CT (computed tomography) face radiology search pattern

When you start taking call as a radiology resident, a common test you are going to encounter is a maxillofacial CT, or face CT. This is especially true if you are taking call at a level 1 or level 2 trauma center. A lot of times, this is done in conjunction with a head and/or cervical spine CT. This is an extremely common test in the setting of trauma, including assault and car accidents (MVA or MVC). The key in these settings is to rule out a significant fracture or soft tissue injury to the face.

Because there are a lot of structures, it is important to have a useful search pattern. Reconstructions, especially the coronal reconstruction, are key when interpreting CT of the face. These allow you to see key structures that are parallel to the slice plane on axial images. Symmetry is extremely helpful, as the left should match the right. Additionally, making sure all the fat and fascia planes are clean is very useful.

This video will walk you through a step-by-step approach to evaluating a CT of the face. I recommend a pattern where you start with the coronals at the cranial (top) part of the image, and then work your way down. In this way, you can look at the brain, orbits, sinuses, palate, mandible, and so forth, minimizing the risk of missing a significant finding. Then you can repeat the pattern with the axial images. Finally, the sagittal images are a nice troubleshooting tool, especially for the mandible and cervical spine. As you practice, you will find you can move more quickly through your search without necessarily focusing on each individual element for too long.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may be involved with patients with facial injuries and other abnormalities.

 

See this and other videos on our Youtube channel.

Board Review 2 – Full lecture

This lecture is a board review lecture geared towards preparation for the radiology resident ABR core exam, although similar material is used for the ABR certifying exam general and neuroradiology sections.

The format of this lecture is case-based. Each case consists of a series of images followed by 1 or 2 questions. The first question is usually to name the diagnosis, while the second is a multiple choice question to test deeper understanding of the specific condition. Try to get the diagnosis before you see the second questions.

These are all general neuroradiology questions.

Board Review 2 – Introduction

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

This video is a brief introduction before beginning the case style review.

Introduction to Neuroradiology Board Review: Part 2

Neuroradiology search patterns

As radiologists, we often forget that we didn’t know how to go through a study from the beginning. This playlist will be a collection of videos on how to approach studies from scratch. This may be particularly useful to beginning medical students and residents who haven’t sat down at the PACS and looked through a study many times.

Be sure to check back often as more videos are added that cover your favorite neuroradiology exams, or check out our full channel on Youtube.

MRA (magnetic resonance angiogram) head radiology search pattern

As a neuroradiologist, one of the most frequently ordered tests you will encounter is an MRA (magnetic resonance angiogram) of the brain. This test is frequently used to evaluate the vessels of the brain, including the carotid and vertebral arteries and their intracranial branches of the circle of Willis.

MRA of the brain can evaluate for vessel occlusion, dissection, aneurysm, and vascular malformations. It can also be used to follow up on vascular findings seen on other studies. The most common indication, however, is to evaluate for stroke, when it is combined with MRA of the neck and an MRI of the brain.

This video will walk you through a step-by-step approach to evaluating an MRA of the brain, including how to approach each vessel. I use an approach that moves from anterior to posterior and then right to left. While others may have a different strategy, the most important part is to have a strategy and stick to it.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with stroke or other vascular malformations of the brain.

See this and other videos on our Youtube channel.

Cervical spine CT (computed tomography) radiology search pattern

For those aspiring radiologists out there, has anyone ever explained to you what you should do when you sit down at the PACS station to look at a cervical spine CT? What are the common indications to get a cervical spine CT?

For those non-radiologists out there, have you ever wondered what exactly is going through a radiologists mind as they look through the images? How do you even begin to look at all of the imaging findings?

This video attempts to demystify a lot of that by showing exactly how you might sit down and look at a cervical spine CT on your own. It starts with the reformatted images (those in sagittal and coronal planes) to get an overview of the alignment and anatomy before reviewing the axial images. This video doesn’t include everything you should look at, but is a guide for how you might begin.

The level of this video is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology. It may also be of interest to those with an interest in radiology who are simply curious to learn more about radiology.

See this and other videos on our Youtube channel.

Neuroradiology job search – part II – Applying and getting a job

This is the second part of a piece about getting a job as a neuroradiologist. The first section covered some general steps that you might take, including deciding on your interests, preparing your CV, and finding a mentor. If you haven’t read it already, you might consider going back and checking out Part 1.

Link to Part I – Preparing for the search

This article focuses on what to do once you are ready to apply.

5. Network

The importance of networking is tremendous. The majority of job openings are known before they ever reach a job board. Knowing about a job prior to its broad posting can give you an advantage, as you may be interviewing for a job while others are just applying. If you know people in your desired area or practice (from residency, meeting contacts, etc.), it is reasonable to politely contact them and ask if they are looking to hire in the upcoming year. In the best scenario, there is a job available and they want to know more about you. If no position is available, you have still put yourself on the radar if a position becomes available.

In addition to people that you are close to, you should also consider secondary networking and new contacts. Our faculty come from multiple geographic regions and many trained at other institutions. Additionally, neuroradiology is a relatively small community. For these reasons, faculty often have contacts in other regions and may be able to introduce you to new people that can help in your search. Society meetings, such as American Society of Neuroradiology (ASNR), are great places to meet people from areas you may be interested in and learn about jobs in other locations.

It is much easier to get introduced to someone by a known party than to simply cold call or email. People get many emails and will often ignore solicitations for jobs. However, if there is a practice or area you are interested in, it may be reasonable to contact them. Blanket emailing or calling of numerous practices may be successful in some cases but is probably the least effective technique.

Blanket emailing or calling of numerous practices may be successful in some cases but is probably the least effective technique.

6. Use online job databases

Online job databases are another extremely useful to find out about job opportunities. Although word of mouth is faster, many jobs eventually end up posted on online job boards. The most useful resources are the society online job boards. Postings can be filtered by type and location to tailor the search further. You can create saved searches and alerts which will email you automatically when jobs meeting your criteria become available. This can save you from compulsively rechecking these sites. Many of these postings will direct you to an online application or recommend you email your CV and/or a cover letter. If you don’t hear back about an application within a couple of weeks, a follow-up call or email may yield more information. The most useful online job boards include:

Radiological Society of North America (RSNA)

ACR logo

American College of Radiology (ACR)

American Society of Neuroradiology

Several of these resources include jobs for non-radiologists, including scientists and researchers. RSNA and ACR cover the entire radiology field while ASNR covers neuroradiology only. Other job posting sites exist although their signal/noise ratio may be lower due to difficult to interpret postings from recruiters and spam.

7. Prepare for the interview

To a certain extent, this goes without saying, but it is still worthwhile to prepare for your interview. Brief telephone interviews are common before in-person interviews and are a good opportunity to introduce yourself to a practice. In-person interviews often involve meeting more people throughout the course of a day. Probably the most important part of the interview is being able to articulate your qualifications and reasonably describe why you are interested in a program. This will be easiest if you learn a bit more about the practice and geography of the reason. You need to be able to state what your goals are and how this job would help you achieve them. Otherwise, the best advice is to relax and be yourself. People want to hire a normal human being, so try your best to be one.

8. Be patient – but not too patient

Each step of the job search is going to take time, as practices are often large organizations that take a while to make decisions. Expect this to take anywhere from days to months, but don’t let a lead get completely cold. When pursuing a job, you should remain in contact until you have either taken the job or it is clear that one or both parties are not interested. Ideally, at the end of each interaction (phone interview, email interview, etc.), you should set up a clear timeline for what will happen next. For example, after an interview set a clear time for follow-up. You can do this by saying something like, “It was great meeting you and your group. I know it may take some time to discuss it with the partners, but it would be great if we could follow up on the phone in two weeks.” This will give you clear time frame without looking overly desperate/anxious about the position.

Ideally, at the end of each interaction (phone interview, email interview, etc.), you should set up a clear timeline for what will happen next.

Many things may change over the lengthy job search process. Your interests and goals may change. New positions will become available. It is a fluid situation. While the peak time to get jobs for the following summer are probably late fall to winter, very good jobs can become available in the spring. The timing of hiring can vary with fluctuations of the job market in general. It’s important to not let your anxiety about the process cloud your judgment and pressure you into taking a job where you won’t be happy. It may also depend on your personal needs. If you are looking for a job with very specific requirements, it may take a bit longer. Seek advice from your colleagues and mentors throughout the process and they can help.

Conclusion

This document is by no means all inclusive, but it is designed to give you some general notion of how to approach the process. Other topics, such as negotiating the terms of your employment and salary although important, are not discussed here. Hopefully it is informative and helps allay some of the anxiety from this inherently stressful process. With preparation and patience, this can be a rewarding process in which you finally move on from being a trainee to an independent radiologist. Good luck.

 

 

Neuroradiology job search – part I – Preparing for the search

You may be thinking, “I just became a fellow, and now you want me to immediately start looking for a job.” However, the fellowship year goes by quickly and a little preparation can make it a smoother process. I would emphasize the importance of finding a rewarding job that matches your interests, uses your specialized skills, and provides appropriate compensation. The goal of this guide is help you make this happen.

The guide is divided into two main parts:

This first section will cover a few key steps that you can take before applying or taking an interview.

1. Think about your goals

The first step in the process is to think about what you want from your career. This can be a daunting step to convert your intangible desires into concrete goals. After an extended time as a trainee, your first instinct might be to say that you just want a job, any job, and you want to be open to as many possible options as possible. While counterintuitive, this can make it harder to find a job which matches your interest. Putting some constraints on your search can help focus your efforts on those options. You will be a better applicant, and we can more convincingly refer you for a position when they are a closer match to what you desire. The best way to approach this is to think about three major considerations: academic vs non-academic, subspecialty fraction, and geography.

After an extended time as a trainee, your first instinct might be to say that you just want a job, any job… this can make it harder to find a job which matches your interest.

Academic vs. non-academic. There is a continuum of jobs ranging from large academic research institutions to small private practices. The largest of academic institutions will emphasize subspecialized care, and each faculty member will likely have an emphasis on research, teaching, or service (and sometimes all of the above). Teaching and working with trainees is a large part of these positions. Case volume and call are often less, but salaries are also often less and physicians are most often employees of the hospital system. Mixed type institutions would include smaller academic centers, non-profit/private health systems, and other hospitals which may have trainees and be very subspecialized (e.g. VA hospitals, Kaiser, etc). These institutions often combine features of big academic centers and private groups.

Private practice groups are at the other end of the spectrum and range in size from less than 10 to more than 100 physicians. Case loads and call may be higher, but there also are also often fewer administrative and teaching requirements. Specialization varies widely, with smaller groups tending toward the general and larger groups as subspecialized as academic centers. Radiologists may be part of a physician group which owns the practice and sometimes imaging centers or equipment. In this case, physicians will often be on a partnership tract in which they are group employees for several years before becoming partners and sharing in the profits of the group. Depending on group structure, salaries may increase significantly upon becoming a partner. If a group owns imaging centers and equipment, there may be a monetary buy-in to become a partner. Other groups are salaried employees of the hospital system or physician group.

Subspecialty content. It is important to think about how much you wish to practice in your desired subspecialty, in this case neuroradiology. With neuroradiology being a significant component of radiology overall, it will likely be a big part of any career. Some people may like the challenge of covering all areas of radiology, while others will prefer to do predominantly neuroradiology. This will somewhat guide you in terms of group size. As part of this, you may think about areas in which you would prefer not to practice (e.g. non-neuro procedures, mammography), which may be a consideration. In general, there has been a tendency of private groups to consolidate and become increasingly subspecialized. In many groups, call is general, but larger groups may even have specialized call pools for neuroradiology.

Geography. Where you want to live is a huge consideration. Many of you may want to stay in the area where you have done your training. Others may seek to return closer to family. Still others may not have a geographic preference at all. It is important to think about what you want, as some geographic goals can help guide your search.

Overall, it is valuable to place some combination of constraints on your search. You may prefer any job type in a specific area if you are very eager to move closer to family. Alternatively, you may be looking for the best academic job in a city, regardless of region.

2. Find a trusted advisor

Finding a faculty member you trust can be an important first step. All faculty have been through a job search and have a wide range of experiences, including some in private practice. That said, it does not have to be someone from your own department. You may have a good relationship with a mentor from residency who can serve in this role. If you don’t have someone in mind, a good way is to approach one of your fellowship faculty either in person or by email and let us know that you would be interested in discussing your job search. Fellowship directors and associate directors are almost always willing to help you through the process, but other faculty members are available.

 

The faculty/fellow relationship has multiple goals. First, we can help you hone your goals and make decisions about what kind of job you are interested in. Second, we can help you prepare for the process, including getting a CV and letters ready. Finally, we can get to know you a little better so that we can help identify jobs which may be of interest. Our faculty members frequently hear about job openings before they are posted, and if we know your interests we may be better prepared to recommend you for a job.

3. Get your CV in shape

It is extremely important to prepare your curriculum vitae, or CV, so that you have it available when an opportunity arises. Many times, exchanging a CV by email is the first step on a job application. A professional looking and streamlined CV may be your best first impression. Most of you have a CV which you used during fellowship applications, but it may not have been updated since then. It should be up-to-date, accurate, and easy to read. Contact information should be prominent and current.

CVs for academic positions and private practice tend to be slightly different. While all CVs include education, awards, and publications, academic CVs may include sections on research or teaching goals. Private practice CVs may include more personal details such as family locations and personal interests. There is no right CV, but it is important that your CV reflect the goals of your career. If you are applying for a variety of jobs, you may have more than one version which is tailored to each job type or location.

Finally, a short cover letter or email can be helpful. This is usually a 1-2 paragraph summary of who you are, what your training is, and what you seek to achieve. This can be emailed to people to give them a quick overview without needing to review a multipage CV.

Your faculty advisor can help you prepare and review your CV. There are a number of CV templates which can be used and its largely a matter of personal preference.

4. Update your online presence

There are two major components to your online presence: your professional presence and your personal social media. Professional social media includes sites such as LinkedIn and Doximity, which are geared towards professionals, are important to make your information available and accurate. Recruiters may search for individuals who meet certain criteria and contact you directly through these sites. More likely, individuals at groups to which you have applied will search online to confirm and find more information about you. For this reason, it is important for your information to be accurate.

Personal social media is delicate balance between staying in touch with friends and family and being appropriately professional. Social media, including Facebook, Twitter, and others, can be a great way to communicate with current contacts and meet new ones. Furthermore, it can even promote your career by getting out knowledge about your education, work, and achievements. On the other hand, poorly thought out social media messages may inadvertently close doors. Family events, vacation photos, and social activities are well within the range of acceptable behavior. Problematic topics are wide-ranging but include such thing as alcohol/drug-use, criticism of individuals or employers, and excessive complaints about current employment. Political comments can be quite risky, particularly in the highly polarized environment in which we live. Comments about patients or which could potentially identify a patient should definitely be avoided. Each individual must consider the balance between self-expression and restraint that will be different for each person. Going forward, be thoughtful about what you are posting and how it may be perceived by someone who does not know you. Looking back, if any tweets or posts are questionable, consider removing them. It sounds crazy but I’ve personally seen people miss out on job opportunities because of social media.

It sounds crazy but I’ve personally seen people miss out on job opportunities because of social media.

Personal social media is delicate balance between staying in touch with friends and family and being appropriately professional. Social media, including Facebook, Twitter, and others, can be a great way to communicate with current contacts and meet new ones. Furthermore, it can even promote your career by getting out knowledge about your education, work, and achievements. On the other hand, poorly thought out social media messages may inadvertently close doors. Family events, vacation photos, and social activities are well within the range of acceptable behavior. Problematic topics are wide-ranging but include such thing as alcohol/drug-use, criticism of individuals or employers, and excessive complaints about current employment. Political comments can be quite risky, particularly in the highly polarized environment in which we live. Comments about patients or which could potentially identify a patient should definitely be avoided. Each individual must consider the balance between self-expression and restraint that will be different for each person. Going forward, be thoughtful about what you are posting and how it may be perceived by someone who does not know you. Looking back, if any tweets or posts are questionable, consider removing them. It sounds crazy but I’ve personally seen people miss out on job opportunities because of social media.

The second part of this article will focus on the process of finding opportunities, applying for them, and taking a job.

Continue to Part II – Applying and getting a job

 

Brain MRI (magnetic resonance imaging) sequences overview

For those aspiring radiologists out there, do you know how to tell the difference in sequences on an MRI of the brain? Has anyone ever sat down with at the PACS station to show you what each sequence is and why you might look at it?

For those non-radiologists out there, have you ever wondered what exactly is going through a radiologists mind as they look through the images?

This video attempts to demystify a lot of that by showing exactly what types of images (sequences) make up a brain MRI, both for a routine noncontrast MRI or an MRI with contrast. It starts from the beginning and shows you what kind of images you have and where to begin as you scroll through. This also shows you a little bit of the search pattern you might employ as you look at the different images.

The level of this video is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology. It may also be of interest to those with an interest in radiology who are simply curious to learn more about radiology.

See this and other videos on ourYoutube channel.