Do medical students need to be taught about interventional radiology?

Created - 12.09.2013

Interventional Radiology is one of the fastest growing fields in medicine today. As undergraduates, students are taught the importance of being able to interpret chest radiographs in dealing with acutely unwell patients.1,2 

Emphasis tends to be placed on the importance of requesting the appropriate investigation to guide clinical decisions, such as the choice of CT over MRI in the initial assessment of suspected stroke when thrombolysis may be considered. Radiology is typically more useful in helping students and junior doctors assess and manage patients than certain other specialties such as ENT and ophthalmology, yet there is no specific rotation in the field, unless a student chooses to do a studentselected module in the area. Typically, students are shown chest radiographs and CT scans on the wards, and asked to present them, often with little formal teaching. I believe Interventional Radiology in particular is a subject which students are inadequately exposed to during their undergraduate careers.

The importance of radiological imaging and intervention in the day-to-day management of both inpatients and outpatients has been increasing markedly in recent years.3,4 For example, in England, the number of radiology examinations rose from roughly 30 million in 2004/5 to almost 39 million in 2010/11.5 Surgeons are becoming increasingly dependent on imaging in planning procedures, with regular multidisciplinary team (MDT) meetings a staple of the modern surgical and radiological working week. The continuous improvements in the quality of CT and MRI imaging will only add to this.

Interventional Radiology has replaced surgery in the management of several emergency situations, such as acute peripheral and visceral ischaemia.2 Embolisation of bleeding arteries can limit the extent of damage following haemorrhage, for example, following GI or renal surgery. Liver lesions which are unsuitable for surgical resection may be specifically targeted with transcatheter arterial chemoembolisation (TACE).6 In fact, almost every other specialty has benefitted from the use of interventional procedures, from radiofrequency ablation in oncology patients, to coronary artery stenting in cardiology, to renal artery stenting and dialysis catheter insertion in renal patients, to image-guided biopsies of liver, lungs, kidneys, and a host of other organs and tissues. 

Additionally, students should be taught about Interventional Radiology as it may offer significant benefits over traditional surgery, including reduced morbidity and mortality, and shorter stays in hospital. Frequently, no general anaesthesia is required. Interventional procedures are often cheaper than surgical alternatives, with improved outcomes. This reduced cost is becoming increasingly relevant given the current economic climate. As interventional procedures continue to replace open surgical techniques, it is crucial that medical students are aware of them, and have at least a basic understanding of the rationale behind choosing an interventional procedure rather than a surgical one.

Interventional radiologists have been pioneers of medical innovation for many years, and were central in the development of angioplasty, Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedures, and radiofrequency ablation (RFA) techniques for liver tumours. Interventional Radiology is now a recognised subspecialty in the UK, and a dual specialty with Diagnostic Radiology in the United States. The future growth and importance of the field in delivering the highest standards of patient care should lead to Interventional Radiology being taught in greater depth and detail to medical students across the UK and further afield.

Killian Mac a’ Bháird, 4th Year Medical Student, University of Glasgow,

6th October 2013

References

1) The Royal College of Radiologists. Undergraduate Radiology Curriculum. London: The Royal College of Radiologists, 2012.

2) General Medical Council. Tomorrow’s Doctors: outcomes and standards for undergraduate medical education. GMC, 2009. [Accessed online 28/09/2013] Available from: http://www.gmcuk.org/TomorrowsDoctors_2009.pdf_39260971.pdf

3) The Royal College of Radiologists. Standards for providing a 24-hour diagnostic radiology service. London: The Royal College of Radiologists, 2009.

4) The Royal College of Radiologists. Standards for providing a 24-hour interventional radiology service. London: The Royal College of Radiologists, 2008.

5) Department of Health. Imaging and Radiodiagnostics. DH 2011.

6) Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D. Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies. J Vasc Interv Radiol. 2006 Feb; 17 (2 pt 1): 217–23.