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.

  1. 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:
      • Presentation of imaging at Neurosurgery work rounds (Tuesday/Thursday/Friday at 7am)
      • Interpretation of inpatient CT/MRI studies
      • Consultations for daily Neurology & Stroke team rounds
      • Coverage for inpatient consultations from 12:00-1:00pm while resident is at conference (may be cross-covered by Inpatient CT/MR Fellow #2)
    • 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
  2. 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
  3. 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
  4. 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
  5. 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
  1. Procedures:
    • Lumbar and cervical punctures
    • Myelography
    • Cisternography
    • Paraspinal biopsies
    • Disc-space aspirations
    • Spinal abscess drainage
    • Head & Neck tumor biopsies