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You answer the message in once we're live and then any questions? All right, we're live. So welcome everyone. Um This evening, we're gonna hopefully tell you all about Ir which is interventional radiology. And the main reason for running this event is um there, there really is very little teaching at medical school about interventional radiology. Um Oh, yeah, my name is Chris. By the way, I'm a ST one radiologist and um Alex, who's another ST one who help me organize this event. We've got, our speakers are Rob, who's a ST six registrar and de who's Aven neuroradiology consultant. We've also got some fantastic guests from um our industry partners. So there's butterfly who are running the um portable ultrasound, um which if you're an early year student, 1st, 1st and 2nd year, I think, and now being taught ultrasounds in their anatomy and hopefully, um from fourth year up, you'll also start to get taught some ultrasound skills. And thanks to Sarah at the back there. Um And then we've got um a team from caffe who are showing you a ensure it's an A I assisted liver ablation system. And, but they'll tell you a lot more about that later. And then we've got cushion from a and uh from cordes. So these guys will help you get hands on with the devices a bit later on. Um And before that, we'll hand over to Rob to give you our first talk um on what is IR if you can save questions up for the workshop bit afterwards, these guys will be around to answer any of your questions. Thank you all for coming and I hope you enjoy it. Hopefully the question won't be. What is IR by the end? OK. So I'm a final year um interventional Radiology registrar here in Cambridge. I do um body ir anything from the neck down unless there's a really big problem. Um And then I go from the neck up, but deal will talk about that afterwards. Um So it's a little bit of an overview about what we're going to talk about. What do we do in Ir um a brief history of where we were and um how we got to where we are now and where we're gonna go in the future. Why do we do things who should do, Ir and then typically what you'd expect to do in a week as an IR consultant. So next slide please. This is just a stock image from Google, but it looks pretty cool. There's a nice shot over someone's shoulder, there's nothing on the blank screen. So I don't know exactly what he's doing. But patients on the table, he's dressed up some cool gear, he's got a microphone on as well. So he's probably talking to someone. So that's pretty much what we do day to day, that's what we look like. Um But what is it? So what the whole point of interventional radiology is to provide minimally invasive image guided surgery? Ok. So we have a strong foundation in diagnostic radiology and we all come through diagnostic radiology currently. Um And we use those skills combined with procedural skills to be able to diagnose and treat a huge number of conditions all over the body in every age group um across every specialty. Um And so that's essentially what it is in short, but most people haven't heard of incident for radiology when I speak to anyone at parties. If I go to a party or wherever or even my friends who still think I'm a radiographer. Um and ask me what I do, no matter how many times I explain it, people still don't really get what it is we do and no one's ever heard of it. There are lots of groups around the world really that have come up with what that are. The sole purpose is to promote interventional radiology. So this is just one called the interventional initiative with the hashtag without scalpel just showing generally what we can treat in the body and how we can treat it. So it's pretty much everywhere you can think of um with a vast range of conditions which we'll speak about shortly ranging from benign to cancer emergencies, blocking things unblocking them more like in the body or minimally invasively and mostly without general anesthetic. So, next slide, please. So how do we get to where we are and where are we currently? So back 100 and 30 years ago or so ruin discovered x-rays randomly and then he got an x-ray of his wife's hand, which is a very famous x-ray. And then she says, I've seen my death. So that's a famous quote. Pretty much straight away. People were using x-rays in every kind of way they could if you went to get your shoes fitted, uh you went like you'd have an x-ray of your foot just to see if it fit in the shoe. Um People started trying to use xrays, the image guidance quite early as well, but they were lagging really with the technology and the the ability to actually be able to use the imaging to their advantage. And it's only really since the sixties that we've seen a rapid progression in image guided intervention and that's with a rapid progression in technology. So with CT ultrasound, MRI and x-ray and with devices and from companies who have had seen a rapid growth in what they've been able to provide us so that we can provide treatments all over the body, um some key points. So Ir was first um termed by Margalis in 67. Um The father of IR first discovered or showed angioplasty in the early sixties. Um moving up to starting doing Eva and stent grafts in the nineties. And then here we, where we are today, this is doctor Ser, one of our consultants doing a um using the CAIN system to ablate a liver tumor. Um So it's essentially a um uh image navigation system which allowed them to target very precisely a liver tumor which 10 years ago, we wouldn't have been able to treat because you can't see it with ultrasound. And this is a fenestrated endovascular aneurysm repair, which has been done solely. Um The procedure itself was done solely without the use of x-rays using fluoroscopic um fiber optic guidance. So there's rapid um progression in what we're able to do and, and how we're able to do it because of technology and advancements. Next slide, please. So this is just um a bit of early history, this guy in the thirties, um who was a, a budding cardiologist, really enthusiastic, said to his professors. You know what I reckon, we can get from a peripheral vein back into the heart and we can do monitoring procedures, imaging, uh whatever, what have, what have you. And it had never been done before in humans, living humans. So he said, I'm gonna do it myself. So he stuck a, a foley catheter in a vein, I think in his ante fossa fed it back to his heart. Took an x-ray. He was like, wow, it's back near the heart, went and showed his professors and they're like, you sa so straight away, that's his career in cardiology gone. And he had to become a urologist. Um And so then that that was the end of him. He didn't do any more cardiology. And it was only decades later when people started doing cardiac intervention that he was recognized. Actually, he was a pioneer, pioneer of it. And he was jointly awarded a Nobel Prize because of it. So pretty cool ending for him. But I like this quote. It was very painful and I think that he was probably, he wasn't describing the catheterization, but I could probably describe that as well. But just about how other people had taken his research or what he'd done while he was just standing by as a urologist. Next one, please. So this is um a guy called Charles Dotter. They used to call him crazy Charlie. Um So he was the father of interventional radiology, American radiologist who thought I know what I can stretch open blocked arteries using a series of dilators and I call it dotter. Um and he worked very closely with industry. So cook to be able to develop these serial dilators to be able to um produce the first angioplasties. And based on what he, he's done, like we've taken forward a number of different techniques that we use today and a nice quote from him is if a plumber can do it for five, so we can do it for blood vessels. And essentially that's kind of a, runs through for a lot of the things that we do today. So, next slide following on from that plumber analogy. So what exactly do we do? Well, if something's blocked, we can unblock it. So if you've got a blocked artery anywhere in the body, we can angioplasty it, we can stent it. If it's a vein, it's called veno ss. Um If it's a somewhere in your biliary tree, if it's somewhere in your kidney, we can try and unblock block tubes. Um If it's leaking, then we can block it. So they same like a plumber. So you can block it with embolization. There's lots of different things that we can use. We can cover across the hole, we can divert flow. If it's cancerous, we can diagnose it, we can get rid of it, we can shrink it. So it doesn't cause a problem and you die of something else. So there's a number of different techniques that we can use if it's not a cancer, but it's a growth or it's another pathology that's causing you problems, then we can do a number of things depending on what the procedure is. So we can block off the blood supply. So it shrinks. Um We can drain things away. Um Essentially anywhere in the body that you can get to with a needle or a wire or a tube, which is everywhere we can do things for. So, next slide, please. Um just a quick slide that we have quite a large role in cancer treatments and diagnosis and not just diagnostically but um in terms of taking biopsies and treatment as well. So here's just a few things, kidney, liver, lungs, this is another infographic from that same interventional initiative. Um we can get into tumors in these um organs, either using CT on its own or with special image guided systems. You can get a needle, um bespoke right into the center of the tumor and we can deliver energy to it in the form of multiple different ways. So heat with radio frequency or microwave ice to freeze it, um even electricity across it. And then we can kill the tumor completely that way with curative intent, which means you don't need a big open operation to get, be able to get rid of the tumor. You can also get into the blood supply into the tumor. So it can go from the artery in the wrist to the groin, find our way to that um to the blood supply that that's supplying it. And we can inject um either inert beads to block off the blood supply beads infused with high doses of chemotherapy agents which can kill the tumor or with high doses of radiation. We can also and it's not just limited to these organs. We're starting to push out to other areas as well. Adrenals, uh metastases in other sites. So, um what we've learned from these organ systems, we can essentially push forward to lots of places across the body. Uh Next slide, please. So, who's it for? Well, essentially it's for everyone and I would encourage everyone to get involved just to see if you like it. So you need to have be a problem solver. So often people will come to you with an issue and it's a procedure you haven't ever done before, but you've done a similar procedure somewhere else in a different part of the body. You think actually, I think I might be able to apply this to help you because you got no other options. And that comes along with innovation and that comes along with working with people from um uh medical device companies to be able to develop tools to create new procedures. Um It helps if you have good hand of eye coordination, but those things can be taught. So don't worry if you don't think you do at the beginning and don't let that put you off. Um There's a lot of working under pressure, so there's a lot of emergency work and you have to work closely with other teams. But I think that's similar in lots of other specialties as well, but it's especially key and eye on uh next slide, please. So this is just a typical week for a consultant. And one key thing to look at is the amount of actual procedures and work that you do. Um So if you were a, a consultant surgeon, you may have one full day of operating on an elective list, either a week or even one full day of fortnight. And the rest of the time you're doing ward rounds, you're doing clinics, you're doing things that you didn't necessarily go into surgery to do the ir almost every single session you're doing intervention. So if you're in ct you might be reporting things, but then you might have to go and do a procedure and then you have your own set list with planned procedures and then an ultrasound, you might have diagnostic um cases, but also lots of interventions and people always come in to get you to do um help them with other things as well. So for me, as well as a trainee, nine out of my 10 sessions a week are intervention and intervening. Whereas my vascular surgery colleagues who we work closely with, they might be in the theater like half a day or a day a week. So if you like practical procedures, you don't have the ward rights to think about. You don't have anything like that. Um IR is a good place to think about. Um You're encouraged greatly to develop your own subspecialty interest. So we're all very generous and we can all do lots of things. But if you have one particular area that you really, like, say, if it's cancer treatment, say if it's dealing with problems in kidneys, just with vascular work, you really focus, um you're really encouraged to focus on that. So you've got a lot of autonomy, autonomy to be able to deliver kind of your, your own self specialty. Uh Next. So the, these are interesting, these are just two cases taken from last Friday. So it's not even like I've saved up the coolest cases um over the past couple of years. But um this is a 50 year old lady who had a sigmoid cancer, had it resected. She's had radiotherapy in her pelvis last year. She had a radiation induced stricture in her left ureter and she kept, she keeps coming back um for like once a week, for the past four weeks with um torrential bleeding um of her bladder. We do CT scans. We keep seeing hematoma in her kidney in a ureter in the bladder and we can't work out why it's there. Um So they ask us to look at the scans, they've been reported as lots of blood in, in the bladder and the kidney. I can't see a reason for it. And because we obviously have a, a strong diagnostic component, we look and we say actually we think there might be an abnormality. So the next slide please. And actually this is the internal IC artery, external IRC artery. And that's the uh a dense stent in the ureter and the arrows moves a little bit. Actually, there's a connection there probably on the CT scan. So this patient has developed a fistula from their artery into their ureter, either from um, the radiotherapy or from the recurrent um, stent changes and possibly some gen. So this can be life threatening because she can just please. And they were thinking of taking the stent out and the stent was actually tampering it and they were gonna take the stent out that day. So we were like who, who stop? Uh We'll take her to Angio. And so next slide, please, we'll have a look and then we'll block off the artery if we need to. So the initial picture on the left, um we've come from the right groin. We've gone up and over the aorta, we put a bit of a bleak angle on and we're injecting dye into the internal iliac artery. So that's a bit of anatomy there, but we can't see the hole. So we probe a little deeper and try and get a little bit further out. And I tried to go into a more peripheral artery and then I thought hang on, I think my wire and my tube have popped somewhere where they shouldn't. And that middle um picture is the end of the catheter in the ureter. So you don't often see an, a catheter starting in an artery and then ending up in the ureter, but that proves that the hole was there even if we didn't mean to do it. Um, and then we blocked off that, um, internal lilac artery with coils and then that blocked off the fistula and she hasn't bled again since the next court case from the same day. Um, young guy in his late thirties presents with severe abdominal pain. We do a CT, he's got an occlusion in his portal vein and his Susic vein and we don't know why, but he's got ischemic bowel because of venous ischemia. Um and he's in a bit of a bad way. They start him on systemic lysis. So um some clot busting rs in the vein, which don't really do much. So they say, can you help? So they come and we say, oh, we think we can have next slide, please. We've got this thing called the tips where we can make a shunt between the fatty vein and the portal vein, which means we can get into the portal system and the superior mesenteric vein. And then we can use what is essentially a medical grade hoover to suck out the clot and then leave behind a catheter which infuses clot, busting drug directly into the clot um to be able to disperse it and get rid of it. So we do that and then the next day or the day after he has the stent extended and we see S MD is completely open and there's good flow across the stent and his bo is no longer ischemic. So that's a cool case. And finally, this is just a, a family guy meme just to show actually an interventional radiologist is a bit of everything and has to be able to work and think laterally um and combine bits from everyone's specialties to be able to work out problems and to work with other people. Um We have questions at the end. You sorry, sorry. Um Hi, everyone. My name is Dee. I'm a consultant in diagnostic and interventional neuroradiology. So we're gonna deal with the brain, uh neck and spine. Um So just a show of hands. Has anyone heard of interventional neuroradiology before? If you have, you put your hands up. So a few of you have. So uh we are part of the interventional radiology family, but we deal with specifically the brain neck and spine. So we use medic uh minimally invasive techniques and imaging to treat conditions of the brain, neck and spine. We also have a role in diagnosing disease. So we do report scans as uh such as MRI S and CT S and fluoroscopy guided studies as well in terms of training. Um So you complete your medical school and you saw your foundation training, you complete two years. Uh General radiology training is five years. But if you want to do intervention, interventional radiology, either Neer or diagno new or body interventional radiology, you've got to do six years in total. So you do three years of general radiology and three years of sub train. Uh Plus, there is an option to do a F if you, if you, if you wanted to next slide. Uh So this is just a typical uh week of a consultant. So on a Monday, um I do angiography all day. So that's usually the diagnostic uh angiography where we do catheter angiograms. And uh we also do things like lumbar punctures which are difficult to do on the wards and uh CSF flow studies and things like that. O on a Tuesday, um I have my G A list where I treat embolized aneurysms under general ahe things like aneurysms, fistulas, AVMs uh and other conditions of the spine as well. On a Wednesday, as I mentioned, we do have a role in reporting as well. So in the morning of I do some outpatient reporting and in the afternoon, I occasionally have acute reporting as well. Uh On a Thursday, we've got our neurovascular PT with our surgical colleagues. Uh And in the afternoon, I do some tic work and sda time. And on a Friday, I've got patient admin. We also have uh on calls on the weekends. So we do uh we've got five colleagues who do interventional neo radiology in our department and we uh do 15 weekend on calls to car acute work over the weekend. Um So I'm just gonna go through uh a few cases which our team uh in my team or five fu did in the past week or so. Uh just to give an idea about things of the kind of things we do in our daily practice. So as a rupture as well, this is um a picture of Google. This is kind of the uh uh sort of environment we work in a large screen which gives us the pictures and 3d images of the brain, et cetera. And we use a, a Bi Plan Aros copy study which has two cameras which gives you kind of a 22 dimensional image of what we're looking at. And these uh these sort of uh eyes are able to create a three dimensional image of the brain vessels. So we can navigate to wherever we want to get to uh in a more accurate manner. Um So this is a patient who I treated. Um I think it was last Thursday. It was a 47 year old male who presented with a left sided weakness and dysphasia. Um So the shots out a stroke. So he had a CT scan, which if I could convince you there's an area of what we call a hyperdensity that suggests a clot in one of the brain vessels. Um And there's an area here which shows what we describe as low density, which is established infarct, but there's an area of brain which looks normal. Now, this to us suggests that there's an area of brain which could be saved from mechanical thrombectomy, which is pulling out the clot. Then we do another CT scan which has contrast allows us to look at the blood vessels in the brain. And that shows there's an occlusion in one of these blood vessels right here. So if you compare to the other side, that blood vessel, which is the middle cerebral artery with the MC is occluded. Next slide. So this is the case where we took the patient to our theater and uh to the a room and uh the patient was uh this patient was actually awake. So it was done under local anesthetic. Um So we put a catheter all the way from the groin up to the neck and we inject contrast to have a look at the blood vessels. And this is an example of what the blood vessel look looked like after we treated it. But this is the patient's ICA the internal carotid artery and there's an occlusion at the MC at that level. So what we do here is we go pull that clot out in order to rec canalys that vessel. And that created sort of uh this image which is blood supply to the remainder of his brain. Next image, please. So this is the kind of device that we use to do that. Um This is a, a drawing a picture of an aspiration catheter. It's a large little catheter which goes all the way up to the clot surface and we apply suction to aspirate it. Uh This is what we call a stent retriever. It's, it's, it's a metal sort of coil or a stent which we deploy within the clot and we pull the stent out with the clot inside it. And that's an example of how it looks like the clot comes out and that's what sort of opens the blood vessel. Uh Next slide, please. Uh This is an example of a uh the thrombectomy which one of my colleagues did uh of a basilar occlusion. Um So, with the basilar occlusion, if it's not treated, uh it's almost certainly it would lead to death. Uh So, similarly, the patient was taken to uh the angio room and we put a Larible catheter uh into the uh basilar artery and aspirated it, which produced this image which confirms the supply uh to the back of the brain. And the basilar tip right here uh is patent in that study. All right. Um Moving on to a case I did over the weekend. This is a patient who presented a quite young female, a 45 year old who presented with um sub arial hemorrhage, which is bleeding from one of the brain vessels. All the white bits shouldn't be there. So that's blood. The patient has a bit of um midline shift as well from the mass effect as well as um hydrocephalus. So, the oven system is dilated because of the blood. And the reason for that is this tiny abnormality in one, the blood vessels, which is an aneurysm coming from the uh posterior communicating artery. So that's the culprit. Uh There's two ways of treating it, treating this. Historically, neurosurgeons would uh open the brain up uh and clip this. Uh But nowadays with ACUs especially uh they tend to go for uh endovascular coiling next s side, please. So that again, we uh go through the patient's groin on the wrist. We put tubes all the way up to the neck, through those tubes, we put smaller tubes into the aneurysm. Uh So that is an example of the aneurysm in the, in the uh once we did the angiogram. So that's the posterior communicating artery and that's the aneurysm. Uh So mentioned before that we do uh sort of detailed 3d images of the uh brain blood vessels. And this is an example of the 3D image it produces. So we'll be able to rotate this uh using our console and that's an aneurysm. And then we decide to treat this using fine metallic coils in order to block it off next slide, please. And uh this is an image of uh the aneurysm after it was treated. So the previous aneurysm you saw here is not there anymore. It's been coiled with fine metallic coils and this is an image of uh, the post procedure. So you expected aneurysm to be there but you can't see it anymore because of, uh, the treatment we've carried out. Um, another example of this, of, of a procedure I did a couple of weeks ago. Um, it's a patient, I think it was a 50 55 year old who presented with sort of limb weakness in the lower limbs and loss of sensation and bladder problems. Um, so the patient had an MRI scan, which showed sort of swelling if I could convince you that there's sort of this brightness here shouldn't be there. It should be all dark that swelling in the spinal cord itself. And that's caused by um abnormality in the blood vessels, the artery end of been connect to uh causing the fistula. So that causes in es in essence heart failure of the spinal cord and at least just fluid collection in the spinal cord. Um and that's, that's also a uh medical condition which you could treat uh using interventional radiology. So the patient was brought to the angio room and we did an angiogram which shows. So that's one of the segmental arteries which supply your back. And um see if I could convince you that there's an abnormal connection between these two vessels here and that is all abnormal blood vessel which is causing uh this fluid build up in the spine. What we did was we took a small uh microcatheter, a balloon. Um into the blood vessel distally inflated it. Uh and we inject embolic agents in order to block the abnormal connection. And once that was the procedure didn't take longer than half an hour. And once that was done that abnormal connection, that abnormal blood vessel is no longer to be seen. So hopefully the patient would show improvement after this uh in a few months or so. Next slide, please. So this is an example of uh something which my colleague did uh last week. Uh So we do things um what we call pre pre um operative embolization of uh uh tumors. So we help our surgical colleagues in order to operate by reducing the blood supply of uh a tumor. So this is a angiofibroma of a 20 year old uh in the sort of anterior scar base and in the jaw region. Uh So my colleague went into the uh blood vessel injected contrast and that shows that there's a very rich blood supply with the material itself. And yet again, we uh inject embolic agents to reduce the blood supply significantly to any of the surgeons uh to do the surgery. Next um slide, please. Uh This is the case actually. Uh these pictures I got from um uh from Google just to give an idea of something else we could potentially do is embolization of uh vascular malformations in the brain avm. So that abnormality is that is normal, which is a uh connection of an artery and vein in the brain as well as an does and that's called ca an AVM something you're born with. Um So we are involved in diagnosing these conditions as well as uh there's potential for endovascular treatment where you go in and block off the abnormality using embolic patients. All right. Uh I think that's about it. Yeah. Uh So that's just an idea snapshot of what, what our department had did last week. Um So as I said, as Rob mentioned, it's, it's uh not a years' worth of cases. It's literally exactly what our department, me and my colleagues did last week just to give you an idea about things kind of conditions we treat. So it's, it's, it's quite varied and there's a lot of different aspects of um conditions we are able to treat endovascularly. All right. Any questions so happy to. So you got one of my colleagues, one of my colleagues, another consultant in our department who said, kind of joined us. So, any questions for us, we're happy to answer. All right. So I hope you've enjoyed those first two talks. And as I said before, you probably already forgotten. I'm Chris. And over there is Alex and we're both ST one. So we've both done F one and F two and both done an F three. And I think it's fair. So we're both keen to do surgery and here we are today. ST one radiologist. Why has that? Happened and how do you become radiologist if you are interested? So, next slide. So we're just gonna talk about the practical steps on how you get to be in our, our shoes in the future. If you, if that's something you want to do and how, and when to apply, why, why become a radiologist and what you can do now? Uh, yeah, practical actionable steps at your stage. Um, that you can actually start to think about. Um So just a show of hands is everyone, put your hand up if you're a medical student. So, pretty much everyone here, if not everyone. And um, any first years c three, first years, excellent and second years, third years, fourth years, fifth years, six years. So a good, good mix. Um No, final years. Interestingly. Um, they're probably a bit busy anyway, next slide. So how does one become a radiologist? You are here? Came to university. Congratulations. You're living the dream. I'm sure your parents are very proud. And, you know, if you come to this talk, maybe some of you are hoping that you'll get to this end stage here. So, what you need to do first is graduate. Good luck with that. Sometimes a bit difficult. You then need to complete a foundation training program. I think Chris and I have sort of both got similar feelings about the foundation program. It's not the best part of your life. I'll be honest, but it's unnecessary. Sort of hurdle that you can get through and then you need to sort of look again in specialty training. Now, depending on what sort of specialty you look at down the line that will vary. But for radiology, we're very fortunate that you can go straight into it following the foundation program. So no years on the wards as an fho other than one f two straight into training, get to call yourself a registrar even if it's not really fully deserved at this point. And so just to give you a bit of an insight on sort of how this all looks, Chris and I are here at this point, Rob is kind of this box here. We have to make up and the and ti to living the dream over and this point, you know, having their horse and having a good life. So how and when do we apply? So when um in the UK, you can apply to radiology if you have no more than 18 months experience in radiology, already applying to ST one and ST three, if you're an international medical graduate and you want to join, having worked already for more than 18 months in another country. Um As I mean, we're, we're two of two that have done an F three and that's for various reasons, Alex did a neurosurgical fellow year because he, that was kind of the path that was going down. I went part time in F two. did various bits and bos but decided that that was the best strategy for me a bit and then applied um the following year. So usually applications um for those in their sort of latter years of med school, you will start to get hear about things like AI which is the um the portal you apply to jobs for um for foundation training. It's exactly the same when you get to um applying to ST one opens in September for people that consider themselves academic. And that means you get one day a week throughout your train training program to do something academic in practicality. It just means you have less time to do all the other stuff you need to do. But yeah, and then it's October for um non academics and then um it's not very well known, but there is actually an entry in February as well rather than just August. So um yeah, we know sort of anecdotally a few, a few people that have entered in February as well. So um yeah, it's like, so I might be getting sort of a bit ahead of things, but the sort of bit we really want to focus on now is what can you do to put yourself in a position to apply? So, radiology applications now and sort of for warning which may change by the time you get there, sort of based on three components, which is a portfolio MS R A which is a multispecialty recruitment assessment. Uh Most specialties now sort of taken that in so of are medical training, which seems to be the sort of outlier and as well as an interview. Now, all of these could change at any point. But one thing that's fairly consistent amongst medical applications that you need to develop some sort of portfolio during this time. And that's what we're gonna focus on about how you can sort of try and start building this so that you're in a position to apply and have a good application. So we are uh in a position where on the eve of the application opening this all changed. So it could well happen, you know, in a few years time when you get around to this, it might all change again before it was 10 points. Um and five domains. Now it's 45 points and seven domains and there was no insight or preparation for that. It just happened um overnight and then everyone was sort of, yeah, a bit shocked and you just kind of anyway, we'll go through it step by step, give you s seven actionable areas and hopefully, um get you thinking about things you can start to do. Now, if you, if uh if you're adjusted to radiology, I think the thing to say as well is that even though these can change generally, the sort of domains that most applications will look at. So if you're taking these little boxes, you'll probably be one regardless. So the sort of major one and the sort of one you want to focus on originally or initially, because this is gonna show your interest in the interview as well as your commitment to specialty. And radiology defines this at the minute as multiple significant radiology work exposures, um read that as two essentially. So it's quite easy to get maximum points in this and something that's really actionable as a student. You know, even by today, speaking to various consultants, you might be able to sort this by the end of the year even. So two takes a week of over three days. But if you know the position you're in student select components are another viable way of doing that. Um Just make sure you're speaking to consultants before. So, you know, like a let us sort of evidence what you've done um for those of you who haven't indicated yet and aren't graduates and all of the big London Medical Schools office or medical physics or imaging degrees, which can also be action as an interest and then attending conferences as well to show, you know, you interest in these things, you're keen to learn more about specialty. And the big thing with conference is while while you're a student, most of them are free. And by the time you get to uh where you're an ST one or, you know, even a foundation doctor, they might slap a several 100 lb price tag on actually. And whilst you are students, I know you are extremely busy with just your sort of your general medical school schedule and there are ways to, to go to conferences and get the time off from funding. But it can be a bit of a fact. So feel free to ask any, any of this stuff and I would cave out all of this portfolio stuff we're talking about as well by saying, only do it if it's actually meaningful to you. And Tick box is a, they only show so much like when you have actually done something for a good reason, that is important to you, you'll do so much better job and it will be much more value of your own time and um other people's time. So if we go on to the next slide, we talk about leadership and this is a very broad church. What does this mean? Um at the end of the day, what it means is in black and white is, have you spent 12 months doing a committee position now, as I say, just personal advice, but only do this sort of thing if you actually care about it and you're doing it for a good reason. Otherwise you're wasting your own time and everyone else on the committee's time. Um But there are so many different societies now you can join as a medical student. They all have medical student reps and, and you'd be very surprised. I've just applied to British Society of Interventional Radiology and their trainees section. I applied thinking, oh, I'm not gonna get this and turns out I was the only one that applied for that particular section. So, um yeah, I got it straight away. No, no questions asked. So, um it's only by applying to these things that you actually find out. And so, yeah, next slide, I think another thing I'd just say about leadership move on is it doesn't, although you won't get full points, you know, if you're particularly passionate for, to play rugby, play something like that, those sort of medical school positions will get your points as well. So if that's something you're more interested in and can see yourself doing a better job of, I think it's also important to demonstrate for these decisions. You're learning the sort of facets of leadership and what kind of management looks like. Ok, teaching, there's kind of two categories for this there. Um Have you demonstrated that you are that you have done some teaching? And then there are teaching qualifications. Um We'll start with teaching. So this is something that changed sort of overnight. Like I mentioned earlier, I kind of was just trying to keep my options open and I wanted to do radiology in particular ir so, and I want to learn about it as well. I thought best way to learn is to teach. So I set up a webinar series, which you can all watch back if you like, there's like 17 episodes with different speakers from across the country and even a few internationally all on different aspects of ir targeting medical students. I did that over three months is the tick box and I did it knowing that the surgical applications required this at the time. And then overnight it happened that, yeah, the radiology one needs it as well. So I was lucky um get evidence for what you do as well. Even if it is just um like a relatively informal teaching session, if there's a consultant or anyone supervising you, even a senior medical student to, you just ask for some feedback. Anything even like a a Google form or something like that um can constitute evidence. So you don't have to be going for the top tier for everything. It's just good to be aware of these things before you start out because beginning with the end in mind helps you design and do things in a way that will help you in future. So, qualifications, I would say the top tier for this is if you can just click back to the main picture. Um So this is over here masters level, like honestly, unless you're um gonna take, you know, two years out or something to do a a, you know, master's or phd and then underneath, we've got a post graduate level. So this is way in the future and you guys really, I mean, most people won't be looking at that at all. There are things you can do. Um And I think so, Sarah at the back who runs the ultrasound and the anatomy demonstration for medical students, I'm not sure if your ultrasound course for med students would fit that sort of category, but potentially the students that come back to teach evidence of that and that demonstrators are usually three that may have the right to do the course. So, yeah, if you are staying around this area, there is the IB course which will give you um a good grounding of the theory and um practice of medical education. So um roles like, I mean, you guys will have supervisions and all your supervisors will be doing this sort of stuff. Um just sort of as part of being a a teacher, there's also lots of easy, very cheap or free courses you can do to tick off the the kind of um 33 points of whatever this is. So you need two teach and teacher days and you can do them both online if you want and then there's an open university course as well, taking your teacher online, which took me about 20 minutes. And that was, you know, most of the points um I would recommend you to learn just for general things. You might be surprised when you see in terms of developing a portfolio. Fine. And so the next section on the uh sort of criteria is audit, quality improvement research. I don't know if the Cambridge have to do Q I project as part of your degree at all. But you know, this is sort of perfect time to start getting these things done. I'm still using a Q I project from when I was a third year medical student. I should probably update, to be honest for you applications and the actual performer sort of guide that you need to do even audit or Q I project. Um A Q I is probably a bit more robust, but it says you can use an audit as well provided, it's shown to uh to make change in the department that you do it in. And again, that's sort of maybe having discussion with consultants supervising you. I'm reaching out early to sort of departments you're interested in doing any sort of projects with and sort of, you know, making them aware of your intentions. And then there's sort of the second section is which is the research. Um you can get maximum points for doing a post grad qu location. Again, it all comes back to that sort of medical education thing. Where do you really wanna be doing an MD or a phd to try and progress your career at this stage? Not necessarily, but you can get four out of five for either doing a national post presentation um as a first offer or a radiology, the publication um sounds quite difficult to do, but you'd be surprised a lot of these conferences really, really want postal presentations just to bulk out the majority. So it looks like there's sort of more attendees than there actually were. Um And, you know, you can sort of think about stacking these things. So if you do an IQ I project on anything uh radiology things, you can then turn that into a presentation as well. And before you know, it, you've done sort of one conceded effort and you've actually sort of got nine points or so from it. Yeah, it could even be a, a on teaching in, you know, over three months and then you present it at a con, you know, you can take all many birds with, with the one I work that you give to medical students. So prizes. This is the um kind of the, the most well elusive, I think for most, for some people, I think the most conventional ways is just by doing well in your year at UNI um I was really lucky from the teaching thing I, I led, I got given this award I didn't know about um which was an exceptional educator on medal. So I used that six points. It is, I think it's um easy to sort of fixate on get intinction. I appreciate Cambridge. Obviously, it's gonna be a lot of bright people and it's gonna be difficult to sort of achieve these things. But really think outside of the box. Uh for example, radiology applies to most aspects of medicine and imaging is involved in every aspect of medicine. So if you can find any sort of royal society or all college competition, you'll be surprised again, like saw Chris saying how few people buy these things. I did something for the RC GP. At one point there was like two essays submitted and it was 500 words and a cash prize. So, you know, it's all just a bit outside the box and you guys have got chu potato, the toothpaste is out of the tube. Um So why become a radiologist? Um I think these guys have have said quite nicely, but once you start working as a doctor as an F one, as A, as an F two, you will realize a lot of the job is um is not what you expected working as a doctor to be. There's a lot of documentation, there's a lot of long ward rounds potentially to 3:04 p.m. in the afternoon sometimes. And that is time spent on a computer documenting for or on behalf of someone else. And and then there's discharge summaries and all these other great things about being an F four or FT and there's the nights and the, the weekends uh and the bleep. So these are all things that cause a lot of people to do an F three year or to go part time or to emigrate or to leave medicine altogether. I think thankfully, radiology has basically none of that sort of the things that you didn't think you would be doing. Um So for me, early days, I in uni I, I really enjoyed and asked me um and did quite well at it and I think you should lean into, you know, your strengths. Um I think as well tech, I just, I'm fascinated by technology and you guys will see very shortly. Some of the stuff and that Cast Nation are one and Butterfly have, have brought along and Cortis um and like just seeing this stuff in real life and actually happening, you know, it's not just um I know it's, it's the one specialty where I've seen real cutting edge tech happen and you, even as an ST one, you'll be seeing something completely new every week, potentially. Um Yeah, hands on short procedures. We kind of alluded to surgery being actually there's a lot of ward rounds and clinics in IR, you do have a certain sort of Swiss cheese between you and the and the um kind of the ward based teams which means that when you get to do a procedure, it is a real thing that you are treating and um you are usually doing that in a, you know, 345 cases a day, sometimes as a real quick dopamine hit each time you're doing one. and it's not like these, these lengthy procedures that, um, yeah, don't always go to plan. It's often a really good outcome right at the end of the procedure. Um, so for, yeah, gen Z sort of instant gratification. It is good specialty to be in. Um, there's a whole host of other reasons on, on there, but for me being able to focus on the work you're doing and do a really good job was quite important in a lot of other specialties. You'll be pulled in all different directions constantly. They, there'll be phone calls, there'll be referrals. Um and with nurses asking you to do this and the other, with radiology, you are, your time is respected. And even if you're just a diagnostic radiologist and not just like they, they play a really, really important role, role and increasingly important, you're, you know, you are left to do the job and do it well. So I, I really value that. Um unless the wrong, I don't know any other and I think as well. So just beginning with the end in mind is really important and there is a new cancer hospital being built in Cambridge. There's a new pediatric hospital being built in Cambridge. There's a, a new pediatric oncology hospital being built in Great Ormond Street. There's all these things that by the time you guys are there, which is probably, you know, 78 years in the future, you guys will be the consultants and you guys will be the the people running these brand new shiny hospitals. So it's good to think 10 years ahead. I think actually, where do I want to be? What do I want to be doing? And what do I want my day to look like? And yeah, so what can you do now? Uh So show up what you're doing here very nicely. Thank you for coming. Uh Be keen but not too keen. Uh I think Chris was sort of keen on the idea. Um But essentially, you know, ask the right people, you've got radiologists in the room here, if you guys are genuinely interested, come and chat, but don't, don't pes the people 100 emails at the same time. Yeah. Beginning with the end of mind is really important. I think, you know, you guys are really, really busy now but making the, the things you do decide to do that are outside of um the kind of traditional medical curriculum and things like that. Thinking ahead, like, how can I help? Not, not just make this a meaningful project but also um get it to work for me in the future. Um being active and, and not passive. So you've got, you've got to make these opportunities. You've got to, you'll, you'll be very surprised as soon as you start asking these questions and, and showing up for stuff, all sorts of doors just wide open. And um yeah, you'll start getting prizes you didn't expect to get and, you know, all sorts of good things will happen. Um, and that just won't happen if you expect them to come to you. Um, the last point on there is, uh, whether you're surgically minded or, or very keen on ir from this stage getting a log book and jotting down, um, digitally any procedure you do, um, and making a habit of it sort of as soon as you've done that procedure or been involved in or just observed it. So the, the two most sort of recommended are e log book if you're very surgically minded and turtle is the ir specific one from British Society of Interventional Radiology. And that's T I RT L. Um So, yeah, fine. So that's what we've spoken about today. Um Sort of how to become radiologist, why I when put by and sort of things you can do. Now again, if anything wasn't clear, you can come and chat to sort of Chris and I maybe more so about the application stuff because we've done that more recently and then sort of the type about sort of what the job actually looks like at consultant level. Um But hopefully you'll enjoy sort of having a look at all the devices we've got to see today. And if you don't mind doing the feedback form, scan the QR code, you can scan it. Now we'll leave this up so you can do it at the end of the workshop as well if, if you prefer, because then you've got a chance to actually play with stuff and talk to people. Um, yeah, we'll open the floor now for questions and then we'll let you get hands on. So, um, has anyone got any questions for any of our speakers? Um, what kind of draws the line between a surgeon and an interventional radiologist? Because, like, some things I would imagine that's quite a blurry line. Yeah. So that's a, there's a short answer and a, a long answer. The short answer is, uh, a surgeon is someone who's done, um, the FCS exam or, uh, or one of the prior MRC S exams. I'm, I'm not sure at what stage they get to call themselves, Miss or Miss. Um, the long answer is actually, you know, all this is intervention procedures. It is surgery for a patient. What do they want to know? They want to know that they're coming into the hospital having an operation of some sort. I don't care what you call yourselves. They just wanna, they want to be able to communicate. Hold my gut is half centimeter, but my largest gut. Ok. When I'm very aggressive, it's half centimeter. I don't open up the skin, take up the bone, open the muscles, the jura, you know, patients are scared for that with reason. So that's a big difference. And some surgeons do similar procedures to what we do. So, like the body ir and vascular surgery. Yeah, there's, we do a lot of cases together and some hospitals, vascular surgeons are doing the stuff that we would do routinely. So, yeah, there are some vascular surgeons that do 90% of their work is endovascular and they'll be deploying things like this. We work very closely with our vascular surgeons and we can do lots of things together and there are things that they can do that we can't do, which mostly involve cutting down of the arteries. But when things get to very advanced level, we're, we're working with wires and catheters all the time in all our other areas of work. So we bring a very specific um set of skills like um to, to the procedure. Um which, which I mean, they wouldn't necessarily be able to bring because they don't do it all the time. Not that they're bad or anything. So, the thing that stops any of any surgical team in that area just doing what you could do, like why wouldn't he just do nephrostomy? Like why wouldn't they just take over work is our strong background in diagnostics to know exactly what we're doing. And when the complication comes, actually, I can spot it quickly. So that's why I think we need the. But if you go to the website for British Society of Interventional Radiology, you'll see the words, image guided surgery. So, you know, I think that's all depend as well in the general public because no one knows what a radiologist is and an intervention radiologist is saying we're surgeons kind of that. I know that we do. Ok. Very is a really good question. Yeah. Yeah. Um With IR kind of trading pathway wise. So do you apply for like ST one radiology and then reapply or is it? So there's no one answer to this anymore. Either there are in the last two years And so they don't have this at Cambridge. But other places in the UK, you can apply as an ST they, they literally called it sti to start with, but they, they ran it as ST bracket. I, and you're saying first three years are the same core radiology. Um But I don't know how it actually works in their job plans. Maybe they've got a bit of protected time, maybe like half a day a week during the first three years. And they don't have to reapply at ST four. And the way it stands now for us will be to reapply at well within our ST three year for either interventional neuroradiology or general interventional radiology, uh radiology. I run through specialty. So in theory, there is no need to reapply. But if you are doing radiology in a center that don't offer ir then you need to apply to change place because otherwise you're not going to get any exposure to that specialty in the center that doesn't do that. Yeah. That's a good clarification. Like you don't lose your job. If you reapply, if you do nothing, you carry on to ST five radiology and it's only by reapplying earlier that you end up ST six. But even then it gets a bit more fluid and flexible and, and it, it is on the training scheme um because everything is related to funding. So for the any trainee part of the salary is paid by, the part of the salary is paid by the hospital and the on calls are paid by the hospital. So for the draining skin to have someone from outside and coming in joining the training scheme after uh not, not at ST one level, that means that the hospital will have to pay extra for that person. So not all training schemes offer uh uh a kind of open application for for outsiders. So if you are interested in doing ir my advice is when you apply for radiology, you need to prioritize the centers that do have ir it's not impossible otherwise, but your life is gonna be harder particularly for the intervention neur because there's not many centers, 26 centers in the country who has it, who does intervention, neurology. So it's got to be one of those things it should apply to. Yeah, um you mentioned you wanted to be a surgeon but you changed your mind. So for all the reasons, if you go back a few slides uh for very many reasons. But, uh, uh, another radiologist in London has a youtube channel called Mr Radiologist and he's done 50 videos on why he did radiologist and he was at Mr. So he was in surgery left and went to radiology and, and it's also, there is a version where it's all 50 in one video for that. But, yeah, the main reason for me was as a third year, I was doing a vascular surgery placement, um, like an SSE type thing and it was a hybrid procedure. The interventional radiologist came in halfway through and the vascular surgeons were like hands off just watching. And I was like, do you guys not do this? And they didn't at that center? And I was just like, wow, this is so cool. It was only an angiogram and angioplasty of the leg. And, but I just thought it was incredible to see live anatomy on the screen have contrast injected, um, blow a balloon up where there was a narrowing and then to see contrast go all the way to the foot. I was just like, wow, you've like, saved this guy's leg and the vascular. Exactly. I mean, I'm still a bit scared of all the, all the newer stuff. But, um, yeah, it is incredible what these guys do, what these guys do for, especially for strokes at the moment. The UK is not in a, a good position when you compare to other countries. Um, there are only so of strokes, about 10% can be treated with mechanical thrombectomy, which is the hoovering out of the clot and in the UK only about 3%. Um So we're, we're yeah, missing out on two thirds of those strokes that can be treated with thrombectomy. And the, the consequence is that a lot of these patients die, like if you have a basilar or a posterior circulation stroke and you're not within a thrombectomy center, your days are numbered and it's, it's really sad, but this is why we're doing these sorts of events to pe people's interest and show that how important this is. And even for the ones that it's not a life or death situation, the quality of life afterwards when you've had a thrombectomy versus not is, yeah, choc and cheese. So anything else before we crack on? Yeah, any other questions, there'll be time in the next hour or so to ask more questions as well. So if something springs to mind or you wanna get anyone's contact details, then feel free to. But thank you all for coming and hopefully now you can get hands on, right? Ok.