How can it be that this specialty society, so associated with concepts of ‘newness’, is old?
We know that in 1974 a group of ‘gadgeteers’ (credit to Mike Dake for the term), dressed in plaid bellbottoms, convened in Key Largo in Florida, USA to talk geek. They munched on that year’s new snack called Skittles, and organised their thoughts and schedules with the new-fangled sticky, but not so sticky, Post-it notes.
Fast forward five decades and we have the newest American board-certified discipline, the most competitive primary residency, a thriving pipeline of discovery, robust global collaboration, and many imitators. We do still have the candy and the note pads, but they have not really changed.
So, how did this remarkable transformation happen? Why, of all the millions of good ideas from 1974 did this one not only survive, but thrive? I don’t know, but here’s my best guess.
A good idea
‘Virtual reality’ guidance obviated any need for dissection and exposure. More precise, less risk. Without image guidance we are surgeons. With it, we are superheroes able to access any structure, anywhere. Shazam! Most medical historians place medical imaging high on the list of greatest medical discoveries of the last century—Sven Ivar Seldinger was in the right place at the right time and interventional radiology (IR) as we know it now is a beneficiary.
Visionaries
The Mount Rushmore of IR should show Charles Dotter of course, probably in the centre. Nearby would be, well, a lot of folks, frankly too many to mention. If the idea that we could in fact take the Fantastic Voyage— the 1966 sci-fi thriller where a submarine is miniaturised and injected into a scientist suffering from a clot, was crazy, imagine dreaming up a system for reimbursement from scratch, or inventing the concept of societal quality guidelines. Imagine saying to an incredulous medical establishment that someday we would be delivering intra-arterial drugs or percutaneously draining abscesses or convening a task force to build a primary specialty and succeeding! The visionaries of the Society of Interventional Radiology (SIR) all deserve to be on that mountain. IR seems to attract a certain type of inventive zealot. We are fortunate for that.
Culture
I think this is where SIR’s light shines brightest. From its earliest days, this society and its meeting was a home for big (outrageous) thinkers, inclusive, open, and representative. We’ve pursued some boneheaded ideas along the way to be sure, and paid for some, but what distinguishes us is our willingness to engage. As our society and specialty mature, the price for taking risks grows, but our future depends upon our ongoing willingness to listen to new ideas.
Teamwork
We are a society of volunteers. It’s extraordinary that in 2023, nearly 10% were active volunteers, and many more were active at the hospital, and local levels. It is also a recipe for operational chaos. That’s where the SIR staff over the years have evolved into essential partners. They mirror the membership. They too believe in the promise of IR. Without the support and guidance of the many association professionals we’ve teamed with, we would be nowhere. Thank you.
Of course, with any big anniversary one begins to look forward. From the perspective of a past SIR leader, here is what I hope the next 50 years bring:
Introspection
There are some things we do in IR that are not sufficiently complex or risky to justify our very expensive time. To stay competitive, our time spent supervising and developing protocols and practice standards should be maintained, but we must advocate for the best care, by the most appropriate trained and supervised providers, both in terms of outcomes and cost. That said, we also must pay more attention to the central operational role we play in nearly every hospital in the country. What percentage of inpatients are touched by IR? What percentage of discharges expedited, complications averted? What savings are attributable to our presence? Core IR merits more attention, tighter definition, better practice models factoring in clinical time, more research, and better economic validation.
Accreditation
The society reflects the field, and its growing diversity. In order to serve membership, the structure of the society must continue to evolve. Pending the future adoption by the American Board of Radiology (ABR), we should follow or join in the Cardiovascular and Interventional Radiological Society of Europe (CIRSE)’s example and embrace voluntary society-based accreditation for subspecialised practice areas. Such a scheme should include clinical practice mandates and span the full scope of the specialty.
Full time IR
With the number of trainees and full members approximately equal—as per the 2003 SIR annual report—a primary residency, clinical practice requirements, and evolving specialty focus areas, I expect that market forces will drive this shift, where the potential exists and individuals are willing to take risks. No need for an edict. That said, in a world where no hospital can function without IR, some geographies will always require part-time providers as long as they have the need for clinical time.
Leave radiology? Keep the ‘R’, drop the ‘D’. Whether you can evolve into a new department or service line, or should stay as you are is a local issue based on strength, level of leadership support and finances. If you are strong enough to stand alone, fine. However, it’s unlikely that leaving alone will somehow make you stronger. As our specialty evolves toward a collection of subspecialised focus areas, and as we mandate clinical practice, we should grow stronger, and fit and be valued in several departments. It’s good to have many friends.
Global IR
IR is a small specialty until you look at it from a global perspective. Collaboration, adherence to standards, and excellence in research, training and practice are our unifying themes. I believe that our growth and continued evolution opportunities for the next 50 years will come through increasing our efforts to effectively network and share our successes and strategies. We are all in this together.
