Years 1-3: Clinical Rotations
Residents are typically assigned in two- to four-week blocks to one of the following subspecialty areas of radiology:
- Thoracic radiology, including radiographs, CT and MR
- Thoracic procedures
- GI fluoroscopy / US
- Gastrointestinal / Genitourinary CT, MR
- Ultrasound, including obstetric ultrasound
- Neuroradiology, including CT and MR
- Musculoskeletal radiology, including CT, MR and US
- Musculoskeletal procedures
- Nuclear medicine, including cardiac, PET, PET-CT
- Breast imaging, including mammography, MR, and procedures
- Head and neck imaging (at the Massachusetts Eye and Ear Infirmary)
- Interventional radiology
- Emergency radiology
- Pediatric radiology
- Cardiovascular radiology including CT and MR
- Electives: a two-week elective in interventional radiology at the Mount Auburn Hospital and three months of elective time are available at the Brigham and Women’s Hospital.
From the beginning, residents are expected to read assigned material, become involved in the performance and interpretation of patient examinations and participate in discussions concerning diagnostic problems. Basic principles of radiology are stressed as the physical and procedural foundations of diagnostic imaging are laid. Residents are encouraged to work toward increasing levels of responsibility, particularly in the emergency radiology rotation, usually completed between the middle of second year and the beginning of third year.
In general, the subspecialty divisions are organized by body system, each encompassing a variety of appropriate modalities to allow residents to become familiar with pathology and pathophysiology and to promote critical selection of appropriate tests. Our radiologists serve as valuable members of the patient care team.
A resident may elect to spend a maximum of three months in rotations at Brigham and Women's Hospital with approval of both program directors. A two-week elective rotation is also available in the Division of Interventional Radiology at the Mount Auburn Hospital, a Harvard-affiliated teaching hospital in Cambridge, MA.
Year 4: Focused Year
The focused year represents an important and valuable opportunity to pursue a year or two six month blocks of subspecialty training in the fourth year of residency. During the focused year, the resident is given experience comparable to a clinical fellow in the subspecialty, with equal exposure to many modalities and procedures. During the focused year, residents take call only in the subspecialty area(s) they have chosen for the focused year.
In addition to daily teaching that occurs during the department's clinical activities, residents are provided a high-quality, organized curriculum of case discussion conferences, lectures and subspecialty conferences providing a broad exposure to the many facets of radiology.
Education is a central focus of the entire department. Teaching sessions are considered an important component of resident education, and staff radiologists take their teaching responsibilities very seriously. Case conferences and lectures are uniformly well planned and executed.
Lunchtime didactic conferences are organized into monthly "minicourses," which are coordinated by each subspecialty and ensure each area, including physics, is covered with a thorough and well-conceived curriculum. A complete subspecialty curriculum is covered over a one-year period in the minicourse format.
Staff radiologists and fellows respect the educational needs of the residents and work to ensure the residents can fully participate in all departmental offerings.
Morning Case Conference
(Daily, 7:30 am - 8:15am): This 45-minute case conference trains residents to identify pertinent findings, correlate images with the clinical presentation and construct a concise but complete differential diagnosis. Most importantly, the comfortable and congenial atmosphere of the residency pervades this conference, creating an excellent opportunity for learning. The variety of cases is drawn from the huge breadth of pathology encountered every day at the hospital. These conferences are conducted by faculty members with interest and expertise in teaching.
(Daily, 12:15 pm - 1:15pm): Daily didactic sessions constitute the fundamental core of the teaching program. These lectures are organized into numerous subspecialty "minicourses," each of which is coordinated by a senior staff member who is responsible for developing a curriculum for the block that covers the fundamental topics of each subspecialty. This organized approach ensures the resident receives broad exposure to each area.
Radiology Pathology Correlation
Tuesday conferences are devoted to radiology pathology correlation. Each resident is assigned one to two conferences per semester, in which cases with pathologic correlation are presented as unknowns to be discussed by a fellow resident. Attendings from each subspecialty are present as additional discussants to discuss the radiologic approach to differential diagnosis, and a member of the Department of Pathology is present to discuss the pathologic evaluation.
Radiology Grand Rounds
On Wednesdays during the academic year, prominent radiologists from around the country are invited to Mass General. The topics of these Grand Rounds typically focus on the latest information and concepts in radiology and are presented in conjunction with the ongoing mini-course. They typically occur twice per month.
Summer Teaching Conferences
The summer daily didactic sessions are directed at the incoming first-year residents, providing a basic core curriculum serving as an introduction to radiology. Special focus is given to radiologic physics and MR physics.
Beyond Interpretation Sessions
Several weeks during the year are devoted to teaching the non-interpretive skills required of the radiologist. These sessions stress the skills and concepts highlighted by the American Board of Radiology and required by the ACGME. These sessions include topics such as statistics, critical and analysis skills, professionalism, ethics and health care policy.
Each subspecialty area convenes conferences that provide additional educational opportunities for the resident. Residents working within a subspecialty are expected to attend, but all residents are welcome. These conferences take on a variety of forms, including a review of interesting cases and didactic sessions with attendings. The current schedule includes:
- Abdominal Imaging: Daily at 4:00 pm
- Neuroradiology: Thursday at 4:30 pm
- Thoracic Imaging: Friday at 8:00 am
- Musculoskeletal Radiology: Multidisciplinary conference Tuesday at 9:00 am
- Vascular Imaging: Thursday at 7:15 am
- Pediatrics: Multidisciplinary conference Friday at 9:00 am
- Nuclear Medicine: Tuesday at 5:00 pm
- Breast Imaging: Daily at 4:00 pm
- Emergency Department: Daily at 8:00 am
- Cardiac Imaging: Wednesdays at 8:00 am
American Institute of Radiologic Pathology (AIRP) Course in Radiologic Pathology
During the third year of residency, the department provides tuition and releases the resident from clinical duties to attend the four-week course in Washington, D.C.
New England Roentgen Ray Society (NERRS)
All residents have NERRS membership, which sponsors a course in the physics of radiology on a citywide basis as well as monthly meetings focusing on each subspecialty. Residents are excused from clinical responsibilities to attend the monthly meetings.
The Holmes Library is centrally located within the department and includes a collection of textbooks and current journals for the exclusive use of residents. Multiple computers are available for online learning by residents. The department subscribes to a number of online educational platforms for residents, which include case studies. Examples include STAT DX, RAD Primer and Quevla.
The Department of Radiology participates in multiple conferences involving many specialties. The most notable of these is the Clinical Pathologic Conference, which is regularly published in the New England Journal of Medicine. Residents find many of these meetings to be of considerable educational value, allowing residents to correlate imaging findings within the latest information in treatment and management.
The Department of Radiology is a busy clinical department offering 24 hours a day, seven days a week service to patients and referring physicians. Residents are required to be on call to provide care during off hours for inpatients, outpatients in offices and satellite urgent care clinics, one of the busiest emergency departments in New England and a level 1 trauma center.
Our call schedule is carefully designed to provide this coverage while also providing an important educational setting for residents, helping to build confidence and experience. These experiences build up to coverage of the emergency department in a one-month night float experience that takes place in the middle or second half of the second year of residency.
- Because our department is centered at a single hospital, only one resident covers the hospital during the overnight hours (9:30 pm to 8 am), decreasing the number of overnight calls required during the residency.
- By the time residents are assigned to overnight call in the second year, they will have trained in all the major subspecialty areas and feel comfortable with the important decisions required of an on-call radiologist. A staff radiologist is also present in the Emergency Department at all hours to ensure prompt review of cases read by the resident overnight.
- The total overnight responsibilities in the Emergency Department shift include a four-week block (five nights a week) plus approximately 15 additional night shifts over the course of the entire residency.
- The overnight is a carefully designed balance of autonomy and back-up.
- Residents are responsible for protocolling, supervising and interpreting all neuroradiology studies, including acute stroke scans, from 3:00 am to 6:30 am. A neuroradiology fellow and attending neuroradiologist are available by pager for urgent questions.
Call schedule is divided among different call "pools" that are assigned to each class of residents in turn.
- July of Year 1 - December of Year 1 | Emergency Room day buddy call: Residents are immediately given the opportunity to learn the basics of the Emergency Department, working with a second-year resident. Shifts are between 8:00 am and 5:30 pm for two weeks.
- October of Year 1 - October of Year 2 | Emergency Room evening coverage: Residents are given the opportunity to learn the basics of the Emergency Department, working with a staff radiologist and fellow in the evening to learn the important categories of acute disease, study selection, patient triage and consultation in the emergency setting. Shifts are between 5:30 pm and 9:30 pm every ninth or tenth weeknight evening.
- December of Year 1 - December of Year 2 | Dodd Saturday: Residents are in-house between 8:00 am and 5:00 pm to cover the inpatient intensive care portable radiographs, emergent and postoperative GI fluoroscopy studies, and abdomen/pelvis CTs. This responsibility rotates among the residents in the class.
- March of Year 1 - March of Year 2 | CT Weekend N/M Beeper Call: Residents interpret inpatient and outpatient CT scans for the thoracic and abdominal imaging sections, reading out with a staff radiologist. Residents protocol the studies in advance and are on hand to provide consultations to referring physicians. Residents also cover the Division of Nuclear Medicine pager to facilitate urgent nuclear medicine examinations. The shift typically runs between 8:00 am and 5:00 pm and includes both days of the weekend. This responsibility rotates among the members of the class.
- March of Year 1 - March of Year 2 | Emergency Room Weekend Days: Residents are assigned to cover the Emergency Department between 8:00 am and 8:00 pm, working with staff radiologists and fellows to cover all modalities, including plain film, ultrasound, CT and MRI.
- March of Year 2 - March of Year 3 | Senior Weekend: Residents interpret inpatient and outpatient CT scans in the thoracic division in the morning. The afternoon is spent focused on body MRI studies. The shift runs from 8:00 am to 5:00 pm on Sundays. This responsibility rotates among the residents in the class.
- Emergency Room nights: A four-week block of night float (five nights a week) is scheduled between the middle and end of the second year. This block is an important step in the development of our residents, where they can apply the principles they have learned to deal with acute problems encountered in a busy ER. The overnight night float rotation is scheduled after a four-week block of ER days. A staff radiologist is also present and reviews all studies dictated by the resident during the night shift. Although challenging, this rotation builds the confidence and skills of our residents. After this rotation is complete, residents help to cover Saturday overnight shifts, as well as one week of overnights during the summer time, for an additional total 11 shifts. There is an ultrasound technologist in-house 24 hours a day, 7 days a week, which enables the radiology resident to focus primarily on the interpretation of studies.
Radiology residents are busy during the workday. They are interpreting studies, interacting with patients and referring physicians, planning and protocoling upcoming studies and participating in the educational activities of the department. Although there is no typical daily schedule because of the variety of clinical rotations, a typical schedule might include:
- 7:30 am - 8:15 am: Morning case conference
- 8:15 am - 12:00 pm: Clinical responsibilities
- 12:15 pm - 1:15 pm: Didactic conference
- 1:15 pm - 5:00 pm: Clinical responsibilities
The Department of Radiology offers many resources to help streamline the residents’ daily work.
Newly updated, next-generation voice recognition software allows residents to efficiently dictate, edit and sign off on each report instantly, making the reports quickly available.
Ultrasound technologists are in the hospital 24 hours a day to complete emergency and portable cases, so the resident can then focus mainly on image interpretation. Each resident is also fully trained in the techniques of scanning so he or she can check and troubleshoot particularly difficult cases. We are fortunate to have many well-trained fellows who serve as an additional source of interesting cases and in-person teaching and function in parallel to the residents.