American College of Radiology Practice Guideline for Interventional Clinical Practice: A Commitment to Patient Care

THE ratification of the Practice Guideline for Interventional Clinical Practice (1) is a milestone for radiology. It represents the recognition by leaders of radiology that interventional radiology and interventional neuroradiology are clinical specialties. Although this has been appreciated and espoused by interventional practitioners (2), recognition and acceptance by radiology is a major step that took significant work on the part of many interventionalists, including especially Drs. Curtis Lewis, Matthew Mauro, David Sacks, James Swischuk, and Michael Pentecost. The Practice Guideline for Interventional Clinical Practice (1) was written for a number of audiences, including radiologists (interventionalists and their noninterventional partners), hospital credentialing committees and administrators, and payors. It may be useful to refer to this document when radiologists request admitting privileges or hospital resources. The document may also be important when negotiating reimbursement or service coverage with payors. Perhaps the most important audience, however, is radiologists. With regard to the radiology audience, this guideline should have substantial impact on the practice of interventional radiology among practitioners who have not already incorporated its spirit. Many of the challenges facing interventional radiology today can be attributed to radiologists themselves, both interventionalists and noninterventionalists. Many interventionalists prefer other areas in radiology but dabble part-time in interventions. They do not mind practicing as technicians, deferring clinical management to the referring doctor. Interventional radiology had a long run with that, but it is over. A radiologist who expects the referring doctor to evaluate the patient, decide whether intervention is indicated, and manage the outcome with regard to the treatment is misled. Interventional radiologic therapies are mainstream and in demand by the public. It is likely that another specialist in the community will offer a more comprehensive service to referring doctors than that just outlined. Noninterventional radiology is an equally important audience for the guideline. The guideline recognizes that, to provide contemporary interventional therapy, one must provide clinical care, and to provide clinical care, interventionalists must have adequate time and resources. Many practices have accepted this and their interventional work is thriving. Many have not. In a recent survey by the Society of Interventional Radiology, only 50% of interventional radiologists who responded said their groups were supportive of clinical practice (3). In many ways, the jobs and cultures of interventional radiology and general radiology are polar opposites. This can potentially be a big problem. There are roughly 20,000 radiologists in the United States, but only approximately 4,000 interventionalists. Predictably, many radiology groups are dominated by noninterventional radiologists. Interventionalists are often in a politically ineffective minority within a radiology practice. Worse, they may be regarded as “not really radiologists” by their partners. The natural tendency of majorities is to rank their priorities higher than those of the minority, and it is difficult for many radiology partners to comprehend the need for clinical time and resources when, for example, they are reading twice as many magnetic resonance (MR) studies compared with 5 years ago. With the skyrocketing demands for MR imaging, computed tomography, ultrasonography, and nuclear medicine, many radiology group practices are challenged to meet their staffing needs. Radiologists often prioritize delivery of those services higher than that of interventional radiologic services. In this context, it is often a challenge to get a fair share of practice overhead allocated to helping interventional radiology succeed. Hopefully, this document, as well as others recently published by Hillman (4) and Swischuk et al (5), will convince noninterventional radiologists that the needs of interventional pracFrom the Department of Diagnostic Imaging, Rhode Island Hospital, Brown Medical School, 593 Eddy Street, Providence, Rhode Island 02903. Address correspondence to T.P.M.; E-mail: tmurphy@ lifespan.org