R E G U L A T I O N S FOR ADMISSION TO THE FELLOWSHIP OF THE COLLEGE OF RADIOLOGISTS OF SOUTH AFRICA

May 2010
R E G U L A T I O N S
FOR ADMISSION TO THE FELLOWSHIP OF THE COLLEGE OF
RADIOLOGISTS OF SOUTH AFRICA
FC Rad Diag(SA)
1.0 INTRODUCTION
The aim of these regulations is to provide the basis to educate, train, develop and
finally certificate competent Specialist Radiologists for utilisation in the
provision of comprehensive healthcare services. Whilst the primary
responsibility of the College of Radiologists of South Africa (C Rad SA) is to
supply competent Specialist Radiologists for South Africa, the C Rad SA will
constantly strive to maintain and promote radiology specialty standards that will
achieve universal reciprocity and portability.
One of the cornerstones of making diagnosis lies within the field of diagnostic
radiology. The form of imaging applied to ailing patients and supported by a
consultative, evaluative and advisory competence constitutes a range of services
and competencies offered by Specialist Radiologists to clinicians. The
combination of raw imaging, evaluative interpretation and a continuously
burgeoning radiological knowledge base provided as a 24-hour 365-day service is
what constitutes the bedrock of the service provided by Specialist Radiologists
Specialist Radiologists should be prudent and diplomatic not to give the
impression that they have assumed exclusive control over what imaging
procedures a patient should undergo. To achieve optimal cooperation, they need
to inform their colleagues about advances, advantages and drawbacks of
radiology. This collaborative approach will provide the mainstay for further
advances and development in clinical medical practice.
The combination of foci described in the above two paragraphs is the description
of the role and responsibility of a Specialist Radiologist at the highest level of
abstraction. In the sections that follow, every attempt is made to unpack and
unravel what this means in tangible competence terms, and what conditions
should be fulfilled to be admitted as a Fellow of the C Rad SA, of the CMSA
register with the Health Professions Council of South Africa (HPCSA) and
practise as a Specialist Radiologist in South Africa.
2.0 …/
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2.0 DEFINING COMPETENCE IN RADIOLOGY
The generic definition of competence is “the condition of being able/capable,
adequately capable; have the potential to do something; properly qualified or
skilled in something.” This definition is too broad and therefore within the
context of Radiology the following additional expansion is advocated.
2.1 COMPETENCY IN RADIOLOGY
Radiological competency is the ‘why’ and the ‘how’ a candidate specialist
should perform, as s/he might due to his/her potential, subjective cognitive
knowledge-based and psychological behavioural processes or human-related
attributes; which s/he has (or not have) and must reveal or manifest, in order to
effectively accomplish radiological competence.
2.2 COMPETENCE IN RADIOLOGY
Radiological competence is the ‘what’ the radiology specialty demands of a
candidate specialist ie the requirements to practise radiology acceptably and
safely, and be able to accomplish radiological objectives within the scope of
clinical medical practice effectively.
2.3 COMPETENT IN RADIOLOGY
To be deemed competent in radiology entails the eliciting and evaluating of the
final state of a candidate specialist’s capability, which demonstrates that person’s
level of effectiveness (performance) as a radiologist against an external norm.
2.4 ADDITIONAL DESCRIPTORS OF COMPETENCE IN RADIOLOGY
The South African Qualifications Authority further categorises competence.
These definitions are contextualised to the specialty of radiology as follows:
2.4.1 fundamental competence is the competence that is basic to the practice of
radiology
2.4.2 core competence is the competence that characterises radiology and its practise
2.4.3 elective competence is the competence that equips for potential expansion and
development of radiology and its practise as determined or influenced by
projected small changes in the environment.
Radiological competence additionally comprises:
2.4.4 radiological knowledge – demonstrating an intellectual grasp of radiology
2.4.5 radiological skill – demonstrating technical, cognitive and interpersonal
dexterity/adeptness when practicing radiology and when providing a
comprehensive clinical imaging service
2.4.6 attributes of a radiologist – these are the personal and professional qualities and
traits that project the individual and contribute to individual and collective
professionalism in radiologists.
This further categorisation of competence in radiology serves to demonstrate the
multidimensional approach that has been used to describe radiological competence
as fully as possible.
3.0 …/
FC Rad Diag(SA) PAGE 3
3.0 EXIT LEVEL OUTCOMES
The candidate specialist who passes the FC Rad Diag(SA) examinations must be
able to fulfil the role of a Specialist Radiologist in the medical and academic
communities, and in society at large.
Central to these examinations is their licensing function: persons awarded the
FC Rad Diag(SA) who, in addition, fulfil the other requirements of all relevant
health legislation, may register and practise as a Specialist Radiologist in terms
of the legislation.
The following sections outline the range of competencies that will be expected of
the candidate specialist that elects to be evaluated by the CMSA in preparation
for registration as a Specialist Radiologist in South Africa.
3.1 Interpret and communicate radiological findings
The candidate specialist should be able to:
3.1.1 Detect and interpret radiological signs using all forms of imaging.
3.1.2 Accurately report radiological findings orally and in writing.
3.1.3 Succinctly define clinico-radiological problems and formulate a working
diagnosis or suitable differential diagnosis.
3.1.4 Tender appropriate advice to health practitioners/clinicians on the selection of
appropriate imaging modalities that will maximise the potential for accurate
diagnosis and optimally benefit patient management and care.
3.2 Manage patients and the service in a radiology department
The candidate specialist should be able to:
3.2.1 Select and, where needed, perform appropriate radiological investigations.
3.2.2 Competently and safely perform radiological procedures.
3.2.3 Be aware of risks and complications of all radiological and related procedures
and appropriately manage general emergencies and specifically those that might
arise from radiological procedures.
3.2.4 Educate and counsel patients concerning the risk/benefit of radiological
investigations and procedures.
3.2.5 Practise radiological protection and equipment safety.
3.2.6 Keep adequate radiological records of all practice activities.
3.2.7 Effectively communicate with health care workers in verbal and written format.
3.2.8 Without derogating from the universally accepted prescripts that guide patient
care, treat patients in their care with respect and dignity at all times.
3.3 Manage a radiological/clinical imaging service provision
The candidate specialist should be able to:
3.3.1 Identify key elements of a radiological service.
3.3.2 Broadly determine and be able to manage the resources required to sustain a
radiological service.
3.3.3 Manage radiology-specific inventory.
3.3.4 Determine the type of radiological and related equipment required and manage
them through their life-cycle.
3.3.5 Determine and implement appropriate performance measures that will
contribute to the efficient, effective and economic use of resources.
3.3.6 Acquire general competence in management, including service deliveryoriented
management.
FC Rad Diag(SA) PAGE 4
3.4 Acquire new information and critically evaluate its quality and utility
The candidate specialist should be able to:
3.4.1 Access information using electronic and traditional methods.
3.4.2 Engage in continuing professional development activities.
3.4.3 Critically appraise the quality, relevance and utility of new information.
3.4.4 Appropriately apply newly acquired information to the benefit of their
competence specifically and to the radiological services generally.
3.5 Engage in research and personal professional development
The candidate specialist should be able to:
3.5.1 Produce a fully evaluated (which may include external evaluation) minidissertation
of between 5 to 10 thousand words, or position papers, or action
research papers, on relevant radiological topics of their choice. In the case of
papers, acceptance and publication by a peer-reviewed journal would be
preferred
AND
have completed formally structured and evaluated course work as determined
by their training centre as part of formative learning.
3.5.2 Manage and produce a completed ‘Critical Performance Portfolio’ (as
determined by the CMSA) as part of meeting examination entry requirements,
as well as a record for continuous professional development.
3.5.3 Continuously pay attention to their personal professional development
(attributes), including leadership development, by engaging relevant learning
opportunities and interactive forums that will shape their behaviour befitting
their profession.
3.6 Advise on matters pertaining to health promotion and disease prevention
The candidate specialist should be able to:
3.6.1 Educate and advise patients regarding health promotion and disease prevention.
3.6.2 Demonstrate an awareness of health promotion and disease prevention priorities
and strategies.
3.6.3 Tender appropriate advice regarding the usefulness of timely radiological
investigations as part of health screening programmes, and the hazards of
potential under-, mal- or over-subscription of radiological investigations or
procedures.
3.7 Play an active role in training other health care practitioners
The candidate specialist should be able to:
3.7.1 Regularly participate in academic teaching activities.
3.7.2 Regularly participate in academic meetings.
3.7.3 Render relevant in-service training to radiation and related practitioners.
3.8 Function as an effective team member in the broad context of health care
The candidate specialist should be able to:
3.8.1 Treat all health care workers with respect.
3.8.2 Recognise the roles other health care workers play; consult appropriately.
3.8.3 Provide leadership when called upon to do so or when the situation demands it.
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4.0 LEARNING OUTCOMES
Candidate specialists preparing for the examination are advised to pay attention to the
following aspects of learning and professional development.
4.1 KNOWLEDGE
The candidate specialist should acquire knowledge of/in:
4.1.1 A broad overview of the principles and applications of imaging in clinical
practice.
4.1.2 Normal imaging anatomy of all organs and systems of the human body.
4.1.3 Understanding of the role that imaging plays in diagnosis and intervention of
common clinical problems.
4.1.4 Radiation biology, protection and safety.
4.1.5 Radiological signs and findings of common clinical conditions and diseases
found in South African hospitals and practices.
4.1.6 Indications, contraindications and complications of radiological procedures and
interventions.
4.1.7 Human rights and the principles of medical ethics and good clinical practise.
4.1.8 Medico-legal aspects of health care in South Africa, with special emphasis on
radiation medicine.
4.1.9 Principles of radiological audit, quality assurance and utilisation of radiological
management information.
4.1.10 Principles of research methods, inclusive of statistical analysis.
4.1.11 The management of a radiological service to patients and health workers,
including service delivery-oriented management.
4.1.12 Knowledge of implements, instruments and specific-ware used in diagnostic and
therapeutic procedures.
4.2 SKILLS
The candidate specialist should acquire and continuously refine the following skills:
4.2.1 Specific skills - Investigative, deductive and logical decision-making
• observation, orientation and illustration
• building a body of evidence and warrants
• synthesis
• guarded decisiveness
• measured approach to taking action
• framing, inquiring, advocating and reflecting
4.2.2 Diagnostic and therapeutic interventional procedures
• above-average hand-eye coordination
• synchronised application of sensory (visual and auditory) and motor
(hands, arms and feet) functions
• leveraging the capacity in radiological equipment and technology to derive
the best results
• choice of implements, instruments and supporting-ware used
• observe and monitor multiple monitors simultaneously (visually and
aurally), including the patient directly
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FC Rad Diag(SA) PAGE 6
4.2.3 Communication
• oral: appropriate to patients, public, health care workers and academic
audiences
• written: report production, record keeping, referral letters, medical reports
and academic writing
4.2.4 Information management
• data access using traditional and electronic techniques
• critical appraisal of information sources and information
4.2.5 Research
• critical appraisal of research methods
• analysis and interpretation of data
• formulating a research report
4.2.6 Teaching and training
• education of patients and communities
• teaching and training of students and fellow colleagues
4.2.7 General skills
• Leadership
• Management
• Interpersonal
4.3 Attributes
These encompass professional and personal attributes, most of which are described
broadly below.
4.3.1 Constantly learn and develop attributes that promote conduct that befits the
highest order of professionalism.
4.3.2 Respect for the rights and values of others; treat everyone with dignity.
4.3.3 Open-mindedness, capacity for self-reflection and critical appraisal.
4.3.4 Insight into personal strengths and recognition of personal limitations.
4.3.5 Ability to recognise and deal effectively with personal stress.
4.3.6 Ability to care for oneself, including seeking health care when needed.
4.3.7 Discipline and insight to continue learning to maintain a high level of clinical
competence.
4.3.8 Dedication to serving the interests of patients at all times.
4.3.9 Promotion of justice and equity in the health care system.
4.3.10 Maintenance of integrity and honesty in professional practice.
5.0 Admission to the examinations
• The CMSA senate (through the Examinations and Credentials Committee) will
review every application for admission to the examination (including
professional and ethical standing) of each candidate.
• There are 2 parts to the examination: part II must be completed within 6 years
of completing part I. Failure to comply will require that the entire part I
examination be repeated.
• Part I can only be repeated 3 times in total
• Both part I subjects must be attempted in the initial exam sitting, but
individual subjects can be ‘carried’ if candidates are not successful in one
subject.
5.1…/
FC Rad Diag(SA) PAGE 7
5.1 Admission to Part I (Radiation physics and imaging anatomy):
5.1.1 Candidates must be registered as medical practitioners with the Health
Professionals council of South Africa (HPCSA). (Candidates need not have any
training in radiology, be part of any radiology teaching programme or hold
registrar training posts in radiology).
5.2 Admission to Part II:
5.2.1 Candidates may be admitted to Part II of the examination having completed 36
months training as a radiology registrar in an HPCSA recognised post (including
supernumerary posts)
AND
have successfully completed both parts of or be exempt from Part I of the
examination (exemption will be granted when there is official reciprocity of
examination as granted and valid for the particular year)
AND
have completed the relevant sections of the performance portfolio, including a
satisfactory continuous assessment certified by the head(s) of department of the
training department(s) (or equivalent).
6.0 Format of the examinations:
6.1 FC Rad Diag(SA) Part I – effective August 2010
• Radiation Physics will be in the form of a 3 hour written paper (that may
include multiple choice questions)
• Imaging Anatomy will be in the form of two or three spot tests (300 spots in
total) involving identification of anatomy on relevant diagnostic images as well
as providing knowledge of radiographic views, imaging technique and relevant
physiology.
6.2 FC Rad Diag(SA) Part II
6.2.1 Written examination: Three written papers of 3 hours each dealing with clinical
radiology and clinical medical practice (including current principles and practice
as well as advances in the field). Emphasis will be on short answers and multiple
choice questions will remain an option.
6.2.2 Case Reporting examination: Interpretation of radiological images and generation
of an appropriate report. There will also be sections of rapid reporting of typical
emergency room imaging (including normal). These may all be presented in the
form of hardcopy or in a digital format of up to 10 stations each lasting from
10-15 minutes.
6.2.3 Oral examination: The candidate will be evaluated on all aspects of radiology as
applied to current clinical practice. The emphasis will be on assessing the
radiological knowledge, skills in interpretation and synthesis of a diagnosis, as
well as the ability to communicate findings in a clear concise manner. Other
professional skills and attributes will also be evaluated. The examination
comprises (at least) two sessions of up to 30 minutes each.
7.0…/
FC Rad Diag(SA) PAGE 8
7.0 Performance in the examinations
7.1 Candidate specialists must achieve 50 % for both physics and anatomy to proceed
to admission to Part II.
7.2 These subjects must be written together at the first attempt
7.3 If 50% is achieved for only one subject, this subject need not be repeated (ie the
subject is exempt for 2 further attempts)
7.4 Only 3 attempts are allowed for Part I (irrespective of whether a subject is being
carried or not)
7.5 Candidates need to have completed the performance portfolio (log book)
including a certified adequate continuous assessment by the relevant head of
department (or equivalent) to apply for Part II of the examination. The
performance portfolio needs to be submitted with the application to enter for Part
II.
7.6 The performance portfolio will be assessed by the current convenor with guidance
from a moderator where necessary and support from the council in questionable
circumstances.
7.7 Candidates entering for Part II need to achieve an overall mark of 45% or more
for the written component of the examination to proceed to the case reporting and
oral components (ie a mark of less than 45% for the written component of Part II
is a failure for the candidate and the examination has to be repeated at the next
sitting).
7.8 At least 2 pairs of examiners participate in the oral examination.
7.9 An overall assessment of Part II will be submitted as a percentage for each
candidate in accordance with the CMSA regulations.
7.10 To succeed in the Part II:
7.10.1 An overall mark of 50% to pass
7.10.2 50% subminimum for the two oral examinations combined
7.10.3 40% subminimum for at least one of the oral examination (examiner pair)
7.10.4 50% subminimum for the reporting session
7.10.5 50% subminimum for more than half of the long cases (ie 5 of 8 or 6 of
10 long cases)
7.10.6 50% subminimum for the rapid reporting
There no limit to the number of attempts allowed for Part II but this must be
achieved within 6 years of obtaining Part I.
7.11 Logbooks will be considered inadmissible if:
7.11.1 there is a significant incomplete log of procedures observed and
performed
7.11.2 there is a record of inadequate continuous assessment by the relevant
HOD
7.11.3 if the continuous assessment is not certified (signed by the head of
department or a person deemed to be the equivalent in his/her absence)
7.11.4 the portfolio is not certified with legitimate consultant signatures for
procedures
7.12 The candidate will be given an opportunity to correct and supplement any
deficiency in the performance portfolio
7.13 In the case of missing signatures / inadequate certification this may be done in
time for the examination
7.14 In the case of inadequate logging of procedures the candidate may be allowed to
remedy this and apply for the next examination.
JOHANNESBURG
May 2010
FC Rad Diag(SA) PAGE 9
8.0 ADMISSION AS A FELLOW
8.1 The candidate having passed both parts of the examination and having been
admitted as a Fellow of the College of Radiologists of South Africa, will be asked
to sign a declaration, as under:
I, the undersigned, …………………………………………………………… do
solemnly and sincerely declare
that while a member of the CMSA I will at all times do all within my power to
promote the objects of the CMSA and uphold the dignity of the CMSA and its
members
that I will observe the provisions of the Memorandum and Articles of Association,
By-laws, Regulations and Code of Ethics of the CMSA as in force from time to
time
that I will obey every lawful summons issued by order of the Senate of the said
CMSA, having no reasonable excuse to the contrary
and I make this solemn declaration faithfully promising to adhere to its terms
Signed at ……………………..……. this ……………………………… day of
……………………………….. 20 ………..
Signature ….……………………...................…………
Witness ……………………………………………………
(who must be a Founder, Associate Founder, Fellow, Member, Diplomate or
Commissioner of Oaths)
8.2 A two-thirds majority of members of the CMSA Senate present at the relevant
meeting shall be necessary for the award to any candidate of a Fellowship
8.3 A Fellow shall be entitled to the appropriate form of certificate under the seal of
the CMSA
8.4 In the event of a candidate not being awarded the Fellowship (after having passed
the examination) the examination fee shall be refunded in full
8.5 The first annual subscription is due one year after registration (statements are
rendered annually)
JOHANNESBURG
May 2010
FC Rad Diag(SA) PAGE 10
A N N E X U R E A
1.0 Core Curriculum for the FC Rad Diag(SA) Part I
Candidates are expected to have a comprehensive knowledge of radiation
physics, imaging, radiation biology and protection pertinent to the practice of
radiology as a specialist, in accordance with the following.
1.1 Radiation Physics and Imaging
1.1.1 Basic concepts of radiation physics
• electromagnetic radiation
• wave-particle duality
• electromagnetic spectrum
• energy of photons
1.1.2 Production of x-rays
• continuous radiation of Bremsstrahlung
• characteristic radiation
• effect of variation of: kV, mA, filtration, voltage waveform
• X-ray tubes: types, construction, line focus principle, heel effect, tube
rating
1.13 X-ray generators
• generator types and waveforms: single phase, 3 phase, 6 and 12 pulse,
medium frequency, capacitor discharge, battery operated
• effect on radiation output
• effect on image quality
• exposure times
• automatic exposure control
1.1.4 Interactions between x-rays and matter
• coherent scatter
• photoelectric effect and characteristic radiation
• Compton scatter
• pair production
• attenuation: linear attenuation coefficient, half value layer, factors
affecting attenuation
• factors affecting scattered radiation – kVp, field size, collimation,
filtration, subject thickness, film-focus distance
1.1.5 Filters, collimators, grids
• inherent filtration
• added filtration
• K-edge filters
• methods to reduce scatter: collimation, compression, grids, air gaps,
compression etc
1.1.6…/
FC Rad Diag(SA) PAGE 11
1.1.6 Luminescent screens
• principles of action
• absorption and conversion efficiency
• intensification factor
• speed
• types of phosphors: advantages and disadvantages
• emission spectrum
• resolution
• response to Kv
1.1.7 Characteristics of x-ray film and film processing
• structure of film
• film speed, sensitivity and specificity
• film processing
1.1.8 Photographic characteristics of x-ray film
• optical density and the grey-scale
• characteristic curve and contrast
• speed
• spectral sensitivity of emulsions
• emulsion types: single, double
1.1.9 Image system performance
• contrast and contrast resolution: subject contrast, film contrast,
radiographic contrast, fog and scatter, dynamic range
• spatial resolution: sharpness, line spread function, modulation transfer
function
• noise: systemic, random, quantum mottle, signal to noise ratio
• geometry: magnification, focal spot size, distortion
1.1.10 Image intensification
• intensifier design
• intensifier operation
• performance factors
1.1.11 Standard x ray system
• design and construction
• generators
• transformers
• cables
• operator console
• tube mountings
• tables
• bucky systems
• general layout of an X-ray room
1.1.12 Fluoroscopy TV systems
• video camera performance factors
• video monitor characteristics
• high resolution TV systems
• spot film cameras
• CCD systems
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FC Rad Diag(SA) PAGE 12
1.1.13 Conventional tomography
• principles
• techniques
• types of tomography including panoramic
• practical application
1.1.14 Mammography
• basic principles of soft tissue and breast imaging
• types of mammography x-ray units
• emission spectra with different anode and filter materials eg molybdenum
tube and filter
• geometric unsharpness as a limiting factor
• recording system: film screen, digital
• magnification techniques
• alternative breast imaging: radionuclide imaging , US, MR
• principles and applications of stereotaxis
1.1.15 Principles of computers
• terminology: pixels, matrix, bits, bytes, display levels (bits per pixel),
storage technology and requirements
• central processing unit, key board, video display unit
• mass storage devices: tape, CD, DVD, MOD
• input and output devices
• network principles
• working understanding of DICOM standards
• basic and middle computer literacy
1.1.16 Computed tomography
• basic principles
• data acquisition: X-ray tubes, collimators, detectors-types and efficiency,
• sampling frequency, calibration techniques
• geometry: generations, spiral, multi-slice technology
• image reconstruction and display: basic principles (voxel and pixels),
various reconstruction algorithms, window width and level
• image quality: spatial resolution, contrast resolution, spatial uniformity,
noise, effect of pixel size, slice thickness, mA, algorithm, sampling
frequency, field of view, pitch, collimation.
• artefacts: partial volume, motion, beam hardening, ring artefact, spiral scan
artefacts etc
• CT fluoroscopy
• tissue density and characterisation and the Hounsfield scale
1.1.17 Computed radiography
• digital fluoroscopy: pulsed fluoroscopy
• computed radiography
• flat panel detectors
• digital subtraction techniques
• equipment requirements: tube, generator, image intensifier, TV chain,
processing
• digital imaging processing
• computer radiography systems [CR]
• direct radiography systems [DR]
• patient archiving and communication systems [PACS]
• radiology information systems [RIS]
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FC Rad Diag(SA) PAGE 13
1.1.18 Magnetic resonance imaging
• basic principles
• relaxation T1, T2, T*
• pulse sequences: spin echo, inversion recovery and STIR, fast imaginggradient
echo, EPI, fast spin echo
• image production: gradient fields, slice thickness, bandwidth, phase
encoding gradients, readout gradients, Fourier transformation techniques
etc
• image quality: signal to noise ratio, spatial resolution, artefacts
• flow effects: flow void, flow imaging
• equipment: magnets, gradient coils, RF coils, computer systems
• magnetic resonance angiography techniques: diffusion, perfusion,
functional,
• MR spectroscopy.
• hazards and bio effects
• environmental problems: shielding
1.1.19 Radionuclide imaging
• basic atom structure and radioactivity
• measurement of radiation and radioactivity: detector types, detector
geometry and efficiency
• imaging systems: gamma camera principles, single photon energy computed
tomography (SPECT), dual energy x-ray absorptiometry (DEXA) positron
emission tomography (PET), hybrid PET, PET CT
• radio-pharmaceuticals: production, characteristics, labelling, production,
half life, isotopes used in clinical practice
1.1.20 Ultrasound
• basic principles of ultrasound and interaction with matter: wave physics,
wave length, frequency, phase, intensity, amplitude, decibel measurement,
velocity in liquids and tissues, acoustic impedance, interference,
diffraction, resonance, reflection, refraction, attenuation, absorption,
scattering
• transducers: piezoelectric effect, design, beam pattern, focus, broad
bandwidth transducers
• pulse echo imaging: A, B, M modes, grey scale, dynamic range, receiver
functions, time-gain compensation (TGC), compression amplifier
• digital processing: scan converter, pre and post processing, image display
and recording
• real time ultrasound: principles, linear, convex, phased, annular arrays
• Doppler ultrasound: Doppler effect, continuous and pulsed wave
instruments, duplex systems, colour Doppler, power Doppler
• ultrasound artefacts: reverberation, attenuation-shadowing and
enhancement, refraction-sound speed error, beam width-side lobes,
instrument artefacts
• biological effects: interaction of sound and tissues, measurement of power
output and intensity, methods of dose reduction, safety recommendations.
• new and evolving techniques
1.1.21…/
FC Rad Diag(SA) PAGE 14
1.1.21 Radiation biology
• radiation units: exposure, absorbed dose-gray, equivalent dose-sievert,
effective dose-sievert
• dose: skin, organ, integral doses
• interaction mechanisms: ionisation, excitation, free radicals, linear energy
transfer
• mutation: spontaneous, radiation induced, dose rate dependence,
genetically significant dose, doubling dose
• effect on chromosomes: types of damage, influence of dose, results of
damage
• radiation induced cancer
• effect on the embryo and foetus
• risk of occupational exposure
1.1.22 Radiation protection
• biological effects; stochastic, non-stochastic, deterministic, weighting
factors
• measurement of detriment
• International Commission on Radiation Protection (ICRP) recommendations
and radiation protection
• dose limits: occupational, public, pregnant women
• methods to reduce dose to occupationally exposed workers and the public:
x ray equipment, radioactive materials
• methods to reduce dose to patients
• methods of assessing radiation dose: dosimetry, film badge dosimeters,
thermo-luminescent dosimeters
• radiation doses for common procedures
1.1.23 Quality assurance and control
This entails identifying the critical aspects that affect the quality of
radiological procedures and techniques eg universally accepted conventions
and/or departmentally tailored/customised protocols, besides those addressed
above, that can be directly controlled.
• QA & C in general radiography and fluoroscopy including fluoroscopy in
specialised imaging procedures
• QA & C in radionuclide imaging
• QA & C in MR scanning
• QA & C in CT scanning
• QA & C in ultrasound
1.1.24 Artefacts
• plain radiography artefacts
• developing artefacts
• ultrasound artefacts
• CT artefacts
• MRI artefacts
• digital and reconstruction artefacts
1.1.25…/
FC Rad Diag(SA) PAGE 15
1.1.25 Basic statistics and research
• components of a scientific publication / presentation
• literature searches
• ethical issues pertaining to research
• cohort
• sensitivity
• specificity
• positive predictive value
• negative predictive value
• accuracy
• prevalence
• incidence
• confidence interval
• inter, intra-observer variability
• Kappa statistic
• variables
• Chi squared test
• student T test
• Mann Whitney test
• P value
• meta-analysis
• reviews
2.0 Radiological anatomy and technique
Candidates will be expected to have a comprehensive knowledge of all aspects of
imaging anatomy demonstrated by current imaging techniques; knowledge of
developmental anatomy, as well as common developmental anomalies and
variations of normality is expected; knowledge of and be familiar with cross
sectional and multi-planar (CT and MR) as well as sonographic anatomy and
knowledge of common imaging procedures used in daily practice of radiology in
South African hospitals, their indications, contraindications, complications is
required
2.1 Radiological anatomy
2.1.1 Head and neck
A comprehensive understanding of the cross sectional imaging anatomy of the
skull base, brain, orbits, paranasal sinuses and middle ear is required. The
vascular anatomy both arterial and venous of the brain, skull, orbits and facial
structures is required. The lymphatic drainage and position of important lymph
nodes must be known.
2.1.2 Spine
A detailed imaging knowledge of the cross sectional and longitudinal anatomy of
the spine, spinal cord, coverings and spaces, cauda equina and nerve roots is
required.
2.1.3 Chest and heart
A detailed knowledge of the anatomy of the lungs, mediastinum and heart is
required. The vascular anatomy including cardiac anatomy using all modern
modalities including multi-detector CT is required.
2.1.4…/
FC Rad Diag(SA) PAGE 16
2.1.4 Abdomen
A detailed anatomy of the cross sectional imaging anatomy of the abdomen is
required including MR. This includes the solid organs of the liver, spleen,
pancreas as well as the hollow organs of the gastrointestinal system, their
vascular supply and lymphatic drainage. The biliary anatomy and variations are
required. The intra and extra-peritoneal spaces, their formation and anatomy is
required.
2.1.5 Pelvis and genitourinary tract
A comprehensive knowledge of the cross sectional imaging, vascular supply and
lymphatic drainage of the kidneys, ureters, bladder and urethra is required.
Knowledge of the anatomy of the prostate and male reproductive tract is required.
Knowledge of the anatomy of the female reproductive tract is required. The
pelvic peritoneal reflections and spaces are also required.
2.2 Specific Organ and System Anatomy
2.2.1 Obstetrics
Knowledge of the embryological and foetal development and the modern imaging
anatomy and investigations of the embryo, foetus, placenta, umbilical cord and
uterus and ovaries in pregnant patients is required, including the ageing of the
foetus.
2.2.2 Breast
The imaging anatomy of the breast is required with a comprehensive knowledge of
the various imaging modalities available to image the breast, including MR.
2.2.3 Endocrine System
A comprehensive knowledge of relevant anatomy of all organs of endocrine
system is required.
2.2.4 Musculoskeletal System
Multi-modality based knowledge of the imaging anatomy of bones, joints,
muscles, tendons and ligaments, is required. The principles and methods of
determining the age of a person is obligatory.
2.2.5 Vascular System
A comprehensive knowledge of the imaging investigation of the arteries, veins
and lymphatic systems is required. Knowledge of modern imaging of the vascular
system including MRA, MRV and CTA is required.
2.2.6 Dentistry
Knowledge of the anatomy of teeth, their development, and imaging and
identification is required.
2.3…/
FC Rad Diag(SA) PAGE 17
2.3 Radiological Technique
• The full scope of all imaging modalities will require focus as they are
relevant to the procedure to be performed. For a full scope refer to the
Performance Portfolio provided by the College of Radiologists of South
Africa
• This will apply equally to the preparation/vetting of the patient and the
examination room, the nature of the procedure, the specific requirements of
the techniques, the choice of contrast agent, common pitfalls of the
procedure, risks and precautions specific to the procedure, complications
associated with the procedure where relevant, and the necessary aftercare.
• The full range of methods of imaging used shall include the utilisation of
spot x-ray technique, ultrasound, fluoroscopy, radionuclide imaging,
computed tomography, magnetic resonance imaging and positron emission
tomography (where available).
• Conventions and protocols where relevant should be emphasised.
• The different and most appropriate form of image capture must also be
considered as integral to the procedure.
• Key aspects of what should be contained in a radiology report as obligatory
are also necessary.
2.3.1 Contrast Agents in Imaging
• basic principles: chemical structure, pharmaceutical actions and toxicity
• types of contrast agents: anatomical space specific eg intravascular, subarachnoid,
gastro-intestinal; imaging specific eg ultrasound and MRI
• applications: fluoroscopic, ultrasound and MR imaging
• adverse reactions and their treatment
JOHANNESBURG
May 2010
FC Rad Diag(SA) PAGE 18
A N N E X U R E B
1.0 Core Curriculum for the FC Rad Diag(SA) Part II examination
The candidate will be expected to have comprehensive knowledge of:
• The role of various imaging techniques in the diagnosis of specific diseases
• The imaging techniques currently available in South Africa to demonstrate
both pathological and physiological processes
• The equipment required to perform imaging techniques
• The safe use of contrast media including the management and prevention of
complications
• The systematic examination, interpretation and oral and written
communication of images together with a differential diagnosis and
correlation of imaging findings.
• Physiological processes relating to physiological imaging
1.1 Clinical Radiology
There are fifteen themes that focus on the areas of knowledge to be acquired.
For the first twelve themes the candidate specialist is expected to acquire
comprehensive knowledge of the macroscopic pathology, clinical signs and
imaging findings of the disease processes, progressive patho-physiology and
the diagnostic signs including prognostic signs associated thereto. The last two
themes entail combining the competence of a Specialist Radiologist with a
service-delivery oriented manager bringing them together into an all-inclusive
pragmatic whole for the benefit of clinicians and their patients.
1.1.1 Neuroradiology (brain and spinal chord)
1.1.2 Otorhinolaryngoradiology
1.1.3 Pulmonary radiology
1.1.4 Cardiac radiology
1.1.5 Breast radiology
1.1.6 Gastro-intestinal and peritoneal radiology
1.1.7 Hepato-biliary and pancreatic radiology
1.1.8 Genito-urinary tract radiology
1.1.9 Musculoskeletal radiology
1.1.10 Vascular radiology
1.1.11 Obstetric and gynaecological radiology
1.1.12 Paediatric radiology
1.1.13 Emergency and trauma radiology
1.1.14 Therapeutic radiology
1.1.15 Management of a radiological/clinical imaging service
1.1.16 HIV and TB (Infectious disease imaging)
1.1.17 Physiological imaging and pathophysiology relating to imaging
FC Rad Diag(SA) PAGE 19
2.0 Clinical Medical Practice
This component of radiology recognises and advocates that the practice of
radiology correlates intimately with clinical management of the patient. This
includes linking relevant aspects of the history, clinical examination and
laboratory investigations and findings to the choice of the diagnostic
investigation or series, the provision of a plausible differential diagnosis and
the making of accurate diagnosis. The point of departure of this area of
competence in radiology stems from the complete and comprehensive
management of the patient’s condition, coupled with a service-based approach
to fellow clinicians in their quest to alleviate morbidity and to contain
mortality.
In its expanded form, this competence requires that the following areas of
focus are developed and honed.
• Be able to make accurate interpretation of history, clinical examination and
laboratory investigations and findings.
• Possess a broad knowledge base of and clinical acumen in disease states,
and the role of radiology in their diagnosis and management.
• Formulate logical approaches to clinical conundrums and the ability to
formulate systematic and/or systemic course/s of action that will benefit
clinical knowledge, patient management and clinical outcomes, inclusive of
influencing or determining prognosis.
• Provide regular or walk-in consulting and advisory services, inclusive of
conducting scheduled clinico-radiological meetings and discussions, which
could finally culminate in credible publications of findings.
JOHANNESBURG
May 2010