Rotations - Diagnostic Radiology Residency

208 Weeks Total

Short Call ~ 10 weeks
Night Float ~ 12 weeks
Ultrasound 8 weeks
Nuclear Medicine 16 weeks
Mammography 12 weeks
Interventional 12 weeks
Neuro CT 12 weeks
Neuro MR 12 weeks
Body CT 12 weeks
Plain Film 8 weeks
Abdominal (Fluoro/Body MR) 12 weeks
MSK 12 weeks
Cardiovascular 8 weeks
Children’s 13 weeks
Brigham & Womens’ OB 4 weeks
AFIP 4 weeks
Research 4 weeks
Senior Electives 10 months

20 residents  

Rotation Descriptions:

Abdomen

Currently, abdominal imaging rotations include both fluoroscopic and MR imaging of the abdomen and pelvis. The day will be split, with morning fluoroscopic examinations, and afternoon MRI interpretation. Morning fluoroscopic examination are primarily composed of basic GI examinations, including barium swallows, UGI, SBS and BE/ACBE. Additional, more complex examinations maybe performed depending on requests, including defograms, T-tube and other tube injections. The morning studies begin @8:00 AM, and the resident will be expected to attend all noon conferences. The afternoon will begin immediately after noon conference has ended, and finishes at the discretion of the staff radiologist, generally @ 5 pm.

Earlier rotations concentrate on basic procedures, anatomy, and equipment use. During the initial fluoro rotation, residents concentrate on appropriate positioning to document the presence or absence of an abnormality, and develop ability to detect basic abnormalities on subsequent image review. 2nd and early 3rd year rotations concentrate on further progression in depth of knowledge, while improving proficiency in performing complex procedures. During subsequent rotations, residents are expected to rapidly evaluate and document the presence/absence of an abnormality during fluoroscopy and image acquisition, and be able to perform the entire gamut of fluoroscopic examinations, independently (with subsequent staff read-out). The resident is given digital learning material including self-guided digital presentations illustrating all of the fluoroscopic abnormalities of the GI tract.

During the MRI afternoons, the residents are expected to be involved in interpretation of all abdominal and pelvic examinations. Earlier rotations concentrate on upper abdominal anatomy and use of basic pulse sequences, later rotations concentrating on pelvic examinations and complex studies (renal MRA, prostate imaging, etc). Lahey has one of the largest regional liver transplant centers in the Northeast, and one of the largest live-donor liver transplant centers in the United States. As a result, the residents will become extremely comfortable evaluating the cirrhotic and non-cirrhotic liver on MRI.

Breast Imaging

Currently, Breast Imaging rotations encompass a wide variety of breast imaging examinations including screening and diagnostic mammography, breast ultrasound and advanced breast imaging studies. The advanced studies include breast MRI, breast scintigraphy and PET CT imaging. Breast interventional procedures with stereotactic, mammographic, ultrasound and breast MRI guidance are also performed routinely. The day begins at 8:00 a.m. and finishes at the discretion of the staff radiologist, generally by 5 pm. Residents are required to attend departmental noon conferences. During the breast imaging rotation the residents are required to attend weekly interdisciplinary Breast Tumor conferences (Friday morning 7am). The resident is expected to make a journal article presentation during the rotation at the Breast Tumor conference. Residents are also required to attend other morning interdisciplinary conferences.

Earlier rotations concentrate on mastering screening mammography. During the initial rotation, residents should concentrate on appropriate work up of the screening patient and detection of abnormal findings. The resident will learn to identify and document the presence or absence of an abnormality. The resident will develop reporting skills incorporating the standardized reporting techniques following ACR and department guidelines. 2nd and early 3rd year rotations will concentrate on further progression in depth of knowledge, while improving proficiency. By the end of the first rotation the resident will begin diagnostic work up of patients, including becoming familiar with diagnostic mammography, breast ultrasound and advanced breast imaging studies. First rotation residents will be introduced to breast interventional procedures beginning with needle localizations.

During the second rotation it is expected that the resident will establish competence and confidence in handling diagnostic mammography and breast ultrasound. It is expected that the resident will be able to scan an area of concern with ultrasound and effectively diagnose, document, and report findings in both benign and suspicious cases. Further the decision process for when to recommend advanced imaging studies.

Resident will progress during the second and third rotations in their ability to interact with patients, convey results and explain procedures while at the same time being able to answer patient questions and allay fears as appropriate. During the second and third rotations, residents should begin to detect with more rapidity the presence/absence of an abnormality during interpretation of screening and diagnostic exams.

The learning of breast interventional procedures will be a phased process depending on the depth of study by the radiology resident. Mastery of needle localization procedures and stereotactic breast biopsy work will be first. As the resident progresses during their rotations through mammography, they will gain supervised experience in all aspects of breast intervention including stereotactic, mammographic and ultrasound guided procedures. By the third rotation it is expected that the resident will be performing all aspects of breast imaging interpretation and intervention at senior level with diligence, competency and confidence. They will have the opportunity to observe if not perform breast MRI interventional procedures. This is an advanced technique that is part of the dedicated breast imager training.

Cardiovascular

As an independent academic medical center which functions as a highly integrated group practice, Lahey Clinic offers comprehensive multimodality cardiovascular imaging services to patients. The nuclear cardiology (SPECT and PET) portion of the CVI rotation is contained within the formal nuclear medicine rotation and daily instruction on this topic occurs on that rotation.

Residents learn cardiac postprocessing of functional and anatomic imaging (CT and MRI) from either key faculty or from the dedicated technologists in the 3D lab who are also familiar with all required standard postprocessing. At the end of their first rotation, residents are expected to be familiar with the independent use of our dedicated Cardiac CT and MR postprocessing software. Selected clinical cardiac MRI cases are also shown at the afternoon conferences and residents participate in these demonstrations.

Residents need to familiarize themselves with the basic physics principles of cardiac MRI. All the related didactic material is covered in a weekly MRI Physics lecture series held in the main Radiology conference room by Dr.Flacke.

Residents are welcome to spend time in the Lahey Cardiology department, specifically the Echocardiography lab, and witness Echos as well as stress Echo and treadmill exercise tests. Witnessing cardiac cath procedures is also available and can be arranged on request. In addition, while on this rotation, residents are expected to observe and scan patients in the Vascular Lab three ½ days per week, to be fit around the other cases that arise in CT or MRI intermittently.

Residents are strongly encouraged to engage in clinical research during their time on the CVI rotation. Staff are available to mentor projects; there are many areas of potential interest which can be pursued. Due to the fractionated nature of the rotation, residents are welcome to embark on a project after discussion with staff any time throughout the year.

Body CT

Currently, body CT rotations encompass both abdominal and pulmonary/thoracic CT training, but we are currently undergoing a transition whereby thoracic CT will be separated from abdominal CT. The day generally begins at 8:00 a.m. and finishes at the discretion of the staff radiologist, generally @ 5 pm. As stated below, all residents are required to attend departmental noon conferences and all morning interdisciplinary conferences.

Earlier rotations concentrate on anatomy and emergent findings, while later rotations should concentrate on more advanced outpatient abnormalities, including oncologic evaluations, preoperative liver and kidney transplant evaluations, etc. Residents are also expected to develop proficiency in protocolling all types of examinations.

ER Shift

ER shifts are designed to help first year residents gain invaluable experience and interpretation of ER cases prior to independent call. All residents will rotate through Ultrasound, CT, Abdomen, MICU/SICU, and Neuro CT prior to starting the ER shift, to be sure they have adequate exposure to the core radiology rotations. Residents on the ER shift are expected to come into the department at 12 noon to attend conference and start their rotation at the end of conference, ~ 1:30 pm. The first half of the ER rotation is interpretation of ER plain films until ~ 4:30 pm, with a short ½ hr break for dinner. From 5 – 9 pm, residents shift gears to primarily interpret CT scans from the ER, with occasional ER US and plain film examinations. Residents are responsible for primary interpretation and dictation, and cases are immediately reviewed with attending radiologists, who are in house until 9 pm. In addition to being the first to recognize and interpret abnormal CT scans, residents will gain good insight into multitasking – answering the pager, dealing with logistics in terms of protocolling, coordination of examinations, and communicating results to clinicians. Your ER rotation is the natural progression of a first year radiology resident towards taking independent call, all the while being immediately supervised by attending radiologists.

Interventional Radiology (IR)

The subspecialty of interventional radiology at Lahey Clinic is a full service discipline and covers a broad range of procedures, ranging from vascular interventions, image-guided therapy for oncology patients, to CT and US guided biopsies/drainages. There are no fellows on service and the sole (or occasionally paired) resident is expected to be an active participant in all procedures, regardless of the complexity. Staff will continually assess interest, skill, and knowledge, and will allow increasing participation as experience is gained. In addition to involvement in interventional procedures, the residents are expected to be involved in other aspects of patient care including pre procedural consents and post-procedural orders/follow-ups.

Musculoskeletal Radiology (MSK)

Currently, the MSK rotation is divided into afternoon and morning sessions. The morning will be dedicated to the interpretation of Musculoskeletal MRI cases, the afternoon will be in fluoroscopy, covering all fluoroscopic examinations, most of which are fluoro-guided arthrograms. The morning generally begins at 8:00 a.m. and residents will be expected to attend all noon conferences. The afternoon begins immediately after noon conference ends, and will finish at the discretion of the staff radiologist, generally @ 5 pm. Residents are required to attend (unless excused), morning weekly interdisciplinary conferences.

Earlier rotations concentrate on basic anatomy and pulse sequences in MRI, and these early MSK rotations will concentrate on the most commonly imaged extremities. Residents will be actively involved in arthrography of multiple joints, with these technical skills mastered during the afternoon fluoroscopy rotation. Residents will be actively involved in the interpretation and evaluation of all MSK MR studies during the month, and will be extremely comfortable with all aspects of Musculoskeletal imaging upon graduation.

Neuroradiology

The goal of residency training in Neuroradiology is to train qualified residents who are well prepared to enter into private practice or fellowship positions. Progressive enhancement of knowledge and proficiency should be seen throughout the residency.

Residents will have approximately 12 weeks of Neuro CT and 12 weeks of Neuro MR. It is expected that residents will progressively develop their abilities to perform and interpret imaging studies of the central nervous system and Head and Neck. Residents will be taught the skills necessary to interpret neuroradiologic CT and MR examinations including: 1) brain and skull 2) spinal cord and vertebral column and 3) head and neck. They will be instructed in the performance and interpretation of invasive procedures including myelography/spinal canal puncture and imaged guided biopsies of the spine, skull base and neck. The residents will receive instruction in the science that underlies clinical neuroradiology, in particular neuroanatomy and neuropathology. They will learn the physical principles of CT and MR.

They will learn the relative value of each modality, enabling to them to choose
the appropriate study and the appropriate protocol for each patient. It is expected that residents will participate in the performance of the full range of examinations done by the division. They will learn the indications and contra-indications for contrast administration and recognize and treat adverse reactions. Residents will protocol and monitor CT and MR exams after they have demonstrated a sufficient level of knowledge and experience to perform these tasks. Residents will aid in the performance of invasive procedures including myelograms, lumbar punctures and other minimally invasive procedures such as image guided vertebral, soft tissue neck and skull base biopsies. They will learn to explain these procedures to patients and their families, obtain preprocedure consent and write pre- and post-procedure orders. They will learn to recognize and treat complications of these invasive procedures.

The residents will learn to dictate concise and appropriate radiographic reports and to serve as consultants to referring physicians.

The day begins at 8:00 AM and finishes at the discretion of the staff. Residents are expected to work side by side with staff, previewing and dictating examinations prior to review with staff. Residents are expected to attend all noon conferences during their rotations. In addition residents are expected to attend the following morning interdisciplinary conferences: ENT, Friday morning Neurointerventional and ER, GI, and GU conferences. Morning rotations on these days will begin immediately after the interdisciplinary conferences finish.

Nuclear Medicine

As per ACGME requirements, all residents are required to complete 16 weeks of training in Nuclear Medicine. We currently have all residents do one 4-week block each year. Residents are expected to be very active participants in the protocolling, interpretation, and communication of results of all types of examinations, ranging from basic nuclear medicine to complex PET/CT, including myocardial perfusion PET scans. Residents will be working with rotating Lahey Cardiology fellows in interpretation of cardiac nuclear stress tests. All residents are required to participate with staff in therapies involving oral administration of I-131. Documentation of the resident’s participation must include the date, diagnosis, and dose of each I-131 therapy. Residents are also required to have laboratory experience in Nuclear Medicine, and a check-list will be provided to ensure that all residents are appropriately trained to receive full Authorized User (AU) status through the Nuclear Regulatory Commission (NRC).

Residents are expected to attend all morning interdisciplinary conferences. Residents in Nuclear Medicine are also in part responsible for running an interdisciplinary conference with the general internal medicine ward teams, which occur 2x/week, with supervision by radiology staff.

Pediatric Radiology

The pediatric radiology rotation is a 13-week rotation at the Children’s Hospital of Boston, Department of Radiology. The goal of residency training in pediatric radiology is to gain valuable exposure and insight into the nuances of pediatric radiology, allowing for a knowledge base appropriate to enter into private practice radiology or fellowship training. During your rotation, you will be one of a group of residents from throughout the Boston and the Northeast, training at one of the best Children’s Hospitals in the United States. The residents are exposed to an exceptional array of pediatric pathology during their time at Children’s Hospital. Residents will have a variety of 1-week rotations, including but not limited to CT, Ultrasound, Neuroradiology, Fluoroscopy, and Plain films/STATS. The residents will also split the overnight call duties with other rotating residents.

Ultrasound

The goal of residency training in ultrasound is to train qualified residents who are well prepared to entire into private practice or fellowship positions. The day generally begins at 8:00 a.m. and finishes at the discretion of the staff radiologist, generally @ 5 pm. The ultrasound rotation will encompass a variety of examinations, ranging from formal routine right-upper quadrant and pelvic examinations, to complex postoperative renal and liver transplant examinations. Residents will spend a progressive amount of time scanning patients, with earlier rotations concentrating more on image interpretation, but later rotations concentrating more on image acquisition. While we do have Ultrasound technologists on-call, we feel that hands-on skills in ultrasound are very important to appropriate patient evaluation.

OB Ultrasound

The goal of the rotation in Obstetrical Ultrasound at the Brigham and Women’s hospital is for residents to gain insight and direct experience in the evaluation of pregnant patients. Although residents are exposed to occasional first trimester pregnancies for both outpatient and ER evaluations, Lahey Clinic does not have its own obstetrical service, and as such, all residents will rotate for one month at the Brigham and Women’s hospital. Residents will directly observe obstetrical ultrasounds, including both normal and abnormal cases. All rotating residents are expected to attend a morning case conference in the ultrasound department, followed immediately by the daily evaluation of obstetrical ultrasound patients. The exposure to high-risk and normal obstetrical patients at the Brigham and Women’s will allow residents to feel comfortable with the depth and breadth of obstetrical abnormalities.