Anna-Maria Belli, Professor of Interventional Radiology at St. George’s Hospital in London, UK, will be presented with the Gold Medal of the European Society of Radiology today. Ahead of the ceremony, she shared her views on which directions interventional radiology should take.
Interventional radiology (IR) procedures initially broke into the field of peripheral arterial disease by opening up blocked arteries and establishing angioplasty as a valid, alternative, minimally invasive therapy for those either unfit or unsuitable for standard bypass surgery. It has now become an accepted therapy, replacing open surgery in many situations and responsible for saving limbs from amputation.
As experience and skill with arterial catheterisation advanced, so did arterial embolisation, which is used with the opposite intention from angioplasty by selectively occluding arteries. Initially this was an emergency procedure used to treat life-threatening haemorrhage, making it difficult to train in. However, with its expanded indication in the treatment of vascular tumours, it has become a common elective procedure and it has been one of Belli’s special areas of research during the four decades in which she has practised as an interventional radiologist. “Embolisation is now an alternative treatment which may replace standard surgical options, e.g. in the treatment of fibroids and benign prostatic hyperplasia,” she said.
Non-vascular interventional radiology has also grown in leaps and bounds, particularly in the management of cancer with interventional oncology. “The new technologies being introduced into interventional oncology are amongst the most exciting developments and indicate a very strong future for IR,” she believes.
Although advances in the technology and application of IR have been spectacular, the subspecialty faces serious threats.
It is of paramount importance for interventional radiologists to take clinical responsibility for managing patients and not act as technicians at other clinicians’ request. “That is simply no longer acceptable, if it ever was,” she said.
Interventional radiologists understand the imaging as well as the clinical and technical role of the therapies they offer. They are consulted for their expertise and have the best understanding of the risks and benefits of their treatments. Therefore they need to see their patients in a clinical setting before and after intervention. “This can be a challenge, as, historically, radiology departments have not been set up with this in mind,” she admitted.
Another issue is the lack of candidates to take up the torch, as insufficient trainees come into the specialty. Their absence is felt particularly strongly in the UK, where a lack of trainees and manpower has become a challenge for diagnostic and interventional radiology services, but this is also true for the rest of Europe.
Belli believes the unclear training pathways and onerous emergency duties, as a consequence of inadequate numbers, may be putting off aspiring candidates. “A clear training path for those who wish to become IRs would attract the more surgically minded junior doctors and prevent them from selecting other surgical specialties,” she explained.
One thing is certain: unless IR has adequate numbers to support major centres and the ability to offer a 24/7 IR service, it will lose ground to other specialties.
Another very serious challenge is attracting more women into the field. Currently, only about 10% of IRs are female, and this percentage is only slowly increasing. With less than 50% of medical school graduates being female, the community needs to address this problem urgently.
Belli was the first, and so far only, female president of the British Society of Interventional Radiology (BSIR), as well as the first female president of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). In her time as president, she created the Women in IR session at CIRSE 2017, and she says the society continues to prioritise this issue.
Empowering women to take on leadership roles is helpful, but, as in many other industries, practical solutions are required to get more women interested in the field. “I think the key is developing flexible training and working schedules. At the moment 80–90% of all IRs work full time, yet we know that women in particular favour flexible working arrangements.”
Belli also blames a disproportionate fear of exposure to radiation for the lack of interest amongst women medical graduates. Radiologists understand how to minimise exposure both for workers and patients, and it is part of their role, but they also need to educate medical students and young doctors who are considering their career options. “No-one should suggest to a woman that she should not become an interventional radiologist because she will be exposed to radiation. This is a form of discrimination, as is the prevention of women performing IR procedures whilst pregnant. The evidence shows that radiation doses are negligible with modern equipment and good technique,” she insisted.
A dedicated interventional radiology (IR) programme will again be held at the ECR in the Cube, a new addition that attracted lots of delegates last year. Spreading over 700m² of floor space in the Mélia Hotel Vienna, the Cube 2.0 will once more provide an engaging, hands-on introduction to the fascinating world of IR, with four main themes, one per congress day: peripheral IR, central IR, oncological IR and neurological IR. Friday, March 1 will notably feature five interactive sessions on oncological IR, with opportunities for participants to simulate oncological interventions.
The Cube is also cooperating with the European Federation of Radiographer Societies (EFRS) and radiographers are very welcome to take part. This ‘Silicon Valley’ of IR education is sure to make a big splash at ECR 2019!