Considerations in Specialty Selections: What Medical Students Think,Know, and Think They Know about Interventional Radiology

PurposeTo compare the motivation, deterrents, knowledge, exposure, and other specialty considerations of first- to fourth-year medical students interested in interventional radiology (IR) with those who are not.Materials and MethodsMatriculants of 5 medical schools varying by region, public/private, class size, and National Institutes of Health research ranking received a 19-question survey with questions about demographics, specialty interests, motivations/deterrents, knowledge, and exposure to IR.ResultsA total of 25.8% (611/2370) of students completed the survey, of which 20.5% (125/611) expressed interest in IR, and 25% (47/186), 26% (40/153), 24% (34/143), and 3% (3/117) of first-year, second-year, third-year, and fourth-year medical students, respectively, were seriously considering IR. Those interested in IR were less motivated by direct patient care (mean, 2.8/5; 95% confidence interval [CI], 2.6–3.0) and longitudinal patient care (mean, 1.6/5; 95% CI, 1.4–1.7) (both, P < .01) and more motivated by salary (2.6/5; 95% CI, 2.3–2.9), job market (2.8/5; 95% CI, 2.6–2.9), and procedures (3.1/5; 95% CI, 2.8–3.4) compared with their peers (all P < .05). Those interested in IR were more certain about their IR knowledge (mean range, 1.6–2.0/3.0; 95% CI, 1.3–2.3) than their peers (mean range, 1.9–2.4/3.0; 95% CI, 1.6–2.1, in which 0 = certain, P ≤ .01); however, both groups scored low in actual knowledge (those considering IR: 35.0–73.2% correct; 95% CI, 23.5–81.4; those who were not: 26.6–66.7% correct; 95% CI, 24.3–75.9, P > .05).ConclusionsAlthough medical students showed interest in IR, they had a limited understanding of IR. IR educators may increase IR interest and understanding among medical students by clarifying the procedural aspects and longitudinal care present in a comprehensive IR practice.     

Public Awareness of Interventional Radiology: Population-Based Analysis of the Current State of and Pathways for Improvement

PurposeTo evaluate the awareness of interventional radiology (IR) among the public and identify methods for improvement.Materials and MethodsParticipants (N = 1,000) were anonymously surveyed using Amazon’s Mechanical Turk crowdsourcing platform about medical and IR-specific knowledge, preferred methods of acquisition of medical information, and suggestions for improving awareness of IR. The survey consisted of 69 questions, including both Likert Scale and free text questions.ResultsOf the participants, 92% preferred undergoing a minimally invasive procedure over surgery. However, 39.8% recognized IR as a medical specialty, and less than 50% of these participants correctly identified IR as procedurally oriented. Of those who discussed or underwent an IR procedure (n = 113), most were also offered to undergo the procedure performed by a surgeon (n = 66). Furthermore, 71% (n = 20) of those who underwent the procedure performed by a surgeon reported that lack of awareness of IR played a role in their decision. Almost half of the respondents (n = 458) were interested in learning more about IR, particularly the diseases treated and procedures performed (42% and 37%, respectively). Short (<10-minute) educational videos and increased patient education by primary care providers (PCPs) were among the most suggested ways to improve awareness. Regarding the ambiguity of the name “interventional radiology,” most respondents (n = 555) reported this to be true, and “minimally invasive radiologist” was the most preferred alternative (21.18%).ConclusionsLack of awareness of IR may underlie underutilization. When presented with the knowledge that IR improves patient outcomes, minimally invasive procedures by an interventional radiologist are more often desired by the public than surgical options. Educational videos and patient education by PCPs may increase awareness of IR.     

A 5-Year Update on the IR Residency Match: 2022 National Survey Results of Program Directors and Matched Applicants Compared with 2017

PurposeTo characterize the experiences of matched applicants (MAs) and program directors (PDs) in the 2022 interventional radiology (IR) residency Match and compare with 2017 data.MethodsSurveys were distributed to IR PDs and MAs from the 2022 Match. Findings were compared with those of 2017 using the 2-sample t test and Fisher exact test.ResultsIn total, 68 MAs (40%) and 47 PDs (52%) responded. Collected demographic traits were similar, including ongoing male predominance (77% of MAs, 83% of PDs). Moreover, 86% of MAs and 87% of PDs were “satisfied” with Match outcomes. Compared with those in 2017, MAs applied to more IR programs (P < .001). MAs reported more research (P = .003) and abstracts/publications (P < .001) and ranked these as more important than PDs did (P < .001 for both). Approximately 82% of PDs gave special attention to candidates who completed a visiting rotation at their institution; 60% of MAs and 95% of PDs believed virtual interviews resulted in overinterviewing (P < .001); both agreed they provided convenience and accessibility. Furthermore, 63% of MAs believed a Step 1 pass/fail system will be less equitable for applicants. Additional data on demographics, medical school experiences, applications, interviews, intern year, and rank process were reported.ConclusionsSatisfaction with Match results remained high from 2017 to 2022, although efforts are needed to improve applicants’ ability to navigate the application process, address overapplying, and evaluate concerns regarding the Step 1 pass/fail system. These survey findings will help inform applicants and PDs for future match cycles.     

Gender-Specific Factors Influencing Medical Students' Career Choice of IR

The authors conducted an anonymous survey to assess positive and negative factors that may affect medical students’ decisions to pursue a career in interventional radiology (IR). The survey was sent to registrants for the Midwest IR Student Symposium in 2016 and/or 2017, with a response rate of 13%; male and female responses were then compared. Female and male medical students shared similar rankings of factors affecting their decisions about choosing IR as a career, such as concern about lifestyle and excitement about therapeutic applications. Access to female IR mentors and diversification of the currently male-dominated workplace were important, gender-specific concerns.     

Research Consensus Panel Follow-Up: A Systematic Review and Update on Cost Research in IR

PurposeTo systematically review cost research in interventional radiology (IR) published since the Society of Interventional Radiology Research Consensus Panel on Cost in December 2016.Materials and MethodsA retrospective assessment of cost research in adult and pediatric IR since December 2016 to July 2022 was conducted. All cost methodologies, service lines, and IR modalities were screened. Analyses were reported in a standardized fashion to include service lines, comparators, cost variables, analytical processes, and databases used.ResultsThere were 62 studies published, with most from the United States (58%). Incremental cost-effectiveness ratio, quality-adjusted life-years, and time-driven activity-based costing (TDABC) analyses were performed in 50%, 48%, and 10%, respectively. The most frequently reported service line was interventional oncology (21%). No studies on venous thromboembolism, biliary, or IR endocrine therapies were found. Cost reporting was heterogeneous owing to varying cost variables, databases, time horizons, and willingness-to-pay (WTP) thresholds. IR therapies were more cost-effective than their non-IR counterparts for treating hepatocellular carcinoma ($55,925 vs $211,286), renal tumors ($12,435 vs $19,399), benign prostatic hyperplasia ($6,464 vs $9,221), uterine fibroids ($3,772 vs $6,318), subarachnoid hemorrhage ($1,923 vs $4,343), and stroke ($551,159 vs $577,181). TDABC identified disposable costs contributing most to total IR costs: thoracic duct embolization (68%), ablation (42%), chemoembolization (30%), radioembolization (80%), and venous malformations (75%).ConclusionsAlthough much of the contemporary cost-based research in IR aligned with the recommendations by the Research Consensus Panel, gaps remained in service lines, standardization of methodology, and addressing high disposable costs. Future steps include tailoring WTP thresholds to nation and health systems, cost-effective pricing for disposables, and standardizing cost sourcing methodology.     

Patient and Provider Perspectives of Telehealth and In-Person Interventional Radiology Clinic Visits

PurposeTo assess patient and provider satisfaction with interventional radiology (IR) outpatient telehealth and in-person clinic.Materials and MethodsThis institutional review board–approved study analyzed patient satisfaction with clinic via survey after an IR outpatient telehealth or in-person visit. A physician telehealth experience survey was completed by 8 IR physicians.ResultsDuring the initial survey period, 44 (83%) of 53 patients completed a survey via telephone compared with 37 (23%) of 158 patients who were offered an electronic survey during the second survey period. Of 81 respondents, 18 (22%) were in-person and 63 (78%) were via telehealth. Of the respondents, nearly all patients (97%) in the telehealth group reported satisfaction with their telehealth clinic visit, with similar rates of high patient satisfaction between in-person and telehealth visits (P = .51). Most patients (98%) in the telehealth group strongly agreed that their physician’s recommendations were clear in the telehealth visit and that their visit was private, similar to in-person visits (P = .13). A telehealth visit saved time for all patients (100%), with 78% reporting >1 hour of time-saving. All IR physicians (n = 8) reported greater efficiency with telehealth clinic than with in-person clinic and that follow-up patterns would change if telehealth was available. However, all providers (100%) found telephone visits less satisfying than in-person visits, with video visits being either equally satisfying (71%) or less satisfying (29%).ConclusionsPatient satisfaction with the in-person and telehealth outpatient IR clinic was high, with patients and providers reporting time-saving and greater efficiency with telehealth, suggesting that telehealth should remain an important component of outpatient IR clinic care.     

Interventional Radiologists Achieve Equivalent Outcomes and Lower Costs for Totally Implantable Venous Access Device Placement Compared to Operating Room Placement

PurposeTo compare the cost and outcomes of surgical and interventional radiology (IR) placement of totally implantable venous access devices (TIVADs) within a large regional health system to determine the service line with better outcomes and lower costs to the health system.Materials and MethodsA retrospective review of all chest port placements performed in the operating room (OR) and IR suite over 12 months was conducted at a large, integrated health system with 6 major hospitals. Secondary electronic health record and cost data were used to identify TIVAD placements, follow-up procedures indicating port malfunction, early adverse events (within 1 month after the surgery), late adverse events (2–12 months after the procedure), and health system cost of TIVAD placement and management.ResultsFor 799 total port placements included in this analysis, the rate of major adverse events was 1.3% and 1.9% for the IR and OR groups, respectively, during the early follow-up (P = .5655) and 4.9% and 2.8% for the IR and OR groups, respectively, during the late follow-up (P = .5437). Malfunction-related follow-up procedure rates were 1.8% and 2.6% for the IR and OR groups, respectively, during the early follow-up (P = .4787) and 12.4% and 10.5% for the IR and OR groups, respectively, during the late follow-up (P = .4354). The mean cost of port placement per patient was $4,509 and $5,247 for the IR and OR groups, respectively. The difference in per-patient cost of port placement was $1,170 greater for the OR group (P = .0074).ConclusionsThe similar rates of adverse events and follow-up procedures and significant differences in insertion cost suggest that IR TIVAD placement may be more cost effective than surgical placement without affecting the quality.     

A Survey of Interventional Radiologists Regarding the Use of Morbidity and Mortality Conferencing in Departmental Quality Improvement Programs

PurposeTo investigate the degree to which morbidity and mortality (M&M) conferencing is utilized in interventional radiology (IR), identify impediments to its adoption, and assess the experience of those using this tool.Materials and MethodsMembers of the Society of Interventional Radiology (SIR) were offered a 9-question survey of practices and experiences regarding M&M conferencing within their quality assessment (QA) programs.ResultsAmong 604 respondents, 37.8% were university-based practitioners and 60% were from outside of university practices. Of all respondents, 43% reported practicing 100% IR, with 28.5% practicing IR 75%–99% and 11% practicing IR <50% of the time. The use of M&M conferencing was significantly greater in university practices (90.7%) than in nonuniversity practices (37.1%) and among practitioners performing at least 75% IR (71.2%) than among those practicing <75% (28.8%). The conferences were held monthly (66.6%) or more often, and the majority (56%) of the events identified were scored using the SIR severity score. Approximately 20% of M&M conferences were multidisciplinary, shared most commonly with vascular surgery. The reasons cited for not using M&M included the lack of time and the logistical challenges of the process. However, among those who participate in M&M conferences, the QA goals of the conference were met at very high rates.ConclusionsM&M conferencing is well established in university IR programs and among full-time practitioners but much less so elsewhere. For those sites that do not utilize M&M conferencing, there may be a considerable benefit to addressing the obstacles that are limiting their implementation of this tool.     

Completeness of Reporting in Abstracts of Randomized Controlled Trials Assessing Interventional Radiology for Liver Disease

PurposeTo assess the completeness of reporting in abstracts of published randomized controlled trials (RCTs) assessing interventional radiology (IR) for liver disease; to assess whether publication of the 2017 CONSORT update for nonpharmacologic treatments (NPTs) resulted in changes in abstract reporting; and to identify factors associated with better reporting.Materials and MethodsMEDLINE and Embase were searched to identify RCTs of IR for liver disease (January 2015 to September 2020). Two reviewers assessed the completeness of abstract reporting according to the CONSORT-NPT-2017-update. The primary outcome was the mean number of CONSORT items completely reported among 10 items reported in <50% of the abstracts published in 2015. A time series analysis assessed the evolution trend over time. Moreover, a multivariate regression model was used to identify factors associated with better reporting.ResultsA total of 107 abstracts of RCTs published in 61 journals were included. Overall, 74% (45/61) of journals endorsed the main CONSORT guidelines, of which 60% (27/45) had a policy to implement them. The mean number of primary outcome items completely reported increased by 0.19 over the study period. The publication of the CONSORT-NPT update did not lead to an increase in the trend of items reported (increase of 0.04 items/month before vs 0.02 after; P = .41). Factors associated with more complete reporting were impact factor (OR = 1.13; 95% CI: 1.07–1.18) and endorsement of CONSORT with an implementation policy (OR = 8.29; 95% CI: 2.04–33.65).ConclusionsCompleteness of reporting is incomplete in abstracts of trials of IR liver disease and did not improve after publication of the CONSORT-NPT-2017 update with abstract guidance.     

Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel on Artificial Intelligence in Interventional Radiology: From Code to Bedside

Artificial intelligence (AI)-based technologies are the most rapidly growing field of innovation in healthcare with the promise to achieve substantial improvements in delivery of patient care across all disciplines of medicine. Recent advances in imaging technology along with marked expansion of readily available advanced health information, data offer a unique opportunity for interventional radiology (IR) to reinvent itself as a data-driven specialty. Additionally, the growth of AI-based applications in diagnostic imaging is expected to have downstream effects on all image-guidance modalities. Therefore, the Society of Interventional Radiology Foundation has called upon 13 key opinion leaders in the field of IR to develop research priorities for clinical applications of AI in IR. The objectives of the assembled research consensus panel were to assess the availability and understand the applicability of AI for IR, estimate current needs and clinical use cases, and assemble a list of research priorities for the development of AI in IR. Individual panel members proposed and all participants voted upon consensus statements to rank them according to their overall impact for IR. The results identified the top priorities for the IR research community and provide organizing principles for innovative academic-industrial research collaborations that will leverage both clinical expertise and cutting-edge technology to benefit patient care in IR.     

Changes in IR from 2007 to 2017 in China

In this article, the updated status of interventional radiology (IR) in China is reported and compared vs that a decade ago based on a poll carried out in 2017 in Jiangsu Province, where the economy and overall health level are among the best of the 31 provinces in China. All 98 polled centers responded, and 56 IR departments (57%) had become independent departments separate from the radiology department; 74 (76%) had inpatient wards. In 2017, there were 538 interventional radiologists performing IR procedures in Jiangsu Province, with a total of 69,277 procedures performed, with interventional oncologic procedures accounting for the largest proportion (58%).     

Reductions in Reimbursement and Relative Value Units for Interventional Radiology Procedures: Trends from 2011 to 2021 Compared with Those for Other Physician Specialties

PurposeTo compare recent trends in Medicare reimbursement and relative value units (RVUs) for interventional radiology (IR) procedures similar to those performed by non-IR specialties.Materials and MethodsData from the Centers for Medicare and Medicaid Services Physician Fee Schedule for facility reimbursement and RVU component values for 23 commonly performed single Current Procedural Terminology IR procedures were compared with similar procedures or procedures for similar indications performed by non-IR specialties between 2011 and 2021.ResultsThe work RVU component decreased in 18 of 23 (78.3%) IR procedures compared with 6 of 23 (26.1%) similar procedures performed by non-IR specialties. The largest change in single RVU component was a 19.2% reduction in practice expense RVU for IR compared with a 16.5% reduction for similar procedures performed by non-IR specialties.ConclusionsAs a specialty, IR experienced a disproportionately greater reduction in reimbursement and RVU valuation for a range of comparable procedures performed by non-IR specialties.     

Results of an American College of Radiology-Society of Interventional Radiology Membership Survey on Exclusive Contracts and the Attitudes of Interventional Radiologists

PurposeTo assess the attitudes of interventional radiologists (IRs) and diagnostic radiologists (DRs) toward exclusive contracts and independently practicing IRs who may request privileges at a hospital where an exclusive contract exists with a different group of radiologists.Materials and MethodsA total of 22,400 survey instruments were distributed to 4,490 IRs and 17,910 DRs in the United States. Statistical evaluation included multivariate ordinal logistic regression analysis with calculation of the odds ratios and forest plots.ResultsCompleted surveys were received from 525 (11.69%) IRs and 401 (2.23%) DRs. Given the low response rate of DRs, data analysis was focused on IRs. Early-career IRs and those in outpatient practices had a more positive attitude toward independent IRs who requested admitting and/or procedural privileges. A supermajority of both IRs and DRs who responded to the survey agreed that the importance of IR to hospital and health system contracts will increase.ConclusionsThis survey identified many interrelated and complex variables that significantly affected the attitudes of IRs in various practice settings toward independent IRs requesting hospital admitting and/or procedural privileges. It will benefit independent IRs seeking admitting privileges to better understand some of the factors that impact the potential willingness of the radiology groups and other IRs with exclusive hospital contracts to work toward mutually beneficial practice paradigms, especially as more clinically oriented IRs complete their training in the new, integrated residency programs.     

Improved Utilization Following Conversion of a Fluoroscopy Suite to Hybrid CT/Angiography System

PurposeTo assess changes in operational utilization following conversion of a single IR suite to a hybrid CT/angiography (Angio-CT) system at an academic tertiary care center.Materials and MethodsThe total number of interventional procedures and diagnostic CT examinations performed in 29 rooms (20 diagnostic radiology, 7 IR, 2 shared between divisions) was calculated in the 24 months before conversion of an IR suite to Angio-CT and 12 months after conversion. The total number of IR procedures (global IR/month) and diagnostic CT scans per month (global CT/month) in both before and after conversion periods was calculated and defined as baseline institutional growth. This was compared against the change in the number of IR procedures performed in the before and after periods in the converted room (Angio-CT/month) as well as the number of diagnostic CT scans performed in the shared rooms (shared CT/month).ResultsThe percent change in global CT and global IR from the before to the after periods was 39.2% and 3.1%, respectively. Shared CT per month and Angio-CT per month increased by 46.7% and 12.0% across the same time periods, respectively. The ratio of the percent increase in Angio-CT per month to percent increase in global IR per month was 3.87. The ratio of the percent increase in shared CT per month to percent increase in global CT per month was 1.19.ConclusionsOperational utilization improved in both diagnostic radiology and IR sections following conversion of a conventional fluoroscopic IR suite to an Angio-CT room.     

The Environmental Impact of Interventional Radiology: An Evaluation of Greenhouse Gas Emissions from an Academic Interventional Radiology Practice

PurposeTo calculate the volume of greenhouse gases (GHGs) generated by a hospital-based interventional radiology (IR) department.Materials and MethodsLife cycle assessment (LCA) was used to calculate GHGs emitted by an IR department at a tertiary care academic medical center. The volume of waste generated, amount of disposable supplies and linens used, and the operating times of electrical equipment were recorded for procedures performed between 7:00 AM and 7:00 PM on 5 consecutive weekdays. LCA was then performed using purchasing data, plug loads for electrical hardware, data from temperature control units, and estimates of emissions related to travel in the area surrounding the medical center.ResultsNinety-eight procedures were performed on 97 patients. The most commonly performed procedures were drainages (30), placement and removal of venous access (21), and computed tomography–guided biopsies (13). Approximately 23,500 kg CO₂e were emitted during the study. Sources of CO₂ emissions in descending order were related to indoor climate control (11,600 kg CO₂e), production and transportation of disposable surgical items (9,640 kg CO₂e), electricity plug load for equipment and lighting (1,060 kg CO₂e), staff transportation (524 kg CO₂e), waste disposal (426 kg CO₂e), production, laundering, and disposal of linens (279 kg CO₂e), and gas anesthetics (19.3 kg CO₂e).ConclusionsThe practice of IR generates substantial GHG volumes, a majority of which come from energy used to maintain climate control, followed by emissions related to single-use surgical supplies. Efforts to reduce the environmental impact of IR may be focused accordingly.     

Internet Search Trends Relevant to Interventional Oncology: A Google Trends Study (2004–2020)

Interventional Radiology (IR) procedures addressing cancer have been grouped in the subspecialty of interventional oncology and represent an important component of modern multidisciplinary cancer care. This study pinpoints temporal and geographical trends of public online searches for terms related to the field, as well as IR-related cancer therapies. Google Trends data were analyzed for long-term (2004–2020) trends in the United States and worldwide. Overall, search interest for IR increased throughout the United States but decreased globally. Specific search volumes for cancer-related IR techniques such as radioembolization and chemoembolization therapies increased by 2.8- and 2.5-fold, respectively, in the United States, whereas the search volumes for ablation techniques remained steady or decreased. Future research and advocacy may focus on increasing public awareness of the field.     

A Review of Professional Liability in IR: Sweeping the Mines

Medical professional liability (MPL) is becoming a substantial issue in interventional radiology (IR), with both impact on health care costs and negative psychological effects on physicians. MPL presents special challenges within IR because of the field’s complex and innovative therapies that are provided to a diverse group of patients and complicated by the off-label use of devices and drugs that is pervasive in the field. This review discusses the principles and practices to avoid and manage MPLs that are specific to the field of IR.     

Feasibility and Procedural Safety of alfapump System Implantation by IR: Experience from the MOSAIC Study,a Multicenter,Open-Label Prospective Study in Cirrhotic Patients with Refractory Ascites

PurposeTo evaluate feasibility, procedural outcomes, and safety aspects of implantation of the alfapump system for management of refractory ascites by interventional radiology (IR) methods.Materials and MethodsThe multicenter open-label prospective MOSAIC study included 29 patients (mean age 60.0 y ± 9.9; range, 32–72 y, 17 [56.7%] male) with cirrhotic refractory ascites who received an alfapump system implanted by IR. The fully subcutaneous alfapump system consists of a pump and 2 silicone catheters, whose distal ends are inserted in the peritoneum and the bladder, respectively. The device moves ascites from the peritoneum to the bladder, reducing the requirement of paracentesis. Pumped volume and speed can be customized as required. The implant procedure was performed under general or local anesthesia. Both catheters were placed under ultrasound guidance. The pump was inserted in a subcutaneous pocket on the upper abdomen. Incidence and severity of procedure-related serious adverse events up to 3 months after implantation were recorded.ResultsTechnical success was achieved in 29 (100%) IR implant procedures. The pump was usually implanted on the right abdomen (76.7%). In 5 patients, deviation from the Instructions for Use was required. Adverse events (requirement of additional incisions, postoperative bleed) occurred in 3 patients. At 3 months after implantation, 3 possibly procedure-related serious adverse events (ascites leakage, bacterial peritonitis, postoperative bleeding) had occurred. Two explantations (2/29; 6.8%) (cellulitis, pump pocket infection) and 4 reinterventions (pump or catheter replacement) were required, corresponding to an adverse event incidence rate of 9/29 (31.0%).ConclusionsPlacement of the alfapump using IR methods is both feasible and technically successful.     

Time-Driven Cost Analysis of Noncuffed Venous Catheter Placement in Infants: Bedside versus IR Suite

PurposeTo compare the direct bundled costs of interventional radiology (IR) suite versus bedside placement of noncuffed central venous catheters in infants.MethodsA single-center retrospective review was performed of all noncuffed upper extremity (peripherally inserted central venous catheter [PICC]) and tunneled femoral (tunneled femoral central venous catheter [TCVC]) catheters placed in infants between January 1, 2018, and December 31, 2018. Propensity score matching was performed adjusting for age, birth weight, procedure weight, and catheter days. Process maps for each procedure were created based on location and sedation type. Technical success and complications were recorded for each placement. The total direct bundled cost for each catheter placement was calculated by summing the procedure and complication costs.ResultsA total of 142 procedures were performed on 126 matched patients with a technical success of 96% at the bedside and 100% in the IR suite (P = .08). The complication rates did not significantly differ between the 2 groups (P = .51). The total direct bundled costs for catheter placement were $1421.3 ± 2213.2 at the bedside and $2256.8 ± 3264.7 in the IR suite (P = .001).ConclusionsThe bundled cost of bedside femoral catheter placement is significantly less than that of fluoroscopic TCVC and PICC placement performed in the IR suite, mainly related to differences in sedation costs.