Course, Hospital and City: Post-doctoral certificate course (PDCC) in Gastroradiology at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh.

Duration: One year PDCC. Degree certificate awarded by SGPGIMS (Autonomous University under the aegis of Government of Uttar Pradesh). Degree is not MCI recognised. However, the one year experience counts as teaching experience.

No. of seats: 2 per year.

Eligibility: MD/DNB in Radiodiagnosis. Post MD/DNB Senior Resident experience is helpful but not a pre-requisite.

Fellowship application process: MCQs (for 60 points, involving all aspects of Radiology) followed by Spotters/practicals (for 40 points). Standard radiology MCQs are asked which can be prepared from any of the radiology MCQ books. MCQs consist of a parent statement with 5 options and each option needs to be marked as true or false. There is no negative marking. There are no interviews and the entire process is completely objective and unbiased. Applications are out in late June/early July every year with the course beginning in second half of August. Check the website www.sgpgi.ac.in for the announcement.

Exams: Exit exam happens after 12 months of course. It consists of two theory papers and a subsequent viva which encompasses both diagnostic and interventional aspects.

Thesis/research/publication: Not required.

Outline of fellowship: Varies every year, but, in general includes monthly rotations amongst various postings. Current rotation includes about 6 months of diagnostic related rotations: 1.5 months of CT, 1 month of MRI, 1.5 months of USG (including guided drainages, biopsies, FNACs), 1 month of conventional and barium studies and 1 month of trauma. Interventional related postings span for 5 months: 3 months for non-vascular interventions and 2 months for vascular interventions. The candidate will have to manage Radiology ward for 1 month.

What to expect from each rotation: There is no specific ‘Gastroradiology’ related work alone which has to be done during the postings; rather one has to report the entire spectrum of imaging studies from head to toe during the particular posting. However, as the institute is a major Gastroenterology centre in north India, the bulk of work remains ‘gastro’ heavy. Having said that, about 50 % of work in USG, CT; 80% in non-vascular intervention, 20% in MRI and 50 % in vascular intervention are Gastroradiology related.

Barium and conventional posting: Reporting of challenging radiographs, supervising and performing various barium procedures. As in other institutes, barium studies have dwindled but include: baseline and follow up swallow studies for achalasia cardia (protocolised), barium defecography (protocolised), BMFTs, T-tube cholangiograms, distal colograms and NJ tube insertion amongst others. Reporting and procedures are independent.

USG posting: You will experience a general spectrum of all USGs (except obstetrics). There is a healthy amount of paediatric liver diseases and paediatric GI diseases (Atresia, PFIC etc.) and various paediatric congenital abdominal anomalies. Guided drainage procedures and biopsies with hands-on independent experience. FNACs happen twice every week with about 25-30 cases in each sitting. Institute is a major referral and treatment centre for HVOTO (hepatic venous outflow tract obstruction) and EHPVO (extrahepatic portal vein obstruction) and hence you will get a lot of exposure in baseline and follow up imaging of same. Reporting is independent.

CT posting: More than 70 % of cases in CT rotation are abdominal CTs with a lot of cases pertaining to malabsorption diseases, IBDs, peritoneal diseases, abdominal malignancies and pre transplant work up. Good exposure to almost all types of abdominal pathologies and enterography/enteroclysis studies. Reporting is under supervision of faculty. You are required to perform CT guided biopsies under supervision during this rotation.

MRI posting: Very few abdominal MRIs are performed. Good exposure to biliary obstruction, pancreatitis related complications and urinary tract anomalies. Decent exposure to prostate imaging.  Reporting is under supervision of faculty. Main bulk is neuro related and you have to report all cases performed during your posting.

Trauma posting: Routine trauma related work which you will expected to cover independently.

Non-vascular intervention: A separate suite with fluoroscopic machine for non-vascular intervention. Independent hands-on exposure to placement of percutaneous drains (USG and CT guided). Major centre for management of pancreatitis and hence, you will learn principle and techniques of its drainage and have hands on discussion with all departments invested in its management. Initially, you will observe and perform biliary interventions (PTBD and stenting) under supervision of faculty but later will be doing it independently. Good exposure to malignant and non-malignant biliary diseases. Major referral centre for iatrogenic biliary injury and one of the largest centres where interventions for non-dilated biliary systems performed. Similar experience (as biliary interventions) for genitourinary interventions (PCN, DJ stenting, fallopian tube recanalization, suprapubic catheterisation etc). Institute is also a major centre of liver tumour management and you will get to observe and assist various tumour ablations (mainly microwave, sometime RFA). PAIRs also performed routinely.

Vascular intervention: DSA suite consists of two machines with cases running on both simultaneously. Institute runs 3 major PDCCs: Gastroradiology, Vascular and Neuroradiology. In your DSA postings, you will be working on cases pertaining to all these specialities (with obvious focus majorly on Gastroradiology related work). You will cover almost entire spectrum of Gastro related interventions. You will get to independently perform various procedures like GI bleed, renal bleed, uterine artery embolization, BRTO, TACE, spleen artery embolization, IVC filter placement, TJLB etc. You will get to assist in procedures such as TIPSS, DIPPS, Portal vein embolization, TARE, varicocele embolization, adrenal venous sampling etc. Additionally, you will be able to independently perform chemoport placement, permacath placement, fistuloplasty etc. You will also get to assist interventions for renal hypertension, aortic interventions and peripheral vascular disease. You will get to observe (if interested) cranial aneurysm and AVM endovascular management.

Ward Posting: We have a 20 bedded radiological ward where we admit and manage our patients. Your duties would include preprocedural evaluation and optimisation of patients with relevant cross referrals. You will also learn post procedural care of all patients and learn management of various complications.

Working hours and night duties: Depends on postings. Postings like USG/barium are from 0930- 1700 hours. CT rotation is dependent on speed of your reporting and begins at 0930 hours and may go on till 9-10 pm by the time you finish reporting. MRI postings run from 0800 to 2000 hours. Trauma and ward posting are shift based (each shift of 8 hours). There is no fixed timings for intervention postings and they tend to be very heavy work-wise. Non vascular interventions run up to 8/9 pm daily. Vascular postings also can go up to 10 pm daily.

Initial 4-5 months you will be posted in USG/CT/barium postings and during this period you will have USG night duties which average to about 4-5 per month. After this, you will get rotated to non-vascular intervention where you will be on call for about 1 week per month. In DSA posting, you are always on call during the entirety of your posting!

Hostel accommodation: Provided

Academic activities and multi-disciplinary meets: Gastroradiology meets happen every Friday at 8 am where interesting cases (from adult gastroenterology, paediatric gastroenterology, surgical gastroenterology) are discussed. You are expected to discuss these cases with these departments’ SRs one day prior and ‘prep’ them for the seminar. It is more of an academic exercise as most of the discussions are ‘retrospective’ and do not have impact on active patient management. That being said, during your regular rotations, all your colleagues from other departments would have active discussion with you regarding patients’ management. In addition, regular gastropathology seminars are conducted for which you will have to eke out time from your schedule to attend. Gastropathology seminars are particularly important if you have a flair for diagnostic radiology.

In addition, you will hold a seminar on various topic every alternate week. Also, you will be involved in junior residents’ training programme by supervising seminars and case discussions. However, these are not strictly followed.

Fees and salary: 75,000 (70,000 course fee and 5,000 examination fee), to be paid in entirety at the time of admission. Salary as per scales of UP government and is about 90-95k per month.

Leaves: 30 ELs and 10 CLs. Obtaining leaves usually not an issue as long as you inform in time and inform the concerned faculty in advance.

Pros and Cons

Pros:

• Excellent hands on exposure to almost entire spectrum of gastro-related interventions.
• Flexible work culture with approachable faculty.
• Good if you have interest in pursuing interventional radiology.

Cons:

• Diagnostic imaging is not very advanced: no DECTs, less reliance on MRI imaging, lack of advanced abdominal malignancy imaging etc.
• No advanced MR imaging for storage/deposition disorders.
• There is usual lack of standard management protocols in institute (varies from one treating physician to physician). Hence, the is intra and interdepartmental variation in various treatment protocols. There is, hence, lack of standardised protocols of radiological interventions and reporting of radiological investigations.
• While the spectrum of cases for diagnostics is very good, the reporting and diagnostic work-up of same is not up to the mark when compared to other major centres. So, if you are interested in more of diagnostics you have limited avenues for same with scarce resources and guides available at your disposition. You will need to put a lot of effort from your side for same, or do not consider this position!

All the best and feel free to contact me via the Café anytime you need further advice!

– Dr Somesh Singh

Senior Resident, SGPGIMS