Neuroradiology Fellowship

Melanie B. Fukui, M.D., Program Director

Length of program: 1 year with second year optional
Number of position(s): 1 per year

Applicants to the Neuroradiology Fellowship Program must be fairly recent graduates of an excellent training program and must be certified or qualified for certification by the American Board of Radiology when starting the fellowship.

The fellowship is a one-year program providing training under the supervision of three senior members of the American Society of Neuroradiology. The initial commitment for the one-year program may be extended to a second year if mutual interest develops on the part of the fellow and the neuroradiology faculty during the course of the first year. Principal training objectives include the practice of skills relevant to the performance of invasive procedures involved in neuroradiology, the acquisition of the principles underlying a sound analysis of images leading to diagnoses with the highest possible degree of reliability and the development of mature clinical judgment that effectively relates neuroradiologic observations to the clinical manifestations of the underlying central nervous system disorder. Although the emphasis is on clinical neuroradiology, fellows are expected to participate with the senior faculty in clinical research correlating radiological observations with patient histories and outcome of treatment.

The fellowship year is divided into rotations that are best characterized as representing a shift in emphasis from one specific neuroradiologic activity to another, rather than a succession of time blocks restricted to one activity to the exclusion of all others. One such rotation of approximately 10 weeks' duration stresses the performance and interpretation of myelography concurrent with familiarization of the techniques and interpretation of spinal computed tomography. A major rota-tion of approximately 20 weeks' duration focuses on neuroangiography, including selective catheterization procedures.

Although fellows are expected to have achieved a working diagnosis at the time of terminating a vascular procedure, a methodical review of the daily caseload involving at least one senior neuro-radiologist, the fellow and residents assigned to this section is undertaken near the end of the working day. Subsequent to a brief orientation in the technical aspects of CCT examinations, fellows are expected to participate in the formal daily CCT reporting sessions, with exception of those occasions when angiographic procedures are still under way.

Magnetic resonance examinations are reviewed daily to allow fellows and residents to discuss these studies with the senior faculty. After the fellows have acquired some experience in interpreting these studies, they are assigned in rotation with the senior faculty to supervise the operations of the MR facility.

Fellows are offered the opportunity to learn neuroultrasonography by applying Doppler duplex techniques to the evaluation of carotid artery blood flow in the department's ultrasound section and by supporting the neurosurgeons with intraoperative localization of deep-seated lesions using ultrasonography. These activities are not restricted to block rotations but are carried out on a time-availability basis. The same applies to polytomographic examinations of craniofacial and vertebral structures in severely traumatized patients.

Supervision of the fellow's activities is graduated and diminishes commensurate with acquisition of experience. Fellows are expected to participate in the supervision of residents assigned to neuro-radiology. Active participation in one weekly extradepartmental neuroscience conference and one weekly intradepartmental multidisciplinary neuroradiology conference is mandatory, and fellows are expected to make every attempt to attend the daily intradepartmental conference. Clinical research is encouraged, and the senior faculty provides assistance in preparing original scientific manuscripts. Basic research support can be arranged for by the Program Director if a worthwhile project is presented.



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