Endovascular surgery

Interventional radiology
Intervention
Balloon dilatation of the stenosed internal jugular vein (photo from an X-ray angiograph monitor). While pressure in the balloon is relatively low, stenosis prevents the balloon from inflating in the middle. Further increase in pressure will dilate the narrowing and restore the full blood flow.
MeSH	D015642
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Interventional radiology (IR), sometimes known as vascular and interventional radiology (VIR), is a medical sub-specialty which provides minimally invasive image-guided diagnosis and treatment of disease. Although the range of procedures performed by interventional radiologists is broad, the unifying concept behind these procedures is the application of image guidance and minimally invasive techniques in order to minimize risk to the patient.

Historically, radiology doctors who regularly used x-ray imaging for the purpose of diagnostic testing were some of the first physicians to use imaging to direct medical procedures. Radiologists pioneered the use of catheter-based techniques such as angioplasty and catheter-delivered stent placement, which are now commonly used by other interventional medical specialties such as interventional cardiology.

Presently, IR physicians use x-ray, ultrasound, CT, and MRI imaging to perform a variety of procedures using needles and small catheters instead of surgical incisions. Thus, some conditions which previously required open surgery can now be treated non-surgically by an interventional radiologist.

Traditional

As in most medical specialties, training varies depending on varying rules and regulations from country to country. In the United States, interventional radiologists are physicians whose education and training traditionally includes completing a college degree, four years of medical school, a year of training in general medicine and/or surgery (internship), a four-year diagnostic radiology residency program, and then a one or two year fellowship in vascular & interventional radiology.

With the evolving need to train more clinically oriented interventionists, two alternative pathways to achieve certification in IR have been established through the leadership of the Society of Interventional Radiology (SIR): The DIRECT and Clinical pathways. For both pathways, the SIR states that the trainee must become proficient in management of inpatient and outpatient pre-procedure, post-procedure, and follow-up clinical care for all disease processes pertinent to the practice of VIR.

DIRECT

The DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training) pathway allows for up to two years of clinical training prior entering the program. Therefore, residents may enter the new pathway from medical school or after two or more years of clinical training in other specialties such as internal medicine or vascular surgery. The core diagnostic training is 27 months in duration, with 21 total months of VIR training for a total of 48 months (four year) duration. The advantage of the DIRECT pathway is that upon successful completion of the program and 12 months of clinical practice, a clinician can achieve both a Diagnostic Radiology board certification and a subspecialty vascular IR certificate. The American Board of Radiology offers a complete list of programs that offer this pathway at: http://theabr.org/ic/ic_other/ic_direct.html.