Diagnostic and Interventional Imaging | KK Women's and Children's Hospital

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

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 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:

carry out radiological duties, which include supervised reporting of studies or performance of procedures related to training module;
participate in presentations during multi-disciplinary sessions, tumour boards and departmental rounds;
attend didactic lectures, multidisciplinary meetings and birth defect meetings;
attend daily radiological review sessions and consensus meetings;
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
Dr Roaa
01.06.2019 to 31.05.2020, Fellow in Breast Imaging
Dr Amina
01.06.2022 to 31.05.2023, Fellow in Women’s Imaging

Team of Experts
Gynae imaging

Gynaecological Imaging:

Dr Lee Yien Sien
Dr Thida Win
A/Prof Ong Chiou Li
Dr Teo Sze Yiun
Dr Lau Li Ching

Obstetric Imaging:

A/Prof Ong Chiou Li

Breast Imaging:

Dr Lee Yien Sien
Dr Thida Win
A/Prof Ong Chiou Li
Dr Teo Sze Yiun
Dr Lau Li Ching

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.