July 2007

Call starts at 7:00 am on Monday and ends at 7:00 am the following Monday.

This handout lists your responsibilities on the rotations you will be assigned to during the year.

On call (see separate on call handout)

There will be 2 fellows on call each week, one primary call person covering all evening emergencies and weekend readouts for UCSD Medical Center and Thornton Hospital, and one person on call as a backup.

The weekend morning call readouts are at 7:00 am both Saturday and Sunday and last about 3-4 hours. This weekend morning call will be with faculty. The afternoon weekend call is usually for 2 hours and will be done solo for fellows that are credentialed. The back-up fellow will need to help when the primary call fellow is a Canadian.

You are on call for a week at a time, from 7 a.m. on Monday until 7 a.m. the following Monday. Your pager must be turned on and with you at all times and you must be easily accessible. Beeper range is approximately 35-40 miles from the UCSD Medical Center.

Call during the week is very light. The resident or technicians may call you for advice. You may be called to provide a protocol for a CT or MR. Rarely, the resident may ask you to come in and review films they do not feel comfortable reading. The most likely reason for being called in is to do a procedure, such as an aspiration of a suspected septic joint. Please go ahead and perform a procedure by yourself if you are credentialed you feel comfortable. Otherwise, call the bone faculty attending on call for that week for advice or assistance. Please do not do a bone biopsy without discussing the case with one of the faculty.

If you trade call, it is your responsibility to notify the attending on call at that time, the front desk of Radiology at each hospital and the hospital operators at each hospital affected about the trade.

VA Hospital

There will be at least 2, and almost always 3, MSK fellows assigned to the VA hospital throughout the year. In addition, there will be an MRI fellow also assigned to the VA as well as a resident rotating on telerad MR. Our research fellows are also based at the VA. You will have the opportunity to interact with radiologists from around the world who come to visit and or do research at the VA.

The VA offers the largest MR experience of the fellowship as all our teleradiology cases are handled at the VA. Teleradiology cases come from multiple sites, with an average of 40-50 MR per day that you will read with faculty. There are busier days when there may be up to 80 cases, so be prepared!

In addition to MR, the fully credentialed VA fellows cover reading for our Mission Valley outpatient site, which only does plain films. You will be paid per case for all the films you read. (rate around $6/case – computer keeps track of who is reading but good idea to keep a rough record for yourself). These have to get read…..promptly.

There is a weekly conference at 7:30 am on Fridays with the orthopedic residents. All fellows should select and prepare the interesting cases to be shown. The majority of the cases come from telerad. The fellows discuss these cases and present the conference using PowerPoint.

UCSD Medical Center at Hillcrest

There is normally one fellow assigned to the University Hospital in Hillcrest. For the first several weeks of the year, 2 fellows will be there together to help deal with orientation and learning the hospital system. The hospital is a trauma center and serves a large indigent population. The workload consists of a blend of conventional radiographs and a moderate number of cross-sectional studies. There is a big CT volume, mainly related to acute trauma.

The bone service at UCSD covers the trauma unit all week. Trauma films must be read as soon as they are performed. Please notify the trauma service about any important findings immediately. You must be on your pager and easily accessible. Phone call are incessant.

Thornton

There will be one fellow assigned to Thornton hospital. This is a large volume rotation consisting of some plain films, some cross-sectional imaging and a lot of osteoporosis studies. Most of the MR arthrography for UCSD patients is also performed at Thornton hospital.

Films from Orthomed (our outpatient orthopedic clinic) are read at Thornton. The Orthomed clinic will be relocating to Thornton in the fall so volume may go up.

The Thornton fellow is responsible for dictating the bone densitometry studies done at Thornton, and there are lots of them. (4^th and Lewis Osteoporosis will be read at Hillcrest). Dr. Hughes is in charge of densitometry and will give you a talk on how to interpret DEXA studies.

Scripps

There will be two fellows assigned to Scripps all year. We will have three fellows there for the first few weeks. It is a very busy rotation. There are numerous radiographs to read (average of 100 per day), plus several cross-sectional studies (approx 20 MR/CT), and an average of 2-3 arthrograms daily. The fellows should review the films and predictate them before reviewing them with one of the bone attendings. You can check with the attending radiologist what time they are planning to stop by that day (usually in the afternoon). After reviewing the x-rays with the attending, you must correct or addend all the films that have a change from your preliminary reading. You must devise an effective and reliable system for correcting your predictated reports.

The bone fellows at Scripps do the arthrograms, which consist mainly of knee, shoulder and hip studies. Please feel free to ask the Interventional radiologists (Harry Knowles or Mohseen Sayeed), or any other radiologist (Shelley Kleinman is very helpful) at Scripps for assistance until you feel comfortable. Many of the arthrograms are for MR arthrography.

Once every couple of months, there is a Thursday evening bone conference at Scripps. Radiologists, orthopedic surgeons and rheumatologists attend the conference. The fellow assigned to Scripps for the week of the conference is responsible for putting the conference together. The fellow needs to gather up 8-12 interesting cases, select the images to be presented, and send them to Dr. Resnick.

Spine

Each fellow will have a one-month rotation with neuroradiology. This rotation is designed to emphasize spine MR, and provide exposure to spine procedures. The primary contact person for this rotation is Dr. Wade Wong in the division of neuroradiology. This rotation will take place largely at the Hillcrest and VA hospitals, though many of the fellows rotate around to the other hospitals depending on the procedure schedule.

Naval Hospital

One fellow will be assigned to attend MR readouts at the Naval Hospital near Balboa Park. They have a large volume of musculoskeletal MR, particularly sports medicine. You will not have clinical privileges for this hospital so you can only act as an observer. The MR readout takes place in the morning, leaving the afternoon free. Please be available on your pager in case one of the other hospitals needs your help.

Children’s Hospital

One fellow will be assigned to pediatric imaging at the Children’s Hospital. They have a large volume of musculoskeletal cases and an excellent teaching file. You will have clinical privileges for this hospital so you can and will dictate, once your credentialing is complete.

Research/Float

Christine Chung is the boss of our research program.

All of you that are interested in research will have some weeks of dedicated research time to work on projects up in the lab or to work on clinical research projects. Those fellows not interested in doing research will remain on the clinical schedule. Research time is an excellent opportunity to do some consolidated work on your projects. It is a good time to set up lab time with Debbie Trudell or to do some MR scanning. Please call Debbie in advance because she has a very busy schedule.

Research time is not meant to be a vacation or a week to do locums. You are expected to be at work daily, to come to the bone conferences and to be available in case you are needed to cover in case of an emergency. The research fellows are our floating personnel that serve as back up if we need help. You must be on your pager and in town and available. Please check your email regularly and keep that pager on in case we need you to work!

Vacation

The chief fellow is the boss of vacation.

You are allowed 20 days of vacation during the year. Vacation is mostly on a first-come, first-served basis, though I make some effort to make sure everyone gets some time off for the major holidays and meetings.

Requests for time off must be submitted by email, I do not accept scraps of paper or verbal requests!! If you can, try to take vacation in blocks of time rather than a day here and there! Single days are allowed, but are more difficult to schedule.

All vacation time you take needs to be on the schedule. You need to let Milton and the chief fellow (or myself until we have a chief fellow) know if you need to go away unexpectedly.