Angio / Interventional Rotation

Goals (common to all of the rotations)

1. Determine the appropriateness of patient selection for a requested procedure through review of available history, imaging, laboratory values and proposed/expected outcomes of the procedure, as well as obtain deficient information in these areas.
2. Demonstrate understanding of history/physical findings or treatment scenarios that would require pre-procedure assistance from other specialty disciplines such as cardiology, anesthesia, surgery and internal medicine.
3. Obtain informed consent after a review with the patient of the procedure(s), risks, benefits and alternative therapeutic options/procedures.
4. Recognize monitoring abnormalities and physical signs/symptoms that need immediate attention during a procedure.
5. Demonstrate appropriate post procedure recovery, patient management and follow-up.
6. Demonstrate understanding and appropriate management of certain pharmacological considerations:
   1. Drug/Contrast Reactions
   2. Antibiotic Therapy
   3. Conscious Sedation
   4. Anesthesia/Analgesia
   5. Anticoagulation

Rotation 1 and 2 (Includes first Neuroradiology)
Knowledge Based Objectives: At the end of the rotation, the resident should be able to:

1. Demonstrate knowledge of basic vascular anatomy.
2. Demonstrate knowledge of basic vascular pathology
3. Demonstrate basic knowledge of vascular catheters, guide wires as well as biopsy devices.
4. Given appropriate films, demonstrate a thorough knowledge of the vascular anatomy of the central nervous system.

Technical Skills: At the end of the rotation, the resident should be able to:

1. Demonstrate proper sterile technique.
2. Demonstrate basic hemostasis techniques.
3. Demonstrate proper handling of guide wires and catheters as a first assistant.
4. Demonstrate proficiency in performance and interpretation of lumbar, dorsal and cervical myelograms.

Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to:

1. Obtain an informed consent from a patient
2. Order appropriate pre procedure labs.
3. Recognize when a patient is not an appropriate candidate for a given exam.
4. Understand and recognize one’s limitations and be able to ask for assistance when needed.
5. Recognize severe complications that would require additional assistance and appropriately communicate with the attending staff and referring physicians.

Rotation 3 and 4 (Includes procedural related goals and objectives for Neuroradiology)

Knowledge Based Objectives: At the end of the rotation, the resident should be able to:

1. Demonstrate continued learning from the section curriculum.
2. Demonstrate understanding of the different vascular access catheters used in the section.
3. Demonstrate understanding of thrombolysis agents and vascular stents as well as the associated complications.

Technical Skills: At the end of the rotation, the resident should be able to:

1. Demonstrate improved needle biopsy and vascular catheter manipulation.
2. Demonstrate basic suture skills for placement of indwelling catheters.
3. Perform with increasing levels of skill in myelography and angiography.
4. Demonstrate increasing ability to accept responsibility for performance and supervision of neuroradiologic procedures.

Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to:

1. Demonstrate improved consultative abilities regarding interventional procedures.
2. Demonstrate improved skills in triage of patients and prioritizing the daily schedule.
3. Improve ability to select the appropriate contrast agent, guide wire and catheter for a given procedure.
4. Make decisions to modify a neuroangiographic procedure when unexpected pathology or angiographic abnormalities occur, then follow through with the performance and supervision of the procedure.