However, they were still largely proceduralists, treating patients as scheduled for them by other clinicians.


“It was almost like how we would perform a CT scan for the radiology department as ordered, with no real patient interaction,” said Kumar Madassery, MD, FSIR, an IR faculty member at Rush. “The difference was that we weren’t just doing the imaging, we were performing procedures: We’d meet patients just before they entered the room and our relationship ended when we were done. Our interaction with them was so limited.”


It also impacted productivity, Drs. Arslan and Madassery said, such as in instances when the referring clinician in the hospital missed some aspect of the patient that prevented the IRs from being able to perform the procedure. That meant rescheduling and unhappy patients.


Rush leadership wanted a solution.


“It told them, I can fix it, but first we need to control the process: We need to see every patient at their bedside the day before the procedure, when the clinicians put the order in, and we need to be able to discuss with the patient their labs, what we’ll be doing, what they should expect afterwards, etc.,” Dr. Arslan said.


“Once we made that connection with the patient, and were able to discuss their procedure with them, we were able to treat them more smoothly and the scheduling problems disappeared,” said Dr. Madassery.


Adding a clinical consult service and avoiding the scheduling problems meant that the IR team saved the hospital both time and money.


Now that they’d established themselves as clinicians, they built a structure for IR at Rush—not yet as a department, but as an independent service line within the radiology department. It was another step forward, but still not ideal.


“Our operations and faculty, our research and education, may have been functionally separated from DR, but we


“As clinicians, we can do more than treat the patients who are brought to us. We can bring in our own patients. And hospital administrators place the greatest value on clinicians who can do that.”


—Bulent Arslan, MD, FSIR


were still under their auspices,” said Dr. Arslan. This meant, for example, that the promotion of IR faculty couldn’t happen without the involvement and support of the radiology department chair.


Finally, in fall 2024, Dr. Arslan approached the hospital administration with the last step. He told them that changing IR’s status at Rush to a department would allow them to bring in their own patients— not just as a consult for other clinicians at Rush. The value proposition was clear and, since the infrastructure was already in place, Rush administrators approved the change.


A clear road ahead Space and staffing The independent IR department launched with six faculty. Though that would be enough to start with, it wouldn’t permit the growth that Dr. Arslan envisioned. As the interim IR chair, he met with the president of the medical group and the president of the hospital to build a strategic plan that allowed them to increase their faculty to nine, with plans to add two more within the following 3 years. In addition, the department has two medical assistants, two clinical coordinators, three nurses, and four advanced practice providers.


Becoming a department also allowed them to get more space, growing from two to five rooms, and increasing their patient volume accordingly.


“About 7 years ago, we would see about a thousand patients a year,” said Dr. Madassery. “Now we’re seeing over 4,000 patients a year.”


According to Dr. Arslan, there is still a need to balance the growth with the resources they receive from the hospital.


“It’s a matter of aligning the resources with the right amount of staffing to increase the patient volume and corresponding revenue in the same proportion.”


With the departmental status and increases in staffing and patient volume, Dr. Arslan said, IR has become highly visible throughout the hospital.


“All surgical medical branches now see my resident fellows and attendings on the floor, talking with patients, which has made a significant difference in their awareness of our clinical nature.”


Scope of service Today, the Rush IR department can take on virtually any type of patient.


“We take on 99% of everything that’s out there, from PAD to aortic care to complex critical limb ischemia, oncology, Y-90, pain procedures,” Dr. Madassery said. “We have robotics, we have histotripsy. You name it.”


To help spread the word on the range of services and increase patient awareness, Rush provides them with dedicated marketing support.


“We meet with them every month to talk through areas of marketing focus,” said Dr. Arslan. “We’ve focused marketing campaigns on histotripsy and critical limb ischemia, and now we’re working with them (in collaboration with the urology department) to promote our prostate artery embolization program. It’s made a huge difference.”


IR residency Even before the formal transition to a department, Dr. Arslan separated the IR residency completely from DR. They now have a 6-year categorical residency, with a total of 27 residents.


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