Ernest J Ring, professor emeritus of Radiology, University of California, San Francisco, USA, and founder, SIR Foundation, is an admired leader in the field. A grant named after him is designed to provide research support to junior interventional radiology faculty members early in their academic careers. He spoke to Interventional News about receiving the ISET 2011 Career Achievement Award and more…
Moments that changed interventional radiology
The first key moment for me was about 3am on an October night in 1971 when as a second year resident I scrubbed in with Stan Baum and Art Waltman on the first use of transcatheter treatment for bleeding from pelvic trauma. The patient was a woman in her 60s who had been involved in a pedestrian vs. automobile accident. She had received dozens of blood transfusions and had undergone three unsuccessful surgical attempts to control the bleeding in her pelvis. Each operation failed to control the bleeding and released whatever tamponade had developed. The surgeon was aware of Stan’s early work localising gastrointestinal bleeding and controlling it with vasopressin infusions. He was sure that would not work for pelvic bleeding but saw no other alternative and asked if we could try something to save her life. A pelvic aortogram showed massive extravasation from the right obturator artery. Vasopressin was infused into the internal iliac artery but failed to control the extravasation from the bleeding branch.
It was at this point that Stan Baum showed the kind of boldness and creativity that characterised many of the pioneers in our field. The patient would surely die if nothing were done. So, he decided to try to plug up the leaking vessel and deal later on with any tissue necrosis that might result. Clotted blood was the only material that any of us could think of for this purpose so he took 20cc of her blood and put it into a sterile stainless steel basin and waited for it to clot. After about 30 minutes we realised that blood from a patient who has had more than 60 transfusions does not clot and I, as the most junior person, got sent to the pharmacy to get a vial of thrombin. With thrombin added to the mixture clot began to form; Stan loaded a syringe and injected it into her internal iliac artery. Repeat angiography showed multiple branches of the internal iliac were occluded, including the obturator artery but the bleeding had stopped. What is more, no tissue necrosis ensued. That was the moment I decided my career would focus exclusively on performing angiographic and transcatheter procedures—interventional radiology had not been named yet.
Another moment that I was fortunate enough to participate in occurred in 1987 when the Society for Cardiovascular and Interventional Radiologists (now the Society of Interventional Radiology) membership voted to change the organisation from a small clique of 70 or so academic physicians to a structure that included all practicing interventional radiologists. It was the real birth of the organisation that has represented our interests so well for more than two decades and continues to set standards to ensure continued clinical excellence through our services.
The most pressing research question in interventional radiology
The most pressing research question in interventional radiology right now is determining the value of treating venous stenoses (CCSVI) in patients with multiple sclerosis. On the one hand, if this procedure is proven to be of value it would be an exciting new treatment for a terrible disease and should be widely implemented. On the other hand, we have an urgent obligation to make sure that desperate patients are not exploited—so confirming research has to be done as soon as possible.
Growing the specialty
The kinds of procedures we traditionally think of as being within the specialty of interventional radiology are obviously doing quite well. Many of the interventions developed by radiologists have become the treatment of choice for a variety of clinical problems and interventional radiology is now a critical asset in hospitals throughout the world. These procedures have become so important in clinical medicine that competition over performing them was inevitable.
I have watched our specialty thrive and expand for almost 40 years despite the ongoing concern about competition; we still get the best and the brightest trainees so I see no reason to believe that it will not continue growing for the foreseeable future.
What does the ISET award mean to you?
The leadership of ISET has pioneered new educational methods in interventional radiology for many years and has been a major force in showing physicians throughout the world how to do things the right way. I am very proud to count them as friends and truly thank them for this honour.