With more than 35 years of tenure at the University of California, San Diego (UCSD) School of Medicine, Anne Roberts retired in 2022 and is a USCD distinguished professor of radiology, emeritus. Having held numerous leadership positions, the development of her self-titled catheter for uterine artery embolization, and now, her most recent gold medal from the Radiological Society of North America (RSNA), Interventional News interviewed Roberts to survey her key moments from a trailblazing career in interventional radiology (IR).
IN: You were previously awarded the Society of Interventional Radiology (SIR) Gold Medal in 2015, the American College of Radiology (ACR) Gold Medal in 2022, and now, the RSNA Gold Medal—what does winning these awards throughout your career mean to you?
I don’t think that anybody goes into their career with the idea that they’re going to win a gold medal of any kind, but the medals are a lovely recognition that I made some contributions to the field. In a way, [the awards] are all tied together because I had been involved in leadership positions with each society during times of development. For example, I had been president of the SIR and then was in leadership with the ACR when the idea of IR becoming a separate specialty arose, and I helped support this, despite the ACR not being initially too enthusiastic. The RSNA Gold Medal was probably also partially in recognition of my involvement in the push toward an IR primary specialty. At the end of the day, the main thing that awards do is say, well, you got involved, you helped, you did something, and some people recognised your work. I’m incredibly fortunate to be recognised since there are so many people who are involved in multiple societies that improve the specialty.
IN: Early in your career you took a sabbatical with the US Food and Drug Administration (FDA) and the Center for Devices and Radiological Health (CDRH). How did your experience influence your IR practice and why did you specifically become involved?
The reason I got involved with the US FDA was because I was eligible for a sabbatical and I knew I wasn’t going to write a book. At the time there was a huge hue and cry about how IR devices weren’t being approved and that it was the FDA’s fault. This was a part of the reason I wanted to get involved, I was going to fix the FDA—talk about hubris. So, I got involved with the CDRH and it was my job to be a reviewer.
I discovered the reason devices weren’t getting through was because interventional radiologists were doing a very poor job of running their studies. They would enrol patients, some would be randomised but then the patients would be off protocol—it was sort of the Wild West, there just weren’t good data to support the FDA’s protocol. I think we’ve gotten better; we have learned a lot about running clinical trials, we’re certainly better than we were.
IN: You were at involved in advancing uterine fibroid embolization and the development of the Roberts Uterine Catheter (RUC)—what did this process look like?
When I was a fellow as Massachusetts General Hospital, Arthur Waltman took several of us to a medical device company to see the manufacturing process, and I watched the Birds Nest filter (Cook Medical) be made—by workers who were soldering the wires, making them all by hand—and I was blown away by that. I realised there was an industry out there that made things to specifications.
When uterine artery embolization came along, a lot of people were using the Waltman loop. I learnt the technique from Arthur but we were using a larger, thicker catheter, and it would tend to hold its shape. I had tried to do this with smaller catheters but the loop tended to unloop, and I couldn’t get it to do what I wanted—I guess that was one of my failures as one of Arthur’s trainees!
So, I approached a manufacturer and said: I want a 5Fr catheter that has a long extra limb and I want it tapered down to a 4Fr so that it’s easier to get into the uterine artery. I want a marker put on the apex so that I can tell when I have got it over the bifurcation so it’s ready to reform. They made it and then they put my name on it.
I didn’t ask them to do that, and I don’t get anything for it. People have said ‘Oh boy, you could’ve made a lot of money’, all I wanted was for people to have something useful. It’s kind of sad that it’s become very difficult to get innovative things made, everybody is very risk averse and understandably so, but it has moved away from the individual being able to design something, and toward company development.
IN: You have previously served as president of the SIR, vice-president of the ACR. Across these appointments what has been your greatest achievement?
The fact that I became president of SIR is probably my greatest accomplishment. I was very young when I became president and there weren’t many women in the society. Arina Van Breda (Sentara Northern Virginia Medical Center, Woodbridge, USA) was the first woman who was president in 1992–3 and she did a great job and was a terrific role model. This was a time of significant change, the society was opening up and some of the old guard weren’t too happy about that, but there were other members that knew this is where we should be going.
IN: You have been involved in several training programmes in Africa—what would you say are the priorities when it comes to making sure interventional radiologists-in-the-making receive the highest standard of training possible?
In Africa, training programmes can be difficult to set up due to the infrastructure of many of these countries. Electricity was a huge problem, for all kinds of medical equipment, but particularly for IR equipment—you can’t have the power suddenly going out. It’s also incredibly hard for them to access IR training, since it is so hands-on—the USA isn’t accepting short-term hands-on trainees from foreign countries, and it’s become difficult to find training in programmes in Europe and Asia.
What is needed is someone like me who’s retired—more or less—and put us someplace for several months at a time. In this way, the people in the community can become trained, and be trained on the problems that are present in their community, with the equipment they have available to them.
IN: What has been your experience as a woman in the field of interventional radiology?
The great thing was at the beginning I never had to wait for a bathroom. Today, it’s unfortunate that many women are worried about going into IR, I think this is misplaced. There are great women in IR and I trained in a place where there were many women doing IR. I never felt that I couldn’t be an interventional radiologist, but there has been discrimination. I once called to apply for a private practice job and introduced myself, and this guy says to me ‘We’ve never hired a woman. We’ll never hire a woman and we’re not interested’. So, there were hurdles along the way.
IN: Where does IR go next? What one innovation do you see for the field in the next five years?
I’m not a very good prognosticator. Five to ten years ago if you spoke about radioembolization I would have said, what’s that? Things have changed a lot over my career, and will continue to change. I’m not smart enough to think that I know—or maybe I’m smart knowing that I don’t know.
Innovation has always driven IR, that’s what we do and it’s what drives the field forward. It’s important that we have people who have a desire for innovation and see IR as a place where this can be done. I don’t know where IR is going to go, but wherever it is, it’s going to be great.
