. &ecogni e an enlarged ascending aorta and aortic valvecalcifcation on a chest radiogra h and suggest the diagnosis oaortic stenosis9. Atate the most common etiologies o the ollowing%"aortic stenosis, % "aortic regurgitation

"mitral stenosis. , "mitral regurgitation"tricus id regurgitation " ulmonary stenosis;. Atate the cardiac diseases associated with mitral annuluscalcifcationLM. )denti y endocarditis and*or com lications o endocarditis onradiogra hs, chest CT and chest 6&:. Atate the advantages and disadvantages o echocardiogra hyand 6&) or evaluation o valvular heart disease

@ased on the Curriculum in Chest &adiology created and endorsedby the Aociety o Thoracic &adiology


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