Special Report

10.1177/1051228403254487ARTICLEJournal of Neuroimaging Vol 13 No 3 July 2003Bakshi et al: Imaging Training for Neurologists

Neuroimaging Curriculumfor Neurology Trainees:Report From the NeuroimagingSection of the AAN

Rohit Bakshi, MD

Andrei V. Alexandrov, MD

Camilo R. Gomez, MD

Joseph C. Masdeu, MD, PhD

A B S T R A C T

Neuroimaging plays a major role in the evaluation of patientswith neurological disorders. Surveys of neurologists haverevealed that most rely on their own readings of images forpatient management, and a majority believe that neurologistsshould be allowed to officially interpret and bill for scan reviews.The importance of neuroimaging training for neurology resi-dents has been stressed by the Association of University Pro-fessors of Neurology. Although there is a desire to promote theneuroimaging education of neurologists, no curricula haveexisted previously. The Neuroimaging Section of the AmericanAcademy of Neurology (AAN) developed a task force of practic-ing neuroimagers to provide a neuroimaging curriculum for neu-rological trainees and training directors. The resulting curriculumis available on the Web sites of the AAN (http://www.aan.com)and the American Society of Neuroimaging (http://www.asnweb.org/education/curriculum.shtml) and will be updatedas the need arises through evolving technology or breadth ofapplications. This curriculum should help in the design of neurol-ogy residency and fellowship programs and subspecialty path-ways in which adequate neuroimaging education and trainingare desired for various reasons, including certification and thedemonstration of competency and proficiency.

Key words: Neuroimaging, MRI, Doppler, angiography, func-tional imaging, education, accreditation.

Bakshi R, Alexandrov AV, Gomez CR, Masdeu JC.Neuroimaging curriculum for neurology trainees: report

from the Neuroimaging Section of the AANJ Neuroimaging 2003;13: 215-217DOI: 10.1177/1051228403254487

Neuroimaging plays a major role in the evaluation ofpatients with neurological disorders. The utility of various

neuroimaging studies is rapidly increasing in both clinicaland research settings. A 1996 survey of neurologistsrevealed that most rely on their own readings of neuro-imaging studies for patient management.1 In 1997, officialneuroimaging training2 and certification3 guidelines forneurologists were published by the American Academyof Neurology (AAN). The importance of neuroimagingtraining for neurology residents has been stressed by theAssociation of University Professors of Neurology, whichin October 2000 issued the following statement:

Residents in neurology must have adequate experience inneuroimaging that assures proficiency in magnetic reso-nance imaging, computerized tomography, andneurosonology. This can be accomplished as an integralpart of supervised patient care during rotations ofrequired adult and pediatric neurology, as well as in theoutpatient clinics where neurology residents shouldreview and interpret their own patients’ neuroimagingstudies under supervision. Additional experience may beattained by elective rotations in subspecialty areas whereneuroimaging is particularly relevant to patient care, suchas cerebrovascular disease, neuro-oncology, neurointen-

Copyright © 2003 by the American Society of Neuroimaging 215

Received November 26, 2002, and in revised form April 2,2003. Accepted for publication April 3, 2003.

From the Buffalo Neuroimaging Analysis Center, TheJacobs Neurological Institute, Buffalo, NY (RB); the De-partment of Neurology, University at Buffalo, State Uni-versity of New York (RB); the Department of Neurology,University of Texas–Houston Medical School (AVA); theDepartment of Neurology, University of Alabama at Bir-mingham (CRG); and the Department of Neurology andNeuroscience, University of Navarre School of Medicine,Pamplona, Spain ( JCM).

Address correspondence to Rohit Bakshi, MD, BuffaloNeuroimaging Analysis Center, The Jacobs NeurologicalInstitute, 100 High Street, Buffalo, NY 14203. E-mail:rbakshi@buffalo.edu.

sive care, cognitive neurology, and epilepsy. Some resi-dents may have additional opportunities to interpretneuroimages during elective rotations in neurosurgeryand neuroradiology. Program directors have responsibil-ity to document this aspect of training.4

In 2002, a survey of more than 700 neurologists foundthat 75% make clinical decisions solely on the basis oftheir independent reviews of neuroimaging scans; 60%believe that neurologists should be allowed to officiallyinterpret and bill for neuroimaging interpretation; and16% formally read neuroimaging studies, including for-mal dictation and reimbursement.5,6

Although there is a desire to promote the education ofneurologists in neuroimaging, no formal curricula haveexisted previously. The objective of this report is to makethe neurological community aware of the availability of aset of curricula covering all of the major modalities ofneuroimaging for the use of neurological trainees (resi-dents and fellows) and training directors. The curriculaare purposely not targeted for one particular stage in aneurologist’s training. Ideally, this should be satisfied in aneurology residency, and that should be the ultimate goal.Those neurologists who have not had this training in resi-dencies should be able to complete these curricula insome other way (eg, fellowships, tutorials, seminars,preceptorships, practical supervised experience, etc).

The major neuroimaging modalities include computedtomography (CT), magnetic resonance imaging (MRI),single-photon-emission CT (SPECT), positron emissiontomography (PET), carotid and transcranial ultrasound,as well as interventional neuroimaging, including catheterangiography. In 1998, the Committee on Sections of theAAN asked all of the sections to develop core curricularepresenting the material in their subspecialties that neu-rological residents or fellows should master. The Neuro-imaging Section developed a task force of practicingneuroimagers representing CT, MRI, functional imaging(SPECT, PET), neurosonology (carotid and transcranialDoppler ultrasound), and interventional (endovascular)neuroimaging. In 1999, this task force served as a writingcommittee for the curriculum that was subsequentlyapproved by the body of the Neuroimaging Section of theAAN at its annual meeting in April 2000. The draft of thecurriculum was circulated to all section members, andtheir comments were incorporated into the final version.This neuroimaging curriculum7 is available on the Websites of the AAN (http://www.aan.com) and the AmericanSociety of Neuroimaging (ASN) (http://www.asnweb.org/education/curriculum.shtml). This curriculumshould help in the design of neurology residency and fel-lowship programs in which adequate neuroimaging train-ing is desired for individuals to achieve proficiency. One

application of this curriculum is in the design ofsubspecialty certification criteria in neuroimaging, cur-rently being studied by the AAN and ASN through theUnited Council of Neurologic Subspecialties (UCNS).The UCNS is a proposed independent, multidisciplinary,nonprofit organization to accredit training and certify inneurology subspecialties, including neuroimaging. It islikely that any criteria adopted by the UCNS for neuro-imaging certification will be based on this curriculum.

For each modality, the curriculum includes the prereq-uisites for trainees, personnel needed for training, facili-ties and setup needed, methods and timetables of training,methods of evaluation of trainees and training processes,continuing education, references and resources, and a list-ing of content (modality-specific topics to be covered ineach area, including basic science, practical issues, andclinical exposure). For example, for MRI and CT, thetechnical content includes X-ray production andcollimation; electricity and nuclear magnetism; radiofre-quency pulse sequences; MRI signals and parameters; Fou-rier transforms; hardware and safety; spin-echo, gradient-echo, and echoplanar methodologies; angiography; arti-facts; and contrast agents. The clinical componentincludes a list of diseases and conditions to be learned cat-egorized as primary tumors, masses, and cysts; vascularconditions and stroke; vascular malformations andaneurysms; infections and granulomatous tissue; hemor-rhage and trauma; toxic and metabolic conditions; degen-erative conditions; seizures and epilepsy; hydrocephalusand cerebrospinal fluid issues; neurocutaneous condi-tions; demyelinating and inflammatory conditions;metastases; congenital and developmental conditions;and miscellaneous conditions (normal, normal variants,head and neck diseases). Other modalities are presentedsimilarly. As neuroimaging evolves, the NeuroimagingSection will update the curriculum over the Internet.

In summary, a neuroimaging curriculum for neurolog-ical trainees is available on the World Wide Web andshould be a useful tool for participants and supervisors oftraining programs and those interested in subspecialtycertification. This curriculum could be satisfied duringneurology residency training with supplementary train-ing as needed in postgraduate neurology and neuro-imaging fellowships and other venues.

References

1. Masdeu JC. What do neurologists think about their role inneuroimaging training and practice? J Neuroimaging 1999;9:39-42.

2. Masdeu JC. American Academy of Neurology neuro-imaging training guidelines. Neurology 1997;49:1738-1740.

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3. Gomez C, Kinkel P, Masdeu J, et al. American Academy ofNeurology guidelines for credentialing in neuroimaging—report from the task force on updating guidelines forcredentialing in neuroimaging. Neurology 1997;49:1734-1737.

4. Association of University Professors of Neurology. Minutesof the General Membership Meeting. Boston, October 15,2000.

5. Liebeskind DS, Yang CK, Sayre JW, Bakshi R. Neuro-imaging of cerebral ischemia in clinical practice [abstract].Stroke 2003;34:255.

6. Liebeskind DS, Yang CK, Sayre JW, Bakshi R. Neuro-imaging of cerebral ischemia in clinical practice: the role ofthe neurologist [abstract]. J Neuroimaging 2003;13:182.

7. Bakshi R, Alexandrov AV, Gomez C, Masdeu JC. Neuro-imaging curriculum for neurology residents and fellows.Available at: http://www.asnweb.org/education/curriculum.shtml. Accessed May 23, 2003.

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