neuroradiology questions

[derisivewords]

Hi,

In pursuing a subspecialty in neuroradiology (interventional or otherwise), does one usually start from a neurology or a radiology residency? Is one path more 'standard' than the other, and what are your thoughts on the training?

---

Members don't see this ad.

 

[triathlete411]

I am currently doing a neuroradiology rotation at my school. As I understand, people complete a rads residency and then do a neuroradiology fellowship, which can be either one or two years. The two year programs include some type of certification and are for people interested in academics.

 

[JMD]

But can you take the neuro residency route? I am interested in this as well. Aren't there some "territorial" issues between rads and neuro?

 

[Jim Picotte]

I know at least one programs allows you to get double certified in both neurology and radiology at the U of Wisconsin. There are probably more out there. You could first do neurology and then radiology as well but that would be around 8 years of residency. There are some territorial issues but for the most part, radiologists are reading all the studies and neurologists are treating the patient. Only neurosurgeons or neurointerventional radiologists do the coiling of the aneurysms and other procedures, not neurologists.

 

[ApacheIndian]

When I interviewed at St. Joe's in Phoenix (affiliated with Barrow's Neurological Institute--a Neuro powerhouse), I was told that most of the Neurointerventional fellowships there were being granted to Neurosurgeons, not Radiologists. That sucks.

 

[panch]

as i see it, there are five routes to Interventional Neuroradiology (INR):

1.) Do a diagnostic radiology residency, then an Interventional/INR fellowship for ~2-3 more years (this is the trad route)

2.) Do the combined neurology/diagnostic radiology/neurorad residency/fellowship. total of seven years, would get double boarded, prolly 1 additional INR fellowship year.

3.) Do both neurology and diagnostic radiology as separate residencies, then a 2 year INR fellowship (excessively long route)

4.) Newly approved, ACGME accreditation of fellowship for neurologists to do INR. Neurology residency would be four years, fellowship will be three years, prolly focusing on cerebrovascular neurology and endovascular stroke care (the newest route, i don't see these neurologists working on AVMs)

5.) Do a neurosurgery residency (seven years), then one year INR fellowship.

and yes, there are HUGE territorial issues b/w rads, neurosurg, cards (e.g. CEAs), and (now) neurology.

choose your adventure

 

[ApacheIndian]

Originally posted by panch
1.) Do a diagnostic radiology residency, then an Interventional/INR fellowship for ~2-3 more years (this is the trad route)

2.) Do the combined neurology/diagnostic radiology/neurorad residency/fellowship. total of seven years, would get double boarded, prolly 1 additional INR fellowship year.

Wait a second... so both of these options would take 7-8 years, but with the 2nd one you'd be boarded in Neurology too? How's that?

 

[panch]

yeah, it can be slightly confusing, but here's the breakdown (note DR=diagnostic radiology, INR=interventional neuroradiology):

the combined neurology/radiology/neuroradiology residency/fellowship: it's offered at a few academic centers across the country (Cleveland Clinic, NYU, Hopkins, U Wisconsin; search FRIEDA for a more complete list). it's a long haul. first year is mainly medicine, some ER, and some DR. next two years are pure neurology. then two years of pure DR. then a two year fellowship in neurorads. both the ABPN (certify neurologists and psychiatrists) and ABR (rads) have worked together on this, i think that they both fudge and count the neurorads "fellowship" as fulfilling part of the requirements for their respective fields w/ special qualifications in neurorads (of course you still have to take the board exams in each field). you'd prolly have to do another year of interventional neurorads fellowship to be able to get privileges at the best hospitals (but not sure bout that)

here's a link to the NYU program:
http://www.med.nyu.edu/Neuro/training/neurorad/index.html

here's a link to the ABR details:
http://www.theabr.org/1_guidelines.html

the traditional DR route might make you more flexible (knowing the rest of DR cold, perhaps knowing more IR)... but i think that the combined route would make one a better INR (you'd have the exam skills, workup, therapeutic paths, and clinical correlations down cold).

the combined route would also be more geared towards those who like to see patients (not something i've seen in the DRs that i've met)
[now i'll duck as the DRs start throwing things at me]

 

[ApacheIndian]

Good info Panch. So are you doing one of these Valu-pack residencies or are you straight Neuro?

Oh and incidentally, I do know what Marchiafava-Bignami disease is, and I didn't just look it up (cross my heart). I ran a Google search on the PD in preparation for one of my early Rads interviews a couple months ago, and one of his abstracts that popped up was this: Radiologic findings in Marchifava-Bignami disease... primary necrosis of the central portion of the Corpus Callosum.

thank you thank you (bowing in various directions)

 

[carrigallen]

Personally, I would suggest that the combined residencies do not necessarily provide better training than the traditional route, despite their additional years. An individual who is double boarded in rad/neuro may not have the equivalent experience that a rad/inr would have. Also, returning to neuro may delay progress towards your earnings potential.

 

[panch]

hey cuts, i'm going straight adult neuro (i was slightly interested in the combined program due to research interests in functional neuroimaging, but i can do that from adult neuro as well)

re Marchiafava-Bignami disease: just some zebra that a neuroradiologist at my institution loves to bring up (he brought it up each time i read w/ him, which was twice and separated by months). i think it's interesting as i love red wine so much.

as far as combined residency vs. one or the other: i'm not inclined to do a combined residency as i think it doesn't give enough exposure in each field. but this is also coming from a person who also considered the combined neuro/psych and neuro/im residencies.

re earnings potential: not something i'm particularly concerned about... i'll be comfortable whatever i do (how much money can one actually spend in a lifetime?). but carrigallen is right, you're not going to make *nearly* as much money as a neurologist as you would as a radiologist (esp an IR/INR).

An individual who is double boarded in rad/neuro may not have the equivalent experience that a rad/inr would have.

but the PDs of the programs would argue that the converse (or is it inverse?) is also true, that a rad/inr may not have the breadth of knowledge and skills that a rad/neuro/inr would. (e.g. while the rads resident spent x months doing RUQ ultrasounds, the neuro/rads resident was diagnosing acute stroke in the ER).

what i say: do one or the other, and see what peaks your interest during residency. unless you're absolutely sure that neurorads/INR is what you want to do, the combined residency would lock you into a decision that you may regret later (as i understand it, you won't be eligible for board certification in either field until you complete the entire seven years, ugh)...

clinical correlation is required

dos centavos

 

[Brewster]

Your experience at Barrow is not at all unusually. INR (aka endovascualr neurosurgery) is becoming increasingly dominated by neurosurgeons who did endovascular fellowships.

 

[enceph]

Originally posted by panch
as i see it, there are five routes to Interventional Neuroradiology (INR):

.....

4.) Newly approved, ACGME accreditation of fellowship for neurologists to do INR. Neurology residency would be four years, fellowship will be three years, prolly focusing on cerebrovascular neurology and endovascular stroke care (the newest route, i don't see these neurologists working on AVMs)

Really? I had not heard about this. Any idea which institutions are offering the fellowship?

 

[Voxel]

The NIR fellowship is open to both radiologists and neurosurgeons. However to stay competent as a neurosurgeon you are going to have to do a certain number of surgical procedures and you will be kept busy by those. If instead you focus on stricly endovascular NIR then you would gain those skills while loosing competency/practice in neurosurgical procedures. It is tough to do both. I think you need to a certain number of neurosurgical procedures each year to renew your board certification as a neurosurgeon. I think it would be tough to do both simultaneously and keep your neurosurgical board cert. Thus in the end you have to ask yourself, if I want to do neurointerventional radiology/endovascular procedures which path is the ultimately the best for me. That's a personal decision, but to me it makes more sense to do it from the radiology route as that would be most interesting and practical, but others would disagree.