Vascular and Interventional Radiology Fellowship
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 the 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.
The program has a minimum of 7.5 full time faculty members with 4.5 located 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.
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.
All six 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.
- Los Angeles General Medical Center: This medical center has three well-organized IR suites (one biplane), containing 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. Ultrasound, CT, and MR, are all available within the Imaging Department. 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. Los Angeles General Medical Center serves the underprivileged 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.
- Keck Hospital of USC: 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 Keck Hospital of USC 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 spend time interpreting vascular ultrasound examinations under the supervision of an attending. Keck Hospital of USC is primarily a surgical subspecialty hospital with an active hepatology service and liver / kidney transplantation program.
- Norris Comprehensive Cancer Center: 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. 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 Permanente Sunset Medical Center: 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. 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.
- HCC II Outpatient Imaging Center and Clinic: 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.
Requirements for admission include:
- Immigration Status: Citizenship/Visa status. You must be a U.S. citizen or permanent resident, or eligible for a J-1 visa. The institution does not sponsor H-1 Visas.
- Medical Education: Fellows must be a graduate of an LCME accredited US or Canadian medical school or – for graduates of international medical schools – be in compliance with ECFMG requirements for post-graduate training in the US.
- Residency: To be considered all fellows must have verification of the satisfactory completion of an ACGME-approved residency.
- California State Medical Licensure: Photocopy of your California medical license (required for training), or if none, a statement by you affirming your eligibility for the license. You must have your California medical license prior to starting the fellowship program.
- State Radiography / Fluoroscopy Operator and Supervisor Permits: California state law requires that all physicians who operate or supervise the operation of radiography and fluoroscopy equipment have a valid operator/supervisor permit to do so. Permit acquisition requires that the physician pass a competency/safety test. A valid California State Medical license is required to qualify for the radiography/fluoroscopy permit. Therefore, our department requires that these permits be in place prior to the start of the fellowship program. The program coordinator will assist in this process.
- BLS/ACLS Certification: All residents must maintain BLS and ACLS certification. The institution provides support for this process.
For further information, contact:
Los Angeles General Medical Center
1200 N. State Street D&T 3D32
Los Angeles, CA 90033