从专培到住培:美国介入放射学培训变革及其启示北大核心CSCD

我国介入放射学培训体系亟待建立。为适应临床需求、培养出更优秀的介入放射学医师,自2015年起,美国介入放射学培训由专科医师培训转变为医学院毕业后可以直接进入的住院医师培训模式,有IR/DR整合培训和独立IR培训两种路径。这种住培模式自实施以来,提高了学科吸引力。本文介绍了美国介入放射学培训体系衍变过程,现行培训模式、培训内容与要求,以及培训效果等内容,为我国探索建立介入放射学培训体系提供借鉴。     

Fellowship and practice trends in neuroradiology training programs in the United States.

BACKGROUND AND PURPOSE: Neuroradiology has become an increasingly diverse and subspecialized discipline. We evaluated the current status and trends affecting fellowship programs and the practice of clinical neuroradiology at academic medical centers, with emphasis on invasive procedures. METHODS: All 85 program directors at Accreditation Council for Graduate Medical Education-approved fellowships in neuroradiology were sent a detailed questionnaire pertaining to various demographic aspects of their program and the performance of certain radiologic examinations of the brain and spine. RESULTS: Sixty-seven programs (79%) responded. As many as 50% of programs are 1 year in length. Twenty-five percent of 2-year fellows leave their program after 1 year of training. During the past 5 years, 36% of programs have decreased in size and 73% reported a decline in the number of applicants. The majority (55%) of programs have had applicants renege on their commitment to begin a fellowship. Twenty percent of 2-year programs do not offer training in endovascular interventional procedures. Neurosurgeons perform endovascular interventional procedures at 18% of centers. There is an 18-fold variation in the volume of neuroangiographic procedures performed each year and a 150-fold variation in the volume of myelographic procedures performed. In 29% of programs, neuroradiologists are nonparticipants in nonvascular interventional spinal procedures; in 40%, they share these procedures with musculoskeletal radiologists/nonradiologists. CONCLUSION: Interest in fellowship programs in neuroradiology is declining. An applicant's commitment to either begin a fellowship or complete 2 years of training cannot be regarded with assurance, and there is a lack of uniformity in many areas of the training experience, particularly in invasive diagnostic and therapeutic procedures.     

Musculoskeletal imaging: current and future trends

Advances in imaging technology and the increasing role of interventional procedures in musculoskeletal imaging have continued to stimulate research over recent years. This review summarises some recent articles on musculoskeletal radiology topics and looks forward to potential future developments in this exciting sub-speciality.     

Snowboarding injuries : current trends and future directions

Snowboarding has become one of the premier alpine sports. The past decade has seen the popularity of snowboarding increase dramatically and the recent Winter Olympic Games at Salt Lake City, USA, showcased the strong visual appeal of the sport and the youth-oriented lifestyle and culture that accompanies it. The injury profile of the sport has also undergone change along with technological advances in boot and binding systems and the changing demographics of the sports participants. Central to the development of injury-prevention strategies is knowledge of the profile of injuries that occur, understanding those who are at particular risk and, if possible, the biomechanical factors involved in each injury type. Snowboarding was initially considered a dangerous, uncontrolled, alpine sport - an opinion based on little or no scientific evidence. That evidence has rapidly grown over the past decade and we now know that snowboard injury rates are no different to those in skiing; however, the injury profile is different. The purpose of this review is to give some perspective to the current snowboard injury literature. It discusses not only the demographic profile of those injured and the type of injuries that occur, but also gives some insight into the progress that has occurred in determining the impact of specific prevention strategies, such as splints to prevent injuries to the wrist/forearm. The next decade will also see a greater understanding of the biomechanical forces involved in snowboard injuries, which may well impact on future technological advances. As the literature indicates, however, some things will not change, e.g. injuries are more likely to occur in beginners and lessons need to be reinforced as a fundamental aspect of any injury-prevention strategy.     

Radioimmunotherapy: Principles, current trends and future directions

Radioimmunotherapy has recently been introduced as a therapeutic modality for B-cell non-Hodgkin's lymphoma. The US Food and Drug Administration (FDA) has approved (February, 2002) 90Y-ibritumomab tiuxetan (Zevalin; IDEC Pharmaceuticals Corp., San Diego CA) and the FDA's Oncologic Drugs Advisory Committee has voted (December, 2002) in favor of 131I-tositumomab (Bexxar; Corixa Corp., Seattle WA), for use in radioimmunotherapy. It is anticipated that once various technical compliance issues are fulfilled Zevalin will be approved for use in Europe, where it will be marketed and distributed by Schering AG (Berlin, Germany). Similarly, approval for Bexxar is anticipated in Europe and it will be marketed by Amersham PLC (London, UK). The aim of this review is to discuss the principles of radioimmunotherapy. The scientific advances that have lead to the acceptance of radioimmunotherapy as a therapeutic modality in cancer are highlighted. Various limitations of radioimmunotherapy particularly for the treatment of solid tumors are considered and future directions for this treatment modality are examined.     

Percutaneous transluminal coronary angioplasty: current procedure and future direction

Atherosclerotic coronary artery disease is a progressive process for which effective palliative methods have been developed. The evolution of surgical bypass grafting over the past two decades now permits its application to most symptomatic patients. In 1977 an alternative, transluminal angioplasty, was first performed in man and has become widely accepted. Advanced radiographic equipment is required for adequate visual control of the placement of catheters, guide wires, and balloons. Careful manipulation of catheters is crucial to success and safety. Procedural details and proper follow-up are described. While a discrete stenotic lesion in a proximal single vessel is the ideal indication, some patients with double-vessel disease are now being accepted. In a personal experience of 2000 cases, successful dilatation was achieved in 88%. Emergency bypass surgery was required in 3.3%. Myocardial infarction occurred in 1.2%, and there were two deaths. In a larger, multiinstitutional study, the primary success rate has averaged 61%. Recurrent stenosis occurs in about 30%; redilatation is possible. Some perspectives about this effective, nonsurgical alternative are offered, including its potential for massive savings in the cost of handling obstructive coronary artery disease.     

Imaging the male reproductive tract: current trends and future directions

The male reproductive system encompasses several organs: the testes, ejaculatory ducts, seminal vesicles, prostate, and penis. The function of this system is to accomplish reproduction. Diagnostic imaging modalities, such as ultrasound, CT, MR imaging, and positron emission tomography (PET), are increasingly used to evaluate the male reproductive tract. The purpose of this review is to provide an overview of the use of imaging techniques in the male reproductive tract and to discuss current trends and future directions in prostate and testicular imaging. This review focuses on the prostate and scrotum.     

The current status of sports medicine training in United States internal medicine residency programmes

OBJECTIVE: To determine the general status of sports medicine training in internal medicine residency programmes in the United States. METHODS: A cross sectional survey of the programme directors and chief residents of each of the 407 accredited internal medicine programmes listed in the 1999-2000 Graduate Medical Education Directory. RESULTS: The questionnaire was returned by 231 of 404 (57%) programme directors and 233 of 404 (58%) chief residents. A chief and director of the same programme (paired responses) replied from 144 of 404 (36%) programmes surveyed. A formal sports medicine curriculum was reported by 22.1% of programme directors. Programmes with a formal curriculum were 2.9 times more likely to offer any of the sports medicine educational experiences (p<0.0001; Cochran-Mantel-Haenszel). Programmes with block rotations were more likely to include all of the educational experiences surveyed than those without (p<0.002 for each; chi(2) test). A total of 162 programmes included sports medicine as part of other rotations. Most programmes only included sports medicine as part of other rotations: 44.6% (103/231) of all programmes and 63.6% (103/162) of programmes with sports medicine as part of other rotations. Some 29.9% (69/231) of directors reported having an elective, and 3.9% (9/231) reported a required rotation. Almost a quarter (21.7%; 50/231) of directors reported that their residents received no clinical experience in sports medicine. CONCLUSIONS: Little attention is given to the subject of sports medicine when internal medicine residency curricula are developed in the United States. Thus only a small percentage of American internal medicine residency programmes provide significant training in sports medicine.     

Status of and trends in nuclear medicine in the United States

Nuclear medicine in the United States has grown because of advances in technology, including hybrid imaging, the introduction of new radiopharmaceuticals for diagnosis and therapy, and the development of molecular imaging based on the tracer principle, which is not based on radioisotopes. Continued growth of the field will require cost-effectiveness data and evidence that nuclear medicine procedures affect patients' outcomes. Nuclear medicine physicians and radiologists will need more training in anatomic and molecular imaging. New educational models are being developed to ensure that future physicians will be adequately prepared.