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  • Writer's pictureFrancesco Bruno Tagliaferro

Who is the Interventional Radiologist?

Updated: Jan 14

The Interventional Radiologist is a doctor specialized in Diagnostic and Interventional Radiology who uses radiological images, such as X-ray, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound, to perform minimally invasive interventions.




The use of radiological images during surgery allows for visualization of surgical instruments and target organs without the need to perform invasive surgical access, limiting the damage to the organism to a minimum and speeding up recovery times.


How to become an Interventional Radiologist in Italy


During the professional training, the interventional radiologist acquires advanced knowledge of imaging techniques and develops specific skills to perform minimally invasive interventions guided by radiological images.


In Italy, to become an interventional radiologist, it is necessary to follow a specific training path:


  1. Degree in Medicine. The first requirement is to obtain a degree in Medicine, clearly.

  2. Specialization in Radiology. Next, you have to get into a Radiology School. In Italy, currently, the radiological residency program is the same for Diagnostic Radiology and Interventional Radiology, while in other countries the two disciplines provide separate training courses. The Specialization in Radiology lasts 4 years and provides in-depth training in the interpretation of radiological images, such as radiography, CT, MRI, and ultrasound. During specialization in radiology, doctors who want to undertake an interventional career dedicate their training to the acquisition of technical and theoretical skills specific to the subject, also and above all working in the Cath Lab with the guidance of trained and experienced Interventional Radiologists.

  3. Additional post-residency training. After completing the specialization in Radiology, it is possible to follow specific training courses to consolidate your interventional skills. These paths may include postgraduate training courses, fellowships or masters dedicated to interventional radiology.

  4. Clinical practice and continuous updating. Once you have acquired specialized skills, it is important to gain practical experience and continue to update yourself on new technologies, procedures and developments in interventional radiology. This can be achieved through clinical practice, participating in scientific conferences or specific courses, etc.



Cath Lab

Historical notes on Interventional Radiology


Interventional Radiology has a rather long history, dating back to the 1960s. X-rays were already widely used for medical purposes, but in those years advances in radiological imaging and material technology made it possible to perform the first minimally-invasive radiological procedures, initially with purely diagnostic purposes (for example the injection of contrast medium directly into the arteries to study the cerebral vasculature in real-time).


After the very first phases, invasive radiological procedures have also been used for therapeutic purposes, with techniques and indications that have evolved and expanded enormously over the years, following the explosive technological advancement that characterizes our era.


In addition to the availability of innovative imaging techniques, the great impetus to Interventional Radiology has been given by the development of dedicated material and specific, increasingly high-performance, safe and reliable, such as biliary/venous/arterial stents, vascular catheters and drainage catheters, balloon catheters for angioplasty, guide wires, vascular introducers, needles for ablation of tumor masses with increasingly sophisticated technology, microwaves /radio frequencies/cryotherapy, etc.


Covered biliary stent
Covered biliary stent

The search for new materials, interventions and indications is always ongoing, due to the important clinical results that interventional radiology has already amply demonstrated in the field, and also for the considerable potential that remains to be explored.


Role of the interventional radiologist


The interventional radiologist works closely with other medical specialties, such as oncology, pulmonology, surgery, emergency medicine and many others, urgently and electively, to provide a precise assessment of the pathology and offer a minimally invasive treatment, when possible.


The interventional radiologist can potentially perform interventions on the whole body, both endovascular and extravascular, always with minimally invasive but high-impact techniques, such as image-guided lung/liver/kidney biopsies, the positioning of drainage catheters, percutaneous ablation of tumor masses, management of vascular complications (e.g. post-surgical bleeding), insertion of vascular venous catheters (e.g. CVC, port-a-cath, PICC) and many other diagnostic and therapeutic procedures.


Therefore, the skills of the interventional radiologist must be broad and multidisciplinary, and require a lot of preparation and continuous updating.


Some examples of intravascular procedures include:


  • Angioplasty: the use of balloons or stents to open and dilate blocked or stenotic blood vessels.

  • Embolization: the insertion of particles or coagulating agents to block or reduce blood flow to tumors or vascular malformations or to stop bleeding.

  • Thrombectomy: the removal of blood clots from blood vessels using special image-guided instruments.

  • Closure of arteriovenous fistulas: the occlusion of the abnormal communications between arteries and veins.


MRI of the prostate and pelvic angiography
MRI of the prostate and pelvic angiography

The extravascular procedures include:


  • Image-guided biopsies: to get tissue samples for histological examination.

  • Ablation of tumor masses: a technique to selectively destroy tumors using thermal energy (radiofrequency ablation, microwave ablation, cryotherapy, etc).

  • Percutaneous drainage: the insertion of a plastic tube (catheter) to remove fluid or pus from cysts, abscesses, or other types of fluid/superfluid collections.

  • Intracorporeal positioning of medical devices of various kinds: catheters, stents, venous filters, etc. to treat a wide spectrum of conditions such as venous insufficiency, occlusion of the bile ducts, pleural effusion, pulmonary embolism, etc.


Percutaneous biliary drainage
Percutaneous biliary drainage

The interventional radiologist, therefore, uses radiological images to diagnose and treat a wide range of medical conditions effectively and safely, minimizing invasive surgical approaches and improving patient outcomes.


Interventional radiology, compared to more invasive surgical approaches, uses small incisions or skin punctures to access the areas of the body to be treated. This significantly reduces trauma to the patient, length of hospital stay and post-operative recovery time.


Additionally, many interventional radiology procedures can be performed on an outpatient basis, allowing patients to go home the same day.


Cryoablation needles
Cryoablation needles


CVC
CVC

In conclusion, interventional radiologists are doctors specialized in diagnostic and interventional radiology who perform a wide range of minimally invasive diagnostic and therapeutic interventions guided by radiological images, which allow them to operate with high precision and safety and with the least invasiveness.

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