Transcript Basic Training Suspecialized Training

Education in Radiology
General Radiology
Suspecialized Radiology
CardioVascular and Interventional CIRSE
Neuroradiology ESNR
Bone & Joints ESSR
Pediatric ESPR
Thorax ESTI
Gastro-Intestinal ESGAR
Genito-Urinary ESUR
Head & Neck ESHNR
Guidelines
for
Training
in
Radiology
General recommendations (1)
• Training should be performed in a large polyvalent
hospital including
– dpt of pathology
– dpt surgery
– dpt internal medecine
– dpt emergency
– dpt intensive care
General recommendations (2)
• Standards of equipment: modalities
– Conventional radiology
– Angiography
– Ultrasonography
– CT
– Internen
– MRI (co-operation with other training departemnts
may be necessary)
General recommendations (3)
• Staffing structures
– The number of qualified radiologists with teaching
and supervisory function in the department should
be sufficient to cover needs of teaching (i.e. in
Belgium 1staff/1-2 in training)
– The expertise of the teaching staff should be
diversified and cover the main areas of activity
General recommendations (4)
• Teaching facilities
– There should be appropriate meeting and
demonstration rooms available in the Department of
Radiology, sufficient to enable the teaching
programme to be implemented
General recommendations (5)
• Teaching material
– There should a selection of good and modern textbooks as
well as other audiovisual material in general radiology
completed by text books in subspecialties
• neuroradiology
• paediatric radiology
• ...
• ultrasonography
• computed tomography
• MRI
• Radiation protection
• Imaging physics
General recommendations (6)
• Part of the training may be at acknowledged and
accredited non-university hospitals but a minimum of
half of the training period should be carried out at
university departments.
• The non-university component should provide training
in at least basic radiology, whilst the univesity
component could provide training in the special
modalities
General recommendations (7)
• All the university departments and training hospitals
should be part of a coordinated national or federal
sheme.
• It is of great importance that co-operation exists
between central authorities (Ministry of Health,
Ministry of Education, National Radiological
Societies, National Insurance Fund etc...) and
regional an local authorities.
General recommendations (8)
• Quantity of practical training
– this is a recommandation on the number of
diagnostic and interventional procedures,
respectively, that the trainnee should do during the
years 1.2.3.4.5
– This training should be recorded on a log book
General Radiology
• The duration of training in radiology should be 5
years.
– The first four mandatory years serving as a
commun trunk.
– The fifth year is concerned with a subspecialty or
an extension of training in general radiology
– Some subspecialties may require further extention
of the training period and may wish to indentify
some training components within the the fourth
year as being germane to their specialist
programme
Training Programmes: 5 years
• Year 1
• Years 2.3.4
• Year 5
Year 1
Year 1
• Acquisition of the necessary knowlegde:
– Physics of image formation
– Radiation protection
– Radiation physics
– Radiation biology
– Anatomy
– Physiology
– Biochemistry related to contrast agents
– Basic understanding of computer science
Year 1
• 46 weeks
• Rotation: folowing rotations are suggested
– Conventional radiology: 18 weeks
– Ultrasound: 8 weeks
– Computed tomography: 9 weeks
– Magnetic Resonance Imaging: 9 weeks
Year 1
• Some form of assesment process should be instituted
at the end of the first year
– to verify that appropriate training has been
undertaken
– to evaluate the knowledge gained
Year 1
• It is not anticipated that a trainee would enter into an
emergeency on-call rotation entailing clinical
responsability until the end of the first year of training
Years 2.3.4
General
Syllabus
for all organ areas, the trainnee must have knowledge
and to be familar with:
• Imaging techniques
• Interventional techniques
• Normal anatomy;, normal variations, development,
physiology
• Pathophysiology, pathologic anatomy, clinical
findings, management of the following group of
disorders (if applicable):
– congenital, infectious, inflammatory, neoplastic, traumatic,
degenerative, occupational, ischemic, endocrine,
immunologic, iatrogenic, fuctional
Theoretical education
• Must not be given parallel to the pratical training but
should folow an educational program, covering the
years 2.3.4. as a whole.
• See organ specifications
Quantity of practical training
• General
– CT: 1500
• 200 head
• 200 spine
• 750 body, incl biopsy and drainage
– Ultrasound: 1200
• 400 abdomen at least
• 200 pelvic at least
– MRI: 750
• 150 brain at least
• 100 spine/spinal cord
• 150 other
Recommendations specific for the
different organ areas
Duration of
training (W ) theory (H)
• Basic Interventional Techniques
• Breast Imaging
• CardioVascular Radiology
• Emergency Radiology
• GI and Abdominal Radiology
• Head and Neck Radiology
• Musculoskeletal Radiology
• Neuroradiology
• Pediatric Radiology
• Thoracic Radiology
• Urogenital Radiology
•
•
•
•
•
•
•
•
•
•
•
8
6
12
8
17
10
17
17
12
17
14
20
15
30
15
35
15
35
30
50
40
30
Year 5
General regulations
• The trainee wants to broaden experience in general
radiology:mixed training
• The trainee devote the whole year to one area of
interest
• The 5th year may be regarded as the first year of
training in a subsecialty
• Irrespective of the composition of the training
program, a log book of activities must be kept
Subspecialty training
Interventional Radiology
European standards for training in
Interventional Radiology
I) General training in Interventional Radiology
II) Subspecialised training in Interventional
Radiology
Curriculum
"General"
Radiology (4 + 1)
Basic knowledge
Subspecialisation
(4 + 2/3)
Expertise
Participating Primary op
Peripheral PTA
Other PTA
Thrombectomy & thrombolysis
25
5
5
Vascular Stenting
5
Embolization
5
Venous interventions
5
5
Curriculum
"General"
Radiology (4 + 1)
Basic knowledge
Subspecialisation
(4 + 2/3)
Expertise
Interventional Radiology
Some trainees in cardiovascular radiology may want to
specialize only in the diagnostic aspects of this
subspeciality, while other may have a special interest
also in the interventional aspects of cardiovascular
radiology . Those trainees who want to acquire expertise
in interventional cardiovascular radiology, are referred to
that part of the Interventional Radiology Training
Program, that is applicable to CardioVascular radiology.
The applicable procedures are:
Some trainees in gastrointestinal and abdominal radiology
may want to specialize only in the diagnostic aspects of
this subspeciality, while other may have a special
interest also in the interventional aspects.
. Those
trainees who want to acquire expertise in interventional
gastrointestinal and abdominal radiology, are referred to
that part of the Interventional Radiology Training
Program, that is applicable to gastrointestinal and
abdominal radiology
The applicable procedures are:
Applicable procedures
-Peripheral Angioplasty, including recanalisation and
stenting
-Renal angioplasty, including recanalisation and
stenting
-Supraaortic angioplasty, including recanalisation and
stenting
-Venous angioplasty, including recanalisation and
stenting
-Thrombectomy and thrombolysis
-Treatment of A-V malformations
-Treatment of bleeding
Applicable procedures
-Gynaecological interventions incl tubar
recanalisation
-Gastro-intestinal tract interventions including
percutaneous biopsy, drainage, biliary drainage,
-TIPS procedures, oesophagal and colonic
dilatation and stenting, percutaneous gastrostomy,
-Urinary tract interventions, including percutaneous
biopsy, drainage, nephrostomy, ureteric stenting.
-Intra-arterial chemotherapy
-Post procedure patient's management
C. CLINICAL TRAINING
Optimally, trainees must spend the equivalence of 4 months
clinical training in a department of Surgery, Internal Medicine
or any subspecialty of Surgery or Internal Medicine.
Life support techniques
Imaging techniques
Interventional techniques
Normal anatomy, physiology of the CardioVascular system
Pathology of the CardioVascular system
Practical training
Participating
Primary op
150
50
Selective angiography incl. Head and
Neck
100
50
Doppler Ultrasound and or Duplex
Ultrasound
50
100
50
50
10
50
Aortography & or Run off
CT Angiography
MRI Angiography and Cardiac Imaging
Phlebography
Imaging techniques
Interventional techniques
Normal anatomy, physiology of the CardioVascular system
Pathology of the CardioVascular system
Practical training
Participation
Peripheral PTA
Primary Op
50
100
20
20
20
20
20
20
Vascular Stenting
10
10
Embolization
20
20
Other PTA (Renal etc...)
Complex PTA
Thrombectomy & thrombolysis
ParticipationPrimary Op
Complex Embolization
Techniques of intravascular chemotherapy
Venous interventions
Complex venous interventions (i. e. TIPS)
Vena Cava filters
5
5
10
10
20
20
5
5
5
10
PTC & PTCD and gallbladder interventions 20
Percutaneous biopsy
Drainage
20
20
20
10
20
ParticipationPrimary Op
Foreign body retrieval
Genito-urinary tract procedures
5
5
20
20
20
20
5
5
Combined surgical and percutaneous procedures
Combined endoscopic and percutaneous procedures
Non vascular interventions & Stenting
Bone interventions
Imaging techniques
Interventional techniques
Normal anatomy, physiology of the CardioVascular system
Pathology of the CardioVascular system
Practical training
Syllabus
•Diseases of the heart and great vessels
•Diseases of the coronary arteries
•Diseases of the arteries
•Diseases of the veins
•Renovascular hypertension
Syllabus
...
d) Normal physiology of cardiovascular system.
e) In-depth knowledge of physiopathology of cardiovascular
diseases.
f) Pharmaceutics of the cardiovascular system.
Imaging techniques
Interventional techniques
Normal anatomy, physiology of the CardioVascular system
Pathology of the CardioVascular system
Practical training
Imaging techniques
Interventional techniques
Normal anatomy, physiology of the CardioVascular system
Pathology of the CardioVascular system
Practical training