Teaching the New Interns About Imaging Appropriateness

We asked Dr. Jeffrey Hogg to share his strategy for making sure the interns at WVU are “Imaging Wisely” and hope many of you will be inspired to do the same.

Kendo and Swerdlow identified seven radiology skills as “essential” for beginning interns. In orientation at WVU Healthcare I review and identify resources to master these:

  1. Choose most appropriate radiologic study for workup of common clinical situations
  2. Communicate relevant clinical history when ordering a radiologic study
  3. Knowledge of limitations of radiologic studies
  4. Recognize common abnormal findings on CXR
  5. Recognize common abnormal findings on AXR
  6. Systematic approach to viewing CXR
  7. Systematic approach to viewing AXR

ACR Appropriateness Criteria (AC) are central to the message. I emphasize that the criteria are free decision support guidelines that optimize safety, diagnostic efficiency, and cost. I appeal to interns’ “Professionalism” to do the best for their patients, using only appropriate studies to avoid wasted time, resources, and excess patient radiation. I list the Medical Specialty Organizations active on ACR AC Expert panels. I demonstrate the ACR AC site organization by “Category”, “Clinical Topic”, and “Variant” to show how they can find imaging guidelines specific to their patient. I show the embedded link to the ACR AC in our electronic medical record. This addresses skill 1.

Hogg Blog Post

Use of ACR AC for communicating clinical history for radiologic studies promotes “Professional Communication”. This addresses skill 2.

Each ACR AC “Clinical Topic” “Summary” teaches epidemiology, natural history, treatment approach, roles and limitations of radiologic studies, addressing skill 3.

The remaining 4 skills are addressed by providing links to tutorials teaching systematic approaches for abdominal and chest radiographs with common abnormal findings.

Reference: Kondo KL, Swerdlow M. Medical student radiology curriculum: what skills do residency program directors believe are essential for medical students to attain? Acad Radiol. 2013 Mar;20(3):263-71.

Jeffrey P. Hogg, MD, professor, neuroradiology, Robert C. Byrd Health Sciences Center, West Virginia University   

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