IR Curriculum

Curriculum for Subspecialty Training

Interventional Radiology

1 Introduction

This curriculum outlines the training requirements for interventional radiology in Year 5 of specialist registrar training (this training maybe undertaken in a modular fashion in Years 4 and 5 if it is advantageous to the trainee or the training scheme). It also outlines the requirements for a sixth year of training for those who wish to become dedicated interventional radiologists.

This document aims to outline a curriculum for training in general interventional radiology, concentrating on vascular, gastrointestinal and uroradiological intervention, thus covering most of the procedures carried out by interventional radiologists. Interventional procedures in other organ systems are excluded as they have special requirements, and will be addressed as appropriate in the training documents of other subspecialties. Biopsy and fluid collection drainage techniques are practised by all radiologists and are not addressed in this document.

Specialist registrars in clinical radiology will have undergone training in interventional procedures in the second, third and fourth years, prior to subspecialty training, and will therefore already have obtained the basic skills.

2 Objectives

The aim of establishing a curriculum for subspecialty training in interventional radiology is to ensure:

• a detailed knowledge of current theoretical and practical developments;
• extensive hands-on experience with graded supervision;
• in-depth understanding of indications, contraindications and complications of interventional procedures as well as their relative efficacy compared with other treatment options;
• development of clinical knowledge relevant to interventional radiology.

Experience will be documented in log-books. If adequate experience cannot be gained in one training centre, it will be necessary for the trainee to have a period of attachment at other training centres.

3 Overview of Training

Structured Training in Clinical Radiology outlines the core of knowledge required during the first three years of training and an optional category in which practical experience is not essential but a theoretical knowledge is required. Basic skills in interventional procedures will have been obtained prior to subspecialist training.

The interventional radiology experience obtained in the first four years will count towards the total experience of subspecialty training in interventional radiology.

For training purposes interventional radiology can be divided into vascular and non-vascular procedures. Whether a trainee trains in all intervention, or selects either vascular or non-vascular intervention, depends on their ultimate goal.

As training in interventional radiology is predominantly hands-on, it is essential that trainees are exposed to at least a minimum number of procedures and that they are the first or sole operator in at least 50% of these. This is to ensure that they develop the necessary manual dexterity and experience the most common complications and how to rectify them.

Clinical knowledge will be obtained by a variety of means such as participation in ward rounds, attending outpatient clinics, close liaison with the appropriate surgical and medical teams and combined clinical and radiological meetings. Clinical acumen will form part of the assessment made by the trainer.

The trainee should undertake an audit of his/her interventional activities and participate in research.

4 Core Requirements

The core requirements for a radiologist working essentially full-time in interventional radiology,and a radiologist doing a mixture of activities one of which is interventional radiology, are similar apart from the total number of procedures performed. The numbers quoted are approximate but are considered achievable in the time given and will ensure a satisfactory level of experience.

Radiologists who devote essentially all their time to interventional radiology will be expected to undertake complex procedures; acquisition of the necessary expertise requires the trainee to undertake a larger number of interventional procedures.

The groupings that follow are based on the concept of modular training.

The procedures listed in the core and optional requirements will be reviewed at intervals, along with the minimum number of procedures required, as it is recognised that some procedures will become obsolete and new techniques will be developed.

All interventional radiologists must have a thorough knowledge of the techniques required to perform sedation and analgesia procedures, as well as patient monitoring throughout and following the procedures, and should be familiar with existing guidelines.

It is the responsibility of the trainee to be aware of the current local and national guidelines in obtaining informed patient consent.

The trainee is expected to keep abreast of other imaging modalities relevant to their practice.

5.Subspecialty Training in Vascular Interventional Radiology

6. Subspecialty Training in Non-Vascular Interventional Radiology

6.1Uradiology

6.2 Gastrointestinal Radiology

7. Dedicated Interventional Radiology Training in Year 6

A trainee who wishes to become, in effect, a full-time interventional radiologist should spend at least two years in subspecialty training. One year of this experience can be obtained during the fifth year of radiology training (or in a modular fashion in the fourth or fifth years of training if it is advantageous to the trainee or the training scheme).

A sixth year is necessary to increase the trainee's experience and enable him/her to perform more complex procedures.