Diagnostic Radiology Program Curriculum

Rotation Information

Cardiothoracic

The Creighton University Cardiothoracic Division of Radiology provides dedicated rotations in diagnostic chest radiography and chest computed tomography. In addition, there are elective opportunities for training in cardiac CT and MRI.

First-year residents begin their training with a rotation devoted to chest radiography. This rotation includes outpatient radiographs from multiple physician clinics across the Omaha metropolitan area, emergency room cases, and ICU portable films. The ICU and medicine teams frequently round through radiology to review portable radiographs.

Additional rotations through the chest service focus predominantly on chest CT and chest CTA studies. There is a monthly multidisciplinary Interstitial Lung Disease conference that residents attend that includes radiology, pulmonology, cardiothoracic surgery and pathology. Residents also participate in a bimonthly interdisciplinary Lung Cancer Conference.

Upper-level residents have exposure to Cardiac CT and MRI. The CT volume is a mixture of coronary artery angiograms and structural heart studies. Cardiac MRI reads are shared with the cardiologists, and there is a monthly Multimodality Cardiac Imaging Conference to review interesting cases and provide interdisciplinary learning.

Abdominal Imaging / Fluoroscopy

The Abdominal/Fluoroscopy rotation provides residents with experience in interpreting abdominal radiography as well as the performance and interpretation of various fluoroscopy studies.

One of the earliest rotations residents complete during the first year, the Abdominal/Fluoroscopy rotation provides a solid foundation for imaging of both normal anatomy and various pathologies of the gastrointestinal and genitourinary system.

First year residents learn basic fluoroscopic techniques enabling performance of a variety of exams, including esophagram, upper GI series, small bowel series, contrast enema, defecography and vesicoureterogram. With further experience, residents can build and adapt their own fluoroscopy “protocols” tailored to answer the specific clinical question, with radiology faculty immediately available for assistance. Fluoroscopy will provide an avenue to gain familiarity with different types of radiologic contrast materials, routes of administration, and indications/contraindications for various imaging procedures. Residents help acquire and interpret images from esophagopharyngograms performed with Speech-Language Pathology and hysterosalpingograms performed with OB-GYN faculty.

Musculoskeletal

Creighton University Musculoskeletal Division of Radiology offers training in both diagnostic imaging and image-guided procedures on the CHI/Bergan Mercy campus. Residents also remotely interpret images from 5 other CHI affiliated hospitals in the Greater Omaha region, as well as, multiple out-patient imaging centers. The first rotation is dedicated to the interpretation of radiographs, with an emphasis on traumatic injuries. Subsequent rotations focus on a more complex interpretation of MRI, CT and Ultrasound imaging of the musculoskeletal system. Typically, one radiology resident covers the musculoskeletal service with a fellowship-trained musculoskeletal attending radiologist, this allows residents to get early exposure to image-guided interventions. We are committed to the undergraduate and graduate medical education at Creighton University and make service to our patients and providers in the areas of Orthopedics, Sports Medicine, Rheumatology and Oncology a the top priority.

Abdominal Imaging / Cross-Sectional

The Cross-Sectional Abdominal Radiology rotation provides dedicated training in abdominal and pelvic imaging, including a variety of CT and MRI exams.

Residents begin their experience with cross-sectional imaging of the abdomen in the first year, an important aspect of preparation for advanced rotations and night call. Initially, residents focus on abdominal CT, with cases including ER patients with acute complaints, inpatients, as well as oncology patients. As a level 1 trauma center, Creighton University Medical Center also treats patients with a wide array of traumatic injuries, and the abdominal imaging resident communicates closely with the trauma team to determine patent management. The rotation includes education on protocols within abdominal imaging, including when to use intravenous and oral contrast material, multiphase exams, MRI protocol selection, and utility of delayed imaging in trauma.

Advanced residents gain experience in interpreting abdominal and pelvic MRI exams, such as MRCP, female pelvis, and dedicated MR protocols of the liver, adrenal glands, or kidneys. In coordination with the department of surgery, residents gain unique experience in imaging of peritoneal diseases such as pseudomyoma peritonei. Residents have the opportunity to interpret specialized abdominal imaging exams under the guidance of fellowship-trained faculty, such as CT/MR enterography, CT colonography, MRI of the prostate, and rectal cancer MRI staging.

Additional experience in abdominal imaging is provided by resident participation in weekly multidisciplinary Tumor Board, and monthly multimodality GI and Urology conferences. These conferences provide valuable insight into the impact of imaging on clinical management as well as exposure to interesting cases.

Nuclear Medicine

On the Nuclear Medicine rotation, the resident will review all requests and tailor the exam to the clinical question. If the clinical information provided is not sufficient, or if a significant change in the requested study is appropriate, the resident will contact the NUC attending and the clinical team as indicated. The technician will obtain relevant history in most cases, however, the resident is to interview and examine the I123 and I131 patients. Results of emergency studies, and unexpected or clinically significant abnormal results, will be reported directly to the requesting physician. 

Each resident is required to actively participate in a minimum of 3 low and high dose iodine treatments with appropriate documentation, and be familiar with the treatment-related safety procedures. Residents have to undergo basic technical training to understand the daily routine quality control methods for cameras, radiopharmaceutical delivery and storage regulations and radiation safety for patients and staff.

Cardiac exams are interpreted in conjunction with the cardiology department, which provides additional exposure to cardiac US exams and a thorough understanding of the clinical background.

The NUCS residents is responsible to prepare the cases for the weekly tumor board conference. Residents also visit Cardinal Health to learn the technical background and preparation of radiopharmaceuticals.

Ultrasound

The Ultrasound rotation provides resident experience and education in the interpretation of both inpatient and outpatient ultrasound exams, ultrasound scanning, common ultrasound artifacts, and correlation of ultrasound with other imaging exams.

Ultrasound training begins during the first year of residency, and common exams interpreted by residents include abdominal (including liver, gallbladder, and bile ducts), renal, thyroid, scrotum, female pelvis, and first-trimester obstetric ultrasound. Residents gain experience with Doppler exams including hepatic vasculature (with and without TIPS stent) and renal artery stenosis evaluation. Ultrasound artifacts are discussed both at the workstation and in dedicated ultrasound didactic lectures. A longitudinal experience in scanning using an ultrasound passport ensures residents gain practice in scanning all of the various ultrasound exams performed in the department. Residents are also encouraged to perform “second-look” scanning with the sonographers to assist with problem-solving. All residents participate in medical student hands on US anatomy education, therefore learning the technical skills is a crucial part of the rotation.

To augment training in 2nd and 3rd trimester ultrasound, residents spend time in OB-GYN clinic under the guidance of Maternal Fetal Medicine colleagues with experience in obstetric ultrasound. Residents are able to assist in performance of obstetric ultrasound exams, and learn interpretation of normal fetal anatomy, common fetal anomalies, placental and umbilical pathology, and imaging of twin pregnancy.

Breast Imaging

Every resident has to complete 3 full months of mammo rotation during the last two years of the residency.

The day starts at 8am in the Breast Center with the review of the previous afternoons screening mammograms, followed by the daily screening and diagnostic exams. You are encouraged to watch the technicians perform the exams to understand the different techniques, positioning and limitations of the exam. You will perform diagnostic ultrasounds with the close guidance of the fellowship-trained faculty.

Under direct supervision of the faculty you will develop full understanding of the screening process, the technical aspect of the studies, gradually learn biopsy techniques and MRI interpretation.

Residents are required to present at the weekly breast conference where imaging findings, histopathology, and treatment options are discussed with the pathology and surgery departments.

Pediatrics

The pediatric rotation is at Children’s Hospital and Medical Center, Omaha. As a regional pediatric center, the institution provides a wide array of cases ranging from routine imaging exams to rare syndromes, malformations, oncology, and orthopedic imaging from birth to 18 years of age. During the 4 week rotation each academic year the residents are tasked with gradually increasing responsibility in performing fluoroscopic procedures and learning US scanning techniques.

On your first day, the Pediatric Radiology Program Director will give you an orientation and discuss the expectations and daily routine with you. You will get a tour of the department, a badge and a parking sticker for the covered parking. The badge gives you access to the doctor’s lounge where you get breakfast and lunch every day.

The residents are assigned to one week long rotations of US/plain film, fluoro/plain film, or CT/MRI. The residents attend the daily noon lecture via Zoom. Trainees are encouraged to attend the pediatric tumor board, pediatric neurological tumor board, child abuse and pediatric surgery-pathology-radiology conferences.

During each rotation, residents are to complete the assigned pediatric radiology lectures from Cleveland Clinic - tailored to the level of their training.

Interventional Radiology

The day of interventional radiology rotation starts at 7:30am and end when the last scheduled patient leaves the department, not sooner than 4:30pm. The resident is responsible for preprocedure workup of the patient, including H&P, lab results, consent, preprocedure routine orders, etc. (Not responsible for procedure note, or post procedure orders.)

PGY-2:

During the first year rotation the residents will learn about the most common interventional radiology procedures. Indications for basic IR procedures, the necessary lab tests and imaging pre and post procedures will be discussed and the main steps of the procedures explained. Common complications of the procedures will be discussed as well. Basic operation of image guidance used during the rotation (US, X-ray, CT) will be discussed. Educational goals for the PGY-2 residents are the understanding of disease processes and conditions patient presents with during the IR rotation. Basic understanding of procedures offered.

PGY-3:

Individually tailored manual training will be emphasized during the second year rotation. Procedures will be discussed and explained in more details, in a step by step fashion and potential problems will be emphasized at each step. (The resident should be able to describe the most common procedures step by step by the end of the rotation.) Resident will learn basic manual techniques, such as US guided access of IJV, brachial / basilica vein access, CT guided biopsy / drainage, etc. Some resident may be able to perform complete procedures alone (with guidance) like tunneled dialysis catheter placement, IVC filter or PICC line placement. Educational goals for the PGY-3 residents are thorough understanding of the procedures with its benefits and complications. Acquire basic manual skills to perform the basic procedures.

PGY-4:

The third year IR training will be centered on more complex clinical decision making. Each procedure offered by IR will be discussed in clinical context and compared to potential alternative. For example, in third year, the resident should be able to offer various treatment alternatives for a patient with lower extremity arterial disease based upon patient general condition, co-morbidities, distribution and severity of arterial stenosis. More complex manual training will be available for residents who consider IR fellowship in the future. Educational goals for the PGY-4 residents are to understand decision making in IR.

PGY-5:

The interventional radiology rotation during the 4th year will incorporate one on one training for board preparation besides the regular board reviews. Rarely seen conditions and complicated procedures will be discussed between the everyday cases. Equipment choices will be mentioned mainly for those who will continue with IR fellowship. The resident will have the opportunity to perform complex cases with immediate help available if needed. Educational goals for PGY-5 residents is board preparation.

Neuroradiology

The neuroradiology rotation involves non-invasive and invasive neuroimaging of the brain, spine, head, neck, orbits, sinuses, facial bones, temporal bones and emergency neuroradiology studies. Imaging modalities predominantly include CT, CT angiography, MR, and MR angiography. Radiographs of the spine and skull are read by the MSK resident.

Residents will rotate through neuroradiology twice during the first year of training and one time each year for the remainder of the training years. Over this time it is expected that residents will progressively develop their abilities to interpret imaging studies of the central nervous system. Residents will learn the relative value of each modality, enabling them to choose the appropriate study and the appropriate protocol for each patient. The residents will learn to dictate concise and appropriate radiographic reports and to serve as consultants to referring physicians.

Lectures

• Daily noon lecture
• Monthly journal club
• Monthly pediatric lectures at Children’s Hospital
• Weekly tumor board conference
• Physics lectures
• Nebraska Radiology Society Meeting
• American Institute of Radiologic Pathology - 4 weeks paid course and housing in Washington, DC
• Board preparatory course - with allowance
• Physics preparatory course - with allowance
• Paid national meeting of your choice if you present