Ross L. Ristagno, MD
Vascular/Interventional Radiology Fellowship Program Director
UC Radiology Department
234 Goodman Street, ML 0761
Cincinnati, OH 45267-0761
(513) 584-6484
(513) 584-0431 (Fax)
Ross.Ristagno@UCHealth.com

Rose Alden
Residency and Fellowship Program Coordinator
UC Radiology Department
234 Goodman Street
Cincinnati, OH 45267-0761

(513) 584-6484
(513) 584-0431, FAX
rose.alden@uchealth.com

Vascular/Interventional Radiology (VIR)

Introduction

The Interventional Radiology Fellowship is a one-year ACGME accredited program. Our goal is to produce an interventionalist with strong clinical and procedural abilities and academic experience appropriate for a career in private or academic practice. Full training is accomplished by rotating the fellows through all the different areas of interventional radiology encompassing a variety of invasive diagnostic and image-guided therapeutic techniques, including all aspects of radiological diagnosis and treatment of a wide array of organs, including blood vessels, biliary ducts, urinary tract, gastrointestinal tract as well as magnetic resonance and computed tomographic studies of blood vessels. The program is structured to enhance the trainee’s knowledge of the signs and symptoms of disorders amenable to diagnosis and/or treatment by interventional radiological techniques. An understanding of the symptoms, as well as the pathophysiology and natural history of the disorders, is fostered. The trainee will learn the indications and contraindications to vascular and interventional procedures,
as well as understand the medical and surgical alternatives to those procedures.

Goals and Objectives

Perform invasive procedures such as diagnostic angiography, diagnostic cholangiography, diagnostic pyelography, needle-placement under image guidance, arterial and venous percutaneous transluminal angioplasty, stent placement catheter-directed thrombolysis, mechanical thrombectomy, embolization, foreign body retrieval, biliary, GU, GI, peritoneal, extraperitoneal and thoracic drainage and sclerotherapy procedures, ureteral embolization procedures, biliary, GI and GU striction dilation and stent placement, biliary and GU stone removal/manipulation, caval filter placement, central venous access placement, tracheobronchial intervention
Interpret non-invasive imaging studies to determine that the requested procedure is appropriate and, if not, assign the correct procedure
Identify factors from patient history, physical and laboratory values that indicate potential risks for bleeding, renal damage, cardiovascular problems, breathing abnormalities, or adverse drug interactions during or after the procedure
Properly evaluate a patient before an interventional procedure using a focused history and physical format and provide appropriate patient follow-up in the inpatient and outpatient setting
Administer and maintain effective conscious sedation for patient comfort during and after the procedure
Recognize and treat complications during and after the procedure including but not limited to contrast/anaphylactic reaction, over sedation, pain, nausea/vomiting, arrhythmia, decreased oxygen saturation, sepsis, hypertensive urgency/emergency, low blood pressure, hyper-hypoglycemia or bleeding/hematoma
Understand radiographic and cross-sectional imaging (sonographic, CT and MR) applied to the diagnosis and performance of interventional procedures
Recognize and understand emergency procedures, their indications and impact

Curriculum

The didactic curriculum includes review of basic tools including guidewires, catheters, needles, embolization materials, stents, angioplasty balloons, and snares. There is also a review of basic techniques for all types of procedures which is reinforced prior to each procedure. The Fellows Conference held weekly will involve discussion of basic and advanced techniques, review of current literature, morbidity and mortality, and a review of new techniques and devices.

Fellows are exposed to outstanding case material. A trainee will perform approximately 1000 or more VIR procedures during the year. The fellow is encouraged to participate in the most challenging cases on the day’s schedule. Therefore, our fellows gain a strong experience in TIPS, PTC, SIRT, TACE,
visceral arteriography, and various embolizations. The interventional radiology exposure is impressive also since our hospital is a level 1 trauma center and a
liver transplant center. The CTA run-offs are interpreted by the VIR fellow.

One month of training is spent at the Cincinnati Children’s Hospital Medical Center under the direction of full-time pediatric interventional radiologists. One month of training is with the University Hospital Vascular surgeons who enrich the fellow’s experience in peripheral vascular disease arteriography and vascular interventions, including endovascular aneurysm repair. A two week rotation is performed in the Vascular Ultrasound Laboratory. There is opportunity to rotate at the Veterans Hospital.

Multidisciplinary weekly conferences include: Hepatobiliary Conference and Thoracic Oncology Tumor Conference. There are monthly VIR Morbidity and Mortality Conferences. There are Interesting VIR Case conferences and VIR Fellow Core Lectures every 2 weeks throughout the fellowship. Participation in clinical research projects and attendance at the annual SIR meeting is encouraged.

Duties and Responsibilities

The fellow will be responsible for coordinating the Interventional Radiology service under the direct supervision of the program director and attending faculty. Responsibility is given gradually as the fellow exhibits clinical and technical skills
as well as judgment commensurate with such responsibility.

The fellow will schedule all cases, complete pre- and post-procedure evaluations, supervise Radiology residents performing simple procedures, complete short-
and long-term follow-up with written documentation, review studies with faculty, dictate and correct reports prior to distribution, and prepare teaching files.
Morning review of cases will be done each day to allow the faculty, fellows and residents an opportunity to discuss techniques, emergency cases and prioritization in scheduling, review evaluations and treatment of complications, and discuss any special requirements with the technicians and nurses.

IR fellows are expected to attend and participate in weekly conferences. In addition, fellows supervise/ conduct monthly conferences for the radiology residents.

Fellows will have one-half day a week free from clinical duties for scholarly activities. Fellows are expected to participate in a research project in conjunction with attending staff. Projects should be designed to result in an abstract for poster presentation or manuscript. Funds to present abstracts at national meetings will
be provided.

Supervision and Evaluation

In all cases, an attending (faculty) radiologist supervision is present. Initially,
the fellow will function as the primary assistant to the faculty radiologist during a procedure. Once the skills are mastered, the trainee will transition to become the primary operator under direct supervision of the faculty who will function as the primary assistant. More complex cases will require greater exposure to these procedures prior to transitioning the trainee to the primary operator position.
In all cases, the trainee will be directly supervised and/or assisted by the faculty radiologist in attendance.

Evaluation of the fellow will be performed quarterly by faculty members by means of a standardized evaluation form. Fellows will meet quarterly with the Program Director to review a composite of faculty evaluations and to discuss their progress to date. At the end of the training program, the fellow will have the opportunity to evaluate the faculty as well as the overall effectiveness of the program in achieving its stated goals and objectives.

Application and Selection Process

Our Vascular and Interventional Radiology program is approved for two ACGME-accredited positions. We participate in the Interventional Radiology Fellowship match administered by the National Residency Match Program (NRMP) and accept the Universal Fellowship Application (.doc). All qualified applicants must have satisfactorily completed a radiology residency, passed all three steps of the USMLE, and have obtained a medical license in the state of Ohio prior to the start of the fellowship.

Applicants are selected based on a review of submitted documentation, relative academic strength and other criteria determined by the Program Director. Applicants must have an MD or DO degree from an accredited institution, completed an ACGME-accredited residency in diagnostic radiology and must be eligible for board certification or certified by the American Board of Radiology. Application deadline is March 15. In addition to registering with the Match, the following documentation is required:

Completed Universal Application
Current CV
Personal statement including goals and professional plans
Three letters of recommendation including a letter from the director of your residency program. Letters of recommendation must be less than six months old.
Copies of USMLE transcripts (Steps 1, 2, and 3 are required prior to beginning fellowship)
Photo (optional)

Selected candidates will be invited to a personal interview where they will meet with the Program Director, other members of the Neuroradiology faculty who are available, and the current fellows. Interviews are conducted between April 1 and May 31.

International Medical Graduates

IMGs interested in applying to our program must register with the National Match (if applicable). University Hospital sponsors J-1 visas only. Requests for H1-B visas are at the discretion of the program director and must receive approval from the department chair and the Associate Dean for Graduate Medical Education. Individuals must have graduated from medical school within the past five years, completed a four-year residency in diagnostic radiology, be board certified or board eligible in the country of training, must have passed all steps of the USMLE (including Step 3) and possess a permanently validated ECFMG certificate. One year of previous training in the United States is desirable, but not required. The ECFMG certificate must be valid at the start of fellowship or the fellow forfeits his/her position in the program. A valid Ohio medical license or training certificate must be obtained prior to start of training. Fellows are selected on the basis of their medical training, general and academic achievements, and personal qualities. No preference is given to any particular medical school or geographic area, nor is race, sex, or national origin a consideration.

In addition to the documents listed above, IMG’s must also include in their application:

Verification of ECFMG certification and photocopies of all USMLE exam results
Copy of medical diploma (translation required)
Medical School transcript
Copies of previous GME experience (translation required)

Salary and Benefits

Detailed information regarding the fellowship benefits, stipends, contracts and other policies and procedures can be found on the Office of Graduate Medical Education website at www.med.uc.edu/residency.

For additional information, please contact

Rose Alden
Department of Radiology
University Hospital
234 Goodman Ave.
Cincinnati OH 45219
rose.alden@uchealth.com
(513) 584-6484
(513) 584-0431 fax