last updated: 12:04 Mon 10 Dec 2012

Training

TO DOWNLOAD the entire charter, click here on the Training Charter or vist the website of ESR and click on the link to the right of 'Brochure VI'.

In a mutual effort with the former EAR and other European subspecialties, ESUR has developed a specific and highly detailed training charter for uroradiologists.

The aim of subspecialialized training in uroradiology is to prepare the radiologist for a career in which a substantial proportion of his/her time will be devoted to uroradiology. Such individuals will be expected not only to provide uroradiological services but also to adopt and develop new imaging and, if appropriate, interventional methods and to disseminate uroradiological knowledge to their colleagues in general radiology.

Expertise and facilities
Training must be undertaken in a hospital(s) with full clinical service in urology, nephrology (including renal transplantation) and gynecology. Initially, when subspecialized uroradiology training is introduced a radiologist eligible for ESUR fellowship should supervise it. In the future, a certified specialist in uroradiology may supervise training. The training department(s) must have a full range of diagnostic equipment including ultrasonography with Doppler, CT and MRI. There must be access to a radiological library containing uroradiology textbooks and journals as well as general radiology textbooks and journals.
Subspecialized training in pediatric uroradiology will be obtained best in a Children's Hospital or in a General Hospital with a dedicated section for Pediatrics and Pediatric Surgery. In most instances such training will form part of pediatric subspecialty training program. Where possible, however, it is recommended that trainees in uroradiology attend a Children's Hospital during their years of uroradiology subspecialty training to broaden the knowledge acquired during their general training.

Duration and general contents of training
The training period be the equivalent of two years whole time training. During this period the trainees must devote all of his/her time to uroradiology. Trainees should acquire a detailed knowledge of the pathological and clinical basis of the specialty. They should obtain extensive experience in all the diagnostic methods listed in the syllabus. Trainees must attend regular clinicoradiological conferences (at least weekly) with their clinical colleagues. Trainees will be expected to be familiar with the current uroradiological literature, both from standard textbooks and original articles.They should be involved in a research project (or projects) and should acquire knowledge of the design, execution and analysis of research projects.

Theoretical training
Trainees should attend 30 hours of formal lectures and they should attend the annual ESUR symposia and /or uroradiology sessions of ECR.

1 - Introduction

The aim of establishing a curriculum for training in urogenital imaging is to ensure trainees have acquired:

  • Knowledge of the relevant embryological, anatomical, pathophysiological and clinical aspects of uronephrology and gynaecology
  • Understanding of the major imaging techniques relevant to uronephrological and gynaecological diseases and problems
  • Understand the role of radiology in the management of these specialist areas
  • Knowledge of the indications, contra-indications, complications and limitations of procedures.

2 - Core of Knowledge

2.1. Urinary & male genital tract – Specific objectives

2.1.1. Renal physiology and kinetics of contrast agents -To understand the physiology of renal excretion of contrast medium

  • To understand the enhancement curves within renal compartments after injection of contrast agents
  • To know the concentrations and doses of contrast agents used intravenously.

2.1.2. Normal anatomy and variants

  • Retroperitoneum:
    • To recognise retroperitoneal spaces and pathways
  • Kidney:
    • To understand the triple obliquity of the kidney
    • To know the criteria of normality of the pyelocaliceal system on IVU
    • To recognise normal variants, such as junctional parenchymal defect, column of Bertin hypertrophy, fœtal lobulation, or lipomatosis of the sinus
    • To identify the main renal malformations, such as horseshoe kidney, duplications, ectopia, or fusions.
  • Bladder and urethra:
    • To know the anatomy of the bladder wall and physiology of micturion
    • To identify the segments of male urethra and location of urethral glands
  • Prostate:
    • To recognise zonal anatomy of the prostate
    • To identify prostatic zones with US and MRI.
  • Scrotum:
    • To know the US anatomy of intra-scrotal structures (testicular and extratesticular)
    • To know the Doppler anatomy of testicular and extratesticular vasculature.

2.1.3. Imaging techniques

  • Sonography of urinary tract
    • To choose the appropriate transducer according to the organ imaged
    • To optimise scanning parameters
    • To recognise criteria for a good sonographic image
    • To recognise and explain the main artifacts visible in urinary organs
    • To be able to get a Doppler spectrum on intrarenal vessels (for resistive index measurement) and on proximal renal arteries for velocity calculation.
  • IVU
    • To list the remaining indications of IVU
    • To know the main technical aspects:
      • choice of the contrast agent
      • doses
      • film timing and sequences
      • indication for ureteral compression
      • indication of Frusemide.
  • Cysto-urethrography
    • To list the main indications of cysto-urethrography
    • To know the main technical aspects:
    • Choice of technique: trans-urethral, transabdominal
    • Choice of the contrast agent
    • Film timing and sequences
    • To remember aseptic technique
  • CT of the urinary tract
    • To define the normal level of density (in HU) of urinary organs and components
    • To know the protocol for a renal and adrenal tumor
    • To know the protocol for urinary obstruction (including stones)
    • To know the protocol for a bladder tumor
  • MR of the urinary tract
    • To know the appearances of urinary organs on T1 and T2w images
    • To know the protocol for a renal and adrenal tumor
    • To know the protocol for urinary obstruction
    • To know the protocol for a bladder tumor
    • To know the protocol for a prostatic tumor

2.1.4. Pathology

  • Kidney and ureter
    • Congenital – covered under 2.1.2.
    • Obstruction
    • Calculus
    • Infection
    • Tumors
    • Cystic diseases
    • Medical nephropathiesVascular
    • Renal transplantation
    • Trauma
  • Bladder
    • Congenital – covered under 2.1.2.
    • Obstruction
    • Inflammatory
    • Tumors
    • Trauma
    • Incontinence & functional disorders
    • Urinary diversion
  • Urethra
    • Congenital
    • Strictures
    • Diverticula
    • Trauma
  • Prostate & Seminal Vesicles
    • Congenital
    • Benign prostatic hypertrophy
    • Inflammatory
    • Tumors
  • Testis & scrotum
    • Congenital
    • Inflammatory
    • Torsion
    • Tumors
  • Penis
    • Impotence
  • Adrenal
    • Masses

2.1.5. Interventional

  • In general
    • To verify indications, satisfactory blood count, and coagulation status
    • To explain the procedure and follow-up to the patient
    • To know what equipment is required
    • To know what aftercare is required.
  • US-guided biopsies/cystic drainage, e.g. kidney mass, prostate
  • CT-guided biopsies
  • Percutaneous nephrostomy

2.2. Gynecological Imaging2.2.1. Techniques

  • US examination
    • To be able to explain the value of a US examination
    • To be able to explain the advantages and limits of abdominal vs. transvaginal approach
    • To know indications and contra-indications of hysterosonography.
  • Hysterosalpingography
    • To be able to describe the procedure
    • To know the possible complications of hysterosalpingography
    • To know the contra-indications of hysterosalpingography
    • To explain the choice of contrast agent
    • To know the different phases of the examination.
  • CT scan
    • To be able to explain the technique of a pelvic CT
    • To know the possible complications of CT
    • To know the contra-indications of CT
    • To know the irradiation delivered by a pelvic CT
    • To know the required preparation of the patient and the choice of technical parameters (slice thickness, Kv, mA, number of acquisitions, etc.) depending on indications.
  • MRI
    • To be able to explain the technique of a pelvic MRI
    • To know the contra-indications of MRI
    • To know the required preparation of the patient and the choice of technical parameters (slice thickness, orientation, weighting, etc.) depending on indications.
  • Angiography
    • To know the main indications of pelvic angiography in women
    • To know how to perform a pelvic angiography

2.2.2. Anatomy

  • To know main normal dimensions of uterus and ovaries with US
  • To describe variations of uterus and ovaries during genital life
  • To describe variations of uterus and ovaries during the menstrual cycle
  • To describe normal pelvic compartments
  • To identify normal pelvic organs and boundaries on CT and MRI
  • To explain the role of levator ani in the physiology of pelvic floor
  • To know what imaging modalities can be used to visualise the pelvic floor
  • To know the factors responsible for urinary incontinence.

2.2.3. Pathology

  • Uterus
    • Congenital anomalies
    • Tumors (benign and malignant)
      • myometrium
      • endometrium
      • cervix
    • Inflammation
    • Adenomyosis
    • Functional disorders
  • Ovaries/Tubes
    • Ovary
    • Cysts
    • Tumours
    • Functional disorders, e.g. precocious puberty, polycystic ovaries
    • Endometriosis
  • Tubes
    • Inflammatory disorders
    • Tumors
  • Pelvis
    • Prolapse
  • Infertility

3 - Technical, Communication and Decision - Making Skills

3.1. Before the examination

  • To check the clinical information and risk factors (diabetes, allergy, renal failure, etc.)
  • To validate the request and the choice of examination
  • To know the specific preparation and protocols, if necessary
  • To explain the examination to the patient and inform him/her about risks.

3.2. To validate the request based on

  • Risk factors
  • Irradiation involved
  • Possible alternatives.

3.3. To perform the examination

  • To know the clinical history and the clinical questions to be answered
  • To know the protocol of examination
  • To assess the anxiety of the patient before, during and after the examination, and provide appropriate reassurance.

3.4. Communication with the patient and the colleagues and recommendations for follow-up

  • To explain clearly the results to the patient
  • To assess the level of understanding of the patient
  • To explain the type of follow-up
  • To assess the degree of emergency
  • To produce a clear report of the examination
  • To discuss strategies for further investigation if necessary
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