Duration: This 3 year program in DM Neuroradiology at SRMC, Chennai is a MCI approved program started in the year 2013. This is the first MCI approved DM program in the country. Eligibility is through NEET examination.

No of seats: 1 per year

Eligibility: MD/DNB Radiodiagnosis

Exams: The Final University exam consists of two-parts. Part 1 is only a theory exam after 3 years consisting of 4 papers each of 100 marks (2×20: 6×10 marks). The theory paper includes the following subjects:

Paper 1 – Basic Sciences- Neuroanatomy, Neurophysiology, Neuropharmacology, MRI Physics

Paper 2 – Neuroimaging

Paper 3 –Neurointerventions

Paper 4- Advances in Neuroimaging and Neurointerventions

This is followed by a practical examination held within the institute in the presence of two internal and two external examiners.

Thesis and Paper publication: Compulsory

Working hours and night duties: SRMC is among the most advanced centers for neurointerventions in the country. Because it is a combined medical center with all specialties unlike other dedicated neuro centers, excellent back-up is available from critical care and other specialties in complex cases. The patients are directly admitted under the Department of Neuro & Interventional Radiology. Daily rounds, pre and post procedure management, daily OPD, follow ups of the patient are done on everyday basis.

There are no definite working hours. Daily works begins with morning rounds, OPDs, IR procedures, patient management and ends with evening rounds. The above mentioned work is distributed among the residents. Night duties are on rotation basis with the bulk of the night calls to be taken by the first year resident.In cases requiring immediate intervention, assistant professors will be available.

About the Department: The highlight of the program is the senior faculty in the department whose reputation gets referrals from across the country for all complex neurointerventions.

As SRMC is an advanced tertiary referral centre for most of the clinical specialties, good referrals also come for other body interventions especially from the oncology and gynaecology departments. The department is a very close knit one with a maximum of 3 DM residents (1per year), 1 or 2 Assistant Professors (who are usually from NIMHANS/PGI/SCTIMST) and the HOD. Because of the small size of the department, everyone knows what is happening in the department, the OPD cases attended, advice given and the follow-up of the cases.

The number of procedures performed definitely will be fewer compared to NIMHANS/SCTIMST/PGI/AIIMS but because of the fewer number of residents, you tend to get good hands on exposure. The ICU is a state of the art facility with a dedicated neuroanaesthesia and critical care team available 24/7 to assist us in any complex situation. The practical points learnt during the rounds and discussion with the critical care team, neurophysicians and neurosurgeons and other specialties is the greatest learning experience and will help you to understand disease completely and for confident diagnosis and treatment of the patient.

The first six months of the program is mainly targeted at acquiring clinical skills and knowledge like how to perform a basic neurological examination, interpreting ECG, ABG and other blood work up with an intense understanding and approach towards the pre procedure work up and post procedure management. These aspects of patient care are undoubtedly one of the best in the country as some of the other Neuroradiology departments are not allotted beds for direct admission under them.

OPD runs from morning 8-5 everyday. The senior faculty meets each and everyone personally. A resident is usually posted in OPD along with the wards and ICU whereas the rest take care of the procedures in the cathlab. Around 70-80 cathlab procedures are performed every month with 70% of the work being neurointervention and rest are body interventions which are referrals from other clinical departments.

Hostel accommodation: Provided on campus.

Academic activities and multi-disciplinary meets: As part of the academic curriculum, there is an academic session twice a week, one day for journal articles and the other for seminar presentations. Every intervention being performed is discussed separately on a case-to-case basis where different management options and practical problems and approaches are discussed, which is extremely helpful.

Though SRMC is a medical college, it has extensive corporate clientele. Hence a lot of time is spent in patient management and counseling. This work pattern is really helpful to begin your career immediately after the residency in a private set up.

Excellent institutional protocols have been set up towards the management of cases, both clinical and more specifically intervention wise. These protocols help us to perform interventions with minimal complications and really helpful when you are practicing independently later on.

Interventions and Hands-on experience: In the first year, you will get to do a few cases, including DSA, and gradually learn about protocols of case management. In the second year, you will get to do a lot of DSA, peripheral interventions and assist neurointervention cases along with seniors. In the final year, you will get to do cases independently or under supervision. 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.

So to sum up about the intervention part by the time a resident finishes his or her three year program, s/he will be able to perform not only diagnostic angiograms but also advance interventions like carotid stenting/stroke/ aneurysm/AVM/DAVF independently. Also almost all peripheral interventions like PAD, bronchial and uterine artery embolization, CVC stenting, GI bleeds, TIPPS, oncology related interventions can also be handled with a thorough knowledge in intervention and clinical aspects.

Neuroimaging is a weak link at the DM course. The institute has advanced MRI and CT units and general reporting is carried out by the diagnostic radiology team. Clinicians in doubtful neurocases however do come to the department for a second opinion.

There is a 2 month external posting in your final year for neuroimaging especially. Choice can be made for NIMHANS/ SCTIMST where advances in neuroimaging can be learnt. There are internal postings of one month each for Neurology and Neurosurgery where clinical rounds and discussion can be attended which are really helpful. This part will be more exciting and make you a clinical neurologist, at least in your neuro intervention ICU and wards.

Fees and salary: Fees is around 20 lakhs/ year and stipend is as per the state board norms which is 40k at present. Financially it is quite a burden for the candidate; but if it can be afforded, the program is a wonderful one.

Modalities available in the Department

1 DSA lab: One Biplane cath lab (Philips FD20/20) which is undoubtedly one of the best in the country.

2 MRIs: 1.5T GE and 1.5 T Siemens

2 CTs

1 USG (in cathlab)

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.

For body, peripheral and oncology interventions you will be able to perform all the cases independently without any doubts.

Pros:

– This may be the only DM program in the country which allows you to have an exposure to all neuro and body interventions which is very essential to acquire jobs outside especially in Tier B and C cities(my personal opinion)

– 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 process and algorithm (which I believe is more important than any other thing)

– Very structured and organized way of learning

Cons:

– Neuroimaging – Exposure is limited

– High fees

My personal opinion on IR and advice for the aspirants: Training in IR is much different from the diagnostic radiology curriculum which most of us underwent. After finishing my MD and a fellowship in body imaging, it took me 2 years to find the right place for IR training. Earlier to joining my DM, I spoke to a lot of IR residents. They used to shuttle between various institutes over a 4-5 year duration to learn all facets of IR from Neuro to periphery. SRMC is the one and only place where I felt all interventions can be learnt with a DM degree in hand.

I knew before hand that neuroimaging at SRMC is sub optimal in exposure but I was OK with it. I made most of what I could with my 2 months neuroimaging training at SCTIMST without many issues for clearing the theory or practical exams.

Post DM I have finished 2 years of private practice in a corporate set up. Initally, I used to do neuroimaging but slowly I have phased out of it as my intervention work occupies most of my time. I do around 100 procedures a month (30-40 cathlab related interventions and rest are ultrasound and CT guided small procedures like biopsies, drainages etc with around 10 cases of Neuro every month). I felt that exclusive IR practice needs a lot of time in patient care and counseling which can’t be scheduled and hence reporting is difficult as it requires specific work timings. Besides you need time for meeting doctors and personal promotions (website, you tube channel videos, CMEs etc) as well, which are required.

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 the kick, 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. Rajesh Poosarla, MBBS, MD, DNB, DM, FIBI 2016-2019,

Consultant Neuro & Interventional Radiologist, Seven Hills Hospital, Visakhapatnam

Contact – 8142115071