Neuroradiology Fellowship Rotations and Program Organization 

The fellow is exposed to imaging and procedures as they apply to the neurovascular system with expected graduated proficiency to the level of a subspecialist in neuroradiology.  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 of the spine
2. Cross sectional imaging-MRI/CT 
3. Advanced Imaging - CTA, CT Perfusion with and without Acetazolamide challenge, MR Neurography, MRI tractography, and MR Spectroscopy 
4. Nuclear radiology (as it applies to the Neurovascular system) 
5. Pathology - soft tissue pathology of the brain, head and neck, and spine. 
6. MRI physics/applications - (includes physical  principles, hardware, applications, newer pulse sequences,  on- site teaching with  hands on MR scanning experience) 
7. 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. Neurosurgical Tumor Board/ENT Tumor Board/Neurology Conference  
3. Quality Improvement  
4. Clinical Practice in the setting of Outpatient Imaging Centers 
5. Research and scholarly activity 

Rotations are scheduled in full day blocks. Some rotations and cases are concurrent to assure adequate exposure and involvement in interesting or more infrequent types of cases. This method also more realistically simulates what is expected of a practicing neuroradiologist after training. Most of the light neurointerventional procedures (e.g. lumbar puncture, myelogram, intrathecal chemo injection) are performed on an inpatient or outpatient basis with the supervision of a Neuroradiology Attending. Procedures that require more intensive periprocedural clinical care (such as kyphoplasty, CT guided bone biopsy) 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 or NeuroIR Attending.

Cases include: 

1. Emergency Department(ED) 
2. Inpatient studies (Stony Brook University Hospital, Southampton Hospital, Easter Long Island Hospital) 
3. Outpatient studies. Outpatient imaging studies are performed at the University Hospital and Out-Patient Imaging Centers at the  Ambulatory Care Pavilion (ACP) 
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 Neuroradiology 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 Neurovascular system; 
3. Demonstrate proficiency in the timely dictation of a concise accurate radiological report; 
4. Demonstrate proficiency in performing procedures including lumbar punctures, myelograms, intrathecal chemo, and kyphoplasty; 
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 neurovascular imaging; 
7. Demonstrate a responsible professional work ethic; 
8. Demonstrate proficiency in the interpretations of plain radiographs; 
9. Formulate and master teaching skills and facilitate the teaching of medical students, radiology residents, neurology and ENT residents, as well as other professionals; 
10. Demonstrate active participation in the Quality Improvement (QI) and monitoring process; 
11. Demonstrate confidence in the interpretation of Emergency Department (ED) emergent studies;  
12. 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; 
13. Demonstrate mastery of the six competencies with knowledge of objective assessment methods as they apply to the program and its goals and objectives; 
14. Active participation and experience in Neuroradiology 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; 
15. Demonstrate proficiency in conference/lecture organization, PowerPoint preparation, and presentation; 
16. Incorporate the goals and objectives into critical self assessment and lifelong pursuit of knowledge; 
17. 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