Transcending region and socioeconomic status, a global survey has revealed patient awareness to be a “universal obstacle” that faces interventional radiology (IR) worldwide. These data have also highlighted disparities in training, practice, education, and reimbursement. The survey was aimed to describe the current global state of IR education and practice in different geographic locations, identify factors limiting development and propose strategies to address these challenges.
“Understanding the factors underlying such disparities is essential in helping to develop IR as a discipline. Such developments will better serve patients in need while also bringing value to the global healthcare system,” write Justin J Guan (Cleveland Clinic, Cleveland, USA) alongside Constantinos Sofocleous (Memorial Sloan Kettering Cancer Center, New York, USA) and co-authors of the survey. According to the World Health Organisation (WHO) in 2021, more than half of the world’s population lacked access to crucial radiology services and even more so departments with interventional capabilities.
Endorsed by the Society of Interventional Radiology (SIR), Guan et al designed an online survey to gather information including respondent demographic information, IR practice characteristics, and respondent opinion on challenges and needs. The survey was distributed among global IR societies and shared on social media platforms, remaining open between June 2022 and September 2023.
Guan and colleagues collected 1,263 responses. Of the 993 respondents who reported speciality affiliation, 811 were interventional radiologists, 85 diagnostic radiologists and 91 identified as both specialties. The majority of respondents were located in Asia, Europe or Africa. Most respondents reported practising in an academic hospital (34.3%), a public hospital (31.8%) or a private hospital (27.9%). The USA was not included in these results, as statistical analyses of US IR practice were used as the basis for comparison.
Over half of the respondents reported having graduated from an accredited radiology training programme, although 24% stated that no structured training programme existed in their country, and 20% indicated that their radiology training offered no exposure to IR. IR teaching responsibilities were least prevalent in Africa (40%) and most prevalent in Europe (83%). Reflecting these disparities, 92% of respondents expressed support for establishing unified global IR training standards.
In terms of IR practice, the most commonly performed procedures worldwide included biopsies, drainages, angiograms, embolization, and venous access procedures. Regionally, biopsies were the most frequently performed procedures in Asia, North America, and Africa, while venous access procedures were most common in South America and Oceania. In Europe, angiograms and embolization were the most widely conducted IR interventions.
The survey also examined reimbursement models, asking repondents to select all that apply, the authors found that national health plans were the primary source of payment for IR procedures globally, covering 66% of cases. Private insurance was the second most common form of reimbursement at 53%, while out-of-pocket payments accounted for 35% and hybrid models 24%. Private insurance was the dominant model in North America, South America, Africa, and Asia, whereas national health plans were the primary source of payment in Europe and Oceania. “Interestingly”, Guan et al write, in Asia, the distribution of payment sources was relatively even, with 54.7% of cases covered by private insurance, 53.7% by national health plans, and 52.4% paid out of pocket.
Several key barriers to the expansion of IR services were identified via the survey, with patient awareness and education emerging as the most critical issue. On a scale of 1 to 3, where higher values indicated greater relevance, patient awareness received a weighted mean score of 2.7 and was cited as the most significant barrier by 72% of respondents. Patient referrals followed closely with a score of 2.6, reported by 65% of respondents. Other significant barriers included limited IR training (2.5, 57%) and reimbursement issues (2.5, 56%). While patient awareness and referrals were the dominant concerns globally, Africa was the only region where IR training was ranked as the highest priority, scoring 2.8, followed by patient awareness at 2.6.
Among practising interventional radiologists, the study highlighted key professional challenges, with patient awareness and hospital support ranking highest. Competition with other specialties was another major concern cited by respondents. These challenges varied by region—in North America, Asia, and Europe, the primary issues were patient awareness and hospital support, while in Africa and Oceania, patient awareness remained a leading concern. In South America, competition with other specialties and reimbursement challenges were ranked as the most significant obstacles.
In their discussion of the survey results, Guan and colleagues underline that not only is awareness about IR low among patients, but “also among referring and primary care physicians, healthcare workers and the public at large”. The authors reference a 2023 Rodgers et al study which published results of a population survey evaluating public awareness of IR in the USA. Of 1,000 respondents, only 40% knew of IR, and less than half described the specialty correctly. “[The USA has] arguably the most developed IR infrastructure in the world”, Guan et al state, casting awareness of IR in other geographies in stark relief.
“Ultimately, there must be global recognition of IR as a medical discipline that offers significant value to the healthcare system,” the authors write. “Global collaboration of IR societies with backing from governments, industry, and other supportive entities is crucial in fostering positive changes and overcoming challenges that hinder the development of IR training worldwide.”
The authors highlight IR’s added value to the healthcare system across numerous specialties and state that the “increasing demand for minimally invasive procedures, coupled with patient-centred care, tailored management plans and the rising incorporation of artificial intelligence and robotics, further enhance IR’s market value”.
Guan and colleagues add that, while North America has the largest IR market share currently, the Asia-Pacific region is projected to have the highest future growth rate, while investment from IR societies, government and industry into regions with less robust IR infrastructure such as Africa and South America is set to improve training and education.
