Interventional radiologist Nick Brown is clinical director of the radiology service at The Wesley Hospital (Auchenflower, New Zealand) and associate professor at the University of Queensland (Brisbane, Australia). He sat down with Interventional News at the European Conference on Interventional Oncology (ECIO; 16–19 April, Stockholm, Sweden) to discuss the current picture of interventional radiology (IR) and interventional oncology (IO) in Australasia—the progress that has been made recently, and how far they still need to go to achieve specialty status, alongside a programme of IR training, education and ultimately, a qualification unique to the region.
“We are certainly very proud to be the first site in Australia and New Zealand to be accredited,” Brown begins, referring to the International Accreditation System for Interventional Oncology Services (IASIOS) certification that I-MED at The Wesley Hospital gained back in September 2021. “There are two other enrolled sites, and possibly some more about to be,” he continues, highlighting how the programme is gaining traction among hospitals in his region as centres seek to be able to demonstrate to referring clinicians that their IO service is high performing. Showing this to patients as well is key, as understanding of IR and IO among the public is often minimal, he explains. “It is always better to have a team working together to promote [IO].”
IASIOS certification improves IO recognition
In Australia and New Zealand, as elsewhere in the world, Brown clarifies, “there are challenges—getting recognition for IO and getting a seat at the MDT [multidisciplinary team] table, having the value of what we do recognised by the hospitals in which we work, by the referring physicians, and by the patients themselves”. Therefore, Brown defines “true success” with IO standards as having a “network of IASIOS sites across Australia and New Zealand and throughout Asia”. This is advantageous, he elaborates, because the centres will be able to “support each other and learn from each other”, rather than having the nearest reference points and collaborators in Europe “on the other side of the world” and in different time zones. Brown adds that the Royal Australian and New Zealand College of Radiologists (RANZCR) does already have a relationship with Singapore “and hospitals in Singapore have been accredited”. The next step towards “a great foundation on which to build”, he stipulates, would be for a hospital in New Zealand to become accredited—“Auckland Hospital may be on the cards”.
Next, Brown turns to address the impact accreditation has had on the service his centre provides, nearly two years on. “We have the IASIOS symbol at the bottom of all our reports, letters, and emails,” he relays, notwithstanding having it prominently displayed in clinic. This prompts some patients to ask about the value of the certification, which Brown sees as a positive thing. However, he says the “real value” lies in how it has informed referrers. “We can say that we are a clinic that has most of our interventional radiologists EBIR [European Board of Interventional Radiology]-certified and we are now accredited with IASIOS—we can explain what this means and why it matters,” Brown details. This has led to an increase in referrals for several key IR procedures, he says.
Striving for better as both a hospital and discipline
“It was a lot of work to get to this standard—we needed dedicated staff and time set aside,” Brown wishes to underline, but nonetheless, he believes his centre has ‘IASIOS Centre of Excellence’ status “within [its] reach”. He then emphasises how important it is that they, at his hospital, “do what we do knowing that it is the best we can do and meets the highest expectations”. Quality assurance in IR and IO has been, and can be, more difficult to achieve than for other specialties like radiation oncology, with quality control “inbuilt”. Wanting to “do better” is what Brown thinks IR, as a whole, should keep at the heart of its practice, in order to bring about better outcomes.
Accreditation, such as IASIOS, is one aspect of the solution to the lack of public recognition of IR, Brown says, moving on to examine the bigger picture—there is a problem everywhere in that people are not familiar with IR. He laments the fact that there are “limitations to what individual interventional radiologists can do” to resolve this issue, so there needs to be a set of strategies at a college, society and government level in all countries for realising better IR recognition through avenues such as policy.
A region-specific training programme is key
Training is another aspect Brown mentions, citing RANZCR’s new training programme currently in development for interventional radiologists and interventional neuroradiologists, as well as a new qualification which will be recognised in Australia and New Zealand. This is superior to relying on certification such as from EBIR and IASIOS, as it is purpose-built, with the locoregional health system and accreditation processes in mind. In addition, Brown stipulates the need to train more interventional radiologists in order to achieve a workforce of adequate size and quality, as part of the solution to under-recognition of IR is “a numbers game”.
Brown then makes a point about the onus that rests on the shoulders of individual clinicians, who can sometimes “take the easy road”. He urges doctors to “not be limited in their thinking by the constraints of the status quo”, and to not simply “do things the way they have always been done”. An example of active change for the better, he adds, would be for consultants to make an effort to do ward rounds themselves, even if this strays from the status quo. “We all need to be the change that we want to see in the world”—this will help enormously in the effort to increase IR awareness through delivering services of the highest possible standard.
Why specialty status matters
Another “really important part” of resolving the lack of recognition, Brown then notes, is achieving specialty status for IR—and this is true of many countries where this is not already the case. Not having IR recognised as a full specialty accompanies the further problem of not having an official IR training programme and qualification. “EBIR is very good in that respect […] as a platform to launch from,” Brown admits, but “long-term structural change” spearheaded by colleges and societies working together is the only way to ensure uniformity of recognition and a high standard of IR training, he avers. It has taken time for RANZCR, the Interventional Radiology Society of Australasia, and the Australian and New Zealand Society of Neuroradiology to collaborate on advancing the cause of IR and INR and to “support a plan specific to [the region]”, learning from some of the European and North American experiences where specialty status has either already been obtained, or is in progress.
Concluding, Brown first sums up the impact of achieving IR specialty status on him—he is looking forward to “no longer being just a diagnostic radiologist, but a dual-trained specialist interventional radiologist as well, with hospital managers and colleagues knowing exactly what that means”. At a national and regional level, Brown then summarises that “we have to stand on our own two feet in our jurisdiction […] as the international standards are not sufficient to create that change for us” in Australia and New Zealand, as regards specialty status, training programmes and qualifications.