This one-year, non-ACGME-accredited Body Magnetic Resonance Imaging (MRI) Fellowship focuses on abdominal and pelvic MRI and includes up to two months of electives in neuroradiology, musculoskeletal radiology or cardiovascular radiology. This fellowship, approved by the IU School of Medicine Office of Graduate Medical Education, is designed for physicians who are familiar with the technical and clinical aspects of body MRI and who intend to practice advanced Body MRI in their career.
Two or three times a week, department staff give didactic talks on the physics and clinical aspects of MRI. Fellows have opportunities to spend time with the magnetic resonance technologists to gather first-hand experience regarding scan protocols and gain valuable insight to how changes are made in individual cases to increase resolution and reduce scan time. Fellows are responsible for showing case(s) of the day to residents every afternoon. In most instances, faculty also take part in case-of-the-day discussion to give further insight to difficult cases. Once a month, each fellow, together with a fourth-year resident, present a Journal Club to the faculty and other residents of the department. The articles are based on a hot topic in Body MRI.
Body MRI fellows are required to undertake research with one of more Abdominal Radiology faculty. The major fields of research are prostate MRI (urology) to determine the value of multiparametric assessment of prostate cancer in determining surgical success and outcomes after chemoradiotherapy as well as advanced diffusion-weighted imaging (intravoxel incoherent motion) and quantitative MR perfusion (dynamic contrast-enhanced MRI) in assessment of response to tumor therapy. In the past, this technique has been used as a research tool but given technological advances, the fellow may be the key member of a team to determine feasibility of incorporating this technique as part of a clinical MRI protocol. Interested fellows are trained on how to design a research study. Basic statistics are covered either by the radiologists or by attending a biostatistics course. Fellows receive guidance on how to write scientific manuscripts and are required to complete at least one manuscript during the fellowship.
Program leaders train fellows to thoroughly develop clinical skills necessary for the proficient performance of all aspects of body MRI. Fellows are guided through interventional procedures, including biopsy of lesions in the lungs and liver, placement of fiducial markers for radiation therapy, cholecystectomy and abscess drainage. Fellows are also trained in the proficiency in the use of advanced magnetic resonance cholangiopancreatography (MRCP) and the use of intravenous secretin in assessing the anatomy and function of the pancreas. Depending on the candidate, further specialized training may be provided in a multiparametric assessment of the prostate, incorporation of MRI perfusion into clinical protocols in patients with hepatic malignancy and utilization of MR Elastography in assessing liver stiffness in patients at risk of hepatic fibrosis. Additional training in musculoskeletal MRI, cardiovascular MRI or positron emission tomography (PET) MRI may also be provided to further clinical objectives.
Fellows choose a faculty mentor for one mandatory research project. This project is presented at the annual IU School of Medicine Department of Radiology and Imaging Sciences Campbell-Klatte conference in the spring and submitted for presentation or publication in a national meeting or journal.
Facilities and Equipment
Body MRI fellows train predominantly at IU Health University Hospital and IU Health Methodist Hospital. Both sites are equipped with 1.5 T and 3.0 T magnets. Cases performed at other sites are read at the University Hospital reading rooms. Advanced procedures that are performed routinely include Secretin-enhanced MRCP, endorectal prostate MRI, MR elastography, Intravoxel Incoherent Motion MRI, and quantitative MR perfusion.
Fellows in this program are responsible for rendering interpretations of Body MRI studies under the direct supervision of a faculty radiologist. The fellow previews the case, formulates a differential diagnosis (if appropriate), formulates any follow-up recommendations (if any), and then presents the case to the faculty radiologist. The fellow then alters their dictated report, if necessary, to reflect the interpretation of the radiology staff prior to final approval by the faculty. The fellow’s patient care responsibility is to report all body MRI scans and communicate findings (especially critical or unexpected ones) with the referring physicians in person, by phone and through dictated report. The fellow also participates in supervising the service by writing protocols, obtaining consent, checking images on patients prior to completion of the study when necessary, and teaching residents and medical students.
The fellow takes part in, and is encouraged to moderate, Multidisciplinary Case Conferences with gastroenterologists, surgeons and oncologists. In this role, the fellow prepares, under the general supervision of faculty, and presents the imaging findings of patients being discussed at these case conferences.
The call responsibilities for Body MRI fellows include 160 hours of general call coverage, comprised of 9-10-hour daytime shifts during weekends. The expectations are to read x-ray examinations (whole body), ultrasounds (all exams), and CT examinations (chest/abdomen/pelvis) for primarily inpatients and ER patients. Call responsibilities may also include fluoroscopic gastrointestinal/genitourinary studies as well as procedures including paracentesis, thoracentesis or fluid collection aspiration/drainage.
Aashish A. Patel, MD
Assistant Professor of Clinical Radiology & Imaging Sciences