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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 attached to KK Women's and Children's Hospital can expect to learn a wide variety of gynaecologic, obstetric and breast disorders. The learning objectives serve as a guide for the trainees. 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 mammograms and breast ultrasound
  • Learn image-guided breast interventions, e.g., biopsies


Duration of Programme

6-12 months


Number of Training Places

Only 1 trainee 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

  • Gynaecological Imaging
    • Hysterosalpingography
    • Ultrasound
    • Paracentesis for malignant ascites
    • Interventional procedures – transvaginal aspiration/drainage/biopsy
    • Tubal contrast studies/sonohysterography
    • CT, MRI
  • 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
    1. Uterine:
      • Mullerian anomalies, contraceptive devices, fibroids, adenomyosis, endometrial polyps, endometrial carcinoma
    2. 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
    3. Sonohysterography:
      • Having mastered the basics of transvaginal sonography and deemed competent, the trainee will be allowed to perform some sonohysterography and/or hysterofoamsalpingograph 


    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:

    1. carry out radiological duties, which include supervised reporting of studies or performance of procedures related to training module;
    2. participate in presentations during multi-disciplinary sessions, tumour boards and departmental rounds;
    3. attend didactic lectures, multidisciplinary meetings and birth defect meetings;
    4. attend 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

    Trainees 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/caregiver such as 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

    • Trainees are required to keep a logbook of their learning experiences. 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 trainee’s performance upon completion of the programme. All trainees will be given a general overall grading status at the end of the programme based on the grading criteria requirements incorporating the six competencies that trainees 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, misbehaviour 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.

    Trainees 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 programme.


    Pre-requisite/Eligibility Requirement(s)

    Entry requirement: FRCR or equivalent


    IV Other Information


    Course Fees

    Course fees will be disclosed upon acceptance.


    Funding

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


    Certification

    A certificate will be awarded upon successful completion of the programme.