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Musculoskeletal Radiology Fellowship Program

Cedars-Sinai Medical Center educates board-eligible radiologists who want to acquire expertise in the imaging diagnosis and treatment of disorders related to the musculoskeletal system. Our goal is to provide clinically-based training to develop the medical knowledge and skills required to demonstrate accurate clinical decision-making as a specialist in musculoskeletal radiology.

The Musculoskeletal Radiology fellowship program at Cedars-Sinai Medical Center is the only Musculoskeletal Radiology fellowship in the State of California that has earned accreditation from the Accreditation Council of Graduate Medical Education. ACGME accreditation assures the public, licensing agencies, credentialing agencies, and funding agencies that the program has undergone a rigorous measure of approval that meets or exceeds quality standards in the medical specialty, and that our physicians have undergone training in U.S. graduate medical education programs that have met or exceeded established standards.

Cedars-Sinai Medical Center received rankings in eleven specialties including orthopedics, and was named one of America's Best Hospitals in the recently released 2009 U.S. News & World Report, which only magnifies our commitment to patient care and education.

We have an active clinical practice including a Level 1 trauma center and perform over 300,000 procedures in the Imaging Department annually. Fellows work hours average about 50 hours per week, and take call for a total of 12 hours on the weekend, once every 4 weeks. Call consists primarily of read-outs of plain film. All other call is handled by radiology residents. The fellow's participation in the core program extends only to the experience required for compliance with the training requirements set forth by the ACGME.

While training in an academic setting has benefits, training in a real-world setting is the true indicator of clinical competence to practice medicine independently. Our larger patient population, advanced imaging procedures, extensive pathology, research opportunities and competitive stipend expose only the surface of why Cedars-Sinai Medical Center remains on the forefront of the most sought after programs for fellowship training.

We look forward to providing a comprehensive training experience and in advancing your career as a specialist in Musculoskeletal Radiology.

About the Faculty

There are 31 full-time physicians and 9 part-time physicians on our radiology staff, two of which are dedicated to musculoskeletal imaging. The presence of an ACGME-accredited diagnostic radiology program as well as close relationships with programs in rheumatology, orthopedic surgery, neurosurgery and other appropriate specialties provides a comprehensive learning experience with no outside rotations.

The program is under the direction of Thomas Learch, MD, who is a former recipient the Golden Apple Award for Excellence in Teaching.

Dr. Learch's studies have been published in multiple journals, including Radiographics and American Journal of Roentgenology. He has presented his research at annual meetings of the Radiological Society of North America, American Roentgen Ray Society, and American Society of Emergency Radiology.

Dr. Learch developed multiple radiology/orthopedic web site pages that have won numerous awards at national medical conferences, including:

• Elbow Arthroplasty Normal and Abnormal Imaging Appearances
• The Limb Sparing Saddle Prosthesis and Pelvic Neoplasia
• Shoulder Arthroplasty - Normal and Abnormal Imaging Appearances
• Knee Arthroplasty - Normal and Abnormal Imaging Appearances
• Imaging Findings in Limb-Sparing Surgery and Endoprosthetic Placement for Shoulder Girdle Neoplasia

Jeffrey Dym, MD is the 2009 recipient of the prestigious Golden Apple Award and is an enthusiastic mentor in teaching musculoskeletal radiology. Dr. Dym's studies have been published in multiple peer-reviewed journals, including Proceedings of the Society for Experimental Biology and Medicine.

Our attending faculty are extensively involved in publications, presentations, research and other scholarly activities. Residents in the core diagnostic radiology residency program boast 100% board-pass rates and have won awards for their exhibits at the RSNA, and have first-authored and contributing-authored articles published by the Radiological Society of North America and American Roentgen Ray Society to name a few.

Clinical and Didactic Experience

The Musculoskeletal Radiology fellowship program integrates core ACGME competencies into every part of the curriculum, supplemented with multiple teaching tools and learning experiences to assess competence in the following six areas:

• Medical Knowledge
• Patient Care
• Professionalism
• Interpersonal and Communications Skills
• Practice-Based Learning
• Systems-Based Practice

There are daily reading sessions to progressively develop a trained eye in the interpretation of all musculoskeletal examinations, including the adult and pediatric patient population. There are multiple clinical and didactic sessions for fellows to gain experience in all areas of musculoskeletal imaging. Fellows have an active role in previewing studies and forming their own opinion as to the findings and clinical implications under faculty supervision, and actively participate in the teaching of residents, preparing and presenting cases.

There are several monthly and bi-monthly conferences, including:

• MSK Section Conference
• Imaging Grand Rounds
• Rheumatology
• MSK pathology conference (combined oncology and pathology)
• Pathology (autopsy conference)
• Neurosurgery Grand Rounds
• Orthopedic Surgery
• Resident Conference
• Radiology/Ortho Conference
• MSK Interesting Case Conference

Since entry into the musculoskeletal radiology fellowship program requires completion of a diagnostic radiology residency accredited by the ACGME or RCPSC and board certification by the American Board of Radiology, fellows actively participate in patient assessment and perform procedures from the start of the program. However, as a trainee, all patient care activities are always performed under the direct supervision of an attending radiologist.

The curriculum provides clinical and didactic experience covering the full continuum of musculoskeletal radiology, including but not limited to:

a. Plain Film Interpretation:
Fellows observe daily interpretations of cases performed by attending radiologists, learning the fundamentals of plain film interpretation, familiarization with protocols, and distinguishing normal from abnormal x-ray findings.

b. Computed Tomography:
Fellows assume increasing responsibility for planning; monitoring and interpreting CT scans, and performs procedures under direct supervision. Fellows review completed cases and exams with the attending radiologist. Fellows are directly involved with protocols for CT exams including post-procedural care, interpretation and dictation, reviews teaching files and attend radiology conferences related to CT

c. Ultrasonography:
Fellows observe interpretations and dictations related to musculoskeletal ultrasound examinations. Important teaching points related to study protocol and basic interpretation are emphasized. The fellow attends conferences in rheumatology and orthopedics, reviews teaching files, and participates in procedures performed by the attending radiologist, supplemented by didactic lectures.

d. Magnetic Resonance Imaging:
This includes one-on-one teaching, formal didactic lectures, and multi-disciplinary conferences. There is substantial participation in MR arthrography and MRI of all joints in a wide variety of clinical conditions.

e. Nuclear Radiology
Fellows have an opportunity to participate in reading sessions with nuclear medicine attending physicians. The training includes PET and SPECT CT for bone scanning, including new technologies in sodium fluoride (F18) using PET CT.

f. Interventional Techniques:
Fellows participate in image-guided procedures and gain extensive experience in procedures involving the musculoskeletal system. Fellows preview cases and form initial interpretations and discussed with the attending radiologist. A gradual increase in responsibility for the interpretation and protocol of cases is given as warranted. The interpretation of studies and performing procedures is enhanced and supplemented by teaching conferences and didactic lectures.

g. Bone Densitometry: Fellows have an opportunity to participate in bone densitometry scanning in nuclear medicine to diagnose and formulate treatment options for medical conditions related to bone loss. The fellow attends departmental and interdepartmental conferences and participates in readouts and consultations in nuclear medicine.

Scientific Meetings:

Fellows have an opportunity to attend and present at one scientific meeting funded by the department annually. Additional meeting time is allowed if making a scientific contribution to a meeting.

Research:

Cedars-Sinai ranks among the top non-university hospitals nationwide receiving research funding from the National Institutes of Health (NIH). The fellowship program has on-going research projects and participation is required. Each fellow is assigned at least one research project and a mentor and is expected to participate in the preparation of abstracts, papers and presentations for publication.

Facilities and Space:

The Imaging Department has 3 conference rooms, one of which is dedicated for resident use for educational activities. The dedicated conference room has desks, computers, a 60¿ flat screen TV, internet access, light box, phones and access to projectors. In addition to the dedicated conference room, there is a dedicated resident lounge with computers, phones, and lockers. Each attending faculty also has his/her individual office.

The nuclear radiology section consists of 22,000 sq. ft. of space. The physics area is approximately 1400 sq. ft.; radiological research 1200 sq. ft., and a 6,000 ft. area for small & large animal research/imaging. There are 25 examining rooms controlled by nuclear radiology and10 nuclear radiology staff offices.

Equipment:

The Imaging Department is a PACS-based center with state-of-the-art equipment including seven CT scanners and new equipment is continually added. Our dual source CT scanner allows images to be obtained in 83 milliseconds. There are six 1.5 Tesla MR scanners. Our 3T MR provides advanced MR imaging for clinical and research studies.

There are three dedicated research servers (Dell PowerEdge 1650) and two NAS servers (Maxtor MaxAttach with 640 GB of storage each). All systems are connected directly with the Kodak PACS, nuclear medicine and MRI workstations, via the hospital intranet. The latest clinical software is available on both the Siemens Leonardo and GE Advantage workstations; both of these workstations allow clinical activities. Specialized C++ libraries developed at Cedars-Sinai are available for generic image manipulation, DICOM support and creation of clinical displays. All research computers are connected to the same intranet, and are directly linked to the Kodak PACS, MRI, CT and nuclear workstations.

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