Peter Gaines

Interventional News talks to Peter Gaines

Interventional News talks to Peter Gaines, current President of the British Society of International Radiology (BSIR), about the important issues facing IR today, how the speciality has evolved, and his love of fishing and rugby.

When did you decide you wanted a career in medicine?

My parents told me that medicine would be rewarding and make me rich. They were only half right.

Why did you decide to specialise in interventional radiology?

Mammography was dull and barium enemas messy.

Who have been your greatest influences?

  1. My mother for her determination. She was from a mining family in South Yorkshire and won a scholarship to the local grammar school.
  2. My father for his great ability to relax.
  3. My wife for calm in the face of three daft kids and a career radiologist.
  4. My three children for being such fun.
  5. I stand in awe of two radiologists. Hugh Saxton was head of Radiology when I first started training at Guy’s Hospital. His attention to detail and regard for the importance of planning and good technique were the ground rules of good interventional radiology. I moved from Guy’s Hospital, London, UK, to Sheffield to work under David Cumberland. He was the complete interventionist. Incredibly bright, the best pair of hands I have witnessed, and a really nice guy. He inspired a breed of interventional radiologists to push the limits in a controlled way.
  6. Joy Division for being the greatest band ever.

What have been your proudest moments?

  1. Proving my parents half right.
  2. A talented group of teenagers playing rugby union took me along as coach so that they could win the Yorkshire Plate in 2003.
  3. In 1994 I was part of a team with Jonathan Beard and Richard Wood who developed the Sheffield Vascular Institute. That revolutionary step placed interventional radiologists alongside surgeons as a single clinical team outside radiology and general surgery. The result was a group of clinicians working together cohesively to a high standard of clinical care. I now have the privilege of working with a group of interventionists who are now my friends and who will further push the boundaries of what we are able to achieve.

As BSIR President, what have you achieved so far and what do you hope to achieve over the next year?

Interventional radiology in the UK is on a very sound footing having been steered over the last few years by some of the great visionaries of our Society. In my time Mike Dean, Tony Nicholson, Tony Watkinson and Andy Adam have all worked tirelessly to guide our speciality to a bright future. As practising diagnosticians and interventionists we have an obligation to accurately document our outcomes. Over the last year, we have worked hard to rationalise our national registries and develop a sound basis for future data collection. In addition, we have radically changed our website and within that, we will be delivering tools to enhance the practise of our members. Specifically, we are producing treatment pathways developed by experts within certain fields, easily accessible patient information leaflets, and comparative outcomes of index procedures delivered at the click of a button. Enhanced funding has been provided to attract young radiologists into the field and fund education and research.
Interventional radiology, in the future, needs to be recognised and sustainable. To achieve both requires a shift in the way that our government perceives the speciality, the way that our services are reimbursed, the way that our Royal College of Radiologists recognises our skills, and the way that patients are referred. We are about to embark upon a long path that will eventually take our speciality to that more certain future.

What do you think are the important issues facing interventional radiology today?

It is important that interventional radiologists have a defined identity. Part of that is related to the issues of recognition detailed above. However, we need recognition not only from the medical profession and government but also from the public.
Other specialities wish to acquire the skills developed in interventional radiology. There may be good reasons for this but the heady standards that we have achieved should not be given up lightly simply because other specialities may be in charge of the patient. Were I to start doing open aneurysm repairs or carotid endarterectomies without training, or after attending a short fellowship without curriculum or assessment, I should be held up for ridicule. Similarly, clinicians without formal structured training in IR skills really should not be allowed near patients.
Interventional radiology now plays a major part in many patients treatment. So that patients are offered the most appropriate treatments based upon informed decision, interventional radiologists should be involved all along the patient pathway. This requires that the interventional radiologist leaves the comfort of their own environment, move to the wards and out-patients, and be willing to make clinical judgements before and after their treatment episode. Clearly such practise is best undertaken as part of a team environment and it will have the benefit of enhancing the credibility of the individuals, their profession, and the clinical team as a whole.

How has interventional radiology evolved since you began your career?

Our practise was restricted by the equipment we used. The miniaturisation of devices through exquisite engineering and the combination of those devices with drugs has relaxed those constraints. The limits are now those of our imagination and intellect.

In which areas have you seen the most change?

Wonderful devices and the refinement of the technique have revolutionised the management occlusive and aneurysmal disease, and we are about to see great developments in interventional oncology. More significantly, and to my great delight, data are now being generated that justify the use of such therapies. Eventually, open surgery will be a faded memory.
Perhaps just as important are the failed lessons of history. How often do we need to see new atherectomy catheters fail before finance stops investing in projects only designed to make quick money for the inventors? How often do we need to see lasers fail as recanalisation devices before medicine remembers the past?

What are your current areas of research?

We are fortunate at the Sheffield Vascular Institute in having a cohesive group of surgeons and radiologists. The group is large enough for us to be able to indulge in specific interests. We all have to do our bit of the mundane work, but my specific areas of clinical and research interests include thoracic aortic disease, carotid disease and vascular anomalies. I am fortunate enough in developing a collaboration with Imperial College to research virtual reality in endovascular therapy.

Outside of medicine, what interests do you have?

  1. Good food and wine.
  2. By coaching junior rugby I can enjoy a standard of sport that I never achieved.
  3. Nature provided Sheffield with some of the finest fly-fishing in the world. I have fished with my father since I was five and the old man is still better than me.
  4. Man provided Sheffield with great golf. I play enthusiastically but badly.
  5. Our house is full of music. My children play, shamefully I don’t.

Medical education:

1973–1978     Manchester Medical School
1978             MB ChB
1981             MRCP
1987             FRCR
2002             FRCP

1978–1979    House Officer Medicine, North Manchester General Hospital
1979–1979    House Officer Surgery, Park Hospital, Manchester
1979–1980    SHO, Cardiothoracic Unit, Wythenshawe Hospital, Manchester
1980–1981    SHO/Registrar, General Ipswich Hospital, Ipswich
1981–1982    Registrar, Greenwich District Hospital
1982–1986    Registrar Guy’s Hospital
1986–1990    Senior Registrar, Diagnostic Radiology, Sheffield Hospitals
1989–1990    Visiting Lecturer, Prince of Wales Hospital, Chinese University, Hong Kong
1990–1992    Senior Lecturer, Sheffield University
1992–1995    Vascular Consultant, Central Sheffield University Hospitals Trust
1995–Now     Consultant Vascular, Sheffield Vascular Institute
Radiologist, Northern General Hospital Trust
2006–Now     Honorary Professor, Sheffield Hallam University

Selected awards
1996             Elected Fellow of CIRSE
2002             Elected as a Fellow of the Royal College of Physicians, London
2002             Oliphant Professor to Flinders University, Adelaide, Australia
2002             The Andreas Gruntzig Memorial Lecture, CIRSE, Lucerne
2005             Watty Fletcher memorial Lecture, BSIR Annual Scientific Congress
2006             Honorary Professor to Sheffield Hallam University
2007             First Prize: British Society of Interventional Radiology

Current committee and society memberships:

  • President of the British Society of Interventional Radiology (BSIR)
  • Member of the Payment by Results Clinical Advisory Panel
  • Board of the Faculty of Clinical Radiology, Royal College of Radiologists.
  • Programme Organiser for the Charing Cross International Vascular Symposium
  • Advisor to the Belgian Government regarding the introduction of new endovascular techniques
  • Member of the CIRSE Interventional Radiology Certification Task Force
  • Executive Committee member of the TACIT (Trans-Atlantic Carotid Intervention Trial) Group
  • Executive Committee member of the International Carotid Stent Study (ICSS)

Journal editorships:

  • European Journal of Vascular and Endovascular Surgery (1997–2002)
  • Vascular Medicine
  • Cardiovascular Interventions Online
  • Interventional Radiology Monitor
  • Carotid and Neurovascular Intervention
  • Cardiovascular and Interventional Radiology