Diagnostic Radiology Residency Rotations & Schedule

Currently, abdominal imaging rotations include both fluoroscopic and MR imaging of the abdomen and pelvis.

Morning fluoroscopic examinations are primarily composed of basic GI examinations, including barium swallows, UGI, SBS and lower GI studies. Additional more complex examinations may be performed, including defograms, T-tube and other tube injections.

Morning studies begin at 8:00 am, and residents are expected to attend all noon conferences. The afternoon begins immediately after noon conference and ends at the discretion of the staff radiologist, generally at 5:00 pm.

Early rotations concentrate on basic procedures, anatomy and equipment use. During the initial fluoro rotation, residents concentrate on appropriate positioning to document the presence or absence of an abnormality and develop the ability to detect basic abnormalities on a subsequent image review.

Second and early third year rotations concentrate on deepening their knowledge while improving proficiency in performing complex procedures. During subsequent rotations, residents are expected to rapidly evaluate and document the presence or absence of an abnormality during fluoroscopy and image acquisition and be able to perform the entire gamut of fluoroscopic examinations independently (with subsequent staff read-out).

Residents are given digital learning material including self-guided digital presentations illustrating all of the fluoroscopic abnormalities of the GI tract.

The afternoon will be in MSK fluoroscopy, covering all fluoroscopic examinations, most of which are fluoro-guided arthrograms and joint injections.

Currently, breast imaging rotations encompass a wide variety of examinations including screening and diagnostic mammography, breast ultrasound and advanced breast imaging studies.

Advanced studies include breast MRI, breast scintigraphy and PET CT imaging. Breast interventional procedures with stereotactic, mammographic, ultrasound and breast MRI guidance are also performed routinely.

The day begins at 8:00 am and finishes at the discretion of the staff radiologist, generally by 5:00 pm.

Residents are required to attend departmental noon conferences. During the breast imaging rotation, residents are required to attend weekly interdisciplinary Breast Tumor Conferences on Friday mornings at 7:00 am. Each resident is expected to make a journal article presentation during their rotation at the Breast Tumor Conference. Residents are also required to attend other morning interdisciplinary conferences.

Early rotations concentrate on mastering screening mammography. During the initial rotation, residents focus on appropriate work-up of the screening patient and detection of abnormal findings. Residents will learn to identify and document the presence or absence of an abnormality.

Residents will develop reporting skills incorporating the standardized reporting techniques following ACR and department guidelines.

Second and early third year rotations will concentrate on further deepening knowledge while improving proficiency. By the end of the first rotation, residents begin diagnostic work-up of patients, including becoming familiar with diagnostic mammography, breast ultrasound and advanced breast imaging studies. First rotation residents will be introduced to breast interventional procedures beginning with needle localizations.

During the second rotation, it is expected that residents will establish competence and confidence in handling diagnostic mammography and breast ultrasound. It is expected that residents will be able to scan an area of concern with ultrasound and effectively diagnose, document and report findings in both benign and suspicious cases.

Residents will progress during the second and third rotations in their ability to interact with patients, convey results and explain procedures while at the same time being able to answer patient questions and allay fears as appropriate. During these rotations, residents should begin to detect with more rapidity the presence or absence of an abnormality during interpretation of screening and diagnostic exams.

The learning of breast interventional procedures will be a phased process depending on the depth of study by the radiology resident. Mastery of needle localization procedures and stereotactic breast biopsy work is first. As residents progress during their rotations through mammography, they will gain supervised experience in all aspects of breast intervention including stereotactic, mammographic and ultrasound guided procedures.

By the third rotation it is expected that residents will be performing all aspects of breast imaging interpretation and intervention at senior level with diligence, competency and confidence. They will have the opportunity to observe if not perform breast MRI interventional procedures. This is an advanced technique that is part of the dedicated breast imager training.

As an independent academic medical center that functions as a highly integrated group practice, Lahey Hospital & Medical Center offers comprehensive multimodality cardiovascular imaging services to patients.

Residents learn cardiac postprocessing of functional and anatomic imaging (CT and MRI) from either key faculty or from the dedicated technologists in the 3-D lab who are also familiar with all required standard postprocessing. At the end of their first rotation, residents are expected to be familiar with the independent use of our dedicated cardiac CT and MR postprocessing software. Selected clinical cardiac MRI cases are also shown at the afternoon conferences and residents participate in these demonstrations.

Residents need to familiarize themselves with the basic physics principles of cardiac MRI. All related didactic material is covered in a weekly MRI physics lecture series held in the main radiology conference room.

Lahey Hospital & Medical Center has one of the largest Lung Cancer screening programs in the country. As a part of the Cardiothoracic rotation, residents will learn to interpret these studies.

Currently, body CT rotations encompass both abdominal and pulmonary/thoracic CT training. The day generally begins at 8:00 am and finishes at the discretion of the staff radiologist, generally at 5:00 pm. Residents are required to attend departmental noon conferences and all morning interdisciplinary conferences.

Earlier rotations concentrate on anatomy and emergent findings, while later rotations should concentrate on more advanced outpatient abnormalities, including oncologic evaluations, preoperative liver and kidney transplant evaluations, etc. Residents are expected to develop proficiency in protocolling all types of examinations.

ER Shift

ER shifts are designed to help first year residents gain invaluable experience and interpretation of ER cases prior to independent call. All residents will rotate through ultrasound, CT, abdomen, and neuro CT prior to starting the ER shift to be sure they have adequate exposure to the core radiology rotations.

Residents on the ER shift are expected to come into the department at noon to attend conference and start their rotation at 1:30 pm.

On this shift, residents primarily interpret CT scans from the ER, with occasional ER ultrasound and plain film examinations. Residents are responsible for primary interpretation and dictation and cases are immediately reviewed with attending radiologists, who are in-house until 9:00 pm.

In addition to being the first to recognize and interpret abnormal CT scans, residents will gain good insight into multitasking—answering the pager, dealing with logistics in terms of protocolling, coordination of examinations and communicating results to clinicians. Your ER rotation is the natural progression of a first-year radiology resident towards taking independent call, all the while being immediately supervised by attending radiologists.

Interventional Radiology (IR)

The subspecialty of interventional radiology at Lahey Hospital & Medical Center is a full-service discipline. It covers a broad range of procedures, ranging from vascular interventions and image-guided therapy for oncology patients to CT and ultrasound-guided biopsies and drainages. The resident is expected to be an active participant in all procedures, regardless of complexity.

Staff will continually assess interest, skill and knowledge and will allow increasing participation as experience is gained. In addition to involvement in interventional procedures, residents are expected to be involved in other aspects of patient care including pre-procedural consents and post-procedural orders and follow-ups.

MRI

The MRI rotation is divided into afternoon and morning sessions. The morning will be dedicated to the interpretation of musculoskeletal MRI cases.

During MRI afternoons, residents are expected to be involved in interpretation of all abdominal and pelvic examinations. Earlier rotations concentrate on upper abdominal anatomy and use of basic pulse sequences. Later rotations concentrate on pelvic examinations and complex studies (prostate imaging, etc.).

Lahey has one of the largest regional liver transplant centers in the region and one of the largest live-donor liver transplant centers in the U.S. As a result, residents will become extremely comfortable evaluating the cirrhotic and non-cirrhotic liver on MRI.

The morning generally begins at 8:00 AM and residents are expected to attend all noon conferences. The afternoon begins immediately after noon conference ends, and will finish at the discretion of the staff radiologist, generally at 5:00 PM. Residents are required to attend morning weekly interdisciplinary conferences unless they are excused.

Neuroradiology

The goal of residency training in neuroradiology is to train qualified residents who are well prepared to enter into private practice or fellowship positions. Progressive enhancement of knowledge and proficiency should be seen throughout the residency.

Residents will have approximately 12 weeks of neuro CT and 12 weeks of neuro MR. It is expected that residents will progressively develop their abilities to perform and interpret imaging studies of the central nervous system and head and neck.

Residents will be taught the skills necessary to interpret neuroradiologic CT and MR examinations including:

• Brain and skull
• Head and neck
• Spinal cord and vertebral column

They will be instructed in the performance and interpretation of invasive procedures including myelography/spinal canal puncture and imaged guided biopsies of the spine, skull base and neck. Residents will receive instruction in the science that underlies clinical neuroradiology—in particular neuroanatomy and neuropathology. They will learn the physical principles of CT and MR.

They will learn the relative value of each modality, enabling to them to choose the appropriate study and protocol for each patient. Residents participate in the performance of the full range of examinations done by the division. They will learn the indications and contra-indications for contrast administration and recognize and treat adverse reactions.

Residents will protocol and monitor CT and MR exams after they have demonstrated a sufficient level of knowledge and experience to perform these tasks. Residents will aid in the performance of invasive procedures including myelograms, lumbar punctures and other minimally invasive procedures, such as image guided vertebral, soft tissue neck and skull base biopsies. They will learn to explain these procedures to patients and their families, obtain pre-procedure consent and write pre- and post-procedure orders. They will learn to recognize and treat complications of these invasive procedures.

Residents will learn to dictate concise and appropriate radiographic reports and to serve as consultants to referring physicians.

The day begins at 8:00 am. and finishes at the discretion of the staff. Residents are expected to work side by side with staff, previewing and dictating examinations prior to review with staff.

Residents are expected to attend all noon conferences during their rotations. In addition, residents are expected to attend morning interdisciplinary conferences including ENT, Friday morning neurointerventional and ER, GI and GU conferences. Morning rotations on these days will begin immediately after the interdisciplinary conferences finish.

Nuclear Medicine

As per ACGME requirements, all residents are required to complete 16 weeks of training in nuclear medicine. We currently have all residents do one four-week block each year. Residents are expected to be active participants in the protocolling, interpretation and communication of results of all types of examinations, ranging from basic nuclear medicine to complex PET/CT, including myocardial perfusion PET scans.

Residents will be working with rotating Lahey cardiology fellows in interpretation of cardiac nuclear stress tests.

All residents are required to participate with staff in therapies involving oral administration of I-131.

Documentation of the resident’s participation must include the date, diagnosis and dose of each I-131 therapy. Residents are also required to have laboratory experience in nuclear medicine, and a checklist will be provided to ensure all residents are trained appropriately to receive full Authorized User status through the Nuclear Regulatory Commission.

Residents are expected to attend all morning interdisciplinary conferences. Residents in nuclear medicine are also in part responsible for running an interdisciplinary conference with the general internal medicine ward teams twice a week with supervision by radiology staff.

Pediatric Radiology

The pediatric radiology rotation is a 13-week rotation at the Boston Children’s Hospital Department of Radiology. The goal of residency training in pediatric radiology is to gain valuable exposure and insight into the nuances of pediatric radiology, allowing for a knowledge base appropriate to enter into private practice radiology or fellowship training.

Residents are exposed to an exceptional array of pediatric pathology during their time at Children’s Hospital. Residents will have a variety of one-week rotations, including but not limited to CT, ultrasound, neuroradiology, fluoroscopy, and plain films/STATS.

Residents will split overnight call duties with other rotating residents.

Ultrasound

The goal of residency training in ultrasound is to train qualified residents who are well prepared to enter into private practice or fellowship positions. The day generally begins at 8:00 am. and finishes at the discretion of the staff radiologist, generally 5:00 pm. The ultrasound rotation will encompass a variety of examinations, ranging from formal routine right-upper quadrant and pelvic examinations to complex postoperative renal and liver transplant examinations.

Residents will spend a progressive amount of time scanning patients, with earlier rotations concentrating more on image interpretation and later rotations concentrating more on image acquisition. While we do have ultrasound technologists on call, we feel that hands-on skills in ultrasound are very important to appropriate patient evaluation.

Women’s Imaging & OB Ultrasound

The goal of the women’s imaging and OB ultrasound rotation at Beverly Hospital is for residents to gain insight and direct experience in the evaluation of pregnant patients. Although residents are exposed to occasional first trimester pregnancies for both outpatient and ER evaluations, Lahey Hospital & Medical Center does not have its own obstetrical service, and all residents will rotate for one month at the Beverly Hospital.

Residents will observe obstetrical ultrasounds, including both normal and abnormal cases. Rotating residents will receive teaching from Beverly Hospital attendings and will be able to participate in noon conferences remotely.