Program Organization

Musculoskeletal Radiology Fellowship Rotations and Program Organization 

The fellow is exposed to imaging and procedures as they apply to the musculoskeletal system with expected graduated proficiency to the level of a subspecialist.  The rotations and curriculum have been instituted to include clinical, technical-hands on experience, didactic teaching, as well as scholarly activity/research. The six competencies set forth by the ACGME are addressed and incorporated into the rotational goals and objectives. 

The rotations include: 

  1. Plain radiography 
  2. Cross sectional imaging-MRI/CT 
  3. Procedures/interventional. This includes imaging guided joint aspirations, therapeutic injections, arthrography, MR/CT  arthrography, image guided biopsies, aspiration/drainage, kyphoplasty (utilizing either x-ray, fluoroscopy, CT, MRI, or Sonography). Some exposure to radiofrequency ablation techniques, as cases arise, is anticipated. 
  4. Dedicated Musculoskeletal Ultrasound  
  5. Nuclear radiology (as it applies to the MSK system), DEXA 
  6. Pathology - bone and soft tissue pathology 
  7. MRI physics/applications - (includes physical  principles, hardware, applications, newer pulse sequences,     on- site   teaching with  hands on MR scanning experience) 
  8. Scholarly activity/research, including a Quality Improvement Project 

Active participation is expected in the following areas

  1. Teaching of Fellow/ Fellow as teacher Journal Club 
  2. Sarcoma Tumor Board/Orthopedic Tumor Board  
  3. Quality Improvement  
  4. Clinical Practice in the setting of Outpatient Imaging Centers 
  5. Research and scholarly activity 

Rotations are scheduled in half day and /or full day blocks.  Some rotations and cases are concurrent to assure adequate exposure and involvement in interesting or more infrequent cases. This method also more realistically simulates what is expected of a practicing radiologist after training. Most of the light Musculoskeletal interventional procedures (e.g. arthrogram, joint steroid injection, joint aspiration) are performed on an outpatient basis with the supervision of a Musculoskeletal Radiology Attending. Procedures that require more intensive periprocedural clinical care (such as kyphoplasty, CT guided bone biopsy, radiofrequency ablation of osteoid osteoma, to name but a few) and all procedures under sedation will be performed in the Interventional Radiology (IR) Department with dedicated IR nursing and technical staff, with supervision of an IR Attending. 

Cases include: 

  1. Emergency Department(ED) 
  2. Inpatient studies (Stony Brook University Hospital, Southampton Hospital) 
  3. Outpatient studies. Outpatient imaging studies are performed at both the University Hospital and Out-Patient Imaging Centers at the  Ambulatory Care Pavilion (ACP) and the Stony Brook Advanced Imaging Centers at Stony Brook Rd and Commack 
  4. Adult and pediatric cases 

The program has been structured and organized based on the ACGME Program requirements, specific objectives and the interpretation of the ACGME general competencies.                                  

Overall goals of the program are to facilitate fellow learning with demonstration of proficiency in Musculoskeletal (MSK) Radiology and to adopt life long learning and self assessment skills.  To this end the fellow will: 

  1. Demonstrate mastery of the knowledge based curriculum; 
  2. Demonstrate proficiency in the protocol of cases and interpretation of cross sectional imaging studies of MSK system; 
  3. Demonstrate proficiency in the timely dictation of a concise accurate radiological report; 
  4. Demonstrate proficiency in performing procedures including aspirations, joint/therapeutic injections, arthrography, bone and soft tissue biopsies; 
  5. Communicate effectively with patients, families, peers, residents, and faculty, technical, nursing, and ancillary staff. Provide consultation with referring physicians and services; 
  6. Apply knowledge learned to support and justify the appropriate clinical indications for ordering and  performing radiologic studies pertaining to both basic and advanced musculoskeletal imaging; 
  7. Demonstrate proficiency in performing and interpreting MSK ultrasound examinations; 
  8. Demonstrate a responsible professional work ethic; 
  9. Demonstrate proficiency in the interpretations of plain radiographs; 
  10. Formulate and master teaching skills and facilitate the teaching of medical students, radiology residents, rheumatology and orthopedic residents, as well as other professional; 
  11. Demonstrate active participation in the Quality Improvement (QI) and monitoring process; 
  12. Demonstrate confidence in the interpretation of Emergency Department (ED) emergent studies;  
  13. Perform critical analysis of journal articles as well as the process of research for discussion and for Journal Club. Includes effective electronic literature review to justify, validate, and critically appraise; 
  14. Demonstrate mastery of the six competencies with knowledge of objective assessment methods as they apply to the program and its goals and objectives; 
  15. Active participation and experience in MSK research including the IRB process, human subjects training.  Preparation of an abstract, manuscript, or case report for presentation at Grand Rounds, or submission at a national meeting, peer reviewed journal, interdepartmental, or at the Department’s Annual Research Day; 
  16. Demonstrate proficiency in conference/lecture organization, PowerPoint preparation, and presentation; 
  17. Incorporate the goals and objectives into critical self assessment and lifelong pursuit of knowledge; 
  18. Develop tools and learning approaches to facilitate the continuous acquisition and use of knowledge. 

Program Organization: 

  1. Initial needs assessment based on fellow’s baseline knowledge and experience 
  2. Rotational schedules 
  3. Program goals 
  4. Program objectives-based on rotational components 
  5. Knowledge (cognitive) based curriculum 
  6. Clinical, technical, and didactic elements. 
  7. General requirements and responsibilities of fellow 
  8. Instructional and teaching responsibilities of fellow (Fellow as teacher) 
  9. Fellow Learning Portfolio and Case –Procedural Logs 
  10. On-call requirements 
  11. Faculty and 360 degree evaluations in addition to more task specific evaluations. 
  12. Fellow evaluation of Program and faculty. 
  13. Fellow self assessment 
  14. Program Director-Fellow meetings 
  15. Summative/Final Evaluation