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VIR (INTERVENTIONAL)


FOR RESIDENTS ON VIR ROTATIONS, PLEASE STAY ON ROTATION IN LIEU OF MEGA CONFERENCE.

BI (VIR)
  • FACULTY REPRESNTATIVE: Dr. Rajesh Patel 
  • LOCATION
    • Cath lab at BI, Dazian Building, 11th floor (IR reading room 11D88, x20-3883) every day except Tuesdays (CT area floor 2). 
    • Dr. Rajesh Patel works at BI Tue/Wed Fri (he is at clinic Mon/Thu). Dr. Rastinehad works at BI Tue/Thu.
  • HOURS: Monday - Friday at BI (7:15 am latest until the last case finishes). An MSH IR fellow or resident might rotate with you.
  • BI VIR PAGER: 13215. Consults received via pager or IR secretary ( x20-2509)
  • RESPONSIBILITIES:
    • Resident is to rotate with Dr. Patel at clinic Monday and Thursday
    • Coverage should be discussed with the VIR attending and fellow prior to Monday 
    • You can borrow radiation protection glasses, but please return them promptly at the end of the rotation.
    • Charting and rounding through PRISM
W VIR and (temporary) SL VIR
  • FACULTY REPRESNTATIVE: Dr. Adie Friedman
  • LOCATION: Mon-Fri at West (4th Floor) (8am until the last case finishes). An MSH IR fellow or resident will rotate with you.
  • Coverage should be discussed with the VIR attending and fellow prior to Monday
  • HOURS: Monday - Friday (7:30 am until the last case finishes). An MSH IR fellow or resident might rotate with you
  • W VIR PAGER: 36481
  • RESPONSIBILITIES
    • Until stated otherwise, the assigned SL VIR resident will report to West and will participate with the responsibilities of the West VIR resident
    • Refer to IR Resident Guide by Joseph Ciavarro JR., MS, PA-C
    • Tips on this rotation can be found at VIR on Call
    • Charting and rounding done through EPIC
SL VIR
  • Faculty representative: TBA
  • LOCATION: Mon-Fri at W with remote coverage. Cover SL VIR pager and periodically touch base with SL VIR staff (23-4446) for pending cases.
  • HOURS
  • SL VIR PAGER: 31118
  • RESPONSIBILITIES
    • Present cases to VIR Fellow and VIR attending.
    • Refer to IR Resident Guide by Joseph Ciavarro JR., MS, PA-C
    • Tips on this rotation can be found at VIR on Call
    • Charting and rounding done through EPIC
VIR CONFERENCES
  • REQUIRED: Mon @ 8:00 AM - Monthly didactic lectures - via webconference: LINK
  • Optional/Recommended: Wed @ 7:15 AM - MSH IR Resident Didactic - via webconference
  • Optional/Recommended: Thu @ 7:00 AM - MSH Multidisciplinary Tumor Board - via webconference, including 16 Baird Hall when at BI.
RESPONSIBILITIES
  • Pre-procedure evaluation 
    • Informed consent form
    • Pre-procedure note in patient’s chart
      • Check relevant lab results (especially PT/INR, platelets, Cr, K)
      • Check for anticoagulation medications
      • Check NPO status pre-procedurally 
      • Mallampati, BMI should be in preop H&P for patients getting monitored sedation 
  • During procedure
    • The degree of involvement in procedures will be determined based on demonstrated ability and interest
    • Familiarity with the clinical presentation, including history, physical examination, laboratory and other tests, pathophysiology of the disease process, and an appropriate assessment should precede resident involvement in any case
    • Residents who acquire competent clinical skills and adequacy in the roles of first and second assistant will graduate to primary operator on appropriate cases
  • Post-procedure 
    • surgical style notes and orders will be written on the patients that the resident has performed procedures on
    • Cases may be dictated during the work day only if there are no ongoing procedures without physician first and second assistants
    • Otherwise, dictations should be done after completion of all procedures and readout
    • All procedure dictations and sign offs should be completed before the end of the work day
  • Inpatient SIGN OUT
    • To communicate between the daytime staff and night and weekend coverage
    • W: This sign out is the responsibility of the residents and fellows and can be found on the HDrive under our Radiology Dept, SLW Residency, sub-folder VIR sign-out
    • BI: The sign out can be found on the desktop of the Room 4 computer and is often managed by the PAs during the day.
    • In addition to the sign out, you should email or call the call resident to transfer care for any patients they need to trend labs, write notes, and/or round on over the weekend
    •  The night and weekend coverage should inform the daytime team of any procedures they did as the daytime team will have to follow the patient
  • Consults
    • Place a consult note after seeing the patient and discussing the case with the attending 
    • Keep track of inpatients on the schedule board.
    • At BI, there is a PRISM Consult note on the Room 4 desktop computer you should use for all notes!
  • Rounding
    • This may be accomplished prior to start of the work day or after completion of all procedures and readout in the department
    • More active patients may be seen both prior to and after the work day
    • Less active patients may be seen less frequently or dropped from the inpatient list (this will be determined on a case-by-case basis by the attending Interventional Radiologist)
VIR PROCEDURE LOG (IMPORTANT!)
  • Make sure you keep a procedure log of your procedures on New Innovations, this is the only way to be HIPAA compliant to share it with another program.
  • You may log procedures you are the first assistant in, or a minor procedure you performed it under supervision of senior resident/fellow.
  • An easy way is to take a patient MRN sticker from the chart and keep it in a physical notebook on the rotation, keep a file on your smartphone, or go through Powerscribe to find dictations you did (but the Powerscribe list may not reflect all the procedures you participated in).
  • For any dictations you perform, please remember to report the DAP and air kerma in your dictations!
  • Under ACGME requirements (link here), you are required to perform at least 25 image-guided biopsies/drainages; these CPT codes count: 
    • 20604, 20606, 20611 - image-guided arthrocentesis/joint injection or aspiration of major joint or bursa (shoulder, hip, knee, subacromial)
    • 32555, 32557 - image-guided thoracentesis, pleural drainage catheter
    • 49083 - image-guided paracentesis
    • 49405, 49406, 49407 - image-guided percutaneous fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), peritoneal or retroperitoneal, transvaginal or transrectal
    • 77012 - CT-guided needle placement/biopsy
    • 76942 - US-guided needle placement/biopsy
    • 77002 - fluoroscopy-guided needle placement/biopsy
    • 77021 - MR-guided needle placement/biopsy
DOCUMENTATION
  • All procedures require a consent, pre-procedural and post-procedural note 
  • Outpatient notes are handwritten
  • Inpatient notes are placed in the EMR
  • Informed consent on Neuroradiology Primer or on paper at nursing bay
INTERPRETER SERVICES
  • Remember to record/document the translator #
  • Non-English interpreters can be reached at:
    • West/SL: 36-5096,  212-523-2187
    • BI:  212-844-8555 or Pacific Interpreters (ask an RN for the number)
      • At BI cath lab, there is a portable translating device in the nursing bay. 
    • MSH: 212-659-8990
  • There are certified Spanish translators at W (Manny, Geraldo, Marcus) that may be able to assist.
RADIATION GOGGLES (DO NOT REMOVE OR TAKE OFF SITE)
  • There are 2 pairs at each site: one regular and one for wear over glasses
    • RH: resident lounge locker (23 / 37 / 31)
    • SL: 70 (19 / 21 / 39) click here for location
  • Each is in a case, with a cloth and wiping spray
  • Please keep them clean and put them back LOCKED UP before you leave for the day (each pair is $$$)

RECOMMENDED BOOKS
  • Interventional Radiology: A Survival Guide by David Kessel (best intro book, there should be a copy at BI at all times).
  • Vascular and Interventional Radiology: The Requisites by John A. Kaufman
  • Vascular and Interventional Radiology by Karim Valji
IR LINKS