The Fellow is expected to train five days a week and have 20 days off during the twelve month fellowship. Ten months will be spent completely in the Breast Center. The Fellow will always train under the direct supervision of a fellowship trained breast imaging radiologist. There are two basic rotations in the breast center for the Breast Imager and Fellow. The rotations are for one week at a time. The first rotation encompasses Diagnostic Breast Imaging. During this week the Fellow will interpret screening and diagnostic mammograms. He or She will be the first radiologist to see the mammogram and decide if the study is normal or needs further imaging. If additional images, including breast ultrasound, are needed, the Fellow will directly supervise these studies. The Fellow will be directly involved in the ultrasound study under the supervision of the attending radiologist and the certified sonographer. As part of the diagnostic training, the Fellow will also perform a breast physical exam of the breast in question.
For the alternating Breast Intervention week, again under the direct supervision of a dedicated breast imaging radiologist, the Fellow and this radiologist will be responsible for performing all breast interventional studies, read screening mammograms, and interpret all Breast Magnetic Resonance Imaging studies. Breast Intervention includes the performance, under the direct supervision of the attending radiologist, of all needle localizations (wires, radioactive seeds, magnetic seeds; whether they are mammographically or ultrasound guided) and interpretation of the specimen mammogram related to the procedure; ultrasound-guided, stereotactic and tomosynthesis-guided, as well as MRI-guided needle biopsies; cyst aspirations; and the performance of axillary lymph node biopsies. The Fellow will learn to set up the equipment for these biopsies and use all the techniques at our disposal for the biopsies. The Fellow will be responsible for the post biopsy care while the patient is in the department. During this rotation the Fellow will also learn and perform the technique for sentinel lymph node injection. During the day there is also time for interpretation of Breast MRI studies and, as time permits, screening mammograms. The Fellow will review these studies independently, pull all the data together, make up his/her mind of the findings and then review the case with the attending breast imager. All studies will be dictated by the Fellow and reviewed by the attending radiologist.
Our breast centers have a breast surgeon or other specialty physician or PA who sees high risk breast patients in clinic. For a minimum of one week the Fellow will train directly with these physicians. The Fellow will see all diagnostic problems, pre-operative and post-operative cases, as well as patients who have had breast cancer surgery in the recent or distant past. Dedicated breast exams and interactions with the patient and families will take place throughout the day. Pre-operative planning and post-operative treatment planning will be discussed. Typically, the attending physician sees thirty to forty patients.
The Fellow will also spend time observing with the Breast Pathologist as well as Breast Surgeon(s) in the operating room watching the multiple breast procedures. This includes segmental mastectomy, axillary lymph node dissection, mastectomy and breast reconstruction.
Every week there is a multidisciplinary breast tumor board conference. The Fellow, along with the assigned attending, is responsible for organizing relevant imaging in a presentation for each case being discussed at the conference. The Fellow (alternating with residents) presents the cases each week. This conference is for an hour, with an average of four cases presented. In addition, the Fellow is expected to give one conference to the radiology residents during the 12 month rotation.
There are many clinical research projects ongoing in the Division of Breast Imaging. In the 12 months, the Fellow is not expected to originate a project but is encouraged to participate in any of them.
Fellows will have the opportunity to work with many Attending Radiologists throughout the year. This mentorship fosters identification of career goals and pathways. Graduates have gone on to careers in both the academic and private practice setting, both regionally and across the country. Fellows will be also be evaluated by each Attending that the Fellow encounters through the various rotations. Individual evaluations are then reviewed by the Fellowship Director with the Fellow. The Fellow has direct interaction in this pr