Interventional radiology (IR) procedures are life-saving or life-altering. Ranging
from the treatment of acute stroke to oncology, IR is bringing significant changes
to traditional treatment options with better outcomes for patients and shorter stays
in hospitals. It is important, therefore, that in a country such as ours, with limited
resources for our population, there is widespread availability of this expertise.
This will increase overall efficiency of our health care system.
The route to become an interventional radiologist requires dedicated training. Though
IR is part of the MD or Diplomate of National board(DNB) radiology curriculum in India,
the 3-year training may only provide an overview of the field. Further training is
necessary to learn the skills required to be a competent and safe interventional radiologist.
With limited number of training posts available in India, there is a shortage of interventional
radiologists to cater to the rising need.
In earlier days, a combination of basic training in radiology, passion for IR, and
some training would have been adequate to pursue IR as a career. The evolution of
IR was predominantly need-based, with initial clinical services including renal angiograms
for potential live renal donors. Training/clinical attachment visits to centers of
excellence, overseas faculty spending dedicated time in Indian institutions to help
set up service, local innovations, workshops etc., had major influences in developing
the specialty. One such example has been published in Journal of Clinical Interventional
Radiology (JCIR).[1]
[2] Subsequently, training of IR practitioners in India was concentrated in a few radiology
departments with a dedicated clinical IR service where one could join as a senior
resident.
Initially, dedicated IR fellowships or post-doctoral certified courses (PDCC) for
duration of 1 or 2 years were the main source of formal training. The selection process
was variable and included written exams and interviews. Some of these were recognized
by the Universities of the National Board though there were variations in the course
title and syllabus.
Over the years, the spectrum of interventional services available has significantly
widened and local availability of certain IR procedures with a short window period
such as stroke intervention, and embolization for massive hemorrhage has become crucial.
Today, formal training to practice IR in India is essential. Various DM super-specialty
courses such as neuroradiology and cardiovascular radiology do have their respective
spectrum of interventional training.
IR super-specialty courses have been introduced including DM and DNB in IR. The selection
process is through a highly competitive single national level entrance exam.[3]
The selection tests are multiple choice questions based, which include questions from
the general radiology and IR. These training courses have a formal syllabus. The institutions
providing these courses need to maintain high standards and have standard infrastructure
and training faculty appointments to continue to fulfil their eligibility to conduct
these courses.
Currently, DM courses pertaining to IR are available in 11 institutions, while DNB
IR is available in 3 hospitals. IR fellowship courses are available in around 45 institutions.
Indian Society of Vascular and Interventional Radiology (ISVIR) plays a role in providing
the expertise at various levels.
Training opportunities overseas are many and some of them have been mentioned below.
In the UK, IR trainees from other countries can apply either for a fellowship or as
a specialist. For fellowship application, one must have full General Medical Council
(GMC) registration and 5 years of radiology training. In the USA, introduction of
IR residency has made the fellowship opportunities limited for overseas candidates.
IR residency can be either an integrated residency, independent residency, or independent
IR residency with early specialization in interventional Radiology (ESIR). However,
completion of diagnostic radiology residency in the USA is mandatory in all these
training pathways. IR practitioners who are trained outside the USA can apply via
the American Board of Radiology (ABR) alternate pathway, which requires completion
of 4 years as a resident or a fellow, faculty member, or as a combination of all.
Canadian IR fellowships are equally competitive, but they are open to international
trainees and the Medical Council of Canada Qualifying Examination (MCCQE) examination
is not mandatory. Statement of purpose letters, letter of recommendation, International
english language testing system (IELTS) results and scanned, verified medical degree
should suffice for the application. In Australia, radiologists can apply for provisional
registration or postgraduate training if the requirements of competent authority pathways
are met. IR trainees can apply for fellowship positions though they require special
purpose postgraduate training registration by medical council of New Zealand. However,
the number of available positions is limited.[4]
The European Board of Interventional Radiology (EBIR) and European Diploma in Interventional
Neuroradiology (EDiINR) are exams with wider recognition provided by the European
society of radiology and Cardiovascular and interventional Radiological Society of
Europe (CIRSE).[5]
[6] Anyone who has completed their 2 years of IR training with the maintenance of logbook
can apply for the EBIR exam. Examinations such as this provide an international uniform
standard of assessment.
Need of the hour is for a greater number of skilled IR radiologists. With limited
number of training positions, landing one is highly competitive and requires intense
preparation.
