Iain Robertson is the current president of the British Society of Interventional Radiology (BSIR) and is the co-author of Interventional radiology: a survival guide, which he said is “aiming to be the book most often stolen from interventional radiology departments”. He spoke to Interventional News about his aims as president of BSIR for 2013, his current research on validated data on interventional radiology outcomes for common procedures, and his love of photography
What drew you to medicine and interventional radiology?
It was by accident really. I was all set to do a degree in maths and physics and really looking forward to it. By chance I met a teacher from a private school that only sent students in either law or medicine. He persuaded me that there would be lots of science in medicine and everyone was very wealthy—wrong on both accounts.
Which innovations in interventional radiology have shaped your career?
Oddly, while I have an addiction to electronic gadgets, I do not get too focused on the latest gadgets in interventional radiology—and there are a lot of them. I am old enough to have seen some of the initial applications of material science, such as nitinol in stents and wires and hydrophilic coatings, which made a huge impact. I remember being told by a senior interventional radiologist colleague that, in his opinion, the invention of the Terumo wire took three to five years off the training of an interventional radiologist. Timing meant that I was lucky to be in the group that benefited from this.
Who were your mentors and what wisdom did they impart to you?
I learned most of my early interventional radiology at the Hammersmith, London, with Professor David Allison and Dr James Jackson. There was a real focus on demanding the highest standards from yourself and thinking ahead on procedures to maximise success and minimise time, risk and complications. At that stage we did not have so much kit and success could only be gained by perseverance and really understanding the kit used. A lesson I learned was that, the most common reason for failure in a procedure, was that I had either not planned it through well enough or just did not know how to use the kit to its best. I still have a mental image of never quite being able to match the skill and understanding achieved by David and James, but I certainly learned a lot. I still shudder when I see colleagues try for a few minutes and immediately reach for another catheter and wire.
As the current president for the BSIR, what are your aims for 2013?
This is a challenging time for interventional radiology in the UK as we are facing changes in workforce, commissioning and service delivery. The specialty has started the move from a technically-focused group to a more clinical focus. Improving 24-hour services that are available seven days a week will remain an important focus for the society. We have profiled the need to expand the interventional radiology workforce to support this programme and are definitely making progress. Only two years ago, we did not really have an accurate number of interventional radiologists needed in the UK or accurate numbers for current workforce, but we have recognised the size of the gap and I am confident that we will see an expansion in the numbers of interventional radiologists produced in the future.
While interventional radiology only became a subspecialty in 2010, we already need to think about adapting our curriculum and training structures. We plan to develop a clearer clinical focus within the curriculum during 2013.
Finally, the society launched a quality and safety group this year, and this will work with key organisations such as the Medical Healthcare Regulatory Authority and NHS Improvement.
Please describe a memorable case where interventional radiology came to the rescue.
It is impossible to pick one case—interventional radiology always seems to be coming to the rescue! Only last month, I had a case of uncontrolled post-partum haemorrhage that was rescued within 40 minutes by interventional radiology techniques.
What is your proudest achievement in interventional radiology?
That is a difficult one but I am hugely proud and honoured to have been president of the BSIR. We are not the biggest society, but through hard work and excellent stewardship from previous presidents, the BSIR council and other members we have become increasingly influential and innovative. The society really punches above its weight.
What developments in interventional radiology have had an impact on the specialty recently?
I think oncological intervention in general is going to be huge for interventional radiology. The earlier detection of tumours in more elderly and frail patients will drive the need for minimally invasive treatments. With new evidence and technology it is easy to see the improvements in radiofrequency ablation and other ablative techniques. Embolization treatments for cancer have moved forward as well and in particular selective internal radiotherapy treatment (SIRT) looks very promising. I think the increase in oncology treatments will need to be reflected in changes to our training so that future interventional radiologist have a better understanding of cell biology and more.
You jointly led the participation in “The system” that was shown at BSIR 2012; please could you explain the importance of this?
Interventional radiologists need to move to being more clinical and less technical, and there are can be no better or more important way of demonstrating that transition than by improving patient safety. The system was supported by a grant from the Health Foundation and deals with a whole patient journey for a patient with biliary obstruction from the general practitioner (GP) to rehabilitation and highlights what can go wrong. It was an opportunity for the society to learn from experts in the patient safety area, and we produced a DVD looking at the experience in the interventional radiology department and provided support and learning materials. The film debuted at the BSIR Annual Scientific Meeting in 2012 and got a fantastic response—so far we have distributed over 650 copies and are having to produce more DVDs. We are just finalising a web-streamed version. BSIR have agreed to continue a programme of work in patient safety, harnessing the whole interventional radiology team, including, vitally, nurses and radiographers.
You have contributed to many journals and books including Interventional radiology: a survival guide, what does your current research focus on?
Most of my current work is looking at validated data on interventional radiology outcomes for common procedures at present, particularly mortality for out-of-hours procedures. We have an active interventional radiology research group in Glasgow and we have recently published validated 30-day outcomes for common interventional radiology procedures, there is surprisingly little data in this area. One lesson that came from this research was that, for common emergency procedures, death often occurs over two weeks after the primary procedure. This is because of the episodic nature of interventional radiology. I propose that only a structured system of follow-up will truly let us know the results. At present, we are comparing the outcomes for in-hours emergency patients vs. out-of-hours emergency patients. A theme in the UK currently is that producing good quality data on interventional radiology outcomes is the way to fuel service change—it is one thing to say that we need interventional radiology out-of-hours services but to make it happen requires data that makes a compelling story.
You were the co-author of “BSIR first biliary drainage and stent report” in 2009, what impact did this have on clinical standards and practice?
This is the largest series of collated records in biliary drainage in the world and shows the effectiveness of the BSIR at collecting data. The in-hospital mortality associated with this procedure is very significant and, gauging from the debates I have had with colleagues, perhaps it is not well recognised. The registry would suggest that we can improve patient selection in this group. After the registry we did a piece of preliminary work looking at risk stratification in Glasgow and the pilot data was so encouraging that it should be possible to develop an effective risk model. There is a useful further project in risk modelling for this procedure just waiting to be picked up.
What advice would you give to interventional radiologists just starting out in the field?
Grab the opportunity to join a rapidly growing field with constant innovation. Move around a bit during your training if possible, getting exposed to different teachers is important. Remember the importance of the interventional radiology team, the radiographer and nurse in the room works with all your colleagues and knows what succeeds and fails—they are invaluable sources of knowledge. Do not be put off by a view that interventional radiology is going to change, that is inevitable and if we focus on providing the best possible service we should be leading that change, not following it.
What are your interests outside of medicine?
I am a very keen photographer—it is the only vaguely artistic thing I can accomplish. I recently managed to complete a 365 project, which is a photo a day for a year published online. It sounds easy but give it a go; it is fun but actually quite hard to do. There is an online community and by looking at other submitted pictures you realise that it is a little like in interventional radiology—getting a great result is often more about the operator than the equipment. I also love swimming (my knees have given out for running) and a bit of cycling stops me from getting too round in the middle.
Consultant interventional radiologist, Greater Glasgow and Clyde, Scotland
Lead clinician, Managed Diagnostic Imaging Clinical Network, Scotland
2009–2011 Clinical director imaging, Greater Glasgow and Clyde, Scotland
1995–2002 Consultant vascular radiologist, Leeds Teaching Hospital Trust, UK
1992–1995 Senior Registrar and Locum Consultant Hammersmith Hospital London, UK
CMO (Scotland) Advisor interventional radiology
University of Glasgow
Affiliations and committee appointments
2012–present Member of the Vascular Liaison Group for the Royal College of Radiologists, the British Society of Interventional Radiology, and the Vascular Society
2011–2013 President of the British Society of Interventional Radiology
2011-2013 Member of the Interventional Radiology Project Group, Department of Health, UK
2010–present British Society of Interventional Radiology QI project lead and Department of Health/NHS Department Institute for Innovation and Improvement liaison
2009–2011 Vice president British Society of Interventional Radiology
2009–2011 Member of the NICE topic selection: Vascular and metabolic conditions
2009–2011 Specialist advisor to NICE including popliteal aneurysms, caesarean section and others
2008–present Interventional radiology representative for the AAA National Screening Project Implementation Group, Scotland
2008–2010 National Carotid Interventions Audit Steering Group member Clinical advisor for NHS Improvement England