The Department of Radiology is responsible for the administration and delivery of radiology teaching to undergraduate students in UCC. Instruction in radiology is integrated into all years of the medical education program and is delivered over the five years of medical school. The radiology curriculum is structured to meet students' needs during each year of college. Guidance has been taken from ‘The Place of Clinical Radiology and Imaging in Medical Student Education: recommended framework for curriculum design (www.rcr.org)’.
The curriculum emphasises:
- Interpretation of basic radiological examinations particularly in the setting of acute medical emergencies;
- Understanding of the role of imaging within clinical investigation and management;
- Knowledge of the legislation relating to the use of radiology in clinical practice;
- Importance of cost effectiveness, appropriate ordering of imaging tests, evidence based practice and relative radiation exposures associated with the different modalities.
The 1st year radiology curriculum in anatomy includes a module in imaging anatomy delivered by clinical radiologists. This programme has been developed jointly with the Department of Anatomy and ensures integration of imaging into the curriculum in anatomy. Imaging anatomy teaching incorporates didactic lectures in a large lecture theatre setting and small group interactive sessions in a modern anatomy laboratory (UCC Flame lab). These sessions include a brief background regarding the relevant radiology, in the form of dedicated introductory lectures and references to diagnostic imaging procedures in all other sessions, but the core information delivery is with regard to radiological anatomy and modality recognition. Radiologic anatomy is taught in parallel with traditional anatomy. This imaging anatomy module represents the first exposure of medical students to radiology.
In recognition of the importance that UCC places on integrative education in the undergraduate curriculum, the post of radiology lecturer is 50% funded by the Department of Anatomy. The lecturer is based one day per week in the Department of Anatomy.
We have assessed the student perception of learning experiences in collaboration with our anatomy colleagues.
- Murphy KP, Crush L, O'Malley E, Daly FE, Twomey M, O'Tuathaigh CM, Maher MM, Cryan JF, O'Connor OJ. ‘Medical student perceptions of radiology use in anatomy teaching’. Anat Sci Educ. 2014 Dec. PMID 25516061
- Murphy KP, Crush L, O'Malley E, Daly FE, O'Tuathaigh CM, O'Connor OJ, Cryan JF, Maher MM. ‘Medical student knowledge regarding radiology before and after a radiological anatomy module: implications for vertical integration and self-directed learning’. Insights Imaging. 2014 Oct;5(5):629-34. PMID: 25107581
2nd and 3rd year graduate entry students receive instruction on imaging modalities focusing on the methods of image creation, image appearances, and imaging indications and contraindications with reference to pathology for emphasis of salient aspects.
Three areas of radiological practice have been chosen for specific emphasis during fourth year. Students are expected to learn the core aspects of these sub-disciplines and identify how they integrate with patient management strategies; familiarity with the radiological modalities that are used, indication, contraindications, complications, clinical factors which determine the optimal method of imaging, patient preparation, communication with referring physicians, what imaging information is required to be given by referring physicians and how imaging affects treatment decisions. The three areas are:
1. Interventional radiology
The CIRSE Curriculum provides guidance. Students are expected to be familiar with the basis of interventional radiology, methods of image guidance, radiation protection principles and issues to address prior to a patient undergoing a procedure. Students should be familiar with vascular and non-vascular interventional radiology, specifically:
- Peripheral vascular disease
- PE and DVT
- GI bleeding
- Percutaneous biopsy, abscess drainage, nephrostomy, biliary drainage, and vascular access including dialysis access
2. Radiological aspects of the multidisciplinary team meetings (MDT)
Students are expected to be familiar with the purpose, conduction and pertinent radiological aspects of MDT conferences. The context in which radiological exams are performed and imaging appearances observed for the diagnosis and staging of cancer, assessment of treatment response and detection of recurrence will be emphasised and students should be familiar with treatment pathways.
3. Emergency department radiology
Students should be familiar with the role of radiology in the emergency department. Most radiologic modalities are used for assessment, triage, diagnosis and follow-up. Students should be familiar with the imaging findings encountered. Examples include:
- Trauma series radiographs
- Peripheral limb radiographs
- CT imaging (abdomen, chest, head,), ultrasound (abdomen)
- MRI (head and musculoskeletal system)
- Nuclear medicine (bone scan) and fluoroscopy (swallowing studies, IR).
The aim of final year radiology instruction is to ensure that students are familiar with the core imaging modalities used in the diagnosis and treatment of diseases pertaining to the main anatomical systems of the body. The common modalities used are plain film imaging, fluoroscopy, ultrasound, CT, MRI and nuclear medicine. Students should be able to recognise and differentiate each imaging modality, be familiar with indications, risks, limitations and contraindications to each modality, be aware of how patients are triaged for a particular radiological examination, be comfortable interpreting radiological images depicting pathologies which are commonly encountered and easily recognized by clinicians, and to know how a patient’s treatment should progress based on the imaging findings. Students receive four one-hour lectures during tutorial blocks. Thoracic, gastrointestinal and musculoskeletal/neurological radiology are emphasised. Students are expected to be familiar with interpretation of the following radiographic findings:
- Cardiac enlargement
- Cardiac failure and pulmonary oedema
- Pleural effusion
- Pulmonary collapse and consolidation
- Misplaced “tubes and lines”
- Pneumothorax, including tension
- Pneumomediastinum and subcutaneous emphysema
- Hyperinflation of lungs
- Free gas beneath the diaphragm
- Detection of pulmonary and mediastinal masses
- Signs of acute vascular problems, including aortic dissection and trauma
- Small and large bowel obstruction
- Toxic megacolon
- Signs of intestinal perforation
- Aortic aneurysm
- Urinary calculi
- Endoluminal foreign bodies
- Common fractures in the limbs
- Fracture of femoral neck
- Fractures of the wrist and scaphoid
- Fractures of the shoulder, including dislocation
- Pelvic fractures
- Signs of osteoarthritis
- Sclerotic and lytic metastases
- Skull fracture
- Cervical spine fracture and dislocation
Students are encouraged to discuss and question structured diagnostic regimens in different clinical settings. This includes the relationship of clinical radiology techniques to other investigations (for example endoscopy, conventional cardiac investigations). The disadvantages of over-investigation are highlighted. The use of integrated small group discussion involving clinician colleagues and radiologists is encouraged as is the importance of Evidence Based Practise. Examples of conditions, for which appropriate diagnostic algorithms could be discussed would include:
Chest and Cardiovascular Disease:
- Aneurysms and vascular dissection
- Pulmonary emboli
- Pulmonary neoplasms
- Abdominal pain
- Abdominal masses
- Abdominal trauma
- Inflammatory bowel disease
- Hepatic neoplasms
- Biliary disease
Renal and Urological Disease:
- Renal failure and urinary obstruction
- Urological neoplasms
- Renal and urinary infection
Endocrine and Breast Disease:
- Thyroid dysfunction and thyroid masses
- Breast Masses
Oncological and Marrow Disease:
- Principles of oncological staging by imaging and knowledge of common staging classifications
- Investigation of haematological disease including anaemia and leukaemia
- Basic knowledge of potential complications of oncological treatment and means of detection
- Bone and soft tissue infection
- Bone and soft tissue trauma
- Bone and soft tissue tumours
- Diagnosis of undisplaced or stress fractures
- Investigation of spinal injury
- Investigation of low back pain
- Metabolic bone disease
- Head injury
- Intracranial haemorrhage and infarction
- Spinal cord compression and radiculopathy
- Intracranial space occupying lesions
Disease in Childhood:
- The principles of imaging in children, including protection of the patient and confidentiality.
- Disease of the chest and gastrointestinal tract in childhood, and certain paediatric neoplasms.
Obstetric and Gynaecological Disease:
- Investigation of suspected pregnancy, including ectopic gestation.
- Post menopausal bleeding
- Gynaecological neoplasms
Students also receive small group tutorials from consultant clinical radiologists in the Mercy University Hospital, the Bons Secours Hospital, The South Infirmary Hospital, South Tipperary General Hospital and Tralee General Hospital. The co-ordination of the schedules for these tutorials is the responsibility of the UCC Radiology Department, based at Cork University Hospital.
Students receive dedicated small group tutorials focusing on radiologic aspects of paediatric radiology delivered by two fellowship trained consultant radiologists and by the senior lecturer.
Students are invited to attend an interactive teaching session conducted by Dr. Michael Bennett on Thursday evenings during the academic year from 5.30 – 7pm. These consist of clinical vignettes, which a panel of final medical students discuss, and as part of this discussion, a radiological review of the relevant pathology is provided weekly by Professor Maher.
In response to concerns over the risks associated with growing levels of exposure to ionizing radiation through medical imaging, the European Council Euratom directive of 1997 recommended that radiation protection should be integrated into the curriculum of medical schools. Final year medical students in UCC receive a radiation protection course during their first week of college. Professor Maher, Dr O’Connor, the UCC lecturer, Mr. Michael Sheehy, physicist, CUH, and Ms. Niamh Moore, clinical CT specialist radiographer, CUH, provide this. Students complete a multiple-choice questionnaire after the course to receive a certificate. The course emphasizes the principles of radiation protection: justification, optimization and the use of doses as low as reasonably practicable. Instruction on which radiological modalities deliver a large absorbed radiation dose is provided. The value of alternative investigations which do not entail exposure to ionising radiation is highlighted. Recognition of increased risk in pregnancy and childhood is discussed and measures used to avoid inadvertent irradiation in early pregnancy are explained.
Students’ awareness of radiation protection and the benefit of instruction has been assessed and published by our group.
O’Sullivan J, O’Connor OJ, O’Regan K, Clarke B, Burgoyne LN, Ryan MF, Maher MM. ‘An assessment of medical students’ awareness of radiation exposures associated with diagnostic imaging investigations’. Insights into Imaging 2010 May;1(2):86-92. PMID: 22347909
During 2014, UCC Radiology department in collaboration with Dr. Sabine Tabirca of the Computer Science Department at UCC, have developed a Radiation Protection App and online module in Radiation Protection. This is now available for download on the Apple App Store and Google Play.
- Royal College of Radiologists, Making the best use of a department of Clinical Radiology: guidelines for doctors (5th edition). RCR, London 2004.
- Royal College of Radiologists: Radiology for Medical Students Paper 4. The Place of Clinical Radiology and Imaging in Medical Student Education: recommended framework for curriculum design. (www.rcr.org)
- Lecture notes on radiology 3rd Ed -Patel, PR (Blackwell)
- Crash Course in Imaging 1st Ed-Kelly B, Nickle IC (Elsevier)
- Radiology MRI cases; www.radsource.us/
- Radiology knee iPad app
- Radiology head iPad app
Each year the department of radiology mentors summer elective students: third year students completing mini-electives and fourth year students completing elective experience prior to entering their final year of medical school. A structured program is provided. Students receive tutorials during this time, attend departmental teaching meetings and multidisciplinary meetings and spend time observing CT, interventional radiology and fluoroscopy in practice. Students also observe radiologists reporting clinical examinations. Students are encouraged to contribute to research and if possible work on their final medicine research project during this time period
Many final year radiology students are mentored for their final year radiology project by the department of Radiology in UCC. Many of these projects have led to peer-reviewed paper publications for the students involved.
O’Sullivan J, O’Connor OJ, O’Regan K, Clarke B, Burgoyne LN, Ryan MF, Maher MM. ‘An assessment of medical students’ awareness of radiation exposures associated with diagnostic imaging investigations’.Insights into Imaging 2010 May;1(2):86-92. PMID: 22347909
Sawbridge D, O’Connor OJ, MacEneaney P, Maher MM, Fitzgerald E. ‘Successful endovascular treatment of an infected external iliac pseudoaneurysm presenting with hemorrhage total hip arthroplasty’.Journal of Vascular and Interventional Radiology 2010 Jul; 21(7):1135-6. PMID: 20570177
McWilliams S, O’Connor OJ, McGarrigle AM, Quigley E, Shanahan F, Maher MM. ‘CT-based estimation of intracavitary gas volumes using threshold-based segmentation: in vitro study to determine the optimal threshold range’.Journal of Medical Imaging and Radiation Oncology2012; 56(3): 289-94 2012 Jun;56(3):289-94. PMID: 22697325
McLaughlin PD, Murphy KP, Hayes SA, Carey K, Sammon J, Crush L, O'Neill F, Normoyle B, McGarrigle AM, Barry JE, Maher MM. ‘Non-contrast CT at comparable dose to an abdominal radiograph in patients with acute renal colic; impact of iterative reconstruction on image quality and diagnostic performance’.Insights Imaging. 2014 Apr;5(2):217-30. PMID: 24500656
Coyle JP, Brennan CR, Parfrey SF, O'Connor OJ, Mc Laughlin PD, Mc Williams SR, Maher MM. ‘Is serum C-reactive protein a reliable predictor of abdomino-pelvic CT findings in the clinical setting of the non-traumatic acute abdomen?’ .Emerg Radiol. 2012 Oct;19(5):455-62. PMID: 22532154
Murphy KP, Crush L, O'Malley E, Daly FE, Twomey M, O'Tuathaigh CM, Maher MM, Cryan JF, O'Connor OJ. ‘Medical student perceptions of radiology use in anatomy teaching’. Anat Sci Educ. 2014 Dec. PMID 25516061
Murphy KP, Crush L, O'Malley E, Daly FE, O'Tuathaigh CM, O'Connor OJ, Cryan JF, Maher MM. ‘Medical student knowledge regarding radiology before and after a radiological anatomy module: implications for vertical integration and self-directed learning’. Insights Imaging. 2014 Oct;5(5):629-34. PMID: 25107581
Sullivan, C, Murphy KP, Power D, Maher MM, O’Connor OJ. ‘Radiation exposure from diagnostic imaging in young patients with testicular cancer’.Eur Rad 2015 Apr;25(4): 1005-13. PMID: 25500962
Murphy KP, Crush L, McLaughlin PD, O'Sullivan HS, Twomey M, Lynch S, Bye J, McSweeney SE, O'Connor OJ, Shanahan F, Maher MM. “The role of pure iterative reconstruction in conventional dose CT enterography”.Abdom Imaging. 2015 Feb;40(2):251-7. PMID 25139642
Karanvir Singh Dhatt
Role of iterative reconstruction in reducing radiation dose in Cystic Fibrosis (CF) patients receiving treatment with Kalydeco
An Assessment of the Quality of Internet Information on Computed Tomography Radiation Dose
Barbara Ann Duffy,
The department of radiology has mentored several postgraduate students:
2010 Dr. Owen O’Connor, MD Thesis awarded
2014 Mr. James Foody, Masters in Engineering awarded in collaboration with Dr Liam Marnane, School of Engineering
2016 Dr. Kevin Murphy, MD Thesis submitted
2016 Dr. Siobhan O’Neill, PhD Thesis awarded
2017 Dr. Fiachra Moloney, MD Thesis due for submission
2016 Ms. Anne Marie McGarrigle, PhD Thesis due for submission