Radiology Resident Resources

Sections - Consult/In-House

On-Call – Consult

Effective 6/15/2020, changes were made to our responsibilities after-hours on Consult and Night Float shifts. See this informational document for most updated policies and save it for your reference!: https://tinyurl.com/bwhradres: https://tinyurl.com/bwhradres

Location: At the time of this writing, after-hours residents (both Consult and Night Float resident) will sit in Shapiro L2 CV reading room.

Hours: Sunday – Friday, 7:00pm – 2:00am
The Saturday evening Consult shift will be covered on a rotating basis and will also run from 7:00pm-2:00am. Consult shifts that fall on holidays will be covered by the same resident assigned to Consult for that week.

Responsibilities:

  • At the beginning of the shift, call the operator to assign the #11883 Radiology Resident On-Call pager to your pager.
  • At the end of the shift, communicate with the Night Float resident regarding any impending emergent studies (STAT abdomen CT or PE CT) or any remaining issues and sign the #11883 pager over to the NF resident’s pager.
  • Refer to the First Actionable Communication Transparency (FACTs): Details for Residents document for the most up-to-date responsibilities of the Consult and NF resident as the duties may change over the course of the academic year.
  • The Consult resident will be responsible for covering the on-call radiology pager (#11883) until the end of their shift (2:00am), at which time it will be transferred to the Night Float resident. At that time, the resident communicates with the Night Float resident to discuss unresolved issues, urgent pending studies, and confirm pager hand-off.
  • During the overlapping period between 10:30pm and 2:00am, when both the Consult and Night Float residents are on-site, inpatient cases and ED cases can be distributed at their discretion and in conjunction with the ED attending. However, the Consult resident shall preferentially be responsible for inpatient examinations.
  • The Consult resident is responsible for providing a preliminary interpretation via ANCR for:
    • Any unread STAT inpatient CT, MRI, abdominal US, and MSK US, and STAT/“patient waiting” outpatient CT, MRI, and radiographs that appear on the “BH Consult After Hours” Primordial worklist.
    • Any non-STAT CT, MRI, or radiograph about which the resident is called. o Time permitting, the Consult resident is encouraged to look at and issue a first communication on as many of the non-STAT inpatient CT and MRI exams (prioritizing “within 6 hour” and then routine studies) as possible during the shift.
    • Additionally, as mentioned above, the Consult resident can help read ED cases between 10:30pm and 2:00am if all inpatient cases that meet the above criteria have been reviewed and the results have been communicated to the responding clinicians.
  • Communication of results should be documented using the ANCR system. Refer to First Actionable Communication Transparency (FACTs): Details for Residents document for further details.
  • The resident will also generate a “sticky note” within Visage saying “ANCR” with a short summary if possible, to ensure that the radiologists reviewing the study are aware that communication already took place on this case.
  • If the Consult resident does not feel comfortable issuing an actionable report on an exam (e.g., CTA or MRI) or is unable to do so within a reasonable time frame due to time constraints, he/she should request that the case be reviewed by the fellow-on-call for the respective division via purple ANCR page using the “Consult” category. Make sure the page option is checked as the fellows are not expected to check their emails after hours.
  • After-hours inpatient ultrasound preliminary interpretation will be performed by the in-house sonographer.
  • All nuclear medicine studies (including V/Q, GI bleeding scans, gallium scans, etc.) are covered by the on-call Nuclear Medicine Fellow.
  • The radiologist officially interpreting studies that have been preliminarily reported by the overnight resident are responsible for notifying the requesting physician of any major discrepancies between the preliminary read and the final report. In this case, a new ANCR should be submitted by the resident/attending faculty member 47 who officially interprets the study. Additionally, the “Worth Another Look - Purple ANCR” system is used in the morning to notify the on-call resident of any major discrepancies or missed findings.
  • The Consult resident covers inpatient and ED fluoroscopy studies, coordinating the study with the Lead technologist on call who is stationed in the Fluoroscopy area (ext. 33880 or 33882). The resident provides the technologist with the patient’s name, MRN, exams to be performed and patient location. If the lead technologist is not available, page directly the "Tower Portable XR Technologist" at 11870 or the "Shapiro Portable XR Technologist" at 12915. If performance of the study would cause the Consult resident to be pulled from their duties outlined above for too great a time to hinder appropriate patient care, the on-call Abdominal Imaging fellow may be called for backup.
  • Perform cystograms and cover contrast reactions. You must go to Tower 9 if there is a contrast reaction or cystogram (connect the contrast to the Foley, give ~300cc or until the patient experiences pain/fullness, then make sure the FOV includes the entire bladder on the post-contrast scan while still at the scanner). Policy is no cystograms on intubated or non-responsive patients.
  • Pay attention to STAT exams when protocoling and if there is a question whether the exam is truly STAT, reach out to the ordering provider for clarification. If it is not truly STAT, either you or the provider can change the order to routine (you must document that you spoke to the provider).
  • If a referring attending requests a radiology attending opinion after hours, the resident should escalate through existing divisional procedures (page fellow who will then reach out to attending) until 11pm. After 11pm, resident should ask ED attending for review. ED attending can decide at her/his discretion to defer to divisional attendings based on case complexity and/or workload.
  • Documentation of the findings/impression:
    • The communication by the Consult resident should be restricted to short, succinct actionable assessments as relevant to the overnight and immediate clinical care of the patient only (rather than incidental findings that can be triaged at the time of the final image interpretation).
    • This communication is performed via ANCR, using red, orange, yellow, or the green (which includes normal, unchanged, or no acute findings) ANCR options. Red and orange ANCRs must be sent by page.
      • Yellow and green ANCRs must be sent by page for a STAT study; for a routine study, the resident may choose whether to send by page or email.
    • The “not yet reviewed by attending radiologist” option should be checked off as appropriate. For “Attending (Sender),” the “Attending (Sender) Not Yet Assigned” button can be checked off as appropriate. This ensures transparency in communication as ANCR can be searched (based on patient name, MRN, or date of birth) by any Brigham Health provider.
    • The resident will also generate a “sticky note” in Visage saying, “ANCR” to ensure that the radiologists reviewing the case the next day are aware that communication already took place on this case. Click on “i” button on top Visage toolbar to enter note.
    • If there are multiple accession numbers for one patient, an ANCR must be generated for each STAT accession and each non-STAT accession with a critical finding. If there are multiple (non-STAT) accessions with no critical findings, a single green ANCR will suffice. A “sticky note” should still be placed in Visage for each accession reviewed by the resident.
  • Protocol all inpatient thoracic, abdomen, and neuro CT studies, and other studies if called and as appropriate.
    • Feel free to protocol inpatient MR studies, but if you are unsure leave it for the fellow.

On Call – Night Float

Location: At the time of this writing, after-hours residents (both Consult and Night Float resident) will sit in Shapiro L2 CV reading room to scanner.

Hours: Sunday – Friday, 10:30pm-7:30am
The Saturday Night Float shift will be covered on a rotating basis and will also run from 10:30pm-7:30am.

Responsibilities: Similar to ED shift + Consult shift.

  • Refer to the First Actionable Communication Transparency (FACTs): Details for Residents document for the most up-to-date responsibilities of the NF resident as the duties may change over the course of the academic year.
  • Your responsibilities are similar to those of the ED day shift plus those of the Consult resident.
    • Remember that means you have to sign in/out of the shared ED Google form: everybody working in the ER are required to update a google doc at the beginning of the shift with your location, phone number (landline and cell phone), and attending you are working with, and also remove your name at the end of your shift. This is used to give the secretaries and techs accurate information about how to reach everyone at all times! You can find you attending location/number in this list.
    • Daily Sign-in Sheet (Google Doc)
  • Vigilantly protocol to avoid interruptions! Protocol both ED and inpatient lists.
  • Regarding which inpatient studies to read during your shift, see: https://tinyurl.com/bwhradres for most updated policies).
  • The Night Float resident is responsible for issuing an actionable report on all STAT inpatient CT, MRI, abdominal US, and MSK US performed during their shift and after they have taken over the responsibilities of the Consult resident.
  • The Night Float resident will also issue an actionable report for any inpatient CT, MRI, or radiograph requested by a referring provider for the purposes of immediate, overnight clinical care.
  • Documentation of the findings/impression via ANCR is the same as listed in the “Consult” section.
  • During the overlapping period between 10:30pm and 2:00am, when both the Consult and Night Float residents are on-site, inpatient cases and ED cases can be distributed at their discretion and in conjunction with the ED attending. However, the Consult resident will preferentially be responsible for inpatient examinations (as discussed in the “Consult Rotation” section) while the NF resident is preferentially responsible for ED exams.
  • The NF resident will then solely cover the Resident On-Call Pager (#11883) from 2:00am to 7:30am as the Consult resident will end their shift at 2:00am. At that time, the Consult and NF residents should communicate to discuss any unresolved issues, urgent pending studies, and to confirm pager hand-off.
  • The NF resident will provide coverage of all ED studies, including radiographs, ultrasound, fluoroscopy, CT/CTA, and MRI.
    • Acute stroke and cord compression MRI/MRAs on ED patients performed during the NF shift are read by the NF resident. (7am – 7pm these are covered by the Neuroradiology division and the Neuro OnCall Fellow).
    • ED neuro MRI studies other than acute stroke and cord compression protocols performed during the NF shift should be reviewed and dictated by the NF resident if the requesting physician is an Emergency Medicine physician and the patient’s disposition hinges on the MRI result. All tumor MRIs and MRIs requested by Neurology/Neurosurgery (patient slated for admission regardless of MRI results) may be referred to the Neuro On-Call Fellow or preliminary reads placed with final read deferred to the Neuroradiology division at the discretion of the ED attending faculty member.
  • The NF resident also covers BWF and NWH ED studies. Refer to the Emergency Radiology resident manual for details of hours of coverage.
  • Once the Consult resident has left at 2:00am, the NF resident should review and issue a preliminary read on all STAT inpatient CTs, MRIs, abdominal US, and MSK US performed, as well as any inpatient CT, MRI, or radiograph for which they are called. Communication of results should be documented using the ANCR system. Refer to First Actionable Communication Transparency (FACTs): Details for Residents document for further details. The resident will also generate a “sticky note” within Visage saying “ANCR” with a short summary if possible, to ensure that the radiologists reviewing the study are aware that communication already took place on this case. If the NF resident does not feel comfortable issuing an actionable report on an exam (e.g., CTA or MRI) or is unable to do so within a reasonable time frame due to time constraints, he/she can first ask the ED attending for a second opinion. If not available, then should request that the case be reviewed by the fellow-on-call for the respective division via purple ANCR page using the “Consult” category. Make sure the page option is checked as the fellows are not expected to check their emails after hours.
  • After-hours inpatient ultrasound preliminary interpretation will be performed by the in-house sonographer.
  • Vascular ultrasounds will be performed by the Vascular US department until 5 PM during weekdays and until 3 PM on weekends. After these hours, lower extremity vascular US will be performed by the ED/inpatient US technologist and all ED vascular ultrasounds will be reviewed by the ED/NF resident and ED attending faculty member.
  • For after-hours upper extremity vascular US, the NF resident should direct requests to the Vascular Lab.
  • Performance of fluoroscopy overnight is generally not feasible due to the volume of ED cases and therefore fluoroscopy studies may be deferred to the next morning.
  • All nuclear medicine studies (including V/Q, GI bleeding scans, gallium scans, etc.) are covered by the on-call Nuclear Medicine Fellow.
  • The radiologist officially interpreting studies that have been preliminarily reported by the overnight resident are responsible for notifying the requesting physician of any major discrepancies between the preliminary read and the final report. In this case, a new ANCR should be submitted by the resident/attending faculty member who officially interprets the study. Additionally, the “Worth Another Look - Purple ANCR” system is used in the morning to notify the on-call resident of any major discrepancies or missed findings.

On Call - In-House (Saturday/Sunday/Holidays)

Location:At the time of this writing, the in-house resident will sit in the main Neuroradiology reading room in the AM and the Abdominal Imaging reading room in the PM.

Hours: 10am – 7pm

  • 10am – 1pm: read neuro cases
  • 1pm – 2 pm: lunch break
  • 2pm – 5 pm: read abdominal cases
  • 5pm – 7 pm: function as the Consult resident (see “Consult” section for responsibilities)

Responsibilities:

  • Call page operator and take over #11883 by 10am. At the end of the shift, communicate with the Consult resident regarding any impending emergent studies (STAT abdomen CT or PE CT) or any remaining issues.
  • There may be Fluoro exams waiting for you when you start the abdomen portion of the shift. These are your responsibility, not the fellow’s. The fellow is responsible for all CSIR procedures. If there are Fluoro studies (there may be post-op swallows on Saturdays), coordinate with the lead XR tech in the Fluoro area. The attending will read out your images and will occasionally watch you perform the study (although usually you’re on your own).
  • If paged about MSK, US, Chest cases, etc. (or Neuro or Abdomen/Fluoro when you are not assigned to that section) during the day before 5pm, you can refer the caller to the appropriate section.