Download Radiology Integrated Pathway Residency

Interventional
Radiology
Integrated
Pathway
Residency
Department of Radiology
Beth Israel Deaconess Medical Center
330 Brookline Ave., TCC-4
Boston, MA 02215
© August 2016
Program Overview
INTERVENTIONAL RADIOLOGY
INTEGRATED PATHWAY RESIDENCY (IR/DR)
Positions available: 2 per year
Applications for Academic Year 2017 are currently being accepted
Apply through ERAS
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.
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VASCULAR & INTERVENTIONAL RADIOLOGY (VIR)
INTEGRATED RESIDENCY CURRICULUM:
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 nonvascular 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.
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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.
Medical Center
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.
Boston
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.
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BIDMC Interventional Radiology
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, multiorgan 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.
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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.
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•
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 USguided 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.
An elderly female patient, very concerned about the
biliary stenting procedure about to be performed, is
comforted by VIR Fellow, Dr. Michael Johnson, who
took the extra time to put her at ease and managed to
complete a very successful procedure!
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 workstationbased 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.
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Additionally, CT-guided procedures are performed in stateof-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.
Application Process:
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
Program Director:
Muneeb Ahmed, MD (Section Chief, VIR Radiology)
Associate Program Directors:
Pricilla Slanetz, MD
Jeffrey Weinstein, MD
Program Coordinator:
Maxima Baudissin
617-754-2523 / 617-754-2651 (fax)
[email protected]
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
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Faculty
VIR
to link to BIDMC Faculty URL
Muneeb Ahmed, MD, FSIR
Jeffrey L. Weinstein, MD
Chief, Vascular & Interventional Radiology
Vice Chair for Interventional Services
Associate Program Director, VIR Fellowship Program
Program Director, Integrated IR/DR Residency
Associate Director, Minimally Invasive Tumor Therapies
Laboratory
Associate Professor of Radiology, Harvard Medical School
Staff Radiologist, Vascular & Interventional Radiology
Program Director, VIR Fellowship Program
Associate Program Director, Integrated IR/DR Residency
Instructor in Radiology, Harvard Medical School
Fellowships:
• Interventional Radiology, Northwestern
Memorial Hospital, Chicago, IL
Fellowships:
NCI Research Fellow in Cancer Radiology, BIDMC
Residency:
Vascular and Interventional Radiology, The Johns
Hopkins School of Medicine, Baltimore, MD
Diagnostic Radiology, Einstein Medical Center,
Philadelphia, PA
Residency:
Diagnostic Radiology, BIDMC
- Chief Resident, Radiology Residency Program
Medical School:
Internship:
Metrowest Medical Center/Harvard Medical
School Affiliate
Academic Activities/Accomplishments:
MD - Jefferson Medical College (now the Sydney
Kimmel Medical College), Philadelphia, PA
• American Board of Radiology Certified
• Certificate of Added Qualifications (CAQ) in
Vascular and Interventional Radiology
• Member, SIR Standards of Practice Committee
• Member, SIR FDA Committee
• Reviewer, Journal of Vascular and
Interventional Radiology
Medical School:
The Aga Khan University Medical College,
Pakistan
Clinical & Research Interests:
RF ablation
Interventional Oncology
Advanced biliary interventions
Research Interests:
Academic Activities/Accomplishments:
• Medical Education
American Board of Radiology Certified
- Certificate of Added Qualifications (CAQ) in Vascular and Interventional Radiology, ABR
• Thromboembolic Disease
• Interventional Oncology
• Ultrasound-guided Interventions
Member, Radiological Society of North America;
Society of Interventional Radiology, New
England Society of Interventional Radiology,
American College of Radiology, Society of
Thermal Medicine
Contact: [email protected]
Contact: [email protected]
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Faculty
VIR
Felipe Collares, MD
Olga R. Brook, MD
Staff Radiologist, Vascular & Interventional Radiology and
Abdominal Imaging
Associate Director of CT Services
Assistant Professor of Radiology, Harvard Medical School
Staff Radiologist, Vascular & Interventional Radiology
Co-Director, Noninvasive Vascular Lab, BIDMC
Director, Mass Vein Care, HMFP
Instructor in Radiology, Harvard Medical School
Fellowships:
Fellowships:
• Vascular and Interventional Fellow, BIDMC
• Advanced Vascular and Interventional Fellow,
BIDMC
• Research Fellow in Vascular and Interventional
Radiology, BIDMC
Clinical Fellowships, BIDMC
• Abdominal Imaging
• Body MRI
• Interventional Radiology
• Ultrasound/Women’s Imaging
Residency:
• Diagnostic Radiology, Hospital Mater Dei Belo
Horizonte, MG, Brazil
Residency:
Diagnostic Imaging
Rambam Medical Center, Haifa, Israel
• Diagnostic Radiology, Centro Radiologico da
Lagoa Rio de Janeiro, RJ ­Brazil
Medical School:
Bruce Rappaport Faculty of Medicine,
Technion – Israel Institute of Technology
Haifa, Israel
Medical School:
• MD, Medicine, Federal University of Minas
Gerais, Belo Horizonte, Brazil
Research Interests:
• MS in Radiology, Federal University of Rio de
Janeiro, RJ ­Brazil
• Superselective vs lobar transarterial
chemoembolization
• Gemstone Imaging/Cyberknife Therapy
• Pancreatic Imaging
• Quality Improvement and radiation dose
reduction in Radiology
Research Interests:
• Use of PercuNav Guidance for improving TIPS
• Endovascular therapies for patients with
varicose veins such as Endovenous laser
ablation and sclerotherapy
Academic Activities/Accomplishments:
• QA issues in VIR
Longitudinal Radiology Educators for HMS
Principal Clinical Experience (PCE) Curriculum
Contact: [email protected]
Contact: [email protected]
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Faculty
VIR
Salomao Faintuch, MD, MSc
Seth J. Berkowitz, MD
Staff Radiologist, Vascular & Interventional Radiology
Co-Director, Advanced Vascular Care, LLC
Assistant Professor of Radiology, Harvard Medical School
Staff Radiologist, Vascular & Interventional Radiology
Instructor in Radiology, Harvard Medical School
Fellowships:
Fellowships:
Clinical Fellow, Interventional Radiology, BIDMC
• Clinical Fellow, Interventional Radiology,
BIDMC
Residency:
• Research Fellow, Interventional Radiology,
BIDMC
Radiology, BIDMC
Medical School:
Residency:
Johns Hopkins University School of Medicine,
Baltimore, MD
Federal University of Sao Paulo, Brazil
Clinical Interests:
Medical School:
• Arterial and venous endovascular
interventions
Federal University of Sao Paulo, Brazil
Research Interests:
• Percutaneous biliary intervention
Academic Interests:
• Interventional therapies for the prostate
• Interventional Oncology
• Cutting-edge embolics
• Imaging informatics
Academic Activities/Accomplishments:
• Percutaneous urinary tract intervention
• Point of care mobile applications
RSNA Research Scholar 2008-2010
• Patient engagement and patient generated
data
Editorial Board - Journal of Vascular and
Interventional Radiology, Journal of the
Association of Vascular Access, RSNA Daily
Bulletin, Radiologia Brasileira
• Teaching tools for medical education
Contact: [email protected]
Reviewer - Radiology, AJR, American Journal of
Transplantation, NIBIB/NIH Study Section
National Society Committees: Society of
Interventional Radiology (Technology
Assessment Committeee & Annual Meeting
Scientific Abstract Reviewer), RSNA Public
Information Committee
Contact: [email protected]
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Faculty
VIR
Sahil Mehta, MD
Barry A. Sacks, MD, FSIR
Staff Radiologist, Vascular & Interventional Radiology
Instructor in Radiology, Harvard Medical School
Staff Radiologist, Vascular & Interventional Radiology
Associate Professor of Radiology, Harvard Medical School
Fellowship:
Vascular & Interventional Radiology,
Massachusetts General Hospital, Boston, MA
Dr. Sacks joined the Department of Radiology at
BIDMC as Chief of the Division of Cardiovascular
and Interventional Radiology (2010-2014).
He has served as Chief of Vascular Radiology
at Beth Israel Hospital, Boston, MA and Chief
of Radiology at MetroWest Medical Center,
Framingham, MA. To date, Dr. Sacks holds nearly
20 patents on interventional catheters and other
medical devices. He continues to specialize in
endocrine interventions.
Residency:
Diagnostic Radiology, BIDMC
(Mini-fellowships: Vascular & Interventional
Radiology, and Global Health)
Internship:
Transitional Year Residency in Medicine and
Surgery, Memorial Sloan Kettering Cancer Center,
NY, NY
Fellowship:
Interventional Radiology, Beth Israel Hospital,
Boston, MA
Medical School:
University of Chicago, Pritzker School of
Medicine, Chicago, IL
Residency:
Beth Israel Hospital, Boston, MA
(Chief Resident 1976-77)
Academic Activities/Accomplishments:
Senior Editor, USMLERx - online question bank
for USMLE
Internships:
Internal Medicine, Baragwanath Hospital
Surgery, General Hospital
Ob-Gyn, Coronation Hospital
Pediatrics, Baragwanath Hospital
Johannesburg, South Africa
Contact: [email protected]
Medical School:
University of Witwatersrand,
Johannesburg, South Africa
Academic Activities/Accomplishments:
American Board of Radiology (ABR)
Certificate of Added Qualification in
Interventional Radiology, ABR
Contact: [email protected]
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Faculty
VIR
Ammar Sarwar, MD
Staff Radiologist, Vascular & Interventional Radiology and
Informatics
Assistant Professor of Radiology, Harvard Medical School
Fellowships:
• Interventional Radiology, BIDMC
• Cardiac Imaging, Massachusetts General
Hospital, Boston, MA
Residency:
Diagnostic Radiology, BIDMC
Medical School:
MB BS - King Edward Medical College, Punjab
University (Currently King Edward Medical University), Lahore, Pakistan
Research Interests:
• Improving imaging utilization
• Determining readmission rates and outcomes
after interventional radiology procedures
• Determining and improving the value of
radiology in healthcare delivery
• Software development for PACS workstations
in diagnostic and interventional radiology
Academic Activities/Accomplishments:
Resident Director for Quality Imrpovement,
BIDMC (2011-2012)
James M. Moorefield Fellowship in Health Policy
and Economics, American College of Radiology
(2012)
Contact: [email protected]
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