what all are the procedures done by the interventional radiologist....
what is the difference between an interventional nephrologist, gastroenterologist, pulmonologist etc when compared to an IR..
IR is a changing field which is facing turf battles with other speciaties. Why? Because what we do works, some of it better than what they have and now they want it for themselves.
Interventional pulmonology - tracheal/bronchial stents, Denver catheter
GI - esophageal, colonic, duodenal stents
Nephrology - Dialysis access, tunneled catheters, AV Fistula / Graft declots
Vascular surgery + Cardiology - angioplasty, stents, stent grafts, IVC filters, carotid stents
Surg/Onc- ports for chemotherapy (easy to do and lucrative)
Neurosurgery/Neurology - transcranial doppler, endovascular repair of avms and aneurysms
Interventional pain - kyphoplasty, facet injections
Orthospine - kyphoplasty
The difference is that pretty much all of these procedures were
developed by radiologists. All of the first four categories can be done by an IR. But any one of the subspecialists listed cant really do what any of the other subspecialist does.
The last three can be performed by a neuro IR.
In addition these are things only done by IR:
Fibroid embolization competes directly with myomectomy or hysterectomy, but OB does not perform UFE.
Chemoembolization/Y90 Radioembolization/RFA/Cryoplasty are complementary what Surg Oncs do when a patient is not a candidate for surgery. Portal vein embolization, can get make a non operable patient a candidate for potentialy curable resection.
In addition to the above an Interventional radiologist performs cross sectional image guided biopsies, abcess drainages, which are less invasive to patients then the open surgical alternatives.
When Urology can't get their stent in from below, or they need urinary diversion to heal a ureteral injury, or access for lithotripsy, they call on us to do a perc neph. We can snag their stents from above, or even put in a double J stent from above.
PTC/biliary drainages compete with ERCP when the GI doc cant get his stent in from below.
TIPS competes with splenorenal surgical shunt creation for portal hypertension. Actually I don't think any surgeons perform them any more, patients just bleed like stink.
IR now and in the future:
IR didn't become a specialty in its own right until about 30 years ago, but its definitely here to stay. You want to see the future of IR? You don't necessarily have to be in a podunk town to practice the kind of IR you want. Look at these guys...
www.endovascularsurgery.com
These are IR CLINICIANS that happen to be radiologists by training. I saw their website 2 years ago when they first started, it was just Padidar and Reza. At that time the website was very basic. Its now a first rate production. Now they brought in other IRs and even vascular surgeons that work for THEM. The ancillary staff has more than doubled in size. They brought in an consultant to help expand theire business. These guys are doing VERY WELL and doing almost exclusively high-end cases in a competitive market (Bay area). This is just one example that IR is alive and well with a bright future.
IR IMO is one of the coolest gigs in all of medicine.
The proof is that the cardiologists, vascular surgeons, neurosurgeons, neurologists, now 'interventional nephrologists' and 'interventional pulmonologists'... they all want to learn to do what we've developed and have already been doing...
Now that I am coming to near the end of my IR fellowship-- Just like the first day of fellowship, I still look forward to going to work everyday.
