FC Rad Diag(SA)

1.0 Core Curriculum for the FC Rad Diag(SA) Part I
Candidates are expected to have a comprehensive knowledge of radiation
physics, imaging, radiation biology and protection pertinent to the practice of
radiology as a specialist, in accordance with the following.
1.1 Radiation Physics and Imaging
1.1.1 Basic concepts of radiation physics
• electromagnetic radiation
• wave-particle duality
• electromagnetic spectrum
• energy of photons
1.1.2 Production of x-rays
• continuous radiation of Bremsstrahlung
• characteristic radiation
• effect of variation of: kV, mA, filtration, voltage waveform
• X-ray tubes: types, construction, line focus principle, heel effect, tube
rating
1.13 X-ray generators
• generator types and waveforms: single phase, 3 phase, 6 and 12 pulse,
medium frequency, capacitor discharge, battery operated
• effect on radiation output
• effect on image quality
• exposure times
• automatic exposure control
1.1.4 Interactions between x-rays and matter
• coherent scatter
• photoelectric effect and characteristic radiation
• Compton scatter
• pair production
• attenuation: linear attenuation coefficient, half value layer, factors
affecting attenuation
• factors affecting scattered radiation – kVp, field size, collimation,
filtration, subject thickness, film-focus distance
1.1.5 Filters, collimators, grids
• inherent filtration
• added filtration
• K-edge filters
• methods to reduce scatter: collimation, compression, grids, air gaps,
compression etc
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1.1.6 Luminescent screens
• principles of action
• absorption and conversion efficiency
• intensification factor
• speed
• types of phosphors: advantages and disadvantages
• emission spectrum
• resolution
• response to Kv
1.1.7 Characteristics of x-ray film and film processing
• structure of film
• film speed, sensitivity and specificity
• film processing
1.1.8 Photographic characteristics of x-ray film
• optical density and the grey-scale
• characteristic curve and contrast
• speed
• spectral sensitivity of emulsions
• emulsion types: single, double
1.1.9 Image system performance
• contrast and contrast resolution: subject contrast, film contrast,
radiographic contrast, fog and scatter, dynamic range
• spatial resolution: sharpness, line spread function, modulation transfer
function
• noise: systemic, random, quantum mottle, signal to noise ratio
• geometry: magnification, focal spot size, distortion
1.1.10 Image intensification
• intensifier design
• intensifier operation
• performance factors
1.1.11 Standard x ray system
• design and construction
• generators
• transformers
• cables
• operator console
• tube mountings
• tables
• bucky systems
• general layout of an X-ray room
1.1.12 Fluoroscopy TV systems
• video camera performance factors
• video monitor characteristics
• high resolution TV systems
• spot film cameras
• CCD systems
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1.1.13 Conventional tomography
• principles
• techniques
• types of tomography including panoramic
• practical application
1.1.14 Mammography
• basic principles of soft tissue and breast imaging
• types of mammography x-ray units
• emission spectra with different anode and filter materials eg molybdenum
tube and filter
• geometric unsharpness as a limiting factor
• recording system: film screen, digital
• magnification techniques
• alternative breast imaging: radionuclide imaging , US, MR
• principles and applications of stereotaxis
1.1.15 Principles of computers
• terminology: pixels, matrix, bits, bytes, display levels (bits per pixel),
storage technology and requirements
• central processing unit, key board, video display unit
• mass storage devices: tape, CD, DVD, MOD
• input and output devices
• network principles
• working understanding of DICOM standards
• basic and middle computer literacy
1.1.16 Computed tomography
• basic principles
• data acquisition: X-ray tubes, collimators, detectors-types and efficiency,
• sampling frequency, calibration techniques
• geometry: generations, spiral, multi-slice technology
• image reconstruction and display: basic principles (voxel and pixels),
various reconstruction algorithms, window width and level
• image quality: spatial resolution, contrast resolution, spatial uniformity,
noise, effect of pixel size, slice thickness, mA, algorithm, sampling
frequency, field of view, pitch, collimation.
• artefacts: partial volume, motion, beam hardening, ring artefact, spiral scan
artefacts etc
• CT fluoroscopy
• tissue density and characterisation and the Hounsfield scale
1.1.17 Computed radiography
• digital fluoroscopy: pulsed fluoroscopy
• computed radiography
• flat panel detectors
• digital subtraction techniques
• equipment requirements: tube, generator, image intensifier, TV chain,
processing
• digital imaging processing
• computer radiography systems [CR]
• direct radiography systems [DR]
• patient archiving and communication systems [PACS]
• radiology information systems [RIS]
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1.1.18 Magnetic resonance imaging
• basic principles
• relaxation T1, T2, T*
• pulse sequences: spin echo, inversion recovery and STIR, fast imaginggradient
echo, EPI, fast spin echo
• image production: gradient fields, slice thickness, bandwidth, phase
encoding gradients, readout gradients, Fourier transformation techniques
etc
• image quality: signal to noise ratio, spatial resolution, artefacts
• flow effects: flow void, flow imaging
• equipment: magnets, gradient coils, RF coils, computer systems
• magnetic resonance angiography techniques: diffusion, perfusion,
functional,
• MR spectroscopy.
• hazards and bio effects
• environmental problems: shielding
1.1.19 Radionuclide imaging
• basic atom structure and radioactivity
• measurement of radiation and radioactivity: detector types, detector
geometry and efficiency
• imaging systems: gamma camera principles, single photon energy computed
tomography (SPECT), dual energy x-ray absorptiometry (DEXA) positron
emission tomography (PET), hybrid PET, PET CT
• radio-pharmaceuticals: production, characteristics, labelling, production,
half life, isotopes used in clinical practice
1.1.20 Ultrasound
• basic principles of ultrasound and interaction with matter: wave physics,
wave length, frequency, phase, intensity, amplitude, decibel measurement,
velocity in liquids and tissues, acoustic impedance, interference,
diffraction, resonance, reflection, refraction, attenuation, absorption,
scattering
• transducers: piezoelectric effect, design, beam pattern, focus, broad
bandwidth transducers
• pulse echo imaging: A, B, M modes, grey scale, dynamic range, receiver
functions, time-gain compensation (TGC), compression amplifier
• digital processing: scan converter, pre and post processing, image display
and recording
• real time ultrasound: principles, linear, convex, phased, annular arrays
• Doppler ultrasound: Doppler effect, continuous and pulsed wave
instruments, duplex systems, colour Doppler, power Doppler
• ultrasound artefacts: reverberation, attenuation-shadowing and
enhancement, refraction-sound speed error, beam width-side lobes,
instrument artefacts
• biological effects: interaction of sound and tissues, measurement of power
output and intensity, methods of dose reduction, safety recommendations.
• new and evolving techniques
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1.1.21 Radiation biology
• radiation units: exposure, absorbed dose-gray, equivalent dose-sievert,
effective dose-sievert
• dose: skin, organ, integral doses
• interaction mechanisms: ionisation, excitation, free radicals, linear energy
transfer
• mutation: spontaneous, radiation induced, dose rate dependence,
genetically significant dose, doubling dose
• effect on chromosomes: types of damage, influence of dose, results of
damage
• radiation induced cancer
• effect on the embryo and foetus
• risk of occupational exposure
1.1.22 Radiation protection
• biological effects; stochastic, non-stochastic, deterministic, weighting
factors
• measurement of detriment
• International Commission on Radiation Protection (ICRP) recommendations
and radiation protection
• dose limits: occupational, public, pregnant women
• methods to reduce dose to occupationally exposed workers and the public:
x ray equipment, radioactive materials
• methods to reduce dose to patients
• methods of assessing radiation dose: dosimetry, film badge dosimeters,
thermo-luminescent dosimeters
• radiation doses for common procedures
1.1.23 Quality assurance and control
This entails identifying the critical aspects that affect the quality of
radiological procedures and techniques eg universally accepted conventions
and/or departmentally tailored/customised protocols, besides those addressed
above, that can be directly controlled.
• QA & C in general radiography and fluoroscopy including fluoroscopy in
specialised imaging procedures
• QA & C in radionuclide imaging
• QA & C in MR scanning
• QA & C in CT scanning
• QA & C in ultrasound
1.1.24 Artefacts
• plain radiography artefacts
• developing artefacts
• ultrasound artefacts
• CT artefacts
• MRI artefacts
• digital and reconstruction artefacts
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1.1.25 Basic statistics and research
• components of a scientific publication / presentation
• literature searches
• ethical issues pertaining to research
• cohort
• sensitivity
• specificity
• positive predictive value
• negative predictive value
• accuracy
• prevalence
• incidence
• confidence interval
• inter, intra-observer variability
• Kappa statistic
• variables
• Chi squared test
• student T test
• Mann Whitney test
• P value
• meta-analysis
• reviews
2.0 Radiological anatomy and technique
Candidates will be expected to have a comprehensive knowledge of all aspects of
imaging anatomy demonstrated by current imaging techniques; knowledge of
developmental anatomy, as well as common developmental anomalies and
variations of normality is expected; knowledge of and be familiar with cross
sectional and multi-planar (CT and MR) as well as sonographic anatomy and
knowledge of common imaging procedures used in daily practice of radiology in
South African hospitals, their indications, contraindications, complications is
required
2.1 Radiological anatomy
2.1.1 Head and neck
A comprehensive understanding of the cross sectional imaging anatomy of the
skull base, brain, orbits, paranasal sinuses and middle ear is required. The
vascular anatomy both arterial and venous of the brain, skull, orbits and facial
structures is required. The lymphatic drainage and position of important lymph
nodes must be known.
2.1.2 Spine
A detailed imaging knowledge of the cross sectional and longitudinal anatomy of
the spine, spinal cord, coverings and spaces, cauda equina and nerve roots is
required.
2.1.3 Chest and heart
A detailed knowledge of the anatomy of the lungs, mediastinum and heart is
required. The vascular anatomy including cardiac anatomy using all modern
modalities including multi-detector CT is required.
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2.1.4 Abdomen
A detailed anatomy of the cross sectional imaging anatomy of the abdomen is
required including MR. This includes the solid organs of the liver, spleen,
pancreas as well as the hollow organs of the gastrointestinal system, their
vascular supply and lymphatic drainage. The biliary anatomy and variations are
required. The intra and extra-peritoneal spaces, their formation and anatomy is
required.
2.1.5 Pelvis and genitourinary tract
A comprehensive knowledge of the cross sectional imaging, vascular supply and
lymphatic drainage of the kidneys, ureters, bladder and urethra is required.
Knowledge of the anatomy of the prostate and male reproductive tract is required.
Knowledge of the anatomy of the female reproductive tract is required. The
pelvic peritoneal reflections and spaces are also required.
2.2 Specific Organ and System Anatomy
2.2.1 Obstetrics
Knowledge of the embryological and foetal development and the modern imaging
anatomy and investigations of the embryo, foetus, placenta, umbilical cord and
uterus and ovaries in pregnant patients is required, including the ageing of the
foetus.
2.2.2 Breast
The imaging anatomy of the breast is required with a comprehensive knowledge of
the various imaging modalities available to image the breast, including MR.
2.2.3 Endocrine System
A comprehensive knowledge of relevant anatomy of all organs of endocrine
system is required.
2.2.4 Musculoskeletal System
Multi-modality based knowledge of the imaging anatomy of bones, joints,
muscles, tendons and ligaments, is required. The principles and methods of
determining the age of a person is obligatory.
2.2.5 Vascular System
A comprehensive knowledge of the imaging investigation of the arteries, veins
and lymphatic systems is required. Knowledge of modern imaging of the vascular
system including MRA, MRV and CTA is required.
2.2.6 Dentistry
Knowledge of the anatomy of teeth, their development, and imaging and
identification is required.
2.3…/
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2.3 Radiological Technique
• The full scope of all imaging modalities will require focus as they are
relevant to the procedure to be performed. For a full scope refer to the
Performance Portfolio provided by the College of Radiologists of South
Africa
• This will apply equally to the preparation/vetting of the patient and the
examination room, the nature of the procedure, the specific requirements of
the techniques, the choice of contrast agent, common pitfalls of the
procedure, risks and precautions specific to the procedure, complications
associated with the procedure where relevant, and the necessary aftercare.
• The full range of methods of imaging used shall include the utilisation of
spot x-ray technique, ultrasound, fluoroscopy, radionuclide imaging,
computed tomography, magnetic resonance imaging and positron emission
tomography (where available).
• Conventions and protocols where relevant should be emphasised.
• The different and most appropriate form of image capture must also be
considered as integral to the procedure.
• Key aspects of what should be contained in a radiology report as obligatory
are also necessary.
2.3.1 Contrast Agents in Imaging
• basic principles: chemical structure, pharmaceutical actions and toxicity
• types of contrast agents: anatomical space specific eg intravascular, subarachnoid,
gastro-intestinal; imaging specific eg ultrasound and MRI
• applications: fluoroscopic, ultrasound and MR imaging
• adverse reactions and their treatment