I find myself in a similar position to the OP, didn't match into rads where I expected and worry what if I go to the program and find out I really cannot live there so I researched the options and spoke to faculty at my medical school.
1. As to your first question, "should I complete an intern year and reapply?", the match is binding for better or worse. You can get an NRMP waiver for your PGY-2 position either for change of specialty or undue hardship; the latter requires supporting documentation. If you obtained a hardship waiver, you are risking not matching in 2019 and remember rads has been getting more competitive; if you got a change of specialty waiver you would have to give up on rads.
2. You could also start your program in 2019 and if necessary transfer between residencies. While there aren't a large number of them, residencies do post openings. You can find these on FREIDA or APDR. I don't know how hard it is to get accepted as a transfer applicant, but I imagine programs who find themselves with a "hole" would be pretty motivated to take someone on.
3. You seem to be concerned about the possibility of pursuing a career in IR and moving to the Midwest. According to SIR there will be option for a two year independent IR residency after DR residency and that "it is expected that most programs with a current VIR fellowship will also have an independent IR residency." That being said, I have no idea how competitive independent IR residencies will be and whether it would be easy or hard to find an IR position in the Midwest.
Matching low is discouraging and not the unknown--having to live in a new city and work with people you barely know--is scary. I personally will try to give myself time to warm up to my PGY-2 match but I also am not in a situation where the match would cause hardship on my family.
I wish you the best of luck during intern year and with your career in radiology.
