Goals

The fellowship training program in pediatric interventional radiology (PIR) at Boston Children’s Hospital provides comprehensive, advanced academic instruction in the interventional management of pediatric conditions. Upon completing the fellowship, the fellow should be proficient in performing IR procedures on children, with an understanding of the specific needs and challenges of pediatric intervention. By the end of the training, fellows are expected to be familiar with a wide range of pediatric disorders and to be able to develop and carry out management and follow-up plans in a competent, organized, and compassionate manner. 

Curriculum

The fellowship program curriculum closely follows the general requirements outlined by the ACGME. This includes both clinical and didactic training encompassing the entire spectrum of pediatric interventional radiology. 

As part of a multi-year effort, coordinating with multiple pediatric IR centers from around the world, SPIR formally adopted a fellowship curriculum for pediatric IR training. This classifies procedures as core or detailed, with all pediatric IR training programs expected to provide training in core procedures. The full fellowship curriculum is available here.

Expectations and Responsibilities

PIR fellows must participate in all clinical and academic activities within the interventional radiology division, as well as relevant departmental and hospital activities.

Clinical Duties Related to Patient Care
1. Procedure Consultation and Planning
  • Discuss procedure requests with PIR staff (usually the call or consult attending) and referring services
  • Review indications, potential contraindications, urgency levels, consent requirements, and logistical considerations
2. Pre-Procedure Preparation
  • Review patient's clinical history, prior procedures, and complications
  • Examine relevant imaging studies and sedation/anesthesia plans
  • Complete written or electronic pre-procedure notes for each case
  • Document special patient instructions, including:
    • Premedications (contrast allergy medications, SBE prophylaxis, anticoagulation)
    • Responses to prior treatments
  • Perform directed history and physical examination when needed
3. Procedure Performance
  • Conduct all procedures under PIR staff supervision
  • Progress through graded responsibilities with decreasing supervision throughout the fellowship
  • Following evaluation, the fellows will be signed off to perform certain procedures, such as GJ changes and hip taps, with indirect supervision
4. Post-Procedure Assessment
  • Perform physical examination of treated area and document in post-procedure note.
  • For arterial procedures, document pulse presence and strength and perform Doppler ultrasound studies as indicated.
5. Post-Procedure Documentation and Communication
  • Enter post-procedure orders and Brief Operative Notes in Epic
  • Provide verbal sign-out with nurse practitioners after the procedure, including procedure details, post-procedure instructions and follow-up.
  • Notify admitting or referring services of:
    • Procedure outcomes
    • Special instructions
    • Follow-up plans
6. Ongoing Care and Documentation
  • Dictate procedure reports on the day of procedure after discussion with IR attending
  • Participate in daily rounds and document notes for inpatients. See guidelines for inpatient rounds.
  • When possible, join follow-up clinic visits.

Membership of Professional Societies

PIR fellows are strongly encouraged to join the following professional societies to enhance their training experience and establish connections within the field:

1. Society for Pediatric Interventional Radiology (SPIR)
Membership Type: Members-in-Training
Application Requirements:
  • Current curriculum vitae
  • Letter of recommendation from an active SPIR member
  • Letter from program director.
Application Process: Apply online.

2. New England Society of Interventional Radiology (NESIR)
Meeting Schedule: Membership includes access both in-person and virtually to 6 educational lectures, with 5 in-person buffet dinners.
Membership: Complimentary membership available for fellows
Application Process: Apply online. 

3. Society of Interventional Radiology (SIR)
Application Requirements:
  • Completed online membership application form
  • CV
Membership: $50 for in-training membership
Application Process:  Apply online.

4. International Society for the Study of Vascular Anomalies (ISSVA)
Application requirements: Apply online. Confirmation of training from program director.
Membership: Active. fellow in-training. $50.
Application Process: Apply online.

These professional memberships provide valuable networking opportunities, continuing education resources, and access to the latest developments in pediatric interventional radiology.

Trainees within the IR Division.

Fellowship Positions
PIR Fellows (2 funded positions)
  • Spend entire fellowship year in PIR, except for one 2-week elective rotation
  • Full clinical responsibilities and call duties

PGY6 Resident Rotations
Tier 1 Rotators (BWH, BIDMC, Maine Medical Center)
  • 6-8 week rotations in IR
  • Full IR fellow responsibilities, including call coverage
  • Complete procedural privileges
Tier 2 Rotators (BMC, Lahey, UMass, St. Vincent's, Dartmouth)
  • 2-4 week rotations in IR
  • Credentialed for procedures but do not take call
  • Limited clinical responsibilities

Specialty Rotations
Pediatric Radiology Fellows (8 fellows)
  • 1-week IR rotation focused on vascular anomalies
  • Required to present at Vascular Anomalies Conference (VAC)
  • Observation-based learning; no procedures required
Diagnostic Radiology Residents
  • Optional 1-week elective at Boston Children's Hospital (BCH) PIR
  • Educational exposure rotation

​Observers
  • Maximum of one observer in the division at any time
  • No clinical privileges or procedural responsibilities
  • Observation only

Call and Conference Coverage

Call and Conference Coverage
Fellows are responsible for ensuring continuous coverage for:
  • Call duties
  • All conferences, including VAC (Vascular Anomalies Conference) and MAS
Coverage Coordination Process
When a fellow cannot provide scheduled coverage:
  1. Fellow initiates backup: The unavailable fellow must arrange coverage with a co-fellow or IR resident
  2. Chief fellow coordination: All coverage changes must be coordinated through the chief fellow
  3. Attending notification: Coverage arrangements must be communicated to attending physicians
Conference Call Coverage
When the on-call fellow attends conferences:
  • Another fellow or resident must cover the call pager during the entire meeting duration
  • This ensures uninterrupted patient care while maintaining educational participation

Elective Rotations

Rotation Parameters
  • Duration: Maximum 2 weeks
  • Location: Outside of IR or Boston Children's Hospital (BCH)
  • Status: Optional, not part of core curriculum
Approved Elective Sites
Special arrangements available with:
  • Interventional Radiology at Brigham and Women's Hospital (BWH)
  • Interventional Radiology at Beth Israel Deaconess Medical Center (BIDMC)
Requirements and Restrictions
Approval Process:
  • Program director approval required for all elective rotations
Timeline Requirements:
  • Advance notice: Must request at least 3 months in advance
  • Timing restrictions: Cannot be scheduled during first or last month of fellowship
  • Rationale: Extended lead time needed for credentialing and coordination with external services and hospitals

Evaluation

Online Evaluation Checklist
  • Fellow completion: End of first month, then quarterly
  • Staff completion: Selected IR staff complete same checklist and provide written feedback
Quarterly Evaluations
  • Format: Formal one-on-one meetings with PIR Fellowship Director or Associate Director
  • Purpose: Performance review and program feedback opportunity
  • Fellow input: Evaluate training program and suggest improvements

​Support and Reporting Structure

Clinical or professional concerns should be discussed with the Program Director immediately.

Clinician Support Services
  • Initial appointment: Scheduled with Office of Clinician Support at fellowship start
  • Follow-up: Additional appointments arranged as needed

Zero Tolerance Policy
The Division of IR maintains zero tolerance for abusive and harassing behavior.

Confidential Reporting Options
Report concerns to any of the following with complete confidentiality assured:
  • Fellowship Director
  • Associate Program Director
  • IR Division Chief
All reports will be handled with strict confidentiality.
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