DEFINITION:Diagnostic Radiology is a branch of medical practice concerned with the use of imaging techniques in the study, diagnosis and treatment of disease.

GENERAL OBJECTIVES:On completion of the program, the graduate physician will be competent to function as a consultant in Diagnostic Radiology. This requires the physician to have the ability to supervise, advise on and perform imaging procedures to such a level of competence, and across a broad range of medical practice, as to function as a consultant to referring family physicians and specialists.

Communication skills, knowledge, and technical skills are the three pillars on which a radiological career is built, and all are dependent on the acquisition of an attitude to the practice of medicine which recognizes both the need to establish a habit of continuous learning and a recognition of the importance of promoting a team approach to the provision of imaging services.

SPECIFIC OBJECTIVES:
 

Medical Expert/Clinical Decision-Maker

General Requirements

• Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
• Access and apply relevant information to clinical practice so as to have competence in clinical radiological skills.
• Demonstrate effective consultation services with respect to patient care, education and legal opinions.

Specific Requirements

• Understand the nature of formation of all types of radiological images, including physical and technical aspects, patient positioning, contrast media.
• Knowledge of the theoretical, practical and legal aspects of radiation protection, including other imaging techniques and their possible harmful effects.
• Knowledge of human anatomy at all ages, both conventional and multiplanar, with emphasis on radiological applications.
• Knowledge of all aspects of clinical radiology, including understanding of disease, appropriate application of imaging to patients, importance of informed consent, complications such as contrast media reactions, and factors affecting interpretation and differential diagnosis.
• Understand the fundamentals of quality assurance in radiology.
• Understand the fundamentals of epidemiology, biostatistics and decision analysis.
• Show competence in manual and procedural skills and in diagnostic and interpretive skills.
• Demonstrate the ability to manage the patient independently during a procedure, in close association with a specialist or other physician who has referred the patient. The radiologist should know when the patient's best interests are served by discontinuing a procedure, or referring the patient to another physician.
• Understand the acceptable and expected results of investigations and/or interventional therapy as well as unacceptable and unexpected results. This must include knowledge of and ability to manage radiological complications effectively.
• Understand the appropriate follow-up care of patients who have received investigations and/or interventional therapy.
• Show understanding of a sound and systematic style of reporting.
• Competence in effective consultation, conduct of clinico-radiological conferences, and the ability to present scholarly material and lead case discussions.

Communicator

General Requirements

• Establish appropriate therapeutic relationships with patients/families.
• Listen effectively.
• Obtain the appropriate information during consultation with referring physicians in order to be able to make recommendations regarding the most appropriate testing and/or management of patients.
• Discuss appropriate information with patients/families and the health care team, and be able to obtain informed consent for tests and procedures when this is needed.

Specific Requirements

• Have the ability to produce a radiologic report which will describe the imaging findings, most likely differential diagnoses, and, when indicated, recommend further testing and/or management.
• Understand the importance of communication with referring physicians, including an understanding of when the results of an investigation or procedure should be urgently communicated.
• Communicate effectively with patients and their families and have a compassionate interest in them.
• Recognize the physical and psychological needs of the patient and their families undergoing radiological investigations and/or treatment, including the needs of culture, race and gender.

Collaborator

General Requirements

• Consult effectively with other physicians and health care professionals.
• Contribute effectively to other interdisciplinary team activities.

Specific Requirements

• Have the ability to function as a member of a multi-disciplinary health care team in the optimal practice of radiology.

Manager

General Requirements

• Utilize resources effectively to balance patient care, learning needs, and other activities.
• Allocate finite health care resources wisely.
• Work effectively and efficiently in a health care organization.
• Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements

• Be competent in conducting or supervising quality assurance including an understanding of safety issues and economic considerations.
• Be competent in computer science as it pertains to the practice of radiology.

Health Advocate

General Requirements

• Identify the important determinants of health affecting patients.
• Contribute effectively to improve the health of patients and communities.
• Recognize and respond to those issues where advocacy is appropriate.

Specific Requirements

• Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.
• Recognize when radiological investigation or treatment would be detrimental to the health of a patient.
• Educate and advise on the use and misuse of radiological imaging.

Scholar

General Requirements

• Develop, implement and monitor a personal continuing education strategy.
• Critically appraise sources of medical information.
• Facilitate learning of patients, housestaff/students and other health professionals.
• Contribute to development of new knowledge.

Specific Requirements

• Competence in evaluation of the medical literature.
• The ability to be an effective teacher of radiology to medical students, residents, technologists and clinical colleagues.
• The ability to conduct a radiology research project, which may include quality assurance.
• Appreciation of the important role that basic and clinical research plays in the critical analysis of current scientific developments related to radiology.

Professional

General Requirements

• Deliver highest quality care with integrity, honesty and compassion.
• Exhibit appropriate personal and interpersonal professional behaviours.
• Practice medicine ethically consistent with the obligations of a physician respecting the needs of culture, race and gender.

Specific Requirements

• Be able to accurately assess one's own performance, strengths and weaknesses.
• Understand the ethical and medical-legal requirements of radiologists.

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty.

The content and organization of each accredited program in diagnostic radiology must be consistent with the specialty training requirements.

Graded responsibility in radiology implies that residents will progress from having all their procedures closely supervised, and all their reports on films checked, to being able to perform procedures with little or no supervision and to report independently. They should, by the end of residency, be skilled in being on call for emergencies, asking for staff advice only when they judge it necessary. Experience in providing consultative services for referring physicians should be well developed at the completion of the residency.

RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in diagnostic radiology.

In those cases where a university has sufficient resources to provide most of the training in diagnostic radiology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

1. Teaching Faculty

There must be a sufficient number of qualified radiology faculty who are able to provide expertise in all areas of radiology.

2. Number and Variety of Patients

The number and variety of patients available to the program on a consistent basis must be sufficient to meet the educational needs of the residents. There must be access to both in and out patient radiology for both adult and pediatric medicine and surgery.

3. Imaging Services Specific to Diagnostic Radiology
   1. Modern imaging equipment (radiographic and fluoroscopic capability, computed tomography, ultrasound, nuclear medicine and MRI) must be available to facilitate teaching in both diagnostic and interventional radiology in the following areas:
      1. chest imaging including both pulmonary and cardiac aspects
      2. musculoskeletal imaging
      3. abdominal imaging
      4. breast imaging
      5. neuroimaging
      6. vascular imaging
      7. pediatric imaging
   2. Ambulatory Services

Residents should become experienced in the provision of timely services for outpatients in both hospital and office circumstances. They should acquire experience in the management of patients having radiological procedures in a short stay environment, including pre- and post-procedure care.

3. Consultation

An active consultation service is essential to gain experience in primary consultations to referring physicians. Residents must participate in consultations on an ongoing basis throughout their training.

All accredited programs in radiology must provide training in provision of services to referring physicians, including but not limited to: advice on imaging strategies for common clinical presentations, effective utilization of imaging services by referring physicians, and skills in communicating and implementing appropriate guidelines in the context of clinical protocols.

4. Community Learning Experiences

Community experiences should be available and must provide a learning environment with appropriate supervision, patient contacts, and opportunities for evaluation based on rotation specific objectives. There must be administrative support and linkages with the program for these rotations.

4. Supporting Services — Clinical, Diagnostic, Technical
   1. Liaison with Other Specialties and Subspecialties

There must be appropriate liaison with teaching services in medicine, surgery, pediatrics, obstetrics and gynecology, anesthesia and oncology.

2. Intensive Care

There must be regular exposure of the residents to the radiology of intensive care.

3. Emergency Facilities

The residents must have experience in providing service for patients from the emergency department, both in and out of regular working hours and under emergency and on-call conditions.

4. Medical Physics Program

A medical physics program with a formal course of instruction for the radiology residents should be in place. If this is not sufficient for complete instruction, alternative arrangements should be in place with another university to provide this instruction.

5. Anesthesia

There should be close links between anesthesia and radiology in the provision of analgesia and sedation for interventional procedures and for diagnostic procedures. The residents should have exposure to these types of patients in order to acquire the appropriate skills.

6. Nuclear Medicine

There must be a nuclear medicine service, preferably with an accredited residency program in nuclear medicine, with adequate facilities and faculty under the direction of a physician qualified in nuclear medicine. Arrangements must be in place for the instruction and supervision of diagnostic radiology residents in nuclear medicine.

7. Pathology

Clinico-pathological correlation is an essential component of the program. Resources must be available to provide this educational experience for the residents.

8. Other

There must be a designated residents' room or area, a radiology library with an adequate supply of appropriate journals and textbooks and a film and/or an electronic teaching collection. A full medical school library must also be available. Access to computer searches of the literature must be available.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM:

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.

1. Organized Scholarly Activities

Both regular resident teaching rounds on case material, and an identifiable program of planned instruction must be in place. The program should include clinical radiology, relevant clinical medicine from various disciplines, medical physics, and pathology.

Residents should be exposed to teachers and experts in all the subspecialty areas of radiology. Usually such faculty will be available from within the program, but disciplines which are not represented locally should be covered by a visiting professor program, and key areas may need to be covered by rotations to other university centres.

2. Basic and Clinical Sciences

The academic program must include teaching in the basic and clinical sciences relevant to the specialty of diagnostic radiology.

3. Biomedical Ethics

The academic program must provide opportunities for the residents to gain an understanding of the basic principles of biomedical ethics as it relates to the specialty of diagnostic radiology including, but not limited to:

• informed consent
• ethics of radiation exposure
• relations between and the nature of the contract between the referring physician and radiologists
• relations between radiologists and other departmental staff including gender issues
• the nature of the relationship between radiologists and patients
• the ethics of billing practices
• ethics of appropriateness of studies
• the ethics of relationships between groups of radiologists.
3. Communication Skills

There must be opportunities for residents to learn effective communication skills for interacting with patients and their families, colleagues, other allied health professionals, and students.There must be instruction in the principles and practice of effective written and verbal communication of radiology results. Development of consultative skills over the course of the residency should be evident.

5. Teaching Skills

Teaching of residents in other programs and of medical students is a useful learning exercise. Teaching of radiography technologists and students, nurses, and referring physicians are skills required of every radiologist, and must be included as part of the residency program.

6. Quality Assurance/Improvement

A documented program of instruction must cover these issues.

7. Research Opportunities for Residents

Opportunities for research by residents include exposure to research conducted by faculty. There should be a faculty radiology research coordinator. Support for research projects, and assistance and advice should be available for residents interested in research.

Critical appraisal is a mandatory skill and documentation of its acquisition is required. This may be within rounds, as part of a formal academic program, and/or within the context of a journal club program.

8. Faculty Research

A satisfactory level of research and scholarly activity must be maintained among the faculty identified in the program.

9. Outside Conference

The program should provide opportunities for residents to attend conferences outside their own university.

SPECIALTY REQUIREMENTS:

PROGRAMS (WITH TRAINING REQUIREMENTS):Programmes( with Training Requirements):

Diplomas(Dip):

Twelve months of approved residency training.

Doctor of Medicine(M.D):

Twenty four months of approved residency training.

Doctor of Philosophy(Ph.D):

Forty eight months(four years)of approved residency training.