Welcome to Neuroradiology! During your brief time with us, we hope you will become familiar with the range of modern imaging tools and techniques that neuroradiologists use to evaluate the central nervous system. This is also an excellent opportunity to review basic neuroanatomy and neuropathology. Here are some practical objectives for your rotation:

1. Try to become an active participant in image preview and read-out sessions. Attach yourself to a resident or fellow who is previewing studies (look for the ones who aren’t talking into Dictaphones!) and please do not be bashful about asking questions. This is a good time to review basic neuroanatomy and the appearance of common pathology on both CT and MRI. If you spend even 45 minutes each evening reading about an interesting case you saw, this will help drive home the lessons and make the material come alive.

2. Attend neuroradiology conferences or those that neuroradiology participates in during your rotation. This includes brain cutting, tumor boards, and interdisciplinary conferences. A full schedule is posted in the reading room.

3. Observe neuroradiology procedures. If possible you should observe each of the following: MRI, CT, carotid ultrasound, fluoroscopically guided lumbar puncture or myelogram, and cerebral angiogram. One of the residents or fellows will show you where the exam rooms are located. Ask a resident or fellow about the other procedures. These examinations can be fit in as time allows and are an excellent way to fill time between read-out sessions.

4. Specific goals related to CT/MRI: You should learn to recognize CT images and the major types of MR images, including T1 (with or without IV contrast), T2, T2-FLAIR, T2*, and diffusion. Understand the major strengths of each image type. Try to distinguish areas of abnormally high/low attenuation on CT, high/low signal on MRI, and list major causes of each. Learn the indications for the administration of intravenous contrast and the important differences between CT and MRI contrast agents.

5. Specific goals related to CTA/MRA/Perfusion: You should understand the roles played by CT angiography, MR angiography, and CT/MR-perfusion imaging in the evaluation of cerebrovascular disease.

6. Specific goals related to fluoroscopic lumbar puncture (LP) or myelography: Learn about midline versus paraspinal approaches for spinal fluid collection. Identify the spinous processes, pedicles, and lamina on fluoroscopic images (or radiographs) and show where the needle should be inserted. List the major potential complications of spinal puncture and ways to reduce the chances of post-LP headache.

7. Specific goals related to angiography: Describe the procedures used to access the common femoral artery, how wires and catheters are used to selectively access vessels of the head and neck, and be familiar with how a digital subtraction angiogram is obtained.

8. Specific goals related to ultrasound: Recognize the major components of a typical duplex US exam of the carotid arteries (2D gray-scale imaging and color Doppler flow analysis). Understand how US is used to characterize atherosclerotic disease and measure degree of arterial stenosis.