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Core Rotations

Mallinckrodt Institute of Radiology provides services in multiple locations at Washington University Medical Center. Most resident rotations are based at Barnes-Jewish Hospital’s two campuses (north and south), which are connected through a series of indoor walkways and are within easy walking distance of each other. Residents spend time on both campuses, seeing a mix of patients in inpatient and outpatient imaging services.

Chest
Consistently rated as one of the top rotations in the residency curriculum, the cardiothoracic imaging rotation covers the review of chest radiographs for Barnes-Jewish Hospital. In addition to routine chest radiographs performed on inpatients, the service covers chest radiography for the medical, surgical, neurosurgical, and cardiothoracic intensive care units. With world-class pulmonary, thoracic surgery, lung transplant, and cardiothoracic surgery services, the cardiothoracic imaging rotation offers exposure to a wealth of diagnoses. This rotation also provides services for fluoroscopic evaluation of mechanical valves and diaphragmatic disorders. Residents attend a dedicated chest imaging conference daily including a weekly interdisciplinary conference that is a resident favorite.

Body Computed Tomography
One of the busiest imaging services in the hospital, the body CT reading rooms often are considered the hub of radiology imaging for the hospital.

Musculoskeletal Imaging
Musculoskeletal (MSK) imaging is a multi-modality rotation, where residents interpret radiographs, ultrasounds, CTs, and MRIs of patients with a wide range of bone and joint disorders from trauma, sports medicine, orthopedics, oncology, and rheumatology. Residents also have the opportunity to participate in the MSK special procedures service during this rotation, where they will receive hands-on instruction for performing image-guided diagnostic and therapeutic interventions for a variety of musculoskeletal conditions, including joint injections and aspirations, bone and soft tissue biopsies, nerve blocks and central epidural injections, vertebroplasties, and targeted therapies for osseous metastatic disease. The experience in the reading room is supplemented with daily didactic and case-based conferences, interdepartmental conferences with pathology, orthopedics, oncology, rheumatology, and bone and mineral medicine, and end-of-rotation follow-up conferences at which residents present and discuss a selection of surgically and pathologically proven cases.

Gastrointestinal/Genitourinary
The GI/GU service offers residents the opportunity to learn the principles and practices of GI and GU imaging. With remote viewing of the fluoroscreen by faculty in the reading room, residents are given the opportunity to independently perform GI contrast examinations, including swallow studies, small bowel followthrough and barium enemas. The residents also learn GU procedures such as hysterosalpingography, cystography, urethrography, vaginography with the attending radiologist. The service is expanding to read 3-D CT urography.

Pediatric
Residents have the opportunity to learn pediatric imaging from full-time pediatric radiologists at St. Louis Children’s Hospital. The facility, one of two full-service pediatric hospitals in St. Louis, is recognized by U.S. News & World Report as one of America’s best children’s hospitals. Residents cover radiology call during the night float and senior call experiences.

Neuroradiology
This service covers CT and MR imaging of the brain, spine, and head and neck for patients referred from throughout the St. Louis region. Residents also have the opportunity to perform standard and advanced imaging techniques, fluoroscopically guided lumbar punctures for CSF aspiration, myelography, and chemotherapy administration as well as diagnostic angiography of the brain and spine.

Nuclear Medicine
This service, which is heavily involved in clinical and research activities, provides residents with the opportunity to learn cutting-edge nuclear medicine. In addition, residents are provided with the requisite physics and laboratory training to meet the NRC requirements while at Barnes-Jewish Hospital. Mallinckrodt Institute of Radiology was one of the first facilities in the nation to have a PET/MRI. This device simultaneously performs positron-emission tomography (PET) and magnetic resonance imaging (MRI) scans. It is located in the Center for Clinical Imaging Research (CCIR), a state-of-the-art research facility. MIR also has a PET/CT service at which head and neck as well as body and chest cases are performed daily.

Emergency/Trauma
The Knight Emergency and Trauma Center, a Level 1 trauma center in St. Louis, is busy 24/7. This 52,000-square-foot facility has a total of 70 beds. During weekday hours, junior residents rotate through the emergency department to “learn the ropes” in preparation for independent call.

Ultrasound
Body ultrasound is one of the busiest imaging and procedural areas in radiology, providing a complete list of gray scale and Doppler imaging services (with the exception of vascular and obstetric imaging). Residents are expected to learn imaging interpretation and how to scan; nearly every patient who comes through this service is scanned by the resident after the sonographer completes the initial evaluation. The ultrasound service performs most of the image-guided biopsies for the hospital, a crucial role in the diagnostic evaluation of abdominal (or gastrointestinal), musculoskeletal, endocrine, and other diseases. Image-guided thoracenteses and paracenteses are performed frequently.

Interventional
With seven dedicated C-arm suites and an active inpatient and outpatient clinic program, this rotation provides residents with the opportunity to be the primary operator on procedures on a daily basis. With cutting-edge services available, residents are exposed to general body interventional procedures, including uterine artery embolization, chemoembolization, TIPS, endovenous laser ablation, and thrombolysis.

Neurointerventional
Upper-level residents rotate through this service. With three fellowship-trained neurointerventional radiologists on staff, this busy service provides diagnostic neuroangiography, carotid stenting, therapeutic embolizations of aneurysms and tumors, and more.

Breast
The breast imaging facility is in the Center for Advanced Medicine and is co-located with the breast surgical practice in a dedicated Breast Health center. Radiologists work side by side with surgeons and support staff to provide state-of-the-art care for patients with breast disorders. The service has full-field digital units and provides diagnostic and screening mammography for St. Louis and surrounding areas. Residents also receive training in breast MRI and perform procedures, including sonographic and sterotactic breast biopsies and breast needle localizations.

Body Magnetic Resonance
A busy clinical service that is consistently rated as one of the top rotations in the residency curriculum, the body MRI service covers all aspects of thoracic, abdominal and pelvic MR imaging and MR angiography.

OB/GYN Ultrasound
Senior residents work with the OB/GYN faculty and house staff for experience in obstetric ultrasound. Residents spend time at Barnes-Jewish Hospital and Missouri Baptist Hospital.

Vascular Ultrasound
Senior residents learn vascular imaging of the extremities and carotid arteries in the vascular surgery section’s vascular ultrasound laboratory.

Cardiac Imaging
This rapidly expanding service includes seven cardiac imagers and a collaborative partnership with the School of Medicine’s Division of Cardiology. All residents receive sufficient training to meet the American College of Radiology’s suggested requirements for cardiac CT interpretation and the American College of Cardiology Level 1 requirements for cardiac imaging.