Radiology & Imaging

Musculoskeletal Radiology Fellowship

The Musculoskeletal Radiology Fellowship at Hospital for Special Surgery is ACGME accredited since 2007 and is the oldest musculoskeletal radiology fellowship program in the country, in existence since 1969. Over 90 Fellows have graduated from our program and can attest to the commitment to train future musculoskeletal radiologists.

All of the radiology faculty are committed to education and are locally, nationally and internationally known and regularly participate in both intra- and inter-departmental conferences. They are consistently invited participants to present original research at formal forums and as visiting professors.  The Radiologist-in-Chief and the Chiefs of all the major modality divisions are recognized globally in the radiology, orthopaedic and rheumatologic communities for their innovative research, imaging expertise and their commitment to teaching.

Hospital for Special Surgery is dedicated to the diagnosis and treatment of orthopaedic and rheumatologic conditions. Approximately 250,000 musculoskeletal imaging examinations are performed annually. There is a broad patient mix with referring physicians from sports medicine, arthroplasty, rheumatology, pediatrics and orthopaedic spine specialties.

The Department of Radiology & Imaging at Hospital for Special Surgery performs approximately 183,000 musculoskeletal x-rays, 14,000 musculoskeletal ultrasound examinations, including ultrasound-guided procedures, 10,000 special procedures, 8000 CTs and 30,000 musculoskeletal MRI examinations annually.  In addition to state of the art computed radiography (CR) and digital radiography (DR) conventional equipment, there are two state of the art Philips CT scanners (64 and 16 slice with 3D reformatting capabilities) and nine GE high field strength 3T and 1.5T MR units.

Curriculum:

The Department of Radiology and Imaging Musculoskeletal Radiology Fellowship experience includes musculoskeletal examinations performed on conventional radiographs, bone mineral densitometry, musculoskeletal ultrasound - both diagnostic, and interventional, CT scanning including QCT, and MRI, with special emphasis on imaging of both routine and esoteric musculoskeletal conditions as well as imaging of the post operative patient including protocol considerations for imaging around arthroplasty.
Numerous interventional musculoskeletal procedures of both the axial and appendicular skeletons are performed including myelograms, discograms, and arthrography as well as image guided (CT, fluoroscopy, ultrasound) tissue sampling, e.g., cyst aspiration and bone biopsies.  

Fellows rotate through all modalities and have dedicated research time. For diagnostic studies, the fellow most commonly pre-dictates the case, then reviews the images with the attending.  For interventional procedures, there is an initial period of one-on-one training of each fellow by an attending, followed by a period of observation of the fellow by the attending, followed by gradual greater responsibility of the fellow for all aspects of the case with attending supervision during the critical parts of the procedure. General competencies with regards to basic procedures are determined by review of the Interventional Radiology staff. All procedure reports are predictated by the Fellow and reviewed by an attending. No procedure or diagnostic study is performed and/or dictated without the direct supervision of an attending. 

The educational experience is enhanced by an intense “point of care” exposure in addition to didactic lectures and conferences. 

Special procedures/arthrography:

The purpose of the special procedures rotation is to provide the musculoskeletal radiology fellow with the foundation to perform interventional diagnostic and therapeutic procedures in the musculoskeletal system confidently, accurately, and safely.  Fellows are trained to perform image guided tissue sampling using either CT or fluoroscopic guidance.  Pre procedure imaging studies are reviewed in detail with the special procedures attending and appropriate trajectory and technique is chosen.  Procedures performed include osseous and soft tissue lesion sampling, radiofrequency ablation for osteoid osteomas and aspiration for suspected spondylodisciitis.  Fellows’ proficiency in performing interventional procedures is determined at periodic Interventional Radiology team staff meetings, which include attending radiologists, Radiology nursing and support staff with a competency sign off by staff. In addition, each fellow keeps a personal log of all interventional procedures they perform during the year and provides that list to the fellowship coordinator at the end of the program.

Conventional radiography:

The purpose of the conventional radiography (x-ray) rotation is to provide a strong foundation in the basic musculoskeletal imaging examination, the conventional x-ray. The Fellow is exposed to a variety of conditions including, but not limited to, arthritis, joint preservation and arthroplasty, contact and noncontact trauma, spine pathology, pediatric conditions and  osseous and soft tissue musculoskeletal tumors.

Computed tomography:

The fellows on the CT rotation are responsible for both non-body (the majority of cases) and body CT.  The fellows review the CT schedule the night before and protocol the cases at which time they review any relevant prior imaging studies. Fellows are exposed to a variety of cases including spine (both pre- and post operative cases), joints, including joint arthroplasty imaging, and extremity work. CT angiography services are also available usually in the setting of preoperative planning for complex lumbar spine and cervical spine surgeries.

Magnetic resonance imaging:

The purpose of the magnetic resonance imaging (MRI) rotation is to familiarize the musculoskeletal radiology fellow with the current applications of MRI in the musculoskeletal system, with an emphasis on noncontrast joint imaging, articular cartilage imaging (including quantitative techniques), MR angiography relevant to orthopaedic conditions, pre and post operative spine and imaging of the painful arthroplasty.

Fellows rotating through the MR division at the Hospital for Special Surgery will be assessed for competency in all standardized joint imaging, as well as specialized imaging, including sternoclavicular joints, pectoralis tears, high resolution nerve imaging (including pelvic floor imaging) and MR angiography.  Fellows have the opportunity to dictate cases throughout their fellowship, either by pre-reviewing images and then reviewing with an attending, or interpreting the images in front of an attending and subsequently dictating the studies.  Errors of interpretation and dictation are addressed.  In addition, fellows are informed are their performance criteria during review sessions with the education division as well as on a one to one basis with the MR attendings. 

Fellows are evaluated based on their interaction with the technical staff, referring clinicians and direct patient interaction.   The fellows are further evaluated on their ability to perform MR angiography and post process the data sets.   An MRI competency checklist, evaluating the fellow’s progress in both interpretation and well as protocoling and the technical understanding of MR image acquisition, especially in the setting of orthopaedic hardware (metal), is used, with evaluation by all of the MR attendings.   

Ultrasound:

The purpose of the ultrasound rotation is to provide the musculoskeletal radiology fellow with the foundation to perform common diagnostic musculoskeletal ultrasound examinations and interventional procedures using ultrasound.   There are currently five IU22 scanners equipped with a wide range of transducers including 12 and 17 MHz broadband linear probes and a 15MHz hockey stick probe, which are ideally suited to musculoskeletal applications.  One machine currently has on-board quantitative software (QLAB) that enables both gray-scale, color and power Doppler analysis of select regions of interest. All systems have compound image capability (sono CT), extended field of view imaging, cine-loop store and contrast harmonics. All Ultrasound images are transferred to the Philips PACS.  Fellows are expected to become proficient in diagnostic scanning of the musculoskeletal system as well as performing commonly requested procedures with sonographic guidance.

Mentorship Program:

Each Fellow has an Attending mentor.  The Attending mentor actively engages the Fellow with regards to the fellowship process, routinely “checking in” on them to see if they have any questions or concerns, and act as a general role model for the Fellow. 

Conferences:

In addition to clinical exposure to routine and complex orthopaedic pathologies, there is a rich academic experience of daily dedicated radiology conferences – all of which are CME-accredited - and multidisciplinary conferences, as well as resident and fellow one on one teaching sessions.

Fellows attend all regularly scheduled weekly conferences which include: Ultrasound tutorials and MRI conferences (Tuesdays); Grand Rounds, which includes Journal Club, interdepartmental conferences including Radiology Pathology correlation, research presentations, quality assurance reviews and outside speakers (Wednesdays); Teaching file conference, which involves review of the cases in the Robert H. Freiberger library (Thursdays); and Fellow presentations-interesting case conference where the fellows present short lectures on a variety of topics (Fridays).

The Department of Radiology and Imaging was one of the first departments at Hospital for Special Surgery to receive CME accreditation for all of its regularly scheduled conferences.

Fellows have opportunities to attend, participate and conduct radiology, orthopaedic, rheumatology, and physiatry resident and fellow conferences at HSS, NewYork-Presbyterian Hospital, and Memorial Sloan Kettering Cancer Center. The Robert H. Freiberger, MD Academic Center and Library contains a teaching file with examples of common, complex and esoteric musculoskeletal conditions and disorders on x-ray, CT, ultrasound, MRI and Nuclear Medicine.

Research:

There are ample opportunities for research and participation in research projects(s) is an expected part of the fellowship. There is also extensive research opportunities and academic mentoring in a supportive atmosphere. There is a nurturing environment for professional growth and development of expertise with monthly research meetings held to assist Fellows in the progression of their research.

The Robert H. Freiberger library has separate cubicles with computers for the fellows for them to do their research.  They have free internet access for online research (literature searches).  A variety of teaching folders with interesting cases are present on the PACS system for the fellows to review.  In addition, a new technically advanced teaching file system is available.
The fellows have access to the Kim Barrett Memorial Library at Hospital for Special Surgery 24 hours a day, seven days a week. The Library is a well-stocked medical library with emphasis on musculoskeletal medicine including orthopaedics, rheumatology and rehabilitation medicine. The Library’s collection includes over 2,000 monographs and 100 CD-Rom texts in the area of Orthopedics, Rheumatology, Sports Medicine and the Rehabilitation Sciences.  The library also maintains an archival collection of monographs that are significant to the history of Orthopedics.  The library maintains over 350 active journal subscriptions both electronic and print. The collection includes full runs of most of the premier journals in Orthopedics and related disciplines including: Acta Orthopaedica Scandinavia, Clinical Orthopedics and Related Research, Journal of Bone and Joint Surgery, Pediatrics, Journal of Pediatric Disorders & Techniques and Neurology. Additionally, the library licenses extensive networked resources available throughout the Hospital and affiliated offices.

Recent Fellow research projects have included:

Use of a Biphasic Copolymer Scaffold for the Treatment of Isolated Osteochondral Defects of the Femoral Condyle (presented at the International Cartilage Repair Society)

Platelet Rich Plasma and Autologous Blood: Where Do They Go? (presented at the Radiological Society of North America (RSNA) annual meeting)

Sacral Stress Fractures after Lumbar Fusion (presented at the RSNA)

Comparison of a Fluoroscopic Three Dimensional Imaging System with Conventional Radiography and CT in Detection of Pars Fractures in the Cadaveric Lumbar Spine (selected for presented at the Hospital for Special Surgery Annual Fellows Research Presentation Day)

Magnetic Resonance Imaging of Metal-On-Metal Hip Resurfacing Implants (presented at the International Society for Magnetic Resonance in Medicine (ISMRM)) annual meeting)

MRI Assessment of Wear-induced Synovitis in Hip Arthroplasty (presented at the ISMRM)

Magnetic Resonance Imaging of Arthroplasty: Comparison of MAVRIC and conventional Fast Spin Echo Techniques (presented at the ISMRM)

MR Imaging Findings of Infection Following Knee Arthroplasty: The Positive Predictive Value of a Lamellated Synovitis (presented at the International Skeletal Society (ISS) annual meeting)

Requirements:

Candidates for the Clinical Fellowship must be Board Certified or Board Eligible in Diagnostic Radiology or have foreign equivalent.
A valid license to practice medicine in the State of New York is a Hospital mandate.
All application materials must be submitted by September 1 for the corresponding July fellowship start date. Applications missing materials after September will not be considered. 

Fellowship Year  Deadline

 Fellowship Year  Deadline
2013-2014  September 1, 2011
2014-2015  September 1, 2012
2015-2016  September 1, 2013
2016-2017  August 1, 2014

Application

Fellowship Application is available for download in both Word and PDF formats.

If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon “Get Acrobat® Reader”. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.

Musculoskeletal MRI Fellowship

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