No. I am not an interventionist by any stretch of the imagination. But, I do have a clue about how best for you to succeed in this rotation. Let’s call it years of experience and intuition based on our interventional radiology rotations’ best residents. On this note, we will get back to the How To Succeed series this week once again, this time in Interventional Radiology.
When we compare interventional radiology to other subspecialties, we find that it has less in common with other radiology areas. Why? Because it overlaps more with many of the features of other surgical subspecialties. So you will need to change your mentality a bit to succeed on this rotation. Let’s delve into the specifics of what you need to succeed on this rotation and how you can adapt to the new expectations. First, we will talk about reading materials and the basic mechanics of what you will need to do. Then, we’ll talk about when you should learn the different aspects of interventional radiology.
Reading Materials
Fortunately for some and unfortunately for others, reading plays a little bit less of a role in this subspecialty rotation in the traditional sense. Of course, you will need to read about cases and how to perform them. But, the majority of what you need to know for this rotation is experiential. For example, the best way to get to know the wires for a fistulogram is to use them. The most salient way to understand the angle you need to use to approach a liver biopsy is to do it.
No amount of reading will allow you to translate all of what you need to know to a successful procedure. You need to watch, then perform with guidance, and finally complete a technique on your own. There is almost no way around it. Therefore, your goal on this rotation should be to get into as many cases as possible.
Background Reading
Even though reading is not the central focus of this rotation, I will give you some of the background reading resources that some of my successful interventional residents have used. These include readings in the newly written book called Vascular Interventional Radiology- A Core Review. Other resources that our residents use are Core Radiology and the Vascular and Interventional Case Review Series. Finally, one of my former residents (now an interventional resident) recommended taking a look at a book called Image-Guided Interventions. This book would be more for the gung-ho budding interventional radiologist, but it is another option. You can click on any of these Amazon links if you are interested in purchasing these books (I am an Amazon Affiliate and get a small percentage).
Other successful residents will google all the devices, wires, and other hardware every time they use one. All successful residents are sure to look up information on significant cases the day before they perform them if they can!
Fundamental Doctrines Of Interventional Radiology
Here are some general guidelines for interventional radiology residents to maximize their interventional radiology experience.
Consent All Patients Early
Every single one of my successful interventional residents has said the same thing, “You need to make sure to consent patients as early as possible before a procedure!” If you cannot consent your patients before the procedure, you will not have the appropriate history that you will need. And, your prep time will be taken by having to consent these patients. This consenting process will interfere with you getting into other procedures during the day. And, a vicious cycle ensues. What does this mean? You will need to get up very early to start the process before the day’s procedures begin. There is no way around this!
Build Trust With Your Attendings
In interventional radiology, you will need to build trust with your faculty, more so than in almost any other specialty. And, the reason is self-evident and straightforward. These radiologists are the key to allowing you to do more and get more “hands-on” experience. If a faculty member does not trust you, you will not get any opportunities to perform procedures. So, listen carefully to what your attendings have to say. And follow their instructions. Most importantly, do not forget to do something that they ask. I guarantee that being lackadaisical will ruin your entire experience!
Get Into As Many Interventional Radiology Cases As Possible
If you are interested in performing well in interventional radiology, your days will be non-stop. You will need to get yourself involved in almost all the procedures that you can. It’s the experience that counts, and there is no way around it. Why? Because to understand how to complete cases, you need to see them and do them. You do not want to become an attending and perform a manual procedure that you have never seen or performed!
Therefore, for this rotation, you may not want to take too long of a pause in the break room. There is time for that when and if you become an interventionist. Now is the time, however, to keep the department moving so that you can get into the next case! So, help get patients in and out of the department, take histories, and get consents. It’s the only way to maximize your case time!
Read The Night Before
Finally, any interventionist worth their salt will tell you that you need to read about the procedure and the disease entities the night before. Look up the disease entity, the history you need to get from the patient, the technique, the wires needed to complete the procedure, and how to finish it. You will enjoy what the interventionist is doing much more the next day because you will understand the whole process. Furthermore, your attendings will be impressed with all the information that you know. Even though you may be exhausted the night before, you should never skip this step!
Guidelines For Each Year Of Interventional Radiology
Year One
Just like surgical interns, you need to get to know the basics before heavily getting involved in the procedural aspects of interventional radiology. The first year is the best year to learn how to consent, take an appropriate interventional history, make orders, do tube rounds, and discharge patients. You need this background to get to the next step!
Of course, many of you will get to start doing some procedures, but there is a lot more to interventional that you need to know. You should learn all these other tasks in your first year as a background for the rest of your time in interventional radiology. Reading about procedures or learning about cases the night before is also vital, even though you may not get to help out as much with the manual techniques this year.
Years Two And Three
During these two years, you should learn the “bread-and-butter” procedures of interventional radiology. Get involved in all sorts of biopsies, PICC lines, catheter placements, and nephrostomies. These are the sorts of procedures that your attendings will allow you to do more, especially if you have established their trust. And, you will build up your repertoire slowly. These are procedures that you should be able to perform as a general radiologist when you leave residency. Make sure to learn them well and execute them many times!
Year Four And Beyond
Year four is the time to get involved in the bizarre, complex, and engaging. Help out with oncology cases, stent placements, uterine fibroid embolizations, and neurointerventional procedures. Get a sense of some of the more intricate techniques. These rotations may be the last time you will get a chance to see the more esoteric aspects of interventional radiology. But, the experience will be invaluable!
Completing Your Interventional Radiology Rotations Successfully
Anyone who says that their interventional experience was easy will probably not maximize their opportunities to learn the subspecialty. To understand what you need to know and be successful, you should be busy in interventional radiology. You should actively take histories, consent patients for procedures, read up on patients/diseases, and get into as many cases as you can. There is no way around it. Experience is the crucial element of this subspecialty, and you desperately need it to succeed. You can not get ahead by sitting back on this rotation. So, take advantage of the opportunities that your residency affords you. Regardless of whether you go into interventional radiology as a career, this experience will go a long way to making you into a well-rounded radiologist!
