The 2024 statement contains points on clinical scope and practice, training and certification, quality improvement, research, professionalism, and global goals and challenges.
Prof. Morgan read from the opening introduction of the statement: “Our global IR societies must collaborate closely to advance common strategic goals and must continue to promote the field of IR and the treatments we provide as first options for patients whenever appropriate.”
The full statement will be published jointly in CVIR and JVIR.
A focus on clinical care
Prof. Christoph Binkert opened the second session of the programme by giving an update on CIRSE’s vision for the future of interventional radiology.
CIRSE’s vision consists of three pillars: A focus on clinical services and patient care, a focus on therapies and treatment, and a focus on training and excellence in IR. The driving point of Prof. Binkert’s CIRSE presidency, which concluded at the end of CIRSE 2024, was clinical services and patient care. “I think this is the most critical part,” he stated, “If we master that part, all of the other parts will naturally fall into place.”
Under Prof. Binkert’s tenure, a clinical services in IR task force was established; a survey on clinical practice was sent to all CIRSE members (with results presented during the meeting); levels of clinical services infrastructure were defined; educational materials, such as CIRSE Academy courses and webinars on clinical practice, were published; a clinical service slide deck was created; and a social media campaign focusing on clinical IR every Tuesday was established. An IR leadership meeting with representatives of CIRSE’s European group member societies was initiated and will be repeated. Additionally, every day at CIRSE 2024 featured at least one session on clinical care.
The next step of the CIRSE vision honing in on therapies and treatment will be the focus of Prof. Philippe Pereira’s presidency. Prof. Binkert pointed out that a good first step in this direction is amplifying the call for IRs to dedicate as much of their time as possible, and in an ideal case 100% of their time, to providing IR treatments rather than splitting their workday between diagnostic and IR work. “If we can do this, we double our force in a very short time. This could be realistic.” Prof. Binkert feels that the last step, training and excellence in IR, can fall into its rightful place only after the first two points are well-implemented.
SIR President Dr. Alda Tam took the stage with a presentation called “Focus on clinical evaluation and longitudinal care of patients by IR physicians,” which gave a reflection on the SIR’s strategy in the US by which the American IR community achieved specialty status for interventional radiology
American interventional radiologists fought for an independent specialty by presenting the changes and shifts that IR has undergone to the American Board of Specialties. They argued that IR is a unique skill set, the procedural complexity has increased, and that longitudinal patient management has become an essential responsibility of IR physicians. “How we convinced the American Board of Medical Specialties was our argument that better trained IRs lead to better patient care,” Dr. Tam stated.
She presented action items; from training items to pathways to curricula, American IRs had to rework every aspect of their approach in the endeavour for specialty status. These actionable items, collected from interviews with more than 70 IRs, trainees, and support staff across the United States, were compiled in an article titled “Opportunities for Excellence in Interventional Radiology Training: A Qualitative Study.” She pointed out that, independently, SIR and CIRSE have come to the same conclusions as to which areas to prioritize.
Dr. Tam read out a quote from the paper: “The word ‘clinic’ and the word ‘clinical’ are just the same as the word ‘car’ and ‘cart’, three letters similar, both modes of transportation, but very different.”
“I think we need to be more specific about what it means to be clinical.” She said, “I think it would be an interesting point to either solidify that definition across the globe, or actually include more details on how we can all get to an appropriate clinical schedule.”
She ended with strong words: “A clear and concise message is one that cannot be lost in translation. IR practice must be synonymous with clinical evaluation and longitudinal care. Part of these sessions, the global summit, the global statement, is to engage the leaders around the world in IR to get to this point.”
Views from the audience
The presentations during the summit evoked a variety of thoughtful and insightful comments from the multi-national audience.
“In my practice, I’ve given up talking about procedures themselves to the public.” stated Dr. Denis Szejnfeld, SOBRICE President, “I talk about the disease … nobody knows about fibroid embolization, just those who are looking for it… I just say minimally invasive, for fibroids, for enlarged prostates, and then the patient can clearly see if it’s for them or not.”
Prof. Sofocleous added – “We are not enough people to be everywhere… but we should really control imaging after a procedure, for at least a year if not longer. For my cancer patients, I see them all for five years.” He reiterated that talking to patients about the disease itself is important, and seeking out patient alliances for specific diseases can be an important way to increase reach.
Prof. Binkert echoed the first two comments and expanded on them. “Once you start referring patients to others … you do this a couple of times and this goes miles. Suddenly you are not the enemy, you are a colleague, and they think twice about trying to “kill” you because you send patients to them. To use hard language, referring patients is an extremely strong weapon in this turf battle.”
Dr. Tam said that she also does not hesitate to refer to other specialties, and that it has lead to her performing a lot more combination cases with colleagues from neighbouring specialties. “I think this is important, because the imaging equipment no longer belongs to us. The ORs of the future are going to have everything that we have in our room … if we’re not in the mix, or part of the team, I think you’re going to see a lot more “turf” problems…the more I’m in there helping ortho, or doing a lung procedure, the more we are continually sharing patients and doing the best thing for the patient.”
A paediatric IR from the United States shared her unique challenge in this realm: “A lot of people aren’t necessarily paediatricians becoming interventionalists, and I don’t always know what the clinical comfort level is with managing them outside of that. I’ve found that collaboration and working with our hospital and services has been the best way to manage our paediatric patients. I’m both; I was a paediatrician before I was an interventionalist, and I can see that there are a lot of gaps to fill, but this is the right direction.”
Prof. Morgan pointed out that not everybody is able to practice clinically, and opened the floor for comments from physicians experiencing barriers to clinical practice in their countries.
Dr. Sheyla Carolina Alfaro Ita of Peru shared that she had only started an outpatient clinic in her hospital last year, after facing great default with management telling her that radiologists should not have consultations and remain only diagnostic. Having won consultations, she is now trying to get beds for IR-exclusive procedures.
Prof. Bien Soo Tan spoke about his experience in Singapore, where his department is the only stand-alone interventional radiology department in the country. “The expectations of residences rotating through us are very different, because when they go to another residency rotation, the clinical aspect is not so intense. They seem to think that the experience of IR is mainly about being in the procedure room and not seeing patients in the ward. The journey is hard, but we need to work at every single aspect to win everybody over, because this is the way to go.”
Dr. Fabian Gaupp, a Yale physician and co-founder of Road2IR who has worked in Tanzania added a unique perspective: “There can actually be an advantage if you start from scratch, because then you can build things the way you think it should be done. Actually, in Tanzania they do a much better job [at clinical practice] than we do at some hospitals in the US. They have IR clinic all day every day.”
A doctor from India pointed out the constant pressure that funding issues pose globally, especially with regards to training, and in particular when larger international organizations such as the WHO don’t yet seem to have interventional radiology on their radar.
“Every continent has the same problems” stated Dr. Ajit K Yadav, ISVIR Secretary, “But every continent has different types of practice and different medical guidelines. The questions we are asking are uniform globally, but we have different diversities in our practice and guidelines.” He explained that it is proving difficult to detach interventional radiology from radiology in India, in spite of good guidelines, and that countries facing an extreme lack of training and patients who cannot pay for treatments are not in the same position as countries who are advanced enough to be able to focus on topics such as SOPs and standardizing training. “Every solution is not fit to every country.”
At the end of the session, Dr. Riddhi Borse, a trainee from Mumbai who has trained at Yale and is now at MGH in Boston, expressed her wish to add a voice from the next generation to the conversation. “The beauty of this conversation is that it lays out so many different models. Although each country and each area have their own nitty-gritties, the beauty of it is that in some parts of the world everything clicks and creates magic. To be able to have access to the blueprint and then to replicate that … saying it worked at x so it might work at y, even having access to these ideas is, I believe, the success of this global summit.”
Both parts of the Global IR Summit at CIRSE 2024 are available to watch on demand via the CIRSE Library, and similar meetings are being planned for the future.
