The Musculoskeletal Radiology Fellowship Program integrates core ACGME competencies into every part of the curriculum supplemented with multiple teaching tools, learning experiences and mentoring for fellows become progressively independent in the selection, interpretation, and performance of procedures and exams related to the musculoskeletal system. Competence is measured by the achievement of milestones developed for each level of the training program.
Fellows must demonstrate competence in the following six areas:
- Medical Knowledge
- Patient Care
- Interpersonal and Communications Skills
- Practice-Based Learning
- Systems-Based Practice
There are daily reading sessions to progressively develop a trained eye in the interpretation of all musculoskeletal examinations. There are multiple clinical and didactic sessions for fellows to gain experience in all areas of musculoskeletal imaging and to have an active role in the clinical, didactic and research components. Fellows perform and interpret image-guided interventions including image-guided percutaneous biopsy procedures, arthrograms and diagnostic/therapeutic injections.
- Routine Radiography: The fellow interprets many routine radiography cases during the year while on call and during regular hours. Additionally, radiographs are reviewed as comparison reference studies for all advanced imaging studies and documented on the radiology report.
- CT: MSK CTs are initially reviewed by the fellow who then presents his findings to the MSK attending. Differential diagnoses are formulated and discussed with the attending. Exams are critiqued by the fellow and attending for quality and dosage.
- Ultrasound: All musculoskeletal ultrasounds are performed with the technologist and musculoskeletal service together. The technologist will prepare the patient and start the examination, then call the MSK fellow and attending to view the exam as well as to perform additional scanning until the study is considered diagnostic and complete. Many ultrasound examinations are also involved with procedures that are performed simultaneously. All exams and procedures are supervised.
- Bone Mineral Density and Radionuclide Scintigraphy: These examinations are performed in the department of nuclear medicine. The fellow is given the opportunity to do dedicated rotations in this department if desired. These exams are also used as reference examinations for CT, MR, and image-guided biopsy, and are frequently incorporated into daily readouts. All MSK tumor examinations and biopsies incorporate bone scan and PET-CT tests for optimal interpretation and successful biopsy endeavors.
- MRI: Musculoskeletal MRIs are initially reviewed by the fellow who then presents his findings to the MSK attending. Differential diagnoses are formulated and discussed with the attending. Exams are critiqued by the fellow and the musculoskeletal radiologist for quality and appropriateness.
- Arthrography, Diagnostic/Therapeutic Injections and Image-Guided Percutaneous Biopsy: All procedures are supervised by an MSK attending. Initially, the fellow observes these procedures and gradually takes on increasing independence in performing these procedures.
Fellows begin work at 8:00 am and leave around 5:00 pm.
- The fellow goes over 10 to 15 studies to review with the attending, sorting out the stat and in-patient studies that the attending has to read when they arrive. Monday's are the most important since the fellow will go through the list of MRI's from the weekend and separate out the patients that need to be dictated soon (i.e. have an appointment on Monday) so the attending can take care of them first thing in the morning.
- The rest of the morning is spent going over the studies reviewed by the fellow and dictating them. The fellow has CT-guided biopsies or ultrasound-guided procedures in the morning 2-3 times a week.
- Lunch is 12-1 pm, notwithstanding a last minute procedure or lecture given by an MSK attending.
- Approximately 2-3 fluoroscopic-guided procedures are performed per day starting at 1pm. The procedures are usually performed by the fellow unless a stat procedure comes across that needs to be done.
- Other procedures performed by the fellow includes:
- Radiofrequency ablation of osteoid osteomas, bone biopsies (2 to 3 a week), muscle biopsies (1 every 2 weeks).
- Joint aspirations (includes hip, shoulder, knee, ankle, elbow, wrist, interphalangeal joints), arthrograms of the same joints as well as therapeutic injections of all the joints as well as the sacroiliac joints (average of 3 a day).
- Plasma-rich protein (PRP) injections.
- Wednesday mornings (8-12) are dedicated to research. The current fellow completed an internal review of the arthrograms performed for a 6-month period and its correlation to the arthroscopy. Research projects are completed within the first six months of the program.
Conferences include, but are not limited to:
- Imaging Case Conference: Rheumatology conference takes place monthly with a presentation on a topic by the MSK attending followed by interesting cases.
- Imaging Case Conference: Orthopedic conference occurs monthly - one of the MSK radiologists presents and goes over interesting cases.
- Sarcoma/Radiology/Pathology Tumor Board - Cases are discussed by the Oncology surgeon, MSK radiologist, Oncologist and the Pathologist. Treatment options, radiology findings, and slides are reviewed.
- Resident-teaching conference - The fellow gives conference to residents, and gives 1 board review annually.
- Interdepartmental Conferences: Orthopaedic surgery, neurosurgery and other surgical specialties, rheumatology, oncology, and core lectures.
There is one resident from the core program on the MSK service about 4-6 months out of the year. The fellow helps the resident with procedures. The attending goes over the imaging studies with the resident.