The Neuroradiology Fellowship provides an opportunity for state-of-the-art radiology clinical and research training at the fellowship level. Mayo Clinic in Arizona is a specialty clinic that focuses on the diagnosis and management of complex medical conditions. The clinical rotations are high in volume, complex in scope of pathology, and include both diagnostic and procedural roles.

Rotation schedule

Rotation	Length
General neuroradiology	12 weeks (three 4-week blocks)
Head and neck imaging and intervention	8 weeks (two 4-week blocks)
Spine imaging and intervention	8 weeks (two 4-week blocks)
Pediatric neuroradiology	8 weeks (two 4-week blocks)
Vascular neuroradiology	4 weeks (one 4-week block)
Trauma/ED neuroradiology	4 weeks (one 4-week block)
Second Shift neuroradiology	4 weeks (one 4-week block)
Elective rotation	4 weeks (one 4-week block)

Rotation descriptions

General neuroradiology: The general neuroradiology rotation educates the fellow in competency-based diagnostic neuroimaging, basic neuroradiology procedural skills, and protocoling of cross-sectional neuroradiologic imaging. The rotation provides exposure to all areas of neuroimaging, including brain, neurovascular, spine, and head and neck imaging.

Head and neck imaging and intervention: The head and neck imaging and intervention rotation provides a deeper educational experience in competency-based diagnostic neuroimaging of the head and neck (including cranial nerves, face, paranasal sinuses, oral cavity, orbits, skull base, temporal bones, suprahyoid neck, infrahyoid neck, and brachial plexus), advanced head & neck procedural skills, and protocoling of cross-sectional head and neck imaging.

Spine imaging and intervention: The spine imaging and intervention rotation provides a deeper educational experience for the fellow in competency-based diagnostic neuroimaging of the spine, advanced spine procedural skills, and protocoling of cross-sectional spine imaging.

Pediatric neuroradiology: The pediatric neuroradiology rotation educates the fellow in competency-based diagnostic neuroimaging and protocoling of cross-sectional neuroradiologic imaging specific to pediatric patients. The rotation provides exposure to all areas of pediatric neuroimaging, including brain, neurovascular, spine, and head & neck imaging.

Vascular neuroradiology: The vascular neuroradiology rotation educates the fellow in competency-based diagnostic neurovascular imaging, protocoling of cross-sectional neurovascular imaging studies, and conventional cerebral and spinal catheter angiograms. Core components of this rotation includes procedural skills, angiographic interpretation, and pre- and post-procedural care. 

Trauma/ED neuroradiology: The trauma/ED neuroradiology rotation educates the fellow in competency-based diagnostic neuroimaging with specific focus on high acuity, high volume emergency department-based imaging of the brain, spine, and head & neck. 

Second shift neuroradiology: The second shift neuroradiology rotation educates the fellow in competency-based diagnostic neuroimaging with primary focus on high acuity, high complexity inpatient and emergency department-based imaging of the brain, spine, and head & neck with secondary focus on outpatient imaging exams.

Elective rotation: Fellows in good standing have the opportunity to choose from multiple elective rotations, which allow for deeper dives into subspecialty neuroimaging or research/academic pursuits.

Didactic training

The Neuroradiology Fellowship education experience centers around reading room-based learning. Depending on the specific rotation, the fellow is assigned to a supervising faculty member (or faculty members) each day for one-on-one learning with case-by-case feedback. As experience grows and competencies are met, faculty work with the fellow to facilitate increased autonomy throughout the fellowship year.

Additional educational offerings include:

• Fellow neuroradiology lecture series: Neuroradiology faculty give fellows one-hour lectures on a wide spectrum of neuroradiology topics during our weekly fellow didactic conference.
• Multidisciplinary conferences: For each rotation (with the exception of trauma/ED neuroradiology and second shift neuroradiology), fellows are required to attend assigned rotation-specific multidisciplinary conferences.
• Resident noon conference lecture series: Fellows attend neuroradiology-specific noon conferences given by our faculty to the diagnostic radiology residents, which typically occur each Monday at noon.
• Journal club: Held four times per academic year, journal clubs allow each fellow the opportunity to present their analysis of a staff-selected journal article.
• Guest lectures/visiting professorships: Fellows attend subspecialty talks pertaining to neuroradiology.

Electives

Neuroradiology fellows in good standing are allowed a four-week elective rotation block, which can be used for gaining further experience and greater autonomy in subspecialty neuroradiology domains (such as head and neck or spine intervention) or research/academic pursuits.

Teaching opportunities

As a fellow, you will deepen your own learning and hone your teaching skills by educating the radiology residents working alongside you in the reading room, as well as rotating students from the Mayo Clinic Alix School of Medicine and rotating residents from the Departments of Neurosurgery and Neurology at Mayo Clinic in Arizona.

Neuroradiology fellows take turns showing interesting and high-yield cases to our on-service residents each week, immediately following the faculty-led didactic neuroradiology conference. Additionally, fellows are asked to give one case-based board review to our radiology residents each year.

Research opportunities

Mayo Clinic neuroradiology fellows have abundant opportunities for research. Each fellow is required to participate in at least one research project with a consulting staff member. At the beginning of the fellowship, each fellow will be paired with a faculty research mentor, who will work with the fellow throughout the year on a research project.

Per the ACGME program requirement, fellows are required to submit at least one scientific paper or exhibit for presentation at a regional or national meeting, and our neuroradiology fellows are strongly encouraged to write up their research and submit it to a peer-reviewed journal by the end of the fellowship. To this end, fellows receive dedicated research days throughout the year and, in addition, fellows in good standing may choose to spend a research elective rotation.

Fellows also receive financial support for travel, lodging, meals, and registration fees for meetings at which they present and for one non-presentation (attendance) trip.

Conferences

Fellows attend weekly multidisciplinary conferences, which are assigned based upon rotation. As the fellow’s experience increases during the year, they are expected to take a more active role in multidisciplinary conference, including presenting cases with faculty supervision and consultation.

Multidisciplinary conferences include:

• Neuro-Oncology (Cranial, Spine, and Peripheral Nerve) Conference (Mayo Clinic Hospital)
• Surgical Epilepsy Conference (Mayo Clinic Hospital)
• Spine Conference (Mayo Clinic Hospital)
• Head and Neck Tumor Board (Mayo Clinic Hospital)
• Combined Neurovascular and Skull Base Conference (Mayo Clinic Hospital)
• Pediatric Epilepsy Conference (Phoenix Children’s Hospital)
• Pediatric Neurosurgery Conference (Phoenix Children’s Hospital)
• Pediatric Neuro-Oncology Conference (Phoenix Children’s Hospital)
• Pediatric Neuroendocrine Conference (Phoenix Children’s Hospital)
• Prognostication Conference (Phoenix Children’s Hospital)
• Pediatric Neurovascular Conference (Phoenix Children’s Hospital)
• Pediatric Head & Neck Conference (Phoenix Children’s Hospital)
• Pediatric Neurology Conference (Phoenix Children’s Hospital)

Procedures

While the primary objective of the training program is for fellows to achieve mastery of diagnostic neuroimaging, the Neuroradiology Fellowship provides ample opportunities for fellows to gain expertise in non-endovascular procedures involving the spine and head and neck during their clinical rotations. Graduating fellows can expect to achieve competency in performing:

• Fluoroscopic-guided lumbar puncture
• Myelography and cisternography
• CT-guided head and neck biopsy
• CT-guided spine biopsy
• CT-guided epidural blood patch
• CT-guided facet joint injection +/- facet synovial cyst rupture
• CT-guided selective nerve root block
• CT-guided interlaminar epidural steroid injection
• CT-guided transforaminal epidural steroid injection
• CT-guided fibrin occlusion of CSF-venous fistula
• CT-guided trigeminal nerve block
• Dynamic CT myelography

Facilities and location

The majority of the fellow’s rotations (10 out of 13, amounting to 40 weeks per year) are performed on-site at Mayo Clinic Hospital in Arizona, a 400+ bed tertiary medical center and teaching hospital on the north side of Phoenix. Routinely ranked as the top hospital in Arizona and as one of the top hospitals in the nation, Mayo Clinic in Arizona offers unparalleled exposure to cutting-edge radiology technology for our fellows, including photon-counting CT and one of the highest clinical volume 7T MRI programs in the country.

Our department’s equipment includes:

• Clinical 7T Siemens Terra.X
• Twelve clinical computerized tomography (CT) scanners, including multiple dual-sourced scanners and one photon-counting CT scanner
• One Siemens NAEOTOM Alpha (photon-counting)
• Two Siemens SOMATOM Force
• One Siemens SOMATOM Definition Flash
• One Siemens Edge Plus in Hybrid OR
• Three GE Revolution Apex
• One GE Discovery 750 HD
• One GE Optima 660
• Two CurveBeam Extremity Scanners (HiRise and LineUP)
• Dedicated interventional and neurointerventional suites with state-of-the art digital subtraction angiography

Neuroradiology fellows will spend two 4-week blocks at Phoenix Children’s Hospital for pediatric neuroradiology. Phoenix Children’s Hospital, an acute care children’s hospital, is located north of downtown Phoenix and is approximately 17 miles from Mayo Clinic Hospital.

Fellows will also spend one 4-week block at Valleywise Health Medical Center (Phoenix) for Trauma/ED Neuroradiology. Valleywise Health Medical Center, a level I trauma center and safety net healthcare system, is also located north of downtown Phoenix and approximately 20 miles from Mayo Clinic Hospital.

Call frequency

Neuroradiology fellows do not take overnight diagnostic or procedural call. 

Fellows are assigned in-hospital weekend call shifts with a frequency of no more than every fourth weekend. On these weekends, the fellow provides Saturday and Sunday on-site coverage from noon to 8 p.m., reading predominantly ED and inpatient exams and providing procedural coverage for emergent lumbar punctures. 

Moonlighting

You may moonlight with program director approval. Moonlighting should not interfere with the required learning and must not violate the work-hour rules of the Accreditation Council for Graduate Medical Education or visa regulations.

Mentorship

At the start of their training, neuroradiology fellows will be paired with a faculty mentor based on the fellow’s clinical and research interests, career aspirations, and personal preferences. Fellows are expected to meet with their mentor at least monthly. 

Evaluation

To ensure that you acquire adequate knowledge and develop the appropriate technical skills to meet program expectations, your performance is monitored carefully during the program. You are evaluated formally by the supervising faculty member after each clinical rotation, and you will meet with the program director to review these evaluations. In addition, you will also regularly evaluate the faculty to ensure that your educational needs are being met.