UCSD Musculoskeletal Radiology bonepit.com Fellow rotations

This handout lists your responsibilities on the rotations you will be assigned to during the year. Please contact me (mpathria@ucsd.edu) if you have any questions about the schedule or any problems with the scheduling of your rotations.

There will be 2 fellows on call each week, one for UCSD Medical Center and Thornton hospital, and one for the VA Medical Center. You are on call from 7 a.m. on Monday until 7 a.m. the following Monday. You are on call from home during the week. During the week, your pager must be turned on and with you at all times and you must be easily accessible. Beeper range is approximately 35-40 miles from the UCSD Medical Center. The on-call fellows will have to come in on the weekend for readouts. The UCSD resident will come in to read inpatient x-rays at UCSD Hillcrest on Saturday and Sunday, the bone films from the ER at Thornton on Saturday and Sunday, and will meet with faculty on Sunday to do the cross-sectional imaging from UCSD Medical Center and Thornton. The VA resident will come in on Sunday to read the teleradiology MR at the VA.

Call during the week is very light. The resident or technicians may call you for advice. You may be called to provide a protocol for a CT or. Rarely, the resident may ask you to come in and review films they do not feel comfortable reading. The most likely reason for being called in is to do a procedure, such as an aspiration of a suspected septic joint. Please go ahead and perform a procedure by yourself if you feel comfortable. Otherwise, call one of the bone faculty for advice or assistance. Please do not do a bone biopsy without discussing the case with one of the faculty.

If you trade call, it is your responsibility to notify the front desk of Radiology at each hospital and the hospital operators about the trade.

There will be 2 or 3 fellows assigned to the VA hospital throughout the year. Please divide up the workload between yourselves, as long as it is fair! The VA offers the largest MR experience of the fellowship. Teleradiology cases are handled at the VA. You will have the opportunity to interact with radiologists from around the world who come to visit and or do research at the VA.

The fellow listed first for the VA is the primary fellow and will also be on call for the weekend for the VA hospital. The VA fellow will need to come in one day on the weekend to do a readout, which will consist largely of teleradiology MR cases. The weekend VA readout will typically be on Sunday in the late morning after the faculty person on call has read out the inpatient studies for UCSD. Please check with the on call faculty for an exact time. An on call faculty schedule is included in this package.

There is a weekly conference at 7:30 am on Fridays with the orthopedic residents. The VA fellows should select and prepare the cases to be shown. The fellow will discuss these cases and present the conference. This presentation is typically done using Powerpoint and features cases from the VA and from the teleradiology case material.

Once a month, at 9:00 am on Friday, there is a Rheumatology conference. The VA fellows should select the cases to be shown. Dr. Resnick will discuss the cases with the rheumatologists at this conference.

There are two fellows assigned to the University Hospital in Hillcrest. The hospital is a trauma center and serves a large indigent population. The workload consists of a chaotic blend of conventional radiographs and a moderate number of PACS cross-sectional studies. There is a big CT volume, mainly related to acute trauma.

The bone service at UCSD covers the trauma unit all week. Trauma films must be read as soon as they are delivered to the trauma board. Please notify the trauma service about any important findings immediately. Have the operator page the trauma resident and note in your dictation that they have been notified. The UCSD bone service also covers the ER readouts and wet readings about half the week. This ER coverage is referred to as PIT or Consult and is indicated on the faculty schedule. On PIT, the file room will call you for wet readings and you need to go to the ER to read the films hanging on the ER alternator. Morning PIT duty is from 8:00 am to 12:30 pm and afternoon PIT duty is from 12:30 to 5:00 pm. You must be on your pager and easily accessible during this time.

There will be one fellow assigned to Thornton hospital. This is a moderate volume rotation consisting of some conventional plain films and some cross-sectional imaging on PACS. All the MR arthrography for UCSD patients is also performed at Thornton hospital.

The Thornton fellow is responsible for dictating the bone densitometry studies done throughout the health care system. There is some information about bone densitometry dictation in this package and Dr. Hughes will meet with you as a group later this month to discuss densitometry.

There will be two fellows assigned to Scripps this year. It is a very busy rotation for a single person to handle, and can get very lonely if you are there alone. The rotation lasts for one week and you will read a large volume of films. There are 3 bone boards at Scripps, plus several cross-sectional studies, and an average of 2-3 arthrograms daily. The fellows should review the films and predictate them before reviewing them with one of the bone attendings. You can check with the attending radiologist what time they are planning to stop by that day (usually in the afternoon). After reviewing the x-rays with the attending, you must correct or addend all the films that have a change from your preliminary reading. You must devise an effective and reliable system for correcting your predictated reports.

The bone fellows at Scripps do the arthrograms, which consist mainly of knee, shoulder and hip studies. Please feel free to ask the Interventional radiologists (Harry Knowles or Mohseen Sayeed), or any other radiologist (Shelley Kleinman is very helpful) at Scripps for assistance until you feel comfortable. Many of the arthrograms are for MR arthrography.

Once a month, there is a Thursday 7:30 bone conference at Scripps. Radiologists, orthopedic surgeons and rheumatologists attend the conference. The fellow assigned to Scripps for the week of the conference is responsible for putting the conference together. The fellow needs to gather up 8-12 interesting cases, select the images to be presented, and present the conference to Dr. Resnick as unknowns or discussion cases.

Each fellow will have a one-month rotation with neuroradiology. This rotation is designed to emphasize spine MR and spine procedures. The primary contact person for this rotation is Dr. Wade Wong in the division of neuroradiology. This rotation will take place largely at the VA hospital, though many of the fellows rotate around to the other hospitals depending on the procedure schedule.

One fellow will be assigned to attend MR readouts at the Naval Hospital near Balboa Park. They have a large volume of musculoskeletal MR, particularly sports medicine. Please note that you will not have clinical privileges for this hospital so you can only act as an observer. The MR readout typically takes place in the morning, leaving the afternoon free. Please be available on your pager in case one of the other hospitals is unusually busy and needs your help.

All of you that are interested in research will have several weeks of dedicated research time to work on projects up in the lab or to work on clinical research projects. Those fellows not interested in doing research will remain on the clinical schedule.

Research time is an excellent opportunity to do some consolidated work on your projects. It is a good time to set up lab time with Debbie Trudell or to do some MR scanning. Please call Debbie in advance because she is going to have a very busy schedule this year.

Research time is not meant to be a vacation, a week to do locums or a week of photography! You are expected to be at work daily, to come to the bone conferences and to be available in case you are needed to cover in case of an emergency. The research fellows are our floating personnel that serve as back up if we need help. You must be on your pager and in town and available. Please check your email regularly and keep that pager on in case we need you to work!

You are allowed 20 days of vacation during the year. We have plenty of fellows this year so it should not be too difficult to take time when you want it, but do plan ahead. Vacation is on a first-come, first-served basis. Only requests submitted in writing or by email will work!! If you can, try to take vacation in blocks of time rather than a day here and there! Single days are allowed, but they are more difficult to schedule.

All vacation time you take needs to be on the schedule. You need to let Mike Holbrook and the chief fellow (or myself until we have a chief fellow) know if you need to go away unexpectedly.