Conferences & Didactics | Interventional Radiology Residency

During July and August, all PGY-2 IR, DR, and ESIR residents receive dedicated lectures daily from 7"15-8 AM that introduce them to the specialty of radiology:

Abdominal (Gastrointestinal and Genitourinary) Radiology:

• Managing contrast reactions
• CT protocols/imaging limitations and indications
• Intro to fluoro
• Abdominal anatomy/how to read an abdominal CT
• Basics of body MRI
• GU/GI MRI
• Intro to abdominal trauma CT
• Abdominal anatomy at the workstation
• Foreign bodies

Cardiothoracic (Cardiac and Thoracic) Radiology:

• Mediastinum
• Intro to chest x-ray
• Emergencies in thoracic imaging
• How to read a chest CT

Interventional Radiology:

• Arterial/venous access

Musculoskeletal Radiology:

• Skeletal trauma

Neuroradiology:

• Head and neck anatomy
• Brain anatomy
• Stroke
• CNS infection
• Neurovascular anatomy/pathology
• Head and spine trauma
• Spine anatomy

Nuclear Radiology and Molecular Imaging:

• Intro to planar/SPECT
• Intro to PET

Pediatric Radiology:

• Intro to pediatric fractures
• Intro to peds chest
• Intro to peds abdomen

Ultrasound (US):

• Vascular ultrasound basics
• Intro to ultrasound
• Intro to pelvic ultrasound
• Body ultrasound

Other:

• How to be an outstanding radiology resident
• How to formulate an effective radiology report
• How to take cases in conference

The PGY 2-4 core didactic curriculum is repeated at least every two years, with a goal to repeat it on a 1.5-year cycle so that residents can be exposed to all essential topics twice before the American Board of Radiology (ABR) Qualifying (Core) Examination in June of the PGY-4 year.

Each of the following practice domains is represented in the core curriculum:
 

• Abdominal (gastrointestinal and genitourinary) radiology
• Breast radiology
• Cardiothoracic (cardiac and thoracic) radiology
• Interventional radiology
• Musculoskeletal radiology
• Neuroradiology
• Nuclear radiology and molecular imaging
• Pediatric radiology

In addition to the practice domains, there is didactic content in the following educational areas:

• CT
• MRI
• Radiography/fluoroscopy
• Ultrasonography

The core didactic curriculum includes the following diagnostic radiology content:

• Anatomy, disease processes, imaging, and physiology
• Specialty/subspecialty clinical and general content
• Topics related to professionalism, physician well-being, diversity, and ethics.
• Training in the clinical application of medical physics distributed throughout the 60 months of the educational program:
  • A medical physicist oversees the physics curriculum, which includes real-time expert discussions and interactive educational experiences
• A minimum of 80 hours of classroom and laboratory training in basic radionuclide handling techniques applicable to the medical use of unsealed byproduct material for imaging and localization studies and oral administration of sodium iodide I-131 for procedures requiring a written directive:
  • Integral to the practice of nuclear radiology, these didactics include, at a minimum, the following subjects:
    • Radiation physics and instrumentation
    • Radiation protection
    • Mathematics pertaining to use and measurement of radioactivity
    • Chemistry of byproduct material for medical use
    • Radiation biology

The core didactic curriculum includes the following core content areas of IR:

• Focused history and physical examination
• Health care team coordination
• Informed consent for IR procedures
• Inpatient care
• IR clinic
• Medical conditions relevant to IR procedures
• Pharmacology relevant to IR
• Procedural sedation for IR procedures
• Recognition and initial management of intra- and peri-procedural emergencies

The residents deliver bimonthly didactic conferences based on Fundamentals of Diagnostic Radiology by Brant and Helms during their PGY 2-3 years, averaging 1-2 Brant & Helms lecture(s)/resident/year.

Resident Rad-Path Conference

Every month during protected didactic time, one of the PGY 3-5 IR, DR, or ESIR residents presents clinically- or pathologically proven cases to their fellow residents at Resident Radiologic-Pathologic (Rad-Path) Correlation Conference, averaging one Rad-Path Conference/resident/year.

Faculty Rad-Path Conference

Every quarter during protected didactic time, one of the faculty members presents clinically- or pathologically proven cases to the residents and faculty at Faculty Rad-Path Conference.

ACR Institute for Radiologic Pathology

The American College of Radiology (ACR) Institute for Radiologic Pathology (AIRP) provides a unique radiology training experience for PGY-4 MHMMC IR, DR, and ESIR residents.  The mission of the AIRP is to advance the science of radiology through a pathophysiologic understanding of disease as the basis for radiologic interpretation.  The AIRP four-week Radiologic Pathology Correlation Course offers a comprehensive review of the radiologic presentation of a broad range of diseases and their pathological basis from all organ systems and imaging modalities, delivered by expert faculty from some of the most prestigious radiology programs in the United States.  The course is offered both virtual and in-person.  The in-person course is held at the AFI Silver Theatre and Cultural Center in Silver Spring, MD, a 32,000 square-foot state-of-the-art facility with more than 400 theater-style seats.  Approximately 95 percent of U.S. IR, DR, and ESIR residents attend the course at some point during their training.

IR M&M

The ACGME Program Requirements for Graduate Medical Education in Interventional Radiology state that “morbidity and mortality related to the performance of interventional procedures must be reviewed during a conference at least monthly and be documented”, and that “residents must actively participate in this review”.  Accordingly, in addition to monthly attendance, PGY 2-6 IR and ESIR residents are each expected to present at least one case at IR M&M Conference annually.  PGY 2-4 DR residents are also expected to present at least one case at IR M&M Conference annually, typically during their IR rotation at MHMMC Portland.

Diagnostic Radiology (DR) M&M

Morbidity and mortality related to the interpretation of radiologic studies is reviewed during a quarterly conference.  Residents actively participate in this review.

The didactic curriculum includes interactive case conferences in addition to the core lecture series.  Faculty present case conferences at various times throughout the academic year, with cases taken as “unknowns”.  During the spring, focus is placed on preparation of the PGY-4 residents to take the ABR Qualifying (Core) Exam in June.

Every Thursday from 12:15-2 PM throughout the 60 months of the educational program, the residents receive training in the clinical application of medical physics.  Our medical physicist developed the physics curriculum and delivers it in person.  The curriculum includes real-time expert discussions and interactive educational experiences.

The residents receive a minimum of 80 hours of classroom and laboratory training in basic radionuclide handling techniques applicable to the medical use of unsealed byproduct material for imaging and localization studies and oral administration of sodium iodide I-131 for procedures requiring a written directive.  Integral to the practice of nuclear radiology, these didactics include, at a minimum, the following subjects:

• Radiation physics and instrumentation
• Radiation protection
• Mathematics pertaining to use and measurement of radioactivity
• Chemistry of byproduct material for medical use
• Radiation biology

IR Journal Club

Every other month during the evening at a venue outside of MHMMC (restaurant, bar, resident or faculty member’s home, etc.), a topic is chosen, and several pertinent articles are discussed by the IR and ESIR residents and faculty.

DR Journal Club

Monthly during protected didactic time, one of the PGY 3-5 IR, ESIR, or DR residents presents an article of their choosing from a recognized radiology journal along with a faculty member who shares an interest in the topic, averaging one Journal Club/resident/year.

Departmental Grand Rounds are held quarterly with a guest lecturer.

The didactic curriculum includes interdisciplinary conferences in which both residents and faculty members participate on a regular basis. Imaging and image-guided procedures are integral to the management of cancer, and so radiology is represented at nearly all interdisciplinary tumor conferences at MaineHealth Maine Medical Center. These include breast, upper GI, lower GI, gynecology, leukemia/lymphoma, liver, lung, melanoma, neuro oncology, pediatric, and urology/prostate. The majority of these conferences are inter-professional, with attendees including physicians, residents, physician assistants, and nurse practitioners from multiple specialties; medical students; nurse navigators; and other health care professionals. IR, DR, and ESIR residents are expected to attend the tumor conference that is pertinent to their rotation at the time.

Furthermore, each division in the MHMMC  Portland Department of Radiology holds QI/QA conferences twice a month that include all health care professionals who work in that division (e.g. technologists, nurses, administrators, physicians, etc.). IR, DR, and ESIR residents are encouraged to attend the conferences that are pertinent to their rotation at the time.

Finally, the IR nursing and technologist staff participate in our monthly IR Mortality & Morbidity (M&M) conferences.

The ACGME requires the program to provide instruction and experience in pain management, including recognition of the signs of addiction.  The Maine Board of Licensure in Medicine requires all clinicians, including residents, to complete three hours of education every two years on the prescribing of opioid medication regardless of whether or not they prescribe opioid medication.  To meet these requirements, MHMMC has developed the “Addiction Medicine Tiered Curriculum” on Canvas, which consists of three, 1-hour long modules addressing core concepts for prevention and treatment of substance use disorders. MHMMC IR, DR, and ESIR residents are required to complete this curriculum every other year throughout their training.

The Fundamentals is a self-paced online training and education program for residents that delivers uniform, high-quality education covering the breadth of IR.  This full-featured online program helps residents advance their IR education and complete their residency as highly trained and competitive physicians. The Society of Interventional Radiology (SIR) designed The Fundamentals for IR and ESIR residents in their PGY 2-4 years.  The Fundamentals modules include the following topics:

• Clinical Medicine
• Intensive Care Medicine
• Image-guided Interventions
• Imaging & Anatomy

The MHMMC Integrated IR Residency Program does not require IR or ESIR residents to complete The Fundamentals given the robust nature of our own PGY 2-4 core curriculum.  However, current IR training pathways require at least one critical care rotation, but this does not occur until PGY-5.  Thus, MHMMC IR and ESIR residents are strongly encouraged to purchase access to The Fundamentals and complete the “Intensive Care Medicine” curriculum during PGY 2-4 in order to reinforce their clinical knowledge, prevent loss of clinical reasoning during their predominantly DR years of residency, and better prepare them to be comprehensive disease specialists.

MHMMC IR and ESIR residents can use Lifelong Learning Funds to purchase access to this program on an individual basis.  There is a discounted fee for SIR members.

The MHMMC IR team (physicians, PAs, residents, and medical students) rounds every morning from 7:30 – 8 AM in the IR Reading Room in order to discuss our patients. Many procedures are performed by the first available provider in the first available room, and so it is important that the entire team be familiar with the details. All patients who are scheduled for procedures that day as well as patients on whom we performed procedures that we are still following are discussed.

All residents (regardless of whether IR, DR, or ESIR) and medical students rotating on IR are assigned the task of reviewing and presenting the patients at morning rounds. Time necessitates that this is a well-organized presentation. Trainees spend time prior to morning rounds reviewing the consultation, diagnoses, problem lists, allergies, medications, laboratory evaluation, and the results of imaging.

Although the MHMMC Integrated IR Residency Program does not require IR or ESIR residents in their PGY 5-6 years to attend the majority of the PGY 2-4 conferences listed above, the ACGME requires them to have 2 hours of protected time every week for didactic activities.  SIR has developed Residency Essentials for this purpose. Residency Essentials is a self-paced online training and education program for residents that delivers uniform, high-quality education covering the breadth of IR.  This full-featured online program helps residents advance their IR education and complete their residency as highly trained and competitive physicians.  During PGY 5-6, IR and ESIR residents have protected time from 3-5 PM every Thursday to complete the 45 Clinical Topics and 4 Requisite Knowledge modules in Residency Essentials. Clinical Topics modules consist of 4-6 hours of material, including recorded didactic lectures and articles, pre- and post-assessments, and additional resources:

• Gastrointestinal
• GU
• Men’s Health
• Neurological
• Oncology
• Pain & Palliation
• Pediatric
• Vascular
• Women’s Health

Requisite Knowledge modules include:

• Business & Law
• Systems
• Physician Wellness & Development
• Research & Statistics

MHMMC purchases access to this program for the IR and ESIR residents.