Current Hot Topics in Interventional Radiology

[PaddyofNine]

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I'm quite interested in this field, and have been doing a bit of reading around on all the big departmental websites as well as AuntMinnie.com and the like. I'm just curious to get some of you guys' opinions on the field.

I think it has a huge future, but how do things look on that side of the pond? Anyone well versed in the field?

What do you think the next five or ten hot topics or procedures will be in interventional radiology in the next 5/10 years?

Just trying to start a bit of a conversation here, any replies appreciated!👍

 

[f_w]

What do you think the next five or ten hot topics or procedures will be in interventional radiology in the next 5/10 years?

- image guided treatment of cancer (chemo/radioembolization/RF/cryo)
- uterine artery embolization for fibroids
- further development of endovascular treatment for peripheral vascular disease
- further development of endovascular abdominal and thoracic aneurysm repair
- endovascular treatment of venous insufficiency

 

[PaddyofNine]

- image guided treatment of cancer (chemo/radioembolization/RF/cryo)
- uterine artery embolization for fibroids
- further development of endovascular treatment for peripheral vascular disease
- further development of endovascular abdominal and thoracic aneurysm repair
- endovascular treatment of venous insufficiency

Cool, thanks. What about neuroradiology?

 

[f_w]

Cool, thanks. What about neuroradiology?

Diagnostic or interventional ?

 

[PaddyofNine]

Diagnostic or interventional ?

Either/Both!

 

[f_w]

Either/Both!

Diagnostic:

- Ever better MRI sequences showing physiologic processes such as perfusion/activity/ischemia.
- Further refinement of MRI sequences demonstrating neuroanatomy (e.g. DTI)

Interventional:
- finally success at interventional stroke treatment
- better mousetrap to occlude aneurysms (probably glue based/coated coils)
- better intracranial stents

 

[veenut]

is the general path to doing interventional rads just doing the 4-5 yrs of diagnostic rads residency, then a fellowship?

or is there a separate residency for it?

 

[f_w]

is the general path to doing interventional rads just doing the 4-5 yrs of diagnostic rads residency, then a fellowship?

or is there a separate residency for it?

Both.

The 'classic' pathway is 1 year internship, 4 years diagnostic radiology residency (with 4-6 months of interventional), 1 year of interventional radiology fellowship. In the end you are board certified in radiology with a certificate of additional qualification in interventional radiology.

The 'DIRECT' pathway is a 6 year track that rolls 2 years of clinical training (mostly surgery internship+vascular surgery) and 1 year of IR with 3 years of diagnostic radiology. Again, you are board certified in rads with a CAQ in IR.

The DIRECT pathway has only recently developed, I am not sure whether anyone has graduated yet. It expect it to be very difficult as passing the general radiology boards with only 3 years of DR experience will be challenging.

 

[danielmd06]

f_w,

Do you know some good reading sources or websites for the neuroradiology info?

Thanks.

 

[f_w]

f_w,

Do you know some good reading sources or websites for the neuroradiology info?

A good and not to pricey book about neurorad is edited by David Yousem and published in the 'Fundamentals' series:

http://www.amazon.com/Neuroradiolog...rt-Grossman/dp/product-description/032300508X

It is geared towards radiology residents, however if you are an interested medical student you should be able to get some mileage out of it. (you might be able to get a better price at your medical school bookstore or by buying a used copy on amazon)

The American Society of Neuroradiology is famous for their outdated and unhelpful website:

www.asnr.org

(other orgs have a 'interested medstudent' portion or even a junior membership, asnr has nothing of that nature)

A good resource for anything radiology is 'Auntminne':

www.auntminnie.com

It is an industry run website, but you might be able to find something that interests you on their medstudent section.

 

[danielmd06]

Thanks for the speedy reply, f_w.

 

[PaddyofNine]

Hey f_w (or indeed anyone else) - do you forsee any big revolutions in IR in acute stroke therapies? I'm very interested in Neuro IR in particular, but am not really up to date with emerging therapies...

 

[hans19]

Hey f_w (or indeed anyone else) - do you forsee any big revolutions in IR in acute stroke therapies? I'm very interested in Neuro IR in particular, but am not really up to date with emerging therapies...

Not until public awareness of strokes increases. The vast majority of patients don't get seen and worked up within 6-12 hours of onset of symptoms and are no longer candidates for embolectomy. Uncle Freddie started talking funny on thursday, family thinks hes got the flu... still talking funny monday and finally decides to bring him into the ER. Exaggerated example but you get the point.

 

[f_w]

do you forsee any big revolutions in IR in acute stroke therapies? I'm very interested in Neuro IR in particular, but am not really up to date with emerging therapies...

At this point, only a small minority patients can potentially benefit from interventional treatment. Most of the tools are either too slow (ia lysis) or too crude (merci embolectomy) to benefit the majority of patients. In addition, only few patients can get to a center with neuro-IR capabilities within the time window required. People point to cardiology and the emergence of primary coronary intervention as a future model for INR. I have my doubts. Myocardium is pretty hardy and can hibernate on very low perfusion rate. Brain is not half as resilient, most of the damage is done in the first 20 minutes, everything we can do today is damage control.

At this point, primary prevention is much more promising. Eliminate smoking, outlaw diabetes, screen people for hypercholesterinemia, make statins available on a no-cost basis to anyone who needs them, screen patients with carotid ultrasound etc.

 

[PaddyofNine]

So you don't see an acute stroke care team in every city, with a NeuroIR on call 24/7 then? Well, there goes my career plan 😀 Back to the books...

 

[f_w]

So you don't see an acute stroke care team in every city, with a NeuroIR on call 24/7 then?

Ahem, no.

Well, there goes my career plan 😀 Back to the books...

Why would you want to make a career out of being on call 24/7 ?

 

[PaddyofNine]

I don't! 🙄 This thing should have a 'sarcastic' button as well as Bold, Underline and Italics!