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NEURORADIOLOGY PROGRAM FOR MGH RADIOLOGY RESIDENTS
Resident Responsibilities
- Hours of Work
The resident should report to the Neuroradiology interpretation area at 8:15 a.m. immediately following the morning conference.
The resident should stay until all daily work is complete, approximately 5:30 p.m.
The resident will be excused for all conferences as outlined.
- Reports
The resident should learn to dictate clear concise reports.
The resident should review, correct, and sign reports promptly. All reports should be signed by the staff within 24 hours.
- Expectations
Learn basic neuroanatomy.
Learn how to distinguish mass effect and brain herniation associated with acute processes from volume loss associated with more chronic processes.
Learn CT pattern of pathologies associated with head trauma: especially subdural hematoma; epidural hematoma; subarachnoid hemorrhage; diffuse axonal injury; parenchymal contusions, hemorrhagic parenchymal contusions; nonhemorrhagic contusions; calvarial, facial and spinal fractures; cerebral edema.
Learn CT patterns of arterial and venous infarction with an understanding of major vascular territories; learn to determine age, i.e., acute versus chronic.
Learn how to identify a mass on head CT, and determine its location including whether it is intra-axial or extra-axial. Locations to be learned include pineal region; sellar; suprasellar; parasellar; cerebello- pontine angle, lobar, cerebellar, callosal; skull base; intraventricular. Begin to learn differential diagnoses.
Learn the CT appearance of major vascular lesions-arteriovenous malformations (AVM's), aneurysms, cavernous malformations, venous anomalies.
Learn the CT appearance of cerebritis, abscess, meningitis, empyema.
Learn the CT appearance of multiple sclerosis, acute disseminated encephalomyelitis (ADEM).
Learn the CT appearance of different types of non-traumatic hemorrhage and the differential diagnoses.
Learn the CT appearance of the normal pediatric brain.
Learn the CT appearance of basic congenital anomalies: Dandy-Walker, Chiari, agenesis of the corpus callosum, schizencephaly and migration abnormalities.
Learn the CT appearance of degenerative disease including disc herniation, spinal stenosis and neural foramen encroachment on CT.
Learn the CT appearance of spinal fractures.
Learn how to dictate a concise and complete head CT report.
- Expectations
The resident and fellow should briefly review what he/she has previously learned about head CT interpretation, and make sure that he/she has learned the information outlined in the expectations listed for the first year rotation.
Learn how to recognize images that are T1-weighted, FLAIR-weighted, susceptibility-weighted, fat saturated, diffusion-weighted, gadolinium-enhanced.
Learn when and why to obtain images with these characteristics and learn how to read them.
Learn how to read MRA’s of the head and neck, and the basics of time-of-flight MR angiography.
Learn when to image a patient with MR versus CT.
Learn the MR appearance of arterial and venous infarctions in different stages with an understanding of the major vascular territories.
Learn when to use and how to read diffusion-weighted images and MR angiograms of the neck and brain.
Learn the MR appearance of intra-axial and extra-axial masses.
Learn differential diagnoses based on location.
Learn the appearance of radiation necrosis.
Learn how PET and perfusion imaging are used to distinguish recurrent tumor from radiation necrosis.
Learn the MR appearance of major vascular lesions--aneurysms, AVM’s cavernous malformations, venous anomalies.
Learn the MR pattern of different stages of hemorrhage.
Learn which stages demonstrate susceptibility.
Learn the MR appearance of infectious processes--cerebritis, abscess, meningitis, empyema, encephalitis.
Learn how major organisms (bacteria, virus, fungus, parasite) infect the brain and their MR appearances.
Learn the MR appearance of congenital infections.
Learn the indications for MR in trauma patients. Understand susceptibility imaging.
Learn the MR appearance of the normal infant and pediatric brains.
Learn how the brain myelinates and the pattern on MR.
Learn the appearance of major developmental anomalies of the brain and spine.
Learn the MR appearance of major neurodegenerative diseases.
Learn the MR appearance of major white matter diseases.
Learn the MR appearance of phakomatoses.
Learn the major spinal intramedullary; intradural; extramedullary, and extradural lesions, and their MR appearances.
Learn how to evaluate cord compression and the major pathologies causing it.
- Expectations
The resident is responsible for the duties and assignments as outlined above in the second year rotation.
The resident should hone in on reviewing and learning all of the major diseases of, and differential diagnoses involving, the brain and spine, and the CT and MR appearances of them.
The resident should review all of the basics of MR and learn the uses of newer MR software such as FLAIR, Spectroscopy, and including diffusion-weighted imaging and perfusion-weighted imaging.
The resident should learn how to perform and interpret CT angiograms of the carotid and vertebral arteries.
The resident should attend and participate in the conferences.
Neuroradiology resident conferences
Daily resident conferences from 12:15 to 1:15 p.m.
The Neuroradiology Minicourse in February
Neuroradiology fellow and resident conferences:
Monday............4:15 to 5:15 p.m.
Tuesday...........4:15 to 5:15 p.m.
Wednesday.......4:15 to 5:15 p.m.
Thursday..........4:15 to 5:15 p.m.
Bibliography
Grossman, R.I. and Yousem, D.M. Neuroradiology, The Requisites, 2d ed. Mosby, Philadelphia, 2004.
Atlas, S. W. Magnetic Resonance Imaging of the Brain and Spine, 3d ed. Lippincott-Williams & Wilkins, Philadelphia, 2002.
Som, P.M. and Curtin, H.D. Head and Neck Imaging. 4th ed. Mosby, St. Louis, 2003.
Barkovich, AJ. Pediatric Neuroimaging, 4th. ed. Lippincott, Williams & Wilkins, Philadelphia 2005.
Yock, D.H. Magnetic Resonance Imaging of CNS Disease: A Teaching File, 2d ed., Mosby, St. Louis, 2002.
Morris, P. Practical Neuroangiography, Lippincott, Williams & Wilkins, Baltimore, 1997.
The ACR CD ROM’s for the brain and spine, and for the head and neck are excellent.
Head and Neck Imaging Rotation
Massachusetts Eye and Ear Infirmary
The rotation on head and neck imaging at MEEI is for one month. The resident experience is primarily directed toward CT and MR evaluation of various ophthalmologic, otologic, and head and neck problems.
Barium studies are done for evaluation of swallowing and for various lesions of the upper aerodigestive tract. Plain films and special procedures related to the same patient population are also done at the Infirmary.
The resident is expected to attend readout sessions for both MR and CT and to participate in fluoroscopic examinations as well as various special procedures such as sialography, dacrocystography and head and neck biopsies. The residents provide coverage for the scanners in the event of various untoward reactions. Ongoing examinations are monitored.
The resident is expected to develop knowledge of the anatomy and pathology of the head and neck. Within the one-month rotation, the resident is expected to concentrate on learning the intricate anatomy of the temporal bone, orbit, skull base, sinuses, oral cavity, larynx, neck and temporomandibular joint. The resident should also become familiar with the most important clinical evaluations.
Bibliography
Som, P.M., Curtin, H. D., editors. Head and Neck Imaging. 4th ed. St. Louis, Mosby Year Book, Inc. 2003.
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Neuroradiology Fellowship Program
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