Monday, December 12, 2016

How To Perform Jugular Venous Access

Accessing the jugular vein is the first step of a wide range of procedures, performed by interventional radiologists as well as intensivists, anesthesiologists, and other proceduralists. The vast majority of central lines, port placements, dialysis catheter placements, and other venous procedures begin with this step. Although common, jugular venous access is a critical step, with serious complications if not performed appropriately.
  • Under ultrasound, visualize the right internal jugular vein which should be compressible (unless thrombosed). The pulsatile carotid should medial/posterior.
    • If partially thrombosed, may be possible to push needle through. 
  • Anesthetize the skin. 
  • Advance the 21G micropuncture needle (green hub) into the jugular vein. 
    • While access can be performed either in plane with the needle or transverse to it, the in-plane approach has the benefit of seeing the entire length of the needle.
    • If the vein is large enough, one can also visualize the tip of the needle within the vein. 
    • If there is spontaneous venous return, advance 0.018 inch microwire into SVC-RA under fluoro 
    • If no return but likely in vessel, attach connection tubing and aspirate. 
    • If bright red / pulsatile return, withdraw needle and hold pressure for 2-5 minutes. 
  • Once access is gained, make a skin incision along the needle and then blunt dissect using the curved Kelly. 
  • Exchange the needle for the 5Fr micropuncture sheath and hub it. 
  • Remove the inner 3Fr stylet and the micropuncture wire, holding your finger over the 5Fr lumen. 
  • Insert 0.035 in J wire and advance into the inferior vena cava. Take care not to irritate the atrium (will cause PVCs). If difficult, ask patient take deep breath and hold, then advance. Make sure the J is facing right/posterior (take-off of IVC from RA). 
    • This step is not actually necessary, but confirms venous access more definitively.
    • If access to the IVC is needed for the procedure and difficulty is encountered, switch the 5 Fr sheath for a Kumpe catheter, and use that to direct the wire into the IVC (which often has a posterior and rightward take-off). 

For more details on interventional radiology procedures, check out the Handbook of Interventional Radiologic Procedures:  

Monday, December 5, 2016

How Much Do Radiology Residents Make - Radiology Resident Salary 2016

As the market for radiology services has evolved over time, individuals interested in a career in radiology have a common question: how much does a radiologist make?

Overall, being a physician is a financially sound career decision. According to CNBC, physician is the #1 profession in terms of income with a median salary of $180,000. However, what this analysis omits is that becoming a physician takes between 7 and 10 years (in the United States) of post-bachelor's training. Presumably, one could earn $50,000 per year in an alternate career if they qualify for medical school, which means they are giving up $350,000 in income before they receive that first full-time physician paycheck. That's no small consideration!

Not only that, but medical school for most people is not free, but rather a significant cost. Often medical school debt alone can be over $100,000. Pile on debt for college as well, and the difference in net worth can be nearly half a million dollars.

That's right: $500,000.

If so, you want to make sure that the specialty you choose can make up for that difference. Some specialties within medicine (such as pediatrics or infectious disease) often pay significantly below the median physician salary quoted above. Before you can earn that higher specialist / consultant income though, you must complete residency. This leads to the question we want to answer today: how much salary does a radiology resident make?

Salary varies based on several factors, the major variant being geography. Areas with high cost of living tend to have higher salaries on paper, but you may end up with less take home pay. Another aspect to consider, especially as you progress in training, is moonlighting opportunities. Not only do these offer extra volume in which to perfect your skills, but moonlighting could also nearly double your income. That's no small thing!

From ERAS, here is a list of the 179 residency participating radiology residency programs in the US. Attempts have been made to match each program to a resident salary from various sources. Not all programs publicly disclose their residents' salary. As a bonus, this table also includes links to nearly each program's website. The data may represent the first year salary or average salary:

StateCityProgram NameSalaryStatus
ALBirminghamBrookwood Baptist Health Program$50,348
ALBirminghamUniversity of Alabama Medical Center Program$52,874
ALMobileUniversity of South Alabama Program$51,843
ARLittle RockUniversity of Arkansas for Medical Sciences Program-
AZPhoenixMaricopa Medical Center Program$54,098
AZPhoenixMayo Clinic College of Medicine and Science (Arizona) Program$55,403
AZPhoenixSt Joseph's Hospital and Medical Center Program-
AZTucsonUniversity of Arizona Program$56,650
CALoma LindaLoma Linda University Health Education Consortium Program-
CALos AngelesCedars-Sinai Medical Center Program$57,595
CALos AngelesKaiser Permanente Southern California (Los Angeles) Program$52,807
CALos AngelesUCLA Medical Center Program$53,766
CALos AngelesUniversity of Southern California/LAC+USC Medical Center Program$52,186
CAOrangeUniversity of California (Irvine) Program$54,696
CASacramentoUniversity of California (Davis) Health System Program-
CASan DiegoUniversity of California (San Diego) Program$53,766
CASan FranciscoUniversity of California (San Francisco) Program$62,518
CASan JoseSanta Clara Valley Medical Center Program-
CASanta BarbaraSanta Barbara Cottage Hospital Program$63,206
CAStanfordStanford University Program$58.955
CATorranceLos Angeles County-Harbor-UCLA Medical Center Program$53,572
COAuroraUniversity of Colorado Program-
CTBridgeportBridgeport Hospital/Yale University Program$55,000
CTBridgeportSt Vincent's Medical Center Program$56,201
CTFarmingtonUniversity of Connecticut Program-
CTHartfordHartford Hospital Program-
CTNew HavenYale-New Haven Medical Center Program$61,900
CTNorwalkNorwalk Hospital Program-
DCWashingtonGeorge Washington University Program$56,584
DCWashingtonGeorgetown University Hospital Program-
DENewarkChristiana Care Health Services Program$59,196
FLGainesvilleUniversity of Florida Program-
FLJacksonvilleMayo Clinic College of Medicine and Science (Jacksonville) Program-
FLJacksonvilleUniversity of Florida College of Medicine Jacksonville Program-
FLMiamiJackson Memorial Hospital/Jackson Health System Program-
FLMiami BeachMount Sinai Medical Center of Florida Program-
FLOrlandoFlorida Hospital Medical Center Program-
FLTampaUniversity of South Florida Morsani Program-
GAAtlantaEmory University Program$55,111
GAAugustaMedical College of Georgia Program-
GASavannahMemorial Health-University Medical Center/Mercer University School of Medicine (Savannah) Program-
HITripler AMCTripler Army Medical Center Program-
IAIowa CityUniversity of Iowa Hospitals and Clinics Program-
ILChicagoAdvocate Health Care (Advocate Illinois Masonic Medical Center) Program-
ILChicagoJohn H Stroger Hospital of Cook County Program-
ILChicagoMcGaw Medical Center of Northwestern University Program$54,973
ILChicagoRush University Medical Center Program-
ILChicagoUniversity of Chicago Program-
ILChicagoUniversity of Illinois College of Medicine at Chicago Program-
ILEvanstonPresence Saint Francis Hospital Program-
ILMaywoodLoyola University Program-
ILOlympia FieldsFranciscan St. James Health Program-
ILPeoriaUniversity of Illinois College of Medicine at Peoria Program-
ILSpringfieldSouthern Illinois University Program-
INIndianapolisIndiana University School of Medicine Program$53,822
KSKansas CityUniversity of Kansas School of Medicine Program-
KSWichitaUniversity of Kansas (Wichita) Program-
KYLexingtonUniversity of Kentucky College of Medicine Program-
KYLouisvilleUniversity of Louisville Program$54,691
LANew OrleansLouisiana State University Program-
LANew OrleansOchsner Clinic Foundation Program$53,125
LANew OrleansTulane University Program-
LAShreveportLouisiana State University (Shreveport) Program-
MABostonBeth Israel Deaconess Medical Center Program$61,733
MABostonBoston University Medical Center Program$60,013
MABostonBrigham and Women's Hospital/Harvard Medical School Program$61,733
MABostonMassachusetts General Hospital/Harvard Medical School Program$61,733
MABostonTufts Medical Center Program-
MABurlingtonLahey Clinic Program$59,920
MACambridgeMount Auburn Hospital Program-
MASpringfieldUMMS-Baystate Program-
MAWorcesterSt Vincent Hospital Program-
MAWorcesterUniversity of Massachusetts Program$58,683
MDBaltimoreJohns Hopkins University Program$52,941
MDBaltimoreUniversity of Maryland Program$55,035
MEPortlandMaine Medical Center Program-
MIAnn ArborUniversity of Michigan Program$55,458
MIDearbornOakwood Hospital Program$51,688
MIDetroitDetroit Medical Center/Wayne State University Program-
MIDetroitHenry Ford Hospital/Wayne State University Program-
MIFarmington HillsBotsford Hospital Program$48,179
MIFlintMichigan State University (Flint) Program-
MIGrand RapidsGrand Rapids Medical Education Partners/Michigan State University Program-
MIPontiacSt Joseph Mercy-Oakland Program$47,500
MIRoyal OakWilliam Beaumont Hospital Program-
MISouthfieldProvidence-Providence Park Hospital/MSUCHM Program$55,368
MNMinneapolisUniversity of Minnesota Program-
MNRochesterMayo Clinic College of Medicine and Science (Rochester) Program$53,461
MOColumbiaUniversity of Missouri-Columbia Program-
MOKansas CityUniversity of Missouri at Kansas City Program-
MOSt LouisSt Louis University School of Medicine Program$52,380
MOSt LouisWashington University/B-JH/SLCH Consortium Program$52,956
MSJacksonUniversity of Mississippi Medical Center Program-
NCChapel HillUniversity of North Carolina Hospitals Program-
NCDurhamDuke University Hospital Program$53,076
NCWinston-SalemWake Forest University School of Medicine Program$48,094
NEOmahaCreighton University Program$59,073
NEOmahaUniversity of Nebraska Medical Center College of Medicine Program$57,632
NHLebanonDartmouth-Hitchcock Medical Center Program$55,479
NJCamdenCooper Medical School of Rowan University/Cooper University Hospital Program$53,580
NJLivingstonSt Barnabas Medical Center Program$57,846
NJLong BranchMonmouth Medical Center Program-
NJMorristownAtlantic Health (Morristown) Program-
NJNew BrunswickRutgers Robert Wood Johnson Medical School Program$57,642
NJNewarkNewark Beth Israel Medical Center Program$57,846
NJNewarkRutgers New Jersey Medical School Program$57,642
NMAlbuquerqueUniversity of New Mexico Program-
NYAlbanyAlbany Medical Center Program-
NYBronxJacobi Medical Center/Albert Einstein College of Medicine Program$64,220
NYBronxMontefiore Medical Center/Albert Einstein College of Medicine Program$60,900
NYBrooklynMaimonides Medical Center Program-
NYBrooklynNew York Methodist Hospital Program-
NYBrooklynSUNY Health Science Center at Brooklyn Program$59,209
NYEast MeadowNassau University Medical Center Program-
NYMineolaWinthrop-University Hospital Program$64,844
NYNew Hyde ParkHofstra Northwell School of Medicine Program$69,000
NYNew YorkHarlem Hospital Center Program-
NYNew YorkHofstra Northwell School of Medicine at Lenox Hill Hospital Program$69,000
NYNew YorkIcahn School of Medicine at Mount Sinai (Beth Israel) Program-
NYNew YorkIcahn School of Medicine at Mount Sinai Program-
NYNew YorkIcahn School of Medicine at Mount Sinai/St Luke’s-Roosevelt Hospital Center Program-
NYNew YorkNew York Presbyterian Hospital (Columbia Campus) Program$65,655
NYNew YorkNew York Presbyterian Hospital (Cornell Campus) Program$61,886
NYNew YorkNew York University School of Medicine Program$61,821
NYPort JeffersonStony Brook Medicine/Mather Hospital Program-
NYRochesterRochester General Hospital Program$53,526
NYRochesterUniversity of Rochester Program-
NYStaten IslandHofstra Northwell School of Medicine at Staten Island University Hospital Program-
NYStaten IslandRichmond University Medical Center Program-
NYStony BrookStony Brook Medicine/University Hospital Program-
NYSyracuseSUNY Upstate Medical University Program$53,821
NYValhallaNew York Medical College at Westchester Medical Center Program$61,277
OHCantonAultman Hospital/Mercy/NEOMED Program$54,184
OHCincinnatiUniversity of Cincinnati Medical Center/College of Medicine Program$55,303
OHClevelandCase Western Reserve University (MetroHealth) Program$56,000
OHClevelandCase Western Reserve University/University Hospitals Cleveland Medical Center Program$56,000
OHClevelandCleveland Clinic Foundation Program$52,665
OHColumbusOhio State University Hospital Program$52,536
OHToledoUniversity of Toledo Program$53,182
OKOklahoma CityIntegris Baptist Medical Center Program-
OKOklahoma CityUniversity of Oklahoma Health Sciences Center Program$52,752
ORPortlandOregon Health and Science University Program-
PABryn MawrMain Line Health System/Bryn Mawr Hospital Program$59,687
PADanvilleGeisinger Health System Program$57,159
PADarbyMercy Catholic Medical Center Program-
PAHersheyPenn State Milton S Hershey Medical Center Program-
PAPhiladelphiaAlbert Einstein Healthcare Network Program$55,007
PAPhiladelphiaDrexel University College of Medicine/Hahnemann University Hospital Program$
PAPhiladelphiaPennsylvania Hospital of the University of Pennsylvania Health System Program$55,120
PAPhiladelphiaTemple University Hospital Program$
PAPhiladelphiaThomas Jefferson University Program$52,920
PAPhiladelphiaUniversity of Pennsylvania Program$
PAPittsburghAllegheny Health Network Medical Education Consortium (AGH) Program$
PAPittsburghUPMC Medical Education Program$53,470
PRSan JuanUniversity of Puerto Rico Program$
RIProvidenceBrown University Program$
SCCharlestonMedical University of South Carolina Program$
TNKnoxvilleUniversity of Tennessee Medical Center at Knoxville Program$50,606
TNMemphisBaptist Memorial Hospital Program$
TNMemphisUniversity of Tennessee/Methodist Healthcare Program$
TNNashvilleVanderbilt University Medical Center Program$
TXDallasBaylor University Medical Center Program$
TXDallasUniversity of Texas Southwestern Medical School Program$55,839
TXEl PasoTexas Tech University Health Sciences Center Paul L Foster School of Medicine Program$
TXGalvestonUniversity of Texas Medical Branch Hospitals Program$
TXHoustonBaylor College of Medicine Program$
TXHoustonMethodist Hospital (Houston) Program$
TXHoustonUniversity of Texas Health Science Center at Houston Program$
TXSan AntonioUniversity of Texas Health Science Center School of Medicine at San Antonio Program-
TXTempleTexas A&M College of Medicine-Scott and White Program-
UTSalt Lake CityUniversity of Utah Program-
VACharlottesvilleUniversity of Virginia Program$52,500
VANorfolkEastern Virginia Medical School Program-
VARichmondVirginia Commonwealth University Health System Program$58,000
VTBurlingtonUniversity of Vermont Medical Center Program-
WASeattleUniversity of Washington Program$55,368
WASeattleVirginia Mason Medical Center Program-
WASpokaneProvidence Sacred Heart Medical Center (Spokane) Program-
WIMadisonUniversity of Wisconsin Program-
WIMilwaukeeAurora Health Care Program-
WIMilwaukeeMedical College of Wisconsin Affiliated Hospitals (St Joseph's) Program-
WIMilwaukeeMedical College of Wisconsin Affiliated Hospitals Program-
WVMorgantownWest Virginia University Program-



Sources:
1. Glassdoor, https://www.glassdoor.com/Salaries/radiology-resident-salary-SRCH_KO0,18.htm
2. Various program websites linked above.