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IRs in focus Guest: Geogy Vatakencherry Sept. 2022 In this episode, Geogy Vatakencherry, MD, FSIR, discusses the evolution of IR and clinical opportunities for IRs-in-training.
Warren Krakov, MD, FSIR: Do you think there will be IO fellowships and residencies? How subspecialized are we going to get?
GV: Will there be subspecialty training? I think so. We see it already to an extent with pediatric or neurointerventional IR, especially with IO, and there are IRs doing amazing stuff with MSK pain and palliative care. I do think we need to build the service lines and expand them. However, I don’t personally love going too into the roots of one subspecialty, because then you lose the forest from the trees. The more holistic you can be, the better off the patient will be—if they come in for one problem, you should be able to assess the other problems that present as well. We should have service line champions, but still be able to offer the various therapies for the best care of the patient. Especially with the growing Medicare population,
we will see a lot of concurrent disease. Hypertension, hyperlipidemia, the basic screening for common cancers—these are things we, as IRs, need to learn to provide care for. We need to understand IVC filter management and blood clot retrieval, but also anticoagulation regiments and how to prevent DVT. We need to know these disease states and the trials surrounding them, so we can use more evidence to support our decision-making, looking at safety, ethics and the durability of not only our own therapies but other pharmacologic therapies and supportive therapies.
Finding success with an office-based lab in interventional radiology Sept. 2022 Joel R. Rainwater, MD, speaks about his experience building a network of 12 office-based labs (OBLs) in 5 states, what interventional radiologists should keep in mind when considering the OBL business model, opportunities for IRs-in- training, and more.
Roger Tomihama, MD: What are some of the key differences you discovered in the hospital as opposed to the OBL setting?
JR: The hospital-based practice usually centers around what are you going to be doing that day. You come into your hospital IR department and there’s a board with cases on it. You may not know the patient beforehand, and there may or may not be a portion of your day that’s dedicated towards helping plan that patient’s care algorithm, which is the opposite in the OBL setting. You made the treatment plan and scheduled the procedure. Those days are filled with you seeing your patient and going through their care plan: it’s just one stop along a lengthy train of decision making. That can be satisfying to a lot of IRs. And it’s also a controlled environment—you have much more control over your staff and facility and how you manage your patients.
Interventional radiology and postpartum hemorrhage response teams June 2022 Janice Newsome, MD, FSIR, speaks on the potential of IRs on postpartum hemorrhage response teams, as well as the need for maternal care data.
JN: There is so much happening physiologically around the time of childbirth that we just don’t know. We classify hemodynamic instability with blood loss, but that doesn't account for the physiology during birth, such as the placenta or even the position of the mother. I’ve seen patients classified as hypotensive because they were laying on their side before delivery. If you’re with a patient and you’re questioning the data or current knowledge, put on your IR hat and get creative. Say, “Can you get blood pressure in the other arm?” or “This reliance on hemodynamic instability may look different in varying populations.” Pause and recognize that we may not know all we need to in this space.
And additionally, as a community, IR is as capable as any other specialty to deal with health inequities—and the entire medical community is waiting on IR to take the lead as it relates to postpartum hemorrhage and embolization and closing the disparity gap present with maternal deaths. We can make a difference not just in mortality, but morbidity as well, where we see patients of color experience poor outcomes 3–4 times more than other communities. If IRs—who already do a good job of listening to patients and families—adapt the motto of “Hear her”, I think we can make a bigger difference sooner.
JVIR audio abstracts
Tune in each month to hear audio versions of the featured abstracts from the Journal of Vascular and Interventional Radiology.
sirweb.org/irq | 29
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