We realize that your choice of a Neuroradiology Fellowship is difficult and that considerations include the academic program, faculty, work environment, geographical location, and various other personal reasons. We also recognize the substantial personal commitment it takes to extend your training and improve your skills. Please know that we take your commitment seriously and commit to train you to the best of our ability. Finally, it is our responsibility to help guide you in your job search and do our utmost to assist you in obtaining the position of your choice.
Overall Program Goals
- The overall goal of the Neuroradiology Fellowship Program is to fulfill the three-fold mission of the University of Virginia Health system: To provide excellence and innovation in the care of patients, the training of health professionals and the creation and sharing of health knowledge
- To that end, the program is designed to enable the Diagnostic Neuroradiology Fellow to accumulate a broad base of medical knowledge, to develop progressively independent interpretive and technical skills under supervision, and to become proficient at accurate clinical decision making and consulting; the fellowship aims to provide teaching and research opportunities for fellows, adjusted to special interests and talents
- At the conclusion of the fellowship, the graduate will have the foundation to build an academic career in radiology, advance subspecialty knowledge and skills as an advanced clinical fellow or instructor, or enter community practice as an expert diagnostic neuroradiologist
As a result of our clinical training and didactic conferences, we expect each neuroradiology fellow who finishes training with us to be able to:
- Understand the functional neuroanatomy of the brain and spine
- Understand the physical principles underlying advanced neuroimaging modalities such as MRI, CT, and PET
- Have good general knowledge of related neuroimaging techniques, such as PET
- Perform and obtain competence in head, neck and spine biopsies
- Perform safely and interpret accurately angiograms, myelograms, CT scans and MRI scans in the most complicated/difficult cases encountered in common clinical practice
- Be able to design and modify CT and MR protocols as new techniques are developed
- Have thorough imaging and clinical knowledge of diseases of the head and neck
- Develop skills and confidence in discussing neuroimaging cases with requesting physicians and teaching other physicians about neuroimaging
- Be familiar with scientific data and issues debated in current neuroradiology literature
- Design and complete a research project
Neuroimaging training includes all aspects of neuroradiology of the head, neck and spine including plain radiographs, computed tomography, and magnetic resonance imaging. The fellow is exposed to all facets of ENT and pediatric neuroradiology. The procedure experience can be subdivided into four distinct areas: diagnostic catheter angiography, neuroendovascular therapeutics, head & neck biopsies, and percutaneous spine procedures (including myelography, vertebroplasty, kyphoplasty, biopsies, etc).
Training in advanced imaging techniques is the cornerstone of our fellowship and includes MR Spectroscopy, MR Perfusion, CT Perfusion, fMRI, DTI and CSF flow analysis. Non-invasive vascular imaging is critical to the expert neuroradiologist: at UVA, your experience will include training in a variety of techniques including high-resolution CT Angiography, 3D TOF MRA, contrast-enhanced MRA, time-resolved MRA, CT venography and 2D TOF MR venography.
Familiarity with various post-processing equipment is essential to be nimble, thorough, and accurate. The Department has vast 3D resources including a 3D Lab with Tera Recon, Vitrea, Leonardo and Advantage Windows workstations. The Tera Recon resources include a thin-client platform that allows for access to all PACS remotely. All platforms are maintained at a high level with regard to version/platform and in-hospital support maintains the systems. The fellows are encouraged to utilize the workstations and become independent of the technologists, even though the 3D techs routinely create the 3D and post-processed images.
Diagnostic neuroradiology fellows rotate on a weekly basis among 5 rotations: early (7am-5pm), procedures (8am-6pm), late (10am-7pm), Long Term Acute Care Hospital (LTACH) (8am-6pm) and academic rotation (8am-5pm). Fellows are on call approximately every fifth weekend.
During the early and late shifts, fellows share the plain films, CT and MRI studies with the 3-4 residents in the reading room. The number of studies is approximately the same for each fellow and resident, but the fellows are expected to read more complex cases (CTAs, advanced CT and MR imaging techniques, MRI of the head and neck, pediatric neuroradiology cases). This was introduced at the request of our present fellows so that they can develop their advanced neuroradiology knowledge while maintaining their skills in reading simpler studies, such as head CTs.
The procedure fellow works with the interventional neuroradiology team, performs diagnostic angiography studies and participates in endovascular treatments, percuatenous vertebroplasties and kyphoplasties. He/she is responsible for all aspects of patient care including the work-up, plan, and performance of the angiogram, post-operative care, and follow-up. Graduated responsibility results in independence in the angio suite while under the direct supervision of attending staff. There is an emphasis on the technical and interpretive aspects of catheter angiography with correlation to non-invasive exams Our fellows meet, and often surpass, the RRC requirement of 50 angio procedures per fellow. The diagnostic fellows actively participate in therapeutic endovascular cases along with the interventional fellow. The diagnostic portion of an angio case, along with initial elements of the therapeutic component, are frequently performed by the diagnostic fellow (i.e. more than just holding and flushing wires!). The procedure fellow also performs the CT-guided procedures with the diagnostic neuroradiology attending. Finally, the procedure fellow also helps the myelography resident with myelograms.
During the “academic” week, the fellow:
- Attends all of the conferences indicated on the neuroradiology conference schedule and, once comfortable, presents some of them
- Is in charge of the Interesting Case conference, and coordinates with another fellow and the residents to present at least four cases
- Is teamed with one attending to serve as a research mentor and works on at least one academic deliverable (peer-review article, review article, teaching conference, QA project)
- Is involved with review of literature, collaboration with technologists including 3D lab to become familiar with advanced imaging techniques and their processing, and preparation of teaching conferences
- Meets at least once during this week with his/her mentor and the division director to discuss research directions and/or review progress
- Is responsible for leading a journal club with their peers
The five fellows split equally the weekday and the weekend calls. During call, fellows have access to PACS from home using VPN. The fellow on call on Monday is also on call Friday, Saturday, and Sunday. The remaining four fellows are on call Tuesday, Wednesday, and Thursday. Before a weekend of call, the fellow is on the Friday late shift. After a weekend of call, the fellow is on academic rotation.
There is no in-house call, but the fellow on call for the weekend reads in-house with staff on Saturdays and Sundays.
Fellows are provided with written evaluations of their performance 4 times during the program year. The faculty performs evaluations of the fellows’ performance at 3, 6, 9, and 12 months.
Anonymous evaluations by the fellows of the program are received twice per year and faculty evaluations are completed quarterly. Faculty are evaluated on a wide range of clinical, teaching, and research skills using a numerical scoring system and written comments through New Innovations.