Neuroradiology

The Radiology Department offers an ACGME-accredited fellowship in Neuroradiology to candidates who have completed an ACGME-accredited residency in Diagnostic Radiology. We participate in the Neuroradiology Fellowship Match administered by the National Residency Match Program (NRMP), and use the universal fellowship application designed by the Association of Program Directors in Radiology.

Typically, interviews begin in late winter/early spring of the candidates 3rd year with the applicant’s program rankings due early that summer. Our program has been certified to accept up to 4 fellows per year. Satisfactory completion of the fellowship fulfills requirements for senior membership in the American Society of Neuroradiology (ASNR) and enables the candidate to sit for the Certificate of Added Qualification (CAQ) in Neuroradiology offered by the American Board of Radiology.

Program Information

Program Director:	Michael Zapadka, MD mzapadka@wakehealth.edu
Section Secretary:	Dacia Hodgin dhodgin@wakehealth.edu
Address:	Department of Radiology Wake Forest School of Medicine Medical Center Boulevard Winston-Salem, NC  27157-1088
Phone:	336-716-7849
Fax:	336-716-2136
ACGME Accreditation:	Yes

Clinical Training Offered

•  Computed tomography (CT) 
•  Magnetic resonance (MR) imaging 
•  Angiography 
•  Endovascular therapy 
•  Myelography 
•  Positron emission tomography (PET) 
•  Head and neck imaging 
•  Neurosonography 

Organization of Fellowship

The fellowship experience encompasses a broad clinical exposure to all aspects of modern diagnostic and therapeutic neuroradiology, including angiography, interventional neuroradiology, myelography, CT, MR, PET, ENT and neurosonography.

The fellowship is largely clinical and procedure-oriented, with a required core of neuroradiology subjects. Typical rotations include angio (3 months), MR (3 months), CT (3 months), ultrasound/nuclear medicine (1 month), and research (1 month).

First Year Rotations (Typical)

Angiography:	3-4 months
MR:	3 months
CT:	3 months
US/Nuclear Medicine:	1 month
Research:	1 month

Research is encouraged and supported throughout the fellowship. Fifteen of our former fellows are in academic medicine; 3 have won the Dyke Award, and 2 are Rhodes Scholars. Active research projects include:

•  Pathology of brain microvasculature in patients after cardiac surgery, in neurodegeneration, and in babies with germinal matrix hemorrhage performed in a fully equipped laboratory for enzyme histochemistry, immunocytochemistry, and differential interference contrast microscopy 
•  fMRI studies of cerebral recovery after infarction 
•  fMRI studies of multisensory processing in Alzheimer's disease and dyslexia 
•  Alterations in cerebral blood flow as determined by FAIR in carotid artery stenosis and physiologic responses to caffeine and acetazolamide 
•  Segmentation and registration of MR and PET images 
•  Novel ligands for PET in brain aging.  

A robust MR physics program, with research into flow measurement, phantom design and innovative pulse sequence development, complements the neuroradiology experience. There is a 7.4T horizontal bore small animal imager/spectrometer on-site in the Department of Biochemistry; this unit is available for new research projects and members of the Neuroradiology section participate in ongoing projects in this program. A multi-detector CT and a 1.5T MR scanner have been recently installed and are 100% dedicated to research. 

Educational Objectives and Philosophy

As a result of this clinical training and didactic conferences, we expect each neuroradiology fellow who finishes training with us to be able to:

•  Perform and interpret angiograms, myelograms, CT scans and MRI scans in the most complicated/difficult cases encountered in common clinical practice  
•  Understand the functional neuroanatomy of the brain and spine  
•  Have good general knowledge of related neuroimaging techniques, such as SPECT, PET, carotid and cerebral ultrasonography  
•  Understand the physical principles underlying advanced neuroimaging modalities such as MRI, CT and PET 
•  Be able to design and modify CT and MR protocols as new techniques are developed  
•  Have thorough imaging and clinical knowledge of diseases of the head and neck  
•  Be familiar with scientific data and issues debated in current neuroradiology literature  
•  Design and complete a research project  
•  Develop skills and confidence in teaching other physicians about neuroimaging 

Facilities, Equipment, and Work Load

The Wake Forest Baptist Medical Center consists of a 4-year medical school and an 850-bed teaching hospital. Serving a population of over 2,000,000 people, it represents the closest academic medical center to patients in western North Carolina, southern Virginia, and western South Carolina.

The neuroradiology case load comprises a well-balanced mixture of congenital, traumatic, degenerative, infectious, and neoplastic diseases. The Medical Center houses a 150 bed children's’ hospital, a rehabilitation facility, and a comprehensive cancer center. The institution’s faculty includes internationally recognized authorities in neurology, neurosurgery, and ENT.

Clinical equipment for neuroradiology is "state of the art". Such equipment includes 9 helical CT scanners, 8 of which are GE LightSpeed multi-detector scanners with 3-D rendering and CT angiographic capabilities. The MRI facility houses 5 GE MRI scanners (4 operating at 1.5 T as well as one operating at 3.0 T).

Advanced techniques are available such as MRA, diffusion imaging, FAIR quantitative cerebral blood flow, fMRI (BOLD activation studies), multivoxel/multinuclear spectroscopy. A Siemens interventional angio suite is also available for exclusive use by neuroradiology. The PET facility has a Siemens cyclotron, and a GE Advance scanner and they are fully under control of the Department of Radiology. A GE 1.5T MR scanner and a GE 16 slice CT scanner are available for research. Two PET/CT scanners are also in place (1 located in the radiology department and 1 for treatment planning located in the Cancer Center).

Approximate yearly workloads in each area are:

•  Neuro CT: 14,000 cases  
•  Neuro MR: 13,000 cases  
•  Cerebral angiography: 400 cases  
•  Neurointerventional: 150 cases 
•  Myelography/Discography: 350 cases  
•  Kyphoplasty, Vertebroplasty: 120 cases  
•  Neuro PET: 300 cases 

Vacation and Benefits

Three weeks of vacation are given each year. Each fellow is also allowed to attend an educational meeting of his/her choice with reasonable expenses paid for by the department. Additional paid meeting time is also allotted if a fellow presents a paper at a national radiology meeting. Salary and fringe benefits are on par with other nationally-recognized fellowships. A book fund is also available ($400 per year). 

Faculty

Joseph A. Maldjian, MD, Section Head
Michael D. Baker, MD
Jonathan H. Burdette, MD
 Allen D. Elster, MD
Carol P. Geer, MD
Annette J. Johnson, MD
P. Pearse Morris, MB, BCh, 
Daniel W. Williams, III, MD
Michael E. Zapadka, DO -Fellowship Director

Application Procedure

Radiology residents who desire to begin a fellowship immediately following the completion of their residency should apply in the late fall/early winter of their 3rd year of radiology residency. Minimum qualifications for the fellowship include successful completion of a diagnostic radiology residency and board certification by the ABR or equivalent, and the ability to obtain a license to practice medicine in North Carolina. A personal interview is required unless there are exceptional circumstances.

A completed application consists of the following:

•  Completed Fellowship Application  
•  Curriculum vitae  
•  Personal statement or letter of interest explaining career choices and goals  
•  Letter of recommendation from radiology residency program director  
•  Dean's letter from medical school (optional)  
•  Two additional letters of recommendation  
•  Photograph (for identification) 

Completed applications, letters of recommendation, and supporting documents should be addressed to Pearse Morris, MD.  Requests for application materials and inquiries concerning interview arrangements, the receipt of materials and administrative details of the application process should be addressed to Ms.Hodgin at dhodgin@wakehealth.edu