The Division of Abdominal Imaging takes great pride in its high profile, high volume CT service. The Duke Radiology Department operates a total of 18 CT scanners across the system, from both General Electric and Siemens Healthcare. These include 5×128 slice, 9×64 slice, 4×16 slice interventional scanners, and 3 systems with CT fluoroscopy; 10 with dual energy capability. The Body CT reading room is the main 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 rotations on the body MR service. While on these rotations, the Fellow will protocol, interpret, and staff out every body MR case. They can expect to read a large number of complex cases with interesting pathology, where imaging is integral to patient care. Duke’s radiologists interpret approximately 8,000 MRI examinations per year.
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 and small-group teaching sessions 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-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® and Feraheme®.
The Duke Department of Radiology operates a total of 13 clinical MRI scanners across our system: 9×1.5T and 4x3T from both General Electric and Siemens Healthcare as well as one research-dedicated, 3T unit.
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 experience with second and third trimester obstetric ultrasound is desired.
Numerous CTA and MRA procedures are performed on a daily basis. A 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 the 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. The workstations in our MRI reading room are also connected with both iCAD and DynaCAD connectivity for perfusion analysis, which are used particularly for multiparametric prostate MRI.
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 full experience with the use and interpretation of CT/PET in oncologic follow up.
Members of the Abdominal Imaging division have a wealth of experience with CT colonography. Fellows receive training in CT colonography technique 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.