Curriculum - Educational Goals and Objectives 

The Neuroradiology fellowship program has integrated our goals and objectives within the six competencies established by the ACGME: 

1. Patient Care 
2.  Medical Knowledge 
3. Practice-Based Learning & Improvements 
4. Interpersonal & Communication Skills 
5. Professionalism 
6. System-Based Practice   

Responsibilities: 

1. Protocoling, monitoring and interpreting CT and MR imaging studies under faculty supervision. 
2. Protocoling and performing patient procedures, including lumbar puncture, myelography, intrathecal chemo, kyphoplasty, and CT guided biopsies under faculty supervision. 
3. Preparing interdisciplinary conferences. 
4. Consulting with referring physicians from neurosurgery, ENT, and neurology. 
5. Effectively communicating study results by timely signing of reports and appropriate direct communication.  

Core Competencies

At the completion of the fellowship, fellow should:

• Understand the nature of the physician-patient relationship and demonstrate a caring and empathic attitude toward all patients.
• Be able to provide expert consultation services to clinicians, students and other radiologists.
• Know the indications, limitations and risks of all neuroradiologic studies.
• Be able to provide accurate interpretation of all neuroradiology imaging studies.
• Be able to perform and interpret all diagnostic neuroangiography and myelography procedures.
• Have a general understanding of basic neurointerventional procedures.

Competency Based Goals and Objectives

COMPETENCY 1. Patient Care. Provide patient centered care that is compassionate and effective for the treatment of health problems and the promotion of health.

     1. Interpret radiographic studies in common and emergency conditions.
     2. Request the radiographic study needed to clarify a clinical problem.
     3. Manage patients effectively using radiographic information.
     4. Interpret common findings on radiographs, CT and MRI accurately. For example, identify the following features on commonly obtained radiographs:

• Lateral neck radiographs: adenoidal and tonsillar hypertrophy, epiglottic and glottic edema, foreign body, retropharyngeal abscess, subglottic narrowing--congenital and acquired, cervical spine abnormalities
• Sinus radiographs: mucosal thickening, masses, air-fluid levels, bone destruction
• Spine radiographs: vertebral dislocation and fracture, vertebral destruction, collapsed vertebra, disc space disease, segmentation anomalies, scoliosis

     5. Use appropriate imaging modalities to diagnose and manage patients.
     6. Conduct timely and appropriate follow-up

COMPETENCY 2. Medical Knowledge. Understand the scope of established and evolving biomedical, clinical, epidemiological and social-behavioral knowledge needed by a neuroradiologist. Demonstrate the ability to acquire, critically interpret and apply this knowledge in patient care.

1. Develop a basic level of proficiency in identifying common abnormalities in these radiographic studies that physicians order in emergent or urgent situations:
2. Recognize the most suitable imaging study for evaluation of various disease conditions 
3. Demonstrate knowledge of reading CT, MRI, and advanced MRI techniques:

Specific Goals:  
     1. Demonstrate proficient knowledge of neuroanatomy 
     2. Demonstrate proficient knowledge of the vascular and venous system
     3. Understand the function of specific structures of the brain
     4. Understand vascular phenomena (blood-brain barrier, local perfusion)
     5. Understand neuropathology:
          a. Neoplasms including primary and secondary tumors; intra-axial versus extra-axial mass.
          b. Vascular disease including stroke, hemorrhage, vascular malformations, and aneurysms.
          c. Infection including Extra-axial empyema, intra-axial abscess, meningitis, encephalitis, ventriculitis.
          d. Metabolic and degenerative disease
     6. Understand advanced imaging techniques (functional MRI, spectroscopy, diffusion/perfusion, diffusion tensor)
     7. Understand contrast utilization including dose and safety.
     8. Understand MRI safety conditions.
     9. Develop skills in preparing and presenting cases for sectional and interdepartmental conferences.
     10. Understand advanced imaging techniques (including CT perfusion and CT angiography) as well as 3D post processing.
     11. Understand CT radiation including practice of “imaging gently” based on As Low As Reasonably Achievable (ALARA) 

Objectives:  At the end of these rotations, the fellow will:

1. Identify normal and abnormal brain, spine, vascular and venous anatomy.
2. Identify standard pulsing sequences by sight or by MR parameters.
3. Explain the limitations of CT and recognize situations where MR and/or advanced neuroimaging is required.  
4. Identify the radiographic manifestations of common, unusual, and rare pathologies within Neurology and Neurosurgery.
5. Make diagnostic and consultative decisions with a consistently high degree of accuracy and significantly interact with clinical referring physicians.
6. Protocol studies using low dose radiation techniques.
7. Participate in all scheduled conferences.

COMPETENCY 3. Communication Skills. Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.
     1. Communicate key patient information related to the radiographic study to the physician.
     2. Counsel patients regarding the basic indications for and risks associated with specialized imaging such as the following:

• Computed tomography (CT)
• Contrast imaging: Myelography
• Nuclear medicine: Positron emission tomography (PET), Single photon emission computed tomography (SPECT)
• Magnetic resonance imaging (MRI)

     3. Use MRI for design of workup and diagnosis 
     4. Consult the interventional neuroradiologist for interventional procedures where appropriate, such as:

• Vascular intervention (know the indications for angioplasty, thrombolysis, embolic therapy)

COMPETENCY 4. Practice-based Learning and Improvement. Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one’s patient care practice.

1. Use scientific methods and evidence to investigate, evaluate and improve one’s own patient care practices and continually strive to integrate best evidence into one’s daily practice.
2. Seek and incorporate feedback and self-assessment into a plan for professional growth and practice improvement.
3. Demonstrate one’s willingness and capability to be a lifelong learner by pursuing answers to clinical questions, using literature, texts, information technology, patients, colleagues and formal teaching conferences.

COMPETENCY 5. Professionalism. Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.

1. Demonstrate commitment, responsibility, accountability for patient care.
2. Consistently use compassion and empathy in one’s role as a physician.
3. Place the needs of patients and society over your own self-interest.
4. Respect your patients/parents privacy, autonomy and need to maintain a positive self-concept, irrespective of age, gender, or health belief system, regardless of acuity of disease.

COMPETENCY 6. Systems-Based Practice. Understand how to practice quality health care and advocate for patients within the context of the health care system.

1. Know the costs associated with different radiologic imaging procedures and how to maximize the information obtained in the most cost effective manner.
2. Clarify how documentation and billing/charges differ for procedures especially the differences between physician fees and hospital charges.
3. Demonstrate sensitivity to the costs of clinical care in radiology and take steps to minimize costs without compromising quality.
4. Know how the need for sedation potentially changes the system and causes problems for the radiology department.
5. The fellow will progress from the first rotation to last to develop the necessary skills to achieve subspecialty-level training in the interpretation of imaging of the brain and spine in pediatrics and adults.