In a rousing address at the annual meeting of the Society of Interventional Radiology in Toronto, Canada, Professor Andy Adam (London, UK) has insisted that "the fate of interventional radiology is inextricably linked with the fate of diagnostic radiology".
Giving the prestigious Charles Dotter Lecture, Adam outlined the challenges and frustrations he believes interventional radiologists must overcome in order to survive, and in a warning to colleagues on both sides of the Atlantic, he advised: "Burying our heads in the sand would not be a good strategy!"
Adam claims that the challenges facing interventional radiology are linked to its relationship to other specialties and to diagnostic radiology. He argued that if one looks back to the inception of the specialty, it is clear that interventional radiology was, and still is, "the use of image guidance to effect treatment", and "not just a collection of minimally invasive procedures, no matter how advanced the technology".
Adam identified four key factors that decide who does what when it comes to practical disciplines: clinical control of patients; the number of practitioners in a particular specialty; skills and training; and research activity.
Of these factors, Adam maintained that the most important is the clinical control of patients. He reminded the audience of Dr Charles Dotter's prediction in 1968 that if interventionists did not assume clinical responsibility for their own patients they faced "forfeiture of territorial rights [which are] based solely on imaging equipment others can obtain and skills that others can learn."
Adam also emphasized the importance of training. Although he welcomed advances in defining a curriculum (in the UK) and the introduction of a Certificate of Added Qualification (in the US), he argued that there was much more work to be done. He said that a greater emphasis should be placed on "mastering procedures and equipment, with less time spent on learning irrelevant facts".
Although he favours offering the option of an early focus on intervention during radiological training, Adam opposes any move that would see interventional radiology sever all its ties with diagnostic radiology. In his view, any such move, would not solve the problems faced by interventional radiology and would hasten its absorption by other specialties. The lack of public recognition of interventional radiology had been well documented but independence from diagnostic radiology would not make the identity of the specialty any clearer. "We are the image-guided part of minimally invasive therapy. No name change (e.g. to 'image-guided surgery'), and no publicity campaign can change this situation; it is a fact of life," Adam said.
According to Adam, although access to sophisticated interventional equipment is an important part of interventional radiology, it will not be the factor that will decide what happens to the specialty, as such equipment is also freely available to non-radiological disciplines. The destiny of interventional radiology is inseparable from that of diagnostic radiology, and what happens to imaging as a whole will determine the future of both. Therefore, interventional radiologists need to assess the factors that will determine what happens to imaging, which itself is evolving, and formulate a corresponding strategy. Adam concluded that although it remains to be seen whether interventional radiology can maintain its unique identity in the future, its essential elements, imaging and sophisticated technology, are both growing rapidly. As a result, image-guided intervention as a whole will prosper.
The 2006 Charles Dotter Lecture will be published in the Journal of Vascular and Interventional Radiology later this year.
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