The future of interventional and neurointerventional radiology: learning lessons from the past

Abstract

The rapid progression of medical imaging technology and the ability to leverage knowledge from non-invasive imaging means that Interventional Radiologists (IRs) and Interventional Neuroradiologists are optimally placed to incorporate minimally invasive interventional paradigms into clinical management to advance patient care. There is ample opportunity to radically change the management options for patients with a variety of diseases through the use of minimally invasive interventional procedures. However, this will need to be accompanied by an increased clinical role of IRs to become active partners in the clinical management of patients. Unfortunately, the development of IR clinical presence has lagged behind and is reflected by declining rates of IR involvement in certain areas of practice such as vascular interventions. Current and future IRs must be willing to take on clinical responsibilities; reviewing patients in clinic to determine suitability for a procedure and potential contraindications, rounding on hospital inpatients and be willing to manage procedure related complications, which are all important parts of a successful IR practice. Increasing our clinical presence has several advantages over the procedure-driven model including enhanced patient knowledge and informed consent for IR procedures, improved rapport with patients and other clinical colleagues through active participation and engagement in patient care, visibility as a means to facilitate referrals and consistency of follow-up with opportunities for further learning. Many of the solutions to these problems are already in progress and the use of IR as a "hired gun" or "technician" is a concept that should be relegated to the past, and replaced with recognition of IRs as clinicians and partners in delivering modern high quality multidisciplinary team-based patient care. The following article will review the history of IR, the challenges facing this rapidly evolving profession and discuss recent developments occurring globally that are essential in maintaining expertise, securing future growth and improving patient outcomes in the modern multidisciplinary practice of medicine.

Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome

“…4 Although most countries officially define the workday as eight hours, many doctors experience working hours well-beyond nine hours due to the need of 24-hour patient-care coverage. 5,6 Neurointerventionists and the rest of the stroke management team are currently feeling the effects of the changes in acute ischemic stroke (AIS) management, 7 due in part to the mounting level of evidence from several large randomized controlled studies since 2015 that demonstrated the value of endovascular therapy (EVT) for first-line and delayed treatment. [8][9][10][11][12][13][14][15][16][17] The significant increase in the number of EVT-eligible patients has proportionally increased the emergency caseload for the neurointerventionists as well as the whole support staff in the stroke unit which extends the number of hours at work and could be a potential source of fatigue.…”

A prospective study integrating a curriculum of interventional radiology in undergraduate education: a tetra-core simulation model

“…Similarly to surgery, IR training via simulation, allows for skills to be practiced and evaluated in a controlled environment by identifying strengths and weaknesses. Previous reports suggest that incorporating IR simulation in undergraduates greatly enhances the skill-set of students planning to follow a career in IR as well as those pursuing allied interventional specialties such as cardiology, anaesthetics and intensive care (Maingard et al 2017). In fact, up to 19% of newly qualified juniors end up in interventional specialities (The Royal College of Radiologists 2018).…”

Social media in interventional radiology

“…Despite this, a minority of IRs had Facebook accounts, and whilst this may not include all accounts with high privacy settings, this may reflect a lost opportunity for IRs in Australia. As IRs become more engaged with active patient management, including the increasing frequency of interventional radiology clinic appointments, the requirement for self‐promotion in the private practice setting may continue to increase and be a driver of future social media use 34 …”