The SIR Foundation Leader in Innovation Award recognizes and promotes innovation within interventional radiology, continuing IR’s historical innovative development that has revolutionized medicine over the last 50 years. The award acknowledges individuals who have conceptualized and implemented an idea that has had an advantageous impact on the practice of interventional radiology. Be sure to attend the award presentation at SIR 2024 on March 24, 10:30 a.m.–noon MT.
Suresh Vedantham, MD, FSIR, the 2024 SIR Foundation Leader in Innovation Award winner, has established himself at the forefront of interventional radiology’s pursuit of data-driven excellence. In this interview with SIR Today, Dr. Vedantham discusses the importance of mentorship, forging new paths and avoiding disease-agnostic thinking.
Can you tell us about your career path and what got you interested in IR?
Suresh Vedantham, MD, FSIR: When I was a medical student, I heard about the TIPS procedure that was just being pioneered by Ernest J. Ring, MD, FSIR, and his colleagues, and that was very exciting to me. At the time, I was exploring general surgery, but when I heard about the TIPS procedure, it made me wonder if interventional radiology may be the path for me, so I applied to radiology instead. In my training and early career, I was incredibly fortunate to learn from outstanding IR faculty at the University of California Los Angeles, Stanford University and Washington University in St. Louis.
After that, my career trajectory took some interesting paths. I started out as a general clinical IR. Several years into my career, having developed a clinical niche in venous interventions, I got involved in organized research, and volunteered on some SIR committees. In 2008 I received funding from the National Institutes of Health (NIH) for the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial, a large multicenter clinical trial focused on deep vein thrombosis (DVT) and catheter-directed thrombolysis. I soon started sharing the lessons I learned and the infrastructure we built with other researchers, and in 2017 was recruited into the dean’s office of my institution to oversee clinical research support. So during the past decade or so, I have lived a second life of sorts as a researcher who supports other researchers, even outside the field of IR.
Why is the work of mentoring new researchers important to you?
SV: Frankly, this work has been the most rewarding aspect of my career. When you’re driving forward and working hard, you don’t think about the long-term impact of your work very much. Sometimes it’s not the big things you accomplish, but the many small things you do that have the largest effect. You have a conversation here and there, you meet with your colleagues and you go to conferences to give talks and answer questions—and over the years, you realize that you’ve benefited so much from those conversations, and you hope that the people you spoke with benefited as well. I’ve realized that these friendly, informal conversations provided me with insights that were critical in planning multicenter studies, and that the information I shared with others became one of the most enduring contributions I’ve made to the field.
I’ve been so honored to work with a number of incredible, young IR investigators who have pushed forward the field of venous disease research over the past decade or so. One of the most notable accomplishments in this field is the work of Akhilesh K. Sista, MD, FSIR, who recently became funded by NIH as the national principal investigator for the Pulmonary Embolism Thrombolysis (PE-TRACT) trial. That trial used some of the lessons learned from the ATTRACT and C-TRACT trials to gain NIH support, build trial infrastructure and enable efficient trial completion.
Dr. Sista has gone above and beyond in becoming a PE disease expert and in pioneering procedures to treat it. He stayed determined, earned the confidence of multispecialty leaders in PE care and research, built a collaborative network, and figured out how to get his research funded by NIH. I am so honored to have been able to advise and help him find his path there, as others did for me.
As this year’s Leader in Innovation Award winner, how would you define innovation?
SV: I’ve always conceived of innovation as a way of thinking that doesn’t necessarily accept boundaries—both for yourself and what you want to accomplish, but also for the field of IR. We should be expanding the scope of what we can contribute to the world, and we shouldn’t let artificial boundaries or inaccurate, limiting perceptions deter us from that.
To me, innovation is also about being open to other ideas, because at the end of the day, no one person is brilliant enough to come up with solutions alone. To innovate usefully, I believe you must be willing to measure success by the actual impact on patients.
New devices and developments are exciting. Speaking as a joyful proceduralist, they’re great fun. But sometimes we learn later on that maybe they weren’t as effective as we thought they were. That’s an expected part of any development process, but I’ve always been interested in the notion that if we want to increase the value of what we develop, we must effectively show where the benefits and limitations are, so that ultimately the patient sees the benefits.
Many past Leader in Innovation awardees have been identified for their work on a device or new therapy—how does it feel to be recognized for your research infrastructure and mentorship?
SV: In being selected for this generous award, I am truly honored and delighted to have our work recognized, and excited about what I hope it represents: an evolution in IR’s conception of innovation and what it requires. Beyond traditional criteria, a reward system is being built within IR that values objective scholarly research and the active translation of a new pathway for IR success into a new generation. I hope early-career IRs notice this progress as well.
My research evolved directly from questions I asked during my clinical work and from my enjoyment in teaching others how to creatively refine venous therapies to be more successful. Out of necessity, I was fortunate to forge a pathway that, for IR, is unusual. Becoming an NIH researcher was like bumping my head in a million places as I tried to find my way through, and it took energy, creativity, adaptability and a lot of help. But in the process, I’ve learned a lot about how an IR can become a clinical scientist who advances care, leads studies, and is trusted to lead guideline panels and other rigorous endeavors in multispecialty forums. But understanding the best career development process for our young researchers is so important, and I think we’re starting to see some of the benefits. Others are following this path to a degree, sometimes branching off in their own ways, but with greater faith that they can ultimately succeed. We’re constantly expanding the reality of what IRs can accomplish.
Ultimately, IRs shouldn’t be limited in what we can do, because we have the most innovative field in medicine in terms of the collaborative mindset, the access and understanding of technology, and the relationship between imaging and intervention.
Where do you think IR needs to go next? Is it more research, more pathways, more therapies?
SV: We should continue proposing and evaluating disruptive therapies in different disease states, but whatever we do should be guided by the major principle of finding and telling the truth. While it’s cliché to say, that’s not always very easy to do—in medicine, science or even in our own lives. We all have biases.
Finding the truth is really about recognizing what those biases are for an IR. It’s about being humble enough to recognize these limitations and find ways to minimize them.
We don’t train from a disease pathway; therefore we need to put in the scholarship to be able to adjust for that. We need to train ourselves in how to overcome bias—and usually our bias is in favor of procedures. That’s completely natural and expected, right? But we need to be willing to integrate research training into IR training and reconceive ourselves as patient advocates.
IRs have done a great job of evolving into direct clinical care, which has been an amazing change in our field over the last couple of decades. With that in mind, I think the next step is to view ourselves as the primary advocates for our patients’ welfare and safety, and part of advocating for them means getting data sooner and holding ourselves to high standards of objectivity.
We should advocate strongly to get good data early on and ensure that the studies we do are designed fairly. Sometimes that may involve having difficult, but necessary, conversations with colleagues and sponsors, encouraging our patients to sign up for the best-designed studies, or suggesting that they avoid poorly designed studies—but that’s what leadership is about. We actually have much more influence than we might think in helping to shape the design of studies.
But that takes training and understanding. It requires us to incorporate discussions on how to think scientifically into our overall thinking and education.
Part of the challenge is that clinical trials take a long time—how can IRs deliver good data in a timely manner, given the time it takes for research?
SV: As wonderful as the trials have been that I’ve been a part of, they weren’t easy, and they did take a long time. If we do one major trial per decade, which is more or less what has occurred in the venous arena, that’s not a great pathway for advancing care in any disease area.
I think we need to embrace technology, both in our clinical practices and in our clinical research. For example, how do we measure the progress of the diseases we treat using sensors and monitors? Remote technology tools greatly enhanced research during the pandemic and could be applied to make IR studies, which are inherently challenging, much easier to get done.
In addition, it’s crucial to have collaborations with other scientists and statisticians to design trials to be simple and efficient.
If someone is interested in pursuing a career in research, or being involved in guideline panels, what would you recommend?
SV: First, become a disease expert and patient advocate. Early in my career, I embraced disease advocacy organizations, and that helped build my credibility outside interventional radiology.
I got very involved in efforts to prevent DVT, even though it wasn’t my core expertise, because I knew other leaders in the field were engaged with it and it was an area that was gaining importance and visibility. I dove into it, and so many opportunities arose that increased my own credibility, knowledge and perspective. The advocacy organizations themselves proved to be invaluable adjuncts to the clinical trials and research that I ended up doing.
Whatever area you’re interested in, don’t just think about the procedural elements of it. Go beyond and interact with the patients and laypersons in other venues and organizations, because I really do think that has an impact on how you think about the disease while also improving your ability to help patients.
Later on, I was also able to take what I learned and apply it to help other investigators across other disease states. That’s something that IRs do all the time—we take tools in one area, use them in another, and then suddenly we have a totally new, fertile area of development. IRs do not have a boxed-in mentality, and that’s a unique asset of our field that we can apply in other areas.
