Interventional radiology Vs Interventional cardiology

[esth0001]

Interventioinal radiologists make more than interventional cardiologists or not?

THANKS

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[f_w]

Somewhat narrow view of the two specialties, don't you think ?

 

[Carb Addict]

I actually agree with f_w, but for what it's worth:

RSNA News

 

[Docxter]

I actually agree with f_w, but for what it's worth:

RSNA News

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

Depending on the survey you'll find different information. Is there a meta-analysis like pooled data on the surveys anywhere?

 

[spyyder]

Do procedures vary between IR and IR Cards or are they virtually the same. Most procedures seem heart related, so does that mean interventional cases will by default be send to Cards? Or is this just arbitrary? If they are both the same, it just seems like if one wants to do interventional, its quicker the radiology way.

 

[MD Dreams]

Remeber, to do IC you have to go through 3 years of IM, 4 years of cards and an additional year of interventional. In other words, you really have to love long term patient management to be able to get to IC. For someone like me who really has a distaste for IM, it is not even an option.

With IR, your main focus is radiology, with varying procedures incorporated into this field. To me it seems like comparing apples and oranges.

Anyway, they both make mad money, at least right now. I think the IC guys have less worries regarding turf battle though, cause they pretty much dominate the heart market.

 

[f_w]

Do procedures vary between IR and IR Cards or are they virtually the same.

IC does:
a. coronary angio
b. coronary interventions (plasty, stents, ia thrombolysis, thrombectomy)
c. renal angio/intervention
d. peripheral angio/intervention
e. carotid angio/intervention

IR does:
c-e plus
- embolization therapy for various applications (pre-op tumors, uterine fibroids, varicocele, pelvic congestion, penetrating trauma, blunt trauma, GI bleeds,hemoptysis, AVMs)
- trans-catheter liver tumor treatment (chemo or radio-embolization of HCC and chemo-resistant colorectal mets)
- biliary intervention (percutaneous biliary drainage etc.)
- GU intervention (perc. nephrostomies, ureteral stents)
- abscess drainage
- tubal re-canalization / tubal occlusion
- percutaneous gastrostomy tubes
- biopsies of various solid organs, lymph nodes using imaging guidance
- image guided tumor ablation (liver, kidney, lung, bone-mets)
- transvenous liver biopsy
- placement of IVC filters
- retrieval of IVC filters
- dialysis access management (intervention on dialysis access grafts/fistulas, Perm-A-Caths)
- venous access (difficult PICCs, central lines, chest-ports)
- catheter directed thrombolysis (arterial bypass grafts, DVT)

(this is not to say that there are no ICs or vascular surgeons offering some of the procedures listed under the IR header. The great majority limits themselves to dabbling into renals, carotids and PVD)

 

[Tedebear]

According to some people on the surgery forum, interventional radiology is an endangered species and will eventually become extinct due to a trent to increase role defining by cardiolgists and vascular surgeons. They hold a very convincing argument. Is there any truth to the assertion interventional radiology will be deceased in the next twenty years?

 

[hans19]

According to some people on the surgery forum, interventional radiology is an endangered species and will eventually become extinct due to a trent to increase role defining by cardiolgists and vascular surgeons. They hold a very convincing argument. Is there any truth to the assertion interventional radiology will be deceased in the next twenty years?

IR pioneered cardiac angiography, which the cardiologists adapted as their own. This forever changed their specialty, as well as that of cardiothoracic surgery.

Vascular surgery is becoming more and more non-operative, and more endovascular. Had vascular surgery not adopted IRs techniques, vascular surgery would have become like cardiothoracic surgeons are today-- looking for work. 🙁

There are always new minimally invasive interventions being developed, usually by interventional radiology. Interventional radiology is steering itself away from cardiovascular disease into oncologic treatments.

But think about it this way, CV disease is no longer the #1 killer, CANCER IS....

IR will be poised to pioneer minimally invasive cancer treatments as well as organ specific, targeted gene therapy. IR will always be the go-to guys for the tough vascular problems that IC and Vascular give up on.
Vascular foreign body? Misplaced caval filter? Better call IR. 🙄

-Hans

 

[medgator]

There are always new minimally invasive interventions being developed, usually by interventional radiology. Interventional radiology is steering itself away from cardiovascular disease into oncologic treatments.

But think about it this way, CV disease is no longer the #1 killer, CANCER IS....

IR will be poised to pioneer minimally invasive cancer treatments as well as organ specific, targeted gene therapy.

-Hans

What about Rad Onc? Some of them are already involved with the radiolabeled monoclonal antibodies. Does IR even have any jurisdiction there?

 

[hans19]

What about Rad Onc? Some of them are already involved with the radiolabeled monoclonal antibodies. Does IR even have any jurisdiction there?

Please elaborate. Radiolabeled monoclonal antibodies for what? Imaging or therapy?

Both are under investigation in nuclear medicine departments at selected institutions.

The role of IR would be in the targeted delivery of gene therapy products- for instance targeting Islet cells in the pancreatic tail for treating DM I (IDDM).

 

[mytirf]

I agree the IR guys are very good at what they do and certainly do many different procedures, but if there was some tough vascular problem, and something went wrong and sent a clot some where or caused an arrhythmia, I'd much rather have the doc with 6 years of taking care of sick patients and hearts than only 1 year and 4 years of looking at films.

Sorry

 

[hans19]

I agree the IR guys are very good at what they do and certainly do many different procedures, but if there was some tough vascular problem, and something went wrong and sent a clot some where or caused an arrhythmia, I'd much rather have the doc with 6 years of taking care of sick patients and hearts than only 1 year and 4 years of looking at films.

Sorry

You are absolutely right. I agree, I don't care what kind of doc you are, if you have a complex arrhythmia, I'd want an EP trained cardiologist to ablate that. IRs and vascular surgeons have no business doing that.

But the ICs I have seen are really sloppy with peripheral interventions. They have 2-3x the rate of retroperiotoneal hematomas, and renal arterial dissections that we do.

As far as 'throwing a clot', I'd rather have the IR guy do the thrombolysis., Vascular surgery asks us to do it all the time. If there was an acute cerebrovascular embolus I would rather have a neurointerventionalist perform the MERCI thrombectomy.

Cardiologists are excellent at treating people with sick hearts. But if your mother had an basilar tip artery aneurysm, you'd still want the cardiologist to do the coiling over the 'film reader' neurointerventionalist?

Sorry

 

[f_w]

According to some people on the surgery forum, interventional radiology is an endangered species and will eventually become extinct due to a trent to increase role defining by cardiolgists and vascular surgeons.

It is changing, thats for sure. The model of the IR sitting in the radiology department waiting for business to come his way is on the way out. There are a couple of very successful practices that have moved to a free-standing surgical type practice model. They manage their patients A-Z and in some cases have hired surgeons to take care of the stuff that can't be done the endovascular route.

Recent medicare billing data showed that the percentage of peripheral interventions done by IR has dropped over the past 8 years or so, but that the marked increase in endovascular intervention overall made up for most of the 'loss' of turf.

As noted by hans, there are plenty of growth areas outside of PVD intervention that more than make up for the change in landscape in peripheral intervention.

I know a couple of vascular surgeons who do peripheral intervention, but none of them offers the full breadth of IR procedures I noted above.

and something went wrong and sent a clot some where or caused an arrhythmia,

If I send a clot somewhere, I take care of it.

As long as you stay out the heart, the potential of kicking someone into arrythmias is rather slim. (and just as the cardiologists have us get them out of trouble at times, we can call on them for a consult if first-line therapies don't do the trick)

You do need a working relationship with someone who can fix an insulted access site for you (if VS gives you an attitude, CT surg or transplant is usually able to help you out).

 

[f_w]

What about Rad Onc? Some of them are already involved with the radiolabeled monoclonal antibodies. Does IR even have any jurisdiction there?

Rad-onc and particularly rad-oncs medical physicists are involved in the treatment planning for radio-embolization procedures at many institutions. This has regulatory and political reasons. I am not aware of too many rad-oncs who have the skill set to do the elaborate visceral angiography and pre-procedure embolization which is an integral part of the procedure.

Radiolabeled antibodies (anti-CD 20) fall into the realm of nuclear medicine (any radiation source you can't 'pick up with your fingers' is part of NM).

 

[medgator]

Rad-onc and particularly rad-oncs medical physicists are involved in the treatment planning for radio-embolization procedures at many institutions. This has regulatory and political reasons. I am not aware of too many rad-oncs who have the skill set to do the elaborate visceral angiography and pre-procedure embolization which is an integral part of the procedure.

Radiolabeled antibodies (anti-CD 20) fall into the realm of nuclear medicine (any radiation source you can't 'pick up with your fingers' is part of NM).

I have met rad onc docs who do use Zevalin and Bexxar.... I think it's a turf battle between the two, but I think most rad oncs aren't interested in it.

 

[f_w]

I have met rad onc docs who do use Zevalin and Bexxar

'Regional practice patterns'

Yes, I know a radonc using Zevalin. But as he is not the 'authorized user' he has the radiologist sign the written directive (depending on whether your state or the NRC regulate your use of isotopes radoncs may or may not administer them on their own).

 

[medgator]

I am curious as to why radioisotopes would be out of the jurisdiction of rad oncs. The residency even requires a certain number of "procedures" in that regard (i.e. giving radioactive iodine, or isotopes).

 

[f_w]

Why is cholecystectomy not part of the practice of urology ? After all, they do 2 years or surgery.

 

[medgator]

Why is cholecystectomy not part of the practice of urology ? After all, they do 2 years or surgery.

I don't get your point.... thats completely outside of the realm of what a urologist does.

 

[f_w]

thats completely outside of the realm of what a urologist does

That is the point.

Nuclear medicine physicians or a nuclear radiologists spend between 18months and 2 years of their training administering open isotopes for diagnosis and treatment. They are the experts on biodistribution and radiation protection with open isotopes (and that is why they can obtain the requisite materials licenses). Radoncs deal mainly with the effects of external beam or sealed source radiation, I doubt that their training in the use of open isotopes goes to the same depth as the nucs folk. I don't doubt that there are rad-oncs with the knowledge and experience to administer open isotopes (just as there are urologists with enough GS expertise to take out a gall-bag), but as the specialties are divided these days, it is not one of their core activities.

As for the training they receive: The RRC requirement is 6 cases of treatment with unsealed sources or targeted radiopharmaceuticals.

 

[tchantel21]

Does anyone here know if it is possible to train into interventional neuroradiology after a neurology residency (and possibly some critical care training in between)?

 

[f_w]

Does anyone here know if it is possible to train into interventional neuroradiology after a neurology residency

Yes, it is possible to do that: 1 year medicine, 3 years neuro, 1 year stroke, 2 years interventional neuroradiology.

 

[HiddenTruth]

Yes, it is possible to do that: 1 year medicine, 3 years neuro, 1 year stroke, 2 years interventional neuroradiology.

What is the path for straight neuroIR from med school?
1 year internship
4 years rads
2 years neurorads
1-2 years neuro IR?

Is that right? Is there another pathway? And, for those of you who have rotated through the service, what's the overall lifestyle like in that field? I'm curious as I recently became interested in the area. Thanks

 

[f_w]

What is the path for straight neuroIR from med school?
1 year internship
4 years rads
2 years neurorads
1-2 years neuro IR?

1 year internship
4 year rads
12 months neurorads (neurorads months from residency can count)
2 years INR
Membership in the ASITN (minimum case#s + sponsorship from senior member)

 

[adeelmd]

I JUST found out I matched into rads today. I want to do INR really badly (it was the main reason I chose rads).... Can you please tell me more about how I can get into inr quicker? Is it 12 months neurorads PLUS your residency months, and can you please tell me more about ASITN membership. now that my next 5 years are set, I want to get some idea on how to get the most out of them.

 

[f_w]

In order to be eligible for a INR fellowship, you have to proove 12 months of training in diagnostic neuroradiology. Originally, this was intended to mean the first year of a 2 year diagnostic neuroradiology fellowship. Now, there are not that many applicants for INR fellowships who come from the radiology end. So if someone is interested in INR, fellowships will often allow you to count some of the neurorad rotations done during residency to count towards this requirement. So if someone has done 8 months of NR during residency, the INR fellowship might set you up with the missing 4 months so you can start your INR training sooner (some residencies will allow you to customize your rotation schedule according to your interests. RRC doesn't allow you to do more than 11 months in any particular specialty, so if you are in one of the residencies that allow emphasis in a specialty, you could potentially go into a INR fellowship directly from residency).

ASITN is the professional society of INRs. In the absence of a formal exam or accreditation for INR, membership in ASITN is often used of a mark of proficiency. Look on ther website http://www.asitn.org/guest/guest.php?page=membership&view=categories
for the criteria for the various levels.
I believe you can become a junior member once you start your training in INR. If your department has a senior member, he/she might sponsor you for this category already during residency.

 

[elazomy]

Radiology is no longer general. There are 7 subspecialities​

Head and neck radiology including neuroimaging and neurointervention​

Cardiothoracic radiology including Echocardiogram, CCTA, Cardiac catheterization​

Abdominal radiology including urogenetal imaging , Endoscopic Us.​

Woman imaging including foetal us​

Pediatric radiology ​

Muscoskletal radiology ​

Vascular and Interventional radiology ​

​

Training throughout Europe is moving towards a three year basic course followed by two years of training in selected subspecialties. After few years we will control the patients by screening programms. we will direct the patients, guide them the and manage them.​

After many years of training in other specialities, some cardiologists, neurologists, and gynacologists leave their specialities and shift themselves to radiology kingdom, they are welcome but we are the law, we are the legality and professionalism …. We are the true radiologists.​

I say to all Rads : "don't worry"​

Radiologists will take over all of medicine​

Let non-radiologists sink in their dreams radiologists are coming J It's our Era.​

>>>​

>>>>​

​

​

Mohamed ramadan​

Radiology resident​

Alexandria Hospital​

Egypt.​

 

[elazomy]

Radiology is no longer general. There are 7 subspecialities​

Head and neck radiology including neuroimaging and neurointervention​

Cardiothoracic radiology including Echocardiogram, CCTA, Cardiac catheterization​

Abdominal radiology including urogenetal imaging , Endoscopic Us.​

Woman imaging including foetal us​

Pediatric radiology ​

Muscoskletal radiology ​

Vascular and Interventional radiology ​

​

Training throughout Europe is moving towards a three year basic course followed by two years of training in selected subspecialties. After few years we will control the patients by screening programms. we will direct the patients, guide them the and manage them.​

After many years of training in other specialities, some cardiologists, neurologists, and gynacologists leave their specialities and shift themselves to radiology kingdom, they are welcome but we are the law, we are the legality and professionalism …. We are the true radiologists.​

I say to all Rads : "don't worry"​

Radiologists will take over all of medicine​

Let non-radiologists sink in their dreams radiologists are coming J It's our Era.​

>>>​

>>>>​

​

​

Mohamed ramadan​

Radiology resident​

Alexandria Hospital​

Egypt.>>​

 

[drjaymehta]

Somebody has posted a topic saying that...

Interventional Radiology is going to become a new speciality i.e it will branch out from diagnostic radiology and will include the clinical rounds and seeing of patients..

If that is true, then all my money is in for Intervnetional radiology....

But I dont know if that is actually true...anyone aware..

 

[gonogo]

Now, there are not that many applicants for INR fellowships who come from the radiology end. So if someone is interested in INR, fellowships will often allow you to count some of the neurorad rotations done during residency to count towards this requirement.

Does this mean that if I go into INR as a radiologist I'd be the outsider? I thought it was mostly radiologists in INR and neurologists were just the exception.

 

[shadowfox87]

Reviving an old thread, sorry, but responses are from years ago and I need to know what the current opinion is. I'm a guy who likes endovascular procedures. I like all interventional specialties. Many things are changing in specialties and new fields are popping up (interventional pulm, nephro). What do you think is the lifestyle differences now in comparison to IR vs IC?

 

[cowme]

both are about as bad as it gets.

GI bleeds/vascular injury and heart attacks love to brew at 2 AM

 

[badasshairday]

both are about as bad as it gets.

Gi bleeds/vascular injury and heart attacks love to brew at 2 am

qft

 

[Dr. USMLE]

both are about as bad as it gets.

GI bleeds/vascular injury and heart attacks love to brew at 2 AM

Not exactly. MIs are much more common than lower GI bleeds that require emergent embolization. Although I agree that the IR lifestyle is not great, it is measurably better than interventional cards. Of the vascular interventionalists, lifestyle: IR > interventional cards > vascular surgery. Also, because pp IR is still largely non-clinical, there are options in IR for routine outpatient procedural practice (with no emergencies), such as in dialysis clinics. The compromise is loss of variety/complexity of cases. Lastly, the option to switch back to DR is unique to IR among the vascular interventionalists. Since they are fundamentally clincial, IC and VS have no equivalent options.

 

[shark2000]

Vascular work sucks because It includes some of the most emergent parts of medicine.

Appears rewarding, exciting and glamerous at first. After doing it for 5 years, everybody gets tired. Similar to ER work.

Just imagine. After studying for 15 years and working 5 years, now at the age of 40 you have to live within half an hour of the hospital to get paged at 2 am to rush into angio suit, wear 8 pound lead and iradiate your whole body.

Agree with the above statement. Radiology has the advantage of switching back to DR work or doing half DR half IR. Regarding lifestyle IR >vascular surgery > IC

 

[supp-2]

In general would imagine IC is still significantly more busy than IR at night/call. For an MI, it's not like the IC comes in and does a cath and goes home (like IR might do for an embolization sent down to them from the MICU). The IC remains responsible for the patient in cardiogenic shock on 2 pressors with a balloon pump and temp pacer all night. You're also often taking general call (ED calls, ACS rule out admits, covering floor patients, consults, patient phone calls).. Can't imagine IR being as busy.. The kicker is though do hospitals have less IR guys taking more frequent call (q2-3) whereas some groups can have a lot of IC (making call q7-10) though q-4-5 still remains more common.

Also although IR can go to DR, IC can always go to General Cardiology as well. Most IC get broad level II and can do echo, nucs, general, ect if they want to hang up the lead.

 

[badasshairday]

In general would imagine IC is still significantly more busy than IR at night/call. For an MI, it's not like the IC comes in and does a cath and goes home (like IR might do for an embolization sent down to them from the MICU). The IC remains responsible for the patient in cardiogenic shock on 2 pressors with a balloon pump and temp pacer all night. You're also often taking general call (ED calls, ACS rule out admits, covering floor patients, consults, patient phone calls).. Can't imagine IR being as busy.. The kicker is though do hospitals have less IR guys taking more frequent call (q2-3) whereas some groups can have a lot of IC (making call q7-10) though q-4-5 still remains more common.

Also although IR can go to DR, IC can always go to General Cardiology as well. Most IC get broad level II and can do echo, nucs, general, ect if they want to hang up the lead.

Lol, you can't read imaging all day as a general cards. Not enough work. Sorry. IR>>>IC. Diagnostic radiology >>IR>>>>>>>>>>general cards. Rather be a hospitalist than do gen cards, PA level work, lol.

 

[badasshairday]

Double post.

 

[badasshairday]

.

 

[bronx43]

Lol, you can't read imaging all day as a general cards. Not enough work. Sorry. IR>>>IC. Diagnostic radiology >>IR>>>>>>>>>>general cards. Rather be a hospitalist than do gen cards, PA level work, lol.

He didn't say all you do is read echos and nucs as gen cards. You think general cardiologists just read imaging all day? PA level work? Lol, ok, whatever you say.

 

[badasshairday]

He didn't say all you do is read echos and nucs as gen cards. You think general cardiologists just read imaging all day? PA level work? Lol, ok, whatever you say.

Yup I said it. You don't need A cardiology fellowship to treat heart failure. CHF = acei, beta blocker. More advance, ok give aldactone and have an ep or interventional guy do pacer/defibrillator implant so they don't die from vfib arrest. Let's use bumex today instead of lasix.


In fact radiologist should just read heart echo because we provide 24/7 imaging service and that stat icu echo needs results at 7pm within an hour of being ordered rather than 3pm the next day, which is what you see in the community.

 

[bronx43]

I think the implication is that (1) general cards sucks and (2) you can't read imaging most of the time so it's not an equivalent option. I.e., IR is significantly better than IC both in nightlife during interventional years and in overall lifestyle after getting that out of your system. Regardless of your preferences, it's definitely true that general cards is saturated with PAs and other midlevels who seem to be able to do the job.

It's also true that the IC pathway of IMx3->cardsx3->ICx1-2 is much less glamorous than the IR pathway of IMx1->radsx4->IRx1-3. Paying your dues in IM is enough to dissuade most competitive applicants. It doesn't contribute much to your future...would be better to do IMx1->cardsx4->ICx1-2 and would probably make cardiology much more competitive.

(1) Ok, not really an argument, so I have no response.

(2) Supp-2 was never making a direct parallel between IC and IR in terms of imaging. He was simply bringing up the fact that IC has an alternative in general cards, and would be able to be hired due to the fact that most have imaging certification. At the end of the day, they're cardiologists. Why would they WANT to read imaging all day?

I will concede lifestyle simpy due to the nature of the job.

Midlevels aren't a big presence in cardiology. There is only one NP that I can think of in our heart hospital, and she's pretty much a secretary for our EP guys. Either way, just because there are mid-levels in cardiology doesn't mean that it is "saturated" with mid-levels. And the suggestion that a NP/PA can do the job of a full fledge cardio attending is just asinine. It reminds me of how general surgeons think they can read abdominal CTs as well as you guys.

I agree that 3 years of IM is too much, but one year is certainly not enough. You simply don't have enough experience with sick patients at the end of internship to be ready. But, I think the same redundancy occurs in radiology. There's no way that I would believe you NEED 4 years of diagnostic radiology to be a proficient IR.

 

[shark2000]

There is no doubt that every field has its own position in healthcare system; pediatrics, radiology, cardiology or trauma surgery. No need to argue. Everybody is different. There are people who like OR, people who like clinic and people who like imaging. On the other hand, there are people who hate OR or clinic or imaging. So there is not a good or a bad field per se.

However, people's interests and priorities in life change rapidly over time. You are not the same person at the age of 20, 30, 50 and 70. The major problem with medicine is long training. You choose to be a doctor when you are 20 and the most productive years of your career is at the age of 40, when you are totally a different person. My IR colleague who has done 100 percent IR for 15 years and has a busy practice, told me that he would change his career to a 100% DR job even with accepting 20-30% pay cut in a heart beat if he were uptodate with his DR skills.

I have come across many surgeons, IR guys, cardiologists and family physicians, who were very passionate about their field once they chose it at the age of 28. However, now at the age of 50 many wish they had a different career. I can say among all fields probably the ones who does not change their career with me in a second are dermatologists and joint replacement orthopods.

Always follow what you like, but also consider that what you like right now, may not be the same in 10 years. Also consider your physical and mental decline over time esp after the age of 40. If you like General cardiology, go for IC. If you like DR, go for IR. Both are good fields. In my biased opinion, I choose Radiology over cardiology any day of the week.

Again, in my biased opinion, if I wanted to choose a procedural field I would choose something with better hours, more outpatient work and less emergencies than IC or IR e.g many surgical subspecialties, derm Mohs surgery or even GI.

Good Luck.