EBNR / European Diplomas / European Diploma in Spine Interventional Neuroradiology / 2. Eligibility Criteria and Terms & Conditions
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The EBNR must ensure that a candidate fulfills all requirements before participating to the final examination. The decision of the EBNR to accept a candidate for the examination is based on a complete online registration, documentation, and records. Those who take the examination agree that they are bound by the EBNR’s rulings regarding credentials and examination scores.

The requirements to be eligible to sit for the final examination for the EDiSINR are the following:

  • The candidate must be a certified radiologist or neuroradiologist (see note 1)
  • The candidate must hold the European Diploma in Neuroradiology (EDiNR) (see note 2)
  • The candidate must be a full member of the ESNR (see note 3)
  • The candidate must have successfully attended and passed the Interventional Spine Week (ISW) (see note 4)
  • The candidate must exhibit proof of training in a recognized interventional neuroradiology of the spine centre and/or clinical activity in the field of interventional spine neuroradiology (see note 5)
  • The candidate must present the requests of the log book (see note 6)
  • Completion of online registration
  • Payment of examination fee

Additional notes:

1. The candidate must be a certified radiologist. In other words, he/she must have completed their radiology training according to her/his local national regulations. Proof of completion of specialist training by the national certifying body must be submitted with the application. Certifications must be officially translated into English. Autocertification is not sufficient.

1.1. This point refers to candidates who undertake dedicated training in neuroradiology only; currently this refers to trainees in Portugal. The candidate must provide official confirmation from the national certifying body demonstrating that she/she is a neuroradiologist.

1.2. A candidate who has completed his or her radiology training in a non-European country, is welcome to sit the examination when this training or experience is deemed adequate by the EBNR Committee.

2. All candidates wishing to sit the final examination for the EDiSINR must hold the European Diploma in Neuroradiology (EDiNR).

3. Individual full membership to the ESNR is a prerequisite to apply. Junior, associate, or institutional membership is not accepted.

4. The candidate must have attended the ISW, and must have passed the written examination administered at the end of those courses. There must not be a longer interval than 3 years between the attendance of the ISW and the final diploma examination.

5. The candidate must have undergone training in Interventional Spine Neuroradiology to become eligible for EDiSINR. In the current absence of formalized training programmes across Europe, a period of observer ship of at least 3 months in an internationally recognized interventional neuroradiology of the spine centre is acceptable. A certificate, signed by the Chairman of the hosting Department, must be presented together with the application. Alternatively, proof of continuous clinical activity in the field of interventional spine neuroradiology, corresponding to at least 25% of the working time of the applicant during a period of at least 2 years, is also acceptable. The applicant should present a log book with number of cases performed. This must be certified in writing by the Head of the Department where the applicant works. All certifications must be officially translated into English. Autocertification is not sufficient.

6. Log Book for Spine Intervention Neuroradiology

This Log Book provides the expected knowledge, the technical skills, the clinical approach and the minimum number and type of spine procedures to perform during the training time. The training time should be documented and consists of at least 6 months at a High Qualification Center of Spine Interventional Neuroradiology. All the requested procedures (see III Minimum procedures) must be performed as a first operator and certified by the director of the referring center.

6.1. Specific procedures

I: Interventions in vertebral body compression fractures (VBCF) for porotic, primary tumor, metastatic , traumatic and hemangioma lesions.

Knowledge

  • Know the anatomy and radioanatomy of the spine and adjacent structures
  • Understand the pathophysiology of osteoporosis, haemangioma and neoplastic disease as it relates to the spine
  • Be familiar with the pathophysiology of traumatic fracture as it relates to the spine

Clinical skills

  • integrate non-invasive testing (CT, MRI, Radionuclide Scintigraphy), physical findings and past surgical history to identify symptomatic levels
  • appropriately identify patients with symptomatic VBCF
  • know the indications for percutaneous vertebroplasty (PV) in patients with VBCF and understand the medical and surgical options in these patients
  • categorise VBCF as to their appropriateness and expected response for treatment with percutaneous techniques
  • identify patients who may benefit from kyphoplasty and the differences between kyphoplasty and vertebroplasty
  • identify patients who might benefit from vertebral augmentation techniques (use of stents, peek cages, etc.) and understand the differences between these methods and their indications
  • list the complications of these techniques and their incidence as documented in the literature for VBCF secondary to osteoporosis and neoplastic spinal involvement
  • list the absolute and relative contra-indications
  • understand pre-procedural, intra-procedural and post-procedural pharmacological management for patients undergoing these techniques including constant sedation, narcotic and non-narcotic allergies
  • understand the role of an anaesthetist/sedationist

Technical skills

  • demonstrate knowledge of proper vertebral body access techniques (transpedicular, parapedicular)
  • be familiar with interventional equipment used in including cements and cement delivery systems, needles, vertebroplasty-enhancing devices (stents, peek cages, etc.) and x-ray screening facilities
  • be aware of CE marking and licensing for cements and additional agents used in vertebroplasty
  • understand when PV can be combined with other curative or palliative minimally invasive techniques of ablation (thermal and cryo- ablation)
  • be familiar with all measures to protect and monitor sensitive neural structures in the spine (including active and passive thermoprotection by means of air or CO2 injection, thermocouples, evoked potentials, etc.)

6.2. Spinal procedures for disc, nerves and facet joints (e.g. selective nerve root blocks, epidural steroid injections, facet joint blocks, sacro-iliac joint techniques, discography, percutaneous decompression of intervertebral discs, RFA neurolysis)

Knowledge

  • demonstrate appropriate knowledge of spinal anatomy and spinal fluoroscopic anatomy
  • understand the pathophysiology and aetiology of various spinal pain syndromes including discogenic pain, facet joint syndrome, spinal stenosis and nerve root impingement

Clinical skills

  • perform a directed history and physical exam in patient with back pain and/or radicular pain
  • be able to direct and interpret imaging
  • integrate non-invasive testing (CT, MRI, Radionuclide Scintigraphy), physical findings and part surgical history to plan appropriate treatment strategies
  • appropriately identify patients with spinal pain syndrome
  • identify the indications for spinal injection procedures on patients with back pain and/or radicular pain
  • understand the medical and surgical treatment options in these patients
  • list the complications of spinal injection procedures and their incidence as documented in the literature
  • list the absolute and relative contra-indications for spinal injection and percutaneous disc decompression procedures

Technical Skills

  • be familiar with interventional equipment as used in spinal injection procedures
  • be familiar with the subtypes (mechanical, thermal and chemical) of disc decompression techniques and the appropriate equipment
  • understand pre-procedural, intra-procedural and post-procedural pharmacological management for patients undergoing spinal injection procedures including conscious sedation, narcotic and non-narcotic analgesics
  • demonstrate appropriate knowledge of steroids and anesthetics used in spinal injection procedures

6.3. Minimum number of procedures to be performed

The above list shows the minimum number and type of procedures to be performed as first operator and certified by the director of the referring center:

  • 50 vertebroplasties
  • 10 mechanical assisted vertebroplasties (balloon kyphoplasty) and 10 vertebral augmentations and apart from balloon kyphoplasty, include the use of peek cages and stents
  • 50 disk treatments
  • 30 biopsies
  • 40 facet infiltrations and/or RFA treatment for facet degenerative disease or osteoid osteoma
  • 50 epidural, foraminal and sacral steroid injection

7. The candidate must have sufficient ability in the English language to communicate with foreign colleagues, to study international literature, and to master the examination.

8. The “Certificate of the ECSINR” will be awarded to all doctors, regardless of individual speciality, who pass all two sets of MCQs.

Please note that candidates, regardless of individual speciality, who are NOT certified radiologists or neuroradiologists CANNOT sit for the final examination for the European Diploma of Spine Interventional Neuroradiology (EDiSINR).