How Many Years Of School To Become A Radiologist

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Interventional radiology (IR), sometimes known as vascular and interventional radiology (VIR), is a medical sub-specialty which provides minimally invasive image-guided diagnosis and treatment of disease. Although the range of procedures performed by interventional radiologists is broad, the unifying concept behind these procedures is the application of image guidance and minimally invasive techniques in order to minimize risk to the patient.

Historically, radiology doctors who regularly used x-ray imaging for the purpose of diagnostic testing were some of the first physicians to use imaging to direct medical procedures. Radiologists pioneered the use of catheter-based techniques such as angioplasty and catheter-delivered stent placement, which are now commonly used by other interventional medical specialties such as interventional cardiology.

Presently, IR physicians use x-ray, ultrasound, CT, and MRI imaging to perform a variety of procedures using needles and small catheters instead of surgical incisions. Thus, some conditions which previously required open surgery can now be treated non-surgically by an interventional radiologist.

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Training

Traditional

As in most medical specialties, training varies depending on varying rules and regulations from country to country. In the United States, interventional radiologists are physicians whose education and training traditionally includes completing a college degree, four years of medical school, a year of training in general medicine and/or surgery (internship), a four-year diagnostic radiology residency program, and then a one or two year fellowship in vascular & interventional radiology.

With the evolving need to train more clinically oriented interventionists, two alternative pathways to achieve certification in IR have been established through the leadership of the Society of Interventional Radiology (SIR): The DIRECT and Clinical pathways. For both pathways, the SIR states that the trainee must become proficient in management of inpatient and outpatient pre-procedure, post-procedure, and follow-up clinical care for all disease processes pertinent to the practice of VIR.

DIRECT

The DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training) pathway allows for up to two years of clinical training prior entering the program. Therefore, residents may enter the new pathway from medical school or after two or more years of clinical training in other specialties such as internal medicine or vascular surgery. The core diagnostic training is 27 months in duration, with 21 total months of VIR training for a total of 48 months (four year) duration. The advantage of the DIRECT pathway is that upon successful completion of the program and 12 months of clinical practice, a clinician can achieve both a Diagnostic Radiology board certification and a subspecialty vascular IR certificate. The American Board of Radiology offers a complete list of programs that offer this pathway at: http://theabr.org/ic/ic_other/ic_direct.html.

Clinical

An integrated Clinical Pathway has been created to provide breadth and depth of clinical experience for trainees who desire a primary career focusing on VIR rather than diagnostic radiology. The 6-year program allows for 29 months of Diagnostic Radiology training, 19 months of clinical training (including a medicine or surgery intern year) and research, and 21 months of VIR fellowship training. The Clinical Pathway is offered by institutions such as UVA, Northwestern and Brigham and Women's Hospital. The Clinical Pathway allows for certification in VIR and for board certification in diagnostic radiology.

Dual Certificate

A newer Dual Certificate program has been approved for implementation, establishing a six-year curriculum similar to the Clinical Pathway, that provides training for Board Certification in both Diagnostic and Interventional Radiology.

Pediatric

A handful of programs currently offer interventional radiology fellowships that focus on training in the treatment of children.

How Many Years Of School To Become A Radiologist Video

Imaging Modalities

Common interventional imaging modalities include fluoroscopy, computed tomography (CT), ultrasound (US), and magnetic resonance imaging (MRI) as well as traditional (plain) radiography:

• Fluoroscopy and computed tomography use ionizing radiation. However, both methods have the advantages of being fast and geometrically accurate.
• Ultrasound is frequently used to guide needles during vascular access and drainage procedures. Ultrasound offers real-time feedback and is inexpensive. Ultrasound suffers from limited penetration and difficulty visualizing needles, catheters and guidewires.
• Magnetic resonance imaging provides superior tissue contrast, at the cost of being expensive and requiring specialized instruments that will not interact with the magnetic fields present in the imaging volume.

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Disorders

Vascular

The field of endovascular surgery arose from interventional radiology techniques to treat disease that is endovascular (inside blood vessels) and has become an alternative to vascular surgery for some conditions such as abdominal aortic aneurysm and peripheral artery disease. Basic techniques involve the introduction of a catheter percutaneously into a large blood vessel by Seldinger technique. Typically the blood vessel chosen is the femoral artery or a vein found near the groin. Access to the femoral artery for example, is required for coronary, carotid, and cerebral angiographic procedures. The catheter is injected with a radio-opaque contrast dye that can be seen on fluoroscopy (live X-ray). As the contrast courses through the blood vessels, characteristic images are seen by experienced viewers and can assist in the diagnosis and treatment of diseases such as atherosclerosis, vascular trauma, or aneurysms.

Endovascular surgery is performed by radiologists, neurologists, neurosurgeons, cardiologists, cardiothoracic surgeons, and vascular surgeons.

Oncologic

Various interventional therapies exist to treat cancer. Tumor type, size, extent of disease, operator experience, and involvement of anatomical structures all factor into deciding which therapy is most appropriate. Some therapies, such as transarterial chemoembolization, block the blood supply to tumors. Other techniques--radiofrequency ablation (RFA), microwave ablation, cryoablation, Irreversible electroporation(IRE), and high-intensity focused ultrasound (HIFU)--directly damage the cancerous tissue. All of these treatments are delivered locally, minimizing damage to nearby tissue and avoiding the systemic side-effects of chemotherapy. Depending on cancer type, extent of disease, and patient characteristics, these therapies may be useful as adjuncts to surgical or medical therapies.

In addition to liver resection and liver transplantation, cryoablation, radiofrequency ablation, microwave ablation, Irreversible electroporation, percutaneous ethanol injection, chemoembolization, and radioembolization each have roles in adjunct or definitive therapy for certain types of liver tumors, depending on cancer type and patient selection/stratification.

In addition to surgery (lobectomy), minimally invasive treatment options, including high-dose radiation therapies and percutaneous thermal (radiofrequency ablation, microwave ablation, and cryoablation) have emerged as safe and effective therapies.

Cryoablation, radiofrequency ablation, microwave ablation, and Irreversible electroporation have emerged as treatment options alongside surgical nephrectomy and radiation therapy. For certain types of tumors, embolization has also been described.

Interventional Radiologists utilize various minimally invasive ablative therapy techniques for the treatment of breast cancer, including: radiofrequency ablation, cryotherapy, interstitial laser therapy, high-intensity focused ultrasonography, and focused microwave thermotherapy.

The appropriate management of prostate cancer is controversial. Common practice involves treating the whole gland in order to fully eliminate the typically multifocal disease. However, this form of treatment (i.e. radical prostatectomy and radiotherapy) is associated with significant negative outcomes including urinary incontinence and impotence. Interventional oncology offers alternative, tissue-preserving focal therapies that might minimize adverse treatment outcomes since they are less invasive and minimally traumatic. These therapies include cryoablation, HIFU, laser-based phototherapy, brachytherapy, radiofrequency ablation, Irreversible electroporation,and photodynamic therapy. Current studies are investigating the efficacy of these therapies for the management of prostate cancer. Patients with recurrent cancer might particularly benefit from these therapies since they apply highly sensitive imaging to guide specifically targeted treatment.

Of the minority of patients with resectable disease, surgery remains the only potentially curative option. Radiotherapy and chemotherapy are mainstays in the treatment and palliation of pancreatic cancer. Irreversible electroporation, may present as a potential treatment option for patients with local andenocarcinoma. Martin et al evaluated overall survival in 54 patients with local pancreatic adenocarcinoma; they compared their IRE-treated cohort to matched stage III patients treated with standard therapy. They found a statistically significant increase in local progression-free survival, distant progression-free survival, and overall survival, amongst the patients treated with IRE.

Neurologic

Spine

Hepatobiliary

Women's Health

Kidney

Other

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Procedures

Common IR procedures are:

• Angiography:

• Balloon angioplasty/stent:

• Cholecystostomy:

• Drain insertions:

• Endovascular aneurysm repair
• Embolization:

Chemoembolization:

Radioembolization:

• Thrombolysis:

• Biopsy:

• Radiofrequency ablation (RF/RFA):

• Cryoablation:

• Microwave ablation:

• Central venous catheter placement:

• IVC filters:

• Vertebroplasty:

• Nephrostomy placement:

• Radiologically inserted gastrostomy or RIG:

• Dialysis access and related interventions:

• TIPS:

• Biliary intervention:

• Endovenous laser treatment of varicose veins:

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Tools

The general basic tools of IR are needles, sheaths, catheters, and wires, however a large subset of highly specialized tools within, and outside of, these basic categories exist. Specialized devices exist to destroy tumors (ablation probes), treat diseased blood vessels (stents and atherectomy devices), stop bleeds (embolics and coils), stop blood clot migration (IVC filters, distal embolization protection devices), etc.

Wires vary in length, material, and shape. These varying properties allow for different functions.

Catheters can be loosely divided into five types:

• Diagnostic angiographic catheters
• Micro catheters
• Drainage catheters
• Balloon catheters
• Central venous catheters

Source of the article : Wikipedia