Abdominal Imaging Fellowship

 Clinical Services   Research  Teaching  • Other Fellowship Information

GOAL:

The goal of the faculty of the Abdominal Imaging Division is to provide an environment for our Fellows which is conducive to both clinical and academic excellence. At the completion of the 12 month fellowship, Fellows will be well positioned to enter a subspecialized private practice or become faculty in an academic department.The Division covers all aspects of abdominal imaging from the diaphragm to the pubic symphysis. Our Division covers CT (including 3D CT), CT/PET, abdominopelvic MR, ultrasound (including vascular ultrasound and first trimester OB ultrasound), and percutaneous interventional procedures (biopsy and drainage). In addition, Fellows will receive some exposure to OB ultrasound and some traditional GI and GU radiology. There are dedicated four week rotations throughout the year.

DUKE UNIVERSITY MEDICAL CENTER (DUMC):

DUMC is located on the edge of the undergraduate campus and is a five minute walk from Cameron Indoor Stadium, home of the Blue Devils.  DUMC is a 1000 bed tertiary care hospital composed of main campus inpatient facilities (Duke North and Duke Medical Pavilion), main campus outpatient clinics (Duke South and Cancer Center), as well as many free-standing clinics.  The Department of Radiology is primarily housed within Duke North Hospital.

In the Department of Radiology, we perform approximately 450,000 examinations and over 20,000 interventional procedures annually.  Duke University Medical Center is a level 1 trauma center and the Emergency Department is contiguous with the Radiology Department on the first floor of Duke North Hospital.  We see a broad range of pathology at Duke University Medical Center.  We provide imaging for a busy trauma service, as well as one of the largest cancer centers in the country.  In particular, Duke specializes in hepatobiliary/pancreatic neoplasms, colorectal neoplasms, melanoma, breast cancer, neuroendocrine tumors, sarcomas, and lung cancer.  Our division also supports a busy abdominal transplant service which performs large numbers of liver, kidney, pancreas, small bowel, and combined organ transplants.

The Division of Abdominal Imaging has close ties to an excellent and busy group of oncologic, urologic, and general surgeons.  In addition, we have excellent working relationships with each of the Divisions within the Department of Medicine.  There are particularly close collaborations with the hepatobiliary, pancreatic, colorectal, and endocrine/thyroid multidisciplinary working groups, which hold regular tumor boards in which our division plays a central role.  These tumor boards are attended and given by faculty from all divisions, and are outstanding educational experiences.

FACULTY:

We have a stable group of faculty with top notch expertise in every area of abdominal imaging including but not limited to hepatobiliary/pancreas, liver, GI, GU, female pelvis, MR, CT, interventional, and ultrasound.  For more information on our Faculty, please click here.

WHAT HAPPENS TO OUR FELLOWS:

Most take positions in high profile private practices. Approximately one fellow per year will enter and remain in an academic practice.

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CLINICAL SERVICES

BODY CT :

The Division takes great pride in its high profile, high volume CT service.  We operate a total of 18 CT scanners (5×128 slice, 9×64 slice, and 4×16 slice interventional scanners, 3 systems with CT fluoroscopy; 10 with dual energy capability) across our system, from both General Electric and Siemens Healthcare.  The Body CT reading room is the main hub of our practice and is covered by three attendings, two to three Fellows, and three residents on any given day.  Approximately 85% of the CT examinations performed at Duke University Medical Center are interpreted by our division.  Our practice is broad and varied, with cases originating from a variety of sources, from our level I trauma center to our world-class oncology programs.  There is no shortage of interesting cases.  We interpret approximately 70,000 CT examinations per year.

BODY MR:

Our body MR service is an integral part of the Duke hepatobiliary/pancreas, oncologic, urologic, small bowel/colon, gynecologic, and transplant practices, and is also used for imaging antepartum and peripartum complications.  Fellows will have dedicated rotations on the body MR service.  While on these rotations, the Fellow will protocol, interpret, and staff out every body MR case.  We read a large number of complex cases with interesting pathology, where imaging is integral to patient management.  We interpret approximately 3,000 MRI examinations per year.

We particularly pride ourselves on the amount and quality of MR teaching at the PACS station, covering a variety of technical and clinical topics.  Dedicated lectures and small-group teaching sessions are also conducted, covering practical MR physics, protocol building and optimization, advanced MRI techniques, and clinical topics.  Additionally, every other year, a dedicated MRI physics course is taught by members of our MD and PhD faculty, and Fellows are encouraged to attend.A number of advanced methodologies are used routinely and taught, including:  the Dixon method for fat suppression; liver fat and iron quantification; single-breathhold multi-phase arterial acquisition; diffusion-weighted imaging; echo sharing techniques; higher-order parallel acceleration; and multiparametric prostate MRI.  In addition, Fellows gain extensive experience with novel contrast agents, including Eovist, Ablavar, and Feraheme.

We operate a total of 13 clinical MRI scanners (9×1.5T and 4x3T) across our system, from both General Electric and Siemens Healthcare as well as one dedicated research 3T unit.

INTERVENTIONAL SERVICE:

The Division performs image guided biopsies and percutaneous drainage procedures using conventional CT, CT fluoroscopy, and ultrasound guidance.  We operate two dedicated procedure rooms with state-of-the-art CT and ultrasound equipment.  The breadth and depth of our interventional procedures is substantial including random and focal lesion biopsies of the liver and kidneys, as well as biopsies of the thyroid, lymph nodes, retroperitoneum, pancreas, and spleen.  Abscess drainages are performed daily, and include abdominopelvic, body wall, and extremity fluid collections.  We also perform thrombin injections for treatment of pseudoaneurysms.  A typical interventional day includes approximately 8-10 cases/day.

When on the intervention service, the Fellow will perform all cases with staff supervision.  We schedule only one resident or Fellow on the intervention rotation per day, so the Fellow will have the opportunity to perform all cases on their day.  Fellows will typically be assigned 2-3 intervention days per month.   During the fellowship, one can anticipate developing excellent skills with percutaneous interventional procedures and becoming comfortable enough to perform these procedures independently immediately after the conclusion of the fellowship.

ULTRASOUND:

For years, our Division has had strong abdominal, vascular, and obstetrical ultrasound.  Ultrasound is primarily covered by an individual who is recognized nationally and internationally as an expert in ultrasound, and has authored one of the primary texts used in resident training.  On the service, a variety of abdominal pathology, benign and malignant gynecologic pathology, and small parts ultrasound will be encountered.

In addition, vascular ultrasound comprise approximately 30% of our ultrasound practice.  Fellows will receive extensive experience in first trimester obstetrical ultrasound, particularly in the acute/emergent setting.  Our Fellows also have the option of spending elective time in the Fetal Diagnostic Clinic, if they wish to gain experience with second and third trimester obstetric ultrasound.

3D IMAGING:

Numerous CTA and MRA procedures are performed on a daily basis.  Our dedicated 3D lab performs the majority of 3D renderings, however a number of 3D workstations and thin clients are available for additional processing by a physician, when necessary.  Solid organ volumetry, 3D vascular assessments, and MR perfusion are routinely performed.

Every workstation in our reading room maintains a thin-client connection with a variety of post-processing software servers, including Tera Recon, Philips Brilliance Portal, and GE Advantage Workstation.  In addition, the workstations in our MRI reading room are connected with both iCAD and DynaCAD connectivity for perfusion analysis, which we use particularly for multiparametric prostate MRI.

CT/PET:

Approximately 15-20 CT/PET examinations are performed per day at DUMC.  The CT portions of these examinations are interpreted by our Division in conjunction with PET interpretation by the Nuclear Medicine division.  CT/PET fusion images are routinely generated, and fusion software is additionally available on the thin client workstations for problem-solving.  Fellows will gain a full experience with the use and interpretation of CT/PET in oncologic follow up.

CT COLONOGRAPHY:

Members of the Abdominal Imaging division have a wealth of experience with CT colonography.  The Fellow will assist in insufflation of the colon and will be responsible for interpreting these studies.  Fellows will gain experience interpreting these studies on Vital Image workstations as well as Tera Recon and Philips Brilliance thin client stations incorporated into our PACS system.  In addition, Fellows will learn a variety of interpretation and problem solving methods, including 2D interpretation with 3D problem solving, 3D fly-through, and virtual dissection.

GI/GU:

Fellows will receive some experience with traditional GI and GU studies during their fellowship. At times, Fellows may be asked to cover these services as Attendings.

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RESEARCH

Clinical research is encouraged, but is not considered a required part of the clinical fellowship.  Most of our faculty are involved in a wide variety of research efforts, spanning the breadth of modalities and imaging techniques.  Many single projects are available for Fellows interested in undertaking relatively limited projects, while those who wish to do so can become involved in longer-term/more intensive research efforts.  In addition, Fellows may choose to either spearhead projects or simply serve as readers/secondary investigators, as they wish.

Fellows who complete projects in time for submission to a national meeting during the fellowship are encouraged to submit their work.  Those whose projects are accepted can often be supported to present their work.  The Division also has a laptop computer which Fellows are encouraged to use for research projects and there is office space for the Abdominal Imaging Fellows in Duke North.  These offices are intended for use during academic days.

Recently completed Fellow-driven projects include research on:

  • Reproducibility of MRI perfusion measurements
  • Feraheme-enhanced MRI for DVT assessment
  • Comparing non-contrast CT and non-contrast MRI for liver lesion assessment
  • Fast Eovist protocols for screening patients with chronic liver disease
  • MRI-based measures of bone marrow perfusion
  • Dual energy CT for iodine quantification
  • Accuracy of fluid collection characterization at CT
  • Effect of contrast warming on extravasation and allergic reaction rates
  • Image-guided wire localization of non-palpable lesions outside the breast
  • Localization of primary colonic tumors at conventional CT
  • 3D vs. 2D T2-weighted techniques for pelvic MRI

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TEACHING

Most teaching occurs at the PACS stations during the course of the work day.  In addition, dedicated Fellows conferences are given 1-2 times per month by members of the faculty, covering a range of topics of interest.  These include advanced clinical imaging topics, clinically relevant clinical/engineering topics, and medicolegal.

A divisional journal club is also held once per month, where key articles from the recent literature are reviewed by members of the Division.

In addition, formal MRI and CT physics courses are given in alternating years.  During years when a course is not given, the topics that would have been covered during that course are emphasized during the Fellows conference.  Fellows also receive Hands-on instruction at one of our MRI scanners approximately once per month, to gain a greater understanding of the role of and challenges facing technologists in imaging patients.  Fellows gain familiarity with MR instrumentation as well as basics of how to position and scan patients, and may scan each other (supervised) during these sessions.

CONFERENCES:

There are a variety of conferences that are available for the Fellows including some conferences specifically designed for the Fellows.

  •  CT Case Conference (Monday and Thursday, 4:30-5:00 p.m.) Participation expected.
  •  Ultrasound Case Conference (Tuesday, 4:30-5:00 p.m.). Participation expected.
  •  MR Case Conference (Wednesday, 4:30-5:00 p.m.). Participation expected.
  •  Radiology-Pathology Correlation Conference (Tuesday, 1 per month, 4:30-5:00 p.m.).  Participation expected.
  •  Fellows Conference (Thursdays, 1-2 per month, 12:00 p.m.). Given by the faculty specifically for the Fellows on topics of special interest.  Participation expected.
  •  Abdominal Imaging Journal Club (one Thursday each month, 12:00 p.m.). Participation expected.
  •  Department of Radiology Grand Rounds (Thursdays, 7:30 a.m.). Participation expected.

TEACHING RESPONSIBILITIES:

  • Noon Abdominal Imaging Case Conference (Monday through Friday, 12:00 p.m., up to one time per month).
  • Medical Student Case Conferences (up to one time per month).
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OTHER FELLOWSHIP INFORMATION

CALL COMMITMENTS:

Weekday Call
Currently, Fellows do not take after hours call Monday through Thursday. After hours call is covered by attendings. Note however that Fellows do participate in in-house body CT evening coverage (3:00 p.m. through 11:00 p.m.), with backup call by an attending.

Weekend Call
It is our goal to have each fellow take weekend call approximately once in a six to seven week block. On weekends, Fellows will take call with an attending. On both Saturday and Sunday mornings, it is expected that all abdominal imaging cases will be interpreted by the Fellow/Attending on call.During the fellowship, it is expected that all interventional procedures will be performed under the supervision of an attending who will be present during the procedure.

VACATION:

Fellows receive 20 days vacation per academic year. Five of these days will be granted during the Christmas/New Year’s break at the discretion of the Section and the other 15 days are to be spread throughout the year.

LICENSE REQUIREMENT:

Fellows must obtain a full, unrestricted North Carolina State license to practice medicine prior to beginning the fellowship.  In addition, they must be credentialed at the Duke University Medical Center prior to beginning training.  It is the responsibility of the future Fellow to obtain a North Carolina license and to obtain credentials at the Duke University Medical Center, and we encourage future Fellows to begin this process at least six months prior to beginning the fellowship.

Information regarding medical licensure in North Carolina can be found at http://www.ncmedboard.org/licensing.  We encourage future Fellows to notify/update the fellowship coordinator during their licensure process, so that the credentialing process can begin as soon as possible following licensure.

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