Duration: One year Post-Doctoral Certificate Course (PDCC) in Hepatobiliary Intervention Radiology (HPB-IR)

Bond: Applicable only in case of discontinuity of the Fellowship mid-way.

The candidates admitted to PDCC courses are to execute a bond of Rs.2,00,000/- (Rupees Two Lakhs only) on a stamp paper, undertaking that in the event of the candidate discontinuing the studies at any time during the course, he/she shall be bound to pay/deposit bond amount as applicable. For this purpose the original certificate of the students are deposited and returned only after paying the said bond amount (this is applicable only in case of discontinuity of the fellowship mid-way).

No. of seats: Three (3) seats per session; total 2 sessions per year starting in January and July each year respectively (So a total 6 seats per year). Kindly note, in some of the sessions, one of the seats may be reserved for a sponsored candidate. ILBS has affiliations with certain medical organisations, Central and State Medical Colleges, hospitals and private medical organisations for academic and research purpose as part of its prospectus and teaching/out-reach programme. In certain academic sessions, one seat (out of the 3) may be reserved for candidates from such organisation; thereby called a sponsored seat. A sponsored candidate must meet the required minimum eligibility criteria and qualifications for the course. Such a sponsored candidate must have been in regular service of the sponsoring organization at the time of admission. Kindly note, that in this case the sponsoring organization must specifically undertake to provide full salary to the candidate and to relieve him/her to pursue the programme for its full duration. In the case one of the seat is reserved for a sponsored candidate, then only 2 candidates may be enrolled in that session through the entrance examination. Similarly, in case such a seat goes vacant, it gets filled through the general/open entrance examination. It is best to check the prospectus for the particular year and crosscheck/call the Academic Cell of the Institute directly regarding further details. 

Eligibility: MD/DNB Radiodiagnosis

Details on the Entrance Exam: The qualifying exam is held twice a year – generally in the month of December and June for the January and the July session respectively. It is conducted in 2 parts. Part 1 is an MCQ based written exam (100 MCQs), generally conducted on a Sunday morning. There is negative marking for wrong answers in the MCQ based exam.

Short listed candidates (generally around 10-15) are called for the second part of the exam the following day. Results of the MCQ based exam are announced on the ILBS website on Sunday evening. The second part is a spotter exam covering the spectrum of diagnostic as well as interventional radiology (20 spotters x 2 marks each). This is followed by an interview with the two consultants of the Department. Questions pertaining to interventional radiology (both vascular and non-vascular) are asked in the interview. Although not mandatory, some amount of exposure in interventional radiology may help during the interview. 

Preparation for the Entrance Examination: Generally requires 1.5-2 months. No reliable question bank of MCQs asked in the examination is available online or in hard-copy. 50-60% of the questions asked in the theory exam are based on hepatobiliary diagnostic radiology. I had read the chapters pertaining to gastrointestinal and hepatobiliary radiology from the book “Computed Tomography and Magnetic Resonance Imaging of the Whole Bod by John R Haaga” for the same. The remaining 30%-40 of the questions are based on interventional radiology, most of the questions are specifically pertaining to hepatobiliary IR. I referred to “Handbook of Interventional Radiologic Procedures Book by Krishna Kandarpa” and “Mauro: image Guided Interventions” for this. Few questions are based on drugs in IR and physics in Radiology. A daily reading of 5-6 hours for a 1.5-2 months would be ideal for the entrance exam.

Fees, salary and leaves: 80,000/- INR per year is the fee. A state government salary of 90-95k per month (based on salary as per the Central Institutes) . 30 ELs and 8CLs. (However, the liberty to grant leaves is at the discretion of faculty).

Exit Exams: Exams (Theory & Practical) are conducted at the end of the one year training period. For the session starting in January, the exit exams are generally held in the first week of December. Likewise, for the session starting in July, the exit exam is generally held in mid-June the following year. Theory examination includes 3 papers on consecutive days, two pertaining to basics and the last one on recent advances in the field of HPB and vascular IR. Practical sessions are generally held on a Sunday during which an external examiner is also called.

Thesis Publication: Compulsory.

Duty hours and emergencies/on call duties: There are obviously no fixed duty hours since this is an interventional radiology fellowship.

For the first six months, the 3 candidates are posted for non-vascular interventional radiology. The day starts at 8 am with daily rounds of all the patients admitted and to look for any post procedure complications of procedures conducted the previous day. This is followed by reporting the status of all the patients to the Consultants at 9 am. A short academic teaching session or a multi-disciplinary meet is generally conducted on most days between 9 and 10 am. This is followed by non-vascular interventional procedures for the rest of the day (for the first 6 months). Department shuts at 8 pm, after which the on call duty hours begin.

For the next 6 months of the academic year, candidates are posted in the vascular DSA Cath-Lab for vascular procedures. Again, the cases begin by 9 am and continue till around 8-9 pm daily. Saturdays are working full day. Sundays and public holidays are off for OPD procedures. Emergency services are to be attended to on all days.

Calls are divided between the 6 fellows (3 from each session). Sunday and public holiday calls are generally given only to the newly joined junior batch fellows. The rest of the days are equally divided among everyone. One can expect around 6-8 calls a month for the first 6 months and 6 calls for the last 6 months of the academic year.  

Intervention and hands-on exposure: The hands-on experience is excellent, especially for non-vascular interventions and hepato-biliary IR. Peripheral and neuro-vascular IR exposure is limited since this is a purely hepatobiliary centre.

The training period is extremely streamlined and the course is extremely well designed. As a fellow, one gets a perfect blend of patient care, complication management, procedures, academics and research.

For the first 6 months – the 3 fellows alternate as follows: 2 get posted to perform non-vascular OPD procedures and 1 gets inpatient and ICU non-vascular procedures. The posting alternate and change every week.

Non vascular procedures include drainages, ascitic and pleural tapping, USG and CT biopsies, pigtail insertions and abscess drainages. This posting also includes pre and post procedure patient care and management, ultrasound screenings for patients on follow up, CT and MRI scan reviews (pertaining to hepatobiliary IR) and a little bit of reporting of MRI and CT scans (again pertaining to hepato-biliary IR only).

For the next 6 months, the 3 candidates are posted in the vascular DSA Angio Suite – One as a primary operator and 2 as secondary operators. Again the postings alternate/change weekly. During the week as the Primary Operator, one is expected to assess and perform all the procedures posted that week.  Only gastrohepatobiliary interventions are performed at this centre, these include TACE, DIPS, TIPS, BARTO, PARTO, TJLB, BCS, liver tumour ablations, PTBD, biliary stenting and biliary leak management etc. TARE is not done at this centre currently. Tunnelled Perma-cath insertions, haemodialysis or AVF fistuloplasty and central venous-plasties are also done quite frequently.

In these 6 months one can expect a good hands on experience for PTBD, TACE, TJLB, HVPG, Permacath and Nephrology Interventions. TIPS and DIPS punctures are usually done by the consultants, but towards the end of the tenure one may get direct hands-on experience with this as well.

Usual rough numbers are as follows: around 15-20 TACE a month, 5-10 TIPS/DIPS a month, and 25-30 liver tumour ablations a month. Other peripheral/neuro and aortic interventions are not generally performed here since this is a dedicated hepatobiliary centre only.

Hostel accommodation: Provided on campus. The campus is spacious; and has facilities of badminton/table tennis/basketball courts, an in house gym and a good library. Two types of accommodation hostels are available on campus. One for married couples (which includes a kitchen, a bedroom and a living/dining area). The other hostel includes single rooms with attached washrooms. To avail the first hostel one needs to contact the office directly at the time of admission.

Your personal experience at the fellowship: 

So, I personally think this fellowship is excellent for anyone wishing to join IR with no prior IR experience. The first 6 months shall tune you to the way the system works. The next 6 months are then easier when it comes to actual vascular work. I had no prior direct hands-on IR experience before this and the fellowship course and training is structured extremely well to acquaint the candidate with interventional radiology. This is a great fellowship immediately after MD/DNB radiology.

Another great thing is that it has minimal diagnostic work (that too for the first 6 months only). So it is ideal for a candidate looking for a purely interventional radiology oriented fellowship.

Since this is also a liver transplant centre, one can expect a lot of IR work related to transplant and its complications.

Now addressing to the concerns of the prospective applicants:  Pros of joining this fellowship are in the form of hands on experience, very friendly and approachable faculty, clinical management/learning and extremely well organised and systemic learning.

As far as the cons are concerned, the biggest con is that it is a purely gastro and hepatobiliary IR fellowship. Almost no peripheral vascular/aortic or neurovascular work is done in the span of a year.

Second downside is that this fellowship may not be the most ideal for someone already well-versed with interventional radiology since for the first 6 months the fellow is predominantly posted in the non-vascular suite. Also, this is a non MCI recognised PDCC course.

Any additional comments/ does it add value over MD /DNB degree: 

This fellowship is highly recommended for anyone immediately after MD/DNB radiology and looking to enter the field of IR. It definitely adds value to the CV. Additional experience for peripheral interventions is however needed after this fellowship. That being said, this fellowship is a one of kind dedicated IR fellowship in the entire country specifically for hepato-biliary interventions. Since this is a dedicated liver and biliary centre, one can expect high volume and high quality state of the art work in this area.

– Dr Karan M Anandpara, DMRD, DNB, PDCC, EDiR

Current Designation: Junior Consultant, Interventional Radiologist; Endovascular Clinic, Symbiosis Hospital & Gurunanak Hospital, Mumbai