Curriculum

Years 1, 2, 3

MIR residents in all programs and tracks spend the first three years rotating through a core curriculum. Our goal is to progressively build competence, turning our residents into well-rounded radiologists skilled in all areas of diagnostic radiology. Core rotations include:

During their first rotation, residents quickly become familiar with normal cross-sectional anatomy of the chest, abdomen and pelvis, and develop an understanding of pathologies seen on CT. In subsequent rotations, they refine their knowledge of diagnoses frequently found on CT and become proficient with advanced CT protocols.

This busy clinical service covers all aspects of body MRI and body MRI angiography. Residents experience a high-volume body-MRI practice with a mix of thoracic, abdominal, and pelvic MRI and MRA imaging. PET/MRI exposure is a feature of our program.

Our breast imaging facility is co-located with a breast surgical practice, providing residents the opportunity to train and work alongside attending radiologists and breast surgeons. . Residents learn how to interpret diagnostic and screening mammograms including tomosynthesis. They also receive training in breast MRI and perform sonographic and stereotactic breast biopsies and needle localizations.

Our cardiac MRI/CT imaging service — one of the largest in the nation — is staffed daily by a cardiac radiologist. Radiology residents are involved in dictating and processing all cases, and have access to cath and echo images for correlation. Residents see a wide variety of cardiovascular pathology. As a result, residents become proficient in understanding cardiovascular disease processes, EKG-gated MRI and CT techniques and protocols, and complex post-processing of images.

The cardiothoracic imaging rotation covers the review of chest radiographs for Barnes-Jewish Hospital, which includes its medical, surgical, neurosurgical and cardiothoracic intensive care units. With world-class pulmonary and lung transplant programs, and cardiac and thoracic surgery services, this rotation exposes residents to a wide variety of diagnoses, from routine to rare and complex.

First-year residents rotate through the acclaimed Charles F. Knight Emergency Trauma Center at Barnes-Jewish Hospital, a Level 1 Trauma Center. The hospital has more than 80,000 emergency visits annually, including about 13,000 trauma patients.

Second, third and fourth-year residents have independent call for both Barnes-Jewish Hospital and St. Louis Children’s Hospital, the latter being the only pediatric hospital in Missouri and Illinois with a Level 1 Pediatric Trauma Center designation. Faculty backup is available to review images from home or come in when needed, and each shift ends with a face-to-face readout with subspecialty attendings.

Residents perform all fluoroscopic exams including swallow studies, barium esophagrams, small bowel studies, barium enemas, hysterosalpingograms and retrograde urethrograms. Remote faculty viewing of the fluoro screen in the reading rooms provides opportunities for residents to independently perform GI/GU examinations.

Working one-on-one with attending radiologists, residents are the primary operators on procedures. Residents gain experience from clinical training and large volume exposure to general body interventional procedures, including percutaneous organ drainage, arterial embolizations, and routine and complex central venous access.

In this multi-modality rotation, residents interpret radiographs, ultrasounds, CTs and MRIs of patients with a wide range of bone and joint disorders, including orthopedic, neoplastic, metabolic, rheumatologic and infectious abnormalities. In addition, the musculoskeletal procedure service provides hands-on instruction for performing image-guided diagnostic and therapeutic interventions for a variety of musculoskeletal conditions.

Beginning with the first rotation, residents read all modalities in neuroradiology and participate in daily lectures and case conferences dedicated to neuroradiology. In addition to performing fluoroscopically-guided spinal procedures and diagnostic cerebral angiography, residents have the opportunity to participate in interpretation of advanced imaging techniques, including diffusion tractography, functional MRI and PET/MRI.

While on service, residents benefit from a unique volume of cases, particularly in the areas of cardiac and PET, as well as exposure to pediatric nuclear medicine. The busy service handles a full complement of imaging, including PET/CT, SPECT, SPECT/CT and planar imaging.

Residents learn pediatric imaging from full-time pediatric radiologists at St. Louis Children’s Hospital. To supplement the daytime experience, residents take radiology call at the hospital during night float and senior call experiences.

All residents have an opportunity to attend the American Institute for Radiologic Pathology, with MIR paying the tuition and providing a stipend to defray costs of travel and lodging. Residents who elect not to attend are provided a four-week rad-path study period at MIR.

Opportunities for research abound at MIR. Not only will you have access to world renowned exports in basic and medical science, but the facilities at MIR provide unmatched access to the best of the best equipment and resources.

The ultrasound service performs most of the image-guided biopsies and aspirations for Barnes-Jewish Hospital, and nearly every patient who comes through this service is scanned by a resident after the sonographer completes the initial evaluation. Residents learn image interpretation and scanning techniques on this busy, hands-on rotation.

Senior residents, in collaboration with OB/GYN faculty and house staff, learn obstetric ultrasound for the first, second and third trimesters at Barnes-Jewish Hospital and Missouri Baptist Hospital.

Residents learn vascular imaging of the extremities and carotid arteries in the vascular surgery section’s ultrasound laboratory.

Designed as a “hospital of the future,” this new 64 private-bed facility opened in November 2019 and features inpatient and outpatient radiology service staffed by MIR faculty. Residents spend one to two months over their four years of training in this facility, primarily rotating on abdominal, musculoskeletal and cardiothoracic services

Year 4

During their final year of training, residents in the diagnostic radiology residency who are not doing an ESIR, research or diagnostic radiology/nuclear medicine track have the option of completing one or more selective rotations.

Options designed by the subspecialty sections include: abdominal radiology, cardiothoracic radiology, musculoskeletal radiology, breast radiology, interventional radiology, pediatric radiology, neuroradiology and nuclear medicine. Interdisciplinary options, such as informatics, oncology and general radiology, also exist.

These “mini-fellowships” vary from six to 12 weeks in length, though longer selectives can be arranged if the schedule allows. Selectives can often be tailored to focus on a resident’s area of interest. Features vary but often include increased autonomy, teaching opportunities, and academic time for research or quality improvement projects. The year is rounded out with time in nuclear medicine and breast imaging to meet requirements, as well as the assigned call and night float opportunities.

Elective Options

Some residents use allotted time in the fourth year to focus on one or more of the following shorter alternatives:

MIR’s local chapter of RAD-AID International helps foster an interest in global health among residents. In 2016, the chapter established a collaboration with the Instituto de Cancerología (INCAN) in Guatemala City, Guatemala. By sharing expertise with doctors at INCAN, the MIR team helped provide the training and tools necessary to improve the medical care patients receive on a daily basis. MIR’s Global Radiology Committee is working to expand opportunities through relationships with facilities in other countries and underserved areas of the local community.

Select residents provide radiology-anatomic correlative training for first-year medical students in the medical school’s Gross Anatomy course through lecture and small group teaching at the cadaver.

Residents involved in projects that require dedicated blocks of research time are encouraged to pursue a research elective that provides uninterrupted time to work on mentored projects.

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