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Body Systems Syllabus

This syllabus defines the learning competencies, the clinical conditions and normal variants for each body system that
trainees are expected to know and demonstrate proficiency in by the end of their training. The clinical conditions and
normal variants are categorised into levels of knowledge as defined below.

Contents
Definitions 161
Learning Competencies 162
Normal Variants 162
Condition Categories 162

BODY SYSTEMS
Abdominal Imaging 162
Normal Variants 165
Adult Clinical Conditions 166
Cardiothoracic Imaging 171
Learning Competencies 171
Normal Variants 174
Adult Clinical Conditions 174
Extracranial Head & Neck Imaging 178
Learning Competencies 178
Neuro/ENT imaging Normal Variants 180
Extracranial Head & Neck Imaging Clinical Conditions 181
Neuroradiology 188
Learning Competencies 188
Adult Clinical Conditions 190
Musculoskeletal Imaging 193
Learning Competencies 193
Normal Variants 195
Adult Clinical Conditions 196
Paediatric Imaging 211
Learning Competencies 211
Paediatric Clinical Conditions 214
Breast Imaging 222
Learning Competencies 222
Breast Normal Variants 225
Breast Clinical Conditions 225
Obstetric & Gynaecological Imaging 227
Learning Competencies 227
O&G Normal Variants 229
Clinical Conditions 229
Vascular Imaging & Interventional Radiology 236
Learning Competencies 236
VIR Normal Variants 238
Adult Clinical Conditions 239

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 161
Learning Competencies diagnosed in timely fashion. They may not be as common
as Category 1.2 conditions.
Required skills and learning competencies are defined for
each body system. 1.3) Less common conditions in which the radiological
appearance has an important role in diagnosis

Normal Variants Definition These include rarer conditions with specific or


characteristic appearances where the patient & clinician
Best practice necessitates particular emphasis on
would be significantly assisted by their inclusion in a
situations which may compromise patient care.
report. The vast majority of truly rare conditions are not
Unrecognised normal variants may be misinterpreted as
included in this category, but a few rare pathologies (e.g.,
possible pathology causing unnecessary clinical concern
Osteogenic sarcoma) are included because of their clinical
and costly investigation. For this reason, an indicative
importance and characteristic imaging findings.
list of normal variants has been developed for each of
the body systems with the exception of Paediatrics. The
Category 2
following textbook is required reading for Paediatric
Normal Variants:
Conditions which are clinically relevant but of lesser
importance due to:
Atlas of Normal Variants that May Simulate Disease.
Theodore E. Keats, Mark W. Anderson. Mosby-Year Book
Less urgency in their diagnosis
Inc 2007. ISBN: 10 0-323-04300-3, ISBN: 13 978-0323-
Less frequency in their occurrence
04300-7

The passing candidate should able to be to suggest the


It should be noted that the Part 1 Anatomy examination
correct disease type and /or diagnosis, however a lesser
now has a specific focus on clinically relevant normal
level of knowledge is still acceptable. Findings should NOT
variants. This examination may contain questions that
be diagnosed incorrectly as other unrelated conditions.
are related to the specific normal variants listed in the
sections below. Please see the Anatomy syllabus for
Category 3
further comments on normal variants and their place in
Anatomy learning and assessment.
Conditions which are rare, but which should be known to
prevent a more serious diagnosis being considered e.g.
Condition Categories Definition mesoblastic nephroma is the most common renal mass in
a neonate (rather than Wilms tumour). For most Category
Condition Categories are defined as follows: 3 conditions the candidate need only know a few facts. It
is not an exhaustive list. Conditions given in Category 3
Category 1 should have clinical relevance in a practical setting, and
it is fully accepted that many rare conditions will not be
1.1) Common Conditions included.

Those that would be encountered in a differential


Abdominal Imaging Learning
diagnosis several times a year in a clinical practice.
Ignorance of these conditions would seriously affect
Competencies
the radiologists status as a peer or useful member of a
The competent (trainee) radiologist will be able to:
multidisciplinary team.

Demonstrate a clinical, pathological and radiological


1.2) Conditions in which the radiology has a major impact
understanding of gastrointestinal disease.
on patient management
Interpret common and important clinical presentations in
abdominal imaging practice for example;
These are conditions that either could be potentially
fatal, or could have major clinical consequences if not

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Abdominal Trauma Ultrasound
Appendicitis
Suspected bowel obstruction Knowledge
Suspected abdominal collection
Jaundice Safety
Renal Colic
GIT Haemorrhage Indications/contraindications for Abdominal Ultrasound/
Upper abdominal Pain (e.g. pancreatitis) specific protocols
Lower abdominal Pain (e.g. diverticulitis) Limitations of Ultrasound in Abdominal Imaging

CORE KNOWLEDGE Equipment and Technique

Explain the strengths, weaknesses and risks (radiation Ultrasound Assessment of Abdominal and Pelvic Viscera
related and other) of the imaging modalities currently abdominal wall
used in diagnosis and assessment of abdominal Ultrasound / Doppler Assessment of Abdominal
abnormalities. Vasculature
Contrast enhanced Ultrasound
Describe/direct assessment or work-up of a clinical Endoluminal Ultrasound (Principles / Indications Only)

BODY SYSTEMS
problem or imaging finding using imaging methods as Ultrasound Image Quality Assessment
appropriate.
CT Scanning
Be able to recommend follow-up imaging at later time
interval when appropriate. Knowledge

Plain X-ray / Fluoroscopy Safety / Scan Preparation / Contrast Use (IV/ Oral)
/ Radiation Safety Dosimetry and Dose Reduction /
Knowledge Technical Factors
Indications/contraindications for Abdominal CT / Specific
Safety / Preparation / Contrast Use (IV/ Oral) / Radiation Protocols
Safety Dosimetry and Dose Reduction / Technical Factors
Indications/ contraindications for Plain X-ray/ specific Equipment and Technique
protocols
Limitations of Plain X-ray /Fluoroscopic Procedures Limitations of CT in Abdominal Imaging

Equipment and Techniques Skills

AP Supine +/- Erect/ Decubitus /Erect chest for free gas / Be able to perform and interpret -
Renal area (Insp/ Exp: re calculi) / Lateral CT Assessment of Abdominal and Pelvic Viscera
CT Assessment of Abdominal Vasculature
Skills CT Assessment of the Retroperitoneum
CT colonography, CT IVC and CT IVP
Be able to perform and interpret - CT Image Quality Assessment
Contrast and Fluoroscopic Contrast Study
Barium Swallow MRI Scanning
Barium Meal
Barium Follow Through / Enteroclysis Safety / Scan Preparation / Contrast Use / MRI General
Barium Enema Safety / Technical Factors
Urethrogram Indications/contraindications for Abdominal MRI /
MCU Specific Protocols
Cystogram Limitations of MRI in Abdominal Imaging
X-ray image Quality Assessment in Abdominal Imaging
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Skills Acts safely

Be able to perform and interpret - Recognise imaging signs related to acute emergency
MRI Assessment of Abdominal and Pelvic Viscera abdominal conditions (e.g. pneumoperitoneum, acute
including liver specific contrast studies colitis, toxic megacolon, ischaemic gut, aortic rupture).
MRI Assessment of Abdominal Vasculature Safely assign a class of diagnosis (benign / normal
MRCP variant / probable malignancy) and direct further
MRI Image Quality Assessment assessment where required.
Correctly categorise indeterminate findings and guide
Nuclear Medicine further investigation if required (e.g. renal cyst /
haemangioma of liver).
Knowledge
Convey findings
Safety / Radiopharmaceutical Use (Labelled RBC /DTPA
MAG III DMSA) / Radiation Safety Dosimetry and Dose Communicates relevant findings including diagnoses,
Reduction treament plans, complications and follow up to the
Nuclear Medicine GIT Bleeding Studies referring clinician, patient and or family/carers and other
Meckels Scans health care team members and assists in formulating
DTPA / DMSA / MAG III an imaging and management plan as necessary (e.g.
Demonstrate knowledge of the principles/ limitations/ surgical consultation, biopsy).
indications of MIBG / Octreotide Scanning/ PET Scans in
the abdomen. Radiological Interventions
Equipment and Technique: Basics only
NMCT Image Quality Assessment Demonstrate knowledge of abdominal interventional
Limitations of NMCT in Abdominal Imaging procedures including the role of procedures, indications
associated complications and their management.
Non Imaging Investigations Examples include:
Percutaneous fine needle biopsy / core biopsy / abscess
Demonstrate knowledge of the role and process of drainage;
other non-imaging investigations (e.g. endoscopy / Biliary and urological interventions such as
colonoscopy / capsular endoscopy / manometry). percutaneous transhepatic cholangiography /biliary
drainage/nephrostomy;
KEY SKILLS Abdominal arterial interventions including embolisation,
chemoembolisation, angioplasty and stenting.
Interpret the examination accurately and safely Communicating effectively with patients and clinicians
regarding the benefits and risks associated with
Recognise the normal abdominal anatomy, and variants. different diagnostic modalities and procedures.
Conduct a thorough and systematic review of
the imaging examination and perceive relevant
abnormalities.
Correctly describe the likely cause of abnormalities in
broad context (e.g. neoplastic, traumatic, inflammatory)
Integrate knowledge of pathology, clinical information
and imaging appearance to form an appropriate
differential diagnosis.
Evaluate the imaging study in light of differential
diagnoses to identify clinically relevant findings.

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Abdominal Imaging Normal Variants
Category 1 Category 2 Category 3
1. Gastrointestinal System

C  olonic interposition (Chilaiditi P hrenic ampulla  Feline oesophagus


Syndrome) I ntramural pseudodiverticulosis B runner gland hyperplasia
A zygosed caecum F unctional megacolon and ogilvie E ctopic pancreatic rest
D uodenal diverticulum syndrome P rominent lymphoid follicles
Primary colonic pneumatosis Gastric diverticulum
Cathartic colon

2. Hepatopancreatobiliary System

Reidels lobe M ilk of calcium bile C  ongenital absence of hepatic


Focal fatty infiltration Agenesis of dorsal pancreas segments
Replaced right hepatic artery Annular pancreas Variant hepatic venous drainage
Variant left hepatic supply Pancreas divisum
B iliary hamartoma

BODY SYSTEMS
3. Renal and Urinary Tract

J unctional zone Accessory renal arteries


D romedullary hump R etroaortic renal vein
Column of bertin Parapelvic cysts
Persistent fetal lobulation R etrocaval ureter
Renal ectopia Congenital megacalices
H orseshoe kidney U reteritis cystica
Ureteral duplication
Urachal remnant
Bladder diverticulum

4. Male Reproductive System

E ctasia of rete testis S crotal pearl


E pidermoid cyst of testis C ongenital prostatic cyst

5. Spleen / Haematological / Bone Marrow

Spenuculi S plenosis Wandering spleen

6. Retroperitoneum

D uplicated IVC Pelvic lipomatosis

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 165
Abdominal Imaging Adult Clinical Conditions
(For Paediatric Conditions, See Paediatric Syllabus)
Category 1 Category 2 Category 3
1. Gastrointestinal System

Oesophagus

Carcinoma P haryngeal pouch L eiomyoma


Trauma (tear and rupture) Oesophageal web S pontaneous intramural
Reflux esophagitis and hiatus Oesophageal varices haemorrhage
hernia Cricopharyngeal spasm S cleroderma
M otility disorders D uplication cyst
Achalasia
Other esophagitis (infective,
corrosive, radiation and auto-
immune)
Diverticula
S chatzki ring

Stomach

Carcinoma Acute gastric dilation  astric diverticulum


G
Peptic ulcer GIST tumours L eiomyoma / leiomyosarcoma
Lymphoma Post surgical appearances and M enetriers disease
Gastritis, acute and chronic complications C orrosive injury
H yperplastic and inflammatory Gastric volvulus colon Organoaxial
polyps colon Mesenteroaxial
Gastric outlet obstruction

Small Bowel

Crohns disease Coeliac disease S mall bowel infections /


Small bowel obstruction M etastatic disease infestations
Ischaemia Lymphoma W hipples disease / Amyloid and
Intussusception P rimary small bowel tumour mastocytosis
Small bowel trauma (adenocarcinoma and / or Polyps & polyposis syndromes
H aemorrhage carcinoid) E osinophilic gastroenteritis
Post surgical appearances and Yersinia
complications G IST tumours
M eckels diverticulum J ejunal diverticulosis
Gallstone ileus
R adiation enteritis
T B

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Large Bowel

Carcinoma Polyps R adiation Colitis


Diverticular disease Angiodysplasia M etastases
Appendicitis I nfective Colitis Lymphoma
Inflammatory bowel disease Carcinoid tumour P neumatosis intestinalis
Obstruction and Perianal sepsis
pseudoobstruction P seudo-obstruction
Ischaemic colitis Post surgical appearances and
Volvulus complications
Toxic megacolon E piploic appendagitis
H aemorrhage M esenteric panniculiti

Peritoneum / mesentery / abdominal wall

A scites R ectus sheath haematoma  esenteric cyst


M
H ernias P seudomyxoma peritonei D esmoid tumour
Peritonitis T B peritonitis M esothelioma, other tumours
Metastases S clerosing peritonitis

BODY SYSTEMS
Pneumoperitoneum

2. Hepatopancreatobiliary system

Diffuse Liver Disease

Fatty infiltration and fatty sparing Acute & chronic hepatitis P rimary biliary cirrhosis
Cirrhosis S clerosing cholangitis W ilson disease
Portal hypertension H aemochromatosis
a  1 anti-trypsin deficiency
G lycogen storage disorder
Post transplant appearances and
complications
C arolis disease

Focal Liver Disease

Cyst Hydatid disease B  iliary hamartomas


Cavernous haemangioma Cholangiocarcinoma B iliary cystadenoma
Metastatic disease Abscess
H epatocellular carcinoma
Focal nodular hyperplasia
H epatocellular adenoma

Trauma / Vascular

Trauma B udd-Chiari syndrome L iver infarction


Portal vein thrombosis Peliosis hepatis
Veno-occlusive disease

Biliary

Cholelithiasis Adenomyosis B  iliary infestation (including


A cute Cholecystitis Gallbladder polyps oriental cholangiohepatitis)
Obstruction Gallbladder carcinoma C holedochal cyst
Cholangiocarcinoma
Cholangitis
Chronic cholecystitis / Porcelain
gallbladder

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Pancreas

A cute pancreatitis Chronic pancreatitis A nnular pancreas


Pancreatic carcinoma P seudocyst E ctopic pancreas
Trauma Ampullary tumour Pancreas divisum
I slet tumours
I ntraductal neoplasia
Cystic pancreatic tumours

3. Renal and urinary tract

Renal Congenital / Developmental

C  ongenital / Developmental:- M edullary sponge kidney C alyceal diverticulum


H orseshoe / Pancake / duplex Adult polycystic kidney disease
kidney
Crossed fused ectopia
Vesicoureteric reflux

Renal Neoplasia

Renal cell carcinoma Oncocytoma M ultilocular cystic nephroma


Transitional cell carcinoma
A ngiomyolipoma

Renal Inflammation / Infection

Renal abscess / carbuncle Tuberculosis S chistosomiasis


A cute pyelonephritis X anthogranulomatous
pyleonephritis

Renal Vascular Conditions

 enal infarction
R R enal AV fistula Polyarteritis nodosa
Renal artery stenosis
Fibromuscular dysplasia
Renal vein thrombosis
Renal artery aneurysm

Miscellaneous Renal Conditions

Obstruction Acute tubular necrosis A cute cortical necrosis


(including PUJ) Papillary necrosis A cquired cystic disease of the
Renal trauma Analgesic nephropathy kidney
Renal calculi R enal atrophy A myloidosis
Simple renal cysts R enal transplant complications D iabetic nephropathy
Contrast media nephrotoxicity Nephrocalcinosis S ickle cell nephropathy
Glomerulonephritis (acute and G outy nephropathy
chronic but not specific subtypes S LE
excepting Goodpastures)
Acute and chronic renal failure

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Bladder, prostate, ureters and urethra

Cystitis (acute and chronic) Neurogenic bladder O ther tumours


Transitional cell carcinoma Diverticula U reteropyelitis cystica
Trauma S chistosomiasis
Urethral strictures Tuberculosis
Ureterocoele M alacoplakia
U rachal remnants

Adrenals

A drenal metastasis Cushings syndrome A ddisons disease and syndrome


A drenal adenoma (functioning and M ultiple endocrine neoplasia A drenal hyperplasia
non functioning) Paragangliomas M yelolipoma
Phaeochromocytoma S pontaneous adrenal
A drenal carcinoma haemorrhage

4. Male reproductive system

Benign prostatic hyperplasia E pididymal cysts Testicular cysts

BODY SYSTEMS
Prostatic carcinoma S permatocoele P rostatitis (acute and chronic)
E pididymo-orchitis Varicocele O ther epididimal / paraepididymal
Testicular torsion S permatic granuloma abnormalities: TB / adenomatoid
Testicular tumours including Testicular microlithiasis tumor
lymphoma / leukemia Testicular trauma
Urethral trauma

5. Splenunculi / Haematological / Bone Marrow

Lymphoma M  yeloma / plasmacytoma S ickle cell anaemia


Trauma M yeloproliferative / S pherocytosis
Spontaneous and delayed rupture myelodysplastic disorders Thorotrast
Infarction L eukemia
Metastases Haemoglobinopathies
A bscess (e.g. thalassemia)
S plenic cyst
Haemangioma
L angerhans cell histiocytosis
I TP
DIC
S plenic Infection
(e.g. mononucleosis)
I mmunosuppression &
Opportunistic infection

6. Retroperitoneum

Lymphoma R etroperitoneal fibrosis I nflammatory aortitis


Lymph node enlargement,
metastases
Sarcoma
A ortic aneurysm

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Techniques and Applications (Adult Abdomen, Pelvis)

A XR B arium meal I ntravenous (CT) cholangiography


IV Pyelogram B arium enema M RI of the pelvis
Barium swallow S mall bowel follow through P TC
E RCP E nteroclysis B iliary stents
CT abdomen & pelvis M RCP U reteric stents
US abdomen & pelvis M RI of the liver C holecystostomy
US of urinary tract CT colonography G astrostomy
US of appendix B iopsy T IPS
Drainage
Duodenal intubation
Abdominal angiography

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Cardiothoracic Imaging Learning Limitations of Plain X-ray /Fluoroscopic Procedures
X-ray image Quality Assessment in Chest Imaging
Competencies
Equipment and Technique
The competent (trainee) radiologist will be able to:

PA and lateral chest views


Demonstrate a clinical, pathological and radiological
Inspiratory and expiratory views and indications
understanding of cardiothoracic disease.
Portable chest views
Interpret common and important clinical presentations
Lordotic view
in cardiothoracic imaging practice for example;
Decubitus view

Cough
Skills
Shortness of breath

Chest pain
Be able to perform and interpret -
Chest trauma

Haemoptysis
Diaphragm screening
Fever

P
 art of multi-system disorder presentations

BODY SYSTEMS
Aspirated foreign body
Anatomical variants

CT
CORE KNOWLEDGE
Knowledge
Explain the strengths, weaknesses and risks (radiation
related and other) of the imaging modalities currently
Safety / Preparation / Contrast Use (IV/ Oral) / Radiation
used in diagnosing and evaluating chest abnormalities.
Safety /Dosimetry/Common methods of dose Reduction
Know the radiation doses of imaging modalities that
/Technical Factors of improving spatial and temporal
utilize ionizing radiation and understand the common
resolution
dose reduction methods.
Indications/contraindications for CT/specific protocols/
CT-guided procedures
Understand the risk of radiation in pregnancy and
alternative imaging pathways in pregnancy.
Equipment and technique
Describe/direct assessment or work-up of a clinical
problem or imaging finding using imaging methods as
Common CT artifacts
appropriate.
Limitations of CT Procedures
CT image Quality Assessment in Chest Imaging
Be able to recommend follow-up imaging at later time
interval when appropriate.
Equipment and Technique
Recognize the radiologically guided diagnostic
and interventional procedures, their indications,
CT/HRCT/Cardiac CT techniques for common clinical
contraindications and basic procedural details.
situations
Contrast media intravenous: indications, benefits, risks
Plain X-rays/Fluoroscopy
IV contrast allergy prevention
IV contrast allergy treatment of an acute reaction
Knowledge
Contrast induced nephropathy and its prevention

Safety / Preparation / Contrast Use (IV/ Oral) / Radiation


Safety Dosimetry and Dose Reduction /Technical Factors/
conventional vs digitial plain radiography/use of grid
Indications/contraindications for Plain X-ray/specific
protocols

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Ultrasound Equipment and technique
Pulmonary embolism assessment
Knowledge PET and its role
NMCT Image Quality Assessment
Safety
Non Imaging Investigations
Ultrasound of pleural effusion diagnosis and
treatment planning Demonstrate knowledge of the role and process of other
Equipment and technique non-imaging investigations (e.g. bronchoscopy) used in
Limitations of ultrasound in chest imaging this area.
US image Quality Assessment in Chest Imaging Recognise and describe cardiac imaging techniques
and findings
Angiography Knowledge in these topics is optional, and may be
examinable
Knowledge
During Phase 1
Safety/Preparation/Contrast Use/Radiation/Technical
Factors/Indications/Contraindications Topics to include:
Identify the strengths and weaknesses of angiography
in chest and vascular disease Acquisition techniques- i.e. difference between a
Equipment and technique routine CT angiogram and a CT angiogram targeting the
Use of angiography in interventional procedures coronary arteries, to include knowledge regarding:
Limitations Contrast: Volume, Rate, Mix, dual v three phase
Image quality assessment Limitations of CT unit with clinical impact i.e. how low
does heart rate need to be, does the heart rate need to
MRI in chest disease be regular
Expected radiation dose exposure for routine Coronary
Knowledge CT with the variation expected with the different CT
units
Safety / Preparation / Contrast Use (IV/ Oral) / Technical Acquisition technique variation:
Factors RV/LV

Indications/contraindications for MRI/specific protocols Pulmonary arteries

Identifies the strengths and weaknesses of MRI in chest/ Triple rule out

cardiac disease and conducts examinations accordingly. Anatomy:


Cardiac chamber structure

Equipment and technique Trabeculations, bands, papillary muscles

Venous anatomy and variation

MR sequences for chest use Arterial anatomy and variation

Limitations of MRI Procedures Valvular structure


MR image Quality Assessment in Chest Imaging AV variation and implications

MV- variation and implications

Nuclear medicine in chest disease Function:


Left Ventricle

Knowledge Radiation dose variation with CT unit

Data / image manipulation for post processing

Safety / Radiopharmaceutical Use / Radiation Safety Validation of technique

Dosimetry and Dose Reduction Right Ventricle

Identifies the strengths and weaknesses of nuclear Radiation dose variation with CT unit

medicine in chest/cardiac disease and conducts Data / Image manipulation for post processing

examinations accordingly Validation of technique

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Cardiac Magnetic Resonance Imaging surgical consultation, biopsy).
Brief introductory knowledge
Technique, sequences, Conditions which are optimally Radiological Interventions
assessed
Myocardial structure, function Demonstrate knowledge of chest interventional
Valvular structure, function procedures including the role of procedures, associated
complications and their management.
Phase 2
Basic principles and indications for chest biopsy or
Advanced study units reporting credentialing, level A drainage:
Fellowship (post 5th year) full credentialing to Fine needle aspiration

supervisor level, level B Core biopsy

Embolization for haemoptysis and AVM

KEY SKILLS Tumour embolization and radio-frequency ablation

Localisation techniques CT, ultrasound and


Interpret the examination accurately and safely fluoroscopy.
Causes of sampling error
Recognise the normal chest anatomy, range of variants

BODY SYSTEMS
Potential complications and their detection and
and changing appearance with age and physiological management
states, including recognising normal imaging studies or Specimen handling
requiring limited work-up to arrive at this conclusion. Communicating effectively with patients and clinicians
Conduct a thorough and systematic review of the regarding the benefits and risks associated with
imaging examination and perceive and describe relevant different diagnostic modalities and procedures.
abnormalities. Judge likely category of abnormality, eg
air space disease, interstitial disease, mediastinal mass.
Within limits of information available, integrate
broader knowledge of pathology, epidemiology, gross
morphology, ancillary tests, clinical presentations and
imaging appearances to form an appropriate differential
diagnosis.
Evaluate the imaging study in light of differential
diagnoses to identify clinically relevant findings.

Acts safely

Recognise and act appropriately upon imaging signs of


a chest emergency in conditions such as:
Tension pneumothorax;
Acute aortic dissection or traumatic aortic rupture.
Pulmonary embolism
Myocardial infarct
Cardiac tamponade

Convey findings

Communicates relevant findings including diagnoses,


treatment plans, complications and follow up to the
referring clinician, patient and or family/carers and other
health care team members and assists in formulating
an imaging and management plan as necessary (e.g.

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 173
Chest Imaging Normal Adult Variants
Category 1 Category 2 Category 3
Technical limitations- Physics and Asymptomatic variations of aortic S uperior accessory fissure
Position (Inspiration, Rotation.) arch branching, including: I nferior accessory fissure
A zygos lobe fissure Right arch with aberrant left I nferior pulmonary ligament
Cardiophrenic fat pads subclavian artery Tracheal cartilage calcification
A berrant right subclavian artery A ortic diverticulum of Variations of segmental and
E ventration- partial / total Kommerell subsegmental branches of
Pectus excavatum A ortic nipple / left superior bronchopulmonary tree
Pectus carinatum intercostal vein A bsence of the left pericardium
Rhomboid fossa C ommon origin of brachiocephalic
Normal thymus and left common carotid arteries
Tracheal buckling (bovine arch)
Bifid rib S eparate origin of vertebral artery
Cervical rib from arch
C ongenital variations of coronary
anatomy, including:
I ndependent ositum of MRC
and conus branch
C ircumflex from RCA
C ircumflex from RC Sinus
L CA from RC Sinus
Polands syndrome

Chest Imaging Adult Clinical Conditions


(For Paediatric Conditions, See Paediatric Syllabus)

Category 1 Category 2 Category 3


1. Air Space/Ground-glass

D iffuse alveolar damage / ARDS E osinophilic lung disease A lveolar microlithiasis


D iffuse alveolar haemorrhage P ulmonary alveolar proteinosis A myloidosis
A spiration pneumonia Toxic inhalation Lymphoma
A telectasis & patterns of collapse P ulmonary sequestration H ydatid disease
A denocarcinoma in lepidic Cryptogenic organizing
originPulmonary oedema pneumonitis
(cardiogenic and other) Acute hypersensitivity pneumonitis
Pneumonia (viral, bacterial & Adenocarcinoma in-situ/minimally
fungal) & complications (e.g. invasive adenocarcinoma
abscess)
Mycobacterial infection
A IDS & other forms of
Immunocompromised host
infection

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2. Airways

Bronchiectasis Tracheal Stenosis Tracheobronchomegaly


Cystic Fibrosis B ronchiolar Disease K artageners syndrome
Chronic Obstructive Airways Tracheobronchomalacia Tracheopathia osteoplastica
Disease R elapsing polychondritis
A llergic bronchopulmonary
aspergillosis

3. Interstitial

Sarcoidosis  iffuse interstitial pneumonias


D
A sbestosis L angerhans Cell Histiocytosis
Lymphangitis carcinomatosa Hypersensitivity pneumonitis
Pulmonary fibrosis Drug reactions
Connective tissue disorders P neumoconiosis, coal, silica
(lung manifestations) Lymphangiomyomatosis
Smoking related interstitial lung
diseases

BODY SYSTEMS
4. Mediastinum

Lymphoma Thymoma Sympathetic ganglion tumours


Superior Vena Cava Obstruction E ctopic parathyroid Fibrosing mediastinitis
Pneumomediastinum E ctopic thyroid Neurenteric cyst
D iaphragmatic hernias Germ cell tumours
Goitre B ronchogenic cyst
Metastatic lymph node Extramedullary haematopoiesis
involvement Nerve sheath tumours
Oesophageal cancer & other
diseases

5. Carcinoma & Nodules

B  ronchogenic carcinoma and Wegeners Granulomatosis


staging P ulmonary hamartoma
Lung (tumour) Biopsy and P ulmonary carcinoid
complications Rheumatoid nodule
Solitary pulmonary nodule:
c auses and management

(solid vs ground-glass nodule)


Metastasis (lung)
Radiation changes

6. Pleura

Pleural effusion Actinomycosis Fibrous tumour of pleura


A sbestos related pleural disease
Malignant mesothelioma
Pneumothorax
H aemothorax
Pleural metastasis
Pleural thickening
E mpyema

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7. Hyperinflation & Cysts

E mphysema Alpha 1 antitrypsin deficiency


Lymphangioleiomyomatosis
L angerhans cell histiocytosis
Neurofibromatosis
Tuberous sclerosis

8. Heart & Pericardium

C  ardiac size & contour C  ardiac mass Pericardial tumours,


Pericardial effusion / Pacemaker & defibrillator Coronary AV fistula
haemopericardium / placement and artificial valves Right ventricular dysplasia
pneumopericardium Coronary artery atheromatous Takotsubo cardiomyopathy
Valvular heart disease disease Valsalva sinus aneurysm
Pericardial calcifications Cardiac aneurysm
Valvular heart disease Cardiomyopathy
Left to right shunt (septal defects
and patent ductus arteriosus)

9. Vessels

P ulmonary embolism & venous Pulmonary arterial hypertension M  arfans / Ehlers-Danlos


thromboembolism AV malformation / angioma S cimitar syndrome
Embolism (septic, air, fat & other) Congenital variants of arteries P ulmonary varix
Aneurysm and veins in chest, including
Dissection transposition of arteries,
Cor pulmonale anomalous venous drainage
A theromatous disease, including Marfans / Ehlers-Danlos
coronary arteries Coarctation / pseudocoarctation
Anomalous origin of coronary
arteries
M anagement of acute hemoptysis

10. Chest Wall

P ectus and Kyphoscoliosis H


 aematopoietic disease (e.g. Polands Syndrome
Rib lesions Sickle cell disease, Thalassaemia)
Rib notching
Rib expansion
Multiple myeloma

Page 176 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
11. Trauma & ICU

Diaphragmatic rupture
Chest wall trauma
Tracheobronchial rupture
Rib/sterna/clavicular/thoracic
spine fractures & Complications
Median sternotomy
E ndotracheal, intercostal tube,
chest drainage tube and catheter
assessment
Thoracotomy and complications
Pacemaker wire position
Central line malpositioning
O  esophageal rupture/Boerhaaves
syndrome
I nhaled and swallowed foreign
bodies

BODY SYSTEMS
12. Techniques & Applications (Adult Chest)

CXR Ultrasound of the chest M RI of mediastinum/certain


CT/HRCT Diaphragmatic fluoroscopy parenchymal disease/heart
CT Pulmonary Angiography Venography of central veins MR venography of the chest
C
 T aortography, including its use Angiography Bronchial angiography
for TAVI CT-guided lung biopsy Pulmonary angiography
CT coronary angiography Embolization
CT of pulmonary masses Tumour ablation
C hest CT in trauma and vascular
diseases

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 177
Extracranial Head and Neck Ultrasound
Imaging Learning Competencies Knowledge
Safety
The competent (trainee) radiologist will be able to:

Indications/contraindications for Extracranial Head &


Demonstrate a clinical, pathological and radiological
Neck Imaging Ultrasound/specific protocols
understanding of extracranial head and neck disease
Ultrasound Image Quality Assessment
Interpret common clinical presentations in head and neck
Limitations of Ultrasound in Extracranial Head & Neck
imaging practice.
Imaging

CORE KNOWLEDGE
CT Scanning

Explain the strengths, weaknesses and risks (radiation


Knowledge
related and other) and roles of the imaging modalities
currently used in diagnosing and evaluating head
Safety / Scan Preparation / Contrast Use (IV/ Oral)
and neck abnormalities (e.g. ultrasound: thyroid,
/ Radiation Safety Dosimetry and Dose Reduction /
parathyroids, neck nodes and salivary glands; CT:
Technical Factors
sinuses (pre FESS), neck (staging of SCC), salivary glands
Indications/contraindications for Extracranial Head &
and thyroid, basic temporal-bone pathology; MRI: IAMs,
Neck Imaging CT / Specific Protocols
common skull base lesions, sinonasal malignancy, large
/ critically placed carcinoma in H & N (e.g. nasopharynx,
Equipment and technique
tongue base).
Describe/direct assessment or work-up of a clinical
CT Image Quality Assessment
problem or imaging finding using imaging methods as
Limitations of CT in Extracranial Head & Neck Imaging
appropriate.
Recognise and act upon an inadequate examination.
Equipment and Technique
Be able to recommend follow-up imaging at later time
interval when appropriate.
Cone Beam CT, its advantages and limitations in Head
and Neck, ENT and Dental imaging.
Plain X-ray / Fluoroscopy
MRI Scanning
Knowledge

Knowledge
Safety / Preparation / Contrast Use (IV/ Oral) / Radiation
Safety Dosimetry and Dose Reduction / Technical Factors
Safety / Scan Preparation / Contrast Use / MRI General
Indications/contraindications for Extracranial Head &
Safety / Technical Factors
Neck Imaging/specific protocols.
Indications/contraindications for Extracranial Head &
Limitations of Plain X-ray /Fluoroscopic Procedures
Neck MRI / Specific Protocols
X-ray image Quality Assessment in Extracranial Head &
Neck Imaging
Equipment and technique

Equipment and Techniques


MRI Image Quality Assessment
Limitations of MRI in Extracranial Head & Neck Imaging
The Orthopantomogram (OPG), Indications, Artefacts
and limitations.

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Nuclear Medicine Evaluate the imaging study in light of differential
diagnoses to identify clinically relevant findings.
Knowledge
Acts Safely
Safety / Radiopharmaceutical Use (Labelled RBC /DTPA
MAG III DMSA) / Radiation Safety Dosimetry and Dose Recognise imaging signs suspicious of conditions
Reduction with significant patient implications (eg malignant or
Dosimetry and Dose Reduction infective lesions).
Equipment and technique Safely assign a benign diagnosis and discriminate such
cases from those that require further assessment.
Demonstrate knowledge of the principles/ limitations/ Correctly categorise indeterminate findings and guide
indications of MIBG / Octreotide Scanning/ PET Scans in further investigation appropriately.
Extracranial Head & Neck Imaging.
NMCT Image Quality Assessment Convey findings
Limitations of NMCT in Extracranial Head & Neck
Imaging Communicates relevant findings including diagnoses,
Role of PET and PET/CT in Head and Neck Cancer treatment plans, complications and follow up to the
imaging and its limitations. referring clinician, patient and or family/carers and other

BODY SYSTEMS
health care team members and assists in formulating
Skills an imaging and management plan (e.g. surgical
consultation, biopsy).
Be able to interpret - Conduct appropriate notifications in relation to
Nuclear Medicine GIT Bleeding Studies infectious diseases and other notifiable conditions.
Meckels Scans

DTPA / DMSA / MAG III Radiological Interventions

Non Imaging Investigations Describe the techniques of imaging guided fine needle
aspirate cytology (e.g. thyroid nodules and neck nodes)
Demonstrate knowledge of the role and process of other and core biopsy.
non-imaging investigations (e.g. nasendoscopy) used in Communicate effectively with patients regarding the
this topic. benefits and risks associated with different diagnostic
modalities and procedures.
KEY SKILLS

Interpret the examination accurately and safely


Recognise the normal head and neck anatomy, range of
clinically significant variants and changing appearance
with age and physiological states, including recognising
normal imaging studies. May require limited work-up to
arrive at this conclusion.
Conduct a thorough and systematic review of
the imaging examination and perceive relevant
abnormalities.
Correctly describe likely category of abnormalities on
imaging examination (eg. solid mass, lymphadenopathy,
cyst).
Within limits of information available, integrate broader
knowledge of pathology (e.g. epidemiology, gross
morphology, ancillary tests), clinical presentations and
imaging appearances to form an appropriate differential
diagnosis.
2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 179
Neuro/ENT Imaging Normal Variants
Category 1 Category 2 Category 3
1. Brain

L arge Virchow-Robin spaces N  ormal appearance of brain at N


 ormal appearance of brain in
A symmetry of hemispheres and different ages in adulthood paediatrics
ventricles Vermian pseudotumour
P ersistent cavum septum C  alcarine pseudotumour
pellucidum C  horoid plexus pseudotumour
C  avum vergae  Low hanging cerebellar tonsils
B  asal ganglia calcification M  ega-cisterna magna
D  entate nucleus calcification
E mpty sella

2. Skull

F rontal hyperostosis N  ormal vault thinning


P arietal foramina
Arachnoid granulations
L arge external occipital
protruberance
Arachnoid granulations
P seudofractures
A ccessory sutures

S uperficial temporal artery


O ccipitomastoid suture
S pheno-occipital synchondrosis

3. ENT

N  eck and pharynx N  eck and pharynx: Calcified stylohyoid ligament


A symmetry of internal jugular P yramidal lobe of thyroid
veins M edian thyroid vein
P ersistent adenoids Temporal bone:

P aranasal sinuses H igh jugular bulb


L ow cribriform plate Variation in mastoid

D ehiscent lamina papyracea development


O nodi cell Aberrant retropharyngeal course
C arotid dehiscence into of carotid artery
sphenoid sinus Paranasal sinus developmental
Temporal bone and pneumotisation variants and
D ehiscent internal carotid drainage patterns
artery
D ehiscent internal jugular vein

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4. VASCULAR

Circle of Willis normal variants Azygos anterior cerebral artery D  uplicated cerebral arteries
Vertebral artery asymmetry & Persistent fetal cerebral arteries
dominance H ypoglossal
Common carotid artery origin Trigeminal

variations
A symmetric internal jugular veins
Jugular bulb variations

Extracranial Head & Neck Imaging Clinical Conditions


Category 1 Category 2 Category 3
1. Imaging Techniques & Applications

F acial x-rays M R of neck S pecial x-ray views of temporal


Routine views are M R of paranasal sinuses bones
L ateral view Angiography of external carotid S ialography

BODY SYSTEMS
C aldwell view branches D acryocystography
Waters view OPG L aryngography
B asal view
PET/CT P haryngography
Lateral airway x-rays Image guided procedures Videofluoroscopy of swallowing
CT face & sinuses C one Beam CT of temporal bones,
CT temporal bones sinus and dental pathology
CT & MR of skull base
CT & MR of nasopharynx
CT of neck
US of Thyroid and Parathyroid
US of salivary glands
US of Neck

2. Nose and sinuses; facial bones

Congenital / Developmental

F rontoethmoidal / anterior skull C hoanal atresia


base encephalocoele A nterior neuropore abnormalities

Trauma / Fractures

Z ygomaticomaxillary fractures Nasal fractures


I solated fracture of the zygoma N asal bone fractures

and zygomatic arch Fractures of the nasal septum

Tripod fracture Fractures of the nasal spine

Maxillary fractures N asoorbitalethmoidal fractures

I solated antral fractures

A lveolar ridge fractures

Mid-face fractures
L eFort types I To III

B ilateral mid-face fractures

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 181
Inflammatory / Infection

RhinoSinusitis, acute S inonasal polyposis I nvasive fungal infection


RhinoSinusitis, chronic F ungal sinusitis
Planning CT for functional M ucocoele
endoscopic sinus surgery Wegeners granulomatosis

Benign Tumours & Tumour-like Conditions

S inus osteoma J uvenile angiofibroma Mandibular and Maxillary Tori


Fibrous dysplasia I nverting papilloma Ossifying Fibroma
Stafne Cyst

Malignant Tumours

Metastases Adenocarcinoma M elanoma


S quamous cell carcinoma E sthesioneuroblastoma
Lymphoma
Chrondo-Sarcoma
Osteo-Sarcoma
Rhabdomyosarcoma

3. Orbit

Congenital / Developmental

D  ermoid, epidermoid Vascular malformation (Cavernous C oloboma


H igh myopia changes in globe haemangioma) Lymphangioma
Neurofibromatosis type 1

Trauma / Fractures

Orbital fractures Ocular Injuries


O rbital rim fractures R uptured globe

B low-out fractures D islocated lens

B low-in fractures R etinal detachment

O rbital emphysema P hthisis bulbi

Foreign body

Inflammatory / Infection

I diopathic orbital inflammatory O  ptic neuritis Dacroadenitis


disease (pseudotumour) P hthisis bulbi Sjogren Syndrome
Subperiosteal abscess
Orbital cellulitis

Benign Tumours & Tumour-like Conditions

C  apillary haemangioma B enign mixed lacrimal tumour


Optic nerve sheath meningioma

Malignant Tumours

Retinoblastoma Lymphoma L acrimal gland malignantcies


Ocular melanoma Rhabdomyosarcoma
Optic pathway glioma

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Other Conditions

Thyroid orbitopathy (Graves) Venous varix of orbit (primary and


secondary)
Carotid-cavernous fistula

4. Temporal Bone and Cerebellopontine angle; Skull base

External auditory canal

Atresia  ecrotising external otitis


N
E xostoses E AC cholesteatoma
Keratosis obturans
S quamous cell carcinoma

Middle ear, mastoid

A cute mastoiditis + abscess  ehiscent jugular bulb


D C holesterol granuloma
A berrant internal carotid artery Cholesteatoma, congenital R habdomyosarcoma
Cholesteatoma, acquired Chronic mastoiditis Post-operative ear

BODY SYSTEMS
Glomus tympanicum
paraganglioma

Inner ear; petrous apex

A pical petrositis L abyrinthitis ossificans C  ongenital labyrinthine


Cochlear implants abnormalities
Otosclerosis C ochlear dysplasia
Cholesterol granuloma petrous C hondrosarcoma petrous apex
apex L abyrinthitis ossificans
L arge endolympatic sac (LEDS)
Otosclerosis
Petrous apex pseudolesion

Cerebellopontine angle and internal auditory canal

A coustic schwannoma E pidermoid cyst A neurysm


Meningioma Arachnoid cyst M etastases
Viral labyrinthitis Neurofibromatosis 2 R amsay-Hunt syndrome
S uperficial siderosis

General temporal bone lesions

Temporal bone fractures F ibrous dysplasia


CSF leak Pagets disease

Skull base

G  lomus jugulare paraganglioma Chordoma of clivus J ugular foramen schwannoma


D ural sinus thrombosis S kull base meningioma C hondroid series tumour
M etastasis Post radiation treatment
appearances and complications

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 183
5. Larynx, hypopharynx, trachea

SCC hypopharynx Vocal cord paresis L aryngocele


SCC larynx L aryngeal trauma Chondroid lesions
Epiglottitis
Tracheal and Laryngeal infection/
inflammation
Inhaled foreign bodies

6. Oral cavity, Pharyngeal mucosal Space

Congenital

Thornwaldts cyst L ingual thyroid


D ermoid of floor of mouth

Inflammatory / Infective

Tonsillar abscess S imple ranula


Ludwigs angina: infection P lunging ranula
extending into sublingual and S ialocoele
submandibular spaces R etention cyst of pharynx

Benign Tumours

B
 enign mixed tumour of
submandibular gland

Malignant Tumours

SCC of oral cavity A denoid cystic carcinoma, minor


SCC of oropharynx / tonsil salivary glands
SCC of nasopharynx / NPC
Lymphoma

Miscellaneous

Z enkers diverticulum

7. Submandibular Space

Congenital / Developmental

Dermoid/Epidermoid cyst
Lymphatic malformation

Infection / Inflammatory

Obstruction / calculus
A cute infection
Chronic infection

Benign Tumours

P leomorphic adenoma
Reactive lymphadenopathy

Page 184 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Malignant Tumours

Salivary gland origin


Metastatic lymphadenopathy
Lymphoma

8. Parotid Space

Congenital / Developmental

1 st branchial cleft cyst, sinus or


fistula

Infection / Inflammatory

Acute parotitis
S jogrens syndrome
Lymphoepithelial cysts of HIV

Benign Tumours

BODY SYSTEMS
B
 enign mixed tumour Warthins tumour H aemangioma (children)
(pleomorphic adenoma)

Malignant Tumours

Mucoepidermoid carcinoma I ntraparotid node metastases A denoid cystic carcinoma


Lymphoma

Miscellaneous

Perineural spread via CN 5 B


 enign masticator muscle D
 enervation atrophy of trigeminal
hypertrophy nerve territories

9. Carotid Space

Congenital / Developmental

Infective / Inflammatory

Lymphadenopathy C
 aseating necrosis due to
Node abscess granulomatosis infection

Vascular Lesions

I nternal jugular vein thrombosis


Carotid arterial dissection
Carotid artery pseudoaneurysm

Benign Tumours

Paraganglioma Nerve Sheath Tumours C astlemans disease


(e.g. carotid body tumour and
glomus vagale)
Reactive lymphadenopathy

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 185
Malignant Tumours

Metastatic lymphadenopathy
Lymphoma

10. Masticator Space

Infective / Inflammatory

M
 asticator space abscess /
cellulitis

Malignant Tumours

S pread of SCC
Perineural spread via trigeminal
nerve
Sarcoma
Lymphoma

Miscellaneous

Benign masseteric hypertrophy S chwannoma of trigeminal nerve

11. Retropharyngeal Space (RPS) and Prevertebral Spaces

Normal Variants & Pseudolesions

R etropharyngeal effusion L evator scapulae hypertrophy

Infective / Inflammatory

S uppurative adenopathy or RPS L ongus colli tendonitis


abscess (calcific HADD)
Prevertebral space infection

Malignant Tumours

Nodal metastases in RPS Lymphoma in RPS nodes

Degenerative

O
 steophytes and calcification in
the anterior longitudinal ligament

12. Visceral Space Organs

Thyroid

Multinodular goitre Hashimotos Thyroiditis Follicular carcinoma


Graves Disease A naplastic carcinoma
Thyroid adenoma
Papillary carcinoma
A ssessment of solitary nodule (e.g.
colloid nodule, follicular lesion)
Sonographic Assessment of
thyroid nodules

Page 186 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Parathyroids

Imaging in hyperparathyroidism D
 evelopmental cysts parathyroid
or thymic origin

13. Neck general

Congenital lesions

2nd branchial cleft cyst S low Flow Malformations: D ermoid cyst


Thyroglossal duct cyst Venous, Lymphatic, Mixed Venous- Thyroglossal duct fistula
Lymphatic 1 st, 3rd and 4th Branchial
High Flow Vascular malformations: Anomalies
AVM or AVF
I nfantile Hemangiomas (true
neoplasms)

Lymph nodes of the neck

K  nowledge of common patterns of R  eactive lymphadenopathy C astlemans disease

BODY SYSTEMS
lymph node and lymphatic spread S uppurative lympadenitis
Lymph node groups in the Head
and Neck, their nomenclature and
definition
Metastases in neck nodes
(especially SCC and papillary
thyroid Ca)
Lymphoma

14. Maxillofacial / Dental

Basic Dental Disease

Caries I mpacted teeth I n maxilla, associated with antral


Periodontal disease K now common dental disease
Periapical sepsis nomenclature for teeth

Odontogenic Lesions

P eriapical granuloma Dentigerous cyst C  ommon / important odontogenic


Periapical cyst cysts and tumours
Periapical abscess A meloblastoma
O dontogenic Keratocyst (OKC)

Trauma

Mandibular fractures T MJ dysfunction


B ody and angle T MJ dislocation
S ymphyseal and

parasymphyseal
C ondylar

R amus and coronoid process

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 187
Neuroradiology Learning Catheter angiography
Competencies Knowledge
Basics of catheter angiography in neuroradiological
The competent (trainee) radiologist will be able to:
practice
Safety / Preparation / IV Contrast Use / Radiation
Demonstrate a clinical, pathological and radiological
Safety, Dosimetry and Dose Reduction / Technical Factors
understanding of neurological imaging practice
Indications/contraindications for Neuroradiological
Interpret common and important clinical presentations
Imaging/specific protocols.
in neurological imaging practice for example;
Equipment and Techniques: / standard projections
Basic knowledge of therapeutic options e.g.
Headache
embolisation, aneurysm treatment
Suspected stroke/collapse
Cranial and Spinal Trauma
Ultrasound
Focal neurological deficit
Radicular/cranial nerve symptoms
Knowledge
Myelopathy

Safety
CORE KNOWLEDGE
Indications/contraindications for Neuroradiology
Explain strengths, weaknesses and risks (radiation
Imaging Ultrasound/specific protocols
related and other) and roles of the imaging modalities
currently used in diagnosing and evaluating
Equipment and Technique
neurological abnormalities. (eg use of IV contrast agents
in CT and MRI, MRI sequence options, ultrasound in the
Basic knowledge of the role of trans cranial doppler
neonate).
ultrasound
Describe/direct assessment or work-up of a clinical
Ultrasound Image Quality Assessment
problem or imaging finding using imaging methods as
Limitations of Ultrasound in Neuroradiology Imaging
appropriate.
Recognise and act upon an inadequate examination.
CT
Recommend follow-up imaging when appropriate.

Knowledge
Plain X-ray / Fluoroscopy
Safety / Scan Preparation / IV Contrast Use / Radiation
Knowledge
Safety, Dosimetry and Dose Reduction / Technical Factors
Indications/contraindications for Neuroradiological CT
Safety / Preparation / IV Contrast Use / Radiation
Imaging / Specific Protocols
Safety, Dosimetry and Dose Reduction / Technical Factors
The use of CT angiography, CT venography and CT
Indications/contraindications for Neuroradiological
perfusion in neurological practice
Imaging/specific protocols
CT Image Quality Assessment
Limitations of CT in Neuroradiology Imaging
Equipment and Techniques

MRI
Limitations of Plain X-ray /Fluoroscopic Procedures
X-ray image Quality Assessment in Neuroradiology
Knowledge
Imaging

Safety / Scan Preparation / IV Contrast Use / MRI


General Safety / Technical Factors
Indications/contraindications for Neuroradiological
Imaging MRI / Specific Protocols

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MR angiographic techniques and imaging appearances to form an appropriate
MR Venography differential diagnosis
The basic principals and utility of MR perfusion, MR Evaluate the imaging study in light of differential
diffusion diagnoses to identify clinically relevant findings

Equipment and Technique Acts Safely

MRI Image Quality Assessment Recognise imaging signs suspicious of conditions with
Limitations of MRI in Neuroradiology Imaging significant patient implications (e.g.: subarachnoid
haemorrhage, isodense subdural haematoma, cord
Nuclear Medicine compression, coning)
Safely assign a benign diagnosis and discriminate such
Knowledge cases from those that require further assessment
Correctly categorise indeterminate findings and guide
Safety / Radiopharmaceutical Use / Radiation Safety subsequent investigation appropriately
Dosimetry and Dose Reduction
Demonstrate knowledge of the principles/ limitations/ Convey findings
indications of SPECT and PET Scans in Neuroradiology

BODY SYSTEMS
Imaging Communicates relevant findings including diagnoses,
Knowledge of tracer options for neuro imaging (eg FDG, treatment plans, complications and follow up to the
DOTA) referring clinician, patient and or family/carers and other
health care team members and assists in formulating
Equipment and Technique: Basics only an imaging and management plan as necessary (eg:
surgical consultation, biopsy)
NMCT Image Quality Assessment
Limitations of NMCT in Neuroradiology Imaging Interventions and techniques
Non Imaging Investigations
Demonstrate competence in lumbar puncture and
Knowledge of the role of non-imaging investigations (e.g.: myelography. Possess basic knowledge about
EEG, nerve conduction studies, CSF examination). interventional techniques used during management
of aneurysms, dural AV fistulae, arteriovenous
KEY SKILL malformations and arterial and venous thrombosis
(thrombolysis)
Interpret the examination accurately and safely Demonstrate knowledge of more advanced imaging
methods including perfusion imaging, and basic
Recognise normal neurological anatomy, common knowledge of MR spectroscopy and functional MRI
normal variants, expected changes with age and Communicate effectively with patients regarding the
physiological stages, including recognising normal benefits and risks associated with different diagnostic
imaging studies or requires limited work-up to arrive at modalities and procedures
this conclusion
Conduct a thorough and systematic review of
the imaging examination and perceives relevant
abnormalities
Correctly describe likely category of abnormalities on
imaging examination (e.g.: stroke, brain tumour, extra-
axial mass effect)
Within limits of the information available, integrate
broader knowledge of pathology (e.g.: epidemiology,
gross morphology, ancillary tests), clinical presentations

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 189
Neuro Imaging Adult Clinical Conditions
(For Paediatric Conditions, See Paediatric Syllabus)

Category 1 Category 2 Category 3


1. Brain and intracranial structures

Congenital malformations (see Paeds Syllabus)

Chiari malformations 1 & 2 Dandy Walker spectrum Septo-optic dysplasia


Agenesis of corpus callosum Holoprosencephaly Hemimegalencephaly
Heterotopic grey matter Microcephaly
Lissencephaly Chiari malformation 3
Schizencephaly
Pachygyria-polymicrogyria

Infection

Meningitis Neurocysticercosis Rickettsial infections


Cerebral abscess Tuberculosis Lyme disease
Empyema Fungal infections
Herpes encephalitis
HIV / AIDS and the CNS
Ventriculitis

Tumours

Intra-axial metastases Other brain tumours Even More Brain Tumours


Leptomeningeal metastases Ependymoma C entral neurocytoma
Meningioma Choroid plexus papilloma G anglioglioma
Astrocytoma Choroid plexus carcinoma G liosarcoma
Glioblastoma multiforme Medulloblastoma P ineoblastoma
Brainstem glioma Haemangioblastoma P ineocytoma
Teratoma Germinoma S ubependymoma
Primary CNS lymphoma DNET Astroblastoma

Supratentorial PNET D ysplastic cerebellar


Pilocytic astrocytoma gangliocytoma
Oligodendroglioma D esmoplastic infantile
Subependymal giant cell ganglioglioma
astrocytoma Atypical teratoid-rhabdoid

Pleomorphic xanthoastrocytoma tumour


Gliomatosis cerebri Angiocentric lymphoma

Atypical meningioma E mbryonal carcinoma


Leukemia H aemangiopericytoma
M alignant meningioma

Non-neoplastic cysts

A rachnoid cyst D  ermoid cyst N


 euroglial cyst
C  olloid cyst E pidermoid cyst
P ineal cyst
C  horoid plexus cyst
E pendymal cyst
P orencephalic cyst

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Trauma

E xtradural haematoma C  arotico-cavernous fistula


S ubdural haematoma Traumatic subdural CSF hygroma
Traumatic subarachnoid
haemorrhage
C  erebral contusion
D  iffuse axonal injury
N  on-accidental injury
I ntracranial herniation syndromes

Demyelination; dementias

M  ultiple sclerosis Alzheimers disease S ubacute sclerosing


Tumefactive demyelination P arkinsons disease panencephalitis
M  ulti-infarct dementia ADEM

Vascular lesions

Thromboembolic infarction F ibromuscular hyperplasia of the S uperficial siderosis

BODY SYSTEMS
C  arotid and vertebral dissection carotids C  ADASIL
S ubarachnoid haemorrhage, C  avernous malformation C  apillary telangiectasia
aneurysmal Arteriovenous malformation
S ubarachnoid haemorrhage, P seudoaneurysm
perimesencephalic (venous) C  erebral amyloid disease
Aneurysm Vasculitis
S pontaneous intracerebral Cranial dural AV fistula
haemorrhage Vascular loop compression (e.g.
H  ypotensive infarction trigeminal neuralgia, hemifacial
D  iffuse hypoxic injury spasm)
Venous infarction Developmental venous anomaly
I ntracranial venous thrombosis

Toxic, metabolic, or degenerative disorders

Acute hypertensive encephalopathy Osmotic demyelination syndrome Effects of drug abuse


(PRES) Status epilepticus Fahrs disease
Mesial temporal sclerosis Carbon monoxide poisoning Idiopathic (benign) intracranial
Alcoholic encephalopathy hypertension
Hepatic encephalopathyEffects of
therapeutic radiation
Effects of chemotherapeutic drugs

Miscellaneous

B  rain death N  ormal pressure hydrocephalus H


 ypertrophic pachymeningitis
O  bstructive hydrocephalus N  eurosarcoidosis
communicating and non- I ntracranial hypotension
communicating
Aqueduct stenosis
C  omplications of CSF shunts

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 191
2. Pituitary and parasellar region

P ituitary microadenoma P ituitary stalk anomalies H  amartoma of tuber cinereum


P ituitary macroadenoma R  athkes cleft cyst P ituicytoma
P ituitary apoplexy L ymphocytic hypophysitis
C  raniopharyngioma E mpty sella

3. Skull

S kull fractures & complications


H  aemangioma
M  yeloma
M  etastases
F ibrous dysplasia
P agets disease
F rontal hyperostosis

4. Spinal cord and related structures; peripheral nerves

E pendymoma S yringomyelia
A strocytoma Transverse myelitis
M  eningioma C  ord demyelination
E pidural haemorrhage Arachnoid cyst
E pidural abscess D  orsal / ventral dural defect
S pinal / epidural metastases S pinal vascular malformations
I ntrathecal metastases Spinal dural AV fistula
Traumatic cord injury M  eningitis
S pinal cord infarction
D  isc prolapse
N  eurofibroma
Transverse myelitis
A rachnoiditis
P ostoperative epidural fibrosis /
scarring

5. Neurocutaneous syndromes

N
 eurofibromatosis 1 Von Hippel Lindau B
 asal cell naevus syndrome
N
 eurofibromatosis 2 Tuberous Sclerosis C
 owden syndrome

6. Cranial Nerve

O  ptic neuritis Vestibular neuritis


S chwannoma B  ell palsy
Vascular compression syndrome P erineural spread
(trigeminal neuralgia)

Imaging Techniques and Applications (Adult Neuro & Spine)

S kull x-ray for trauma M


 yelography & CT myelography S pinal interventions bone, disc
C  T skull and brain and facet joints (principles)
M  RI of brain
M  RI of pituitary
C  T of spine
M  RI of spine

Page 192 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Musculoskeletal (MSK) Imaging Ultrasound
Learning Competencies Knowledge

The competent (trainee) radiologist will be able to:


Safety

Demonstrate a clinical, pathological and radiological


Indications/contraindications for MSK Imaging
understanding of MSK imaging
Ultrasound/specific protocols
Interpret common clinical presentations in MSK imaging
practice.
Equipment and Technique
Interpret clinical emergencies where intervention

e.g. surgical or oncological, is required. E.g.


Ultrasound Image Quality Assessment
fracture dislocation of spine, pathological or
Limitations of Ultrasound in MSK Imaging
complicated peripheral joints fractures with
potential neurovascular harm or alignment
CT Scanning
problem e.g. stress fracture, infection.
Acquire further relevant clinical information from
Knowledge
referring clinician which may affect radiological

BODY SYSTEMS
diagnosis or differential diagnosis.
Safety / Scan Preparation / Contrast Use (IV/ Oral)
/ Radiation Safety Dosimetry and Dose Reduction /
CORE KNOWLEDGE
Technical Factors
Indications/contraindications for MSK Imaging CT /
Explain the strengths, weaknesses and risks (radiation
Specific Protocols
related and other) of the imaging modalities currently
used in diagnosing and evaluating MSK abnormalities.
Equipment and Technique
Recognise and act upon an inadequate examination.
Describe/direct assessment or work-up of a clinical
CT Image Quality Assessment
problem or imaging finding using imaging methods as
Limitations of CT in MSK Imaging
appropriate.
Recognise and act upon an inadequate examination.
MRI Scanning
Be able to recommend follow-up imaging at later time
interval when appropriate.
Knowledge

Plain X-ray / Fluoroscopy


Safety / Scan Preparation / Contrast Use / MRI General
Safety / Technical Factors
Knowledge
Indications/contraindications for MSK Imaging MRI /
Specific Protocols
Safety / Preparation / Contrast Use (IV/ Oral) / Radiation
Safety Dosimetry and Dose Reduction / Technical Factors
Equipment and Technique
Indications/contraindications for MSK Imaging/specific
protocols.
MRI Image Quality Assessment
Limitations of MRI in MSK Imaging
Equipment and Techniques

Nuclear Medicine
Limitations of Plain X-ray /Fluoroscopic Procedures
X-ray image Quality Assessment in MSK Imaging
Knowledge

Safety / Radiopharmaceutical Use / Radiation Safety


Dosimetry and Dose Reduction
Octreotide Scanning/ PET Scans in MSK Imaging

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 193
Equipment and Technique: Basics only an imaging and management plan as necessary plan
(e.g. surgical consultation, and non-primary bone or soft
NMCT Image Quality Assessment tissue sarcoma biopsy) with referring physician team.
Limitations of NMCT in MSK Imaging
Radiological Interventions
KEY SKILLS
Describe the imaging guided techniques and planning
Interpret the examination accurately and safely of joint aspiration, diagnostic and therapeutic injections
Recognise the normal MSK anatomy, range of variants and biopsy (excluding primary sarcoma of bone and
and changing appearance with age and physiological soft tissue) in the MSK system, including strengths and
states, including recognising normal imaging studies or weaknesses of different procedures.
requires limited work-up to arrive at this conclusion. In relation to potential primary sarcoma of bone and
Conduct a thorough and systematic review of soft tissue biopsy, be able to refer to an orthopaedic
the imaging examination and perceives relevant oncology and radiology service in a designated specialty
abnormalities. unit.
Correctly describe perceived abnormalities in terms of Assess the adequacy of a biopsy specimen in relation
location, appearance and possible differential diagnosis. to pathology requirements and be aware of common
Within limits of information available, integrate broader problems associated with biopsy adequacy.
knowledge of pathology (eg epidemiology, gross Communicate effectively with patients regarding the
morphology, ancillary tests), clinical presentations and benefits and risks associated with different diagnostic
imaging appearances to form an appropriate differential modalities and procedures.
diagnosis. Interact effectively with other health care team
Evaluate the imaging study in light of differential members such as surgeons, rheumatologists, oncologists
diagnoses to identify clinically relevant findings. and pathologists during management of MSK
conditions.
Acts Safely

Recognise imaging signs which would lead to a change


in management, such as infection, fracture/dislocation,
tumor.
Safely diagnose other lesions or normal anatomy
without excessive investigation or patient risk.
Correctly categorise indeterminate findings and guide
investigation appropriately including knowing when
to refer for MSK subspecialist or multidisciplinary
team opinion particularly with respect to potentially
significant tumour or tumour-like bone or soft tissue
conditions. This is especially related to potentially
primary bone or soft tissue sarcoma, which requires
dedicated specialised team/unit referral. Have
awareness of anatomical compartment contamination
and effect on management and prognosis for the
individual patient.

Convey findings

Communicates relevant findings including diagnoses,


treatment plans, complications and follow up to the
referring clinician, patient and or family/carers and other
health care team members and assists in formulating

Page 194 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Musculoskeletal Imaging - Normal Variants
Category 1 Category 2 Category 3
1. Extraneous to Musculoskeletal System

Superimposed hair braid


Superimposed soft tissue

2. Technique / Artifact

M  ach effect
Projectional variants
(e.g. lucency greater tuberosity
humerus, tuberosity radius
simulating bone lesion, epiphysis
proximal humerus simulating
fracture)

3. In relation to Musculoskeletal System

BODY SYSTEMS
A ccessory Ossicles that may Hyperostosis frontalis interna
simulate fracture Variants of pneumatisation of
Sutural variants that may simulate paranasal sinuses
fracture I ntracranial calcifications
Vascular channels P seudosubluxation of C2/3
Nutrient foramina Accessory ribs
Bone island Variations in pedicle size
A nomalies of segmentation Notochordal remnants
Transitional spine S coliosis of sacrum
Variants of epiphyseal fusion Fibrous cortical defect
Variants of ossification (bone, Coccygeal angulation
epiphysis, apophysis, ossicles, P hyseal scar
sutures, synchondroses, ligaments) M etaphyseal density
Vacuum phenomenon B ipartite patella / other bones
Growth arrest lines E specially with MRI, awareness
Fusion of carpal / other bones of normal red and white marrow
Variants in bone marrow fat pattern in growth and ageing
content Variants of glenoid labrum (e.g.
Potentially symptomatic / painful Buford complex)
normal variants (awareness Variants of acetabular labrum
required for patient care) E g. fusion: Tarsal coalition
A wareness that some previous E g. Ossicles / ossification centres:
normal variants have been Os tibial externum
further investigated and are
pathologic eg. many os
acetabulum are infact stress
fractures related to FAI.

Spinal Variants

L imbus vertebra Craniovertebral junction variants Filum terminale fibrolipoma


Conjoined nerve roots Ventriculus terminalis
Bone island
Lumbar segmentation &
numbering anomalies

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 195
Ankle & Foot Variants

Tarsal coalition
Ossicles around the ankle & foot
Accessory muscles of the hindfoot
L ow soleal musculotendinous
junction
Accessory soleus

References:
Atlas of Normal Variants that May Simulate Disease. Theodore E. Keats, Mark W. Anderson. Mosby-Year Book Inc 2007. ISBN:
10 0-323-04300-3, ISBN: 13 978-0323-04300-7

Musculoskeletal Imaging Clinical Conditions


(For Paediatric Conditions, See Paediatric Syllabus)

Category 1 Category 2 Category 3


1. Shoulder and Clavicle

Normal appearances

Plain film findings Arthrography


U ltrasound findings
M R findings
CT findings
M R arthrography

Imaging Techniques & Applications

S tandard plain film views of the Additional special x-ray views: Westpoint view for instability
shoulder joint True AP and lateral views of A rthrography and joint aspiration
A P external rotation the scapula M R arthrography
A P internal rotation S capular neck C T arthrography
True anatomical AP for GH S capular spine N on-rotator cuff ultrasound
joint space S uprascapular notch

A xial view C oracoid and acromion

O utlet view for impingement S capulothoracic

Standard projections for the  icipital groove


B
clavicle A cromioclavicular joint

S ternoclavicular joint

M RI of shoulder
U ltrasound of rotator cuff
CT of shoulder & scapula

Impingement

P lain film signs of subacromial U  ltrasound findings in I nternal impingement syndrome


impingement subacromial impingement C oracoid impingement syndrome
M RI signs of subacromial
impingement

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Bony Trauma

C  ommon fractures L ess common fractures


(Greater tuberosity, Humeral (Coracoid process, scapular spine)
neck, Neck and body of scapula,
Acromion)
Clavicular fractures & related
complications
Sternoclavicular joint dislocation
and subluxation

Joint Trauma

L oss of alignment and congruity G  lenoid hypoplasia


at the GHJ (dislocation and B ony Bankart lesion
subluxation) R everse Hill-Sachs defect
H ill-Sachs defects
Posterior glenoid rim fracture
AC joint subluxation

BODY SYSTEMS
Arthritis and Bursitis

Osteoarthritis Atypical infective arthritis O  ther arthritides


Rheumatoid arthritis P soriatic arthritis (Gout, amyloid)
Septic arthritis, bacterial Osteochondromatosis O ther bursitis
Osteomyelitis Calcium pyrophosphate S ternoclavicular hyperostosis
arthropathy (CPPD)

Glenohumeral Capsule & Ligament Injuries

Bankart injuries Adhesive capsulitis, including T UBS (Traumatic Unilateral with


treatment options Bankart lesion, usually requiring
S LAP injuries in general surgery)
A MBRI (Atraumatic,
Multidirectional, Bilateral,
Rehabilitation, rarely needs an
Inferior capsular shift)
SLAP lesions types I to IV
GLAD lesion
HAGL lesion
Inferior instability
IGL lesion
M icroinstability (superior
instability)
Perthes and ALPSA lesions
Labral cysts
R otator interval injuries and
synovitis

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 197
Tendon Injuries and Degeneration

C  alcific tendinopathy (HADD) P ectoralis major tears / avulsion L ong head of biceps instability
Rotator cuff tendinopathy / tears L ong head of biceps dislocation O ther tendon injuries or avulsions
Long head of biceps tendinopathy (e.g., coracobrachialis, short head
/ tears of biceps, etc.)
Subscapularis tear / avulsion
Infraspinatus tear / avulsion

Miscellaneous Disorders

AVN & bone infarcts Traumatic osteolysis of the outer O steochondral lesion OCD
clavicle A cromial apophysitis
S uprascapular nerve palsy S capulothoracic bursitis
Post-op changes & complications A xillary nerve palsy
in humeral head prosthesis Q uadrilateral space syndrome
Parsonage-Turner Syndrome

2. Elbow and Forearm

Normal appearances

P lain film findings M  R findings U ltrasound findings


E lbow ossification centres CT findings A rthrography

Imaging Techniques & Applications

E ssential elbow views: Additional views  T of the elbow


C
A P, lateral Axial M R of the elbow
O blique R adial head-capitellar U S of the elbow
A P and lateral forearm views in Cubital tunnel U S & MR of elbow / forearm
zero rotation S tress for MCL instability nerves

Bony Trauma

C  ommon elbow fractures L ess common elbow fractures S tress fracture of olecranon
(Epicondylar, lateral condylar, (Coronoid, olecranon) Essex-Lopesti fracture/subluxation
capitellar, radial head & neck, Coronoid process fracture
ulnar) P lastic bowing of the forearm
Supracondylar fractures & related bones
complications
Fracture-Dislocations (Monteggia,
Galeazzi)
Nightstick fracture
Greenstick fractures

Joint Injuries & Overuse syndromes

S oft tissue signs of intra-articular L oose bodies and os R adiocapitellar overload syndrome
fracture supratrochleare C apitellar OCD
S upinator sign S ynovial osteochondromatosis Valgus extension overload
Fat fad displacement

Page 198 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Infection & Inflammation

Osteoarthritis P soriatic arthritis B  icipital radial bursitis


Rheumatoid arthritis CPPD O ther arthritides
Gout (Amyloid)
Septic arthritis
Osteomyelitis
Olecranon bursitis

Tendinopathy & Tendon Injuries

Posterior dislocation of elbow B  rachialis injuries


Collateral ligament injuries H yperextension injuries
L ateral epicondylitis
M edial epicondylitis
B iceps tendinopathy and rupture
Triceps tendinopathy and rupture

Neuropathies & Nerve Injuries

BODY SYSTEMS
U  lnar neuropathy R  adial (posterior interosseus)
M edian neuropathy neuropathy
A nconeus epitrochlearis
S ynovial fringe syndrome

3. Hand and Wrist

Imaging Techniques & Applications

E ssential views MRI A dditional views


PA Bone scan P isotriquetral view

O blique Additional views C arpal boss view

L ateral H ook of hamate view A nterior ridge of trapezium

S caphoid view F unctional views for carpal

instability (including stress,


ulnar deviation, clenched fist)
D RUJ instability views

Bony Trauma

Common carpal fractures Phalangeal fractures AVN/OCD of capitate


S caphoid S tress views for thumb MCPJ, & Less common carpal fractures
Triquetral indications Anterior ridge of the trapezium
S caphoid AVN Lunatomalacia Pisiform
Thumb
Nonunion & repair of scaphoid Capitate
fractures
M CP joint (UCL and RCL)
Stress fracture
Fractures at base MC1
Hook of hamate
Volar plate injuries
Pisiform
MCP fracture/dislocations
Distal radial growth plate
CMC joint injuries, esp. 5th

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 199
Joint Injuries, Carpal Instability

S capholunate dissociation SLAC & SNAC wrist


Soft tissue signs of intra-articular DISI & VISI
fracture Lunate & perilunate dislocations
P ronator quadratus fat plane TFCC Injuries
displacement DRUJ instability
S caphoid fat pad displacement

Arthritis & Inflammation

Osteoarthritis S oft tissue abscess U lnar impingement syndrome


Rheumatoid arthritis S eptic tenosynovitis H amato-lunate impingement
Psoriatic arthritis Gout S cleroderma
CPPD Haemochromatosis S LE
Septic arthritis and osteomyelitis Reflex sympathetic dystrophy A cromegaly
O ther arthritides
(e.g. amyloid)

Tendons

E xtensor tendinopathies Tendon injuries P roximal and distal intersection


(de Quervains and ECU) FDP rupture 3 types syndrome
Flexor tendinopathies B owstringing

E xtensor tendon injuries

E xtensor hood injuries

Miscellaneous

Ganglia C  arpal boss syndrome H ypothenar hammer syndrome


Carpal tunnel syndrome
Guyons canal syndrome

4. Pelvis, Hip and Thigh

Imaging Techniques & Applications

X  R AP pelvis M  RI of pelvis & hips U S of groin


NB. int rotation of hips U S of hip joints A dditional views
Lateral views of the hip B one scan of pelvis & hips J udet

Frog leg P rone symphysis

C ross-table O bturator

Sacroiliac joint views F lamingo

CT of pelvic fractures A SIS

L esser trochanter

Bony Trauma

D isruption of the pelvic ring Apophyseal avulsions S tress reaction and fractures
A nterior and posterior column A SIS, PSIS A pophysitis

injury I schial tuberosity Femoral shaft

Pubic rami fractures L esser trochanter Thigh splints


Sacral stress fracture Tensor fascia lata G roin strain osteitis pubis

I liac crest

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Joint / Articular Injuries

D islocations of the hip Transient osteoporosis


Loose hip fragment R egional migratory osteoporosis
A cetabular fractures Nontraumatic avascular necrosis
Femoral neck fractures
S ubcapital

S tress / incomplete

I ntertrochanteric including

classification
Complications e.g, avascular

necrosis (AVN)

Arthritis and Inflammation

Osteoarthritis S ynovial chondromatosis A nkylosing spondylitis


Rheumatoid arthritis Other hip conditions A cromegaly
Septic arthritis L abral tears / cysts D ISH-related (diffuse idiopathic
Sacroilitis Transient osteoporosis skeletal hyperostosis)

BODY SYSTEMS
I diopathic chondrolysis A nkylosis, joint changes in
AVN of the femoral head
paraplegia & quadriplegia
S napping hip syndromes

I liopsoas bursitis, infection


Other septic bursitis

Nerve & Muscle Pathology

Muscle and tendon tears I ntramuscular and intermuscular I nflammatory myopathies


A dductor hematoma Polymyositis

Q uadriceps Peripheral nerve sheath tumours D ermatomyositis

H amstrings Course & injuries to femoral nerve N erve entrapments


G luteus
Necrotising fasciitis O bturator neuropathy

Muscle wasting I ntramuscular abscess S ciatic nerve entrapment

Myositis ossificans Diabetic myonecrosis M eralgia paraesthetica

(Heterotopic ossification) P udental nerve entrapment

Cellulitis G roin hernias (sports hernia)

Post-Treatment Changes

H  ip joint prosthesis & Arthrodesis of hip F emoral rods, nails, plates &
complications Pelvic fracture fixation complications
Radiation necrosis

5. Knee and Leg

Imaging Techniques & Applications

A P, Lateral views F lexed weight-bearing view  R & CT arthrography


X
Intercondylar view (Rosenberg M RI of knee M R arthrography
view) CT of knee U S of knee
Patellofemoral skyline view L eg length assessment (CT, X-ray)
K nee alignment by CT

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 201
Bony Trauma

F racture healing B  one scan findings in fractures P lastic bowing of the fibula
Long bone fractures Fibular head fracture Transient osteoporosis of the knee
Growth plate fractures S tress fractures of the growth
Patellar fractures plates
Bone bruising (MR) E valuation of orthopaedic
Salter-Harris type I fractures prostheses and fixation
Stress fractures of femur, patella, S pontaneous osteonecrosis of the
tibia and fibula knee (SONK)
Osteochrondritis dissecans

Knee Injuries

Common avulsion injuries L ess common avulsions U ncommon avulsions


ACL, PCL, MCL, LCL S egond and reverse Segond G erdys tubercle avulsion

Osteochondral fractures fracture C apsular avulsion

Tibial condyle M edial retinacular avulsion A rcuate avulsion

Femoral condyle from patella B iceps femoris avulsion

Patella A pophysis of tibial tuberosity Vertical patellar fractures


Tibial plateau fracture Q uadriceps avulsion U ncommon meniscal findings
Soft tissue abnormalities on plain Patellar sleeve fractures M eniscal ossicle

films Abnormal ossicles around the Parameniscal cyst

Joint effusion knee M eniscocapsular separation

Lipohaemarthrosis L ess common meniscal conditions Thickening of ligamentum


Chondrocalcinosis D iscoid meniscus mucosum
MCL soft tissue swelling M eniscal cyst O ther patellar conditions
Osteochondral loose bodies Post-operative meniscal Fongs syndrome

D islocations & related change E xcessive lateral pressure

complications L ess common tendon syndrome (ELPS)


Internal derangement pathologies H offas disease

Meniscal tears (all types) Popliteus tendon injury Patellar position & tracking

Ligament tears I liotibial band tendinopathy abnormalities


Posterolateral corner injury and rupture P lica syndrome

Patellar tendinopathy and rupture Q uadriceps tendinopathy and

Patellar conditions rupture


Ganglia periarticular,
intraosseous and cruciate
ligament

Leg Trauma

R  uptured popliteal cyst P roximal tibiofibular joint P roximal tibiofibular joint


Gastrocnemius tear Fractures and dislocations I nstability due to hypoplastic

(tennis leg) facets


Other muscle tears

Arthritis / Synovitis / Bursitis

Osteoarthritis P igmented villonodular synovitis L ipoma arborescens, knee


Rheumatoid arthritis S ynovial osteochondromatosis R eflex sympathetic dystrophy,
Chondrocalcinosis, including CPPD B ursal pathology knee
Popliteal (Baker) cysts P repatellar bursitis H aemophillia
I nfrapatellar bursitis G out
Pes anserine bursitis

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Neurovascular

F or vascular pathology, see VIR P roximal tibiofibular joint


syllabus ganglion causing peroneal nerve
entrapment

6. Ankle and Foot

Normal Appearances & Functional Asoects

A natomy of ankle ligaments


L ateral ligament complex

D eltoid ligament

D istal tibiofibular syndesmosis

Biomechanics of a diastasis injury

Imaging Techniques & Applications

A P, Lateral views M  RI of foot & ankle A dditional Ankle views


Mortise view U S of the Achilles tendon I mpingement

BODY SYSTEMS
Views of toes U S of foot and ankle Weight bearing

Oblique views S tress

CT for complex fractures P roximal fibular shaft for

Bone scan Maisonneuve fracture


A dditional foot views
A xial heel

Weightbearing

N avicular

H arris-Beath

P lantodorsal midfoot

O s tibiale externum

S kyline sesamoids

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 203
Ankle Injuries

Common Ankle Fractures M  idfoot injuries A nkle impingement


Weber classification L isfranc fracture-dislocation A nterolateral

D upuytrens fracture Osteochondritis dissecans OCD A nteromedial

M aissoneuve fracture talar dome Posterolateral Ankle arthrofibrosis


Posterior lip of distal tibia AVN of the talus C lassification of talar dome
M edial malleolus S tress Fractures fractures
Commonly missed hindfoot D istal fibula L auge-Hansen classification of
fractures D istal tibia ankle injuries
Talar dome Talar neck and lateral process

Tibial plafond D istal tibial growth plate

A nterior process of calcaneum O ther ankle ligament injuries

Posterior process of talus A nterior talofibular ligament

L ateral process of talus (ATFL)


Talar neck

Calcaneal fracture classification &


analysis
Subtalar dislocation
A vulsion fractures & ligament
injuries
L CL complex

D eltoid ligament

D istal tibiofibular syndesmosis

Foot & Ankle Tendon Injuries & Tendinopathies

A chilles tendinosis & tear H  aglund syndrome (retrocalcaneal


bursitis)
Tibialis posterior tendon injuries &
tenosynovitis
P lantar fasciitis
Other heel conditions
P lantar fibromatosis

Painful os tibiale externum


Other tendinopathy &
tenosynovitis
F DL

FHL

Peroneal

Tibialis anterior

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Foot Injuries

Forefoot fractures & dislocations Other Hindfoot conditions M  ueller-Weiss syndrome


B ase of fifth metatarsal Tarsal coalition (spontaneous atraumatic
Fractures of tarsal bones S inus tarsi syndrome osteonecrosis of the tarsal
M idtarsal fractures & Tarsal tunnel syndrome navicular)
dislocations O ther tarsal stress fractures
O ther conditions of the forefoot
B unionette formation
M etatarsal fractures (acute & 2 nd MT base stress fracture

stress) Painful os intermetatarseum


S pecial 5th MT fractures

Fractures & dislocations of toes M ortons neuroma


S piral distal shaft

J ones fracture

Fracture of the tubercle

Other forefoot injuries


Turf toe

P lantar plate rupture

Toe deformities

S esamoid stress fractures,

sesamoiditis

BODY SYSTEMS
H allux valgus and metatarsus

primus varus
H allux rigidus

Freibergs infraction

Arthropathy and Infection

Osteoarthritis  idfoot ganglia


M A cromegaly
Post-traumatic arthritis Neuropathic (Charcot) foot H emochromatosis
Rheumatoid arthritis Diabetic foot
Septic arthritis and osteomyelitis R eiters syndrome
Reflex sympathetic dystrophy

7. The Spine (For Spinal Cord & Nerves, See Neuro Syllabus)

Congenital and Developmental Disorders (Also see Paediatric Syllabus)

Chiari I malformation Failure of vertebral formation M eningocoeles


Neurofibromatosis Type 1 Partial vertebral duplication D ural dysplasia
Neurofibromatosis Type 2 Vertebral segmentation failure M ucopolysaccharidoses
Idiopathic scoliosis K lippel-Feil spectrum S ickle cell disease
Congenital scoliosis and kyphosis Congenital spinal stenosis O steopetrosis
Schmorl node Neuromuscular scoliosis O chronosis
Scheuermann Disease I diopathic kyphosis C audal Regression Syndrome
Tethered cord Connective tissue disorders N eurenteric cyst
D iastematomyelia Achondroplasia O steogenesis imperfecta
Posterior element incomplete
fusion
S acrococcygeal teratoma

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 205
Spinal Infections and Inflammatory Disorders

Infections
D iscitis (pyogenic, TB) Granulomatous osteomyelitis E chinococcus
E pidural abscess HIV S chistosomiasis
Subdural abscess S pinal meningitis C ysticercosis
Paraspinal abscess S eptic facet joint arthritis
Osteomyelitis P seudoinflammatory:
pseudoarthrosis of ankylosing
spondylitis

Spine Post-procedural Imaging

Post-operative Imaging and Complications


 ecurrent vertebral disc herniation
R P seudomeningocoele
Post-operative infection B one graft complications
Peridural fibrosis
H ardware failure

Cervical Spine

Routine Non-trauma Views Additional non-trauma views


N eutral lateral F lexion and extension

A P from C3 toT1 A dditional trauma views

A P atlantoaxial region  Swimmers view

A P obliques O ther Injuries

A cute trauma Views R otary atlantoaxial subluxation

C ross-table lateral R adicular symptoms following

W ith clinical neuropathy cervical spine injury


CT or MRI Neurocentral joint degeneration
A P views after lateral view R heumatoid arthritis, esp. atlanto-
cleared axial subluxation
F lexion and extension with

patient UNAIDED!!
S pinal alignment signs

P revertebral soft tissue

swelling
H yperflexion injuries
Wedge compression fracture

 Clay shovelers fracture

F lexion teardrop fracture

U nilateral or bilateral

facet dislocation / fracture


dislocation
A cute disc protrusion

H yperextension injuries
F racture of the posterior arch

of the atlas
E xtension sprain injuries

E xtension teardrop fracture

H angmans fractures

Odontoid process fracture


Jefferson fracture

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Thoracic Spine

Routine views Additional views


A P weight bearing L ateral centred on the
Lateral (long exposure) thoracolumbar junction
A cute trauma Cross-table lateral if unable to
Wedge compression fractures stand
A ge of fractures Other injuries
Burst fractures Thoracic disc protrusion
Fractures and dislocations

Lumbar Spine

Routine views Bone scan, including SPECT


A P S tress fractures of the spinous
L ateral process
C oned lumbosacral junction Interspinous bursopathy
3 0 angled sacroiliac joints
Other conditions
L imbus vertebra
A dditional views

BODY SYSTEMS
S chmorls nodes
O blique views
S cheuermanns disease
A cute trauma
L umbosacral pseudarthrosis
Wedge compression

B urst fracture

Transverse process

C hance injuries

I njury to ring apophysis

Vertebral osteonecrosis
Bone stress and stress fractures of
the pars
Sacroiliitis
D iscitis & vertebral osteomyelitis

Degenerative Spinal Conditions & Arthritides

D  egenerative disc disease OPLL N  eurogenic (Charcot) arthropathy


nomenclature Degenerative scoliosis S eptic arthritis facet joint
D egenerative disc disease Facet joint synovial cyst O ssification of ligamentum flavum
B ulge Ankylosing spondylitis
D isc annular tear GIT-related spondylitides
D isc herniation, cervical S eptic arthritis sacroiliac joint
Foraminal disc extrusion

D egenerative endplate changes

Spondylolisthesis
Instability
Spondylosis
A cquired spinal stenosis
D ISH
Facet arthropathy
Rheumatoid arthritis
E pidural lipomatosis

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 207
8. Bone Dysplasias (also see Paediatric Syllabus)

M  ultiple Hereditary Ollier disease M ucopolysaccharidoses


Osteochondromas (diaphyseal M affucci syndrome S pondyloepiphyseal dysplasias
aclasis) Achondroplasia
Neurofibromatosis Osteogenesis imperfecta
M eleorrhostosis
Osteopoikilosis
Trevors disease

9. Bone Marrow & Metabolic Diseases

Osteoporosis Hemochromatosis O  steopenia / osteoporosis related


Osteomalacia Hemosiderosis to primary bone tumour
Renal osteodystrophy M yelofibrosis G auchers Disease
Patchy red marrow E xtramedullary hemopoiesis
Leukemia Hyperparathyroidism
Radiation changes I mmune suppression states
Treatment-related benign reactive
changes
Haemoglobinopathies
Thalassaemia
S ickle cell anaemia

10. Peripheral Nerve Conditions

Muscle denervation B rachial plexus pathology I diopathic brachial plexus neuritis


Thoracic Outlet Syndrome Trauma H ypertrophic neuropathy
Common nerve entrapments Traumatic neuroma Peripheral neurolymphomatosis
Median nerve R adiation plexopathy L eprosy
S uperior sulcus syndrome

O ther entrapment neuropathies

S upracapsular n.

Posterior interosseus n.

R adial n.

U lnar n.

Femoral n.

Posterior tibial n.

C ommon peroneal n.

11. Bone Tumours

Imaging Methods
X-Ray M RI B
 iopsy methods (appropriate
CT surgical consultation first!)
Nuclear imaging
Secondary Malignancy
M  etastases, lytic
Metastases, blastic
Multiple myeloma

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Primary Osteoblastic
Osteoma Osteoblastoma
Osteoid osteoma
Osteosarcoma
Primary Cartilaginous
E nchondroma Chondromyxoid fibroma
Osteochondroma
Chondroblastoma
Chondrosarcoma
Primary Fibrous
F ibrous dysplasia Fibrosarcoma Fibroxanthoma
Nonossifying Fibroma
Fibrous cortical defect
Malignant fibrous histiocytoma
Miscellaneous
Giant cell tumour E wing sarcoma A damantinoma

BODY SYSTEMS
Intraosseous haemangioma Lymphoma
A neurysmal bone cyst P lasmacytoma
Multiple myeloma Chordoma
Tumour-Like Lesions
 nicameral bone cyst
U B  rown tumour Thoracic elastofibroma
Intraosseous lipoma B one infarct
H eterotopic ossification
Paget disease

12. Soft Tissue Tumours

Imaging Methods
X-Ray CT U  ltrasound (cyst vs. solid)
MRI N uclear imaging
B iopsy methods (appropriate
surgical consultation first!)
Secondary Malignancy
Lymph node metastases M  etastases, muscle
M etastases, fat
Primary Fatty
Lipoma
Liposarcoma
Primary Fibrous
F ibromatosis / desmoid Fibrosarcoma, soft tissue
Malignant fibrous histiocytoma
Other Primary Soft Tissue Tumours
Synovial sarcoma S oft tissue chondroma
S oft tissue chondrosarcoma
L eiomyosarcoma
R habdomyosarcoma

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 209
Peripheral Nerve Tumours
B  enign peripheral nerve sheath M  alignant peripheral nerve sheath
tumour tumour
Neurofibroma, solitary Neurofibroma, plexiform
Primary Vascular
Capillary haemangioma A ngiosarcoma
Lymphangioma
Capillary malformation
(e.g. Sturge Weber syndrome)
Venous malformation
A rteriovenous malformation
Miscellaneous Tumours and Tumour-Like Lesions
Pigmented villonodular synovitis G  iant cell tumour of the tendon E lastofibroma of the chest
Synovial osteochondromatosis sheath
Myositis ossificans Aneurysm
Tumoral calcinosis Venous varix
Soft tissue ganglion U nrecognised muscle tear
Apophyseal avulsions

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Paediatric Imaging Learning Indications/contraindications for Paediatric Imaging/
specific protocols.
Competencies
Equipment and Techniques
The competent (trainee) radiologist will be able to:

Limitations of Plain X-ray /Fluoroscopic Procedures


Demonstrate a clinical, pathological and radiological
X-ray image Quality Assessment in Paediatric Imaging
understanding of paediatric disease
Interpret common and important clinical presentations
Ultrasound
in Paediatric Imaging
Demonstrate knowledge of the special conditions
Knowledge
related to the paediatric imaging examination including
increased patient sensitivity to radiation, often limited
Safety
co-operation and comprehension, potential emotional
stress and possible need for sedation. There is also a
Indications/contraindications for Paediatric Imaging
need to empathise with anxious parents.
Ultrasound/specific protocols
Identify the likely paediatric abnormalities that may be
encountered and assessed in a general practice.
Equipment and Technique

BODY SYSTEMS
CORE KNOWLEDGE
Ultrasound Image Quality Assessment
Limitations of Ultrasound in Paediatric Imaging
Interacts effectively with other health care team
members such as medical imaging staff, the childs
CT Scanning
parents/carers, paediatric clinicians, GPs and relevant
statutory authorities during management of paediatric
Knowledge
conditions.
Explain the strengths, weaknesses, risks and roles of
Safety / Scan Preparation / Contrast Use (IV/ Oral) /
the imaging modalities, currently used in diagnosing
Radiation Safety Dosimetry (ALARA principle) and Dose
and evaluating paediatric abnormalities (to the parents/
Reduction / Technical Factors
carers and sometimes to the child). The trainee needs
Indications/contraindications for Paediatric Imaging CT /
to demonstrate knowledge of the different range of
Specific Protocols
pathology depending on the childs age and clinical
features on the interpretation of investigations. (E.g. a
Equipment and Technique
vascular renal mass in a neonate vs. a child of 4 years
with a supra renal mass and elevated urinary VMA etc).
CT Image Quality Assessment
Describe and direct assessment or work-up of a clinical
Limitations of CT in Paediatric Imaging
finding using imaging methods as appropriate.
Recognise when referral to a tertiary centre is necessary. MRI Scanning
Acts effectively in the paediatric setting in order to
maximise the likelihood of a successful diagnostic study. Knowledge
Recognise and act upon an inadequate examination and
suggest further investigations or referral to a paediatric Safety / Scan Preparation / Contrast Use / MRI General
centres. Safety / Technical Factors
Indications/contraindications for Paediatric Imaging MRI
Plain X-ray / Fluoroscopy / Specific Protocols

Knowledge
Equipment and Technique

Safety / Preparation / Contrast Use (IV/ Oral) / Radiation


MRI Image Quality Assessment
Safety Dosimetry and Dose Reduction / Technical Factors
Limitations of MRI in Paediatric Imaging

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 211
Nuclear Medicine Acts Safely

Knowledge Correctly assign the class of diagnosis based on the


imaging appearances when this is possible, (E.g. benign/
Safety / Radiopharmaceutical Use (Labeled RBC /DTPA normal variant/ inflammatory processes/neoplasm),
MAG III DMSA) / Radiation Safety Dosimetry and Dose suggesting appropriate diagnoses for age and to direct
Reduction further assessment where required.
Nuclear Medicine GIT Bleeding Studies Recognise and act appropriately upon imaging signs of
Meckels Scans a paediatric emergency.
DTPA / DMSA / MAG III) Correctly categorise indeterminate findings and to
Demonstrate knowledge of the principles/ limitations/ guide investigation appropriately and this also includes
indications of MIBG / / PET Scans in Paediatric Imaging referral to a paediatric radiology centre.
Appreciate the age of consent and the need for full
Equipment and Technique: Basics only disclosure of the benefit and risk of a particular
examination and procedure. Consent is required
NMCT Image Quality Assessment (either verbally or in writing) before an examination or
Limitations of NMCT in Paediatric Imaging procedure is to be performed.
Recognise the radiological findings of child abuse and
KEY SKILLS suggest relevant further investigations.

Interpret the examination accurately and safely Convey findings


Recognise normal paediatric anatomy, range of variants
and changing appearances with age and physiological Communicates relevant findings including diagnoses,
states; including recognising normal imaging findings treatment plans, complications and follow up to the
or those that require limited work-up to arrive at the referring clinician, parents/carers and other health care
diagnosis. team members and assists in formulating an imaging
Conduct a thorough and systematic review of the and management plan as necessary.
imaging examination and to recognise relevant
abnormalities. Radiological Interventions & Paediatric procedures
Correctly describe the likely site of abnormalities on
imaging examination. (e.g. diaphyseal destructive Describe, perform with systematic approach to imaging
lesion, suprarenal mass). Within the limits of clinical and recognition of pathology and correctly evaluate:
information available, to integrate broader knowledge  A micturating cystourethrogram recognise vesico-
of pathology (e.g. epidemiology, gross morphology, ureteric reflux, duplex system, trabeculated bladder
and possible ancillary tests), clinical presentations and and posterior urethral valves
imaging appearances to form an appropriate differential  An airways and chest screening for diaphragmatic
diagnosis. movement and tracheomalacia.
Evaluate the imaging study in light of differential  A barium swallow for vascular ring/sling and gastro-
diagnoses to identify clinically relevant findings. oesophageal reflux
Activities may include eliciting clinically relevant  A non-ionic contrast / barium meal recognise to
findings or appropriate further investigative pathways assess malrotation or volvulus
including talking to and examining the patient. Discuss US renal tract
the case with the referring clinicians, the parents/ US cranial
carers, reviewing previous imaging, reviewing relevant US hip for DDH and joint effusion
literature and providing suggestions for further imaging US pylorus
which may include biopsy or other interventional US intussusception
procedure.
Describe the technique for, risks of and
contraindications to contrast media enema studies in
the evaluation of common paediatric distal small bowel

Page 212 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
and large bowel pathologies, including hirschsprungs
disease, Microcolon, colonic and ileal atresia and
meconium ileus.
Reference for Paediatric Imaging Radiation Dose
The Image Gently Campaign (lower radiation dose in the
imaging of children)

http://www.pedrad.org/associations/5364/ig/

Paediatric Normal Variants

There are numerous normal variants in children and


adolescents in virtually all body systems.

Atlas of Normal Variants that May Simulate Disease.


Theodore E. Keats, Mark W. Anderson. (most upto date
version available)

BODY SYSTEMS

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 213
Paediatric Imaging Clinical Conditions
Note there is extensive overlap with the adult syllabus in the various body systems. Some of the required paediatric syllabus
is included in the adult syllabus.

Category 1 Category 2 Category 3


NEONATES & FIRST 3 MONTHS

1. Head and spine

Aqueduct Stenosis Common Orbital lesions Hydranencephaly


Arachnoid cyst Dandy Walker spectrum Septo-optic dysplasia
Callosal dysgenesis E ncephalocoeleHoloprosencephaly Hemimeganencephaly
Chiari malformations spectrum
Choanal atresia Neuronal migrational
Hydrocephalus abnormalities
Infections meningitis and Porencephaly
encephalitis TORCH Infections
Intracranial haemorrhage Vein of Galen Aneurysm
Neonatal encephalopathy
(Hypoxic Ischemic Injury)
Neoplasms supra and infra
tentorial tumours
Abusive Head Trauma
Periventricular Leukomalacia
Trauma

2. Neck

Congenital abnormalities e.g. L ingual thyroid / / Thyroid


Branchial abnormalities agenesis
Thyroglossal duct cyst Torticollis
Fibromatosis colli Vascular Malformations e.g.
Lymphadenitis lymphangioma
Neoplasms e.g.
haemangioma, neuroblastoma,
rhabdomyosarcoma
Prevertebral abscess
Trauma e.g. Cervical spine
fractures and normal variants
simulating fractures

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3. Chest

A ssessment of Intravascular lines Aortic Co-arctation Ebsteins anomaly


and ET tubes B ronchopulmonary foregut Neonatal VSD /ASD / TAPVD
Chronic Lung Disease of malformations e.g. Bronchial Pericardial defects
Prematurity Atresia, Congenital lobar Pleuropericardial cyst
Diaphragmatic Hernia overinflation, CPAM, Pulmonary Pulmonary Haemorrhage
Hyaline membrane disease Sequestration P ulmonary Hypoplasia/congenital
Infections including bronchiolitis, Dextrocardia and anomalies of venolobar syndrome
pneumonia, abscesses and situs Truncus Arteriosus
aspiration Persistent Pulmonary Hypertension
Meconium Aspiration Tetralogy of Fallot
Neonatal mediastinal masses Transposition of the Great vessels
(Normal thymus / masses benign Variants of aortic arch and major
and malignant) branch anomalies
Neonatal Pneumonia and Vascular rings/slings
Aspiration
Oesophageal atresia and tracheo-

BODY SYSTEMS
oesophageal fistula
Patent Ductus Arteriosis
Pulmonary Interstitial Emphysema
Pneumothorax/
Pneumomediastinum
Transient tachypnoea of the
Newborn

4. Abdomen & Pelvis

Stomach & Duodenum, Spleen


Duodenal Atresia and Web Duplication Cysts
Gastroesophageal reflux Gastroschisis
Malrotation with or without small Omphalocoele
bowel volvulus Trauma
Pyloric Stenosis
Small and Large Bowel
Hirschsprungs disease Anal atresia Colonic atresia
Ileal Atresia & Stenosis Colonic Duplication
Meconium Ileus
Meconium peritonitis
Meconium Plug Syndrome/small
left colon
Microcolon
Necrotising Enterocolitis
Pancreas & Retroperitoneum
A drenal haemorrhage Annular pancreas
Neuroblastoma Pancreatitis
Hepatobiliary
Neonatal hepatitis / Biliary atresia C  holedochal cyst B ile plug syndrome
H epatoblastomas L iver tumours non Liver Transplantation
H aemangioma/ hepatoblastoma Spontaneous bile duct perforation
haemangioendothelioma Vascular Malformations

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 215
Kidneys & Urinary Tract
Nephroblastomatosis Anomalies of renal / position H US
Non-obstructive/non-refluxing and fusion: Including Horseshoe/ Neurogenic bladder
(primary) megaureter Ectopia/ Duplex/ Crossed Fused Renal vascular accident
Posterior urethral valves Ectopia Sacrococcygeal teratoma
PUJ/ VUJ obstruction Autosomal dominant and recessive
Pyelonephritis Polycystic Kidney Disease
Urachal anomalies Mesoblastic Nephroma
Ureterocoele Multicystic dysplastic Kidney
Vesicoureteric Reflux Nephrocalcinosis
Wilms Tumour
Genital Systems (Some overlap with O&G, Abdomen curricula)
H ernias Abnormalities of uterine fusion Foreign bodies
/ development and uterine
obstruction
Cryptorchidism
Epididymitis
Hydrocoele
Testicular/ovarian neoplasm
Testicular trauma
Torsion of the testicular appendix
Torsion testis/ovary
Varicocoele
Vascular
H aemangiomas AVM Vascular tumours
Vascular malformation e.g. (other than haemangioma)
Lymphatic Malformation/ Venous
Malformation

5. Neonatal Imaging Techniques and Applications

CXR  T brain, skull & spine


C
A XR U S of spine
Skeletal XR & survey M RI of brain & pituitary
Skull x-ray M RI of spine
IVP
MCU
US of abdomen & pelvis
US of brain
Barium swallow
Barium meal
Barium enema

THE BABY, TODDLER, CHILD AND ADOLESCENT

1. Head, Neck & Spine

Normal refer to adult syllabus


Sutures on x-ray and CT N
 ormal appearances of the
cerebrum at different ages &
normal myelination

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Developmental (Some overlap with Neuro Syllabus)
B enign macrocrania of infancy Arachnoid cyst F ibrous dysplasia
(increased subarachnoid fluid Branchial cleft cyst R athkes cleft cyst
space of infancy) Colloid cyst
Craniosynostosis M alformations of cortical
Dermoid, epidermoid cyst development
Heterotopic grey matter

Lissencephaly

Schizencephaly

Pachygyria - polymicrogyria

Neurocutaneous / Phakomatoses
N  eurofibromatosis 1 Tuberous sclerosis
Neurofibromatosis 2 Von Hippel Lindau
Neoplastic and Hamartomatous
(Some overlap with Neuro syllabus; NB. Different categories for Adult vs. Children)
C  horoid Plexus Papilloma/ Haemangioblastoma H amartoma of the tuber cinereum

BODY SYSTEMS
carcinoma Langerhans cell histiocytosis
Craniopharyngioma Oligodendroglioma
Ependymoma Rhabdomyosarcoma
Gliomas (including brain stem and
optic nerve)
Medulloblastoma
Pilocytic Astrocytoma
Pineal tumours
Pituitary tumours
Retinoblastoma
Vascular
Vascular malformations M  oya moya
Venous thrombosis S turge-Weber Syndrome
Infective
M  eningitis / Cerebral abscess ADEM
Retropharyngeal abscess Transverse myelitis
Sinusitis, tonsillitis and enlarged
adenoids
Trauma
Intra cranial haemorrhage S hearing injuries
NAI abusive head trauma
Skull fractures and complications
Miscellaneous
Dysmyelination syndromes MELAS
Leighs disease
Spine
Scheuermanns condition Inflammatory Spinal diseases
Scoliosis idiopathic/ congenital Sacrococcygeal Teratomas
Spinal dysraphism Spinal Bone Tumours
Spinal Cord Tumours
Tethered cord

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 217
Imaging Techniques and Applications (Paediatric Neuro, H&N, Spine)
Skull x-rays Angiography
Spinal x-rays M R angiography
A irway x-rays M yelography
CT skull and brain L umbar puncture
MRI of brain
MRI of pituitary
CT of spine
MRI of spine

2. Chest (Incl. Heart)

Normal see adult chest syllabus


Thymus

Developmental
Bronchogenic cyst Agenesis/aplasia
Dextrocardia/Situs inversus K artagener and immotile cilia
Diaphragmatic Hernia syndrome
Laryngomalacia Neurogenic and oesophageal
Tracheomalacia duplication cysts
Swyer-James syndrome
Traumatic
P neumatocoele

Neoplastic and hamartomatous


Mediastinal lymphoma Dermoids
Mediastinal germ cell tumour
Lymphangioma
Thoracic neuroblastoma
Infective
Bronchiolitis
Croup
Epiglottitis
Non-resolving pneumonia
including tuberculosis / chronic
aspiration / bronchiectasis/ foreign
body/ abscess & empyema
Typical and atypical pneumonias
Miscellaneous
Foreign body Histiocytosis
A sthma Tuberous sclerosis
Cystic fibrosis
Vascular
A SD/ VSD/ PDA and left to right P artial anomalous Pulmonary
shunts Venous drainage
A cute pulmonary oedema/ fluid Reduced pulmonary vasculature
overload Tetralogy of Fallot

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Imaging Techniques and Applications (Paediatric Chest)
CXR CT Chest MR Chest
Airway x-rays

3. Musculoskeletal

Normal see adult MSK syllabus


Developmental & Nutritional
DDH Osteochondroses C ongenital Pseudarthrosis of the
Fibrous dysplasia Rickets tibia
Osgood-Schlatters Talipes Equinovarus Heavy metal Poisoning
Perthes Disease Tarsal Coalition Scurvy
Slipped capital femoral epiphysis Vertebral Segmentation anomaly, Vertical Talus
Thalassemia including Klippel-Feil Syndrome
VACTERL Deformity Discoid meniscus
Inherited
Achondroplasia Cleidocranial dysostosis

BODY SYSTEMS
Haemophilia MPS
Osteogenesis Imperfecta Osteopetrosis
Osteopoikilosis
Sickle cell disease
Traumatic
Fractures
Greenstick

Plastic bowing

Salter harris

Torus

Fracture Dislocation
monteggia
Epiphyseal/apophyseal avulsion
Injury to the physis
Non-Accidental injury
Stress and toddlers fractures
Bone Infarction / osteonecrosis
Infective & Inflammatory
Brodies abscess
Juvenile inflammatory arthritis
Osteomyelitis / Discitis
Septic Arthritis
Transient Synovitis

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 219
Neoplastic, hamartomatous and related conditions
Aneurysmal Bone Cyst Chondroblastoma Adamantinoma
Ewings Sarcoma Fibromatoses Chondromyxoid fibroma
Cartilage tumours Metastases
Enchondroma

Olliers

Fibrous dysplasia
Langerhans Cell Histiocytosis
Osteosarcoma
Osteochondroma
Non-Ossifying Fibroma/ Fibrous
cortical defect
Osteoid Osteoma/ Osteoblastoma
Unicameral Bone Cyst
Vascular tumours
Imaging Techniques and Applications (Paediatric MSK)
X-rays C  T scan U S of other joints
Skeletal survey M RI scan
US of hip joint
Bone scan

4. Abdomen & Pelvis

Normal
Developmental
Duplex kidney and complications Biliary atresia Mesenteric cyst
Multicystic dysplastic kidney Meckels diverticulum Urachal rest
PUJ obstruction Choledochal cyst
Traumatic
A ssessment of major blunt trauma Testicular trauma
and visceral perforation
Torsion testis/ovarian
Neoplastic and hamartomatous
Liver Haemangioma Hepatoblastoma
Nephroblastomatosis Fibrolamellar hepatoma
Neuroblastoma and Multilocular cystic nephroma
ganglioneuroma
Ovarian teratoma
Wilms tumour
Infective / inflammatory
Appendicitis & mesenteric adenitis Epididymitis C holecystitis and cholelithiasis
Bladder and upper tract urinary
infection including: Pyelonephritis
and renal abscess
Inflammatory bowel disease
Hydronephrosis
Reflux nephropathy

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Vascular
H  enoch-Schonlein Purpura Liver transplant
K awasakis disease Renal transplant
Miscellaneous
Intussusception Coeliac disease I ngested foreign bodies and
Reflux oesophagitis and hiatus Hydrometrocolpos bezoar
hernia C aroli disease
Imaging Techniques and Applications (Paediatric Abdomen, Pelvis)
A XR E nteroclysis E RCP
IV Pyelogram R enal scintigraphy M RCP
MCU I ntussusception reduction M RI of the liver
Barium swallow M RI of the pelvis
Barium meal A bdominal angiography
Small bowel follow through
Barium enema
CT abdomen & pelvis
US abdomen & pelvis

BODY SYSTEMS
US of urinary tract
US of appendix

5. Other Systemic Conditions

Chromosomal
D owns syndrome M arfan syndrome N oonan syndrome
Turners syndrome
Other
Leukaemia and Lymphoma M astocytosis

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 221
Breast Imaging Learning Distinction between screening and diagnostic
mammography
Competencies Role of Ultrasound Screening in dense breasts
Role of MRI screening in high risk women
The competent (trainee) radiologist will be able to:

CORE KNOWLEDGE
Demonstrate a clinical, pathological and radiological
understanding of breast disease.
Explain the strengths, weaknesses and risks (radiation
Interpret common and important clinical presentations
related and other) of the imaging modalities
in breast imaging practice for example
currently used in diagnosis and assessment of breast
abnormalities.
Breast lump
Describe/direct assessment or work-up of a clinical
Breast pain
problem or imaging finding using imaging methods as
Nipple discharge
appropriate.
Recognise and act upon an inadequate examination.
Describe the pathology of breast disease
Be able to recommend follow-up imaging at later time
interval when appropriate.
Incidence of carcinoma of the breast
Risk factors:
Mammography
racial

genetic
Knowledge
hormonal

dietary
Basic physics of mammography including exposure
Other
factors
Basic knowledge of film-screen mammography units
Local spread
Comparison of film/screen vs digital mammography
Patterns of metastatic disease in breast carcinoma
Comparison between CR vs full field Digital (DR)
Staging of breast carcinoma
Standard mammography positioning techniques
Survival rates
Rationale for compression and magnification
Other types of breast disease as listed in the level 2
Image quality assessment criteria
document
Mammography quality control procedures
Special mammography positions and techniques
Explain basic principles and issues of screening related
Imaging of breasts with implants
to breast cancer in Australia and New Zealand
Radiation related mammography risk

Aim of Screening Ultrasound


Target group
Differences between opportunistic and population Knowledge
screening
Screening intervals including at risk screening Indications/contraindications for use of breast
Randomised controlled trials methodology ultrasound
False negative rates Ultrasound equipment and technique
Interval cancer rates Ultrasound image quality assessment
Screening artefacts: Limitations of breast ultrasound
Lead-time bias

Length bias

Screening controversies
Cost effective screening
Genetic factors including BRCA-1 and BRCA-2 genes
and gene testing.

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MRI Distinction between malignant and benign (invasive and
non invasive) mammographic features
Knowledge Lesion localisation techniques (Clock face vs quadrants)
Unusual mammographic patterns of malignant breast
Indications/contraindications for use of breast MRI pathology
Standard MRI breast sequences Unusual mammographic patterns of benign breast
Special sequences for assessment of breast implants pathology
MRI image quality assessment Imaging the post-operative breast
Limitations of breast MRI Commonly missed lesions on mammography
Mammographic artefacts
CT Implant mammography
Normal ultrasound breast anatomy
Knowledge Ultrasound differentiation between benign and
malignant disease
Use of CT in breast cancer staging Ultrasound features of cysts
Common CT appearances of metastatic disease in Breast implant ultrasound
breast carcinoma Normal MRI breast anatomy

BODY SYSTEMS
Accuracy of CT compared with other modalities MRI differentiation between benign and malignant
Role of CT in detection of incidental breast lesions disease
MRI features of cysts
Nuclear Medicine Breast implant MRI

Knowledge KEY SKILLS

Imaging findings in benign and malignant breast Interpret the examination accurately and safely
disease using Tc-sestamibi or Tc-tetrofosmin Recognise the normal breast anatomy, range of variants
scintimammography and changing appearance with age and physiological
Indications/contraindications for Nuclear Medicine bone states; recognise normal imaging studies.
scanning in breast cancer staging Recognise breast pathology: benign, in-situ and invasive
Indications/contraindications for PET or PET/CT in breast lesions.
cancer imaging Conduct a thorough and systematic review of the
Accuracy of PET or PET/CT compared with other imaging examination and perceive relevant findings,
modalities positive and negative.
Describe assessment or work-up of a clinical problem Within limits of information available, form an
or mammographic finding using imaging methods as appropriate differential diagnosis by integrating
appropriate imaging findings with broader knowledge of clinical
Recognise and describe imaging findings in the presentation, epidemiology, pathology, and ancillary
breast tests.
Evaluate the imaging study in light of differential
Normal mammographic anatomy and development; diagnoses to identify clinically relevant findings.
patterns and variations with age
Mammographic features of breast pathology: Acts Safely
asymmetric density

circumscribed mass Recognise imaging signs suspicious of malignant breast


stellate lesion disease.
architectural distortion Safely assign a benign diagnosis and discriminate such
micro-calcifications cases from those that require further assessment.
macro- calcifications Correctly categorise indeterminate findings and guide
further investigation if required.

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 223
Triple Test

Explain the importance of the triple test, i.e.


concordance between imaging, clinical and pathological
findings in formulating a management plan.

Convey findings

Communicates relevant findings including diagnoses,


treatment plans, complications and follow up to the
referring clinician, patient and or family/carers and other
health care team members and assists in formulating an
imaging and management plan as necessary.

Radiological Interventions

Demonstrate knowledge of breast interventional


procedures including the role of procedures, associated
complications and their management.
Principles, indications and technique of:
Fine needle aspiration
Core biopsy
Methods of stereotactic and vacuum assisted biopsy
Ultrasound guided biopsy
MRI guided biopsy
Causes of biopsy sampling error
Management of potential complications
Specimen handling and radiography
Localization techniques:
Hook wire

Carbon tracing

Sentinel node mapping

Clinical trials of isotope seeds for localising lesions

Principles and indications of Ductography


Communicating effectively with patients and clinicians
regarding the benefits and risks associated with
different diagnostic modalities and procedures.

Page 224 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Breast Imaging - Normal Variants
Category 1 Category 2 Category 3
NORMAL VARIATIONS OF THE BREAST

E xtraneous to breast Accessory nipples Polands syndrome


Cassette artefacts Variations of lymphatic drainage
D eodorant artefact Sentinel node(s)

Normal lymph nodes & lymphatic A xillary

drainage I nternal mammary


Skin lesions I nfraclavicular
Sternalis Contralateral
Normal breast
Normal asymmetry
A ccessory glandular tissue
Variation in appearance over time
/ hormonal state
Normal chest wall

BODY SYSTEMS
Breast Imaging Clinical Conditions
Category 1 Category 2 Category 3
1. Breast Cancer Screening

P rinciples of mammographic I ndications for ultrasound and A lternative breast screening


screening MRI in breast screening methods
E vidence for population screening C omputer aided diagnosis
Population vs. sporadic screening
Categorisation in breast screening

2. Malignant Disease

Invasive breast cancer I nflammatory carcinoma S arcomas of the breast


D uctal Papillary carcinoma M etastatic disease to the breast
Lobular I ntracystic carcinoma Lymphoma of the breast
Subtypes (medullary, tubular, Atypical ductal hyperplasia M ale breast cancer
mucinous) Columnar cell change Pagets disease of the breast
D CIS P hylloides tumour
I nvestigation of axillary
lymphadenopathy

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 225
3. Benign Disease

Fibroadenoma P ost operative appearances  anagement of breast pain


M
Breast cysts e.g. seroma, scarring, breast C osmetic oil and gel injections
Simple reconstruction, reduction D iabetic mastopathy
Complex mammoplasty M ultiple papillomatosis
Breast abscess Giant fibroadenoma G ranulomatous mastitis
H amartoma and lipoma LCIS Chronic breast abscess
Benign breast calcifications Radial scar
Breast hematoma Ductal papilloma
Fat necrosis Usual ductal hyperplasia
Sclerosing adenosis and fibrocystic Lymphoedema of the breast
change Gynaecomastia
Breast abscess and mastitis B reast implants Types
& Complications

Techniques & Applications for Breast Imaging


 ammography, analogue
M Vacuum-assisted biopsy F eatures of cancer on breast MRI
Mammography, CR & digital Hook wire localisation C auses of false positives on breast
Common mammographic artifacts I ndications for breast MRI MRI
Mammography-ultrasound lesion Principles of BI-RADS
correlation
Ultrasound of the breast
Triple-test principle
Fine-needle biopsy
Core biopsy

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Obstetric and Gynaecological Equipment and Technique

Imaging Learning Competencies Ultrasound Image Quality Assessment


Limitations of Ultrasound in O&G Imaging
The competent (trainee) radiologist will be able to:

CT Scanning
Demonstrate a clinical, pathological and radiological
understanding of O&G disease.
Knowledge
Interpret common and important clinical presentations
in O & G imaging
Safety / Scan Preparation / Contrast Use (IV/ Oral)
Explain the basic principles of routine screening for
/ Radiation Safety Dosimetry and Dose Reduction /
obstetric abnormality in first and second trimester
Technical Factors
Indications/contraindications for O&G / Specific
CORE KNOWLEDGE
Protocols

Explain the strengths, weaknesses and risks and roles of


Equipment and Technique
the imaging modalities currently used in diagnosing and
evaluating obstetric and gynaecological abnormalities.
CT Image Quality Assessment

BODY SYSTEMS
Explain the role and process of other non-imaging
Limitations of CT in O&G Imaging
investigations e.g the use of blood tests in First
Trimester Screening, Second Trimester Screening, the
MRI Scanning
implication of BRCA positivity etc
Describe/direct assessment or work-up of a clinical
Knowledge
problem or finding using imaging methods as
appropriate.
Safety / Scan Preparation / Contrast Use / MRI General
Recognise and act upon an inadequate examination.
Safety / Technical Factors
Indications/contraindications for O&G Imaging MRI /
Plain X-ray / Fluoroscopy
Specific Protocols

Knowledge
Equipment and Technique

Safety / Preparation / Contrast Use (IV/ Oral) / Radiation


MRI Image Quality Assessment
Safety Dosimetry and Dose Reduction / Technical Factors
Limitations of MRI in O&G Imaging
Indications/contraindications for O&G Imaging/specific
protocols.
Nuclear Medicine

Equipment and Techniques


Knowledge

Limitations of Plain X-ray /Fluoroscopic Procedures


Safety / Radiopharmaceutical Use (Labelled RBC /DTPA
X-ray image Quality Assessment in O&G Imaging
MAG III DMSA) / Radiation Safety Dosimetry and Dose
Reduction
Ultrasound
Demonstrate knowledge of the principles/ limitations/
indications of Nuclear Medicine Scanning/ PET Scans in
Knowledge
O&G Imaging

Safety
Equipment and Technique: Basics only

Indications/contraindications for O&G Imaging


NMCT Image Quality Assessment
Ultrasound/specific protocols
Limitations of NMCT in O&G Imaging

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 227
KEY SKILLS to ensure the communication with the patient is
appropriate; meaning timely, using terms that the
Interpret the examination accurately and safely patient can readily comprehend, with an appreciation of
Appreciate the normal anatomy, range of variants and their social support and social network, with empathy
changing appearance with age and physiological states, for the content, and acceptance of the possible need for
including recognising normal imaging studies or those repeat explanations.
that require limited work-up to arrive at this conclusion.
Conduct a thorough and systematic review of Radiological interventions
the imaging examination and perceive relevant
abnormalities. Describe the techniques of both routine and ultrasonic
Judge the likely site of abnormalities on imaging hystero-salpingography, HyCoSi (hysteron salpingo
examination. (eg. endometrial vs. myometrial / contrast sonography), amniocentesis and CVS,
myometrial vs. adnexal) and appropriate category of appreciating their place in investigation and their
abnormality (eg ovarian mass lesion / fetal abdominal complications.
wall defect), in order to determine a differential Communicate effectively with patients regarding the
diagnosis benefits and risks associated with different diagnostic
Within limits of information available, integrate a modalities and procedures, appreciating their cultural
broader knowledge of clinical presentations, imaging circumstances, social support and social network.
appearances and pathology (eg epidemiology, gross Interact effectively with other health care team
morphology, ancillary tests), to form an appropriate members such as medical imaging staff, obstetricians,
differential diagnosis. gynaecologists, neonatologists, midwives, nurses, GPs
Re-evaluate the imaging study in light of differential and pathologists during management of obstetric and
diagnoses to identify clinically relevant findings. gynaecological conditions.
Activities may include eliciting clinically relevant
findings, or appropriate further investigative pathways
including talking to and examining the patient,
reviewing previous imaging, reviewing relevant
literature, or obtaining a second opinion, follow up,
biopsy, or further imaging.

Act safely

Recognise imaging signs suspicious of conditions with


significant patient implications (e.g. fetal abnormality /
ectopic pregnancy/ abnormal placental site).
Safely assign class of diagnosis (benign / normal variant/
probable malignancy / significant fetal abnormality) and
direct further assessment where required.
Correctly categorise indeterminate findings and guide
further investigation appropriately.

Convey findings

Appropriately communicate relevant findings


including diagnoses, their implications and assists in
formulating an applicable imaging and management
plan. (e.g. urgent obstetric or emergency service
referral, amniocentesis, IV cannulation and possible
laparoscopy). Particularly in this setting, where the
diagnoses may be distressing, care should be taken

Page 228 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Obstetrics & Gynaecological Imaging Normal Variants
Category 1 Category 2 Category 3
1. Gynaecology

Variations of uterine version


Physiological ovarian follicle
Arcuate uterus

2. Obstetrics

Braxton-Hicks contraction Physiological pericardial fluid Circumvallate placenta


Placental lakes Brachycephaly
Debris/vernix in amniotic fluid Decreased end diastolic velocity
Normal gut herniation before 12 in umbilical artery due to fetal
weeks respiration or movement
Transient rotated foot position Placental shelf
Dolichocephaly
Corpus luteum with increased

BODY SYSTEMS
circumferential vascularity in first
trimester (vs ectopic)
Succenturiate lobe

Obstetric & Gynaecological Imaging Clinical Conditions


Category 1 Category 2 Category 3
GYNAECOLOGICAL IMAGING

1. Ovarian Lesions

Physiological
P hysiological cysts & their
complications including
haemorrhagic cysts ie corpus
luteal, follicular
Corpus Luteum of pregnancy
Ruptured follicle midcycle
Developmental
Pre / postmenopausal appearance A bsent / streak ovaries

Idiopathic
E ndometriosis
Polycystic ovary syndrome
Neoplastic
S urface epithelial-stromal; Serous, O  ther surface epithelial-stromal Struma Ovarii
mucinous & endometrioid tumors Ovarian carcinoid
Germ cell tumors S econdary neoplasms
S ex cord stromal tumors

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 229
Inflammatory / Vascular
Tubo-ovarian abscess Ovarian torsion O varian vein thrombosis

Miscellaneous

Ovarian Torsion Ovarian Stimulation Luteomas of Pregnancy


Ovarian Hyper stimulation Meigs Syndrome
syndrome
Theca lutein cysts

2. Adenexal Non-ovarian lesions

Physiological / Developmental
B road ligament cysts
Wolffian duct remnants
Paraovarian & fimbrial
Inflammatory
PID & hydrosalpinx Tubal occlusions Tuberculosis Salpingitis
tubovarian abscess Salpingitis Isthmica Nodosa
Neoplastic
C arcinoma of the fallopian tube
Tubal metastases
Tubal leiomyoma
Idiopathic
Tubal Endometriosis

Vascular
Adenexal varices

3. Non-pregnant Uterus and Cervix

Physiological Changes related to age


A ge related physiological
alterations
Congenital / developmental anomalies
M ullerian Duct Uterine Anomalies Absent uterus I ntersex states
(Subseptate / bicornuate etc.)
Nabothian cysts
Benign tumours / hyperplastic lesions
Leiomyoma
A denomyosis
Cervical polyp
Malignant neoplasms / dysplasia
SCC of the cervix Leiomyosarcoma
Inflammatory / Post surgical / Iatrogenic
IUD placement & complications A sherrmans syndrome
E ndometrial adhesions

Page 230 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Vascular
Arteriovenous malformation

4. Endometrial Lesions

Physiological
C
 hanges related to age and the
normal and abnormal menstrual
cycle
Neoplastic / dysplastic
A typical endometrial hyperplasia Gestational Trophoblastic Disease M  alignant mixed mllerian tumors
and endometrial carcinoma S tromal tumors
Endometrial polyps
Infective
E ndometritis

Hyperplastic / proliferative

BODY SYSTEMS
S imple endometrial hyperplasia Adenomyosis
E ndometrial polyps
E ndometrial cysts

5. Vagina & Labia

Malignant neoplasms / dysplasia:


S CC of vagina A denocarcinoma
R habdomyosarcoma (Pediatric)
Pagets disease
Vulval carcinoma
Vaginal Leimyoma
Infective/Inflammmatory
Bartholins Cyst Bartholonitis
Vaginal Foreign Body Vaginal Fistula
Congenital/developmental anomalies
M
 ullerian Duct Fusion Anomalies Gartner duct cysts Imperforate Hymen
(Hematometra/ colpos) Labial adhesions
Vaginal Atresia
Ambiguous genitalia
Techniques & Applications (Gynaecological)
Transabdominal ultrasound Pelvic MRI P elvic angiography & embolisation
Transvaginal ultrasound Sonohysterogram Pelvic venography & embolisation
Pelvic CT HyCoSi
H ysterosalpingography

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 231
Abdomen and Renal Tract

1. First Trimester

Miscarriage Cervical incompetence Heterotopic pregnancy


Ectopic pregnancy Chorio-amniotic separation Abdominal Ectopic
Gestational trophoblastic disease
Perisac haematoma
Physiological (e.g., extrusion
of the gut into the cord,
mineralisation of the skull vault)
Nuchal Scan
S canning and interpretation of BOO Ienencephaly
combined first trimester screening Limb defects Encephalocele
Cystic Hygroma Acrania anencephaly spectrum Hydrocephalus
Cystic hygroma / hydrops Gastroschisis
2VC Omphalocele

2. Second Trimester Morphology Scan

ASUM Guidelines For the Mid Trimester Obstetric Scan


June 1991, Reaffirmed May 1996, Revised October 1999, July 2005
CHECKLIST OF STRUCTURES TO BE SCANNED
Head
Falx
Cavum Septum Pellucidum
Skull Bones
Lateral Ventricles
Choroid Plexus
Cerebellum/Vermis
Nuchal thickness
Cisterna Magna
Face
Orbits
Nasal Bone
Jaw
Lips
Profile
Diaphragm
Right
Left
Heart
FHMD
Position
Axis
4 Chambers
Intraventricular Septum
Foramen Ovale
Mitral Valve
Tricuspid Valve

Page 232 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Great Vessels
Left Ventricular Outflow Tract
Right Ventricular Outflow Tract
Aortic arch
Ductal Arch
Abdomen
Stomach / Situs
Kidneys
Bladder
Abdominal Wall
Spine
Ossification Centres
Skin Line
Extremities
12 Long bones
Hands/Fingers

BODY SYSTEMS
Feet/Toes
Position of joints
Umbilical Cord
Insertion
3 Vessels
Other
Cervical incompetence

Abnormal Second Trimester Scan

Sonographic Markers of Aneuploidy


Nuchal thickening
Echogenic gut
Choroid Plexus cysts
Echogenic intracardiac foci
Single vessel cord
Short humerus
Short femur
Absent nasal bone
Neural Axis
Anencephaly ACC Hydranencephaly
Hydrocephalus Holoprosencephaly spectrum Encepholocele
Choroid plexus cyst Arachnoid Cysts
Chiari II Dandy Walker Spectrum
Spina Bifida Mega cisterna magna
Vein of Galen
Intracranial Tumours
Sacral Agenesis
SCT
Cerebellar hypoplasia

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 233
Face and neck
Absent nasal bone Cystig Hygroma
Cleft lip palate Micrognathia
Chest cardiac
CDH Pleural Effusion CHAOS
CPAM Cardiac defects Teratoma
Pericardial Effusion Pentralogy of Cantrell
Arrythmias
Abdomen and Renal Tract
Omphalocoele B owel atresias including Duodenal Bladder extrophy
Gastroschisis atresia Cloaca
Renal Pelvis dilatation Abdominal cysts Adrenal masses
BOO, posterior urethral valves Ascites Renal masses
Renal agenesis Abdominal calcifications Hepatic masses
MCDK Echogenic kidneys
Horseshoe kidney
Ectopic kidney
MSk
Club foot Abnormalities of the hand / feet Skeletal dysplasias
Polydactyly Arthrogryposis
Radial ray Focal femoral deficiency
S coliosis, segmental spine
anomalies
Other
Fetal Hydrops Eetal infection Heterotaxy syndrome

3. Third Trimester

R outine Assessment of fetal Fetal dopplers


growth and wellbeing Fetal anaemia
IUGR
macrosomia
Placental assessment
Umbilical Artery dopplers

4. Placenta Membranes and Cord Abnormalities

Placenta Praevia Placenta increta/percreta/acreta Chorioangioma


Placental Haemorrhage & Doppler studies relating to Cord cysts
Abruption IUGR and placental insufficiency Umbilical Vein Varix
A nomalies of placental form, including umbilical, Amniotic band syndrome
thickness or cord insertion (e.g. Circumvallate Placenta
succinturate lobe / marginal cord Velamentous cord insertion
insertion etc.) Chrioamnion separation
Placental insufficiency & IUGR
Vasa praevia
Retained products of conception
SUA

Page 234 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
5. Liquor abnormalities

A ssessment and evaluation of


normal and abnormal liquor
volumes
Oligohydramnios
Polyhydramnios

6. Multiple Pregnancies

F irst trimester determination of TTTS, staging T RAPS (twin reverse arterial


chorionicity and amnionicity, ie: Discordant twin growth perfusion)
DCDA, MCDA, MCMA Conjoined twins
Recognition of twin peak sign Fetus-in-fetu
Acardia

7. Post partum complications

Endometritis Ovarian Vein Thrombosis


RPOC

BODY SYSTEMS
LSCS complcations eg collections

8. Aneuploidy

Trisomy 21 Trisomy 13 Turners syndrome


Trisomy 18 Triploidy

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 235
Vascular Imaging and Ultrasound
Interventional Radiology Knowledge
Learning Competencies
Safety
The competent (trainee) radiologist will be able to
Indications/contraindications for Vascular Imaging &
Demonstrate a clinical, pathological and radiological Interventional Radiology Ultrasound/specific protocols
understanding of vascular disease.
Interpret common and important clinical presentations Equipment and Technique
in vascular imaging and interventional radiology
Construct management plans for common clinical Ultrasound Image Quality Assessment
presentations in vascular imaging and interventional Limitations of Ultrasound in Vascular Imaging &
radiology. Interventional Radiology

CORE KNOWLEDGE CT Scanning

Explain the strengths, weaknesses and risks (radiation Knowledge


related and other) and roles of the imaging modalities
and procedures currently used in vascular imaging and Safety / Scan Preparation / Contrast Use (IV/ Oral)
interventional radiology. / Radiation Safety Dosimetry and Dose Reduction /
Demonstrate knowledge of the indications, Technical Factors
contraindications and complications of interventional Indications/contraindications for Vascular Imaging &
procedures as well as their relative efficacy compared Interventional Radiology CT / Specific Protocols
with other treatment options (including no treatment).
Where appropriate participates in the clinical Equipment and Technique
assessment and counselling of a patient prior to the
performance of an interventional radiology procedure. CT Image Quality Assessment
Describe / direct assessment or work-up of a vascular Limitations of CT in Vascular Imaging & Interventional
or interventional radiology problem using imaging Radiology
methods as appropriate.
Explain the preparation, techniques and protocols for an MRI Scanning
investigation or procedure.
Recognises and act upon an inadequate examination or Knowledge
procedure.
Safety / Scan Preparation / Contrast Use / MRI General
Plain X-ray / Fluoroscopy Safety / Technical Factors
Indications/contraindications for Vascular Imaging &
Knowledge Interventional Radiology MRI / Specific Protocols

Safety / Preparation / Contrast Use (IV/ Oral) / Radiation Equipment and Technique
Safety Dosimetry and Dose Reduction / Technical Factors
Indications/contraindications for Vascular Imaging & MRI Image Quality Assessment
Interventional Radiology/specific protocols Limitations of MRI in Vascular Imaging & Interventional
Radiology
Equipment and Techniques

Limitations of Plain X-ray /Fluoroscopic Procedures


X-ray image Quality Assessment in Vascular Imaging &
Interventional Radiology

Page 236 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Nuclear Medicine health care team members and assists in formulating an
imaging and management plan as necessary.
Knowledge
Radiological interventions
Safety / Radiopharmaceutical Use (Labelled RBC /DTPA
MAG III DMSA) / Radiation Safety Dosimetry and Dose Competent in the techniques of basic diagnostic
Reduction angiography. Familiar with common vascular
Nuclear Medicine GIT Bleeding Studies interventional procedures such as angioplasty and
Meckels Scans stenting.
DTPA / DMSA / MAG III) Competent at basic biopsy and image guided drainage
Demonstrate knowledge of the principles/ limitations/ procedures. Familiar with the steps involved in
indications of MIBG / Octreotide Scanning/ PET Scans in percutaneous nephrostomy insertion.
Vascular Imaging & Interventional Radiology Assess the adequacy of interventional procedures,
recognise and manage complications and
Equipment and Technique: Basics only demonstrate knowledge and application of the follow-
up of procedures.
NMCT Image Quality Assessment Competent in the knowledge, clinical presentations,

BODY SYSTEMS
Limitations of NMCT in Vascular Imaging & assessment and management of interventional
Interventional Radiology radiological procedures.
QA for procedural radiology.
KEY SKILLS Communicating effectively with patients and clinicians
regarding the benefits and risks associated with
Interpret the examination accurately and safely different diagnostic modalities and procedures.
Recognise the normal anatomy, range of variants and
changing appearance with age and physiological states.
Conducts a thorough and systematic review of the
imaging examination and perceive the relevant
abnormalities.
Within the limits of information available, integrates
broader knowledge of pathology (eg. Epidemiology,
gross morphology, ancillary tests), clinical presentations
and imaging appearances to form an appropriate
differential diagnosis.
Evaluates the imaging study in light of differential
diagnoses to identify clinically relevant findings.

Acts Safely

Recognises imaging signs suspicious of conditions with


significant patient implications (eg. traumatic aortic
injury, aortic dissection, embolism, aneurysm leak).
Safely assign a class of diagnosis.
Correctly categorises indeterminate findings and guides
investigation appropriately.

Convey findings

Communicates relevant findings including diagnoses,


treatment plans, complications and follow up to the
referring clinician, patient and or family/carers and other

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 237
Vascular and Interventional Imaging Normal Variants
Category 1 Category 2 Category 3
1. General and peripheral vascular

C  arotid tonsillar loops Persistent sciatic artery


Popliteal entrapments

2. Thoracic vascular

A ortic arch variants Double SVC L eft SVC


Co arctation Thoracic outlet syndrome A zygous continuation IVC

3. Abdominal vascular

D ouble IVC L eft IVC H  epatic arterial variants


A ccessory renal arteries Coeliac / mesenteric arterial R enal vein variants
variants

4. Urointervention

 orseshoe kidney
H U reteric variants U rachal variants
Pelvic kidney
E xrarenal pelvis
Parapelvic cysts

5. Gastrointestinal and hepatobiliary

Chyladites B illiary tree variants

Page 238 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1
Vascular and Interventional Radiology Clinical Conditions
Category 1 Category 2 Category 3
VASCULAR DIAGNOSTIC CONDITIONS

1. General Vascular combine with peripheral vascular

A neurysms Fibromuscular hyperplasia G  ranulomatosis with polyangitis


A therosclerosis (Wegeners Granulomatosis)
Fibromuscular hyperplasia Takayasus Arteritis
A rteriovenous malformation Giant Cell Arteritis
E mbolism Vasculitis other
Patterns of vascular trauma / Polyarteritis Nodosa
injury H ereditary Haemorrhagic
Telangectasia

2. Peripheral Vascular combine with general vascular

Vascular grafts and complications I atrogenic femoral B  uerger disease (Thromboangitis

BODY SYSTEMS
D eep venous thrombosis Pseudoaneurysm and AV fistula obliterans)
R aynaud phenomenon
Popliteal artery entrapment
syndrome
A dventitial cystic disease of
popliteal artery
K lippel-Trenauny-Weber Syndrome
M ay Turner syndrome

3. Chest and Neck Vascular

C  ommon congenital variants of S ubclavian steal syndrome Thoracic outlet syndrome


thoracic aorta S uperior vena cava syndrome Paget-Schroetter (effort) syndrome
Spontaneous aortic dissection Aortitis
Traumatic aortic injuries Haemoptysis
Carotid artery stenosis P ulmonary AVM
Carotid artery dissection
Pulmonary embolism

4. Cardiac

P rinciples of cardiac CT P rinciples of cardiac MRI C ardiac catheterisation


Principles of echocardiography I ndications for coronary Transoesophageal
Coronary artery anatomy and angiography echocardiography
variations P rinciples of cardiac nuclear
Coronary artery ischemic disease imaging

5. Abdominal Vascular

A bdominal aortic aneurysm S plenic and other visceral artery C  oeliac artery compression
Mesenteric ischemia aneuryms syndrome
GI haemorhage Aortic endoleak B udd Chiari syndrome
Blunt abdominal and pelvic Vascular complications of A ortoenteric fistula
trauma pancreatitis M esenteric vein thrombosis
Retroperitoneal and rectus sheath Portal hypertension / varicies
haematoma R enal artery stenosis

2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1 Page 239
VASCULAR & NONVASCULAR INTERVENTIONS

1. Principles of Interventional Procedures

P rinciples of conscious sedation, P rinciples of patient aftercare and


analgesia and anticoagulation followup
Correct site / correct procedure R ole of multidisciplinary care
Pre-procedure blood tests
Sterile and aseptic practice
Taking consent
Risks of various common
interventions

2. Vascular Intervention

 iagnostic arteriography
D Percutaneous angioplasty C  omplex arterial and venous
D ialysis fistulography Vascular stent insertion access
Percutaneous venous access E mbolisation I VC filter retrieval
Central and PICC line insertion IVC filter insertion Foreign body retrieval
L umbar sympathectomy Thrombolysis / thrombectomy
A ortic stent grafts

3. Uroradiology Intervention

Nephrostomy Antegrade stent insertion / Varicocele / ovarian vein


Renal biopsy ureteric dilatation embolisation
Transrectal prostate biopsy U terine fibroid embolisation
Fallopian tube recanalisation

4. Gastrointestinal & Hepatobiliary Intervention

G  I tract dilatations and stenting Transjugular liver biopsy H  epatic chemoembolisation


Liver biopsy principles and Percutaneous transhepatic H epatic radioembolisation
techniques cholangiogram and drainage Percutaneous local ablative
Other abdominal organ biopsy B iliary stenting therapies (principles)
Percutaneous abscess drainage Percutaneous gastrostomy Transjugular intrahepatic
portosystemic shunt (principles)

Page 240 2014 RANZCR. Radiodiagnosis Training Program Curriculum Version 2.1

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