The arsenal of skills a trainee needs to navigate emergency IR

Emergency interventional radiology (IR) sits at the heart of acute care.¹ It calls for resilience, razor-sharp thinking and calm under pressure. Whether you’re embolizing a life-threatening bleed to rescuing a septic kidney, emergency IR can test your technical skills, decision making and ability to stay calm. Here, Thevarajah Viyasar (Hamilton, New Zealand) shares how to not just survive it but thrive when the pressure is on.

1. Ask the right questions

In emergencies, especially trauma, clarity amid chaos is vital and identifying the crux of the emergency is key. Combining calm communication with sound knowledge of acute pathology aids decision making and sometimes the best intervention is to wait. The ability to balance risks and benefits develops only with experience, so seek case exposure and discussion. Even when patients aren’t suitable for intervention, interventional radiologists play a crucial hidden role in guiding referring teams.

2. Know the imaging

Even in emergencies, there’s always time to think, review imaging and plan. Careful interrogation of prior imaging clarifies anatomy, guides the most appropriate intervention, sometimes this will be surgical or none, and shortens procedures.² This reduces radiation, blood loss and complications.^3,4 Technical precision matters but excellent diagnostic skills are what make an interventional radiologist truly excel.⁵

3. Make your environment work for you

Planning is key, but it starts with knowing your equipment. Knowing what’s available in the department: stents, balloons and embolics means you can adapt if/when challenges arise. Knowing the drugs available to make patients comfortable will allow a smooth procedure.⁶ Organising the lab ergonomically and preparing preferred tools boosts wellbeing.⁷ The best interventional radiologists optimise these details, turning small gains into big advantages, especially under pressure.

4. Don’t be a lone hero, teamwork beats tunnel vision

Emergency IR is demanding and recognising your limits and knowing where to find help from seniors or colleagues like anaesthetists is essential. Stress impairs judgement, so self-awareness and composure are crucial, a moment of haste can lead to hours of avoidable procedural time.⁸ Debrief, reflect, and protect your wellbeing in and outside work; resilience grows from rest and reflection, not relentless effort.⁹

5. Master small-vessel access

Everything begins with access, whether it’s a bile duct or a branch of the superior mesenteric artery. Proficiency in fine catheterisation improves speed and precision in emergencies. There’s no substitute for practice; high-volume exposure builds the dexterity that defines great interventional radiologists so get stuck in!

References:

1. Kang KS, Lee MS, Kim DR, et al. The Role of Interventional Radiology in Treatment of Patients with Acute Trauma: A Pictorial Essay. Taehan Yongsang Uihakhoe Chi. 2021 Mar;82(2):347-358. doi: 10.3348/ jksr.2020.0099.
2. Garg T, Shrigiriwar A. Radiation Protection in Interventional Radiology. Indian J Radiol Imaging. 2022 Jan 10;31(4):939-945. doi: 10.1055/s-0041- 1741049.
3. Goutnik M, Nguyen A, Fleeting C, et al. Assessment of Blood Loss during Neuroendovascular Procedures. J Clin Med. 2024 Jan 24;13(3):677. doi: 10.3390/jcm13030677.
4. Lamb T, Tran A, Lampron J, et al. The impact of time to hemostatic intervention and delayed care for patients with traumatic hemorrhage: A systematic review. J Trauma Acute Care Surg. 2023 Aug 1;95(2):267-275. doi: 10.1097/ TA.0000000000003976.
5. Ahmed, Kamran & Keeling, Aoife & Khan, et al. (2009). What Does Competence Entail in Interventional Radiology?. CVIR. 33. 3-10. 10.1007/ s00270-009-9732-2.
6. Johnson S. Sedation and analgesia in the performance of interventional procedures. Semin Intervent Radiol. 2010 Dec;27(4):368-73. doi: 10.1055/s-0030-1267851.
7. Walker B. Duke surgery introduces ergonomics program to improve surgeon health. (2017). Available at: https://surgery.duke.edu/news/duke-surgery-introduces-ergonomics-program-improve-surgeon-health
8. Tam A, Bateman S, Buckingham G, et al. The effects of stress on surgical performance: a systematic review. Surg Endosc. 2025 Jan;39(1):77-98. doi: 10.1007/s00464-024-11389-3. Epub 2024 Dec 3.
9. Evans TR, Burns C, Essex R, et al. A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers. Front Psychiatry. 2023 Mar 24;14:1078797. doi: 10.3389/fpsyt.2023.1078797.

Thevarajah Viyasar is an interventional radiology fellow and senior medical officer at Health New Zealand in Hamilton, New Zealand.