DOW INSTITUTE OF RADIOLOGY
DOW UNIVERSITY OF HEALTH SCIENCES
OJHA CAMPUS
SIX MONTHS CERTIFICATE COURSE IN NEUROSPINAL IMAGING
(For those who want to excel in Neurospinal Imaging)
Location / Department : Dow Institute of Radiology, Ojha Campus.
Duration
: 6 Months
Timimg
: 9 AM till 5 PM
Course Fee
: 1,50,000/=
Number of Candidates : Two
Eligibility Criteria
: MBBS (From PMDC recognized institute)
MD, MCPS, FCPS. OR
Four year trained in Diagnostic Radiology
Objectives
: After completion of training period, the candidate will be able:
a) To develop an analytical approach in CT and MRI Imaging.
b) To learn Neurospinal Anatomy and relevant physics of CT & MRI.
c) To learn interpretation of MRI and CT Imaging of Neurospinal axis.
d) To learn appropriate reporting pattern.
CURRICULUM:
The program offers the opportunity for candidate to perform, consult, conduct, and
interpret, under close supervision and examinations in neurospinal axis radiology. The
procedures shall include CT, MR imaging and myelography
CLINICAL COMPONENT:
The program in neurospinal axis radiology provides a sufficient volume and variety of
patients
with
neurological,
neurosurgical,
neuro-ophthalmologic,
neurootorhinolaryngologic, spinal, and other pertinent disorders so that candidate gain
adequate experience in the full gamut of neuroradiologic examinations and
interpretations. The program provides an adequate volume and variety of noninvasive
neuroradiologic examinations, e.g., CT, MRI.

GENERAL COMPETENCIES*:

The program requires its fellows to obtain competencies in the 5 areas below to
the level expected of a new practitioner.

a. Patient Care that is compassionate, appropriate, and effective for the
treatment of health problems and the promotion of health.

b. Medical Knowledge about established and evolving biomedical, clinical, and
cognate
(e.g.,epidemiological and social-behavioral) sciences and the application of this
knowledge to patient care.


c. Practice-Based Learning and Improvement that involves investigation and
evaluation of their own patient care, appraisal and assimilation of scientific
evidence, and improvements in patient care.

d. Interpersonal and Communication Skills that result in effective information
exchange and team with patients, their families, and other health professionals.

e. Professionalism, as manifested through a commitment to carrying out
professional responsibilities, adherence to ethical principles, and sensitivity to a
diverse patient population.
DOW INSTITUTE OF RADIOLOGY
DOW UNIVERSITY OF HEALTH SCIENCES
OJHA CAMPUS
NEUROSPINAL IMAGING COURSE STRUCTURE
Section I: DEFINITION AND SCOPE OF THE SUBSPECIALTY OF
NEUROSPINAL IMAGING:
The body of knowledge and practice of neurospinal axis radiology comprises both imaging and
interventional procedures related to the brain, spine and spinal cord, head, neck, and organs of
special sense in adults and children. Special training and skills, beyond residency training, are
required to enable the neuroradiologist to function as an expert diagnostic and therapeutic
consultant and practitioner. The objective of training in this subspecialty of radiology is to
provide fellows with an organized, comprehensive and highly supervised full-time educational
experience in the selection, interpretation, and performance of these examinations and
procedures and to provide them with opportunities and skills for research in the field of
neurospinal axis radiology.
Section II: DIAGNOSTIC NEUROSPINAL IMAGING PROGRAM AT DUHS:
INTRODUCTION:
The Diagnostic Neurospinal axis radiology Fellowship Program at the DUHS Hospital covers all
of the disciplines of diagnostic neurospinal axis radiology including, head (intracranial),
ENT/head and neck (extracranial), pediatrics and spine. The program takes place in a highvolume academic environment.
Through this one-year program you will receive training in all aspects of neurospinal axis
radiology imaging, including plain films, ultrasound, myelography, computed tomography and
magnetic resonance imaging. You will also observe neurovascular angiography and intervention
procedures.
The Diagnostic Neurospinal axis radiology Fellowship prepares you for subspecialty practice or
an academic career in neurospinal axis radiology.
Our fellowship program provides a well-balanced clinical, research and teaching curriculum.
This program is the first of its type in the country and would provide a means of increasing
skilled professionals in this field. This in turn would help in promoting neurospinal axis
radiology in this country.
Trainees will be supervised directly by neuroradiologists. Faculty is always available for
supervision, assistance and consultation.
ELIGIBILITY FOR SELECTION:
Trainees must have completed a four year residency in Diagnostic Radiology at an institution
accredited by the College of Physicians and Surgeons Pakistan (CPSP). Cleared FCPS I & II in
Diagnostic Radiology or any equivalent examination will be given preference. MCPS passed
applicants will also be considered.
DURATION OF TRAINING:
This is a one year program leading to fellowship in Neurospinal axis radiology.
CURRICULUM:
The program offers the opportunity for fellows to perform, consult, conduct, and interpret, under
close supervision, procedures in neurospinal axis radiology. The procedures shall include CT,
MR imaging, ultrasound of the central nervous system and vessels, myelography and plain film
radiography related to the brain, head, neck, and spine. With regard to invasive neurovascular &
interventional procedures, fellows will be given a chance to observe a good number of such
procedures performed by the vascular & interventional radiology team.
CLINICAL COMPONENT:
Clinical and educational experience in the basic clinical neurosciences, e.g., neurosurgery,
neurology, neuropathology, neuro-otolaryngology, and neuro-ophthalmology, and in the basic
radiological sciences, e.g., radiation and MR physics, radiation biology, and the pharmacology of
radiographic contrast materials will be reviewed on an ongoing basis. DUHS has strong clinical
services in neurological surgery and neurology and makes our neurospinal axis radiology
program even stronger. The program in neurospinal axis radiology provides a sufficient volume
and variety of patients with neurological, neurosurgical, neuro-ophthalmologic, neurootorhinolaryngologic, spinal, and other pertinent disorders so that fellows gain adequate
experience in the full gamut of neuroradiologic examinations, procedures, and interpretations.
The program provides an adequate volume and variety of noninvasive neuroradiologic
examinations, e.g., CT, MR, and plain film studies and invasive procedures, e.g.,
neuroangiography, myelography, DSA, and therapeutic embolization.
DIDACTIC COMPONENT:
In addition to clinical procedures, the neurospinal axis radiology fellowship program offers
several intradepartmental and interdepartmental conferences in which fellows participate on a
regular basis. There is a Neurospinal axis radiology/Neurology/Neurosurgery Conference weekly
during which problem cases are discussed with input from all services. A similar conference
aimed at the residents from these services is also held on a weekly basis. There is also a monthly
Neurosciences grand round. Fellows are encouraged to present the radiological aspects of cases
that are discussed in clinical conferences related to the allied disciplines, such as neurosurgery
and the neurological sciences. They should also prepare clinically or pathologically proved cases
for inclusion in the teaching file. Fellows should attend at least one national meeting or
postgraduate course in neurospinal axis radiology while in training. Diagnostic reports generated
by fellows will be closely reviewed for content, level of confidence, grammar, and style.
RESEARCH ACTIVITY OF THE FELLOW:
The fellow is required to do at least one original research project leading to a published paper in
a peer reviewed journal. The trainee will also have to submit two completed audits and would
have to present a scientific paper at any national/ international meeting.
TEACHING RESPONSIBILITY OF THE FELLOW:
The trainee will teach residents and medical students informally on a daily basis during review
and dictation of studies performed.
WORK SCHEDULE:
The diagnostic neurospinal axis radiology fellow will participate in the daily evaluation of
neurospinal axis radiology examinations. The fellow will also undertake one to two sessions per
week of general reporting and Body CT, Ultrasound or MRI to keep abreast with other areas of
Radiology. The weekly schedule is given in Appendix IV towards the end of this document.
The trainee is on call during the entire year and takes call for general radiology. The trainee is
placed in the pool of Instructors for the purpose of call sharing and takes the same number of
calls as any other instructor.
EVALUATION OF THE FELLOW:
To ensure that you acquire adequate knowledge and develop your technical skills, your
performance will be monitored carefully during the course of your fellowship. Formal
assessment would be carried out at 02 monthly intervals by program director or assigned
consultant. Further verbal debriefing will be done at 06 months by the director based on the i)
assessment forms , ii) review of overall progress and iii) review of research/audit projects. Any
shortfalls would be communicated to the fellowship committee.
EVAUATION OF THE FELLOWSHIP PROGRAM:
The fellow will have to submit a report about the fellowship program in a formal manner towards
the end of the fellowship. They would also have to evaluate the involved faculty on a prescribed
format. This would help in getting feedbacks from the fellow which would in turn help in further
refinement of the program if needed.
Section III: OBJECTIVES OF THE FELLOWSHIP:
KNOWLEDGE BASED OBJECTIVES:
The overall goal of the fellowship program is to prepare the fellow in training to become a
competent and independently practicing neuroradiologist in a clinical or academic/research
setting. The neurospinal axis radiology fellow, upon completion of his training, should be
familiar with the topics in the core curriculum. The fellow is expected to build upon information
mastered during residency training. Information sources may include general textbooks;
however, the fellow is expected to enhance his understanding of basic disease processes with
specialty textbooks, review articles, and original medical literature. The fellow should be able to
independently interpret CT, MR imaging, ultrasound of the central nervous system and vessels
plain film radiography related to the brain, head, neck, and spine, cerebral angiography and
myelography,. The fellow should also be conversant with advanced imaging techniques such as
magnetic resonance spectroscopy and functional neuroimaging. The fellow should be conversant
with basic issues in clinical neurosurgery, neurology, neuropathology, neuro-otolaryngology,
neuro-ophthalmology, and the basic radiologic sciences, to include radiation MR physics,
radiation biology, and the pharmacology of radiographic contrast materials. The fellow should
be an active participant in inter-departmental conferences, institutional conferences, local
extramural conferences, and national meetings. Fellows will prepare clinical or pathologically
proved cases for inclusion in institutional teaching files. Fellows will participate in daily “film
reading” sessions and should be able to formulate reasonable diagnostic conclusions and
differential diagnoses under the supervision of staff and faculty. The fellow should be able to
generate a cogent consultation report on case material. Fellows should be able to critically
discuss recent radiologic literature and, where possible, undertake investigative studies of either
a clinical or basic science nature.
TECHNICAL AND NON-INTERPRETIVE OBJECTIVES:
Upon completion of the neurospinal axis radiology fellowship, the fellow should be able to
perform or supervise CT, MR imaging, ultrasound of the central nervous system and vessels, and
plain film radiography related to the brain, head, neck and spine and myelography. The fellow
should be familiar with diagnostic equipment. The fellow should be able to care for patients in
the pre-, peri-, and post-procedural time period.
DECISION MAKING/VALUE JUDGMENT OBJECTIVES:
At the conclusion of the neurospinal axis radiology fellowship, the fellow should be able to
determine the appropriate diagnostic test for a given clinical problem, deliver a cogent
consultation to clinical colleagues, and accurately determine the choice of imaging modality and
protocol for neuroradiologic studies.
Section IV: GENERAL COMPETENCIES*:
The fellowship program requires its fellows to obtain competencies in the 6 areas below to the
level expected of a new practitioner.
a. Patient Care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health.
b. Medical Knowledge about established and evolving biomedical, clinical, and cognate
(e.g., epidemiological and social-behavioral) sciences and the application of this knowledge
to patient care.
c. Practice-Based Learning and Improvement that involves investigation and evaluation of
their own patient care, appraisal and assimilation of scientific evidence, and improvements in
patient care.
d. Interpersonal and Communication Skills that result in effective information exchange and
team with patients, their families, and other health professionals.
e. Professionalism, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient
population.
f. Systems-Based Practice, as manifested by actions that demonstrate an awareness of and
responsiveness to the larger context and system of health care and the ability to effectively call
on system resources to provide care that is of optimal value.
(*Adapted from the minimum program requirements approved by the Accreditation Council for
Graduate Medical Education (ACGME) USA. September 28, 1999).
Section V: GENERAL
(CURRICULUM):
TOPICS
IN
NEUROSPINAL
AXIS
RADIOLOGY
By the completion of four years of residency, the resident should be familiar with the imaging
findings and surgical/medical implications of the following entities:
I. Brain and its Coverings
A. Normal anatomy
B. Basic and Advanced Instrumentation
C. Congenital CNS lesions
D. CNS Infections
E. Neoplasms and other masses
F. Trauma
G. White Matter Disease
H. Cerebrovascular disease
I. Metabolic disease
J. Generalized systemic disorders
K. Hydrocephalus
L. Cognitive imaging
II. Head and Neck
A. Deep spaces of the neck
1. Buccal space (anatomy, contents)
2. Sublingual space (anatomy, contents)
3. Submandibular space (anatomy, contents)
4. Parotid space (anatomy, contents)
5. Parapharyngeal space (anatomy, contents)
6. Masticator space (anatomy, contents)
7. Retropharyngeal space (anatomy, contents)
8. Perivertebral space (anatomy, contents)
9. Posterior cervical space (anatomy, contents)
10. Pharyngeal mucosal space (anatomy, contents)
a. Oral cavity
b. Oropharynx and nasopharynx
c. Mandibular and dental imaging
11. Visceral space (anatomy, contents)
a. Larynx and hypopharynx
b. Thyroid
12. Special issues
a. Perineural spread
b. Carotid encasement
c. Bone and cartilage involvement
B. Primary and nodal squamous cell carcinoma
1. Primary tumor staging
2. Lymph node staging
3. Postoperative neck
C. Orbit
1. Imaging techniques
2. Anatomy/embryology
Lesion localization based on relationship to muscle cone
3. Intra-ocular
4. Intraconal
b. Extraneural
5. Conal (Extra-ocular muscles)
6. Extra-conal masses
7. Extraorbital
8. Trauma
D. Paranasal sinuses
F. Temporal bone
G. Cystic neck masses
III. Spine
A. Anatomy and biomechanics
B. Imaging modalities
C. Developmental spine disease
D. Inflammatory and demyelinating disease
E. Neoplastic disease
F. Trauma
G. Metabolic, endocrine, toxic
H. Systemic disorders
I. Degenerative disease
J. Vascular lesions
K. Cystic lesions