Interventional Radiology Training Research Articles

Expanding global health opportunities for UK-based interventional radiology trainees

As the future workload of interventional radiologists in the UK continues to expand, it is imperative that current IR trainees are given maximal opportunities to expand their skill sets. This paper argues that opportunities for involvement in international collaborative fieldwork should be expanded for interventional radiology trainees in the UK, as a means of maximising their future competency and positive contribution to the advancement of global healthcare. The study builds upon first-hand experience of the authors in the field and a review of the relevant literature. This scoping review aimed to ascertain the current global health opportunities for interventional radiology trainees primarily in Resource Limited Countries (RLCs). This review further contrasted these opportunities with ones provided to trainees within North America and European countries. This review found that the opportunities for international collaborative fieldwork for UK interventional radiology trainees are sparse. The availability of such opportunities in the US is significantly greater as is the awareness and appreciation of the benefits of such international collaborations for trainees. Benefits include greater experience with a variety of pathologies, a potentially larger volume of workload, improved cultural competency and proficiency and greater cost-conscious and more sustainable practices. It is also pertinent that any future global partnership opportunities for UK clinicians are crafted with care to benefit both UK and international healthcare professionals, institutions and patients within RLCs. Significant work is needed to expand opportunities for global health for interventional radiology trainees in the UK. It is incumbent upon the major radiology societies and educational bodies within the UK to expand upon such opportunities to develop a robust, world-leading workforce, which would subsequently enhance our global health positionality and reflexivity.

Interventional Radiology Training in Singapore

AbstractThis short review chronicles the training process of interventional radiologists in Singapore over the decades since the introduction of angiography as a technique back in the 1950s to the current state today.

Creating a Sustainable Foundation for IR Services and Training in Sub-Saharan Africa: 5-Year Update on the Road2IR Initiative

PurposeTo evaluate the growth and quality of an interventional radiology (IR) training model designed for resource-constrained settings and implemented in Tanzania as well as its overall potential to increase access to minimally invasive procedures across the region. Materials and MethodsIR training in Tanzania began in October 2018 through monthly deployment of visiting teaching teams for hands-on training combined with in-person and remote lectures. A competency-based 2-year Master of Science in IR curriculum was inaugurated at the nation’s main teaching hospital in October 2019, with the first 2 classes graduating in 2021 and 2022. Procedural data, demographics, and clinical outcomes were collected and analyzed throughout the duration of this program. ResultsFrom October 2018 to July 2022, 1,595 procedures were performed in Tanzania: 1,236 nonvascular and 359 vascular, all with local fellows as primary interventional radiologists. Of these, 97.2% were technically successful, 95.2% were without adverse events, and 28.9% were performed independently by Tanzanian fellows and faculty with no difference in adverse event and technical success rates (P = .63 and P = .90, respectively), irrespective of procedural class. Ten IR physicians graduated from this program during the study period, followed by another 3 per year going forward. Partner training programs in Uganda and Rwanda mirroring this model commenced in 2023 and 2024, respectively. ConclusionsThe reported training model offers a practical and effective solution to meet many of the challenges associated with the lack of access to IR in sub-Saharan Africa.

Augmented Reality in Interventional Radiology: Transforming Training Paradigms.

The ascent of medical technology places augmented reality (AR) at the forefront of potential advancements in interventional radiology (IR) training. This review delves into the symbiotic relationship between AR and conventional IR training, casting light on the opportunities and hurdles intrinsic to this integration. A targeted literature review was conducted using the databases PubMed, Cochrane Library, and Embase. Search terms included ((("Augmented Reality" OR "Virtual Reality")) AND ((Education OR Training))) AND (("Interventional Radiology")). Ten studies identified using the comprehensive inclusion criteria helped scrutinize the use of AR in IR training. Key outcomes include improved procedural accuracy, reduced training duration, and heightened trainee confidence. However, it also identifies limitations such as small sample sizes, reliance on simulation environments, and technological constraints in AR implementation. Despite these challenges, the review underscored the transformative potential of AR in IR education, suggesting its capacity to revolutionize training methodologies. However, it also calls for continued technological development and empirical research to address current challenges and fully leverage AR's capabilities in medical education.

Understanding the current acute aortic syndrome (AAS) pathways-The Collaborative Acute Aortic Syndrome Project (CAASP) protocol.

Acute aortic syndrome (AAS) is an emergency associated with high peri-hospital mortality rates. Variable clinical presentation makes timely diagnosis challenging and such delays in diagnosis directly impact patient outcomes. The aims of the Collaborative Acute Aortic Syndrome Project (CAASP) are to characterise and evaluate the current AAS pathways of a cohort of hospitals in the UK, USA and New Zealand to determine if patient outcomes are influenced by the AAS pathway (time to hospital admission, diagnosis and management plan) and demographic, social, geographic and patient-specific factors (clinical presentation and comorbidities). The objectives are to describe different AAS pathways and time duration between hospital admission to diagnosis and management plan instigation, and to compare patient outcomes between pathways. The study is a multicentre, retrospective service evaluation project of adult patients diagnosed on imaging with AAS. It will be coordinated by the UK National Interventional Radiology Trainee Research (UNITE) network and Vascular and Endovascular Research Network (VERN) in conjunction with The Aortic Dissection Charitable Trust (TADCT). All AAS cases diagnosed on imaging between 1st January 2018 to 1st June 2021 will be included and followed-up for 6 months. Eligibility criteria include aortic dissection (AD) Type A, Type B, non A/B, penetrating aortic ulcer, and intramural haematoma. Exclusion criteria are non-AAS pathology, acute on chronic AAS, and age<18. This project will evaluate patient demographics, timing of presentation, patient symptoms, risk factors for AD, physical examination findings, timing to imaging and treatment, hospital stay, and mortality. Univariate and multivariate analysis will be used to identify predictors associated with prolonged time to diagnosis or treatment and mortality at 30 days.

Challenges in research opportunities for interventional radiology trainees and interventional radiology in the UK

Challenges in research opportunities for interventional radiology trainees and interventional radiology in the UK

Impact of the IR/DR Primary Specialty Certification on Scientific Research in the Field

Research is essential to the development, maintenance, and success of interventional radiology (IR) as a primary specialty. IR physicians must embrace a more sophisticated research approach toward the procedures we perform and the diseases we treat to accompany our elevated status. Identifying impactful research needs and directing a comprehensive research portfolio will anchor our position as an essential specialty within a thriving health care system. Doing so will ensure that this historic opportunity is maximized for the benefit of IR physicians, IR trainees, and, ultimately, IR patients.

Supporting endovascular practice in 2023 and beyond: the BSET Fellowship Programme

British Society of Endovascular Therapy (BSET) Fellowships were introduced to provide an opportunity for vascular or interventional radiology trainees to acquire new or more complex endovascular skills during a 6-month period in a UK-based endovascular unit of their choice. They were established in 2008 in response to the rapidly expanding field of endovascular practice, with the aim to support high quality endovascular training as well as a new hybrid skillset for those from a vascular surgical background. Since vascular surgery gained independence as a specialty in 2012, evolutions in both vascular surgery and interventional radiology training programmes have facilitated increased exposure to complex endovascular interventions. However, these Fellowships continue to offer a unique opportunity, where trainees benefit from a period of concentrated exposure, working to develop a specific subspecialty interest and ‘fine tune’ their skills in preparation for consultant practice. Further, these Fellowships also offer interventional radiology trainees to be exposed to a larger volume and variety of endovascular procedures, benefiting their future independent practice.

Interventional radiology training in the UK: a view from within-a national survey.

Interventional radiology (IR) training in the UK has evolved since recognition as a subspecialty in 2010 and introduction of a new curriculum in 2021. The changing landscape, increasing workload and COVID-19 have affected training. The purpose of this study was to review trainees' perspectives on training and develop strategies to further improve training. Online survey approved by the British Society of Interventional Radiology Council distributed to British Society of Interventional Radiology Trainee members between 9 March 22 and 25 March 2022. The survey was open to all UK based ST4-6 IR trainees and fellows. Descriptive and thematic analysis was undertaken. 43 responses were received from 17/19 UK training regions. Females represented 10% (4/41) and 5% (2/43) less than full time (LTFT) trainees. 82% (31/38) felt their curriculum was suitable for their training and 28/38 (74%) were satisfied with IR training. Vascular IR, Interventional Oncology, paediatrics and stroke thrombectomy were identified as areas of training desiring improvement. 45% (18/40) stated exposure to IR led clinics and 17.5% (7/40) to IR led ward rounds. Only 6/38 (15.7%) received structured IR teaching at least once a month. Approximately, a third of respondents (13/38) stated training opportunities were significantly compromised secondary to COVID-19. This survey shows overall good satisfaction with IR training. However, improved training opportunities in vascular IR, interventional oncology, paediatric IR and stroke thrombectomy are required. In addition, access to clinics, ward rounds and protected time for research is needed to improve training quality. New national UK IR training survey.

Regional variation in the use of revascularisation for peripheral artery disease in Japan: a cross-sectional observational study

ObjectivesWe aimed to investigate the regional variations in the number of interventions and surgeries for peripheral artery disease (PAD) and explore the major determinants of the variations.DesignCross-sectional study.SettingThe Japanese Ministry...

Gender differences in self-assessed performance and stress level during training of basic interventional radiology maneuvers

ObjectivesGender differences have been reported to influence medical training. We investigated gender differences encountered during training in interventional radiology maneuvers.MethodsCatheter handling was analyzed under standardized conditions in 64 participants naïve to endovascular procedures (26 women, 38 men). Objective (e.g., catheter pathway, catheter movements, required time) and subjective parameters (stress level) were recorded. The NASA-Task Load Index (NASA-TLX; 1–20 points) was used to assess participants’ stress levels and perceived workload.ResultsIn the easier tasks, no significant differences between male and female participants regarding catheter handling were observed. In the most complex task, female participants took themselves more time (688 ± 363 vs. 501 ± 230 s; p = 0.02), asked for help more frequently (n = 19 vs. n = 8) and earlier than men (203 ± 94 vs. 305 ± 142 s; p = 0.049), whereas men stood out by more agitated catheter handling (6.0 ± 1.8 vs. 4.8 ± 1.6 movements/s; p = 0.005). Overall, female participants perceived tasks to be more difficult (11.5 ± 4.2 vs. 9.6 ± 3.3; p = 0.016), perceived higher stress levels (8.9 ± 4.9 vs. 6.3 ± 4.4; p = 0.037), and rated their own performance lower (9.12 ± 3.3 vs. 11.3 ± 3.3; p = 0.009). However, female participants were able to correlate self-assessed with objective parameters correctly (r between −0.555 and −0.469; p = 0.004–0.018), whereas male participants failed to correctly rate their performance (p between 0.34 and 0.73). Stress levels correlated with objective parameters in males (r between 0.4 and 0.587; p < 0.005), but not in female participants.ConclusionPerceived stress levels, self-evaluation skills, and catheter handling differ greatly between untrained male and female participants trying to solve interventional radiological tasks. These gender-specific differences should be considered in interventional radiology training.Clinical relevance statementAs psychological aspects may influence individual working strategies gender-specific differences in self-perception while learning interventional radiology maneuvers could be essential regarding success in teaching and treatment outcomes.Key Points• After performing standardized training, 38 male and 26 female volunteers showed significant differences regarding objective and self-assessed performance, as well as in perceived workload while performing simulated endovascular catheter maneuvers.• After solving simulated endovascular radiological tasks, female participants were able to self-assess their objective performance much more accurately than male participants.• Women took more time to solve simulated endovascular tasks and asked earlier and more frequently for help than men.

Better safe than so ray: national survey of radiation protection amongst interventional radiology trainees in the United Kingdom.

To establish the provision and use of radiation personal protective equipment (PPE) and dosimetry amongst UK interventional radiology (IR) trainees and highlight areas of improvement in order to enhance the radiation safety. A survey questionnaire was designed by members of the British Society of Interventional Radiology (BSIR) trainee committee via survey monkey and distributed to UK IR trainees via the BSIR membership mailing list, local representatives and Twitter. The survey was open from 04/01/2021 to 20/02/2021. Only IR trainees in years ST4 and above were included. Of the 73 respondents, 62 qualified for analysis. Respondents (81% male) spent a median of 5.5 sessions (half day list) per week in the angiography suite and 58% (n=36) had difficulty finding appropriately sized lead aprons at least once a week. Overall 53% (n=33) had concerns about their radiation PPE. Furthermore 56% of trainees (n=35) experienced back pain among other symptoms attributed to wearing the lead aprons available to them. 77% (n=48) regularly wore lead glasses. For trainees requiring prescription glasses (n=22) overfit goggles were provided however 17 (77%) of these trainees felt the goggles compromised their ability to perform the procedure. Eye and finger dosimeters were used by 50% and 52% of respondents respectively. Compliance with body dosimetry was 99%. Provision of radiation PPE and dose monitoring for IR trainees is suboptimal, particularly access to adequate eye protection or suitably fitting leads. Based on the findings of this survey, recommendations have been made to promote the safety and radiation awareness of IR trainees. Radiation protection practices for IR trainees nationally are poor. Provision of suitable eye protection and well fitting lead body protection is low.

Awareness of interventional radiology and image guided musculoskeletal interventions among orthopaedic surgeons, rheumatologists, and physiatrists: A multi-site analysis

PurposeEvaluate physicians who treat musculoskeletal (MSK) disorders in their knowledge of image-guided MSK interventions, and identify areas that could benefit from education. Materials and methodsA 17-question survey was distributed to orthopaedic surgeons, physiatrists, and rheumatologists in the 14-hospital health system. It inquired about demographics, practice environment, awareness of interventional radiology (IR) and MSK radiology (MSKR) training, referral patterns, and knowledge of image-guided MSK interventions. ResultsIn total, 59 of 303 physicians completed the survey (41% orthopaedists, 35% physiatrists, and 24% rheumatologists). Most (93%) were attendings and 41% were female. A minority of survey respondents (17%) recognized the designation of IR as a distinct specialty of medicine per the American Board of Medical Specialties, in contrast to MSKR, which is not designated as a distinct specialty. When queried about IR procedures not under investigation, 24% selected genicular artery embolization and 31% selected embolization for adhesive capsulitis. Barriers to referral were as follows: 21% of specialists performed the procedure, 17% listed electronic medical record challenges, 14% reported scheduling difficulty, 13% reported no barriers, 11% reported difficulty consulting, 11% referred to another specialty, 10% did not have enough knowledge of image guided procedures, and 3% reported the procedure is not performed by IR or MSKR. ConclusionsSurvey data reveal a knowledge gap among surveyed physicians regarding IR as a specialty as well as areas of IR research in MSK disorders. Findings suggest areas where referring physicians can be educated and identify barriers to referral.

The Impact of a Hands-On Interventional Radiology Training Course on Radiology Resident's Training: A Single Academic Institution Experience

Abstract Purpose The aim of this study was to investigate the outcomes of an instructional hands-on training course that introduces radiology residents to the essential tools and skills needed to perform basic interventional radiology (IR) procedures. Materials and Methods This study was performed over a single academic year at a single academic institution. A precourse survey was sent to all radiology residents to identify areas of weakness and potential opportunities for improvement. In view of the responses, a hands-on training course was designed to cover the basics of vascular and soft-tissue access, catheters, wires, embolics, and closure devices. The training was provided in a one-to-one setting by a single IR attending over a period of 45 minutes and was concluded with hands-on training on an ultrasound (US) vascular access phantom whenever possible. An anonymous postcourse survey was then distributed and the results were analyzed. Results The average reported comfort level with basic IR concepts prior to course attendance was 1.7 on a 5-point scale (1 = not comfortable, 5 = very comfortable). This increased to an average of 4 following the course. Ninety-three percent of residents reported they have more confidence getting into the IR suite and assisting in IR procedures following the course. Residents who had an opportunity to train on the US vascular access phantom gave an average response of 4.6 out of 5 to a question of how helpful the experience was in improving their US hand skills (1 = not helpful, 5 = extremely helpful). One hundred percent of responders reported that the course successfully met its goal. Finally, the overall responses were unanimously in favor of continuing the hands-on training course. Conclusion A personalized, cost-effective, hands-on training course can improve the IR training experience of radiology residents, especially in the early training phase. This model is of particular value for smaller to medium-sized academic institutions with limited financial and educational resources.

Whitepaper: Training in Diagnostic and Interventional Breast Radiology.

Breast imaging represents an integral part of radiology and is subject to strict quality controls. Regarding this, precise diagnostics including multimodal assessment by mammography, sonography, and MRI, including image-guided biopsy and localization procedures, is often decisive and must be performed by experts with profound knowledge and skills in all of these procedures.However, due to numerous restructurings, breast imaging has been shifted more and more towards large, specialized centers, resulting in less patient exposition and training opportunities for radiologists in smaller sites. The following whitepaper summarizes the current circumstances and discusses opinions of the participating societies. Under the leadership of the German Roentgen Society (DRG) and with the participation of the DRG's AG Mammadiagnostik, the CAFRAD (Chefarztforum Radiologie), the KLR (Konferenz der Lehrstuhlinhaber für Radiologie e. V.), the DRG's Forum Junge Radiologie (FJR) and the Berufsverband der Deutschen Radiologen e. V. (BDR), possible solutions were discussed and consented for a structured training in breast radiology in the future. In addition to the teaching provided at the primary workplace, qualified training should be ensured through flexible, multi-institutional, interdisciplinary, and cross-sectoral collaboration. Furthermore, the integration of online case collections and close cooperation with certified breast cancer centers and mammography screening units is recommended. It is indispensible that online courses and case collections adhere to the standards of the national societies and include a maximum of one third of the required cases. In order to provide training in breast radiology at a high professional level, a paradigm shift with closer cooperation of all participants is necessary. This includes close collaboration of the breast imaging societies with the federal medical associations to establish new teaching concepts like e-learning in the training schedule of radiologists. · Breast diagnostics is an integral part of radiology training.. · Due to recent restructurings, smaller training centers have difficulties in meeting the case numbers demanded by the Specialist Training Regulations (WBO). Improved integration of the new structures and their adaptation to the needs of education are necessary to guarantee standardized high-quality training of young radiologists.. · The integration of certified case collections enables quality-assured training, even across regions in online-based formats. In accordance with the "blended learning principle", up to one-third of the required number of patient studies can be substituted with cases from a certified case collection.. · Legally secured short- and medium-term internships may complement training in radiology.. · Sauer ST, Bley TA, Wenkel E et al. Whitepaper: Training in Diagnostic and Interventional Breast Radiology. Fortschr Röntgenstr 2023; 195: 699 - 706.

Importance and potential of simulation training in interventional radiology.

Simulation training is a common method in many medical disciplines and is used to teach content knowledge, manual skills, and team skills without potential patient danger. Simulation models and methods in interventional radiology are explained. Strengths and weaknesses of both simulators for non-vascular and vascular radiological interventions are highlighted and necessary future developments are addressed. Both custom-made and commercially available phantoms are available for non-vascular interventions. Interventions are performed under ultrasound guidance, with computed tomography assistance, or using mixed-reality methods. The wear and tear of physical phantoms can be countered with in-house production of 3D-printed models. Vascular interventions can be trained on silicone models or hightech simulators. Increasingly, patient-specific anatomies are replicated and simulated pre-intervention. The level of evidence of all procedures is low. Numerous simulation methods are available in interventional radiology. Training on silicone models and hightech simulators for vascular interventions has the potential to reduce procedural time. This is associated with reduced radiation dose for both patient and physician, which can also contribute to improved patient outcome, at least in endovascular stroke treatment. Although a higher level of evidence should be achieved, simulation training should already be integrated into the guidelines of the professional societies and accordingly into the curricula of the radiology departments. · There are numerous simulation methods for nonvascular and vascular radiologic interventions.. · Puncture models can be purchased commercially or made using 3D printing.. · Silicone models and hightech simulators allow patient-specific training.. · Simulation training reduces intervention time, benefiting both the patient and the physician.. · A higher level of evidence is possible via proof of reduced procedural times.. · Kreiser K, Sollmann N, Renz M. Importance and potential of simulation training in interventional radiology. Fortschr Röntgenstr 2023; 195: 883 - 889.

Feasibility of Network-Based, Online Endovascular Simulator Training in Real Time: Results from a Pilot Study.

To test the feasibility of an online, simulator-based comprehensive interventional radiology (IR) training curriculum in times of COVID-19-induced travel restrictions. A network of six VIST simulators (Mentice, Gothenburg, Sweden) was installed in six geographically different radiology departments. Two courses with six sessions each took place. 43 participants were recruited on a voluntary basis among local residents. The training sessions were conducted in real time with interconnected simulation devices and were led by experts in the field of IR on a rotational basis. The participants attitude toward various topics was quantified before and after training on a seven-point Likert scale (1 = "not at all", 7 = "to the highest degree"). In addition, post-course surveys were conducted. The courses led to an improvement for all items compared with baseline: interest in IR (pre: 5.5, post: 6.1), knowledge of endovascular procedures (pre: 4.1, post: 4.6), likelihood of choosing IR as a subspecialty (pre: 5.7, post: 5.9). Experience with endovascular procedures (pre: 3.7, post: 4.6) improved significantly (p = 0.016). In the post-course surveys high satisfaction rates with the pedagogical approach (mean 6), the teaching content (mean 6.4), and the duration and frequency of the course (mean 6.1) were observed. The implementation of a simultaneous endovascular online training curriculum in different geographic locations is feasible. The curriculum has the potential to meet the demand for training in IR in times of COVID-19-associated travel restrictions and can complement future training in the context of radiologic congresses. · The implementation of a simultaneous endovascular online training curriculum in different geographic locations is feasible. For interested residents, the presented online curriculum can offer a low-threshold and comprehensive entry into the world of interventional radiology at the site of their training..

The Gender Gap in Interventional Radiology: Barriers, Opportunities, and the Role of the Integrated IR Residency

To review the gender gap in Interventional Radiology (IR) and explore the role of the Integrated IR residency. A retrospective review of gender demographic data of medical school applicants to Integrated IR residency from 2016-2021, and active residents/fellows ("trainees") in IR and peer specialties from 2007 to 2021. Women comprised 21.0% of medical student applicants to the Integrated IR residency in the 2020-21 academic year, versus 12.9% of Diagnostic Radiology (DR) resident applicants to the Independent IR residency; these figures have stayed relatively constant since 2016-17 and represent a statistically significantly difference (p=0.000044). The Integrated pathway has become the dominant source of IR trainees, growing from 4.4% in 2016-17 to 76.3% in 2020-21 (p=0.0013). From 2007 to 2021, the percentage of all IR trainees who were female grew from 10.5% to 20.3% (p=0.005). From 2017 to 2021, the percentage of Integrated IR residents who were female grew from 13.3% to 22.0% (p=0.053, 19.1% year-over-year growth), and has been higher than the percentage of female Independent IR residents (p=0.048). Women continue to be underrepresented in IR, though this gender gap is improving. The Integrated IR residency appears to have majorly contributed to this improvement, consistently supplying more women into the IR pipeline than through the fellowship/Independent IR residency. Women are significantly better represented among current Integrated IR residents than Independent residents. The now-dominant Integrated IR pathway must increase women recruitment for continued gender gap improvement.

Abstract No. 111 Current Status of Diagnostic Radiology and Interventional Radiology Training in Latin America

Abstract No. 111 Current Status of Diagnostic Radiology and Interventional Radiology Training in Latin America

Results of the 2020 Survey of the American Alliance of Academic Chief Residents in Radiology

Rationale and objectivesAn annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). The purpose of this study is to summarize the 2020 A3CR2 chief resident survey. Materials and methodsAn online survey was distributed to chief residents from 194 Accreditation Council on Graduate Medical Education–accredited radiology residencies. Questions were designed to gather information about residency program practices, benefits, fellowship or advanced interventional radiology (IR) training choices, and the integration of IR training. Subsets of questions focused on the perception of corporatization, non-physician providers (NPPs), and artificial intelligence (AI) in radiology and their relationship to the radiology job market. Results174 individual responses from 94 programs were provided, yielding a 48 % program response rate. Extended emergency department coverage has steadily decreased over the last 5 years (2016–2020), however only 52 % of programs have independent overnight call (without attending coverage). Regarding the impact of new integrated IR residencies on training, 42 % indicated there was no appreciable impact on their DR or IR training, while 20 % indicated DR training for IR residents suffered and 19 % indicated IR training for DR residents suffered. Corporatization in radiology was perceived as the biggest potential threat to the future job market. ConclusionsIntegration of IR residency did not detrimentally affect DR or IR training in most programs. Radiology resident perception of corporatization, NPPs, and AI may help residency programs shape educational content.