Leo Schultze Kool, MD, PhD

Interventional radiology is growing rapidly as a subspeciality. The presence of a state-of-the-art interventional service within a radiology department will have a significant impact on that department's staffing, training, logistics, finances, and resources. Ongoing turf battles will also require substantial involvement from department heads.

The analogy between interventional radiology and radiotherapy is striking. Professional societies are struggling to decide whether interventional radiology should maintain its present position within diagnostic radiology or become an independent specialty, as radiotherapy has.

In the Netherlands, as in many other countries, interventional radiology remains part of diagnostic radiology. The interventional service is managed in a way similar to other subspecialties within diagnostic radiology.

But the responsibilities of an interventional radiologist do not end with the completion of a successful procedure. Follow-up, reporting, and clinical management of patients should be a part of any interventional radiology service and a part of practitioners' daily work. This aspect is often difficult to organize within a radiology department where the layout, facilities, and personnel are all focused on diagnosis.

Training and accreditation for interventional radiology is another issue. Many professional societies have set out minimum requirements for doctors who wish to practice image-guided intervention, and they have started training programs for their members. Specialists other than radiologists, however, will no doubt look to carry out interventional procedures. Their case for doing so may even be supported by local hospital boards. Discussions of-or battles over-turf will have to be dealt with by the chair of the radiology department. He or she will often have only a minimal affinity with and/or understanding of interventional radiology.

The optimal way to train in interventional radiology would be through a complete fellowship. Interventional training programs have so far been open only to doctors who have completed a radiology residency.

Specialists with different backgrounds should be granted access to these training programs, too. These candidates could undergo an additional 12-month rotation in diagnostic radiology to acquire the knowledge of cross-sectional imaging they'll need.

Ideally, different professional societies would join forces to design the curriculum for an interventional radiology fellowship. Societies with an overly protective attitude toward their own specialty may obstruct this process, though. This would not be in patients' best interests.

Diagnostic radiology department heads may be concerned by the continually rising costs of interventional radiology procedures, limited reimbursement (depending on the country), lack of reimbursement for clinical duties associated with intervention, and number of personnel required.

The question consequently arises: Should diagnostic radiology departments be supporting interventional radiology to this extent?

The rapid growth of interventional and/or minimally invasive procedures and the absolute need for a round-the-clock interventional radiology presence in hospitals will only add to these concerns. Finding sufficient numbers of highly trained professionals to cover this work 24 hours a day, seven days a week, will not be easy. Round-the-clock availability implies that staff will have to be compensated for their out-of-hours work, both in time and financially.

The speed of future growth in interventional radiology will likely be limited by the constraints that are inherent in radiology departments. If major changes within departments cannot be made, then interventional radiology will have to leave diagnostic radiology. The survival of interventional radiology will then depend on interventionalists taking the lead in forming multidisciplinary treatment groups with other specialties.

The future of interventional radiology remains uncertain. The major threat to its survival might be not turf battles with other disciplines, but radiology itself.

DR. SCHULTZE KOOL is head of the Minimally Invasive Technology Expertise Center, St. Radboud University Medical Center, in Nijmegen, the Netherlands.

Editor's Note: The future of interventional radiology is a hotly contested topic. If you have any opinions on this subject that you'd like to share, please contact us at di-europe@btconnect.com. This column does not necessarily reflect the views of DI Europe's Editorial Advisory Board.

Leo Schultze Kool, MD, PhD

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