Inside access
By Justin Guan, MD, Constantinos T. Sofocleous, MD, PhD, FSIR, FCIRSE, Nadar Ashraf, MBBS, and Behnam Shaygi, MD, MS
Spotlighting recent JVIR research
Results of a Global Survey on the State of Interventional Radiology 2024
Justin J. Guan, MD, et al. JVIR. 2024; 36(5):751-760.
Inside Access provides interviews and behind-the-scenes on open access articles from the Journal of Vascular and Interventional Radiology. Read the full article on JVIR.
Constantinos T. Sofocleous, MD, PhD, FSIR, FCIRSE: I am a professor of IR at Weil-Cornell Medical College and have practiced as an attending physician with a focus on interventional oncology/ radiology at Memorial Sloan Kettering Cancer Center in NYC since 2002.
I exclusively practice IO, and my focus has been colorectal metastatic disease to the liver and lung. I served as the SIR International Division councilor from 2021–25. The global survey was an initiative to understand the universal limitations of IR development with the hope to guide eff orts from societies and healthcare stakeholders who have an interest in expanding IR outreach to the patient.
Tell us about you, your team and your institution. Justin Guan, MD: I am an interventional radiologist at Cleveland Clinic Main Campus with joint appointment as assistant professor of radiology at Lerner College of Medicine of Case Western Reserve University. My practice focuses on embolization, interventional oncology and percutaneous biliary endoscopy. The Cleveland Clinic is a large hospital system with over 23 hospitals worldwide and over 6,700 beds in total. At Main Campus in Cleveland, my team consists of over 20 IRs. We also have an accredited IR residency program and match two integrated IR residents and two independent IR residents each year. I previously served as chair of the International Division’s Global Trainee Network and now serve as the Global Education Committee liaison.
20 IRQ | SUMMER 2025
Why did you pursue this topic? JG: For many years, the International Division had wanted to understand the current global state of IR training and what regions of the world off er IR services, but this information did not exist. This topic had been discussed during radiology conference proceedings previously; however, no one has ever really tried to poll radiologists from diff erent countries to see what IR training and IR practice are actually like. With the support of Dr. Sofocleous, we made a push to send our questionnaires to diff erent global IR societies. Fortunately, with the help of the global IR community, we were able to reach radiologists from all over the world.
What are the key takeaways from your research? JG: There are two main takeaways from our results:
1. Quality, dedicated IR training is inadequate in much of the world. The United States has only recently made integrated IR residency an approved training pathway, but in virtually all other developed countries where the IR is recognized, IR is still considered
a subspecialty of radiology, and trainee exposure to the fi eld depends on the regional availability of IR services. In many places, trainees have no IR exposure during training. We know that IR interventions improve patient outcomes and shorten hospital stays compared to surgical alternatives, so patients are well served by the ability of minimally invasive, image-guided procedures. But we need to have well-trained IRs to off er these services to the patients.
2. There must be improved recognition of the IR specialty among both the public and primary service physicians, especially family medicine, internal medicine and surgery physicians. Patients usually prefer less invasive treatments when given the choice, but only if they know about the existence of these options.
How might this research infl uence treatment, practice or clinical processes in interventional radiology? JG: Even in the United States, there are variations in what IR services are provided and poor understanding of the specialty by patients and other specialty physicians. So, our results, regardless of how profound in countries outside of United States, also apply to our patient population. As a medical community we should fi nd eff ective and innovative ways to spread awareness of our specialty.
Any next steps or plans for follow-up research? JG: This paper presented our data on a regional level, comparing data between diff erent regions or continents globally. However, we collected data down to the country level. Our hope is that we can work further with regional IR societies to analyze and present country-level data for those societies. For instance, we will be presenting our fi ndings for IR in the
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