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European Charter for education and training in Clinical Neuroradiology (diagnostic and interventional)

Please download the European Charter on Training of Medical Specialists in the EU as a PDF.

Standards of Training in Neurointerventional Therapy

1. Preamble

Interventional Neuroradiology is defined as invasive diagnostic and therapeutic interventions involving the Central and Peripheral Nervous Systems, Head & Neck, Brachio-cephalic vessels and Spine. Endovascular approaches represent one of the most complex aspects of interventional neuroradiology

2. Definition and Objectives

Interventional neuroradiology uses percutaneous and catheter technology, imaging and clinical expertise to diagnose and treat diseases of the head and neck, spine and the central nervous system.

The unique clinical and invasive nature of this specialty requires special training and skills:

  • Be familiar with the signs and symptoms of disorders amenable to diagnosis and treatment by neurointerventional techniques;
  • Conduct thorough and accurate neurologic examinations to evaluate patients with neurological disorders;
  • Understand the pathophysiology and natural history of these disorders;
  • Know the indications for and contraindications to neurointerventional procedures; be skilled in the clinical and technical aspects of their implementation;
  • Be familiar with other therapeutic alternatives;
  • Have a thorough understanding of the pre- and postoperative management of patients;
  • Have an appropriate understanding of neurointensive care management;
  • Understand the fundamentals of radiation physics, radiation biology and radiation protection, and the basic sciences related to technical aspects of neurointerventions;
  • Be skilled in the clinical and technical aspects of their implementation.

The objective of training in interventional neuroradiology is to provide trainees with an organized, comprehensive, supervised, fulltime educational experience in techniques of neurointerventional procedures, diagnostic neuroradiology, including the comprehensive clinical management of the diseases involved.

3. Duration of Training

  • Specific training applies to trainees who have completed an accredited residency in radiology.
  • After validation of the background acquired in specific imaging, the complementary training cannot last less than two years or more than three years.
  • Trainees with an accredited training in radiology can complete the programme in two years if they enter the programme after at least 12 months of dedicated, elective training in the clinical aspects of patient assessment acquired in an accredited programme, or its equivalent, and 12 months of diagnostic neuroradiology in an accredited programme, or its equivalent
  • This experience must include training in treatment-planning, patient care, the fundaments of invasive monitoring, neurointensive care, the pathophysiology and natural history of the diseases to be treated
  • This experience must include training in image interpretation, basis of interventional techniques, use of radiation physics and protection.

4. The programme director

  • Must be certified by the national board of radiology or neuroradiology;
  • Must have special expertise in interventional neuroradiology and interventional neuroradiology must constitute at least 50% of his/her practice.
  • Is responsible for enforcing the curriculum, selecting and supervising the trainees and selecting faculty members.

5. Faculty

  • must include at least one additional full-time member with expertise in interventional neuroradiology, who is certified by a national board of radiology or neuroradiology, or possess equivalent qualifications. The faculty must provide supervision of trainees. The effectiveness of the faculty should be periodically evaluated by the institution in consultation with trainees.
  • The proportion of trainers to trainees should not exceed the ratio of 1:2.

6. Patient Population

  • The institution’s patient population must have a diversity of illness from which a broad experience in interventional neuroradiology can be obtained. There must be an adequate variety and number of neurointerventional procedures for each trainee. Each trainee must participate in a minimum of 160 endovascular procedures over 2 years of which in 30 he/she should be the principal operator*.
  • Each trainee must maintain a personal case logbook, which the programme director must certify at the completion of training.
    * Critical mass for training versus critical mass for "up to standards" practice.

7. Research Facilities

The institution should provide facilities to support research projects

8. Educational Programme- Curriculum

  • The training programme must offer teaching and clinical experience which encompasses the full clinical spectrum of interventional neuroradiology.
  • Before assuming primary responsibility for performing neuroradiological interventional procedures, trainees must acquire basic neuroradiological knowledge and skills.

8.1. Prerequisites

  • Unless already acquired, trainees must demonstrate the following knowledge and skills:
  • The basic and clinical neurosciences, including neuroanatomy, neurobiology, pathophysiology and natural history of neurological disorders;
  • The clinical aspects of patient assessment, treatment options and patient management related to neurological diseases, including the fundamentals of neurointensive care management;
  • The use of all available imaging modalities, delivery systems and embolic materials related to interventional neuroradiology;
  • The basic radiology sciences including radiation physics, radiation biology, radiation protection,and the pharmacology of imaging contrast agents;
  • The proper use and interpretation of the laboratory tests used in interventional neuroradiology
  • The clinical indications, risks and limitations of neurointerventional procedures;
  • The use and administration of drugs commonly employed in conjunction with neuroendovascular procedures.

8.2. Neurointerventional

  • The interventional neuroradiology trainees should have the opportunity to do all of the following under close supervision: perform clinical pre-procedure evaluation of patients; interpret preliminary diagnostic studies; consult with other clinicians when ever needed; perform diagnostic and neurointerventional procedures; generate procedural reports.
  • The continuity of care must be of sufficient duration to assure that the trainee is familiar with the outcome of the neurointerventional procedure.
  • Direct interactions of trainees with patients must be closely observed to assure that appropriate information is provided and that the highest standards of care and concern for ethics and patient welfare are maintained.
  • Communications, consultation and coordination of care must be documented with appropriate notes in the medical record.
  • There shall be departmental and interdisciplinary conferences in which trainees participate on a regular basis. There must be documented regular reviews of all mortality and morbidity related to the performance of neurointerventional procedures.
  • Trainees must participate actively in the review. Trainees should be encouraged to attend and participate in local extramural conferences and should attend at least one national or international meeting and postgraduate course in interventional neuroradiology while in training.

9. Evaluation

The programme director, in consultation with the neurointerventional faculty must evaluate the competence and progress of each trainee annually. The evaluation must include an assessment of knowledge, technical skills, attitudes and interpersonal relationships as well as decision-making skills and clinical management skills. These evaluations should be documented and provided to and discussed with each trainee. The programme director certifies the competence of the trainees at the completion of training.

10. Trainee Participation in Research

The educational environment should encourage trainees to undertake investigative study in relevant clinical or basic sciences subject areas. Trainees may participate in research projects conducted by the faculty or other trainees or may undertake a project as principal investigators. They should learn the fundamentals of the experimental design, performance and interpretation of results. They should be encouraged to submit their work for presentation at national or international meetings and for publication in scientific journals.

11. Teaching quality assurance

The programme director is expected to insure that his/her programme is of highest academic standard. Ideally the programme director should seek accreditation by an external authority. At least annually, trainees must be given the opportunity to provide a written evaluation of the programme and the faculty.