Boston University Medical Campus
Radiology

V. Clinical Curriculum

The clinical curriculum complies with the Residency Review Committee (RRC) of the Accreditation of Graduate Medical Education (ACGME), follows the recommendations of the Association of Program Directors in Radiology (APDR), and fulfills the requirements of The American Board of Radiology (ABR).

Our residents learn in a resident-centered environment with a “hands-on” approach. We have few fellows. At BMC, most radiologic examinations are performed and interpreted by residents. During the typical workday, studies are previewed with the faculty and the final report is co-signed by the faculty radiologist. There is ample opportunity, especially during off-hours coverage in Emergency Radiology when residents have the primary responsibility for interpretation of all emergency and portable studies; they occasionally perform emergency fluoroscopy.

A supervising faculty radiologist is available in Emergency Radiology daily until 9:00 p.m. Faculty reviews all off-hours examinations either the next morning or later in the weekend day. If not discussed personally with the resident, faculty communicates via an e-mail system to provide residents with feedback. Subspecialty faculty radiologists are “on call” for telephone consultation and always come to the hospital for special procedures. The PACS system allows teleradiology image review with faculty, as needed.

During the first two months of training, new first-year residents attend a series of introductory lectures designed to augment their early clinical exposure. They are oriented to the medical center and are introduced to the practice of radiology. During the early months, first-year residents learn general radiographic interpretation, fluoroscopic techniques, and familiarize themselves with the vocabulary of Diagnostic Radiology. They are also exposed to the subspecialties of Body Imaging, Pediatric Radiology, and Neuroradiology.

Most clinical rotations are 4 weeks in length and occur at one of the primary training sites. On average, residents spend the majority of their time at BMC and rotate at the BVAMC for 1-2 blocks per year. Third-year residents attend the Armed Forces Institute of Pathology (AFIP) course in Diagnostic Radiology in Washington, D.C.

Through the principle of graded responsibility through repeated exposure, residents gain increasing responsibility throughout their residency, and graduate as mature, independent, skilled, and confident radiologists.

Given recent changes to the American Board of Radiology examinations, which will now include an initial certification examination at the beginning of the 4th year of residency, we are planning to modify the 4 year residency curriculum accordingly. The core rotations including general radiology, neuroradiology, nuclear medicine, interventional radiology, breast imaging, body CT, ultrasound and MRI will remain the same during the first 3 years of residency, with graded responsibility as the resident advances through their training. We plan to provide two months of study elective time immediately preceding the board examination. During the 4th year, we are tentatively planning on offering a three to four 3-month elective blocks in various rotations of the resident’s choosing, based on a lottery system. Final plans for the new format of the 4th year are tentative.

SAMPLE 4-YEAR ROTATION SCHEDULE

There are designated CT, MR, and US rotations at HAC and a Body Imaging (CT and US) rotation at ENC. There are 4 CT scanners, including three 64-slice scanners and one 16-slice scanner. Three of the four CT scanners are equipped with CT fluoroscopy for interventional procedures.

The CT rotation exposes residents to a wide variety of thoracic, gastrointestinal, and genitourinary diseases, as well as imaging of trauma. The Virtual Colonoscopy program has been expanded.

BMC has 4 high-performance 1.5T MR systems and a 3T research MR scanner. Body MR cases include abdominal and pelvic, cholangiopancreatography (MRCP), cardiac, angiography, and musculoskeletal including arthrography.

The US rotation provides training in performing and interpreting general abdominal, obstetrical, and gynecological studies.

Residents perform a variety of image-guided interventional procedures on both the CT and US rotations starting in the first-year, including tissue biopsy and abscess drainage procedures.

BREAST IMAGING:

Approximately 12,000 screening mammograms are performed annually at BMC. Diagnostic mammograms and breast ultrasounds bring the total to approximately 15,000 breast imaging procedures at BMC. Considering studies referred to BMC from outside clinics, approximately 18,000 cases are interpreted annually and are available to residents. The resident experience includes screening and diagnostic mammography, ultrasound, magnetic resonance imaging, needle localization, ductography, and core biopsy.

GENERAL RADIOLOGY:

At ENC, residents focus on performance and interpretation of barium gastrointestinal fluoroscopic studies and genitourinary studies. All procedures are recorded electronically for “soft copy” interpretation. Experience includes interpretation of plain radiography of the chest, abdomen, and skeleton.

At HAC, the general reading room is located within Emergency Radiology so that all ambulatory, inpatient, emergency, and trauma studies are interpreted by the general radiology section. Most studies involve the chest, abdomen, and musculoskeletal system. Patients present with a wide variety of acute and non-acute conditions.

NEURORADIOLOGY:

Residents experience the full spectrum of acute and non-acute central nervous system disorders. Modalities include CT, MR, as well as angiography and myelography in a high-volume clinical setting. ENC is a referral center for Neurology and Neurosurgery, particularly spine disease. HAC provides an intense exposure to trauma and emergent cases. Diffusion-weighted MRI is routine and MR spectroscopy is on-line.

NUCLEAR RADIOLOGY:

This section performs a wide variety of diagnostic imaging studies on adults and children. There are 4 state-of-the-art, dual-detector gamma cameras capable of whole-body imaging and tomographic (SPECT) imaging. Special features include: attenuation correction and gated SPECT for cardiac imaging and CT/MR/SPECT image fusion software. All nuclear images are acquired, processed, and reviewed digitally. Studies are accessible on the departmental PACS system, an important consideration for cross-correlation with other imaging modalities and useful for off-hours cases. Residents participate in radionuclide therapies, notably I-131 to treat hyperthyroidism and thyroid cancer. A combined PET/CT system is present at the Moakley Medical Services Building.

PEDIATRICS:

Pediatric Radiology is located at HAC. Experience includes radiography, fluoroscopy, CT, and US on a wide range of patients ranging in age from premature infants to young adults. Cases include emergency, acute, and trauma pediatric imaging.

VASCULAR/INTERVENTIONAL:

Residents participate “hands on” in a wide variety of procedures, and learn patient management and decision-making. Procedures include diagnostic angiography, angioplasty, stent and graft placement, GU, GI and biliary interventions, venous access, dialysis fistula management, TIPS, and uterine artery embolization. Emergency call provides residents with excellent trauma experience.

BOSTON VA MEDICAL CENTER (BVAMC) ROTATIONS

Currently, 5 residents rotate to the BVAMC during each block.

BVAMC GENERAL RADIOLOGY:

General Radiology includes plain films on inpatients and outpatients. Particular strengths include thoracic radiology, ICU radiology, and onco-radiology. Residents perform many fluoroscopic examinations on patients with complex pathologies.

BVAMC MUSCULOSKELETAL/ MR IMAGING:

This rotation is tailored to give a comprehensive overview of body MRI with an emphasis on the musculoskeletal system. A wide variety of MR studies from both VA campuses include chest, abdominal, MR angiography studies. The studies are supported by dedicated MR workstations and interpretation sessions with faculty.

A 3.0T, state-of-the-art, clinical MR unit installed at Jamaica Plain has been fully operational for 4 years. An additional 1.5T MR has been fully operational at the West Roxbury campus for over 3 years.

BVAMC CROSS-SECTIONAL IMAGING:

This rotation is broad-based and includes all organ systems imaged by CT and Ultrasound. A 64-slice CT scanner is in place at the Jamaica Plain campus and a 64-slice and 320-slice scanners are in use at the West Roxbury campus.  A wide variety of diagnostic examinations of the thorax, abdomen, extremities, vascular system, and head and neck are scanned each year. CT-guided interventional procedures include biopsies and drainages on both inpatients and outpatients. These studies are coordinated and performed by residents under direct supervision of the faculty radiologist.  Ultrasound includes a variety of abdominal, urological, and small parts US examinations, and a rich and varied exposure to vascular US with over 1,000 carotid duplex studies interpreted annually. Residents are encouraged to develop “hands on” scanning expertise.