In the wake of the recent joint statement from the British Society of Interventional Radiology (BSIR) and the Royal College of Radiologists (RCR) advocating for the increased provision of interventional radiology services in the UK (see here), and in anticipation of the publication of the Provision of Interventional Radiology Services (POIRS) document in the summer of 2019, BSIR president Trevor Cleveland writes about why patient access and awareness of interventional radiology (IR) procedures is crucial.
It is important to improve the provision of IR (image guided surgical) procedures across a range of emergency and elective, adult and paediatric services, because they have the ability to treat people with reduced morbidity, and generally have a quicker recovery time. IR as a specialty has evolved within what was originally a diagnostic service, with the expertise in image interpretation as a cornerstone to its effectiveness and success. The situation now is that IR procedures are the “go to” option in a number of emergency and elective scenarios, offering treatment for patients who previously needed more invasive open surgery, or were considered too high risk for those treatments. In many ways, image-guided procedures complement the open options, and extend the range of people who can have effective treatment (including cancer treatments). In other scenarios, the minimally invasive nature of IR procedures has meant that some open surgical side effects and complications can be avoided.
By its very nature, a new specialty develops in a relatively uncoordinated way, with pockets of enthusiasm and expertise being developed. The time has come, and the clinical need exists, for IR to come out of those shadows and be recognised for the specialty that it is, and the great things it can offer patients.
The POIRS and RCR Census tell us that we need more interventional radiologists in training, and that we need to use our current capacity more effectively. We also know that trainees and consultants can be discouraged in taking on IR procedures because of the high emergency commitment (so we need to make that more acceptable to work life balance), the higher risk of litigation, and the low level of recognition of the specialty.
However, it is clear that IR procedures offer great short and long term benefits for patients, to which they deserve to have access in a timely fashion, and for these to be performed by well trained, well-practised and fresh doctors.
Interventional radiologists must take primary responsibility in the patient pathway
It is important that interventional radiologists take primary responsibility in the patient pathway. The techniques, work up, follow up and audit of IR procedures, like all interventions, carry with them benefits and risks unique to the procedures and to individuals. It makes sense for patients and interventional radiologists to meet, discuss and address questions and expectations. Indeed, it is a requirement from the General Medical Council (GMC) that these facilities exist. Perhaps, in the past, where simple imaging was “ordered”, the situation was different. But as the complexity, and the potential risk:benefit analysis becomes more complex, such a situation is not tenable. It can be a very difficult balance, because there are a number of high volume procedures, which are relatively straight forward, and mandating direct face-to-face IR input may result in delay in treatment.
There are two potential ways to address this. One is to have very clear information for patients and other clinical teams, with specific training designed to allow for delegated responsibilities along the consent process. This at least reduces the time pressures required of interventional radiologists directly. The other approach is to significantly increase the IR capacity. Of course the latter is the ideal, but difficult to achieve, particularly in the short term. It is vital that these two strategies run concurrently, to ensure the highest quality service to patients possible.
Alongside this, it is important that patients have the opportunity to have a review with an interventional radiologist after a procedure, to ensure optimised aftercare, to manage any difficulties or complications, and it is essential that interventional radiologists are made aware of outcomes, and are able to record these for audit and quality purposes.
BSIR is addressing challenges facing IR in the UK
One of the challenges for IR, which BSIR is trying to address, is the general lack of understanding of what IR is, and what we can offer. This level of misunderstanding exists in many areas, including amongst patients, commissioners, general practitioners and even fellow hospital clinicians.
BSIR has established a communications team, which includes interventional radiologists alongside communications experts. We have been leveraging a number of areas to try to raise the knowledge and profile of IR, including social media, web site information, newsprint (including Interventional News) and through direct involvement in parliamentary groups.
In addition, BSIR has recognised for a number of years that medical students and junior doctors often have not been exposed to, or understand, IR procedures. To address this, we support a series of essay and case study applications, which, if successful, give the opportunity (with expenses support) for both groups to attend the BSIR annual scientific meeting (13–15 November, Manchester, UK), where there are specific events for them, in addition to the main programme. We also support local meetings of interested groups, as well as training events. These are aimed at increasing the awareness of IR, as well as trying to encourage suitably minded trainees to join the IR specialty.
Trevor Cleveland is an interventional radiologist at the Sheffield Teaching Hospitals NHS Foundation Trust and the Sheffield Vascular Institute, Sheffield, UK.