CT angiograms of the abdomen/pelvis and extremities. These are listed under:
Synapse --> Unread Studies by Modality --> CT - CTA Vascular
Very rarely, a CT venogram is performed, which IR would read as well.
The IR staff cover two services:
Category Examples
Vascular PICC/mediport, embolization, dialysis fistula-gram, TIPS, IVC filter
Gastric percutaneous gastrostomy
Biliary biliary drain placement
Urinary nephrostomy tube
Percutaneous ablation liver, kidney
Category Examples
Aspirations thoracentesis, paracentesis
Drain placement abdominal abscess, cholecystostomy tubes
Biopsies thyroid, lung, liver, kidney
In general, an attending will be present for the majority of procedures. Ideally, a trainee (resident or fellow) will scrub for every procedure.
If trainees feel comfortable with basic procedures (such as port placement or paracentesis), they may do these independently with the attending’s approval.
For procedures involving moderate sedation with Versed and fentanyl (such as port placement, drain placement, and solid organ biopsies), an attending is required for at least the preprocedure timeout.
Trainees should arrive around 7:30am to review clinical notes and imaging for the day’s cases. Printed outpatient schedules may be found in the radiology holding area.
At 8am, “board meeting” occurs in the angio rooms hallway and in the body IR reading room. Attending, trainees, technologists, and nurses meet to discuss scheduled outpatients and requests for inpatients.
Throughout the day, patients arrive in the holding area (this is the responsibility of the “board runner” (a nurse or technologist) and the holding area charge nurse. (Occasionally a procedure is done in the patient’s room, particularly if they are in the ICU.)
A trainee obtains informed consent from the patient using the iPads found in the holding area, then enters a “Radiology physician procedure note” in Sunrise, completing the preprocedure assessment and ASA class if sedation is needed, and leaving the note incomplete. (If you arrive before 8am, sometimes you can do this before board meeting.)
The patient is moved to a procedure room or the CT scanner. Equipment is prepared, preprocedure imaging is performed, and a site marked if necessary.
Trainee and/or attending scrubs in and prepares a sterile field and the back table. Timeout is performed, after which moderate sedation and/or local anesthesia can be administered.
The procedure is performed. Trainee and/or attending removes sharps from the table before scrubbing out. Trainee or attending modifies note in Sunrise, adding postprocedure information and saving it as complete. Trainee or attending enters necessary postprocedure orders.
When free time is available or after all procedures are complete, trainee or attending creates a dictated report of the procedure in Powerscribe. (A useful template is “All Site” --> “IR generic”).
I like to review the next day’s cases at the end of the day. This makes the morning a little less busy. You can find the next day’s printed outpatient schedule in a binder in the reading room, sorted by date, and make a copy for yourself.
Three IR pagers exist: 1 for angio call (almost exclusively held by a fellow), 1 for body IR call (held by a body imaging fellow or resident), and 1 for an IR attending that staffs both of these.
The body IR call trainee receives the pager Friday afternoon, is on call through Monday morning, then takes calls after hours Tues-Thurs before handing off the pager.
The attending on call is listed on QGenda. They rotate daily.
This info applies mostly to body IR as the IR fellows handle angio call, although the principles are similar.
After receiving a request for a procedure, the trainee should obtain the patient’s name and MRN, a brief clinical history, and a callback number. Ideally, the trainee can review clinical notes and labs on Sunrise and imaging on Synapse from home.
For most cases, the trainee will call the attending and present the relevant information. The attending will then decide to do the case after hours, on the next day (possibly Sat or Sun), or defer to the next workday. If after-hours or weekend procedure is to be done, both attending and trainee will come to the hospital to do the procedure.
If a request is obviously nonurgent (such as any biopsy), the trainee can skip calling the attending and directly tell the ordering provider that the procedure will be done on the next workday, and to make the patient NPO at midnight if sedation is expected. If this is done, the on call trainee should pass on the request to the applicable daytime IR team the next workday morning, and Monday morning if received over a weekend.
If the primary team is insistent about performing an after hours procedure, the trainee should call the attending and ask them to make a decision. Occasionally, direct attending-to-attending communication may be necessary.
A few days before your IR rotation begins, go visit the appropriate reading room. The current trainee should be able to give you a brief tutorial, including:
Find out which attending is on call with you over the weekend and how they like to be contacted.
During the week, attendings will change nightly, but hopefully you won't have to call them.