1. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification Examination Eight years experience and Introduction of Animal using catheterization examination Toshio HYOGO JSNET SQE Board Members

2. Symposium Neuroradiologicum 2010 Japanese Society of Neuro Endovascular Therapy (JSNET) established 1982 members : 2601 (2010.9) –Neurosurgeon (85.4%) –Radiologist (5.5%) –Neurologist (6.2%) –Others (2.9%)

3. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification examination started preparation for making examination and educational system since 1997 First Qualification Examination in 2002

4. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification examination purpose “ The basic therapeutic level should be secured by the Society to avoid unnecessary complications which are caused by improper techniques and immature experiences.”

5. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Consulting Specialist

6. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Application Training more than 6 years training after graduating medical school –including more than 1 year training of endovascular treatment under the supervision of the consulting specialist must be a board certificated doctor –neurosurgery –radiology (neuroradiology) –ER –neurology –internal medicine –from 2008

7. Symposium Neuroradiologicum 2010 Post Graduate Clinical Training 2 years Neurosurgery 4 years JSNET Specialist Application After graduating Medical School Radiology 3 years & 2 years ER 3 years Internal medicine 3 years Neurology 4 years Board Examination More than 6 years training including 1 year NET training

8. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Application experienced more than 100 cases of endovascular procedure –as an operator, 1st assistant or 2nd assistant –including minimum 20 cases as an operator required minimum numbers of various cases –20 cases : aneurysm coil embolization –15 cases : revascularization, angioplasty –5 cases : AVM or dAVF embolization

9. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Application membership of JSNET –more than 4 years experienced more than 300 cases of cerebral angiography

10. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Qualification Examination Paper test 200 questions of multiple choice styles knowledge covered neuroanatomyneoruphysiology neuropathologyneuropharmacology basic radiologyinstruments & devices aneurysmbrain and spinal AVM dAVFtumortrauma cerebrovascular disease etc.

11. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Qualification Examination Paper test Consulting specialists have duties to make questions in their allotted sections based on scientific papers. Selection of the collected questions are made by its quality.

12. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Qualification Examination Paper test After the paper test, computer analysis of each question is performed, and improper questions (too difficult or too easy) or low discrimination coefficient questions are removed for the judgment.

13. Symposium Neuroradiologicum 2010 Questions Which are wrong ways to decrease the irradiation dose to the patient during the procedure? Select two. 1) using low pulse rate fluoroscopy mode 2) procedure using enlarged fluoroscopy mode 3) shortening the patient-X ray tube distance 4) decrease the X-ray tube current 5) using focused irradiation field

14. Symposium Neuroradiologicum 2010 Questions Which are wrong ways to decrease the irradiation dose to the patient during the procedure? Select two. 1) using low pulse rate fluoroscopy mode 2) procedure using enlarged fluoroscopy mode 3) shortening the patient-X ray tube distance 4) decrease the X-ray tube current 5) using focused irradiation field

15. Symposium Neuroradiologicum 2010 Questions Which arteries or veins (sinus) are passing through hypoglossal canal ? Select two. 1) persistent proatlantal artery type I (intersegmental) 2) ascending pharyngeal artery 3) inferior petrosal sinus 4) marginal sinus 5) anterior condylar vein

16. Symposium Neuroradiologicum 2010 Questions Which arteries or veins (sinus) are passing through hypoglossal canal ? Select two. 1) persistent proatlantal artery type I (intersegmental) 2) ascending pharyngeal artery 3) inferior petrosal sinus 4) marginal sinus 5) anterior condylar vein

17. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Qualification Examination Paper test passed applicants go to next step Oral test 1) case orientated practical questions about the treatment 2) basic knowledge about the device, basic technique and proper handling of device and materials on the table for one applicant with two examiner : 20 min each section

18. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Qualification Examination “ How to evaluate the practical technique? “ Practical test two examiners visit to applicant’s hospital on prefixed day observe the procedure

19. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Practical test treatment strategy skill acceptable technique safety in angiographic suit spread the high standard of the technique, instrumentation and facility

20. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Practical test This practical test have an essential problem. “ We are afraid that the test may give an unnecessary pressure to the applicant, which may affect the procedure itself or decision making during the procedure.”

21. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Practical test Committee has been searching better test method, and concluded the practical test was able to be changed to the test using animal model.

22. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Catheter handling examination using animal In 2006, the animal model using swine catheter handling test using DSA, fluoroscopy has been installed.

23. Symposium Neuroradiologicum 2010

24. JSNET Specialist Qualification system Catheter handling examination using animal guiding catheter navigating technique microcatheter assembly and handling navigation to the target area GDC deposition (aneurysm model since 2008) Two examiner to an applicant 20 min

25. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Specialist Qualification Examination from Practical test to Practical inspection An examiner visit applicant’s hospital and observe the procedure from start to end and make a report to him and committee after the inspection.

26. Symposium Neuroradiologicum 2010 Specialist qualification examination stats. Some practical test delayed to the next year Paper test passed applicants allowed 3 times chance of oral exam. 20022003200420052006 Applicants160998312088 Paper test passed13076487250 Oral test passed11256416864 Final successful10955397264 Final successful %68.155.647.06072.7 2002 to 2006

27. Symposium Neuroradiologicum 2010 2007200820092010 Applicants82104125126 Paper test passed62668069 Oral test passed57605872 Final successful56605767 Final successful %68.357.745.653.1 Total 627 / 2010/08 Averaged successful rate : 58.7% 2007 to 2010

28. Symposium Neuroradiologicum 2010

29. JSNET Specialist Qualification system Consulting Specialist Application must be a specialist more than 5 years experience as a specialist more than 3 published papers directly related interventional neuroradiology more than 10 times paper presentation at the society or related society meetings

30. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Consulting Specialist Application experienced more than 200 cases of endovascular procedure as an operator

31. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Consulting Specialist Application required minimum numbers of various cases –40 cases : aneurysm embolization –20 cases : revascularization or angioplasty –10 cases : brain or spinal AVM emb. –20 cases : dAVF embolization –20 cases : brain, head and neck tumor emb. –from 2000 (start) to 2006

32. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Consulting Specialist Application required minimum numbers of various cases –40 to 40 cases : aneurysm embolization –20 to 30 cases : revascularization or angioplasty –10 to 5 cases : brain or spinal AVM emb. –20 to 10 cases : dAVF embolization –20 to 10 cases : brain, H&N tumor emb. –from 2007

33. Symposium Neuroradiologicum 2010 We set new numbers of these requirements according to the results of the specialist activity investigation in 2006. 10 years after the initial planning, we change the regulation closed to the current activity of Japan.

34. Symposium Neuroradiologicum 2010 20002001200220032004 Applicants145213914 Successful14348812 Consulting Specialist qualification stats. total :132 2010/08 20052006200720082009 68201911 3719 10

35. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system Future problem Keeping high quality of paper test Improved animal model quality and method Numbers of specialists –now 24.1% of the members : 627 –keep some percentage? or –expand as naturally?

36. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system to the Public 2006.5 JSNET had been incorporated NPO non-profit-organization join the Japanese Board of the Specialties officially recognized society in Japan

37. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system 2008.4 CAS for carotid stenosis one of the requested conditions by Japanese Government Guideline for carotid stenting Clinical trial, new treatment or new device of neuro-intervention based on this title Onyx, Enterprise VRD, Merci system etc

38. Symposium Neuroradiologicum 2010 JSNET Specialist Qualification system re-registration every 5 years 50 cases activity report to specialist 100 cases activity report to consulting specialist Continuing Education Program

39. Symposium Neuroradiologicum 2010 We presented JSNET specialist qualification examination system and eight years experience. The JSNET will continue to complete the specialty system and aim to provide better IVNR treatment in Japan.