This section of our website is dedicated to students interested in interventional radiology and is overseen by our Medical Student Council.
Under the drop-down menu at the top of the screen labeled "Medical Students" you will find an introduction to the specialty as well as great resources on how to get involved, explore IR, and become a competitive applicant for residency.
Get involved by Joining the Society of Interventional Radiology. Membership is FREE to students. Also consider applying for a position on the Medical Student Reserves, a group of medical students who work on short-term projects throughout the year.
Congratulations MSC Members: 2020 Match Results
|Hanzhou (Hanssen) Li||Emory Univ IR|
|Lynsey Maciolek||MD Anderson/Univ. of TX – Houston IR|
Biodesign & Innovation
|Yosef Frenkel||Montefiore Med Ctr IR|
|John Moon||Emory Univ IR|
|Neil Jain||Georgetown Univ IR|
Diversity & Inclusion
|Shannon Sullivan||CWRU/Univ Hospitals Cleveland Med Ctr DR|
|Ayalivis De La Rosa||Emory Univ IR|
|Belinda Asare||Johns Hopkins DR|
|Erik Hilborn||UMiami/Jackson Memorial IR|
|Rajath Rao||Mount Sinai Medical Center – Miami DR|
|Roger Kayaleh||UPMC IR|
|Nicole Law||Univ of Utah IR|
|Varun Singh||Massachusetts General Hospital IR|
|Josh Maclaughlan||Loma Linda Univ IR|
|Shelby Curren||Monmouth Med Ctr DR|
IR Interest Groups
|Lisa Liu||Univ of Colorado IR|
|Jordan Wells||Univ of Arkansas for Medical Sciences IR|
|Jared Cline||Univ of Southern California DR|
|Daniel Phadke||UVA IR|
|David Berezovsky||Rutgers RWJ IR|
|Mary Elizabeth McLaughlin||Cornell Univ IR|
|Jordan Taylor||UNC DR|
|Ansh Johri||Univ of Massachusetts IR|
Patient & Family Centered Care
|Sameer Singhal||Brigham & Women’s Hosp IR|
|Alain Nathan Sahin||Univ of Ottawa DR|
|J. Erik Winterholler||Univ of Wisconsin – Madison IR|
|Connie Liou||Columbia IR|
|Nathan Loudon||Univ of Michigan IR|
|Anisha Banda||Univ of Washington IR|
Public Relations & Communication
|Adam Swersky||Northwestern IR|
|Alex Sher||Mount Sinai IR|
|Albert Jiao||Brigham & Women’s Hosp DR|
|Kyle Maughan||Vanderbilt IR|
|Aesha Patel||Rush Univ Med Ctr IR|
|Dylan Ropert||Indiana Univ IR|
|Zhao Zhang||Mayo Clnic – Jacksonville DR|
|Gregg Khodorov||Thomas Jefferson Univ Hosp IR|
|Ricky Patel||Rush Univ Med Ctr IR|
|Scott Shuldiner||Kaiser Permanente Los Angeles IR|
|Monica Matsumoto||Upenn IR|
|Joseph Knox||UCSF DR|
Web & Technology
|Madhu Joshi||UCLA IR|
|Abin Sajan||New York Pres-Columbia IR|
|Sami Chau||University of Southern California IR|
Last updated 4/3/20
I Took an IR Research Year: Student Perspectives
As the career path to interventional radiology evolves, so too do the aspects of what may make a competitive candidacy. What was previously a decision about fellowship during the PGY3-4 years can now be a specialty choice made as an MS3 (or earlier). Like other competitive specialties, spending an extra year in the middle of medical school to fully immerse yourself and conduct IR research is an opportunity to strengthen your application and demonstrate to residencies how dedicated you are to the field. Read about the experiences of 3 medical students who are currently in the middle of an IR research year.
You may also find this article from the archives helpful!
Click below to navigate directly to each student’s testimonial:
Nikhil is taking a research year between his 2nd and 3rd year at George Washington University School of Medicine and Health Sciences in Washington, DC.
What is your research?
One year of clinical research at Children’s National Medical Center and George Washington University Hospital which includes work on:
• IGTFusion Trial: Ongoing study validating and setting up clinical trial for an image fusion utility for tumor biopsy and ablations
• May-Thurner’s Reading Study: Ongoing study on MRV reading accuracy
• PAD Outcomes Study: Retrospective quality assessment between IR and VS
How did you hear about your research?
I reached out to my mentor in the IR department at GWUH who connected me with my current mentor at Children’s National Medical Center, Dr. Karun Sharma.
How did you decide?
I explored the idea very last minute, just before the start of M3. I then read up on the idea of taking a research year on various forums and the current article on the SIR website. While I was interested and had prior interest in research, and was passionate about pursuing IR, I was not so sure about adding an additional year to my training. I was fortunate that my research was funded, which made my decision easier as I otherwise would have struggled to pay rent!
I weighed the following pros and cons:
• Wanted a research focused career
• Would help highlight my passion towards IR down the line
• Helps build connections and network for future opportunities/residency
• Making sure that IR was the right field for me
• Taking a little break from school
• No longer graduating with the friends I had made in the first two years of medical school
• Forgetting stuff learned in preclinicals
• Returning with my clinical skills a little rough around the edges
• Possibility of realizing IR wasn’t right for me and having committed to a year off (thankfully the opposite revelation happened)
Research experience in setting up a clinical trial (IRB proposals, review process, grant application process), paper writing skills, connecting with mentors at my home institution as well as at Children’s National. I will attend SIR 2020 and give an oral presentation.
As for publications, I had 4 before (non IR related), but will hopefully have at least 2 more that are IR related now.
Was this the right decision?
Yes! Children’s National is a refreshing experience and I am loving exploring the world of pediatric IR, something that I may not have gotten to learn more about otherwise. Additionally, I definitely realized that IR was the right field for me and hopefully set myself up on a good footing for residency applications.
Simone is taking a research year between her 2nd and 3rd year at the Chicago Medical School at Rosalind Franklin University of Medicine and Science in Chicago, IL.
What is your research?
One-year translational research at Northwestern University working with my mentor/PI Dr. Samdeep Mouli on two main projects:
• Assessing the safety and feasibility of using Y90 in the prostate (animal model)
• Figuring out the optimal time to give TACE or Y90 in combination with immunotherapy for HCC (animal model)
How did you hear about your research?
I attended the Midwest Interventional Radiology Medical Student Symposium (MIRMSS) last spring. Shortly after, an email was sent out to people who attended advertising for this opportunity.
What helped you decide?
I received the email in May and was scheduled to start rotations in June/July, so I had to make the decision quickly. I ultimately just wrote down the pros and cons:
• Research is in IR – good for my residency application
• Networking – build connections that will help with future opportunities/residency
• Opportunity to attend other conferences and learn more about the field
• Funded – it’s always nice to get paid!
• Hands-on skills – performing surgeries, cell suspension, antibody staining, flow cytometry, histology, etc.
• Shadowing opportunities – scrub in on cases, attend resident/fellow lectures
• Ultimately determines if IR is the right field for me
• Reputation of the institution
• Nice break from school, especially having just taken Step 1
• Working with animals
• Delay graduation by 1 year and not graduating with my friends
What are your (ongoing) experiences?
Prior to this year, I had very little experience in research. Since then I have developed a wide variety of skills such as:
• Lab skills: I do a lot of tissue processing such as cell suspension and counting, and antibody staining
• Data analysis: Gathering histopathologic data and running the flow cytometry and analyzing the results.
• Annual Chicagoland Radiology Expo
• Radiological Society of North America (RSNA) Annual Meeting
• NYC Medical Student Interventional Radiology Symposium
• Society of Interventional Radiology (SIR) Annual Meeting
• Annual Medical Education Conference (AMEC) – upcoming
• American College of Radiology (ACR) Annual Meeting – upcoming
• New Cardiovascular Horizons (NCVH) Annual Conference – upcoming
Connections within the institution – I have gotten to know the residents, fellows, physicians, and PDs in both the diagnostic and interventional radiology programs at Northwestern.
Publications – Prior to this year I had no publications. At the end of this year I will come out with at least 6 papers from my two main projects, clinical projects, and assisted projects.
Abstracts/Presentations – I have submitted abstracts to upcoming conferences in which I will be able to present my work from this year.
Miscellaneous – Free time to enjoy life! I got to go on vacations, hang out with friends, and start back up on my hobbies again. I was able work on several projects and tasks for the RFS-MSC and get my sub-committee (Diversity Outreach – IRIG Committee) started on its projects for the year.
Was taking a research year the right decision?
ABSOLUTELY!! I came into this job with no prior experience and not a strong interest in research, but now I see it in a whole new light and hope to incorporate it into my future career. I have learned a substantial amount this year not only about IR as a field, but developing a large skill set in research that I previously did not have. This year allowed me to figure out if this is truly the right field for me – and the answer is yes. I have absolutely no regrets about my decision to take a research year. I strongly believe that I could not have created the same knowledge and experiences in IR and research had I not taken the leap. If you are thinking about taking a research but not sure if it is worth it, my advice is to write down the pros and cons and weigh them based on what is most important to you. However, I will say that taking a research year will definitely not hurt you when it comes to applying for residency!
Siddhant is taking a research year between his 5th and 6th year of the 6-year, integrated BA/MD program at the University University of Missouri – Kansas City School of Medicine in Kansas City, MO. His research is part of the TL1 Predoctoral Training Program at Washington University in St. Louis with Dr. Suresh Vedantham as his primary mentor.
One year of clinical research at Washington University in St. Louis which includes work on:
• ATTRACT (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) NIH sponsored, multicenter, randomized control trial – post-hoc analysis of completed clinical trial
• C-TRACT (Chronic Venous Thrombosis: Relief with Adjunctive Catheter-Directed Therapy) NIH sponsored, multicenter, randomized control trial – active engagement in on-going clinical trial
How did you hear about your research?
I first heard about the TL1/MSCI program at Washington University through a school wide email at my home institution (University of Missouri – Kansas City).
How did you decide?
This was a well thought out decision for me, but it wasn’t easy. There are a lot of factors that go into taking a research year. Nevertheless, I decided pretty early. Applications for my program were due Feb 20th so I reached out to my mentor around November.
• IR is an innovative field- research helps you be a part of that innovation
• Follow your research passions full time
• Get to learn new skills
• Expand your professional network
• Take a break from medical school
• Confirm you have chosen the right specialty
• Boost your resume
• Delay graduation by 1 year
• May or may not be compensated (NIH- funded programs such as TL1/MSCI are typically compensated though- thankfully)
• May need to relocate… then relocate back (if research is not at your home institution)
• Improve certain clinical skills but will definitely forget a lot of smaller details typically tested on board exams
What are your (ongoing) experiences?
Research – Full time research in a clinical science lab, interacting with professionals from diverse backgrounds (physicians, nurses, project managers, clinical trial coordinators, statisticians, residents, fellows). Also grant and paper writing.
Student – Full time student in the Master of Science in Clinical Research (MSCI) program. Example coursework includes: Analysis of Clinical Data, Designing Outcomes and Clinical Research, Introductory and Intermediate Statistics, Scientific Writing and Publishing, and Ethical Legal Issues in Clinical Research.
Certificate – An online curriculum in Entrepreneurship for Biomedicine Program (E4B) – nine nanocourses including Introduction to the World of Biomedical Innovation & Entrepreneurship, Survive and Thrive as an Innovator, Identifying Opportunities for Innovator, Building Effective Teams, Diversity and Inclusion in Innovation & Entrepreneur, Validating your Innovation, Fishing for Customers, Ethics in Biomedicine Innovation, Selling your Innovation
Conferences – Will attend 3 conferences throughout the year (American Venous Forum (AVF), Society of Interventional Radiology (SIR) Annual Meeting, Translational Science 2020)
Publications – I had 3 publications (2 basic science and 1 case report) prior to research year – none in interventional radiology. I will have at least 2 first author publications in IR after this year
Clinical Exposure – In addition to observing multiple IR procedures, I regularly attend IR clinic days with my mentor
Connections within the institution – During my year off, I made numerous meaningful connections with medical students, staff members, nurses, residents, fellows, and attendings at Wash U. The residents and fellow were extremely easy to converse with, and, in addition to helping me understand complex cases and procedures, frequently shared their insights about IR. Additionally, I was welcomed to the ORs anytime and, to the faculty’s great credit, I experienced first-hand how they always made time for teaching and engagement, despite how busy their day was. With IR being such a tight-knit community, I not only feel like I established an invaluable core mentor-mentee relationship to advance my career and knowledge of IR, but also created life long working relationships that I can turn to anytime in the future.
SIR-RFS – I have directly contributed to several projects for the RFS-MSC, and have been appointed Chair of MSC Reserves, helping interested medical students get involved with various RFS-MSC subcommittees: Education, Diversity and Innovation, IRIG, etc.
Was this the right decision?
YES! Clinical research requires its own unique skill set and level of understanding. When starting my research year, I knew very little about research methodology and how to design a good clinical trial or research study. While I obviously have a long way to go, this formal research experience, combined with structured coursework on the subject, has definitely provided me with a strong foundation from which I hope to continue to grow.
Perhaps the most valuable aspect of my research experience was being able to closely observe the day-to-day operations of an ongoing large, multicenter, NIH-funded clinical trial (C-TRACT) and the mentorship which came from the experience. Whenever I had any questions, I was able to address them directly with my mentor who gracefully shared his experiences and insight. Considering all that I have learned this year, I am unsure of any other avenues where a trainee could hope to gain such exposure.
Finally, soon after discovering the field of IR, I was hooked. What truly drew me to the field was its innovative spirit and diversity of cases. However, with innovation comes the irrefutable need to be informed and knowledgeable about the evidence backing that innovation. After this year, I feel much more confident in my abilities to distinguish between high-quality evidence and lower-quality evidence thereby, directly influencing the quality of care I hope to give my patients as a future Interventional Radiologist.
Previously updated on 4/9/20
The medical student guide to the updated SIR guidelines for managing thrombotic and bleeding risk in IR patients
Sanjog Singh MS4, University of New Mexico School of Medicine
Chris Gutjahr, Assistant Professor in Interventional Radiology, University of New Mexico School of Medicine
Even the newest of IR trainees quickly come to realize that the prevention and management of bleeding is an incredibly important consideration for any image-guided intervention. The SIR published its first consensus guidelines on management of thrombotic and bleeding risk in 2012 and updated them through two important papers published in JVIR earlier this year (links at the bottom of the page.) Part I is a relevant review of the physiology and pharmacology of hemostasis. Part II lays out the most updated recommendations. We will focus on 4 major takeaways from the updated recommendations, and we have structured them in the form of an algorithm that can be used to evaluate periprocedural bleeding and thrombosis for all IR patients:
1. Evaluate bleeding/thrombosis risk based on patient-specific factors.
2. Evaluate procedure-associated bleeding risk.
3. Evaluate periprocedural labs.
4. Use the recommended hold and re-initiation times for commonly used antithrombotics in the context of the overall clinical picture.
Of note, the data remains limited to retrospective studies due to minimal availability of high-quality, randomized, controlled data. Thus, the recommendations should be considered in the context of the patient’s overall clinical status, and a physician may deviate from them as necessitated by the individual patient, available resources, and established guidelines within the institution.
1. Evaluate bleeding/thrombosis risk based on patient-specific factors. Specific characteristics and comorbidities unique to a patient may increase their risk of bleeding or forming a clot and warrants pre-procedural evaluation. For instance, an underlying bleeding diathesis increases risk of periprocedural bleeding while an underlying malignancy may predispose a patient to periprocedural clot formation. There exist several scoring systems that can help evaluate an individual patient’s bleeding and thrombosis risk. The challenge is that these scoring systems refer to long-term risk, and therefore extrapolating from long-term risk to periprocedural risk is difficult and has not been validated. Nonetheless, when used as a component of the overall clinical picture, they are often used in clinical practice as a general guide to considering factors that may increase patient-specific bleeding/thrombosis risk. The two scoring systems highlighted in the JVIR article are the CHA2DS2-VASc score used to predict annual stroke risk in patients with nonvalvular atrial fibrillation and the HAS-BLED score in assessment of patient bleeding risk. Consider the components of these risk stratification systems when performing a pre-procedural bleeding/thrombosis risk assessment in all IR patients.
2. Evaluate procedure-associated bleeding risk. Periprocedural bleeding risk also depends on the procedure being performed. The risk of a major bleeding event is considerably lower for a nephrostomy tube exchange than for a TIPS, for example. The major update in the guidelines is in the categorization of procedure-related bleeding risk. Previous guidelines divided procedures into 3 tiers: low, moderate, and high bleeding risk. The new guidelines use a two-tier system: low risk and high risk. Low risk procedures are those that are expected to rarely have hemorrhagic complications or occur in areas where bleeding is easily identified and controlled, whereas high risk procedures or those in which hemorrhagic complications may be expected or involve locations where bleeding can have devastating consequences. In an attempt to define risk, high risk procedures can be categorized as having a > 1.5% risk of major bleeding or a 2-day risk of major bleeding of 2-4%. Low risk procedures have < 1.5% risk of major bleeding or a 2-day risk of major bleeding of 0-2%. In addition to considering the procedure-related bleeding risk, the guidelines recommend factoring in location and potential consequences of bleeding.
3. Evaluate periprocedural labs. Certain lab values are frequently used in IR to assess periprocedural bleeding risk. When interpreting these lab values, it is helpful to keep these 2 thoughts in mind: 1) Be aware of what a positive or negative lab value does and does not tell you. For instance, the prothrombin time (PT) test evaluates the coagulation cascade and may be used to assess bleeding risk before procedures. It was developed to identify the cause of bleeding in symptomatic patients; however, mild to moderate PT prolongation has not been shown to predict bleeding risk in a nonbleeding patient. 2) Always keep in mind the patient’s full clinical context. A useful example is a chronic liver disease (CLD) patient. These patients have nearly twice the thrombotic risk of the general population, yet many of them have an increased PT/INR. This paradox occurs because routine coagulation studies such as the PT/INR reflect a change only in the pro-coagulation factors and not the anti-coagulation factors. The liver produces the majority of both pro-coagulation and anti-coagulation factors used in hemostasis, and patients with CLD have rebalanced primary and secondary hemostasis due to relative decreases in both. Recall that whether excessive bleeding or clot formation occurs is a product of the relative balance between pro/anti-coagulation factors, and not necessarily the absolute value of the pro-coagulation factors. Therefore, a CLD patient with an INR of 3 may be incorrectly assumed to be anticoagulated when, in fact, they may be rebalanced or tipped towards pro-thrombosis, and the elevated INR is only taking into account the decrease in pro-coagulation factors.
With these two concepts in mind, the most commonly used periprocedural labs for evaluating bleeding risk are the PT/INR, platelet count, and hemoglobin. Keep in mind that there are no high-quality data to guide whether preprocedural lab testing reduces periprocedural bleeding risk. The panel did not recommend routine hemoglobin or platelet counts for procedures with low bleeding risks. However, they may be indicated if a patient inherently has a higher bleeding risk such as those with hematologic disorders and patients receiving certain chemotherapies. For procedures with high bleeding risk, the panel recommends routine preprocedural tests which may include hemoglobin, platelet count and PT/INR. PTT or anti-Xa can be considered for patients receiving heparin. The suggested laboratory thresholds are to transfuse platelets if <50 x 109/L and correct INR to 1.5-1.8. Although of low quality, available literature suggests low bleeding risk procedures can be safely performed at INR >1.5 or platelet count > 20 x 109/L. Thus, the recommendation for low bleeding risk procedures is to correct INR to within range of 2.0-3.0 and transfuse if platelets < 20 x 109/L. If arterial access is required for low risk procedures, the recommended INR threshold is < 1.8 for femoral access and <2.2 for radial access.
Low Risk Procedures
Expected to rarely have hemorrhagic complications
Occur in areas where bleeding is easily identified or controlled
-Catheter exchanges (gastrostomy, abscess, nephrostomy)
-Dialysis access interventions
-IVC filter placement
-PT/INR, hemoglobin, and platelet count not routinely recommended
–INR: correct to within range of 2.0–3.0‡
-Platelets: transfuse if < 20×109/L
< 1.5% risk of major bleeding
2-day risk of major bleeding of 0-2%
High Risk Procedures
Hemorrhagic complications may be expected
Involve locations where bleeding is difficult to identify or can have devastating consequences
-Solid organ ablations
– Portal vein interventions
– Solid organ biopsies
-Routine labs including PT/INR, hemoglobin, and platelet count recommended
–INR: correct to within range of 1.5–1.8
-Platelets: transfuse if < 50x109/L
> 1.5% risk of major bleeding
2-day risk of major bleeding of 2-4%
Additionally, PT/INR and PTT can be used to monitor the presence and level of specific anti-coagulants such as warfarin and heparin respectively. Tests such as thrombin time and Xa activity test can be used to measure the presence and level of direct oral anticoagulants such as apixaban. You may see thromboelastography (TEG) used at some point during your IR rotations. TEG works by assessing the viscoelastic properties of clot formation in whole blood from the start of primary hemostasis through clot lysis. In contrast to PT and PTT which only analyze a part of the clotting cascade, TEG measures the entire process of hemostasis including platelet function, clot formation, fibrin cross-linking, etc. The value of TEG in the preprocedural workup is unknown, and these tests have not been validated to assess bleeding risk in nonbleeding patients. Some authors have advocated that TEG has distinct benefits for patients with CLD in whom traditional coagulation studies are less accurate.
4. Use the recommended hold and re-initiation times for commonly used antithrombotics in the context of the overall clinical picture. Antithrombotic medications are among the most commonly prescribed medications in the US and consist of antiplatelets and anticoagulants. Antiplatelets work by inhibiting platelet activation and aggregation, while anticoagulants work by either blocking the synthesis or inhibiting the action of pro-thrombotic enzymes in the coagulation pathway. Part I of the consensus guidelines article goes into some detail and has some useful tables regarding each class of medication.
One of the most common questions IR physicians get from consulting providers is whether or not to hold anticoagulation and/or antiplatelets. Three factors must be considered when answering this question: 1) the overall patient status including thrombotic and bleeding risks 2) procedural bleeding risk 3) pharmacological factors of the medication being held. The goal, of course, is to minimize risk of medication-related bleeding during the procedure while avoiding thrombosis since the patient has some propensity to form clots.
Essentially, the decision must be made whether the procedure can be performed while the patient is on the anticoagulant. If not, then decisions on how long to hold the medication before the procedure, and when to resume the patient’s anticoagulant after the procedure must be made. Stepwise algorithms to assist in decision making are provided in the article (see algorithm.) Additionally, medication specific recommendations are included (see table). For some patients with a high thrombotic risk, ‘bridging’ with a different anticoagulant is required to minimize the periprocedural risk of a thrombotic event. Bridging is done with a parenteral agent that has a short half-life, typically heparin, giving the ability to minimize the amount of time a patient is not anticoagulated.
Take away points
· The clinical decision-making for periprocedural management of thrombotic and bleeding risk is complex and should be specific to each patient with variables including the provider, the practice, available resources, the patient’s specific risks, and comorbid conditions affecting the decision.
· The new consensus guidelines provide useful timetables and algorithms for management but should be used in the context of the previous point.