ER Evening —10 weeks
Night float—12 weeks
Nuclear medicine—16 weeks
Neuro CT—12 weeks
Neuro MR— 12 weeks
Body CT—12 weeks
Plain film—4 weeks
Abdominal (fluoro/body MR)—12 weeks
Pediatric Radiology (Boston Children’s Hospital)—13 weeks
Women’s Imaging (Beverly Hospital)—4 weeks
Senior electives—3 months
The program director is responsible for making sure that residents do not regularly perform excessively difficult or prolonged duties and ensuring that assignments are fair and reasonable. The director is responsible for radiology residents’ schedules, assuring compliance as well as appropriate documentation and will regularly review compliance with duty hours.
An overview of our duty hour guidelines:
- Duty hours reflect the concept that patient care and the health and well-being of residents are both of the utmost importance. There is an established wellness curriculum based on the ACR course and other resources. Residents are required to notify the program director or attending on call if there is any serious violation of their standard duty hours. These policies apply to the sponsoring institution and its affiliates, Beverly Hospital, AIRP and Boston Children’s Hospital.
- Duty hours will be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
- Residents will be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period.
- Residents will receive a 10-hour time period between all duty periods and after in-house call.
- Moonlighting or extended hours are included in the 80-hour work-week. Residents will not have outside employment that jeopardizes this requirement or impinges on training.
- Residents are required to record duty hours on a monthly basis.
Night Float/ER Evening Schedule
The residents will be on a night float/ER evening schedule as outlined here:
- ER evening: During the week, a first year or early second year resident will be on ER evening covering Emergency Room cases and staying in the hospital between 5 and 9 pm with direct staff supervision by both neuroradiology and body imaging staff.
- Night float: Must be at least a second-year radiology resident (PGY-3), and will be in-house beginning at 9 pm, with hospital coverage finished by 7:30 am. Residents are expected to sign out overnight cases by 8:30 am. Night float will be either a two-week (six days each week) or one-week rotation, depending on the resident’s preference.
- There will be three 12-hour weekend shifts to cover Saturday/Sunday.
- There is 24-hour staffing supported by our dedicated ER section overnight
- On-call rooms are provided for residents with nighttime duties. Meals are available.
Night Float—Beginning Second Year
6 days each week, Sunday to Friday:
- Sunday through Thursday 9 pm to 7:30 am
- Friday night 9 pm to 9 am
- Saturday between = Off
- Cover all ER examinations, primarily CT, plain radiographs and ultrasound. All ER studies are reviewed with on-site Emergency Radiology attending staff.
Divided into three 12-hour shifts:
- Saturday 9 am to 9 pm
- Overnight Saturday 9 pm to 9 am
- Sunday 9 am to 9 pm
- Daytime shifts have in-house staff coverage until 6 pm
Residents are expected to be at Lahey Hospital & Medical Center at approximately 8 am on weekdays when not attending morning interdisciplinary conferences. Unless the resident is on call, they are free after the daily work is complete, at the discretion of the assigned staff.
Residents should attend morning interdisciplinary conferences as deemed appropriate by the clinical educator for each particular rotation. All noon conferences are protected time for the residents unless residents are involved in a procedure. Residents are required to record conference attendance.
Call responsibilities are divided between night float and weekend shifts. Night float blocks are created in the beginning of the year and residents will make their own weekend schedules amongst themselves.
Holidays are covered by the second years.
Residents have the following responsibilities:
- Case of the week
- Conference attendance
- Conference preparation
- Medical student rotations: the resident as professor
- Resident seminars
- Teaching files
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 lower GI studies. Additional more complex examinations may be performed, including defograms, T-tube and other tube injections.
Morning studies begin at 8 am, and residents are expected to attend all noon conferences. The afternoon begins immediately after noon conference and ends at the discretion of the staff radiologist, generally at 5 pm.
Early 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 the ability to detect basic abnormalities on a subsequent image review.
Second and early third year rotations concentrate on deepening their knowledge while improving proficiency in performing complex procedures. During subsequent rotations, residents are expected to rapidly evaluate and document the presence or 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).
Residents are given digital learning material including self-guided digital presentations illustrating all of the fluoroscopic abnormalities of the GI tract.
During MRI afternoons, 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 concentrate on pelvic examinations and complex studies (renal MRA, prostate imaging, etc.).
Lahey has one of the largest regional liver transplant centers in the region and one of the largest live-donor liver transplant centers in the U.S. As a result, residents will become extremely comfortable evaluating the cirrhotic and non-cirrhotic liver on MRI.
Currently, breast imaging rotations encompass a wide variety of examinations including screening and diagnostic mammography, breast ultrasound and advanced breast imaging studies.
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 am 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, residents are required to attend weekly interdisciplinary Breast Tumor Conferences on Friday mornings at 7 am. Each resident is expected to make a journal article presentation during their rotation at the Breast Tumor Conference. Residents are also required to attend other morning interdisciplinary conferences.
Early rotations concentrate on mastering screening mammography. During the initial rotation, residents focus on appropriate work-up of the screening patient and detection of abnormal findings. Residents will learn to identify and document the presence or absence of an abnormality.
Residents will develop reporting skills incorporating the standardized reporting techniques following ACR and department guidelines.
Second and early third year rotations will concentrate on further deepening knowledge while improving proficiency. By the end of the first rotation, residents 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 residents will establish competence and confidence in handling diagnostic mammography and breast ultrasound. It is expected that residents will be able to scan an area of concern with ultrasound and effectively diagnose, document and report findings in both benign and suspicious cases.
Residents 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 these rotations, residents should begin to detect with more rapidity the presence or 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 is first. As residents progress 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 residents 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.
As an independent academic medical center that functions as a highly integrated group practice, Lahey Hospital & Medical Center 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 3-D 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 related didactic material is covered in a weekly MRI physics lecture series held in the main radiology conference room.
Residents are welcome to spend time in the cardiology department, specifically the echocardiography lab, and witness echo, stress echo and treadmill exercise tests. Witnessing cardiac catheter procedures is also available and can be arranged on request. Residents are expected to observe and scan patients in the vascular lab three half-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. There are many areas of potential interest which can be pursued, and staff are available to mentor projects. Residents are welcome to embark on a project after discussion with staff any time throughout the year.
Currently, body CT rotations encompass both abdominal and pulmonary/thoracic CT training. The day generally begins at 8 am and finishes at the discretion of the staff radiologist, generally at 5 pm. 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 expected to develop proficiency in protocolling all types of examinations.
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 noon to attend conference and start their rotation at 1:30 pm. The first half of the ER rotation is interpretation of ER plain films until 4:30 pm with a half-hour break for dinner.
From 5 to 9 pm., residents shift gears to primarily interpret CT scans from the ER, with occasional ER ultrasound 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.
The subspecialty of interventional radiology at Lahey Hospital & Medical Center is a full-service discipline. It covers a broad range of procedures, ranging from vascular interventions and image-guided therapy for oncology patients to CT and ultrasound-guided biopsies and drainages. The resident is expected to be an active participant in all procedures, regardless of 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, residents are expected to be involved in other aspects of patient care including pre-procedural consents and post-procedural orders and follow-ups.
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 am and residents are 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 at 5 pm. Residents are required to attend morning weekly interdisciplinary conferences unless they are excused.
Earlier rotations concentrate on basic anatomy and pulse sequences in MRI. These early MSK rotations 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.
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:
- Brain and skull
- Head and neck
- Spinal cord and vertebral column
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. 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 protocol for each patient. Residents 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 pre-procedure consent and write pre- and post-procedure orders. They will learn to recognize and treat complications of these invasive procedures.
Residents will learn to dictate concise and appropriate radiographic reports and to serve as consultants to referring physicians.
The day begins at 8 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 morning interdisciplinary conferences including ENT, Friday morning neurointerventional and ER, GI and GU conferences. Morning rotations on these days will begin immediately after the interdisciplinary conferences finish.
As per ACGME requirements, all residents are required to complete 16 weeks of training in nuclear medicine. We currently have all residents do one four-week block each year. Residents are expected to be 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 checklist will be provided to ensure all residents are trained appropriately to receive full Authorized User status through the Nuclear Regulatory Commission.
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 twice a week with supervision by radiology staff.
The pediatric radiology rotation is a 13-week rotation at the Boston Children’s Hospital 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.
Residents are exposed to an exceptional array of pediatric pathology during their time at Children’s Hospital. Residents will have a variety of one-week rotations, including but not limited to CT, ultrasound, neuroradiology, fluoroscopy, and plain films/STATS.
Residents will split overnight call duties with other rotating residents.
The goal of residency training in ultrasound is to train qualified residents who are well prepared to enter into private practice or fellowship positions. The day generally begins at 8 am. 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 and 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.
The goal of the women’s imaging and OB ultrasound rotation at Beverly 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 Hospital & Medical Center does not have its own obstetrical service, and all residents will rotate for one month at the Beverly Hospital.
Residents will observe obstetrical ultrasounds, including both normal and abnormal cases. Rotating residents will receive teaching from Beverly Hospital attendings and will be able to participate in noon conferences remotely.