หล กส ตรการฝ กอบรมแพทย ประจ าบ าน สาขาร งส ว ทยาท วไป

Transcription

1 หล กส ตรการฝ กอบรมแพทย ประจ าบ าน สาขาร งส ว ทยาท วไป 1. ว ตถ ประสงค ของหล กส ตร 1.1 ร งส แพทย ท ผ านการอบรมม ความร ความช านาญท จะปฏ บ ต งานในประเทศได อย างเหมาะสม 1.2 ร งส แพทย ท ผ านการอบรมม ความร ความช านาญในมาตรฐานสากล 1.3 ผล ตร งส แพทย ท สามารถน าความร ไปเผยแพร ถ ายทอดและศ กษาค นคว าด วยตนเองต อได 1.4 ผล ตร งส แพทย ท ม เจตนคต ท ด ต อว ชาช พ ม จร ยธรรมท ด 2. หล กเกณฑ การฝ กอบรมแพทย เฉพาะทาง สาขาร งส ว ทยาท วไป 2.1 ค ณสมบ ต ของผ ขอร บการฝ กอบรม ได ร บปร ญญาแพทยศาสตร บ ณฑ ตหร อเท ยบเท าและได ร บอน ญาตให ท าการประกอบว ชาช พเวช กรรมตามหล กเกณฑ ของแพทยสภา ม ค ณสมบ ต ครบถ วนตามเกณฑ แพทยสภาในการเข าร บการฝ กอบรมแพทย เฉพาะทาง 2.2 หล กส ตร ระยะเวลาของการฝ กอบรม 36 เด อน แบ งเป น เวชศาสตร น วเคล ยร (Nuclear Medicine) 6 เด อน ร งส ร กษา (Radiation Oncology) 6 เด อน ร งส ว น จฉ ย (Diagnostic radiology) 22 เด อน ว ชาเล อก (Elective) 1 เด อน พยาธ ว ทยา (Pathology) 1 เด อน ในส วนสาขาว ชาร งส ว น จฉ ย 22 เด อน แบ งเป น General/Fluoroscopy 9 เด อน Computed Tomography (CT) 3 เด อน Magnetic Resonance Imaging (MRI) 1 เด อน Ultrasound Obstetrics and Gynecology 1 เด อน General 2 เด อน Mammography 1 เด อน -1 -

2 Pediatrics 1 เด อน Neuroradiology and Neurointervention 2 เด อน Body vascular and Interventional Radiology 2 เด อน หล กส ตรด าน Medical Radiation Physics และ Radiobiology แบ งเป น Medical Radiation Physics ประมาณ 44 ช วโมง Radiobiology ประมาณ 21 ช วโมง เน อหาว ชาภาคทฤษฎ ของว ชาสาขาร งส ว น จฉ ยแบ งเป น 9 ห วข อค อ 1. Alimentary System 2. Body vascular and Interventional Radiology 3. Cardiovascular system 4. Genito-urinary and obstetric and gynecology system 5. Musculoskeletal System 6. Neuroradiology 7. Pediatric Radiology 8. Respiratory system 9. Computers in Radiology 2.3 ว ธ การฝ กอบรม ให แต ละสถาบ นท แพทยสภาร บรอง จ ดการฝ กอบรมตามหล กส ตร ท งน ให อย ในกรอบตามความ เหมาะสม 2.4 การประเม นผลเม อจบหล กส ตรโดยคณะอน กรรมการฝ กอบรมและสอบความร ความช านาญในการ ประกอบว ชาช พเวชกรรมสาขาร งส ว ทยาท วไปโดยการสอบ ค ณสมบ ต ของผ ม ส ทธ สอบเพ อว ฒ บ ตรสาขาร งส ว ทยาท วไป ม ค ณสมบ ต ตามข อ 2.1 และ ฝ กอบรมครบตามข อก าหนดของหล กส ตรในสถาบ นท ได ร บการร บรองตามข อก าหนดของ แพทยสภา และ สอบผ านว ชาMedical radiation Physics และ Radiobiology ตามกฎเกณฑ และ ได ร บการส งช อเข าสอบโดยสถาบ นท เข าร บการฝ กอบรม ท งน ในข อ รวมความถ งการม หร อไม ม ป.บ ณฑ ต ให ข นก บกฎเกณฑ ของแต ละสถาบ น ว ธ การสอบ -2 -

3 ตามกฎเกณฑ ท คณะอน กรรมการฝ กอบรมและสอบความร ความช านาญในการประกอบว ชาช พเวช กรรมสาขาร งส ว ทยาท วไปเป นผ ก าหนด 3. เน อหาหล กส ตร 3.1 ว ชา Medical radiation Physics และ Radiobiology 3.2 ว ชา ร งส ว น จฉ ย (Diagnostic Radiology) 3.3 ว ชา ร งส ร กษา(Radiation Oncology) 3.4 ว ชา เวชศาสตร น วเคล ยร (Nuclear Medicine) 3.5 ว ชา พยาธ ว ทยา (Pathology) -3 -

4 หล กส ตรว ชา Medical Radiation Physics and Radiobiology ว ตถ ประสงค ของหล กส ตร เพ อให ร งส แพทย ม ความร พ นฐานทางร งส ฟ ส กส และ ช วร งส ทางการแพทย ใน แขนงต าง ๆ ด งน 1. ร ร งส ชน ดต าง ๆ สามารถอธ บายการเก ดและค ณสมบ ต ทางฟ ส กส ของร งส น น 2. ร ว ธ การว ดร งส ด วยเคร องว ดร งส แบบต าง ๆ 3. ร พ นฐานส วนประกอบและเทคน คของการใช เคร องม อทางร งส ว ทยา 4. ร หล กการวางแผนร กษาผ ป วยด วยร งส หร อใช ร งส ร วมร กษา 5. ร หล กการค านวณปร มาณร งส ท ผ ป วยได ร บจากการได ร บร งส ร วมร กษา 6. ร ผลของร งส ต อส งม ช ว ต 7. ร ว ธ ป องก นอ นตรายจากร งส 8. ร หล กการข นพ นฐานในการเตร ยมเก บและการควบค มค ณภาพของสารเภส ชร งส ประสบการณ การเร ยนร 1. ศ กษาจากเอกสารประกอบการบรรยาย และต ารามาตรฐาน 2. ม การบรรยายร งส ฟ ส กส ส ปดาห ละ 2 ช วโมง เป นเวลาประมาณ 44 ส ปดาห 3. ม การบรรยายช วร งส ทางการแพทย ส ปดาห ละ 1 ช วโมง เป นเวลาประมาณ 21 ส ปดาห การประเม นผล ม การสอบข อเข ยน CONTENTS -4 -

5 MEDICAL RADIATION PHYSICS 1. BASIC RADIOLOGICAL PHYSICS (10 hours) 1.1 Basic nuclear physics 1.2 Radiation qualities, quantities and International Standard (SI) units 1.3 Interaction of photon with matter 1.4 Interaction of electrons and heavy particles with matter 1.5 Production and detection of X-rays 1.6 Radiation dosimetry 1.7 Basic knowledge in computer 2. DIAGNOSTIC RADIOLOGY (10 hours) 2.1 X-ray film and processing 2.2 Intensifying and fluorescent screen 2.3 X-ray circuit and the rectification of generator 2.4 X-ray tube and shielding, the rating of X-ray tube 2.5 Fluoroscopy and radiography 2.6 Special X-ray equipments and procedures 2.7 Ultrasound, computed tomography, magnetic resonance imaging, digital radiography and quality assurance in diagnostic radiology 3. RADIOTHERAPY (10 hours) 3.1 Photon and particle beams 3.2 Output measurement and the use of isodose chart 3.3 Therapy planning 3.4 Special techniques in radiotherapy 3.5 Brachytherapy 3.6 Quality assurance in radiotherapy 4. NUCLEAR MEDICINE (10 hours) 4.1 Radiophamaceuticals -5 -

6 4.2 Nuclear instrumentation 4.3 Radionuclides quantitative studies in nuclear medicine 4.4 Bone densitometer 4.5 Quality assurance in nuclear medicine 5. RADIATION PROTECTION (4 hours) 5.1 Radiation hazards and their controls 5.2 Maximum permissible levels of radiation 5.3 Radiation safety monitoring and legal aspects 5.4 Planning of radiation establishments and protection in diagnostic radiology, radiotherapy and nuclear medicine MEDICAL RADIATION PHYSICS 1. BASIC RADIOLOGICAL PHYSICS 1.1 Basic nuclear physics The atom - Atomic structure - Binding energy of electrons - Ionization and excitation processes - Electromagnetic radiation - Electron transitions: Characteristic x-rays and Auger electron emission - Mass-energy equivalence (Einstein formula) Nucleus - Nuclear constituents - Nuclide and its classification - Nuclear forces - Nuclear stability - Nuclear fission and fusion - Nuclear energy levels Nuclear disintegration Methods of radioactive decay -6 -

7 Alpha transitions Isobaric transitions - Beta minus decay - Beta plus decay - Electron capture Isomeric transitions - Gamma decay - Internal conversion Decay schemes Single photon emission Interaction of gamma radiation in NaI crystal Radioactivity Law of radioactive decay Half-lives - Physical half-life - Biological half-life - Effective half-life Units of radioactivity Specific activity Production of radionuclides Reactor-produced radionuclides Accelerator-or cyclotron-produced radionuclides Fission-produced radionuclides 1.2 Radiation qualities, quantities, and SI units Activity Ionizing radiations Intensity (energy flux density or energy fluence rate) Exposure and its limitation Absorbed dose Relationship between exposure and absorbed dose in air Relationship between exposure and absorbed dose in tissue or other materials -7 -

8 1.2.8 Kerma Stopping power Linear energy transfer (LET) Specific gamma ray constant Relative biological effectiveness (RBE) Dose equivalent (DE) Nominal standard dose (NSD) 1.3 Interaction of photon with matter Attenuation of photon beam Mass, electronic and atomic attenuation coefficient Intensity Scattering Photoelectric effect Compton effect Pair production. 1.4 Interaction of electrons and heavy particles with matter 1.5 Production and detection of X-rays Properties of X-rays - X-ray production - Results of interaction between electron and atom in an X-ray tube target - Spectrum of radiation Quantity and quality of X-rays - Heat and X-ray production - The distribution of X-rays around thin and thick target - The determination of half value layer of X-ray beam - Calculation of HVL and inverse square law 1.6 Radiation dosimetry Standard methods of radiation measurement - Ionization method - Calorimetric method - Chemical method -8 -

9 1.6.2 Solid state dosimeter - Film dosimetry - Thermoluminescent dosimetry - Semiconductor detector - Scintillation detector 1.7 Basic knowledge in computer Computer definition Type of computer - Analog and digital computer - Specific and general purpose computer Computer system Computer structures - Hardware - Software Programming language Data processing system Consideration in computer utilization 2. DIAGNOSTIC RADIOLOGY 2.1 X-ray film and processing Radiographic terminology Radiographic film Silver image formation Image characteristics Radiographic exposure Secondary radiation fog Additional density factors Geometry of image formation X-ray film processing 2.2 Intensifying and fluorescent screen Historical -9 -

10 - Fluorescence - First use of intensifying screen Screen characteristics - Modes of uses - Types of screens Screen versus unsharpness - screen-film contact Care of screens 2.3 X-ray circuit and the rectification of generator Autotransformer: three phase transformer High voltage transformer Vacuum tube and solid state rectifiers Half-wave rectified circuit Full-wave rectified circuit Six-pulse, six-rectified circuit Twelve-pulse, twelve-rectified circuit High frequency circuit Contactor switching; electronic switching 2.4 X-ray tube and shielding, the rating of the X-ray tube The properties of tungsten target Description of rotating anode tube The stationary anode tube Tube shielding and electrical shockproof cables The rating of X-ray tube - Electrical rating - Max kv, max ma, max power - Thermal rating - Max production, temperature rise and cooling of the target - Factors influencing rating - Current - Tube kilovoltage -10-

11 - Focal spot size - Wave form - Exposure time - The use of rating charts 2.5 Fluoroscopy and radiography Introduction to fluoroscopy and radiography - Meaning - Luminescence - Phosphorescent materials - Fluorescent materials - Mechanism of fluorescence - Construction of fluorescence screen X-ray machines - Composition of general radiographic machine - X-ray tube - Beam limiting devices - Tube support - High tension cable - High tension generator and circuit - Control table - X-ray table - Composition of fluoroscopic machine - X-ray tube - X-ray tube carriage and screen holder - Fluorescent screen - Fluoroscopic table - Serial changer or spot film device - Additional accessories - Image intensifier - Optical viewer and image distributor - Video tape recorder, cine camera, photospot camera -11-

12 - Quality assurance 2.6 Special X-ray equipments and procedures Tomography Stereoradiography Magnification radiography Soft tissue radiography Mammography and xeroradiography 2.7 Ultrasound, computed tomography, magnetic resonance imaging, digital radiography and quality assurance Basic physics of ultrasound - Historical background - Physical properties of ultrasound - Ultrasonic transducers - The properties of sound when passing through tissues - Acoustic impedance - Axial and lateral resolution - Instrumentation in ultrasonography - A-mode, B-mode, and M-mode - Static image and real time - Doppler ultrasound - Quality assurance and routine preventive maintenance Computed tomography (CT) - Limitations of conventional radiography - Principle of operation of CT. - Scanning - Image reconstruction - Display - Image-adjustment technique - CT structure - Process - Hardware -12-

13 - Advantages and application of CT - Limitations of CT. - Fluctuation of radiation flux - Artifacts - Evaluation of CT - First generation - Second generation - Third generation - Fourth generation - Fifth generation - Ultrafast CT - Radiation dose from CT - Quality assurance in CT - Spiral (helical) CT Clinical applications of computed tomography - Attenuation value determination of histopathology - Effect of center and window level on lesion detection - Partial volume effect on lesion detection - Double exposure technique for detection with marked difference of attenuation Magnetic resonance imaging (MRI) - Physical basis for NMR: properties of atomic nuclei, nuclei in a magnetic field, lamour frequency, magnetization resonance - Theoretical basis for MR imaging: relaxation process, advantage considerations - Quality assurance in MRI -13-

14 2.7.5 Digital radiography and digital subtraction - Basic principle - Digital image conversion from fluoroscopic image - Computer subtraction of digital image - Clinical application 3. RADIOTHERAPY 3.1 Photon and particle beams Teletherapy unit and high energy X-ray generators Basic principle of linear accelerator and dosimetry Terminology: penumbra, surface output, build up region, back scatter factor, tissue air ratio, percentage depth dose, given dose, skin dose, tumor dose and exit dose Tissue-maximum ratio Tissue-phantom ratio Scatter-air ratio Perturbation of isodose distribution The potential for heavy particle radiation 3.2 Output measurement Measurement of output with ionization chamber SSD and STD techniques and dosage calculation Dose determination for Co Therapy planning Beam modification and beam direction devices - Shielding - Beam flattening filter - Tissue compensator - Wedge filter - Front and back pointer - Patient immobilization Simple dose distribution and combination of isodose charts -14-

15 3.3.3 Oblique incidence and its correction Wedge filter technique Integral dose Prescribing, recording and reporting 3.4 Special techniques in radiotherapy Total body irradiation Stereotactic radiotherapy and stereotactic radiosurgery Intraoperative radiotherapy 3.5 Brachytherapy Radiation sources - Ra Cs Co-60 - Ir Cf Clinical application of radiation sources Dose rate in brachytherapy - High dose rate (HDR) - Medium dose rate (MDR) - Low dose rate (LDR) Preloading Manual afterloading Remote-control afterloading Surface mould Implantation Intracavitary 3.6 Quality assurance in radiotherapy Quality assurance in teletherapy - Cobalt-60 - Linear accelerator Quality assurance in brachytherapy -15-

16 4. NUCLEAR MEDICINE 4.1 Radiopharmaceuticals - Characteristics of an ideal radiopharmaceutical and precautions - Production of radionuclides - Preparation of radiopharmaceuticals - Quality control of pharmaceuticals 4.2 Nuclear instrumentation Nuclear instrumentation for in-vitro measurement - Dose calibrator - The gamma-well counter - Liquid scintillation counter - Fluorescent excitation techniques Nuclear instrumentation for in-vivo studies - Single and multiple probe system - Bone densitometer - Gamma camera and collimators - SPECT - PET - Computerized digital and imaging system - Quality control of nuclear instrumentations Quality assurance in nuclear medicine 4.3 Radionuclide quantitative studies in nuclear medicine In vitro studies Basic principle of RIA and related techniques (RIA, EIA, FIA, etc; IRMA, ELISA, IFMA, etc) - Quality control of RIA and related techniques In vitro thyroid function tests and their applications - Total T3 and T3, Reverse T3 - T3 uptake test - Free thyroxine index - Free T4, Free T3-16-

17 - Sensitive TSH - Thyroid binding globulin (TBG) - Thyroglobulin - Thyrotropin releasing hormone (TRH) stimulation test - Tanned red cell hemagglutination (TRC) or thymune-t and thymune-m - Thyroglobulin (Tumor marker of CA thyroid) In vivo studies - Data acquisition and computer analysis of various organ function studies, (brain, heart, kidney, lung...etc) 4.4 Bone densitometer - Single photon absorptiometer (SPA) - Dual photon absorptiometer (DFA) - Dual energy X-ray absorptiometer (DEXA) - Etc. (quantitative bone CT, Ultrasound, neutron activation analysis) 5. RADIATION PROTECTION 5.1 Radiation hazards and their controls Historical introduction Types of radiation Source of radiation Needs for patient dose limitation Concept of radiation hazard control - External irradiation - Internal irradiation 5.2 Maximum permissible levels of radiation 5.3 Radiation safety, monitoring and legal aspects Radiation protection survey Radiation safety monitoring - Area monitoring - Personal monitoring -17-

18 5.3.3 Legal aspect 5.4 Planning of radiation establishments and protection in diagnostic radiology, radiotherapy, and nuclear medicine Design of diagnostic, deep therapy and teletherapy installations Calculation for primary and secondary radiation barrier Radiation protection in diagnostic radiology Choice of X-ray equipment from the point of view of radiological safety - Radiographic equipment - Fluoroscopic equipment - Mass miniature radiographic equipment - Dental radiographic equipment - Mobile and portable equipment Staff radiation protection Protection of patients and the general public Radiation protection in radiotherapy Installation of - Gamma-ray beam unit - X-ray and electron beam units - Remote controlled after-loading equipment Therapeutic uses of small sealed radioactive source - Loss or breakage of a small sealed source - Protection of persons in proximity to patients undergoing treatment with small sealed sources Radiation protection in nuclear medicine Hazards from radioactive unsealed source Maximum permissible body burden, MPBB Maximum permissible concentration, MPC Hot lab design monitoring Rules and regulation in the hot lab Hot lab monitoring Storage of radioactive materials -18-

19 Accidents Contamination and decontamination Radioactive waste disposal and control Transportation of radioactive materials -19-

20 RADIOBIOLOGY 1. REVIEW OF RADIATION INTERACTIONS WITH MATTER 1.1 Types of ionizing radiation 1.2 Excitation and ionization 1.3 Free radical production 1.4 Chain of events between absorption of energy and expression of biological effects 2. RADIATION CHEMISTRY 2.1 Direct and indirect effects of radiation 2.2 Radiolysis of water 2.3 Formation of various types of free radicals from water molecules 2.4 Interaction of free radicals with macromolecules 2.5 Factors influencing free radical interaction 2.6 G value, ionic yield 3. EFFECTS OF RADIATION ON SEVERAL MACROMOLECULES 3.1 Effects of radiation on lipids, proteins and nucleic acids 3.2 Changes in structures and functions of macromolecules following irradiation 4. RADIATION DAMAGE TO CELL COMPONENTS 4.1 Effects of radiation on Cell membrane Mitochondria Lysosome Endoplasmic reticulum Nucleus 4.2 Cellular functional defects following irradiation of cell organelles 5. LETHAL ACTION OF IONIZING RADIATIONS AND MOLECULAR DEFENSE MECHANISMS 5.1 Cell inactivation Loss of reproductive integrity: reproductive death Loss of specific function: interphase death -20-

21 5.2 Mechanisms of cell inactivation Disruption of cytoplasmic membrane Interfering of chromatin function 5.3 Molecular defense system Free radical repair DNA repair 6. CELL SURVIVAL STUDIES AND SURVIVAL KINETIC ANALYSIS 6.1 Surviving from reproductive death: clonogenicity 6.2 Methods and types of clonal assays 6.3 Analysis of cell survival curves Straight line curve Shoulder-type curve Curvilinear curve 6.4 Mathematical models for survival kinetics Exponential model Two-component model Linear-quadratic model 6.5 Usage of cell survival data 7. CELLULAR RECOVERIES FROM RADIATION DAMAGES 7.1 Radiation-induced damages Repairable damages: sublethal and potentially lethal damage Irrepairable damages: lethal damages 7.2 Cellular recovery processes Recovery observed in split dose experiment : repair of sublethal damage (SLD) Recovery observed after postirradiation treatment : repair of potentially lethal damage Significance of shoulder regeneration in dose fractionation Significance of recovery from PLD 7.3 Interpretation of cell survival kinetics Multitarget model Repair model -21-

22 8. FACTORS INFLUENCING CELLULAR RECOVERIES 8.1 Individual cell repair capacity 8.2 Time factor: fractionation and dose rate 8.3 Stage of cell cycle 8.4 Intercellular contact and stromal factors 8.5 Linear energy transfer 9. PROLIFERATION KINETICS AND ORGAN RESPONSE 9.1 Parameters for cell kinetics Cell cycle time Growth fraction Cell loss factor Potential and actual doubling time 9.2 Classification of cells according to mitotic behaviors Uncommitted stem cell (USC) Committed stem cell (CSC) Reverting mature cell (RMC) Fixed mature cell (FMC) 9.3 Types of tissues Rapidly renewing system Slowly renewing system Non-renewing system Expanding system: tumor 9.4 Normal organs Parenchymal and stromal compartments Kinetics of radiation responses: early responders and late responders 9.5 Tumor organs Tumor cell populations Tumor growth Tumor cell kinetics Kinetics of radiation responses: regression and regrowth -22-

23 10. HYPERTHERMIA AND PHOTOSENSITIZERS 10.1 Hyperthermia Physics of heat transfer Heating by microwave and ultrasound Heat as a cytotoxic agent Mechanisms of cell inactivation by heat Temperature and heating time Thermotolerance Hyperthermic responses in normal and tumor organs Hyperthermia and radiation in combination 10.2 Photosensitizers Hematoporphyrin: a cytotoxic agent by light activation Mode of action Mechanisms of tissues and tumor localization Potential role of photosensitizers in cancer treatment 11. GENETIC EFFECTS OF RADIATION 11.1 Effects of radiation on chromosomes 11.2 Qualitative aspects of radiation-induced chromosome aberrations Chromatid-type aberrations Chromosome-type aberrations 11.3 Quantitative aspects of radiation-induced chromosome aberrations Relationship between radiation dose and frequency of chromosomal aberrations Factors influencing aberration yield 11.4 Gene mutation Frameshift mutation Dominant, recessive and sex-linked mutation 11.5 Chromosome mutation Change in the number of chromosomes Chromosome breaks Relation of mutation frequency to radiation dose 11.6 Radiation genetics in animals 11.7 Radiation genetics in man -23-

24 11.8 Genetically significant dose 12. EFFECTS OF RADIATION ON TOTAL ORGANISM 12.1 Tissue or organ radiosensitivity 12.2 Lethality-immediate lethal effect L.D Definition - Determination - Difference - Various effects on L.D Acute radiation syndromes in mammals Typical relationship between dose and time Interrelationship of organ system in acute radiation syndromes 13. BONE MARROW SYNDROME 13.1 Manifestation Prodromal period Latent period Period of severe illness 13.2 Histologic changes 13.3 Cytologic changes 13.4 Peripheral blood changes 13.5 Infection in bone marrow syndrome 14. GASTROINTESTINAL SYNDROME 14.1 Manifestation-N-V-D syndrome 14.2 Histologic changes Cell lining of small intestinal villi and crypt Cell lining of large intestine Normal structure of gut lining cell Effect on cell renewal 14.3 Effect on bone marrow in the syndrome 14.4 Effect on fluid and electrolytes 14.5 Infection -24-

25 15. CENTRAL NERVOUS SYSTEM SYNDROME 15.1 Manifestation 15.2 Histologic and cytologic changes 15.3 Consequences of vascular damage - Blood brain barrier - Immediate cause of death 15.4 Human experience 15.5 Diagnosis of radiation injury 15.6 Characteristic types of radiation accidents 15.7 Therapeutic outlines 16. THE LATE EFFECTS OF RADIATION 16.1 Late somatic effects - Sterility - Lengthening of life span - Late effect on bone and hair 16.2 Radiation carcinogenesis Step of cancer reduction Mechanism of action in radiation-induced cancer Threshold dose of radiation Radiation carcinogenesis in experimental animals Radiation carcinogenesis in man 17. MODIFICATION OF RADIATION INJURIES 17.1 Physical modification of radiation exposure Quantity of radiation Quality of radiation Partial body irradiation Significance of LET - in simple biological system - in higher biological system Dose rate 17.2 Chronic irradiation -25-

26 17.3 Biological modification of radiation exposure External factors - Age, sex, endocrine status - Health status, diet - Genetic constitution - Temperature - Hibernation Internal or cellular factors - Ploidy, nuclear & chromosome volume - Cytoplasmic factor - Additional nuclear parameter - Cell differentiation - Stage of cell dynamic cycle 17.4 Oxygen effects Definition and universal effect of oxygen Condition under oxygen effect Oxygen concentration within a definite range Adaptation to oxygen effect and dependence on LET Mechanism through which the oxygen effect occurs - Toxicity of oxygen - Generation of free radicals by oxygen - Auto-oxidative chain reaction of free radicals - Formation of peroxide 17.5 Chemical factors which modify the radiation response Radioprotective agents - The thiols group - Structure - Mechanism of action - Competitive removal of free radicals - Repaired by donation of H2 atoms - Interaction with cellular components - Production of tissue hypoxia - Other theories -26-

27 Radiosensitizers 18. APPLICATION OF THE OXYGEN EFFECT TO RADIOTHERAPY 18.1 Hypoxic and anoxic tumor 18.2 Left history of a tumor according to cell oxygenation 18.3 Tumor recurrence 18.4 Experimental evidence 18.5 Model experiments 18.6 In vivo measurement 18.7 Method of increasing tumor oxygen tension Hyperbaric oxygen therapy Inhalation of pure oxygen at atmospheric pressure Regional oxygenation by infusion of hydrogen peroxide 18.8 Method ofreduction of radiosensitivity of normal tissue Regional hypoxia Hypothermia 19. RADIATION EFFECT ON IMMUNITY 19.1 Type of immunity 19.2 Radiation effect on natural immunity 19.3 Phase of antibody production in acquired immunity Primary antibody response Radiation effect on primary antibody response Radiation effect on secondary antibody response 19.4 Tissue rejection 19.5 Chimeras and tissue or organ transplantation -27-

28 20. EFFECT OF RADIATION ON EMBRYO AND FETUS 20.1 Development of embryo and fetus Preimplantation Organogenesis Fetal stage 20.2 Effect of radiation on embryo and fetus at various stages of development Prenatal death Congenital anomalies Functional defects 20.3 Consequences to the radiologist -28-

29 Diagnostic Radiology 1. Radiology of Alimentary system Theory, Knowledge 1. Imaging methods and positioning ต องร 1.1 Soft tissue technique lateral neck 1.2 Supine film abdomen 1.3 Acute abdomen series 1.4 Decubitus film abdomen 1.5 Lateral cross table film abdomen 1.6 CT arterial portography 1.7 Sialography 1.8 Esophagography 1.9 Upper GI study 1.10 Small bowel series 1.11 Barium enema 1.12 Loopography 1.13 Fistulography 1.14 Cholangiography 1.15 Ultrasonography of abdomen - Conventional - Color doppler 1.16 Intraoperative sonography 1.17 CT scan of abdomen 1.18 MRI of abdomen 1.19 Cavitary probe sonography -29-

30 ต องร ต องร ต องร ต องร 2. Indications and contraindications of each modality 2.1 Upper GI series 2.2 Small bowel series 2.3 Barium enema 2.4 Ultrasonography of abdomen 2.5 CT scan abdomen 2.6 CT arterial portography 2.7 MRI abdomen 2.8 MRA, MRV 3. Dynamic physiology of the system 3.1 Swallowing mechanism 3.2 Physiology of gastrointestinal tract 3.3 Physiology of hepatobiliary system 3.4 Physiology of exocrine and endocrine pancreas 3.5 Lymphatic drainage of gastrointestinal, hepatobiliary system and pancreas 4. Normal roentgenographic anatomy of the system 4.1 Normal roentgen anatomy of salivary gland 4.2 Normal roentgen anatomy of esophagus 4.3 Normal roentgen anatomy of stomach, small bowel, colon 4.4 Normal roentgen anatomy of liver and biliary tree 4.5 Normal roentgen anatomy of the pancrease 4.6 Normal roentgen anatomy of abdominal and retroperitoneal cavity 4.7 Roentgen anatomy of abdominal and retroperitoneal nodes 5. Pathologic images of the system 5.1 Extraluminal air 5.2 Retroperitoneal air 5.3 Free fluid in peritoneal cavity 5.4 Fluid collection in abdominal cavity and retroperitoneum 5.5 Intestinal and colonic obstruction -30-

31 5.6 Intestinal and colonic ischemia Ulcerative disease of gastrointestinal tract 5.7 Polyposis syndrome of gastrointestional tract 5.8 Esophageal and gastric varices 5.9 Abscesses of liver, spleen 5.10 Acute cholecystitis 5.11 Acute and chronic pancreatitis 5.12 Biliary tract stone Ttraumatic lesion of liver and spleen 5.13 Disease of salivary gland 5.14 Flow imaging in TIPS (Transjugular intrahepatic porto systemic shunt) 5.15 Imaging analysis in liver transplantation Skill (Technical and Judgement) Procedure ท ต องสามารถท าได ด วยตนเอง จ านวนรายท ต องท าได ด วยตนเอง 1. Sialography 5 ราย 2. Esophagography 50 ราย 3. Upper GI study 50 ราย 4. Small bowel series 50 ราย 5. Barium enema (Double contrast study) 50 ราย 6. Loopography 5 ราย 7. T tube cholangiography 10 ราย 8. Fistulography 5 ราย 9. Ultrasonography abdomen 100 ราย 10. CT scan abdomen 100 ราย 11. MRI abdomen 20 ราย Procedure ท เคยช วยหร อเคยเห น และสามารถอธ บายข นตอนว ธ การท าได 1. CT arterial portography 1 ราย 2. MR venography, MR splenoportography 2 ราย 3. MRCP 5 ราย -31-

32 2. Body vascular and Interventional Radiology Theory and Knowledge 1. Imaging methods and positioning ต องร 1.1 Basic instrumentation Imaging equipments, fluoroscope, CT, ultrasound Choices of catheter and guidewires,needles ควรร 1.2 Special instrument, special catheter, embolic materials 2. Indications and contraindications of each modality ต องร 2.1.Abdominal intervention specific on Abscess drainage Percutaneous transhepatic cholangiography(ptc) Percutaneous transhepatic biliary drainage(ptbd) Percutaneous nephrostomy(pcn) Ultrasound guided biopsy or Fine needle aspiration (FNA) ควรร 2.2. Chest intervention Biopsy or Fine needle aspiration FNA under fluoroscope Empyema drainage 2.3 Vascular Intervention Diagnostic and treatment of upper and lower GI bleeding Angioplasty Tumor embolization 3. Dynamic physiology of the system 4. Normal roentgenographic anatomy of the system ต องร 4.1 Hepato- biliary system 4.2 Renal anatomy 4.3 Intraabdominal anatomy. 5. Pathologic images of the system ต องร 5.1Biliary Obstruction 5.2Obstructive uropathy ควรร 5.3 Inflammatory process with abscess formation Skills (Technical and Judgement) -32-

33 Procedure ท ต องสามารถท าได ด วยตนเอง จ านวนรายท ต องท าได ด วยตนเอง 1. Reduction of Intussusception 1 ราย 2. PCN 1 ราย 3. PTBD 1 ราย 4. Abscess drainage 2 ราย 5. Biopsy under US guidance 2 ราย 6. Aortogram and peripheral run off 2 ราย 7. Venogram lower extremity 2 ราย Procedure ท เคยช วยหร อเคยเห น และสามารถอธ บายข นตอนว ธ การท าได TOCE 3 ราย Angioplasty 1 ราย Treatment of GI bleeding 1 ราย Biopsy under flu, CT อย างละ 1 ราย Stone or foreign body removal 1 ราย อ นๆท ต องร 1. Contrast media 1.1 ชน ด 1.2 ข อบ งช 1.3 ข อห าม 1.4 การใช ในผ ป วยกล มท ม ความเส ยงต อการเก ด adverse reaction 1.5 การด แลผ ป วยท เก ด adverse reaction 2. Cardiopulmonary (CPR) ม การฝ กทบทวนความร และภาคปฏ บ ต โดยสม าเสมอ สถาบ นฝ กอบรมควรให แพทย ประจ าบ านได ร บการอบรมการท า CPR ท ถ กต องป ละอย างน อย 1 คร ง โดยแพทย ผ เช ยวชาญเฉพาะด าน 3.Radiation protection 4.Patient rights 5.Consent form แพทย ผ เข าร บการฝ กอบรมควรร ว ธ การอธ บายผ ป วยก อนให เซ นใบย นยอมร บการ ตรวจ ร กษาหร อให สารท บร งส หร อ การกระท า invasive procedure อ นๆ -33-

34 3. Cardiovascular System Theory and knowledge 1. Imaging methods and positioning ต องร 1.1 Plain film Teleheart Cardiac series 1.2 Fluoroscopic examination 1.3 Aortogram and peripheral run off 1.4 Venography ควรร 1.5 Helical and Electron Beam CT 1.6 MRI 1.7 Echocardiogram 1.8 Cardiac catheterization 1.9 Selective arteriogram 1.10 Lymphangiogram 2. Indications and contraindications of each modality ต องร 2.1 Plain film 2.2 Fluoroscopic examination 2.3 Aortogram and peripheral run off 2.4 Venogram 2.5 CT scan ควรร 2.6 MRI 2.7 Echocardiogram 2.8 Cardiac catheterization 2.9 Selective arteriogram 2.10 Lymphangiogram -34-

35 3. Dynamic physiology of the system ต องร 3.1 Normal heart and pulmonary circulation 3.2 Aorta and branches ควรร 3.3 Fetal Circulation 3.4 Endocrine disease effecting the heart 3.5 Cardiac catheterization 4. Normal roentgenographic anatomy of the system ต องร 4.1 Normal roentgen anatomy of the heart including pericardium 4.2 Normal roentgen anatomy of the great vessels including branches and tributaries 4.3 Normal roentgen anatomy of the lungs including pulmonary vasculatures 4.4 Normal roentgen anatomy of the mediastinum 4.5 Normal roentgen anatomy of the chest wall 4.6 Normal roentgen anatomy of the peripheral venous anatomy of the lower extremity ควรร 4.7 Normal anatomy of the portal system 4.8 Normal roentgen anatomy of the lymph node 5. Pathologic images of the system ต องร 5.1 Congenital heart disease, left to right shunt 5.2 Acquired heart disease, mitral valvular disease 5.3 Abnormal cardiac calcification 5.4 Abnormality of the aortic arch, thoracic aorta and their branches 5.5 Cardiomyopathies 5.6 Pericardial effusion 5.5 Pulmonary hypertension both arterial and venous 5.8 Pulmonary edema 5.9 Pulmonary embolism and infarction 5.10 Trauma, pneumopericardium, penumomediastinum 5.11 Hypertensive and atherosclerotic heart disease 5.12 Deep venous thrombosis 5.13 Aneurysm and dissection -35-

36 ควรร 5.14 Uncommon congenital heart disease 5.15 MRI of the aneurysm and dissecting aneurysm Skills (Technical and judgement) Procedure ท ต องสามารถท าได ด วยตนเอง จ านวนรายท ต องท าได ด วยตนเอง 1. Aortogram and run off 1 ราย 2. Peripheral venogram 1 ราย 3. Positioning of plain film 20 ราย อ นๆท ต องร Contrast media, CPR,Consent form เช นเด ยวก บในห วข อ Interventional Radiology 4. Genitourinary System, Obstetric and Gynecology Radiology and Breast Imaging Theory and knowledge 1. Imaging technique and positioning, Technique and Proparation ต องร 1.1 Plain KUB 1.2 Excretory Urography 1.3 Retrograde pyelography 1.4 Voding cystourethrography 1.5 Cystography 1.6 Renal angiogram 1.7 Sonography 1.8 Duplen sonography 1.9 MRI of renal 1.10 MRA of renal artery 1.11 CT 1.12 Hysterosalpingogram 1.13 Fisulogram 2. Indications and contraindications of each modalities. 3. Dynamic and physiology of the genitourinary tract, obstetric and gynecology system. ต องร 3.1 Physiology of ovary in different phase of menstruation 3.2 Physiology of endemetrium according to menstruation phase and aging -36-

37 3.3 Physiology and function of kidney 4. Normal roentgenographic anatomy of the KUB system ต องร 4.1 Kidney, ureter, bladder, urethra 4.2 Seminal vesicle, Prostate gland, scrotum, testis 4.3 Uterus, cervix, ovary, vagina 4.4 Adrenal gland 4.5 Pregnancy 5. Pathologic images of the KUB system ต องร 5.1 Congenital malformation anomlie in number - renal agenesis - supernumerary kidney anomalie in size and form - hypoplasis - hyperplasia - Horseshoe kidney - Cross ectopy anomlie in position - malrotaion - ectopia - nephroptosis other - benign cortical nudule - abberant papilla - megcalyces - Anomalie of renal pelvis, ureter and urethra - Ureterpelvic junction obstruction - Duplication of pelvis and ureter - Retrocaval ureter - Ureterocele - Ureteral Diverticula -37-

38 - Patent Urachus and Urachal cyst - Vesicoureteral reflux - Posterior urethral valve - Bladder entrophy 5.2 Trauma Renal trauma - contusion - cortical laceration - calyceal laceration - fracture with laceration of renal capsule Bladder rupture Urethral rupture 5.3 Renal cystic disease ม อย มากมายแต ท พบบ อยๆ ค อ - Simple cyst - Multiloculr cyst - Medullary cystic disease - Medullary necrosis - Medullary sponge kidney - Multicystic kidney - Polycystric disease - Polycystic disease - Adult polycystic kidney disease - Infantile polycystic kidney disease - Calyceal diverticulum - Parapelvic cyst - Perinephric cyst 5.4 Tumor - Angiomyolipoma - Wilm s tumor - Renal cell CA - Transitional cell CA of bladder, ureter and renal pelvis - Squamous cell CA -38-

39 5.5 Infection - TB - Bacterial 5.6 Miscellaneous - Renal transplantation - Obstructive uropathy - I.U.D. (Intrauterine device) - Abnormal pregnancy. - Endometriosis - Ectopic pregnancy - Orchictis - Torsion testes - Urinary tract stone and Obstructive uropathy - Nephrocalcinosis - Neurogenic bladder etc. Skill (Technical and Judgement) 1. Procedure ท สามารถท าได ด วยตนเอง และแปรผลได จ านวนท ต องท าได ด วยตนเอง 1.1 Excretory urography 50 ราย 1.2 Cystourethrography 5 ราย 1.3 Cystography 5 ราย 1.4 Hysterosalpingogxrphy 10 ราย 1.5 Obstetric sonography 40 ราย 1.6 Gynecologic sonography 20 ราย 1.7 Sonography of the KUB 30 ราย 1.8 CT of the KUB system 10 ราย 1.9 Sonogram of the testes, scrotum 5 ราย 2. Procedure ท ควรเคยช วยหร อเคยเห น และสามารถอธ บายถ งข นตอนว ธ การท าได (ระบ จ านวน) 2.1 Amniocentesis 2 ราย -39-

40 Breast Imaging Theory and Knowledge 1. Imaging methods and positioning ต องร 1.1 Mammography Standard views (Craniocaudal, Mediolateral oblique) Supplement (Spot compresion, Exaggerated craniocaudal, Magnification, Roll, Mediolateral, Axilla) Equipment 1.2 Ultrasonography ควรร 1.3 MR mammography 1.4 Galactography 1.5 Intervention (biopsy, mammotomy) 2. Indications and contraindications of each modality 3. Dynamic physiology of the breast system ต องร 3.1 Breast development 3.2 Aging changes and involution 3.3 Lymphatic drainage 4. Normal anatomy of the breast system ต องร 4.1 Fibroglandular tissue 4.2 Latiferous ducts 4.3 Supporting structures(connective tissue stroma, ligaments) 4.4 Nipple 4.5 Lymph nodes 4.6 Vascular supply 5. Pathologic images of the systems ต องร 5.1 carcinoma 5.2 Ductal carcinoma in situ 5.3 Fibrocystic change -40-

41 5.4 Fibroadenoma 5.5 Calcifications(benign, malignant ) 5.6 Abscess ควรร 5.7 Benign breast change (fibroadenosis, radial scar) 5.8 Proliferative lesion (papilloma, papillomatosis) 5.9 Phyloides 5.10 Fat necrosis 5.11 Implantation Skills (Technical and Judgement) Procedure ท ต องสามารถท าได ด วยต วเอง 1. Film interpretation of mammography จ านวน 20 ราย 2. Ultrasonography interpretation of the breast จ านวน 20 ราย Procedure ท เคยช วยหร อเคยเห น และสามารถอธ บายข นตอนว ธ การท าได 1 MR mammography จ านวน 1 ราย 2 Galactography จ านวน 2 ราย 3 Interventiona (needle localization,biopsy) Sterotactic จ านวน 1 ราย Ultrasonography จ านวน 1 ราย 5. Radiology of Musculoskeletal System Theory and Knowledge 1. Imaging methods and positioning 1.1 Conventional plain film of bone and joint 1.2 Special investigation Arthrography Ultrasonography Computed Tomography (CT scan i.e., conventional CT, 3D-CT) Magnetic Resonance Imaging (MRI i.e., conventional MRI, MR arthrogram, etc.) 2. Indications and contraindications of each modality 3. Dynamic physiology of musculoskeletal system 4. Normal roentgenographic anatomy of the system -41-

42 4.1 Axial skeleton Spinal column Pelvis 4.2 Appendicular skeleton Upper extremity Lower extremity 4.3 Bone marrow Axial skeleton Appendicular skeleton 5. Pathologic images of the system ต องร 5.1 Degenerative disease 5.2 Trauma, sports injury 5.3 Bone & soft tissue neoplasm (benign, malignant) 5.4 Infection ควรร 5.5 Metabolic, endocrine disease 5.6 Congenital disease 5.7 Bone marrow disease i.e., hematologic disease, infiltrative (malignant) disease, deposition disease, etc. 5.8 Miscellaneous Skills (Technique and Judgement) 1. Preparation for special investigation 2. Plain film interpretation 3. Contrast studies Arthrogram 4. Common ultrasonographic investigation Soft tissue lesion Palpable mass Infection i.e., cellulitis, abscess formation Joint effusion 5. Interpretation of CT scan, MRI in common diseases -42-

43 6. Neuroradiology (Including head and neck, intervention) Theory and Knowledge 1. Imaging methods and positioning 1.1 Plain film 1.2 Myelography 1.3 Ultrasonography 1.4 Computed Tomography 1.5 Magnetic Resonance Imaging 1.6 Angiography 2. Indications, contraindications and complications of each modality 3. Dynamic physiology of central nervous system 4. Normal roentgenographic anatomy of 4.1 Skull and spine 4.2 Brain and cranial nerves 4.3 Cerebrospinal fluid system 4.4 Neck and intracranial vessels 4.5 Spinal cord, peripheral nerve and vascular supply 4.6 Meninges 4.7 Orbits 4.8 Sinonasal area 4.9 Temporal bone 4.10 Soft tissue of the neck (suprahyoid and infrahyoid neck) 4.11 Oral cavity 5. Pathologic images of ต องร 5.1 Congenital malformation of the brain Disorders of organogenesis Chiari malformations Cephaloceles Anomalies of corpus callosum Dandy - Walker complex Disorders of diverticulation and cleavage Holoprosencephaly -43-

44 5.1.3 Disorders of sulcation and migration Schizencephaly Gray matter heterotopia Disorders of size Microcephaly Macrocephaly Destructive lesions Hydranencephaly Porencephaly 5.2 CNS Infection and inflammatory disease : Common congenital central nervous system (CNS) infection : toxoplasmosis, rubella, cytomegalovirus, herpes simplex Acquired CNS infection Encephalitis Abscess Ventriculitis and ependymitis Meningitis Empyema (subdural, epidural) Specific Infection HIV and CNS complications Cysticercosis Tuberculosis 5.3 Trauma Primary lesions Skull fracture, scalp hematoma / laceration Extracerebral hemorrhage Epidural hematoma Subdural hematoma Subarachnoid hemorrhage Intracerebral lesions Cortical contusion Intraventricular hemorrhage -44-

45 Brainstem injury Deep cerebral gray matter injury Diffuse axonal injury Secondary lesions Cerebral herniations Traumatic ischemia, infarction Diffuse cerebral edema Hypoxic injury 5.4 Intracranial Hemorrhage Traumatic intracranial hemorrhage Non - traumatic intracranial hemorrhage Hypertension Intracranial aneurysm Intracranial vascular malformation Hemorrhagic infarction Amyloid angiopathy Coagulopathies / blood dyscrasia Tumor 5.5 Cerebral ischemia and infarction Acute infarction Subacute infarction Chronic infarction Lacunar infarction Hypoxic - ischemic encephalopathy Venous occlusion 5.6 Brain Tumors and Tumorlike mass Primary brain Tumors Metastatic Brain Tumors Lesions at specific anatomic area : Pineal region masses Intraventricular masses Cerebellopontine angle masses Foramen Magnum masses -45-

46 Sellar / Suprasellar masses Skull Base and cavernous sinus masses Scalp, cranial vault, meningeal masses 5.7 Acquired metabolic, white matter and degenerative disease of the brain Normal aging brain Multiple sclerosis Alzheimer disease 5.8 Congenital malformation of the spine and spinal cord Craniovertebral junction anomalies Meningocele Myelomeningocele Lipomyelomenigocele Tethered Cord 5.9 Non-neoplastic disorders of the spine and spinal cord Infection spondilitis discitis Degenerative disease of the spine Spinal injury 5.10 Tumors, cysts and tumorlike lesions of the spine and spinal cord Extradural masses Intradural extramedullary masses Intramedullary masses 5.11 Fracture of facial bones 5.12 Inflammatory disease of sinonasal area 5.13 Exopthalmos and orbital mass 5.14 Inflammatory disease of temporal bone and sequalae otitis media mastoiditis acquired cholesteatoma 5.15 Squamous cell carcinoma of head and neck 5.16 Disease of salivary gland -46-

47 6. Basic knowledge of interventional neuroradiology 6.1 Principle of various interventional methods 6.2 Indication and contraindication of various interventional methods 6.3 Complication of various interventional methods Skills (Technical and Judgement ) 1. Preparation for special investigations (including sedation technique) 2. Plain film interpretation 3. Contrast studies จ านวนรายท ต องท าได ด วยตนเองและแปรผลได อย างน อย 3.1 Myelography 10 ราย 3.2 Angiography 5 ราย 3.3 Sialography 10 ราย 4. Special investigations ท สามารถอธ บายข นตอนว ธ การท าได และแปรผลได 4.1 Cranial ultrasonography 5 ราย 4.2 Color Doppler Imaging of neck vessels 5 ราย 4.3 Computed tomography of the brain 100 ราย 4.4 Computed tomography of the spine 5 ราย 4.5 Computed tomography of the orbits 5 ราย 4.6 Computed tomography of the temporal bone 5 ราย 4.7 Computed tomography of the sinonasal area 5 ราย 4.8 Computed tomography of the supra and infra-hyoid neck 5 ราย 4.9 Magnetic Resonance Imaging of the brain 20 ราย 4.10 Magnetic Resonance Imaging of the spine 10 ราย 4.11 Magnetic Resonance Imaging of the orbits 5 ราย 4.12 Magnetic Resonance Imaging of the supra and infra - hyoid neck 5 ราย 4.13 Magnetic Resonance Angiography of the brain & neck 5 ราย 5. Judgement of contrast medium administration including technique -47-

48 7. Pediatric Radiology Theory and Knowledge 1. Imaging methods and positioning ต องร 1.1 Neonatal head ultrasound 1.2 Head CT for headache and seizures 1.3 Head CT for head trauma 1.4 Neck CT 1.5 Orbital CT 1.6 Sinus CT 1.7 Spine CT 1.8 MRI of the brain for headache or seizures 1.9 MRI of the brain for tumor 1.10 MRI of the spine for tethered cord 1.11 MRI of the spine for tumor 1.12 Fluoroscopy for diaphragmatic movement 1.13 Chest computed tomography for vascular ring 1.14 Chest computed tomography for airway disease 1.15 Chest computed tomography for interstitial lung disease 1.16 Chest computed tomography for mediastinal mass 1.17 Enema(barium) for intussusception 1.18 Enema for Hirschsprung disease 1.19 Enema for low obstruction in a neonate 1.20 Upper GI for esophageal atresia and TE fistula 1.21 Upper GI for H-type or recurrent tracheoesophageal fistula 1.22 Upper GI for GER 1.23 Upper GI for hypertrophic pyloric stenosis 1.24 Upper GI for malrotation 1.25 Abdominal ultrasound for abdominal mass 1.26 Abdominal ultrasound for abdominal pain 1.27 Body CT 1.28 IVP 1.29 VCUG -48-

49 ควรร 1.30 Renal ultrasound 1.31 MRI of brain for demyelinating disease MRI of spine for spinal dysraphism 1.33 Airway fluoroscopy for tracheomalacia 1.34 Cine CT for non-fixed airway obstruction 1.35 MRI of the chest for vascular ring 1.36 Enema(air) for intussusception 1.37 Testicular ultrasound for undescend testis 1.38 Ultrasound for hypertrophic pyloric stenosis 1.39 Ultrasound for acute appendicitis 1.40 Body MRI 1.41 Ultrasound for hip effusion 1.42 Ultrasound for congenital dysplasia of the hips 2. Indications and contraindications of each modality ต องร ของ imaging methods and positioning ท งหมด ควรร ของ imaging methods and positioning ท งหมด 3. Dynamic physiology of the system ต องร neurological system, respiratory system, alimentary system, genitourinary system, embryology 4. Normal roentgenographic anatomy of the system ต องร every systems 5. Pathologic images of the system ต องร 5.1 Intracranial hemorrhage in neonates 5.2 Congenital anomaly of CNS and spinal cord 5.3 Common Intracranial tumors in children 5.4 Neck masses 5.5 Upper airway obstruction in children 5.6 Cystic lung lesions mediastinal mass 5.7 Unique pulmonary problems in neonates 5.8 Lung infections congenital heart disease 5.9 Neonatal cholestesis 5.10 Liver tumors in children -49-

50 5.11 Congenital anomaly of gastrointestinal tract 5.12 GER 5.13 High intestinal obstruction in neonates and infants 5.14 Low intestinal obstruction in neonates and infants 5.15 Neonatal ascites, congenital anomaly of KUB system 5.16 Common neoplasms of retroperitoneum 5.17 VUR 5.18 Metabolic bone disease 5.19 Common bone tumors in children ควรร 5.20 Strokes in children 5.21 Congenital anomaly of male and female genital tracts 5.22 Congenital bone dysplasias 5.23 Battered child syndrome Skills (Technical and Judgement ) Procedure ท ต องสามารถท าได ด วยตนเอง จ านวนท ต องท าได ด วยตนเอง ตามข อ 1.1 ท งหมด ไม ต ากว ารายการละ 3 ราย 8. Radiology of respiratory system Theory and Knowledge 1. Imaging methods and positioning ต องร 1.1 Conventional chest x-ray (Chest PA, lateral, oblique, lordotic, tomogram) 1.2 CT (conventional CT, HRCT, CT angiography) ควรร 1.3 MRI 1.4 Ultrasonography 2. Indications and contraindications of each modality 3. Dynamic physiology of the system 4. Normal roentgenographic anatomy of the system 4.1 Large and small airways 4.2 Lung ( secondary pulmonary lobule, alveoli, interstitium) 4.3 Pulmonary vasculature -50-

51 4.4 Mediastinum 4.5 Lymph node and lymphatic system 4.6 Pleura 4.7 Diaphragm 4.8 Chest wall 5. Pathologic images of the system 5.1 Congenital disorder of the lungs and airways ต องร Tracheoesophageal fistula Bronchial atresia Pulmonary sequestration Cystic adenomatoid malformation ควรร Congenital lobar emphysema Pulmonary hypoplasia Absence (agenesis or aplasia) of the lungs or lobes of the lungs Congenital lymphangiectasia Tracheal bronchus and other abnormal bronchial branching 5.2 Chest trauma ต องร Pulmonary parenchymal trauma Injury to the aorta and great vessels Diaphragmatic rupture Tracheal or bronchial rupture ควรร Injury to the heart and pericardium Indirect effect of trauma on the lungs e.g. fat embolism Torsion of the lung 5.3 Neoplasms of lungs, airways and pleura ต องร Bronchogenic carcinoma Lymphoma Hamartoma -51-