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The rocky road to recognizing interventional radiology as a full clinical speciality

The rocky road to recognizing interventional radiology as a full clinical speciality Hamady and McCafferty CVIR Endovascular (2021) 4:7 CVIR Endovascular https://doi.org/10.1186/s42155-020-00202-6 EDITORIAL Open Access The rocky road to recognizing interventional radiology as a full clinical speciality 1* 2 Mohamad Hamady and Ian McCafferty Over the past decades, interventional radiology (IR) has biological links to radiology. Otherwise, IR could slip made significant progress in technological applications, into a low key service, catering only for lines, biopsies quality of care, training, expansion, and even recogni- and drainages. Furthermore, the successful transatlantic tion. The historical challenges IR faces have deepened in experience of restructuring IR and lessons learned are the past ten years or so, following the remarkable suc- worth studying in depth. Time matters, and life does not cess of image-guided minimally invasive surgery. forgive those who do not seize opportunities at the right Serious Intrusions into the field and vicious turf com- time. petition, lack of proper recognition, suboptimal recruit- There is overwhelming enthusiasm and understanding ment path and workforce issues, lack of recognized among interventional radiologists regarding the need to clinical training, mismanaged relation with diagnostic augment IR’s status. Members of the British Society of radiology, growth in cost and complexities of interven- Interventional Radiology, who constitute almost one fifth tions as well as moral duty to ensure best medical care of the Royal College of Radiologists, voted anonymously and protection for patients are among the threats and in November 2019 in favor of recognizing IR as an inde- challenges facing modern IR. The biggest responsibility pendent specialty. However, currently, no country in the is how to turn these threats and challenges into EU views IR as an independent specialty. opportunities. A list of underlying causes and hurdles can be blamed All interventional radiologists know what needs to be for this extended delay in making radical changes to IR done, and extensive discussions have been occurring for status. To confront opposing powers and overcome hur- a long time. There is little argument that clinical prac- dles, several strategic and tactical goals should be adopted, tice, profile, clear identity, and advancing science are using a range of political, scientific, organizational, and some of the main pillars for the specialty’s long-term educational tools. One of the most important actions survival. Achievements have been made in some areas— should be highlighting the monetary value that IR pro- at a slow pace, but one could argue that these achieve- vides to patients and health-care systems (Rubin 2017). ments have been too little too late. An example is day-case services. Interventional radiology Given the scale of IR’s success in almost all aspects of is positioned in a unique place, where units can offer inte- medicine, the increasing clinical responsibilities of inter- grated streamlined care pathways, from clinical assess- ventionalists, and the inability to cope with massive ment through radiological workup, interventions, and growth of services and procedures in the field, IR’s sur- discharging patients to longitudinal care. vival will be at risk if the current structure, mentality, One of the few consolations of COVID-19 was the and mainstream ideology are not adjusted. The only way outstanding performance of IR units in many parts of to secure a viable future career in IR for the coming gen- the world (Rostampour et al. 2020). The contribution to erations is to establish a clinical specialty, which has patient care, when several other surgical and medical specialties caved in, should be distinctly and regularly highlighted to management and health policy makers. * Correspondence: m.hamady@imperial.ac.uk Department of Interventional Radiology, Imperial College-London, Praed The ambulatory services that IR can offer extend well Street, London W2 1NY, UK beyond vascular interventions to include oncology, Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Hamady and McCafferty CVIR Endovascular (2021) 4:7 Page 2 of 2 palliative care, and pain management (Buss 2017). The Acknowledgements Not applicable. safety of day-case vascular interventions was clearly doc- umented over a decade ago (Huang et al. 2008). The re- Authors’ contributions cent documentation of Get It Right First Time (GIRFT) The authors read and approved the final manuscript. on Radiology report in the UK recommended day-case Funding facilities as a way forward to improve cost-effective, Not applicable. high-quality health care (Halliday et al. 2020). Availability of data and materials Interventional radiologists would benefit from taking Not applicable. on leadership roles at local and national levels, as well as engaging in the administrative aspects of health-care Ethics approval and consent to participate Not applicable. management. Interventional radiology’s involvement in senior hospital management allows its voice to be heard Consent for publication at a decision-making level. Not applicable. Attention should be given to recruitment. A direct Competing interests recruitment path to IR from year one of training, as The authors declares that they have no competing interests. will be the case in the UK beginning in 2022, is a Author details crucial step, not only to obtain the most suitable can- Department of Interventional Radiology, Imperial College-London, Praed didates but also to shape the training curriculum. The 2 Street, London W2 1NY, UK. Consultant Interventional Radiologist, Queen clinical competency of the IR curriculum must receive Elizabeth Hospital, Birmingham, UK. priority attention by national training bodies. Parallel to this line of shaping future generations, involvement in education and organized events for medical stu- References Buss MK (2017) The intersection of palliative care and interventional radiology: dents is equally important to spread the word and enhancing understanding and collaboration. Semin Intervent Radiol 34(2): bust myths about IR among young trainees, especially 140–144. https://doi.org/10.1055/s-0037-1602756 female doctors (Xu et al. 2020). Halliday K et al. Getting It Right First Time On Radiology Report. https://www. gettingitrightfirsttime.co.uk/clinical-work-stream/radiology. Accessed on Needless to say, national societies and CIRSE should th December 14 , 2020 continue to support the hard work and innovation, ad- Huang DY, Ong CM, Walters HL, Wilkins CJ, Evans DR, Edmondson RD, Jones K, vancements in technology, and the promotion of Rashid HI, Deane CD, Goss DE, Sidhu PS (2008) Day-case diagnostic and interventional peripheral angiography: 10-year experience in a radiology evidence-based practice. Comprehensive data collection specialist nurse-led unit. Br J Radiol 81(967):537–544 that shows the value for money as well as the quality of Rostampour S, Cleveland T, White H, Haslam P, McCafferty I, Hamady M care that IR offers to patients will be a decisive tool to win (2020) Response of UK interventional radiologists to the COVID-19 pandemic - survey findings. CVIR Endovasc 3(1):41. https://doi.org/10. the hearts and minds of politicians and the public alike. 1186/s42155-020-00133-2 It is also crucial to win over the cautious minds of Rubin GD (2017) Costing in radiology and health care: rationale, relativity, one’s diagnostic radiology colleagues, who have a ten- rudiments, and realities. Radiology. 282(2):333–347. https://doi.org/10.1148/ radiol.2016160749 dency to fixate on today’s issues rather than look at fu- Xu Y, Pervez A, Theodoulou I, Zhong J, Lam S, Gkiousias V, Matthews L, Persad ture benefits that fully functioning IR could offer. The MAS, Makris GC (2020) Future interventional radiologists and where to find conversation should be approached with positive and them-insights from five UK interventional radiology Symposia for junior doctors and medical students. Cardiovasc Intervent Radiol 9:1–8. https://doi. persuasive thinking to demonstrate the enormous bene- org/10.1007/s00270-020-02655-7 fits of a full clinical IR specialty to all parties and explain the serious implications if no action is taken. There is a Publisher’sNote real chance that this partnership between diagnostic Springer Nature remains neutral with regard to jurisdictional claims in radiology and IR could be a wonderful opportunity for published maps and institutional affiliations. mutual growth and expansion of the medical fields. It is more important than ever that IR communities and individuals take personal and organizational respon- sibility to move toward an established clinical specialty that centralizes patient care and ensures viable career prospects for trainees. Image-guided minimally invasive surgery is the future of medicine—but the role and existence of IR, if it con- tinues in the current format, is threatened by viciously competing specialties. Finally, “I’ve learned; That oppor- tunity is never lost; someone will take the ones you miss.” (Andy Rooney). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png CVIR Endovascular Springer Journals

The rocky road to recognizing interventional radiology as a full clinical speciality

CVIR Endovascular , Volume 4 (1) – Jan 6, 2021

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10.1186/s42155-020-00202-6
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Abstract

Hamady and McCafferty CVIR Endovascular (2021) 4:7 CVIR Endovascular https://doi.org/10.1186/s42155-020-00202-6 EDITORIAL Open Access The rocky road to recognizing interventional radiology as a full clinical speciality 1* 2 Mohamad Hamady and Ian McCafferty Over the past decades, interventional radiology (IR) has biological links to radiology. Otherwise, IR could slip made significant progress in technological applications, into a low key service, catering only for lines, biopsies quality of care, training, expansion, and even recogni- and drainages. Furthermore, the successful transatlantic tion. The historical challenges IR faces have deepened in experience of restructuring IR and lessons learned are the past ten years or so, following the remarkable suc- worth studying in depth. Time matters, and life does not cess of image-guided minimally invasive surgery. forgive those who do not seize opportunities at the right Serious Intrusions into the field and vicious turf com- time. petition, lack of proper recognition, suboptimal recruit- There is overwhelming enthusiasm and understanding ment path and workforce issues, lack of recognized among interventional radiologists regarding the need to clinical training, mismanaged relation with diagnostic augment IR’s status. Members of the British Society of radiology, growth in cost and complexities of interven- Interventional Radiology, who constitute almost one fifth tions as well as moral duty to ensure best medical care of the Royal College of Radiologists, voted anonymously and protection for patients are among the threats and in November 2019 in favor of recognizing IR as an inde- challenges facing modern IR. The biggest responsibility pendent specialty. However, currently, no country in the is how to turn these threats and challenges into EU views IR as an independent specialty. opportunities. A list of underlying causes and hurdles can be blamed All interventional radiologists know what needs to be for this extended delay in making radical changes to IR done, and extensive discussions have been occurring for status. To confront opposing powers and overcome hur- a long time. There is little argument that clinical prac- dles, several strategic and tactical goals should be adopted, tice, profile, clear identity, and advancing science are using a range of political, scientific, organizational, and some of the main pillars for the specialty’s long-term educational tools. One of the most important actions survival. Achievements have been made in some areas— should be highlighting the monetary value that IR pro- at a slow pace, but one could argue that these achieve- vides to patients and health-care systems (Rubin 2017). ments have been too little too late. An example is day-case services. Interventional radiology Given the scale of IR’s success in almost all aspects of is positioned in a unique place, where units can offer inte- medicine, the increasing clinical responsibilities of inter- grated streamlined care pathways, from clinical assess- ventionalists, and the inability to cope with massive ment through radiological workup, interventions, and growth of services and procedures in the field, IR’s sur- discharging patients to longitudinal care. vival will be at risk if the current structure, mentality, One of the few consolations of COVID-19 was the and mainstream ideology are not adjusted. The only way outstanding performance of IR units in many parts of to secure a viable future career in IR for the coming gen- the world (Rostampour et al. 2020). The contribution to erations is to establish a clinical specialty, which has patient care, when several other surgical and medical specialties caved in, should be distinctly and regularly highlighted to management and health policy makers. * Correspondence: m.hamady@imperial.ac.uk Department of Interventional Radiology, Imperial College-London, Praed The ambulatory services that IR can offer extend well Street, London W2 1NY, UK beyond vascular interventions to include oncology, Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Hamady and McCafferty CVIR Endovascular (2021) 4:7 Page 2 of 2 palliative care, and pain management (Buss 2017). The Acknowledgements Not applicable. safety of day-case vascular interventions was clearly doc- umented over a decade ago (Huang et al. 2008). The re- Authors’ contributions cent documentation of Get It Right First Time (GIRFT) The authors read and approved the final manuscript. on Radiology report in the UK recommended day-case Funding facilities as a way forward to improve cost-effective, Not applicable. high-quality health care (Halliday et al. 2020). Availability of data and materials Interventional radiologists would benefit from taking Not applicable. on leadership roles at local and national levels, as well as engaging in the administrative aspects of health-care Ethics approval and consent to participate Not applicable. management. Interventional radiology’s involvement in senior hospital management allows its voice to be heard Consent for publication at a decision-making level. Not applicable. Attention should be given to recruitment. A direct Competing interests recruitment path to IR from year one of training, as The authors declares that they have no competing interests. will be the case in the UK beginning in 2022, is a Author details crucial step, not only to obtain the most suitable can- Department of Interventional Radiology, Imperial College-London, Praed didates but also to shape the training curriculum. The 2 Street, London W2 1NY, UK. Consultant Interventional Radiologist, Queen clinical competency of the IR curriculum must receive Elizabeth Hospital, Birmingham, UK. priority attention by national training bodies. Parallel to this line of shaping future generations, involvement in education and organized events for medical stu- References Buss MK (2017) The intersection of palliative care and interventional radiology: dents is equally important to spread the word and enhancing understanding and collaboration. Semin Intervent Radiol 34(2): bust myths about IR among young trainees, especially 140–144. https://doi.org/10.1055/s-0037-1602756 female doctors (Xu et al. 2020). Halliday K et al. Getting It Right First Time On Radiology Report. https://www. gettingitrightfirsttime.co.uk/clinical-work-stream/radiology. Accessed on Needless to say, national societies and CIRSE should th December 14 , 2020 continue to support the hard work and innovation, ad- Huang DY, Ong CM, Walters HL, Wilkins CJ, Evans DR, Edmondson RD, Jones K, vancements in technology, and the promotion of Rashid HI, Deane CD, Goss DE, Sidhu PS (2008) Day-case diagnostic and interventional peripheral angiography: 10-year experience in a radiology evidence-based practice. Comprehensive data collection specialist nurse-led unit. Br J Radiol 81(967):537–544 that shows the value for money as well as the quality of Rostampour S, Cleveland T, White H, Haslam P, McCafferty I, Hamady M care that IR offers to patients will be a decisive tool to win (2020) Response of UK interventional radiologists to the COVID-19 pandemic - survey findings. CVIR Endovasc 3(1):41. https://doi.org/10. the hearts and minds of politicians and the public alike. 1186/s42155-020-00133-2 It is also crucial to win over the cautious minds of Rubin GD (2017) Costing in radiology and health care: rationale, relativity, one’s diagnostic radiology colleagues, who have a ten- rudiments, and realities. Radiology. 282(2):333–347. https://doi.org/10.1148/ radiol.2016160749 dency to fixate on today’s issues rather than look at fu- Xu Y, Pervez A, Theodoulou I, Zhong J, Lam S, Gkiousias V, Matthews L, Persad ture benefits that fully functioning IR could offer. The MAS, Makris GC (2020) Future interventional radiologists and where to find conversation should be approached with positive and them-insights from five UK interventional radiology Symposia for junior doctors and medical students. Cardiovasc Intervent Radiol 9:1–8. https://doi. persuasive thinking to demonstrate the enormous bene- org/10.1007/s00270-020-02655-7 fits of a full clinical IR specialty to all parties and explain the serious implications if no action is taken. There is a Publisher’sNote real chance that this partnership between diagnostic Springer Nature remains neutral with regard to jurisdictional claims in radiology and IR could be a wonderful opportunity for published maps and institutional affiliations. mutual growth and expansion of the medical fields. It is more important than ever that IR communities and individuals take personal and organizational respon- sibility to move toward an established clinical specialty that centralizes patient care and ensures viable career prospects for trainees. Image-guided minimally invasive surgery is the future of medicine—but the role and existence of IR, if it con- tinues in the current format, is threatened by viciously competing specialties. Finally, “I’ve learned; That oppor- tunity is never lost; someone will take the ones you miss.” (Andy Rooney).

Journal

CVIR EndovascularSpringer Journals

Published: Jan 6, 2021

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