Learning Objectives

Its graduates will be prepared to provide timely and accurate interpretation of clinical imaging studies.
They will know the risks, benefits, and costs of each imaging modality, enabling them to choose the appropriate study and the appropriate protocol for each patient.
They will be able perform an array of procedures safely and effectively, including cerebral angiography, myelography, head and neck biopsy, vertebral biopsy, spine augmentation, and other percutaneous spine interventions.
They will learn to recognize and treat complications of these invasive procedures.
The fellows also will be expected to have gained substantial experience in neuroradiology research.

The training will give them more than sufficient background to obtain ABR certification in neuroradiology and provide excellent patient care.

Patient care

Fellows must be able to provide patient-centered care that is compassionate, appropriate, and effective.

The fellow will demonstrate the following abilities.

Meticulously obtains the clinical information needed for interpretation of imaging studies and performance of procedures.
Evaluates requested neuroimaging studies to determine if there is an appropriate indication for the study requested. If necessary, is able to suggest alternatives to the referring physician
Correctly modifies imaging protocols based on identification of unexpected or novel findings.
Reliably recognizes abnormalities on neuroimaging studies. Imaging modalities are to include magnetic resonance imaging, computed tomography, radiography, positron emission tomography, and Doppler ultrasound
Reliably recognizes imaging artifacts and normal structures.
Provides focused and appropriate differential diagnoses for abnormal imaging findings
Provides provisional interpretations and consultations of any and all radiographs, CT scans, and MRI.
Formulates appropriate management recommendations
Promptly communicates urgent and important imaging findings to referring physicians. Records such communication in the medical record.
Demonstrates a knowledge of radiation risks for patients and health care providers and integrates this knowledge into clinical practice
Demonstrates a knowledge of contrast and other pharmaceutical risks for patients and integrates this knowledge into clinical practice
Provides to patients an appropriate, procedure-specific, discussion of patient experience and procedure risks prior to all invasive studies and interventional procedures. Competently and compassionately answers questions prior to obtaining informed consent.
Performs interventional procedures competently for level of training. These procedures include diagnostic cerebral angiography, myelography, sialography, head and neck biopsy, spine biopsy, nerve root block, facet injection, epidural injection, discography. By the completion of the training program they will be sufficiently competent to perform these procedures independently.
Routinely obtains follow-up on patients who have undergone interventional procedures
Skillfully uses hospital and personal information technology in patient care

Medical knowledge

Fellows will demonstrate progressive acquisition of key knowledge in both established and evolving aspects of neuroimaging and the broader neurosciences.

The fellow will demonstrate the following abilities and knowledge.

Thorough knowledge of neuroanatomy and physiology. This is to include detailed anatomy of the brain, meninges, vascular structures, calvarium, skullbase, orbit, neck, and spine.
Ability to accurately describe the location of normal and abnormal findings in the central nervous system, head and neck, and spine
Level-appropriate knowledge of CNS pathophysiology
Thorough knowledge of classic imaging findings for all diseases of the central nervous system, head and neck, and spine
Level-appropriate knowledge of atypical imaging findings of the central nervous system, head and neck, and spine
Thorough knowledge of imaging anatomy, physiology, and pathophysiology at all stages of human development.
Ability to generate an accurate and succinct case specific differential diagnosis given clinical history and imaging findings
Ability to protocol complex MRI examinations of the central nervous system, head and neck, and spine, including the use of fat suppression, saturation bands, magnetization transfer
Thorough knowledge of MR physics. This is to include MR sequence design, determinants of signal intensity, and MR artifacts
Thorough understanding of and ability to perform all aspects of advanced neuroimaging studies. These are to include functional magnetic resonance imaging, diffusion tensor imaging and tractography, magnetic resonance spectroscopy, and MR perfusion imaging
Thorough knowledge of CT physics.
Ability to protocol and monitor advanced CT applications, including CT angiography, CT perfusion, and 3D CT reconstruction
Thorough knowledge of important clinical issues relevant to imaging of the central nervous system, head and neck, and spine
Ability to use imaging findings to differentiate different types of focal intracranial lesions (neoplastic, inflammatory, vascular) based on anatomic location, contour, intensity and enhancement pattern. Identify and differentiate diffuse intracranial abnormalities. Recognize treatment-related findings (e.g. post surgical and postradiation).
Ability to provide focused and accurate differential diagnoses for lesions in the orbit, skull base, petrous bone and soft tissues of the neck. Understand and be able to identify patterns of disease spread within and between areas of the head and neck (e.g. perineural and nodal spread). Recognize treatment related findings (post-surgical and post radiation).
Ability to provide focused and accurate differential diagnoses for all pathology and post-treatment changes of the spine.
Ability to recognize the appearance of acquired and congenital lesions of the newborn, infant, child and adolescent.
Thorough understanding of and ability to interpret positron emission tomography studies of the brain, spine, and head and neck.
Ability to create and interpret multiplanar and surface reconstructions of the vascular structures of the central nervous system, head and neck, and spine.
Ability to perform full postprocessing of advanced imaging studies, including DTI, DWI, perfusion imaging, fMRI.
Ability to perform diagnostic cerebral angiograms of the cervical, cranial, and spinal vessels. These skills to include patient workup, moderate sedation, vascular access, advanced catheter manipulation, use of continuous flush systems, operation of biplane angiographic unit, vessel specific dose protocols, arterial closure, and post-procedure care
Ability to provide focused and accurate differential diagnoses for all angiographic findings.
Knowledge of the indications, risks and benefits for neurointerventional procedures including thrombolysis, embolization, angioplasty and stenting.
Ability to perform image-guided biopsies of structures of the spine and head and neck.

Practice-based learning and improvement

Fellows will demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.

The fellow will demonstrate the following abilities:

Seeks out and integrates new knowledge relevant to clinical practice and disease pathophysiology through reading and conferences
Assists in maintaining the Neuroradiology Division teaching case database and obtains follow-up on select patients who have undergone imaging studies
Maintains willingness to learn from errors
Maintains a computerized database of the invasive procedures performed as a fellow, including complications
Participates in department and neuroradiology division QA activities

Interpersonal and communications skills

Fellows will demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.

The fellow will demonstrate the following abilities:

Creates, clear, concise and meaningful reports in a timely fashion.
Works effectively with department faculty, residents, and support staff
Interacts in an effective and collegial manner with referring physicians, performing at the level of a practicing neuroradiologist
Provides advice for referring physicians asking questions about CT and MR examinations of the central nervous system, head and neck, and spine
Interacts compassionately and appropriately with patients

Professionalism

Fellows will demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

The fellow will demonstrate the following behaviors:

Acts with honesty, integrity, compassion, and sensitivity
Interacts with others in a respectful manner (to include appropriate dress, verbal, and non-verbal behavior)
Signs reports within 24 hours
Arrives punctually for scheduled duties and organizes division activities
Attends and participates in all required conferences on a regular basis
Follows ethical practices pertinent to the practice of neuroradiology, including patient confidentiality, informed consent and proper documentation.
Approaches work with a positive attitude, treating each patient’s study or procedure as if it were the study of a valued friend
Serves as a role model for medical students, junior radiology residents, and residents in other specialties.
Identifies those cases that require additional expertise in assessment of imaging studies.

Systems-based practice

Fellows will demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

The fellow will demonstrate the following practices:

Incorporates knowledge of relative costs and effectiveness for imaging tests and image-guided procedures into clinical practice
Incorporates of knowledge of ethical coding and billing practices
Advocates for and assistance to patients navigating the complex medical system
Coordinates care with referring physicians
Demonstrates commitment to safety initiatives within the department, hospital, and larger health care system
Critically evaluates published clinical imaging literature