IR Integrated Residency

Introduction

BMC is excited to offer comprehensive training in interventional radiology and diagnostic radiology through its integrated IR/DR residency.  Facilities and equipment are state of the art.  Training is comprehensive, including trauma, dialysis, vascular, biliary, portal hypertension, non-vascular intervention, interventional oncology and neurointerventional procedures.  Clinical care and longitudinal follow-up are stressed.  Trainees run the clinical service supported by 3 full time PAs and 5 IR attendings.

Program’s Mission

Boston Medical Center, the sponsoring institution, has the following mission statement: Exceptional care, without exception. The department of Radiology, embodies the same mission by providing care regardless of race, ethnicity, gender, language, or socioeconomic status. Our residencies pride themselves in remaining focused on the patient and showing sensitivity to all aspects of diversity. Many quality improvement projects completed by residents focus on issues relating to our underserved patient population. Resident well-being encompasses many aspects of our training program, from design of effective educational interventions, provision of meaningful and timely feedback, provision of clinical support when needed while allowing residents to perform at their highest appropriate level of independence and listening to resident feedback and instituting changes based on thoughtful communication. Only through an ongoing dialog can we continue to improve.

Program Aim

Our residency program’s major aim is to produce graduates who are outstanding diagnostic and interventional radiologists who are prepared for careers in either private practice or academic medicine. The diagnostic component of our training emphasizes early resident independence and autonomy. The aim of the interventional component of training is to provide comprehensive training in image guided interventional procedures throughout the body and across disease spectrums. We provide training and experience in clinical evaluation and management of patients undergoing image guided procedures through experiential learning, clinical care and didactic instruction.

Participating Sites

Boston Medical Center

Boston Medical Center is a major teaching facility with an emphasis on the underserved patient population. We have a high volume with a very broad range of pathology, reflecting our diverse patient population. Boston Medical Center is a busy level 1 trauma center and has the busiest emergency department in New England.  We have excellent support of our program through the department and institution. Our faculty is diverse, all of whom have subspecialty expertise. The trainees in our residency program enjoy an outstanding clinical and educational experience.

Boston VA Healthcare System (West Roxbury, Jamaica Plain campuses)

Referral VA.  Major teaching hospital with a high volume and very diverse range of pathology in a population of veterans. Emphasis on hands-on training by residents. Subspecialty radiology staff are present, providing a wide range of expertise, with excellent teaching of our residents. Excellent site support through the affiliation with Boston Medical Center. As a result, the residents who rotate have an outstanding educational experience which rounds out the experience they gain at Boston Medical Center.  Residents will have rotations on both diagnostic radiology and interventional radiology at the VA.

Boston Children’s Hospital

The 3-month rotation is heavily weighted toward pediatric general diagnostic radiology and pediatric interventional radiology so that the residents will learn to become familiar with the concepts behind and the image findings in infants and children. They will also be exposed to various imaging modalities as they are used in infants and children, including nuclear medicine, US, CT, MRI, interventional radiology, and conventional fluoroscopy. The residents will participate in pediatric general diagnostic radiology activities under the supervision of the attending staff. Residents will attend lectures at Children’s Hospital according to their schedule Monday through Friday. There are 37 pediatric radiology attendings at Children’s and the hope is our residents will have interactions with the majority of them.

Equipment

Within the section of Interventional Radiology at BMC, there are 4 fully equipped modern interventional procedural suites for fluoroscopically guided interventions including 1 biplane neuro angiography suite that are each equipped with digital subtraction angiography capabilities. All these suites also include cone-beam CT, post-processing 3-D, image-overlay and roadmap imaging capabilities. There is one CT suite for CT-guided interventions such as thermal ablations, biopsies, drainages, etc. There is a dedicated procedure room for ultrasound guided interventions.  Additionally, a minor procedure room is available for venous access and other minor procedures.  Anesthesia-supervised sedation can be provided within any of the interventional radiology procedural suites.

Modern diagnostic imaging equipment is present throughout the institution for the performance of medical imaging including 4 modern CT scanners, 3 MRI units, 10 ultrasound units, 1 PET-CT, 1 SPECT-CT, Numerous computed radiography (CR) and digital radiography (DR) units.  Duplex vascular imaging is offered in the radiology department and in a dedicated vascular lab.

Similar up to date equipment is present at the VA West Roxbury campus and Children’s Hospital.

Interventional Radiology Clinic

All faculty members have dedicated time in the interventional radiology outpatient clinic which is held in the surgery specialty clinic space.  This is a modern, dedicated clinic space supported by medical assistants and advanced practice providers.  Interventional radiology maintains a robust outpatient clinic where consultations are seen and post procedure longitudinal follow up takes place.

During PGY- 5 and PGY- 6, residents will have assigned weekly clinical rotations. The rotation is designed so that the trainee will participate in the dedicated interventional radiology outpatient clinic under the supervision of an attending physician. The resident will perform supervised history and physical examinations on clinic patients and in consultation with faculty will formulate a management plan for each patient, recording all data in the electronic medical record.

While most interventional radiology elective cases are performed on an outpatient basis with same day discharge, those patients requiring admission will be cared by the interventional radiology team.  Residents involved in these procedures will handle the admission, procedure related inpatient care, discharge planning and procedure related follow-up.

Additionally, residents will provide ongoing follow-up of hospitalized inpatients who undergo procedures by interventional radiology such as patients undergoing percutaneous drainage, embolization, thrombolysis or other intervention.  Residents are responsible for inpatient follow-up and arranging outpatient follow-up in the interventional radiology clinic.  Frequently, the resident will personally see the patient he or she was involved in in the inpatient setting at the scheduled outpatient visit to provide for continuity of care.

Responsibilities in these clinical experiences are designed to be progressively expanded over the course of trainee matriculation.  For example, a junior level trainee may only have hospital inpatient follow-up responsibilities; whereas, a PGY-5 and PGY-6 resident will provide both inpatient follow-up and outpatient longitudinal care.  The overarching goal is to ensure that the supervised resident increasingly assumes the role of the primary clinician in the management of interventional radiology outpatients and inpatients.

Faculty

At BMC, five full time board certified interventional radiologists serve as the primary teaching faculty in IR.  The faculty come from diverse training backgrounds with complementary clinical experiences.  All are committed to resident education and ensuring the resident experience on the IR is a positive one.    At the VA 2 full time and 1 part time board certified interventional radiologists support the service where at a given time one BMC resident (either DR resident or IR/DR resident) will rotate.

 Physician Extenders

Physician Assistants function as staff members in the section of Interventional Radiology and may be involved in clinical care activities including procedure workups and minor procedures such as paracentesis and venous access. They also provide clinical care in both the outpatient clinic and inpatient settings and provide a complementary role to the trainees, often accompanying them on consultations and rounds. Physician extenders will not have supervisory responsibilities over residents.  The physician extenders also participate in evaluation of residents.

 

Representative Schedule of Interdepartmental conferences

Day        Conference                        Frequency

Mon      Vascular Conference      Every Monday at 4 PM

PERT Conference             4th Monday at 4 PM

Tues      GU Tumor board              Every other Tuesday at 4 PM

Wed      HBP Multidisciplinary Conf           Every Wednesday 7:30-8:30 AM

Thurs     Trauma (TACS) – Radiology conference Every other Thursday 10AM-11 AM

Friday    Thoracic Oncology Conference  Every Friday at 11AM

Colorectal Oncology Conference Every other Friday at 8 AM

 

Resident and faculty participation in conferences

A diagnostic radiology conference is held daily at noon.  To ensure comprehensive representation of the scope of diagnostic radiology, there are rotating faculty responsibilities for conference content which are shared among each subspecialty divisions of the Department of Radiology.

The IR morbidity and mortality conference are held monthly.  Cases are prepared and presented by residents and faculty in consultation with appointed faculty mentors, who also serve as discussants.

Multidisciplinary interdepartmental conferences are also held on a regular basis with various medical and surgical specialties as detailed in the schedule above.  Residents prepare and present relevant cases in consultation with appointed faculty members who are also in attendance.

A daily interventional radiology working conference is held from 7:15-8:15 AM in the interventional radiology conference and consultation area. This is attended by all faculty physicians, physician assistants, and all trainees on rotation in interventional radiology. All scheduled inpatient and outpatient procedures are presented by individual residents for discussion and review during the conference. Each presentation includes a case synopsis, salient laboratory and clinical data, review of pertinent imaging and discussion of appropriate procedural technique. After review of the scheduled procedures, each of the interventional radiology inpatients is presented by the resident responsible for the procedure. The pertinent clinical, imaging and laboratory data are reviewed, and patient dispositions are determined.

Several interdepartmental multidisciplinary conferences are held on a weekly basis and others are held at monthly or quarterly intervals. Residents are assigned discussant or presentation roles in these conferences supported by radiology faculty supervision. For example, in the case of the weekly hepatobiliary pancreatic conference, patients are presented to a multidisciplinary group of Interventional Radiologists, Medical, Radiation and Surgical Oncologists, who discuss appropriate management options. The radiology resident has the responsibility of presenting and reviewing all pertinent imaging findings to the group attending this conference.

Journal Club

A monthly journal club is held on Friday mornings led by residents where 1 or 2 recently published articles from the medical literature are critically reviewed.  Residents are tasked with evaluating the methodology of the study under discussion as well as the research design.  Discussion is facilitated by a faculty mentor with participation from the entire IR section.

Radiology Physics

There is a dedicated course in physics which runs throughout the academic year for all residents. There are a total of 21 lectures given by the dedicated department medical physicist, who covers topics such as an introduction to imaging and risks, radiation biology, MR physics, CT physics, mammography physics, nuclear medicine physics, ultrasound physics, radiography physics, and the radiation biology.

By the end of their first year, residents are required to complete an online radiation safety training module. During new trainee orientation, they attend a hands-on radiation safety training lab given by our department’s head medical physicist. By the end of their first year, they are expected to have completed the RSNA/AAPM Online Physics Modules, which covers topics such as radiation safety. They are registered for the Foundations of Physics program given by Telerad Physics Teaching, which is a 12 week-long course of weekly live interactive lectures which supplements the topics given by our department curriculum.

Prior to ABR core examination, all third year residents attend the ABR Core Exam Physics program given by Telerad Physics Teaching, which is a 4 day live online review session that includes topics such as radiation safety, MR physics, CT physics, mammography physics, nuclear medicine physics, and ultrasound physics. Additionally, third year residents are given a “Radioisotope Practicum” consisting of 10 hours of lectures/hands-on labs, which consists of training for  proper radiation signage, Written Directives and Authorized User requirements, portable radiation detection equipment and quality control, handling of radioactive materials, response to radiation spills and accidents, safe handling, administration, and quality control of radionuclide doses used in clinical medicine including therapeutic doses of unsealed sources, radionuclide generating systems, radiobiology, calibration and quality control of dose calibrators, well counters, and thyroid counting equipment. The course is directed by a board-certified health physicist.

Curriculum

The first 3 years of the curriculum are focused on diagnostic radiology (DR) and are identical to the curriculum for those residents in the diagnostic radiology program.  The last 2 years are focused on interventional radiology including interventional radiology related and ICU rotations.

The IR clinical curriculum consists of rotations on interventional radiology at BMC and several interventional radiology related rotations.  By the conclusion of the residency, IR/DR residents will complete a total of 18 months on interventional radiology, 5 months interventional radiology related rotations and 1 month of ICU.  Please refer to the block diagram for more details on the rotations.

Interventional Radiology related rotations:

Intensive Care Unit (ICU) one 4-week rotation during PGY-5 (outside of Radiology)

Vascular Surgery two 4-week rotations during PGY5 and PGY6 (outside of Radiology)

Neurointerventional Radiology two 4-week rotations during PGY5 and PGY6(within radiology)

Musculoskeletal Radiology Procedures one 4-week rotation during PGY5 or 6 (within radiology)

Block-Diagram.pdf

Call

IR/DR residents take diagnostic radiology call during their first 3 years similar to their diagnostic radiology resident colleagues.  BMC has implemented a night float system for after hours resident diagnostic radiology call coverage.  Residents are supervised by attending staff in house overnight.  When residents rotate on IR, residents take interventional radiology call from home shared with the other residents on the IR service on a one in every 3 to 4 night frequency.  Residents rotating on off-service rotations such as ICU and vascular surgery will take call on those services similar to other ICU or surgical residents.  Some of the most interesting and impactful patient experiences take place after hours in both diagnostic and interventional radiology.  BMC residents on call are on the front lines of patient care without an additional tier of fellows or advanced trainees to dilute the resident experience.

 

Application Process

We will be accepting applications for one PGY-2 position beginning July 2023 in the main residency match this fall.  All applications must be submitted through ERAS.  We are not considering applications of any candidate outside our current BMC diagnostic radiology residents for any other position.