Radiology Residency

Program Coordinator

Dr. Anthony Pease
Phone: 919-513-6375
Email: tony_pease@ncsu.edu

Introduction
The Radiology Residency Program at North Carolina State University is an official part of the post-veterinary training program within the College of Veterinary Medicine. A strong collaborativespirit between the Veterinary College and area medical schoolsat Duke University, and the University of North Carolinais a resource which enables trainees to broaden their educationalexperience.

A. Purpose and Objectives
The purpose of this program is to provide clinical and investigationaltraining in veterinary radiology that is based on the recommendedMinimal Standards for a Veterinary Radiology Residency Programas stated by the American College of Veterinary Radiology(ACVR). Completion of the program will provide sufficienttraining to allow the resident to take the certificationexamination administered by the ACVR.

Specific objectives are:
* To become competent in small andlarge animal radiographic diagnosis.
* To become knowledgeable and familiar with the uses, operation, limitations and safety features of diagnostic x-ray equipment, including x-ray machines, digital radiography, image intensifiers, pressure injectors, videotape recorders, etc.
* To understand and apply the factors that are used to make diagnostic quality radiographs.
* To understand and apply the fundamentals of radiation physics, radiobiology, radiation dosimetry, and radiation safety.
* To understand the basic concepts of radiation therapy allowing implementation of therapy protocols using megavoltage radiation.
* To understand and apply the basic techniques of clinical nuclear medicine in regards to equipment and common radiopharmaceuticals.
* To understand and apply the basic techniques of diagnostic ultrasound and the clinical applications of duplex color flow Doppler imaging.
* To provide instruction and exposure to other diagnostic imaging modalities such as computed tomography and magnetic resonance imaging.
* To provide the support and atmosphere for investigation from which a manuscript will be submitted for publication in a refereed journal.
* To gain experience in teaching of radiologic related subjects to veterinary students.

B. Minimum Requirements of Radiology Resident Candidate
The candidate must possess a DVM or equivalent degree from an AVMA accredited veterinary college or its equivalent as defined by the Educational Commission for Foreign Veterinary Graduates of the AVMA. The candidate must also have completed a general internship or equivalent experience.

C. Content of Residency Program
This residency program is a three year structured training program designed to satisfy the ACVR guidelines for radiology resident training. Areas emphasized include clinical diagnosis, investigational skills, teaching, radiation oncology, nuclear imaging, diagnostic ultrasound, and computed tomography. The candidate will be exposed to sufficient material to provide the necessary information to successfully complete the ACVR Certification Examination.

There are various scheduled activities, other than clinic duty and daily rounds, where radiologists and residents interact. These include interactive periods where faculty from various disciplines present both review sessions and current material for discussion, and known-case conference where residents review radiographs presented by a radiologist. Known-case conference is designed to prepare residents for the environment typical of the ACVR Oral Examination. Residents are also given a series of written examinations in anatomy, physics, radiation protection and biology, special radiographic procedures, and physiology as a means of preparation for the ACVR written examination. The following is a list of the primary responsibilities and time commitments of the resident on a yearly basis.

Year 1
The resident will:
* become familiar with technical procedures, and operation of equipment.
* be scheduled through rotations in diagnostic radiology rotations, in nuclear imaging, radiation therapy, computed tomography, magnetic resonance imaging and diagnostic ultrasound. The resident will dictate radiographic reports. Dictations are closely supervised a board-certified radiologist. Dictations are promptly reviewed at rounds, which are generally attended by two radiologists.
* review the teaching files prepared for the 3rd and 4th year veterinary students.
* attend the course in physics of diagnostic imaging given to incoming physician radiology residents at the University of North Carolina Memorial Hospital.
* prepare and give weekly quizzes to senior veterinary students in the radiology rotation.
* attend radiology lectures and laboratories given for the 3rd year veterinary students.
* attend and participate in daily radiology rounds
* share emergency duty with other radiology residents.
present a seminar in the House Officer Seminar Series.
take the prepared mock exams in preparation for the ACVR exam

Year 2
The resident will:
* continue rotations in diagnostic radiology ,diagnostic ultrasound with additional rotations in nuclear imaging, radiation therapy, computed tomography, and magnetic resonance imaging large animal ultrasound and cardiology.
* continue to dictate radiology reports.
* prepare and give weekly quizzes to senior veterinary students in the radiology rotation.
* attend the course in physics of therapeutic radiology and radiation biology given to incoming physician radiation oncology residents at the University of North Carolina Memorial Hospital.
* prepare and give one lecture in the course given to third year veterinary students
* initiate prospective investigational project with the ultimate goal of publishing results in a recognized refereed scientific journal.
* attend and participate in daily radiology rounds
* share emergency duty with other radiology residents.
present a seminar in the House Officer Seminar Series.
take the prepared mock exams in preparation for the ACVR exam

Year 3
The resident will:
* continue rotations in diagnostic radiology, nuclear imaging, diagnostic ultrasound, radiation therapy, computed tomography, and magnetic resonance imaging.
* continue to dictate radiographic reports.
* prepare and give weekly quizzes to senior veterinary students in the radiology rotation.
* prepare and give one lecture and one laboratory session in the course given to third year veterinary students.
* attend the ACVR meeting and presents results of investigational project.
* complete research project and prepare manuscript for publication.
* attend and participate in daily radiology rounds.
share emergency duty with other radiology residents.
take the prepared mock exams in preparation for the ACVR exam

D. Radiology Faculty
* J. Douglass, DVM, MS, Assistant Professor, ACVR Diplomate, Primary Interests: Diagnostic Radiology, Ultrasound
* K.A. Spaulding, DVM, Associate Professor, ACVR Diplomate, Primary Interests: Diagnostic Ultrasound, Cross-Sectional Imaging, Diagnostic Radiology
D.E. Thrall, DVM, PhD, Professor, ACVR Diplomate. Primary Interests: Diagnostic Radiology, Computed Tomography, Radiation Oncology
Ian D. Robertson, BVSc, Assistant Professor, ACVR Diplomate, Primary Interests: Computed Tomography, Magnetic Imaging, Computers
* Open Position, Diagnostic Radiologist

E. Technical Staff
* Scarlett Utterback AHT, Imaging Technologist ,Staff Supervisor
* Carolyn Green, AHT, Imaging Technologist

F. Former and Present Residents
* Ian D. Robertson, BVSc, 1986-89, Diplomate ACVR, NCState CVM
* Lisa J. Forrest, VMD, 1989-92, Diplomate ACVR (Radiology, Radiation Oncology), Associate Professor, University of Wisconsin
Joseph D. Stefanacci, VMD, 1989-92, Diplomate ACVR, Radiologist, Private Practice- Pennsylvania
Robert W. Kramer, DVM, 1990-93, Diplomate ACVR, Private Practice, Seattle, Washington.
* William J. Weber, DVM, 1992-94, Diplomate ACVR, Private Practice, Dayton, Ohio.
* William T. Drost, DVM, 1992-95, Diplomate ACVR, Assistant Professor, The Ohio State University
* Gregory Starrak, DVM, 1993-96, Diplomate ACVR, Private Practice, Vancouver, British Columbia.
* Marianna Schafer, DVM, 1994-97, Private Practice, Cleveland, Ohio
* Oscar Ramirez, DVM, 1995-98, Diplomate ACVR, Private Practice, Houston, Texas
* Sandra VanCamp, DVM, 1996-99, Private Practice, Ft.Collins, CO
* Mark Matteucci, DVM, 1997-2000 - Private practice, San Francisco California
* Helen Thomas, DVM, 1998-2001 -Visiting Instructor. Davis California
Santos Ramirez, DVM, 1999-2002- Assistant Professor, LSU
Lenore Mahammadian 2000-2003- Private Practice, San Diego California

G. Equipment
Small Animal Diagnostic Radiology
Room 1: 80kW Siemens Multix conventional high-frequency radiography unit
Room 2: 600 mA, 150 kVp, Toshiba, R-F unit.
Room 3: Siemens Digital C-arm angiographic unit.
Room 4: Siemens 80kW high frequency R-F suite with Infimed PlatinumOne digital capture system
Large Animal Diagnostic Radiology
100kW Indico high frequency generator, driving two ceiling mounted tubes. One tube autotracks with a floating gantry mounted cassette holder and the other tube allows imaging at floor level.
Radiation Therapy
AECL Theratron 780 Isocentric cobalt machine.
PLUNC multi-dimensional treatment planning computer.
Diagnostic Ultrasound
Siemens Elegra with 3D imaging and 2D Siescape. (PACS connectivity)
Nuclear Medicine
Technicare Omega 500 planar gamma camera interfaced with computer using NucLaear MAC acquisition and processing software. (PACS connectivity)
Computed Tomography
General Electric Sytec SRi CT V 3.0 scanner with helical and 3-D capabilities. (PACS connectivity)
Computed Radiography
Fuji SmartCR computed radiography system. (PACS connectivity)
Computerization and Image Archiving
A custom built, web-based Radiology Information System (RIS) allows patient registration, procedure ordering, study reporting and linking of reports to images enabling online viewing of images and associated reports.
A RIS linked, picture archiving and communication system (PACS) (AMICAS -Windows 2000 Server platform) with multiple dual monitor and single monitor DICOM workstations and hospital accessibility via web browser enables instant online review of digital images and reports.
A Lumisys 75 radiograph scanner with worklist function and computer support equipment is used to digitize images for both teaching and clinical purposes.
Polaroid slide maker.
Darkroom
Kodak M6A-N automatic film processor.
Radiograph duplication/subtraction unit.

H. Animal Resources
Approximate yearly case load:
a. a. small animal diagnostic radiology: 7091
b. small animal ultrasound: 1999
c. large animal diagnostic radiology: 952
d. large animal ultrasound: 170
e. small ruminants diagnostic radiology: 30
f. small ruminants ultrasound: 3
g. exotic animals diagnostic radiology: 30
h. exotic animals ultrasound: 7
g. avian diagnostic radiology: 130
h. avian ultrasound: 5

Radiology Class Schedule

Seminars in Veterinary Practice
Radiology Rounds

Course Description
Residents will review recent imaging studies and the accompanying report with a faculty radiologist. Reports are reviewed and critiqued for grammar, proper terminology, and content. Residents are also quizzed on imaging studies to evaluate their interpretation ability.

Objectives
To provide a mechanism for constructive critique of report generation and interpretation of imaging studies. Pathophysiology will be reviewed as applicable. This nonofficial course provides a feedback mechanism for residents to evaluate the accuracy of their dictated report, and an opportunity for one-on-one consultation with a faculty radiologist.

Prerequisites
Acceptance into the NCSU radiology residency program.

Instructor
Radiology faculty

Radiology Clinics

Course Description
Residents will participate in clinical activities of the radiology area. This involves on-the-fly interpretation of imaging studies, and performance of specialized procedures such as myelography and ultrasonography. Residents are under the direct supervision of a faculty radiologist, but function independently to provide image interpretation service to the Teaching Hospital. Residents are instructed in radiation safety procedures as well as proper use of diagnostic radiology, nuclear medicine, ultrasound, magnetic resonance, computed tomographic and radiation therapy equipment.

Objectives
To be competent in operation of a variety of sophisticated medical imaging equipment. To create a level of skill in image interpretation and conduction of specialized procedures such that the resident can pass the Certification examination of the American College of Veterinary Radiology. To create a thought process conducive to solving of clinical problems.

Prerequisites
Acceptance into the NCSU radiology residency program, or instructor permission.

Instructor
Radiology faculty.

SVM 610
Special Topics in Radiology
Physics of Diagnostic Radiology*

Course Description
In this course, residents are instructed in radiation safety and protection, the basic physical principles of matter, radioactivity, and imaging equipment and methodology.

Objectives
To familiarize the resident with the basic physical and operational principles associated with modalities used for clinical imaging.

Prerequisites
Acceptance into the NCSU radiology residency program, or instructor permission.

Instructor
David Washburn, PhD, University of North Carolina.

Credit Hours
2 Course meets for two hours each week. Lecture format.

Grading
Pass/fail. Based on instructor assessment of understanding of diagnostic imaging physical principles. Enrollment: Open

Textbook
Christensen's Physics of Diagnostic Radiology, 4th Edition, Lea & Febiger.

SVM 610
Special Topics in Radiology
Physics of Radiation Therapy*

Course Description
In this course, residents are instructed in the basic physical principles of matter, radiation therapy machines, interaction of radiation with matter, and radiation treatment planning.

Objectives
To allow the resident to understand the importance of physical principles regarding the therapeutic administration of ionizing radiation. Additionally, an understanding of the principles of equipment operation will facilitate optimal utilization of such equipment.

Prerequisites
Acceptance into the NCSU radiology residency program, or instructor permission. Instructor: Edward Chaney, PhD, University of North Carolina Credit Hours: 2 Course meets for two hours each week.

Lecture format. Grading: Pass/fail. Based on instructor assessment of understanding of radiation therapy physical principles.

Enrollment
Open

Textbook
The Physics of Radiation Therapy, 2nd Edition, Williams & Wilkins

SVM 610
Special Problems in Radiology
Radiation Biology*

Course Description
Residents are instructed in the biologic effects of radiation from molecular to mammalian levels of complexity. Introductory radiochemical interactions are also discussed. Tumor biology and physiology are reviewed with respect to their influence upon the biologic effects of ionizing radiation.

Objectives
To familiarize the resident with a basic understanding of the biologic effects and hazards of ionizing radiation.

Prerequisites
Acceptance into the NCSU radiology residency program, or instructor permission.

Instructor
Elaine Zeman, PhD, University of North Carolina

Credit Hours
2 Course meets for two hours each week. Lecture format.

Grading
Pass/fail. Based on results of a cumulative examination given at the end of the course.

Enrollment
Open

Textbook
Radiobiology for the Radiologist, 4th ed, Lippincott

Radiology

Course Description
Residents will be involved with lecture administration and informal review of radiographs with veterinary students. Lectures will be given as part of VMA 960. Review of radiographs with professional students occurs during the clinical rotation (VMA 976).

Objectives
To familiarize the resident with formal and informal teaching methods applicable to instruction in the professional veterinary curriculum.

Prerequisites
Acceptance into the NCSU radiology residency program, or instructor permission.

Instructor
Radiology faculty

Textbook
None