Resident and Fellow Responsibilities

Fellow and Resident Responsibilities for MR Rotation

Hours

At least 1 Fellow is expected to be present at 8am each day. If a case requiring monitoring is scheduled for 730 am then someone must be present at 730 am for the case. Residents are expected to arrive ASAP after 730 am conference is finished. If conference is cancelled for the day then residents are expected to arrive at 8am. The day will end when the work is done. Rarely, this is AFTER 5pm.

Readout

Cases are readout several times per day depending on attending availability. Since the ratio of trainees to cases is ususally only 2-3 : 1, it is very beneficial that everyone be present for the readout all cases. This allows everyone to see 2-3 times more cases than they dictate and generates more discussion about findings and technique. Please don't review your case and then disappear to dictate while other cases are being reviewed.

Protocoling Cases

Each case needs to have a protocol. Protocols are listed on the website for your reference. Protocol changes will be reflected on the web site. ( Protocols in IDX are only ABDOMEN or PELVIS. Please type in the specific protocol in the text box.)

Protocoling should be done by the residents and fellows as a group effort. Protocols should be done as far in advance as reasonably possible since many cases will require more clinical history or clarification (i.e. local versus global staging of rectal cancer?) which requires communication with the ordering physician. Commonly, the schedule changes daily so you must also check the schedule first thing in the morning. If a case has been added on overnight, obtain the relevant information to protocol before the patient arrives. You may have to review prior studies when protocoling.

At the least, the following days cases should be protocoled before leaving for the day. It is encouraged to review the next days cases with today’s attending so that questions can be answered.

Assigned Cases

The fellows will assign the next days cases to themselves and to the residents prior to leaving for the day. Do this every day for the next day’s cases. Write the cases, a basic history, scan time, scanner and trainee assigned to each case on the white board in the reading room.

When you are assigned to a case that case becomes your responsibility. Make sure the history is correct, the protocol is correct, and that the case is scanned correctly. Sometimes this means monitoring the case at the scanner with the technologist. You are not expected to know everything at the scanner. Call and get help when you need it. This is how you learn. If the case is crappy and you did your best to make it better nobody will be mad. If you try something educated and it does not work nobody will be mad. If the case was neglected and it comes out poorly, then we will be unhappy.

It is recommended that residents rotating through for the first time be assigned routine liver, kidney, and pelvis cases. Once you are comfortable with the basics, attack more complicated cases.

Since you know what you will be responsible for the next day, this is a great opportunity to do some advanced reading. For example, if you are responsible for monitoring a uterine anomaly case the next day . . . read about uterine anomalies!!! This way you can make more intelligent decisions about protocols and the readout sessions will be more valuable

Monitoring

It is encouraged to monitor as many cases as you can at the scanner. Practically, routine livers, kidneys, and pelvises will not need to be monitored this way. However, certain cases require a trainee to be present at the scanner to help guide the techs.

Cases that require monitoring:

MR Urography

MR Enterography

Uterine Anomaly

Local Prostate Staging

Local Cervical Cancer Staging

Local Rectal Cancer Staging

Extremity MRA

Liver MRA (i.e. transplant workup)

Pregnant Appendicitis during the daytime

Penile or Testicular MRI

Cases that do not require monitoring (optional):

Routine Liver/Pancreas

Routine Kidney

Pelvic Mass

Pre Embolization

Uretheral Diverticulum

Brachial Plexus

Lumbar-Sacral Plexus

Oncology Abdomen/Pelvis

Cooper Lymphoma Protocol

Higgins Cylinder Cervix Protocol

Ano-Reactal Fistula

Defecography

Case Followup / Conferences

There is an online interesting case database. All interesting cases should be placed in the database. Examples of an interesting case include

Cases with a finding requiring follow-up such as suspected neoplasm in any organ, even common neoplasms like RCC and ovarian cancer. Metastatic workups are generally not interesting unless there are new interesting findings.
Uncommon neoplasms or findings
Cases where no-body know what the diagnosis is
Cases that are a good example of something or a good example of an MR technique (i.e. a case where diffusion helped out a lot)
Cases that are a good example of a scan that we do not do very often such as scrotal, anorectal fistula, enterography
Fun cases

When you have downtime, search the database for cases that require follow-up and get the follow-up. Then add the follow-up to the database. Put selected images into a PowerPoint slide for presentation at either body club or Wednesday’s Interesting Case Conference. (You do not need to make a detailed presentation, just show the images and discuss the case). Each trainee is expected to have 2 cases prepared each week for Interesting Case Conference. We will collect these PowerPoint presentations each week and at the end of the year everybody will get a copy of all of the cases.

Research

Throughout the year you will be expected to help the staff with their research projects. This might involve

consenting clinical patients and ensuring that the trial sequences are run correctly
being a reader on a retrospective study

If you want to do a project of your own we will help and support you 100%. Most fellows do not want to do a project of their own. This is why you will help us with our projects.

Scanner time

Starting in September (after you become more familiar with the MR service) I will get the MR fellows 1 day per week to spend at the scanners with the technologist learning how to scan a case. Each June the fellows realize they want to do this. The time to learn is September, not just before going off to your job.

Report Dictation

Reports should be dictated before the end of the day in which they are read. Please be careful describing technique and be watchful for spelling mistakes.

Communicating with referring physicians

We have limited MR scanner time but few people realize this. When physicians call to add on cases try to accommodate them. Take a number to call back. Check with schedule – often cases can be squeezed in. The section policy is generally, just say yes. When questionable requests arise (i.e. MRI to f/u lung nodules), be firm but polite. Any questions or problems please just turf to an attending.