Dansk Forening for Interventionel Radiologi / Danish Society of Interventional Radiology

IR Uddannelse

DFIR´s forslag til uddannelse i Interventionel Radiologi

Interventions radiologi (IR) er ikke et anderkendt subspeciale i Danmark, og man kan derfor ikke stille krav til en dansk IR uddannelse. DFIR anbefaler nedenstående retningslinjer for et egnet uddannelsesforløb, som kompetencegivende til en slutstilling indenfor IR – jfr. retningslinjerne i CIRSE. Lokalt i Danmark vil uddannelsesbehovet dog kunne variere afhængig af, hvorledes en IR slutstillingen er sammensat. Nogle vil helt eller overvejende være vaskulære, andre mere modalitets/organ orienterede og atter andre både-og.

Før påbegyndelse af IR uddannelsen kræves speciellægeanerkendelse i Diagnostisk radiologi, som på nuværende tidspunkt er på 5 år inklusive I-stilling.

Mindre interventionelle indgreb forekommer på de fleste hospitaler i Danmark. (pleuradranage, biopsi, nefrostomi m.m.). Disse kompetencer er opnået som en del af speciallægeuddannelsen i Diagnostisk radiologi. De mere specielle interventionelle procedure som f.eks. karintervention, emboliseringer og perkutan tumorablation tilbydes kun på højtspecialiseret hospitaler og kræver supplerende IR uddannelse.

DFIR anbefaler, at alle nye speciellæger i Diagnostik radiologi, som ønsker at blive interventionsradiolog, som minimum skal gennemgå en supplerende 2-årig uddannelse med tilknytning til et IR afsnit på universitetshospital i Århus, Odense eller København. De anbefalede kompetencer, som en interventionsradiolog skal opnå, fremgår af det danske IR uddannelsesprogram, som er en oversættelse af CIRSE´s Syllabus. IR-uddannelsen kan afsluttes med en europæisk eksamen (EBIR), som afholdes i tilslutning til den årlige CIRSE- eller Europæiske Radiolog kongres. Se CIRSE´s hjemmeside her.

Universitetshospitalerne har højt specialiserede funktioner med forskellige organisatoriske opbygninger, og de samarbejder med de regionale sygehuse. Derfor er det på nuværende tidspunkt ikke muligt at tilbyde en ensartet IR-uddannelse over hele landet. Uddannelses skal tilpasses de lokale forhold og den uddannelsessøgendes ønsker.

Ved interesse for IR, kan man de fleste steder under den radiologiske speciallægeuddannelse få tildelt udvidet funktionstid og oplæring i IR. Efter speciallægeanerkendelsen i Radiologi, vil det almindeligvis være muligt i samarbejde med den uddannelsesansvarlige overlæge og med et eller flere universitetshospitaler, at sammensætte et kvalifikationsgivende IR forløb.

Download den danske oversættelse af CIRSE´s Syllabus her.

CIRSE´s originale Syllabus fra 2008 kan downloades her.

CIRSE’s forslag til uddannelse i Interventionel Radiologi

  • General radiological training should take place over a four year period. This common trunk includes training in Cardio Vascular and Interventional Radiology to basic level suitable for practice in a community hospital.
  • It is the opinion of CIRSE that the subspecialty in Interventional Radiology requires a strong clinical background and will spread over two years.

General training
in Interventional Radiology

Expertise:
To be suitable for general training in the subspecialty, a Radiology Department must be located in a hospital with a clinical service in Vascular Surgery, Cardiology and optionally Cardiac Surgery. The Radiology Department must be equipped with up to date CT, MR, Colour Doppler Ultrasound and Angiography equipment. The staff must include at least one physician, eligible for fellowship of the CIRSE, experienced in Angiography and in Interventional techniques.

Duration of training:
Trainees should spend 12 weeks in imaging techniques and 8 weeks in basic Interventional techniques.

Syllabus:
Trainees must be familiar with the full range of cardiovascular diagnostic techniques. They should understand the principles of all the methods and in particular they will be expected to know the indications, contraindications and complications of each imaging method.

Theoretical training:
50 hours.

Practical training:

A. IMAGING TECHNIQUE:They should have performed at least the standard number of the following diagnostic procedures. (recorded in a Log Book)

Diagnostic Procedures Participating Primary operator
Aortography & or Run off 50 25
Selective Angiography inkl. Head and Neck 100 50
Doppler Ultrasound and or Duplex Ultrasound 50 100
CT Angiography 30 30
MR Angiography and Cardiac Imaging 30 30
Phlebography & Venous Catheter Angiography 10 50

B. INTERVENTIONAL TECHNIQUE:

Trainees should understand the indications and the technical aspects of all the Interventional techniques in order to be able to discuss with the clinicians on indications and benefit of percutaneous treatments.
They should have performed at least the standard number of the following diagnostic procedures (recorded in a Log Book)

Interventional Radiology Participating Primary Operator
Peripheral PTA 25 5
Other PTA 5
Thrombectomy & thrombolysis 5
Vascular Stenting 5
Embolization 5
Venous Interventions 5
Vena Cava filters 5 5
PTC & PTCD 5 5
Biopsy 50 20
Drainage 10 10

Subspecialized training in Interventional Radiology

The duration of the subspecialized training is of 2 years and must include extensive clinical education. The aim of subspecialized training is to prepare the radiologist for a career in whicha substantial proportion of his/her time will be devoted to cardiovascular and interventional radiology. Such individuals will be expected not only to provide a diagnosis, treatment and follow up but also to disseminate knowledge to their colleagues in general radiology and to be able to discuss with a strong clinical background, with the referring clinician on the diagnosis and the choice of diagnostic imaging techniques and treatments.

Expertise:
Training must be undertaken in a hospital with a full clinical department in vascular surgery, cardiology, preferably cardiac surgery, intensive care units and related departments related to the field of interventional techniques.
Initially when subspecialized cardiovascular and interventional training is introduced it should be supervised be a radiologist eligible for full CIRSE fellowship.
The training department must have a full range of diagnostic equipment including CT, MRI, Doppler Colour Ultrasound, Angiography and Interventional Radiology, Equipment must include adequate monitoring possibilities.
There must be access to a Radiological Library containing textbooks and the most important journals.

Duration of training:
2 years.

Syllabus:
Trainees should acquire an in-depth knowledge of the pathological and clinical basis of the speciality. They should obtain extensive experience in all the diagnostic methods. Trainees must attend regular clinicoradiological conferences (at least weekly) with their clinical colleagues. Trainees will be expected to be familiar with the current subspecialized literature, both from standard textbooks and original articles. They should be encouraged to develop a critical approach in their assessment of the literature. They should be involved in research and scientific publication. They should acquire a knowledge of the design, execution and analysis of research projects. They should attend and participate actively in scientific program and the educational activities of the annual meeting of the CIRSE. Certification is subordinated to the publication of an article as first author in the field of the subspecialisation.

Quantity of theoretical training
200 hours.

Quantity of practical training:

A. IMAGING TECHNIQUE:The topics included in the general training program for CardioVascular and Interventional Radiology must be studied in greater depth. The trainees must have an extended knowledge of all imaging modalities including newer imaging modalities of the cardiovascular system as AngioCT, Colour Doppler Ultrasound and Magnetic Resonance.

They should have performed at least he standard number of the following diagnostic procedures (recorded in a Log Book).

Diagnostic Participating Primary Operator
Aortography & or Run off 150 50
Selective angiography inkl. Head and Neck 100 50
Doppler Ultrasound and or Duplex Ultrasound 50 100
CT Angiography
MRI Angiography and Cardiac Imaging 50 50
Phlebography 10 50

B. INTERVENTIONAL TECHNIQUE:

The trainees should have performed at least the following procedures (recorded in a Log Book)

Interventional Radiology Participating Primary Operator
Peripheral PTA 50 100
Other PTA (Renal etc.) 20 20
Complex PTA 20 20
Thrombectomy & thrombolysis 20 20
Vascular Stenting 10 10
Embolization 20 20
Complex Embolization 5 5
Techniques of intravascular chemotherapy 10 10
Venous interventions 20 20
Complex venous interventions (i.e. TIPS) 5 5
Vena Cava Filters 5 10
PTC & PTCD and gallbladder interventions 20 20
Percutaneous biopsy 20 20
Drainage 10 20
Foreign body retrieval 5 5
Genito-urinary tract procedures (nephrostomy, ureteral procedures, tubal recanalisation …) 20 20
Combined surgical and percutaneous procedures
Combined endoscopic and percutaneous procedures
Non vascular interventions & stenting 20 20
In-depth practice of advanced life support techniques

C. CLINICAL TRAINING:

Optimally trainees must spend the equivalence of 4 months clinical training in a department of Surgery, Internal Medicine or any subspecialty of Surgery or Internal Medicine

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