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Diagnostic and Interventional Imaging

I About The Programme
II Assessment and Evaluation
III Target Audience and Eligibility Requirements
IV Other Information

I About The Programme

Name of Programme

Training Programme in Advanced Women's Imaging

Overview

Trainees/fellows attached to KK Hospital can expect to learn a wide variety of gynaecologic, obstetric and breast disorders. The learning objectives serve as a guide for the trainee/fellow. Fellows/trainees may also train in specific modules under O&G imaging or breast imaging.

For more information on the Department of Diagnostic and Interventional Imaging and the services they offer, click here.

Aim of Programme

Gynaecological imaging

  • Develop skills in interpretation of gynaecological imaging studies (ultrasound, CT and MRI)
  • Attain competency in performing diagnostic and some interventional procedures in gynaecology,
    e.g., transvaginal ultrasound, HSG, sonohysterography

Obstetrical imaging (observership only)

  • Acquire knowledge of imaging features of common foetal and obstetrical abnormalities

Breast imaging

  • Develop skills and competency in reading of mammograms, and breast ultrasound
  • Learn image-guided breast interventions, e.g. biopsies

Duration of Programme

6-12 months

Number of Training Places

Only 1 fellow at any one time. No specific month of intake.

Content Areas

Practical experience in the various procedures listed will depend on the length of posting. Most of the topics are covered during the core lecture programmes of Diagnostic Radiology Residency. Additional tutorials may be arranged with the training mentors. The trainees should also avail themselves to the collection of interesting cases, books and journals.

The following is a list of procedures available in the department:

IMAGING/INTERVENTIONAL PROCEDURES

  1. Gynaecological Imaging
    • Hysterosalpingography
    • Ultrasound
    • Paracentesis for malignant ascites
    • Interventional procedures – transvaginal aspiration/drainage/biopsy
    • Tubal contrast studies/sonohysterography
    • CT, MRI

  2. Breast Imaging
    • Mammography (screening and diagnostic)
    • Digital breast tomography
    • Ultrasound – conventional and volumetric
    • Biopsies – ultrasound/stereotactic mammography
    • MRI

HYSTEROSALPINGOGRAPHY

The trainee learns to perform cannulation of the uterus using a variety of cannulas and catheters such as the Foley catheter, Leech Wilkinson cannula and the uterine injectors (2 mm and 4 mm).

Learning objectives:
Normal uterine and tubal anatomy
Tubal patency, spasm, obstruction
Tubal diseases – salpingitis isthmica nodosa, hydrosalpinges
Uterine anomalies – mullerian malformations, Asherman’s syndrome, synechia, polyps, submucosal lesions (fibroids)

GYNAECOLOGICAL ULTRASOUND

  • Transabdominal and transvaginal scans
  • Contrast imaging for assessment of tubal patency
  • Sonohysterography
  • Ultrasound-guided procedures

Ultrasound technique and anatomy
Transabdominal scan
Transvaginal scan
Normal uterine and ovarian anatomy – age related and cyclic changes with menstrual cycle

Early pregnancy scans
Normal first trimester pregnancy
Abnormal first trimester scans – threatened abortion, embryonic demise, gestational trophoblastic disease, ectopic pregnancy

Common uterine and ovarian anomalies
Uterine:

Mullerian anomalies, contraceptive devices, fibroids, adenomyosis, endometrial polyps, endometrial carcinoma
Ovaries:
Physiological cyst – follicles, corpus luteal cysts
Haemorrhagic cysts
Endometriotic cysts
Neoplasmas: teratomas, epithelial tumors
Acute conditions: torsion, pelvic inflammatory disease, pelvic abscesses
Extrauterine/extraovarian anomalies: paraovarian cysts, pseudocysts, bowel anomalies, distal ureteric anomalies
Pitfalls in gynaecologic ultrasound

Sonohysterography:
Having mastered the basics of transvaginal sonography and deemed competent, the trainee will be allowed to perform some sonohysterography and/or hysterofoamsalpingography.

COMPUTED TOMOGRAPHY

Mainly gynaecologic oncology cases: cervical, uterine, ovarian cancers
1 session/week.
The fellow is expected to participate in case presentations at tumour boards.

MRI PELVIS

  • Gynaecological oncology (ca cevix, uterine malignancy, ovarian)
  • Other gynaecological / pelvic pathology
  • Non gynaecological pelvic studies

OBSTETRIC ULTRASOUND (Antenatal Diagnostic Clinic – Observership)

Learning objectives:
Overview of prenatal diagnosis
Learning of foetal anomalies by systems
Obstetric ultrasound report
Presentation of post-natal findings at Birth Defect clinic
How to communicate findings to patients and documentation

Foetal anomalies
The trainee should attend the weekly Birth Defect Clinic where ultrasound findings of foetal anomalies are presented and management is discussed. Post-natal findings are presented for correlation to antenatal diagnosis.

BREAST IMAGING

Mammography (includes tomosynthesis), breast ultrasound (includes whole breast automated scans) and MRI.

The trainee can expect to learn the basics of screening mammography and detection of cancers, how to perform assessment of mammography screen-detected findings, how to utilise advanced breast imaging techniques (tomosynthesis and whole breast volume scans) in assessment. The trainee will also gain some exposure to image-guided breast biopsies and breast MRI.

Training Methods

The trainee will participate in:

  1. radiological duties, which include supervised reporting of studies or performance of procedures related to training module;
  2. presentations during multi-disciplinary sessions, tumour boards and departmental rounds;
  3. attending didactic lectures, multidisciplinary meetings and birth defect meetings;
  4. daily radiological review sessions and consensus meetings;
  5. self-study with the use of departmental library or online educational resources.   

Past and Present Fellows

  • Dr Chu Ka-Man (Hong Kong)
    01.07.2011 to 31.08.2011, Observer in Women’s Imaging
  • Dr Marwar Mohammed Al Meslemani (Bahrain)
    01.10.2010 to 31.10.2012, Fellow in Breast and Gynaecological Imaging
  • Dr Farhana Fadzli (Malaysia)
    01.09.2015 to 31.12.2015, Fellow in Breast Imaging

Team of Experts

The programme is managed by the following experts:

Gynaecological Imaging:
• A/Prof Ong Chiou Li
• Dr Lam Shu Lin
• Dr Thida Win

Obstetric Imaging:
• A/Prof Ong Chiou Li

Breast Imaging:
• Dr Teo Sze Yiun
• Dr Lee Yien Sien

II Assessment and Evaluation

Aims of Assessment

Fellows are required to continually demonstrate the following six competencies throughout the programme:

(A) Patient Care

  • Communicate clearly and with care and compassion during all interactions with patient/care giver during consent taking, or explanation of imaging results

(B) Medical Knowledge

  • Possesses good basic knowledge of imaging anatomy and pathology
  • Demonstrates knowledge of imaging protocols, and methods for optimising image quality.
  • Makes accurate observations, interprets findings, formulates radiological reports and provides diagnosis or differential diagnoses that are useful for clinical management of patients

(C) Practice-Based Learning and Improvement

  • Has good basic understanding of safety in radiological investigations
  • Applies ALARA principles in imaging
  • Recommends imaging appropriately
  • Recognises and manages contrast reactions.
  • Where required, able to select sedation agent and dosage appropriately for procedures
  • Fulfills institutional requirements of patient safety
  • Possesses self-directed learning plan based on self-reflection of learning experience and feedback

(D) Interpersonal and Communication Skills

  • Understands critical result reporting and urgent communication of results to referring clinicians
  • Communicates effectively with colleagues to ensure proper transfer of care
  • Clear and accurate reports
  • Communicates effectively under stressful situations

(E) Professionalism

  • Advocates importance and priority of patient interests
  • Fulfills training related responsibilities
  • Treats colleagues with respect
  • Maintains patient confidentiality
  • Recognises his/her limitations and seeks help when needed
  • Responses appropriately to feedback/constructive criticism
  • Functions effectively as a team member

(F) Systems-Based Practice

  • Participates in incident/occurrence reporting as per hospital guidelines
  • Participates in quality improvement project if assigned.

Assessment Approaches

  • Fellows are required to keep a logbook of their learning experience. This will be regularly reviewed with their assigned supervisors.
  • Records directly observed procedures as part of learning experience
  • Maintains a record of mini-clinical examinations conducted and graded by supervisors
  • 6-monthly global assessment with 360 multi-source feedback

Evaluation Process

General overall grading system

The general overall grading system evaluates the Fellow’s performance upon completion of the fellowship programme. All Fellows will be given a general overall grading status at the end of the fellowship programme based on the grading criteria requirements incorporating the six competencies based knowledge, skills and performance that Fellows must demonstrate throughout the programme.

Grading Status
Description
​Grading Criteria Requirements
CMP
​Completes the programme
  • At least 80% attendance
  • Satisfactory performance
  • Active participation in meetings
  • Satisfactory multi-source feedback scores
USP*
​Unsatisfactory performance
  • Less than 70% attendance
  • Lack of participation in work meetings, or presentations
  • Lack of responsibility and safety
DCP
​Did not complete the programme
  • Less than 60% attendance
  • Failure to provide supporting documents as valid reasons for non-attendance.
WDN
​Withdrawn from the programme
  • Voluntary withdrawal or early termination due to disciplinary actions


*Training may be terminated in the event of trainee’s non-compliance to hospital regulations, misbehavior resulting in disciplinary actions, or engagement in illegal activities. Other factors such as incompetence, language impairments or safety concerns would also be taken into consideration.

*Fellows with USP may opt for extension of their training up to 3 months during which they must demonstrate improvement in their skills, and learning ability.


III Target Audience and Eligibility Requirements

Target Audience

Those who have completed basic Radiology training and successfully exited from program.

Pre-requisite/Eligibility Requirement(s)

Entry requirement: FRCR or equivalent


IV Other Information

Course Fees

Course fees will be determined upon application.

Funding

Candidates should be self-funded or have funding from external sources/institutions.

Certification

A certificate of completion of fellowship training will be provided upon successful completion of program.