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Centennial Sounding Board |
1 Department of Radiology, Division of MRI, University Hospitals of Cleveland/Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106.
Received February 18, 2000;
accepted after revision March 2, 2000.
Address correspondence to J. R. Haaga.
Introduction
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First, the image and identity of interventional radiology must be enhanced. Perhaps a first step might be to change its name. The importance of a suitable name is well recognized by image builders and public relations firms. In many instances, a poor quality product will gain wide acclaim and acceptance solely because of its appealing and attractive name. Likewise, a useful, desirable, or even revolutionary product may be overlooked or fail to succeed in the marketplace because of a poorly chosen name.
The importance of this concept became apparent to me when my wife and I were having coffee on a Sunday morning and I was expounding the virtues of my favorite professional topic, interventional radiology. My ego was slightly bruised because, although I imagine myself a reasonably clever person who has made some worthwhile contributions to our subspecialty, it was quite clear that my wife and I were not communicating at the onset of the conversation. The crux of the problem was not the specific details of what I was saying but rather her misunderstanding of the term "interventional radiology." A name should clearly indicate the nature of the subject without requiring further explanation. As I look at the current name from a lay perspective, I must confess neither the word "interventional" nor the word "radiology" communicates a definition of most of the procedures currently performed in our subspecialty.
In my opinion, our subspecialty should devise a new name to define the cadre of our many invasive procedures. Although I am not in favor of any specific name, I would like to suggest "imaging-guided microsurgery" to replace the term "interventional radiology." Imaging guidance is the critical element of what we do; it is that which separates us from other specialists who perform unguided procedures, such as open laparotomies or laparoscopic procedures. Within our subspecialty, we might choose to use technique-specific terms, such as "CT-guided" and "MR-guided." However, to the lay world, we should offer the more generalized and recognizable concept of imaging guidance.
The term "microsurgery" might also be suitable when we examine the specific nature of our field compared with other clinical subspecialties. If we review the minimally invasive procedures performed by surgeons and others, the devices that are used for these "minimal" procedures are seldom smaller than 2 mm in diameter, whereas ours are seldom larger.
I also believe that the prefix "micro" is suitable to be used as part of the new name of our subspecialty because micro implies more than minimal diminution and even less invasiveness than the term "minimal invasion" used by our surgical colleagues.
Furthermore, a more encompassing term like my suggested "microsurgery" should be used because the scope and depth of our field are remarkable when one surveys the vast array of procedures we perform. Our vascular procedures are now well established and well recognized and include not only traditional angiography, but also therapeutic procedures such as angioplasty and stent placement. Virtually every organ system and type of anatomic problem are evaluated and treated using our techniques, including the head, neck, chest, mediastinum, liver, gallbladder, pancreas, kidney, and so forth. As imagers, radiologists perform not only procedures such as needle aspirations and biopsies to diagnose problems and disorders, but also many clinical treatments. We perform drainages of anatomic cavities, pleural spaces, organs, biliary systems, kidneys, cysts, and many other anatomic areas. Tumor therapy using chemicals, radiofrequency (RF), liquid nitrogen freezing, laser heat, focused sonography, and various other techniques, is also being performed. Recent innovations include the local placement of enzymes or other drugs to enhance abscess drainage or to destroy localized tumors. Thrombogenic agents, such as thrombin, are being injected to seal off pseudoaneurysms in blood vessels.
Procedural complications are now rare because we have developed techniques to minimize their occurrence. The argument of other subspecialists that we must be able to deal with our own complications is null and void if our complication rates are extremely low. Problems related to hemostasis, air and fluid leakage, and procedure complications are being solved using new techniques and approaches to seal procedure pathways with sealants, glues, coils, and other agents.
It is difficult to imagine the techniques and procedures of the future, but several predictions are easy to make simply by extrapolating the few methodologies that already exist. In years to come, small tumors of every organ, including breast, chest, liver, and kidney, will be detected, biopsied, and eradicated using local imaging guidance. This methodology will be as widespread and well accepted as the current treatment for moles on the skin. Lesions will be detected, biopsied, and treated at one visit. The conversation between the radiologist or imager and the patient will resemble this: "Today, we found a lesion, biopsied it, and eradicated it. We will have the biopsy results in several days so that you and your regular physician can plan the follow-up treatment and establish the prognosis." The success rate for treatment of certain tumors, such as pancreatic cancer, will be improved by both palliative and curative procedures. Imaging-guided RF ablation will achieve complete relief of pain in patients with incurable disease. Other patients with inoperable pancreatic cancer due to minimal arterial or venous encasement will become candidates for Whipple's operations after RF destruction of local tumor encasement.
Our microsurgery techniques must also develop, improve, and continue to evolve along with our clinical development to ensure our supremacy among physicians performing procedures intended to maximize benefit with the least trauma and cost to the patient. We must continue to show that imaging-guided microsurgery is "rocket science" because of the complexity needed to understand, use, and develop the sophisticated imaging equipment that it requires and the complexity of its new techniques. Whereas success in real estate is predicated on "location, location, location," success in our field depends on "innovation, innovation, innovation" to provide the necessary leadership that shows quite clearly that radiologists are "rocket scientists."
For us to control our routine diagnostic studies, we must also control the imaging-guided microsurgical techniques. Imaging follows the procedures because the procedures add considerable success to our patient care.
Imaging-guided microsurgery will be a major determinant of the future success of Radiology.
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