The Birth of a Section
Although emergency radiology has existed as a quasidiscipline for decades, its modern manifestation as a specialized field in radiology is only about 20 years old, coinciding with the recognition of emergency medicine as a subspecialty, dramatic advances in trauma care, and the emergence of CT as a fast and powerful tool for evaluating acutely ill and injured patients. At NYU Medical Center, until three years ago, radiology services for the Bellevue Emergency Department (ED) were provided by one general radiologist. CT was performed and interpreted in the main radiology department on the third floor of Bellevue Hospital, and Tisch Hospital emergency radiology services were provided entirely by the main radiology department.
Under the guidance of Department Chair Robert I. Grossman, M.D., and Vice Chair for Clinical Affairs and Operations Bernard Birnbaum, M.D., the department’s emergency radiology service dramatically expanded its scope and mission from this one-person operation, which provided limited daytime radiology coverage for the Bellevue ED, to a fully staffed emergency radiology section, providing expertise to both the ED staff and in particular working in close conjunction with the trauma surgery service. As section chief, I have had a challenging and exciting experience overseeing the threeyear gestation of the division of ED Radiology at NYU. The birth process has been at times painful, but the section has definitely arrived, kicking and screaming, and now is well into early adolescence. Like all adolescents, the section — which provides full-body emergency coverage — is now attempting to individuate itself in the context of an entrenched NYU academic culture of organ-based imaging. In the process of attaining our goals, we not only ensure the timely delivery of cutting-edge emergency radiology imaging and consultative services, but also educate our residents in ED radiology, participate in Continuing Medical Education (CME), and perform research in the field.
The Bellevue Hospital Emergency Radiology Department, situated near the main ED, now includes two Philips digital radiography rooms, a conventional x-ray room, a fluoroscopy room, and a Philips four-slice multi-detector CT scanner, as well as a dedicated reading room with multiple PACS reading stations. The Tisch Hospital Emergency Radiology Department, strategically located across the hall from the main ED, includes a digital radiography room, a Siemen’s Sensation 16-slice CT, and a spacious reading room with multiple PACS reading stations. The presence of full-service radiology facilities, staffed with dedicated radiologists in the ED, ensures rapid imaging of ED patients, timely interpretation of studies, and, critically, the availability of radiologists for consultation by the clinical staff. This represents a major improvement in communication with clinical services, has contributed to shortened length of stay in the ED, and has generally enhanced patient care. In particular, the presence of on-site ED radiologists has been received with great enthusiasm by the clinicians, and has markedly enhanced radiology resident training and supervision.
The ED Radiology section is now composed of four dedicated, full-time radiologists. Assembling a team of multitalented and motivated physicians who are not wedded to imaging a specific organ system, or a specific modality, or, for that matter, to the notion of a “9-to-5” job, has proven critical to the success of the section. On this account, we have been extremely fortunate, and I would like to take this opportunity to offer brief profiles of these gifted individuals.
(left to right) Mark P. Bernstein, M.D., Haskel Fleishaker, M.D., Melvyn A. Feliciano, M.D., Alexander B.
Baxter, M.D.
Melvyn Feliciano, perhaps the most colorful member of our section, spent time as a research assistant in Paleo-oceanography, climatology, and molecular psychopharmacology before hearing the call of medicine. Dr. Feliciano completed his radiology residency training in 1994 at Montefiore Medical Center, and stayed there for an additional year of neuroradiology fellowship training under Jacqueline Bello, M.D. Following a brief stint in private practice, Dr. Feliciano returned to the academic fold to complete a Body Imaging fellowship at the Hospital of the University of Pennsylvania with Beverly Coleman, M.D., and Dr. Birnbaum. With a strong background in both neuroradiology and body imaging, Dr. Feliciano found himself uniquely qualified for, and increasingly interested in, traumatology, a developing field specifically concerned with the diagnosis and treatment of the multiply injured patient. Dr. Feliciano’s prior faculty appointments include University of Medicine and Dentistry of New Jersey–Cooper University Hospital, the sole Level 1 trauma center for Southern New Jersey, and acting section chief of ED Radiology at the Hospital of the University of Pennsylvania, where he further honed his traumatology skills. Dr. Feliciano’s outstanding clinical and teaching skills, burnished by his prior experience running an ED Radiology Section, have made him a key player in the section.
Mark Bernstein completed a Craniofacial Imaging Research fellowship at the University of Toronto in 1997 before realizing that he preferred imaging to plastic surgery, his original career choice. Dr. Bernstein completed his radiology residency at the University of Western Ontario in 2002, followed by a fellowship in Trauma/Critical Care Radiology at the University of Maryland Shock Trauma Center in Baltimore, under Stuart Mirvis, M.D., and Kathirkama Shanmuganathan, M.D. Dr. Bernstein’s interests include the growing role of multi-detector CT (MDCT) in the evaluation of blunt and penetrating trauma, with a specific interest in the assessment of spinal and vascular injuries. Since joining our section, Dr. Bernstein has played a pivotal role in updating MDCT trauma protocols and developing a multidisciplinary algorithm to “clear” cervical spine studies. Currently, he is examining the utility of flexion/extension radiography in the evaluation of cervical spine trauma. Dr. Bernstein is also actively involved in resident education, and has initiated a biweekly joint Trauma-Radiology conference. Having trained at the same institution as Maurizio Miglietta, D.O., Chief of Trauma Surgery and Critical Care Director at NYU, and sharing a similar philosophy, Dr. Bernstein brings an added dimension to our relationship with Trauma Surgery.
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