Scheduled on an individual basis
Brigham and Women's Hospital, Boston MA
The subspecialty of abdominal imaging and intervention is frequently undergoing changes in practice patterns, new imaging technologies, and new interventional techniques. This course addresses knowledge, competence, and performance gaps due to limited experience due to the introduction of new imaging modalities, both for diagnosis of gastrointestinal and genitourinary diagnoses, and new interventional techniques such as ablations. This program is designed to expose the participant to a wide range of abdominal and pelvic CT scans, MRI exams, ultrasounds, and interventional radiology procedures, including radiofrequency, cryoablations, microwave, and irreversible electroporation. The program curriculum includes didactic lectures, participating in daily read-out sessions, and observing interventional radiology procedures. Abdominal Imaging and Interventional case rounds occur daily at 4 PM, and include case-based and interactive presentations of the most interesting cases of the day by the trainees and informal discussions by the faculty.
Observers are exposed to a wide variety of abdominal and pelvic CT scans, MRI exams, ultrasounds, and interventional procedures; special imaging exams include prostate MRI, rectal MRI, MRCP, MR elastography, CT colonography, CT and MR enterography, and CT urography. Interventional radiology procedures performed by the Division of Abdominal Imaging and Intervention include fine needle aspiration biopsy, large needle (core) biopsy, catheter drainage of fluid collections, image-guided para- and thoracocentesis, and tumor ablations of all organ systems including organs of the abdomen, pelvis, lung, and bone.
The Advanced Multimodality Image Guided Operating (AMIGO) suite is a state-of-the-art medical and surgical research environment that houses a complete array of advanced imaging equipment and interventional surgical systems. Multidisciplinary teams of specialists use this equipment array and the unique design of the suite to efficiently and precisely guide treatment — before, during, and after surgery — without the patient or medical team ever leaving the operating room. This innovative operating and imaging research suite encourages collaboration among multidisciplinary teams of surgeons, interventional radiologists, imaging physicists, computer scientists, biomedical engineers, nurses, and technologists. Harnessing the benefits of advanced technology and an efficient three-room design, the AMIGO teams aim to develop and deliver the safest and most-effective state-of-the-art therapies in a patient-friendly environment. Brigham and Women's Hospital is home to the National Center for Image-Guided Therapy (NCIGT), which is the National Institutes of Health's (NIH) central resource for all aspects of research into image-guided procedures. Our multimodality image-guided operating suite is instrumental to advancing the mission of the NCIGT — to provide more-effective patient care.
Physicians use the suite to incorporate research protocols designed to enhance standard clinical procedures and to develop new therapeutic approaches. Procedures that you may observe during your time in AMIGO include: Neurosurgery (Brain tumor resection, Deep brain stimulation, Transsphenoidal pituitary tumor resection, Laser brain ablation, Brain biopsy, Skull base); Interventional Radiology; Ablation (Cryoablation (MR, PET/CT) Kidney+, Microwave (PET/CT, MR) Liver,+, RF ablation, IRE); Biopsy (MRI Guided Prostate, Lung Biopsy (MRI, PET/CT); Radiation Oncology (Gynecologic HDR Brachytherapy); Endocrine Surgery, Video-assisted Thoracoscopic Surgery, Spine Discectomy and Fusion, Breast Conserving Surgery.
The section performs a wide range of vascular and nonvascular interventional procedures in four state of the art interventional suites. The day typically begins with morning rounds. Elective and emergent procedures are performed by board certified interventional radiologists. Every Wednesday there are didactic lectures. In addition to direct observation each room is connected to a video conferencing network feed into our reading room. Fluoroscopy as well as live video imaging is viewable on large screen video monitors.
As the incidence of breast cancer rises, the need for skilled and experienced breast imaging radiologists is continuing to increase across the US and globally. Radiologists must meet federal, state and American College of Radiology credentialing criteria and be current and confident in their skills. The Breast Imaging Observership is offered with a choice of 1 or 2 weeks in the division of Breast Imaging, Department of Radiology, Brigham and Women’s Hospital. Participants will have the opportunity to focus on diagnostic versus screening mammography, breast MRI or percutaneous procedures including biopsy, fine needle aspiration, drainage, etc, based on their needs and section activities. Depending on their preference, they will begin each day at the designated time for pre-operative wire localizations, or percutaneous biopsies, diagnostic imaging or breast MRI. All visiting fellows will accompany faculty as they review, and interpret a wide variety of Breast Imaging examinations, including screening and diagnostic mammograms in our all digital facility, breast ultrasound examinations on state-of-art equipment, and breast MRI examinations. Visitors will also be given the opportunity to interactively observe examinations and percutaneous breast procedures being performed. They are expected to ask questions, discuss pertinent details of each case, offer suggestions for work-up and management steps and make recommendations. In addition to the one-on-one teaching by Breast Imaging faculty during diagnostic work-ups, visiting fellows can observe the entire gamut of image guided interventional breast procedures. These include procedures performed using all imaging modalities (mammography, US, MRI). Participants will attend case conferences, bi-weekly multi-disciplinary breast conferences including a tumor board; and a bi-weekly review focusing on radiologic-pathologic correlation of all core needle biopsy cases.
Emergency Radiology is a rapidly growing area of clinical practice that focuses primarily on the imaging of the acutely ill, injured, or severely traumatized patient. Our section aggregates all emergency imaging and realigns the clinical practice of radiology with the principal referring services of emergency medicine and trauma surgery. The Emergency Radiology Observership, held in the division of Emergency Radiology, provides the attendee an exposure to all the modalities and organ systems, including radiographs, ultrasound, CT and MRI. The day starts with a morning conference to review the interesting and challenging cases from the last 24 hours. The attendee will be able to observe the frequent read out sessions through-out the day and informal sessions to solidify the concepts to appreciate that the reliable, timely, and accurate imaging is vital in emergency radiology. In addition to BWH which is a Level 1 trauma center, the section covers Emergency Radiology cases from Faulkner Hospital and Foxboro Urgent Care Center. The attendee will also be able to attend didactic lectures or case based interactive sessions, held twice a week, on relevant ER topics for ER fellows and residents.
The subspecialty of Musculoskeletal Imaging and Intervention is continually growing due to the constant advancements in technology, diagnostic utility, and procedural interventions. The BWH Musculoskeletal Imaging and Intervention Observership will provide the attendee with exposure to all areas of up-to-date Musculoskeletal Imaging and Intervention: CR, CT, MRI, Arthrography, Ultrasound, US/CT guided MSK interventions (soft tissue/bone biopsies, aspirations/injections and ablations), as well as Fluoro/CT guided Spine Interventions. Some of our unique services include: Dual Energy CT for Gout/CPPD, MR Neurography, MRI for Cartilage Repair Surgeries (the division works closely with the internationally renowned BWH Cartilage Repair Center), and MR Guided Focused Ultrasound. The attendee will have the opportunity to tailor their experience to their individual needs, with the core daily experience including participation in daily read out sessions, informal discussions with faculty and fellows, and the opportunity to review our up-to-date MSK MRI Protocols. The case load covers all areas of MSK: Tumor, Sports, Rheumatology/Arthritis/Metabolic, Trauma, Spine, Infection, Joint Replacement, Cartilage Imaging, and occasionally, Genetic/Congenital Imaging. All observers will attend our dedicated MSK educational conferences: Weekly MSK Interesting Case Conference, Tumor Board Conference, Interdisciplinary Sarcoma RAD PATH Conference, MSK Fellows Instructional Conference, Sports Conference, as well as Monthly Interdisciplinary Spine and Rheumatology Conferences. Observers have the option to attend Daily General Radiology Residency Educational Conferences as well as Departmental Visiting Professor Rounds.
Neuroradiology primarily focuses on imaging of the central nervous system and provides diagnostic information for diseases in the brain, spine, and head and neck. Participants of observership in the Neuroradiology subspecialty will be exposed to cross-sectional modalities including CT, MR and PET as well as advanced imaging techniques such as diffusion weighted imaging, perfusion weighted imaging, MR spectroscopy, and function MRI. In addition, there are ample opportunities to observe image-guided neurointerventional procedures including cerebral and spine angiography, vertebroplasty/kyphoplasty, myelography, spine steroid injections, head, neck and spine biopsy and ablation procedures. The educational experience will also be enhanced by several multidisciplinary clinical and research conferences that take place weekly at BWH as well as local affiliated hospitals.
The Tumor Ablation Observership is a tutorial in the principles and practice of image-guided percutaneous focal tumor therapies (ablation). It is intended to educate radiologists who are new to the field and interested in adding ablation to their practice as well as to educate experienced radiologists in the basic practice of ablation. The tutorial includes one-on-one seminars with faculty centered on prepared presentations by the faculty supplemented by ongoing question-and-answer opportunities. In addition to presenting the academic underpinnings of image-guided focal therapies, the observer learns the basic, practical elements of the care of the ablation patient, including the basic interpretation of post-ablation imaging.
In addition to didactic sessions, the observer accompanies the faculty during the staff’s patient care, weekly review of past, current, and pending clinical cases, during a busy patient clinic, and during CT and MRI-guided ablation treatments. Ablation modalities used by the service include including radiofrequency, cryoablations, microwave, and irreversible electroporation.
The specialty of thoracic imaging has progressed dramatically. Thoracic radiologists are now central in caring for the patient with lung cancer adding value by performing core lung biopsies for genomics. This has become a large part of our work. We have also added to patient care by our robust lung cancer screening program for early lung cancer detection. One of our most exciting ventures is working with our surgeons in both the operating room and in the AMIGO (Advanced Multimodality Image Guided OR). Radiologists and surgeons work alongside each other with the radiologist performing either a biopsy, placing fiducials for marking, or guiding the surgeon into the lesion and the surgeon resecting the lesion at the same time, in the AMIGO suite. Our observership is designed not only to update the attendee on the latest diagnostic tools we use but also to spark innovation in those who attend the Chest observership and help them advance in their own institutions.
The attendee will be able to observe not only read-out sessions but will be able to observe in the AMIGO suite and our more traditional lung biopsy suites where we do most of our biopsies for genomics and diagnosis. They will be able to attend our weekly interdisciplinary conferences including our Interstitial lung disease conference, our radiology/cytology conferences where we review our most interesting biopsy cases, the thoracic surgery/pathology/radiology conference, and our weekly interesting case conference.
Continued advances in ultrasound technology and diagnostic utility, including 3D and 4D sonography and Doppler, make it difficult for those who practice ultrasound to stay current and up-to-date on new techniques and diagnostic capabilities. The Ultrasound Observership, held in the division of Ultrasound in the Department of Radiology provides the attendee with an overview of current ultrasound practice and techniques, including 2D, 3D, and 4D sonography, Doppler, and ultrasound guided needle aspiration and biopsy procedures. Attendees will be able to observe first hand sonography in obstetrics, gynecology, abdomen including deep Doppler, thyroid, scrotum, and neonatal. Visitors will attend a daily case conference given by the Ultrasound attending or fellow. The remainder of the day, visiting fellows will accompany faculty as they review, scan, and interpret a wide variety of sonographic examinations, including abdominal, obstetrical, gynecological, thyroid, and scrotal.
The duration of most observerships is one to two weeks; however, longer observerships, up to a maximum of three months, can be arranged upon special request. Physicians will earn up to 38.75 AMA PRA Category 1 Credits™ (one week) or 77.50 AMA PRA Category 1 Credits™ (two weeks) for time spent during the observership program. The department also has opportunities for visitors to observe radiology research within Brigham and Women's Hospital radiology research facilities and laboratories.
|Course Tuition in US Dollars||Week 1||Week 2||Subsequent Weeks|
|Physicians, PhD scientists||$1,800||$1,200||$1,000|
|Physicians in training (residents and fellows), graduate students||$1,500||$1,000||$800|
|Allied Health Professionals||$1,500||$1,000||$800|
Anyone wishing to spend time in the Brigham Radiology Department, whether that person is a physician in training (resident or fellow), radiologist, physician in another medical specialty, or radiology research scientist, should apply via email to email@example.com.
Please email a copy of your CV, dates you may be interested in observering as well as which section in Radiology you are interested.