FIRST YEAR AND/OR FIRST ROTATION

Date last updated: 12/11/17

I. NEURORADIOLOGY EXAMINATION
1. Prior to: Indications & ACR appropriateness, Protocoling
2. During: Safety - contrast material, radiation dose; Quality - adequacy of images
3. Interpretation: Approach, Normal anatomy, Normal variants, & Pathology. (see below)
4. After: Reporting; Medicolegal considerations and responsibilities, including communicating
results

II. TECHNIQUE, PHYSICS AND INDICATIONS

1. Understand the basic principles behind and indications for Radiological examinations-
a. Radiography
b. CT
i. CT window and level settings, slice thickness, inter-slice gap
ii. CT attenuation of normal and abnormal structures.
iii. Dose measures for CT, i.e. CT dose index (CTDI) values, and strategies for
radiation dose reduction.
iv. MultiplanarReformations and 3D reconstructions
c. Contrast- Types of contrast media- identify risks and manage reactions
2. Recommended Supplement for call- CT angiography & CT venography
CT and CTA- helical imaging parameters i.e., pitch, and image reconstruction algorithms
(e.g., MPR and 3D).

III. ANATOMY& NORMAL VARIANTS

1. Brain
a. Cerebral lobes and surface anatomy, including identification of prominent sulci andgyri
b. Basal ganglia and thalamus
c. Brainstem and cranial nerves
d. Pituitary and pineal glands
e. Ventricles and basal cisterns
f. Meninges
g. Basic skull and skull base anatomy
h. Vascular – cervical and intracranial- arterial and venous
i. Normal variants, including vascular variants
2. Spine
a. Osseous components
b. Vertebral anatomy and differences between cervical, thoracic and lumbar spine

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 c. Spinal canal and cord- intramedullary,intradural-extramedullary andextradural
compartments
d. Normal variants
3. Head and Neck
a. Calvarium
b. Anatomy of spaces of neck
c. Salivary glands, thyroid
d. Oral cavity and oropharynx, hypopharynx, laryngopharynx
e. Lymph node levels
f. Orbits- bony and ocular anatomy
g. Sinus anatomy – turbinate and meatal anatomy, theosteomeatal unit (OMU) and normal
drainage pathways of the paranasal sinuses
h. Normal variants
4. Basic MR anatomy
a. Brain
b. Head & Neck
c. Spine
d. Normal MRI variants
5. CT Angiography and CT Venography

IV. INTERPRETATION APPROACH

1. Radiography
2. CT
3. Brain
4. ENT
5. Spine

V. BRAIN PATHOLOGY
1. Edema- cytotoxic (CVA) versus vasogenic (tumor, inflammation, infection), osmotic and
interstitial
2. Stroke-
a. Ischemic versus hemorrhagic
b. Arterial versus venous
c. Vascular distributions
d. Patterns of ischemic stroke
e. Early detection by CT
3. Neoplasms-
a. Single versus multiple
b. Primary versus secondary
c. Location: intra-axial versus extra-axial, gray or white matter, supra-versus infratentorial
d. Enhancement pattern

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 e. Pediatric versus adult
4. Trauma-
a. Fractures- calvarial, skull base, temporal bone
b. Hematomas-
i. Extra-axial: Epidural (arterial and venous), Subdural (different ages)
ii. Intra-axial: Contusions and shearing injury (grading)
c. Non-accidental trauma
5. Hemorrhage
a. Blood Density evolution – expected evolution and variants
b. Type, by location – parenchymal, epidural, subdural, subarachnoid
c. Hemorrhagic transformation of infarcts- differentiation from contrast
d. Hypertensive bleeds- common sites
e. Differentiation of subdural from extradural blood
f. Hyperdensenoncalcified lesions on CT
g. Calcified intraparenchymal lesions
6. Hydrocephalus-
a. Differentiate atrophy from hydrocephalus
b. Distinguish intraventricular vs extraventricularobstructive
c. Radiographic acuity/ compensation
d. Shunt types
e. Shunt follow up- ventricle size measurements
f. Complications of shunts- slit ventricle, shunt dependence, trapped ventricle
7. Brain herniation patterns
8. Calcifications- physiologic versus pathologic, causes
9. Postoperative findings on CT
10. Vascular disorders –
a. Aneurysms, arterio venous malformations
b. dissection,
c. thrombosis (arterial and venous)
d. NASCET criteria

VI. SPINE PATHOLOGY

1. Trauma-
a. Stable versus unstable fractures
b. Compression, burst and chance fractures
c. Fracture patterns and associated injuries
d. Spondylolysis and Spondylolisthesis
2. Post-operative spine- x-rays & CTs for assessment of hardware, alignment
3. Spinal Hemorrhage-
a. Epidural
b. Subdural

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 c. Subarachnoid

VII. HEAD AND NECK

1. Maxillofacial, mandibular and orbital trauma- fracture classifications
2. Sinusitis- acute and chronic
3. Neck Infections and abscesses-Airway compromise
4. Foreign bodies
5. Thyroid lesions: Dx and management
6. Abnormal lymph nodes: Dx and management
7. Vascular anomalies – vascular compromise, including atherosclerosis, stenosis, clot and
occlusion

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SECOND YEAR/ROTATION–
Review all materials from 1st rotation plus:
I. TECHNIQUE AND INDICATIONS
1. Understand the basic principles behind and indications for use of methods of MR
examinations
a. Brain: T1, T2, FLAIR, DWI, SWI, 3D GRE, 3D, post-contrast, fat suppression
b. Vascular: TOF MRA, post-contrast MRA, TOF MRV, post-contrast MRV, fat
suppression techniques
c. ENT: IR, fat sat post-contrast
d. Spine: T1, T2, STIR,GRE, 3D, fat sat post-contrast
2. Types of contrast media- identify risks and manage reactions
3. Lumbar Punctures: fluoro-guided LP, myelogram (C/T/L), cisternogram- indications,
techniques and perform

II. ANATOMY:
1. Brainstem, cranial nerves, white matter tracts
2. Spine vascular structures
3. Orbits and sinuses
4. Temporal bone
5. Skull base
6. Head and neck- spaces of neck, lymph node levels

III. BRAIN PATHOLOGY- CT and MRI Correlation:

1. Differential diagnosis by location
2. Stroke- Role of CTA, CTP, MRI, MRA, MRP, Evolution of stroke, TIA, vascular occlusion
and atherosclerosis
3. Tumor-
a. WHO Grading and imaging correlates
b. Gliomatosis
c. Tumor mimics- subacute infarcts, subacute hematomas, demyelinating lesions
d. Ring enhancing masses
e. Intraventricular masses
f. Tumors crossing corpus callosum
g. Cerebellopontine angle tumors and mimics
h. Cortical based tumors
i. Fat containing masses
j. Calcified/hemorrhagic masses
k. MR diffusion and MR Perfusion
l. Pineal and pituitary tumors
m. Nontumoral cysts- Arachnoid, Colloid, Dermoid/Epidermoid, Enlarged VR spaces,
Porencephalic cysts
4. Trauma-
a. Skull base and temporal bone fractures
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 b. Evolution of hematomas based on location- Parenchymal vs. SAH vs. SDH/EDH
c. Sequelae of brain herniation
d. Chronic findings after trauma
e. Criteria of brain death
f. Chronic traumatic encephalopathy
g. Traumatic intracranial and extracranial dissections
h. Traumatic carotid cavernous fistula
5. Hemorrhage –
a. Determining age of hemorrhage on MRI
b. Patterns of bleeds- hypertensive, amyloid angiopathy
c. When to suspect underlying lesion
d. Primary tumors known to hemorrhage
e. Hemorrhagic metastases to brain
f. Hemorrhagic transformation of infarcts
g. Venous infarcts
h. Embolic- septic emboli and mycotic aneurysms, fat emboli
i. Nontraumatic, nonaneurysmal subarachnoid hemorrhage
6. CNS infections-
a. Parenchymal versus extra-axial
b. Typical (pyogenic abscess) versus atypical (Herpes, Neurocysticercosis, Lyme)
c. Infections in Immunocompromised (HIV/ AIDS)
d. Chronic granulomatous infections (Tuberculosis, fungal)
e. Noninfectious inflammatory conditions (including sarcoidosis)
7. Demyelinating diseases- primary- types of MS, criteria, role of imaging,ischemic, infection
8. CSF dynamics-
a. Intracranial hypo-and hypertension
b. CSF leaks
c. CSF diversion procedures
d. Normal Pressure Hydrocephalus
9. Vascular-
a. Basics of CTA, MRA and DSA
b. Aneurysms
c. Arterial and venous variants
d. Arteriovenous malformations (basics)
e. Carotid stenosis
f. Dissection
10. Epilepsy- Temporal Lobe anatomy, Mesial Temporal Sclerosis

IV. SPINE PATHOLOGY

1. Degenerative spine disorders, including lexicon
a. Types of disorders –
i. Diffuse idiopathic skeletal hyperostosis
ii. Disc herniation

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 iii. Disc-osteophyte
iv. Juxta-articular cysts
v. Ossification of the posterior longitudinal ligament
vi. Spinal stenosis
vii. Spondylolisthesis and spondylolysis
b. Disc morphology – bulge, protrusion, extrusion, sequestration
c. Lumbar Disc pathology location – central, subarticular, foraminal, far lateral, anterior
2. Trauma-
a. MRI- criteria of instability
b. Ligamentous injuries
c. Cord injury
d. Epidural, subdural and subarachnoid hemorrhages
e. Craniovertebral fractures- Atlanto-occipital dislocation, C1/C2 fractures
3. Spine infections and inflammations
a. Discitis Osteomyelitis
b. Spinal Abscess
c. Nonpyogenic infections
d. Acute and chronic inflammatory polyneuropathies
e. Demyelination- Multiple sclerosis and ADEM
f. Transverse Myelitis
4. Tumors-
a. Extradural
b. Intradural extramedullary
c. Intramedullary
5. Post-operative- CT and MRI for hardware, acute bleeds. Recognizing acute postsurgical
complications including acute epidural and hardware associated hemorrhage; misplaced or
incorrectly placed hardware. Chronic hardware failure including features of hardware
loosening and fractures. Metal artifact reduction techniques for CT and MRI.

V. HEAD AND NECK PATHOLOGY

1. Sinus and osteomeatal unit (OMU) disease- infection, inflammation, tumors
2. Facial and orbital trauma- fracture associations and complications
3. Skull base and temporal bone basics
4. Neck- lymphadenopathy, infections, tumor classification based on location

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THIRD YEAR/ROTATION
Review material for R1 and R2
I. TECHNIQUE AND INDICATIONS-Understand the basic principles behind and indications
for use of methods of examination-
a. CT- CTA, CTV, CT Perfusion- Dual energy CT
b. MRI – Basics of advanced imaging techniques
i. Diffusion tensor imaging (principles of DTI)
ii. Functional MRI (principles of BOLD)
iii. MR artifacts
iv. MR perfusion (use in neoplasms and stroke)
v. MR spectroscopy (NAA, Choline, lactate)
vi. Susceptibility weighted imaging
c. Myelography
d. Cisternography
e. Digital Subtraction Angiography- Observe, indications, anatomy
f. Be able to choose appropriate examination types for a variety of clinical situations and
recognize strengths and weakness of each type of imaging exam- ACR Appropriateness
Criteria® (http://www.acr.org/Quality-Safety/Appropriateness-Criteria)

II. ANATOMY
a. White matter- normal myelination

III. BRAIN PATHOLOGY

a. Stroke–
i. Hypoxic ischemic encephalopathy (HIE)-Preterm, Term and Adults
ii. Vasculitis
iii. Posterior reversible encephalopathy syndrome (PRES)
iv. Risks and benefits of and imaging after thrombolysis/ neurointerventional procedures
b. Tumor- MR Perfusion techniques, MR spectroscopy,RANO Criteria
c. Hemorrhage- underlying lesions, active bleeds
d. Vascular- atherosclerosis, vasculopathies, venous thrombosis, arteriovenous malformations,
vascular injuries
e. CNS infections-
i. Congenital Infections-CMV, Toxoplasmosis
ii. Fungal and less common infections
iii. Sequelae of infections
iv. AIDS and complications
v. Routes of spread of non CNS infections to brain
f. White matter-
a. Inherited metabolic disorders (limited)
b. Demyelinating and dysmyelinating diseases- toxic and metabolic

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g. Neurodegenerative- Alzheimer's, metabolic, infectious(Prion disease)
h. Cranial Nerve Pathologies- Schwannomas, leptomeningeal carcinomatosis, perineural spread,
infection (Lyme), inflammation (Sarcoid)
i. Congenital/developmental-
i. Brain malformations- Chiari 1 and 2, Holoprosencephaly, Dandy Walker spectrum
ii. Corpus callosum anomalies-agenesis/dysgenesis
iii. Sulcation and migrational anomalies
iv. Phakomatoses-NF1,NF2, Tuberous sclerosis, Sturge Weber and von Hippel Lindau
j. Epilepsy- malformations of cortical development
i. Hemimegalencephaly
ii. Heterotopia
iii. Polymicrogyria, Lissencephaly and schizencephaly
iv. Focal cortical dysplasia
k. Toxic/Metabolic- Alcoholic, Wilson’s, Hepatic encephalopathy, Osmotic demyelination,
Chemotherapy, drug abuse

IV. SPINE PATHOLOGY

a. Congenital-
i. Neural tube defects-Myelomeningocele, Lipomyelomeningocele, Lipomas, Dermoid,
Caudal Regression, SacrococcygealTeratoma
ii.Segmentation anomalies
iii.Phacomatoses-NF1,NF2
d. Congenital/Metabolic/Connective tissue-- Osteogenesis Imperfecta,
Marfan’s,Osteopetrosis,
e. Craniovertebral junction variants-Platybasia, Basilar invagination
b. Spine vascular- infarcts, vascular malformations
c. Miscellaneous- arachnoid cysts, cord herniation, DISH, OPLL, Longuscoli tendonitis
d. Spinal manifestations of systemic diseases/Arthritis -Sickle cell, renal/dialysis, Gout/CPPD,
seronegative spondyloarthropathy, rheumatoid arthritis
e. Post procedural imaging and complications- MRI findings- hemorrhage, soft tissue injury,
arachnoiditis
f. Nerve plexus- Brachial and Lumbosacral-anatomy and pathology

V. HEAD AND NECK PATHOLOGY

a. Sinonasal tumors- nodal and perineural spread
b. Orbital tumors- Retinoblastoma, Lymphoma, optic glioma,meningioma
c. Orbital Infections and Inflammation-Preseptal versus post septal, endopthalmitis, optic
neuritis, psueudotumor, PHPV, retinopathy ofprematurity, thyroidorbitopathy
d. Congenital skull base variants and pathologies-nasal masses, meningioma, fibrous
dysplasia,chordoma, cartilaginous tumors
e. Pharyngeal and laryngeal tumors-benign and malignant

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f. Mandible/maxilla –cysts, infections, tumors,fractures
g. Salivary gland - infections and tumors
h. Temporal bone pathology
i. Cholesteatoma and cholesterol granuloma
ii. Facial nerve & internal auditory canal enhancement differential diagnosis
iii. Fractures
iv. Glomus tumors
v. Vascular anomalies – Aberrant carotid artery, vascular dehiscence
vi. EAC atresia
vii. Otitis Externa
viii. Coalescent Mastoiditis
ix. SCCD and EVAS/LESA
x. Otospongiosus
i. Neck- pediatric cysts and tumors, venolymphatic malformations
j. Postsurgical/ Post treatment Neck
k. Calvarial Lesions- Craniosynostoses, Fibrous dysplasia, Paget’s, Histiocytosis

FOURTH YEAR (R4)

Date last updated: 12/11/17

Should also review everything in the R1 – R3 curriculum

I. TECHNIQUE AND INDICATIONS
1.Review to ensure independent proficiency (R4 – 1 month)
a. Obtaining informed consent
b.Overseeing conscious sedation
2. Independently perform (with appropriate supervision) (R4 – 1 month)
a.Lumbar Punctures
b. Myelography
c. Cisternography
3. Post-Processing (R4 – 3 month)
a. Continue proficiency at creating 3D reformats for CT and MRI
b. Continue proficiency at processing MR perfusion images
c. Become familiar with DTI tractography
4. Contrast – Be familiar with the following (R4 – 3 month)
a. Macrocyclic vs. linear gadolinium agents
b. Relaxivity
5. Observe and participate in spine biopsies (R4 – 6 month)
6. Develop more in depth knowledge of advanced MRI techniques(R4 - 6 month)

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 a. MR perfusion (further knowledge for use in neoplasms and stroke; specifically
distinguish recurrent high grade glioma from radiation necrosis)
b. MR spectroscopy (NAA, Choline, lactate)
c. Susceptibility weighted imaging
7. Develop more in depth knowledge of CT techniques
a. Dual energy CT (technique and applications) (R4 – 6 month)
b. Radiation dose reduction (R4 – 6 month)

II. ANATOMY
1. General
a. Be proficient with anatomy in the brain, spine, head &neck in appropriate depth on
multi-planar and multi-modality images and especially be able to interrogate 3D image
volumes to identify small structures.(R4 – 1 month)
2. Brain
a. Be proficient with cortical anatomy in the eloquent regions
(motor/sensory cortex – identify central sulcus, pre- and post-central gyri, superior and
middle frontal gyri, superior frontal sulcus; Broca’s area – inferior frontal gyrus
including pars triangularis and pars opercularis; Wernicke’s area – superior and middle
temporal gyri, superior temporal sulcus) (R4 - 3 months)
b. Reviewmore global gyral and sulcal anatomy (R4 - 6 months)
(i.e., cingulate gyrus, angular gyrus, cuneus, calcarine sulcus, parahippocampal gyrus)
3. Head & Neck
a. Name and recognize the anatomy of the spaces of the neck to include the nasopharynx,
oropharynx, hypopharynx, oral cavity, larynx, prevertebral space, carotid space, parotid
space, masticator space, pharyngeal mucosal space, parapharyngeal space. (R4 – 1
month)
b. Be proficient withanatomy of the skull base, sinonasal region, temporal bone, and
orbits.(R4 – 3 month)
c. Become more familiar with the anatomical course of cranial nerves 1-12including the 3
major divisions of CN 5. (6 months)
4. Spine
a. Be proficient with the pertinent craniocervical junction anatomy including ligaments
such as the alar and transverse ligaments and the tectorial membrane. (R4 – 3 month)
b. Routinely recognize the main ligaments of the spine, including the anterior and
posterior longitudinal ligaments, ligamentum flavum, interspinous ligaments,
supraspinous ligament, and nuchal ligament.
c. Be able to anatomically localize the extradural, intradural extramedullary, and
intramedullary spaces.
5. Vascular
a. Identify the main extra- and intracranial arteries.

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 i. Neck – Aortic arch, brachiocephalic trunk, left and right common and internal
carotid arteries, the external carotid arteries and their main branches (SALFOPSM
mnemonic) (R4 – 1month)
ii. Head – Internal carotid arteries, anterior cerebral arteries, middle cerebral arteries,
anterior communicating artery, vertebral arteries, posterior inferior and anterior
inferior cerebellar arteries, superior cerebellar arteries, basilar artery, posterior
cerebral arteries, posterior communicating arteries. Know the segmental anatomy
of these named arteries as well as their major branches.

III. BRAIN
1. General concepts
a. Further develop the ability to use imaging findings to differentiate different types of
focal intracranial lesions (neoplastic, inflammatory, vascular) based on anatomic
location (e.g. intra- vs. extra-axial), contour, intensity and enhancement pattern. (R4 – 1
month)
b. Accurately identify and differentiate diffuse intracranial abnormalities (e.g.
hydrocephalus versus atrophy). (R4 – 3 month)
c. Be able to identify and differentiate acquired lesions (traumatic, ischemic,
inflammatory and neoplastic) of the newborn, infant, child, and adolescent.(R4 – 3
month)
d. Learn to recognize congenital lesions, malformations, and disorders of the perinatal
period on CT and MR. (R4 – 6 month)
e. Deepen knowledge of treatment related findings (e.g. post-surgical and post-radiation)
and the imaging techniques to discern these scenarios. (R1 – 3 month)
f. Be able to access and incorporate clinical history including prescribed
medications/therapies (bevacizumab) and histologic biopsy information as they impact
imaging exam performance, protocol and interpretation. (R4 – 3 month)
2. Be proficient with the following scales
a. American Society of Anesthesiologists (ASA) physical status classification system
(prior to sedation) (R4 – 1 month)
b. Glasgow Coma Scale (GCS) (R4 – 1 month)
c. Alberta Stroke Program Early CT Score (ASPECTS) score (R4 – 1 month)
d. National Institutes of Health Stroke Scale (NIHSS)(R4 – 3 month)
e. Spetzler-Martin Arteriovenous (AVM) grading system(R4 – 3 month)
f. Hunt-Hess score (aneurysms)(R4 – 6 month)
g. Fisher Scale (subarachnoid hemorrhage)(R4 – 6 month)
3. Stroke
a. Proficiency in interpretation of CT/CTA, MR/MRA, CT/MR perfusion images (R4 – 1
month)
b. Grade internal carotid artery stenosis using NASCET criteria. (R4 - 1 month)

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 c. Deepen familiarity with contraindications to tPA (e.g., MCA infarct greater than ½ of
MCA territory, acute hemorrhage, time cut offs for IV tPA and mechanical
thrombectomy) (R4 – 1 month)
d. Recognize patterns of acute infarction (e.g., embolic, watershed/borderzone, vasculitis,
diffuse hypoxic ischemia, venous infarction) (R4 - 3 month)
e. Routinely identify cervical arterial stenosis in the carotid and vertebral arteries. (R4 - 3
month)
f. Be able to routinely process and interpret MR and CT perfusion images for acute stroke
cases. (R4 – 6 month)
g. Confidently interact with clinical stroke team and neurointerventionalists. (R4 – 6
month)
4. Tumor
a. Become proficient with the most recent WHO brain tumor classification(R4 – 3 month)
b. Comfort with conventional MR imaging with DWI, MR
perfusion, MR spectroscopy in initial tumor assessment and follow-up imaging(R4 - 6
month)
c. Be able to list a reasonable differential for masses based on imaging appearance,
location, age, sex, and clinical history (R4 – 6 month)
d. Interpret MR perfusion to differentiation tumor progression from radiation necrosis (R4
– 6 month)
5. Vascular
a. Proficiently identify the correct anatomical location of aneurysms (R4- 3 month)
b. Be able to routinely recognize and grade AVMs, and recognize cavernous
malformations, developmental venous anomalies, and capillary telangiectasias (R4 - 6
month)
c. Become proficient with the indications, risks and benefits for neurointerventional
procedures including thrombolysis, embolization, angioplasty, and stenting.(R4 – 6
month)
d. Be familiar with certain etiologies of parenchymal hemorrhage (e.g., AVM, cavernous
malformation, hypertension, amyloid angiopathy, primary tumors and metastases (R4 –
6 month)
6. CNS infections
a. Comfort with diagnosing bacterial cerebral abscess and subdural empyema, recognizing
source if via direct extension (e.g., paranasal sinus or mastoid temporal bone origin)
(R4 – 1 month)
b. Broaden and deepen your knowledge of viral and atypical infections (e.g., herpes
encephalitis, tuberculosis, Lyme disease, progressive multifocal leukoencephalopathy,
Creutzfeldt-Jakob Disease, neurocysticercosis, coccicioidomycosis)(R4 – 3 month)
7. White matter

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 a. Broaden and deepen your knowledge of demyelinating and dysmyelinating diseases –
(e.g., ADEM, PML, more in depth knowledge of MS) (R4 – 3 month)
b. Broaden and deepen your knowledge of inherited metabolic disorders (i.e., MELAS,
Alexander’s disease, Canavan’s disease) (R4 – 6 month)
c. Broaden and deepen your knowledge of additional white matter diseases – (e.g., central
pontine myelinolysis/extrapontine myelinolysis, heroin inhalation
leukoencephalopathy, X-linked adrenal leukodystrophy) (R4 – 6 month)
8. Neurodegenerative
a. Broaden and deepen your knowledge of the more common and some of the rare
neurodegenerative disorders (e.g., Alzheimer Disease, Parkinson disease, iron
deposition disease, Wernicke encephalopathy, normal pressure hydrocephalus,
multisystem atrophy, progressive supranuclear palsy, amyotrophic lateral sclerosis) (R4
– 6 month)
b. Recognize and correlate the typical patterns of Alzheimer disease on PET, MRI, and
CT
9. Cranial Nerve Pathologies
a. Differentiate cerebellopontine angle vestibular schwannoma from meningioma (R4 – 1
month)
b. Recognize optic nerve pathology such as optic neuritis, optic nerve glioma and
meningioma. (R4 – 3 month)
c. Know the segments of the facial nerve and which can normally enhance (R4 – 3 month)
d. Become proficient with the assessment of perineural spread of tumor and the
connections between CNs 5 and 7 as well as their branches (R4 – 6 month)
10. Congenital/developmental
a. Know some of the childhood causes of hydrocephalus (e.g., aqueductal stenosis,
communicating hydrocephalus from infection or subarachnoid hemorrhage, choroid
plexus papilloma) (R4 – 1 month)
b. Be familiar with the phakomatoses (e.g., NF1, NF2, tuberous sclerosis, Sturge-Weber,
Von Hippel-Lindau) (R4 – 3 month)
c. Broaden and deepen your knowledge of brain malformations (e.g., schizencephaly,
focal cortical dysplasia), sulcation and migrational anomalies (e.g., lissencephaly,
heterotopia, polymicrogyria, holoprosencephaly spectrum) (R4 – 6 month)

IV. SPINE
1. General concepts to know
a. Be able to localize spinal lesions to the appropriate space (extradural, intradural-
extramedullary, intramedullary) and have a short differential for lesions in each space.
(R4 – 1 month)
b. Be proficient in differentiating inflammatory and neoplastic lesions. (R4 – 3 month)
c. Broaden and deepen your knowledge of the imaging features of intraspinal processes
including syringomyelia, arachnoiditis, and spinal dysraphism. (R4 – 3 month)

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 d. Reliably recognize expected post-surgical findings and short term and long term
complications of surgery(i.e., epidural scarring, CSF leak, phlegmon/abscess, hardware
failure, non-union) (R4 – 3 month)
e. Reliably recognize congenital lesions, malformations, and disorders of the perinatal
period on CT and MR. (R4 – 6 month)
f. Be able to integrate patient symptoms with imaging findings to discuss culprit lesions
with referring clinicians and in interdisciplinary settings. (R4 – 6 month)
2. Congenital
a. Gain more understanding of the spinal imaging findings of the phakomatoses (e.g., von
Hippel-Lindau, NF2) (R4 – 6 month)
b. Broaden and deepen your knowledge of neural tube defects (e.g., myelomeningocele,
epidermoid) (R4 – 6 month)
c. Learn more about segmentation anomalies (e.g., Klippel-Feil Spectrum,
Diastematomyelia) (R4 – 6 month)
3. Degenerative
a. Routinely use standard nomenclature and classification of lumbar disc pathology(R4 –
1 month)
b. Differentiate disc bulge, protrusion, and extrusion (R4 – 1 month)
c. Recognize the specific nerve root affected by degenerative lumbar disc pathology in the
lateral recesses and foramina(R4 - 3 month)
d. Be able to identify varying degrees of spinal canal stenosis, cord compression, and
myelomalacia (R4 - 3 month)
e. Know imaging features of diffuse idiopathic skeletal hyperostosis (DISH) and
ossification of the posterior longitudinal ligament (OPLL) (R4 - 6 month)
4. Spine vascular/trauma
a. Be able to differentiate epidural hematoma, subdural hematoma, and subarachnoid
hemorrhage(R4 – 1 month)
b. Recognize traumatic spinal cord edema and hemorrhage (R4 – 1 month)
c. Proficiently identify carotid and vertebral artery dissection on CT/CTAand
MRI/MRA(R4 - 3 month)
d. Routinely identify spinal ligamentous injury (e.g., ALL, PLL, ligamentum flavum,
transverse ligament, tectorial membrane) (R4 - 3 month)
e. Be familiar with the classification of spinal arteriovenous malformations/fistulas (types
1-4) (R4 – 6 month)
5. Spine Infection/Inflammation
a. Consistently identify discitis/osteomyelitis and associated paraspinal/epidural
phlegmon and abscess (R4 – 1 month)
b. Recognize subacute combined degeneration (R4 – 3 month)
c. Know imaging features of ankylosing spondylitis and spinal rheumatoid
arthritis(R4 - 3 month)
d. Recognize spinal multiple sclerosis imaging findings (R4 - 3 month)

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 e. Know imaging features of neuromyelitis optica (R4 – 6 month)
6. Nerve plexus
a. Be proficient with brachial and lumbosacral plexus anatomy(R4 - 3 month)
b. Be proficient with brachial and lumbosacral plexus pathology (e.g., trauma,
intrinsic/extrinsic tumor, infection)(R4 – 6 month)

V. HEAD AND NECK

1. General concepts to know
a. Identify pathologic processes on multi-planar MRIexaminations. (R4 – 1 month)
b. Further hone the differential diagnosis of mass lesions. (R4 – 3 month)
c. Be able to identify landmarks and anatomic features pertinent to the operative
approaches to the sella and skull base. (R4 – 3 month)
d. Learn to recognize post-treatment related findings (e.g. post-surgical and post-
radiation). (R4 –3 month)
e. Reliably identify key areas of involvement which impact cancer staging schemes. (R4
– 6 month)
f. Understand and be able to reliably identify patterns of disease spread within and
between areas of the head and neck (e.g. perineural and nodal spread). (R4 – 6 month)
g. Understand andreliably recognize congenital lesions, malformations, and disorders of
the perinatal period on CT and MR. (R4 – 6 month)
2. Sinonasal cavities
a. Describe adjacent anatomy to sinonasal tumors for pre-operative considerations (R4 - 1
month)
b. Broaden and deepen your knowledge of invasive fungal sinusitis, allergic fungal
sinusitis, sinonasal polyposis(R4 – 3 month)
c. Be familiar with some of the more common congenital lesions (e.g., pyriform aperture
stenosis, choanal atresia) (R4 – 3 month)
d. Become familiar with functional endoscopic sinus surgery (FESS)(R4 – 6 month)
3. Skull base
a. Be able to describe the components of the skull base typically involved in trauma or
tumor (R4 – 1 month)
b. Develop a differential for lesions within and around the sella turcica (R4 – 3 month)
c. Be familiar with the various types of encephaloceles (R4 – 6 month)
d. Be able to describe the course of perineural tumor spread from primary tumor to
brainstem including skull base foramina.(R4 – 6 month)
4. Orbits/Face
a. Accurately recognize post-septal infection and abscess, invasive fungal sinusitis(R4 - 1
month)
b. Be proficient in recognizing and describing with zygomaticomaxillary complex (ZMC)
fractures, naso-orbitoethmoid (NOE) fractures, and LaFort 1, 2, and 3 fractures. (R4 – 3
month)

Page 16 of 42
 c. Be familiar with some of the congenital lesions (e.g., coloboma, dermoid/epidermoid,
persistent hyperplastic primary vitreous (PHPV)) (R4 – 3 month)
d. Be able to offer an ordered, appropriate differential diagnosis for orbital lesions (R4 – 6
month)
5. Temporal bone
a. Broaden and deepen your knowledge of mastoiditis and complications (R4 – 1 month)
b. Have a differential diagnosis for imaging findings that could explain tinnitusand
trigeminal neuralgia (R4 – 3 month)
c. Understand and be familiar with the utility of DWI for cholesteatomadetection and
recurrence (R4 – 3 month)
d. Be familiar with the third window phenomenon and some of its causes (most notably
superior semicircular canal dehiscence) (R4 - 6 month)
6. Suprahyoid and Infrahyoid Neck
a. Become familiar with the imaging findings of squamous cell carcinoma, lymphoma,
and minor salivary gland tumors (R4 – 3 month)
b. Learn about human papillomavirus (HPV) associated squamous cell carcinoma (R4 – 3
month)
c. Develop a differential for lesions in each of the suprahyoid neck subsites (R4 – 3
month)
d. Be familiar with some of the more common congenital head and neck lesions (e.g.,
hemangioma, venolymphatic malformation, branchial cleft cysts) (R4 - 3 month)
e. Become familiar with the AJCC criteria for the various head and neck subsites and
develop comfort in identifying the appropriate anatomy to give the correct T-stage. (R4
- 6 month)
7. Nodes
a. Know the lymph node level classification per the American Joint Committee on Cancer
(AJCC)(R4 - 6 month)
b. Be familiar with the up to date AJCC cancer staging system for nodal metastatic
disease from head and neck cancer(R4 – 6 month)
8. Post-surgical/Post-treatment Neck
a. Recognize expected post-operative changes (R4 – 3 month)
b. Recognize expected post-radiation changes on CT and MRI(R4 – 3 month)
c. Identify post-operative complications(R4 – 3 month)
d. Be able to identify post-operative tumor recurrence on CT and MRI (R4 – 6 month)
9. Becomefamiliar with the following scales
a. Keros Classification(R4 - 6 month)
b. AJCC lymph node classification as above (R4 - 6 month)
c. AJCC criteria for the various head and neck subsites for T and N staging as above (R4 -
6 month)

Page 17 of 42
FELLOWSHIP CURRICULUM

Date last updated: 6/19/17

Should also review everything in the R1 –R3 and R4 curricula

I. TECHNIQUES AND INDICATIONS

A. In depth understanding (or awareness) of the physics, imaging principles, data processing, clinical
indications, artifacts, limitations, and contrast properties, patient safety aspects and utilization for the
following CT, MRI, US and nuclear medicine techniques

1. CT

a. Conventional

b. Dual Energy CT

c.Perfusion CT

i. CBV, CBF, MTT, Tmax, TTP, permeability

ii. Use in stroke, stroke mimics, neoplasms

d. 4D CT (for parathyroid adenomas)

e. Awareness of the following CT techniques

i. Cone beam CT

ii. Cerebrovascular reactivity

2. MRI

a. Conventional

b. MR Spectroscopy

i. SVS, 2D-CSI, 3D-CSI

Page 18 of 42
 ii. Localization of normal and abnormal metabolites at different field
strengths

c. Functional MRI

i. BOLD technique

ii. Ability to perform paradigms, post processing and interpret results

d. DWI/Diffusion Tensor Imaging

i. Metrics - ADC, FA, Eigen values

ii. Ability to perform fiber tracking

e. MR Perfusion Imaging

i. Use in stroke, stroke mimics, neoplasms

ii. DSC with calculations of CBV, CBF, MTT, Tmax, TTP, permeability

iii. DCE - CBF and Ktrans map generation,

iv. ASL - PASL, PCASL

f. Some awareness of the following MR techniques (iii - viii optional)

i. Resting state FMRI/connectivity

ii. Cerebrovascular reactivity

iii. T1 Rho imaging

iv. Quantitative Susceptibility Mapping

v. Restriction Spectrum Imaging

vi. Neurite Orientation Dispersion and Density Imaging

vii. Neurovascular Uncoupling

viii. MR fingerprinting

ix. High-angular-resolution diffusion imaging and Q-ball vector analysis

3. Nuclear Medicine

a. Positron Emission Tomography

i. FDG - PET

ii. PET - CT

Page 19 of 42
 iii. PET - MRI

iv. Amyloid imaging (awareness)

b. Tc-99m-pertechnetate scintigraphyfor thyroid imaging

c. Tc-99m sestamibi scintigraphy for parathyroid imaging

4. Ultrasound

a. Carotid US

b. Transcranial Doppler

B. Should have an in depth knowledge (or awareness) of the indications, contrast utilization,
catheter/needle selection, radiation exposure and risks of the following procedures and should be able to
perform (or have awareness of how to perform) them

1. Digital Subtraction Angiography

2. Myelography

3. Cisternography

4. Minimally invasive spine procedures (awareness)

a. Epidural steroid injections

b. Facet injections

c. Bone biopsies

5. Head and Neck Procedures

a. Videofluoroscopy/pharyngoesophagrams

b. Modified barium swallows

c. Sialograms (awareness)

d. Dacrocystograms (awareness)

e. US and/or CT guided biopsies - thyroid, salivary gland, nodes

f. Sclerotherapy (awareness)

g. Ablations (awareness)

Page 20 of 42
C. Should understand the indications for, have knowledge of use of therapeutic agents, and observe and
participate in the following procedures

1. Neuroendovascular procedures

a. Acute stroke embolectomy with stent retrievers

b. Aneurysm Coiling

c. AVM/AVF treatment with liquid embolic agents

d. Carotid stenting/angioplasty

e. Particle embolization for epistaxis, of vascular tumors

2. Vertebroplasty/Kyphoplasty

II. ANATOMY

1. Brain - Have a detailed understanding of the following on CT, MRI and multiplanar 2D and 3D
reconstructions

a. Gyraland sulcal anatomy of the supratentorial and infratentorial brain

b. Deep gray nuclei, brainstem and cranial nerves

c. Functional neuroanatomy of the brain

d. White matter tracts of the supratentorial and infratentorial brain

e. Arteries and veins of the supratentorial and infratentorial brain

2. Head and Neck - Have a detailed understanding of the following anatomy on CT, MRI and multiplanar
2D and 3D reconstructions and where appropriate on cone beam CT, PET CT, US, and DSA

a. Cranial Nerves

b. Skull base and cranial nerves

c. Temporal bone, middle and inner ear

d. Face, Sinonasal cavity

e. Oral cavity, Pharynx and Larynx

f.Thyroid and parathyroid glands, thoracic inlet and brachial plexus

g. Orbit and visual pathways

h. Mandible, temporomandibular joint

Page 21 of 42
 i. Neck, including spaces of the suprahyoid and infrahyoid neck, lymph nodes

j. Salivary glands

k. Vascular supply to the major structures of the head and neck

3. Spine - Have a detailed understanding of the following anatomy on CT, MRI, myelography and
multiplanar 2D and 3D reconstructions

a. Spinal cord and nerve roots, including the functional neuroanatomyand dermatomes

b. Meninges and thecal sac

c. Vertebral column

d. Ligaments

e. Paraspinal musculature

f. Vascular supply to the spinal cord, meninges and vertebral bodies

4. Pediatric - Have a detailed understanding ofthe normal developmental processes of the central nervous
system and know the normal appearance on US, CT and MRI (including DWI and MRS) of the brain,
spinal cord, vertebral column and head and neck structures during fetal development and during various
stages of childhood.

a. Brain/skull - normal gyration, myelination, pituitary changes, suture closure,

growth

b. Spine - normal changes in marrow, ligaments, conus position, growth

c. Head and neck - normal changes in nodes, lymphoid tissue, cartilages, growth

III. BRAIN PATHOLOGY

1. Stroke/ischemia - have a detailed understanding of:

a. Appearance of stroke in all major arterial territories with associated functional deficits

b. Clinical and imaging scales to assess stroke - NIHSS, ASPECTS, collateral scores

c. Accurate interpretation of NCCT/CTA, MR/MRA, CT/MR perfusion, ASL,

SWI images

d. Management decisions to administer IA or IV therapy based on imaging and

Page 22 of 42
 clinical characteristics, including understanding of embolectomy with stent
retrievers

e. Common and uncommon causes of stroke and their appearances on US,

MR/MRA, CT/CTA and DSA- atherosclerosis, dissection, cardioembolic,

FMD, Takayasu's, Ehlers Danlos, Erdheim Chester, primary CNS vasculitis,

Infectious vasculitis, RCVS, Susac's, CADASIL, Moya Moya, vasospasm from

vasoactivedrugs

f. Stroke mimics - hemiplegic migraine, seizures, hypoglycemia

g. Global ischemia/hypoxia

h. Evaluation and treatment of cervical carotid artery disease - imaging with US,

CTA, MRA, DSA; NASCET criteria; treatments - angioplasty, stenting; pathologies -

atherosclerosis, dissection, FMD, Takayasu's, Ehlers Danlos,

Erdheim Chester

i. Neonatal and pediatric stroke

2. Brain tumors - have a detailed understanding of:

a. All tumor pediatric and adult tumor types identified in the WHO 2016

classification of brain tumors and their appearance on MRI, MRP, MRS, SWI, DWI,
CT, DSA

b. Brain tumor genomics, and the relation of specific genes to location, biology

outcome, and treatment response

c. Treatment options; treatment related changes including radiation necrosis,

radiation angiopathy, pseudoprogression and pseudoresponse; and treatment

response according to the RANO criteria

d. Understand the basic concepts of texture analysis

3. Hemorrhage/Vascular malformations - have a detailed understanding of:

a. (1) All of the following vascular lesions on CT/CTA, MRI, MRA and DSA; (2)
etiologies of these vascular lesions, (3) clinical scales for grading these lesions and (4)
endovascular and surgical treatments

Page 23 of 42
 i. Arteriovenous Malformations/Arteriovenous Fistulas- Spetzler-Martin
AVM grading, Borden and Cognard DAVF classification, treatment with
liquid embolic agents versus surgical treatment

ii. Aneurysms- etiologies - congenital, mycotic, oncotic, Fisher Scale

(subarachnoid hemorrhage), Hunt-Hess score, coiling, flow diverting devices,
surgical treatments

iii. Moya Moya - Encephaloduroarteriosynangiosis

iv.Cerebral venous sinus thrombosis - including IV therapy and

endovascular clot lysis and clot retrieval

v. Congenital vascular malformations (vein of Galen, etc)

vi. Small vessel vasculopathies (RCVS, primary CNS angiitis

b. All of the hemorrhagic lesions listed below with emphasis on: (1) their appearances on
CTincluding dual energy CT, MRI including SWI, and DSA; (2) etiologies of these lesions including
genetics, and (3) treatments

i. Amyloid angiopathy

ii. Hypertension

iii. Coagulopathy, including DIC

iv. Hemorrhagic primary and secondary tumors

v. Hemorrhagic infections

vi. Cavernous malformations

c. The principles and clinical utility of the following techniques

i. Dual Energy CT - differentiating calcification from hemorrhage and

contrast blush from hemorrhage

ii. SWI - including differentiating calcification from hemorrhage on phase

images

iii.CTA - contrast extravasation, spot sign

4.Infection/Inflammation - have a detailed understanding of:

a. Pathophysiology and appearance of bacterial, viral, parasitic, fungal and prion

infections on MRI, MRP, MRS, SWI, DWI, and CT in pediatric and adult

patients

Page 24 of 42
 b. Noninfectious granulomatous diseases affecting the CNS

c. Different organisms and patterns of infection in immunocompromised versus

immunocompetent hosts

d. Inflammatory conditions associated with dysregulated immunity- e.g. IRIS,

autoimmune syndromes such Anti-NMDA receptor (NMDAR), Pediatric

Autoimmune Neuropsychiatric Disorders Associated with Streptococcal

infection (PANDAS), limbic encephalitis, neuromyelitis optica spectrum

disorders, etc.

e. Treatment options

5. White Matter Diseases - have a detailed understanding of:

a. The application of MRI including volumetric FLAIR and DIR sequences, MRP, MRS,
DWI, DTI and DSI in the evaluation of white matter diseases in pediatric and adult patients

b. Multiple sclerosis and all of its variants including clinical assessment with the

McDonald criteria

c. Other demyelinating diseases such as ADEM

d. Leukodystrophy (Classic, Demyelinating), and Hypomyelination

e. Myelinolysis syndromes

f. Toxic injury to the white matter - e.g. heroin, cocaine, toluene, metronidazole,

methotrexate, Marchiafava Bignami, delayed hypoxia

g. Ischemic injury - chronic including assessment with the Fazekas score;

delayed hypoxia

h. Small vessel vasculopathies (Susac's, CADASIL, Primary angiitis of the CNS)

i. Other infectious/inflammatory causes - PML, HIV, SSPE

j. PRES

k. Treatment options

6. Neurodegenerative - have a detailed understanding of:

a. The application of MRI including volumetric T1 sequences, MRP, MRS, DWI,

Page 25 of 42
 DTI, resting state fMRI, PET, SPECT and amyloid imaging in the evaluation of
neurodegenerative diseases

b. The clinical assessment of patients with ND conditions including

neurocognitive tests such as theMMSE

c. Primary conditions - Alzheimer's, frontotemporal dementia, Lewy body

disease, Parkinson's, multisystem atrophy, progressive supranuclear palsy, amyotrophic

lateral sclerosis, cerebellar degeneration syndromes, iron deposition Diseases, Huntington's
disease

d. Normal pressure hydrocephalus including CSF flow imaging and treatment options

e. Importance of quantitative MR in neurodegenerative diseases

7. Trauma - have a detailed understanding of:

a. SDH, EDH, IPH, DAI, fat emboli in pediatric and adult patients

b. Brain herniation patterns

c. Calvarial/skull base fractures

d. Use of DTI, DWI, and SWI in the evaluation of TBI

e. Chronic traumatic encephalopathy

f. Use of GCS in the evaluation of patients with TBI

g. Quick brain assessment of pediatric patients with TBI

h. Abusive headtrauma

i. Traumatic venous and arterial vascular injury

8. Congenital - have a detailed understanding of:

a. Malformations in cortical development (MCD) - lissencephalies, heterotopia,

focal cortical dysplasias, schizencephaly, polymicrogyria, hemimegalencephaly and newer

classifications of MCD (awareness)

b. Malformations of the corpus callosum and interhemispheric cysts

c. Holoprosencephaly - alobar, semilobar, lobar, middle interhemispheric variant

d. Septo-optic dysplasia

e. Midbrain–hindbrain anomalies - Dandy-Walker malformation spectrum,

Page 26 of 42
 Joubert syndrome, cerebellar vermian dysgenesis/hypoplasia,

rhombencephalosynapsis

f. Chiari I and Chiari II anomalies of the craniocervical junction

g. Mesenchymal malformations - calvarial, skull base defects, cephaloceles,

lipomas, arachnoid cysts

h. Phakomatoses - Neurofibromatosis type 1 and 2, von Hippel-Lindau syndrome, tuberous

sclerosis, Sturge-Weber

9. Toxic/Metabolic - have a detailed understanding of:

a. The application of CT/CTA and MRI/MRA, MRS, DWI, and DTI in the

evaluation of toxic and metabolic diseases

b. Inborn errors of metabolism/hereditary disorders

c. Hypoglycemia

d. Hepatic encephalopathy

e. Radiation injury

f. Chemotherapy (Methotrexate) toxicity

g.Carbon monoxide poisoning

h. Opiate (heroin, cocaine) toxicity

i. Other medication toxicity - Vigabatrin, metranidazole

j.Alcoholtoxicity- Wernicke's, Marchiafava Bignami, cerebellar atrophy

k. Immunosuppressant (cyclosporin) toxicity - PRES

l. Antiepileptic medication toxicity - cerebellar atrophy

10. Hydrocephalus-understand pathophysiology of obstructive and communicating

hydrocephalus

a. Recognize signs of increased intracranial pressure

b. Recognize signs of intracranial hypotension

c. Slit ventricle syndrome

Page 27 of 42
IV. HEAD AND NECK PATHOLOGY

1. Orbit and visual pathways - have a detailed understanding of:

a. Congenital lesions, including microphthalmia, PPHV, coloboma, NF-1,

dermoid and epidermoid cysts

b. Tumors including rhabdomyosarcoma, retinoblastoma, meningioma,

optic/chiasmal glioma, ocular melanoma, orbital lymphoma, and lacrimal gland

tumors

c. Inflammatory disorders of the orbits including optic neuritis, sarcoidosis,

idiopathic inflammatory disorders (pseudotumor)

d. Orbital infections - bacterial and invasive fungal

e. Vascular and lymphatic malformations including hemangioma, lymphangioma

and venolymphatic malformations

f. Orbital prostheses and post-surgical and post treatment changes

2. Nose, nasopharynx and paranasal sinuses- have a detailed understanding of:

a. Congenital lesions including choanal atresia and frontoethmoidal

encephalocele

b. Infectious and inflammatory disorders of the nose and paranasal sinuses

including acute and chronic bacterial sinusitis, fungal sinusitis, polyposis,
mucocele andWegener granulomatosis

c. Neoplasms including inverted papilloma, juvenile angiofibroma, hemangioma,

osteoma, fibrous dysplasia, squamous cell carcinoma, adenocarcinoma,

melanoma, esthesioneuroblastoma, and lymphoma

d. Functional endoscopic sinus surgery and other procedures and treatment related changes

3. Temporal bone - have a detailed understanding of:

a. Congenital disorders - common cavity, cochlear aplasia/hypoplasia, IP-I, IP-II,

IP-III deformities, large vestibular aqueduct and sac syndrome, EAC atresia and its associations,
ossicular deformities

b. Temporal bone tumors and CPA tumors

Page 28 of 42
 c. Temporal bone fractures

d. Cholesteatoma and other inflammatory lesions

e. Mastoiditis, otitis media, malignant otitis externa, petrous apicitis and other

infections of the temporal bone

f. Vascular and non-vascular lesions leading to tinnitus

g. Otosclerosis/otospongiosis

h. Tegmen thinning, meningoceles, and semicircular canal dehiscence

h. Surgical procedures related to inner ear, middle ear and mastoid and other

treatment related changes

4. Parotid space - have a detailed understanding of:

a.Infectious and inflammatory lesions of the parotid space including parotitis, Sjogren
syndrome, and benign lymphoepithelial lesions in HIV.

b. Neoplasms of the parotid space including Warthin tumor, benign mixed tumor,

adenoid cystic carcinoma, mucoepidermoid carcinoma, lymphoma, lymph node

metastases and malignant tumors of the skin

c. Facial nerve pathology

d. Surgical procedures and other treatment related changes.

5. Masticator space and face (mandible and maxilla) - have a detailed understanding of:

a.Neoplasms/mass lesions including benign and malignant peripheral nerve

sheath tumors of the trigeminal nerve, mandibular and maxillary neoplasms and cystic lesions

b. Infectious and inflammatory lesions of the mandible and maxilla including

osteomyelitis, osteoradionecrosis, bisphosphonate osteonecrosis

c. Facial fractures

d. Denervation atrophy

e. Surgical procedures and other treatment related changes.

6. Carotid space - have a detailed understanding of:

a. Neoplasms of the carotid space including carotid body paraganglioma, glomus

Page 29 of 42
 vagale paraganglioma, schwannoma, and neurofibroma

b. Vascular lesions of the carotid space including carotid artery pseudoaneurysm,

carotid artery dissection, and jugular vein thrombosis

7. Oral cavity, oropharynx and retropharyngeal space - have a detailed understanding of:

a. Congenital lesions including dermoid and epidermoid cysts, accessory salivary

tissue, lymphangioma and lingual thyroid gland

b. Inflammatory and infectious lesions of the oral cavity and oropharynx

including abscesses, sialadenitis and ranula; and retropharyngeal abscesses

c. Neoplasms including squamous cell carcinoma, malignant tumors of the minor

salivary glands and benign mixed lesions of the minor salivary glands

d. Surgical procedures and treatment related changes.

8. Hypopharynx, larynx and cervical esophagus - have a detailed understanding of:

a. Neoplasmsof the hypopharynx and larynx, including squamous cell carcinoma

of the hypopharynx, of the supraglottic, glottic and subglottic regions,

chondrosarcoma and other malignant tumors of the larynx; esophageal

carcinoma

b. Post-surgical and post radiation changes of the hypopharynx and larynx

c. Vocal cord paralysis

d. Laryngeal trauma

e. Laryngocele, pharyngocele, laryngeal web, laryngeal stricture, tracheal

stenosis

f. Swallowing disorders

g. Zenker diverticulum

h. Epiglottitis and croup

9.Thyroid and parathyroid glands - have a detailed understanding of:

a. Thyroiditis

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 b. Multinodular goiter

c. Neoplasms including thyroid and parathyroid adenomas, thyroid carcinoma,

and thyroid lymphoma

d. Surgical procedures and other treatment related changes

10. Lymph nodes of the head and neck region - have a detailed understanding of:

a. Nomenclature of the lymph nodes and nodal regions

b. Infectious and inflammatory disorders including reactive lymph node

enlargement, suppurative lymph nodes, Kimura disease, Castleman disease

c. Neoplasms including lymphoma and nodal metastases

d. Neck dissections

11. Skull base and cranial nerves - have a detailed understanding of:

a. Skull base neoplasms/diffuse diseases - meningioma, macroadenoma,

chordoma, chondrosarcoma, plasmacytoma, metastases, Langerhans cell

histiocytosis, fibrous dysplasia

b. Jugular foramen neoplasms/other lesions - glomus tumor, schwannoma,

meningioma, jugular vein diverticulum

c. Skull base fractures

d. Cavernous sinus neoplasms and inflammatory lesions

e. Common and uncommon pathologies affecting cranial nerves 1 - 12

f. Perineural tumor spread

g. Surgical procedures and other treatment related changes

12. Congenital and trans-spatial lesions - have a detailed understanding of:

a. Embryology of the head and neck region

b. Congenital cystic lesions - branchial cleft, thymic, thyroglossal duct

c. Congenital vascular and lymphatic malformations

d. Neurocutaneous syndromes in the head and neck

Page 31 of 42
 e. Fibromatosis coli

f. Congenital malformations of the skull base and face

V. SPINE PATHOLOGY

1. Degenerative Disease - have a detailed understanding of:

a. The application of CT, MRI myelography and discography in the evaluation of

degenerative disease of the spine

b. Nomenclature for degenerative changes

c. Intervertebral disc degeneration and herniation - annular fissure, protrusion,

extrusion, sequestration, location - central, subarticular, foraminal, far lateral,

anterior

d. Vertebral marrow changes and osteophyte formation - Modic classification

e. Facet arthropathy/synovial cysts

f. Spondylolisthesis, spondylolysis and segmental instability

g. Spinal canal and neural foraminal stenosis - grading schemes for mild,

moderate and severe

h. Other degenerative conditions - OPLL, DISH

2. Spine tumors - have a detailed understanding of:

a. The application of CT, MRI, bone scans, and PET in the evaluation of spinal

tumors

b. Treatment options and treatment related changes/complications- surgery,

chemotherapy, vertebroplasty

c. Intramedullary lesions - ependymoma, astrocytoma, oligodendroglioma,

ganglioglioma, hemangioblastoma, metastatic disease

d. Intradural extramedullary lesions - meningioma, nerve sheath tumors,

hemangioma, paraganglioma, carcinomatosis (from primary CNS tumors and

Page 32 of 42
 nonCNS tumors)

e. Extradural lesions - osteoid osteoma, osteoblastoma, ABC, osteochondroma,

hemangioma, giant cell tumors, osteosarcoma, chondrosarcoma, chordoma, Ewing

sarcoma, lymphoma, leukemia, multiple myeloma, metastatic disease

f. Treatment options and treatment related changes

3. Spine trauma - have a detailed understanding of:

a. The application of CT, MRI, STIR, GRE, DWI, DTI, and myelography to spine trauma,
including the identification of spinal cord, ligamentous, spinal column,

vascular

b. Mechanisms of injury to the cervical, thoracic and lumbar spinal

columns

c. Stable versus unstable fractures

d. Upper cervical spine fractures - Classification of atlanto-occipital dislocation,

occipital condyle fractures, odontoid fractures, and traumatic spondylolisthesis

ofC2 (Hangman's); Jefferson and other C1 fractures

e. Lower cervical spine fractures - hyperflexion, hyperextension injuries

f. Thoraco-lumbar fracture classification - hyperflexion compression injuries,

burst fractures, flexion-distraction injuries, fracture-dislocation injury

g. How to differentiate acute from chronic compression

h. Nerve root and brachial plexus injury

i. Pediatric spine trauma

j. Treatment options and treatment related changes

4. Infectious and inflammatory diseases of the spinal column and spinal cord– have

detailed understanding of:

a. The application of CT, MRI, STIR, GRE, DWI, DTI, and myelography to spinal
column infectious and inflammatory diseases

b. Hematogenous and nonhematogenous routes of infection

c. Vertebral discitis-osteomyelitis +/- epidural abscess - bacterial, mycobacterial

Page 33 of 42
 (tuberculosis), fungal (aspergillus, candida), parasitic causes (hydatid)

d. Vertebral column inflammatory conditions - Ankylosing spondylitis, Psoriatic

arthritis, rheumatoid arthritis, sarcoidosis, dialysis related amyloidosis

e. Leptomeningealinfections - bacterial, mycobacterial (tuberculosis), fungal

(cryptococcus), parasitic (cysticercosis)

f. Infectious myelitis - Nonviral (spinal cord abscess), viral - herpes, CMV, HIV

g. Inflammatory diseases of the spinal cord and leptomeninges - multiple

sclerosis, ADEM, neuromyelitis optica, acute transverse myelopathy, Guillain

Barre, CIDP, Charcot Marie Tooth, neurosarcoidosis

5. Vascular lesions of the spinal column and spinal cord -

a. The application of CT, CTA, MRI, MRA, DSA and myelography to spinal

column infectious and inflammatory diseases

b. Spinal AVMs/AVFs types I - IV - classification, imaging features and

endovascular therapy versus surgical options.

c. Cavernous malformations

d. Spinal cord infarctions - arterial and venous

6. Congenital - have a detailed understanding of:

a. The application of CT and MRI to evaluate congenital lesions

b. Open spinal dysraphism (myelocele, myelomeningocele) - surgical repairs

c. Closed spinal dysraphism associated with a mass - lipomyelocele,

lipomyelomeningocele, meningocele, myelocystocele - surgical repairs

d. Closed spinal dysraphism spectrum - segmental spinal dysgenesis, dorsal

dermal sinus, split cord malformation (diplomyelia and diastematomyelia)

e. Tethered cord - spinal cord release surgery

f. Anomalies of vertebral formation and segmentation (vertebra, hemivertbra) -

Associated thoracic insufficiency syndrome

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 g. Cystic lesions - Neurenteric cyst, arachnoid cyst, epidermoid

7. Post-operative spine

a. Scarring versus recurrent disc

b. Hardware failure

c. Nonunion

d. Infection

e. CSF leak

8. Toxic/metabolicdisease of the spinal cord - have a detailed understanding of:

a. The application of CT and MRI to toxic and metabolic diseases of the spine

and spinal cord

b. Subacute combined degeneration

c. Radiation myelopathy

FOURTH YEAR (R4)

Date last updated: 12/11/17

Should also review everything in the R1 – R3 curriculum

I. TECHNIQUE AND INDICATIONS
1.Review to ensure independent proficiency (R4 – 1 month)

a. Obtaining informed consent

c. Overseeing conscious sedation

8. Independently perform (with appropriate supervision) (R4 – 1 month)
a. Lumbar Punctures
b. Myelography
c. Cisternography
9. Post-Processing (R4 – 3 month)
a. Continue proficiency at creating 3D reformats for CT and MRI
b. Continue proficiency at processing MR perfusion images
c. Become familiar with DTI tractography
10. Contrast – Be familiar with the following (R4 – 3 month)
a. Macrocyclic vs. linear gadolinium agents
b. Relaxivity

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11. Observe and participate in spine biopsies (R4 – 6 month)
12. Develop more in depth knowledge of advanced MRI techniques(R4 - 6 month)
a. MR perfusion (further knowledge for use in neoplasms and stroke; specifically distinguish
recurrent high grade glioma from radiation necrosis)
b. MR spectroscopy (NAA, Choline, lactate)
c. Susceptibility weighted imaging
13. Develop more in depth knowledge of CT techniques
a. Dual energy CT (technique and applications) (R4 – 6 month)
b. Radiation dose reduction (R4 – 6 month)

II. ANATOMY
2. General
a. Be proficient with anatomy in the brain, spine, head &neck in appropriate depth on multi-planar
and multi-modality images and especially be able to interrogate 3D image volumes to identify
small structures.(R4 – 1 month)
2. Brain

a. Be proficient with cortical anatomy in the eloquent regions

(motor/sensory cortex – identify central sulcus, pre- and post-central gyri, superior and middle
frontal gyri, superior frontal sulcus; Broca’s area – inferior frontal gyrus including pars
triangularis and pars opercularis; Wernicke’s area – superior and middle temporal gyri, superior
temporal sulcus) (R4 - 3 months)

b. Reviewmore global gyral and sulcal anatomy (R4 - 6 months)

(i.e., cingulate gyrus, angular gyrus, cuneus, calcarine sulcus, parahippocampal gyrus)

3. Head & Neck

a. Name and recognize the anatomy of the spaces of the neck to include the nasopharynx,
oropharynx, hypopharynx, oral cavity, larynx, prevertebral space, carotid space, parotid space,
masticator space, pharyngeal mucosal space, parapharyngeal space. (R4 – 1 month)
b. Be proficient withanatomy of the skull base, sinonasal region, temporal bone, and orbits.(R4 –
3 month)
c. Become more familiar with the anatomical course of cranial nerves 1-12including the 3 major
divisions of CN 5. (6 months)
4. Spine
a. Be proficient with the pertinent craniocervical junction anatomy including ligaments such as
the alar and transverse ligaments and the tectorial membrane. (R4 – 3 month)
b. Routinely recognize the main ligaments of the spine, including the anterior and posterior
longitudinal ligaments, ligamentum flavum, interspinous ligaments, supraspinous ligament, and
nuchal ligament.
c. Be able to anatomically localize the extradural, intradural extramedullary, and intramedullary
spaces.
5. Vascular
a. Identify the main extra- and intracranial arteries.

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 i. Neck – Aortic arch, brachiocephalic trunk, left and right common and internal carotid
arteries, the external carotid arteries and their main branches (SALFOPSM mnemonic)
(R4 – 1month)
ii. Head – Internal carotid arteries, anterior cerebral arteries, middle cerebral arteries,
anterior communicating artery, vertebral arteries, posterior inferior and anterior inferior
cerebellar arteries, superior cerebellar arteries, basilar artery, posterior cerebral arteries,
posterior communicating arteries. Know the segmental anatomy of these named arteries
as well as their major branches.
VI. BRAIN
1. General concepts
a. Further develop the ability to use imaging findings to differentiate different types of focal
intracranial lesions (neoplastic, inflammatory, vascular) based on anatomic location (e.g. intra-
vs. extra-axial), contour, intensity and enhancement pattern. (R4 – 1 month)
b. Accurately identify and differentiate diffuse intracranial abnormalities (e.g. hydrocephalus
versus atrophy). (R4 – 3 month)
c. Be able to identify and differentiate acquired lesions (traumatic, ischemic, inflammatory and
neoplastic) of the newborn, infant, child, and adolescent.(R4 – 3 month)
d. Learn to recognize congenital lesions, malformations, and disorders of the perinatal period on
CT and MR. (R4 – 6 month)
e. Deepen knowledge of treatment related findings (e.g. post-surgical and post-radiation) and the
imaging techniques to discern these scenarios. (R1 – 3 month)
f. Be able to access and incorporate clinical history including prescribed medications/therapies
(bevacizumab) and histologic biopsy information as they impact imaging exam performance,
protocol and interpretation. (R4 – 3 month)
2. Be proficient with the following scales
a. American Society of Anesthesiologists (ASA) physical status classification system (prior to
sedation) (R4 – 1 month)
b. Glasgow Coma Scale (GCS) (R4 – 1 month)
c. Alberta Stroke Program Early CT Score (ASPECTS) score (R4 – 1 month)
d. National Institutes of Health Stroke Scale (NIHSS)(R4 – 3 month)
e. Spetzler-Martin Arteriovenous (AVM) grading system(R4 – 3 month)
f. Hunt-Hess score (aneurysms)(R4 – 6 month)
g. Fisher Scale (subarachnoid hemorrhage)(R4 – 6 month)
3. Stroke
a. Proficiency in interpretation of CT/CTA, MR/MRA, CT/MR perfusion images (R4 – 1 month)
b. Grade internal carotid artery stenosis using NASCET criteria. (R4 - 1 month)

c. Deepen familiarity with contraindications to tPA (e.g., MCA infarct greater than ½ of MCA
territory, acute hemorrhage, time cut offs for IV tPA and mechanical thrombectomy) (R4 – 1
month)

d. Recognize patterns of acute infarction (e.g., embolic, watershed/borderzone, vasculitis, diffuse

hypoxic ischemia, venous infarction) (R4 - 3 month)

e. Routinely identify cervical arterial stenosis in the carotid and vertebral arteries. (R4 - 3 month)

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 f. Be able to routinely process and interpret MR and CT perfusion images for acute stroke cases.
(R4 – 6 month)

g. Confidently interact with clinical stroke team and neurointerventionalists. (R4 – 6 month)

4. Tumor

a. Become proficient with the most recent WHO brain tumor classification(R4 – 3 month)

b. Comfort with conventional MR imaging with DWI, MR

perfusion, MR spectroscopy in initial tumor assessment and follow-up imaging(R4 - 6 month)

c. Be able to list a reasonable differential for masses based on imaging appearance, location, age,
sex, and clinical history (R4 – 6 month)
d. Interpret MR perfusion to differentiation tumor progression from radiation necrosis (R4 – 6
month)
5. Vascular

a. Proficiently identify the correct anatomical location of aneurysms (R4- 3 month)

b. Be able to routinely recognize and grade AVMs, and recognize cavernous malformations,
developmental venous anomalies, and capillary telangiectasias (R4 - 6 month)

c. Become proficient with the indications, risks and benefits for neurointerventional procedures
including thrombolysis, embolization, angioplasty, and stenting.(R4 – 6 month)

d. Be familiar with certain etiologies of parenchymal hemorrhage (e.g., AVM, cavernous

malformation, hypertension, amyloid angiopathy, primary tumors and metastases (R4 – 6
month)

6. CNS infections

a. Comfort with diagnosing bacterial cerebral abscess and subdural empyema, recognizing source
if via direct extension (e.g., paranasal sinus or mastoid temporal bone origin) (R4 – 1 month)
b. Broaden and deepen your knowledge of viral and atypical infections (e.g., herpes encephalitis,
tuberculosis, Lyme disease, progressive multifocal leukoencephalopathy, Creutzfeldt-Jakob
Disease, neurocysticercosis, coccicioidomycosis)(R4 – 3 month)
7. White matter
a. Broaden and deepen your knowledge of demyelinating and dysmyelinating diseases – (e.g.,
ADEM, PML, more in depth knowledge of MS) (R4 – 3 month)
b. Broaden and deepen your knowledge of inherited metabolic disorders (i.e., MELAS,
Alexander’s disease, Canavan’s disease) (R4 – 6 month)
c. Broaden and deepen your knowledge of additional white matter diseases – (e.g., central pontine
myelinolysis/extrapontine myelinolysis, heroin inhalation leukoencephalopathy, X-linked
adrenal leukodystrophy) (R4 – 6 month)
8. Neurodegenerative

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 a. Broaden and deepen your knowledge of the more common and some of the rare
neurodegenerative disorders (e.g., Alzheimer Disease, Parkinson disease, iron deposition
disease, Wernicke encephalopathy, normal pressure hydrocephalus, multisystem atrophy,
progressive supranuclear palsy, amyotrophic lateral sclerosis) (R4 – 6 month)

b. Recognize and correlate the typical patterns of Alzheimer disease on PET, MRI, and CT

9. Cranial Nerve Pathologies

a. Differentiate cerebellopontine angle vestibular schwannoma from meningioma (R4 – 1 month)

b. Recognize optic nerve pathology such as optic neuritis, optic nerve glioma and meningioma.
(R4 – 3 month)

c. Know the segments of the facial nerve and which can normally enhance (R4 – 3 month)

d. Become proficient with the assessment of perineural spread of tumor and the connections
between CNs 5 and 7 as well as their branches (R4 – 6 month)

10. Congenital/developmental

a. Know some of the childhood causes of hydrocephalus (e.g., aqueductal stenosis,

communicating hydrocephalus from infection or subarachnoid hemorrhage, choroid plexus
papilloma) (R4 – 1 month)

b. Be familiar with the phakomatoses (e.g., NF1, NF2, tuberous sclerosis, Sturge-Weber, Von
Hippel-Lindau) (R4 – 3 month)

c. Broaden and deepen your knowledge of brain malformations (e.g., schizencephaly, focal
cortical dysplasia), sulcation and migrational anomalies (e.g., lissencephaly, heterotopia,
polymicrogyria, holoprosencephaly spectrum) (R4 – 6 month)

VII. SPINE

1. General concepts to know

a. Be able to localize spinal lesions to the appropriate space (extradural, intradural-

extramedullary, intramedullary) and have a short differential for lesions in each space. (R4 – 1
month)
b. Be proficient in differentiating inflammatory and neoplastic lesions. (R4 – 3 month)
c. Broaden and deepen your knowledge of the imaging features of intraspinal processes including
syringomyelia, arachnoiditis, and spinal dysraphism. (R4 – 3 month)
d. Reliably recognize expected post-surgical findings and short term and long term complications
of surgery(i.e., epidural scarring, CSF leak, phlegmon/abscess, hardware failure, non-union)
(R4 – 3 month)
e. Reliably recognize congenital lesions, malformations, and disorders of the perinatal period on
CT and MR. (R4 – 6 month)

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 f. Be able to integrate patient symptoms with imaging findings to discuss culprit lesions with
referring clinicians and in interdisciplinary settings. (R4 – 6 month)
2. Congenital
a. Gain more understanding of the spinal imaging findings of the phakomatoses (e.g., von Hippel-
Lindau, NF2) (R4 – 6 month)
b. Broaden and deepen your knowledge of neural tube defects (e.g., myelomeningocele,
epidermoid) (R4 – 6 month)
c. Learn more about segmentation anomalies (e.g., Klippel-Feil Spectrum, Diastematomyelia) (R4
– 6 month)
3. Degenerative

a. Routinely use standard nomenclature and classification of lumbar disc pathology(R4 – 1

month)
b. Differentiate disc bulge, protrusion, and extrusion (R4 – 1 month)
c. Recognize the specific nerve root affected by degenerative lumbar disc pathology in the lateral
recesses and foramina(R4 - 3 month)
d. Be able to identify varying degrees of spinal canal stenosis, cord compression, and
myelomalacia (R4 - 3 month)
e. Know imaging features of diffuse idiopathic skeletal hyperostosis (DISH) and ossification of
the posterior longitudinal ligament (OPLL) (R4 - 6 month)
4. Spine vascular/trauma
a. Be able to differentiate epidural hematoma, subdural hematoma, and subarachnoid
hemorrhage(R4 – 1 month)
b. Recognize traumatic spinal cord edema and hemorrhage (R4 – 1 month)
c. Proficiently identify carotid and vertebral artery dissection on CT/CTAand MRI/MRA(R4 - 3
month)
d. Routinely identify spinal ligamentous injury (e.g., ALL, PLL, ligamentum flavum, transverse
ligament, tectorial membrane) (R4 - 3 month)
e. Be familiar with the classification of spinal arteriovenous malformations/fistulas (types 1-4)
(R4 – 6 month)
5. Spine Infection/Inflammation
a. Consistently identify discitis/osteomyelitis and associated paraspinal/epidural phlegmon and
abscess (R4 – 1 month)
b. Recognize subacute combined degeneration (R4 – 3 month)

c. Know imaging features of ankylosing spondylitis and spinal rheumatoid

arthritis(R4 - 3 month)

d. Recognize spinal multiple sclerosis imaging findings (R4 - 3 month)

e. Know imaging features of neuromyelitis optica (R4 – 6 month)

6. Nerve plexus

a. Be proficient with brachial and lumbosacral plexus anatomy(R4 - 3 month)

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 b. Be proficient with brachial and lumbosacral plexus pathology (e.g., trauma, intrinsic/extrinsic
tumor, infection)(R4 – 6 month)

VIII. HEAD AND NECK

1. General concepts to know

a. Identify pathologic processes on multi-planar MRIexaminations. (R4 – 1 month)

b. Further hone the differential diagnosis of mass lesions. (R4 – 3 month)
c. Be able to identify landmarks and anatomic features pertinent to the operative approaches to the
sella and skull base. (R4 – 3 month)
d. Learn to recognize post-treatment related findings (e.g. post-surgical and post-radiation). (R4 –
3 month)
e. Reliably identify key areas of involvement which impact cancer staging schemes. (R4 – 6
month)
f. Understand and be able to reliably identify patterns of disease spread within and between areas
of the head and neck (e.g. perineural and nodal spread). (R4 – 6 month)
g. Understand andreliably recognize congenital lesions, malformations, and disorders of the
perinatal period on CT and MR. (R4 – 6 month)
2. Sinonasal cavities

a. Describe adjacent anatomy to sinonasal tumors for pre-operative considerations (R4 - 1 month)

b. Broaden and deepen your knowledge of invasive fungal sinusitis, allergic fungal sinusitis,
sinonasal polyposis(R4 – 3 month)

c. Be familiar with some of the more common congenital lesions (e.g., pyriform aperture stenosis,
choanal atresia) (R4 – 3 month)
d. Become familiar with functional endoscopic sinus surgery (FESS)(R4 – 6 month)

3. Skull base

a. Be able to describe the components of the skull base typically involved in trauma or tumor (R4
– 1 month)
b. Develop a differential for lesions within and around the sella turcica (R4 – 3 month)
c. Be familiar with the various types of encephaloceles (R4 – 6 month)
d. Be able to describe the course of perineural tumor spread from primary tumor to brainstem
including skull base foramina.(R4 – 6 month)

4. Orbits/Face

a. Accurately recognize post-septal infection and abscess, invasive fungal sinusitis(R4 - 1 month)
b. Be proficient in recognizing and describing with zygomaticomaxillary complex (ZMC)
fractures, naso-orbitoethmoid (NOE) fractures, and LaFort 1, 2, and 3 fractures. (R4 – 3 month)
c. Be familiar with some of the congenital lesions (e.g., coloboma, dermoid/epidermoid, persistent
hyperplastic primary vitreous (PHPV)) (R4 – 3 month)
d. Be able to offer an ordered, appropriate differential diagnosis for orbital lesions (R4 – 6 month)

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5. Temporal bone

a. Broaden and deepen your knowledge of mastoiditis and complications (R4 – 1 month)
b. Have a differential diagnosis for imaging findings that could explain tinnitusand trigeminal
neuralgia (R4 – 3 month)
c. Understand and be familiar with the utility of DWI for cholesteatomadetection and recurrence
(R4 – 3 month)
d. Be familiar with the third window phenomenon and some of its causes (most notably superior
semicircular canal dehiscence) (R4 - 6 month)
6. Suprahyoid and Infrahyoid Neck
a. Become familiar with the imaging findings of squamous cell carcinoma, lymphoma, and minor
salivary gland tumors (R4 – 3 month)
b. Learn about human papillomavirus (HPV) associated squamous cell carcinoma (R4 – 3 month)
c. Develop a differential for lesions in each of the suprahyoid neck subsites (R4 – 3 month)
d. Be familiar with some of the more common congenital head and neck lesions (e.g.,
hemangioma, venolymphatic malformation, branchial cleft cysts) (R4 - 3 month)
e. Become familiar with the AJCC criteria for the various head and neck subsites and develop
comfort in identifying the appropriate anatomy to give the correct T-stage. (R4 - 6 month)
7. Nodes
a. Know the lymph node level classification per the American Joint Committee on Cancer
(AJCC)(R4 - 6 month)
b. Be familiar with the up to date AJCC cancer staging system for nodal metastatic disease from
head and neck cancer(R4 – 6 month)
8. Post-surgical/Post-treatment Neck

a. Recognize expected post-operative changes (R4 – 3 month)

b. Recognize expected post-radiation changes on CT and MRI(R4 – 3 month)
c. Identify post-operative complications(R4 – 3 month)
d. Be able to identify post-operative tumor recurrence on CT and MRI (R4 – 6 month)
9. Becomefamiliar with the following scales
a. Keros Classification(R4 - 6 month)
b. AJCC lymph node classification as above (R4 - 6 month)
c. AJCC criteria for the various head and neck subsites for T and N staging as above (R4 - 6
month)

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