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The World Federation of Interventional and Therapeutic Neuroradiology has developed and published guidelines for the specialized training required in order to practice Interventional Neuroradiology. (Interventional Neuroradiology 4:195-197 1998) The South African Neurointerventional Society has adopted these guidelines and amended them to suit the South African medical environment. It is essential however that doctors working in neurointervention receive a minimum standard of training that will ensure the best outcomes for patients.The interventional neuroradiologist must
1. be familiar with the signs and symptoms of disorders amenable to diagnosis and treatment by neurointerventional techniques
2. conduct thorough and accurate neurological examinations to evaluate patients with neurological disorders
3. understand the pathophysiology and natural history of these disorders
4. know the indications and contraindications to neurointerventional procedures
5. be skilled in the clinical and technical aspects of their implementation;• be familiar with other therapeutic alternatives
6.have a thorough understanding of pre and post operativemanagement of patients
7.  have an appropriate understanding of neurointensivecare management
8. understand the fundamentals of radiation physics, radiation biology and radiation protection, and the basic sciences related to technical aspects of neurointerventions.

Training:
a. Theobjectiveoftrainingistoprovidetraineeswithan organized, comprehensive, supervised, fulltime educational experience in techniques of neurointerventional procedures and diagnostic neuroradiology, including the comprehensive clinical management of the diseases involved
b. Trainees with an accredited training in Radiology or Neurosurgery may enter a programme of Neurointerventional training
c. TrainingPeriod
  i. The training period should be of 12 to 24 months duration, depending on the case load of the training unit and on the percentage of time (at least 50 %) that the trainee will be involved in                      neurointervention.
  ii. The trainee must participate in at least 100 neurointerventional cases and must be the primary operator in at least 50 of these.
  iii. Each trainee must maintain a personal case log book which the programme director must certify at the completion of training.
d. Programme Director:
The programme director must:
 i. be a member of the South African Neurointerventional Society;
 ii. have special expertise in interventional neuroradiology and must concentrate at least 50% of his/her practice in interventional neuroradiology;
 iii. have a full or part time position in an academic neurosurgery or radiology department.
e. TrainingInstitutions:
 i. The institutions where training is conducted must have neurology, neurosurgery and neuroradiology departments as well as appropriate inpatient, outpatient, emergency and intensive care facilities.
 ii. Modern imaging and procedure rooms and equipment must be available and must permit the performance of all neurointerventional procedures.
 iii. Patient Population:
 1. The institution’s patient population must have a diversity of illness from which a broad experience of interventional neuroradiology can be obtained. There must be an adequate variety and number of neurointerventional procedures for each trainee.
2. The number of trainees in the programme must be commensurate with the interventional neuroradiolgy capacity of the programme to offer an adequate educational experience.

f. Preliminary Requirements
i. Before assuming primary responsibility for performing neurointerventional procedures, trainees must acquire basic neurosurgical or neuroradiological skills, depending on the trainees background.
ii. the use of all available imaging modalities, delivery systems and embolic materials related to interventional neuroradiology;
iii. the basic radiology sciences including radiation physics, radiation biology, radiation protection and the pharmacology of imaging contrast agents;
iv. the basic and clinical neurosciences, including neuroanatomy, neurobiology, pathophysiology and natural history of neurological disorders;
v. the clinical aspects of patient assessment, treatment options and patient management related to neurological disease, including the fundamentals of neurointensive care management;
vi. the proper use and interpretation of the laboratory tests used in interventional neuroradiology;
vii. the clinical indications, risks and limitations of neurointerventional procedures;
viii. the use and administration of drugs commonly employed in conjunction with neurointerventional procedures.
ix. Trainees who have acquired these skills and have demonstrated competence in these areas can continue into the clinical phase of training at the discretion of the programme director.

g. Neurointerventional Clinical Training:
i. The trainees should have the opportunity to do all of the following under close supervision:
1. Perform clinical pre-procedure evaluation of patients;
2. Interpret preliminary diagnostic studies;
3. Consult with clinicians;
4. Perform diagnostic and therapeuticneurointerventional procedures;
5. Generate procedural reports
ii. Interactions between trainee and patients must be closely observed to assure appropriate information, standards of care and concern for ethics and patient welfare are maintained.

h. Research
i. The trainee should be encouraged to participate in research projects of either a clinical or basic science nature.
ii. The trainee should be encouraged to submit their work for presentation at national or international meetings and for publication in scientific journals

i. Evaluationi. The programme director must evaluate the competence and progress of each trainee. The evaluation must include an assessment of intellectual abilities, technical skills, attitudes and interpersonal relationships as well as decision- making skills and clinical management skills.

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