Who are Interventional Radiologists?Radiologists are licensed and medically-trained physicians who specialize in diagnosing patients with the guidance of medical images. A radiologist is adept and knowledgeable in producing the optimal image using cutting-edge imaging technology. To become a radiologist, an individual must complete four years of medical school, followed by a two-year internship program and a three to seven-year residency. Radiologists may go through a two-year fellowship to become interventional radiologists. The number of years it takes to become an interventional radiologist may range from ten to thirteen years. Interventional radiologists specialize in performing treatments, following a diagnosis made through medical imaging. Depending on their training, interventional radiologists may specialize in one or more medical fields, including neuroradiology, nuclear medicine, pediatric radiology, interventional oncology, cardiology, and pain medicine. Individuals looking for interventional radiologists may refer to the Society of Interventional Radiology (SIR). This nonprofit organization may help patients look for a radiologist specializing in a particular field. SIR members who are looking for fellowship training may also refer to SIR Fellowship (FSIR) programs. Interventional radiology procedures are divided into two classifications according to purpose (diagnostic or therapeutic). Some diagnostic radiology techniques can also be used as therapeutic procedures.
Interventional Radiology (IR) Procedures
- Ablation is a procedure wherein dead tissues or tumors are destroyed by inserting needles through the skin.
- Aspiration is the retrieval of fluid or tissue samples by inserting a suction needle into a lesion, cysts, or tumor. Aspiration procedures are guided by fluoroscopy, MRI, CT, and ultrasound.
- Balloon-occluded retrograde transvenous obliteration (BRTO) is used to prevent gastric variceal bleeding.
- Biopsies use the guidance of ultrasound or CT for accurate needle placement into the organs. The needle collects tissue samples to allow doctors to evaluate the disease.
- Catheter and stent insertions are commonly guided by X-ray images. However, some procedures may also use CT or MRI.
- Catheter and stent insertion is useful for removing blood clots in vascular structures (angiogram).
- Corticosteroid injections on tissues and muscles help relieve pressure, pain, or blockage caused by inflammation. This procedure uses ultrasound images as guidance.
- Closure devices are an alternative to manual compression (usually taking four to six hours) of catheter insertion sites upon completion of IR procedures. This device allows the patient to move immediately after the procedure.
- Embolizations use small resin particles that block blood flow in affected vessels. This procedure helps save patients from blood loss.
- Foreign body retrieval uses a snap wire loose system to retrieve materials left inside the body during IR procedures.
- Gastrostomy is performed by inserting a tube into the stomach. This procedure is performed with the guidance of an ultrasound.
- Hemodialysis access maintenance keeps the blood vessels and veins clear from blood clots or from becoming narrow.
- Percutaneous drainage uses a catheter to remove fluid, abscess, or air with X-ray or ultrasound guidance.
- Thrombolysis uses a catheter to administer the medication directly to the blood clot. This procedure is used on blood clots on lower limbs and organs.
Interventional Radiology (IR) Treatments
- Angioplasty is a procedure wherein a stent or sheath is inserted into the vein. A balloon is inflated at the blockage site to decongest the blood vessel.
- Ascitic tap is used to drain fluid in a cavity, particularly the abdomen. This procedure is done to relieve pressure and pain or to analyze fluid for infections or diseases.
- Biliary drainage is a procedure wherein a stent is inserted through the skin and into the liver. Bile storages are present in the liver and gallbladder. Sometimes, the bile duct system can experience obstruction. A biliary drainage procedure uses X-ray images as guidance to relieve the ducts from congestion.
- Bursal injections use needles to administer corticosteroids into the bursa, relieving inflammation or pain.
- Carotid stenting is used to increase blood flow in the brain. Obstruction of the carotid artery reduces blood flow to the brain, which may lead to a stroke.
- Carpal tunnel ultrasounds can be used to diagnose carpal tunnel syndrome. The carpal tunnel contains the median nerve, which is prone to compression.
- Cervical nerve root sleeve injections are used to treat arthritis pain or prolapsed discs by administering corticosteroids on the cervical nerve.
- Chemoembolization is performed by injecting the chemotherapeutic drugs directly into the tumor. This procedure requires guidance from X-ray images.
- Endovascular treatment for cerebral vasospasm is used to prevent a ruptured aneurysm. The blood released into the brain can cause compression on the arteries, resulting in decreased blood flow (vasospasm).
- Inferior vena cava filters prevent blood clots in legs from moving to the heart and lungs.
- Lumbar epidural steroid injections relieve the patient from chronic back pain or leg pain. CT or MRI guides this procedure for accurate needle placement.
- Lumbar nerve root sleeve injections are used for back and leg pain caused by compression on the nerve. CT images are used for this procedure.
- Nephrostomies are procedures that allow urine drainage in the event of a blocked ureter. A needle is inserted into the kidney with the guidance of an ultrasound.
- Pleural aspirations are done to remove fluid in the lungs. This procedure can be guided by X-ray images, chest CT, or an ultrasound.
- Radiofrequency ablations are non-surgical and minimally invasive procedures that use heat to stop or reduce pain.
- Radioembolization is a treatment for liver cancer. This procedure uses X-ray images to guide the insertion of micro radioactive spheres into the liver and destroy cancer cells.
- Uterine Fibroid Embolization (UFE) is performed to reduce benign tumors’ blood supply in the uterus.
- Vertebroplasty is performed by injecting polymethylmethacrylate (plastic cement) into damaged vertebrae.
Interventional Radiology (IR) BenefitsIR allows physicians to diagnose and treat certain conditions without the need for open surgeries. The absence of surgeries means patients go through less pain and shorter recovery time. Depending on the condition, some procedures do not require hospital stays. Moreover, non-invasive procedures have less risk of complications. Many IR treatments are preventive measures for arterial diseases’ lethal outcomes, such as heart attacks, limb infractions, and ruptured aneurysms. Moreover, in the event when traditional surgery or invasive treatments are too dangerous, IR treatment options may be presented.
Job Description and Average Salary of Interventional RadiologistsAccording to the 2016 survey from the American Medical Group Association (AMGA), radiology is one of the highest-paid specialties in medicine (1). In the United States, full-time radiologists earn an average annual salary range of $592,750 to $610,500. Interventional radiologists’ salaries vary according to years of experience and location. Depending on the cost of living, the base salary may be higher in larger states (New York, Florida, Michigan) compared to smaller states (Iowa) (2). Radiologists and interventional radiologist jobs have higher job outlooks than other healthcare professionals due to the growing demand for diagnostic imaging services (3). Related job titles in radiology, such as radiologic technologists (radiographers), also have an increasing job outlook (4). Radiographers specialize in operating imaging equipment. Interventional radiologist’s job description includes analyzing patient records, preparing a comprehensive report, performing treatments following a diagnosis, and having excellent patient care. Attending annual scientific meetings and in-trainings among health professionals are also part of the job description. Due to the influx of new imaging technologies, radiologists are obligated to learn, review journals, and undergo training continually. They can do this by registering with radiological societies, such as the Radiological Society of North America (RSNA) and the Society of Interventional Radiology (SIR). Interventional radiologists may also review scientific papers from the Journal of Vascular and Interventional Radiology (JVIR). The JVIR provides updated news on therapeutic interventions, disease management, and techniques. The SIR Foundation also conducts annual meetings or virtual meetings to keep interventional radiologists updated on innovative therapies. Medical students and radiologists interested in becoming interventional radiologists may refer to the Society of Interventional Radiology website at www.sirweb.org.
History of Interventional Radiology (IR)The first arteriograms were performed in 1953 when surgeons presented an ingenious method to look at the vascular system without surgery. A catheter was used to inject sodium iodide into blood vessels. The sodium iodide would be distributed into the vascular system and become visible through X-ray (5). This procedure became a clinical practice that was developed during the ‘60s and ‘70s. Some hospitals called it a “specialty procedure” or “angiography.” The objective was to evaluate tumors, blood vessels, veins, lymphatics, tissues, or organ structure (6). During its beginnings, the purpose of the procedure allowed physicians to study the condition, conduct vascular mapping, or search for trauma before a surgical procedure. Interventions were non-existent at the time. In 1963, the first scientific paper for the IR procedure was written by Dr. Charles T. Dotter. The article mentioned the potential of using catheters to perform intravascular procedures (7). By the mid-‘70s, the transcatheter techniques became a standard practice. These IR procedures were angioplasty, embolizations, and vasoconstrictor infusions (8). The technique of arterial angioplasty would continue to be accepted throughout the medical community. By 1980, therapeutic procedures in radiology were introduced (9).
ConclusionMedical imaging allows interventional radiologists to improve a patient’s quality of life without invasive procedures. Due to new technologies, new techniques are regularly introduced. Interventional radiologists must continuously keep themselves updated in the latest advancement in medical imaging and therapies. The future of interventional radiology is expanding, and job outlooks are also rising due to increasing demand (10). All these factors are why interventional radiology is considered to be at the forefront of modern medicine (11).
- American Medical Group Association. Productivity Survey. Retrieved from https://www.amga.org/performance-improvement/best-practices/benchmarking-surveys/compensation-survey/
- US National Labor Statistics Prediction. Retrieved from https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-6
- US National Labor Statistics Prediction. Retrieved from https://www.bls.gov/ooh/healthcare/radiologic-technologists.htm#tab-6
- Brooks B. Intra-Arterial Injection of Sodium Iodide: Preliminary Report. JAMA. 1924;82(13):1016–1019. doi:10.1001/jama.1924.02650390006002
- Murphy, T. P., & Soares, G. M. (2005). The evolution of interventional radiology. Seminars in interventional radiology, 22(1), 6–9. https://doi.org/10.1055/s-2005-869570
- US National Labor Statistics Prediction. Op cit.
- Midulla, M., Pescatori, L., Chevallier, O., Nakai, M., Ikoma, A., Gehin, S., Berthod, P. E., Ne, R., Loffroy, R., & Dake, M. (2019). Future of IR: Emerging Techniques, Looking to the Future…and Learning from the Past. Journal of the Belgian Society of Radiology, 103(1), 12. https://doi.org/10.5334/jbsr.1727