Interventional Radiology Integrated Pathway Residency (IR/DR)
In 2012, the American Board of Medical Specialties (ABMS) named Interventional Radiology (IR) as a separate specialty (similar to Pediatrics, Internal Medicine, Surgery, etc.). In recognition of this change, IR training is transitioning from a fellowship to a dedicated residency program. Training and certification for the IR residency will still fall under the American Board of Radiology (ABR). With the phasing out of the traditional fellowship pathway nationally by 2020, two new pathways have been recognized to become an Interventional Radiologist. The ABR and Accreditation Council for Graduate Medical Education (ACGME) recognize that a strong Diagnostic Radiology (DR) background is vital to training in Interventional Radiology (IR). This concept provides the foundation for the first new training pathway: The Integrated Pathway.
The Integrated Pathway has been approved by the Residency Review Committee (RRC) of the ACGME. Beth Israel Deaconess Medical Center is proud to be among the first programs to gain ACGME approval for this program. The program consists of an internship year followed by 3 years of Diagnostic Radiology (DR) training and 2 years of Interventional Radiology (IR) training. Physicians graduating from this program will receive a combined DR/IR certificate from the American Board of Radiology ABR, pending successful completion of a final certification exam.
Beth Israel Deaconess Medical Center is offering two positions for the Integrated Pathway in the 2017 Match. The first three years and four months will be identical to existing diagnostic radiology curriculums with clinical rotations on the core diagnostic sub-specialties including ultrasound, mammography, abdominal imaging, chest radiology, emergency radiology, and musculoskeletal radiology. This time will also include rotations on interventional radiology. The diagnostic lecture series, didactic activities, diagnostic call, and other educational elements of the program will be nearly identical to the existing DR residency. Beginning in the third year of the IR/DR residency, residents will spend dedicated time on the Interventional Radiology service including IR-related rotations e.g. Intensive Care Unit (ICU) and vascular surgery in addition to performance of procedures in the IR suites. A total of 24 blocks of IR rotations will be completed prior to graduation. Based on our current volume, we anticipate each resident to graduate with a case log of at least 1000 procedures per resident which will fulfill all ACGME requirements.
Sample Block Schedule (click to enlarge):
Our Department prides itself on being supportive of its residents and places strong emphasis on the quality of individualized teaching in procedural techniques.
Beth Israel Deaconess Medical Center (BIDMC) is a Harvard Medical School-affiliated academic medical center that provides tertiary clinical care, including Level 1 trauma care, advanced oncologic care, multi-organ transplantation, and robotic surgery. Among independent teaching hospitals, BIDMC is a leader in biomedical research with a large amount of funding from the National Institutes of Health. BIDMC has 672 beds, including 463 medical/surgical beds, and 69 critical care beds (including 6 ICUs) – staffed by over 1,200 physicians on the active medical staff. The radiology department at the main campus performs 320,000 exams annually. The main hospital is divided into two adjacent campuses. The West campus houses many of the center’s ICUs, including its Trauma ICU, the emergency room, and the majority of its operating rooms. The East campus has inpatient services for Oncology and OB/GYN, and has facilities for advanced GI endoscopy (ERCP/EUS), urology, and same-day surgery. BIDMC has a growing number of affiliations with community hospitals and practices, including affiliations with BID-Needham, Milton, and Harrington Hospitals– all of which form the basis for an active, expanding referral base at the medical center.
The Vascular and Interventional Radiology Practice
The Interventional Radiology section has a busy practice (approximately 4,700 diagnostic and interventional procedures performed each year) supported by 9 full-time fellowship-trained IR attending physicians. The IR section prides itself on building strong collaborative relationships with other physician specialists within BIDMC and its affiliates, and strives to provide the best patient care and clinical service possible.
Our IR physicians perform a wide range of IR procedures, across all imaging modalities (both vascular and non-vascular interventions using both fluoroscopy and cross-sectional imaging). Examples of this include (but are not limited to) the following:
- Advanced biliary interventions: The IR section has a very busy advanced hepatobiliary practice (including biliary drainages, cholangioplasty, metallic stenting, biopsy, and management of biliary leaks) and collaborates closely with the advanced endoscopy group at BIDMC (which maintains the region’s largest ERCP/EUS practice) and the Pancreatic Cancer Center.
- Interventional Oncology: The IR section also has an active Interventional Oncology practice –performing transarterial chemoembolization (with conventional lipiodol and drug-eluting beads) for primary and secondary liver tumors, radioembolization, and CT/US-guided tumor ablation of liver, kidney, lung, bone, adrenal, and soft tissue tumors using various ablation technologies (radiofrequency, microwave systems, and cryoablation). IR also works with 4 other medical specialties in a multidisciplinary single-site liver cancer clinic.
- Hepatic interventions: Our IR physicians work closely with our Liver Transplant Center and as key participants in BIDMC’s Liver Tumor Board/Clinic, and perform advanced hepatic interventions including liver biopsies (percutaneous and transjugular), transjugular intrahepatic portosystemic shunts and associated procedures (TIPS/BRTO), post-transplant interventions (arterial and venous angioplasty/stenting).
- Radial Artery Interventions: We routinely perform transradial arteriography for interventions including radioembolization, chemoembolization and uterine fibroid embolization.
- Arterial and venous interventions: The IR section performs a wide range of general arterial and venous interventions, including IVC filter placement and retrieval (including complex embedded filters), treatment of DVT (thrombolysis, angioplasty, and stenting), treatment of arterial and venous stenosis (angioplasty and stenting), and treatment of arterial bleeding (such as traumatic and gastrointestinal bleeding). IR physicians also treat pulmonary AVMs, and perform bronchial artery embolizations and sclerotherapy of adult venous malformations.
- Hemodialysis care and vascular access: Through its partnership with transplant surgery and nephrology, IR physicians perform procedures at the hospital-affiliated outpatient Advanced Vascular Care (AV Care) center, which focuses on managing hemodialysis access care for patients from several different outpatient dialysis centers. This includes tunneled catheter placement/removal, fistulograms, balloon angioplasty, stenting, and mechanical thrombectomy/thrombolysis, venograms. The BIDMC hospital IR practice also performs fistula and dialysis interventions on inpatients and those cases that require higher levels of care.
- Endocrine interventions: The IR section has a busy endocrine-related practice, including performing adrenal vein sampling, ectopic parathyroid angiography and embolization, thyroid biopsies, and benign adrenal adenoma ablation. BIDMC is the world’s leading center for minimally invasive treatment of hormonally active benign adrenal tumors.
- Urologic interventions: The IR section performs percutaneous nephrostomies (and nephroureteral stents) and suprapubic catheter placement for acute urinary obstruction, as well as for lithotripsy guidance in the management of urinary stone disease.
- Gynecologic interventions: The IR section performs embolization for the elective treatment of uterine fibroids, pelvic congestion syndrome, and for the emergent treatment of uncontrolled postpartum hemorrhage. We also perform fallopian tube recanalization procedures.
- Enteric interventions: IR physicians routinely place percutaneous feeding tubes, including primary gastrostomy, gastrojejunostomy, and jejunostomy tube placement and their subsequent management.
- Cross-sectional interventions: IR physicians also staff the cross-sectional IR physician rotation during which they perform routine CT- and US-guided biopsies and drainages (in the chest, abdomen, and pelvis).
- Spine interventions: IR physicians also perform CT-guided spine biopsies and epidural abscess drainages, and perform image-guided treatments for pain, such as facet joint injections, kyphoplasty/sacroplasty, and celiac plexus blocks.
- Endovenous ablation: The IR section has an outpatient practice performing patient consults and treating lower extremity venous disease using sclerotherapy and endovenous ablation.
In addition to IR physicians, there are 3 advanced practice PA/NPs who manage the outpatient care of our IR patients. The IR practice is also supported by a large group of very competent IR nurses and technologists.
Interventional Radiology Facilities
The main hospital-based facility has a total of 5 available procedural suites. This includes: 3 state-of-the-art angiography suites on the West Campus all of which include high-resolution digital subtraction angiography, rotational angiography, cone-beam CT, and workstation-based volume-rendered imaging with reconstructions. In addition, an adjacent Fluoroscopy room is used for minor procedures such as central venous access or drain exchanges. On the East Campus, an advanced angiographic suite, with a new holding area, break room and reading room opened in 2016.
Additionally, CT-guided procedures are performed in state-of-the-art procedural CT scanners on both the East and West Campuses. Dedicated ultrasound machines with needle guidance software and equipment and ultrasound procedural suites for biopsy/drainage procedures are also present on each campus. Two additional portable ultrasound units are available for vascular access procedures.
Interventional Radiology has two dedicated IR clinic rooms on the West Campus close to the IR procedural area. These rooms are complete outpatient clinic rooms (with examination tables, appropriate equipment including teaching aids, instrumentation for vitals assessment, desks and computers). In addition, IR physicians are an integral part of the Liver Tumor Multidisciplinary Clinic, staffed by a physician assistant, clinic coordinator, and medical assistant, where they see patients with hepatic malignancies in conjunction with hepatology, medical oncology, transplant surgery, and radiation oncology.
Vascular and Interventional Radiology (VIR) Integrated Residency Program
We are proud to offer a 5-year combined program leading to an IR/DR combined certificate from the ABR. Two positions are available each year for this pathway through the NRMP match. IR/DR integrated residents are expected to participate in all facets of patient care, including initial consultations, detailed patient evaluations, treatment planning, procedures, post-procedure care, and outpatient clinic follow-up.
Through an organized schedule, IR/DR integrated residents will rotate through 4 weekly ‘core’ rotations in which they are assigned to procedural suites in the West (2 weeks) or East (1 week) campus , and a fourth ‘External’ rotation that includes time at a hospital-affiliated outpatient vein center (Mass Vein Care), staffing IR clinic, performing cross-sectional procedures on the CT-guided Ablation service, and rotating through an outpatient Advanced Vascular Care (AVCare) outpatient dialysis access management center. During rotations at the main hospital, residents will be exposed to a wide range of complex vascular and non-vascular procedures, including performing arteriography for traumatic or acute bleeding, interventional oncology, advanced biliary interventions, uterine fibroid embolization, and advanced vascular access management, to name a few.
While on the ‘East’ campus rotation, IR/DR integrated residents will also interpret non-invasive vascular imaging studies under IR faculty supervision. The residents will rotate through the ICU for one month to become better acquainted with taking care of high-acuity patients. Each resident will also spend 1 month rotating on the endovascular part of the Vascular Surgery service, where they learn the clinical evaluation and management of peripheral arterial disease, and will participate in endovascular procedures including peripheral angiography and interventions, carotid artery stenting, and endovascular treatment of aortic aneurysms.
The IR/DR integrated residents will be provided with an in-depth educational curriculum and conference schedule. IR faculty will provide specific case-based clinical and technical teaching during daily clinical teaching rounds. Residents will receive weekly appropriate didactic lectures and activities on a range of topics during protected lecture time in addition to a weekly case conference. Residents are expected to prepare a monthly morbidity and mortality conference and attend monthly evening meetings of the New England IR society in which world-renowned faculty speak on a range of IR topics. Residents will also attend multidisciplinary conferences where IR faculty and other specialists make joint clinical treatment recommendations for patients.
IR/DR integrated residents have opportunities to participate in ongoing research within the section, and can partner with a faculty mentor to participate in specific projects. The Department of Radiology requires that all residents complete a scholarly project during their training. Early on the residency, the Section Chief and Program Director will work with IR/DR integrated residents to identify potential projects.
Finally, IR/DR integrated residents will receive regular feedback throughout their training to allow them to improve their performance. Each diagnostic rotation has an educational liaison responsible for giving feedback and will serve as the point person for the rotation and any issues that may arise. Residents will receive regular feedback through quarterly core-competency based online evaluations from Diagnostic and, later in their training, IR faculty and the IR residency director. A multi-source 360 evaluation from other residents, nurses, technologists, and patients is also performed bi-annually during the residents’ final two years of training. IR/DR integrated residents are also expected to participate in QA/QI within the section through M&M conferences, and, should they choose, perform a QA/QI project.
Departmental Educational Activities
Daily didactic morning conferences are held for the residents during their first three years of training. Speakers include departmental faculty with frequent lectures from HMS faculty at other institutions, alumni, as well as guest lecturers from around the world. Visiting professors from other major national and international teaching centers also participate in resident education for the Department.
The Department of Radiology has a close working relationship with a number of clinical services and our radiologists lead or participate in several multidisciplinary conferences, including Medical Management, Melanoma Management, Urology Management, Thoracic, Pancreaticobiliary, and Liver Tumor Boards as well as Medical and Surgical Grand Rounds.
As befits a great medical city, Boston is host to several regional and national medical conferences sponsored by Harvard Medical School as well as other medical schools and associations. The monthly New England Roentgen Ray Society meeting is a regional meeting for the six New England states and includes a special program for residents and fellows. The New England Society of Interventional Radiology also holds regular meetings which provides a highly valuable educational experience.
All applications will be accepted and reviewed using the Electronic Residency Application Service (ERAS) of the Association of American Medical Colleges (AAMC). All residents will have to have completed an accredited internship prior to matriculating into the VIR Integrated program.
IR/DR Integrated Residency Program Leadership
Muneeb Ahmed, MD FSIR (Section Chief, Vascular and Interventional Radiology)
Associate Program Directors
Priscilla Slanetz, MD
Jeffrey Weinstein, MD
617-754-2523 / 617-754-2651 (fax)
Beth Israel Deaconess Medical Center
330 Brookline Avenue, WCC - 308
Boston, MA 02215