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Gaida KrūmiņaHead of Department of Radiology Riga Stradins University,Chief Radiologist of Latvian Ministry of Health

Baltic Congress of Radiology, October 8, 2010

Clinical diagnostic

Education

Research

• Investigations• Consultations, tutorials, interdisciplinary conferences

•Outpatient and out‐clinic councils

•Undergraduate• Postgraduate training•Doctoral programs• Continuing professional development

• Exchange programs for fellowship

•Undergraduate• Postgraduate•Doctoral• Projects of Latvian Academy of Science

• International grants


Advantages

Multi profile hospital

Intensive patient’s flow

Concentration of advanced technologies

Academic team

Work in interdisciplinary command


NeuroHead and neckChestBreastCardiovascularAbdominalGenitourinaryMusculoskeletalPediatricInterventionalEmergency radiology


Prescription

Choice of protocol

Investigation

Imaging description

and preliminaryconclusion

Exchange of viewpoint

with clinicists

Consensus


Doctors are ordering too many unnecessary imaging tests, raising the cost of healthcare and exposing patients to excess amounts of radiation

Some imaging procedures are not justified

Medical physicists, radiologists, radiation oncologists and educators have to identify and eliminate unnecessary imaging tests


Payment mechanisms and financial incentives in the health care system

Practice behavior of referring physicians; self‐referral, including referral for additional radiologic examinations

Defensive medicine: doctors who order tests to protect against potential lawsuits

Missed educational opportunities when inappropriate procedures are requested

Patient expectations

Duplicate imaging studies


Development of evidence‐based appropriateness criteria for imagingGreater use of practice guidelines in requesting and conducting imaging studies Better communication among doctors: non radiologists and radiologistsProviding physicians with decision‐making technologyEducation of referring physicians, patients, and the public


HendeeWR at al, Radiology, Aug, 2010RSNA 2010

Common conception and quality standardsElaboration of optimal investigation algorithms, protocols, guidelines, its testing and implementationPrevention of duplication and unnecessary imaging testsImplementation of united PACSUnified planning of change or purchasing of new high technologiesPET/CT


Education

Teachers

CPD

Courses

Congresses

Visiting scholarship

Publications Lectures

Expertises

Students

Undergraduate Postgraduate Doctoral CME


Department of Radiology Riga Stradins university:ProfessorAssociated professor4 assistants24 invited teachers ‐ qualified, experienced radiologists with good teaching skills covering all main branches of diagnostic and therapeutic radiology


Teaching program Medicine ‐ 6 years: preclinical phase 2 years, clinical phases 4 yearsRadiology: formal curriculum ‐ 3rd, 4th year, elective course‐ 5th yearYearly number of students 300‐360Classic teaching type: independent discipline with own examE‐ learning: special software produced by RSULecture and hands‐out topics: radiological anatomy, radiological techniques, radiation protection, radiology of diseases, interventional radiology, appropriateness criteria Teaching stuff: dedicated teachers, general radiologists, sub‐specialized radiologists, radiology traineesRadiological department, team meetings visiting Exam: orally and writing multiple choice testIndependent scientific work


ESR Education Committee and ESR Working Group on Undergraduate TeachingStock of present state : survey on teaching

Integrated program throughout Europe – well timed, necessary stepUnified guidelinesSupport of teaching process from ESR: internet‐based exercises, teaching files on CDs, unified multiple choice control test samples


Requirements of European Training Charter for Medical specialists in the EU (UEMS), specialty of general radiologyCertified as medical doctorCompetitive interviewLength of training 4 yearsObligatory formal teaching: lectures, seminars, multi choice tests, logbooks, independent clinical research work in the 2nd, 3rd, and 4th yearFirst year trainees: basic sciences, radiation biology, protection, anatomy, techniques; theoretical test , practical exam in conventional radiologyOn call responsibilities from the 2nd yearModular rotations: system basedClinically orientated diploma work and final written national exam


Acceptation in the university doctoral program

Detailed annotation of the work, foreruns, publications, etc.Successful competitive interview

6 doctoral, 5 post doctoral students in radiology

Growing tendency of interdisciplinary promotion work themes: stomatology and radiology, orthopedic surgery and radiology, internal medicine and radiology, oncology and radiology, genitourinary, abdominal surgery and radiology


ESR and UEMS guidelines: CME/CDP should ideally be organized by a single professional body and preferably the same professional body responsible for postgraduate training, as, from an organizational perspective, these areas are mutually supportive

CME – educational branch in Department of Radiology RSU10‐14 courses at basic and advanced levelsAdvanced spring course for foreign radiologists “CT and MRI of the Head, Spine, Joints, Chest, and Abdomen”Utilized credit points approved from national professional authoritiesProfessors ‐ lecturers at courses organized by ESR: postgraduate training programs during ECR, ERASMUS course etc.


Knowledge of basic elements of scientific methods and evidence base, including statistics is critical for assessment and understanding of published papers and promotion of personal research

Undergraduate level. 5th and 6th year students ‐ participation in clinical research trials or an independent scientific studyPost graduate training. Elaboration and presentation of an independent clinically orientated study at the 2nd, 3rd and 4th year is mandatoryDoctoral themes are a part of the general university research directions, national and international scientific projects headed and supervised by academic staff


Functional MRI in follow‐up of glial tumors


Doctoral work, author Dr. Anvita BiezāSupervisor Prof. Gaida Krūmiņa

Brain perfusion disposition in acute stroke with known atherosclerosis


Doctoral work, author Dr. Maija RadziņaSupervisor Prof. Gaida Krūmiņa

Aorta remodelation after endoluminal aortic aneurysm repair using sac anchoring endoprosthesis


Pre treatment

Post treatment

Doctoral work, author Dr. Jānis ŠavlovskisSupervisors Asoc. Prof. Dainis Krieviņš, Asoc. Prof. Igors AksiksConsultant Dr. Med. Kārlis Kupčs

Brain ageing and early cognitive disturbances


National project of the LatvianAcademy of Science “Humanity ageing”Head and coordinator Prof. G.Krūmiņa

CSF flow patterns in patients with hydrocephalus and Chiari I malformation


Doctoral work, author Dr.Med. Henrijs OzoliņšSupervisor Prof. Gaida Krūmiņa

Stereotactic body radiotherapy in the treatment of liver cancer


National project of the Latvian Center of Oncology Riga East Clinical University hospital Head and coordinator Dr. Med. Olga Utehina

Transrectal US in prostate cancer detection


B‐mode USPower DopplerUS

Contrast‐enhanced US

Doctoral work, author Dr. Arta StrazdiņaSupervisor Prof. Gaida Krūmiņa

Influence of liver fibrosis and steatosis to hepatic vein blood flow in patients with chronic virus hepatitis C


Initial fibrosis Severe fibrosisDoctoral work, author Dr. Pēteris PriedītisSupervisors Prof. Gaida Krūmiņa, Prof. Ludmila Vīksna

MRI in myelodysplastic syndrome, aplastic anemia and evaluation of autologous allogeneic transplantation results


Doctoral work, author Dr. Anita Jansone‐LaizāneSupervisors Asoc. Prof. Ardis Platkājis, Prof. Sandra Lejniece

Before treatment After treatment

TMJ morphology in patients with severe dentofacial anomalies

Dimensional morphology of masticator muscles in patients with skeletal malocclusions


Doctoral work, author Dr. Zane KrišjāneSupervisors Prof. Ilga Urtāne, Prof. Gaida Krūmiņa Doctoral work, author Dr. Katrīna Zepa

Supervisors Prof. Ilga Urtāne, Prof. Gaida Krūmiņa

Radiological analysis of risk factors in recurrent hip dislocation after primary total hip replacement


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Doctoral work, author Dr. Pēteris LīkumsSupervisors Prof. Gaida Krūmiņa, Dr.Med. Pēteris Studers

Education

InnovationResearch


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