1213
Derek Harwood-Nash
International Fellowship Application
820 Jorie Boulevard  Oak Brook, IL 60523
ELIGIBLE APPLICANTS must have completed their formal radiology training (MD or equivalent) and have held a
faculty position in an academic institution for no less than 3 and no more than 10 years. Please complete the form,
save it to your computer and send it to CIRE@rsna.org, preferably as a PDF attachment. The following documents
are also required to complete your application. Signed documents are to be forwarded as PDF attachments or
mailed to arrive by the application deadline.
Deadline: July 1, 2012







A copy of your curriculum vitae (please send this document as an e-mail attachment)
A letter from your home institution that describes what institutional needs will be met by study in
North America
A letter from the national radiologic society of your country confirming current membership and/or
attendance at its meeting in the past two years
An additional letter of reference (optional)
Proof of proficiency in English- a TOEFL or equivalent test score taken within the last two years.
For applicants of countries where English is an official language, no TOEFL test is required, but the
letter from your home institution must attest to your verbal fluency in English.
A documented list of academic productivity, research, and involvement in trainee education
A 400-word personal statement (see page 2)
Please provide the following information:
Degree:
MD, PhD,
Other
Last Name
First Name
Mailing Address
Date of Board Certification
Name of Home Institution
Number of beds
Number of radiology residents
Institution Phone
Fax
Home Phone
E-mail
Date of Birth
Name of Medical School
Graduation Date
Location of Residency Training
Completion Date
Location of Additional Training
Completion Date
Please indicate the medical societies to which you belong:
How long have you held a faculty position in a teaching hospital?
Page 1 of 4
Indicate your language fluency:
Languages I speak
Languages I read
Languages I write
Please give us your proposed dates for the start and end of this fellowship course of study (in 2013):
Start Date
Stop Date
I would like to study at the following institution(s) - [If more than one, please list them in order of priority]:
1)
2)
3)
Please indicate your area of special interest in radiology:
Please briefly describe your responsibilities at your teaching institution:
Name, address, and fax number for your department’s training director:
Please give any other information you believe would assist the Committee on International Relations and Education in its
selection:
Provide a 400-word personal statement that covers the following points:
 Specific educational needs and objectives that can be met only by a course of study in North America
 Specific plans for using the knowledge and experience gained to benefit and improve the practice of radiology in
your home institution and radiologic community
Please note that your personal statement is an important part of your application.
Personal Statement:
This form is available online at: http://www.rsna.org/DHN
For further information, please contact staff at:
CIRE@rsna.org
The application will not be considered complete unless the
application form and all supporting documents are received in one
of the following formats:
o PDF attachments, emailed to: CIRE@rsna.org
o
hard copies, mailed to arrive by July 1, 2012
Radiological Society of North America
DHN – Attention: Department of Research
820 Jorie Blvd
Oak Brook, IL 60523
USA
Page 2 of 4
HOST INSTITUTIONS AND SPECIALTY AREAS
RSNA DEREK HARWOOD-NASH INTERNATIONAL FELLOWSHIP
Institution
Specialty
Brown University/Rhode Island Hospital
Providence, Rhode Island
Pediatric Imaging, Body Imaging, Vascular &
Interventional Radiology, Ultrasound, Thermal Oblation
Services, Emergency Radiology, Nuclear Medicine
Brigham & Women's Hospital
Boston, Massachusetts
Abdominal imaging, Neuroradiology,
Oncoradiology, MSK Imaging, Mammography
Case Western Reserve University & University
Hospitals Case Medical Center
Cleveland, Ohio
Abdominal Imaging, Thoracic Imaging, Nuclear Medicine,
Mammography, MRI, Neuroradiology, Pediatric Imaging,
Angio-Interventional Radiology, Musculoskeletal Imaging
Children's Hospital
Boston, Massachusetts
Pediatric Neuroradiology, Pediatric Head & Neck
Radiology, All Pediatric Subspecialties
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Pediatric Neuroradiology, Pediatric Thoracic and
Abdominal Imaging, Pediatric Musculoskeletal Imaging,
Pediatric Interventional Radiology
Children’s National Medical Center
Washington, D.C.
Pediatric Radiology, Pediatric Ultrasound, Fetal Imaging,
Pediatric Nuclear Medicine, Pediatric CT / MRI
Columbia University Medical Center
New York, New York
Functional MRI, Neuroradiology, Pediatric Radiology,
Nuclear Medicine / PET
Duke University Medical Center
Durham, North Carolina
Cardiothoracic Imaging
Emory University School of Medicine
Atlanta, Georgia
Abdominal Imaging, Neuroradiology
Hahnemann University Hospital
Philadelphia, Pennsylvania
Neuroradiology, Ultrasound, Cross-Sectional Imaging
Indiana University School of Medicine
Indianapolis, Indiana
Abdominal Imaging, Neuroradiology, Breast Imaging,
Nuclear Medicine, Pediatric Radiology
Johns Hopkins Hospital and University
Baltimore, Maryland
Pediatric Neuroradiology, High-end Pediatric MR Imaging,
Pediatric Uroradiology, Pediatric Ultrasonography
Lahey Clinic
Burlington, Massachusetts
Magnetic Resonance Imaging, Mammography,
Nuclear Medicine & PET, Body Imaging
Louisiana State University HSC
Shreveport, Louisiana
Interventional (non-vascular), Neuroradiology,
Nuclear Medicine, Cross-Sectional Imaging
Mallinckrodt Institute of Radiology
St. Louis, Missouri
Interventional Radiology
Mayo Clinic
Rochester, Minnesota
Abdominal Imaging, Neuroradiology, Vascular
Interventional Radiology, Nuclear Medicine,
Thoracic Radiology
Mount Sinai School of Medicine
New York, New York
ENT Radiology, Hepatobiliary Disease,
Liver Cancer – Chemoembolization,
ttrium 90, Radiofrequency Ablations
Mammography/Breast Imaging, Neuroradiology,
Pediatric Radiology/Ultrasound, Vascular and
Interventional Radiology
Page 3 of 4
Institution
Specialty
Nationwide Children’s Hospital
Columbus, Ohio
Pediatric Radiology, Pediatric Interventional,
Pediatric Ultrasound, Pediatric MR & CT,
Pediatric Oncologic Imaging
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Diagnostic Ultrasound, MRI,
MSK Radiology
University of California, San Diego
San Diego, California
Musculoskeletal Imaging, Interventional Spine,
Vascular & Interventional Radiology
University of Florida
Gainesville, Florida
Cardiac Imaging
University of Maryland Medical Center
Baltimore, Maryland
Thoracic & Cardiac Radiology, Trauma,
Nuclear Medicine PET-CT, MSK, Abdominal
University of Michigan
Ann Arbor, Michigan
Thoracic Radiology,
Thoracic Cardiovascular CT and/or MRI
University of Rochester
Rochester, New York
Ultrasound, Body MRI & CT, Photoacoustic Imaging
University of Texas Southwestern Medical
Center / Children’s Medical Center
Dallas, Texas
Pediatric Neuroradiology
University of Virginia
Charlottesville, Virginia
Chest, Abdomen, Pelvis, CT, Body MR,
Non-Vascular Invasive Procedures, Ultrasound Imaging
Wake Forest University
Winston-Salem, North Carolina
Mammography/Women’s Imaging,
Interventional Radiology
Wayne State University /
Detroit Medical Center
Detroit, Michigan
Pediatric Radiology, Neuroradiology,
Trauma Radiology, Body Imaging
William Beaumont Hospital
Royal Oak, Michigan
Neuroradiology, Vascular/Interventional Radiology,
Breast imaging
Page 4 of 4