Call

Call

• Call starts and ends officially at Friday 8 AM

• However, since the Call Fellow is typically the CT procedure fellow during the week, it makes most sense to switch the pager over at the end of the day on Friday (5pm) since many inquiries regarding procedures will come during the day on Friday while the fellow finishing call week will still be doing CT/US biopsies/aspirations. 

• Please sign out the pager (36321) to yourself on Friday before your call weekend (dial “0” on any in-house phone or 617-726-2000 from any outside line). 

During the entire week, you will be paged to answer protocol questions and occasionally consult on cross sectional studies. You can view images from home using VPN+Visage native, Citrix Epic, Citrix Visage, Citrix VDI, or Epic Haiku – refer to other helpful info (MGB Vitals - Service Now has some instructions on how to set up VPN)

DIAGNOSTIC STUDIES ON-CALL

Originally: On Friday night and/or Saturday, you preview all cross-sectional MSK reading from the top of the list.

Currently (2025): Read CT and MR until you and the attending reach a total of 80 studies. Each attending has their preferences for when and how to do read out, so check with them before call starts on Friday.

Pro-actively contact the staff, as they may have forgotten they are on call.

Make sure you have all your drafts ready prior to your meeting time, unless instructed otherwise by the staff.

SUNDAY and HOLIDAYS please screen all inpatient cases. If the Sunday is followed by a regular Monday, dictate all inpatient cases until noon. If the Sunday is followed by a holiday Monday, dictate all inpatients Sunday and all inpatients Monday until noon. For all other cases, review for urgent findings. If there are urgent findings (abscess, unexpected fracture, etc), please call the responding clinician and dictate the case, documenting the name of the responding clinician, and the time and date you talked to the responding clinician. In general, if you talk to ANYONE about a case, i.e. give a wet read, grab the case and draft it at minimum (if there is no urgent finding) - that way, if there is a discrepancy between what you said and the final read, the correct information can be conveyed.

PROCEDURES ON-CALL:

You may be called to do a procedure in the evening or on the weekends, including emergent aspirations and biopsies. Always evaluate the history, physical exam, clinical tests, imaging, and indications for procedure (including how it will change management) before approving any procedure. If you are unsure, call your staff for instruction on how to proceed.

The most frequently requested procedure is hip/shoulder aspiration for infection. If you are called for an aspiration:

1. Review relevant imaging

a.      If there is no imaging, patient should get something

b. Minimum: XR to check for fracture (Do NOT aspirate a fractured hip).

c.      Also look for radiographic signs of infection.

d. Ideally will need more imaging to justify an aspiration attempt during off-hours (ultrasound, CT or MRI)

2. Review indications for procedure (labs, fevers, chills, other symptoms; what is the onset of pain? has there been trauma?).

3. Discuss with staff and obtain additional imaging, if necessary.

4. Call ED tech manager at 617-726-9048 (or the main ED imaging desk at 617-726-3050) and ask for a fluoroscopy room and tech on Ellison 2. ED tech manager will need patient's name, MRN and referring physician. They will then arrange the room/tech, place patient on call and page you when ready.

5. If it is an ultrasound case, call White 2 US to request a room and a tech to help you.

6. Bring ALL your supplies with you (see below). You can get a consent form in Ellison or White 2.

7. Place the orders and print the requisitions so you have it ready in case you get a sample.

8. When patient gets to the procedure room, check if there are patient stickers in his medical chart for the consent form and samples (otherwise you may need to print them in some front desk area, e.g. Blake CT, or ask someone from the floor).

9. After the procedure, remember to write a brief procedure note in the chart (check the CT Biopsy website to see how you can do it) and deliver the specimens to the lab.

We rarely do BIOPSIES on call, and there needs to be a very good reason to approve one. Most cases would not involve change management if biopsy is done during regular week hours (when the entire team and more resources are available)

1.              Review relevant imaging.

a.      Appropriate indications include: 1, infection in a critical area;  2, tumor with spinal cord compression requiring emergency decompression.

b.      Make sure the biopsy is technically feasible

2.              Discuss with your staff before OK'ing on-call biopsies.

3.              If you decide to proceed with the biopsy:

a.      Check Qgenda to find the IR CT tech on call (Tech schedule > IR > Filter by task > CT IR Call). Call or page the CT tech to coordinate with the IR fellow/attending (you can also find their call schedule/pager on Qgenda) and reserve a CT room. Techs have call shifts 8am-8am, and they have one hour to get to the hospital, so the earliest time you can do a case is 9am, unless you want to do a case before sunrise.

b.      If the patient needs sedation:

                       i.      Make sure the patient has been NPO

                       ii.      MSK radiology does not have a dedicated radiology nurse, so you have to call the IR fellow/attending on call (can also be found on Qgenda) to figure out their schedule to share their nurse  (or call a second nurse, they will let you know).

4. If it is an Anesthesia case (extremely rare, but it has happened before), please note that you need to contact each service (IR fellow, CT tech on call, nurse, anesthesia staff) separately and coordinate all of their schedules to get it done. Probably best to figure out anesthesia schedule first,  then touch base with the IR fellow/attending and CT tech to make sure you have a room, then confirm with anesthesia and everyone else where and when the case would be done. Again, this is extremely unusual (e.g. a possibility could be an urgent infection case in a pediatric patient). Definitely ask for help from other staff to help coordinate it if you need.

NWH procedures - These are rare. forward pager 53690 to your pager after 5pm on Friday. You may be contacted directly by the NWH person on call. Contact your staff to decide what to do. If you decide to proceed contact the ED to arrange the procedure. 617-243-6185.

For a fluoroscopy-guided aspiration you will need:

• Discogram tray (available in Ellison with the On Control trays, top cabinet; there is also a large Tupperware with supplies including contrast, lidocaine, and needles in the GI fluoroscopy room in the far back corner next to cytology).

• 3.5. inch 20 gauge or 18 gauge needle

• Lidocaine

• Iodinated contrast (Isovue, Omnipaque)

• At least 1 10 or 20 mL luerlock syringe (check the tip!)

• Deadhead(s)

• Purple top tube (for cell count - helps avoid coagulation if fluid contains some blood)

• Microbiology and Pathology bags 

• Sterile gloves for you and the Attending 

For ultrasound-guided aspiration you will need:

• Ultrasound Kit (Available in Yawkey 6 fluoroscopy room; Discogram kit does not include sterile towels) 

• Chlorhexidine stick

• Ultrasound probe cover

• 3.5 inch 18 or 20 gauge needle depending on thickness of collection 

• Lidocaine 

• At least two luerlock syringes (10 or 20 mL depending on size of collection) 

• Deadhead(s) 

• Purple top tube (for cell count - helps avoid coagulation if fluid contains some blood)

• Microbiology and Pathology bags 

• Sterile gloves for you and the Attending