Interventional Radiology Study Guide for Interventional Radiology

Oral Exam Study Guide

Last verified on July 23, 2020
  1. Competencies included within the Interventional Radiology/Diagnostic Radiology (IR/DR) certificate
The certificate in IR/DR connotes competency in three areas:
  • Image interpretation
  • Periprocedural management of patients (This includes pre- and post-procedure.)
  • Image-guided procedures
  1. How the oral exam fits into the exam process
Candidates for this oral exam have already passed the DR Core Exam that includes Physics and Noninterpretive Skills. The oral exam is part of the Certifying Exam for the IR/DR certificate. Candidates for the oral exam who have not already passed the DR Certifying Exam (computerized) will be tested on computerized General Diagnosis and Interventional Radiology modules. This will occur either just before or just after this oral exam. Candidates who have already passed a DR Certifying exam need take only the IR oral exam.
  1. How the oral exam is organized
Each candidate must complete four 30-minute oral exams.
  • The exam format is one-on-one, using cases prepared and selected by the ABR.
  • Each 30-minute exam will involve a unique examiner, so that candidates will interact with four different examiners.
  • The exam sections occur sequentially, without interruption.
  • The examiner will guide the candidate through the cases.
  • The exam is not tailored to an individual candidate’s practice profile, but encompasses the totality of IR.
  1. Exam content: general description
Individual cases may emphasize one area of competency more than the others. At all times, competencies in image-guided procedure, periprocedural patient management, and image interpretation will be assessed by the candidate’s examiner.
  • The exam structure has changed from that of the Vascular and Interventional Radiology Subspecialty oral exam and is now organized into two major groups: Imaging of IR and Intervention.
  • Imaging of IR cases will emphasize image interpretation related to IR. This includes CTA, MRA, US, vascular US, Nuclear Medicine, SPECT/PET, invasive angiography/venography/lymphangiography, invasive biliary/genitourinary imaging, and plain films. Images may be pre-procedure diagnostic studies, intraprocedural imaging, or follow-up imaging. Patient management as related to the imaging findings may be discussed.
  • Intervention cases will emphasize periprocedural management, and procedures, but also include procedure-related image interpretation.
  • Periprocedural management includes pre-procedure or disease-related work-up, consultation, patient selection, imaging, medical management; and post-procedure medical management, imaging, follow-up, identification and management of complications or inadequate outcomes, and disease-specific management.
  • Procedures includes indications and contraindications, procedural planning, procedural techniques, device selection and utilization, intra-procedural patient management, procedural endpoints, identification and management of intra-procedural complications, and knowledge of expected outcomes.
  • The Intervention portion of the exam has been designed in a manner that should more closely reflect actual clinical practice and will allow the exam to be adapted to changes in clinical practice over time. Rather than organization and labeling by subject areas, the 30-minute exams will be assembled with Imaging and Intervention cases in roughly a 1:3 ration (Imaging of IR: Intervention).
  • The Intervention cases are grouped into six “buckets” or topic areas. There are no specific requirements for the number of cases from each bucket in the exam, although each topic area will be examined. This approach permits construction of an exam that covers the full spectrum of IR and can be flexible to reflect changes in clinical practice. This format also allows adjustment and revision of the exam content over time. These “buckets” and samples of contents are as follows. (Note that this is not a comprehensive or complete listing.)
    • Arterial interventions
      • Revascularization, aneurysm/pseudoaneurysm management, embolization, infusion therapy
    • Venous interventions
      • Revascularization, acute and chronic thrombus management, reflux management, embolization, sampling
    • Oncology interventions
      • Embolization, ablation, management of malignant effusions/ascites
    • Core IR
      • Percutaneous biopsy, fluid drainage, venous access, percutaneous enteral access, foreign body removal
    • Biliary/Pancreas/GU interventions
      • Organ drainage, stent placement, management of stones, recanalization, occlusion
    • Miscellaneous procedures
      • Portal hypertension, musculoskeletal (including spine), pain management, lymphatic
  • Pediatric and quality of care/patient safety content is incorporated into all of the “buckets.” For example, abscess drainage, and renal artery angioplasty in children, will be included in the appropriate buckets. Similarly, radiation safety and management of intra-procedural crises will be incorporated into appropriate cases in all buckets.
  1. Taking the exam
The examiner controls the display of cases on the monitor and the pace of the exam.
  • The examiner will clearly identify the beginning of the exam, the transition between cases, and the end of the exam.
  • Examiners will usually provide only enough information necessary for discussion of the case. There is no requirement that this information be provided, nor is there a set point in the case when the information may be provided.
  • There are many ways to manage patients and perform procedures, so examiners will not indicate whether they agree or disagree with the candidate. Similarly, examiners will not offer words of encouragement or discouragement.
  • The examiner may redirect the candidate if necessary or stop a discussion to move on to the next case. Candidates should not become flustered if this happens. This is done with their best interest in mind.
  1. Appendix: Topics included in the exam
This is a general outline and is not all-inclusive.
  • CT and CTA
  • MRI and MRA
  • Noninvasive vascular lab
  • Vascular ultrasonography
  • Venous color flow imaging
  • Arterial color flow imaging
  • Doppler
  • Ankle: brachial indices
  • Segmental limb pressures
  • Pulse volume recordings (PVRs)
  • Arteriography (all)
  • Thoracic aorta and brachiocephalic arteries, including carotids
  • Upper extremity arteries
  • Lower extremity arteries
  • Abdominal and pelvic arteries
  • Collateral pathways
  • Hemodynamics
  • Venography and venous sampling
  • Head and neck
  • Upper extremity veins
  • Lower extremity veins
  • Pelvic veins
  • Portal and mesenteric veins
  • Superior vena cava
  • Inferior vena cava
  • Collateral pathways
  • Hemodynamics
  • Pulmonary angiography
  • Pulmonary arteries
  • Pulmonary veins
  • Hemodynamics
  • Dialysis access evaluations
  • Dialysis access intervention
  • Lymphangiography
  • Venous access (all: tunneled, nontunneled, ports)
  • IVC filter placement and retrieval
  • Foreign body retrieval
  • Venous ablation (varicose veins)
  • TIPS and TIPS evaluation/revision
  • Venous Angioplasty/stents/covered stents, venous (all)
  • Arterial angioplasty/stents/atherectomy/covered stents
  • Thrombolytic therapy, thrombectomy: arterial and venous
  • Aortic endografting (thoracic and/or abdominal)
  • Embolization, emergency (trauma, GI bleed, bronchial bleed, pseudoaneurysm, other)
  • Embolization, including elective, arterial, and venous
  • Chemoembolization (TACE/DEB TACE)
  • Radioembolization
  • Tumor ablation
  • Transcatheter infusion therapy (e.g., vasopressin)
  • Biopsy
  • All organs
  • Abscess drainage
  • Body cavity
  • Organ
  • Tube management
  • Paracentesis, thoracentesis
  • Chest tube placement
  • Tunneled catheter drainage of refractory pleural effusion or ascites
  • Biliary intervention
  • PTC
  • Biliary drainage
  • Biliary stents
  • Biliary biopsy
  • Percutaneous management of retained  bile duct stones
  • Cholecystostomy
  • Urinary intervention
  • Nephrostomy
  • Nephroureterostomy
  • Nephrostolithotomy tract establishment and dilatation
  • Suprapubic cystostomy
  • Percutaneous enteral access
  • Gastrostomy/gastrojejunostomy
  • Jejunostomy
  • Cyst and lymphocele management
  • Gastrointestinal stents
  • Transplant interventions, miscellaneous
  • Pain management
  • Vertebroplasty
  • Fallopian tube recanalization
  • Hospital inpatient care
  • Follow-up post intervention
  • Quality & safety activities
  • Radiation safety
  • Life support principles
  • Principles of image quality
  • Contrast material
  • Conscious sedation