2010-2011 academic year
Image Diagnostics and Radiotherapy (20550)
Qualification/course: bachelor's degree in Medicine
Year: third
Term: first
Number of ECTS credits: 6 credits
Student commitment: 150 hours
Teaching language or languages: Catalan and Spanish
Teaching staff: Manuel Algara, Manuel Sanz, Emili Miralles, Palmira Foro, Núria Rodríguez, Xavier Sanz, Martí Lacruz, Jaume Quera, Ivan Vollmer, Ángel Gayete, Albert Solano, Juan Sánchez and Xavier Perich.
1. Subject presentation
The subject of Image Diagnostics and Radiotherapy is a basic training subject in the bachelor's degree in Medicine. It has 6 ECTS credits. It is taught in the first term of the third year of the degree as 30 theoretical hours, 24 practical hours and 12 hours of seminars.
Teaching will be by the lecturers Manuel Algara (UPF), who will be the coordinator; Manuel Sanz (UAB); Emili Miralles, Palmira Foro, Núria Rodríguez, Xavier Sanz and Martí Lacruz (UPF); Ivan Volmer, Ángel Gayete, Antonio Soriano and Juan Sánchez (UAB).
2. Competences to be acquired
During the subject, students should obtain the competences required by the educational authorities and stipulated in the degree syllabus, which are as follows:
• Recognise the morphology and structure of tissues, organs and systems using imaging techniques.
• Understand the principles of telemedicine.
• Assess the risk-benefit relationship of diagnostic and therapeutic procedures.
• Understand the basics of the interaction of radiations with the human body.
• Learn the bases of radiological imaging.
• Learn the basic radiological semiology of various items of equipment and systems.
• Have an understanding of other diagnostic imaging techniques.
• Assess the indications and contra-indications of radiological studies.
• Be able to apply radio protection criteria in diagnostic and therapeutic procedures with ionizing radiation.
• Understand the principles and indications of radiotherapy.
• Be able to interpret a radiological image by systematic reading.
General objectives
Teaching within the subject has the following aims:
To provide students with the relevant knowledge to enable them to understand the use of radiation in biomedicine and its dangers.
• To make students aware of the the importance of the risk-benefit ration of diagnostic and therapeutic procedures.
• To inspire curiosity among students as regards radiations and encourage appropiate use of this technology.
• To provide students with a methodology for use as a tool for carrying out healthcare and research work.
• To help students to achieve the basic transversal competences.
• To involve students in their own learning.
Specific objectives
The specific objectives for each topic are listed in each topic, seminar or practical session. These objectives will be the subject of assessment of the students' academic performance.
3. Contents
Syllabus to be taught in lectures. Duration: 30 hours.
Subject 1. Instrumentation
Historical and conceptual introduction. Definition of radiodiagnosis. Objectives. Limitations. Simple radiology: thorax, abdomen and bone. Radiology with contrasts: oral and endovenous. Air as a contrast. Study of empty viscera. Radiography with iodinated contrast. Retrograde and antegrade urographies. Conventional, digital subtraction, CT and MRA angiography. X-ray and computed tomography (CT). Using the contrast. Distension of the empty viscus with oral contrast. Magnetic resonance tomography (MR). Using the paramagnetic contrast. Portable X-ray examination: indications and limitations. Moving images: fluoroscope with image intensifier: indications and precautions. Tomography with ultrasounds: indications, advantages and disadvantages.
Duration: 1 hour.
Prior knowledge required of students: Physics for Health Sciences, First year of the Medicine course.
Subject 2. Formation of X-ray images
Energy sources. The X-ray tube. Radiographic exposure factors. X-ray beams: transmitted and blocked beams. Attenuation due to interaction with matter: photoelectric and Compton effects. Diffuse radiation: how to control it. radiographic plates, digital media, reinforcement plates, radiographic chassis. Spatial and contrast resolution. Geometry of image formation. Psychological factors in two-dimensional perception. Biological risks of low energy ionizing radiation at repeated doses.
Duration: 1 hour.
Prior knowledge required of students: Physics for Health Sciences, First year of the Medicine course.
Subject 3. Computed tomography (CT) and ultrasound scanning (US)
Computed tomography (CT): historical and conceptual introduction. Components of a tomogram for X-rays. Thickness of the section and spiral technique. Examination time. Visual field. Image matrix. Map of electronic density in tissues: Hounsfield Units (HU). Three-dimensional reconstruction. High resolution technique. Contrast: arterial, capillary or parenchymatous and late (venous) phases.
Ultrasound Scanning (US): historical and conceptual introduction. Physical bases for image formation. Limitation of the visual field. Transducers and uses. Artefacts. Ecographic semiology: simple and complex (mixed) cystic lesions, solid lesions. Doppler Effect indications.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Physics for Health Sciences.
Subject 4. Magnetic resonance
MR versus CT. Advantages and disadvantages. Clinical indications. Physical bases of MR. Magnetic moment of the hydrogen nucleus. Magnetic moment due to the flux of an external magnetic field. Precession motion. Oscillating magnetic pulses (radiofrequency). Relaxation of hydrogen nuclei. Intensity of the MR signal. T1 (spin-lattice) and T2 (spin-spin) relaxation times. MR signals of simple cystic lesions, lesions with pus and solid lesions. T1-weighted images, lightly T2-weighted images and T2-weighted images.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 5. Basic image diagnosis semiology
Radiodiagnosis as an equivalent to clinical examination. Direct commitment with macroscopic pathological anatomy. Electronic density maps of the organism (CAT), distribution of free versus bound water (MR); and a sectorial map of acoustic impedance (US). Anatomic reductionism determined according to the energy source used. Signs in the image with diagnostic value. Limitations of radiodiagnosis. Biological bases determining the density of a lesion in conditions injury CAT, MR or echogenicity in US. Correlation with clinical practice. Radiological report: which questions can be answered.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 6. Thoracic semiology I: pulmonary parenchyma
Basic patterns in pulmonary radiology. Airspace consolidation. Collapse. Nodule. Hyperclarity. Overinflation. Bronchial pattern. Diffuse disease. Definition and recognition.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 7. Thoracic semiology II: mediastinum
Mediastinal behaviour. Basic semiology: identifying and locating signs. Limitations of simple radiology. Advantages of CAT. Ability to compartmentalise lesions and define the internal characteristics of their relationship. Large vessels: elongation, dilation, atheromatosis, hematoma, ulcer, dissection.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Anatomy.
Subject 8. Thoracic semiology III: thoracic pleura and wall
Common signs of extrapulmonary lesions. Semiology of pleural and thoracic wall lesions. Pneumothorax: degree, associated lesions, bilaterality. Free and loculated pleural effusion. Solid pleural pathology. Thoracic wall lesion mimicking pulmonary pathology. Semiology of the most common pathologies.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Anatomy.
Subject 9. Semiology of the central nervous system I
Indirect viewing of the CNS parenchyma: Angiography. Representation of encephalus and marrow according to the subarachnoid vessels. Pneumoencephalography. Direct viewing of the CNS parenchyma: CAT and MR of the cranium and marrow. Blood-brain barrier. Cerebral oedema: vasogenic, cytotoxic and periependymal. Space occupying lesion: number, size, location, radiological characteristics, lesional matrix and calcification. Displacement of neighbouring structures.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Anatomy.
Subject 10. Semiology of the central nervous system I
Haemhorrage of the CNS: intracerebral, subarachnoid, subdural and epidural. Demyelination: name, size and distribution of the lesions. Leukoencephalomalacia: size and location of the lesions. Hydrocephalus: dilated ventricular segments, level of involvement; differential diagnosis: obstructive and extraventricular. Alteration in the form, structure and relationship with the vicinity of the CNS.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Anatomy.
Subject 11. Skeleton semiology I
Reaction of the bone crystal matrix as a radiological expression of the pathology. Lytic, blastic and mixed lesions. Radiological criteria of benignity and malignancy: surrounding area, transition area, types of bone destruction, periostic reaction. Anatomical variations of normality: when not to biopsy. Degenerative disease due to use and wear. The skeleton as a reflecion of metabolic disorders: osteoporosis and Paget's disease. Assessment of traumatised patients. Vascular bone pathology: osteonecrosis and osteochondrosis. Congenitial bone diseases: congenital dysplasia of the hip. Unnecessary bone studies.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Anatomy.
Subject 12. Skeleton semiology II
Basic radiological criteria of articular pathologies. Limitations of radiological signs and their pathogenesis. Clinical correlation. Rheumatoid arthritis and seronegative spondyloarthropathy. Infection: radiological signs in the tubular and flat bones, axial skeleton and articulations. Radiological signs in articular disease due to crystal deposition. Radiological signs in bone lesions of neuropathic origin. MR in the study of soft tissue lesions. Interventional radiology in the diagnosis and treatment of lesions of the skeleton and soft tissues.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Anatomy.
Subject 13. Semiology of the peritoneal cavity and the empty viscera.
Radiological examination of the peritoneal cavity and identification of the recesses. Radiological semiology of the empty viscera. Transmural lesion and extension to the mesentry. Radiology with oral contrast in the study of the intestinal lumen: filling defect, stenosis, image of addiction, rigidity of an intestinal wall segment. Simple abdomen plaque in follow-up of the intestinal monitoring Traffic.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Anatomy.
Subject 14. Semiology of solid peritoneal masses
Semiology of solid peritoneal masses: liver, spleen, mesentry and abdominal wall. Integrated radiological semiology in diffuse and focal parenchymatous diseases. Level of precision necessary in the anatomical location of lesions. The bladder and bile ducts. Radiological examination of the intrahepatic and extrahepatic system. Basic integrated examination: ultrasound scanning and cholangiography. Magnetic resonance, wirsungraphy.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Anatomy.
Subject 15. Semiology of the retroperitoneum: anatomical spaces and viscera
Retroperitoneal anatomical spaces: anterior pararenal, perirenal, posterior pararenal, common retroperitoneal. Pancreas: alteration in shape, size, calcifications, edema, focal or solid cystic lesion, alteration of the peripancreatic fat, pseudocyst. Uptake of dye in parenchyma. Extrahepatic biliary atresia. Kidneys: shape, size and symmetry, deformity of the renal area, focal, cystic and solid lesions. Urinary tract lesions: dilation, obstruction, intraluminal lesion. Urinary calculus. Prostate: determining the volume; prostate biopsies, target areas and number of samples. Testicular ultrasound scanning: cystic and solid lesions. Indications of MR.
Uterus and ovaries: alterations in size, solid, cystic and mixed lesions.
Duration: 1 hour.
Prior knowledge required of students: First year Medicine Anatomy.
Subject 16. Functional imaging. Biochemical and technological foundations
What is a functional image? Difference between morphological and functions imaging. How is it performed? The use of isotopes in biomedicine. Physiological foundations of studies with isotopes. Single photon emission computed tomography (SPECT) and positron emission tomography (PET).
Duration: 1 hour.
Prior knowledge required of students: the characteristics of electromagnetic radiation. First year Medicine Physics for Health Sciences.
Subject 17. Isotopic vascular and cardiological studies
Vascular, cardiac and pulmonary isotopic examinations. Indications. Most common diagnoses. Future outlook.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 18. Isotopic studies in oncology and hematology
Isotopic staging and response evaluation examinations. Role of PET in oncology. Role of SPECT and bone gammagraphy. Studying sentinel ganglions.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 19. Other isotopic studies
Isotopic examinations of the osteomuscular system. Bone gammagraphy and other isotopic renograms. CNS studies. Cerebral function by MN. Functional neuroimaging.
Studies of the nephrological system Studies of the digestive system Indications. Most common diagnoses.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 20. Molecular imaging and animals models in biomedical research
Concept of molecular imaging. PET as a molecular imaging paradigm. Advanced clinical research. Basic biomedical research. From animal to human research. PET in genomics. PET in the research and development of new medicines.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 21. Radiotherapy. Basic knowledge
What is radiotherapy? Irradiation and contamination. External and internal irradiation. General considerations of equipment. Historical development.
Duration: 1 hour.
Prior knowledge required of students: the characteristics of electromagnetic radiation. First year Medicine Physics for Health Sciences.
Subject 22. Radiobiology I.
Action of ionizing radiation on the environment. Direct and indirect action, linear energy transfer. Action of radiations on cells. Cellular response to irradiation: repairable, potentially repairable and lethal lesions. Delay in division. Concept of cell death and apoptosis. Survival curves. Factors modifying radiosensitivity: radioprotectors and radiosensitizers. The oxygen effect.
Duration: 1 hour.
Prior knowledge required of students: the cell and the cell cycle.
Subject 23. Radiobiology II
Action of radiations on tissues and organs. Clinical effects of radiations: physiopathology, symptomatology and treatment. Clinical effects of partial and total radiation of an organism. Concept of lethal dose-50.
Duration: 2 hours.
Prior knowledge required of students: the cell and the cell cycle.
Subject 24. External radiotherapy equipment and main techniques
Types of radiotherapy. Teletherapy units. Other radiotherapy units: radiodiagnosis and ultrasound scanning equipment, CAT units. Concept of bundle and field. Conformal field (?). Opposing and parallel fields. Crossed fields. Rotatory techniques. Treatment plan: fraction dose and total dose.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 25. Dose simulation and calculation
Concept of simulation. Types of simulation: conventional and virtual. Importance of reproducibility and immobilisation. Image fusion systems. Treatment volumes. Critical organs and dosage limitations. Dosimetric calculation. Dose-volume histograms.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 26. Cancer and its classification system
Concept of neoplasia. Classification of cancers. Natural history of cancer. TNM system. Importance of multidisciplinarity: tumours committees and functional units.
Duration: 1 hour.
Prior knowledge required of students: the cell. First and second year Medicine anatomy and physiology.
Subject 27. Radiosensitivity and radiocurability
How can cancer be cured with radiation? Concepts of radiosensitivity and its differences with respect to radiocurability. Indications of radiotherapy: radical exclusive, palliative and adjuvant. Combined treatments and their sequences: concomitant and sequential.
Duration: 1 hour.
Prior knowledge required of students: the cell.
Subject 28. Brachytherapy and main techniques
Use of brachytherapy. Needs. Brachytherapy units: high-dose rate, pulsed-dose rate and low-dose rate. interstitial, endocavitary and metabolic technique.
Duration: 1 hour.
Prior knowledge required of students: none.
Subject 29. Toxicity due to radiation use
Concept of acute, sub-acute and chronic radiotoxicity. Radio-induced cancers. Most common types of toxicity. Prevention and treatment of the most common toxicities. The importance of informed consent.
Duration: 1 hour.
Prior knowledge required of students: pharmacology.
Subject 30. Technological breakthroughs and their problems
Breakthroughs in radiotherapy: IGRT, IMRT, radiosurgery, dynamic arc, respiratory synchronisation. Failures. Interruptions to treatment.
Duration: 1 hour.
Prior knowledge required of students: none.
Seminar lectures. Duration: 12 hours.
Seminar 1. Radiation protection theory
Radiation protection standards. The inverse-square law.
Duration: 2 hours.
Venue: UPF classrooms.
Prior knowledge required of students: First year Medicine Physics for Health Sciences.
Seminar 2. Radiation protection experiments.
Radiation detectors. Measuring radioactivity. Calculating the inverse-square law.
Duration: 2 hours.
Venue: Radiotherapy Service, Hospital de l'Esperança.
Prior knowledge required of students: First year Medicine Physics for Health Sciences.
Seminar 3. Radiological clinical interface levels
The various electronic densities in the human body and their clinical relationship.
Duration: 1 hour.
Venue: UPF classrooms.
Prior knowledge required of students: subjects 1-4.
Seminar 4. General semiological bases in image diagnosis
Image diagnosis semiology.
Duration: 1 hour.
Venue: UPF classrooms.
Prior knowledge required of students: subject 5.
Seminar 5. Magnetic resonance
Semiology of magnetic resonance.
Duration: 1 hour.
Venue: UPF classrooms.
Prior knowledge required of students: subject 6.
Seminar 6. Thoracic examinations
Differential diagnosis between diffuse lesions and pulmonary parenchymatous lesions.
Duration: 1 hour.
Venue: UPF classrooms.
Prior knowledge required of students: subjects 7-9.
Seminar 7. Examinations of the articulations and soft tissues
Magnetic resonance of the articulations and soft tissues.
Duration: 1 hour.
Venue: UPF classrooms.
Prior knowledge required of students: subjects 11-12.
Seminar 8. Examinations of the abdomen and pelvis
CAT and MNR indications.
Duration: 1 hour.
Venue: UPF classrooms.
Prior knowledge required of students: subjects 13-15.
Seminar 9. Nuclear medicine
Viewing functional images: pulmonary, cardiac, bone, sentinel and SPECT.
Duration: 2 hours.
Venue: UPF classrooms.
Prior knowledge required of students: subjects 16, 17, 18 and 19.
Practical sessions. Duration: 24 hours.
Practical session 1. Visit to the radiodiagnosis service and examination of the patient by X-ray
Duration: 1 hour.
Venue: Radiodiagnosis Service. IDIMAS.
Prior theoretical knowledge: subjects 1-2.
Objective: to understand the workings of the radiodiagnosis service. Analyse the patient's awareness of the radiological examination that needs to take place. Identify the level of urgency for the examination. Be aware of the information to be given to the patient on the test to be carried out. Identify anatomy and morphological variations according to the patient's age and phenotype.
Format: see the reception of patients, inspect and analyse test requests. Witness the interface between patients and the administrative programming process. Viewing a third category radioactive facility. Viewing of the parts of a conventional radiology device and a CAT. Viewing if spatial reconstruction capacity (coronal, sagittal and oblique). Application of levels and windows according to Hounsfield units.
Practical session 2. Ultrasound Scanning
Duration: 1 hour.
Venue: Radiodiagnosis Service. IDIMAS.
Prior theoretical knowledge: subject 4.
Objective: to understand the operation of a tomogram emitting pulsed ultrasound beams. Identify the echograph and transducers. Electronic, sectorial, linear, ring, sequential activation probes. The FNA and/or biopsy.
Format: students perform an ultrasound scan in order to be able to appreciate the visual field depending on the transducer and its location. Measurement: recording system: M-mode and B-mode. Doppler principle. Identification of empty viscera occupied by liquid: gallbladder, choledochus, urinary bladder, renal calyxes and pelvis, small intestine loops.
Practical session 3. Magnetic resonance
Duration: 1 hour.
Venue: Radiodiagnosis Service. IDIMAS.
Prior theoretical knowledge: subject 5.
Objective: understand the workings of an MR tomogram and the system for reading and the necessary precautions for preventing risks to professionals and patients.
Format: view the examination tunnel where the patient is positioned and the degree of cooperation necessary by the patient to carry out an examination with diagnostic potential. Design of the study based on the clinical information available. Determination of the topographic range to be examined. Observe the quality control process of images and the archiving process. Participate in the informative process of an MR examination.
Practical session 4. Thorax CAT I
Duration: 1 hour.
Venue: classroom.
Prior theoretical knowledge: subjects 6-7.
Objective: review the general radiological semiology of the thorax.
Format: case-problems will be used to review the various patterns of pulmonary pathology, with special emphasis on the aspects that conventional radiology is unable to resolve. Different electronic densities. Topographic location. Pattern of lesions (solid and cavitated). Air bronchogram. Pulmonary nodule.
Practical session 5. Thorax CAT II
Duration: 1 hour.
Venue: classroom.
Prior theoretical knowledge: subjects 6-7.
Objective: review of the radiological semiology of the thorax mediastinal, pleural, thoracic wall and diaphragm pathology .
Format: case-problems will be used to review various intra- and extrapulmonary pathologies, with special emphasis on the aspects that conventional radiology cannot cover. Establish the differential diagnosis based on its location.
Practical session 6. Thorax CAT III
Duration: 1 hour.
Venue: classroom.
Prior theoretical knowledge: subjects 6-7.
Objective: review the radiological semiology of the thorax. Vascular pathology. Using the contrast.
Format: case-problems will be used to review the various patterns of vascular thoracic pathology, development disorders, hematomas, etc. Establish the differential diagnosis between ganglia and adenopathy. Study of the pericardium.
Practical session 7. Central nervous system. Anatomy
Duration: 1 hour.
Venue: classroom.
Prior theoretical knowledge: subject 10.
Objective: recognise the structures of the encephalus, the base of the cranium, and the spinal column.
Format: case-problems will be used to analyse the anatomy of the three anatomical regions by means of CAT and MR. Advantages of sagital, coronal and MR projections depending on the anatomic region. Study of the medullary parenchyma: subarachnoid and epidural space and its relationship with the vertebrae.
Practical session 8. Central nervous system. Semiology
Duration: 1 hour.
Venue: classroom.
Prior theoretical knowledge: subject 10.
Objective: discuss and assess the advantages of MR compared to CAT. Using the contrast.
Format: case-problems will be used to analyse the major neurological syndromes by means of CAT and MR. cerebral oedema (vasogenic and cellular), space occupying lesion (supra and infratentorial) and assessment of the pathways, vascular malformations, cerebral haemhorrages (temporal evolution), displacements and deformities, demyelination, hydrocephalus (obstructive and non-obstructive), subdural and epidural lesions, hematomas, seromas empyema. Cerebral atrophy, nervous system malformations (Arnold Chiari type II).
Practical session 9. Bone system
Duration: 1 hour.
Venue: classroom.
Prior theoretical knowledge: subjects 11-12.
Objective: recognise bone structures by means of simple radiology, CAT and MR. The strength of each technique will be shown according to semiological diagnosis. Assess the clinical context with regard to the type of lesion.
Format: case-problems will be used to review the major patterns of bone pathology based on the long bone, flat bone and vertebra structure (cervical and and lumbar). Types of volumetric studies. Study of the changes in bone densities: lytic and blastic metastasis.
Practical session 10. Articulation and soft tissues system
Duration: 1 hour.
Venue: classroom.
Prior theoretical knowledge: the chapter on the abdomen in Hoffaster's radiology atlas. Subjects 11-12.
Objective: recognise joint structures and soft tissues by means of simple radiology, CAT and MR. The strength of each technique will be shown according to semiological diagnosis. Assess the clinical context with regard to the type of lesion.
Format: case-problems by means of MR of three anatomical regions: knee, back and hands. Relationship between the lesion and the bone. Analysis of lesion pathways.
Practical session 11. Abdomen CAT I
Duration: 1 hour.
Venue: classroom.
Prior theoretical knowledge: the chapter on the abdomen in Hoffaster's radiology atlas. Subjects 13-15.
Objective: recognise abdominal-pelvic viscera: liver, spleen, prostate, uterus. Viewing of the radiological semiology of the abdomen.
Format: case-problems will be used to review the major patterns in abdominal pathology: ascites, hepatic lesions (solid, cystic and mixed), dilations of bile ducts. Lesions of viscera walls. Analysis of injuries in the male and female pelvis.
Practical session 12. Abdomen CAT II
Duration: 1 hour.
Venue: classroom.
Prior theoretical knowledge: the chapter on the abdomen in Hoffaster's radiology atlas. Subjects 13-15.
Objective: recognise the pancreas and the pancreatic and bile ducts, and the urinary system: kidney, ureter and bladder. View of the radiological semiology of the abdomen. Using the contrast.
Format: case-problems will be used to review the major patterns in abdominal pathology: Pancreatic lesions (solid, cystic and mixed) dilation of pancreatic ducts. Renal lesions: cysts, hydronephrosis. Prostate lesions: prostate biopsy strategy. Retroperitoneal pathology: adenopathies. Vascular lesions: aneurysms and dissecting aneurysms.
Practical session 13. How is a gammagraphy performed?
Duration: 2 hours.
Venue: IDIMAS Nuclear Medicine Service.
Prior theoretical knowledge: subjects 16, 17, 18 and 19.
Objective: students will consider the tasks that have to be carried out in order to perform a gammagraphy and the radiation protection measures that must be taken.
Format: the students, in groups and supervised by a tutor, will see the preparation of radioisotopes, gamma cameras and all the necessary equipment. If possible, they will see a real case. They will see the differences between the images seen by the nuclear physician and the images included in the network. They will learn to understand a report.
Practical session 14. How is a PET performed?
Duration: 2 hours.
Venue: IAT.
Prior theoretical knowledge: subject 20.
Objective: students will consider the tasks that have to be carried out in order to perform a PET and the radiation protection measures that must be taken.
Format: the students, in groups and supervised by a tutor, will see the preparation of the markers, the cyclotron, the tomogram and all the necessary equipment. If possible, they will see a real case. They will see the need for interdisciplinarity between the nuclear physician and the radiologist. They will learn to understand a report.
Practical session 15. Breast cancer
Duration: 2 hours.
Venue: Radiotherapy Service, Hospital de l'Esperança.
Prior theoretical knowledge: subjects 3, 4, 5, 6 and 8. Students must have studied breast cancer (in virtual format).
Objective: students will consider the tasks that have to be carried out in order to be able to perform an irradiation - definition of volumes, dosimetry and quality control systems.
Format: the students, working in a group and supervised by a tutor, will study a real case and assess the indication of radiation, with its advantages and disadvantages. They will see how the virtual simulation and dosimetry are carried out, and will see the quality control systems. The toxicity that may appear will be assessed.
Practical session 16. CNS cancer
Duration: 2 hours.
Venue: Radiotherapy Service, Hospital de l'Esperança.
Prior theoretical knowledge: subjects 3, 4, 5, 6 and 8. Students must have studied CNS cancer (in virtual format).
Objective: students will consider the tasks that have to be carried out in order to be able to perform an irradiation: CAT-MNR image fusion, definition of volumes, dosimetry and quality control systems.
Format: the students, working in a group and supervised by a tutor, will study a real case and assess the indication of radiation, with its advantages and disadvantages. They will see how the virtual simulation and dosimetry are carried out, and will see the quality control systems. The toxicity that may appear will be assessed.
Practical session 17. Prostate cancer
Duration: 2 hours.
Venue: Radiotherapy Service, Hospital de l'Esperança.
Prior theoretical knowledge: subjects 3, 4, 5, 6 and 8. Students must have studied prostate cancer (in virtual format).
Objective: students will consider the tasks that have to be carried out in order to be able to perform an irradiation: definition of maximum volumes and doses, dosimetry, IMRT and quality control systems.
Format: the students, working in a group and supervised by a tutor, will study a real case and assess the indication of radiation, with its advantages and disadvantages. They will see how the virtual simulation and dosimetry are carried out, and will see the quality control systems. The toxicity that may appear will be assessed.
Practical session 18. Lung cancer
Duration: 2 hours.
Venue: Radiotherapy Service, Hospital de l'Esperança.
Prior theoretical knowledge: subjects 3, 4, 5, 6 and 8. Students must have studied lung cancer (in virtual format).
Objective: students will consider the tasks that have to be carried out in order to be able to perform an irradiation: CAT-PET image fusion, definition of volumes, dosimetry and quality control systems.
Format: the students, working in a group and supervised by a tutor, will study a real case and assess the indication of radiation, with its advantages and disadvantages. They will see how the virtual simulation and dosimetry are carried out, and will see the quality control systems. The toxicity that may appear will be assessed.
4. Assessment
The activity is assessed solely on the basis of specific objectives.
a) Assessment methods
Assessment will be by means of multiple choice tests (five alternatives, one correct answer, random correct answers discarded) essay tests, mostly of short answers with objective correction criteria, and true or false tests (random correct answers discarded).
b) Type and number of assessments
The practical sessions during the course will be assessed as follows:
• An assessment consisting of true or false questions willl be carried out at the end of each practical session.
• Report (individual) of 150-200 words on the three practical sessions in the radiodiagnosis service explaining the most important points.
• Report (group) of a maximum of 1,000 words on two of the four cases studied in the radiotherapy oncology service.
At the end of the teaching process, a final evaluation of the theory will take place, consisting of a multiple choice test with questions on all the subjects covered and an essay test with short questions.
There will also be a multiple choice test on the planned objectives in the practical sessions.
c) Impact of the various types of assessment on the final accreditative mark
Final assessment:
MCT 25%
Test: 25%
Practical session: 15%
Assessment during the course: true/false questions 5%
Individual report: 15%
Group reports: 15%
d) Pass criteria and qualitative grades
Student must participate in the programmed activities and obtain a mark of 5 or higher to pass the subject.
Passing 70% of the objectives leads to a Good mark and passing 90% of the objectives leads to an Excellent mark.
5. Bibliography and teaching resources
5.1. Basic bibliography
As the subject is very specific, we do not recommend any reference books. Most of the bibliography will be given to students in photocopy format or as chapters of books or publications we consider to be of interest.
Reference books:
Fundamentos de radiología de Squire's. Novellini, RA. Harvard University Press, 1997.
Cancer principles and practice of oncology. 8th Edition. DeVita Jr, Vincent T. Jr; Lawrence, Theodore S.; Rosenberg, Steven A.; DePinho, Ronald A.; Weinberg, Robert A. Lippincott Williams & Wilkins (LWW), 2008.
Oncología médica. Editors: H. Cortés-Funes et al. Madrid: Nova Sidonia Oncología, 1999.
Volúmenes blanco en oncología radioterápica. Editor: Pilar Samper, 2006.
Principles and Practice of Radiation Oncology. 5th Edition. Carlos A. Perez, MD; Luther W. Brady, MD; Edward C. Halperin, MD. Lippincott Williams & Wilkins (LWW), 2009.
Radiobiología. Valls A. and Algara M. 1st edition Eurobook, 1994.
Oncología radioterápica, principios, métodos, gestión y práctica clínica. 1st edition Calvo FA, Biete A, Pedraza V, Giralt J, de las Heras M. Arán, 2010.
6. Methodology
As a requirement for passing the subject, students must undertake the activities scheduled during the academic year. Attendance at lectures will nonetheless be monitored. There will be a thorough check in the other activities.
The following activities are planned for the teaching process:
Lectures
Although the lecturers will discuss the content in lectures, students' participation will be encouraged. This activity will take place in the Faculty's classrooms.
The objectives should mostly be achieved during the scheduled face-to-face activities.
Seminars
The seminars will take place in groups of 30 students, and the aim is to apply the knowledge of the concepts explained in the lectures. Student will suggest the questions to be answered.
This activity will take place in the Faculty's classrooms (except for the practical part of the Radiological Protection Seminar). The content of seminars is subject to scheduled face-to-face assessment.
Practical sessions
18 practical sessions will take place, at the image diagnosis service (Hospital del Mar), the IAT (PRBB), the IOR (Hospital de l'Esperança) and in the classrooms of UPF. At the end of every practical session, students must complete a control sheet which will be assessed (true or false questions). Students must hand in a report (individual) of 150-200 words on the three practical sessions at the image diagnosis service, explaining the most important details, and at the end of the practical sessions at the IOR, a group report of at most 1,000 words on two of the four clinical cases studied.
Assessment of the objectives planned for these sessions will also take place during the examination period.
7. Programme of activities
The programme of activities in the subject is included in the Faculty's official timetable.
The report hand-in dates will be announced during the course.