Frequently Asked Questions
Q1. How many MSK MRIs the fellow will be able to dictate in average day and what are the percentage of oncology cases approximately?
A1. It depends on each day because you some have days with procedures and other days without any procedure. If you have no procedure at all and spending all day dictating studies, if you are a fast reader you can expect to dictate 20 to 30 MRI’s on a very busy day. In reality, you will also be reading other modalities including CT and Ultrasounds, so typically you will be reading a combination of those. Our Fellowship structure is such that you read all modalities every day, just like being an attending, but primarily focusing on MRI.
Percentage of oncology cases will also depend on each day. However we do have a large number of orthopedic oncology cases, thanks to referral and close connection with Orthopedic oncologist Dr. Fazel Khan. Typically, if you read 20 MRI’s, then I would say 10 to 20 % of those (again variable on each day) can be oncologic imaging.
Q2. How frequent are the tumor boards?
A2. Twice a month, every other Thursday morning at 7:00am, we have soft tissue sarcoma board with Orthopedic oncologist Dr. Fazel Khan, other oncology/general surgeons, as well as radiation oncologists and pathologists. The conference is about 1 hour in length, discusses about 5 to 10 cases (variable), and MSK Fellow will be presenting radiological aspects of each case. Often, these are the cases MSK Fellow actually biopsied with IR attending already, or cases to be biopsied in the near future.
Also, there is a monthly (every 4th Wednesday) orthopedic grand round which is actually orthopedic tumor board attended by Orthopedic attendings, residents and fellows, MSK Radiology attendings and fellow, and a pathology attending and fellow. Typically 3 cases are discussed per conference. Orthopedic residents present clinical aspects, MSK fellow presents radiology aspects, and pathology resident presents histopathological slides. This conference lasts about an hour as well.
Q3. How many procedures in average day the fellow will be able to perform and how the schedule look like? Meaning there is only one fellow and there are procedures and MRI list?
A3. Given there is only one MSK fellow, initially time priority is given to MSK procedures, particularly those with IR attendings such as CT guided bone biopsy, bone marrow biopsy, US guided soft tissue tumor biopsy, fluoro guided kyphoplasty, etc. You might typically do one or two heavy IR procedure like those mentioned above per day. For example, kyphoplasty takes at least 2 hours from start to finish, and it will take more if one includes pre-procedure preparation and post-procedure care. On the other hand, more light MSK procedures (with MSK attendings) like arthrogram injection, joint aspiration, or joint steroid injection, you might be doing up to 5 to 6 of those per day.
When those procedures are done, then MSK fellow will return to the reading room and dictate studies, mainly MRI, but also other modalities. Although MSK Fellow is expected to dictate as many MRI’s as possible, in reality it is not practically possible to dictate every single MRI’s because of procedures and we do have Radiology residents rotating to MSK so they will also be dictating studies. Together, we generally manage to dictate everything in a timely manner.
Q4. Are moonlighting opportunities available/ allowed during the fellowship!?
A4. ACGME accredited fellowship means our MSK fellow cannot officially do moonlighting in our institution. This can be a good thing because our fellow will not be forced to perform undesirable attending-level duties like ER coverage in the evening or on weekends. Some non-ACGME programs will require MSK fellows to do such coverage. However, if you actually want to do such internal moonlighting, then you should look for non-ACGME accredited fellowship program. All applicants are encouraged to talk to our current MSK fellow about this during the time of virtual interview.
Q5. Are there any elective time or optional training available?
A5. One half day per week is allocated as an optional/elective time for MSK Fellow to suite their specific clinical and research interest with the approval of MSK fellowship program director. For example, the past fellows have done following activities using this half-day session. Prospective fellows are welcome to discuss potential options with the program director at the time of interview as well as after fellowship has begun.
Pain management procedures with anesthesiology department
Didactic teaching of advanced MRI protocol applications and scanning with MRI physicist
Radiological research leading to publication and conference presentation
Focused clinical training such as dedicated MSK ultrasound scanning
Focused MSK interventional procedure training with IR attending (e.g. kyphoplasty)