Interventional radiology

Created - 12.09.2013

I have read with interest over the past several years about the development of interventional training for vascular surgeons and other groups. We have one interventionalist surgeon at our hospital and the development has been very positive, (spouse is of course one of our radiologists). 

However as our work becomes the territory of others; oesophageal stenting is now vanishing to the endoscopists, colonic stenting to follow, (not sure I'm too disappointed about that), are we equipping our trainee interventional radiologists, (IRists), with the necessary tools? And what about us grey haired practitioners, just left to do the PICC lines in the corner?

As so eloquently put by Derrick Martin at the BSM Interventional course, if we undertake interventional radiology, (IR), procedures then we must be able to deal with our own complications. Thus if I am to continue to perform oesophageal stenting, upper GI endoscopy needs to be learnt so misplaced or displaced stents can be recovered. Furthermore we must carry out these interventional procedures in the safest and most cost effective manner; so colonic stenting should be a purely through the scope affair without our input. But I see no help from the BSIR to get IRists trained in endoscopy. And as for the basics of vascular intervention, where are the courses for arterial cut-down both to gain access and repair puncture wounds?

Perhaps our problem is that we weld ourselves to radiology rather than having a standalone attitude of “SIR”. But here lies the dichotomy, if IR is to be practised in the smaller centres then a mongrel radiologist doing both general and interventional work needs to exist. A pure IRist will not put up with the reduced technical requirements of the sticks.

Then we have the problem of IR sub-specialty branches of GI/GU/ biopsies and drainages. The remains of calculi extraction have long gone from our world, and biliary stenting, after failed ERCP, is generally in the most seriously ill, with high mortality and morbidity. Urology IR becomes the nephrostomy service especially for the VUJ stone on Friday night. The answer is the multi-tasked IRist is a dying species and we require individuals to learn the necessary extreme techniques of a single system. As for drainages and biopsies, come-on generalists man(and women)-up and take these on!, especially as we edge to a national 24/7 IR on-call.

So what do I want the BSIR to do, 1) be more pro-active in providing and directing courses which will sustain the present IRists; 2) provide a road-map for non-vascular sub-specialist organ system training. If we fail to provide these basics then IR will, I believe in 10 years, become a supra-regional service for vascular and there will be only a few IRists involved in the other sub-specialty branches.

Dr Mark E Lipton, Consultant Radiologist GI and Intervention, CHD Diagnostics and Clinical Support Wirral University Teaching Hospital