ser talk dr.n. khandelwal

Emergency Radiology Fellowship Program

N. KhandelwalN. Khandelwal

Professor & HeadProfessor & Head

Department of RadiodiagnosisDepartment of Radiodiagnosis

PGIMER, ChandigarhPGIMER, Chandigarh

Introduction

Subspecialization in medicine has increased due to:Subspecialization in medicine has increased due to:

Enhanced knowledge about various diseasesEnhanced knowledge about various diseases

Technological advances allowing diagnosis and Technological advances allowing diagnosis and

treatment of many diseasestreatment of many diseases

Technologies have also become more complexTechnologies have also become more complex

Types of Radiologists

Three types

General radiologist

Subspecialist radiologist

Multispeciality radiologist

General Radiologist - Radiologist trained in residency without completing

a fellowship or otherwise training in a subspeciality

- Includes fellowship-trained radiologists who spend

a significant amount of time interpreting studies

outside their area of expertise; so called ‘Hybrid

Imagers’

Subspecialist Radiologist

Fellowship trainedFellowship trained

Radiologist who has developed personal Radiologist who has developed personal

expertise and competence in his area of expertise and competence in his area of

interestinterest

Spends most of his time in his primary Spends most of his time in his primary

specialityspeciality

Multispeciality Radiologist (MSR)

A general radiologist who also develops

additional focused expertise in a number of

subspeciality areas

Primary provider of imaging care

Needs the support of single-speciality

radiologist

Statistics of Radiologists in India

268 medical schools that run radiology courses268 medical schools that run radiology courses

35,000 medical students35,000 medical students

No. of radiology seats is 747 ( 537 MD seats, 210 DNB seats), no. No. of radiology seats is 747 ( 537 MD seats, 210 DNB seats), no.

of DMRD seats is 253 of DMRD seats is 253

Total number of radiologists in the country is 10,000 ( Ratio Total number of radiologists in the country is 10,000 ( Ratio

1;100,000 population)1;100,000 population)

Limited subspeciality radiologistsLimited subspeciality radiologists

Quant Imaging Med Surg 2014;4:449-450

Advantage of Subspecialists

- Work is done faster, more accurately and

more efficiently

- Work done is of the highest quality

- Improved quality of patient care

2011 2012 2013 2014 2015

PGI DataPGI Data

No. of patients in Emergency & Trauma Section

Non-communicable diseases are rapidly

growing in number in India

Increased burden of cardiac diseases and

stroke, predicted to be a major cause of

death and disability in India by 2020

Growing problem of road traffic accidents

Emergency patients are critically ill

Require maximum care by specialists

Emergency services are provided by

residents drawn from various specialities

Are presently attended by the least qualified

personnel

CASECASE

40 year old female with headache and 40 year old female with headache and seizures for 1 weekseizures for 1 week

What is this MR image?What is this MR image?1.1. DWIDWI2.2. SWISWI3.3. Perfusion map Perfusion map 4.4. FLAIRFLAIR

What is this MR image?What is this MR image?1.1. DWIDWI2.2. SWISWI3.3. Perfusion map (rCBV)Perfusion map (rCBV)4.4. FLAIR imageFLAIR image

FINAL DIAGNOSIS?FINAL DIAGNOSIS?

1.1. TuberculomaTuberculoma2.2. Pyogenic abscessPyogenic abscess3.3. MetastasesMetastases4.4. HydatidHydatid

TUBERCULOMA

DIAGNOSIS?DIAGNOSIS?

1.1. TuberculomaTuberculoma2.2. Pyogenic abscessPyogenic abscess3.3. MetastasesMetastases4.4. HydatidHydatid

PYOGENIC ABSCESS

DIAGNOSIS?DIAGNOSIS?

1.1. TuberculomaTuberculoma2.2. Pyogenic abscessPyogenic abscess3.3. MetastasesMetastases4.4. HydatidHydatid

NO MEMBRANES

DIAGNOSIS?DIAGNOSIS?

1.1. TuberculomaTuberculoma2.2. Pyogenic abscessPyogenic abscess3.3. MetastasesMetastases4.4. HydatidHydatid

What could be the primary?What could be the primary?

1.1. BreastBreast2.2. ProstateProstate3.3. OsteosarcomaOsteosarcoma4.4. Retroperitoneal sarcomaRetroperitoneal sarcoma

Cystic metastasis in brainCystic metastasis in brain

Squamous cell carcinoma of lungSquamous cell carcinoma of lung

Adenocarcinoma of lungAdenocarcinoma of lung

Carcinoma breastCarcinoma breast

Uterine carcinoma(rare)Uterine carcinoma(rare)

Melanoma(very rare)Melanoma(very rare)

Mammography

Emergency Radiology Fellowship

First task is to identify the medical institutions

which provide emergency services on a large

scale

Institutes should have adequate beds and ICU

services specifically dedicated for emergency

medicine

Emergency Radiology Fellowship

Radiologists with adequate qualification and

teaching experience should be there

Should have special interest in emergency

radiology with atleast 5 years teaching experience

There should be atleast 3 full time faculty

members

Emergency Radiology Fellowship

Teachers should be on full time basisTeachers should be on full time basis

Should not be involved in the teaching/ Should not be involved in the teaching/

patient care activities of the parent patient care activities of the parent

departmentdepartment

Eligibility criteria of teachers may be

revisited after 10 years

Emergency Radiology Fellowship

Faculty should be ably supported by non-

teaching/ paramedic staff

Radiology technologists should also be

trained in handling critically ill patients

Long term goal should be to also have

emergency radiology technician courses

Emergency Radiology Fellowship

ER section should have adequate patient

workload and infrastructure

State-of-the-art imaging modalities should be

available

Latest equipment should be there

Simulator training modules to be encouraged

Emergency Radiology Fellowship

Uniform core curriculum

Should be a competency based curriculum

Stress should be on practical and

procedural skills and providing standard of

care to the patients

Emergency Radiology Fellowship

Evaluation system for the fellows should

include internal assessment, theory and

practical examination

Stress should be on short cases, spotters

and procedural skills

Some Cautions

Subspeciality level of expertise may not be

required in routine daily practice

Become less proficient in areas outside the

speciality

Approach should be multidisciplinary without

conflict of interests

Some Cautions

Risk of ‘fragmentation’ : natural tendency of

subspecialist imagers to feel closer to their

medical and surgical subspeciality

counterparts

Career pathways for ER specialists need to

be planned

Conclusion Need to work proactively to address the imaging

needs of the future

Emergency Radiology Fellowship is a necessity

Need for evolving a basic common curriculum for

ER Fellowship program

SER should and will take the lead in this process

November 11-13, 2016Venue: Lecture theatre complex, PGIMER, Chandigarh

In collaboration with Society of Breast Imaging (SBI), USA

Post Graduate Institute of Medical Education and Research