‘A natural evolution’

Dr. Spencer observed that IR has evolved substantially in the past decade. “Think back to the time when we were all simply MDs before specializing,” said Dr. Spencer, who noted that venous and genitourinary diseases are big part of her practice. “It was the same playing field. In IR, many of us started in the same place—as surgeons—then on to radiology and IR. That was a great training ground for being a clinician. IR primary specialty status is a natural evolution, but in the end we have to prove that we are effective clinicians.”

Close collaboration essential

Dr. Johnson noted that the procedures interventional radiologists do every day may not be cutting edge, but they are essential for treating such problems as bile duct strictures and stones, portal hypertension, varicocele, and uterine fibroids. Dr. Johnson, who specializes in minimally invasive treatments for liver and renal cancers, emphasized the need for close collaboration.

“Whether it’s urology or nephrology, we have to have open communication, especially on the liver transplant team and liver and renal cancer cases,” he said. “I find the joint multi-disciplinary conferences we host at Indiana University make a difference. We’re all the same page.  In my case, my partner and I share clinic space with the nephrologists upstairs. Having a conversation about whether to embolize a tumor before surgery is simplified by sheer proximity.”

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He added, “Our administrators recognize the versatility of the interventional radiologist as a clinician in a multi-disciplinary environment.”

Over the past 20 years, Dr. Johnson has traveled frequently to Kenya, where he works hand-in-hand with urologists treating diseases of the kidney, bladder, and ureters. “You gain an appreciation for how much interventional radiology has evolved in 40 years,” he related. “I started as a surgeon, then moved onto a residency as a radiologist, and then specialized in IR. For me, IR is the perfect fit.”

Dr. Johnson is in the midst of the PRESERVE (Predicting the Safety and Effectiveness of Inferior Vena Cava Filters [IVCF]) study looking at both retrievable and permanent IVCFs. The FDA issued a letter in 2010 suggesting IVCFs should be removed when they are no longer needed.

The PRESERVE study now has 50 medical centers nationwide enrolling at least 1,800 patients. “We’ll be looking at complications using IVCFs and the increased utilization of retrievable IVCFs,” he said. “This study represents a shift in recognizing that registries, not just randomized controlled trials, can be used to test safety and effectiveness of such devices.”

As with other specialties, interventional radiologists face economic challenges, such as a disconnect between what payers and providers expect, according to Dr. Fueredi. The number of procedures being scrutinized by payers only seems to increase, he said. Alternative payer models are coming and will focus on shared gain and shared risk.

“We’ll have new emerging procedures that impact urologists and IRs,” Dr. Fueredi said. “The hot topic at this meeting was how to code the emerging prostate arterial embolization procedure. For nephrologists and IRs, we’re in the same boat with dialysis access codes. There has to be a reasonable risk profile across the specialty.”