As a large tertiary referral center, our fellows have unique exposure to a wide range of pathology from a diverse patient population. Fellows are involved in advanced brain tumor imaging, complex head and neck cases, and varied spine pathology on a daily basis in the reading room. .
In addition regular close supervision by the neuroradiology staff during daily read out sessions, the fellow attend neuroradiology conferences for residents and fellows weekly. Brief, focused personal one-to-one discussions, called Mini-Didactics, are utilized daily, and there is a running list of topics to ensure that the full scope of the curriculum is covered over the course of the year. The fellow has weekly reading assignments as well, with the ultimate goal of having gone through at least two neuroradiology texts.
Attendance at multidisciplinary conferences is an important part of the fellowship and of neuroradiology training in general. In these conferences, the fellow gains experience and skills in consultation and presentation necessary to become an expert consultant within the neuroradiology subspecialty. There are two weekly Head and Neck conferences, and a Neuro-oncology conference; the fellow prepares for these conferences by reviewing the cases with staff, and attends the conferences with the staff present. Additional conferences include Neurovascular, Neurology Grand Rounds, and Neurology teaching conferences.
The fellow is required to attend a national neuroradiology meeting, and funding is provided. Fellows in the past have had oral presentations and posters in the American Society of Neuroradiology and the American Society for Functional Neuroradiology.
Specific areas of training include:
Fellows participate in all functional MRI examinations. The fellow will learn how to assess patients for fMRIs, as well as perform and process fMRIs. Diffusion tractography is included in all pre-operative evaluations and the fellow will gain the knowledge to process and interpret these examinations. These are primaril done for pre-operative planning for brain tumor resections at LUMC, however, there is a growing practice in pre-operative evaluation for functional neurosurgery .
There is a wide range of pathology exposure at LUMC. New brain tumor diagnoses, degenerative disease, demyelinating, infectious and post-treatment exams are encountered daily. Up-to-date stroke imaging with perfusion and the collaborative efforts of the neurology and neurointerventional services make the neuroradiologist a key element in facilitating appropriate care. The fellow will be very comfortable with all aspects of neurovascular imaging given the high volumes at LUMC.
Head and Neck
From salivary duct stones to advanced head and neck cancers, the fellow gains a broad exposure to reading neck CTs and MRIs. The otolaryngology department at LUMC includes leading specialists in all areas of otolaryngology, and active colloboration with neuroradiology. Fellows are taught to approach different neck pathologies, and how to appropriately relay the information for swift and accurate treatment decisions. The fellow will be comfortable radiologically staging primary tumors, and assessing for disease recurrence on complex post-operative neck exams. This education is supplemented by attending the weekly Head and Neck Tumor Boards, during which treatment decisions are actively discussed.
The fellow will be exposed to non-accidental trauma, all types of congenital malformations of the brain, head, neck and spine, as well as neonatal intracranial ultrasounds and fetal MRIs. Pediatric tumors and infections are covered in great detail. The fellow will be comfortable in assessing normal brain development.
From trauma to degenerative disease, post-operative spine cases to metastases, there is extensive exposure to spine imaging. Fellows will be able to comfortably approach any and all types of spine cases upon completion of fellowship training.
In addition to extensive exposure to CTAs and MRAs, the fellow will assist in at least 50 diagnostic angiograms. While most neuroradiologists may not be performing angiography in their practices, we feel it is important to learn about techniques, variant anatomy, and the different stents and embolization methods to become an truly skilled CTA and MRA reader.