neuroradiology

[autechre]

I am currently an intern in a neuro/psych program and am interested in neuroradiology and neuroimaging. Is specialization in this area possible for a neurologist?

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[neurologist]

I am currently an intern in a neuro/psych program and am interested in neuroradiology and neuroimaging. Is specialization in this area possible for a neurologist?

Sort of, but it's not easy and unfortunately you started out by picking the wrong combined residency.

There are a few combined neuro/radiology/neuroradiology residencies (7 years long) that get you there. I think they generally work as 1 year internship, then 2 years each of neuro, general rads and neurorads. You end up being board certifiable in all three.

You will absolutely NOT get into a traditional neurorads fellowship with a neuro residency . . . they all require a radiology residency.

There are some "neuroimaging" fellowships that take neurologists but I'm not sure what the benefit of those are in terms of getting you to the point of being certified in reading images and actually being able to get paid for it. And you don't do any kind of interventional stuff.

There are a few fellowships in what is variably called "neurovascular medicine" or "vascular neurology" or "critical care and vascular neurology" wherein a neurologist can do 2 or 3 years of stroke/critical care including interventional neuroradiology. I'm not sure if these programs are ACGME certified. If you want to check some of these out go to the websites for NYU (I think it's under their radiology residency listing) and UMDNJ Neurology website -- I know for sure that these 2 have such programs.

 

[amiz]

try my neuro-CD. [email protected]

 

[Molly Maquire]

Actually, in the past most people who did the combined neuro/rads programs tried to use it as a backdoor into a radiology residency. For this reason, I think most of these combined programs are closing.

 

[charcot]

Check out the american society for neuroimaging.
Basically, you take a course and then a comprehensive "board style" exam.
You are then credentialed to read and bill for reading head CT's and brain MRI's. Most insurance companies are now accepting this credentialling system and many PRIVATE PRACTICE neurologists are doing it.

There are a dozen companies out ther now helping neurology groups buy and staff MRI centers.

Key points, you must adhere to stark laws, that is you can't constantly self refer all your patients to an MRI center you own and read from. The technical fees and pro fees must be uniquely separated and revenue streams equivariant.

Also, your malpractice premiums will shift up becuase of missed reads, etc.

bottom line, yes you can practice neuroradiology as a neurologist, but only after "special" training and in a private practice setting, at increased risk of being sued.

 

[NeuroSync]

Sort of, but it's not easy and unfortunately you started out by picking the wrong combined residency.

There are a few combined neuro/radiology/neuroradiology residencies (7 years long) that get you there. I think they generally work as 1 year internship, then 2 years each of neuro, general rads and neurorads. You end up being board certifiable in all three.

You will absolutely NOT get into a traditional neurorads fellowship with a neuro residency . . . they all require a radiology residency.

There are some "neuroimaging" fellowships that take neurologists but I'm not sure what the benefit of those are in terms of getting you to the point of being certified in reading images and actually being able to get paid for it. And you don't do any kind of interventional stuff.

There are a few fellowships in what is variably called "neurovascular medicine" or "vascular neurology" or "critical care and vascular neurology" wherein a neurologist can do 2 or 3 years of stroke/critical care including interventional neuroradiology. I'm not sure if these programs are ACGME certified. If you want to check some of these out go to the websites for NYU (I think it's under their radiology residency listing) and UMDNJ Neurology website -- I know for sure that these 2 have such programs.

Where are the neuro/radiology/neuroradiology residencies? More generally, where would I find a listing of all residencies? I am jumping the gun a bit here, as I just got accepted to UW, but I am definitely interested in neurology, and perhaps a neurorad combo, and I know how important it is to plan ahead for clinical rotations, letters of recommendation, and the like.

 

[charcot]

Where are the neuro/radiology/neuroradiology residencies?

Hopkins, NYU and Cleveland Clinic. They each take 1 resident per year. Most are MD/PhDs with publications in relevant fields i.e fMRI etc. It's a seven year program including internship. 1 yr med, 2 neuro, 2 rads, 2 neurorads. If you want interventional its additional training.
Now this mught seem like a sweet deal, but you will be taking the boards for neurology and radioogy along with people who have put in 3 years and 4 years, respectively. Plus each exam has an oral component. And the CAQ examination for neurorads is also a board unto itself. That's 6 board exams!!
The goal of the training is to bridge these two very different fields into what seems like a natural overlap. But, there is little similarity in culture or professional structure of these fields. Most programs have you do rads first and once residents taste that good seated life, they drop out of the neurology part where you run around carrying a list of 12 patients who need daily labs, discharge summaries and someone to tell their family they had a stroke. The only program that makes you put in time on neurology first is Hopkins I think, and their residents don't get a chance to drop the neuro part because the good life comes after having done neurology's scut. In the end,, I am not sure where grads end up. They are trained for academia, but they will be competing for RO1s with straight PhD's who have done the same research but are paired up with clinicians. So they are taking a pay cut and have spent twice as long training.
My advice to you is figure out which lifestyle you like better during med school rotations. It's one or the other.

 

[lusiks]

Sorry, have to disagree here.

There are currently only 2 active combined programs: Hopkins and NYU. Cleveland Clinic is waiting for approval and does not accept any applications yet.

As for the curriculum structure, wrong again. BOTH Hopkins and NYU make you do 2nd and 3rd years in NEUROLOGY, Radiology comes after that.

You are right though about drop-outs - as far as I know, Hopkins has NO graduates from this program sofar (not one person went through till the end). NYU is supposed to be better, but even they are not that happy (per their residency coordinator Patricia). I guess the reason for dropping out is that these programs are very long and intensive, and you must have real committment to BOTH fields and want to pursue an academic career, otherwise this is just too much and once people realize that they drop out.

Btw, NYU takes 2 residents every year (not one), and Hopkins takes one resident every OTHER year. Per NYU's coordinator, they do not stress on filling up both positions anymore (they might just take one person or nobody at all).

Links to check out other details:

http://www.med.nyu.edu/radiology_edu/residency/combinedneuroint.html

http://www.neuro.jhmi.edu/NroRad/

Hope this helps.
L.

 

[syrinx]

I was told by the coordinator that NYU will not take any residents into the combined program this year.

 

[NeuroSync]

That's interesting. Thanks for the information.

 

[lusiks]

syrinx, that was my feeling too for NYU, now you confirmed it. Did you consider applying there? Did anybody interview for these combined spots?

 

[syrinx]

syrinx, that was my feeling too for NYU, now you confirmed it. Did you consider applying there? Did anybody interview for these combined spots?

I was scheduled to interview for the regular neurology program but emailed the coordinator to switch my application to the combined program. A month later I got a reply saying they decided not to take any residents this year. I think its a shame these programs are falling apart. I personally believe that a neurology/neuroradiology combined program makes a lot of sense especially in advancing these fields in an academic sense. I mean if something like med-peds exists than neurology-radiology should certainly exist. Oh well.

I hope the opportunity to do neuroradiolgy fellowship after neurology residency someday exists. Neuropathology is already an option, although pathology residents are probably favored in getting these fellowships.
Interventional neurology fellowship is now available to us but only at limited places. And again, neuroradiology fellows definitely have the preference.
I hope more of our generation of neurology residents have the balls and the drive to pursue academic leadership positions and change things. Otherwise,
the future of neurology as a profession is in jeopardy.

 

[Whisker Barrel Cortex]

University of Wisconsin also had a combined neuro/rad/neurorad tract several years ago. However, everyone ended up switching to pure radiology so it was shut down.

 

[RADRULES]

I don't get it, if you wanted to be a neuroradiologist... why did you pick neurology?

Neuroradiologist are and will be the standard for neuroimaging for a LONG time. Frankly, you need to do a radiology residency to accurately interpret brain and spine neuro cases. Nobody can interpret cross sectional imaging isolated from the rest of the body.

There are a few neurologist who I know who would probably match up well with the AVERAGE general rad out in practice, when they use their clinical exam and history to help... but really Neuroradiologists are at another level, with many of the fellowships being 2 years of intensive post-residency training, CAQ, not to mention interventional experience.

That is all.

 

[Fantasy Sports]

Neuroradiologist are and will be the standard for neuroimaging for a LONG time. Frankly, you need to do a radiology residency to accurately interpret brain and spine neuro cases. Nobody can interpret cross sectional imaging isolated from the rest of the body.

Neuroradiologists will be the standard in an academic setting or in an incredibly large private practice, where there are enough to go around and where they are specifically trained for that organ. Unfortunately neuroradiologists are very scarce in most areas, and the fact is that most neurologists are better at reading BRAIN scans than a general radiologists (I repeat: only for the brain... it makes perfect sense. And general radiologists could kick a neuros arse reading scans of every single other organ system out there) is why some states are allowing neurologist certification for reads after s/he completes reads on X scans and gets approval for a neuro. Its only a matter of time before the standard scans are done by a neuro, with only the extreme cases being sent to the academic center to have a read by a neurorad (and then again, the more complicated cases would be treated at the academic center as well).

It will be interesting to see how this develops in the future.