Participants in the imaging track will become experts in the utilization and interpretation of diagnostic imaging. They will design and conduct research to advance the field.
Mentor : Joshua Broder, MD
Resources: Targeted readings will be provided by the Imaging Track mentor. Competency assessment tools will be available through www.empacs.org
Additional literature searches will be performed with the assistance of the track mentor.
Other requirements include lectures, CQI, and a scholarly project.
| PGY1• Demonstrate competency in the interpretation of
• Understand existing clinical decision rules including
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PGY2• Demonstrate competency in the interpretation of
• Understand the process of clinical decision rule development and describe areas of utilization where clinical decision rule development could improve efficiency of utilization |
PGY3• Demonstrate an understanding of the indications for less commonly utilized diagnostic tests in emergency department patients
• Develop and submit an IRB proposal to validate new teaching and competency assessment tools in the interpretation of radiology studies • OR • Develop and submit an IRB proposal to derive and validate a clinical decision rule for an emergency imaging test |
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Ongoing Research... all approved by Duke IRB |
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Head CT interpretation Study A randomized controlled trial of two internet methods for improving head CT interpretation. Background & significance Rapid interpretation of diagnostic imaging studies is vital to emergency medical care. Emergency physicians outside of tertiary care centers often must make critical decisions based on their own assessment of imaging studies, prior to interpretation by a radiologist. Surveys of emergency medicine providers show that radiology interpretation services are often not available at night, and in many cases clinical care decisions are made prior to radiology interpretation of imaging studies even during weekday business hours. Prior studies have shown live, brief targeted training exercises to improve emergency medicine resident interpretation of computed tomography images of the head in a substantial and sustained fashion. Studies have also shown emergency physicians to have high inter-rater reliability with radiologists in interpretation of abdominal CT for urolithiasis. To our knowledge, no studies have evaluated the accuracy of emergency physicians in interpreting CT performed for the assessment of appendicitis, aortic dissection, pulmonary embolism, or abdominal trauma, nor have studies investigated the utility of internet training tools to improve the accuracy of CT interpretation by emergency physicians with regard to these conditions. No studies have investigated online tools for improvement of interpretation of head CT by emergency physicians. Purpose of the study: 1) to measure the baseline accuracy of emergency medicine providers in interpreting computed tomography for a variety of emergent medical conditions 2) to measure the effect of brief standardized training exercises on accuracy of CT interpretation and error rate Our null hypothesis is that internet-based training will not reduce error rates immediately or in a sustained fashion. We have designed evidence-based, brief training exercises in CT interpretation for appendicitis, aortic dissection, pulmonary embolism, blunt abdominal trauma, and intracranial pathology. We propose to test the accuracy of emergency medicine providers at various levels of training immediately before, immediately after, and 3 months after completion of these brief training exercises. |
Abdominal CT Sticker Study A prospective blinded trial of the correlation of the location of abdominal pain and tenderness with acute pathology detected by CT. Background and significance CT scan has become a powerful and increasingly utilized diagnostic modality in the evaluation of emergency department patients with abdominal pain. The diagnostic power is accompanied by a substantial radiation exposure. CT-related radiation is now implicated in up to 2% of US cancers [1] , and CT utilization has increased by nearly 600% in the past decade, including dramatic increases in use in the emergency department setting. [2] , [3] Efforts to limit CT exposures have included clinical decision rules (utilized by the physician to determine the need for diagnostic imaging) and adjustment of CT protocols to reduce radiation exposure based on factors such as patient size and mass. [4, 5] While the standard practice has been to perform CT of the entire abdomen for evaluation of abdominal pain and tenderness, a few preliminary studies have suggested that more limited CT of the lower abdomen and pelvis can be performed for evaluation of conditions such as suspected appendicitis. [6, 7] Less research has focused on dose reduction by restricting the region of the body to be imaged based on features of the patient's exam such as location of tenderness. If the body region containing the acute pathology can be reliably identified by clinical exam, future CT scan protocols could be tailored to the region of tenderness, reducing radiation exposures while preserving diagnostic sensitivity. Prior studies have investigated limited CT in the setting of suspected appendicitis [6, 7] . Our protocol will enroll patients with abdominal pain and tenderness in any location, with a more diverse potential differential diagnosis. If our hypothesis is correct, the technique would be widely applicable to the undifferentiated patient population that is seen in emergency departments. Purpose of the study: To determine the correlation between the region of abdominal tenderness determined by the examining physician and the location of acute pathology diagnosed on abdominal CT. We hypothesize that the acute pathology diagnosed by CT will lie within the region marked on the abdominal wall by the examining physician prior to CT. |
Trends in ED CT utilizationA retrospective study of CT utilization from the emergency department. Purpose of the study The purpose of this study is to characterize changes in computed tomography (CT) utilization in the emergency department (ED) over a multi-year period. Background & significance CT has become a major diagnostic tool in the emergency room setting. A recent study looking at data from 2003 alone , showed CT or MRI to have been used in 7.9% of all ER visits (1). (We suspect that the vast majority of these studies were CT). In this study we hope to go into more detail regarding usage patterns by examining both the rate of increase and the types of scans that have increased. We will also break out the increase according to patient demographic, complaint, and time of presentation. We suspect that there may a subset of patients with multiple scans and will look in more detail in this group to examine rationale and result of scan. The underlying reason behind the study lies in the fact that CT is a major contributor of radiation exposure in the general public (2). In so far as its use is warranted, this exposure represents a reasonable tradeoff. However just as an individual radiation worker monitors his or her exposure with monthly readings, it may be valuable to monitor usage in the aggregate ER setting. If overuse in a particular area is suspected, this could be addressed with an additional study to evaluate outcome and possible remediation.
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