FEATURE The pediatric pathway
Education and opportunities for pediatric IR training By Gulraiz Chaudry, MBChB, MRCP, FRCR, FSIR
Gulraiz Chaudry, MD, MBChB, FSIR, is a pediatric IR and director of the pediatric vascular and interventional radiology fellowship at Boston Children’s Hospital. Dr. Chaudry spoke to IR Quarterly about the training path to pediatrics and its challenges and opportunities.
IRQ: Tell us about yourself and your path to pediatric IR. Gulraiz Chaudry, MD, MBChB, FSIR: My path was a bit convoluted. I trained as a pediatrician fi rst, then radiology, then completed a pediatric radiology fellowship and a pediatric IR fellowship. What I found most interesting during my pediatric training was seeing an ill child and being able to do something directly for them. Therefore, I enjoyed pediatric ER and cardiology. I also wanted to do increasingly interesting things throughout my career, and I felt sometimes as a pediatrician that became diffi cult. I went into radiology with a specifi c interest in pediatric radiology—and then when I was exposed to IR during that residency, it seemed like a perfect fi t.
IRQ: What is the current training pathway for pediatric IR? GC: Essentially, there are two main training pathways. One is via the IR residency, whether the IR/DR program or the independent residencies. What this entails is spending 1 full year in fellowship after IR training. Many institutions, including ours, also off er an alternative option where candidates can complete DR training and a 1-year pediatric radiology fellowship prior to starting their 1 year of pediatric IR. Both have their strengths and weaknesses.
28 IRQ | WINTER 2024
I think the residents coming in with IR training have greater procedural skills, but the ones that come in with pediatric training have a greater understanding of pediatric conditions. Sometimes there is also a diff erence in terms of employability—some children’s hospitals like to have the IR physicians perform some diagnostic (although that requirement seems to be decreasing), while some IR groups require their physicians to be able to perform IR procedures in adults.
IRQ: Can you tell us more about the pediatric IR fellowship? GC: I can start off by trying to describe our fellowship. Our fellowship is a 1-year program and it’s spent entirely in the pediatric IR department, with 2 weeks of elective time. We have two fellows and one rotating PGY-6 resident that spends 6 to 8 weeks in our department. The rotating resident assumes the responsibilities of a third fellow. Their training is in body IR for the entirety of the year. We gradually introduce them to more complex procedures, along with greater authority to perform procedures with indirect supervision. We do not have any diagnostic training as part of our fellowship. We do have non- procedural training as well, including didactic lectures, journal clubs and interdisciplinary conferences.
IRQ: What are some of the key diff erences in pediatric and adult IR that make it so crucial to have dedicated pediatric training? GC: I think the fi rst thing is the conditions we treat. The conditions we treat are very different, especially
congenital conditions. Our hospital has a very large vascular anomalies department, which treats children born with congenital vascular anomalies. We therefore perform a lot of sclerotherapy and embolization. In addition, many conditions we treat are very rare and would not be routinely seen in adult IR departments.
As we treat patients of all ages, from neonate to adults, there is also a huge range in our patients’ size and weight. That does require specifi c changes or modifi cations of procedures depending on the individual patient. For example, in adults, we wouldn’t be too concerned about a contrast dose; however, in children, a contrast dose that is too high can result in renal impairment. You also have to know your drug doses—which doses and drugs can be used in small children. There are almost no catheters or devices that are approved for pediatric use. It’s all off -label use, and often requires some degree of modifi cation.
IRQ: There’s been great success with the IR/DR residency and that standardization—is there any desire or eff ort to try to standardize what pediatric training would look like? GC: This is a topic I’ve been very focused on for the last couple of years. I think one of the major weaknesses of pediatric IR training has been the lack of standardization. If you perform a fellowship in our hospital as opposed to one in Cincinnati, Philadelphia or Phoenix, all of these could potentially be diff erent. I’m not saying that the diff erences are substantial, but there are no standards. We have therefore worked—both as part of SIR and in SPIR—to come up with a set of guidelines or a curriculum that every fellowship can use.
We’re in the process of getting that approved by the SPIR board and the training programs so that we can at least come up with a basic set of guidelines that we all agree on. The idea is that these guidelines will provide a framework for what a fellow completing
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