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Real life case
- A 50 year old man presents to the emergency department with a history of high speed motor vehicle collision
- CT scan shows a large liver laceration with active bleeding from a hepatic artery branch
- You are the ER doctor on shift and you have managed to stabilize his vitals but the patient is still requiring ongoing blood transfusions
- What is the appropriate management?
- If you said “Surgery”, you would be wrong
- This case will be managed by interventional radiology
Introduction
Interventional Radiology (IR) is a relatively new medical field which performs minimally invasive therapies under imaging guidance. Interventional radiologists are physicians who perform these minimally invasive treatments. IR is currently a subspecialty of Radiology: interventional radiologists have completed a diagnostic radiology residency, followed by subspecialty/fellowship training in IR.
What do we do?
- Vascular/angiography
Coiling of splenic artery pseudoaneurysm
- Peripheral Vascular Disease
Angioplasty and stenting of superficial femoral artery
- Interventional Oncology
Hepatocellular carcinoma can be treated with Transarterial Chemoembolization (TACE) or Radiofrequency Ablation (RFA)
- Gastrointestinal, Genitourinary, Hepatobiliary
Percutaneous gastrostomies, nephrostomies, biliary drainages
- Women’s health
Uterine fibroid embolization: before and after
- Biopsies and Drainages
Diverticular Abscess Drainage
- Musculoskeletal
Steroid injections for pain relief
- Neurointerventional
Basilar artery occlusion treated with angioplasty and stenting
Is IR the right career for me?
- Desire to treat patients and improve morbidity/mortality
- Prefers performing minimally invasive treatments instead of major surgeries
- Strong empathy for patients and interest in patient care
- A team player who enjoys working in a multidisciplinary setting
- Interest in creative problem-solving and “thinking on the fly”
- Preferably also enjoys diagnostic radiology and “solving puzzles” with imaging
- Not afraid of longer work hours than diagnostic radiology, but lifestyle is usually still better than surgery
How do I become an interventional radiologist?
Current training pathway:
- Diagnostic Radiology Residency (5 years)
- IR Fellowship (1 year)
Training pathway will be changing soon:
- In the near future, the training pathway will involve increasing the duration of IR training to 2 years, but 1 year will be double-counted within the diagnostic radiology training. This change will allow for more training in clinical skills and IR related imaging. Total length of time will stay the same (6 years).
- In the more distant future, IR may become its own specialty and have its own residency program
I’m curious … what now?
GET INVOLVED! BECOME A MEMBER TODAY!
All trainees:
- Find a mentor
- Do research in IR
Medical student:
- Electives in Diagnostic Radiology, Interventional Radiology
- Shadow an interventional radiologist
Resident:
- Core IR rotations + elective IR rotations
Get connected!
Websites:
- Canadian Association for Interventional Radiology (CAIR) www.cairweb.ca
- Society of Interventional Radiology (SIR) www.sirweb.org
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE) www.cirse.org
CAIR Annual Meeting
- Medical students welcome, free registration!
- Fellows Day, guest lectures, hands-on demonstrations
CAIR Medical Student Discovery Nights
- Selected cities every year
- Meet and greet with IR staff and residents
- Free food and drinks, hands-on demonstrations
How to learn IR
Interventional Radiology is an exciting constantly evolving field, so to become a good interventional radiologist, a trainee must be proactive in seeking out learning opportunities throughout medical school, residency, and fellowship. There are many ways to learn IR, and they are detailed below. The list below is by no means comprehensive, and trainees are encouraged to try other resources as well. If you have suggestions for good resources that are not listed here, please feel free to contact us, and we will add it to the list below!
Textbooks:
- Handbook of Interventional Radiologic Procedures (Kandarpa and Machan): This is a great pocketbook and serves as a quick reference during your IR rotations as a resident/fellow. Organized by procedure, the book gives you a quick summary of the pre-procedural work-up (including indications, contraindications, consent), procedure technique (step-by-step), and post-procedural care and follow-up.
- Vascular and Interventional Radiology: The Requisites (Kaufman and Lee): This is a textbook in the Requisites Series, and offers much more detail on each procedure than the Handbook. It provides good explanations and teaches the fundamentals of IR, great for residents and fellows.
- Vascular and Interventional Radiology (Valji): This is an alternative textbook to the Requisites. Some trainees prefer this book over the Requisites, but they are both great books to learn the fundamentals.
- Atlas of Vascular Anatomy (Uflacker): This is a great imaging atlas to learn the details of vascular angiographic anatomy, which you will not find in standard imaging anatomy textbooks. The image quality is a little outdated, since this current edition was published in 2006.
Online resources:
- Society of Interventional Radiology: The United States society for interventional radiologists – contains a wealth of information on IR procedures, physicians, and the annual SIR scientific meeting.
http://rfs.sirweb.org/ – This is the SIR Resident and Fellow Section (RFS), which is targeted to trainees, providing education on IR procedures, clinical skills development, and IR fellowships and residencies in the US. - Atlas of Vascular Anatomy, Medical University of South Carolina: a great quick reference of vascular anatomy for the entire body with drawings and angiographic correlation.
- Endovascular Catheters for Interventionalists: A useful guide for trainees introducing various endovascular catheters and how to use them. Click here to view the pdf format. It is also available in iBook format for free if you have an iMac or an iPad: click here.
Conferences:
Attending conferences is a great way to learn IR. At the conference, you will find dedicated content for trainees, talks on IR fundamentals, and cutting-edge scientific exhibits. It is also a great way to directly interact with interventional radiologists. Common conferences that trainees go to would be CAIR (Canadian) and SIR (US).
Please note there are travel scholarships/grants for trainees for both the CAIR and SIR conferences:
- For CAIR: If you are a resident or fellow, you can submit an interesting case and present it at Fellows Day as part of the meeting. If your case gets accepted, you earn a free trip to the meeting. Please contact us for more information.
- For SIR: They have medical student and resident travel scholarships, which Canadian trainees are eligible for. Please visit the SIR annual meeting website for more details.
Clinical experience:
No matter how much theory and how many textbooks you read, the clinical experience is most important and irreplaceable. IR is definitely a procedural subspecialty – the more hands-on experience you get the better. Try to maximize your exposure both to the clinical and procedural aspects of IR through shadowing, core rotations, and electives.
Acknowledgments
Dr. Jason Wong (University of Calgary) for providing many of the images for this presentation.
Dr. Edwin Zhang (University of Alberta) for putting together this presentation.
Please note that you can use these presentations to introduce IR to your colleagues or trainees. We simply ask that you keep the CAIR background and contact information as well as the slide mentioning the authors.