Interventional radiology: Beyond needles and images

Interventional radiology (IR) is unique amongst procedural disciplines because its ‘parent specialty’ is a diagnostic discipline that has no infrastructure for clinical practice. Charles Dotter, who performed the first angioplasty on 16th January 1964, recognised the risks inherent in this unique situation, stating: “If my fellow angiographers prove unwilling or unable to accept clinical responsibilities, they face forfeiture of territorial rights based solely on imaging equipment others can obtain and skills that others can learn.”

IR requires four sets of skills: first, its practitioners need to be able to interpret the radiological images that they need for their procedures. Second, they must have sufficient manual dexterity to master the necessary techniques. Third, they need to understand the pathology, physiology, and clinical aspects of the diseases that they encounter. Finally, they need to be able to assess a clinical situation and decide how best to treat the patient, sometimes quickly and based on incomplete information. The first two requirements pose no significant challenges. Image interpretation is the essence of radiology. And although not all radiologists are particularly dextrous, many have the practical skills for the performance of common interventional radiological procedures. Knowledge of pathology, physiology and clinical medicine is more problematic. In some countries, including the UK, substantial clinical experience used to be expected before beginning radiological training. In the 20th century, many British radiologists had a formal qualification in internal medicine before radiology training, but this is now unusual. As imaging became more complex, many training organisations sacrificed clinical experience in favour of more lengthy training in radiology. The ability to make swift decisions about treatment is a substantial challenge. Most diagnostic radiologists are thinkers and problem-solvers. Radiology attracts people who enjoy detecting abnormalities and using the related clues to suggest a possible diagnosis. This is a complex and immensely valuable skill and has placed imaging at the heart of modern medicine. Most radiologists have the mindset of a physician rather than a surgeon. A “surgical mindset”, however, is much more useful in IR, and not only because timely action is necessary in emergency situations. Diagnostic radiologists are not usually required to make decisions on clinical

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