IR receives subspecialty status in Portugal!

January 12, 2024

After years of efforts from Portuguese IRs, the General Assembly of the Portuguese Medical Association officially approved interventional radiology as a subspecialty in Portugal in December of 2023. Additionally, the EBIR exam will become a cornerstone for Portuguese IRs.

APRI, the Portuguese Association of Interventional Radiology, was founded in 2018 with a goal of promoting awareness and accreditation of IR in Portugal. Subspecialty recognition marks a great step forward and a victory for interventional radiologists throughout Portugal.

In order to make this goal a reality, APRI members Dr. Belarmino Gonçalves, Prof. Tiago Bilhim, Dr. Paulo Vilares Morgado, and Dr. Alfredo Gil Agostinho formed an IR subspecialty working group at the behest of the Portuguese College of Radiology. These four IRs represent most of the major interventional radiology centres in Portugal, and as contemporary colleagues have developed their careers with a similar vision for the future of interventional radiology in Portugal. We spoke to the working group to learn more:

CIRSE: Portuguese IRs split from SERVEI to form APRI in 2018 – can you tell us what the push was at the time to find your own society? What impact has having your own society had on the development of IR in Portugal?

APRI: In the early years of the past decade a few IR centres started to push IR and to ensure a proper training for  residents and young specialists. IR was almost forgotten in radiology congresses and there were only a few dedicated talks in radiology meetings. At the beginning, APRI was created to separate interventional clinical radiologists from other specialists,  and to join young people with the most experienced IRs. After some years of our young society, the membership of many skilled IR colleagues has led to countrywide acceptance and support of our society. APRI’s successful meetings and CIRSE support empowered the need for the subspecialty.

APRI has been a CIRSE group member since its beginning. Can you elaborate on how your membership has been beneficial both to APRI and to CIRSE?

With APRI’s creation in 2018, the already strong CIRSE membership in Portugal became even more firmly established. Portuguese CIRSE members almost tripled and young residents became very aware and enthusiastic about IR. Together both, societies translated and adapted the IR Syllabus and Curriculum into Portuguese and it is now readily available to other Portuguese speaking countries. Partnerships were created for CIRSE congresses, and CIRSE Academy became available for all members. We also hope in the future to increase EBIR certification among Portuguese IRs and to also have the EBIR exam in Portuguese.

The four of you formed a subspeciality working group – how has this group worked to ensure IR would become a subspecialty in Portugal? What role has CIRSE played in this effort?

This working group was formed by the Portuguese College of Radiology as part of the Portuguese Medical Association. This group included four IR representatives of big IR centres in Portugal. We worked together for the same goal, having several meetings, lobbing with colleagues, and ensuring a proper internal IR certification programme after concluding a radiology residency. After several joint meetings, a full IR subspecialty programme was presented to the Portuguese Radiology College and submitted for approval. Of course, IR awareness, IR recognition and patient needs came first. Our daily job, multidisciplinary hospital meetings, IR departments and units, IR advertising, APRI creation and CIRSE IR curriculum support played a huge role to have become accepted as an important part of radiology and medicine.

CIRSE, as a large organization representing interventional radiology, is the main scientific, pedagogical, educational support and stimulus for the creation of the IR subspecialty. CIRSE helped in providing the political and organizational backbone needed to overcome obstacles in achieving subspecialty status.

What role will the EBIR now play in IR certification in Portugal?

The EBIR exam will be a cornerstone certification to ensure highest standards of quality for all newly formed IRs in Portugal. Due to national laws, we cannot make it mandatory, but all candidates for IR subspeciality status that hold the EBIR certificate will only have to go through a curriculum evaluation and will not need to undergo a theoretical examination. Those who do not have an EBIR certificate will have to pass a national theoretical and practical exam.

How do you expect that subspecialty status will change the landscape of IR in Portugal?

This is a great question and it was addressed during our national IR meeting last October. This question goes round two ways: 1. Radiologists that perform some IR procedures are worried that they will not be allowed to perform IR anymore; 2. Only very few will be able to perform IR – not enough human resources. As for point number 1, IR certification in Portugal is not intended to exclude radiologists. This means that we will not be monitoring radiologists who do not possess the title and will not prohibit radiologists who do not have an IR subspeciality certificate from performing IR. An IR certification will be a plus, an added value, a tool that radiologists can use to assure a quality education and certification. It is not intended to reduce IR manpower, it is intended to elevate the quality of clinical care and certify IR manpower in Portugal. One can expect that progressively, over the next years, more and more IRs will have the IR certificate and will eventually comprise the majority of IRs practicing in Portugal. This window of opportunity will probably attract more and different medical students into radiology residency, aiming for IR, and will naturally change the national landscape of practicing IRs with more clinical and interventional skills.

It is a common belief that the existence of IR as a sub-specialty is the biggest driver for the development, financing and affirmation of IR both in Portugal and around the world.