interventional neuroradiology

[dr barb]

I am currently interested in neurosurgery, but the more I learn about interventional neuroradiology, the more intrigued I become. Can anyone enlighten on the kinds of procedures involved in this field? Also, I have no idea about the lifestyle - is it as rigorous as NS? Also, what is the typical salary like?

Thanks in advance for the info.

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[eddieberetta]

INR includes angiograms of the head and neck, cerebral and spinal circulation and related procedures (aneurysm coiling, embolization, angioplasty, stenting), and spinal interventional procedures (myelography, fluoro-LP, vertebroplasty) as well as percutaneous biopsy in the head and neck and spine (not intracranially) under imaging guidance.

(Please fill in if I have missed anything).

Interventional radiologists work longer hours than most radiologists, and have more rigorous on-call duties (emergency angio). In some places this may approach a typical neurosurgeon's hours, but many are able to work out a happy medium.

The pay is excellent, usually in the order of 400-600K although some outliers make a lot more by working inhuman hours.

You should also be aware that most INRs do at least some diagnostic radiology as part of their practice. In addition, there are opportunties for neurosurgeons to train in neuroangiography, so the specialty distinctions are becoming a bit blurred.

 

[dr barb]

Thanks for the info. I was wondering, based on what you know of both specialties (neurosurgery and interventional neuroradiology) which do you think is a better choice? I'm very interested in procedures, and I really don't mind crazy hours.

 

[eddieberetta]

That's a decision that only you can make. You should shadow an interventional neuroradiologist and a vascular neurosurgeon and see what you like. You should also shadow a diagnostic radiologist because if you have no interest in diagnostic radiology, the radiology route is not for you. At the same time, if you do not like the bread and butter of neuro (spine, spine and epi/sub durals) then think twice.

Like you, I was once torn between radiology and some surgical specialties. I picked radiology and am very happy with my decision. You say that you are intersted in procedures and that you don't mind crazy hours? Both specialties can offer you that!

 

[dr barb]

Thanks for the advice!

 

[GeorgeC97]

this is a good topic. you will really have to do a lot of investigation at your institution and other institution about WHO are the current and 'future' fellows. Of course, in teh past, this fellowship has gone to radiologists, but now, in my opinion and what i hear, the fellowships are going to teh neurosurgeons.
I've been told almost anywhere that neurosurgery is taking over that field, but b/c it is such a small field, it is hard to predict.
one vascular neurosurg/INR guy said he had his dream job of coiling one day and clipping another day.

 

[Voxel]

To say that neurosurgery is taking over Neuro-IR is far from the truth. It is true that they are taking neurosurgery trained residents for fellowship, but that does not mean neurosurgeons are taking over the field. I think the field is very young and growing. Right now there are not enough radiologists or neurosurgeons in this field.

I also believe it would be difficult to be a general neurosurgeon and a neuroIR person. One needs to keep up the intracranial operating part of one's practice to maintain your neurosurgical skills. This is just my opinion.

I believe that the option to be an NIR will be open to both fields for many years to come. If you want to do it , you will be able to do it from both specialties. Don't let people scare you away from radiology because NIR is what you want to do. I would say that there are more than radiologists than neurosurgeons in NIR fellowship. If anyone has the real numbers, I would like to know. Please post.

 

[Careofme]

Can a neurologist enter a interventional neuroradiology fellowship? Would the lifestyle/pay/hours be the same as a radiologist who entered the fellowship? I am confused as to the distinct differences between the two pathways.

Thanks.

 

[samsoccer7]

^

 

[Idiopathic]

What is residency like, as far as # of years and breakdown (i.e. a full diagnostic radiology residency followed by fellowship?)

 

[eddieberetta]

The breakdown is 1 year of internship + 4 years of rads residency + 1 year of diagnostic neuroradiology (CAQ) + 6-12 mo neuroangio.

Some people are skipping the dx neuro these days and doing body intervention followed by neuro intervention. Some programs require an additional fellowship research year (but it's a buyer's market for fellowships now).

 

[samsoccer7]

There was a good question up above.... can Neurologists take Neuroradiology fellowships?? I doubt it, but I would like to inquire at least...

 

[Voxel]

First, I would not say it is the most lucrative area. A few other fields come to mind such as derm, plastics, retinal optho, spinal surgery, etc. Second, there is no way you will make that much money taking 6 months of vacation. Third, you would have to find a partner who would be willing to work part-time with you to get 6 months off, which would be highly unlikely. Fourth, doing exclusively neurointerventional radiology is only possible in highly densely populated areas like nyc, la, etc where there are enough multiple cases to do on a daily basis.

 

[RADRULES]

Keep in mind, however, that one year of NIR fellowship will pay off big time in the future. By having the skills to read diagnostic neuro studies and do complex NIR procedures, you are basically every group's wet dream. The bottom line is that MANY (not all) diagnostic neuro guys out there do NOT like to do procedures. Most of the neuros I work with would like to read the MRs and CTs, collect the money, and go home.

Personally, I think I would do NIR before VIR. Why? Because that 1 extra year after a neuro fellowship will enhance your marketability and future salary tremendously.

As for the NS guys, most of them like to operate. A few are interested in NIR, and there is plenty of work to go around. But, remember that the rad will always have superior diagnostic skills. I do not see them as much of a threat, and most NIRs and NSs have a good working relationship.

 

[samsoccer7]

Every time I wonder if rads is for me, RADRULES swoops in and convinces me. Damn good job man. Can anybody in here hook me up with a rad spot at their program? But I'm pretty sure NeuroIR is gonna be my future, sounds like the trends are in that direction, and some of the stuff they do is badarse (embolizing tumors, on-site chemo, stroke care, avm, fistulae, etc.). Of course, in private practice, I'm not sure how many of those procedures are performed. Anybody have an idea on that one?

Anybody actually have any first (or second) -hand experience with NeuroIR guys in private and watch what they do and what their lives are like? Some people say it blows, but it also seems like you could find a job that's 50% neuroIR and 50% diag neuro and have a cushy lifestyle and do some sweet stuff?

 

[Voxel]

NIR is not condusive to a cushy lifestyle especially if you are the only one in your hospital/group that does NIR (statistically very likely in private practice). Aneurysms rupture/bleed at all hours of the night, and on weekends. You will be called to do the procedure if it is coilable and the risk/benefit favors endovascular coiling vs surgical clipping. You may have to work something out with your neurosurgery colleagues or find atleast another person who does NIR, so that you are not on-call 24/7.