Future health care will need to be efficient-"better, safer, faster," which is precisely what interventional radiology (IR) offers patients, health care providers and hospital administrators.
Touching every organ system and improving management of many disease states, IR has changed medicine with its creative approaches and disruptive technologies, saving millions of lives worldwide. Today's interventional radiologists don't just perform procedures-they work in medical offices, accept direct referrals for disease management, admit and manage patients in hospitals and follow patients longitudinally. IR's future value proposition for hospitals is compelling, and facilities can actively foster IR's growth.
Interventional radiologists are the masters of catheter-based therapy, and many of these new treatments are less costly and risky for patients than surgical options. With new and effective catheter-based treatments, IR's central importance in cancer care is well-recognized. Providing both curative and supportive care for cancer patients, interventional radiologists have advanced embolic agents for the treatment of liver cancers and rapidly developing technology in percutaneous tissue ablation (heating tissue with microwaves and focused ultrasound, and freezing with cryoprobes). They are beginning to use these advances with adjunctive chemotherapy.
All the catheter-based procedures widely used to treat vascular disease-from guidewire catheter placement in arteries, to balloon angioplasty, to stent placement and even drug-eluting stents-were developed by interventional radiologists, who are also the only medical specialists who treat the gamut of vascular diseases with catheter means.
These physicians open up totally occluded arteries with stents; provide intra-arterial catheter thrombolysis of intracerebral arteries for acute stroke; and perform a catheter-based portosystemic shunt, thrombolysis for deep vein thrombosis and intracerebral angioplasty for vasospasm. Again, in many cases, substantial disability remains low in risk and cost, saving the system tremendous expense.
Uniquely qualified to deliver care
While many specialties offer catheter-based therapy, a disproportionate amount of brilliant innovations have come from IR, because pushing the envelope of catheter techniques is a testament to an interventional radiologist's true skill level. These physicians are steeped in a tradition of innovation and invention-of pioneering modern medicine with the devices, drugs and methods to treat patients minimally invasively. Research presented at the 2010 Annual Meeting of the Society of Interventional Radiology showed advances in peripheral arterial disease, carotid stenting, and liver, prostate, colon, soft tissue and breast cancers.
All members of the IR team play a critically important role in care. Interventional radiologists, physician extenders, technologists and radiology nurses must provide patients with a comforting environment. Technologists control the procedural area and ensure safe and effective use of ionizing radiation; since most IR patients are awake or lightly sedated, this is extremely important.
All the staff work to control light, temperature, the noise level and the nature of conversation in the suite-taking care of the patient from the gurney trip to the suite, in transferring a patient to the procedural table, in controlling how quickly a patient is moved and the required degree of consideration.
The core strength of interventional radiologists is their mastery of imaging. IR is a component specialty of radiology that is separate and distinct, and when viewed as an admitting service and revenue generator, hospital administrators take notice, particularly in a budget-conscious economy. The diverse collection of critical services provided in a timely manner with a high degree of expertise by on-site interventional radiologists continues to deliver tremendous value to a hospital.
Interventional radiologists often place (and remove) a port or infusion catheter, perform an ablation or infusion or embolization procedure, do biopsies or drainage procedures and recanalize vascular obstructions. For many, interventional radiologists perform procedures using imaging; for others, interventional radiologists make patients more comfortable at the end of their lives. They analyze imaging studies, referring patients to other specialists when appropriate, and see patients in offices on a regular basis for follow-up. Interventional radiologists also formulate treatment plans and provide critical input on most others.
Interventional radiologists will continue to offer patients and the health care system what no other specialty can: the most in-depth knowledge of the least invasive treatments available using imaging guidance (offering less risk, pain and recovery time compared to open surgery) coupled with diagnostic and clinical experience across disease and organ systems.Whether in a traditional hospital-based practice or subspecialty office-based environment, interventional radiologists are uniquely qualified to deliver this new medicine in a fashion others emulate but can never duplicate.
Interventional radiologists provide services that are better for patients' outcomes and safer with shorter hospital stays and a faster recovery compared to open surgery or more invasive options. Strong IR programs are in our patients' and nation's best interests-and all this translates to improved economics when compared to surgical options.
Timothy P. Murphy, MD, FSIR, is president-elect of the Society of Interventional Radiology and director of the Vascular Disease Research Center at Rhode Island Hospital, Providence.
Looking Ahead: Interventional MS Treatments
One major clinical development on the horizon is the recent recognition that venous interventions may play an important role in treating some patients with multiple sclerosis (MS). The Society for Interventional Radiology (SIR) supports evidence-based clinical research to determine the safety and effectiveness of interventional MS treatments-for example, for chronic cerebrospinal venous insufficiency (CCSVI, a reported abnormality in blood drainage from the brain and spinal cord).
CCSVI's role in MS-and its endovascular treatment by an interventional radiologist via balloon angioplasty and/or stents to open up veins-is being actively investigated and could be transformative for patients. The idea that the etiology of some MS patient symptoms may have a venous component is a radical departure from current medical thinking.
SIR is moving rapidly to catalyze the development of needed studies by bringing together researchers in image-guided venous interventions, neurology, central nervous system imaging, MS outcomes assessment and clinical trial methodology. While the medical establishment can't yet endorse balloon angioplasty and stents as routine clinical treatments for MS, SIR has assumed a national leadership role in launching needed efforts. If the MS treatment continues to show promise, the capacity of angiography departments will be strained and may
require expansion in the next several years.
-Timothy P. Murphy, MD, FSIR