D. Manson, MD, FRCPC

THE HOSPITAL FOR SICK CHILDREN

Pediatric Interventional Fellowship - Goals and Objectives

DEFINITION OF PEDIATRIC INTERVENTIONAL FELLOWSHIP

Pediatric interventional radiology is the organ/system-based subspecialty of Diagnostic Radiology dedicated to diagnosis and therapy of disorders and diseases in children utilizing different imaging techniques.

TRAINING YEAR SPECIFIC OBJECTIVES

1) Medical Expert: 1.1)Acquire an understanding of the basic radiographic and monitoring equipment to be found in a modern angiographic suite: digital imaging, ultrasound, CT, the contrast injector, the pressure monitor, the oximeter, ECG trace, oxygen and suction. 1.2)Develop appropriate professional and ethical approach to parents and children in pre-procedural patient visits, in obtaining consent, and in follow-up management. 1.3)Gain experience acting as a “consultant” in discussing, prioritizing and evaluating technical issues, appropriateness, potential risks, options and alternatives of an interventional/angiographic procedure with the referring clinical service. 1.4)Know how to sedate a patient for an interventional procedure in accordance with HSC guidelines and how to deal with allergic reactions and non-allergic hemodynamic crises. PALS certification is expected for fellows working in IGT, as well as attendance at the Sedation Course HSC. 1.5)Demonstrate appropriate concern for radiation protection and body substance precautionary measures. Understand techniques to minimise exposure to radiation and contaminated equipment. To be trained in thorough scrubbing, aseptic technique and self-protection regarding needles, body fluids and radiation (HSC training). 1.6)Acquire a detailed understanding of the normal and variant arterial, venous, solid organ and nonvascular anatomy as it relates to interventional procedures. 1.7)Become familiar with the usual catheters, wires, tubes, devices and contrast volumes used for procedures at the different body sites in different sized children. 1.8)Become competent in insertion, removal and maintenance procedures of vascular access devices (PICC, PORT and CVL), enterostomy access devices (Gastrostomy, Gastrojejunosotomy and Cecostomy tubes) in all children from premature neonate up to full adult size.

The Hospital for Sick Children Page 1 of 3 555 University Ave, Toronto, Ontario Canada M5G 1X8 www.sickkids.ca 1.9)Acquire a basic understanding and proficiency or competency in common vascular interventional procedures (may include angioplasty, embolization, thrombolysis and stenting). 1.10) Acquire a basic understanding and proficiency or competency in a variety of non-vascular interventional procedures, in the gastrointestinal genitourinary, hepatobiliary and musculoskeletal systems. 1.11) Acquire a basic understanding and proficiency or comptency of US, CT and fluoroscopically guided biopsy techniques (solid organ and lesional) , and drainage techniques in the abdomen, chest and retroperitoneum.

1.12) Preparation and presentation of imaging at clinical rounds with an ability to discuss the different facets of interventional procedures as pertains to the clinical cases. 1.13) Complete and submit a log of cases that you performed, assisted at, or observed during your period in interventional. Complete the HSC -IGT Quality Assessment sheet of cases performed by you to a high standard and signed off by a staff member 1.14) A second year pediatric interventional fellow, or an adult interventionalist gaining pediatric skills, should become competent in all of the above plus more complex angiography, some principles of embolization, cecostomy tube placement. He/she starts to function more independently, with graded responsibility. 1.15) Adult Interventionalist – should acquire 2nd year skills within their first year in pediatric interventional fellowship.

2) Communicator: 2.1)Trainees will be responsible for explaining the procedure to the patient/family, including the risks of possible complications and answering questions.

3) Collaborator: 3.1)Gain experience in reviewing pediatric interventional cases brought to attention by clinicians on a daily basis. 3.2)Enhanced through obtaining the appropriate history to guide decisions regarding the best imaging modality to pursue imaging investigation. 3.3)Responsible for communicating requests for further imaging to imaging technologists.

4) Manager: 4.1)Gain experience in screening and protocoling. 4.2)Learn how to prioritize cases. 4.3)Develop skills to become increasingly responsible for interventional cases, including proper delegation of authority to residents and technologists.

5) Health Advocate:

The Hospital for Sick Children Page 2 of 3 555 University Ave, Toronto, Ontario Canada M5G 1X8 www.sickkids.ca 5.1)Gain expertise in the selection of appropriate tests or follow-up studies from discussion with referring doctors and consultants. 5.2)Take into consolidation the benefits/risks of procedures, in consultation with referring doctors. 5.3)Gain expertise in guiding referring clinicians to the imaging study or studies most appropriate for their patients.

6) Scholar: 6.1)One academic day is assigned per week for trainees to pursue research projects. 6.2)Research activity done at The Hospital for Sick Children. 6.3)Publish scientific papers. 6.4)Present work at Interventional Radiology meetings. 6.5)It is expected that the resident will prepare at least one manuscript for presentation and/or publication, and will actively participate in the teaching of radiology residents and residents from other clinical services. 6.6)Attend and present at various clinical rounds.

7) Professional: 7.1)Incorporate ethical practice, professional regulation and high personal standards of behaviour. 7.2)Recognize that the pediatric population is a uniquely different population of patients, requiring a completely different clinical approach to the child as well as to the family. The fellow must be able to demonstrate an appreciation for this unique circumstance in order to relate appropriately with the child, the family and the differing pediatric clinical services involved. If this is not intrinsic to the fellow, the fellow must be able to demonstrate to the staff radiologists an understanding of this approach, and be able to successfully demonstrate an appropriate attitude. A failure to appreciate this, if serious enough, can be considered grounds for dismissal from the program.

The Hospital for Sick Children Page 3 of 3 555 University Ave, Toronto, Ontario Canada M5G 1X8 www.sickkids.ca