rad onc to IR?

[radonctoIR]

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I don't know of anyone who has, but is it possible to train as an interventionalist coming out of radiation oncology? There are a lot of very cool procedures that are being done in IR now. Do you think they would train someone with an oncology background? I don't know what kind of job you would do afterwards, especially if you can't take diagnostic call. But certainly things like doing your biopsies and fiducials, stents, RFA, embos, kyphoplasties would be useful. What programs would be open to this?

 

[Pointless]

No, these are completely unrelated and you would need to do a radiology residency prior to starting a radiology fellowship like IR. Hope that helps.

 

[medgator]

No, these are completely unrelated and you would need to do a radiology residency prior to starting a radiology fellowship like IR. Hope that helps.

I've heard that may be changing down the road though as IR May branch off into its own field/track

 

[Sheldor]

I've heard that may be changing down the road though as IR May branch off into its own field/track

I'd heard this too, pretty sure their mission statement aligns with them being more like a surgical subspecialty like ENT or Uro with a stand alone residency.

Pretty sure Zeitman gave a talk at RSNA this last year about the future of rad onc and IR. Obviously with interventional onc on the rise there is going to be some overlap with brachytherapy in terms of treatment mentality.

 

[radonctoIR]

In a diagnostic residency there is usually only 3 months of IR. So in total their fellows are doing only 1 year and 3 mo of IR. Also, if I understand correctly they do accept neurologists to train in neuro IR. So couldn't a radiation onc train to become an interventionalist, without doing a diagnostic residency?

 

[Sheldor]

In a diagnostic residency there is usually only 3 months of IR. So in total their fellows are doing only 1 year and 3 mo of IR. Also, if I understand correctly they do accept neurologists to train in neuro IR. So couldn't a radiation onc train to become an interventionalist, without doing a diagnostic residency?

Do you mean theoretically or in real life? In real life, the answer is as above.

Theoretically raises some interest questions though. I could see a future where IR was more like Plastics now, where you can actually get there from multiple routes. Sure, most people do the fellowship after doing a general surgery residency, but they also allow ENT to apply and do those.

 

[badasshairday]

In a diagnostic residency there is usually only 3 months of IR. So in total their fellows are doing only 1 year and 3 mo of IR. Also, if I understand correctly they do accept neurologists to train in neuro IR. So couldn't a radiation onc train to become an interventionalist, without doing a diagnostic residency?

Most radiology residents do up to 6-12 (up to even 15+ in some residencies) months of IR if they have plans to go to IR. Most programs these days allow quite a bit of flexibility for electives during 4th year. IR has a huge amount of procedures (venous, arterial, oncologic, musculoskeletal) and the fellowship is demanding therefore it is important for a rads resident to spend a lot of time in IR if they want to do the fellowship. That is not even including many programs that have an additional amount of time spent in interventional Neuro-radiology.

Not only that most programs have a minimum of 4 months of VIR and in addition to this diagnostic radiology does a lot of procedures anyways. CT guided biopsies are common in MSK radiology, Body, Chest imaging as well. MSK will also do fluoro guided pain injections, rf ablations, and cryoablations of bone tumors, bone biopsies. Other sections do many fluoro guided, CT guided (lung, liver), U/S guided procedures (breast biopsies etc).

Many people don't realize this but radiology residency is generally a pretty procedure laden field even outside of VIR.

Some think VIR will split off, but honestly I wouldn't count on it. They may become a little more peripheral but will always be tied to diagnostic radiology for the most part. There really just isn't enough 100% VIR, especially high-end oncology procedures, to go around in private practice except in select groups. I suspect oncology procedures will for the most part be done at academic centers and very large rich community hospitals.

 

[radonctoIR]

Do you mean theoretically or in real life? In real life, the answer is as above.

Theoretically raises some interest questions though. I could see a future where IR was more like Plastics now, where you can actually get there from multiple routes. Sure, most people do the fellowship after doing a general surgery residency, but they also allow ENT to apply and do those.

Both.

Noone has addressed yet the neurology to neuro IR pathway. Why should it be any different for radiation oncs?

Another example is pain fellowship. Multiple specialties are eligible for pain fellowship.

 

[Gfunk6]

When I was a medical student, I used to fantasize about being boarded in two specialties. I thought it would be 'cool' to merge the best aspects of two seemingly related fields.

Now that I have gone through the trial by fire and emerged on the other side, let me just say that these types of dual residencies are a silly idea. First off, most of your Rad Onc residency does not involve brachytherapy just like most of your Rads residency does not involve IR. Therefore, you are learning a LOT of extra 'stuff' that will not be applicable to your future career. Second, your training will be extended ridiculously. Third, there is the issue of turf.

In the end, the decision to make something like this happen is solely in the hands of the ABR. Since Rad Onc has been unsuccessful at even lobbying for the right to give oral chemo, I think it is very safe to say that IR/Rad Onc brachy merger has no future.

 

[medgator]

Since Rad Onc has been unsuccessful at even lobbying for the right to give oral chemo

Didn't realize we were lobbying for that

I am very happy to keep my med onc colleagues employed giving stuff like Xeloda and Temodar.... even if oral, their toxicities are nothing to sneeze at.

 

[seper]

I have to fight so hard to find a MedOnc willing to give Temodar to uninsured/underinsured GBM patients, so I wish I can write for it myself.

However, it's a slippery slope. I've spoken to RadOncs from Europe who were required to adminster concurrent cisplatin. That's something I don't ever want to do.

 

[medgator]

I have to fight so hard to find a MedOnc willing to give Temodar to uninsured/underinsured GBM patients, so I wish I can write for it myself.

However, it's a slippery slope. I've spoken to RadOncs from Europe who were required to adminster concurrent cisplatin. That's something I don't ever want to do.

Whether you write it or the med onc writes it, the patient likely won't be able to afford it if they are uninsured/underinsured

 

[seper]

Managed medicaid plans pay for it in my state.

 

[medgator]

Managed medicaid plans pay for it in my state.

that's pretty good.... Usually with those expensive oral drugs, it's not the med onc that's the limiting step, it's the insurance plans that require a flat % of the drug's cost to be paid by the patient from what I've had problems with.

 

[radonctoIR]

Aren't rad oncs allowed to give xeloda? At least I think I have seen that

 

[Gfunk6]

"Allowed?"

If you are licensed to practice medicine in your state, you can perform brain surgery/spine surgery/open heart surgery legally.

However, it is poor form and will make you liable for complications if you perform something without the appropriate residency/fellowship training.