MS1 Radiology Questions Reading/Procedures

[JPSmyth]

I posted this in the AMA but I figured more potentially helpful eyes would see it here as it's own thread...

1. I am an MS1 very interested in radiology, and I have a few questions that I was hoping some people on here might be able to answer.
   
   
   From my research on SDN it seems that most DR residencies have a typical day of morning conference 7-8, reading from 8-12, 12-1 lunch didactic, 1-5/6 reading.
   
   
   During those reading times, are they broken up by leaving the reading room to do procedures? How many procedures does an average resident do per week? I'm sure this varies from program to program and the rotation you're on but any insight would help.
   
   
   If you had to give a ratio of time spent reading / time spent doing procedures what would you say that is? 80/20? 70/30?
   
   
   Since I am interested in doing procedures/seeing patients on occasion would it be best for me to look into IR residency/fellowship which would lead to dual board certification so I can split my practice into some days spent reading other days spent in clinic?
   
   
   Thanks so much!
   

---

Members don't see this ad.

 

[bjb305]

it's highly dependent on where you go.. at my institution, we have a procedure rotation that we all do 3 months of throughout the 4 years. this rotation includes all CT/US guided biopsies and drains. Our IR rotation is totally separate which includes the cholangios and intravasc procs. other places i know the IR department handles all procedures.. it just all depends. The other rotations have some procs like LPs on neuro and joint aspirations/injections on MSK. i'm sure you could do a lot of procedures without IR trained as long as you're comfortable with them. Like I plan on doing all biopsies and drain placements when i get to private cause i got trained in them a lot

 

[JPSmyth]

it's highly dependent on where you go.. at my institution, we have a procedure rotation that we all do 3 months of throughout the 4 years. this rotation includes all CT/US guided biopsies and drains. Our IR rotation is totally separate which includes the cholangios and intravasc procs. other places i know the IR department handles all procedures.. it just all depends. The other rotations have some procs like LPs on neuro and joint aspirations/injections on MSK. i'm sure you could do a lot of procedures without IR trained as long as you're comfortable with them. Like I plan on doing all biopsies and drain placements when i get to private cause i got trained in them a lot

Very interesting, thank you. So as an attending in breast, neuro, or MSK you will have the opportunity to do procedures relatively often? (Aside from being an IR are these the most hands on subspecialties within rads?)

Do attendings in academics do procedures or are those usually done by physicians in other fields?

 

[Gadofosveset]

Very interesting, thank you. So as an attending in breast, neuro, or MSK you will have the opportunity to do procedures relatively often? (Aside from being an IR are these the most hands on subspecialties within rads?)

Do attendings in academics do procedures or are those usually done by physicians in other fields?

It varies a lot. You won't be able to predict your future role in biopsies as a diagnostic radiologist other than to say you'll probably do some. Usually a group will let you get involved with more, if you want, particularly the harder or riskier ones.

I'm in academic radiology and I do a fair number of biopsies. I like them. I would not have been able to predict this role in residency.

 

[Gadofosveset]

If you want to get the most experience with biopsies, pick a residency with few fellows, show initiative in residency, try to focus your IR rotations on IR-lite procedures rather than watching vascular work or endovascular oncology work (if you have a choice), then go to a fellowship where you can practice even more but with different attendings to see how their style differs.

 

[JPSmyth]

If you want to get the most experience with biopsies, pick a residency with few fellows, show initiative in residency, try to focus your IR rotations on IR-lite procedures rather than watching vascular work or endovascular oncology work (if you have a choice), then go to a fellowship where you can practice even more but with different attendings to see how their style differs.

Thanks. Won't most large academic institutions that will hve "good" Radiology residencies have fellows usually though? Like big name competitive programs. Not saying that I'll be able to match into one of them but I'm just curious as I would like to aim high obviously

 

[Gadofosveset]

Yes.

This leads to a paradox where graduating residents from smaller programs can be better than residents at big name programs in procedures that are not high end IR.

Of course, you need to look at the whole picture before deciding on a residency.

 

[bjb305]

Yes breast neuro and MSK attendings will do procedures. Breast will do all breast biopsies, MSK will do all of the bone biopsies since ortho oncs require certain structures to be avoided in the biopsies and generally the MSK folks know this, and neuro will do tons of LPs, some places do disc/vertebral biopsies, facet injections, kyphos.. just all depends

 

[JoshSt]

If you're interested in procedures, do surgery as a very early rotation in MS3 to see if the OR is for you or not

 

[JPSmyth]

If you're interested in procedures, do surgery as a very early rotation in MS3 to see if the OR is for you or not

I have done a few hundred hours in shadowing and I know that surgery isn't for me. I didn't hate it, but I just don't see myself being in those shoes. I think minimally invasive stuff is awesome, like what interventional cards does, but their lifestyle is pretty bad I heard.

 

[tco]

I have done a few hundred hours in shadowing and I know that surgery isn't for me. I didn't hate it, but I just don't see myself being in those shoes. I think minimally invasive stuff is awesome, like what interventional cards does, but their lifestyle is pretty bad I heard.

You'll want more of a Body imaging lifestyle, it seems. It's busy, don't get me wrong. But IR will come in during the middle of the night for emergent procedures, as well.

 

[JPSmyth]

You'll want more of a Body imaging lifestyle, it seems. It's busy, don't get me wrong. But IR will come in during the middle of the night for emergent procedures, as well.

Will definitely look into this! Is there overlap in the procedures that body imaging and IR do, or are all the body imaging procedures so minor that IR doesn't wSte their time with them?

Thanks

 

[tco]

Will definitely look into this! Is there overlap in the procedures that body imaging and IR do, or are all the body imaging procedures so minor that IR doesn't wSte their time with them?

Thanks

Some Body Radiologists don't do any procedures. A few Body Radiologists have a wide range of procedures they'll do, including US and CT guided drains, biopsies, and even ablations for cancer. This is all dependent on the program you trained at, your comfort level, and what your job wants you to do. Don't forget that only a couple of generations ago, it wasn't uncommon for "regular" DR guys to do angios quite often.

 

[radnonymous]

.

 

[JPSmyth]

Some Body Radiologists don't do any procedures. A few Body Radiologists have a wide range of procedures they'll do, including US and CT guided drains, biopsies, and even ablations for cancer. This is all dependent on the program you trained at, your comfort level, and what your job wants you to do. Don't forget that only a couple of generations ago, it wasn't uncommon for "regular" DR guys to do angios quite often.

Cool, when the time comes to look for residency programs I will look for some that allows residents to learn procedures. Thanks

 

[JoshSt]

Cool, when the time comes to look for residency programs I will look for some that allows residents to learn procedures. Thanks

You'll do some IR as a DR resident, just ask what procedures other services do and their volume.

As above, even with a non-procedural body fellowship, you'll likely be comfortable doing some simple procedures from your residency. It depend the balance of IRs and what procedures are done by non-IRs.

That's good you've done a lot of shadowing and ruled out surgery.

 

[Gadofosveset]

Procedures are a nice break from reading diagnostic studies. I also like talking to patients (most of them, anyway).

Procedures get as routine as reading scans, though... hopefully after a year or two of doing them you've developed enough skill so that each procedure is not a new exciting adventure.

If one thinks IR procedures are somehow more intrinsically valuable then diagnostic imaging, though, that's a misunderstanding/misappraisal of both. A lot of the procedures I get orders for are of little benefit in the grand scheme. A misread diagnostic scan can cause havoc. And it can go the other way around, too. A poorly-done biopsy can totally alter a patient's life. It's immaturity to land too hard one way or the other; it seems to be a medical school disease to assign partisan value judgments to everything one encounters. Just do what you enjoy and do some patients some good.

I got fooled in medical school about the "boredom" of reading scans all day. Procedures only for me, please. But that was my mistake. Watching someone read studies is like watching someone read a book, pretty damn boring for the observer, but not that boring for the reader. My ideal practice would have a mix of both.