New Privilege List - DI / Radiation Oncology - Sutter Medical Center

Sutter Medical Center, Sacramento
Department Of Diagnostic Imaging & Radiation Oncology - Delineation Of Privileges
NAME:
Request Privilege Appointment Requirements Proctoring Required
IV. INTERVENTIONAL NEURORADIOLOGY
[ ] Core Neuro-Interventional Radiology
Includes performance of image-guided therapeutic and
diagnostic procedures which involve intracranial
catheterization and/or instrumentation. For example
(not all inclusive): aneurysm coiling; intracranial
angioplasty and stenting; cerebral infusion treatment;
embolizations intra and extra cranial; and, cord cyst
puncture
(This privilege criteria is shared with another
department)
[ ] Extra-Cranial Cerebral Revascularization
Includes angioplasty and/or placement of stents in the
extra-cranial circulation with proximal or distal
protection devices.
(This privilege is shared with another department)
(Continued on next page)
Pathway A:
1. Current certification by the American Board of
Radiology; AND
2. Completion of a one or two-year Neuroradiology
fellowship AND
3. Completion of an interventional Neuroradiology
fellowship
-OR-
Pathway B:
1. Current certification by the American Board of
Radiology; AND
2. Completion of a two-year Neuroradiology
fellowship
AND
3. Continuous practice in a Joint Commission
accredited hospital since training in
Neuroradiology with demonstration of
interventional procedure experience in fellowship
training.
ALSO:
Fifty (50) Neurointerventional Radiology cases in the
previous two years as demonstrated by a letter from
the Director of the training program or Department
Chief.
PREREQUISITES
1. Hold one of the following groups of privileges:
a. Neuro-Interventional Radiology and Cerebral
Angiography Privileges; or,
b. Interventional Radiology Peripheral
Transluminal Angioplasty and Cerebral
Angiography Privileges.
– AND –
2. Document prior experience in using distal
protection devices in at least 20 cases in any
vascular territory.
First six (6) cases .
Current senior staff
members who qualify
under these criteria and
have been performing
these procedures will be
grandfathered in and
proctoring will not be
required.
First six (6) extracranial
revascularization
procedures.. Proctoring
will be performed by
another Senior Staff
physician who holds
extra-cerebral
revascularization
privileges and who has
also successfully
completed proctoring.
Reappointment
Requirements
Twelve (12)
interventional
Neuroradiology
cases in previous
two years.
Requirements can
include cases that
the physician
performed at other
facilities and are
not exclusive to
Sutter Medical
Center, Sacramento
patients.
Physician should
be prepared to
supply verification
of volume
performance if
requested.
Six (6) intra-cranial
cerebral
revascularization
(carotid stent)
procedures with
use of distal
protection devices.
Should an applicant
not attain the
suggested number
Number
Performed
Page 12 of 17
Note: Approval is subject to the terms of the hospital's exclusive contract for Radiology services, i.e., approval is for second opinion consultations only, it being understood that the
hospital's contracting Radiologists are primarily responsible for these services.