Program Director: Anup Shetty, MD
The Mallinckrodt Institute of Radiology at the Washington University School of Medicine offers a one-year fellowship training program in advanced abdominal and pelvic imaging, including CT, MR, US, fluoroscopy and image-guided procedures. Our aim is to development outstanding subspecialist radiologists with expertise in abdominal imaging and the skills to hit the ground running in their future practice. The program typically accepts seven fellows per year.
Our faculty are nationally and internationally renowned and provide a wide breadth and depth of knowledge, experience, and teaching styles. As a non-ACGME accredited fellowship, we provide our fellows the opportunity for graduated responsibility as the fellowship progresses and the ability to begin reading cases independently, albeit with a staff member feet away in a highly supportive environment, during fellowship rather than for the first time on their first day of attending practice. We believe this offers our fellows the best of both worlds and optimally prepares them for their career.
Facilities and Equipment:
Fellows spent nearly all of their time on the campus of the Washington University School of Medicine in Barnes Jewish Hospital (BJH) and the Center for Advanced Medicine (CAM). BJH is a large tertiary care hospital with over 1000 beds, a 200+ mile referral base and uniformly strong medical, surgical, and oncologic departments that lend themselves to incredible opportunities for learning radiology. The CAM is the outpatient center, intimately linked with the Siteman Cancer Center, a National Cancer Institute Comprehensive Cancer Center. Between BJH and the CAM, which are connected through the medical center campus by an indoor link, MIR operates 9 clinical Siemens MR scanners, including three 3T magnets, and 11 Siemens CT scanners, including dual-energy platforms, with additional MR scanners in operation at satellite facilities, the studies of which are read by MIR radiologists. Our state-of-the-art US department, featuring GE sonography machines, offers advanced diagnostic and procedural capabilities. MIR was one of the first facilities to obtain a combined PET/MR platform, which is leveraged for both research and clinical studies.
Fellows also have the option to spend time at Barnes Jewish West County Hospital, a smaller facility in the western suburbs of St. Louis, which offers a more relaxed set up mixing CT, US, and fluoroscopy in a smaller setting with a single resident.
Services: Our fellows rotate through the various modalities on a daily basis and attend and present at several multidisciplinary and tumor board conferences during each 4-week block.
Body CT: Fellows spend approximately 30% of their time reading body CT cases during fellowship, which includes CT imaging of the chest, abdomen, and pelvis and more advanced CT techniques, including CT urography, colonography, and angiography. Fellows develop expertise with 3D postprocessing and manipulation and will experience a wide variety of cases, ranging from complex inpatient studies to oncologic follow-up and every possibility in between. Fellows will also perform CT-guided biopsies under the supervision of experienced attendings.
Ultrasound: Fellows perfect their scanning skills under the supervision of expert attendings and experienced sonographers while reading a diverse mix of diagnostic cases, including liver, renal, and pancreas transplant, abdominal, renal, and thyroid ultrasound and optionally shoulder sonography. Fellows have the opportunity to regularly scan patients, allowing them to troubleshoot difficult cases and develop confidence in their abilities. The US services are the busiest procedural service of the fellowship, as we perform a high volume of US-guided biopsies and aspirations, including liver and renal biopsies, deep peritoneal and pelvic biopsies, lymph node and thyroid biopsies, thoracenteses and paracenteses, and thrombin injection of pseudoaneurysms.
MRI: The body MR service covers a wide gamut of disease, not limited only to abdominal and pelvic imaging but also vascular and thoracic MR. Fellows will develop comfort and expertise reading complex liver cases, working closely with hepatopancreaticobiliary surgeons, medical and radiation oncologists, interventional radiologists and gastroenterologists in a multidisciplinary setting. At a busy liver transplant center, fellows will learn the intricacies of transplant imaging and all of the considerations that go into providing optimal service to patients and their referring clinicians. As prostate MRI volume continues to grow by leaps and bounds, our fellows will be poised to be both comfortable and proficient with reading prostate MRI and working closely with referring urologists. Our urologists use a MR-transrectal ultrasound fusion platform for guiding prostate biopsies, placing a premium on optimal technique and careful interpretation of prostate MRI, skills that fellows will rapidly develop. Fellows are deeply involved in the colorectal multidisciplinary conference and rapidly gain expertise in rectal cancer staging with pelvic MRI.
Other services: Fellows will spend a limited amount of time on the gastrointestinal/genitourinary (GI/GU) fluoroscopy service during the early months of fellowship, refining their technique under the supervision of expert abdominal imaging staff. While not regularly scheduled on this service later in fellowship, fellows have the opportunity to spend more time on service at their discretion. Fellows may also choose to receive additional experience and training in emergency and cardiac imaging.
Our fellows receive the bulk of their education in the reading room, working side by side with attendings on busy services, reading out cases and performing procedures together. There is dedicated weekly teaching for fellows, which includes staff didactic lectures on advanced topics, guest speakers from other subspecialties including surgery, pathology and internal medicine, interesting case conference “pizza rounds,” journal club, and morbidity and mortality conferences. Fellows also have the option of attending morning teaching conferences given by abdominal section staff and noontime department wide radiology teaching conferences on a variety of topics. Multidisciplinary conferences provide another opportunity for fellows to observe the expert approach to challenging cases.
Research and Teaching:
Fellows are highly encouraged to participate in research projects during fellowship, under the guidance of section faculty members or even outside of the section if desired, and a multitude of opportunities are available.
We feel strongly that teaching is an important element of the fellowship, and highly encourage our fellows to take advantage of the opportunity to teach residents. As the largest radiology residency program in the country, MIR offers fellows the chance to make a broad impact on resident education, which serves the dual role of motivating the fellow to know their material well enough to effectively teach. Fellows are expected to give one morning teaching conference to residents during each four-week block, on an US, CT, or fluoroscopy topic of their choice to residents on service. Fellows also will give a noontime teaching conference to all residents during the latter months of the fellowship year, which emphasizes the effort and discipline required to teach effectively, a valuable skill regardless of future career path.
Fellows receive academic time during each block to spend productively how they see fit, whether that is developing educational materials, performing research, or spending time in the OR with our surgical colleagues. We also recognize that fellows need time to take care of personal tasks and can often use their nonclinical time flexibly.
Call and Weekends:
One of the overarching themes of the fellowship is collegiality, as we treat our fellows like junior faculty and share the responsibility of call and weekends. Call is taken one week at a time and consists of home pager call, consulting with residents reading emergent and after-hours cases on an as-needed basis, and rarely coming into the hospital for a fluoroscopic procedure. Fellows are able to view studies from their home computers. Calls from residents are infrequent, and fellows take call approximately once a month.
MIR offers Saturday half-day services for each modality, and abdominal fellows will share in the coverage of CT, GI/GU, and MR services on Saturday mornings. Staff cover the Saturdays with fellows during the first few blocks to ensure that fellows are comfortable with the work flow, and eventually fellows will begin to cover Saturday mornings independently with a resident. There are no regularly scheduled overnight responsibilities with the exception of call.
Fellows receive a CME fund for books and travel, protected time for meetings and job interviews, and allotted vacation time. Fellows are assigned faculty mentors that they meet with regularly to ensure that they are adjusting to fellowship well, meeting the goals of fellowship, and thinking ahead to their eventual career plans. Fellows enjoy the benefits of the vast MIR network of former residents and fellows when the time comes to seek a job, and are always considered a part of the MIR family even after they graduate, whether it’s getting together at RSNA and other meetings, collaborating on projects, or consulting on challenging cases.
Please contact Katrina Bridges at email@example.com or (314) 362-2928 for information on how to apply. Interviews will commence from December 2019 through March 2020 per the SCARD agreement, and are only offered after applications are complete. Applicants are strongly encouraged to have their completed fellowship application materials submitted in a timely fashion prior to the beginning of the interview season, as interviews and positions will be offered on a rolling basis.