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
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(Gastrostomy, Gastrojejunosotomy and Cecostomy tubes) in all children from
premature neonate up to full adult size.
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.
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555 University Ave, Toronto, Ontario
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4.3) Develop skills to become increasingly responsible for interventional cases,
including proper delegation of authority to residents and technologists.
5) Health Advocate:
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
555 University Ave, Toronto, Ontario
Canada M5G 1X8
www.sickkids.ca
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