VASCULAR and INTERVENTIONAL



1695450-1113790DIAGNOSTIC RADIOLOGYGOALS & OBJECTIVESVASCULAR and INTERVENTIONAL00DIAGNOSTIC RADIOLOGYGOALS & OBJECTIVESVASCULAR and INTERVENTIONAL3429057467500ROTATION GOALS: By the end of residency training, the resident should have a basic knowledge of a range of IR procedures and be competent in a number of basic procedures (see table below).ROTATION OBJECTIVES:MEDICAL EXPERT:To develop an understanding and become competent in a number of basic IR procedures, as listed below. (see table).To demonstrate an understanding of basic angiographic catheters, needles, guidewires and drains.To learn the normal and common variants of arterial and venous anatomy upper and lower extremitiesthorax (lungs, great vessels, etc.)abdomen, including solid organ vascular supply (liver, spleen, pancreas, kidneys) abdomen, including viscera (esophagus, stomach, small bowel, large bowel)pelvic vascular anatomyTo learn the important anatomy of the liver, biliary system, gallbladder, pancreas, and GU system as they relate to angiography and interventional procedures. To understand the risks and potential complications of interventional radiology proceduresTo understand the use and complications of contrast, radiation protection and safe technique.To become familiar with common pathologies of the hepato/biliary/pancreatic and GU system, which necessitate interventional procedures.To develop skills for patient management during IR procedures:obtaining informed consentsedation and pain controlallergic reactions & prophylaxishemodynamic instabilityinterpretation of patient vitalsanticoagulation and reversal managementTo develop an understanding of the role and use of ultrasound in interventional techniques.To develop an understanding of CT angiography (thorax, abdomen, pelvis and legs), its indication, limitations, and the post-processing of axial images (curved reformats, 3D VR, MIPs, etc.)COMMUNICATOR:To be able to communicate with referring physicians in obtaining a relevant clinical history and in identifying key clinical questions or issues for IR procedures.To be able to consult with referring physicians, both before and after, the procedures are performed.To be able to provide organized, succinct, and thorough CTA reports.To demonstrate effective communication skills when dealing with patients, during consent and procedures, as well as with consulting clinicians and health team members.To be able to explain the procedure and findings in terms that the patient and family can understand.COLLABORATOR:To demonstrate good consulting skills when interacting with other physicians & health team members.To interact appropriately with other radiology department staff, demonstrating good team skills in approaching and managing patient care.LEADER:To demonstrate awareness of the indications for various IR procedures.To consider the advantages and disadvantages of operative versus interventional techniques.To consider available imaging resources when planning and recommending patient care, using them effectively and efficiently.HEALTH ADVOCATE:To recognize and consider radiation doses when recommending, approving and performing IR procedures.To demonstrate knowledge and awareness of radiation protection and the appropriate handling of bodily fluids.To educate and advise on the use and misuse of vascular and non-vascular imaging and intervention.SCHOLAR:To set personal learning goals & objectives during rotation.To demonstrate an ability to be a teacher of vascular and non-vascular imaging and intervention to medical students, residents, technologists and clinical colleagues.PROFESSIONAL:To demonstrate integrity, honesty and compassion.To show sensitivity and care to the patient and the patient’s family.To practice understanding ethical and medical-legal requirements of radiologists.To demonstrate awareness of own limitations.To be punctual and available for the assigned duties.METHODS:The workday begins at 8:00 am or 8:30 am when there are resident rounds.Rotation Responsibilities:Clinical:Involvement in patient care and procedures in the IR suitesReview requested procedures, appropriateness, and individual patient factorsInterview patients, explaining procedures and obtaining informed consentPlan and carry out a number of procedures (see table below)Fill out post-procedure orders, care and discharge of patientsConsult and report findings to referring physicians, as appropriateReview and reporting of CTAs assigned to IR, including the post-processing (3D, curved reformats, vessel analysis, etc.)PGY 2 - Two Blocks (KGH)By the end of the two blocks, the resident should aim to be able to perform, without supervision, the procedures listed in the first table below (see Procedures).PGY 5 – One Block (KGH)By the end of the block, the resident should aim to be able to perform, with some assistance/supervision, the procedures listed in the second table below (see Procedures).RECOMMENDED READING:RadCases, Interventional Radiology, Ferral, Lopez (2010)Handbook of Interventional Radiologic Procedures, Fifth Edition, Kandarpa (2016)Vascular and Interventional Radiology, Karim Valji (2006)Teaching Atlas of Vascular and Non-vascular Interventional Radiology, Brian Funaki and Jonathan Lorenz (2007)The following is a list of topics to aid the resident in organizing the self-directed learning while on rotation:Vascular Interventions and ImagingAortic aneurysm imaging (conventional and CT angiography), endovascular repair and post-procedure follow-up and complicationsPeripheral arterial disease imaging (conventional and CT angiography), endovascular treatment and complicationsAcute peripheral arterial thrombosis – diagnosis and intra-arterial thrombolysis.Renal artery stenosis – etiology (i.e. atherosclerosis, FMD), diagnosis (conventional, CT and MR angiography), treatment and complicationsMesenteric ischemia – etiology (i.e. atherosclerosis, median arcuate ligament syndrome), diagnosis, treatment and complicationsThoracic outlet syndromeVasculitis – diagnosis and treatment of complicationsIVC filter insertion and removal – indications and complicationsContrast allergy treatment and premedicationCentral Venous AccessPICCsPort-a-cathsSingle/Dual/Triple lumen central venous cathetersTunnelled central venous catheters (Hickman catheters)DialysisTemporary and permanent hemodialysis catheter insertion, exchange and acute and chronic complicationsHemodialysis fistula creation, types, imaging and treatment of complications including stenosis, thrombosis and steal syndromeHepatobiliary Imaging and InterventionsPortal vein embolizationTransarterial hepatic chemoembolization.TIPSPercutaneous transhepatic cholangiogramTranshepatic common bile duct stentingCholecystogram and cholecystostomyGastrointestinal Imaging and InterventionsUpper and lower gastrointestinal hemorrhage diagnosis and treatmentPercutaneous gastrostomy, jejunostomy and cecostomy tubesPercutaneous intraperitoneal abscess drainage Thoracic Imaging and InterventionsChest tube placement in treatment of pleural effusions, empyemas, pneumothorax.Hemoptysis and bronchial artery embolizationPulmonary AVM/AVF diagnosis and embolization.Urogenital InterventionsNephrostograms, cystograms, ileal conduits and neobladdersNephrostomy tube insertion, exchange and complicationsUreteral stent insertion and exchangeUterine artery embolizationTraumaDiagnosis with conventional and CT angiographyEmbolization (i.e. splenic, hepatic, arterial laceration/hemorrhage)Vascular and Interventional EquipmentVascular access needlesGuidewiresCatheters and vascular sheathsAngioplasty balloonsVascular and non-vascular stentsEmbolization materialCommonly Used MedicationsConscious sedation (i.e. Versed, fentanyl, narcan)Pre-procedural (antibiotics, contrast nephropathy prevention)Anticoagulation and thrombolysis (i.e. heparin, tPA, protamine)Vasodilators (i.e.nitroglycerin)Procedures NOTE: Residents will be given graded responsibility for procedure components commensurate with their level of skill, knowledge, interest and enthusiasm.Able to perform without supervision, by the end of the rotation:ProcedureTypeBiopsiesThyroid FNA > 20 mmLiver Non-targetedKidneyNon-targetedDrainageParacentesisThoracentesisDrain exchange (ie nephrostomy, G-tube, etc)Venous accessPICC linesTemporary dialysis line insertionCTA / MRAInterpretation of CTAs, including 3D workstation post processingAble to perform with some assistance/supervision, by the end of the rotation:ProcedureTypeBiopsiesNeck, axilla, inguinalTargeted kidneyTargeted liverDrainageIntraperitoneal drain insertionChest tube insertionVenous accessTunneled hemodialysis line insertionHickman line insertionAble to participate in and develop an understanding of the steps and components of these procedures, the indications and possible complications:ProcedureTypeBiopsiesRetroperitonealOmentumDrainageAbscess drain insertionBiliary drain / cholangiogramNephrostomyCholecystotomyFeeding TubesG-tubes, GJsVenous accessPort insertionAngiogramPeripheralPTA / stenting / thrombolysisFistulogram angioplasty / stentingMesenteric / embolizationTIPSPortal vein embolizationCarotid / stentingIntracranial diagnosticInterventional oncologyTACE/TAELocal ablation therapy (RFA, microwave)IVC filtersInsertionRemoval ................
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