In the USA, Interventional Radiology is a primary specialty and requires completion of an Accreditation Council for Graduate Medical Education (ACGME) approved training program. However, there are many IR fellowships in USA, which allow trainees to gain further experience in a specific area of interventional radiology. These sub-specialty fellowships are non-ACGME-accredited programs which accept a direct application. Most of these applications have a prerequisite of english language competence and completion of medical licensing examinations (USMLE) and ECFMG certification.