Interventional Radiology Fellowship
Overview
Scope and Duration of Training: Vascular and Interventional Radiology (VIR) is a complex field that has gained sub-specialty recognition by the American Board of Medical Specialties. The backbone of the field was once the diagnosis and management of peripheral vascular disease. Practitioners now, however, provide a much broader range of medical care because of their unique expertise in image guided percutaneous interventions in the chest, abdomen, and extremities. A goal of the VIR education program at USC is to provide the trainees with didactic, clinical, and hands-on technical training in this sub-specialty. Specifically, this training shall provide sufficient experience for the fellows to pass the certificate of added qualification in Interventional Radiology.
The University of Southern California offers a one-year training program in Vascular Interventional Radiology. The education program is organized to provide comprehensive, full-time training and experience in the evaluation and management of patients requiring image guided VIR procedures; and provides a supervised experience in performance of imaging guided procedures. Imaging modalities included in the training program include fluoroscopy, angiography, computed tomography, and ultrasonography for guiding interventions. Vascular diagnostic studies using angiography, ultrasound, CT and MRI are also included in the training. Training areas include: vascular diagnosis, vascular intervention, non-vascular intervention, pre-procedure care, post-procedure care, and quality assurance. Additionally, imaging and monitoring equipment requirements are reviewed and safety issues discussed. The role of conscious sedation is demonstrated. Adjuvant therapies for our patients are discussed including analgesia, anticoagulation and antibiotic therapies. The role of the Interventional Radiologist as part of a physician team is emphasized. The trainee will learn arteriography and venography techniques, angioplasty, stenting, thrombolysis, embolotherapy, TIPS, filter placement, urologic interventions, biliary interventions, gastrointestinal interventions, and percutaneous biopsy and drainage procedures among others.
The program is structured to first enhance the trainee’s knowledge of the signs and symptoms of disorders and then to teach the indications and contraindications for percutaneous interventions. The trainee will acquire the technical skills required for the successful practice of Interventional Radiology. A system of incremental graded responsibility is used. After basic techniques are mastered, the focus of the program shifts to teach patient evaluation and management, and clinical judgment. Trainees learn when to avoid a procedure, when to start a procedure, when to stop a procedure and how to handle complications.
In addition to technical and imaging training, the program provides trainees with a structured experience in the clinical assessment of patients with disorders amenable to percutaneous therapies, and a structured experience in the follow up of patients after such treatments are performed. These pre-procedure and post-procedure care experiences take place both in the hospital and outpatient settings. Fellows work in an environment that promotes the development of a medical knowledge base relevant to percutaneous minimally invasive therapies and that includes an understanding of the pathophysiology of the underlying diseases. Training includes an emphasis on radiation biology, radiation physics, and radiation protection as they pertain to the interventional environment.
The training program provides opportunities for research into new technologies and in the evaluation of clinical outcomes of interventional radiology. Specific research areas of emphasis include embolic agents, particularly liquid agents, and newer Interventional Oncology therapies.
Faculty / Fellow Numbers: The program has a minimum of 7.5 FTE faculty members – 4.5 FTE faculty on the USC campus and 3 at Kaiser Permanente. The fellowship is accredited for 4 fellows. Therefore, the ratio of faculty to fellows is 1.75:1, well above the ACGME requirement of 1:1.
Program Director / Faculty: Program Director: Dr. Michael Katz is a full time USC faculty member certified by the American Board of Radiology in Diagnostic Radiology and has a Certificate of Added Qualifications in Vascular and Interventional Radiology. Faculty: All 6 other faculty members are full time Interventional Radiologists and each has a Certificate of Added Qualifications in Vascular and Interventional Radiology. All aspects of Vascular and Interventional Radiology are represented within the faculty. All faculty members demonstrate a commitment to the subspecialty and VIR as documented by membership in professional societies, publications in the field, and ongoing acquisition of CME credits in the field on a yearly basis. This faculty provides fellows with didactic teaching, hands-on supervision of clinical procedures, and direct supervision of periprocedural patient care including management decisions, interpretive skills, and consultative aspects of the specialty.
Facilities/Rotations:
1. LAC + USC Medical Center: (Three month experience over the course of the year.) This medical center has recently (11/2008) relocated to a brand new facility. It has three well organized IR suites (one biplane), containing state of the art flat-panel digital angiography units as well as a patient holding area. All procedure rooms are equipped with physiologic monitoring and resuscitative equipment. Each suite contains a dedicated ultrasound machine that has transabdominal and vascular capability. The hospital also has new state of the art CT and MRI. The suite is staffed with dedicated IR technologists and nurses. This busy hospital provides trainees with a large volume of cases and an extremely diverse case-load. There is experience in a broad spectrum of diseases and procedures. Exposure to advanced disease states occurs. The hospital is a level I trauma center and extensive experience with the diagnosis and management of traumatic injuries and bleeding complications is available. Additionally, there is a particularly high volume of embolization procedures.
2. USC University Hospital: (Three month experience over the course of year.) The purpose of the University Hospital rotation is to gain experience with complex interventions at a tertiary referral center. Specifically, there is an active transplant service at the University Hospital and trainees are exposed to the management of multiple transplant complications. Additionally, there is a very large dialysis center associated with the University Hospital and trainees get extensive experience with the management of dialysis accesses.
This hospital has a well organized IR suite containing two flat panel digital interventional procedure rooms which include dynaCT (one biplane). The procedure rooms are equipped with physiologic monitoring and resuscitative equipment and are staffed by dedicated IR technologists and nurses. There is a patient holding area (shared with cardiology) in close proximity to the procedure area. Ultrasound, CT, and MR, are all available within the Imaging Department. A dedicated Non-invasive Vascular Ultrasound Lab exists in the hospital and fellows each spend time interpreting vascular ultrasound examinations under the supervision of an attending.
3. Norris Comprehensive Cancer Center: (Three month experience over the course of year.) The purpose of the Norris Cancer Hospital rotation is to educate the trainees in oncologic interventional radiology. The primary focus is on chemoinfusion and chemoembolization for malignancies. Local ablative techniques are used including radiofrequency ablation, cryablation, and Y-90 selective internal radiation treatment. There is additional experience in the management of other conditions caused by extensive malignancies, such as gastrointestinal hemorrhage, pulmonary embolus, and biliary obstruction. This hospital has a single flat panel digital IR procedure room, which includes dynaCT. It is staffed by dedicated IR technologists and nurses, and equipped with physiologic monitors and resuscitative equipment working in an HMO setting is achieved.
4. Kaiser Permanente Sunset Medical Center: (Three months experience over the course of year.) This rotation allows the trainees to perform a large number of interventions for peripheral vascular disease, including stent-grafts. This hospital has a large AVM referral center with multidisciplinary treatment planning/implementation. There is a large volume of embolization for uterine fibroids. Additionally there is experience with pediatric intervention as well as image guided biopsies and drainages. There is an established Interventional Oncology program offering chemoembolization and radiofrequency ablation. Exposure to working in an HMO setting is achieved.
5. HCC II Outpatient Imaging Center and Clinic: (Experience throughout the year.) The Interventional Radiology section has an active outpatient clinic for consultation with new patients and for patient follow up visits. Clinic visits typically precede or follow procedures for peripheral vascular disease, venous disease, uterine fibroids, or Interventional Oncology. A multipurpose angiography room exists for the performance of outpatient interventional procedures.
Patient Population: The patient population for the program is extremely broad because each of the clinical venues is unique in its focus. LAC+USC Medical Center serves the poor of LA County and brings a large population of patients with penetrating trauma, non-penetrating trauma, advanced cancer, end stage renal disease and liver disease, and unusual infectious diseases. USC University hospital is primarily a surgical subspecialty hospital with an active hepatology service and liver / kidney transplantation program. Norris Comprehensive Cancer Center provides a high level of care to patients with unusual and complex cancers and is a leader in the management of liver cancer. Kaiser Sunset hospital provides the fellows with an HMO experience that includes a large volume of aortic stent-grafts, vertebroplasty procedures, and uterine artery embolization procedures.
Faculty:
Michael Katz, MD
Associate Professor of Radiology
Director, Vascular/Interventional Fellowship
Sue Hanks, MD
Associate Professor of Radiology
Chief of Radiology LAC+USC Medical Center
M. Vicki Marx, MD
Professor of Radiology
Vice Chair for Education
Donald Harrell, MD
Associate Professor of Radiology
John Park, MD
Assistant Professor of Radiology
Michael Katz, M.D.
Program Director