This is a cardiothoracic curriculum document for radiology residents meant to serve not only as a study guide for radiology residents but also as a teaching and curriculum reference for radiology educators and radiology residency program directors. This document represents a revision of a cardiothoracic radiology resident curriculum that was published 10 years ago in Academic Radiology . The sections that have been significantly revised, expanded, or added are (1) lung cancer screening, (2) lung cancer genomic profiling, (3) lung adenocarcinoma revised nomenclature, (4) lung biopsy technique, (5) nonvascular thoracic magnetic resonance, (6) updates to the idiopathic interstitial pneumonias, (7) cardiac computed tomography updates, (8) cardiac magnetic resonance updates, and (9) new and emerging techniques in cardiothoracic imaging. This curriculum was written and endorsed by the Education Committee of the Society of Thoracic Radiology. This curriculum operates in conjunction with the Accreditation Council for Graduate Medical Education (ACGME) milestones project that serves as a framework for semiannual evaluation of resident physicians as they progress through their training in an ACGME-accredited residency or fellowship programs. This cardiothoracic curriculum document is meant to serve not only as a more detailed guide for radiology trainees, educators, and program directors but also complementary to and guided by the ACGME milestones.
Introduction
This document is a revision of a previously published cardiothoracic curriculum for diagnostic radiology residency and reflects interval changes in the clinical practice of cardiothoracic radiology, including updates in the Accreditation Council for Graduate Medical Education (ACGME) requirements for diagnostic radiology training programs.
Radiology residency programs must define the specific knowledge, skills, behaviors, and attitudes required of residents and must provide adequate educational experience to achieve competency in six areas defined by the ACGME: (1) patient care (PC), (2) medical knowledge (MK), (3) professionalism (P), (4) interpersonal/communication skills (ICS), (5) practice-based learning and improvement (PBLI), and (6) systems-based practice (SBP). These six areas, as they specifically relate to radiology, have been previously published .
The 10 subspecialty areas of radiology residency, as defined by the ACGME, are neuroradiology, musculoskeletal radiology, vascular and interventional radiology, cardiac radiology (new since 2005), chest radiology, breast imaging, abdominal radiology, pediatric radiology, ultrasound (including obstetrical ultrasound and vascular), and nuclear medicine.
The Society of Thoracic Radiology (STR) Education Committee has responded to the changing practice of cardiothoracic imaging and the revised ACGME guidelines by revising the previously published Cardiothoracic Curriculum document. There have also been important changes to the structure of radiology residencies across the United States since the last curriculum document was published . The STR Education Committee decided to keep the structure of the curriculum document divided into years 1 and 2, then years 3 and 4 combined, recognizing that the new residency format with general and subspecialty years may not allow a trainee to achieve all the educational goals and objectives in years 3 and 4 if the trainee has not selected cardiothoracic imaging as a subspecialty. Ideally, the third and fourth rotations must occur in year 3 or very early in year 4 so that both occur before the new core American Board of Radiology (ABR) examination that typically occurs early in year 4.
This curriculum document is focused on adult cardiothoracic imaging, as pediatric radiology is considered a separate subspecialty by the ACGME. There is overlap, however, between cardiothoracic imaging and other ACGME subspecialties and, where appropriate, components of other ACGME subspecialties, such as ultrasound or vascular and interventional radiology, are also included. Educational objectives for physics are not included in this document, as most radiology residencies include a physics course with its own course objectives.
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Table 1
Nine New Content Sections in the Cardiothoracic Resident Curriculum
Content Comment Lung cancer screening With results of the National Lung Cancer Screening Trial available and lung cancer screening programs being developed in North America and internationally, residents should have some awareness of the evidence and mortality benefit behind lung cancer screening with CT and the LUNG-RADS reporting system. Lung cancer genomic profiling Genetic profiling of lung cancer performed on lung biopsy specimens provides useful information about endothelial growth factor receptor status especially for adenocarcinoma subtype as well as common genetic mutations such as anaplastic lymphoma kinase (ALK) and kirsten rat sarcoma (K-RAS) that help with targeted therapy with EGFR/tyrosine kinase inhibitors versus standard chemotherapy. Revised nomenclature for primary lung adenocarcinoma The International Association for the Study of Lung Cancer (IASLC) revised the adenocarcinoma classification in 2011 to include adenocarcinoma in situ (AIS, formerly known as bronchioloalveolar carcinoma) and added “minimally invasive adenocarcinoma” with reclassification of invasive adenocarcinoma subtypes. Lung biopsy techniques More detail on lung biopsy technique and management of complications were added. Thoracic MR Thoracic MRI applications have been expanded to include protocols such as chemical shift sequences to help differentiate thymic hyperplasia from thymoma. Updates on idiopathic interstitial pneumonias (IIP) Updates on idiopathic interstitial pneumonias have been added. Cardiac CT updates More content on cardiac CT have been added to include more specific knowledge requirements. Cardiac MR updates Cardiac MRI applications have been expanded and more detail on clinical applications and disease specific knowledge has been added. New and emerging techniques Since the last curriculum document, new and emerging techniques have developed. Although residents are not expected to have detailed knowledge of these emerging new techniques, an awareness of such techniques is encouraged.
CT, computed tomography; EGFR, epidermal growth factor receptor; LUNG-RADS, Lung Imaging Reporting and Data System; MRI, magnetic resonance imaging.
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Year 1 (First 4-week Rotation)
Goals
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Objectives
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Conferences and Study Materials
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Year 2 (Second 4-week Rotation)
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Objectives
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Conferences and Study Materials
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Years 3–4 (Third 4-week Rotation to Occur in Year 3 or Early in Year 4 Before Core Examination for the ABR Examination)
Goals
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Objectives
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Conferences and Study Materials
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Appendix
Supplementary material
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Appendix S1
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References
1. Collins J., Abbott G.F., Holbert J.M., et. al.: Revised curriculum on cardiothoracic radiology for diagnostic radiology residency with goals and objectives related to general competencies. Acad Radiol 2005; 12: pp. 210-223.
2. Accreditation Council for Graduate Medical Education : Program requirements for graduate medical education in diagnostic radiology. Available at: http://www.acgme.org/Specialties/Overview/pfcatid/23 Accessed February 2015
3. Collins J., Rosado de Christenson M., Gray L., et. al.: General competencies in radiology residency training: definitions, skills, education and assessment. Acad Radiol 2002; 9: pp. 721-726.
4. Aberle D.R., Adams A.M., Berg C.D., et. al.: Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365: pp. 395-409.
5. Kazerooni E.A., Austin J.H.M., Black W.C., et. al.: ACR-STR practice parameter for the performance and reporting of lung cancer screening thoracic computed tomography (CT). J Thorac Imaging 2014; 29: pp. 310-316.
6. American College of Radiology : ACR Lung Imaging Reporting and Data System (Lung-RADS). Available at: http://www.acr.org/Quality-Safety/Resources/LungRADS