1. Interventional Radiology Medical Student Introduction
Dr Nadeem Shaida
MBBS MRCS FRCR FHEA
Consultant Vascular & Interventional Radiologist

2. Overview What is Interventional Radiology? Sub branch of Radiology
Using imaging to perform invasive procedures
Fluoroscopy (X-rays), CT, US, MRI main modalities
“Pinhole surgery”

3. Overview What is Interventional Radiology?
Sub branch of Radiology
Using imaging to perform invasive procedures
Fluoroscopy (X-rays), CT, US, MRI main modalities
“Pinhole surgery”
Obvious advantages of minimal access
Quicker
Often under LA therefore shorter recovery time
Able to do procedures in sicker patients

4. History 1895 – First Xray Mrs. Roentgen 1st Nobel Prize in Physics
“Mobile” Xray Unit
1927 – First angiogram Egas Moniz
1929 – First aortogram Reynaldo dos Santos

5. History 1895 – First Xray Mrs. Roentgen 1st Nobel Prize in Physics
“Mobile” Xray Unit
1927 – First angiogram Egas Moniz
1929 – First aortogram Reynaldo dos Santos
1953 – Seldinger technique
Key for obtaining access

6. History 1895 – First Xray Mrs. Roentgen 1st Nobel Prize in Physics
“Mobile” Xray Unit
1927 – First angiogram Egas Moniz
1929 – First aortogram Reynaldo dos Santos
1953 – Seldinger technique
Key for obtaining access
1964 – Charles Dotter – “Father of IR”
First angioplasty
Links with industry forged early

7. IR = Innovation Term“Interventional Radiology” coined in 1967
1966 – Embolisation of spinal AVM
1967 – Judkins coronary catheterisation
1967 – Selective vasoconstriction for GI bleed
1970s – Development of occlusive “coils”
1973 – Embolisation for trauma
1974 – Thrombolysis for arterial occlusion
1977 – (Chemo)embolisation of liver tumours
1980 – Cryoablation of tumours
1982 – TIPSS Procedure
1985 – Catheter delivered stent
1990 – Radiofrequency ablation
1991 – EVAR
1999 – Islet cell transplanation
2004 – Selective Internal Radiation Therapy

8. IR Today? Vascular Non-vascular Interventional Oncology
Neurointervention
MSK intervention
Many many other procedures!

9. Vascular IR Angioplasty Balloon dilatation Drug eluting balloon Stent
Drug eluting stent
Biovascular scaffolds

11. Vascular IR Angioplasty Aneurysm repair EVAR TEVAR Visceral aneurysms
Ruptured AAA
Branched/Fenestrated EVAR

14. Vascular IR Angioplasty Aneurysm repair Haemorrhage control GI tract
Pelvic trauma
Visceral trauma (Spleen/kidney/liver etc)
Haemoptysis (Bronchial)

16. Vascular IR Angioplasty Aneurysm repair Haemorrhage control
Venous interventions
Ilio-femoral DVT PE
Pelvic congestion syndrome
Chronic venous occlusive disease

18. Non Vascular IR Drains/Biopsies Nephrostomy PTC & Biliary Drainage
Gastrostomy/ feeding procedures
IVC filters
Fibroid embolisation
Varicocoele
TIPSS Procedure

22. Interventional Oncology
Transarterial embolisation of liver
Transarterial chemoembolisation
SIRT procedure (Radioembolisation)
Ablative procedures
RFA
Microwave
Cryotherapy

25. Neurointervention Aneurysms – Coiling v Clipping Carotid stenting
AVM embolisation
Stroke thrombolysis
Venous stenting

27. IR Weekly Timetable Mon am – US list (Biopsy/Ablation assessment)
Mon pm – IR list (Fibroids/Varicocoele)
Tue am – Theatre (EVAR)
Tue pm – Vascular MDT
Wed am – TIPSS (Once/month)
Wed pm – Vascular MRI
Thu am – IR (TAE/SIRT/PVE/Biliary Stenting)
Thu pm – Liver tumour MDT
Fri am – IR (Angioplasty/Stenting/AVM embolisation)
Fri pm - CT

28. Whos It For?
Everyone!

29. Whos It For? Everyone! But it helps if… Hand eye co-ordination
Adaptability
Prepared to improvise/innovate
Interested in emerging technologies
Teamworking
Coolness under pressure!

30. Career Pathway FY1/FY2 Core training (Not essential)
Taster week radiology
Core training (Not essential)
Radiology training
Years 1-3 as normal
Final FRCR sat at beginning of year 4
Since 2010 – New IR curriculum
Leads to CCT in Radiology (Interventional Radiology)
Years 4-6 IR training

31. Career Prospects Good! In UK national T & Cs
Shortage of radiologists in general
Shortage of IR highly acute (BSIR 200 deficit)
Centralisation of services
In UK national T & Cs
Other countries well remunerated
Downsides
On call
Specialty creep

32. Key Resources BSIR CIRSE nadeem.shaida@addenbrookes.nhs.uk
Undergraduate curriculum
Medical student Links
CIRSE