Common Interventional Radiology Topics and Questions at the Radiology Oral Board Exam

Common Interventional Radiology Topics and Questions at the Radiology Oral Board Exam include: nephrostomy tube placement, biliary drainage and cholangiography, abscess drainage, cholecystostomy tube placement, lung biopsy, gastrostomy tube placement, treatment of pancreatic pseudocysts, treatment of liver cysts (sclerotherapy), treatment of esophageal carcinoma with stents, sclerosing cholangitis, treatment of pericardial effusion, treatment of a patient with fractured ureteral stents, and management of a patient with a chest tube in the wrong position.

Biliary Obstruction and Drainage

The radiology candidate at the oral board examination should be able to discuss imaging findings of biliary obstruction on conventional percutaneous and tube cholangiography as well as MR cholangiopancreatography (MRCP), CT and ultrasound. The differential diagnoses such as sclerosing cholangitis, biliary stricture, cholangiocarcinoma, metastases, and pancreatic carcinoma will likely be discussed. The procedure for performing transhepatic cholangiography and drainage are a frequent part of this discussion. Be sure to remember to mention antibiotic therapy before the procedure to minimize the risk of sepsis.

Lung Biopsy

At the radiology oral board examination you will be highly likely to have a case which will revolve around the discussion of lung biopsy. The context of the discussion may revolve around solitary or multiple pulmonary nodules. The differential diagnosis may be discussed. Remember to exclude a pulmonary AVM before you decide to proceed with a biopsy. (Safety of the patient is most important.) Be prepared to discuss the lung biopsy procedure as well as risks (complications).

Nephrostomy Tube Placement

Nephrostomy tube placement is a frequent topic at the radiology oral board examination. Hydronephrosis is very common in Louisville. Be prepared to discuss the etiologies of hydronephrosis including: stones, strictures, and neoplasms. You will likely be asked to briefly explain the procedure as well as percutaneous nephrostomy indications and complications. For a review of common indications of percutaneous nephrostomy a nice case review is available at: http://rad.usuhs.mil/medpix/medpix.html?mode=pt&pt_id=9355&imid=28323&quiz=yes#top Antibiotic prophylaxis is controversial, but should definitely be used for stones or suspected infection. When in doubt give the antibiotics (safety is always the best approach in Louisville).

Abscess Drainage

Abscess drainage is another frequent topic at the radiology board examination. Be prepared to discuss the potential source of the abscess and potential drainage routes (including transvaginal and transrectal drainage approaches). Potential sites most commonly discussed are: peri-appendix (right lower quadrant), liver, and spleen. Be prepared to discuss potential complications and reasons for choosing specific drainage approach. Would you use CT, ultrasound, or fluoroscopy? Think about safety issues including radiation exposure to pediatric and female patients. Verbalize your safety concerns. Remember the antibiotics to prevent sepsis.

Percutaneous Cholecystostomy Tube Placement

The placement of a percutaneous cholecystostomy tube is a potential topic in Louisville. You may be shown nuclear medicine, ultrasound, or CT images of a patient with acute cholecystitis (usually acalculous cholecystitis). The case will probably be framed in light of a severely ill patient in the intensive care unit who is too ill for surgery. What can you do to help? Be prepared to discuss the cholecystostomy tube procedure and possible complications. Remember to give antibiotics pre-procedurally.

Treatment of Esophageal Cancer
	Treatment of Esophageal carcinoma with esophageal stent placement has been a topic on the radiology oral board. This question is not likely to come up as often as the previously mentioned topics. However, you should be prepared to briefly discuss this as a treatment option if the case warrants.

Pericardial Effusion Treatment
	You may see a case of pericardial effusion on CT. If the patient is symptomatic, treatment with catheter drainage could be discussed. Again, this topic is less likely than some of the earlier topics, but you should be able to discuss catheter drainage of a pericardial effusion if the case warrants it.

Treatment of Fractured Ureteral Stents
	You may see fractured ureteral stents on a case at the oral board exam. If you recognize this on a KUB or CT, you will want to be able to discuss percutaneous snare retrieval of the catheter fragments and placement of a new double j stent.

Chest Tube Management
	You may encounter a case of an incorrectly placed chest tube for pneumothorax or empyema. You should be able to discuss etiologies of the underlying problem, techniques of chest tube placement, repositioning options, and possible complications.

Gastrostomy Tube Placement
	You should be able to discuss how to place a gastrostomy tube.

Pancreatic Pseudocyst Treatment
	Be prepared to discuss the role of percutaneous aspiration and/or drainage of a pancreatic pseudocyst. Know the technique, timing considerations, and potential complications.

Treatment of Hepatic and Renal Cysts
	Symptomatic hepatic or renal cysts can be treated with sclerotherapy. I would know the various materials that can be used and the technique. If you choose to use alcohol to ablate the cyst, be sure to mention sedation for the patient.

Treatment of a Bile Duct Injury

You may see images of a bile leak or bile duct stricture related to a laparoscopic cholecystectomy. Be prepared to discuss this type of case. You may not be told the etiology of the problem. You should be able to discuss drainage of the biloma and possible drainage catheter placement for diversion of a leak. Most leaks respond to drainage of the biloma and time for the leak to seal. Stricture may be treated with balloon dilatation and catheter drainage.