Ser talk dr.n. khandelwal

1. Emergency Radiology Fellowship
Program
N. KhandelwalN. Khandelwal
Professor & HeadProfessor & Head
Department of RadiodiagnosisDepartment of Radiodiagnosis
PGIMER, ChandigarhPGIMER, Chandigarh

2. 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 andTechnological advances allowing diagnosis and
treatment of many diseasestreatment of many diseases
Technologies have also become more complexTechnologies have also become more complex

3. Types of Radiologists
Three types
 General radiologist
 Subspecialist radiologist
 Multispeciality radiologist

4. 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’

5. Subspecialist Radiologist
 Fellowship trainedFellowship trained
 Radiologist who has developed personalRadiologist who has developed personal
expertise and competence in his area ofexpertise and competence in his area of
interestinterest
 Spends most of his time in his primarySpends most of his time in his primary
specialityspeciality

6. 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

7. 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, 210No. of radiology seats is 747 ( 537 MD seats, 210
DNB seats), no. of DMRD seats is 253DNB seats), no. of DMRD seats is 253
 Total number of radiologists in the country isTotal number of radiologists in the country is
10,000 ( Ratio 1;100,000 population)10,000 ( Ratio 1;100,000 population)
 Limited subspeciality radiologistsLimited subspeciality radiologists
Quant Imaging Med Surg 2014;4:449-450

8. Advantage of Subspecialists
- Work is done faster, more accurately and
more efficiently
- Work done is of the highest quality
- Improved quality of patient care

9. 2011 2012 2013 2014 2015
PGI DataPGI Data
No. of patients in Emergency & Trauma Section

10.  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

11.  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

12. CASECASE
40 year old female with headache and40 year old female with headache and
seizures for 1 weekseizures for 1 week

17. What is this MR image?What is this MR image?
1.1. DWIDWI
2.2. SWISWI
3.3. Perfusion mapPerfusion map
4.4. FLAIRFLAIR

18. What is this MR image?What is this MR image?
1.1. DWIDWI
2.2. SWISWI
3.3. Perfusion map (rCBV)Perfusion map (rCBV)
4.4. FLAIR imageFLAIR image

19. FINAL DIAGNOSIS?FINAL DIAGNOSIS?
1.1. TuberculomaTuberculoma
2.2. Pyogenic abscessPyogenic abscess
3.3. MetastasesMetastases
4.4. HydatidHydatid

20. TUBERCULOMA

22. DIAGNOSIS?DIAGNOSIS?
1.1. TuberculomaTuberculoma
2.2. Pyogenic abscessPyogenic abscess
3.3. MetastasesMetastases
4.4. HydatidHydatid

23. PYOGENIC ABSCESS

25. DIAGNOSIS?DIAGNOSIS?
1.1. TuberculomaTuberculoma
2.2. Pyogenic abscessPyogenic abscess
3.3. MetastasesMetastases
4.4. HydatidHydatid

27. NO MEMBRANES

28. DIAGNOSIS?DIAGNOSIS?
1.1. TuberculomaTuberculoma
2.2. Pyogenic abscessPyogenic abscess
3.3. MetastasesMetastases
4.4. HydatidHydatid

29. What could be the primary?What could be the primary?
1.1. BreastBreast
2.2. ProstateProstate
3.3. OsteosarcomaOsteosarcoma
4.4. Retroperitoneal sarcomaRetroperitoneal sarcoma

30. 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)

31. Mammography

32. 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

33. 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

34. 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 parentpatient care activities of the parent
departmentdepartment
 Eligibility criteria of teachers may be
revisited after 10 years

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. November 11-13, 2016
Venue: Lecture theatre complex, PGIMER, Chandigarh
In collaboration with Society of Breast Imaging (SBI), USA

43. Post Graduate Institute of Medical Education and Research