In a new global statement, aimed to set forth the essential elements of interventional radiology (IR) and continuing challenges facing the specialty, the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) and the Society of Interventional Radiology (SIR) query: Have we reached the tipping point?
SIR and CIRSE first published a joint statement which sought to define IR in 2010, following the Royal College of Physicians and Surgeons of Canada’s denial of the Canadian Interventional Radiology Association’s request for official recognition. The motivation for the 2024 document was both to reflect on how far IR has come as a discipline and where it needs to go next. This updated statement, which was this week co-published in the journal CardioVascular and Interventional Radiology (CVIR) and Journal of Interventional Radiology (JVIR), was first presented during the Global IR Summit at the CIRSE Annual Congress (14–18 September, Lisbon, Portugal), and sparked talks over the desynchronised development of international IR.
The central tenet of the updated document is the uptake of clinical practice and longitudinal care in IR over the 15-year interim, as presented in the session by Parag Patel (Froedtert Hospital, Milwaukee, USA) and Robert Morgan (St George’s NHS Trust, London, UK). They outlined the areas that necessitated an update, which alongside increased clinical practice, include the recognition of longitudinal care of patients provided by IR in some countries, the need to promote subspeciality or specialty recognition, and the developments in certification over the last decade, particularly via the European Board of Interventional Radiology (EBIR). The increased commitment to diversity amongst interventional radiologists and overarching workforce developments, such as their increased presence on interdisciplinary boards, and the importance of IR-led clinical studies, were also covered.
The project for this updated global statement was launched during CIRSE 2022 and spearheaded by lead authors Morgan, Patel, Alda Tam (MD Anderson Cancer Center, Houston, USA), and Christoph Binkert (Medizinisch Radiologisches Institut, Zürich, Switzerland). At the time of print, the document has been circulated and endorsed by 47 national IR societies.
Morgan indicated that the statement is essentially a call to action to promote IR, especially in countries where interventional radiologists have limited resources to endorse their services. “Our global IR societies must collaborate closely to advance common strategic goals and must continue to promote the field of IR and the treatments we provide as first options for patients whenever appropriate.” Informing their understanding of geographical disparities across international IR training and practice, Morgan referenced a global survey of IR status carried out by the international division of the SIR, presented earlier in the session by Constantinos T Sofocleous (Memorial Sloan Kettering Cancer Center, New York, USA).
Expanding on why the survey was carried out, Sofocleous said that “the world is not equal, and IR services throughout are extremely different with many disparities”. The anonymous survey was distributed to members of global IR societies and investigated demographics, local/regional practice characteristics, and professional challenges and practice needs.
“Of our responders, 92% agreed that there is a great need to establish unified global IR training standard”, Sofocleous said. He described the shortage in dedicated IR training programmes in “most” regions worldwide, as well as a “pronounced” shortage in IR exposure in Africa, Asia and South America. He also highlighted the lack of IR teaching responsibilities in Africa, however, he noted that, “interestingly”, they were more prevalent in Europe when compared to the USA. Regarding IR practice, the investigators found that public awareness of IR services was a universal issue, showing “no difference” between Africa and the USA—the geographies at either end of the spectrum concerning IR infrastructure.
As Sofocleous stated during the session: “Public awareness is our greatest universal need, and this should drive our future investments. Establishing training programmes, providing access to online education and organising local IR conferences in Asia, South America and Africa are all key takeaways [from the survey].”
With the information gained through this endeavour, the subsequent Global IR Statement concludes that a ‘tipping point’ may in fact be reached in the next two decades, initiating the formal designation of IR as a distinct sub- or primary specialty worldwide. However, this goal can only be achieved through “close collaboration” between societies to promote IR as the first option for patients when appropriate.
Other lectures during the Global IR Summit delved deeper into the ideas at the core of the Global IR Statement. Binkert expanded on the idea of clinical service as the driving force behind the advancement of IR. “I think this is the most critical part,” he stated, “If we master clinical service, all of the other parts will naturally fall into place.”
Session co-moderator Alda Tam spoke about the paths taken in the USA in establishing IR as one of 39 distinct specialities: “In short, how we convinced the American Board of Medical Specialties [ABMS] was our argument that better trained interventional radiologists lead to better patient care.”
The talk then turned to monitoring and measuring the progress of IR in future, and how development can be captured worldwide. Sofocleous stated that attention should be paid to marketing IR, shifting focus from imaging-oriented to disease-oriented messaging—“to show what our field has to offer each disease type”. However, “we don’t have enough boots on the ground”, he added, explaining that, if this were not the case, the installation of an interventional radiologist among every panel that dictates disease-specific guidelines would be an ideal metric to mark IR’s international growth in the coming years.
Patel inserted that: “As a specialty that has organised ourselves, we need to take responsibility for the promotion of IR services. We must be more vocal as a field, enrol in more clinical trials, and be at the table when multidisciplinary guidelines are being brought about.”
Closing the session, Morgan stated that raising the profile of IR worldwide is a question that has “taxed people better than us for many, many years”. He stated that through continual idea-sharing in forums such as the Global IR Summit, headway can be made, and a feasible method of monitoring IR’s development can be established.
