Guide Diagnostic Reference Index of Clinical Neurology

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Hankey's Clinical Neurology

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Articles Cases Courses Quiz. About Blog Go ad-free. To achieve any success in neuroimaging training efforts, a healthy respect for the complexity of imaging technology is needed.

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That encompasses recognizing how artifacts can mimic pathology, understanding how certain techniques can mask or highlight pathology, and learning the process for unbiased interpretation of images while concisely addressing the clinical question. Such training requires a combination of technical didactics and high volume of experiential learning. It is encouraging that UCNS approved sites have doubled in number in the last year, but more are still needed.

Interest level for imaging education is high among neurologists. The neuroimaging section of the American Academy of Neurology AAN , established in as one of its five original clinical sections, currently has about members. Anecdotal communications such as blog posts and personal letters of inquiry provide further examples of enthusiasm for more imaging education. This is especially true of next generation tech savvy medical students, residents and neurologists, many of whom are attracted to the renewed emphasis on developing novel, clinically meaningful neurodiagnostics e.

Also concerning is the dangerous paucity of trained neurologist-neuroimager representation in guidelines development and advocacy. Under recently adopted legislation, physicians who order certain imaging studies will be penalized if they do not adhere to Appropriate Use Criteria AUC , tracked through an approved clinical support system.

This legislation will directly affect how every neurologist practices, yet neurology is not even at the decision-making table. There is precedent for formal training of clinician imagers, perhaps most notably in the field of cardiology where fellowships in cardiovascular imaging using nuclear medicine, MRI and CT are commonplace.

These programs accept radiologists and cardiologists into their cardiovascular imaging educational programs, setting the stage for a multidisciplinary future. Is the heart a more complicated organ then the brain? But political turf and the economic gain of a few have played over reason, to the detriment of the proper care of the general public. Experienced neuroimagers find the mix of clinical neurology and imaging to be fulfilling, and believe that such an integrated career can be an incentive for medical students to choose neurology as a specialty.

Given the predictions of a dangerous shortfall in the US neurology workforce, 17 this lure should not be taken lightly. These exciting opportunities are subdued by practical realities. There is a lack of awareness by medical students and residents that neurologists can and do receive training and develop careers in neuroimaging. Disappointingly, we regularly hear from residents who are actively discouraged from such a career path by their attending radiologists or, even more sadly, some neurologists.

Localization in Clinical Neurology

Neurology leadership has always recognized the value of imaging training for neurologists, and residents need to know that they can indeed legitimately train in neuroimaging and be reimbursed for their efforts. They have seen the patients and therefore they can take the imaging results and directly apply them. Neuroradiologists are certainly skilled in reading these exams, but trained neurologist-neuroimagers offer a unique opportunity to apply their expertise in the nervous system to improve continuity of care for the patient.

Ultimately, neuroimaging must be better incorporated within clinical neurology departments than it is at the present time. It is an integral part of clinical neurology and neurosciences and is increasingly based on neurophysiological knowledge. External factors, including healthcare reform, reimbursement cuts and increasing health imaging scrutiny may accelerate the development of partnerships and blur traditional boundaries between specialties and departments. This arrangement would optimize patient care, improve training, and expand opportunities for research.

The evolution of anatomic and especially functional neuroimaging will dictate the need for neurologists to be sitting at the same table as our esteemed neuro-radiology colleagues. With the complete support of the AAN, ASN, UCNS, Association of University Professors of Neurology AUPN , and ideally the American College of Radiology, Chairs of Neuroimaging must be created for neuroimaging trained neurologists within academic neurology, more university based neuroimaging fellowships must be established, and neuroimaging incorporated as soon as possible as part of the training in neurology.

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  7. Only within the domain of academic neurology departments can neuroimaging be rightfully recognized as a fundamental part of the practice of neurology. We would venture to say that most neurologists do understand the importance of neuroimaging, but are unable to surpass the hurdles that have been placed in front of our profession.

    How many bright students and neurology residents have been deterred from entering the field of neurology and neuroimaging? It is so painful to witness our unintended neglect in establishing neuroimaging as a subspecialty. This is, first of all, a battle for our own leadership to focus on a subspecialty that has rightful presence in the domain of neurology. At the end of the day, it is best for our patients. Masdeu JC.

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