Neuroradiology Fellowship at The Mount Sinai Medical Center

Director

Contact

Ms. Gifty Mensah
Tel: (212) 241-1497

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
Norman E. Leeds, M.D., F.A.C.R.
Author of approximately 180 publications in major journals and books
Past President of the American Society of Neuroradiology
Past President of the New York Roentgen Society
Areas of Interest: Brain tumors, MR spectroscopy, Alzheimer�s Disease

Neuroradiology Staff

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
Bradley N. Delman, M.D.
Assistant Professor of Radiology
Zelig R. Weinstein, M.D.
Assistant Clinical Professor of Radiology

Neurointerventional Staff

Aman Patel, M.D.
Associate Professor of Radiology
David M. Johnson, M.D.
Assistant Clinical Professor of Radiology

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 four full-time network coordinators who manage the GE PACS Centricity viewing stations, IDXRad scheduling/report system, and Web interface. Hospital equipment includes:

Magnetic Resonance Imaging: 8 scanners

(2) GE Signa Excite HDX (1.5T)
(2) GE Signa Excite 2 (1.5T)
(1) Siemens Sonata (1.5T)
(1) Siemens Allegra (3.0T)
(1) Siemens Avanto (1.5T)
(1) Br�ker research scanner (9.4T)

Computed Tomography: 7 scanners (additional 64-slice to be installed by April 2007)

(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
(2) 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: With Drs. Drayer, Naidich, Leeds, Sacher, Stollman, Delman, Law. This rotation is usually covered by two fellows, although only one is assigned when another fellow is on vacation/conference.
- 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
    - Angiograph
- 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
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 2005, the section produced:

CT: 12,550 cases: Head CT: 8,570; Spine CT: 1,500; ENT CT: 2,480
MRI: 12,310 cases: Brain MRI: 7,390; Spine MRI: 4,280; ENT MRI: 640
Angio-interventional: 570 cases: Diagnostic neuroangiography: 270; Neurointerventional: 260; Spinal interventional: 40
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:

Registration with NRMP opens   	                           March 21, 2007

Interviews Begin   	                                                April 2, 2007

Rank order list submission opens      	     May 23, 2007

Interviews end   	                                                June 2, 2007

          Rank order list deadline   	                                        June 20, 2007

          Match Day   	                                                             July 4, 2007

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.