“Even [in Singapore], healthcare costs are spiralling, so we are also learning how to be prudent.” Farah Gillan Irani is an Indian-born and educated interventional radiologist who has practised in Singapore since 2009. She has been a principal investigator in a drug-eluting balloon (DEB) angioplasty trial, a reviewer for CardioVascular Interventional Radiology and the Journal of Interventional Radiology for the last 10 years, and is vice chair of the cardiovascular interventional radiology (IR) subsection of the Singapore Radiological Society (SRS). She charts the progress in IR that she has observed in South East Asia and the Indian subcontinent to Interventional News, explains the value of fellowships abroad, and imparts her passion for extreme climbing and cycling pursuits.
What attracted you to a career in IR?
During my training, IR in India was a very nascent field and we did not have much exposure to its enormous potential. Having completed my finals, I happened to attend an IR conference where I heard Dr Sundeep Punamiya speak. The science he presented, his clarity of thought and depth of knowledge about this radiology subspecialty completely drew me in. Having wanted to be a surgeon, I wanted to work with my hands and have direct patient contact. In IR, I found the happy medium of being in one of the most rapidly innovating fields of medicine with the ability to alleviate patient suffering through minimally invasive procedures.
Who were your mentors?
Prof Andreas Adam and Dr Tarun Sabharwal from Guy’s and St Thomas’ Hospital (London, UK), Prof Afshin Gangi from the University of Strasbourg (Strasbourg, France), and Prof Bien Soo Tan from Singapore General Hospital (Singapore).
Could you describe a particularly memorable case of yours?
Sometimes it is not the most technically challenging case or the thrill of using a new device that stays with you, but the impact of the simplest procedure on a patient’s outcome. I was on call and the team got called in for a massive gastrointestinal bleed in a62-year-old patient with a duodenal ulcer which, in spite of clipping, continued to bleed. The patient was in haemorrhagic shock with three inotropes and on his third round of the massive blood transfusion protocol. In the chaos of treating a very unwell patient, the IR nurse and radiographers maintained their calm and prepped the patient. A simple gastroduodenal artery embolization using glue and coils stopped the bleed 20minutes after accessing the femoral artery to closure. Following a short hospital stay he was discharged home, and then came to see us in clinic ever so grateful. This case remains with me as it shows that our simple minimally invasive IR procedures are highly effective and that teamwork saves patients’ lives.
How does practising in India compare to practising in Singapore?
I have not worked as a consultant IR in India and hence, I cannot compare the practice in these two very different countries. India is a huge country with great disparities in wealth and access to healthcare. In rural India, the health infrastructure mainly caters to family medicine with just basic services available. While, in large urban cities, state-of-the-art IR services are available, however affordability of IR kit can put many procedures out of reach. This is in contrast to Singapore, which has a small population and one of the best healthcare systems in the world. The latest imaging equipment is readily available, able to use these expensive devices in our patients. Yet, even here, healthcare costs are spiralling, so we are also learning how to be prudent. Luckily, IR is also now starting to be recognised as a speciality in its own right in India and there are several IR fellowships available to train the next generation.
What are the priorities for the IR subsection of the Singapore Radiological Society (SRS), of which you are currently vice chair?
What challenges does IR face in Singapore and your wider region? Minimally invasive IR procedures are front and centre and critical to the running of any major acute hospital, but many of the public do not know who we are and what IR is about. As part of the IR subsection, public education has been part of our goal. This year, we want to extend that outreach to medical students early in their career so that our field is recognised, and we can attract the brightest and most talented young people into our fold.
IR is also now recognised as a Chapter in the Singaporean College of Radiologists (CRS) under the Academy of Medicine Singapore. We are working with the College to get subspecialty recognition by the Singapore Medical Council and Ministry of Health. On a related note, it is gratifying to see that IR is now practised at a high level in Thailand, Malaysia, Vietnam and has a presence in Bangladesh, Myanmar, Mongolia, and even Cambodia. The latter is thanks to the outreach programmes organised by the Asia Pacific Society of Cardiovascular and Interventional Radiology.
“It is gratifying to see that IR is now practised at a high level in Thailand, Malaysia,Vietnam.”
You have been a reviewer for CVIR for the last 10 years? What have you learned through doing this?
It has been an amazing journey. As a reviewer, you geta ring-side seat observing the amazing innovation in your field and delve into the depths of various aspects of anatomy, physiology, imaging and new devices. Being a reviewer carries responsibility. As a gate keeper for the wider IR community, you need to make sure that the science is sound, safe, truthful, verifiable and beneficial to patients, doctors and healthcare systems. As a reviewer, I have gained immense knowledge and it has inspired me to undertake research of my own.
You were principal investigator for a randomised trial comparing drug-eluting balloon angioplasty with conventional angioplasty for haemodialysis arteriovenous fistula or arteriovenous graft stenoses. What led you to become involved and what did you take away from the trial?
In Singapore, we have a very high incidence of renal failure for which many patients depend on long-term haemodialysis, as our renal transplantation numbers are low due to a lack of organs. Repeated and frequent interventions to maintain access circuit patency is costly. Hence, when drug-eluting balloons were introduced, our team decided to evaluate whether these devices truly increased duration of lesion and circuit patency and reduced healthcare costs. Along with our renal medicine physicians and vascular surgery colleagues, we designed and undertook this trial. Running trials is hard work and requires input from many people. Research co-ordinators, statisticians and allied health staff are just as important as the clinicians. As principal investigator, I was but a representative of the amazing and dedicated team. The adage “it takes a village to raise a child” is very applicable.
You undertook fellowships in London, Strasbourg and Toronto. What advice would you give to (interventional) radiologists-in-training who are considering spending time in hospitals abroad?
I would highly recommend that everyone does a fellowship abroad. The wealth of experience gained is immeasurable. You are exposed to a different system of medicine and are able to take ideas back to your own practice. It also helps you appreciate the attributes of your own system. You learn different ways of doing the same procedure and these experiences help you formulate your own best way of doing it. On a personal level, you are exposed to a different culture which you need to respect, and you are out of your comfort zone, so the experience teaches you about your own strengths and weaknesses. It is an important lesson in life and just not medicine.
What are your hobbies and interests outside of medicine?
I enjoy sports, and these days, I am into cycling, the gym and golf (which I have recently taken up). Singapore General Hospital celebrated its bicentenary in 2021, and as part of the celebrations, we cycled200km around Singapore to raise funding for our patients. I also enjoy hiking and trekking and have been lucky to have undertaken trips in the Americas, Africa, Europe and Asia. I was recently introduced to via ferratas, which I find thrilling; I have done the one in Kinabalu and one in the Dolomites. Being a Parsee, food is an integral part of our culture. Living in Singapore—a food lover’s paradise—I enjoy discovering, and eating at, amazing Hawker Centre stalls as well as the gourmet Michelin Star restaurants. I enjoy cooking and one of my goals is to do a gourmet cookery course.