As interventional radiology continues to surge forward as a specialty in the United States, SIR is also working to increase the awareness and practice of IR around the world. To recognize this growth, IR Quarterly will begin a special series spotlighting the growth of IR in specific countries in Asia, Africa, Europe and the Americas and how the society is meeting those needs. IRQ interviewed Brian Stainken, MD, FSIR, SIR international division councilor, to discuss this growth.
How has IR grown around the world since the global statement defining IR?
Brian F. Stainken, MD, FSIR
Since it was issued in 2010, awareness and delivery of what we call IR has expanded rapidly both in terms of interest and the number and types of providers. I think we can reasonably say that IR in some form is now practiced in every corner of the world. As a new discipline, however, recognition of the IR specialty and its benefits to patients, payers and government entities has lagged behind.
Why is it important for SIR to support the growth of IR on an international level?
As the saying goes, a rising tide floats all boats. But our boat here in the United States is relatively small. In a world linked together by common themes of clinical competence, consistent education and validation through research, we become something new. As we help to open new markets and defend our specialty as unique and important, we all grow stronger. Arguably that one element has been missing in our strategy over the years. There is strength in numbers. In addition, here at home we might just learn a thing or two along the way.
How has SIR supported the growth of IR in those countries?
We’ve focused on the young physicians. Six years ago, we introduced SIR’s International Scholar Program. This program, which has now hosted over 60 scholars, targets young, talented IRs, people who we think may one day lead our profession. We host them at the SIR Annual Scientific Program and establish observerships for many before and after the meeting.
Through this program we’ve hosted scholars from 30 countries and every continent except Antarctica. We spend the meeting week with them, attending lectures, taking about issues and learning. But as important as our hosting is, what is equally significant is the connections these young doctors make with each other, building the relationships and networks that will carry them forward.
The connections they form and the enthusiastic perspective they bring are an inspiration. I am proud to see how many of our former scholars are now in society leadership positions in their home countries. This program is now coordinated by Venkatesh Krishnasamy, MD.
In addition to the scholarship, we have served as a partner for many national societies, helping stabilize some of their programs and assist with strategies to support common IR objectives such as national recognition and reimbursement. We’ve been partnering with some IR societies for many years, such as the Indian and Brazilian societies. We’ve worked with newer groups like the Argentinian IR society and the newly formed Asia-Pacific society.
In Egypt, the national society approached us last year to help validate their board certification process. Karim Valji, MD, FSIR, offered to work on a project that led to a collaborative agreement wherein we send two observers to their examinations and also provided some lectures to their trainees. Our presence makes their national examination stronger—and that makes IR stronger. At this point we’ve completed one cycle and we’re starting the second cycle.
How much does interventional radiology vary around the world?
There are, of course, regional differences in types and relative prevalence of different diseases. Amoebic abscesses are a common problem in eastern Asian countries but extraordinarily rare in the United States. Our colleagues in Asia defined many aspects of contemporary HCC management.
And probably, if we looked for the most cost-effective providers, they would not be based here in the United States. When a patient pays for an embolization personally and by the coil or ampule of particles, it’s a whole different conversation, especially if you use more than you said you would!
It’s arguable, but I think one way interventional radiology varies the most around the world relates to reimbursement. In many countries IR is completely inpatient because one is paid by the bed, not by the care delivered. It’s changing in countries like China and India where Insurance systems are expanding and markets are achieving a size that supports direct sales, but even in countries where the bed is covered, your access to IR (vs. surgery) depends on your ability to pay for the device. And, because of tariffs and middlemen, the cost of a device can easily be 2–3 times what you or your hospital pays.
We need to help our colleagues in their efforts to achieve national recognition and from there build rational value-based models for reimbursement.
How does the society help foster the growth of IR when different regions vary so widely?
We’ve used different tools in different parts of the world. In Africa, the International Scholarship has worked well, with three scholars from Ghana, at least one from Nigeria and one from Ethiopia, and at least one from Kenya. These IRs go back with an element of the passion and direction that is a huge yield for the investment. Our next step to foster the growth of IR in Africa is to work with the emerging local and regional societies there.
In India, the national society is growing and increasingly secure. One of their biggest challenges is manpower. They’ve done great work in board certification examination and in creating a new training pathway that will at least double the number of people training in IR there.
Many of their trainees would like to do an observerships in the United States, so in December we’re launching a program in which American programs host Indian observers for three months month. Each year, these observerships will dovetail at the annual meeting, with some people just beginning their program and others just ending theirs. We hope that program delivers on the promise to expose the young Indian interventional radiologists to our practice of IR here and hopefully will inspire them when they return to India. As we gain experience we hope to expand this program to other countries.
The SIR Executive Council has also approved The Americas project, in which we’ll bring together Latin American, Canadian and U.S.-based IRs and explore new ways we can work together to strengthen our practices in this continent.
One other project we are introducing this year is called the Give Back Program, a platform that will allow experienced IRs in the United States to go to another country as a volunteer and educate young IRs for a few weeks. There is a lot of interest in the program from abroad, and we will send out our first solicitation for SIR member volunteers later this year. This program is being coordinated by Shams I. Iqbal, MD.
What other roles might the society play in the future?
Fundamentally, we should serve as a partner and an example. The best interests of IR are served by strong national and regional societies working together. We have a lot to share as do our colleagues in Europe. Setting the table for IR around the world, agreeing to standards for training and certification, national recognition, research, and advocacy for fair and value-based reimbursement schemes is a good start. As IR grows stronger, so do we.
How can IRs in the United States get involved in SIR’s efforts overseas?
There are a ton of opportunities. Volunteer with the Give Back program or sign up a with our volunteer Speakers Bureau. If you are bilingual or an expat let us know.
Help us host at the Annual Scientific Meeting, where we have a growing representation of international registrants. There are a lot of chances there to meet and share and learn and make connections with IRs from all over the world. Constantinos T. Sofocleous, MD, PhD, FSIR, is the International Division representative to the Annual Meeting Committee.
We’re also partnering with a growing number of scientific meetings worldwide and we’re happy to facilitate anyone who’s interested in presenting or participating at those meetings.
Anyone who’s interested in getting involved can contact me directly at or reach out to the society at dkatsarelis@sirweb.org.
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Read an essay by 2017 International Scholarship recipient Jhoana Rivera, MD.
