Neuroradiology
fMRI images, such as these from our GE 3T magnet, reconstructed on PRISM software, permit precise location of brain structures linked to specific neural function.
Drs. Cromwell and Merlis bring many years of expertise in all areas of neuroradiology; in addition to clinical duties, both are active in many aspects of departmental administration, scheduling, and medical education. Dr. McIntyre is Director of Spine Radiology, and is a sought-after resident mentor and national speaker. Dr. Eskey, division head and director of the neuroradiology fellowship, is skilled in a range of interventional procedures; he serves currently as president of the Eastern Neuroradiological Society and as a member of the Editorial Board of the American Journal of Neuroradiology. With rapidly rising volumes in all areas of neuroradiology, the department has in the past two years recruited several highly talented new colleagues. Dr. Belden, joining us from Albany Medical Center, is a seasoned neuroradiologist with expertise in head and neck imaging and fMRI. We were delighted to welcome Dr. Pastel to the faculty following completion of his fellowship here in 2009. Dr. McNulty, previously practicing at both DHMC and the VA Hospital, is now with the department full-time, splitting her clinical responsibilities with neuroradiology and the VIR division.
Our technological capabilities have expanded with the acquisition of the flat-panel biplane angiography suite last year, and with new and upgraded MR scanners—including a powerful GE 3T system, permitting Dr. Belden to initiate fMRI clinical service this spring. While DHMC has been active in fMRI research for years, the new service represents the first availability in northern New England of clinical fMRI. Capable of mapping the motor, sensory and visual cortex, as well as certain language and memory functions, fMRI scans can be reconstructed for highly lifelike, versatile images which significantly enhance pre-surgical planning for a range of neurological procedures. Other areas of expanded capabilities in the division include diffusion tensor imaging and CT perfusion studies.
The interventional neuroradiology service, comprising both spine and endovascular procedures, was introduced five years ago and has been growing steadily. Working closely with the sections of Neurosurgery, Otolaryngology, and the Department of Neurology, we provide endovascular treatments that include the most effective advances in bioactive coils, cerebrovascular access devices, liquid embolic materials, stents, and clot retrieval devices. The digital biplane angiography suite is producing studies of excellent quality while reducing radiation exposures. The interventional service relies on the contributions of our associate providers, Sharene Evans, ARNP and Anne Michaels, PA, the nursing teams, and the highly skilled cadre of CT and MR technicians.
Education is a key part of our mission, and we are proud of our role and the recognition we have received—Dr. McIntyre, for example, was the 2008 recipient of the Residents' Teaching Award. Weekly didactic or case conferences for residents provide both structured learning and practice with boards-style cases. In addition to the didactic conferences, we hold regular clinical conferences with Neurology, Neurosurgery, Otolaryngology, and Pediatrics. Weekly or monthly case conferences include general Neuroradiology, Cerebrovascular Imaging and Treatment, Neuro-oncology, Endocrinology, Pediatric Neuroimaging, and Head and Neck Oncology. The ACGME-accredited neuroradiology fellowship, now in its seventh year, provides thorough training in CT and MR imaging and interventional procedures, including advanced endovascular brain techniques.
Neuroimaging research is performed by the core clinical faculty and by several dedicated basic scientists. We continue our collaborations with the Dartmouth Brain Imaging Laboratory and the Advanced Imaging Center. Projects underway cover innovation in advanced imaging at 3T in glioblastoma recurrence, MRI in pediatric head trauma, CTA in intracerebral hemorrhage and aneurysm evaluation, imaging of pharyngeal carcinoma, vertebroplasty, and synovial cyst rupture.
