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Duration

2years – 1year of preliminary & 12 continuous months of specialized INR training

Course director

Dr Vipul Gupta, Director Neurovascular Intervention Unit/Interventional Neuroradiology

Requirements

CV + 2 recommendations

Eligibility

MD / DNB Radiology

DM Neuroradiology / Neurology

DNB Neurosurgery

Mch Neurosurgery

Definitions, Objectives & Scope of the Specialty

INR is a relatively new medical specialty that has been rapidly evolving over the past 2 decades. It uses interventional procedures, radiologic imaging & clinical expertise to diagnose & treat vascular disease of the CNS, Head – Face – Neck & Spine in adults & children.

It is an important & difficult specialty with strong & direct impact on patients with high risks connected to interventional procedures.

INR specialist requires to have special training, experience & expertise, so as to independently interpret clinical & investigational findings, perform & conduct INR procedures, consult with patients & communicate with referring physicians.

The training program will include training in the following

  • Signs & symptoms of disorders amenable to diagnosis treatment by INR techniques.
  • Basic neurological examinations to evaluate patients with neurological disorders.
  • Neuroanatomy, Pathophysiology & natural history of neurovascular disorders, indications & contraindications to INR procedures.
  • Clinical & technical aspects of INR procedures
  • Medical & surgical alternatives
  • Pre & post procedure management of Neurovascular patients. Neurointensive care management in consultation with Neurointensivist.
  • Fundamentals of imaging, radiation physics, biology & protection
  • Newer developments, strengths, weaknesses & risks of INR procedures

Objective of the training is to give the fellows an organized, comprehensive, supervised & full time education in INR with its wide panorama & scope.

Research should be encouraged; time & facilities should be made available during training


Duration

2years – must certain 1year of preliminary & 12 continuous months of specialized INR training. Program director to certify the preliminary 1year training, if done in a separate institute.

Institute:

having in-house Neurosurgery, Neurology & INR, with inpatient hospital beds with suitably equipped INR suite, ICU, modern imaging (CT, MR).

The trainee will be provided practice based learning & improvement, with

  • Exposure, participation (Hands on) in selective intra & extracranial vessel cannulation with microcatheters.
  • Exposure, participation in deployment of detachable coils, embolization with particles, NBCA, Onyx & sclerosants.
  • Exposure, participation in remodeling (balloon assisted or stent assisted) in aneurysm coiling.
  • Angioplasty & stenting of supra-aortic & intracranial vessels.
  • Acute arterial & Venous Stroke Therapy.
  • Participation in morbidity & mortality meeting.
  • Conferences with related fields.
  • Detailed knowledge of pharmacology of drugs used in INR procedures including contrast media, anticoagulation, thrombolytics & Antiplatelet agents.
  • Attendance / presentation in at least 1 national meeting - RAIN Meeting / Indian Stroke Association / NSI / ISVIR / ISNR / Monsoon Meeting / Society for Cerebro-Vascular Surgery).
  • Two/One topics as thesis/papers depending upon length of course

Trainee is expected to maintain a detailed logbook for the duration. This should be certified at the end of the training.

One Year Course

  • 50 diagnostic angiograms
  • Detailed case work in 20 therapeutic cases

Two year course:

  • 100 Diagnostic (Cerebral + Spinal) Angiograms.
  • He should be an operating physician in 20 cases (supervised / assisted).
  • Detailed case work (Neurointerventional) should include

    • BAVMs 10
    Aneurysms 10
    Stroke 5
    Stenting 5
    ECA Work 10

Faculty:

  • Director of Interventional Neuroradiology (Endovascular Neurosurgery)
  • Co- faculty- Consultant stroke and Interventional Neuroradiology
  • Senior consultant Interventional Neuroradiology

Annually, the program will evaluate the faculty performance in relation to the education program, with written, confidential evaluation by the fellows. If deficiencies are found, the program should prepare a written plan of action to improve performance.

Applicants will be interviewed by Program Director or an appointed committee

There would be an oral exam at end of fellowship with two examiners (an internal & one external examiner).