Section outline

  • Dr. Eva Rubio

    Welcome to Fluoroscopy, the sloshiest, messiest and most embarrassing section of radiology. That’s why we love it! Fluoroscopy is part improvisational theater, part hands-on medicine and part procedural. Mastering fluoroscopy means interfacing with nervous parents who stare at you while you perform a procedure on their child, making a diagnosis on the fly, ducking body fluids, all while maintaining your composure, or at least your sense of humor.

    Here are a few tips to help you channel your inner best fluoroscopist.

    1. Know as much as you can about the patient – it never inspires the family’s confidence if we have to ask if they’ve any other imaging studies or procedures recently – ideally we are supposed to know that! They want to know that we are “on top of it”.

    2. When you walk into the fluoroscopy room please do three things: Greet the family with a smile; Identify yourself to the family with your title, and then Wash your hands in front of the family. Every time. You will make the best possible impression this way.

    Fluoroscopy competencies for fellows:

    July-Sept:

    • Participate fully on service

    • Review PDF on pediatric abdominal fluoroscopy (fluoro website)

    • Attain buttonology understanding of the equipment, how to minimize dose

    • Pre-dictate all HKU/inpt plain films

    • Acquire competency in all examinations in the “basic” section (see list below)

    • Understand all of our contrast agents

    • Progress from observation to performing studies with attending in the room

    • Read Peter Strouse article on the upper GI (fluoro website)

    • Develop an understanding of which studies are performed for various indications

    • Review provided cases in PACS

    Oct-Dec:

    • Pre-dictate all HKU/inpt plain films.

    • Be able to explain equipment / buttonology and how to minimize dose to students, residents and visitors.

    • Work on developing competency in all examinations in the “advanced” section (see list below).

    • Be able to correct orders/recommend the proper study and contrast agents – take calls and consults from the floor.

    • Progress from performing studies with attending in the room to being able to perform studies with the attending nearby or observing remotely.

    • Read Steven Kraus article on the pressure colostogram and anorectal malformations (fluoro website).

    • Review provided cases in PACS.

    • By the end of December please take time to review Sections 1, 2 and 3 of the fluoroscopy education module on the image gently website, https://www.imagegently.org/Procedures/Fluoroscopy/Pause-and-Pulse-Resources

    Links to the PDF versions are in the middle of the page…


    These are rather long so set aside enough time. The material should be considered essential for a fellowship trained pediatric radiologist.

    Jan-March:

    • Pre-dictate all HKU/inpt plain films.

    • Demonstrate competency in all examinations in the “advanced” section.

    • Should now take all calls from the floor and elsewhere, be able to correct orders/recommend the proper study and contrast agents.

    • Should be able to perform all or most studies with the attending nearby or observing remotely.

    • Should take an active teaching role with students, residents or visitors.

    April-June:

    • Should be ready to manage the fluoroscopy service independently with an attending mentoring from a nearby reading room, including all but rare or unusual studies.

    Basic skill competencies with (the number of studies they should be checked off on, with accession #):

    Gastrostomy tube check (3)

    NJ tube placement (3)

    Esophagram

    Outpatient Upper GI (3)

    Outpatient enema (3)

    Modified barium swallow (5)

    GJ exchange (3)

    Intussusception (depends on baseline previous experience, availability of studies) (3 as primarily performing, just observing does not count)

    Advanced competencies with (the number of studies they should be checked off on, with accession #):

    Newborn enema (3)

    Newborn upper GI (5)

    GJ new placement (3, must be done successfully!)

    Pressure colostogram – these do not come around very often – always participate when you can

    Intussusception (depends on baseline previous experience, availability of studies) (3 as primarily performing, just observing does not count)