Duration: Three years DM course in Interventional Neuroradiology and Neuroimaging at the Sri Chitra Tirunal Institute for Medical Sciences and Technology (SCIMST). The entrance exam consists of four phases. The first phase is theoretical (MCQ based), 2nd one is practicals (Spotters and Cases). 3rd phase consists of a viva and a departmental interview. 4th phase is the final interview with institutional HODs.

No. of seats: 3 per year: 2- merit-based and 1 – sponsored (AFMC quota)

Eligibility: MD/DNB Radiodiagnosis

Exams: Internal assessment (Only theory) exams will be conducted every six months, and the Final University exam consists of two-parts. Part 1 is only a theory exam after 1.5 years (usually in July) of the course. Part 2 or Final exam is in December at the end of 3 years with both theory and practicals.

Tips for securing the DM course: Know both general radiology and Neuroradiology, especially functional anatomy, primary pathology, embryology, and imaging techniques. Advanced imaging modalities like fMRI, ASL, MR perfusion, QSM, CSF flow studies, SWI applications are must-know topics. Get used to basic DSA images, neuro-angiography anatomy, diagnostic and common neuro-intervention cases like stroke, CCF, Aneurysm, AVM etc. Recent stroke and aneurysm management trials (RCTs) can be asked. There are no MCQ/ question banks to guide you for the DM entrance exam. You can try the FRCR question bank/ MCQs for practice. Previous year question papers are available in the SCTIMST website, which may give you some orientation.

Thesis/Paper publication: Compulsory

Working hours and night duties: SCTIMST is the only institute with a separate neuro-intervention center with ICU and wards; it will be busy like any other surgical wards or ICU.  Neurointervention cath lab posting is hectic but exciting. After the regular working hours (8 am to till it ends), residents will be busy making reports and preparing and posting tomorrow’s case. Usually we can finish the work by 8 or 9 pm on a typical day. Apart from the duty person, the rest are on call for any emergencies. Night duty will be on every third day. Night duty persons must evaluate and manage all persons in ICU and wards like any other surgery residents would do (s/he can report and get guidance from consultants at any time telephonically). Sometimes night duty will be on every alternate day.

OPD posting working hours will be for 10-12 hrs roughly. After finishing regular ward and ICU rounds, that person has to attend OPD, which usually ends by 5 or 6 pm. After that, the residents have to finish pending ward work and handover to the duty resident.

Routine imaging posting duty hours will be from 8 am to 4 pm, but usually, the working hours go till 6 pm. During imaging posting, there will be night duty every third or fourth day. All cases have to be reported on the same day and presented to the consultants on the next day (so literally the entire day will be busy).

Hostel accommodation: Provided on campus.

Academic activities and multi-disciplinary meets: As part of the academic curriculum, there is an academic session every morning for two hours, during which seminars, journal articles, and interesting cases are discussed. The details are as below:

Apart from these, there will be weekly PMC (patient management conference for epilepsy) where all consultants will discuss the case and its management. The students will have some difficulty in adapting academic activities and working hours initially, but should be able to balance it later on. The outside posting can be opted for in any of the central institutions like AIIMS, NIMHANS, etc. There will be a separate bedside neurology class where residents have to present a case to neurology consultants. This part will be more exciting and make you a clinical neurologist, at least in your neuro intervention ICU and wards.

Fees and salary: Fee and Salary: The salary structure is Central Govt. Level 11 pay scale as per 7th CPC (same as that of AIIMS/ PGI), so it comes to approximately 90-100k. The annual tuition fees levied by SCTIMST is about 20k per year.

Modalities available in the Department

2 DSA lab: One Biplane cath lab (GE) and 1 Philips single plane cath lab

2 MRI: 3T GE and 1.5 T Siemens

2 CT and 1 USG

Interventions and Hands-on experience: In the first year, you will get to do a few cases, including DSA, and gradually learn about the total protocol of case management. In the second year, you will get to do a lot of DSA and assist neuro intervention cases along with seniors. In the final year, you will get to do cases independently or the supervised chance for cases. However, the number of cases given to you will essentially be based on your knowledge, hard work, and skills. At the end of the final year, you will be confident enough to do procedures independently. I have done specific procedures like mechanical thrombectomy independently, but the point is consultants will supervise you. When neuro lab has no or less number of cases (rare), you may learn cases from peripheral vascular intervention lab. You may soon get separate postings for peripheral vascular interventions as per current plans.

DSA and Neurointervention workload:

The following table shows the average number of cases a resident is expected to do or assist during his three-year course. This is just an approximate number; however, caseload may vary depending on many factors.

In major neuro interventions, mostly you may get a chance to do a few steps like onyx injection / NBCA injection / deploying few coils/thrombectomy/stent deployment/balloon placement/microcatheter navigation, etc. But you will be allowed to perform a few cases like DAVF / Mechanical thrombectomy /carotid stenting / AVM glue injection / Scalp AVM embolization etc independently (but supervised) if you are confident enough.

Pros:

• Neurointervention center and ICU managing skills: Since you have a separate ward and ICU, you will be managing everything (patient admission, evaluation, bed allotment, post-procedure care, discharge, follow up, review OPD) under consultant supervision.
• In-and-out learning of whole protocols: Before getting full hands-on in the procedure, you will know in-and-out of the whole contract and algorithm (which I believe is more important than any other thing)
• Very structured and organized way of learning
• Very rare to see a complication: As compared to other ICU or neuro intervention center, the death rate is very less
• Hands-on Neurointervention in the 3^rd year
• Neurointervention caseload is higher than any other institute in India
• Largest stroke intervention center in India
• Superb academics – way ahead than AIIMS/ PGI/ SRMC/ JIPMER/NIMHANS
• Exposure to fMRI, resting-state fMRI, and other advanced neuroimaging techniques
• Clinical Neurology: As far as I know, this is the only center where you have bedside neurology classes and presentation. After a year, you will be familiar with clinical localization, which is very useful for imaging and intervention.

Cons:

• Intervention spectrum – You will mostly get to do neuro cases; however, if you are free, you can go to the peripheral lab and assist procedures.
• Less exposure to trauma imaging, paediatric metabolic disorders, and neuro-infection.
• MRI caseload is not very high like NIMHANS etc.
• Too much of academics: At times you will feel exhausted in balancing work and academic presentation (not very often though)
• Language – Initially, it will be a barrier; but gradually, you will learn.

More details about the course and my experience

While a lot of people used to say that a radiologist can never be a clinician or surgeon, this branch breaks all such perceptions. I felt that life would be more satisfying for me if I start learning IR. During my MD period, I used to check out the SCTIMST website because of the desire to become an interventional radiologist.

I am always grateful to God for allowing me to learn neuro-intervention in SCTIMST under my consultants. Initial few months were difficult adapting to the routine, but once you get oriented and catch the pace, you will enjoy working. Yes, of course, you will be very busy in work and academic activities, so that the time will fly like a second, but I got some unexplained happiness.

After the second year, the joy of catheterization, coil deployment, or an embolic agent injection made me more exciting and thrilled. When I did my first thrombectomy in my final year, I felt a delight which cannot be explained. Sometime, you will be mentally exhausted because of academic stress and work, but of course, you know it’s part and parcel of any good institution.

 I would emphasize that the Neuro-intervention stream at SCTIMST is exhaustive and ‘gold standard,’ undoubtedly the best in India, with perfect learning protocols (from patient admission in our ward to discharge and follow up). However, the hands-on experience is not very high. Earlier, neuro residents used to get a lot of peripheral intervention cases. After the start of DM in cardiovascular imaging & peripheral intervention, we got fewer cases. But now it is almost entirely neuro work.

My consultants have always encouraged and motivated me, which made me do a lot of publications and presentations. It also helped me in fetching awards, including best fellow in IR, ISVIR 2020. The significant positive thing is that if you are passionate and disciplined, you may get the freedom to explore the subject by yourself. They try to enhance their students at every point in time, and any criticism is only for my betterment and progress. To be frank, I used to sometimes sleep in the duty room in the evening for an hour before starting my reporting, but I have seen consultants noticing it and not even saying a word about it. This kind of freedom and the confidence they keep in a student drives us to great heights.  

My suggestion:  Neurointervention procedures and ICU management consist of a lot of mental and physical exhaustion, and with that we have to cope up with academics as well. You can get leg pain, shoulder ache , headache and fatigue etc, but trust me, if you have a passion for saving a life, go for it, and once you start experiencing it, nothing can stop you.

All the best wishes to the aspiring neurointerventionists. Feel free to contact me anytime in case you have any doubts/ queries.

– Dr. Vinayagamani S, MBBS, MD, DNB, DM (SCTIMST); 2017-2020,

Contact – 9910538994

Current Designation: Consultant Neuro & Interventional Radiologist, Vadamalayan Hospitals, Madurai