Tag: interventional radiology

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How To Succeed In Interventional Radiology

interventional radiology

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 return to the How To Succeed series this week again, this time in Interventional Radiology.

When we compare interventional radiology to other subspecialties, it has less in common with other radiology areas. Why? Because it overlaps more with many of the features of other surgical subspecialties. So, it would help if you changed your mentality to succeed on this rotation. Let’s delve into what you need to succeed on this rotation and how you can adapt to the new expectations. First, we will discuss reading materials and the basic mechanics of what you must 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 must read about cases and how to perform them. But, most of what you need to know for this rotation is experiential. For example, using the wires for a fistulogram is the best way to learn about 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 everything you need to know to a successful procedure. You need to watch, perform with guidance, and finally complete a technique independently. 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 background reading resources that some of my successful interventional residents have used. These include readings in the newly written book Vascular Interventional Radiology- A Core Review. Our residents also use Core Radiology and the Vascular and Interventional Case Review Series. Finally, one of my former residents (now an interventional resident) recommended looking 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 to purchase 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 will 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 your getting into other procedures during the day. And a vicious cycle ensues. What does this mean? It would help if you got up 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 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 cannot 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 want to perform well in interventional radiology, your days will be non-stop. You will need to get involved in almost all the procedures you can. The experience counts, and there is no way around it. Why? Because to understand how to complete cases, you need to see and do them. You do not want to become an attending and perform a manual procedure you have never seen or performed!  

Therefore, you may not want to pause in the break room for too long for this rotation. 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 must read about the procedure and the disease entities the night before. Look up the disease entity, the history you need from the patient, the technique, the wires required to complete the procedure, and how to finish it. You will enjoy what the interventionist is doing more the next day because you will understand the whole process. Furthermore, your attendings will be impressed with all that you learned. 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 know the basics before getting heavily 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. As a background for the rest of your time in interventional radiology, you should learn all these other tasks in your first year. 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

You should learn the “bread-and-butter” interventional radiology procedures during these two years. Get involved in biopsies, PICC lines, catheter placements, and nephrostomies. These are the procedures your attendings will allow you to do more, especially if you have established their trust. And you will build up your repertoire slowly. You should be able to perform these procedures 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 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 see the more esoteric aspects of interventional radiology. But the experience will be invaluable!

Completing Your Interventional Radiology Rotations Successfully

Anyone who says 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 possible. 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 in making you a well-rounded radiologist!

 

 

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Can I Practice Radiology With Color Blindness?

color blindness

Question:

Does having partial red-green color vision deficiency hamper the chances of a resident to pursue Interventional Radiology? Or will it even prevent me from applying for the post of a professor after completing MD Radiodiagnosis?

Color Blind Future Radiologist

Answer:

Dear Color Blind Future Radiologist,
Fortunately, most interventional procedures, you can view in black and white. And, that same rule also applies for most of the radiology field, interventional and non-interventional. Usually, we look at images without color overlay when reading CT scans, plain films, MRIs, and fluoroscopy.
Moreover, you can change the color settings on the software of most equipment such that you can avoid the pitfalls of red-green color deficiency. Even color doppler ultrasound and nuclear medicine (the most color driven modalities) usually have different color settings. In these colorful modes, you should be able to set it so that you see the information appropriate for your eyes.  So, you should be able to get around the problem.
However, there is one caveat. It is critical to notify your faculty about your color blindness to ensure that they change the settings on the equipment. Don’t be shy about bringing this issue to their attention. You will only be hurting yourself. If you let them know up front, you can look at the images in a color scheme that you can read. In the end, it is possible to become a full-fledged radiologist with a partial color blindness deficiency!
Instead of worrying about color blindness, most importantly, now you can concentrate on improving your application. Since IR has become so competitive, you can spend your time on what matters, garnering a spot in a field with few positions. And, no longer do you have to worry about how partial color blindness will affect their selection of you as a candidate!
Regards,
Barry Julius, MD

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I Am A Foreign Grad And Want Interventional Radiology… Help!!!

want interventional radiology

Question For Residency Director

Dear Dr. Julius,

First of all, thank you for writing up this excellent blog. I found the ‘choosing fellowships’ section to be of highly beneficial to me. But even after that beautifully written post, I am still undecided. I am currently a radiology resident in the UK. And, I am keen to apply for a fellowship in the USA(I have completed my USMLE). I like working with my hands. Moreover, I think that I am talented. I understand that the traditional interventional radiology fellowship will no longer be available by the time I am eligible to commence my fellowship (2021).

Now, I am quite interested in neurointerventional radiology. By 2021, I would have completed a five years residency in the UK (3 years in general radiology and two years in neuroradiology). Realistically speaking, what are my chances of getting into a two-year fellowship in neurointerventional radiology being a foreign medical graduate? I understand that it is a competitive fellowship. Also, what kind of interventions do I get to perform by doing a body fellowship?

Many thanks for your help!

 

Answer:

Azygos Lobe,

Unfortunately, all those years in the UK are not directly transferrable to the United States requirements. So, you are stuck with one of two possibilities in the United States. First, you could look to satisfy the alternate pathway requirements. However, interventional fellowships of any sort have become the most competitive of them all in the United States. Even though you may want interventional radiology, getting a slot as a foreign grad may be next to impossible. And, if you were to find one, you may not satisfy the requirements for licensure in many individual states within the U.S. when you completed your fellowship and looked for work here. Therefore, that would be a tough road to choose.

Second, you could theoretically apply to repeat your clinical and radiology residencies in the USA. But, that would mean an additional five years of training.  And, then you could ask for a fellowship in interventional for a year or two (Depending on whether the program has ESIR)

And finally, the most unlikely option, you can apply directly to the IR/DR residencies. But again, only a few accepted applicants were foreigners because it has become one of the most competitive residencies in the match.

To sum up, your options are a bit limited. For your best chances, I would apply to the US residencies and start anew. That would involve many years but would be the most likely scenario to succeed. It would be a tough road to follow.

Body Fellowship For Interventional Practice

In terms of the body fellowship, depending on the location, you may encounter a bit of interventional variability. Some programs do more biopsies and drainages. Others may have a mammo/breast component. And, even others may have a small interventional/vascular element. It comes down to the individual program practice patterns. So, you need to ask around before committing to any particular body fellowship.

Let me know if you have any other questions,
Barry Julius, MD

 

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ESIR Programs: Let The Buyer Beware

Radiology programs, radiology program directors, Early Specialization In Interventional Radiology (ESIR) directors, and residents interested in interventional radiology are dealing with a mini-crisis. For years, programs have allowed residents to make a choice to start an interventional fellowship several years into residency. Instead today, new residents face the crunch of having to make this decision to join up with ESIR programs right away. And, they should not take this decision lightly. Why? Well, that is exactly what we are going to discuss today!

So, What’s The Urgency, Huh?

Like anything else in the world, when you have limited supply and excess demand, you create bottlenecks. And, unfortunately, in many programs across the country, the number of ESIR spots available does not equal the number of residents interested in the program. Therefore, this problem exists in some programs, right here right now.

So, if a program has two residents interested in this program, but it only has one spot available, the program director needs to make the final decision by either one of two methods. First, the program can decide on a first come first serve policy. But, let’s say that you have two residents that decide they want to join a program at the same time. Well then, that leads us to the other way to decide. And, that would be a long drawn out application process to determine the most “qualified” applicant.

Either way, this puts pressure on the applicant and the program to make a decision pronto. As you now understand, the resident and program need to make rushed decisions together.

Why Can This Decision To Join ESIR Have Permanent Implications?

OK. First, I will mention the positive. ESIR programs allow residents throughout the country to decrease the number of years of a fellowship from two to one. And, these residents will be able to hit the proverbial ground running at their interventional fellowships from the very beginning. But, at what cost?

Problem 1

Here comes the tough part. ESIR programs need to allow residents to complete approximately one year of interventional related activities during radiology residency. So, where does the time come from? It has to come from somewhere, right? Well, here is the rub. Programs need to draw the time allotted to ESIR from the normal diagnostic radiology activities. So, residents that complete an ESIR program have less overall experience in the standard rotations like MRI, ultrasound, etc. And therefore, the training of an ESIR resident is not truly equivalent to a standard diagnostic radiology resident.

So, what are the implications of this? In the workforce still, most practices need radiologists that can perform interventional radiology (IR) but can also help out with some of the general work. Well, residents that start a typical IR job will not have the same experience and comfort level with general radiology practice. As you can see, this creates a serious problem for the ESIR graduate.

Problem 2

Unfortunately, the problems do not end here. Let’s say that you start the ESIR program. And then, you then apply for fellowship toward the end of residency. Due to the changes in allocated slots for interventionalists with new DR/IR programs, ESIR programs, and “independent fellowships”, fewer residents can easily drop out of interventional radiology during residency. So, fewer spaces become available for interventional programs throughout the country. And therefore, you, as an ESIR applicant to fellowship, may have a lower likelihood of gaining admission to an interventional radiology fellowship than residents applying in prior years.

So, who is to say for sure that you can obtain an interventional fellowship after residency as an ESIR applicant? In this case, theoretically, ESIR programs have now doubly screwed this resident. First, they completed a program for which they have a real chance of not completing the required CAQ certification. And second, they have less diagnostic radiology experience.

Problem 3

Many folks that want to do interventional radiology really do not know what they want to do until they have completed several IR rotations. So, what happens if the ESIR program resident decides that they do not like interventional radiology toward the middle or end of their residency? Well, they potentially have prevented another interested applicant from getting a spot. In addition, they have again decreased their own training in diagnostic radiology- a lose-lose situation. They will potentially graduate as a “second-rate” diagnostic radiologist.

Bottom Line For The Applicant To ESIR Programs

For those of you applying to ESIR and know for sure that you want to do interventional radiology, well then, go for it. But, I have a sneaking suspicion that many ESIR applicants are not in this category. So, if the program offers you a choice to apply for an ESIR program, make sure to think twice. The implications of joining this program can be far-reaching for the rest of your career!