Hi,
I've been following the thread on neuro IR and saw that you're a neuroradiologist going into the field. I just matched to radiology this year and I'm really interested in doing neuroIR. I have a couple of questions and would really appreciate if you could provide some answers.
How long do most neuroIR fellowships take? I've seen that some (i.e. MIR) have a 2-year neurorad-neuroIR integrated fellowship, while others (probably most of them?) are 2 years after a 1-year neurorad fellowship. Why the difference in a year of training?
THe new model is 1 +2 however 1 +1 can work well. It all depends on your own personal level of confidence and to some extent how much angio experience you have going in. Also matters if you take a job with no support where you are "it" or you join an established neurovascular program with mentors.
-Why is IR only a 1-year fellowship while to become a neuroIR you need in many cases 3 years? I'm confused regarding the scope of the two fields. Are the techniques in neuroIR much more difficult than in IR? Can IR docs perform neuroIR procedures? Regarding this last question, if you go to the SIR website you'll see that they list many of the neuroIR procedures as part of general IR, so I was wondering if as an IR doc I'd be able to do neuro IR.
IRs generally do not do many or any of the INR procedures (above the arch, or involving the spine). However people are flexible, and some have picked up some skill out of interest or local need. However, most IR will not feel comfortable providing INR without additional training. It is not because the procedures are technically impossible to learn. Although I believe that INR procedures are technically more delicate than IR work. However, even more important, the diseases we treat are more complex, the risks of treatment greater, and therefore a much more nuanced understanding of the indications, rationale and objectives of treatment are needed. In addition, many of the diseases we treat are not well known or understood by general radioloigsts or even other doctors, in some cases even by non-vascular neurosurgeons! (For example, dural fistulas). So the INR becomes a key clinical player determining the need for treatment and guiding the care of the patient. It takes time to learn about the radiology, and clinical aspects of these diseases, therefore the trainnig is longer. However 2 years (1 + 1) may be enough for the motivated individual.
-Do neuroradiologists (not neuroIR) perform lot of procedures?
Some diagnostic neuroradiologists perform diagnostic cerebral and spinal angio, but most newly minted DNRs do not do angio and it is increasingly concentrated among the INRs.
We perform:
Aneurysm coiling
Vessel sacrifice and flow remodelling stent
Stenting of the intra and extracranial head and neck arteries
embolization of vascular malformations and tumors of the head neck and spine using a variety of agents both intra vascular and percutaneous
Embolization for epistaxis and trauma
acute stroke intervention
Percutaneous biopsy and intervention in the extracranial head and neck and spine
Spine pain procedures
A few other miscellaneous things
As you can see, I'm trying to understand what justifies the length of a neuroIR fellowship.
More complex diseases, smaller more delicate vessels, much more difficult anatomy, unfamiliar to the general world of medicine and even to many radiologists and neurosurgeons, much greater consequence of error.
As an illustrative point, think about how often we as radiologists are pimped about the major arterial anastomoses in the pelvis (i.e. in the setting of aortoiliac occlusive disease) we all know and understand this anatomy, it is bread and butter and useful for IR. Well in INR we need to know the anastomoses between face and brain arteries something not covered for the average radiology resident, but knowledge of this can means the difference between an elegant success and a catastrophic stroke, much more important than how the iliac artery is reconstituted!!!
Finally, when during residency do applications for neuroIR start? Is there a list with the 'top fellowship programs'?
No. It is a small community. Word of mouth is important. You must apply very early, perhaps year 3. Spots fill early, but people change their mind and so last minute opening are not rare.
Sorry for all the questions, but I really haven't had the chance to talk to a someone who's starting a neuro IR fellowship and I'm just trying to have a good idea of the field.
Again, thanks so much in advance and I'd really appreciate your answers.
