PGY3 Angiography/Interventional Radiology

Supervisor:               Dr. Melissa Skanes, HSC  

Supervisor:               Dr. Ravi Gullipalli, SCM

Please note: There is a PowerPoint on BrightSpace within the Angiography shell.  You are required to review this presentation on Radiology Physics prior to the commencing this rotation.

The following is an outline of the goals and objectives of the Interventional Radiology rotation during PGY3, incorporated into CANMEDS format. The CANMEDS roles will be assessed throughout all rotations and will remain consistent throughout all of residency. 

The assessment tools utilized during the rotation include the ITER rotation evaluation sheet.  An examination assessing knowledge obtained as per the listed curricula at each stage of training will be given on the last day.  The examination will assess the acquisition of knowledge throughout the rotation.  A pass mark is 70%.  The inability to pass the exam couldrender the rotation incomplete, and the rotation will be completed at a later date. 

Duties and Responsibilities

• To understand the rationale for interventional procedures for each patient.
• To have an expectation of expected positive outcomes and possible complications.
• To fully understand the anatomy of the organ systems involved in each intervention.
• To be able to obtain informed consent and discuss the case appropriately with the patient and family members if necessary.
• To review requests for in-patient procedures and to make recommendations as to the appropriate investigation and intervention with the approval of the staff interventionalist.
• To be exposed to a wide variety of angiographic and interventional procedures as possible during the rotation and participate in the procedures with the staff interventionalist.
• To understand interventional techniques.
• To report these examinations in a timely fashion under the supervision of the staff interventionalist.
• To supervise the pre and post-procedure care of inpatients and outpatients in conjunction with the staff radiologist.

ONE 4-WEEK ROTATI2 (OR SECOND 4-WEEK ROTATION)

Suggested Reading List

Please read the corresponding RSNA physics module, as outlined in the Physics module, as outlined in the physics curriculum

(Copies of the suggested reading can be obtained through either Dr. Heale or Dr. Collingwood)

• Imaging  Atlas of Human Anatomy – Weir & Abrahams
• Vascular & Interventional Radiology – Kaufman & Lee
• Introduction to Cerebral Angiography – Osborn
• SIR syllabi-

 

1. Medical Expert
2. Communicator

Have thorough working knowledge of the anatomy of the vascular, biliary and urologic systems and other necessary anatomy. The vascular anatomy includes the aorta and its major branches as well as the vascular anatomy of the brain and neck.

Understand the pathophysiology of atherosclerosis and be familiar with the techniques of vascular recanalization including angioplasty stenting and thrombolysis. 

Become competent in basic interventional techniques especially with respect to accessing the femoral artery and central and peripheral veins to gain some understanding of basic interventional devices.

Gain an understanding of the IR role in hemodialysis patients, especially as it relates to access problems regarding, native fistulas, grafts, and central lines.

Understand the various central venous access techniques and devices used in IR.

Gain an understanding in urologic interventions, including percutaneous nephrostomy and antegrade stenting. This includes the indications for and the complications of the procedure.

Gain an understanding in biliary interventions including percutaneous transhepatic cholangiography, percutaneous biliary drainage and stenting. This includes the indications for and the complications of the procedure.

Understand the rationale for catheter neuroangiography and be able to identify the major vessels.

Become familiar with conscious sedation and analgesia and be able to manage complications of intravenous sedation.

            Be familiar with contrast reactions and their treatment.

            Become familiar with contrast injection rates and volumes for angiographic procedures.

Be able to independently perform an angiograph examination of the abdominal aorta and lower extremities.

Gain knowledge of how to perform an angiographic procedure including contrast injection volume and rates and the indications for antibiotic prophylaxis.

            Be able to perform a cerebral angiogram (PGY4 & PGY5).

 

Communicate effectively with patients/families, referring physicians, and co-workers, including IR technologists and nurses.

Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.

Establish effective relationships with patients and be able to obtain informed consent for interventional procedures.

Establish good relationships with peers and other health professionals while effectively providing and receiving information. Handles conflict situations well.

Produce succinct reports that describe findings, most likely diagnosis and interventions performed.

            Complete records and reports effectively, as well as oral presentations.

 

1. Collaborator
2. Manager

Gain an understanding of the role of Interventional Radiology in patient care.

Interact effectively with health professionals by recognizing their roles and expertise.

Collaborate effectively and constructively with other members of the health care team.

Contribute to interdiscipline activities and rounds.

The skills of being a collaborator are developed on a day to day basis. Residents are strongly encouraged to interact with house staff and referring physicians as “first contact” in order to better develop these skills. In addition residents will be required to be active participants in inter and intra discipline rounds.

 

Understand the effective use of allocation and utilization of health care resources with specific attention to radiology.

Demonstrate competence in and make use of computer science/information technology as it pertains to Diagnostic Radiology.

 Make cost effective use of health care resources based on sound judgment.

Set realistic priorities and use time effectively in order to optimize professional performance.

Understand the principles of practice management.

Understand the fundamentals of quality assurance.

 

1. Health Advocate
2. Scholar

Recognize the benefits and risks of interventional investigations including the risks and benefits of interventional radiology procedures versus surgical options.

Promote health of the population through the application of radiology.

Recognize the Radiologist’s role to ensure appropriate radiological investigation and act as an advocate for patients in terms of their diagnostic imaging needs.

Understand and communicate the benefits and risks of radiological investigation and treatment including population screening.

Understand the issues regarding screening (mammography, lung cancer, colon cancer, cardiac calcification and total body).

            Recognize the burden of illness upon the patients served by Radiology.

 

Understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community.

Have a personal commitment of continued education and demonstrate a commitment to the need for continuous learning.

Develop and implement an ongoing and effective personal learning strategy.

Critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design with respect to Radiology.

Demonstrate an ability to be an effective teacher of radiology.

The skills of being a medical scholar are learned on a day to day basis under the umbrella of a long term plan. For a resident, this would include seeing as many cases as possible during the days with follow-up reading performed at night.

 

1. Professional

Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and appropriate professional behavior.

Demonstrate integrity, honesty, compassion and respect for diversity.

Fulfill medical, legal and professional obligations of a Diagnostic Radiologist.

Demonstrate reliability and conscientiousness.

Understand the principles of ethics and apply these in critical situations.

Demonstrate an awareness of personal limitations, seeking advice when necessary.

Accept advice graciously.