Fellowship Director: Timothy Clark, MD
The vascular and interventional radiology fellowship at NYU is a one year training program. Three fellows are accepted annually. The training is clinically oriented: the workday is usually completely occupied performing a full schedule of routinely scheduled cases supplemented by a large number of add-on emergency studies.
The training philosophy is one of graded responsibility. The fellows are given responsibilities commensurate with their level of training and experience; they are considered attendings in training. Fellows have the primary clinical responsibility to assess all patients and answer patient questions prior to procedures (alone or with the attending physician), review all pertinent medical records, lab studies and imaging studies, assist and/or perform the studies, and manage patients in the post-procedure and long-term post procedural period. Before a procedure is performed however, the case is thoroughly discussed with the attending physician to ensure that it is appropriate, no contraindications exist, and informed medical consent has been obtained. The fellow initiates procedure planning including guidance techniques and instrumentation. Each procedure is performed by one fellow and one staff member, ensuring a preceptor-like arrangement where trainees' progress can be closely monitored with instruction on a one to one basis. After having gained the necessary level of competence and expertise, the fellow's role shifts from observer and assistant to primary operator assisted and guided by the attending staff.
Post-procedural care and follow-up are strongly emphasized. Hospital rounds are made at least once daily, seeing patients who have undergone procedures that day and patients being followed on an ongoing basis. This includes patients primarily admitted to the Vascular and Interventional Service as well as medical and surgical patients who have undergone interventional procedures. Patients seen in outpatient follow-up are also seen both by the attending staff and the fellow.
Clinical experience is gained in three hospitals: Tisch Hospital (a university teaching hospital), Bellevue Hospital (a city hospital), and the New York Department of Veterans' Affairs Medical Center. Two fellows are assigned to Tisch Hospital and the third fellow is assigned to Bellevue Hospital and the Manhattan VA Hospital. This rotation changes on a weekly basis. At each site, the fellow is the first to be called for after-hour emergency vascular or interventional procedures. Attending consultation and backup is provided at all times.
Didactic and interactive instruction are carried out on an ongoing basis. In addition to discussing studies as they are performed, daily fellow case review sessions are conducted. Radiologic morbidity/mortality conferences are conducted monthly. Weekly combined service conferences are held each week with the Division of Vascular Surgery, and biweekly conferences are held with the GI Malignancy Group (medical and radiation oncology, surgical oncology, interventional radiology). Fellows are encouraged to attend the departmental daily noon conference and weekly CT/MRI conferences, which includes a full series of didactic lectures encompassing interventional radiology.
Fellows gain experience with the entire spectrum of vascular and interventional radiology, including peripheral artery disease, renal artery stenting, transjugular portosystemic shunts (TIPS), percutaneous biliary interventions (including drainage, stenting, fiberoptic cholangioscopy and electrohydraulic lithotripsy), uterine artery embolization (UAE) and inferior vena cava filter placement. A large hepatobiliary malignancy practice exists, working closely with the Departments of Surgery and Medical Oncology, which provides a large caseload of chemoembolization and hepatic thermal ablation procedures including radiofrequency ablation and cryoablation. Thermal ablation of lung and renal tumors is also performed. Venous interventions performed include thrombolysis, angioplasty, stenting, and placement of chest ports and tunneled catheters. Vertebroplasty is also performed in our section. In conjunction with the Section of Interventional Neuroradiology, the fellows also have the opportunity to train in carotid artery stenting.
A close working relationship exists with the Department of Urology, and the interventional section performs percutaneous nephrostomies, stenting, stone removal, cyst and abscess drainage, and renal biopsies.
A broad experience in dealing with oncologic cases is obtained by working closely with the Department of Surgery and Medical Oncology. Experiences include biopsy under various forms of guidance, biliary and GU drainage procedures, and embolization/chemoembolization techniques. These patients are followed closely throughout their entire hospital and out patient course. The interventional physicians (including the fellows) frequently function as the "primary care" providers for patients with indwelling biliary or GU catheters.
GI cases comprise a relatively small part of the interventional practice at NYU. The procedures are primarily tube placements, gastrostomies and dilatations of gastrointestinal strictures.
All fellows are entitled to attend one major national meeting. In addition, there are many conferences on vascular and interventional radiology in the immediate area which are easily accessible, including the monthly New York Angio Club.
Extensive teaching files are maintained by the Section. Films from illustrative or unusual cases are indexed and filed with accompanying clinical information. An extensive digital teaching file is also available. Fellows are encouraged to both use and contribute to the teaching file, which is freely accessible at all times.
