Rethinking minimum case requirements for interventional radiology training

Purpose: Interventional Radiology (IR) is a field constantly undergoing growth and change, where physicians are trained to perform an array of techniques to treat different pathologies. Since the scope of practice is broad, training new residents can pose many challenges and vary tremendously based on caseload and the purview of the IR department at any given institution. The final goal is to provide a categorization schema for volumes of different IR techniques that is applicable across a wide variety of IR training programs.

Methods/Materials: We conducted a retrospective data analysis at a single level one trauma, tertiary care academic medical center, that reviewed the number of different cases performed by IR residents from 2014-2022. Using a combination of this analysis and pre-existing IR society recommendations, we (1) propose a new categorization schema to ensure an adequate exposure to a variety of techniques, and (2) suggest minimum case volumes that should be completed during training to obtain technical competence.

Results: Our proposed schema includes completion of 1,000 procedures during the dedicated IR training years (PGY5-6) distributed among 20 categories including; arteriography (with angioplasty, stent placement, embolization, thrombolysis or thrombectomy), diagnostic venography, venography (with venoplasty, stent placement, or ablation), IVC filter placement, TIPS de-novo or revision, central venous access or removal, fluoroscopic/CT/US guided biopsy or drain placement,, fluoroscopically guided lumbar puncture or vertebroplasty/augmentation, CT guided ablation, lymphangiography with/without intervention, manipulation of existing catheters, recanalization and foreign body retrieval.

Conclusions: Our minimum case requirements schema has specific case volumes and categories that are specific, yet provides a range of procedures that employ the same technique. This technique-based categorization may permit target volumes to be established that are achievable for all IR departments at different institutions.