Pediatric Radiology Fellowship Curriculum

Curriculum

Texas Children’s Hospital is the largest free-standing pediatric hospital in the world with more than 40 pediatric subspecialties and a level I comprehensive trauma center with large referral base, giving our fellows exceptional breadth and depth of experience with both rare and routine diagnoses.

The Texas Children’s Hospital Pediatric Radiology fellowship consists of one-month rotations in key areas such as fluoroscopy, ultrasound, plain radiography, body CT/MR, neuroradiology, and emergency radiology (call), as well as subspecialty areas including fetal imaging, nuclear medicine, musculoskeletal radiology, cardiac imaging, and interventional radiology (if desired). Fellows with specific subspecialty interests can tailor their schedule to spend more time in these areas.

The first two months involve core rotations, followed by overnight call shifts. After that, fellows alternate between core and elective rotations, typically on a weekly basis, though consecutive weeks in a specific rotation can be arranged. The program director meets with fellows quarterly to review their progress and address any areas needing further development. As fellows identify areas of interest or prepare for job searches, additional subspecialty rotations can be added.

During the Pediatric Interventional Radiology rotation, fellows gain experience in bread-and-butter cases, including vascular access, percutaneous biopsies, and drainages, as well as complex liver transplant interventions, portal vein recanalization, venous thrombectomy/thrombolysis, trauma angiography and intervention, and treatment of low-flow and high-flow vascular anomalies and vascular tumors with sclerotherapy, embolization, and ablation techniques. Fellows also have the opportunity to participate in the weekly multidisciplinary Vascular Anomalies Clinic and help care for patients with complex vascular malformations and genetic syndromes.

During the typical work day, the fellow is responsible for dictating all studies assigned to their rotation. All studies are reviewed with the faculty member. All rotations have a 1:1 trainee-to-faculty ratio (i.e. residents and fellows are not doubled up on rotations).

The fellows are also responsible for preparing and presenting interdepartmental conferences. The fellows are expected to deliver two noon conferences during the year, one hot seat conference and one didactic conference, on a topic of their own choosing.

Fellows take call on a night float system, shared with the senior rotating residents. Night float shifts are from 11pm to 7am, Sunday through Thursday, followed by a post-call day off. There are no clinical duties during the day while the fellow is on the night float system. Fellows will do between 3 and 4 weeks (15 and 20 shifts) of night float during the fellowship year.

In addition, fellows do 5-6 weeks (5 consecutive days) of evening shift rotations, from 5 to 11pm, on call with a faculty member.

The fellows also cover a Saturday shift from 9am to 6pm, working with a faculty member. Saturday shifts do not take place on holiday weekends.

While on call, the fellow is responsible for providing preliminary interpretations on emergency and stat inpatient studies, including plain films, ultrasounds and CT/MR studies, as well as occasional fluoroscopy procedures (upper GI series for malrotation, air enema for intussusception reduction). Overnight the fellows also provide preliminary interpretations on neuroradiology studies. A faculty member checks out all studies at 7am the following morning. There is an ultrasound technologist in-house 24 hours a day, but the fellows are expected to scan each ultrasound patient to arrive at their own impression.

Moonlighting opportunities are available at TCH, once the fellow has completed their first week of night float.

Didactic

The Radiology Department offers a robust structured lecture schedule, including daily conferences at 7:30 a.m. or noon. These conferences blend didactic presentations with interactive formats, such as case discussions and gameshow-style competitions.

The department also participates in over 40 interdisciplinary conferences, with varying frequencies—daily, weekly, or monthly. Most conferences are now virtual, with Radiology playing a primary role in many of the conferences, including Neonatology Morning Report, Solid Tumor Rounds, Surgery/Radiology/Pathology Conference, Pulmonary Rad-Path Conference, and Musculoskeletal Sarcoma Conference.

Fellows are also provided with a specialized curriculum separate from the rotating residents and directed at the higher educational level of the fellows. Fellows’ Conferences include didactic topics presented in a “How I Do It” format; for example, in addition to a noon conference on “Interstitial Lung Disease” in children, the fellows receive a second conference on “Approach to Interstitial Lung Disease” where our renowned chest expert, Dr. Paul Guillerman, provides a step-by-step approach to interpreting high resolution chest CT, focused at the fellow level. Fellows’ conferences also include hands-on ultrasound sessions on identifying the appendix and the mesenteric vascular pedicle (for excluding midgut volvulus), hands-on fluoroscopy training with our Radiology PAs and physicists, and CT and MRI physics lectures.

A variety of fellow-level topics are offered by Fellows’ College, a series of academic and career development lectures and workshops organized by the Pediatric Fellowship program directors at Texas Children’s Hospital. Fellows’ College not only provides outstanding lectures and group sessions by engaging lecturers from a variety of different clinical departments, but it also allows our fellows to work alongside pediatric subspecialty fellows from other departments and build collaborative relationships.

Journal clubs are held 5-6 times over the course of the fellowship year, with articles selected by faculty and presented by the fellows, concentrating on study design. Each fellow will present two articles at journal club over the course of the fellowship year.

Clinical

Roughly one month is spent on each rotation, including the core areas of fluoroscopy, ultrasound, plain radiography, body CT/MR, neuroradiology and ER (call), as well as in subspecialty areas including fetal imaging, nuclear radiology, MSK, cardiac imaging and interventional radiology. Fellows with specific subspecialty interests may choose to spend more time in one subspecialty area and less time on the other subspecialty rotations.

All of the fellows will rotate through the same introductory core rotations in the first two months, followed by their first overnight call shifts. We then blend advanced rotations with the basic rotations, rotating on a weekly basis unless consecutive weeks on a rotation are desired. The program director meets with the fellows on a quarterly basis to review their progress and identify any areas that need further training.

As the fellows begin identifying areas of specific interest, and/or interviewing for jobs and identifying areas that need further study, we can increase the number of subspecialty rotations.

During the typical work day, the fellow is responsible for dictating all studies assigned to their rotation. All studies are reviewed with and supervised by a faculty member. All rotations have a 1:1 trainee-to-faculty ratio (i.e. residents and fellows are not doubled up on rotations).

Fellows are allowed more and more autonomy as the fellowship year progresses, commensurate with their increasing clinical skills and pediatric radiology acumen. Fellows are expected to take a primary role on each rotation, managing phone calls and protocols, checking studies for completeness, and providing consults by phone and/or in person.

Call at Texas Children’s Hospital is very busy, with a large volume of high acuity studies. Call helps prepare our fellows to be both efficient and accurate when they join the workforce. All call shifts are performed 1:1 with a faculty member who is also in-house, and the fellow and faculty member together cover studies being performed at all three hospital sites from the reading rooms at the main hospital in the Texas Medical Center.

Fellows take call on a night float system, shared with the senior rotating residents. Night float shifts are from 10 p.m. to 7 a.m., Sunday through Thursday, followed by a post-call day off. There are no clinical duties during the day while the fellow is on the night float system. Fellows will do between three-four weeks (15 and 20 shifts) of night float during the fellowship year.

In addition, fellows do five-six weeks (five consecutive days) of evening shift rotations, from 5 to 10 p.m.. The fellows also cover weekend shifts from 9 a.m. to 5 p.m., once per month. Holiday weekends are free of assigned call shifts.

While on call, the fellow is responsible for providing preliminary interpretations on emergency and inpatient studies, including plain films, ultrasounds and CT/MR studies, as well as performing occasional fluoroscopy procedures (air enema for intussusception reduction, for example). Overnight, the fellows also provide preliminary interpretations on neuroradiology studies. There is an ultrasound technologist in-house 24 hours a day, but the fellows are expected to scan each ultrasound patient to arrive at their own impression.

Moonlighting opportunities are available at Texas Children's Hospital, once the fellow has completed their first week of night float. Moonlighting shifts mirror the regular call shifts, but cover overnight on the weekends and holidays.

All rotations take place at Texas Children’s Hospital in the world-renowned Texas Medical Center, and at Texas Children’s Hospital - West Campus, in the suburb of Katy, to the west of Houston. Texas Children’s Hospital has a second community location in the Woodlands, a suburb well to the north of Houston, but its remoteness precludes on-site clinical rotations for the fellows.

Training sites include:

Texas Children’s Hospital – West Tower (inpatient and emergency services, NICU)
Texas Children’s Hospital – Legacy Tower (intensive care and outpatient services, including Nuclear Radiology)
Texas Children’s Pavilion for Women (inpatient and outpatient maternity and labor and delivery services, NICU and well-baby nursery)
The Abercrombie Building (inpatient services, Medical Staff Services)
The Mark A. Wallace Center (outpatient services, including the main Radiology reading room)
The Feigin Tower (research facilities)
Texas Children’s Hospital – West Campus (inpatient, outpatient and emergency services in a community setting)

Research

Clinical and basic science research opportunities abound, with excellent research mentors available in all general and subspecialty areas. Each fellow is matched with a mentor before the fellowship year begins, based on shared interests. The fellows are allotted academic time to work on their research projects, with the goal of project completion in time for abstract submittal to the Society for Pediatric Radiology annual meeting (abstract deadline typically in late October). Accepted scientific abstracts will be presented by the fellows at the meeting, with expenses paid by the department. Fellows are strongly encouraged to publish their manuscript prior to the end of the fellowship year.

The Research Program in the E.B.Singleton Department of Radiology at Texas Children’s Hospital is overseen by the vice-Chair for Research, Ananth Annapragada, Ph.D., FAIMBE, FNAI. All pre-award, post-award and research coordination for ongoing projects are managed by Dr. Annapragada and his staff. The Department as a whole is remarkably productive publishing between 150 and 200 papers per year (an average of 2.5 – 3 per faculty member per year!) We are the pre-eminent Research Department in Pediatric Radiology, winning the Caffey Award for best paper at the annual SPR meeting 6 of the last 12 years, including a 3-peat in 2022, 2023 and 2024.

A unique feature of the Research program is our rigorous Pilot Project Program. This is an internally funded grant program that is oriented at faculty who with their trainees wish to conduct a preliminary study leading to a larger grant application. A typical Pilot grant will support up to $30,000 of approved expenses facilitating extensive pre-clinical and clinical work. The program has had a remarkable success rate, with ~50% of awardees going on to secure significant extramural grants.

Additionally, the Department of Radiology is home to the Translational Imaging Group. TIGr is unique among Radiology departments, and works on long-term projects of significant basic-science and clinical impact, usually extramurally funded either by the NIH or other Foundation/Philanthropy sources. TIGr is considered the “SkunkWorks” in Radiology, taking projects from bench scale concept to clinical use in a 10-20 year time frame. TIGr is home to 7 faculty with ranks from Instructor to Professor, operating as a matrixed organization, sharing 14 staff, and a floating population of graduate students and other trainees. TIGr faculty provide research intensive didactic coursework for Pediatric Radiology trainees, with topics including Research Methodology, AI, 3D printing, Imaging Physics of all modalities, Chemistry and Toxicology of Contrast Agents, Nanomaterials and Nanoparticle Imaging Agents, Advances in Molecular Imaging, and Infusion Reactions. TIGr faculty are world acknowledged experts in their fields, and are available as consultants, advisors, or mentors as appropriate for any of our trainees.

CJ Yen, Class of 2019

Yen CJ, Mehollin-Ray AR, Bernardo F, Zhang W, Cassady CI. Correlation between maternal meal and fetal motion during fetal MRI. Pediatr Radiol. 2019;49(1):46-50. doi:10.1007/s00247-018-4254-1.

Brandon Fuqua, Class of 2019

Artunduaga M, Fuqua BL, Pierry C, Soto Giordani GA, Roman-Colon AM. Imaging diagnosis of epipericardial fat necrosis in children. Pediatr Radiol. 2020;50(2):285-288. doi:10.1007/s00247-019-04531-0.

Matthew Ditzler, Class of 2018

Ditzler MG, Kan JH, Artunduaga M, et al. Modified Friedman technique: a new proposed method of measuring glenoid version in the setting of glenohumeral dysplasia. Pediatr Radiol. 2018;48(12):1779-1785. doi:10.1007/s00247-018-4196-7.

Kelly Hagedorn, Class of 2018

Hagedorn KN, Hayatghaibi SE, Levine MH, Orth RC. Cost Comparison of Ultrasound Versus MRI to Diagnose Adolescent Female Patients Presenting with Acute Abdominal/Pelvic Pain Using Time-Driven Activity-Based Costing. Acad Radiol. 2019;26(12):1618-1624. doi:10.1016/j.acra.2019.03.023.

Elizabeth Snyder, Class of 2018

Snyder EJ, Zhang W, Jasmin KC, Thankachan S, Donnelly LF. Gauging potential risk for patients in pediatric radiology by review of over 2,000 incident reports. Pediatr Radiol. 2018;48(13):1867-1874. doi:10.1007/s00247-018-4238-1.

Lauren May, Class of 2017

May LA, More SR, Masand PM, Ketwaroo PD, Krishnamurthy R, Jadhav SP. Value of emergent pediatric cardiac computed tomographic angiography service: initial experience at a large children's hospital. Pediatr Radiol. 2020;50(8):1095-1101. doi:10.1007/s00247-020-04659-4.

May LA, Guillerman RP, Zhang W, Orth RC. Unfounded conclusions of equivalence in diagnostic accuracy studies: a pervasive fallacy of inference in pediatric radiology scientific abstracts. Pediatr Radiol. 2018;48(13):1861-1866. doi:10.1007/s00247-018-4222-9.

Andrew Sher, Class of 2016

Sher AC, Seghers V, Paldino MJ, et al. Assessment of Sequential PET/MRI in Comparison With PET/CT of Pediatric Lymphoma: A Prospective Study. AJR Am J Roentgenol. 2016;206(3):623-631. doi:10.2214/AJR.15.15083.

Sher AC, Orth R, McClain K, Allen C, Hayatghaibi S, Seghers V. PET/MR in the Assessment of Pediatric Histiocytoses: A Comparison to PET/CT. Clin Nucl Med. 2017;42(8):582-588. doi:10.1097/RLU.0000000000001717.

Kate Mangona, Class of 2015

Mangona KLM, Guillerman RP, Mangona VS, et al. Diagnostic Performance of Ultrasonography for Pediatric Appendicitis: A Night and Day Difference?. Acad Radiol. 2017;24(12):1616-1620. doi:10.1016/j.acra.2017.06.007.

Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP. Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study. Radiology. 2017;282(3):835-841. doi:10.1148/radiol.2016160175.

Karen Lyons, Class of 2014

Lyons K, Seghers V, Sorensen JI, et al. Comparison of Standardized Uptake Values in Normal Structures Between PET/CT and PET/MRI in a Tertiary Pediatric Hospital: A Prospective Study. AJR Am J Roentgenol. 2015;205(5):1094-1101. doi:10.2214/AJR.15.14304.

Lyons K, Seghers V, Williams JL, et al. Qualitative FDG PET Image Assessment Using Automated Three-Segment MR Attenuation Correction Versus CT Attenuation Correction in a Tertiary Pediatric Hospital: A Prospective Study. AJR Am J Roentgenol. 2015;205(3):652-658. doi:10.2214/AJR.14.14231.

Lyons K, Cassady C, Mehollin-Ray A, Krishnamurthy R. Current Role of Fetal Magnetic Resonance Imaging in Body Anomalies. Semin Ultrasound CT MR. 2015;36(4):310-323. doi:10.1053/j.sult.2015.05.013.

Lyons K, Cassady C, Jones J, et al. Current Role of Fetal Magnetic Resonance Imaging in Neurologic Anomalies. Semin Ultrasound CT MR. 2015;36(4):298-309. doi:10.1053/j.sult.2015.05.012.

Bagatell R, McHugh K, Naranjo A, et al. Assessment of Primary Site Response in Children With High-Risk Neuroblastoma: An International Multicenter Study. J Clin Oncol. 2016;34(7):740-746. doi:10.1200/JCO.2015.63.2042.

Erica Schallert, Class of 2013

Schallert EK, Kan JH, Monsalve J, Zhang W, Bisset GS 3rd, Rosenfeld S. Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis? [published correction appears in Pediatr Radiol. 2016 May;46(5):734]. Pediatr Radiol. 2015;45(8):1174-1181. doi:10.1007/s00247-015-3293-0.

Monsalve J, Kan JH, Schallert EK, Bisset GS, Zhang W, Rosenfeld SB. Septic arthritis in children: frequency of coexisting unsuspected osteomyelitis and implications on imaging work-up and management. AJR Am J Roentgenol. 2015;204(6):1289-1295. doi:10.2214/AJR.14.12891.