An analysis of data collected on interventional radiology (IR) practice in the UK has shown an increasing trend in the number and complexity of procedures between 2017 and 2021, despite an imbalance in provision and demand of IR services, as well as a “striking” lack of records regarding safety and service-cost data.
In their introduction, researchers led by Mo Hamady (Imperial College London, London, UK) state that demand for IR services has been driven by the evolution of technology and clinical knowledge as well as an expanding range of treatments. However, the Royal College of Radiologists commented that the expansion of IR has not met anticipated rates due to a shortage in consultants, nurse and radiographer support, as well as inpatient and day beds.
“To help improve the future provision of IR services, we need to understand the current demand as well as a shortfall in the resources dedicated to provide 24/7 IR services nationally and regional variations in IR provision,” the authors write. Currently, there is no comprehensive data collection protocol to outline the number and type of IR procedures carried out in the UK, and limited data are available on IR facilities and workforce within National Health Service (NHS) trusts.
To remedy this lack, Hamady et al used the 2000 Freedom of Information Act to obtain data regarding IR procedures carried out in radiology departments only at NHS trusts in England and Wales between 2017 and 2021. This included IR workforce and facility information, number of IR consultants, nurses, trainees, angiographic suites and day-case units; analyses of procedure complexity and frequency by region.
Vascular procedures included those for which the basis of the procedure was mainly endovascular, such as angiogram, angioplasty, vascular stents, embolization, and thrombolysis. Non-vascular procedures included those for which an endovascular approach was not necessary, including ultrasound-guided biopsies and aspirations, nephrostomy, tumour ablation and vertebroplasty.
A total of 1,3400,352 IR procedures were analysed from 116 NHS trusts between 2017 and 2021. Throughout this period, the number of IR procedures increased from 256,592 to 292,030 procedures per year, respectively. A decrease in procedure numbers was observed in 2020—falling to 232,202 in correlation with the COVID-19 pandemic—but rose by 20.5% in 2021.
Over the five-year period, there were significantly more intermediate and complex IR procedures performed. Intermediate procedures were defined as a day or inpatient case of up to one hour using local anaesthetic with or without moderate sedation, the procedure must involve more than one type of equipment with an average cost of up to £500 and post-operative monitoring of at least two hours must be carried out.
Between 2017 to 2021, a total of 423,235 vascular and 917,117 non-vascular procedures were performed across the trusts. In 2021, across 118 trusts, there were a total of 561 IR consultants, 982 IR nurses, and 103 IR trainees. The authors comment that, in this analysis, they confirm the demand and utilisation of IR services has increased despite a “major” shortage in workforce, which no doubt has caused widespread burnout among UK interventional radiologists.
The authors add that a “postcode lottery” became clear in their analysis of IR procedures and number of consultants per region, highlighting the difficulty in maintaining IR services in certain areas of the UK.
“The main way to understand the need to achieve a standard level of IR service provision across the UK, monitor the quality of care and identify areas of cost saving is through a robust and centralised data registry,” the authors state. Previously, there has been “useful but limited” efforts to collected data on IR applications by the British Society of Interventional Radiology (BSIR) inferior vena cava registry and iliac angioplasty and stent registry, Hamady et al state.
Hamady and colleagues assert that a revision of services is needed and should include on-call provision and a broader national registry by the Royal College of Radiologists. They note that their analysis, although a start, was limited by NHS trusts’ limited resource to capture data and the subjectivity of criteria for the complexity of procedures. The research team state that “centralised and harmonised” data collection of IR procedures is key to better understand the scope of IR services, and to better understand pitfalls and assess training opportunities.
