Neuroradiology Fellowship at The Mount Sinai Medical Center

Director

Contact

Ms. Stephanie Morgan
Tel: (212) 241-1497
Fax: (212) 241-4323

Mailing Address

Department of Radiology
Box 1234
Mount Sinai Medical Center
One Gustave L. Levy Place
New York, NY 10029-6574

Appplication Process

Introduction

The Neuroradiology fellowship at Mount Sinai Medical Center is a post-residency program which exposes fellows to all aspects of contemporary neuroimaging. It is fully accredited by the ACGME. Fellows become firmly grounded in clinical neuroradiology and optimal patient care. In addition, the pursuit of original research is strongly encouraged, as is publication based upon this research. Graduating fellows are eligible to sit for the American Board of Radiology's Certificate of Added Qualification (CAQ) in Neuroradiology.

Mount Sinai Medical Center is a tertiary care center on the Upper East Side of Manhattan. It serves a large number of neurosurgical and neurological patients referred directly from the community, regional affiliates, and from clinicians throughout the country and abroad.

The Departments of Neurosurgery and Neurology also draw patients from across the nation and from other countries.

Neurologic research at Mount Sinai involves strong concentrations of stroke, Parkinson's Disease and related disorders, cortical anatomy and comparative neurobiology, aging and Alzheimer's Disease, and multiple sclerosis. There are four full-time neuropathologists who maintain extensive brain banks of dementia, AIDS, and comparative anatomy of primates. The Section of Neuropathology also serves as aresource to many New York area hospitals for brain cutting and neuropathologic analysis. There are strong positive interactions between neuroradiology and allied departments, affording fellows significant hands-on exposure in associated fields to provide a most complete understanding of neurologic processes.

An important goal of the fellowship is to train fellows in practical academic skills, including teaching in small group settings, formal lecturing, incremental participation in writing, optimization of patient throughput (without sacrificing quality). Therefore, in addition to interpreting neuroradiologic studies at a sophisticated level, it is expected that fellows will also be able to:

Organize and run a neuroradiology section
Plan and execute research projects
Prepare and present academic material at hospital, local, and national levels

Attending Radiologists

Senior Faculty

Burton P. Drayer, M.D., F.A.C.R.
Dr. Charles M. and Marilyn Newman Professor and
Chairman, Department of Radiology
Author of over 200 publications in major journals and books
Past President of the American Society of Neuroradiology
Editor of the Neuroimaging Clinics of North America
Areas of Interest: Aging, Multiple Sclerosis,
Metabolic Diseases, Brain Tumors
Thomas P. Naidich, M.D., F.A.C.R.
Professor of Radiology and Neurosurgery
Irving & Dorothy Regenstreif Research Professor of Neuroscience (Neuroimaging)
Vice Chair of Radiology, Academic Affairs
Chief, Section of Neuroradiology
Author of over 250 publications in major journals and books
Past Editor of Neuroradiology and International Journal of Neuroradiology
Areas of Interest: Neuroanatomy, Pediatric neuroradiology, Anatomic-pathologi correlation
Peter M. Som, M.D., F.A.C.R.
Professor of Radiology and Otolaryngology
Professor of Radiology, Otolaryngology and Radiation Oncology
Chief, Head & Neck Radiology
Author of over 350 publications in major journals and books
Past President and founding member American Society of Head & Neck Radiology
Editor of Head and Neck Imaging (4th edition in preparation)
Areas of Interest: Head & Neck Imaging

Neuroradiology Faculty

Bradley N. Delman, M.D.
Associate Professor of Radiology
Meng Law, M.D.
Associate Professor of Radiology and Neurosurgery
Michael Sacher, M.D.
Associate Professor of Radiology
Aryeh Stollman, M.D.
Assistant Clinical Professor of Radiology
Lawrence N. Tanenbaum, M.D.
Director of MRI, CT and Outpatient/Advanced Imaging Development
Associate Professor of Radiology

Neurointerventional Faculty

Aman Patel, M.D.
Director of Neurointerventional Service
Associate Professor of Radiology and Neurosurgery

Equipment

The hospital is furnished with state-of-the-art imaging equipment for both clinical and research applications. Time may be scheduled for research on both clinical and research scanners (depending upon availability). Since September 1997, cross-sectional imaging has been filmless. There are five full-time IT and network coordinators who manage the GE PACS Centricity viewing stations, IDXRad v10 integrated scheduling/report system, and Web interface. Hospital equipment includes:

Magnetic Resonance Imaging: 8 scanners

(1) GE Discovery 750 (3.0T)
(2) GE Signa Excite HDX (1.5T)
(1) GE Signa Excite 2 (1.5T)
(1) Siemens Sonata (1.5T)
(1) Siemens Allegra (3.0T)
(1) Siemens Avanto (1.5T)
(1) Bruker research scanner (9.4T)

Computed Tomography: 9 scanners

(1) GE Discovery CT 750 HD 64-slice
(1) GE Lightspeed HDXT 64-slice (located in the Emergency Department)
(1) Siemens Sensation Cardiac 64-slice
(2) Siemens Sensation 16-slice
(1) GE LightSpeed 8-slice
(1) Siemens Emotion 6-slice
(1) Siemens Sensation 4-slice
(1) Siemens VolumeZoom 4-slice

PET: 3 scanners

(1) GE DLS Discovery PET-CT (16-slice)
(2) GE PET Advance
(1) GE PET B512

Angiography: 1 dedicated neuro unit

(1) Philips Integris biplane neurointerventional suite

Also available (primarily for body interventional):

(3) Philips Integris monoplane angiography suites
(1) Philips BV300 C-arm procedure room

Fluoroscopy: 5 shared fluoroscopy stations

(4) Philips DSI fluoroscopy rooms
(1) GE Advantx fluoroscopy rooms

PACS network (GE Centricity):

(28) Departmental Reading Stations

Post-Processing Workstations:

(7) Siemens Leonardo/Wizard workstations
(1) TeraRecon server with clients on PACS reading stations
(2) TeraRecon Workstations
(3) Vital Images Vitrea 2 workstations

Clinical Experience

The Mount Sinai Neuroradiology fellowship is organized into four primary rotations: Angiography, ENT, and Inpatient CT/MR 1 and 2. Elective time in the second year provides for additional experience in such fields as pediatric neuroradiology, advanced physics, etc., as chosen by the fellows to meet specific goals or needs.

Inpatient CT/MRI: This rotation is usually covered by two fellows during the day, although only one may be assigned when necessary.
- Studies include:
  - CT/MRI of:
    - Brain
    - Cervical, thoracic & lumbar spine
    - Internal Auditory Canals
  - Other advanced modalities such as:
    - MR angiography (without and with gadolinium)
    - MR perfusion/diffusion
    - MR spectroscopy
    - MR CSF Flow studies
    - 3D surface imaging
    - Functional imaging
    - Cervical and Intracranial CT Angiography
- Responsibilities of Fellow #1:
- Responsibilities of Fellow #2:
  - Primarily interpretation of CT/MRI studies but other responsibilities will limit time spent on interpretation:
  - Study approval and inpatient neuroimaging coordination
  - Sedation H&P (primarily for pediatric patients)
  - Brain cutting (weekly)
  - Light microscopy (daily in early afternoon)
  - Journal Club preparation (for following Monday)
  - Teaching Files
  - Pathology report retrieval
  - CT Angiography monitoring and post-processing
- Late-shift Fellow:
  - Covers 3-11pm by rotation (not expected in hospital before 3pm)
  - Primarily interpretation of CT/MRI Studies
  - Study approval and inpatient neuroimaging coordination
  - Teaching Files
  - CT Angiography and CT/MR Perfusion monitoring and postprocessing
Outpatient (OP):
Responsibilities include monitoring of outpatient services and previewing and reviewing outpatient studies
- Studies include:
  - CT/MRI of:
    - Brain
    - Cervical, thoracic and lumbar spine
    - Internal Auditory Canals
  - Other advanced modalities such as:
    - MR angiography (without and with gadolinium)
    - MR perfusion/diffusion
    - MR spectroscopy
    - MR CSF Flow studies
    - 3D surface imaging
    - Functional imaging
    - Cervical and Intracranial CT
    - Angiography

Head and Neck (ENT): Under the direct supervision of Dr. Peter Som.
- Studies include:
  - CT/MRI of:
    - Temporal bones
    - Paranasal sinuses
    - Orbits
    - Neck
    - Temporomandibular joints
  - Other advanced modalities such as CT dentascan, nodal MR spectroscopy, MR
    sialography, etc.
  - Radiographs of the paranasal sinuses and facial bones
  - Modified barium swallows
- Responsibilities of the ENT fellow include
  - Performance of modified barium swallows with the speech pathologists
  - Interpretation of inpatient and outpatient CT/MRI studies with Dr. Som
  - Interpretation of outside consultation CT/MRI studies with Dr. Som
- The ENT fellow is also expected to
  - Prepare interesting cases from current ENT and recent CT/MRI rotations for presentation at Tuesday 8:30am case conference and Friday 8:30am case conference
  - Interpret outside neurosurgical imaging with supervision
Angiography: Primarily with and under the direct supervision of Dr. Aman Patel and Dr. David Johnson.
- Studies Include:
  - Diagnostic cerebral angiography
  - Aneurysm coiling
  - Embolization of tumors and AVMs with particles, coils and/or glue
  - Angioplasty
  - Carotid stenting
  - Balloon test occlusion
  - Wada testing
  - Petrosal sinus sampling
  - Spinal/paraspinal biopsies
  - Vertebroplasty & kyphoplasty
- Responsibilities of the Angio-interventional fellow include:
  - Pre-procedural evaluation of patients, including a brief H&P and a more detailed neurological exam
  - Tray preparation and patient preparation
  - Assistance with angiography and interventional procedures (to the level of a fellow's experience)
  - Brief post-procedural note, signing of orders
  - Optimizing patient turn-around time
  - Accompanying unstable patients back to Neurosurgical Intensive Care Unit (NSICU)
  - Periodic evaluation and discharge of ambulatory patients in the Special Procedures recovery area
  - Daily floor/ICU rounds on post-procedure patients
  - Ensuring hard copies are hung
  - Interpretation of hard copy films prior to dictation
  - Other responsibilities that may become necessary for optimal patient care
Education:

Primary presentation at biweekly interesting case conference
Coordination of rotating topics conferences on Wednesday afternoons
Brain cutting with neurology and neuropathology (weekly)
Light microscopy (daily in early afternoon)
Journal Club preparation (for following Monday)
Additions to the electronic teaching file
Pathology report retrieval

Procedures:

Lumbar and cervical punctures
Myelography
Cisternography
Paraspinal biopsies
Disc-space aspirations
Spinal abscess drainage
Head & Neck tumor biopsies

Caseload

The section of neuroradiology performs and interprets almost 26,000 cases per year. In 2008, the section is expected to produce:

CT: 14,530 cases
Head CT: 9,920
Spine CT: 1,735
ENT CT: 2,875

MRI: 14,250 cases
Brain MRI: 8,555
Spine MRI: 4,955
ENT MRI: 740

Angio-interventional: 680 cases
Diagnostic neuroangiography: 325
Neurointerventional: 310
Spinal interventional: 45

Myelography: 85 cases

Miscellaneous: approximately 250 cases
Includes paraspinal abscess drainages, CT and fluoroscopic localizations, lumbar punctures under fluoroscopic visualization, sinus radiographs. Other section (Emergency & Musculoskeletal) interpret the majority of the radiographs of skull and spine.

Application Process

Physicians who have completed a residency in General Radiology are invited to apply. The National Residency Match Program (202-862-6077) will coordinate the assignments for neuroradiology fellowships starting with the July 2002-June 2003 academic year. A universal fellowship application is available from the Association of Program Directors in Radiology.

The NRMP timeline for applicants entering in July 2008 is:

Action Date

Registration with NRMP opens March 4, 2009

Interviews Begin February 23, 2009

Rank order list submission opens May 13, 2009

Interviews end May 23, 2009

Rank order list deadline June 10, 2009

Match Day June 24, 2009

To apply, please forward universal application, CV, 3 letters of reference (including one from program director) and personal statement.

Fellows in New York State must obtain a full license to practice medicine from the New York State Education Department.