Neuro-radiology exposure in residency?

[deleted1208015]

My residency program does not give us a dedicated neuro-radiology block the way some other neurology residencies do. However we get around 6-8 weeks of elective time each year, some of which which can be used to do neuro-radiology. We are a big program with many subspecialties so our base curriculum is fairly widespread and we do at around 2-4 weeks in all the subspecialties including niche ones like neuro-onc, neuro-optho, etc, at some point in residency. Elective time is also equally distributed across all PGY2-4 years.

I have three questions:

1) Should I do a dedicated neuro-radiology rotation at all, or should neuro-radiology be one of those strictly “learn as you go” things throughout residency?

2) If I do decide to do a neuro-radiology rotation, should it be earlier as a PGY-2 so I can get a stronger hold and confidence in reading imaging early on? Or should it be as a PGY-4 when I’ve accumulated a stronger clinical accumen?

3) What proportion of my time should I spend on this? When I add it all up we get around 10 weeks total through residency for dedicated EEG/epilepsy so I think a fair amount of my elective time would need to be spent on EEG.

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[s5260205]

You should be able to pick up a lot of neuro-radiology from your regular inpatient rotations. You will need a system to look at each image (e.g., CTA head and neck for stroke, starting from the aortic arch and chase each vessel up into the brain looking for any abnormality), and once you have a system down, then the rest is just practice and practice. I make a conscious effort to go over every image ordered (including non-brain/spine one, such as CT a/p and CXR, although much worse than I am with brain/spine).

I find my neuro-radiology rotation to be not the most helpful and actually learned the most of imaging from my neuro-oncology and neuro-immunology rotations where the neurologist might even be better at picking up finer details as they have the advantage of seeing patients directly. A 2-week rotation can be helpful, but if you don't have a lot of electives, it may be better spent on something else like EEG or EMG (just my personal opinion).

 

[DrSatan]

1) Should I do a dedicated neuro-radiology rotation at all, or should neuro-radiology be one of those strictly “learn as you go” things throughout residency?

Yes, you may as well do it. I found mine to be somewhat helpful purely from asking them pointed questions about things I did not understand related to MRI and CTA. Actually reviewing the images was not particularly helpful.

2) If I do decide to do a neuro-radiology rotation, should it be earlier as a PGY-2 so I can get a stronger hold and confidence in reading imaging early on? Or should it be as a PGY-4 when I’ve accumulated a stronger clinical accumen?

I'd focus on learning on the job. Sadly there was an amazing neuroimaging resource that has since bit the dust. If you can find a way to make this website work, you'll learn a solid base: www.headneckbrainspine.com/Neuroanatomy-modules.php

3) What proportion of my time should I spend on this? When I add it all up we get around 10 weeks total through residency for dedicated EEG/epilepsy so I think a fair amount of my elective time would need to be spent on EEG.

I wouldn't do more than a 2 week elective. Again, my experience was not that useful. It was a chill rotation which is why I did it during PGY4.

 

[Spinothalamic]

You should be able to pick up a lot of neuro-radiology from your regular inpatient rotations. You will need a system to look at each image (e.g., CTA head and neck for stroke, starting from the aortic arch and chase each vessel up into the brain looking for any abnormality), and once you have a system down, then the rest is just practice and practice. I make a conscious effort to go over every image ordered (including non-brain/spine one, such as CT a/p and CXR, although much worse than I am with brain/spine).

I find my neuro-radiology rotation to be not the most helpful and actually learned the most of imaging from my neuro-oncology and neuro-immunology rotations where the neurologist might even be better at picking up finer details as they have the advantage of seeing patients directly. A 2-week rotation can be helpful, but if you don't have a lot of electives, it may be better spent on something else like EEG or EMG (just my personal opinion).

Totally agree. Just look at every image for your own patients and later when you become a senior resident look at all the images for the patients on the service. Between this and occasionally going to the reading room to discuss specific cases, you will be great.

 

[s5260205]

There are several resources available for learning neuroanatomy. Dr. Anne Osborn is a radiologist who has authored several books, including Osborn's Brain which is arguably the gold standard for learning brain anatomy. One of her books is Imaging Anatomy Brain and Spine which has slice by slice images of CT/MRI with all the anatomic structures labelled. The book is also organized by anatomic regions which can help to serve as a quick references/atlas. The downside of this book is that this is normal anatomy and not pathologic ones, though you can easily supplement the pathologic ones with online free resources like Radiopaedia (or Osborn's Brain which has anything and everything you can learn for neuroanatomy). Highly recommend if you have any educational fund to spare (or Aarrgh!).