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