Description:
The vascular and interventional radiology rotation hopes to teach the resident basic angiography and image guided techniques, as well as interpretation of the imaging involved.
General Goals:
- To become familiar with the indications, contraindications, technique and expected benefits of interventional diagnostic and therapeutic procedures.
- To develop a level of technical proficiency.
- To learn to avoid complications, by technique modification, caution, common sense, etc. Learn the management of complications when they occur.
- To develop an appropriate, professional communication style when dealing with patients and families.
- To learn and practice radiation safety (ALARA principle) while operating the appropriate imaging equipment for interventional procedures.
- To communicate well, develop a descriptive ability that is concise and function as a true consultant when dealing with colleagues and referring physicians.
- To master vascular anatomy, normal, variant and pathological, as well as the pertinent imaging techniques and findings on all modalities used in IR including the principles, applicability and limitations of MRA and CTA.
- To realize and master the periprocedure aspects of IR cases, especially, the pre-procedure consultation, procedure planning and goals, the procedure performance and interpretation, and the post-procedure care and management of the patient.
Specific Goals:
To have performed (under supervision) basic interventional procedures.
- Basic angiography – femoral arterial and venous puncture, master the safe handling of catheters, flushing, injecting, connecting, power injection, manipulation and exchanging including the obtaining of hemostasis following arterial and venous procedures, and supervision of image acquisition.
- Image guided (Fluoro, US, CT) procedures; including a) biopsy techniques, including coaxial access systems and other specific biopsy devices, b) drainage of abnormal fluid collections.
- Percutaneous access to the biliary and renal systems.
- To become familiar and competent at conscious sedation and patient monitoring.
Responsibilities:
- Starting time is 7:45 a.m. sharp.
- Prior to the day’s procedures, scan the day’s cases and discuss with the fellow or attending physician the most suitable schedule and use of rooms/facilities, etc.
- The resident should evaluate the patient, which includes reviewing the history, indications for the procedure, pertinent labs, previous relevant imaging, interviewing the patient and obtaining full informed consent.
- The patient evaluation together with a directed physical examination and informed consent has to be included in a clear and legible pre-procedural note.
- The resident must maintain their personal procedure log, the IR procedure log (angio reading room), a log of the services’ “active” inpatients that need continued follow-up and any IR department research related data collection sheets that need completion and dictate the cases he/she is involved with following review with the relevant attending.
- The resident must ensure that all relevant pre-procedure medications have been requested and administered (e.g., many procedures require antibiotics prior to commencement; therefore, anti-infective orders need to be written).
- There are a number of conferences which the IR team attends and presents at, including Surgical M+M (Thursday mornings) and Vascular Conference (Wednesday afternoons). The resident should coordinate the imaging of the patients to be presented and gain valuable experience in presenting the interesting cases.
- With respect to both on-call and daytime cases, the resident must obtain the relevant information, discuss the request with an attending, relate the decision to the requesting service and coordinate the case staffing.
Above all, the resident is not on service purely for the purpose of paperwork and consenting patients. At the end of the rotation the resident should have gained useful knowledge and experience from their hard work and, hopefully, have enjoyed their time in the angio/interventional section. The interventional radiology service is a team effort, and both the fellow and attendings will always share and help with the service’s tasks and aid the resident at all times.
Reading List:
Textbooks:
- Cope C, Burke DR, Meranze C: Atlas of Interventional Radiology. JP Lippincott, New York, 1990.
- Kadir S, Diagnostic Angiography. WB Saunders Co, Philadelphia.
- The SCVIR Syllabus Series
- Peripheral Vascular Interventions
- Visceral and Thoracic Arteriography and Interventions
- Portal Hypertension
- Venous Interventions
- Biliary Interventions
- For reference: Abrams Angiography 4th ed. Little Brown and Co.
Journals:
- Journal of Vascular and Interventional Radiology
- Cardiovascular and Interventional Radiology
- American Journal of Roentgenology
- Radiology
Multimedia:
- SCVIR Interactive Videodisc Training Programs
- Peripheral Vascular Disease
- Peripheral Vascular Interventions
- Portal Hypertension
- Venous Interventions
- Biliary Interventions