A Physician's Guide to Interventional Radiology

Home , Interventional radiology

A Physician’s Guide to Interventional Radiology Your partner in clinical care Interventional radiology (IR) can be a trusted partner in the diagnosis and care of your patients—particularly those with complex or challenging medical conditions who are not responding to traditional courses of treatment. Learn when and how to collaborate with IR to help your patients explore targeted treatment

options for their condition.

2 A Physician’s Guide to Interventional Radiology | Your partner in clinical care An interventional radiologist can help you with diagnosis and with delivering cutting-edge treatments—particularly in difficult or challenging situations where a collaborative approach often provides the best outcome.

Interventional radiology: Why IR? Your partner in clinical care Interventional radiologists are board-certified Patients come with unique challenges. Some may physicians who use advanced imaging guidance, not respond well to treatment. Others may have including X-ray, CT, MRI and ultrasound to recurring symptoms and want to explore other help diagnose patients and deliver targeted options. Through a multidisciplinary approach, treatments. Interventional radiologists treat many an interventional radiologist can work with you different types of diseases in the hospital and in to identify and provide your patients with the outpatient settings. IR can reduce the length of best targeted treatment options for their specific hospital stays, minimize potential complications disease or condition. and save lives.

Interventional radiology (IR) can work with Interventional radiologists are trained in both you to address an array of medical problems, diagnostic radiology and the appropriate including cancer, vascular diseases, and use of minimally invasive treatments. IRs are men’s and women’s health conditions. An often on the front lines of clinical advances interventional radiologist can also help you and use the latest image-guided technologies with diagnosis and with delivering cutting-edge to help solve some of the toughest medical treatments—particularly in difficult or challenging problems. Interventional radiologists collaborate situations where a collaborative approach may with colleagues from multiple specialties to provide the best outcome. understand a patient’s unique needs, exchange ideas and find targeted solutions to patient care. Collaborating with an IR gives you and your To do this, IRs must not only possess in-depth patient access to a range of innovative, minimally knowledge of the least invasive treatments invasive, targeted treatments. available, they must understand other disciplines Interventional radiology can be your partner in and innovative procedures to enhance patient clinical care. Whether for diagnosis or treatment, outcomes and support the overall treatment plan. ask an IR how they can help.

3 A Physician’s Guide to Interventional Radiology | Your partner in clinical care What conditions can IR help me treat? Interventional radiologists treat people who suffer from a wide variety of conditions, including:

• Vascular disease: IRs treat the pain and disability associated with peripheral arterial disease (PAD) using balloon angioplasty and/ or stenting. They also treat varicose veins and other forms of vascular disease, such as acute and chronic deep vein thrombosis and pulmonary embolism.

• Cancer: Chemoembolization, selective internal radiation, cryoablation, radiofrequency ablation, microwave ablation and other emerging methods (such as immunotherapy) are used to target many types of cancer, sometimes downstaging disease to allow for transplant or other curative steps. IRs help manage cancer pain and provide palliative cancer care. They also perform biopsies and chest port placement, rounding out the comprehensive, minimally invasive care of patients with cancer.

• Women’s health conditions: Uterine fibroids, certain types of pelvic pain, and some infertility issues are treatable through IR therapies. Embolization is used to block the flow of Interventional radiologists blood to treat fibroids, adenomyosis, uterine collaborate with colleagues arterio-venous malformations, and postpartum hemorrhage. Chronic pelvic pain from pelvic from multiple specialties venous disease or congestion can also be to understand the patient’s eliminated with embolization. Infertility due unique needs, exchange to fallopian tube blockage can be treated by minimally invasive recanalization. ideas and find targeted • Men’s health conditions: IRs can help relieve solutions to patient care. symptoms associated with enlarged prostates using prostate artery embolization and can also treat varicoceles (enlarged veins in the scrotum) with minimally invasive embolization.

4 A Physician’s Guide to Interventional Radiology | Your partner in clinical care When should I consult with an IR?

If your patient is not responding well to treatment, not a candidate for the course of treatment you offer or is simply seeking another treatment option, adding an IR to your team can help you identify the best course of treatment going forward. Below are some of the common conditions IRs treat and the techniques they use.

Vascular disease Treatments Cancer Treatments

Abdominal aortic Arterial angioplasty Bile duct cancer Irreversible aneurysm and stenting electroporation (IRE) Bone cancer Atherosclerosis Catheter-directed Microwave ablation thrombolysis Chronic venous Breast cancer Palliative pain insufficiency Deep venous treatments angioplasty and Cancer pain Critical limb ischemia stenting Radiofrequency Kidney cancer ablation (RFA) Deep vein thrombosis Endovenous ablation Cryoablation Peripheral arterial IVC filter placement Lung cancer disease Vertebral Radiofrequency Primary liver augmentation Pulmonary embolism ablation cancer Trans-arterial Stroke Sclerotherapy Palliative cancer chemoembolization (TACE) Varicose veins care Radioembolization May-Thurner syndrome (Y-90)

Women’s health Treatments Men’s health Treatments

Adenomyosis Fallopian tube Benign prostatic Prostate artery recanalization hyperplasia (BPH) embolization Infertility due to blocked fallopian tubes Ovarian or pelvic vein Varicoceles Varicocele embolization embolization Pelvic congestion syndrome Uterine artery embolization Uterine fibroids

5 A Physician’s Guide to Interventional Radiology | Your partner in clinical care What other diseases and conditions Will IRs offer longitudinal care? do IRs treat? Interventional radiologists frequently partner with Interventional radiologists treat many more primary care physicians and referring specialists diseases and conditions, including, biliary to provide coordinated care before, during and diseases, hypertension, kidney disease, vertebral after treatment. They consult in clinics and work compression fractures, and trauma and bleeding. on collaborative multidisciplinary teams to help IRs work with pediatric patients and their families. achieve the best possible outcomes for patients. They are also skilled in developing unique or Most IRs have hospital admitting privileges and customized treatments for otherwise challenging many have clinical offices to provide patient or complex disease processes. To view a consultations. The IR will remain an integral part of complete list of the diseases and conditions that the care team every step of the way. interventional radiologists treat and a glossary of IR treatments, visit sirweb.org/patients. During postprocedural office visits, IRs will monitor the condition and assess whether further How do IRs work with me and treatments are needed, communicating and coordinating with you throughout the process. my patients? Ensuring the delivery of the right care at the If I refer to an IR, will I “lose” my patient? right time from the right person is a vital aspect of clinical care. Interventional radiologists can Interventional radiologists practice coordinated provide assessments and working diagnoses that care, in clinics and on collaborative teams with complement, confirm or augment your own. IRs PCPs and other specialists. Referring to an can assist in creating a treatment plan, keeping interventional radiologist doesn’t affect patient you informed every step of the way. retention because you are still involved in the patient’s treatment plan. Preprocedural consultations are an integral part of a successful referrer–IR relationship. The More patients are taking an active role in their own interventional radiologist will work closely with care, sharing health care experiences and asking you to understand prior treatments, challenges questions in online discussion forums, on social and concerns. They will talk with your patient in media and through patient advocacy groups. Often an office setting to understand their issues, review these questions are about whether minimally their past medical and surgical history, assess invasive treatment options exist and whether they the results of prior diagnostic testing, explain are the right choice for their condition. treatment options and answer any questions. Visit sirweb.org/patients to download Patient FAQs to help answer your patient’s questions about interventional radiology and to Find an IR near you.

Interventional radiologists can provide assessments and working diagnoses that complement, confirm or augment your own.

6 A Physician’s Guide to Interventional Radiology | Your partner in clinical care Interventional radiologists work as partners with primary care physicians, hospitalists and other specialists to help produce the best possible outcomes for patients.

What kind of training do IRs receive? What’s the best way to partner with an In 2012 the American Board of Medical Specialties interventional radiologist? (ABMS) approved a dual primary certificate in IRs understand that availability, communication interventional radiology and diagnostic radiology. and trust are the foundations of a productive With this approval, the ABMS confirmed the skill multidisciplinary team. Identifying, developing set unique to IR that combines diagnostic imaging, and maintaining relationships makes the referral image-guided procedures and periprocedural process run smoothly. Many interventional patient care. radiology practices have established, formal referral agreements with specialist groups The elevation of IR to a specialty level—with its and other clinicians. In geographic regions or own distinct residency program—places it at the organizational scenarios where this may not be same level as surgery, pediatrics and internal possible, simply reaching out to a local IR for medicine in the ABMS hierarchy. Medical students conversation is a great start. and diagnostic radiology residents choose from among three pathways to become an Incorporating interventional radiology into your interventional radiologist. All training pathways treatment plan is possible within many practice lead to the American Board of Radiology (ABR) environments, from regional or community IR/DR Certificate, which certifies practice in both health systems that support coordinated care interventional radiology and diagnostic radiology. to private practices and teaching hospitals. No matter the practice model, IRs work as partners with primary care physicians, hospitalists and other specialists to help produce the best possible outcomes for patients.

What’s the best way to find an IR?

Visit SIR’s Doctor Finder (sirweb.org/findanIR)—a comprehensive database of SIR-member interventional radiologists practicing in the United States and internationally—to find an interventional radiologist near you.

7 A Physician’s Guide to Interventional Radiology | Your partner in clinical care 3975 Fair Ridge Drive Suite 400 North Fairfax, VA 22033 (703) 691-1805

sirweb.org