RECOMMENDED EMERGENCY RADIOLOGY CURRICULUM FOR RESIDENTS

This document outlines a model residency curriculum for training in emergency radiology (ER). This is intended as an ideal curriculum to produce comprehensively trained emergency radiologists for academic and private practice with a breadth of training exposure to become expert diagnosticians and thought-leaders in the field. If a specific fellowship does not offer certain components, it is possible and suggested to draw on external educational resources to augment expertise in deficient areas.

Traumatic
      1. CNS
           a. Intracranial injury
               i. Subdural and epidural hematoma
               ii. Subarachnoid hemorrhage
               iii. Cortical contusion
               iv. Diffuse axonal injury
           b. Blunt and penetrating cerebrovascular injury
           c. Calvarial and skull base fractures
           d. Spinal trauma
                i. Spinal cord contusion/transection
                ii. Spinal epidural hematoma
                iii. Nerve root avulsion
       2. Spine
           a. Cranio-cervical junction and cervical spine
                i. Occipital condyle fracture
                ii. Atlanto-occipital dislocation/subluxation
                iii. Atlanto-axial rotary fixation
                iv. Jefferson fracture
                v. Dens fracture
                vi. Hangman’s fracture
                vii. Flexion or extension tear drop fracture
                viii.Facet dislocation
                ix. Acute ligamentous injury
           b. Thoraco-lumbar spine
                i. Compression fracture
                ii. Burst fracture
                iii. Chance fracture
                iv. Complex fracture-dislocation
                v. Pathological fracture
       3. Head and Neck (non-CNS)
           a. Maxillofacial fractures (e.g. LeFort fractures)
           b. Orbit
                i. Ocular injuries
                    (1) Globe rupture
                    (2) Lens dislocation
                    (3) Vitreous hemorrhage
                    (4) Subchoroidal hemorrhage
                    (5) Retrobulbar hematoma
                ii. Extraocular muscle herniation/entrapment
        4. Thoracic
             a. Pulmonary – contusion, laceration, hematoma
             b. Pleural – Pneumothorax, hemothorax
             c. Cardiac and pericardial injury – mediastinal hemorrhage, pneumomediastinum
             d. Diaphragmatic injury
             e. Blunt and penetrating injury to the airway and esophagus
             f. Rib fractures
             g. Sternal fracture
        5. Abdominal
            a. Solid organ trauma: hepatic, splenic, pancreatic, renal and other organs, with
                familiarity with the American Association of Surgeons of Trauma (AAST) and CTbased classification system.
            b. Traumatic bowel and mesenteric injury
            c. Hemoperitoneum, pneumoperitoneum, retroperitoneal hemorrhage
            d. Bladder, urinary collecting system, and ureteral injury
            e. Traumatic abdominal wall hernias and diaphragmatic injuries
            f. Obstetric and non-obstetric female pelvic emergencies
                i. Uterine trauma
                ii. Fetoplacental trauma
            g. Male pelvic emergencies
                i. Urethral and penile trauma
                ii. Scrotal and testicular trauma
        6. Musculoskeletal
            a. Fractures and dislocations: focus on subtle or missed emergent fractures (e.g.,
                 Lisfranc, Segond fractures) and supplemental radiographic views or other imaging
            b. Familiarity with classification systems where clinically appropriate
        7. Vascular
            a. Aortic injury
            b. Peripheral vascular injury
            c. Contained (pseudoaneurysm and AV fistula) and uncontained (active bleeding)
                vascular injury
Non-traumatic
        1. CNS
            a. Cerebrovascular ischemia
                 i. Arterial infarction
                 ii. Venous infarction
            b. Intracranial hemorrhage
            c. Intracranial neoplasm
            d. Intracranial herniation patterns
            e. Intracranial infections
                i. Meningitis
                ii. Encephalitis
                iii. Abscess/cerebritis
                iv. Subdural empyema
            f. Dural sinus thrombosis
            g. PRES
            h. Pituitary apoplexy
            i. Spinal cord emergencies
               i. Cord compression
               ii. Cauda equina syndrome
        2. Spine
                   i. Diskitis/osteomyelitis
                   ii. Epidural abscess
                   iii. Disk herniation
        3. Head and Neck (non-CNS)
            a. Paranasal sinuses
                 i. Acute or chronic sinusitis
                 ii. Aggressive fungal sinusitis
                 iii. Complications of sinusitis
                      (1) Orbital cellulitis
                      (2) Orbital subperiosteal abscess
                      (3) Osteomyelitis
                      (4) Epidural abscess
                      (5) Subdural empyema
                      (6) Cavernous sinus thrombosis
            b. Soft tissues of the face
                i. Orbital cellulitis
                ii. Parotitis
                iii. Submandibular sialoadenitis
                iv. Ludwig angina
            c. Odontogenic infections
            d. Neck
                i. Retropharyngeal and prevertebral abscess/edema
                ii. Tonsillitis and tonsillar/peritonsillar abscess
                iii. Epiglottitis
                iv. Croup
                v. Lymphadenitis and suppurative adenopathy
                vi. Jugular thrombophlebitis
            e. Ear
               i. Otitis externa and media
               ii. Cholesteatoma
               iii. Otomastoiditis
               iv. Apical petrositis
        4. Thoracic
             a. Pulmonary infection and inflammation, including diseases of the airways,
                  parenchyma, and pleura
             b. Pulmonary edema
             c. Thoracic vascular emergencies (e.g., aortic aneurysm, pulmonary embolism)
             d. Primary and metastatic thoracic malignancy; familiarity with thoracic oncologic
                 emergencies
             e. Foreign body aspiration
        5. Abdominal
             a. Gastrointestinal inflammation, infection, and hemorrhage
             b. Gastric, midgut, and colonic volvulus
             c. Bowel obstruction
             d. Bowel ischemia (etiologies and patterns of disease)
             e. Epiploic appendagitis, omental infarct
             f. Pancreatitis
             g. Gallbladder and biliary emergencies
             h. Urologic infection and calculous disease
             i. Ascites, peritonitis, intra-abdominal abscess
             j. Abdominal wall hernias
             k. Acute and chronic liver parenchymal and vascular disease
             l. Abdominopelvic malignancies
             m. Obstetric and non-obstetric female pelvic emergencies
                   i. Subchorionic hemorrhage
                   ii. Placenta previa
                   iii. Placenta abruption and hemorrhage
                   iv. Endometritis
                   v. Spontaneous abortion
                   vi. Fetal demise
                   vii. Ectopic pregnancy
                   viii.Ovarian cystic disease, ovarian mass
                   ix. Ovarian torsion
                   x. Pelvic inflammatory disease
              n. Male pelvic emergencies
                   i. Testicular torsion
                   ii. Epididymitis, orchitis
                   iii. Acute fluid collections – hydrocele, hematocele, pyocele
                   iv. Testicular infarction
                   v. Abscess
                   vi. Fournier’s gangrene
          6. Musculoskeletal
              a. Bone and joint infection
              b. Bone and joint prosthetic and peri-prosthetic complications
              c. Cellulitis and necrotizing fasciitis
              d. Soft-tissue abscess
              e. Compartment syndrome
              f. Muscle and ligamentous injuries
          7. Vascular
              a. Deep venous thrombosis
              b. Thrombophlebitis
              c. Peripheral arterial emergencies (e.g., thrombosis)
          8. Breast imaging
              a. Mastitis and breast abscess
              b. Breast implant rupture
Advanced imaging interpretive skills (*may be part of other rotations in residency)
          1. Understanding mechanisms of blunt trauma
          2. Penetrating injuries, including ballistic and stab injuries (e.g., ballistic pressure wave
              theory)
          3. Optimal exam protocoling for polytrauma
          4. CT cystography (trauma): indications and technical factors
          5. Extremity CTA
          6. Head and neck CTA*
          7. MRI protocoling and interpretation*
              a. Brain and spine MRI
              b. Musculoskeletal MRI for osteomyelitis, or radiographically occult fracture
              c. Abdominal MRI for appendicitis in the pregnant patient
          8. Emergent nuclear medicine*
              a. Ventilation and perfusion scintigraphy
              b. Hepatobiliary scintigraphy
              c. Tagged-RBC scintigraphy for GI bleed
              d. Osteomyelitis imaging
          9. Coronary CTA*
         10. Dual-energy CT (DECT), if available
Non-interpretive skills
        1. Awareness of imaging workflow in the ED
        2. Ability to triage imaging appropriately in times of high volume
        3. Wellness and burnout
        4. Time management and work-life integration
Quality and safety
        1. IV contrast reaction management
        2. IV infiltration management
        3. Radiation dose optimization
        4. MRI safety
        5. Managing imaging of pregnant and pediatric patients in the ED