Interventional Neuroradiological Fellowship runs over 12 months

The Neurointerventional Service (NIS) provides 24 hour a day comprehensive neurointervention investigation and treatment of adult, paediatric and trauma related cerebrovascular diseases. The RMH is a level 1 trauma centre, including comprehensive stoke centre, neurosurgical unit, and also provides neurointervention service to the Royal Children’s Hospital. Applicants are generally appointed for 12 months. Preference will be accorded to applicants with experience in angiographic procedures.

The Fellowship comprises:

  • ~45 weeks of core fellowship
  • 1 academic session (see above)
    • 6 Angio sessions
    • 2 General sessions (CT / MRI / Plain films) *
    • 1 session CVS clinic
  • 5 weeks annual leave
  • additional call requirements include:
    • approximately 1 in 2 week call for intervention
  • weekly academic session
  • multiple weekly multidisciplinary clinical meetings

* For self funded fellowships the general sessions are negotiable.

Angio lab sessions

  • sessions: 6 per core week
  • performing, reporting and reviewing studies with rostered consultant
    • closely supervised performance of procedures dependent upon proficiency and experience of candidate
    • expectation of increasing independence as year progresses
  • protocolling studies
    • this should be performed first thing in the morning (8 - 8:30am) and immediately after lunch (2-2:30pm)
  • supervising the inpatient angio labs
    • responsible for protocols as necessary
    • responsible for managing emergency add-ons

Angio lab procedures

  • Diagnostic cerebral and spinal angiograms
  • Depending upon angiography experience, catheter skills may be acquired performing peripheral arterial and venous interventions.
  • Neurointervention procedures include treatment & invasive investigation of:
    • Aneurysm
      • Coiling
      • Balloon assisted coiling
      • Stent assisted coiling
      • Flow diverting stent (e.g. PED)
    • Vasospasm
      • IA vasodilators
      • angioplasty
    • Acute Stroke
      • Clot retrieval
      • IA thrombolysis
      • Angioplasty
    • Stroke secondary prevention
      • Carotid stenting
      • Intracranial angioplasty and stenting
      • Vertebral artery stenting
      • Subclavian artery stenting
    • DAVF
      • CCF
      • Sigmoid, transverse, torcula etc
    • AVM
      • NBCA
      • Onyx
    • Vein of Galen malformation (paediatric neurointervention)
    • Tumour embolisation
    • Trial balloon occlusion
      • Carotid
      • Vertebral
    • Petrosal sinus venous sampling
    • Wada testing
    • Spinal interventions
      • SDAVF
      • SCAVM
      • Vertebroplasty
      • Tumour embolisation
    • Trauma embolisation (Level 1 trauma centre)
      • Particulate
      • Coils
      • Covered stent

On call

  • frequency one in two weeks
  • duties to include being contact point for organizing emergency cases
  • liaising with on call NIS consultant, referring unit, ER, radiology registrar, Anaesthetics, radiographers, Nurses.
  • Triaging emergency cases
  • Involved with patient and family together with admitting unit
  • Assisting with the procedure
  • Ensuring timely completion of reports

Academic session

Each week an academic session is included in the roster. This is not an ‘afternoon off’ but rather a time to prepare meetings / conduct research / reading etc.

Expectations:

  1. complete at least one study which could be presented at a national or international meeting and lead to a publication
  2. involvement in projects / activities within the department targeted at improving the Neurointervention service
  3. involvement in teaching registrars

Meetings

Meetings form a cornerstone of the fellowship year. They give you access not only to a sub-population of abnormal and clinically demanding cases, but also grant you an insight into the place imaging occupies in modern multidisciplinary management of these patients. Additionally presenting these meetings develops your skills in discussing imaging findings with a group of senior clinicians.Combined neuroscience meeting

  • Frequency: weekly (Mon 12:00)
  • Consultant
    • Diagnostic neuroradiology: PP / FG / (PMD / BMT)
    • Neurovascular and neurointervention: PJM / RJD
  • Attendance: weekly
  • Role when attending: occasionally preparing / running neurovascular / NIS component of the meeting in the second half of the year

Journal club & research meeting

  • Tuesday 0800 weekly

Clinical grand round

  • Wednesday 0800, clinical round commencing in 4S
  • Daily ward rounds as required 0800

Stroke meeting

  • frequency: weekly (Tue 15:00)
  • attendance: rarely - only when no other registrars available to take it
  • role when attending: preparing / running the meeting

Cerebrovascular case review meeting

  • 0830 Friday, weekly meeting.
  • Fellow role to prepare cases for joint discussion with Neurosurgery & NeuroIntervention Service

Cerebrovascular Outpatient Clinic

  • 0900 Friday weekly

Journal club

  • A weekly journal club where either papers are presented or research projects are discussed

Quarterly review

Each quarter an informal meeting with the fellowship director (or equivalent) will occur giving each fellow the opportunity to receive and give feedback on fellowship so far, including how well reciprocal expectations are being met, workload / productivity, possible ways of improving the fellowship.