A panel at the British Society of Interventional Radiology (BSIR) meeting (4–6 November, Birmingham, UK) debated how the specialty can turn years of policy documents into real change. In the session titled ‘Enough of the position statements, what do we actually need and how to achieve it?’, experts said that interventional radiology (IR) in the UK must stop “recycling” the same policy debates and start acting.
Fifteen years ago, session co-chair Raman Uberoi (The John Radcliffe Hospital, Oxford, UK), wrote the first Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Standards of Practice Guidelines document setting out who interventional radiologists are, what they need and how IR services should be delivered throughout Europe. Now heading into its fourth iteration, Uberoi opened the discussion with a blunt question to the panel: has it had any impact?
“I’m not sure of the impact they have—it seems to only be us that’s reading them,” said panellist Narayanan Thulasidasan (Guy’s and St Thomas’ NHS Foundation Trust, London, UK). Among the rest of the panel opinion was divided, Yuri Gupta (Royal Sussex County Hospital, Brighton, UK) said his team had quoted the document to argue successfully for a one-in-eight on-call rota for their population size. Guidance specific to IR, Gupta said, is not available elsewhere as an authority to put in front of management. “It’s not the answer, but it is definitely a tool,” he said. Uberoi conceded that the document had “only had limited impact” and said that what is needed is “a better process for implementation”.
IR’s “branding and identity” issue
BSIR president Raghuram Lakshminarayan (Hull University Teaching Hospitals NHS Trust, Hull, UK) argued that difficulties lie in how interventional radiologists’ message is carried upwards. Leaders at the Royal College of Radiologists (RCR), he said, fully understand that interventional radiologists “own the patient journey”, and they do believe that they can advocate for the specialty, but he doubted that they can. He stated that, when leaders of the RCR meet with government ministers, IR is being left out of the briefing notes, and so “translation” of what IR can offer is being critically overlooked.
According to Gupta, the root cause of the problem is IR’s own structure as a “horizontal, multi-modality specialty”. IR is skilled in complex techniques that are individually low in volume for each organ, he explained, and so “no single patient group campaigns on our behalf”.
“We haven’t got that unified voice,” Gupta said, “and the name of our specialty reflects that. It’s a branding and identity issue.”
A suggestion from the floor, from a diagnostic radiology registrar, was to put the rebrand to the public. However, this was met with a note of caution from the panel, referencing the 2016 public poll which gathered 124,000 votes to name the UK’s £200 million-pound polar research vessel ‘Boaty McBoatface’.
Gupta said a survey had found the public preferred “image-guided radiologist”, which Uberoi did not see as an improvement. Alternatively, Thulasidasan proposed that IR “gather their greatest hits” and leverage the thousands of patients whose lives have been “irrevocably” changed by IR procedures to speak for the specialty.
Don’t ask, act
Co-chair Mohamad Hamady (Imperial College London, London, UK) asked for practical steps each of the panel would do tomorrow if IR was awarded faculty status today. Panellists listed day case units, clinics, access to National Health Service (NHS) bodies and directors, more anaesthetic lists, and 24-hour IR posts.
On clinics, Thulasidasan view was to act first and formalise later: “We don’t need to sit here and argue about a job plan to start a clinic. Just start a clinic.” He explained that he ran his clinic unpaid for two years before a new manager arrived and found it too well established to close. While in the realm of admin, others noted that pre-procedure consultation is now effectively a legal requirement to obtain consent, and that clinic letters help educate referrers about what IR does.
Is faculty status needed?
Several panellists saw gaining faculty status as the best route to lasting change for the specialty; Uberoi recalled that a vote on the idea 12 years ago produced 92% support, but only 212 members had voted. “We need to actually be united as a specialty,” he said, emphasising that the proposal does not mean “breaking away from the college”.
Hamady however offered a word of caution from the US path to faculty status, which was achieved in seven years, propelled by “heavy losses”. He detailed that IR went from controlling 85% of peripheral work in the early 1990s, to approximately 15% by the mid-2000s, as cardiology and surgery took on the rest. “We don’t want to be there,” he said, “because that would be too little, too late.”
Training blind spots
Questions from the floor raised retention in IR run-through training as it stands today, although Lakshminarayan rejected the claim that two in three trainees drop out. He said that ST1 retention is closer to 65–70%, adding that many applicants list diagnostic radiology and IR given the competition of roughly 3,000 applicants for 300 posts.
Later, an ST2 IR trainee described how an RCR document setting out run-through entitlements, including one IR session a week, had helped her negotiate early exposure to IR.
“This guideline exists?” Lakshminarayan asked in response, expressing concern that this document was not better known. “It’s obviously not been nicely socialised and is not being made available to trainees,” he said. “This is a loophole that needs to be fixed.”
The session ended with a final plea from Lakshminarayan for someone to take IR onto Celebrity Traitors or Strictly Come Dancing, to fix the specialty’s visibility issue.
