Thoraco-Abdominal Radiology Fellowship

Now Accepting Applications for 2010 and 2011

GOAL 

The goal of the fellowship is to provide advanced training in cross-sectional imaging of the chest and abdomen and pelvis.  Training is in adult and pediatric CT scanning, abdominal and obstetrical ultrasound and MR imaging.  Extensive experience will be gained in interventional procedures, such as CT- and ultrasound-guided biopsies, abscess drainages and if desired, fluoroscopically-guided GI tract interventions.

The attending faculty of the Thoracoabdominal Division emphasize to our housestaff that referring clinicians are our valued customers and that patient care is our primary mission as physicians.  We also believe that the months spent on every rotation should be pleasurable and educationally challenging.

TEACHING STAFF

• William Brant, M.D. - Professor, Division Director ThoracoAbdominal
• Gia DeAngelis, M.D. - Assoc. Professor; TA Division; Medical Director ED; Fellowship Director
• Eduard de Lange, M.D. - Professor; TA Division
• Spencer Gay, M.D. - Professor; TA Division; Medical Director CT
• Marc Sarti, M.D. - Asst. Professor ; TA Division
• Bruce J. Hillman, M.D. - Professor; TA Division 
• Christopher Kramer, M.D. - Assoc. Professor; Angiography Division 
• Drew Lambert, M.D. - Asst. Professor; Medical Director GI
• Ruth Moran, M.D. - Asst. Professor; Medical Director US
• Juan Olazagasti, M.D. - Asst. Professor; Medical Director Chest
• Hubert Shaffer, M.D. - TA Division;  Medical Director GI
• Brian Williamson, M.D. - Professor; TA Division and Nuclear Medicine
• Patrick Norton, M.D. - Asst. Professor; TA and Cardiac/ Angiography Division 
• Klaus Hagspiel, M.D. - Asst. Professor; Cardiac/Angiography Division 

ROTATIONS

The fellows rotate in 4 main areas: procedures (most are CT and ultrasound procedures), diagnostic CT, and diagnostic US and MRI. Rotations are usually on a 1 week cycle.  A month of Cardiovascular Imaging through the division of Angiography is included and an additional month of elective outside of Thoracoabdominal can be worked into the schedule.

RESPONSIBILITIES

The fellow is responsible for completion of the clinical schedule in the area they are assigned.  Their responsibilities include monitoring of the patient schedule to allow efficient patient throughput and providing early reports to the referring physicians when necessary.  In addition, when the schedule allows, the fellow may choose to participate in interventional fluoroscopic procedures if desired. 

Responsibilities of day shift: The daytime resident, fellow and attending on CT, US, and MRI will read-out all studies completed prior to 4:30 p.m. on weekdays (the exception is portable US cases where there is a significant lag time in when those exams arrive in order to be read). It is strongly recommended that the day attending / fellow check with the technical staff before 1630 hours as they may not always efficient at getting the RIMS requests into the reading room. 

Responsibilities of the interventional shift: The Interventional rotation starts at 10am because of typical add-on of interventional cases. The attending / fellow reviews with the late resident for those cases performed between 4:30 and 7pm. If possible, the Interventional Attending should also periodically check in to both the US and CT reading rooms throughout the day and at 1630 hours, to provide active relief for the day shift staff.

One of the residents doing the CT or US rotation will rotate being the late resident until 7pm. The upper level night on-call resident is responsible for all Ultrasound, Body CT and Teleradiology studies ongoing or requested after 7 p.m. The night resident will be available in the Department from 7 p.m. until checkout the following morning.  The on-call fellow and attending radiologist are on pager to back-up the night resident.

We give immediate reporting of cases done throughout the day using a voice recognition system.  For significant unexpected findings, the requesting physician or his or her nurse should be contacted directly.  Reports should be dictated and signed expeditiously.

The department has a PACS system in place. All cross-sectional imaging is interpreted on high-resolution monitors. Prior studies are immediately or near immediately available. Images for teaching films or conferences are easily transferable to one's networked folders and to a designate PACS Teaching File.

Body CT:  There are three helical scanners (one Picker PQ 6000 (to be upgraded to a 64 slice this year) and 2 GE 16 slice scanners (one GE 16Pro with Fluoro capability and one GE 16 Lightspeed).

Pro multidetector Lightspeeds (8 slice and 16 slice) in the University Hospital.  The CT scanners at Fontaine are two GE 16 slice Lightspeed and a GE 8 slice Ultra. Fellow is assigned to Fontaine (higher caseload) or to the hospital. At the hospital, the fellow on Body CT functions as the primary CT consultant with close attending backup.  The clinical day begins at 8.00 a.m. with night case checkout.  The cases for the day should be clearly protocoled (write a plan for each case on the request), preferably the evening prior. Technologists will be preparing the patients for the exams and injecting contrast where needed.  A physician must be in the CT area during injection of intravenous contrast.

The dictation of cases is shared between the resident on the CT service and the fellow.

All fellows are asked to contribute cases to the Drainage Conference (last Friday of the month, noon in the Radiology Library).

Ultrasound:  There are 5 ultrasound examination rooms, two of which are also used as interventional rooms.  Equipment consists of 4 ATL Phillips 5000 sonoCT, one Phillips IU 22, one Acuson Sequoia, and one Sonosite. Additional units (IU 22 Phillips) are at Fontaine. The average number of cases per day is around 60. Cases also include those done off-site at the Imaging Center at Fontaine.

The fellow will be expected to rapidly develop the ability to perform most ultrasound exams including abdominal, pelvic, vascular, and obstetrical exams and to develop proficiency in ultrasound guided intervention.  Carotid ultrasound experience can be gained in the surgical vascular lab at selective times if requested.

The day begins at 8 a.m.  Check-out of the 1590 night resident (CT/US) ultrasound cases is usually performed by the ultrasound attending, but the fellow may be asked to assume this responsibility if the attending is unavailable.  The Ultrasound fellow generally participates in the ultrasound interventional procedures performed before 10:00 a.m.  Interventional ultrasound cases after 10:00 a.m. may also be performed by the diagnostic ultrasound staff if the procedure team is tied up in a CT case. 

Because ultrasound is a high volume area, it is essential that the schedule run efficiently and that reporting and dictation are current.  Approximately half of the cases are scheduled outpatients, and the rest are generally add-on outpatients, emergency room, and hospitalized patients.  Some cases are also received from the Imaging Center (Fontaine), Northridge, the Kidney Center, and a few from various remote hospitals with whom UVA has a contract via Teleradiology.  It is the fellow's responsibility to make sure the schedule runs smoothly and to prioritize cases with the help of the lead technologist and the attending radiologist, when necessary.

The ultrasound fellow or attending is responsible for preparing and presenting the Gynecology Oncology Tumor Board (Wed 4pm in the Cancer Center 4^th floor conference room).

Procedures:  Procedures week is a later shift and runs between 10am and 7pm. The attending on procedures is also the attending on call. The fellow may or may not be on call. An attending and either a fellow and / or resident are paired during this week.

The number of interventional cases is variable and may be as high as 15 in one day. Interventional procedures such as these should not proceed without the attending radiologist being present unless other arrangements have been made.  Requests for interventional cases go through the fellow or attending for approval.  If the case is not to be performed that day, the fellow may want to fill out the "Request for CT/US/Fluoro Interventional Procedure" form and follow the procedure listed in the interventional guideline books, which are located in CT and US). Gene Demsky, RN, is invaluable in scheduling and coordinating both outpatient and emergent cases. The fellow is also an important link to the referring physicians and should help coordinate scheduling interventional procedures and following up with results.  Interventional cases may require coordination with nursing and cytology.  Patient history, lab values, and any pertinent imaging studies must be reviewed.  Optimally the majority of the scheduled out-patients should be reviewed. Occasionally an outpatient should receive a follow-up call at home in the evening after a procedure.

Interventional cases require coordination with our nursing is sedation is required. Cytology should be notified prior to cases that require it. Cases may also rarely require coordination with fluoroscopy.

Cardiac and Vascular CT / MRI: A separate cardiovascular rotation is included in MRI training. Studies are performed under supervision of Drs. Chris Kramer, Klaus Hasgspiel and Patrick Norton. Interpretation is done in the Cardiovascular Lab in the Division of Angiography. MR angiography studies include evaluation of primary vascular disease such as aortic aneurysm, dissections, renal artery. Fellows will attend the lectures related to Cardiac Imaging and attend the Cardiac MRI physics and case review .

We are pursuing a dedicated 3D lab by the end of the year. It will contain Advantage Windows Workstations (GE), Leonardo's (Siemens), Terrarecon workstations, and a Viatronics workstation. In addition Charles Stanley (Imaging Manager CT, MRI, 3D Lab) and Gary Hartwell (Physics) are working with Siemens to develop a distibuted thin client model for their Leonardo applications; when developed, it will capable of doing server-based 3D and high end data processing.

By the end of this year, a Siemens Open Scanner and a Siemens Definition is planned. The Definition is a 64 slice Dual Tube system will be used for extremely high end cardiac work including acute chest pain work ups and plague characterization.

Magnetic Resonance Imaging:  University - three 1.5 Tesla MRI Siemens (one Avanto, one Sonata, one Vision. The 1.5 Vision at the hospital is to be replaced by a 3.0 Trio Siemens this year.  Fontaine - three 1.5 T Siemens (two Symphony, one Avanto) and an Open Field 0.7T Hitachi (to be replaced by a 1.5T Siemens Espree). We also have a 1.5T Avanto Research Scanner. In principle, all exams are scheduled in 45-minute slots and are performed by standard protocols. The Body MRI cases performed at the Imaging Center are available on PACS and to be read by the MRI fellow. The scanners operate regularly during weekdays and weekends. A research 1.5 Tesla MRI Siemens Vision scanner is located in the MR4 building near the hospital.  Most MRI cases involve liver, biliary, pancreatic and gynecologic oncology cases.

Breast MRI cases for the assessment of possible cancer and MRI guided needle localizations may be performed either on the clinical or research magnet depending on the research status of the case.  These studies are done by mammography but the abdominal fellow is welcome to be involved.

Although there are standardized protocols for most types of Body MR studies, it is important that the fellow review and protocol requests for studies on the day before the patients are imaged.  The attending radiologist is consulted when necessary.  For adequate planning of the exam, it is important that the fellow be aware of the clinical question; he/she may need to contact the referring clinician or the Clinical Archive System to get all necessary information.  Since there is a great demand for MRI studies, the schedule is tight and delays need to be avoided as much as possible.  It is, therefore, extremely important that the fellow responds immediately when paged by the MRI technologist if there are any problems or questions about the study. 

When the schedule is full, any cases that are added on during the day will go on the standby list, and these will be done in slots that may open up due to cancellations.  Many add-on cases are done late in the evening and, when necessary, the fellow on-call may have to supervise these cases or discuss with the on-call in-house resident although this is rarely needed.  The fellow assigned to Body MRI needs to inform the on-call fellow of any studies that are scheduled or expected to be performed in the evening or weekend. Furthermore, the fellow covering the weekend needs to check for any in-patient studies that are performed Friday night or over the weekend and review those cases with the weekend on-call attending. If exams are added on in the evening, the technologist may call the fellow on call for a protocol up 10pm and after that only if it is definite that the patient will be imaged (unless you make other telephone or paging arrangements).

The fellows are expected to acquire a thorough knowledge of MR physics.  Physics lectures are informally arranged by John Mugler, Ph.D.  and Jim Brookeman.

Musculoskeletal MRI: These exams are performed and interpreted through the Musculoskeletal Division and majority of these cases are performed at the UVa Musculoskeletal Center at Fontaine. If desired, a fellow may be able to rotate there for 2 - 4 weeks. If there is any time outside this formalized period in the schedule, they are always welcomed by the MSK Division to participate in the reviews of the MRI cases at Fontaine.

CONFERENCES:

Fellows prepare and present along with the Radiology attendings:

1. GI Tumor Board on Thursday 7 - 8am. Cancer Center Conference room. MRI Fellow will be assigned first.
2. Chest Tumor conference on Tuesdays 11-2. Cancer Center Conference room. Ultrasound Fellow will be assigned first. Review cases with chest attending the afternoon before.
3. Gyn Tumor Board on Wednesdays 4pm (usually covered by an attending and / or fellow). Cancer Center Conference Room. This has variable participation.
4. 1:00 Resident lectures related to Cardiac Imaging.
5. 1:00 Resident lectures related to Thoracoabdominal Imaging (not required but encouraged - attendings are to cover the respective services).
6. Cardiac physics and interesting case conference. Last Wednesday of the month. 12:00. Camp Heart. (4^th Floor New Hospital).
7. Drainage Conference: last Friday at noon each month. Fellows and attendings present informative Interventional cases.

TEACHING AND FORMAL LEARNING

The fellows are expected to teach the radiology residents and medical students who rotate through their areas on a daily basis.

Fellows can to attend the 1:00 p.m. residents' conference if the conference is related to thoracoabdominal imaging. The attending on that service is to be consulted during that time instead of the fellow or resident.

Each fellow is required to give 2-3 pre-scheduled 1:00 p.m. residents' conferences per year involving any or all of the three imaging modalities: US, CT, and Body MRI.  Fellows can easily obtain the images from PACS and use the Power Point computer software. There are high-speed networked computers everywhere in the department. Additional computers are provided in the Department of Radiology's Multimedia Room.

Fellows are encouraged to prepare and submit a scientific paper or exhibit for a national or regional meeting.  A project should be chosen that can be completed within the fellowship year.  Time away and reimbursement for one meeting are provided if the fellow is presenting an exhibit or paper in accordance with the departmental policy.

Teaching files: Personal teaching file cases will be stored using an electronic format rather than copy film.  Contributions to an electronic Teaching File can be made directly to the PACS teaching file during regular usage of the Mediprime computers.

CALL

Weekday call is M-Friday CT/US/MRI / interventional call and Weekend Call is either plain film (primarily chest) read-outs or CT/US/MRI / interventional call. The total call assignments work out to 1/4. The call is also distributed between interventional and chest readout call among attendings; occasionally the attending does not have a Fellow also assigned.

If assigned to the weekend chest readout call, you read primarily the unit films off a PACS based system. When done, your responsibilities end as there is no pager call.

If assigned to the CT, US and MRI / interventional call, you are available outside the hospital on your pagers during that week or weekend to back up the night or on-call resident.  The CT/US night resident will do any CT and US interventional cases on weekdays after 7 p.m. The on-call resident on Saturdays, Sundays, and holidays will be in-house to perform CT and US diagnostic studies.  The on-call fellow will be the back-up for the CT/US resident and will be the first call for interventional procedures and MRI studies. Studies that are done on-call outside the regular hours will be checked out with the attending radiologist the following morning.

When interventional procedures are requested outside regular hours, the on-call resident (beeper # 1590) will notify the fellow on call. The fellow will inform the on-call attending radiologist prior to performing any interventional procedure.  For drain placements, the attending will be present during the procedure.  Resident cases performed over the weekend will be checked out daily with the attending at 8:00 a.m. The fellows are required to be involved with the procedural nurse in monitoring all CT/US-placed drainage catheters every day (where necessary), including the weekends. This may involve the fellow working with the procedural nurse in looking at follow-up studies, deciding when a drain is to be pulled, communicating with the housestaff about the status of those drains and seeing the patient on the floor when necessary.

As the year progresses, the fellows may check out the resident as an instructor (attending).

EVALUATION

The fellows are evaluated monthly by the attending radiologists of the section where they are assigned.  The fellows will meet during the year with the Fellowship Director to discuss their performance based on their evaluations.  Ongoing informal evaluations during the rotation should be made as appropriate.

VACATION

The fellows have 22 working days vacation. Additional days are worked into the schedule during New Year's/Christmas holiday. Extra days are added when taking call during designated hospital holidays. Approval from the person who writes the division clinical schedules needs to be obtained (at this time, request via email). If requested on short notice, vacation should be approved by the medical director of the section where the fellow is assigned for the period s/he wishes to be absent. No more than one fellow can be absent on vacation or at a meeting at the same time (unless special arrangements are made), including the last week of June.

MEETING GUIDELINES FOR FELLOWS / INSTRUCTOR LEVEL 1

Some meeting expenses are provided for first-year fellows/Instructor Level I for presentation of a paper or a poster (for work done primarily at the University of Virginia), or a refresher course/workshop at a major national meeting.

SICK LEAVE AND MATERNAL POLICY

Sick leave or maternity leave for first-year Fellows or Instructor Level I will follow the guidelines as outlined by the Housestaff Leave Policy for the University of Virginia Hospitals.

PROMOTION TO INSTRUCTOR

As close to beginning the fellowship as possible, the fellows will be promoted to the status of Instructor in the Department of Radiology.  Although Instructors have more independence, authority and responsibility than fellows, the change to Instructor is not intended to significantly affect the teaching, guidance, and instruction that one will receive from our faculty during the fellowship training.

Additional responsibilities as Instructor include more independence to read-out cases without over-reading every case by an attending radiologist.  However, in cases where the Instructor feels uncomfortable with interpretation, there will always be a backup attending for consultation, when needed.  Functioning as Instructor enhances a fellow's training by providing the opportunity to interpret cases independently.  An attending will supervise but not necessarily review all activities.

With instructorship status, the fellows are all faculty members who can read independently. Under HCFA rules, if a fellow reads a case or performs a procedure independently, s/he must sign the written report independently without the countersignature of another attending radiologist.

Fringe benefits for Instructors include a retirement fund called TIAA-CREF.  The amount paid in annually by the department is 10.4 % of the Instructor's salary.  When the person leaves, three options are available: (1) maintain the TIAA-CREF account and use it as a retirement fund; (2) roll these funds into another retirement fund; or (3) redeem the funds, incurring income taxes and a penalty (20%).

As an Instructor, the fellow will receive a life insurance policy to cover accidental death in the amount of twice the total salary.  Disability insurance in the amount of 66% of salary will also be provided.  Malpractice insurance is the same as that for the attending staff and is covered through Piedmont Liability Trust.  Health insurance is provided through Southern Health under the same conditions as for the other Faculty.

Qualification

Applicants must be American Board of Radiology eligible (or equivalent) with good recommendations.  A personal interview is required.

If you are interested in applying please send:

1. Application Form
2. CV
3. Personal statement
4. 3 current letters of recommendation
5. 2 X 2 photograph
6. ECFMG certification (if applicable)
7. Copies of USMLE steps 1 -3

Please mail all completed applications to the address below.

Inquires 

Send completed form or
for further information contact:

Christina Melton
Department of Radiology
P. O. Box 800170
University of Virginia Health Sciences Center
Charlottesville, VA 22908-0170

Phone:  (434) 924-9484
FAX:  (434) 924-9515
E-mail:  cfm9c@virginia.edu

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