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Clinical Radiology
Volume 12 No 4 I September 2016 47
Background
Interventional radiology (IR) is a
subspecialty of radiology that utilises
minimally-invasive image-guided
procedures to diagnose and treat
diseases in nearly every organ system.
Interventional oncology (IO) is a
subspecialty of interventional radiology
that deals with the diagnosis and
treatment of cancer and cancer-related
problems using targeted minimally
invasive procedures.
The field of endovascular surgery
arose from interventional radiological
techniques to treat disease that is
endovascular and has become an
alternative to vascular surgery for some
conditions such as abdominal aortic
aneurysm and peripheral artery disease.
Interventional cardiologists have now
also entered the field of interventional
radiology performing endovascular
procedures on the pelvic, renal and
carotid arteries (Drive-by renal stenting).
It is now well recognised that
interventional radiologists have
almost completely lost control of the
endovascular management of peripheral
vascular diseases to vascular surgery,
and carotid stenting to cardiology. This
has lead them to concentrate and direct
their practices towards interventional
oncology.
This was helped along by private
hospital angiography facilities wanting
to fill their available lists and offering
vascular surgery the opportunity to have
angiographic facilities without having to
pay a facility fee. The same opportunities
were available but were not taken up
by interventional radiologists, with the
exception of a small number of lone
practitioners.
In the meantime, vascular surgeons
have decided to enter the arena of
interventional oncology and are now
readying themselves to be trained in IO.
At present neither IR nor IO is recognised
by the Australian Health Practitioner
Regulation Agency (AHPRA) as a
subspecialty whereas vascular surgery is.
The Problem
It is quite possible that interventional
radiologists will lose intervention
completely as they do not control
the referral base and do not act as
consultants. Many just do what is
requested on the referral without actively
getting involved with the patient.
In a nutshell, interventional radiology
is not recognised by AHPRA as a
subspecialty; interventional radiologists
cannot refer to themselves; they do not
have recognition in the hospitals they
operate in; and there is no recognised
interventional radiology subspecialty
credentialing.
CoPET and EBIR
At present the Conjoint Committee in
Peripheral Endovascular Therapy (CoPET)
recognition of training is a very easy way
of getting credentialed as it is widely
recognised by hospital administrators
as a form of accreditation. It is often
used by hospital administrators to
counter a complaint from interventional
radiologists that the vascular surgery
operator is performing suboptimally, with
the statement that he or she is CoPET
accredited.
The European Board of Interventional
Radiology (EBIR) qualification is the future
and interventional radiologists should
be encouraged to sit this exam. I believe
that new Fellows should complete their
training by sitting the EBIR. At present
only a small number are allowed to sit the
exam and this needs to be addressed by
increasing the places available.
Also there should be a formal notification
from the College and the Interventional
Radiology Society of Australasia (IRSA)
to all stakeholders that EBIR is now
the superior accreditation process
replacing CoPET. I believe if we do not
make this widely known, EBIR will just
be another qualification, and its impact
will be minimised and its importance
marginalised.
Solving the Problem
This is not going to be easy but the
following are a few of my ideas. Firstly,
interventional radiologists need to
become consultants who manage their
own patients. They should have inpatient
admitting rights and clinical privileges
should be obtained. To put interventional
radiologists on an equal footing with
surgeons and interventional cardiologists,
self-referral should be allowed, and
finally, the EBIR accreditation should be
mandated.
I also believe that the College and IRSA
need to enter into discussions to change
the training curriculum.
All interventional radiologists need
to get actively involved in preserving
a subspecialty that rightfully belongs
to us. I recommend that we discuss
our approach to these issues in the
recently formed Interventional Radiology
Standing Committee of the College.
A/Prof Lourens Bester
Head of Clinical Radiology, School of
Medicine, Sydney
Interventional Radiology 2016 –
Where do we stand?
A/Prof Lourens Bester shares his views
on the current state of play
If you have any comments about this
article on interventional radiology,
please contact A/Prof Bester directly
on