The Division of Abdominal Imaging takes great pride in its high-profile, high-volume CT service. The Duke Radiology Department operates upwards of 20 CT scanners across the system, from both General Electric and Siemens Healthcare. Scanners include a variety of models including those with dual-energy capability as well as a photon counting scanner. The Body CT reading room is a hub of the Abdominal Radiology practice and is covered daily by four attending physicians, two to three fellows, and three residents. The 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 and outpatient centers. Duke’s radiologists interpret approximately 70,000 CT examinations per year with no shortage of interesting cases.
The body MR service is an integral part of the Duke hepatobiliary/pancreas, oncologic, urologic, and transplant practices, and is also used for imaging antepartum and peripartum complications. Fellows can anticipate dedicated time on the body MR service, during which time they will protocol, interpret, and staff out body-MR cases. Time on the body MR service represents a unique opportunity for one-on-one teaching with national experts in MR-specific content such as LI-RADS and PI-RADS. Fellows also read a smaller number of body MR exams while on the CT service to facilitate continuous learning. Overall, fellows will read a large number of complex cases with interesting pathology, where imaging is integral to patient care.
The Abdominal Imaging Department prides itself on both the case volume and the quality of MR teaching at the PACS station, covering a variety of technical and clinical topics. Dedicated lectures are also conducted, covering practical MR physics, protocol building, and optimization, advanced MRI techniques, and clinical topics. A number of advanced methodologies are used routinely and taught, including the Dixon method for fat suppression; liver fat and iron quantification; single-breath-hold 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® and Feraheme®.
The Division performs image-guided biopsies and percutaneous drainage procedures using conventional CT, CT fluoroscopy, and ultrasound. Two dedicated procedure rooms provide state-of-the-art CT and ultrasound equipment. The breadth and depth of available 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. Thrombin injections for treatment of pseudoaneurysms are also performed. A typical interventional day includes approximately 10-12 cases per day.
Only one resident or fellow is scheduled on the interventional rotation per day, and fellows will typically be assigned 2-3 interventional days per month. This assures that the interventional radiology fellow will have the opportunity to perform all cases presented that day with attentive staff supervision. During the fellowship, one can anticipate the development of excellent skills with percutaneous interventional procedures and a deeper level of comfort performing these procedures independently in the first post-fellowship career placement.
The Division of Abdominal Radiology has strong abdominal, vascular, and obstetrical ultrasound training. 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 comprises approximately 30% of our ultrasound practice. Fellows receive extensive experience in first-trimester obstetrical ultrasound, particularly in the acute/emergent setting. Fellows also have the option of spending elective time in the Fetal Diagnostic Clinic, if the experience with second and third-trimester obstetric ultrasound is desired.
Members of the Abdominal Imaging division have a wealth of experience with CT colonography. Fellows receive training in CT colonography techniques and will subsequently perform and interpret these examinations. Fellows learn a variety of interpretation and problem-solving methods, including 2D interpretation with 3D problem-solving, 3D fly-through, and virtual dissection.
Fellows receive some experience with traditional GI and GU studies during their fellowship. At times, Fellows may be asked to cover these services as Attendings.