How is your programs IR experience?

[werewethere]

To DR residents and IR fellows:
How is the IR at your home program? What could be better? What is great? Residents, how do you keep up your skills when you're off IR service? Fellows, how do you keep your diagnostic skills up? Any tips for what to look for, especially for the M4s applying to DR and looking for a good IR experience? What are good places for IR training?

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[Reza Rajebi]

Hi,

We have 3 IR attendings all 100%. Currently, they are interviewing for 4th IR. There is a NP who does small cases such as Para, Thora, PICC placement and port removal. She is extremely friendly and teaches a lot. In my first rotation I spent some time with her to refresh my basic skills and get ready for bigger cases.

There is a great variety of cases for a mid-size academic program. We have a great Oncology and Onco Surgery program in our hospital, so there is a lot to do with Onco cases. Lots of fistula and renal work. Being a trauma center, we deal with so many splenic and pelvic embolization cases. Unfortunately, we don't do that much vascular work as of most of other places.

We do the consults and if somebody does the consult, they also do the procedure and followup that case.

There is also a great deal of CT-guided chest and mediastinum biopsy available through out thoracic section which is really helpful to learn CT-guided procedures.

An outpatient clinic has been recently started. However, we are trying to change this to a resident-run clinic. It is hard to get people involved but we are hopeful.

In terms of keeping our skills up and learning new skills, we recently found out about a great surgical lab in our institution with ultrasound machines and etc., so, we go up there and do microcath punctures and wire changes.

I wish we had more research opportunity in our program. I mean randomized prospective studies. As someone who is interested in clinical research and looking for a research-based career, I think we should do more standardized prospective studies in IR.

 

[werewethere]

Hi,

We have 3 IR attendings all 100%. Currently, they are interviewing for 4th IR. There is a NP who does small cases such as Para, Thora, PICC placement and port removal. She is extremely friendly and teaches a lot. In my first rotation I spent some time with her to refresh my basic skills and get ready for bigger cases.

There is a great variety of cases for a mid-size academic program. We have a great Oncology and Onco Surgery program in our hospital, so there is a lot to do with Onco cases. Lots of fistula and renal work. Being a trauma center, we deal with so many splenic and pelvic embolization cases. Unfortunately, we don't do that much vascular work as of most of other places.

We do the consults and if somebody does the consult, they also do the procedure and followup that case.

There is also a great deal of CT-guided chest and mediastinum biopsy available through out thoracic section which is really helpful to learn CT-guided procedures.

An outpatient clinic has been recently started. However, we are trying to change this to a resident-run clinic. It is hard to get people involved but we are hopeful.

In terms of keeping our skills up and learning new skills, we recently found out about a great surgical lab in our institution with ultrasound machines and etc., so, we go up there and do microcath punctures and wire changes.

I wish we had more research opportunity in our program. I mean randomized prospective studies. As someone who is interested in clinical research and looking for a research-based career, I think we should do more standardized prospective studies in IR.

Sounds good. How many rotations do you get to do during four years?
What kinds of cases have you been assisting in? Primary operator in?

 

[Reza Rajebi]

It depends how much we are interested in IR. My program is really great in scheduling the rotations we want. Obviously you have to do minimum months of some rotations as per the ABR but otherwise we can ask for more rotations in this or that.

Regarding cases, I am a second year resident so I am new in IR department but I have done PICC, Para, Nephrostomy, abscess drainage, and CT guided chest and liver biopsy as primary. I've also deployed multiple coils for GI bleeding and varicocele.

In terms of assisting, any case that comes into the department and I am there, I'll go in and do as much as I can. At this point, all cases are amazing to me. I guess that is why I love IR.

RR

 

[IRmonkey]

At my instiution interventional is divided up. A group of 12 radiologists belong to the traditional vascular IR group. They perform a fair amount of interventional oncology (Y-90, TACE, etc), Peripheral arterial work, vein work, hepatobiliary, interventional urology, embolizations, etc. About half of them see patients in clinic at the vascular medicine center. We typically ahve 1-2 fellows and the residents are able to work with staff 1-on-1 (of course it is variable on how much we do depending on the staff and procedure).

The US group performs the paras/thoras and any of the other procedures performed with US-guidance. They also perform all of the ablation procedures -which are numerous- performed with either US or CT guidance.

The neuroradiology group is also very active and performs the kyphoplasties, does the head/neck angio cases, and biopsies/ablates anything involving the head/spine. They are quite aggerssive in their case selection and do some amazing stuff.

There are also a few radiologists that almost exclusively do spine/pain intervention.

As residents we rotate through VIR for 3 consecutive months. During that time we rotate call with the fellow(s). We also are able to do procedures when we rotate through the different modalities: US -biopsies/paras/thoras, CT - ablations/biopsies/drains/etc, neuro - myelos/cerebral angio/kyphoplasty, MSK - joint injections/aspirations.

We have a very active/aggressive US group that does nearly all of the ablation (cryo, RF) as well as the paras/thoras, US-guided biopsies/drainages etc. CT-guided proceduers are performed by much of the same staff. Some of the VIR staff also perform the US/CT-guided procedures.

There are some very active interventional researchers with interests that cover high-end basic science, kyphoplasties, IR/Onc/immunology, MR-guided interventions/ablations, ablation research, CT-US fusion research, HIFU fibroid ablation, etc.

 

[omarsaleh66]

University of Mississippi -Jackson MS

IR here is very strong for the residents. No fellows so we get to do all the cases. IR does about 20-25 cases a day, ranging from routine PICC, drains, biopsies, PCNs, fistulograms to more advanced cases like TACE, SIR Spheres, UFE, etc.. We are very weak in PAD as vascular surgery here is very dominant but we do a little PAD work, no aortas. Residents here get to do alot of VIR. Typically we get 4 months VIR and 2 month NIR. Since I am going into IR, I did 6 months VIR, 2 months NIR and am scheduled to do a vascular surgery month later (to get some PAD exposure and some noninvasive vascular lab experience.)

Our Chair is an IR and very well known in the IR community and that really helps when u need a letter for VIR fellowship.

Off service, I like to keep my IR skills up by scrubbing into cases late in the day, or during easy rotations I get away and do some cases. Im on peds this month (easy rotation so this week, I did 2 cerebral angios, gtube, LP, adrenal vein sampling, IVC filter and gonna try to do a UFE tomorrow. If u do this u can rack up fellow like numbers throughout your residency. I think I got 600 atleast.


My advice is to go to programs where there is strong IR service but no fellows so u can develop some serious skills. We also take IR call for a year so we come in and do cool trauma cases, GI bleeds, neuro cases (sometimes), etc... If u are really hardcore, u might want to take your co-residents IR call and come in and do more cases. All of this isnt necessary, but I love IR, its like playing a video game!!!

Im interviewing for fellowships right now, and some people like extra IR experience, and some places dont care and will train you from scratch, so dont feel obligated to do this but it cant hurt!!!

Other great places to train for IR are San antonio, and arkansas - when I interviewed, I saw residents doing insane procedures, more hardcore than us. These places have fellows, but residents get to do alot!!!

To DR residents and IR fellows:
How is the IR at your home program? What could be better? What is great? Residents, how do you keep up your skills when you're off IR service? Fellows, how do you keep your diagnostic skills up? Any tips for what to look for, especially for the M4s applying to DR and looking for a good IR experience? What are good places for IR training?