Why I want a career in interventional radiology

Created - 12.09.2013

Like any other medical student in their final year, the question I get asked most frequently is “So what are you going to specialise in?". If interrogated during my first year, I can guarantee that my response would not have been “Interventional Radiology”. 

Despite thoroughly enjoying my journey through university towards my future career, I have also experienced the frustration of not knowing where the final destination will be. However, earlier this year during a small group teaching session given by a doctor in her first year of clinical radiology training, the inspiration I had been waiting for finally arrived.

During the tutorial the doctor spoke passionately about her ambition to become an interventional radiologist, to which I admitted my lack of knowledge about the specialty. During medical school, radiology appears to be a subject often taught in isolation without a clinical context. However, during clinical attachments it becomes clear that imaging is an integral part of almost every patient’s admission to hospital. The radiologist suggested that I might follow a patient journey through an interventional procedure to understand what the job involves.

She directed me to a 76 year old man that had been admitted with abdominal pain. He had a past medical history of an infra-renal abdominal aortic aneurysm that had been stable in diameter (4.7cm) for the past 5 years with ultrasound monitoring. He had presented to A&E with 2 days of severe, central abdominal pain that did not radiate to the back. On examination he was haemodynamically stable with an expansile, pulsatile mass in the abdomen. CT angiogram revealed the diameter had increased to 5.7cm with a focal bulge at the right anterolateral border filled with a thrombus which corresponded with the clinical presentation. I then attended the vascular multidisciplinary meeting and was impressed by the consultant Interventional Radiologist that led the team through discussion of complicated cases, ultimately formulating a management plan. The following day I saw my first endovascular aneurysm repair (EVAR) which was unlike anything I has seen before. The use of real-time imaging allowed the Interventional Radiologist to visualise the insertion of the graft, which produced an incredibly satisfying end result. Even more satisfying was seeing the patient back on the ward with only minor discomfort in the groin, expecting a speedy recovery. I was then compelled to find out more about a career in Interventional Radiology and was astonished by its variety. I was fascinated to read about transcatheter arterial chemoembolization in hepatocellular carcinoma and the future of ‘personalized oncology’ using image-guided biopsies to help determine individual molecular pathology.1,2

In conclusion, Interventional Radiology is an expanding sub-specialty that requires excellent knowledge of anatomy and clinical presentations, leadership skills and the ability to develop complex technical skills. The rewards of this exciting specialty are the satisfying results of using imaging both diagnostically and in management without comprising on patient contact. Described as ‘the cutting edge of medicine without the cutting’,3 it is an area I am determined to pursue in the future.

Harriet Turnbull, 5th Year Medical Student, Brighton and Sussex Medical School

References

1) Gu L, Liu H, Fan L, et al. Treatment outcomes of transcatheter arterial chemoembolization combined with local ablative therapy versus monotherapy in hepatocellular carcinoma: a meta-analysis. J Cancer Res Clin Oncol. 2013 Sep 29.

2) Abi-Jaoudeh N, Duffy AG, Greten TF, et al. Personalized oncology in interventional radiology. J Vasc Interv Radiol. 2013 Aug;24(8):1083-92; quiz 1093.

3) Society of Inverventional Radiology [Online]. 2013 [accesssed 2013 October 07]. Available from URL: http://www.sirweb.org/about-us/