“Imaging of the Intervention” a new paradigm for our specialty

Interventional Radiology (IR) is a subspecialty of diagnostic Radiology. It has dramatically developed in the recent past and has became part of daily practice in most Health Care centres in Europe and worldwide. Because of its major role in various diseases, IR has gained wide acceptance and despite turf battles on some intervention, IR are in a central position to create, perform, determine the indication and the follow-up of mini-invasive image guided interventions. It is common sense that optimized results and appropriate levels of activity of Interventional Radiology relies on sound clinical judgement but also in a large part on the results of Imaging workup. Unfortunately, Interventional Radiologists today share the experience that imaging is not optimized in several aspects and that there is a need for better understanding of the principle, the indications, results and complications of Interventional procedures. First of all, there is not enough awareness of the indications for IR procedures among diagnostic radiolog-ists. How many cases are not referred to IR for advice, despite obvious feasibility? How many pelvic MR patients are not referred for possible Uterine Fibroid Embolization? How many aortic imaging studies are not referred for possible EVAR/TEVAR? How many typical osteoporotic fractures? How many complex biliary stenoses ?…. These missed opportunities are patients who lose the potential benefit of undergoing minimally invasive intervention. In addition the field of IR does not develop appropriately. Secondly, when reading the report from our diagnostic radiology colleagues, we know that we often have to re-analyse/re-interpret the images for our own purpose, in order to answer our own specific IR related questions. Examples include: CTA workup for Abdominal Aortic Aneurysms reporting on the " length of the aneurysm " but not on the infra-renal neck; Lower limb CTA reporting on " calcified arteries " and " infiltration " of the Superficial Femoral Artery with no attempt to search for a tight stenosis that could be amenable for balloon dilatation; Liver imaging reporting on " 2 metastasis in the left liver " or HCC workup before chemo-embolisation that do not search for extra hepatic feeding arteries. There are many other examples covering the whole field of IR with all types of imaging techniques. Such reports which do not consider IR factors do not prompt referring clinicians to propose Intervention Radiological procedures for their patients, thereby reducing the appropriate growth and appreciation of IR. If all this is true for …