Getting the Most Out of Your Neuroradiology Rotation

by
Per-Lennart Westesson, MD, PhD, DDS
Department of Radiology
University of Rochester Medical Center

Your Neuroradiology rotation can be a unique time during your Radiology residency. It gives you the opportunity to become more knowledgeable in this exciting area of radiology, to see a lot of cases and learn specific procedures. The following are some tips of how to get the most out of this training experience.

Get Organized
Start by getting organized. Prepare five binders, one for each major area of neuroradiology and label them accordingly. You may have binders for brain, spine, head and neck, pediatrics and procedures. Whenever a good article, teaching point or differential diagnosis comes along, just drop it into the appropriate binder. Of course, with computer technique, all this could be done electronically if you so prefer. This is valuable when preparing for the Boards and it will also serve as a resource for your future practice.

Study the Books
Read the neuroradiology major textbooks. I recommend that you have access to at least three of the major books during your rotation. Start early since time will be short. The requisites, Anne Osborn's Diagnostic Neuroradiology, a procedure-oriented book and a head and neck book are the basic that also is all you will need. The books that you have used during your residency training will be the bibles for your future practice. Don't stick to one time, read the book several times. It is better to quickly read through and then come back multiple times than to try to read one from beginning to end.

Read Up On Cases
Cases are the best learning tools. Every time you run into an unusual, interesting or didactic case, read up on it and collect your notes in the appropriate binder. Information that is attached to cases stick much better than just reading.

Prepare a Teaching File
During your neuroradiology rotation you should prepare two teaching file cases. These are good for conferences, for future teaching and for your learning. Prepare them relatively simple with a short clinical presentation, radiographic images, differential diagnosis and a short discussion. This can be stored in PowerPoint format.

Case Presentations
Do not be afraid to expose yourself by taking difficult cases. Start early in your residency at the time when nobody expects you to be an expert. The longer you wait, the more difficult it will be to get started. When you pick a case, identify the study, describe the findings and then start to think what it might be. It is not the best thing to start by listing those things you don't think it can be. It only illustrates that you don't know what it is. In many cases, the diagnosis is screaming out but don't go for it immediately. Instead of jumping to the diagnosis, systematically mention pertinent positive and negative findings and give a differential diagnosis. Finally, give your top three diagnostic choices with the first one being what you think it actually is.

If you get the case right then it is great and you can continue to talk about the pathophysiology, disease process and how it is treated. If you miss the case it is also alright because you will never miss that again. During each rotation make sure you get a variety of exposures. Get the straightforward cases done first and then spend time on the more intricate head and neck and spine cases.

Select a Mentor
It is important that you identify somebody who can be your mentor during your neuroradiology rotation. This should be one of the faculty members or one of our fellows. This is somebody who will help you, will be your go-to person and will be a role model. The mentor should ideally also be the one who helps you with a research project if you have a desire to get involved in research.

Call
Nobody likes call but realize that call is practice for your future. When you are by yourself making decisions on your own, you learn and you mature.

Research
Research is important even if you are aiming for a career in private practice. Take advantage of being in an academic setting and participate in research projects. Start by finding something you find interesting and then ask your mentor what research can be applied to this specific area. The idea is to aim for a publishable manuscript or presentation at one of the national meetings such as RSNA or ASNR. Attending such a meeting is valuable by itself, but it becomes quite a different experience if you get to present.