Emergency Or Trauma Radiology

[Pokemon Trainer]

Hi there I had a quick question regarding the emergency radiology or trauma radiology (i think only UBC offers this) fellowship.

 

One of the biggest things I enjoy about radiology is the contact/discussion with other physicians.  With the advent of pacs and other technology, it's become a lot easier for clinicians to access the imaging right at their own department, leading to a lot less visits to the radiology room for a discussion.  This was something I REALLY enjoyed seeing on my electives.  Some of the older rads i've talked to say that this case discussion (outside of rounds) with other physicians has decreased significantly over the years.

 

This has led me to ask about emergency or trauma radiology.  In academic centers, are these radiologists centralized in the ER for physicians to drop by quickly for questions and image overview.  I'm assuming this entirely because the acuity of cases that come up in the ER may need more verbal reports, thereby facilitating more discussion among colleagues.  Again I am not entirely sure, was really hoping some of you out there could enlighten me on this particular fellowship and if this is anything like I am imagining.  Thank you very much!

[rmorelan]

The director of that program was actually the guest speaker at Ottawa at one of our recent visiting professor talks. Extremely interesting guy, and very interesting program.

 

You are not wrong with how they schedule things at Vancouver from what he said. First you cannot GET ANY imaging without first talking to the radiologists there (and there is a staff rad there 24/7 - which is pretty unusual). The work is extremely diverse - they do tons of cardiac and neuro imaging for instance in the acute setting, which is again somewhat unusual. Well run fellowship I think from what I have heard.

 

now there are issues as well though - the main one is that there often isn't a dedicated ER radiologist team at many if not most centres. That is one of the reasons UBC is actually pretty unique with that fellowship (they do - and have actually managed to force other groups to give up imaging to them - like acute strokes which are normally the neuro rad team at most places). Most radiologists are going to be community radiologists and that means they have to have a diverse skill set that is a lot more than emerg - that fellowship includes a lot but is too focussed for general practise. Why would a community centre hire you instead of someone with say a traditional body fellowship - someone that has extra training going through the bulk of the imaging a community practise will see - cancer follow-up/work up, breast imaging, inpatient imaging, biopsies, a billion none emergent plain films, MRI for many, many things that don't come up in emerg and so on. Emerg radiology is actually a relatively small component of a radiology (for instance there are say 40-50 working radiologists at Ottawa on a given day - 3 would do emerg in a 24 period).

 

At most academic centres to contrast with the community you still end up with similar issues. Emerg shifts are usually just staffed by people from other areas of radiology (you do a shift in emerg basically but your "day job" is a body/chest/msk rad etc). So now if you want to get hired at a academic centre where do you fit in? You don't know know cardiac/msk/body..... to fit into a traditional radiology department. So you have to get another rad subspecialty to actually fit in.  Also because emerg is less developed I would say in most departments it can be a bit trickier setting up research etc, it is location specific with respect to how much interaction you have with the emerg docs....

 

At Ottawa for instance there are two people on staff that completed that UBC program - extremely skilled and dare I say brilliant radiologists.  However both of which had to take another fellowship in something else after in order to actually get a job. Would you be willing to take an extra year (and one year therefore loss of pay) in order to do emerg knowing you still may spend only a day or two a week doing emerg in the end (at most)? Many may actually but that is something you have to consider in your overall process of things.

[W0lfgang]

From my perspective, it seems that a lot of these drop-in visits have been replaced by multidisciplinary rounds, of which there are plenty in most areas of radiology. You'll get plenty of interaction.

[geraldthegorilla]

Hi there,

 

First, regarding interactions with other physicians, in my experience as a radiology resident rotating through different services, there remains collaboration with other groups.  I've found that this might be more intensive depending on the radiology subspecialty, and you'll experience this on call.  For example, the general surgery folks will often come to ask your opinion on what's going on in an abdomen whereas that is not always so necessary for the neurosurgery or ortho teams who can see, for themselves, a frank subdural or pelvic ramus fracture on CT.

 

ER radiology is a relatively new field of radiology in Canada with the genesis of new ER radiology training programs and work groups in the works or just around the corner.  I've worked on call and as a resident within the largest Canadian trauma centre where there is also a new ER rads program.  The program is in the process of hiring new ER radiologists so its final shape has not yet been formed.  During call, however, the resident sits in a reading room adjacent to one of the ER CTs within the ER.  When a trauma arrives, the resident gives the initial reads to the trauma team leader and the other (typically surgical) teams at the scanner.  During the day, i.e., off-call, the CT techs call the fellows or staff to come and give these initial reads.

 

As for ER fellowships, you need to think about what you're looking for.  If you wish to be trained in reading scans from bad MVAs or violent crimes then one of the many ER fellowships within the US might be a better idea as their volumes of these types of cases tend to be higher.

 

Cheers,

GtG

 

Hi there I had a quick question regarding the emergency radiology or trauma radiology (i think only UBC offers this) fellowship.

 

One of the biggest things I enjoy about radiology is the contact/discussion with other physicians.  With the advent of pacs and other technology, it's become a lot easier for clinicians to access the imaging right at their own department, leading to a lot less visits to the radiology room for a discussion.  This was something I REALLY enjoyed seeing on my electives.  Some of the older rads i've talked to say that this case discussion (outside of rounds) with other physicians has decreased significantly over the years.

 

This has led me to ask about emergency or trauma radiology.  In academic centers, are these radiologists centralized in the ER for physicians to drop by quickly for questions and image overview.  I'm assuming this entirely because the acuity of cases that come up in the ER may need more verbal reports, thereby facilitating more discussion among colleagues.  Again I am not entirely sure, was really hoping some of you out there could enlighten me on this particular fellowship and if this is anything like I am imagining.  Thank you very much!