Interventional News’ Co-Editor-in-Chief, and new president of the Society of Interventional Radiology, Brian Stainken, on “organising the aisles” of the interventional superstore, and the “magic” of which interventional radiologists are too modest to boast.
Technological innovation in the field of interventional radiology is very exciting. Was this a major motivating factor for you as you moved into the field?
Like many, I found interventional radiology accidentally. I was a surgical intern in the early 80s at the Naval Hospital in San Diego, and I had a patient who suffered terribly from postoperative complications. I remember thinking that I was not sure I could ever look a patient in the eye and say that I thought major surgery was a good idea. That is a problem for an aspiring surgeon!
I was fortunate during that time to have seen some of the early giants of interventional radiology, people like Joe Bookstein and Skip van Sonnenberg. I read the first edition of Athanasoulis’ text book and I was hooked. This was something I could believe in. And I do.
For me, it is not so much about the technology, it is more about the elegance of the solutions, and the huge positive impact our approach has had on medicine. I can now look someone in the eye and say I can help.
What innovations have shaped your career?
I am not so sure any specific innovations have. Certainly, many people have: I was a fellow at the University of California, Los Angeles with Tom McNamara, Antoinette Gomes, Steve Rose, and Scott Goodwin. Even back then Tom was a visionary. Tom, Steve, and Scott taught me to do what I do. I draw on that experience every day. After LA, I joined the group at UCSD. I was lucky to be among the first to perform percutaneous cryoablation and I can count over a hundred percutaneous prostate and open liver cryoablation procedures to my credit, but what shaped my career more were the people: Anne Roberts, Karim Valji, Horacio D’Agostino, Giovanna Casola. You just cannot find any better. In the mid-90s, we moved “back east” to Albany, New York. Those were the home made endograft days. I had the opportunity to join forces there with a talented group of interventional radiologists and vascular surgeons who pushed my ‘endovascular’ skills to the limit. I built one heck of a home-made aortic endograft, or so I thought at the time! We also did a lot of work with mechanical thrombectomy, at that time also combining the tool with thrombolytic agents. I also recall returning from a meeting and suggesting to my partner, Gary Siskin, that he get involved with this new technique called fibroid embolization. I could go on for hours about innovations, but for me, it is really been about people.
What developing technologies or techniques are you watching closely for the future?
Interventional cancer therapies: There is a lot of excitement about the role of interventional radiology in cancer care. There is tremendous opportunity, not just in the tools, but in the approach. We are starting to think with a higher level of sophistication, looking at combinations, adjuvant approaches… these technologies are in their infancy. I believe that we need to push the horizon. Right now we are focused on firefighting non-resectable disease after it reaches our primitive thresholds for detection. As we are able to better stage or visualise the extent of disease, we will see interventional radiology solutions routinely being considered in the context of definitive treatment with curative intent. I believe we should watch developments in advanced visualisation (i.e. fused/molecular imaging), high resolution/microscopic targeting, and combined treatments. Having lost two parents to cancer in the past two years, I hope ultimately that there will be a better understanding of prevention, and that our children or grandchildren will regard our current use of burning lances and ice balls as …quaint and well intentioned.
Beyond cancer care, there is truly no disease state or organ system, and no specialty which has not enjoyed the benefits of interventional techniques. I used to say the only exception was psychiatry, but then we found out that carotid stents improve cognition. What could be better? I think I’ll sign up.
What innovative projects are you currently involved with?
I am a bit busy with the Society of Interventional Radiology these days. In that context, we are working on multiple fronts. We just enjoyed our most successful meeting ever in San Diego, pretty remarkable given the challenging economy. We are already busy planning for 2010 in Tampa, Florida. In addition, there are a host of ongoing projects, all focused on serving our members’ needs. We have an active research foundation, service line initiatives, advocacy (political, payor, and hospital), standards, publications and international relations all moving forward at a brisk pace. It is challenging and very exciting.
When I have time away from Society duties, I practice interventional radiology, in Providence, Rhode Island, while serving as Diagnostic Imaging Department Chair and General Nuisance. After 15 years in academic medicine, I have enjoyed many aspects of the transition to more of a small-hospital, private-practice environment, although I do miss training fellows.
When not busy otherwise, I have been blessed with an infinitely patient dermatologist wife of 25 years (Marsha), whom I met at medical school orientation, three children – two in college and one almost there. We even have a Portuguese Water Dog puppy named Gus (and yes, we did get ours before the Obamas!). We just finished building a house on the shore just south of Providence where we will someday retire. I enjoy boating, skiing, scuba, and chopping wood. I do not repair household appliances or cut the grass.
With exciting therapeutic developments hitting the headlines in the mainstream media, do high patient expectations of interventional techniques pose a challenge for interventionalists?
Not as long as the expectations are accurate. I practice interventional radiology full time and see patients in consultation every day. Most of my time with them is spent discussing expectations. It is so important to be on the same page, no one else can do that for you. The other part of the equation is to communicate the same to the other members of that patient’s healthcare team: Chief complaint, history of present illness, examination, planned procedure, intent, risks, benefit, and options; all typed and clear. Interventional radiologists need to use more letterheads and stamps. We are bad communicators.
I do believe that we have a tendency to oversimplify the skills required to do what we do. It is a bit like magic. If you do it well it seems effortless. But behind the scenes, it is much more complicated than it appears and it is okay to say so. Interventional radiologists are a bit too modest. You can do a lot of damage through a small hole. The word “minimal” applies to invasiveness, not requisite skill or training.
How do you keep up with this fast-developing field?
Well, of course I read every issue of Interventional News cover to cover!
I do read The Journal of Vascular and Interventional Radiology and other journals almost every month, and I try to attend meetings, although these days I find myself mostly in meetings at the meetings!
I do a fair amount of research on patients with complicated problems, mostly online. I know I will hear about this later, but I am an unabashed Google researcher. It is amazing what is out there and it is so easy to find.
As the new president of the Society of Interventional Radiology, how can the Society help professionals to keep up with developments and stay ahead of professional challenges?
Great question! We have been wrestling with organising the bounty of interventional radiology for a while. It is wonderful that there is such broad opportunity but, especially as each domain matures, it is a lot to stay abreast of.
It is analogous to the difference between a general store and a “superstore”. We have grown into the big box and its time for us to organise the aisles. For interventional radiology, what we see is a group of domains, or service lines, each focused on a disease state or organ system which comprises a major portion of our portfolio. Within each of these service lines we are developing educational programming, a research plan, business plans, and market analysis. Over the next few years, we see as many as a dozen domains under the society umbrella. We know that every practice is different. We will leave it to our members to decide what they want to buy. This concept translates well to our colleagues throughout the world, who we hope will partake of these materials and translate to their local marketplace as well.
We are extraordinarily fortunate to be where we are, when we are.
1975-1979 Bachelor of Science: Boston College, Massachusetts, USA
1979-1983 Doctor of Medicine: Georgetown University, Washington, DC, USA
1984-1986 Physician: Emergency Department, Naval, Hospital Guam, Agama Guam
2003-present President: Imaging Network of Rhode Island, Roger Williams Medical Center, Providence, Rhode Island, USA
1991 Navy Achievement Medal
2002 Fellow, Society of Interventional Radiology
2003 Fellow, Cardiovascular and Interventional Radiological Society of Europe
2008 Gold Medal, Association of Vascular and Interventional Radiographers
2003 Examiner, American Board of Radiology
Stainken BF. Mechanical thrombectomy: basic principles, current devices, and future directions. Tech Vasc Interv Radiol 2003;6(1):2-5.
Siskin GP, Stainken BF, Dowling K, Meo P, Ahn J, Dolen EG. Outpatient uterine artery embolization for symptomatic uterine fibroids: experience in 49 patients. J Vasc Interv Radiol 2000;11(3):305-11.
Siskin GP, Stainken BF, Mandell VS, Darling RC, Dowling K, Herr A. Management of failing prosthetic bypass grafts with metallic stent placement. Cardiovasc Intervent Radiol 999;22(5):375-80.
Stainken BF, Sales J, Mandell V, Siskin G, Dowling K, Herr A. Mechanical thrombectomy for acute lower extremity ischemia: Experience in fifty patients. 25th Annual Scientific Meeting of the Society of Cardiovascular and Interventional Radiology: 2000 Mar 25-30; San Diego, USA. J Vasc Interv Radiol 2000;11(2):209.
Stainken B, Sansivero G, Chu A, et.al. Cooperative approach for the placement of peripherally inserted central catheters at a university hospital. Radiol 1995;197(p):521.
Stainken B, Casola G, Lim G, VanSonnenberg E, Schmidt J. Percutaneous transperineal cryoablation of the prostate as an adjunct or salvage procedure, Radiol 1995;197(p):217.
Stainken B. Clinical patient management. In: Siskin C, editor. Interventional radiology in women’s health. New York, USA: Thieme Medical Publishers; 2009.
Stainken B. Transcatheter arterial embolization in the management of splenic trauma. In: Baum SA, Pentecost MJ, editors. Abrams’ Angiography: Interventional Radiology. 2nd ed. Baltimore, USA: Lippincott, Williams and Wilkins; 2005. p. 1019-25.
Stainken B. Prostate Intervention, Clinical Urography ed 2, Pollack McClennan, 2000; chapter 131, pgs 3421-3428.