Time to Purposefully Plan Ahead: A Call for Quality in Research

Abstract

Interventional radiology (IR) is a crucible of ideas, invention, and innovation, often born from the on-thespot imagination of an interventional radiologist and then tested in the experience of patients. What usually happens next?—The case report; the series of 10; the validation by others; the large rear-looking series reporting same, variants, or embellishments; cautionary notes of technical advancements; and site reviews of databases to suss out prognostic factors and distinguishing features among patients. This process has worked for years; this has been our standard and our sustenance. What needs to happen more frequently?—Methodical prospective planning and study. We need to take tangible steps to move beyond standard IR research, constituted mostly of retrospective studies of treatments. Yes, we are limited—we do not “own patients”; we participate in narrow aspects of their care. These are shallow surmountable arguments of expediency. Furthermore, they will not build the new, clinical interventional radiologists that we are now graduating. Data quality must advance where possible and be reproducible and abstractable. There are innumerable examples of how prospectively studied therapies reveal worse outcomes than the retrospective reports: (i) The original Dialysis Outcomes and Quality Initiative recommendations for access patency after balloon angioplasty were largely based on expert consensus and retrospective reports. When these recommendations were studied in controlled fashions, clinical patencies of one third to one half were discovered. (ii) The many early articles on transjugular intrahepatic