Neuroradiology

Curriculum

1.   Rotate 6 months in neuroradiology in the PGY3 year in conjunction with rotation in SRS and neuro-ophthalmalogy.

2.   Maintain advanced cardiac life support certification.

Reading List/Supplemental Reading

• Diagnostic Neuroradiology.  Anne G. Osborn.   St. Louis:   Mosby-Year Book, Inc., 1994.
• Neuroradiology:   The Requisites.   Robert I. Grossman and David M. Yousem. 2nd ed. St. Louis: Mosby, 2003. 
• Diagnostic Imaging: Brain.  Anne Osborn, Susan Blaser, Karen Salzman, eds. AMIRSYS, 2004
• Diagnostic Imaging: Head and Neck.  H. Ric Harnsberger, Patricia Hudgins, Richard Wiggins, Christian Davidson, eds. AMIRSYS, 2004
• Practical Neuroangiography.  Pearse Morris.  Philadelphia: Lippincott Williams & Wilkins, 1997.
• Interventional Neuroradiology:   Strategies and Practical Techniques.   J. J. Connors III and Joan C. Wojak.  Philadelphia:   W. B. Saunders Company, 1999.
• Magnetic Resonance Imaging of the Brain and Spine [Volumes 1 and 2].  Scott W. Atlas.  3rd ed.   Philadelphia:   Lippincott Williams & Wilkins, 2002.
• Diagnostic Imaging: Spine.  Jeff Ross, Michael Brandt-Zawadzki, Mark Chen, Kevin Moore, Karen Salzman, eds. AMIRSYS, 2004
• Pediatric Neuroimaging.   A. James Barkovich. 4th ed. Philadelphia:  Lippincott-Raven Publishers, 2005.

Goals and Objectives

The resident will become thoroughly familiar with all aspects of neuroradiology including myelography/CT, angiography/CT and MRI’s and neurointerventioanl procedures.  The resident will become familiar with all aspects of administering and monitoring sedation of the conscious patient.

Competencies

Medical Knowledge – The resident will be competent in:

• The techniques and interpretation of myelography and lumbar puncture.
• The techniques and interpretation of angiography, including neurointerventional procedures, of the intracranial and extracranial vessels.
• The techniques and interpretation of MRI of the brain (including MR angiography), head and neck (including neck, orbit, and temporal bone), and spine. 
• Understanding the techniques and indications for MR spectroscopy, perfusion imaging, and PET.
• Learning all aspects of administering and monitoring sedation of the conscious patient
• In the protocols and interpretation of CT, angiography and MRI of the brain (including CT angiography, CT myelography and MR angiography), head and neck (including neck, orbit, and temporal bone), and spine.

Patient Care and Assessment – The resident will be able to:

• Participate in the pre- and post-procedural care of patients undergoing CT myelography and CT angiography procedures, including obtaining informed consent and rounding on patients.
• Continue rounding on any patient who has sustained a complication, following a procedure, until resolution.
• Interpretate the CT scans and assessment of patient.

Practice Based Learning – The resident will be able to:

• Gradually function independently in the interpretation of radiological scans (CT, MRI, angio) but will be supervised during daily interpretation sessions with faculty.
• Contribute cases to the departmental teaching file (one per week), with images and a description of imaging findings and teaching points, with references. 
• Collect missed cases for monthly quality assurance conference.
• Maintain a procedure log, including complications and their outcomes

Systems Based Practice – The resident will be able to:

• Maintain a procedure log, including the tracking of complications and their outcomes.
• Learn the appropriate indications for CT (with and without contrast) as well as myelography and the proper progression of imaging studies in the evaluation of trauma, headache, back pain, and suspected increased intracranial pressure
• Learn the appropriate indications for angiography of the intracranial and extracranial circulation.  The resident will also learn the proper progression of imaging studies in the evaluation of atherosclerotic vascular disease, vascular trauma, and intracranial hemorrhage.
• Review the appropriate indications for MRI of the brain (including MR angiography), head and neck (including neck, orbit, and temporal bone), and spine.  The resident will also review the proper progression of imaging studies in the evaluation of stroke, vascular trauma, cord compression, back pain, neoplasm, and intracranial hemorrhage.    The resident  will also learn the proper progression of specialized imaging studies such as MR spectroscopy, perfusion imaging, and PET.

Interpersonal and Communication Skills – The resident will be able to:

• Preview all cases before reviewing with staff, in order to form an independent interpretation opinion and develop communication skills with staff.
• Communicate urgent and unexpected findings on radiology studies to the referring physician in a timely manner.
• Be especially conscious of his interactions with patients and members of their family.
• Relate information clearly and concisely; demonstrate good listening skills; show appropriate compassion.

Professionalism - The resident will become competent in:

• Maintaining professionalism by adhering to neuroradiology’s requirements/policies:

        - Remaining in the clinical area of assignment throughout the day; any “down time” should be used for reading

        - If you are scrubbed into a procedure as noon conference approaches, you will ask the attending if you may be excused for conference. 

        - You are expected to return to the service by 1:30 PM if there is a noon conference; if not, return by 1 PM. 

        - You will remain on service until the end of the work day, which is typically 6 PM, but is determined each day by your attending. (In other words, do not leave the service until your attending gives you permission to do so).

        -You will dress in a manner appropriate for the duties you are expected to carry out on a particular day. Scrubs are reserved for rotations requiring procedures.  Lab coats must be worn over scrubs.

• Conducting verbal and written communications with the radiology faculty, clinicians, hospital staff, patients and their families in a professional manner, adhering to the ethics of the profession and hospital policy.
• Professionalism encompasses the following characteristics: altruism; respect for others; honor; integrity; ethical behavior; accountability; excellence; duty-advocacy; social responsibility; and cultural competence.  In order to facilitate the formation of professionalism, several methods will be employed by the program, including 360E evaluations, performance feedback, and group discussions.

Evaluation

At the end of this rotation, each member of the faculty will complete an evaluation form based on the goals and objectives outlined above.  The resident will have the opportunity to review and sign this form at the next meeting with your advisor or the program director.  At any time during the rotation, the resident  may request verbal feedback from the faculty.  The resident may also review their evaluations in the coordinator’s office during regular business hours.  Finally, if they would like to discuss a specific evaluation with a faculty member, this will be promptly facilitated by the program director.

Additional Resources:            

Journals:         Radiology

                                                    American Journal of Roentgenology

                                                    RadioGraphics

                                                    American Journal of Neuroradiology

The American College of Radiology Teaching File

The American College of Radiology Syllabi on Neuroradiology

The American College of Radiology CD-ROM discs on Neuroradiology

Web-based

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