The Radiology Blog

How To Perform An Ultrasound-Guided Breast Biopsy

2011-10-27T19:38:00.000-07:00

A quick Google search for 'how to perform an ultrasound-guided breast biopsy' produces many results. However, most are oriented at patients, not practitioners. You could try reading the ACR guidelines for ultrasound breast biopsy, but good luck actually learning how to do the procedure from that. This post aims to be a guide aimed at residents and other trainees on how to perform a breast biopsy using ultrasound and standard equipment. Please note, this post assumes that the biopsy is indicated based on suspicious mammogram findings (typically, BIRADS 4A or higher).

Preparation & Consent

Review imaging results, including any relevant mammograms and ultrasounds.
Make sure you have all necessary equipment available.
To consent, first confirm that you have the right patient and right procedure
After taking the patient to a private area, describe the procedure.
Be sure to explain that clip will be left and patient will have a mammogram afterwards to confirm location of clip/biopsy

Risks

Pain (will use local anesthesia)
Bleeding / Hematoma formation (low; anesthesia may include epinephrine)
Infection (low; ~1/1000)
Damage to adjacent structures (chest wall, pneumothorax, implant rupture, etc)
Nondiagnostic biopsy / need for return

Have patient sign the consent, retain the signed copy, give a copy to the patient.
Explain post-procedure instructions
- Do not wash the area for two days
- Maintain wrap for two days
- No heavy lifting for two days
- Only use Tylenol for pain control (no aspirin or Ibuprofen)
- If pain persists, or breast becomes red and swollen, contact provider.

Procedure

The patient should be positioned supine on the bed with the breast to biopsy exposed and marked by the ultrasound technologist. A support may be placed underneath the breast of interest to better expose the target area.
Perform a timeout to ensure the correct patient and correct procedure.
Open kit

Tape needle tray down
Cut keyhole opening in drape.
Put loading needle on syringe

Raise bed
Put on sterile gloves and clean the area with betadine. This is also known as "prep and drape in the usual sterile fashion."
Take probe cover from the ultrasound tech and cover probe; secure with rubber band.
Load Bicarb + Lido without epi (9:1); Load Bicarb + Lido with epi (9:1). Use the lidocaine without epinephrine for the skin wheal to prevent skin necrosis.
Unpack the biopsy device and clip.

The device you choose to use depends on the lesion characteristics.
For superficial lesions, try a standard biopsy needle (may be referred to as Temno/Bard/scissors/etc).
For deeper lesions, the vacuum-assisted device (ex. Mammotome). The advantage of having vacuum on is that the tissue is pulled down into the trough, and the larger gauge creates a larger tissue sample.

Scan area to locate lesion; turn flow on to ensure no large vessels are nearby.
Create surface wheal with lido without epi; insert needle up to 2cm away from the probe a for deeper mass
Use spinal needle (or other anesthesia needle) to create tract to lesion; insert anesthesia as needed.
Aim to get tip of needle beneath lesion and put copious lidocaine to raise the lesion. This is especially important for deep lesions near the muscle wall.
Retract needle and then use scalpel to widen dermototomy.
Insert sampling device and aim for center of lesion

For Temno / Bard, insert with device loaded but trough closed. Once through lesion, open trough, let the technologist record a picture, then fire
For vacuum-assisted device, make sure the device in correct clock position, then ask tech to picture and take sample for you

After firing, retract the device and hand sample to tech
Repeat 3-6 times for the biopsy needle; 4-8 times for the vacuum-assisted device.
After last sample, insert a clip to mark the location and have the technologist record the location on the ultrasound machine.
Withdraw clip insertion device, apply pressure for hemostasis.
Remove drapes, clean wet then dry, then apply bandage.
Ensure sample is properly stored and documented. Send the patient for a post-procedure mammogram.

Ideally the lesion and the tip should always be in view, which means the ultrasound probe should be scanning a plane that contains both. For example:

Courtesy: www.radiologyinfo.org

That's it! Not too involved for a procedure, but it is important to get practice coordinating the ultrasound probe with the needle as it advances. For patient information on this procedure from ACR, click here.

Accredited U.S. Diagnostic Radiology Residency Programs 2011

2011-02-07T06:00:00.000-08:00

Following our post about accredited U.S. diagnostic radiology residency programs in 2009, we decided to update the list using data from the American Council of Graduate Medical Education. The table below reflects programs that are accredited through June 30, 2011. If you are considering a program, make sure to check with the program coordinator or program director regarding how many years the program is accredited for as well as when their next site visit by ACGME will be. The list below is provided as is and no implicit or explicit guarantee about the validity of the information is being made. If interested, contact the programs directly for the most up-to-date information.

Radiology-diagnostic

Program Number / Name / Address	Specialty	Director	Phone / Fax / Email
[4200111007] University of Alabama Medical Center Program University of Alabama at Birmingham Department of Radiology 619 South 19th Street, JTN331 Birmingham, AL 35249-6830	Radiology-diagnostic	Joseph C. Sullivan, MD	(205)934-3166 (205)975-4413 jcsullivan@uabmc.edu
[4200111008] University of South Alabama Program University of South Alabama Medical Center Department of Radiology 2451 Fillingim Street Mobile, AL 36617	Radiology-diagnostic	Jeffrey Campbell Brandon, MD	(251)471-7866 (251)471-7882 jbrandon@usouthal.edu
[4200121006] Baptist Health System Program Trinity Medical Center 800 Montclair Road Department of Radiology Birmingham, AL 35213	Radiology-diagnostic	Bibb Allen, MD	(205)592-1257 (205)592-5211 virginia.fadlevich@bhsala.com
[4200312010] St Joseph's Hospital and Medical Center Program St Joseph's Hospital and Medical Center Department of Diagnostic Imaging 350 West Thomas Road Phoenix, AZ 85013	Radiology-diagnostic	Randy Richardson, MD	(602)406-6994 (602)406-7191
[4200321011] University of Arizona Program University of Arizona Health Sciences Center P.O. Box 245067 1501 North Campbell Tucson, AZ 85724	Radiology-diagnostic	William K. Erly, MD, BA	(520)626-7402 (520)626-1518
[4200331255] Maricopa Medical Center Program Maricopa Medical Center 2601 E Roosevelt Phoenix, AZ 85008	Radiology-diagnostic	Gujjarappa T. Srinivas, MD	(602)344-1532 (602)344-1004
[4200421012] University of Arkansas for Medical Sciences Program University of Arkansas For Medical Sciences Arkansas Children's Hospital 1 Children's Way, Slot 105 Little Rock, AR 72202	Radiology-diagnostic	Robert F. Buchmann, DO	(501)364-4865 (501)364-4863
[4200511013] University of California (Davis) Health System Program University of California (Davis) Medical Center Department of Radiology 4860 Y Street, Suite 3100 Sacramento, CA 95817	Radiology-diagnostic	Rebecca Stein-Wexler, MD	(916)703-2271 (916)703-2258 rebecca.steinwexler@ucdmc.ucdavis.edu
[4200511021] University of Southern California/LAC+USC Medical Center Program Los Angeles County-USC Medical Center Department of Diagnostic Radiology 1200 North State Street, D&T 3D321 Los Angeles, CA 90033	Radiology-diagnostic	M. Victoria Marx, MD	(323)409-7270
[4200511023] UCLA Medical Center Program Ronald Reagan-UCLA Medical Center David Geffen School of Medicine at UCLA 757 Westwood Plaza, Suite 1638 Los Angeles, CA 90095-7437	Radiology-diagnostic	Robert D. Suh, MD	(310)267-8797 (310)267-2059
[4200511035] Los Angeles County-Harbor-UCLA Medical Center Program Los Angeles County-Harbor-UCLA Medical Center Box 27 1000 W Carson Street Torrance, CA 90509	Radiology-diagnostic	Richard Renslo, MD, BA	(310)222-2831 (310)320-6138 brrodriguez@dhs.lacounty.gov
[4200512020] Kaiser Permanente Southern California (Los Angeles) Program Kaiser Foundation Hospital Center for Medical Education 4733 Sunset Blvd, 3rd Floor Los Angeles, CA 90027	Radiology-diagnostic	George G. Vatakencherry, MD	(323)783-4631 (866)455-3867 george.g.vatakencherry@kp.org
[4200521001] David Grant Medical Center Program David Grant USAF Medical Center Department of Radiology 101 Bodin Circle Travis AFB, CA 94535	Radiology-diagnostic	Robert A. Jesinger, MD, MS	(707)423-7669 (707)423-7207 robert.jesinger@us.af.mil
[4200521014] University of California (Irvine) Program University of California, Irvine Department of Radiological Sciences 101 The City Drive South, Route 140 Orange, CA 92868	Radiology-diagnostic	Arash Anavim, MD	(714)456-6579 (714)456-6832 aanavim@uci.edu
[4200521015] Loma Linda University Program Loma Linda University Medical Center 11234 Anderson Street PO Box 2000 Loma Linda, CA 92354	Radiology-diagnostic	Paul Jacobson, MD	(909)558-4000 (909)558-0202
[4200521018] Cedars-Sinai Medical Center Program Cedars-Sinai Medical Center Attn: Joseph Stuckelman S Mark Taper, 8700 Beverly Boulevard, M335 Los Angeles, CA 90048	Radiology-diagnostic	Marcel Maya, MD	(310)423-3419 (310)423-8335 stuckelmanj@cshs.org
[4200521027] University of California (San Diego) Program University of California (San Diego) Medical Center 200 West Arbor Drive Department of Radiology San Diego, CA 92103	Radiology-diagnostic	Tudor H. Hughes, MBBS	(619)543-3534 (619)543-3746 thughes@ucsd.edu
[4200521031] University of California (San Francisco) Program University of California, San Francisco Department of Radiology, Box 0628 505 Parnassus Avenue, Suite M391 San Francisco, CA 94143	Radiology-diagnostic	Aliya Qayyum, MBBS	(415)353-8753 (415)476-0616 Aliya.Qayyum@radiology.ucsf.edu
[4200521034] Stanford University Program Stanford University School of Medicine Department of Diagnostic Radiology 300 Pasteur Drive, H-1307 Mail code 5621 Stanford, CA 94305-5621	Radiology-diagnostic	Terry S. Desser, MD	(650)723-7816 (650)723-1909 iworthey@stanford.edu
[4200521914] Naval Medical Center (San Diego) Program Naval Medical Center San Diego Radiology, Suite 204 34800 Bob Wilson Drive San Diego, CA 92134-1204	Radiology-diagnostic	Stephen L. Ferrara, MD	(619)532-6755 (619)532-8714 stephen.ferrara@med.navy.mil
[4200522033] Santa Barbara Cottage Hospital Program Santa Barbara Cottage Hospital PO Box 689 Pueblo at Bath Street Santa Barbara, CA 93102	Radiology-diagnostic	Bernard Chow, MD	(805)569-7279 (805)569-8279
[4200531032] Santa Clara Valley Medical Center Program Santa Clara Valley Medical Center Department of Radiology 751 South Bascom Avenue San Jose, CA 95128	Radiology-diagnostic	Rajul Pandit, MD	(408)885-6370 (408)885-6360
[4200721038] University of Colorado Denver Program University of Colorado Denver Department of Radiology 12631 E. 17th Avenue, MS 8200 Aurora, CO 80045	Radiology-diagnostic	David Rubinstein, MD	(303)724-1982 (303)724-1983 david.rubinstein@ucdenver.edu
[4200811040] St Vincent's Medical Center Program St Vincent's Medical Center 2800 Main Street Bridgeport, CT 06606	Radiology-diagnostic	Joshua M. Sapire, MD	(203)576-5065 (203)581-6537 sappynyc@yahoo.com
[4200812039] Bridgeport Hospital/Yale University Program Bridgeport Hospital Diagnostic Radiology 267 Grant Street Bridgeport, CT 06610	Radiology-diagnostic	Noel Velasco, MD	(203)384-3834 (203)384-3833 pnvela@bpthosp.org
[4200821043] Yale-New Haven Medical Center Program Yale-New Haven Medical Center P.O, Box 208042 333 Cedar Street, EP 2-502 New Haven, CT 06520-8042	Radiology-diagnostic	Syed Ahmad Jamal Bokhari, MBBS, MD	(203)200-5180 (203)200-5170 ydrresidency@gmail.com
[4200821216] Norwalk Hospital Program Norwalk Hospital Department of Radiology Maple Street Norwalk, CT 06856	Radiology-diagnostic	Edward B. Strauss, MD	(203)852-2715 (203)855-3967 susie.mccusker@norwalkhealth.org
[4200821225] University of Connecticut Program University of Connecticut Health Center 263 Farmington Avenue Farmington, CT 06030	Radiology-diagnostic	Harold Moskowitz, MD	(860)679-4082 (860)679-1090 moskowitz@uchc.edu
[4200822041] Hartford Hospital Program Hartford Hospital PO Box 5037 80 Seymour Street Hartford, CT 06102	Radiology-diagnostic	Michael T. O'Loughlin, MD	(860)545-2870 moloughlin@jeffersonradiology.com
[4200822042] Hospital of St Raphael Program Hospital of St. Raphael Department of Radiology 1450 Chapel Street New Haven, CT 06511	Radiology-diagnostic	Philip A. Dinauer, MD	(203)789-6289 (203)789-4118
[4200911044] Christiana Care Health Services Program Christiana Care Health System 4755 Ogletown-Stanton Road Newark, DE 19718	Radiology-diagnostic	Michael B. Sneider, MD	(302)733-5582 (302)733-5589 msneider@christianacare.org
[4201011045] Georgetown University Hospital Program Georgetown University Hospital Department of Radiology 3800 Reservoir Road, NW Washington, DC 20007	Radiology-diagnostic	Sandra J. Allison, MD	(202)444-3380 (202)444-1804 villaros@gunet.georgetown.edu
[4201021046] George Washington University Program George Washington University Hospital 900 23rd Street, NW Room G-113 Washington, DC 20037	Radiology-diagnostic	Robert K. Zeman, MD	(202)715-5156 (202)715-5210 gwuradrz@yahoo.com
[4201021247] National Capital Consortium Program Walter Reed Army Medical Center Department of Radiology 6900 Geogia Avenue NW Washington, DC 20307	Radiology-diagnostic	Frank E. Mullens, MD, MPH	(301)295-5050
[4201112260] Florida Hospital Medical Center Program Florida Hospital Medical Center 601 E Rollins St Orlando, FL 32803	Radiology-diagnostic	Laura W. Bancroft, MD	(407)615-1902 (407)303-7844
[4201121048] University of Florida Program University of Florida College of Medicine Department of Radiology PO Box 100374 Gainesville, FL 32610	Radiology-diagnostic	Lori A. Deitte, MD	(352)265-0291 (352)265-0438
[4201121049] Jackson Memorial Hospital/Jackson Health System Program Jackson Memorial Hospital/Jackson Health System Department of Radiology (R-130) 1611 NW 12th Avenue, WW 279 Miami, FL 33136	Radiology-diagnostic	Gary H. Danton, MD, PhD	(305)585-7500 (305)585-5743
[4201121050] Mount Sinai Medical Center of Florida Program Mount Sinai Medical Center of Florida Department of Radiology 4300 Alton Road Miami Beach, FL 33140	Radiology-diagnostic	Jeffrey Neitlich, MD	(305)674-2680 (305)674-3919 jneitlic@msmc.com
[4201121051] University of South Florida Program University of South Florida College of Medicine Box 17 12901 Bruce B Downs Blvd Tampa, FL 33612	Radiology-diagnostic	Carlos R. Martinez, MD, BA	(813)974-6311 (813)974-3482
[4201121223] University of Florida College of Medicine Jacksonville Program Univ of Florida College of Medicine/Jacksonville 655 W 8th Street, Box C90 Department of Radiology Jacksonville, FL 32209	Radiology-diagnostic	Barry M. McCook, MD	(904)244-4225 (904)244-4296 johneise.croxton@jax.ufl.edu
[4201121250] College of Medicine, Mayo Clinic (Jacksonville) Program Mayo School of Graduate Medical Education 4500 San Pablo Road Jacksonville, FL 32224	Radiology-diagnostic	Jeffrey J. Peterson, MD	(904)953-0423 (904)953-0430
[4201212054] Mercer University School of Medicine (Savannah) Program Memorial Health University Medical Center Department of Radiology 4700 Waters Avenue Savannah, GA 31403	Radiology-diagnostic	Deborah J. Conway, MD	(912)350-7394 (912)350-7363 larismi1@memorialhealth.com
[4201221052] Emory University Program Emory University Hospital Dept of Radiology 1364 Clifton Road, NE, Rm D125A Atlanta, GA 30322	Radiology-diagnostic	Mark E. Mullins, MD, PhD	(404)712-4686 (404)712-7908
[4201221053] Medical College of Georgia Program Medical College of Georgia BA -1411 1120 15th Street Augusta, GA 30912	Radiology-diagnostic	Gilberto Sostre, MD	(706)721-3214 (706)721-5213 nucradgil@aol.com
[4201421933] Tripler Army Medical Center Program Tripler Army Medical Center MCHK-DR, Department of Radiology 1 Jarrett White Road Tripler AMC, HI 96859	Radiology-diagnostic	Kevin M. Nakamura, MD	(808)433-6582 (808)433-4688
[4201611060] Rush University Medical Center Program Rush University Medical Center Department of Diagnostic Radiology 1653 West Congress Parkway Chicago, IL 60612	Radiology-diagnostic	Joy S. Sclamberg, MD	(312)942-5781 (312)942-8180
[4201611061] University of Chicago Program University of Chicago Medical Center Dept of Radiology, MC 2026 5841 South Maryland Avenue Chicago, IL 60637	Radiology-diagnostic	Stephen Thomas, MD	(773)702-3550
[4201611064] Loyola University Program Foster G. McGaw Hospital-Loyola University of Chicago Department of Radiology 2160 South First Avenue Maywood, IL 60153	Radiology-diagnostic	Laurie M. Lomasney, MD	(708)216-1084 (708)216-0899
[4201612063] St Francis Hospital of Evanston Program St Francis Hospital of Evanston 355 Ridge Avenue Evanston, IL 60202	Radiology-diagnostic	Joseph D. Calandra, MD	(847)316-6101 (847)316-2241
[4201621055] John H Stroger Hospital of Cook County Program John H. Stroger, Jr. Hospital of Cook County Department of Radiology 1901 W Harrison Street Chicago, IL 60612	Radiology-diagnostic	Mark Pisaneschi, MD	(312)864-6776 (312)864-9855
[4201621059] McGaw Medical Center of Northwestern University Program Northwestern University/Feinberg School of Medicin 676 N St Clair Street Suite 800 Chicago, IL 60611	Radiology-diagnostic	Robert K. Ryu, MD	(312)695-3718 (312)695-5645 jclark@nmff.org
[4201621062] University of Illinois College of Medicine at Chicago Program University of Illinois Hospital 1740 W Taylor Street, Suite 2483 Chicago, IL 60612	Radiology-diagnostic	Edward A. Michals, MD	(312)996-0235 (312)355-2098
[4201621065] Southern Illinois University Program Southern Illinois University School of Medicine MMC Box 101 701 N 1st Street Springfield, IL 62781	Radiology-diagnostic	John B. Becker, MD	(217)757-2387 (217)788-5588 skelton.stacie@mhsil.com
[4201621217] Advocate Illinois Masonic Medical Center Program Advocate Illinois Masonic Medical Center 836 West Wellington Avenue Chicago, IL 60657	Radiology-diagnostic	Kevin J. Kirshenbaum, MD	(773)296-7820 (773)296-7821 kevin.kirshenbaum@advocatehealth.com
[4201621243] University of Illinois College of Medicine at Peoria Program University of Illinois College of Medicine at Peoria 530 NE Glen Oak Avenue Peoria, IL 61637	Radiology-diagnostic	Terry M. Brady, MD	(309)655-7768 (309)655-7365 lorid@uic.edu
[4201721066] Indiana University School of Medicine Program Indiana University Medical Center Department of Radiology 550 N. University Blvd., Room 0641 Indianapolis, IN 46202	Radiology-diagnostic	Darel E. Heitkamp, MD	(317)944-3424 (317)948-2803 lshuman@iupui.edu
[4201821068] University of Iowa Hospitals and Clinics Program University of Iowa Hospitals and Clinics 200 Hawkins Drive Department of Radiology Iowa City, IA 52242	Radiology-diagnostic	Joan E. Maley, MD	(319)356-3452 (319)356-2220 joan-maley@uiowa.edu
[4201911069] University of Kansas School of Medicine Program University of Kansas Medical Center Department of Radiology, Mail Stop 4032 3901 Rainbow Blvd Kansas City, KS 66160	Radiology-diagnostic	Philip L. Johnson, MD	(913)588-5887 (913)588-7899 pjohnson@kumc.edu
[4201912070] University of Kansas (Wichita) Program Wesley Medical Center Medical Education - Radiology 550 N Hillside Wichita, KS 67214	Radiology-diagnostic	Kamran Ali, MD	(316)962-2211 (316)962-7231 becky.mann@wesleymc.com
[4202021071] University of Kentucky College of Medicine Program University of Kentucky Medical Center Department of Radiology 800 Rose Street, Room HX315 Lexington, KY 40536	Radiology-diagnostic	Michael A. Brooks, MD	(859)323-7209 (859)323-2510 sajone2@email.uky.edu
[4202021230] University of Louisville Program University of Louisville School of Medicine Department of Radiology 530 S. Jackson Street, Suite C07 Louisville, KY 40202	Radiology-diagnostic	Peter C. Hentzen, MD, PhD	(502)852-5875 (502)852-1754
[4202111075] Louisiana State University (Shreveport) Program Louisiana State University Health Sciences Center PO Box 33932 1501 Kings Highway Shreveport, LA 71130	Radiology-diagnostic	Mardjohan Hardjasudarma, MD, MS	(318)675-6232 (318)675-6351
[4202112074] Ochsner Clinic Foundation Program Ochsner Clinic Foundation 1514 Jefferson Highway New Orleans, LA 70121	Radiology-diagnostic	JAMES M. MILBURN, MD	(504)842-4796 (504)842-7132 kdixon@ochsner.org
[4202121235] Tulane University Program Tulane University Medical Center 1430 Tulane Avenue SL54 New Orleans, LA 70112	Radiology-diagnostic	Cynthia W. Hanemann, MD	(504)988-7627 (504)988-7616 chaneman@tulane.edu
[4202131259] Louisiana State University Program LSU Health Sciences Center Department of Radiology 1542 Tulane Ave, Rom 353 New Orleans, LA 70112	Radiology-diagnostic	Aran Toshav, MD	(504)568-4647
[4202211076] Maine Medical Center Program Maine Medical Center Department of Diagnostic Radiology 22 Bramhall Street Portland, ME 04102	Radiology-diagnostic	Scott E. Fredericks, MD	(207)662-2571 (207)662-5255
[4202311077] Johns Hopkins University Program The Johns Hopkins Hospital 601 North Caroline Street Room 4210 Baltimore, MD 21287	Radiology-diagnostic	Karen M. Horton, MD	(410)955-3222 (410)614-0341 kmhorton@jhmi.edu
[4202311079] University of Maryland Program University of Maryland Medical Center Department of Radiology 22 South Greene Street Baltimore, MD 21201	Radiology-diagnostic	Charles S. Resnik, MD	(410)328-3477 (410)328-0641 bstewart@umm.edu
[4202411087] Mount Auburn Hospital Program Mount Auburn Hospital Department of Radiology 330 Mount Auburn Street Cambridge, MA 02138	Radiology-diagnostic	Pierre Sasson, MD	(617)441-1610 (617)499-5193
[4202412088] Baystate Medical Center/Tufts University School of Medicine Program Baystate Medical Center Department of Radiology 759 Chestnut Street Springfield, MA 01199	Radiology-diagnostic	Stephen C. O'Connor, MD	(413)794-3521 (413)794-4382 teresa.lalli@bhs.org
[4202412089] St Vincent Hospital Program Saint Vincent Hospital Department of Radiology 123 Summer Street Worcester, MA 01608	Radiology-diagnostic	Paulomi Kanzaria, MD	(508)363-7034 (508)363-7224
[4202421080] Beth Israel Deaconess Medical Center Program Beth Israel Deaconess Medical Center 330 Brookline Avenue E CC-4 Radiology Boston, MA 02215	Radiology-diagnostic	Jim S. Wu, MD	(617)667-1283 (617)667-8212 jswu@bidmc.harvard.edu
[4202421081] Boston University Medical Center Program Boston University Medical Center 820 Harrison Ave FGH Bldg, 3rd Floor Boston, MA 02118	Radiology-diagnostic	Avneesh Gupta, MD	(617)638-6610 (617)638-6616
[4202421085] Brigham and Women's Hospital/Harvard Medical School Program Brigham & Women's Hospital Department of Radiology 75 Francis Street Boston, MA 02115	Radiology-diagnostic	Barbara N. Weissman, MD	(617)732-6295 (617)264-5250 bwhradres@partners.org
[4202421086] Tufts Medical Center Program Tufts Medical Center Department of Radiology 800 Washington Street, #299 Boston, MA 02111	Radiology-diagnostic	Harprit S. Bedi, MD	(617)636-0067
[4202421090] University of Massachusetts Program University of Massachusetts Medical School Department of Radiology, Rm S2-825 55 Lake Avenue North Worcester, MA 01655	Radiology-diagnostic	Joseph Makris, MD	(508)856-2783 (508)856-1860 rad.residency@umassmed.edu
[4202422082] Lahey Clinic Program Lahey Clinic Medical Center Department of Diagnostic Radiology 41 Mall Road Burlington, MA 01805	Radiology-diagnostic	Christopher D. Scheirey, MD	(781)744-8170 (781)744-5232 christopher.scheirey@lahey.org
[4202431083] Massachusetts General Hospital/Harvard Medical School Program Massachusetts General Hospital Dept of Radiology, FND 216 Boston, MA 02114	Radiology-diagnostic	Theresa C. McLoud, MD	(617)724-4255 (617)726-3077
[4202511093] Henry Ford Hospital Program Henry Ford Hospital Department of Radiology 2799 West Grand Boulevard Detroit, MI 48202	Radiology-diagnostic	Eric M. Spickler, MD	(313)916-1384 (313)916-8857
[4202512092] Oakwood Hospital Program Oakwood Hospital and Medical Center 18101 Oakwood Boulevard Dearborn, MI 48124	Radiology-diagnostic	John H. Finger, MD	(313)436-2583 (313)436-2809 john.finger@oakwood.org
[4202512102] William Beaumont Hospital Program William Beaumont Hospital Department of Radiology 3601 West Thirteen Mile Road Royal Oak, MI 48073	Radiology-diagnostic	Matthias J. Kirsch, MD	(248)898-6047 (248)898-2496
[4202521091] University of Michigan Program University of Michigan Health System Department of Radiology 1500 East Medical Center Drive Ann Arbor, MI 48109-5030	Radiology-diagnostic	Janet E. Bailey, MD	(734)936-8869 (734)763-9523
[4202521096] Wayne State University/Detroit Medical Center Program Wayne State University School of Medicine 4201 St Antoine, DRH 3L8 Detroit, MI 48201	Radiology-diagnostic	Wilbur L. Smith, MD	(313)745-3430 (313)577-8600
[4202521099] Grand Rapids Medical Education Partners/Michigan State University Program Grand Rapids Medical Education Partners Diagnostic Radiology Residency 1000 Monroe NW Grand Rapids, MI 49503	Radiology-diagnostic	Jay Harolds, MD	(616)391-9087 harolds112@cox.net
[4202521103] Providence Hospital and Medical Centers Program Providence Hospital and Medical Centers 16001 West Nine Mile Road Department of Radiology Southfield, MI 48075	Radiology-diagnostic	Edsa Negussie, MD	(248)849-3051 (248)849-5394
[4202531100] Michigan State University (Flint) Program Michigan State University Flint Area Medical Educa One Hurley Plaza-7W Flint, MI 48503	Radiology-diagnostic	Ureddi R. Mullangi, MD	(810)232-7000 (810)232-7020 umullangi@msufame.msu.edu
[4202532101] St Joseph Mercy-Oakland Program St Joseph Mercy-Oakland Department of Radiology, H-23 44405 Woodward Avenue Pontiac, MI 48341	Radiology-diagnostic	James Denier, MD	(248)858-3233 (248)858-3244 denierja@trinity-health.org
[4202621104] University of Minnesota Program University of Minnesota Medical Center, Fairview Department of Radiology, MMC 292 420 Delaware Street, SE Minneapolis, MN 55455	Radiology-diagnostic	Tim H. Emory, MD	(612)626-5529 (612)626-5580 emory002@gmail.com
[4202621105] College of Medicine, Mayo Clinic (Rochester) Program Mayo Graduate School of Medicine Department of Radiology 200 First Street, SW Rochester, MN 55905	Radiology-diagnostic	Kristen B. Thomas, MD	(507)284-0440 (507)293-3680 sorenson.tammy@mayo.edu
[4202711107] University of Mississippi Medical Center Program University of Mississippi Medical Center Department of Radiology 2500 North State Street Jackson, MS 39216	Radiology-diagnostic	Anson L. Thaggard, MD	(601)984-2695 (601)984-2683 bedmonds@umc.edu
[4202811108] University of Missouri-Columbia Program University of Missouri Medical Center Department of Radiology One Hospital Drive Columbia, MO 65212	Radiology-diagnostic	Dana Mazuru, MD	(573)882-1026 (573)884-8524 MazuruD@health.missouri.edu
[4202811111] Washington University/B-JH/SLCH Consortium Program Mallinckrodt Institute of Radiology 510 South Kingshighway, Box 8131 St Louis, MO 63110	Radiology-diagnostic	Jennifer E. Gould, MD	(314)362-2900 (314)362-2276 lammersl@mir.wustl.edu
[4202821110] St Louis University School of Medicine Program St Louis University School of Medicine 3635 Vista Avenue at Grand Blvd PO Box 15250 St Louis, MO 63110	Radiology-diagnostic	B. Kirke Bieneman, MD	(314)268-5781 (314)268-5116
[4202821231] University of Missouri at Kansas City Program Saint Luke's Hospital of Kansas City c/o Daphne Urquhart; Medical Education 4401 Wornall Road Kansas City, MO 64111	Radiology-diagnostic	Lisa H. Lowe, MD	(816)234-3725 (816)983-6912 durquhart@saint-lukes.org
[4203021112] University of Nebraska Medical Center College of Medicine Program University of Nebraska Medical Center 981045 Nebraska Medical Center Department of Radiology Omaha, NE 68198	Radiology-diagnostic	Matthew DeVries, MD	(402)559-3135 (402)559-1011
[4203021220] Creighton University Program Creighton University School of Medicine Department of Radiology 601 North 30th Street Omaha, NE 68131	Radiology-diagnostic	James J. Phalen, MD	(402)449-4753 (402)449-4525
[4203211113] Dartmouth-Hitchcock Medical Center Program Dartmouth-Hitchcock Medical Center One Medical Center Drive Lebanon, NH 03756	Radiology-diagnostic	Anne M. Silas, MD	(603)650-7480 (603)650-5455 Anne.M.Silas@hitchcock.org
[4203311116] Atlantic Health (Morristown) Program Morristown Memorial Hospital 100 Madison Avenue PO Box 1956 Morristown, NJ 07962	Radiology-diagnostic	Jeanne R. Schwartz, MD	(973)971-5372 (973)290-7294
[4203321215] St Barnabas Medical Center Program Saint Barnabas Medical Center 94 Old Short Hills Road Livingston, NJ 07039	Radiology-diagnostic	Lyle R. Gesner, MD	(973)322-5267 (973)322-2851 lgesner@sbhcs.com
[4203321226] UMDNJ-New Jersey Medical School Program U M D N J - New Jersey Medical School Department of Radiology, Room C-318 150 Bergen Street Newark, NJ 07103	Radiology-diagnostic	Stephen R. Baker, MD	(973)972-5188 (973)972-7429
[4203321228] UMDNJ-Robert Wood Johnson Medical School Program UMDNJ-Robert Wood Johnson Medical School Department of Radiology One Robert Wood Johnson Place New Brunswick, NJ 08903	Radiology-diagnostic	Judith K. Amorosa, MD, FACR	(732)235-7721 (732)235-6889 amorosa@umdnj.edu
[4203321244] UMDNJ Robert Wood Johnson Medical School (Camden)/Cooper University Hospital Program Cooper Hospital/University Medical Center One Cooper Plaza B23 Camden, NJ 08103	Radiology-diagnostic	Joshua D. Brody, DO	(856)342-2383 (856)365-0472 brody-joshua@cooperhealth.edu
[4203331115] Monmouth Medical Center Program Monmouth Medical Center Department of Radiology 300 Second Avenue Long Branch, NJ 07740	Radiology-diagnostic	Richard B. Ruchman, MD	(732)923-6806 (732)923-6216 RRuchman@sbhcs.com
[4203331118] Newark Beth Israel Medical Center Program Newark Beth Israel Medical Center 201 Lyons Avenue at Osborne Terrace Newark, NJ 07112	Radiology-diagnostic	Hillel J. Karp, MD	(973)926-7960 (973)282-0911
[4203421120] University of New Mexico Program University of New Mexico Medical Center Department of Radiology MSC10 5530, 1 University of New Mexico Albuquerque, NM 87131	Radiology-diagnostic	Jennifer Pohl, PhD, MD	(505)272-0932 (505)272-5821 raderas@salud.unm.edu
[4203511121] Albany Medical Center Program Albany Medical Center Hospital Department of Radiology MC113 43 New Scotland Avenue Albany, NY 12208	Radiology-diagnostic	Allen M. Herr, MD	(518)262-2397 (518)262-4210 aherr@communitycare.com
[4203511123] Nassau University Medical Center Program Nassau University Medical Center Department of Radiology 2201 Hempstead Turnpike East Meadow, NY 11554	Radiology-diagnostic	Nalini Kanth, MD	(516)572-6785 (516)572-5941 nkanth@numc.edu
[4203511131] Long Island College Hospital Program Long Island College Hospital 339 Hicks Street Brooklyn, NY 11201	Radiology-diagnostic	Deborah L. Reede, MD	(718)780-1793 (718)780-1611
[4203511138] New York Presbyterian Hospital (Columbia Campus) Program New York and Presbyterian Hospital (Columbia Campus) HP-3-320 180 Fort Washington Avenue New York, NY 10032	Radiology-diagnostic	Anna Rozenshtein, MD	(212)305-6495 (212)305-5777
[4203511146] University of Rochester Program University of Rochester Medical Center 601 Elmwood Avenue PO Box 648 Rochester, NY 14642-8648	Radiology-diagnostic	Steven P. Meyers, MD, PhD	(585)275-1128 (585)273-3549
[4203512128] Bronx-Lebanon Hospital Center Program Bronx-Lebanon Hospital Center 1650 Grand Concourse Bronx, NY 10457	Radiology-diagnostic	Helen T. Morehouse, MD, FACR	(718)518-5272 (718)518-5224
[4203512145] Rochester General Hospital Program Rochester General Hospital Department of Diagnostic Imaging 1425 Portland Avenue Rochester, NY 14621	Radiology-diagnostic	Kenneth N. Van Sickel, MD	(585)922-3220 (585)922-3518 jackie.delio@rochestergeneral.org
[4203512254] Staten Island University Hospital Program Staten Island University Hospital 475 Seaview Avenue Staten Island, NY 10305	Radiology-diagnostic	Mary M. Salvatore, MD	(718)226-3518 (718)226-8335 msalvatore@siuh.edu
[4203521126] Albert Einstein College of Medicine Program Montefiore Medical Center Dept. of Radiology 111 East 210th Street Bronx, NY 10467	Radiology-diagnostic	Mordecai Koenigsberg, MD	(718)920-5506 mkoenigs@montefiore.org
[4203521127] Albert Einstein College of Medicine at Beth Israel Medical Center Program Beth Israel Medical Center First Avenue at 16th street New York, NY 10003	Radiology-diagnostic	James E. Silberzweig, MD, FSIR	(212)420-2409 (212)420-2073 jsilberz@chpnet.org
[4203521129] New York Presbyterian Hospital (Cornell Campus) Program New York and Presbyterian Hospital (Cornell Campus 525 East 68th Street New York, NY 10065	Radiology-diagnostic	Kevin W. Mennitt, MD	(212)746-3655 (212)746-8596 kem9003@med.cornell.edu
[4203521132] NSLIJHS/Hofstra North Shore-LIJ School of Medicine at Long Island Jewish Medical Center Program Long Island Jewish Medical Center 270-05 76th Avenue New Hyde Park, NY 11040	Radiology-diagnostic	Lawrence P. Davis, MD	(718)470-7235 (718)343-3893 eacobacc@lij.edu
[4203521135] Mount Sinai School of Medicine Program Mount Sinai Medical Center Department of Radiology Box 1234 One Gustave L Levy Place New York, NY 10029	Radiology-diagnostic	Kathleen P. Halton, MD	(212)241-4013 (212)241-4234
[4203521136] New York Medical College at Westchester Medical Center Program New York Medical College Macy Pavilion, Room 1319 Department of Radiology Valhalla, NY 10595	Radiology-diagnostic	Susan Rachlin, MD	(914)493-8550 (914)493-7407 linkowskir@wcmc.com
[4203521137] New York University School of Medicine Program Bellevue Hospital Department of Radiology 462 First Avenue New York, NY 10016	Radiology-diagnostic	Michael M. Ambrosino, MD	(212)263-6369 (212)263-7666
[4203521143] SUNY Health Science Center at Brooklyn Program S U N Y Health Science Ctr at Brooklyn, Dept of Radiology Box 45 450 Clarkson Avenue Brooklyn, NY 11203	Radiology-diagnostic	John Amodio, MD	(718)245-4447 (718)245-4473
[4203521147] SUNY Upstate Medical University Program SUNY Health Science Center at Syracuse 750 East Adams Street Syracuse, NY 13210	Radiology-diagnostic	Michele Lisi, MD	(315)464-7434 (315)464-2570
[4203521214] Harlem Hospital Center Program Harlem Hospital Center 506 Lenox Avenue New York, NY 10037	Radiology-diagnostic	Roberta C. Locko, MD	(212)939-4901 (212)939-4836 roberta.locko@nychhc.org
[4203521218] Lenox Hill Hospital Program Lenox Hill Hospital Department of Radiology 100 E 77th Street New York, NY 10021	Radiology-diagnostic	Neal F. Epstein, MD	(212)434-2522 (212)434-2253
[4203521221] Maimonides Medical Center Program Maimonides Medical Center 4802 Tenth Avenue Brooklyn, NY 11219	Radiology-diagnostic	Steven Shankman, MD, BA	(718)283-7117 (718)635-8411 csmith@maimonidesmed.org
[4203521222] SUNY at Stony Brook Program University Hospital-SUNY at Stony Brook Dept of Radiology School of Medicine, Stony Brook University Stony Brook, NY 11794	Radiology-diagnostic	William H. Moore, MD	(631)444-3580 (631)444-7538
[4203521224] St Luke's-Roosevelt Hospital Center Program St. Luke's Roosevelt Hospital Center 1000 Tenth Avenue, 4th Floor, Rm 4C-12 Dept of Radiology New York, NY 10019	Radiology-diagnostic	Nolan J. Kagetsu, MD	(212)523-7048 (212)523-6019 kagetsu@columbia.edu
[4203521229] New York Medical College (Richmond) Program Richmond University Medical Center Department of Radiology 355 Bard Avenue Staten Island, NY 10310	Radiology-diagnostic	Kikkeri Vinaya, MD	(718)818-3153 (718)818-4180 kvinaya@rumcsi.org
[4203521240] Winthrop-University Hospital Program Winthrop University Hospital 259 First Street Mineola, NY 11501	Radiology-diagnostic	Jonathan Luchs, MD	(516)663-3682 (516)663-8467
[4203521251] Albert Einstein College of Medicine (Jacobi) Program Albert Einstein College of Medicine (Jacobi) Progr 1300 Morris Park Avenue Bronx, NY 10461	Radiology-diagnostic	Melvin Zelefsky, MD	(718)918-4595 (718)918-7535 angela.trotta@nbhn.net
[4203531124] NSLIJHS/Hofstra North Shore-LIJ School of Medicine at North Shore University Hospital Program North Shore University Hospital Department of Radiology 300 Community Drive Manhasset, NY 11030	Radiology-diagnostic	James B. Naidich, MD	(516)562-4797 (516)562-4794 jnaidich@yahoo.com
[4203611148] University of North Carolina Hospitals Program UNC Dept. of Radiology CB 7510 Chapel Hill, NC 27599	Radiology-diagnostic	Jeffrey K. Smith, MD, PhD	(919)966-2885 (919)966-1994 jksmith@med.unc.edu
[4203611150] Wake Forest University School of Medicine Program Wake Forest University School of Medicine Department of Radiology Medical Center Blvd Winston-Salem, NC 27157-1088	Radiology-diagnostic	Rita I. Freimanis, MD	(336)716-8048 (336)716-1278
[4203631149] Duke University Hospital Program Duke University Medical Center Department of Radiology Box 3808 Durham, NC 27710	Radiology-diagnostic	Charles M. Maxfield, MD	(919)684-7585 (919)684-7151 stewa028@mc.duke.edu
[4203812154] Cleveland Clinic Foundation Program Cleveland Clinic 9500 Euclid Avenue Mailcode Hb6 Cleveland, OH 44195	Radiology-diagnostic	Tan-Lucien Mohammed, MD	(216)444-2136 (216)636-5030 dred@ccf.org
[4203821152] University Hospital/University of Cincinnati College of Medicine Program University of Cincinnati Medical Center 234 Goodman Street Mail Location 0761 Cincinnati, OH 45219	Radiology-diagnostic	Robert D. Wissman, MD	(513)584-6016 (513)584-0431 Robert.Wissman@uchealth.com
[4203821153] Case Western Reserve University/University Hospitals Case Medical Center Program Case Western Reserve University Program 11100 Euclid Avenue Cleveland, OH 44106	Radiology-diagnostic	Mark R. Robbin, MD	(216)844-3113 (216)844-5922 mark.robbin@uhhospitals.org
[4203821156] Ohio State University Hospital Program Ohio State University 395 W. 12 Ave Room 486 Columbus, OH 43210	Radiology-diagnostic	Mark King, MD	(614)293-8369 (614)293-6935 laura.volk@osumc.edu
[4203821157] University of Toledo Program The University of Toledo Department of Radiology Mail Stop#1200 Univ Med Ctr, 3000 Arlington Avenue Toledo, OH 43614	Radiology-diagnostic	Lee S. Woldenberg, MD	(419)383-3552 (419)383-6422 wendy.gobbell@utoledo.edu
[4203821232] Aultman/Mercy/NEOUCOM Program Aultman Hospital Department of Radiology 2600 Sixth Street, SW Canton, OH 44710	Radiology-diagnostic	Stephen M. Passerini, MD	(330)363-6267 (330)363-2485 ewymer@aultman.com
[4203821242] Case Western Reserve University (MetroHealth) Program MetroHealth Medical Center Department of Radiology 2500 MetroHealth Drive Cleveland, OH 44109	Radiology-diagnostic	Melissa T. Myers, MD	(216)778-4016 (216)778-4375 mbutler@metrohealth.org
[4203912158] Integris Baptist Medical Center Program INTEGRIS Baptist Medical Center Graduate Medical Education 3300 Northwest Expressway, Room 100-4394 Oklahoma City, OK 73112	Radiology-diagnostic	Kerri J. Kirchhoff, MD	(405)552-0926 (405)552-5102 annette.kezbers@integrisok.com
[4203921159] University of Oklahoma Health Sciences Center Program University of Oklahoma Health Sciences Center Dept of Radiological Sciences PO Box 26901 Oklahoma City, OK 73190	Radiology-diagnostic	Jay S. Hiller, MD	(405)270-5165 (405)297-5973 jay-hiller@ouhsc.edu
[4204031160] Oregon Health & Science University Program Oregon Health & Science University Diagnostic Radiology, L340 3181 SW Sam Jackson Park Rd. Portland, OR 97239	Radiology-diagnostic	Jim C. Anderson, MD	(503)494-5266 (503)494-9663 gaddisg@ohsu.edu
[4204111173] Temple University Hospital Program Temple University Hospital 3401 North Broad Street Philadelphia, PA 19140	Radiology-diagnostic	Beverly L. Hershey, MD	(215)707-2640 (215)707-5851 beverly.hershey@tuhs.temple.edu
[4204111174] Thomas Jefferson University Program Thomas Jefferson University 132 S 10th Street Suite 780 Main Bldg Philadelphia, PA 19107	Radiology-diagnostic	Levon Nazarian, MD	(215)955-4916 levon.nazarian@jefferson.edu
[4204121162] Bryn Mawr Hospital Program Bryn Mawr Hospital 130 S Bryn Mawr Avenue Department of Radiology Bryn Mawr, PA 19010	Radiology-diagnostic	Vikram S. Dravid, MD, FACR	(484)337-3436 (484)337-3434
[4204121163] Geisinger Health System Program Geisinger Medical Center Department of Radiology 2007 100 North Academy Avenue Danville, PA 17822	Radiology-diagnostic	Anne P. Dunne, MD	(570)271-6203 (570)271-5976 jwhemma@geisinger.edu
[4204121164] Penn State University/Milton S Hershey Medical Center Program Milton S Hershey Medical Center 500 University Drive, Dept. of Radiology, H066 PO Box 850 Hershey, PA 17033	Radiology-diagnostic	Donald Flemming, MD	(717)531-8704 (717)531-0922
[4204121165] Albert Einstein Healthcare Network Program Albert Einstein Medical Center 5501 Old York Road Philadelphia, PA 19141	Radiology-diagnostic	William Herring, MD, FACR	(215)456-6226 (215)456-1749 radiology@einstein.edu
[4204121169] Drexel University College of Medicine/Hahnemann University Hospital Program Hahnemann University Hospital 3rd Floor, North Tower MS 206 Broad and Vine Streets Philadelphia, PA 19102	Radiology-diagnostic	Robert Koenigsberg, DO, MSc	(215)762-8804 (215)762-2350 Robert.Koenigsberg@drexelmed.edu
[4204121170] Mercy Catholic Medical Center Program Mercy Catholic Medical Center 1500 Lansdowne Avenue Darby, PA 19023	Radiology-diagnostic	Oleg M. Teytelboym, MD	(610)237-4355 (610)237-2599 oteytelboym@mercyhealth.org
[4204121175] University of Pennsylvania Program Hospital of the University of Pennsylvania 3400 Spruce Street One Silverstein Philadelphia, PA 19104	Radiology-diagnostic	Mary H. Scanlon, MD, FACR	(215)662-2832 (215)662-3093 susan.lamey@uphs.upenn.edu
[4204121176] Allegheny General Hospital-Western Pennsylvania Hospital Medical Education Consortium (AGH) Program Allegheny General Hospital Department of Diagnostic Radiology 320 East North Avenue Pittsburgh, PA 15212	Radiology-diagnostic	Matthew S. Hartman, MD	(412)359-8616 (412)359-6912 mhartman@wpahs.org
[4204121177] UPMC Medical Education Program University Health Center of Pittsburgh Medical Arts Building, Suite 503 3708 Fifth Avenue Pittsburgh, PA 15213	Radiology-diagnostic	Philip D. Orons, DO	(412)647-7338 (412)647-1137 oronspd@upmc.edu
[4204131171] Pennsylvania Hospital of the University of Pennsylvania Health System Program Pennsylvania Hospital (UPHS) Department of Radiology 800 Spruce Street Philadelphia, PA 19107	Radiology-diagnostic	Michael B. Love, MD	(215)829-5699 (215)829-7482
[4204221182] University of Puerto Rico Program University of Puerto Rico School of Medicine PO Box 365067 Medical Sciences Campus San Juan, PR 00936-5067	Radiology-diagnostic	Angel A. Gomez, MD, MPH	(787)777-3535 (787)777-3855 angel.gomez2@upr.edu
[4204321183] Brown University Program Rhode Island Hospital Department of Radiology 593 Eddy Street Providence, RI 02903	Radiology-diagnostic	Martha B. Mainiero, MD	(401)444-5184 (401)444-5017
[4204521184] Medical University of South Carolina Program Medical University of South Carolina Department of Radiology 96 Jonathan Lucas, MSC 323 Charleston, SC 29425-3230	Radiology-diagnostic	Leonie Gordon, MBBCh	(843)792-7179 (843)792-9319
[4204712186] Baptist Memorial Hospital Program Baptist Memorial Hospital Memphis Department of Radiology, Attn: Ginger Tubbs 6019 Walnut Grove Road Memphis, TN 38120	Radiology-diagnostic	John A. Ellzey, MD	(901)226-3001 (901)226-3159 ginger.tubbs@bmhcc.org
[4204721187] University of Tennessee/Methodist Healthcare Program UT/Methodist Healthcare Radiology Residency Medical Education/Radiology Residency 251 South Claybrook, Wilson Hall, Rm A213 Memphis, TN 38104	Radiology-diagnostic	Eric B. Hutchins, MD	(901)516-8529 (901)516-2771 gienappa@methodisthealth.org
[4204721189] Vanderbilt University Program Vanderbilt University Medical Center - Radiology 1161 21st Avenue South CCC-1121 Medical Center North Nashville, TN 37232	Radiology-diagnostic	Thomas S. Dina, MD	(615)322-3780 (615)322-3764 radprogram@vanderbilt.edu
[4204721236] University of Tennessee Medical Center at Knoxville Program University of Tennessee Medical Center 1924 Alcoa Highway Knoxville, TN 37920	Radiology-diagnostic	Kathleen Hudson, MD, MEd	(865)305-9062
[4204811194] University of Texas Medical Branch Hospitals Program University of Texas Medical Branch Hospital Department of Radiology 301 University Boulevard Galveston, TX 77555-0709	Radiology-diagnostic	Leonard E. Swischuk, MD	(409)747-2849 (409)772-7120 femcdani@utmb.edu
[4204811198] Texas A&M College of Medicine-Scott and White Program Scott and White Memorial Hospital 2401 South 31st Street Temple, TX 76508	Radiology-diagnostic	James B. Schnitker, MD	(254)724-4507 (254)724-6588
[4204812257] Texas Tech University Health Sciences Center Paul L Foster School of Medicine Program Texas Tech University Health Sciences Center 4800 Alberta Avenue El Paso, TX 79905	Radiology-diagnostic	Arvin E. Robinson, MD, MPH	(915)545-6845 (915)545-6607
[4204821192] University of Texas Southwestern Medical School Program University of Texas Southwestern Medical Center 5323 Harry Hines Boulevard Dallas, TX 75390	Radiology-diagnostic	Diane M. Twickler, MD	(214)648-9107 (214)648-2678 diane.twickler@utsouthwestern.edu
[4204821195] Baylor College of Medicine Program Baylor College of Medicine Department of Radiology One Baylor Plaza Houston, TX 77030	Radiology-diagnostic	Pedro J. Diaz-Marchan, MD	(713)798-3224 (713)798-8359 lburlin@bcm.edu
[4204821196] University of Texas at Houston Program University of Texas Medical School at Houston Department of Diagnostic Radiology 6431 Fannin Street, Suite 2.026 Houston, TX 77030	Radiology-diagnostic	Sandra A. Oldham, MD	(713)500-7640 (713)500-7647
[4204821197] University of Texas Health Science Center at San Antonio Program Univ of Texas Health Science Center Department of Radiology 7703 Floyd Curl Drive San Antonio, TX 78229	Radiology-diagnostic	Rajeev Suri, MD	(210)567-6482 (210)567-5541
[4204821248] San Antonio Uniformed Services Health Education Consortium Program Brooke Army Medical Center Radiology Residency Program - DOR 3851 Roger Brooke Drive, Room 133-2 Fort Sam Houston, TX 78234-6200	Radiology-diagnostic	Paul M. Sherman, MD	(210)292-5290 (210)292-3946 shermrod@gmail.com
[4204822190] Baylor University Medical Center Program Baylor University Medical Center Department of Radiology 3500 Gaston Avenue Dallas, TX 75246	Radiology-diagnostic	Umesh D. Oza, MD	(214)820-3795 (214)820-7577
[4204921199] University of Utah Program University of Utah School of Medicine Department of Radiology 30 North 1900 East, #1A71 Salt Lake City, UT 84132	Radiology-diagnostic	H. Christian Davidson, MD	(801)581-7553 (801)581-2414
[4205031200] University of Vermont Program University of Vermont College of Medicine Department of Radiology 111 Colchester Avenue-Mailstop 326PA1 Burlington, VT 05401	Radiology-diagnostic	Kristen DeStigter, MD	(802)847-3100 (802)847-4822 Kristen.Destigter@vtmednet.org
[4205111201] University of Virginia Program University of Virginia Health System 1215 Lee Street PO Box 800170 Charlottesville, VA 22908	Radiology-diagnostic	Spencer B. Gay, MD	(434)982-0428 (434)924-8698 bun4n@virginia.edu
[4205113252] Naval Medical Center (Portsmouth) Program Portsmouth Naval Medical Center 620 John Paul Jones Circle Portsmouth, VA 23708	Radiology-diagnostic	Raymond E. Bozman, MD	(757)953-1198 (757)953-7327 bridget.wakefield@med.navy.mil
[4205121202] Eastern Virginia Medical School Program Eastern Virginia Medical School Department of Radiology PO Box 1980 Norfolk, VA 23501	Radiology-diagnostic	Lester S. Johnson, MD, PhD	(757)446-8990 (757)446-8441
[4205121203] Virginia Commonwealth University Health System Program Medical College of Virginia PO Box 980615 1250 E Marshall Street, Rm 3-406 Richmond, VA 23298-0615	Radiology-diagnostic	Lakshmana D. Narla, MD	(804)828-3524 (804)628-2015 klrobb@vcu.edu
[4205412206] Virginia Mason Medical Center Program Virginia Mason Medical Center Graduate Medical Education 925 Seneca Street H8-GME Seattle, WA 98111-9943	Radiology-diagnostic	Felicia P. Cummings, MD	(206)583-6079 (206)583-2307 Joanne.VanderDoes@vmmc.org
[4205421205] University of Washington Program University of Washington Medical Center 1959 NE Pacific Street Box 357115 Seattle, WA 98195	Radiology-diagnostic	Angelisa M. Paladin, MD, MS	(206)685-8307 (206)543-6317
[4205421207] Providence Sacred Heart Medical Center Program Radiology Residency Program 101 West 8th Avenue PO Box 2555 Spokane, WA 99220-2555	Radiology-diagnostic	Terri H. Lewis, MD	(509)474-3021 (509)474-2891 Sherry.Bucholz@providence.org
[4205421239] Madigan Healthcare System Program Madigan Army Medical Center MCHJ-R Bldg 9040A Jackson Ave Tacoma, WA 98431	Radiology-diagnostic	Neris M. Nieves-Robbins, MD	(253)968-5604 neris.nievesrobbins@amedd.army.mil
[4205521208] West Virginia University Program West Virginia University Hospitals Robert C Byrd Health Science Ctr PO Box 9235 Morgantown, WV 26506	Radiology-diagnostic	Robert J. Tallaksen, MD	(304)293-3092 (304)293-3899 jfast@hsc.wvu.edu
[4205612213] Aurora Health Care Program St. Luke's Medical Center 2900 West Oklahoma Avenue Milwaukee, WI 53215	Radiology-diagnostic	Robert A. Beres, MD	(414)649-6298 (414)649-5296 camille.dykas@aurora.org
[4205621210] University of Wisconsin Program University of Wisconsin E3/311 Clinical Sciences Center 600 Highland Avenue Madison, WI 53792	Radiology-diagnostic	David H. Kim, MD	(608)263-8310 (608)263-8297 ARichgels2@uwhealth.org
[4205621211] Medical College of Wisconsin Affiliated Hospitals Program Medical College of Wisconsin Department of Radiology 9200 West Wisconsin Avenue Milwaukee, WI 53226	Radiology-diagnostic	Guillermo F. Carrera, MD	(414)805-3750 (414)259-9290
[4205622212] Wheaton Franciscan Healthcare-St Joseph Program Wheaton Franciscan - St. Joseph 5000 W. Chambers Street Milwaukee, WI 53210	Radiology-diagnostic	David W. Litzau, MD	(414)447-2196 (414)874-4533

If you are looking for information on xray technician schools or ultrasound technician schools, many programs exist across the country, in particular in California and Texas. These programs are for the allied health specialists who assist the doctors who specialized in diagnostic radiology with the acquisition of diagnostic images. Check out these sites for more information: Radiologic Technologist Programs or Sonographer Training Programs. Good luck!

Radiologist Salary Levels Affected By Medicare Changes?

2011-01-28T12:31:00.000-08:00

According to a recent article in Medscape, nonradiologists are being paid more by Medicare for non-invasive diagnostic imaging:

January 6, 2011 — Nonradiologist physicians are now paid more by Medicare for noninvasive diagnostic imaging (NDI) than are radiologists, according to a study that appears in the January 2011 issue of the Journal of the American College of Radiology.

"Radiologists have always been considered the physicians who 'control' ...NDI and are primarily responsible for its growth," write lead author David Levin, MD, professor emeritus and former chair of the Department of Radiology at Thomas Jefferson University Hospital, in Philadelphia, Pennsylvania, and colleagues. "Yet nonradiologists have become increasingly aggressive in their performance and interpretation of imaging."

To find out how actual Medicare dollars for NDIs are allocated, the study authors used Medicare Part B files to track overall payments to radiologists and nonradiologists from 1998 to 2008.

In 1998, payments to radiologists for NDIs were $2.563 billion, 27% higher than the $2.020 billion that went to nonradiologists, the researchers report. However, from 1998 to 2006, Medicare payments to nonradiologists increased by 166% vs 107% to radiologists. By 2006, nonradiologists were receiving more total payments than radiologists.

At the beginning of 2007, the Deficit Reduction Act of 2005 went into effect. The law, passed by Congress, was aimed at reining in Medicare and other government spending. By 2008, payments to radiologists had been cut by 13%, and nonradiologists took an 11% loss.

The article goes on to discuss how self-referral is one of the big drivers in this change in net revenues to nonradiologists, which makes sense. However, the statistics quoted are not necessarily relevant to the issues of radiologist salaries! Think about it: a percentage change depends on the level from which the statistic starts. Since radiologists in general earn about three times the annual salary of internists, a slightly larger cut in Medicare reimbursements is not actually leading to a lower salary for radiologists.

Second, there are many more nonradiologists in practice as compared to radiologists. There are a million practicing physicians in the U.S., but roughly only 50,000 radiologists, meaning there are twenty times as many non-radiologists! In other words, each radiologist is still getting a fairly large piece of the pie.

Lastly, the general increase in the amount of imaging is a major boon to radiologists, despite the increased workload. Even if nonradiologists are compensated for simple imaging, eventually some of that imaging will lead to the need for more complex imaging studies, which generates relative value units (the almighty RVUs) for radiologists. While this trend is something to be mindful of, at least we know for sure that interventional radiologist salary levels will not be affected! The effect will be marginal for modalities that require patient-radiologist interaction like ultrasound studies or mammography, but it remains to be seen how the trend will affect general / plain film radiologists.

Radiology's Growing Role In Psychiatry

2011-01-21T06:00:00.001-08:00

A recent piece in the journal Nature details the role for imaging in psychiatry, specifically the development of near infrared spectroscopy (NIRS) for the diagnosis of mental health disorders, in particular bipolar disorder, in Japan:

Last year, doctors in Japan started using a relatively new technique — near-infrared spectroscopy (NIRS) — to distinguish between schizophrenia, depression, bipolar disorder and normal mental-health states (see page 148). It is not difficult to see why this was a popular move. Doctors like it because it is easy to use. Patients like its objective nature, and that it provides them with physiological evidence of a disorder. And officials at the health ministry are happy because it represents a public success of their drive to innovate.

In Japan, NIRS diagnosis is one of dozens of advanced medical techniques offered to patients — at their own expense — despite not having gone through the clinical trials needed for approval by national health insurance. But is it ready for the clinic? Most scientists contacted by Nature do not think so. The patient groups of the supporting studies were small. The tests have not been reproduced in various clinical settings as one might hope. There is no international consensus on how best to measure NIRS parameters, much less a clear consensus on how to apply them to mental health. And if it is not ready, the same advantage that has patients lining up for it — the authority of an objective, physiological measure, the air of the incontrovertible — will become an obstacle. A misdiagnosis that carries the authority of an 'objective' measurement will probably be even more difficult to overturn.

Click here to read on about the difficulties of introducing any new diagnostic technique and validating it, both in terms of how to define appropriate application of a technique as well as who should foot the bill during the experimental phase of a technique. Still, the idea of using MRI or ultrasound techniques much like infrared is extremely promising given the lack of ionizing radiation involved. Patient safety groups may still raise various concerns, but certainly the main risk of oncogenesis is mitigated.

Regardless of the outcome of this particular technique, the field of "radiopsychiatry" or whatever you would like to call it is almost certain to boom over the next decade, especially as techniques become validated and scaled up for use in clinics around the world, leading to a boom not only in radiology but as well as in psychiatry. Ultimately, patients with mental health disorders will benefit the most as they get more objective and accurate data about the nature of their ailments.

Ultrasonographer / Ultrasound Radiologist Salary And Jobs

2011-01-14T06:00:00.001-08:00

The entire economy is slowly recovering from the slump of 2008, but unemployment remains high. While medicine in general and radiology in particular is relatively insulated from macroeconomic trends, radiology residents just graduating and entering the private market may face an adverse situation as radiologists are less likely to invest in a new practice in a down economy. However, the impact of the economic situation varies by subspecialty and region as well. Ultrasonography differs from fields like IR or mammography in that the quality of the sonographer has a large impact in the nature of the practice.

According to the Bureau of Labor Statistics:

Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association's Physician Compensation and Production Survey, median total compensation for physicians varied by their type of practice. In 2008, physicians practicing primary care had total median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation of $339,738.

Self-employed physicians—those who own or are part owners of their medical practice—generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health insurance and retirement.

That's right - the median salary for physicians as a whole is $186,044. Wow - that's a large number for any profession. It gets even better: for specialists like radiologists, the median salary is a whopping $339,738! Of course, after 14 years of college, medical school, internship, residency, and fellowship, such levels of compensation are somewhat rational. Smaller states counterintuitively provide higher levels of compensation. While it is hard to find breakdown statistics by fellowship for ultrasound in particular, it is generally known that interventional radiology earns slightly more than diagnostic radiology. Per the Radiologic Society of North America (RSNA), using data from 2009:

Of the 30 specialties surveyed, interventional radiologists scored third highest and diagnostic radiologists earned the fifth highest salary for 2009.

With a median salary of $454,205, diagnostic radiologists' compensation increased by 3.7 percent in 2009, while interventional radiologists reported a median salary of $478,000, which was unchanged from the year before.

Again, a staggering number: diagnostic radiologic salaries were $454,205 for 2009! Even if ultrasound radiologist salary levels were 10% below the average, a salary of $409,000 would still be in the top 10 of physician specialties and in the top 1% earners nationally. Per the BLS, the future looks bright:

Employment is expected to grow much faster than the average for all occupations. Job opportunities should be very good, particularly in rural and low-income areas.
Employment change. Employment of physicians and surgeons is projected to grow 22 percent from 2008 to 2018, much faster than the average for all occupations. Job growth will occur because of continued expansion of healthcare-related industries. The growing and aging population will drive overall growth in the demand for physician services, as consumers continue to demand high levels of care using the latest technologies, diagnostic tests, and therapies. Many medical schools are increasing their enrollments based on perceived new demand for physicians.

Despite growing demand for physicians and surgeons, some factors will temper growth. For example, new technologies allow physicians to be more productive. This means physicians can diagnose and treat more patients in the same amount of time. The rising cost of healthcare can dramatically affect demand for physicians’ services. Physician assistants and nurse practitioners, who can perform many of the routine duties of physicians at a fraction of the cost, may be increasingly used. Furthermore, demand for physicians' services is highly sensitive to changes in healthcare reimbursement policies. If changes to health coverage result in higher out-of-pocket costs for consumers, they may demand fewer physician services.

Job prospects. Opportunities for individuals interested in becoming physicians and surgeons are expected to be very good. In addition to job openings from employment growth, openings will result from the need to replace the relatively high number of physicians and surgeons expected to retire over the 2008-18 decade.

Job prospects should be particularly good for physicians willing to practice in rural and low-income areas because these medically underserved areas typically have difficulty attracting these workers. Job prospects will also be especially good for physicians in specialties that afflict the rapidly growing elderly population. Examples of such specialties are cardiology and radiology because the risks for heart disease and cancer increase as people age.

If you are interested in radiology and ultrasound in particular, the future holds much promise for continued growth in ultrasound radiologist salary levels despite stagnation in the job market overall. Even if you are looking for training as an ultrasound technician at an ultrasound technician school, the salary trend will benefit you through the "trickle-down" effect. Here's to 2011!

Does Radiologist Salary Matter?

2009-11-30T15:39:00.000-08:00

Before answering the question does radiologist salary matter, it is important to know what we are discussing in the first place, namely the salary range for a radiologist. The question is more complex than it seems on the face of it, as there are many factors that play into what a radiologist's salary ultimately is. Do they work in the Southwest or the Northeast? Is it fair to compare the salary of a mammographer to the salary for an interventional radiologist? How much experience does the radiologist have? All these questions enter into the equation. However, to simplify, most people would agree that most radiologists earn between $300,000 and $500,000 across sub-specialties and regions. Clearly, a good salary by any standard, but that brings us to the questions posed above:

Does Radiologist Salary Matter?

The knee-jerk response is, of course! Sure it does! Would all these doctors be radiologists if salary did not play a role? And yes, of course, salary mattters - it is doubtful that most radiologist, or most doctors in general, would work for free. However, the point of this question isn't to question the amount of salary radiologists receive, but whether a higher salary is correlated with higher job satisfaction.

Like radiologist salary, many factors play into radiologist job satisfaction. These factors include scheduling flexibility, opportunities for career advancement, job security, and workload. Interestingly though, another factor to consider that is more intangible is the work environment. Across practice settings, having a sense of teamwork and camaraderie based on mutual respect can enhance the work experience for everyone involved, from x ray technician to the senior parter or chair of the department. This concept cannot be overstated - you will be around these people for a majority of your day, so you might as well like them.

If salary were the only consideration, you would expect to see all radiologists competing for the jobs with the highest compensation, but clearly this is not the case. In fact, some commentators view an excessive emphasis on income as a sign of job dissatisfaction. The sense that salary is all that matters implies that the physician has lost interest in the work itself and is looking for other outlets in order to feel a sense of worth. Fortunately, practices and hospitals are increasingly likely to provide resources these issues earlier instead of letting them fester and affect job performance. Ultimately, salary is only one of many items that play into a radiologist's job satisfaction.

Locum Tenens Radiology Jobs Gaining Popularity

2009-11-20T15:20:00.000-08:00

Locum tenens radiology jobs have been around for a long time but have recently become more popular. This trend is especially marked among mid-career radiologists looking for more career flexibility. According to Medscape:

Plagued by issues of managed care, mounting paperwork, malpractice costs, and diminishing reimbursements, a percentage of physicians are stepping away from traditional practices to explore alternative career options. Some have chosen to hang out a new shingle: doctor for hire.

In previous years, locum tenens (a Latin phrase meaning "to stand in another's place") positions were typically filled by early career and semiretired physicians, but recently more midcareer physicians are choosing temporary assignments. A 2008 survey of 12,000 doctors, most of them primary care physicians, reported that 7.5% expected to work as locums in the next 3 years. In 2009, the number of physicians working as locums is anticipated to increase by 16% over that of 2008, according to a report by the Braff Group, a healthcare merger and acquisitions company.

For some physicians, working as a locum is a bridge between full-time assignments or a way to experience how medicine is practiced in various parts of the country before choosing to move to one area. For others, locum tenens work is a way to supplement retirement savings hit hard by the recession. Yet, for a growing number of physicians, locum tenens work is their preferred form of medical practice.

Clearly, the motivations for working locum tenens are quite varied, but the increasingly rigid nature of U.S. healthcare is driving physicians to consider what practice settings best fit their career goals. What are your career goals? Does locum tenens make sense for what you want to achieve? The New England Journal of Medicine recently explored this topic and noted the following:

A decade ago, physicians who elected the free-spirited locum tenens lifestyle — as a way to try out practice settings or merely explore new places — tended to cluster at either end of the career spectrum: doctors just out of training and those nearing retirement.

Those two groups still account for the majority of medical professionals who take temporary assignments, an estimated 60 percent, but there’s a shift afoot. Surveys conducted in recent years have found that a growing number of physicians who might be deemed “mid-career” are looking to locums as either a bridge to a potential career change or a semi-permanent practice option.

For New York City internist and infectious disease specialist John L. Ho, MD, locums has proved a good foundation for making his move from a 22-year stint in academia to the next chapter — whatever that may be. He is working as a hospitalist at Southern Maine Medical Center in Biddeford, filling in for a physician who is currently serving in the National Guard. He landed in coastal Maine after completing his first Staff Care assignment at rural Eastern Maine Medical Center.

“I always maintained my love of acute care medicine, even though my major activity at Cornell was research based. I truly got tired of running from grant to grant,” Dr. Ho said. “I am enjoying these assignments and all of the patient interactions I have now,” said Dr. Ho. He also likes the non-urban setting far more than he expected. His colleagues have been welcoming and collegial, and the patients surprisingly cordial, based on his previous experience in a large urban center. “They’re much more grateful. They actually say ‘thank you’ — and that has been gratifying,” he said.
Marci Malone, MD, is among the growing number of physicians who take locum tenens assignments regularly in addition to working full time in a practice. In fact, many colleagues look at the New York anesthesiologist quizzically when she talks about spending her “vacation” working locum tenens in remote corners of the Southwest. Since 2001, she has spent roughly a month each year working at Indian Health Service (IHS) hospitals in places like Gallup, New Mexico, and isolated Chinle, Arizona, where she has gone several times. “I have a hard time taking a vacation, so this is my idea of what to do with my spare time,” Dr. Malone said.

She finds both the work and the setting a welcome reprieve from the urban rat race, and the facilities, contrary to what some physicians might expect, she observed, are modern and well run. “The facilities may not be completely computerized, but from the anesthesia standpoint, they have almost all of the toys any of us could want,” she said. “The case load is different at IHS hospitals than at urban centers, however, because we’re not usually dealing with typical ER patients. The cases can be less demanding because most of the patients who need surgery, even if they have four comorbidities, have received a lot of regular and preventive care.”

The OR workday is often slightly shorter than her typical New York shift, but the call duty can offset that plus. “It can be just as brutal at times,” she said. Those challenges are easier to deal with, she added, because she enjoys the patients. She has grown especially fond of the Navajo Nation patients she cares for during her Arizona assignments. “They are very gracious people who have little but are willing to share what they have. Working with them helps me reset my expectations about life,” Dr. Malone said.

Hearing the experiences of these physicians shows that you could get more out of locum tenens than you would have initially expected. In addition to extra radiologist salary, you may also experience a new part of the country or new setting, interacting with patients and colleagues you never would have otherwise. Locum tenens radiology jobs could potentially broaden not only your intellectual horizons but your social ones as well.

Radiology Locum Tenens Salaries And Jobs

2009-11-10T13:00:00.000-08:00

As with any job, an important consideration is salary, whether it be mammographer salary trends or interventional radiologist salaries or radiology salary trends in general. However, one aspect these discussions do not fully capture is the availability of temporary employment within radiology, also known as locum tenens positions.

What are locum tenens radiology jobs?

Locum tenens is Latin for a placeholder, or one who temporarily fulfills the duties of another. Within American medical practice, there are many opportunities for locum tenens work, especially in hospitals that are under-staffed or are work in underserved areas. Of course, by definition, these jobs are temporary in nature. Still, many practitioners find them desirable for a variety of reasons.

What are the advantages and disadvantages of locum tenens radiology positions?

As locum tenens radiology jobs are temporary, they are afforded certain benefits not available to permanent employees while denied others. In general, per Wikipedia, there are several common advantages and disadvantages to a locum tenens position in any field:

Locums provide a ready means for organisations to fill positions that are either only temporarily empty (during sickness, leave or for other reasons) or for which no long-term funding is available. Locuming also allows a professional to try (and get experienced in) a wide range of work environments or specialisation fields which a permanent employee may not encounter.

However, the locum situation also has a number of disadvantages - the transient nature means extra stress and work for the locums whenever they have to fit into a new position, and for the hiring organisation, this generally means that the required flexibility (and often, the lack of a guaranteed income) has to be rewarded with high salaries. These may in the long term create higher costs for the hiring organisation than adding more full-time positions (especially in highly-skilled, accredited professions, and unlike the situation in some professions where cheap temporary labour or significant use of interns actually undercuts wages and reduces total staff costs).

Also, and especially true in professions where knowing all procedures and past case histories is important (such as for doctors working on patients, who may dislike not being treated by their own doctor, or by constantly shifting doctors), locums may provide lesser-quality work (or be seen as posing such a risk, fairly or not). Further, locums often experience resentment from permanent staff, for example because they are paid more, or because they are considered to shoulder less responsibility.

It is up to you to weight the advantages and disadvantages of any particular situation as compared to your career goals. If you are unsure, locum tenens is something to consider trying because by its nature, it does not require a significant commitment.

Why do practices offer locum tenens jobs?

Another important to consider is the motivation of your potential employer in offering the job. Is a partner taking a sabbatical? Are they looking for someone to 'tryout' before offering a full-time position? Are they trying to provide a service for which they have a low but still significant volume of business? All of these are possible reasons, and most employers will be up-front about their reasons for creating the opportunity. Indeed, they have little incentive not to be. However, it is still your responsibility to make sure you have this question answered for that particular opportunity before making a final decision.

How much do radiologists working locum tenens get paid?

There is a wide range of compensation available for locum tenens radiology positions, depending on the specifics of the job and the work required. While it is difficult to draw a direct comparison to the salaries of, say, interventional radiologist salaries, radiologists working locum tenens can make up to $1200 to $1500 per 8 hour shift. Again, this number can vary significantly by number of studies read, the type of study being read, the specific shift (daytime vs night, weekday vs weekend), the practice setting, and geographic location.

Whether you are starting out in radiology and want to sample different practice settings, in mid career and want to broaden your clinical experience, or in the twilight of your career but still want to be an active radiologist, a locum tenens radiology job may be the right option for you. Start searching today!

How To Read A Pelvis Plain X-Ray

2009-10-25T17:51:00.000-07:00

There is a great post on Bone Broke? Me Fix!, a blog by an orthopedics resident, about how to read a pelvis film:

I saw the Quick Guide to reading a Chest X-ray over at ScrubNotes, and decided to publish the ortho version: How to read an AP Radiograph of the Pelvis. As with the CXR, it is important to evaluate the AP radiograph of the pelvis using a systematic approach. Here is that approach that I have been taught.

There are six lines that one should evaluate when looking at an AP radiograph of the Pelvis.
1. The iliopectional line to evaluate the anterior column.
2. The ilioischial line to evaluate the posterior column.
3. The dome of the acetabulums.
4. The 'tear drop' to evaluate the anteroinferior portion of the acetabular fossa.
5. The anterior rim of the acetabulum.
6. The posterior rim of the acetabulum.

It is also, of course, important to evaluate the rest of the bony structures visible on the radiograph, including the pubic rami, the SI joints, the neck of each femur, the visualized lumbar spine and sacrum, and the pubic symphysis.

Fractures in the pelvis can be difficult to visualize and if there is doubt, one can order additional views, including inlet and outlet views to further evaluate for rami fractures. The inlet view will allow for evaluation of the superior rami for fractures and the pelvis for anterior-posterior displacement of the pelvis. Outlet views will allow for evaluation of the inferior rami for fractures and for determination of superior-inferior displacement of the pelvis. Judet views are one additional study that can be ordered to evaluate the acetabulum. These views are shot at a 45 degree angle to the pelvis. The obturator oblique radiograph will allow for evaluation of the anterior column and the posterior wall of the acetabulum. The iliac oblique, conversely, will allow for evaluation of the posterior column and the anterior wall of the acetabulum.

For more, check out the full post: How To Read An AP Pelvis

What Is Ultrasound Imaging?

2009-09-13T12:10:00.000-07:00

There are several major modalities in radiology: plain x-ray, computed tomography (CT), magnetic resonance imaging (MRI). Today, we cover another major tool in the radiologist's toolbox, ultrasound.

What is ultrasound imaging or medical sonography?

Ultrasound imaging, also known as medical sonography, utilizes the principles of sound waves and physics to generate images without using radiation. Ultraound is a type of sound wave. All sound waves can be characterized by their frequency and amplitude, which denote the amount of energy carried by the wave. Ultrasound refers to spectrum of acoustic waves with a frequency above the range of human hearing, approximately 20,000 hertz.

The basic question regarding ultrasound is how are sound waves converted into a diagnostic image? The basic process involves three steps: the creation of appropriate sound waves, the reception of the echoes, and the processing of those echoes into an image. A transducer on the ultrasound machine produces sound waves in the 2 to 18 megahertz range. These waves are then transmitted into the body via an interface, typically a rubber-coated probe with a gel interface with the patient's skin in order to produce efficient transfer of waves into body tissues. Once the wave is in the body, it propagates until it hits tissue of sufficient density to create a reflection, or echo. The echo travels in reverse, eventually striking the transducer, which contains a receiver. The receiver's vibration is translated into an electronic signal. The ultrasound machine contains a processor which calculates the time it took the echo to return and how strong the echo was in order to determine which pixel on the screen to light up, and at what intensity. Repeating this process for each wave and each pixel yields the image seen on the ultrasound machine's screen. This covers the basics of ultrasound image production, but more technical discussions are easily found.

What are the benefits of ultrasound?

The main benefit of ultrasound is that it does not use radiation, which makes it safer to use in general. Ultrasound is particularly useful in pregnant women to image the fetus, as well as in newborns who are still undergoing tissue development which may be susceptible to radation. Another major benefit of ultrasound is portability. Although the machines are expensive, they can be wheeled around on a cart, which makes it easy to do bedside imaging or imaging on critical patients who cannot be moved easily. Furthermore, this reduces expense as a dedicated ultrasound facility is not necessarily needed.

What are the applications of ultrasound?

Ultrasound has applications in nearly every field of medicine. Some of the most prominent are cardiology, obstetrics, gastroenterology, and gynecology/urology. In cardiology, ultrasound in combination with Doppler sonography is used to produce echocardiograms, which assess both the structure of the heart as well as flow within the heart. Obstetric ultrasounds are very common, and are used to track healthy pregnancies as well as diagnose problems in difficult pregnancies. In gastroenterology, ultrasound is better at producing images of certain pathologies, such as biliary disease like gallstones and liver imaging. For urology / gynecology, ultrasound is used to image the kidneys, bladder, ovaries, and other pelvic structures for a variety of pathologies.

What Is An MRI (Magnetic Resonance Imaging)?

2009-08-21T23:10:00.000-07:00

After the development of computed tomography (aka the CT scan), the next big jump in radiology was the development of the imaging modality known as magnetic resonance imaging, or MRI.

The History of Magnetic Resonance Imaging (MRI) Development

The basis of MRI lies in understanding how to apply the chemical principle of nuclear magnetic resonance to living tissue to produce an image (discussed more fully below). While there are many people involved in the research that brought MRI to fruition, the Nobel Prize Committee recognized two individuals in particular: Paul C. Lauterbur and Sir Peter Mansfield. In Lauterbur's own words, here is how he came upon the idea of using NMR for biomedical imaging:

After I returned to Stony Brook, by a long, leisurely automobile drive from California with my family, and settled in again to my department (where I found the same arguments continuing that had been going on when I left) another unexpected event occurred. It had its beginning several years earlier, when a field service engineer for Varian, the leading NMR company, saw an opportunity and asked for my opinion on his idea of starting his own company to make or distribute specialized NMR equipment and supplies. His business plan seemed reasonable, and I encouraged him to go ahead. For a time the company thrived, and I was a member of the Board of Directors.

In May of 1971, however, some other members of the board compared notes with the company's banker and found that the company had engaged in some very dubious business practices and was, in fact, bankrupt. At a hastily-called Board meeting, appropriate actions were weighed, and the banker, there as a guest, threatened to close the company that day unless someone he trusted could be persuaded to take over as President, Chairman of the Board, and Chief Executive Officer. I was the only academic on the Board, the semester had just ended, and the others believed that I was free for the summer, so that I was asked to take the job. I agreed, flew to the company headquarters in New Kensington, PA, near Pittsburgh, at the beginning of each week and back to Stony Brook and my family and students for the weekend.

The developments at the company could supply the plot for a novel, but the incident that is important for my purpose here is that a post-doc arrived with tumor-bearing rats to check the proton NMR relaxation times of their tumors and normal tissues and organs. I was there to observe the experiments, and noted that large and consistent differences were observed for specimens from all parts of the sacrificed animals and that the experiments seemed well-done. Some individuals were speculating that similar measurements might supplement or replace the observations of cell structure in tissues by pathologists, but the invasive nature of the animal procedure was distasteful to me, the data too complex, and the sources of differences too obscure, to be relied upon for medical decisions. As I pondered the problem that evening, I realized that there might be a way to locate the precise origins of NMR signals in complex objects, and hence to form an image of their distributions in two or even three dimensions. That story, and its consequences, is told more fully elsewhere.

As for the first MRI image itself, here is Mansfield's account:

I was still very much concerned with imaging speed and also the question of sliced definition. After a lot of thought and discussion with Peter Grannell we came up with a method of slice selection which looked as though it might work reasonably well. Alan Garroway also came up with a different method of slice selection using a string of short pulses to define the slice and between us we thought that the sensible approach would be to combine our efforts and publish a short note on the general technique of slice selection. This was sent to the Journal of Physics and was published in the form of a letter. The question of imaging times was still concerning me and during the course of 1974 I spent a great deal of time turning over my thoughts on how this may be achieved. One way forward was what I called line scan imaging. In this method a line of magnetization in a specimen was selectively excited and read out. This process was repeated until the object had been scanned. The technique was much faster than the sensitive point scan method of Hinshaw and also turned out to be faster than the projection reconstruction method of Paul Lauterbur, but I was still not satisfied. Nevertheless, line scanning was used to produce a number of images and in particular it was used to scan the finger of one of my early research students, Dr Andrew Maudsley. The scan times for these finger images were 15-23 minutes. These were the first images of a live human subject and were presented at a special meeting of the Medical Research Council which was convened in 1976 to review the work of the several imaging groups that had sprung up both at Nottingham and also in Aberdeen. All groups were vying for MRC support and this meeting was called specially to review the topic and to decide how best to support the work. The images demonstrating live human anatomy were annotated by Professor Rex Coupland, then head of the Department of Human Morphology. They produced a startling response at this meeting and convinced the MRC that our work should be supported. We produced a grant application requesting a substantial sum of money to produce a whole body MRI machine.

Since the 1970s, the rapid development of technology in broad terms has fostered the development of MRI as a practical, and in some cases now, essential tool for physicians, changing the standard of care forever.

The Principles Behind Magnetic Resonance Imaging (MRI)

A detailed explanation of the physics and chemistry that go into using magnets to produce images is beyond the scope of this blog. However, Wikipedia has a nice section that explains MRI in plain and easy-to-follow terms:

The body is largely composed of water molecules which each contain two hydrogen nuclei or protons. When a person goes inside the powerful magnetic field of the scanner, the magnetic moments of these protons align with the direction of the field.
A radio frequency electromagnetic field is then briefly turned on, causing the protons to alter their alignment relative to the field. When this field is turned off the protons return to the original magnetization alignment. These alignment changes create a signal which can be detected by the scanner. The frequency of the emitted signal depends on the strength of the magnetic field. The position of protons in the body can be determined by applying additional magnetic fields during the scan which allows an image of the body to be built up. These are created by turning gradients coils on and off which creates the knocking sounds heard during an MR scan.
Diseased tissue, such as tumors, can be detected because the protons in different tissues return to their equilibrium state at different rates. By changing the parameters on the scanner this effect is used to create contrast between different types of body tissue.

Contrast agents may be injected intravenously to enhance the appearance of blood vessels, tumors or inflammation. Contrast agents may also be directly injected into a joint in the case of arthrograms, MR images of joints. Unlike CT, MRI uses no ionizing radiation and is generally a very safe procedure. Patients with some metal implants, cochlear implants, and cardiac pacemakers are prevented from having an MRI scan due to effects of the strong magnetic field and powerful radio frequency pulses.

The Future of Magnetic Resonance Imaging (MRI)

MRI has found many applications in the medical field. Functional MRIs are used to assess how differential delivery of glucose reflects neurological function in conscious subjects. There are many potential applications of functional MRIs, ranging from studies in psychology and economics to more medically-related applications in psychiatry. In oncology, MRIs are being paired with PET scans to further improve the sensitivity of tumor detection. If the last few decades are any indication, the next ten years will likely see an explosion of MRI installations and application development, to the degree that one day an MRI might be as routine as a plain x-ray.

What is PACS?

2009-08-14T15:09:00.000-07:00

Imagine you writing a blog about, say, vegetarian Indian food recipes. The blog would consist of a collection of recipes (text data) and images of the food prepared (visual data). To transfer this information to other people, you would need some kind of system that would store the data and then be able to transfer it at will to other interested parties. This structure is the blog software and the server hardware. In other words, this is a picture archival and communication system, or PACS.

The History of Picture Archival and Communication System (PACS)

The concept of a PACS was first discusssed in the early 1980s. While no one individual can be credited with the full development of PACS, this article in Imaging Economics describes some of the contributions of early leaders in PACS development:

"Any image, anytime, anywhere—that's the mantra," says Reuben Mezrich, MD, PhD, describing the capability of the modern PACS (picture archiving and communications system). "But none of this could have happened without DICOM (digital imaging and communication in medicine).

"If you could give a Nobel Prize for DICOM, that would be a good thing," adds Mezrich, professor of radiology and chairman of the radiology department at the University of Maryland School of Medicine, Baltimore.

DICOM is a meticulously developed set of standards that allow systems to interface. It specifies how devices built in conformance with the standards react to commands and data being exchanged. DICOM, for instance, lets a CT scanner made by one manufacturer, an MRI scanner made by a second company, and an ultrasound machine made by a third company all communicate with the same PACS. It is because of DICOM that images from all three modalities, and others as well, can be displayed and interpreted at the same PACS workstation. The images can all be sent to the same PACS archive. DICOM is the computer standard that lets a PACS do its work.

If, as Mezrich suggests, a prize were given for DICOM, the recipient would most likely be Steven C. Horii, MD, who is now a professor of radiology and clinical director of medical informatics at the Hospital of the University of Pennsylvania, Philadelphia. By informal acclaim from his peers, Horii is credited with being the DICOM point man. He is cited for putting in the long hours and the blood, sweat, and perseverance that were necessary to DICOM's creation.

As with the development of any new standard, many people from many different backgrounds were involved to help create PACS and DICOM and secure their interoperability with other systems, which was the key to the success of the standard.

Picture Archival and Communication System (PACS) And Radiology

Almost all modern radiology services now use some kind of PACS system to manage their data and communicate with other services. The four basic components of PACS are:

Imaging Modality - CT, MRI, X-ray
Secure Network - to transmit data, typically over a VPN or SSL connection
Workstations - to view and manipulate images
Archives - to store and retrieve images

The most common format used on PACS is DICOM (Digital Imaging and Communication in Medicine). Although the format is widely used, it is not a strictly defined format. Vendors have the ability to define their own metadata tags for new features unique to their own systems. While this gives DICOM flexibility, it limits interoperability, as legacy viewers are unable to interpret novel metadata tags. Another issue for PACS is the integration of full field digital mammography (FFDM) into existing PACS systems versus the non-integrated solution of buying separate mini PACS workstations for digital mammography.

Regardless, PACS is key to the functioning of a modern filmless radiology department. Beyond simply proving image archival and display, a PACS must be able communicate with other hospital information systems, such as the hospital information server (typically where the full patient's EMR and biodata is stored) as well as the radiology information server (RIS).

The future of radiology is dependent on the continual development of PACS as a standard and as a tool that lets radiologists communicate their findings to their own colleagues, to other specialties, and ultimately to patients themselves.

Mammographer Salary For 2009

2009-08-07T15:23:00.000-07:00

Many of you have heard about mammography and the various trends in this field over the past 10 or 15 years. After hitting a low point a few years ago, the field seems to be making a comeback, primarily due to tort reform. The field has many opportunities for young practitioners.

What is a mammographer?

Before discussing salary issues, we should first define which field and specialists we are talking about. Mammographers are diagnostic radiologists who are fellowship-trained in imaging of the breast. Some centers are moving away from the name of 'mammography' towards the broader field of women's imaging, which would include imaging of the female genitourinary tract, as well as have a broader role in patient care, specifically women's health issues. Regardless, the main focus would still remain on diagnosing and intervening on disease of the breast using various imaging modalities. The main modality is, of course, a mammogram, which uses intense radiation beams in special machines at various planes to produce 2-D images of the breast. However, new imaging including MRI and musculoskeletal radiology are opening new avenues for imaging of the breast. Some programs now offer a combined mammography/musculoskeletal fellowship for radiology residents interested in pursuing the cutting edge in mammography.

In addition to diagnosing lesions of the breast, mammographers are involved in biopsying such lesions through stereotactic biopsies, in which the biopsy is performed via large bore needles in the radiology suites instead of in an operating room. Furthermore, a mammographer may be heavily involved in patient care, as the mammographer often may be the first physician to inform a patient of a suspicious breast lesion which may turn out to be cancerous. Such a diagnosis can have a huge impact on a patient's life, even if the lesion eventually turns out to be benign. Given the gravity of the situation, it is important for mammographers to be fully trained to deal with all the dimensions of their job.

Why is mammography making a comeback?

A few years ago, litigation posed a serious threat to mammography. A mammogram is a screening tool, but it offers no guarantee of preventing breast cancer. Sometimes, unfortunately, women would receive regular mammograms and still receive a diagnosis of advanced breast cancer. There is no way for the mammographer to prevent this unfortunate combination of circumstance and genetics. However, a subset of these patients would involve a lawyer. Once a lesion has been diagnosed, it is easy for a lawyer to look back at old mammograms and highlight the suspicious area and ask of the mammographer why more was not done at an earlier time. This approach utilizes a logical fallacy which can be easily summarized as "hindsight 20/20." In reality, there are many suspicious lesions on mammograms, but working up every questionable spot on a mammogram would lead to more harm than good, so the mammographer must be judicious in following questionable areas, with the risk that sometimes this conservative approach more produce more harm in a particular individual.

Some states have realized that this puts the mammographer in an untenable positions. By instituting tort reform, they do not free the mammographer of liability but rather acknowledge that such errors are not born out of malice but rather are a function of the system we inhabit. This reform has helped mammographers function more appropriately, thus increasing demand for the field. According to the Centers for Medicare Services, mammographers are one of the highest compensated medical specialities as of 2008:

Diagnostic Radiology - M.D.s Interventional - $463,219
Diagnostic Radiology - M.D.s Neuro-Interventional - $500,000
Diagnostic Radiology - M.D.s Non-Interventional - $420,858
Mammography - $540,028
Nuclear Medicine (M.D.s Only) - $331,866
Radiation Therapy (M.D.s Only) - $395,166

Source: http://www.cms.hhs.gov/AcuteInpatientPPS/Downloads/AMGA_08_data.pdf

Given this data, if you were considering mammography before but were unsure of the future of the field, give it another look. You might be surprised by what you find.

How To Read A Chest X-Ray

2009-07-30T17:34:00.000-07:00

Let's say you are trekking in the Himalayas and suddenly become short of breath. Even though you are on your way to Annapurna Base Camp in a remote corner of the world, you would most likely be taken to a local clinic and have a plain film chest x-ray taken of your chest to help determine the etiology of your dyspnea, just like in any other part of the world. This post is not a comprehensive account of how to read a chest x-ray, but rather a collection of tips and tricks that should help one read most plain chest x-ray films.

The Plain Film Chest X-Ray: PA And Lateral Views

While there are many possible views that can be taken of the chest, the two most common are the PA view and the lateral view. The PA view, or Posterior-Anterior view, positions the beam at the patient's back. The radiation then travels through the spine, lungs, heart, and finally skin until it meets the detector or film anterior to the patient. The advantage of a PA film over an AP, or anterior-posterior, view is a reduction in the enlargement of the cardiac silhouette. Since the heart is closer to the film, its shadow is less distorted.

The PA view is often taken simultaneously with a lateral view. The benefit of having two views is that the radiologist is better able to visualize abnormalities in 3-D space with two views. Otherwise, there is a chance that two abnormalities can be in the same sagittal plane, yielding only one shadow on the PA view. The lateral view would distinguish between these two lesions. In other words, the PA view tells you where things are, medial to lateral, while the lateral view tells you where things are in an anterior to posterior sense.

How To Read A Plain Film Chest X-Ray

There is no right or wrong way to read a chest x-ray, but it is beneficial to develop a systematic method of doing so. The first thing to always check is that the film is associated with the correct patient. After doing so, to read a PA view, I utilize a mnemonic called RIP ABCDEFGH. Here is how it works:

Rotation: Check to see that the patient is not rotated. You can look at the clavicles and make sure the vertebral processes line up nicely in between them.
Inspiration: Check to see that you can see about 9 ribs on each side. Less than 8? It is likely poor inspiration.
Penetration: You should be able to see lucencies in the middle of the film representing the intervertebral discs. If there are none, the film is over-penetrated; if they are too well-defined, the film is under-penetrated.

Airway: Trace the lucency from the neck down towards the carina. It should be midline and you should be able to see two bronchi splitting from it.
Bones: Look at the shoulder joint and trace out each rib contour to check for fractures or other abnormalities.
Cardiac Silhouette: Check the right and left heart borders.
Diaphragms: These should be well-defined with no obscuration of their margins.
Empty Space =)
Fields: Look at the lung fields bilaterally and compare. Don't forget the apices.
Gastric Bubble: Check for a lucency in the left upper abdominal quadrant.
Hardware: Make sure the placement of any lines or other hardware is appropriate.

Pretty simple, no? After going through this process several times, it becomes routines. You can then use the lateral view to confirm your findings. Develop a process for evaluating lateral films as well, but in general, they are used to confirm what is seen on the PA view. While simple, learning how to read a chest x-ray is a basic skill all radiologists should know well before moving on to reading more advanced imaging, even in the remote reaches of Nepal =)

How A CT Abdomen/Pelvis Is Performed

2009-07-18T17:05:00.000-07:00

CT Scan of the Abdomen (Source: Wikipedia)

The patient was having nonspecific abdominal pain that had not resolved after several days in the hospital. On the suggestion of her kidney doctors, a computed tomography (CT) scan of the abdomen and pelvis with contrast was ordered. The patient desired the exam in order to find out the etiology (origin) of her pain.

When ordering any imaging study, CTs in particular, it is important to consider several things beforehand:

Is this study necessary?
Is this study appropriate?
What are the risks of this study?
What are the benefits of the study?
Will the study reveal new information that will affect the management of the patient?
For hospitalized patients, does this study need to be performed in-house, or can it done on an outpatient basis?

In the case of this patient, the answers to these questions were as follows:

Yes, to determine the etiology of her pain, which could have potentially been serious.
One could argue about whether an ultrasound should have been performed first, but a CT provides a great deal more information, so the CT was preferred.
The major risks include radiation and contrast-induced nephropathy. The risk of radiation is development of a future cancer, but this is tied to cumulative radiation exposure, so one CT by itself is not a huge harm. Contrast-induced nephropathy is potentially quite serious, but in this patient, her kidney function was so depressed that there was not much kidney function to preserve to begin with.
The benefits would be to rule out any potentially urgent, addressable causes of her pain.
Yes, potentially (see #4)
In practical terms, it made sense to do this study as an inpatient, versus having the patient come back for a separate study.

After the order was sent by the primary team, the radiologist has to look over the order to ensure that it is appropriate and then protocol it. The protocol is the specific routine that the scanner will run while acquiring the images. After approval, the patient was taken down to the CT scanner room. Contrast was infused into her via an intravenous (IV) line. Since the area of interest was any soft tissue mass causing the pain, the scanner was programmed to wait until the contrast had entered the venous phase after perfusing through the arteries, roughly 80 seconds after the infusion began. At this point, the scanner spun into action, using its radiation beam and detectors to create the typical cross-sectional images of a CT scan. The scanner only scanned the patient's abdomen and pelvis in order to ensure a limited dose of radiation. After the scan, the patient was returned to her room. The images were sent to the radiologist's Picture Archiving and Communication System (PACS) machine, where she was able to interpret the images minutes after the scan had been taken.

Fortunately for the patient, the scan was negative and she was discharged home. The contrast would be dialyzed off at a later date.

Interventional Radiologist Salary

2009-02-08T07:48:00.001-08:00

An interventional radiologist is a sub-specialized radiologist. After completing an internship and four year diagnostic radiology residency, one must also complete a one year fellowship in interventional radiology (IR) to become an interventional radiologist.

What does someone in interventional radiology (IR) do?

An interventional radiologist is actually quite different from the typical diagnostic radiologist. In IR, the focus is on performing procedures using imaging techniques rather than interpreting studies. An IR specialist can utilize a number of modalities, including ultrasound, CT, and fluoroscopy. Procedures can range from simple line placements to complex procedures involving delivery of therapeutics, long term implantable devices, or embolizations.

What is compensation like in interventional radiology?

Like most radiologists, IR specialists are well compensated. The numbers change from year to year due to radiologist salary trends, but if one presumes the average diagnostic radiologist's salary to be $350,000, then the average interventionalist will make roughly $50,000 more. Bear in mind that many factors impact this differential. First, location and years out of residency will have a significant impact on the actual salary. Second, your practice setting will also matter a great deal. In general, private practice interventionalists can expect to earn double academic interventionalists, but will also likely work more as well as parttake of more of the traditional diagnostic film reading. Even within private practice, one must consider whether the partners are compensated on equal terms or based on revenue generated. Still, compared to other surgical subspecialties, IR is very competitive with basically all of them, expect perhaps neurosurgery / spine surgery.

Is the salary differential worth it?

This is a difficult question to answer. First and foremost, you should pursue a field that you love. However, that's easier said than done. If you have an interest in vascular surgery vs. interventional radiology, or neuroradiology vs. interventional radiology, how does one decide? You should try talking to peers or others within the field, but at some point, compensation does become an issue. One must realize that IR is more demanding than other fields within radiology, and the compensation boost is not necessarily proportional to that difference. However, if it is a field that you find interesting, the incentive itself will not matter so much. The work will be rewarding and that in itself will make it worthwhile. And, hey, it's radiology: the salary will be adequate in any case.

What does the future hold for interventional radiology?

No one can predict the future. However, it seems a pretty safe assumption that IR will continue to compensate well. While this economy has made everyone more cautious, one of the benefits of a career in medicine is relatively good job and salary stability compared to other fields. While no one knows exactly what the future holds, it is hard to envision a future where IR is "outsourced" or compensation declines, especially as new technologies are developed which expand the span and scope of the field.

Radiologist Salary Trends

2009-01-29T22:14:00.000-08:00

The trend of radiologist salaries is, needless to say, one of great import to those within the field of radiology, whether they like to admit it or not. I was recently talking to a friend of mine, who is an excellent student, and will no doubt make a great pediatrician some day. Fortunately for them, pediatrics is not too competitive, so they had their choice of programs. After complimenting them on how easy life must be, they retorted, "Well, don't worry, you'll be fine, and you'll end up making three times as much as me!" They said it jokingly, but it was the first time someone had ever associated me directly with the earning potential of a radiologist and compared it to their chosen specialty.

Radiology Salary Trends: Will It Last?

As I replied to my friend, I noted that radiology often faces encroachment from other specialties, such as cardiology, gastroenterology, and neurosurgery, as these referrers bring their own patients. At any time, they (as a group) could decide to not refer to a radiologist and start reading their own films. While it's not truly as simple as that, you can see that some areas, they have succeeded, such as wresting interventional cardiology away from the radiologists and into the hands of the cardiologists. My friend was not buying it: you're still going to make more than me, they retorted, but perhaps not as high a multiple!

Are Radiologist Salaries Too High?

Some influential radiologists have considered whether we in fact are getting paid too much. In one opinion piece, the radiologist Howard P. Forman of Yale Radiology notes:

"Unlike other specialists and primary care providers, we performa service that is requested. Simple supply and demand economicswould dictate a higher salary for radiologists since the numberof radiologists in practice has not kept pace with the increaseddemand for our services. In 2001, 4,176 diagnostic and 274 therapeuticradiology procedures were performed per 1,000 Medicare non–managedcare enrollees [3]. The study, which appeared inRadiology in2005 found that "on average, between 1998 and 2001, utilizationper Medicare enrollee increased 16% per year for MRI and 7%–15%per year for CT, ultrasound, interventional radiology, and nuclearmedicine, while that for radiography increased 1% per year." [3]At the same time, the number of those certified by the AmericanBoard of Radiology remains somewhat steady. In 1999, the AmericanBoard of Radiology issued 1,218 new general certificates; in2002, 1,114 certificates were issued and in 2005, 1,335 new certificateswere issued [4].

Our salaries are assumedly set by the market with fees negotiatedwith and set by commercial and government payers. However, theassumption that our fees are market-based rests on the premiseof open competition. Open competition requires relatively lowbarriers to entry, among other things. In fact, our market isnot quite so "open," and one could argue that the supply ofradiologists is held back by nonmarket forces, including theMedicare and Accreditation Council on Graduate Medical Education(ACGME) limits on training positions offered.

The disproportionate number of medical students eager to enterour profession compared with the number of training positionsavailable would, indeed, suggest that salaries are higher thana competitive market would offer. Do we benefit from this? Assuredly!We are attracting the brightest and most ambitious of our graduatingmedical students in this country. Ultimately, this comes atthe expense of other equally important medical fields. Put a differentway, the relative attractiveness of radiology as a professionmust be due, in part, to the salaries that we are paid. If radiology,in and of itself, is a very fulfilling specialty, then the salarieswould be expected to be lower than average. If, on the otherhand, the field had serious lifestyle obstacles, the salarymight reasonably be expected to be higher than average. If thelatter is the case, then one would not expect such a huge excessof medical student interest relative to training positions."

Source: http://www.ajronline.org/cgi/content/full/189/4/755

The Radiologist Salary Rebuttal

Dr. Forman goes on to note that radiologist do work hard for their income, but where does one find that balance between radiologist salaries and the other costs in the system. On the one hand, the radiologist is often highly trained, being able to spot not only a variety of natural disease processes, but also the reactions to external factors, such as chemotherapy drugs or gout treatments, or even new agents such as vivimind (an anti-Alzheimer's drug). On the other hand though, the marginal cost of a read once a radiologist is fully trained is very low, so it is hard to justify a high salary when the only tangible outlay on the part of the radiologist is their time. Given how many other costs are facing the system, it is hard to defend this rate, even if it is nominally pegged to images read instead of time directly.

Regardless, the debate shall continue, but I do not envy the policymaker who has to make the decisions about reimbursement rates!

What Is A Good Radiology Resident Salary?

2009-01-12T21:48:00.000-08:00

Before entering the field of radiology, many medical students are curious about the rumors they hear about lucrative careers in radiology. The curiosity is often dashed when students realize that they will have to wait until they complete an internship, 4 years of residency training and possibly another year of fellowship before being paid as a full-time radiologist. Still, for the more persistent rumor-chasers, the curiosity persists. Residents earning six figure incomes? How is this possible?

Well, for starters, most radiology residents do not earn that much during residency. For example, at Virginia Commonwealth University, the radiology residents are paid as follows:

PGY 2 – $46,026
PGY 3 – $47,684
PGY 4 – $48,581
PGY 5 – $50,808

By most Americans' standards, these salaries are reasonably competitive. However, given the additional hours of work and call that residents suffer through, the salaries approach minimum wage when considered on an hourly basis. Imagine if a residency works on average 60 hours a week for 48 weeks a year. The total hours, 48 x 60 = 2880 hours. At a salary of $48,000, this works out to $16.67 per hour before taxes. While these numbers are used solely for demonstration, many residents would agree that the pay is not as competitive, especially when compared to other professionals with graduate degrees (JD, PhD).

At many institutions though, the salary can be augmented during residency. The first method is to provide the residents with a book fund, anywhere from $500 to $2000, that can be used to purchase textbooks and other educational materials (including laptops in some cases). The second, and potentially most lucrative method, is through a process known as moonlighting. Often performed by third and fourth year residents, moonlighting can either be performed within the hospitals affiliated with the program or externally at another, unaffiliated hospital. During the moonlighting, the resident can perform a variety of tasks, just as a fulltime radiologist would, providing that they have the appropriate insurance coverage and license. Moonlighting can pay quite well, with some places offering up to $1000 per night of work. The resident still has to abide by resident work-hour restrictions, as well as by any restrictions imposed by the residency program.

When you consider moonlighting opportunities, a resident who decided to utilize them religiously could conceivably make over $100,000 a year. However, the reality seems to be that this is true of only a few residents, mostly those with families or large debt who really need the funds. The majority of residents who are able to moonlight seem to do a small amount, simply to supplement their income or have a little extra spending money. Ultimately, the compensation one receives when one starts to work full-time as a radiologist will dwarf the amounts involved during residency, but it is reassuring to know that there are avenues available to supplement your income as a radiology resident.