What Surgeons Should Know About Interventional Radiology

As far as interventional radiologists are concerned, there is no turf battle. I don't think any of my colleagues are saying interventional radiology is only for radiologists, or that only interventional radiologists should treat patients who would benefit from endovascular interventions.

What we object to is untrained people fiddling with endovascular techniques. We think that is bad for patients. We think it is bad for the whole ethos of interventional radiology and for medicine generally.

Faced with far more work than we can handle, we encourage people from other fields of medicine to learn interventional radiology. Our concern is that all physicians who say they practice interventional radiology be well trained and properly accredited.

Just as medicine has training programs for gastroenterologists and for neurosurgeons, we should be developing more training programs for interventional radiology that will take in radiologists and other specialists. For example, a neurosurgeon who sees the future in the treatment of cerebral aneurysm should be able to receive training in interventional radiology as part of his education.

We don't care where these specialists come from. They can come from neurology, neurosurgery, and vascular surgery. Proper training in relevant diagnostic radiology and intervention can benefit everybody.

Nowadays many vascular surgeons go to a 1-week or 2-week course in endovascular techniques. They learn a little bit about catheters, and then they just start placing them. We don't want surgeons to go to a 2-week course to learn some tricks that they try on patients.

I took out more than one appendix early in my career. If a person fell down in front of me with acute appendicitis, I could do an emergency appendectomy today. The outcome would be terrific, if I do not run into any complications. If I have a problem, however, I would not know what to do.

Yes, any physician can learn a trick or two. When you start having problems, you have to have all the skills at your disposal. You have to have a great knowledge of what is available to get you out of trouble.

Surgeons are doing interventional radiology, but they are cherry-picking individual procedures. Ask vascular surgeons in the United States whether they do endovascular stent grafting. They will say, "Yes, for aortic aneurysms."

Ask what they would do if a patient ruptured an artery during one of those procedures. The majority of vascular surgeons would operate on the patient at that point.

An interventional radiologist would have other options. We might treat that rupture with a stent graft or embolize it. Calling in a surgeon would be an option, but it would not be our only choice.

Interventional radiology is developing at a fantastic pace. We are treating lung and liver cancers, embolizing fibroids, and stabilizing accident victims who come into the hospital with ruptured livers and ruptured spleens. Our field is becoming so important; some of us would like to see an interventional radiologist in every hospital. That may not be practical given the shortage of trained people.

We are all on call, and we are called into hospitals constantly. Many of my colleagues work singly or share responsibilities with two or three colleagues. Working 5 days and 1 night in 3 for the rest of your life isn't much fun. The reality is every hospital would probably need six or seven interventional radiologists, if physicians in my field are to have a decent lifestyle.

What will probably happen is a hub-and-spoke system. Some centers will have a group of physicians who can do everything there is to do in interventional radiology. Others will have physicians who just do some procedures. They don't all have to be interventional radiologists, but they all have to know what they are doing.

If you are a surgeon, please come and learn our skills. Interventional radiology has developed fantastically over a 40-year time period. Over the next 40 years, it is going to increase exponentially. We need to have a large number of highly skilled people out there to accommodate the growing demand for endovascular and other interventions.