Body CT (hospital based with interventions)
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Ultrasound (hospital based with interventions)
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Body MR (hospital based)
The fellow-instructor spends three months in “body” MR, which includes abdominal and pelvic examinations. Because of the great breadth of this material, as well as the inclusion of musculoskeletal MR in the other three month MR block, we provide our fellow-instructors with a 2+ Gb iPad compatible e-book. The contents include a curriculum of recommended readings and embedded text and video content.
Abdominal MR material covers the entire gamut of indications. We are a busy GI oncology hospital with a Cancer Center located on campus. The chair of surgery is a nationally recognized expert on pancreatic and endocrine surgery. Our interventional radiology service is recognized as one of the best in the country and we interpret a high volume of MR and CT cases for hepatocellular carcinoma and cholangiocarcinoma.
Pelvic MR material is weighted towards gynecologic oncology. Our radiation oncologists embraced MR as a tool for both pre- and post-treatment evaluation of cervical carcinoma over 25 years ago and this continues to be the primary use for gynecologic oncology imaging. Other indications include evaluation of fibroids and characterization of pelvic masses.
We have been performing prostate MR for over a year. Our examinations are predominately done using an endorectal coil on a 3T unit. We are collaborating with urology, medical physics, and pathology in a project to correlate whole-mount prostate sections with corresponding MR images. This is acknowledged to be the optimal way to improve accuracy when interpreting this difficult examination. A team approach is routinely used during readout with the fellow-instructor and most examinations are reviewed by three or more faculty.
Musculoskeletal Imaging with Emphasis on MR (outpatient based and hospital based with option for interventions)
Musculoskeletal MR comprises a significant part of our fellowship. Fellow-instructors interpret musculoskeletal examinations in both outpatient imaging and hospital-based settings. There is a close relationship between the abdominal and musculoskeletal sections and many faculty members participate in both sub-specialties. We provide a 2 Gb e-book for iPad that includes the curriculum as well as embedded written and video content.
The case material at our imaging center consists primarily of “sports medicine” examinations of the large and small joints. We perform up to six MR arthrograms a day using a streamlined approach that allows the radiologist to perform these procedures in approximately ten minutes from the time of consent to the completion of injection. We provide imaging for the Milwaukee Brewers and have an excellent relationship with their physicians and trainers. Though not required, many of our fellow-instructors also choose to interpret musculoskeletal CT and radiographic examinations.
Musculoskeletal case material at the hospital is more balanced between imaging of the joints as well as osseous/soft tissue masses and infection. We hold interdisciplinary sports medicine conference twice a month, presented by faculty from both radiology and orthopedics. Orthopedic oncology conference is held weekly and is presented by faculty from orthopedic oncology, radiation therapy, surgical oncology, medical oncology, and pathology. There are invariably five or more members of the musculoskeletal section in attendance. Fellow-instructors can elect to participate in CT and ultrasound guided soft tissue/bone biopsies.
The inclusion of musculoskeletal MR is uniformly emphasized as one of the strengths of our fellowship and provides an additional skillset for those considering private practice or outpatient-based academic positions. The fellow-instructor can create a musculoskeletal “mini fellowship" by electing to interpret other imaging modalities, participate in procedures, and attend sub-specialty conferences.
Abdominal Interventional Service
The fellow-instructor will have the opportunity to perform non-vascular interventional procedures.
Soft tissue biopsies are performed using CT or ultrasound guidance. These include solid abdominal organ, intraperitoneal/retroperitoneal, and neck (thyroid/nodal) masses.
Drainages of fluid collections are performed using CT, ultrasound, or a multimodality approach. Transrectal and transvaginal ultrasound directed drainages are well accepted by patients and often preferable to the transgluteal approach. The scope of procedures can be found in many traditional dedicated interventional radiology fellowships.
Our program emphasizes a comprehensive team approach. Staff radiologists and trainees work closely with physician extenders, radiology nurses/anesthesiologists, and technologists in order to provide excellent outcomes and ensure patient comfort.
We are currently remodeling our dedicated hybrid CT/US procedure suite to accommodate an increasing procedural volume. We are also in the process of constructing an outpatient consultation service and post-procedural follow-up clinic.
The program’s goal is to provide comprehensive training such that the fellow-instructor is cognizant of all important preprocedural, periprocedural, and postprocedural issues. At the end of the fellowship, our graduates will be able to perform the full gamut of image-guided biopsy and drainage procedures. This marketable skillset can provide additional employment options both in academic medicine or private practice.
All of MCW Abdominal/Body Imaging fellow-instructors have placed in excellent positions.