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 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)
- Vascular and abdominal intervention
- 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, to be involved in the performance and interpretation of patient examinations, and to 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 of rotations at the Brigham and Women's Hospital with approval of both program directors, and there is a two-week elective rotation in Interventional Radiology at the Mount Auburn Hospital, a Harvard teaching hospital in Cambridge, MA.
Year 4: Focused year
The focused year represents an important and valuable opportunity to pursue a year 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 the variety of 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 "hot seat" case discussion conferences, lectures, and subspecialty conferences that provide 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 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 that each area is covered with a thorough and well-conceived curriculum, rather than a random selection of esoteric topics. A complete subspecialty curriculum is covered over a two-year period in the minicourse format.
- Staff radiologists and fellows respect the educational needs of the resident and work to ensure that the resident is able to fully participate in all departmental offerings.
Morning case conference
(Daily, 7:30am - 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 Mass General. These conferences are conducted by faculty members with particular interest and expertise in teaching.
(Daily, 12:15 - 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 that the resident is given a 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 Pathology department 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 sessions typically focus on the latest information and concepts in radiology and are presented in conjunction with the ongoing Minicourse.
Summer teaching conferences
The summer daily didactic sessions are directed at the incoming first-year residents, providing a basic core curriculum that serves 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 of the non-interpretive skills required of the radiologist. These sessions stress the skills and concepts that are highlighted by the American Board of Radiology and required by the ACGME. These sessions include topics such as statistics, critical and analysis skills, professionalism, and ethics, and heath care policy.
Each subspecialty area convenes conferences that provide additional educational opportunities for the resident. Residents working within a particular subspecialty are expected to attend, and all residents are welcome. These conferences take on a variety of forms, including a review of interesting cases, "hot seat" case conferences, and didactic sessions with attendings. The current schedule includes:
- Abdominal Imaging: Daily at 4 pm
- Neuroradiology: Thursday at 4:30 pm
- Thoracic Imaging: Friday at 8 am
- Musculoskeletal radiology: Multidisciplinary conference Tuesday at 9 am
- Vascular Imaging: Thursday at 7:15 am
- Pediatrics: Multidisciplinary conference Friday at 9 am
- Nuclear Medicine: Tuesday at 5 pm
- Breast Imaging: Daily at 4 pm
- Emergency Department: Daily at 8 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 in order to attend the four-week course in Washington, DC.
New England Roentgen Ray Society (NERRS)
All residents are provided membership in the NERRS, 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 located centrally within the department and includes a collection of historical resources, current journals, and a large library of textbooks for the exclusive use of residents. These materials can be checked out for use during each subspecialty rotation. A complete library of CD-based computer resources, including the ACR Teaching Files, is also available for use by the residents.
The Department of Radiology participates in multiple conferences that involve a number of specialties at Massachusetts General Hospital. 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 at Mass General is a busy clinical department that offers 24 hour a day, 7 day a week service to our patients and referring physicians. This necessitates resident call to provide care during off hours—for inpatients, outpatients in offices and satellite urgent care clinics, one of the busiest emergency department 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 is needed to cover 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 of the major subspecialty areas and feel comfortable with the important decisions that are required of an on-call radiologist. A staff radiologist is also present in the Emergency Department 24/7 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
- 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 7:30 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 and 9:30 pm every 9th or 10th 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 abdominal radiographs. 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 Nuclear Medicine pager to facilitate urgent nuclear medicine examinations. The shift typically runs between 8 am and 5 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 am and 8 pm, working with staff radiologist and fellows to cover all modalities (including plain film, ultrasound, CT and MRI).
- 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 have the opportunity to apply the principles they have learned to deal with acute problems encountered in a very 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 Friday and Saturday overnight shifts with a total of approximately 10 additional shifts during the course of the residency. Of note, 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.
The Mass General Department of Radiology is a world-renowned center for research in radiology, including basic, applied, and clinical research. The department received the most NIH funding of any radiology department in the country last year. Although not required, many residents elect to pursue one or more research projects during their residency. Residents can apply for dedicated research time during the residency in blocks of one or more weeks in order to focus full-time on an ongoing project. In addition, residents are sponsored to attend major radiology conferences at which a scientific abstract has been accepted for presentation. Time may be devoted to basic research during the focused year. The ACGME requires all residents to complete a scholarly project during their residency.
Basic research is largely performed in an easily accessible, off-campus facility in Charlestown, which is equipped with all state-of the-art imaging technologies that are exclusively dedicated to research. Areas of particularly intense research interest include contrast agents, functional neuroimaging, teleradiology, and molecular imaging.
Clinical and health services research as well as quality improvement research is also an important component of the department's activities. Numerous projects are ongoing in all divisions, and residents can quickly become involved in research by developing a project with a faculty mentor.
More detailed information about ongoing work in the department can be accessed at the following sites:
Mass General Imaging Global Health Programs
Mass General Imaging's Global Health Programs are dedicated to addressing unmet medical imaging needs and healthcare disparities for vulnerable and crisis-affected populations. We have programs that focus on education/training, technology transfer, research, clinical service, and institutional development.
Nuclear medicine imaging provides unique information that often cannot be obtained using other imaging procedures. It has the potential to identify disease in its earliest stages, allowing for the diagnosis and accurate identification of the severity of a variety of diseases. They can pinpoint molecular activity within the body, and monitor patients´ responses to therapeutic interventions.
The humanitarian side of nuclear weapons is well known. And many NGOs won´t take nuclear medical equipment into areas like Iraq and other countries that are thought to be developing these types of weapons.
However, there are a number of ways you can get involved, and avoid getting involved in a humanitarian mission working alongside the Navy, who are also looking for individuals with this specialization and doctors that have completed a four-year residency in diagnostic radiology. Though the armed forces do do good work as well.
The World Health Organization estimates that around half of the world´s population has little or no access to radiological services. And a recent study says that advances in technology and cognitive ingenuity have enabled interventional radiologists to move out of the medical center and into tents, ships and battlefields.
You don´t even need to leave the U.S. Radiologists Dr. Garry Choy, MD and Sung Han Kim, MD, recognized the need to support developing countries that were gaining access to imaging equipment back in 2008. They founded the non-profit iRadX, to help poorer countries becomes independent through the implementation of sustainability mechanisms. Volunteers go to western Uganda, for example, and start a two-way conversation with local physicians. In-country physicians can also ask questions and garner advice from a distance. To find out more about iRadX, see this post from the American College of Radiology.
The American College of Radiology Foundation (ACRF) has also been working with volunteer radiologists, as have Radiologists Without Borders.
Brigham and Women´s Hospital Breast Imaging fellow Michyla Bowerson is one young doctor who is passionate about humanitarian work. She created a blog about her trip to Rwanda in 2016. Check it out here.
This hospital takes a trip almost every year. In 2015, they also went to Rwanda. In 2014, it was Haiti. Before that, New Mexico and Bangladesh. They have performed computed tomography-guided biopsies, ultrasound-guided biopsies and worked with HIV and TB patients.
Doctors seem to get a lot out of their volunteering experiences. Once lady, Dr. Hudgins, dedicated six months to refining her general medicine skills through volunteering on a sabbatical while taking time away from the Radiology Department where she worked. She volunteered at Grady Emergency Room and the City of Refuge, a free clinic. She says of her experience, “I was on the steep part of the learning curve for all six months.” But it inspired her. After the time away, she decided to update her obstetric ultrasound and plain film skills, carry on volunteering part-time, and go to Honduras. Read the full story here.
Ready to move into the humanitarian arena? There are many ways you can do it, but getting onto your residency is an important piece of the puzzle. Let us know if you would like any help writing your personal state.