Interventional Radiology Physicians Research Articles

Abstract No. 175 Efficacy of multidisciplinary physician panels in increasing student awareness of the role of interventional radiology in the treatment of pulmonary embolism

To assess the efficacy of a Pulmonary Embolism Response Team (PERT) physician panel event in introducing medical students to the multidisciplinary treatment of pulmonary embolism (PE) and exposing students to the role of interventional radiology (IR) in the management of PE Medical students were invited to a PERT multidisciplinary physician panel event with attending representation from pulmonology, vascular medicine, and interventional radiology. The event began with a brief overview of the pathophysiology of PE followed by interactive cases with audience polling and panel discussion. Attendees were instructed to complete a pre-panel and post-panel survey to assess knowledge of the pathophysiology, clinical evaluation and treatment of PE and to gauge student understanding of each specialty’s role in a PERT. Likert scores (from 1 to 5) were used to quantify changes in pre- and post-survey results. Paired t-test was used to determine statistical significance. A total of 20 medical students (MS1-50%, MS2-25%, MS3-20%, Other-5%) attended the panel. Survey results revealed a significant improvement in student understanding of the goals and operations of a PERT from pre- to post-panel: 2.4 to 3.9 (P < 0.001). No significant differences were noted regarding student interest in the multidisciplinary practice of medicine. Student ratings of confidence in their knowledge of the pathophysiology of PE improved from 3.0 to 3.8 (P < 0.001). This is supported by a 46% increase in mean content quiz scores after the panel. Notably, students performed better on questions testing knowledge of PE pathophysiology and risk-stratification (33% improved to 83% correct; 56% improved to 94% correct). Student reported knowledge of the role of IR physicians in a PERT increased from 2.4 to 3.9 (P < 0.001) following the event. Student reported knowledge of the role of pulmonology and vascular medicine in a PERT also increased, from 1.9 to 3.9 (P < 0.001) and 2.1 to 3.6 (P < 0.001), respectively. Multidisciplinary physician panels tailored to medical students demonstrate significant potential in promoting interest in multidisciplinary medical practice and filling in knowledge gaps. Our experience suggests that the case-based format with attending physician representation is an effective method to engage and educate students regarding the multidisciplinary teams that IR physicians work within and the diseases that IR helps treat. Additionally, the interactive aspect of the event with live audience polling and follow-up panel discussion may have contributed to student content retention.

Abstract No. 470 “Day in the Life of IR” YouTube Series: recruiting undergraduate and medical students to interventional radiology

The “Day in the Life of IR” video series was developed by the Society of Interventional Radiology (SIR) MSC PR and Communications Committee to generate interest and promote the field of interventional radiology (IR). This series aims to expose undergraduate and medical students to IR physician perspectives of a typical day. As IR continues to grow as a specialty, it is essential to promote awareness and recruit future generations of physicians to this innovative field [1,2]. Currently, it is difficult for undergraduate and medical students to shadow IRs in hospitals, depending on COVID-19 protocol, so the video series gives students a glimpse at what an IR does.

Temporal and geospatial variations among the interventional radiology physician workforce in the United States

ObjectiveTo analyze the temporal trends and state-wide geospatial variations in Vascular and Interventional Radiology (VIR) workforce in the United States. MethodsThe State Physician Workforce Data from the AAMC website was accessed for years 2015, 2017, and 2019. The variables collected for each state included total number of active physicians, total number of physicians per specialty and total number of female physicians in VIR. Comparative data was obtained for vascular surgery (VS), diagnostic radiology (DR), and radiation oncology (RO). The annual growth rate for total physicians and sub-analysis of female physicians in each state was computed for each specialty. ResultsFrom 2015 to 2019, the total number of active physicians in the United States grew by 1.8% per year. Growth of active physicians in VIR grew by 8.3%, DR 0.06%, VS 4.4%, and RO 1.9% per year. Colorado and Minnesota had the highest growth rate for VIR physicians (15%). VIR physicians per 100,000 people increased from 0.84 (2015) to 1.10 (2019) in the US. In comparison, VS physicians increased from 0.99 (2015) to 1.14 (2019), DR physicians decreased from 8.61 (2015) to 8.43 (2019), and RO physicians grew from 1.48 (2015) to 1.56 (2019). Women represented 6.8% of the VIR workforce in the US in 2019 and increased by a rate of 16% annually in the US from 2015 to 2019. In comparison, the number of women in VS has grown by 21%, DR by 2%, and RO by 2.4% during the same period. The state of Maryland has the highest proportion of women in VIR at 18%. ConclusionThe number of VIR physicians is increasing at a higher rate than the national overall physician growth, and while female VIR physicians makeup a small fraction of the VIR workforce, their numbers have increased at a faster rate than overall VIR physicians.

Transradial Access: A Comprehensive Review

Transradial access (TRA) via the left radial artery is an alternative to traditional transfemoral access for catheter-based procedures that is becoming increasingly more relevant in all types of arterial vascular interventions. First investigated in the realm of cardiology, TRA has been proven to provide many benefits (such as lower complication rates, lower cost, and improved patient comfort during and after the procedure) when compared with traditional femoral access while maintaining efficacy. This article provides an in-depth summary of the technical aspects of radial access while incorporating more recent data to explain patient preference for TRA, and the ways that TRA can improve peri-procedure workflow and compensation. It also describes potential complications, such as radial artery spasm, difficult anatomic variants and radial artery occlusion, and then gives techniques for mitigating and treating these complications. The article explains why TRA has become an important option for vascular and interventional radiology physicians, and why it is likely that this will continue to grow in relevance.

Examining Twitter use in interventional radiology: A comparison with cardiology and orthopedic surgery

Objectives: The objectives of the study were to characterize the similarities and differences in amount and quality of user engagement on Twitter between interventional radiology (IR), cardiology, and orthopedic surgery and identify trends in Twitter use by the IR community. Material and Methods: General specialty hashtags and groups of users were identified for IR, cardiology, and orthopedic surgery and used for stratified searches of tweets using Symplur Hashtag Finder over a 5-year period. Analytics for total statistics, associated hashtags, common words, total Twitter activity, and a network analysis were obtained for predefined user groups. Results: A total of 278,866 IR, 420,021 cardiology, and 106,684 orthopedic surgery tweets were analyzed. IR had the highest percentage of retweets, media files, mentions, and replies. Between physicians, IR had fewer users than cardiology and orthopedic surgery but a greater percentage of users tweeting at higher volumes compared to cardiology and orthopedic surgery. IR had greater average interactions per user than cardiology and orthopedic surgery, but IR overall had a lower percentage of tweets by organizations. Conclusion: Social media activity in IR demonstrates substantial interaction and engagement despite having less users than cardiology and orthopedic surgery. Most of this activity was noted to be between IR physicians, while the other two specialties had more interaction with users unrelated to the medical field. These data provide insight into the nature of Twitter users within IR; being aware of these results could motivate users to increase their own interactions with patients and members of the public sphere.

Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity?

This review suggests that there is a critical need to renew understanding of adverse events and complications within interventional radiology and to redefine a robust commitment to patient safety a...

Malignant Gastrointestinal Obstruction: Options for Decompression and Nutrition

AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.

An initial investigation of a wireless patient radiation dosimeter for use in interventional radiology.

Radiation exposure during interventional radiology (IR) procedures is a critical issue. We have developed a wireless real-time dosimeter for IR patients that use nontoxic phosphor (four sensors). We evaluated the basic performance parameters (such as dose linearity, batch uniformity, reproducibility, and wireless-communication conditions) of the developed system using an IR X-ray system. Further, we investigated the influence of noise from other medical equipment on our wireless real-time dosimeter in the IR X-ray room. Overall, our wireless system exhibited excellent performance in terms of uniformity, reproducibility, and linearity; moreover, the wireless communication performance was better. The developed system enabled real-time visualization of patient radiation dose, without noise contamination from other medical equipment. In addition, the wireless system can be easily installed in a location where the PC screen (display) can be readily viewed by the IR physician. Hence, we developed a wireless system that can display the patient radiation dose data in real time; the system performed satisfactorily upon application in radiation dosimetry. Therefore, our wireless system will facilitate the real-time monitoring/management of patient radiation dose during IR.

3:54 PM Abstract No. 123 Observing the trends: What can interventional radiology physicians and policy makers learn from what their patients are searching the internet for?

3:54 PM Abstract No. 123 Observing the trends: What can interventional radiology physicians and policy makers learn from what their patients are searching the internet for?

3:00 PM Abstract No. 208 Demographic trends in female interventional radiology trainees with the advent of the integrated interventional radiology residency

Interventional radiology (IR) is among the medical specialties with the lowest level of female representation. The purpose of this study was to examine changes in gender representation in the IR training pool since the advent of the integrated IR residency in 2015-2018. Electronic Residency Application Service (ERAS) data were reviewed from 2015-2018 for IR residency and Vascular and IR fellowship applicant data. The Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book records were reviewed from 2015-2018 for active IR resident and fellow data. The American Medical Association’s (AMA) FRIEDA online database was reviewed for current IR residency and fellowship statistics. The Society of Interventional Radiology (SIR) 2018 registry data were reviewed for current SIR membership data. Chi-square analysis was used to compare the proportion of female IR trainees between application cycles. Since 2010, female trainees constitute 44% of all residents across specialties. Female IR fellows in training constituted only 8% (23/275) of all IR trainees in 2015-2016. In the 2017 application cycle, 23% (247/1062) of integrated IR applicants were female, with similar strong interest at 19% (99/522) in the 2018 cycle. Traditional IR fellowship female applicants were lower at 12% throughout that period. In the 2016-2017 and 2017-2018 academic years, 15% (2/13) and 13% (8/60) of integrated IR residents were female, respectively (χ2: 0.039, P = 0.843). Currently, 18% (41/224) of integrated IR residents are female, representing a near doubling of female IR trainees. This is compared to the 2018 total active SIR female membership of 9% (319/3622), female resident membership of 17% (131/793), and female medical student membership of 25% (389/1573). There is a significant under-representation of females in the IR physician workforce. Concurrent with the advent of the integrated IR residency, however, there is an increasing female constituency, at the medical student, IR applicant, and IR resident levels.Tabled 1YearIR Residency ApplicantsVascular and IR FellowsIntegrated IR ResidentsTotal Female IR Trainees2015-2016Data unavailable23/275 (8%)None23/275 (8%)2016-2017Data unavailable46/284 (16%)2/13 (15%)48/297 (16%)2017-2018247/1062 (23%)39/290 (13%)8/60 (13%)47/350 (13%)2018-201999/522 (19%)21/222 (10%)41/224 (18%)62/446 (14%) Open table in a new tab

4:03 PM Abstract No. 124 Stop the bleeding: What interventional radiologists need to know about the Medicare physician fee schedule cut

Health care reimbursement occurs through private insurance or government programs such as Medicare and Medicaid (CMS). We evaluate the models of physician payments and discuss current policies affecting interventional radiology (IR) practices. We evaluated CMS Physician Fee Schedule (PFS) proposed rules for 2020-2021. CMS accepted the American Medical Association (AMA) procedural terminology (CPT) codes and AMA Relative Value Scale Update Committee recommendations. The terms included re-direction and increased reimbursement for primary care and nonprocedural specialties, while negatively impacting procedure-based specialties. IR outpatient clinic data was collected from Jan to Sept 2019 and used to estimate the economic impact of the proposed changes to health policy rules were to be implemented. Following implementation of the CMS 2020 ruling, IR PFS rates will decrease by 4% for bone biopsy, lumbar spine puncture, abdominal aortography, angiography, and duplex ultrasound. In addition, proposed changes to E/M code payment are predicted to result in additional 2% cuts, with an overall 6% reduction in Medicare payments by 2021. Total allowable Medicare charges for IR are $432,000,000, therefore, this reduction may equate to approximately $26,000,000 lost reimbursement. In our institution’s outpatient IR practice with 1,559 clinic visits over nine months and $251,964 in billings (mean, $162 per visit), this estimates to potential payment reductions of $20,000 per year or $10 per visit in E/M reimbursement only. This reduction can be compounded by ineffective E/M documentation. Advocacy efforts to mitigate this reduction include communication with legislators through Comment Letters to CMS and Grassroots Programs, as well as educational resources for IR physicians to optimize documentation. The proposed 2020-2021 Physician Fee Schedule rate reduction is predicted to decrease reimbursement for IR services by at least 6%. Support of SIR Advocacy efforts is needed to mitigate the undervaluing of IR services.

Abstract TP41: Similar Outcomes of Endovascular Ischemic Stroke Treatment Performed by Interventional Radiologists and Neuro Interventional Fellowship Trained Physicians

Introduction: Endovascular stroke treatment (EVT) may be provided by physicians with varying specialty training. It is possible that physicians without dedicated neurointerventional training will have outcomes inferior to physicians with such dedicated training. Methods: Eight academic or community hospitals who provide EVT performed by interventional radiology (IR) and neurointerventional (NI) physicians (neurointerventional radiology, endovascular neurosurgery, or interventional neurology) in the same institution submitted sequential retrospective data limited to the era of modern clot extraction devices. Clinical outcome (modified Rankin score [mRS]) and successful revascularization (modified Thrombolysis in Cerebral Infarction [mTICI]) were compared between specialties, stratified for treating hospital, patient age, stroke severity, and clot location. Results: A total of 1079 patients were entered (661 treated by IR and 418 treated by NI) and 90 day mRS was available for 1013 patients (632 treated by IR and 381 treated by NI). For IR vs NI, median stroke onset to puncture was 220 vs 217 minutes (p=0.25), median door to puncture was 67 vs 75 minutes (p=0.18), successful revascularization (mTICI 2b or higher) was 82% vs 84% (p=0.38), symptomatic intracranial hemorrhage was 7.8% vs 6.7% (p=0.58), emboli to new territory was 2.1% vs 4.5% (p=0.22), 90 day mRS 0-1 was 30% vs 35% (p=0.06), and 90 day mRS 0-2 was 43% vs 50% (p=0.03). There was no significant difference in outcomes for clot locations in the internal carotid, M-1, M-2, or basilar arteries. When outcomes were adjusted for hospital, patient age, and stroke severity, physician specialty was not a significant predictor of mRS 0-1 (p=0.687 odds ratio 0.940, confidence interval 0.694-1.272) or mRS 0-2 outcome (p=0.695 odds ratio 0.944, 95% confidence interval 0.707-1.260). Conclusion: There was no significant difference in procedural or clinical outcome for EVT performed by IR vs NI physicians.

Effect of a dedicated inferior vena cava filter retrieval program on retrieval rates and number of patients lost to follow-up.

PURPOSE We aimed to assess the efficacy of a dedicated inferior vena cava (IVC) filter retrieval program on filter retrieval rates and number of patients lost to follow-up. METHODS A dedicated IVC filter retrieval program began in July 2016. This consisted of tracking all patients with retrievable filters placed by interventional radiology (IR). At the time of filter placement, patients were scheduled for a retrieval consult in the IR clinic. Any missed appointments were followed up by a physician assistant. The program was overseen by a single IR physician. To assess this program's efficacy, we reviewed the records of all patients who had retrievable IVC filters placed by IR nine months prior to and nine months after program initiation. Demographics and clinical factors were then collected and compared. A P value of < 0.05 was considered statistically significant. RESULTS Prior to the program, 76 patients (31 males, 45 females; mean age, 64.2 years) had retrievable filters placed; 75% were placed due to a contraindication to anticoagulation. From this group, five filters were removed (6.6%), 42 patients were lost to follow-up (55.3%), 22 patients died (29.0%), and seven filters were deemed permanent by a physician after placement (9.2%). All five retrievals were successful and no complications were reported. After program initiation, 106 patients (59 males, 47 females; mean age, 58.8 years) had retrievable filters placed; 75.5% were placed due to a contraindication to anticoagulation. In this group, 30 filters were retrieved (retrieval rate 28.3%), 17 patients were lost to follow-up (16%), 23 patients died (21.7%), 28 filters were deemed permanent by a physician after placement (26.4%), and decisions were still pending in eight patients (7.5%). One patient (3.3%) had a minor complication during filter retrieval. Initiation of a filter retrieval program increased our retrieval rate (6.6% vs. 28.3%; P < 0.001) and reduced the number of patients with filters that were lost to follow-up (55.3% vs. 16%; P < 0.001). CONCLUSION Dedicated filter retrieval program is effective in increasing filter retrieval rates and decreasing the number of patients lost to follow-up.

Tanzania IR Initiative: Training the First Generation of Interventional Radiologists.

Despite a population of nearly 60 million, there is currently not a single interventional radiologist in Tanzania. Based on an Interventional Radiology (IR) Readiness Assessment, the key obstacles to establishing IR in Tanzania are the lack of training opportunities and limited availability of disposable equipment. An IR training program was designed and initiated, which relies on US-based volunteer teams of IR physicians, nurses, and technologists to locally train radiology residents, nurses, and technologists. Preliminary results support this strategy for addressing the lack of training opportunities and provide a model for introducing IR to other resource-limited settings.

Role of Interventional Radiology in the Management of Infection

Interventional radiology (IR) is plays a crucial role in the management of localized infections, utilizing percutaneous access to loculated fluid collections for drainage and source control. Interventions have been developed in multiple organs and systems and used over decades, allowing the IR physician to provide patient care in many cases where surgical options are not optimal. In this review, we will examine the emergent, urgent, and routine nature of various IR procedures in the infectious context and timelines for each in regards to the decision making process. An algorithmic approach should guide the clinician's decision making for IR procedures in both large academic centers and smaller community hospitals. This approach and the pertinent procedural technique are described for multiple systems and organs including the biliary tree, gallbladder, genitourinary tract, and thoracic, abdominal, and pelvic abscesses. Increased awareness of the abilities and limitations of IR physicians in clinical scenarios needs to be implemented, to allow multispecialty input in efforts to decrease morbidity and mortality.

Awareness of Interventional Radiology Among Medical Students at a Saudi Medical School: Clerkship versus Pre-clerkship Years.

ObjectivesWe sought to assess the awareness of interventional radiology (IR) as a specialty among medical students and determine any difference between the clerkship and pre-clerkship years.MethodsWe conducted a cross-sectional, survey-based study in February 2018 at King Abdulaziz University, Jeddah, Saudi Arabia. Five hundred and forty-two medical students were enrolled. The survey consisted of 17 items canvassing student awareness of and interest in IR. The data were compared using the chi-square test.ResultsA large proportion of the respondents (n = 199, 36.7%) rated their knowledge of IR as poor, and 85 (15.7%) reported that they knew nothing about IR. Only 87 students (16.1%) responded that they would consider a career in radiology. The most common reason for not considering IR was lack of knowledge (42.9%). Students in their clerkship years had more interest and exposure to IR than pre-clerkship students (73.0%, p < 0.001 and 55.7%, p = 0.030, respectively). Awareness of IR was significantly more common among those interested in diagnostic radiology and IR (65.5%, p < 0.001 and 61.5%, p = 0.010, respectively).ConclusionsAwareness of and exposure to IR is poor among medical students, and can only be increased by a direct contribution from IR physicians to the undergraduate curriculum. Lack of a unified radiology curriculum in medical schools across the country should be addressed by the Council of Deans of Saudi Medical Schools. Involvement of the Saudi Interventional Radiology Society and Radiological Society of Saudi Arabia is essential.

Abstract No. 566 Physician professional fees, global office fees, and Medicare reimbursement for common IR Procedures: what the IR resident and fellow needs to know

Studies have shown that physicians have a limited understanding of the financial aspects of their interventions. This is especially true for trainees who often receive minimal education on the matter. To improve the understanding of interventional radiology (IR) residents and fellows, we evaluated physician professional fees in the facility setting, global fees in the office setting, and Medicare reimbursement for 10 of the most commonly performed IR procedures. Data was also included on the percentage of each procedure being performed by an IR physician. The 2016 “Medicare Provider Utilization and Payment Data: Physician and Other Supplier” database was used to extrapolate information regarding providers, type of service, average submitted fee for a service, and average Medicare reimbursement in the “facility” or “office” setting. For this study, we focused on tunneled catheter placement, port placement/removal, fistulogram, venous thrombectomy, venoplasty, venous stenting, IVC filter placement/removal, and tumor embolization. Table 1 summarizes the mean (SD) facility professional fee, mean (SD) office global fee, and mean (SD) Medicare reimbursement. Professional and global fees exhibited broad variability. For example, the mean professional fee for a port removal was 845 with a SD of 345 while IVC filter placement was 2,127 with a SD of 2,835. Overall, 57% of the investigated procedures in the facility setting was performed by IR versus 25% in the office setting. The role of IR varied from 99% (tumor embolization) to 36% (venous stenting) in the facility setting versus 100% (tumor embolization) to 21% (tunneled catheter placement) in the office setting. Knowledge of procedural fees can benefit physicians, especially trainees. It is important for practice development, cost conscious decision making, and patient education. Currently, there is large variability in professional/global fees and IR physician involvement for the evaluated procedures. Mean professional and global (SD) fees, mean (SD) Medicare reimbursement, and the percentage of each procedure performed by IR physicians is provided in table 1 for review.Table 1Mean Professional Fees (SD), Global Fees (SD), and Medicare Reimbursement (SD) for Common IR ProceduresProcedureFacility SettingOffice Setting# IR Providers(PPIRP)Mean (SD) Professional FeeMean (SD) Medicare Reimbursement# IR Providers(PPIRP)Mean (SD) Global FeeMean (SD) Medicare ReimbursementTunneled catheter placement2350 (66%)1456 (938)221 (18)62 (21%)2192 (660)569 (73)Port placement1882 (48%)2012 (1426)288 (22)136 (67%)3537 (1486)817 (279)Port removal354 (55%)835 (345)157 (15)38 (32%)895 (336)217 (38)Fistulogram1562 (57%)1041 (836)89 (11)266 (24%)2178 (734)380 (90)Thrombectomy370 (67%)1965 (1618)199 (28)128 (22%)5091 (1354)1313 (199)Venoplasty1184 (55%)1862 (1536)181 (18)240 (23%)3977 (1464)953 (207)Venous stenting128 (36%)2404 (3385)240 (19)103 (23%)11,526 (3357)3519 (487)IVC filter placement528 (75%)2127 (2835)192 (17)1 (50%)11,1842044IVC filter removal28 (78%)2846 (2265)295 (24)2 (67%)5469 (2113)1102 (17)Tumor embolization273 (99%)8196 (11,736)482 (39)10 (100%)22,004 (12,922)6563 (3310)PPIRP = percent performed by IR physicians. Calculated by dividing the number of procedures performed by IR physicians by the total number of procedures performed by all providers (includes radiologists, vascular surgeons, interventional cardiologists, and others). Open table in a new tab

03:45 PM Abstract No. 38 The development of a machine learning smart speaker application for device sizing in interventional radiology

Smart speakers such as the Amazon Echo and Google Home offer a fundamentally new method for interacting with software. These tools offer unique value in interventional radiology (IR), as a conversational voice interface allows IR physicians to interact with software and retrieve information without breaking sterile scrub. We present a smart speaker application developed specifically for use during IR procedures, using natural language processing (NLP) and machine learning to rapidly provide information about device sizing and compatibility in IR. We have developed a device sizing application for the Google Home smart speaker device. This application processes a human voice query and provides sizing recommendations. It can, for example, specify the minimum sheath size needed for a particular Amplatzer plug, among many other sizing tasks. Size data was acquired in an extensive literature review, with data compiled for 475 IR devices (catheters, sheaths, stents, vascular plugs, etc.). Natural language processing was implemented using Dialogflow, which extracted information of interest from an input query. Logic operations and other data processing were performed using a Python script deployed to the cloud. The conversational application is found to offer an effective tool for device sizing in interventional radiology, achieving excellent performance for a wide range of tasks. Technically satisfactory outcomes were seen using a training data set of 10 samples for each information category and a classification threshold of 0.3. Smart speakers have the potential to offer immense value in interventional radiology, giving proceduralists the ability to access modern information technology while maintaining procedural sterility. This work represents an early step in developing a suite of smart speaker IR tools for intra-procedural support. Future applications may focus on sterile approaches to querying the inventory database, performing dictations during procedural downtime, and accessing key data from the electronic medical record. These tools offer significant value to interventional radiologists and allow us to benefit from the power of machine learning.

Bridging the Gender Gap in the Society of IR: A Benchmark Study

PurposeTo evaluate the evolving representation of women in the Society of Interventional Radiology (SIR). Materials and MethodsA retrospective review of the available gender demographic data of various SIR subgroups between 2008 and 2017 was performed. The gender makeup of the following groups was analyzed: SIR membership, SIR Executive Council members and officers, Annual Meeting invited speakers, committee chairs, Journal of Vascular and Interventional Radiology (JVIR) first and senior authors, JVIR editorial board, IR Quarterly (IRQ) authors, and active interventional radiology (IR) residents and fellows. ResultsFrom 2008 to 2017, the percentage of female representation in SIR members doubled (from 6% to 13.1%). In the same period, female representation also significantly increased in Executive Council members (0% to 20%) and officers (0% to 50%), SIR Annual Meeting presenters (5.1% to 15.4%), and JVIR first authors (10% to 14.5%) and senior authors (7.1% to 11.9%). From 2012 to 2017, there were increases in female representation among SIR committee chairs (21% to 28%) and IRQ authors (4.5% to 27%). However, the percentage of female IR residents and fellows did not significantly change between 2008 and 2017 (11% vs 16.2%; P = .51). ConclusionsWomen interventional radiologists are underrepresented within SIR, representing only 9.2% of active IR physicians. There has been a steady increase in female representation within most areas of SIR evaluated in this study. Although these trends are reassuring, efforts toward increasing recruitment and retention of women in IR need to improve in light of the infancy of IR as a residency program.

Access to Interventional Radiology Services in Small Hospitals and Rural Communities: An ACR Membership Intercommission Survey

PurposeTo evaluate the status of interventional radiology (IR) staffing, recruitment, and retention in the United States, specifically as they apply to small hospitals and rural communities. Materials and MethodsA 22-question survey was created by an ACR intercommission workgroup and circulated via e-mail to ACR members who self-identified as a “group practice leader,” “general radiologist,” “interventional radiologist,” or “abdominal radiologist.” Contingency tables were constructed, and bivariate analyses were performed to assess overall responses and the distribution of responses among specific groups of respondents. ResultsA total of 1,005 e-mail recipients completed the survey. A statistically significant greater proportion of responders from rural hospitals (versus nonrural hospitals) answered that (1) their group falls short or far short of meeting demand for IR services (29.1% versus 14.3%), (2) they had difficulty recruiting IR physicians to their practice (67% versus 40.6%), and (3) they had difficulty retaining IR physicians (40% versus 29%). The most frequently reported reasons for difficulty recruiting were that IR-trained physicians “do not want to do diagnostic work” (56.2%) and “do not want to practice in a small or rural setting” (48.8%). A greater proportion of respondents from rural hospitals perceived that they had difficulty retaining IR physicians because of perceived inadequate “complexity of case mix” (67.5%) or “number of cases” (66.1%). ConclusionSmall hospitals and rural communities experience greater difficulty recruiting and retaining IR physicians and meeting IR service demands compared with their nonrural counterparts.