Musculoskeletal Radiology Fellowship Rotations

Our goals for the division include:

  • Providing excellent patient care and timely service to our referring clinicians.
  • Fostering a service-oriented atmosphere in our reading rooms as well as in our personal interactions with referring clinicians, imaging technologists and radiology colleagues.
  • Providing efficient image interpretation such that we add value to the patient’s workup. 
  • Learning from each other and remembering that we’re all teachers as we interact with residents, medical students and clinicians daily.

Our specific goals for your fellowship are that by the end of the year:

  • You will have seen enough cases that you feel comfortable interpreting radiographs, CT and MRI studies involving the musculoskeletal system, and that you will also feel competent to perform basic musculoskeletal ultrasound examinations. 
  • You will feel comfortable performing a wide range of image-guided musculoskeletal procedures, including arthrography, bone and soft tissue biopsies, and a variety of pain control injections.
  • You will feel comfortable operating independently in all areas of our practice, including the interpretation of emergency radiology studies, having been given graded responsibilities as the year progressed. 
  • You will compose and deliver one case conference to the members of the MSK Division and Radiology residents. 
  • You will complete at least one research project during the year.  This includes submission of at least one manuscript for attempted publication.  If timing allows, you will have had the opportunity to present your work at a meeting.

Job Description

Clinical Duties

Our division covers all musculoskeletal imaging studies performed at Hospital and Tilley Drive (Orthopedic outpatient). Fellows will rotate among 3-6 tracks as the service evolves.

  1. UVM Medical Center–  MSK MRI
  2. UVM Medical Center – Radiographs
  3. UVM Medical Center – CT/US/Proc
  4. Tilley -  MSK MRI
  5. Tilley - Radiographs
  6. Tilley -  CT/US/Proc

MR Rotation

Duties: 

  • Consultant for clinicians and radiology colleagues re: MSK imaging studies
  • Interpretation of: MSK MR studies
  • Prepare and present radiology portion of weekly sarcoma conference beginning around mid-year.  MSK attending will be present.

Daily Work:

Consultant:  The fellow assigned to this rotation functions as the primary  consultant for ED and inpatient clinicians with questions regarding MSK cross-sectional imaging studies, and except in extreme circumstances, the clinician should receive a, “Hi, can I help you?” within 30 seconds of entering the room, and the fellow will provide as much help as possible until the clinician’s concerns have been addressed.

In general, the fellow should be present in the reading room as much as possible and accessible via pager when not physically in the room. (Name and pager # should be written on the whiteboard each day).

Cross-Sectional Imaging Studies: The fellow should arrive in the reading room by 8:00 A.M. and organize all cross-sectional MSK studies that accumulated overnight. Generally, this fellow should focus on ED and Inpatient cross-sectional studies followed by outpatient studies (sort by "reading priority").  Reports should be pre-dictated. 

Use the MSK HP or “high priority” protocol worklist in Epic to protocol your studies.  These are inpatients, ED patients, and pending outpatients without protocols.  Please check this protocol worklist intermittently throughout the day. This will limit tech calls to the reading room for protocols, improving efficiency for all. Keep the HP list empty. 

Before leaving for the day, the fellow should check the MSK MR CT worklist in Epic to see if there are any remaining ED or inpatient studies that need to be interpreted.  Ideally, all high priority studies will be read prior to going home.

They should also check Epic for HP studies to be protocoled.

Plain Films:  The fellow should assist with the interpretation and dictation of radiographs in the MSK reading room whenever the cross-sectional volumes allow.

CT/US/Procedure Rotation:

Duties:

  • Interpret CTs and US’s and perform procedures. Sort by "reading priority" and read from the top.
  • Participate in the ultrasound clinic, which will include US guided procedures and diagnostic work. Work closely with Lori for approval of US procedures.
  • Organize and perform all image-guided MSK procedures and diagnostic ultrasound exams. For procedures, this includes consent, Epic pre-sedation notes when necessary, and procedure-related orders
  • Assist where needed as determined by the workload and attending the service.

Daily Work:

CT interpretation: The fellow assigned to this rotation is responsible for the interpretation of CT’s in conjunction with the resident(s) assigned to the MSK service. The workload will be divided between the resident(s) and fellow in a manner commensurate with their levels of experience.

Use the MSK CT/US worklist and sort by reading priority. Focus on inpatients and ED patients, then work on outpatients. Use reading priority to triage your reading from the Epic worklist.  Ideally, all high priority studies will be read prior to going home.

Make some effort to leave the highest priority studies for the first year resident; however, if the resident is at a conference or there are many high priority studies, please jump on these.

MSK Procedures: Typical procedures performed include CT, US or fluoroscopically guided pain procedures, and other percutaneous procedures.

The fellow is responsible for checking with ultrasound and fluoroscopy each afternoon to determine which procedures are scheduled for the following day.

Ultrasound: This rotation will evolve as the US clinic evolves. Presently, US consists of a combination of US exams and procedures performed at the hospital. 

Radiograph Rotation

Duties:

  • Interpret radiographs
  • Serve as a backup consultant to the resident for clinicians in the reading room. 

Daily Work:  

  • Radiograph Interpretation: The fellow should arrive no later than 8am and preview and triage your readings by reading priority. This rotation will consist of supervised and non-supervised work depending on whether the fellow is credentialed for non-supervised work.
  • Protocolling: First thing in the morning, the fellow needs to protocol all cross-sectional studies. The lists should be checked again midday and at the end of the day for potential add-ons.  We protocol 2 weeks in advance to facilitate pre-authorization and any potential new orders that might be needed. 

Call Duties: Clinical Instructors Only

General: Each fellow will be given a pager and will be on call, typically on a weekly basis. The fellow will be assigned to either the general or cross-sectional call pools, commensurate with their percentage of attending FTE.

If the fellow is called by a resident for assistance with any clinical issue, the fellow should provide the necessary support for the resident. 

If the procedure is on a pediatric patient, the clinical team must arrange for anesthesia or the pediatric sedation team to handle the patient sedation.

Academic and Educational Opportunities

Teaching

Each fellow will provide interactive teaching at the view box with the residents and medical students throughout the day. 

Conferences

  • Rheumatology Conference – Case-based conference correlating imaging and clinical findings in rheumatology patients.
  • Sarcoma Conference- This case-based conference integrates imaging and pathologic findings with clinical treatment planning. The Hospital 2 Fellow covers this conference.  The list of cases is usually e-mailed to the MSK Division by Monday of that week and usually includes non-musculoskeletal sarcomas as well. Early in the year, the hospital attending will accompany the fellow to the conference. 
  • Academic Time/Research: Each fellow is expected to complete at least one project over the course of the year for publication. Initial projects will be selected/assigned at the July research meeting. If a project is presented by a fellow at a national meeting, the fellow must have written up and submitted the final manuscript in order to be reimbursed for travel expenses. Usually, the only possibilities are the SSR meeting in March and the ARRS meeting in May due to the timing of deadlines relative to the fellow academic year.
  • Arthroscopy: Each fellow will spend one-day observing arthroscopic procedures with the Sports Medicine team during the second half of the year.

Vacation

Guidelines:  Each fellow is allotted twenty-two days of vacation per year plus additional days at Winter Break and Holidays. All requests go through the fellowship director. We ask that you follow these guidelines:

  1.  Use at least half of your vacation days prior to January 1.  As the year progresses, it becomes more difficult for everyone to get the days off they desire if these have been allowed to accumulate. 
  2. Only one fellow will be off at any time (except for extremely extenuating circumstances). This will generally be on a first come, first served basis, so please plan ahead. You can negotiate with your colleagues if there is a conflict.  Extenuating circumstances may be discussed with the Fellowship Director and Division Director.
  3. Vacation may not be taken during the last week of the fellowship. 

Procedure for Requesting Time Off:

  1. E-mail your request for time off to the fellowship director.
  2. The director will need to approve it before it is placed on the division’s calendar. 
  3. You will then receive confirmation via e-mail once it has been approved.
  4. Holidays: University holidays typically include July 4, Labor Day, Thanksgiving, Christmas (3 or 4 days, weekend plus holiday), New Years (3 or 4 days,  weekend plus holiday), and Memorial Day.

Evaluation

Fellows will receive quarterly evaluations, including a midyear and end of year evaluation as well as feedback on as needed/desired basis.