Thoracic Radiology Fellowship, AIIMS, New Delhi

Hospital department and City: Department of Radio-diagnosis, AIIMS, New Delhi

Duration: One year

No of seats / timing: Three per year; two in general category, one sponsored. Maximum no of fellows at any point of time is three only.

Exams are held twice in a year, January and July Sessions, as per vacancy, with the process starting 3-4 months before. Details are available on the AIIMS website (aiimsexams.org)

Accreditation: A fellowship certificate and certificate of teaching experience are awarded by AIIMS at the successful completion of tenure and exit exams.

Eligibility: MD/DNB Radio-diagnosis with a 3-year mandatory senior residency from an MCI recognized teaching hospital / institute.

Entrance exam: Two step examination, with stage I being a computer based theory exam of 60 marks covering whole of the radiology syllabus, with minimum marks of 50% to be secured for eligibility for the stage II departmental assessment. Based on merit, three stage I successful candidates are called for stage II departmental assessment for each seat. Departmental assessment (40 marks) comprises of two long cases related to thorax with case / general thoracic viva including related interventions, and twenty spotters. Final result is based on combined stage I and stage II marks.

Fellowship Structure: This fellowship is a mix of both diagnostic and intervention components in tandem with training imparted mainly under the patronage of Prof (Dr.) Ashu Seith Bhalla and team of consultants. Dr Bhalla is a highly acclaimed and accomplished radiologist with interests in head and neck, and thoracic radiology, and is one of the best in the country with international repute. Most of the patients are referred from the department of pulmonary medicine, with significant number from other clinical departments like general medicine or thoracic surgery as well, essentially wherever it pertains to our domain. Cardiac radiology is functioning as a separate department at AIIMS, and is not part of this fellowship programme.

The diagnostic component encompasses imaging pertaining to thorax excluding cardiac imaging, with exposure to radiology of diverse disease conditions, including interstitial lung diseases, chest infections, chest tumours, and vascular disease. One gets to see, discuss and report the whole gamut of ILDs, tumours and other rarer conditions in every week, as AIIMS is apex referral centre of the country. There is robust clinical and pathology follow-up of cases with availability of serial imaging on PACS.

In a week, two days are dedicated for vascular interventions mostly pertaining to thoracic and head/neck radiology. There are two interventional DSA suites in the department working in tandem. On a particular IR day, 3-4 bronchial artery embolizations, 3-4 head/neck/extremity AVM embolizations, 1-2 pre-operative tumour embolizations for JNA, carotid body tumours and other head neck tumours, 1-2 diagnostic head/neck angiograms / cross circulation angiograms are done with other occasional procedures like pulmonary AVM embolization, dental bleeds etc. In addition, many shorter procedures like sclerotherapies, permacath insertion, PICC line insertion and other catheter placements are done routinely.

Fellows are part of almost all of these vascular procedures, getting hands-on under supervision in first few months under the faculty, with fairly independent hands-on in the latter part of fellowship under broader supervision of faculty. Emergency embolizations and procedures in off duty hours are mostly done by fellows, with faculty on standby.

Fellows are required to do difficult chest biopsies, pigtail drainages, tube placements as well, with senior residents assisting the same on a dedicated day.

During the latter part of fellowship, fellows gets to spend time in the DSA lab with other faculty as well, wherein one gets ample opportunity to observe other procedures as well like TACE, TARE, TJLB, TIPS, UAE, GI bleed embolizations, BRTO / PARTO, peripheral vascular interventions etc.

There is no mandatory thesis as part of course but you are expected to write few papers / publications.

Academic activities and multidisciplinary meets: Every week there is clinico-radiological meet with pulmonary medicine department at fixed hours. Fellows are required to attend the weekly chest cancer clinic in pulmonary OPD to give opinion on cases, and the pulmo-pathology meet.

Fellows have to give presentations on interesting cases / interventional techniques or journal club every week at a dedicated time slot. You would also get an opportunity to present a paper / lecture in related conferences as feasible.

Duty hours: Daily 9am to 5 pm, except Saturday upto 1 pm. However, the work hours can extend beyond the prescribed hours depending on the departmental work. There’s no night duty, although you are on call for related emergency procedures after the duty hours. Most of vascular IR work gets over by 5 pm, with non vascular work going on till 7-8 pm, mostly done by senior residents posted in IR lab. Fellows are always on call for emergency procedures, which are however not so frequent, at times once a week to once a month even.

Fees and Salary: Nominal fee of few hundred rupees is to be paid at time of admission to fellowship. The salary is two increments above the third year senior residents, which translates into 1.3-1.35 lakhs/month including HRA at present.

Accommodation: No accommodation is provided to fellows by the institute and you are required to arrange at your own. There are ample options available around the campus in different locations as per need and comfort.

Leaves: You are entitled to 24 leaves in a year, which can be availed any time, guided by the needs of the department and discretion of faculty.

Exit exams: Only practical exams including spotters and two long cases followed by case based and intervention viva.

Tips to secure Fellowship: In addition to general radiology texts, one must go through AIIMS MAMC PGI series in chest radiology, clinico-radiology series books on ILD, chest infections, tumors, and know the basics of various chest-related interventions.

Pros and Cons: I feel that in the current times, sub-specialty diversification is the way forward, as the vast expanse of the subject demands this. Each one of us may choose a specialty or two to excel in. This fellowship provides the right mix of both diagnostic and intervention components to further your career.

I don’t see any con per se except that a month or so of diagnostic cardiac imaging component will add a different dimension in terms of completeness of the course.

Personal experience: Working at AIIMS amongst the greats in the field is a different experience wherein one is vying to spend more time in their presence to learn the nuances of the subject. Chest diagnostic radiology in itself is very challenging wherein one doesn’t get fulfilling experience during residency or senior residency, especially in ILDs, and you get to see very rare conditions being at AIIMS.

The faculty is extremely caring and gentle, with a cordial working environment, and work tirelessly to impart the best possible training to the next generation of radiologists. All residents (junior and senior) are hardworking, dedicated and respectful professionals. Support staff is highly responsive, accommodative and professionally competent.

I found the programme very balanced, with impetus on both diagnostic and interventional part, adding a definite edge and direction to my career ahead. My time at the place was highly memorable and well spent.

– Dr Mohammad Wani, Thoracic Radiology Fellow AIIMS 2019-2020

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