STANFORD UNIVERSITY NEURORADIOLOGY FELLOWSHIP The neuroradiology fellowship at Stanford University Medical Center is designed to be a well-balanced academic training program that encompasses all of the basic and advanced clinical and research areas of both adult and pediatric neuroradiology. The overall aims of this fellowship are two-fold: to produce neuroradiologists with the highest level of clinical expertise, and to produce the future leaders in academic neuroradiology. The goal of this fellowship program is for Neuroradiology fellows to develop knowledge, skills and attitudes necessary to properly evaluate, diagnose and manage patients with neurological, ENT and neurosurgical diseases. Therefore, this fellowship requires participation in clinical, research, and educational aspects of neuroradiology. Neuroradiology fellows will be exposed to all imaging modalities used to evaluate neurologic disease, including CT, MR, myelography, angiography, and imaging guided biopsies, during the course of the fellowship. Interventional neuroradiologic procedures are also performed at state-of-the-art levels at Stanford, and neuroradiology fellows will actively participate in these procedures. Goal of the Neuroradiology Fellowship Program Core Competencies Fellows should achieve the Interpersonal System following objectives: and -Based Patient Medical Practice-Based Communicati Professional Learni Care Knowledge Learning on Skills ism ng 1. Acquire specific knowledge about the physical principles of imaging modalities (CT,MR,ultrasound and digital subtraction angiography). X X 2. Identify the practical uses of CT, MR, ultrasound and digital subtraction angiography in the evaluation of neurologiocal, ENT and neurosurgical diseases. X X X 3. Develop thorough knowledge of the physical and physiological properties of contrast agents used in CT, MR, and angiography; including contraindications and management of potential complications. X X X 4. Effective implementation of CT and MR scanning protocols with the appropriate use of contrast agents. X X X 5. Assess appropriate X X X clinical indications for neuroradiologic procedures. 6. Effectively counsels patients and/or family members prior to neuroradiologic procedures and obtains written informed consent. X X X 7. Master the manual techniques and intraoperative skills required for performing neuroradiologic procedures; including identification and management of potential complications. X X 8. Identify pertinent radiologic findings on CT, MR and digital subtraction angiography examinations. X X X 9. Properly interprets and formulates an impression of the CT, MR and digital X subtraction angiography findings. 10. Demonstrate the appropriate use of X X recommendations and follow-up imaging. 11. Identify normal anatomy and development of the brain, spine and head X X and neck on all imaging modalities. 12. Perform prioritization and triage for neuroradiologic X X X X emergencies during routine work day and on-call duties. 13. Perform expert consultation of neuroradiologic imaging studies with referring clinicians. X X X 14. Produce clear, concise and accurate dictated reports. X X X 15. Develop awareness of cost effectiveness of diagnostic studies and their resource limitations in health care. X X X 16. Participate in conferences and teaching of residents and medical students. X X 17. Develop a detailed knowledge of neurological, ENT and neurosurgical pathology. X X 18. Gain an understanding of research methodology, study design and presentation of results. X 19. Demonstrate good interpersonal skills among professional colleagues and support staff. X X X 20. Always demonstrates respect, compassion, integrity and honesty. X 21. Demonstrate initiative, proactive learning and insight. X X 22. Punctuality and attendance for all daily activities. X 23. Effective use of information resources, scientific studies and technology to pursue self improvement and education. X X X 24. Provide quality patient care X X X The fellow’s evaluation will be based on his/her individual performance in fulfilling these competencies. Website A lot of resources (clinical, education and research) are available from our website, which you are encouraged to visit and explore: http://med.stanford.edu/neuroimaging.html Assigned Rotations and Responsibilities: The fellowship is divided into multiple assigned clinical rotations, which include the following: First year Shared Second year inpatient Sherman late Hoover II (PET-MRI) myelo/ENT/procedures Hoover night float myelo/ENT/procedures Hoover Sherman early vacation VA/float fellow INR INR LPCH LPCH conference/protocols elective elective board preparation (elective early in the year) Please note the differences between first year and second year rotations and time spent on particular rotations, reflecting different goals for the first and the second year, and different levels of knowledge and expertise. A schedule is posted for each month, and neuroradiology fellows, along with the radiology residents on neuroradiology, will be assigned to one or more of these rotations each day. It is anticipated, schedule permitting and clinical performance following milestones, that each fellow will receive research elective time of at least two weeks in the first year of fellowship and at least eight weeks in the second year of fellowship. Elective time will vary depending on the overall number of fellows. Note also that assignments to the various rotations can change on a daily basis, but generally clinical rotations last approximately one week. The specific responsibilities of the fellow on each rotation are generally self-evident but are detailed below: INR is a rotation under the direction of Drs. Michael Marks, Huy Do, Jeremy Heit and Robert Dodd. Specific duties for this rotation will to some extent vary according to the abilities of the fellows and will evolve with time. Details should be clarified with Drs. Marks, Do, Heit and Dodd. It is anticipated that the fellows will gain significant expertise in all aspects of diagnostic neuroangiography, and in addition will receive gradual exposure to neurointerventional procedures. Note that a dedicated neurointerventional fellow will also participate in these procedures. CT and MRI are either separate or combined rotations under either Outpatient Sherman, Outpatient Hoover 2 or InPatient depending on where the fellow is located. During these rotations, the fellow has the primary responsibility of giving preliminary readings, calling emergency reports and all significant findings to the ER or referring physicians, handling any problems encountered by technologists, protocol direction, and preparing cases for formal read-outs with the neuroradiology attendings. It is often the case that old films and more extensive history are important, and the fellow should make all efforts to obtain these when possible. The Neuroradiology Reading Rooms should be the major places of residence by the fellow when assigned to these rotations during the day. Specific duties include 1) making sure that the appropriate protocol is implemented for each patient; 2) helping to solve any problems with sedation in MR; 3) triage of add-on requests by clinicians; 4) review of MR cases when appropriate prior to taking the patient off the table; and 5) answering all questions or problems from MR technical staff. The assigned attending on the Read-Out rotation is the back-up for questions regarding these areas and should be sought when necessary. Fellows must always be available on beeper during these assignments. Dictations are performed by the fellow or assisting resident for all cases. No dictations are to be finalized prior to review with the attending. (Note: during noon resident conferences, the fellows are responsible for all CT and MRI coverage) Myelography and Biopsies at Stanford is a specific assignment. Usually this rotation is assigned along with another rotation to the same fellow or resident. Biopsies and myelograms will be performed by fellows with direct supervision by an attending. Fellows will initially perform all myelograms, but radiology residents will be given graded degrees of responsibility in performing myelograms after neuroradiology fellows demonstrate adequate expertise. All invasive procedures will be monitored by a staff neuroradiologist in addition to a neuroradiology fellow. The fellow will be expected to obtain patient consent, to place appropriate orders, to communicate with CAPR and to insure that the patient is stable for discharge. Conferences: Neuroradiology actively participates in multiple clinical and didactic conferences. Assigned fellows are required to attend most of these conferences (unless otherwise noted as optional), and they are scheduled to give teaching conferences to the radiology residents during the year. The most important fellow conference is the Interesting Case Conference held every Tuesday morning, during which current cases of interest are shown to the group. Fellows and residents are responsible for preparing these cases (retrieving old films, obtaining history, etc.) and presenting them. Fellows are also expected to attend as often as possible the Neurosciences Grand Rounds held every Friday morning. Below is a comprehensive list of didactic and clinical conferences: CONFERENCES ATTENDED BY NEURORADIOLOGY TRAINEES Conference Frequency Responsible individual or service/Department Pediatric ENT Conference 3rd Wednesday Otolaryngology Oto Radiology Conference 2nd Monday, bimonthly Otolaryngology Skull